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Cardell® MAX12-HD - Veterinary Instrumentation

1. uh 47 SECTION 7 ECG MONITORING 50 7 1 GENERAL INFORMATIO 50 7 2 PREPARATIONS 50 7 3 ATTACHING ECG ELECTRODES 51 1 4 po a BM E ee ee EE 53 7 5 PREPARATION FOR MONITORING 58 TB ACARI OETUE rtu tetas tet tust E EE RETE 58 7 PBEOGAU TONS etos ee 59 7 10 CLEANING AND MAINTENANCE eccrn eren 60 7 11 TROUBLESHOOTING ed eee duos ttt reet 60 2 M1 0 5 15 09 CARDELL MAX 12HD User s Manual SECTION 8 RESPIRATION MONITORING 62 8 1 GENERAL INFORMATION c0ccecceeceeceeeseeseeseeeeeeeeeeeeueeaes 62 8 2 RESPIRATION SETUP odia ect reote odes 62 8 3 RESPIRATION MONITORING PREPARATION 65 8 4 ALARM SETUP Sd testem rae teste atom aues me eed eue e 65 SECTION9 SPO2 MONITORING 66 9 1 INTRODUCTION ense udo dede eoo seo atit eee ee aei ees 66 9 2 SPOZ SENSOR e ec e e e E CE 67 Qo SPO2 SETUP tum adir Ma MI LEE a e gu EE 69 9 4 PREPARATION FOR TO 9 5 ALARM SETUP visi duci aae seeds Maus te dece e 71 OG PRECAUTIONS 2 decore uUo david 72 9 7 CLEANING AND 72 9 8 TROUBLESHOOTING 5 o e eire EE Poe NEP Ex eee PE RES T3 SE
2. 25 4 1 BRIEF INTRODUCTION sooo ooa Ese PEE SEE Ebr px EP DERE vis 25 4 2 ALARM ON OFF e 26 4 3 ALARM LIMITS SETUP Dur deos an obe eco ska 27 4 4 ALARM SOUND VOEUME 5 5 iore eec eae 28 4 5 DEFAULT ALARM LIMITS eene 28 4 6 ALARM NODE 29 4 7 ALARM EVENT REVIEW 0ccccececececeeeeeeececececececeseeaeaees 30 0 5 15 09 Cardell MAX 12HD User s Manual SECTION 5 MONITORING SYSTEM SETUP 32 BIS VS LENG SETUP 32 5 2 ECG WAVEFORM RECALL eene nennen nnne nnn 33 5 3 REND DISPLAY 6 tinte eed 35 54 DEMO MODE dte imei ec eet Ne eise mete a edes 37 5 9 DISPEAY SETUP LAS A Mu eL ERA e pube 38 5 6 PATIENT INFORMATION SETUP eee 39 5 7 DATE AND TIME SETUP eren 40 5 8 VOLUME AND BRIGHTNESS SETUP 41 5 9 HR PR PRIORITY SETUBS 42 5 10 DISPLAY INTERFACE SELECTION 43 5 11 CENTRAL STATION COMMUNICATION 44 5 T2 ABOUT zc Suck cared cero e tese rite va esp vidis Mee RR EE deals 44 5 13 CHOOSE LANGUAGE eoa expri e porco ee den 45 SECTION 6 46 6 1 RECORDER INTRODUCTION eee 46 6 2 RECORDER SETUP i
3. S 105 14 2 SYSTEM CALIBRATION 24 32 beh e tac oo eles 109 APPENDIX 1 PRODUCT SPECIFICATIONS 111 APPENDIX 2 BP REFERENCE VALUEG 117 APPENDIX DEAD SPACE 120 APPENDIX 4 DIRECT BP MONITORING 123 APPENDIX 5 ACCESSORIES 129 4 M1 0 5 15 09 CARDELL MAX 12HD User s Manual SECTION 1 INTRODUCTION 1 1 General Welcome to the Cardell MAX 12 HD Multiparameter Monitor for use small and large animals It continuously monitors and displays the following physiological parameters blood pressure ECG respiration arterial blood oxygen saturation of arterial hemoglobin SpO2 carbon dioxide CO2 and temperature Some versions include invasive BP and or multigas monitoring It converts the various physiological changes into data and calculates analyzes the data and then displays the data on the screen When the monitored data exceed the preset limits an alarm system activates and sends a signal to alert the staff s attention The Cardell MAX 12 HD Multiparameter Monitor uses internal battery power or AC power Before using the patient monitor please read this manual thoroughly in order to use the monitor correctly and to ensure the monitor performs according to the specifications and in conformity with the safety standards This manual is an integral part of the product and describ
4. Storage and Transportation lt 95 condensing Barometric pressure Working 86 106 kPa Storage and Transportation 50 106 kPa Specifications subject to change without prior notice APPENDIX 2 BP REFERENCE VALUES Which Blood Pressure is Normal in Dogs or Cats It is essential to know the reference range of blood pressure in a given species in order to properly evaluate the animal s blood pressure and detect hypertension or hypotension When using different measurement techniques oscillometry or direct blood pressure measurements one must also remember that methodological factors influence results Therefore technique specific reference values should be known Species specific breed specific and individual differences in normal blood pressure ranges can be observed The most accurate assessments are made by comparing different blood pressure readings over time using serial measurements made at regular intervals at least once yearly This makes it possible to detect the initial signs of related disease e g cardiovascular and renal disease more sensitively and at an earlier stage The normal values for dogs and cats are not identical FELINE NORMAL VALUES The blood pressure values for cats are not breed specific However the most sensitive way to detect changes in feline blood pressure is also by comparing individual blood 1 Adapted from Essential Facts of Blood Pressure in Dogs and Cats Egner Carr amp
5. Cardell MAX12 HD Veterinary Vital Signs Monitor User s Manual CARDELL veterinary Monitor 12 HD 120 85 95 m 60 20 37 0 38 0 C 120 85 95 m 60 20 37 0 38 0 C 120 85 95 60 20 37 0 38 0 C 1 1207 5 95 60 20 37 0 38 0 C E 2008 03 13 16 42 28 0020 lt Rev 5 15 08 CARDELL MAX 12HD User s Manual TABLE OF CONTENTS SECTION 1 INTRODUCTION 5 P GENERA d cea re ae retine ER ence ted Pr ed 5 1 2 PRODUCT SUPPORT de ou ee eh ee 5 1 3 IMPORTANT INFORMATION eene 6 SECTION 2 SAFETY 7 2 l SAFETYNOTICE end obi Cea ea enna 7 2 2 SAFETY REQUIREMENTS cececcececcececcececececeecececaecuceeeeees 8 2 3 SAFETY SYMBOLS inse GR phano thue one Kon SEPT 10 2 4 TINSTAEEATIONG doceret eve ieee vows tend teu esae e S es 11 SECTION 3 DEVICE DESCRIPTION 13 3S TERONTPANEEaz mide tiere ade tts tette 13 3 2 REAR PANEL iiio eot vuU ER ERE SE E RENE UAM NR dip EOS 16 3 3 SIDE PANEL exe PET OUI perdete olet uses 18 3 4 BEFORE MONITORING eene eene nnne renes 21 3 5 DISPLAY ILLUSTRATIONS si cs o cede reu Paro ree x e e 22 3 0 VIEN c eoe n Eo ER eb von eh oe RN Ens Bet pun dv eee dees 24 SECTION 4 ALARM SETUP
6. WARNING Prolonged use or the patient s condition may require changing the sensor site periodically Change sensor site and check skin integrity circulatory status and correct alignment every 2 3 hours If there is any change move the sensor to another site CAUTION Clean the sensor surface with 70 ethanol before and after use But do not immerse it totally into the liquid CAUTION Do not autoclave ethylene oxide sterilize or radiate the sensor 9 7 Cleaning and Maintenance 9 7 1 Clean the sensor 1 Clean the sensor with a soft cloth moistened in soapy water or mild detergent saline 1 or one of the following solutions Microzid pure Mucocit 4 Incidin 10 Cidex pure Sporicidin 1 16 Mucaso 3 Buraton pure alcohol pure Alconox 1 84 Cetylcide 1 63 2 Clean the sensor surface with soft cloth and let it dry completely 3 Wipe the receiving part and flashing part of the sensor with soft cloth immersed in the detergent or alcohol 72 0 5 15 09 CARDELL MAX 12HD User s Manual 4 Check the sensor and cable each time before use If any damage is found please replace them immediately 9 8 Troubleshooting 9 8 1 No SpO2 data Failure Phenomenon During monitoring process there is no SpO2 waveform or data Inspection Method Check if there the red light on the sensor is on Solution If there is no red light inside the sensor the wiring connectors may have become loos
7. corresponding to the white cuffs sizes SV1 SV5 CAUTION Before measurement make sure you have chosen the right cuff size on the monitor Select measurement mode MANU AUTO STAT NOTE The current NIBP Measurement Mode will display to the upper right of NIBP parameter Manual MANU Press NIBP Start Stop button on the front panel and the NIBP measurement will start immediately NOTE During an NIBP measurement if the NIBP Start Stop button is pressed again the measurement will be stopped immediately CAUTION The initial inflation pressure is 150 mmHg Automatic AUTO The patient monitor will inflate the cuff at the start of each automatic measurement cycle NOTE Anytime during NIBP measurement pressing the NIBP Start Stop button will stop the NIBP measurement immediately 80 M1 0 5 15 09 CARDELL MAX 12HD User s Manual STAT Continuously measure patient s NIBP for 5 minutes The mode is mainly used to closely monitor a patient s blood pressure changes in emergency situations During the STAT measurement press the NIBP Start Stop button on the front panel and the measurement will immediately stop Select time interval Select time interval in AUTO displays behind the mode Adjustable ranges in minutes are 1 10 15 30 60 90 120 180 240 480 The time interval means time between last NIBP measurement start to next NIBP measurement start Chang
8. gt knob When the device is in Demo mode you will see DEMO MODE on the screen Press Demo mode again to return to normal monitoring mode 0 5 15 09 37 Cardell MAX 12HD User s Manual 5 5 Display Setup The display setup menu can be entered from the system main menu and is used to change the channel mode and the parameters of the channels Waveform Channel 1 displays ECGI ECG waveform and indicates ECG waveform speed and ECG mode Waveform Channels 2 8 can be selected to display parameters or waveform If Expand is selected on the Channel Setup menu the height of the channel above it increases Selecting None displays a blank channel in the parameter area The Temperature parameter is displayed at the bottom of the parameter area Note In the process of setup when a parameter setup of a channel is the same with that of another channel then the original parameter will be displayed in exchange The parameter displayed in the main menu changes with the display channel setup NOTE If you do not select NIBP channel the monitor cannot measure NIBP Channel Setup Channel Setup can be set to display parameters on 6 channels or 8 channels Step 1 Press knob to enter Channel Setup press knob to enter channel selection mode and use dial to highlight 6 or 8 press knob to confirm click on OK Step 2 Rotate knob to select a waveform channel number Press the knob to enter th
9. Brown 2003 0 5 15 09 117 Cardell MAX 12HD User s Manual pressure readings taken over time Normal feline blood pressure 124 84 Other investigators have reported comparable reference values Feline Reference Values Systolic Diastolic mmHg mmHg 125 11 8929 Brown et al 1997 123 14 88 15 Curtet 2001 125 12 86 15 Weber et al 2002 CANINE NORMAL VALUES The normal values for dogs are breed specific Those for Golden Retrievers Labradors and giant breeds tend to be lower than the overall average and those for greyhounds and in general racing hounds tend to be higher The table that follows lists the normal values for common dog breeds using oscillometric blood pressure monitors Average canine blood pressure 133 75 This figure was calculated as the mean of 1782 oscillometric measurement in clinically healthy dogs of different breeds The overall average is therefore serves as a point of reference only The individual or at least breed specific value must be known to most accurately determine whether a given patient s blood pressure deviates from normal Breed Systolic Diastolic Pulse Rate mmHg mmHg Labrador Retriever 118 17 66 13 99 19 Golden Retriever 122 14 70 11 95 15 Great Pyrenees 120 16 66 6 95 15 Yorkshire Terrier 121 12 69 13 120 14 West Highland 126 6 83 7 112 13 Border Colli
10. CARDELL MAX 12HD User s Manual User can activate alarm function and setup alarm limits one by one Main Menu Rotate the knob NIBP Press knobRotate the knob SYS DIA alarm Press knob Rotate the knob Press the knob Adjust parameter range Parameter Alarm range SYS Upper Limit lower limit 254 mmHg SYS Lower Limit 30 upper limit mmHg DIA Upper Limit lower limit 220 mmHg DIA Lower Limit 10 upper limit mmHg SYS DIA Alarm 0 40 mmHg The Alarm trigger when the following abnormal events occur and messages will be displayed in the NIBP parameter area Cuff loose Cuff not connected Cuff position error Overpressure protection Measurement out of limits or Measurement error Take the following steps after seeing the messages 1 Cuff is too loose not connected or applied to a wrong position If the NIBP parameter area displays Cuff loose or Cuff not connected or Cuff position error please check the position of the cuff first and check whether the inflation hose is damaged 2 Overpressure Protection If the NIBP parameter area displays Overpressure protection it indicates that the internal inflation circuit results in an NIBP measurement failure Please contact Midmark for service 3 Measurement Pressure out of Limit If the NIBP parameter area displays Measurement Pressure out of limit it is because the patient s blood pressure is extremely
11. when not using closed suction system in order to avoid moisture buildup and FilterLine occlusion disconnect the Airway Adapter from the patient s endotracheal tube CAUTION Loose or damaged connections may compromise ventilation or cause an inaccurate measurement of respiratory gases Securely connect all components and check connections for leaks WARNING When used with closed suction system do not place the Airway Adapter between the suction catheter and endotracheal tube Consumables Endotracheal Dead Space With Tube Adapter Tube Bore FilterLine H Set Regular yellow gt 4 5 lt 7 3 cc FilterLine Set Exotic yellow lt 4 0 mm lt 0 5 Table 3 Specifications for Intubated Consumables Airway Adapters NOTE For more information on what to consider when choosing between airway adapters refer to Appendix 3 Dead Space Cause Effect amp Control in Small Animal Anesthesia by Dr Robert Stein founder of the Veterinary Anesthesia Support Group www VASG org 92 0 5 15 09 CARDELL MAX 12HD User s Manual 12 2 CO Setup CO setup includes change CO measurement mode Measure Standby select the speed of waveform turn on the calibration function change units etc To enter the setup menu do as follows then the screen will display CO setup menu MAIN gt Rotate Knob gt CO2 gt Press Knob MENU Work M
12. 15 09 67 Cardell MAX 12HD User s Manual 7 Be sure that the sensor cable is positioned along the side of the animal s face and body to avoid entanglement with the animal WARNING Do not use supplemental tape to adhere the clip and sensor directly to the site this can restrict blood flow and cause inaccurate measurements For best results secure the sensor cable independently from the sensor 8 Connect the sensor assembly to the Interface Cable a Place the plastic hinged cover in the unlocked position perpendicular to the connector b Connect the sensor assembly to the Interface Cable c Lock the plastic hinged cover to prevent accidental cable disconnection Figure 10 Sensor to Interface Cable 9 Plug the Interface Cable into the SpO2 connector on the side panel of the monitor Push the cable in until you hear an audible click WARNING The A indicates that the SpO2 sensor connector is insulated and defibrillation proof which can ensure patient and monitor safety during defibrillation and electrosurgery 10 Press the ON STANDBY pushbutton to turn ON the monitor 11 Verify that the sensor is properly positioned by observing at least ten 68 M1 0 5 15 09 CARDELL MAX 12HD User s Manual seconds of a continuous pleth waveform being displayed across the screen When a valid signal is detected the monitor displays the SpO2 and Pulse Rate values Should the perfusion light be
13. 5 15 09 CARDELL MAX 12HD User s Manual 5 CO Waveform Fill To fill the Waveform or not MAIN MENU gt Rotate Knob gt gt Press Knob gt WaveformFilling gt Press Knob gt Rotate Knob gt Press Knob 12 3 Alarm Setup CO2 monitoring alarm includes parameter limit alarm and abnormal status alarm Alarm is to give alert when the monitoring results are abnormal It is audible and visual with LED indicators and flashing readings NOTE Default alarm limits should be adjusted according to patient condition Parameter Limit Range Parameter Range Upper Limit lower limit 100 mmHg EtCO Lower Limit 0 upper limit mmHg InCO Upper Limit lower limit 100 mmHg InCO Lower Limit 0 upper limit mmHg REST Upper Limit lower limit 100 mmHg REST Lower Limit 0 upper limit mmHg 12 4 Precautions CO measurement can be affected by Changes in atmospheric pressure Halogenated anesthetic vapors Calibration drift Fluid contamination Inaccurate CO readings can be caused by Reuse of or failure to change sampling line 0 5 15 09 95 Cardell MAX 12HD User s Manual SECTION 13 IBP MONITORING Optional 13 1 General Information The device displays the maximum systolic pressure minimum diastolic pressure mean pressure and an IBP waveform The IBP waveform can be observed in different channels and the waveform speed is the same as that of the ECG wavefor
14. 800 643 6275 Fax 813 264 6218 6 M1 0 5 15 09 CARDELL MAX 12HD User s Manual SECTION2 SAFETY 2 1 Safety Notice 2 1 1 Intended Use The Cardell MAX 12 HD is used to provide continuous monitoring display and recording of physiological parameters such as ECG non invasive blood pressure SpO2 CO2 respiration and temperature 2 1 2 Application Environment This device is for use by trained veterinary personnel in veterinary centers The device is restricted to be used on one patient at a time 2 1 3 Operator Requirements Only veterinary personnel who have read the Operator s Manual should use this monitor 2 1 4 Terminology The terms danger warning and caution are used throughout this manual to point out hazards and to designate a degree or level of seriousness Please familiarize yourself with their definitions and significance DANGER is defined as a source of potential injury to an animal WARNING indicates a potential hazard or unsafe practice which if not avoided could result in death or serious injury CAUTION indicates a potential hazard or unsafe practice which if not avoided could result in minor personal injury or product property damage 0 5 15 09 Cardell MAX 12HD User s Manual NOTE provides application tips or other useful information to assure that you get the most from your equipment 2 1 5 Monitor Safety The safety statements presented in this chapter refer to the equi
15. CARDELL MAX 12HD User s Manual SECTION 4 ALARM SETUP 4 1 Brief Introduction Alarms are designed to give an alert when the monitoring results are abnormal It is rendered with audible sounds visual LED indicators and flashing readings Alarms have three degrees Emergency 5 beeps flashing red LED Warning 3 beeps flashing yellow LED Alert 1 beep continuous yellow LED Emergency Alarm Asystole SYS DIA is too low Apnea Alarm Warning Alarm Parameter values exceed set limits equipment alarms Alert Alarm Low battery power Warning alarm equipment conditions are as follows LEAD OFF LOOSE CUFF PROBE OFF AIR LEAK CUFF POSITION ERROR OVERPRESSURE RANGE EXCEEDED OTHER ERROR NO WATERTRAP Optional Multi gas FILTER OCCLUSION CALIBRATION ERROR OCCLUSION LOW SIGNAL When sensors or probes are unplugged the screen will display Probe off or No sensor and alarm Note When Asystole is displayed on the screen please check for the ECG Gain of the relative channel to see if it is too low to detect heart rate If so user can switch the ECG lead or change the source channel for the alarm To effectively control the system alarm function the monitor has alarm 0 5 15 09 25 Cardell MAX 12HD User s Manual ON OFF and sound volume selection which can be set through Setup Rotate the knob in main menu and when the arrow points to Alarm Setup press the knob to enter alarm setup me
16. Display Screen In the above figure you can see ECG recall on the top of the screen The status bar at the right side indicates the position and length of the waveform recall The five time stamps at the left side are the start times of every three lines of recalled waveforms The first line is 24 seconds including 4 segments and each segment is 6 seconds A segment in red at the bottom of the screen see next page is magnified with lead mode and amplitude marked 0 5 15 09 33 Cardell MAX 12HD User s Manual out The two times at the bottom indicate the start and end time of ECG waveform recall respectively NOTE The ECG waveform recall speed does not change with the current sweep speed In the process of ECG waveform recall rotate the knob and you can scroll up and down the ECG waveform in memory Press ECG Analysis and an ECG segment analysis can be done using electronic calipers See figure below ECG Analysis Senge ones Amplitude Asystole 2006 10 31 11 10 10 T or ETT ETE 2006 10 31 11 10 10 2006 10 31 11 10 15 Exit Fig 5 3 ECG Analysis Press Position and a base point can be set on the magnified ECG waveform Then rotate the knob and the cursor will move along the waveform displaying measurement information Move the cursor to change the relative time and amplitude of the point and measure the EGC segment Press to select ECG Analysis waveform 34 M1 0 5 15
17. ECG 1 signals ECG 2 to detect heart rate based on ECG 2 signals ECGZ ECG3 ECG 3 to detect heart rate based on ECG 3 signals ECG 4 to detect heart rate based on ECG 4 signals 56 M1 0 5 15 09 CARDELL MAX 12HD User s Manual NOTE When using three leads it only detects HR based on ECGI signals Lead Mode Three lead and Five lead are options standard configuration is three lead v Five Lead Three Lead When selecting Five Lead the ECG leads you can choose are V aVR aVL aVF and the RESP leads you can choose are RA LA RA LL LA RL LL RL When selecting Three Lead the ECG leads you can choose are I II III and the RESP leads you can choose are RA LA RA LL Work Mode Monitoring Surgical Diagnosis mode is for the needs of different circumstances User may set in accordance with the actual needs v Monitor Operation Diagnosis Diagnosis mode To display the original ECG waveform which is not filtered Monitoring mode To display the waveform where interference has been filtered Surgical mode This is only for the circumstances where there are significant interferences outside and ECG waveform has significant distortion for example operating room It is not calibration significant Alarm sound On Off 0 5 15 09 57 Cardell MAX 12HD User s Manual To turn the ECG alarm sound on or off 7 5 Preparation for monitoring 1 Select correct electrodes 2 Connect e
18. Insert the temperature probe into the temperature socket in the side panel WARNING Connect temperature probe with patient and insert the other end of the cable into the temperature socket of the monitor completely The screen will display the temperature reading 4 Set temperature alarm limits WARNING Before performing temperature measurement do not get the temperature probe close to a heat source If it has been close to a heat source then let it cool down for 5 minutes before performing measurement 5 Start to monitor patient s temperature CAUTION It takes 10 seconds for the patient monitor to display stable reading CAUTION The patient monitor performs an auto temperature calibration every hour Should the Temperature calibration error message will appear please contact Midmark WARNING When temperature probe is not connected or temperature probe falls off the monitor will stop the measurement and display in parameter area but without an audible alarm It is recommended to check 88 M1 0 5 15 09 CARDELL MAX 12HD User s Manual the connection of the temperature probe regularly 0 5 15 09 89 Cardell MAX 12HD User s Manual SECTION 12 CO2 MONITORING 12 1 General Information The Cardell MAX 12 monitor uses Microstream non dispersive infrared NDIR spectroscopy to continuously measure the amount of CO2 during every breath the amount of CO2 present at the en
19. Rotate the knob gt RESP gt Press knob Rotate the knob Waveform Filling Press the knob 0 5 15 09 63 Cardell MAX 12HD User s Manual Apnea Alarm Operator can turn on off Apnea Alarm as follows Main Menu Rotate the knob RESP A Press the knob Rotate the knob Apnea Alarm Press the knob Apnea Alarm Time 5 10 15 20 120 seconds are available for Apnea Alarm Time selection Main Menu Rotate the knob RESP APress the knob Rotate the knob Apnea Alarm Time Press the knob Rotate the knob Press the knob If Apnea Alarm is ON Apnea alarm will be triggered when the system detects an abnormity according to the Apnea Alarm Time setup An Apnea Alarm is classified as an Emergency Alarm To set RESP alarm limits Main Menu Rotate the knob RESP Press the knob Rotate the knob RR Upper Limit jor Lower Limit Press the knob Rotate the knob Press the knob RR Alarm Operator can turn on off the RESP Alarm as follows Main Menu Rotate the knob RESP APress the knob Rotate the knob RR Alarm Press the knob 4 M1 0 5 15 09 Hn CARDELL MAX 12HD User s Manual 8 3 Respiration Monitoring Preparation 1 Place electrodes in proper positions 2 Select proper respiration lead combination 3 Set respiration alarm limits NOTE Electrodes must be placed in proper positions CAUTION Patient motion may result in a respiration measurement error 8 4 Alarm Se
20. alarm limits follow these steps to return to the factory alarm limits for dogs cats or horses Rotate the knob Default Setup Press knob Rotate the knob Dog Cat Horse Other Default Press the knob The default alarm limits of the patient monitor are as follows Parameter Dog Cat Horse HR PR Upper 180 180 50 28 M1 0 5 15 09 CARDELL MAX 12HD User s Manual bpm Lower 50 90 24 SpO2 Upper 100 100 100 96 Lower 90 90 90 NIBP SYS Upper 160 160 160 mmHg Lower 70 70 70 NIBP DIA Upper 100 100 100 mmHg Lower 40 40 40 SYS DIA Lower 20 20 20 mmHg Resp Upper 55 55 55 bpm Lower 5 5 5 Temp Upper 40 0 40 0 40 0 Lower 36 0 36 0 36 0 CO IBP SYS Upper 160 160 160 mmHg Lower 70 70 70 IBP DIA Upper 100 100 100 mmHg Lower 40 40 40 EtCO2 Upper 60 60 60 mmHg Lower 20 20 20 InCO2 Upper 10 10 10 mmHg Lower 0 0 0 4 6 Alarm Mode The device provides two alarm modes standard and auto which can be set in the alarm setup menu 67 s Rotate knob Alarm Setup Press knob Rotate knob Alarm Mode Press the knob Rotate the knob Std Auto Press the 0 5 15 09 29 Cardell MAX 12HD User s Manual knob 1 Standard Alarm Mode When abnormal event happens and all alarm functions are on alarm will persist until a response is received 2 Auto Al
21. cable has no contact with metal or other conductor or device grounding part During defibrillation do not touch the patient table or device WARNING Use only the recommended IBP cable and transducers 13 7 Troubleshooting If the IBP waveform channel displays Calibration Error please re enter the IBP Setup menu and press the Zeroing key If the Calibration Error prompt still exists replace the transducer If the IBP waveform channel displays No signal received please turn off the machine and turn it on again If the prompt still exists please contact Midmark for help If the IBP value has a big difference from your expected value please perform zeroing again by following the steps in section 13 3 describing Transducer Zeroing before performing IBP measurement SECTION 14 Cleaning and Maintenance 14 1 Cleaning WARNING Do not under any circumstances perform any testing or maintenance on the monitor while the monitor is being used to monitor a patient The monitor must be turned OFF Unplug the monitor from the 0 5 15 09 105 Cardell MAX 12HD User s Manual AC power source and remove the internal battery CAUTION Do not open the monitor to clean or repair it Contact Midmark for service needs CAUTION Disconnect all accessories from the monitor before cleaning Do not immerse any part of the electrical connector of the cable or accessories in the cle
22. default setting see Alarm Setup 9 4 Preparation for Monitoring 1 Select the proper size sensor 2 Apply the sensor to a proper position on the patient If possible keep the sensor at the same level of the patient s heart WARNINGS eDo not apply the SpO2 sensor to an extremity where there is arterial catheter blood pressure cuff or injection tube e Make sure the light emitting part and light detecting part face each other e Make sure the sensor is applied to a region of arterial blood flow e Make sure there is no extreme motion e Make sure skin where the sensor is applied is neither too thick nor too thin Make sure there is no strong ambient light coming into the sensor Cover the site with opaque material 3 Plug the sensor into the SpO2 connector on the patient monitor 4 Set the upper and lower limits of SpO2 CAUTION Handle the sensor and the wiring with care There are sensitive electrical parts in the sensor that can be damaged by negligent treatment Keep the wiring away from pointed things Normal wear and tear caused by patient motion or sensor cleaning will limit the life of the probe Longevity can be extended by careful treatment WARNING During prolonged monitoring check and change the sensor position regularly in order to avoid damage to the patient s skin Special patients need special treatment 70 0 5 15 09 CARDELL MAX 12HD User s Manual SENSOR REMOVAL CAUTION Fo
23. heart rate or Pseudo asystole We suggest when ECG waveform is too low change the lead and adjust to the ECG lead which has maximum amplitude Otherwise the monitor may give Asystole alarm 7 9 Precautions WARNING When using defibrillator make sure the electrode and patient cable are not in contact with metal or other conductor surface or grounding devices During defibrillation do not touch patient table or instrument WARNING Ensure conductive parts including electrodes of the patient cable do not come into contact with any conductive surfaces WARNING Do not use the patient monitor during MRI or CT scan CAUTION Leads and cables should be away from patient s neck 0 5 15 09 Cardell MAX 12HD User s Manual 7 10 Cleaning and Maintenance CAUTION Please always obey the detailed instructions supplied together with the transducer which are more updated than the information here The following instructions shall be treated as general guidance when there is no specific method When the cable is found worn out or damaged please replace the cable at once 7 10 1 ECG cable cleaning In order to keep the cable dust free please clean it with clean cloth with soapy water or a mild detergent 7 10 2 ECG cable disinfection In order to avoid long term damage to the cable we recommend that you only disinfect the cable when it s necessary according to your hospital regulations CAUTION Do
24. medical devices shall meet IEC60601 1 The complete system shall meet the latest valid standards of IEC60601 1 1 M1 0 5 15 09 17 Cardell MAX 12HD User s Manual 3 3 Side Panel There are eight receptacles on the side panel See Fig 3 4 18 0 5 15 09 CARDELL MAX 12HD User s Manual Fig 3 4 MAX 12HD Side Panel 1 SpO2 SpO2 extension cable connection 2 6 IBP 1 amp 2 IBP cable optional connections 3 NIBP Cuff hose connection 4 CO Sampling Line connection 5 ECG RESP ECG cable connection 7 8 TEMP 1 amp 2 Temperature probe extension cable connection Please check precautions of each parameter in related sections IBP 1 amp 2 is an optional parameter On the right side panel is the built in printer on the left side panel the two 0 5 15 09 19 Cardell MAX 12HD User s Manual rechargeable batteries are housed To load thermal paper Slightly press panel of recorder as arrow points then the panel will eject and place paper inside see recorder panel diagram for the recorder paper orientation And pull a section of paper about 10cm out and restore the panel MAX 12HD is Class I device with internal power and complies with IEC60601 EN60601 requirements A Devices connecting to the patient monitor should meet IEC standards Data processing device should meet IEC950 and medical devices should meet IEC60601 1 The complete system shoul
25. not autoclave the cable 7 11 Troubleshooting 7 11 1 Inaccurate Heart Rate 1 check patient s ECG signal a check adjust lead placement b check clean the patient s skin c check replace ECG electrodes 2 check if ECG waveform amplitude is normal 7 11 2 No ECG waveform After leadwires are connected but there is no ECG waveform and the screen shows lead off or no signal received 1 Check if the electrodes are in good contact with the patient and if the leadwires are open 2 Check all the external connections of the ECG leadwires 3 Check the ECG electrodes Prolonged placement of electrodes may result in polarized voltage and the electrodes should be replaced 4 If no signal received is displayed on the ECG channel then the ECG 60 0 5 15 09 CARDELL MAX 12HD User s Manual module has communication problem with the main unit Turn off the machine and turn it on again If problem still remains contact Midmark 7 11 3 ECG baseline shift ECG scan baseline is not stable on the display 1 Check if the working environment is too humid and if the machine has moisture inside If yes keep the machine on for 24 hours and keep the ambient environment dry 2 Check the electrode quality and whether the skin is clean where the electrode is placed 0 5 15 09 61 Cardell MAX 12HD User s Manual SECTION 8 RESPIRATION MONITORING 8 1 General Information The monitor provides two
26. on a beat to beat basis using the R R interval of the QRS complex It is necessary to make sufficient preparations before monitoring in order to get accurate readings Patient Cable The patient cables consist of the main cable connected to the patient monitor and the leadwires connected to the patient WARNING At ECG receptacle you can see e label which indicates that the signal input part is highly insulated and defibrillator proof In addition it is guaranteed that the monitor will not be damaged during defibrillation and HF surgical operation CAUTION Use only electrodes ECG cable and leadwires recommended by Midmark 7 2 Preparations 7 2 1 Skin Preparation and Lead Contact Sites where leads are attached to the body must be properly prepared to optimize contact Dogs and cats have enough electrolyte material on their skin and hair so that merely moistening lead sites with 7096 isopropyl alcohol is appropriate This will usually be sufficient for ECG recording monitoring for a short time 30 to 60 minutes depending upon the relative humidity For monitoring during longer periods an electrode paste should be used It 50 M1 0 5 15 09 CARDELL MAX 12HD User s Manual is best to first wet the hair at the lead attachment site with alcohol then place paste on the moistened hair and skin It is important that the paste be in direct contact with skin For patients with dense undercoat rub paste with fingers to assur
27. respiration monitoring methods thoracic impedance indirect and through the CO2 microstream sampline line direct NOTE If the patient is intubated direct respiration monitoring through the CO2 sample line is recommended If you choose to monitor respiration using the thoracic impedance method place the ECG electrodes on the patient s trunk for more reliable readings 8 2 Respiration Setup To enter respiration setup menu RESP Lead RESP Gain Waveform Speed Waveform Filling v Apnea filarm fipnea filarm Time RR Upper Limit RR Louer Limit v RR filarm Fig 8 1 Respiration Setup Menu Setup Rotate the knob RESP Press the knob Respiration setup menu is as figure on the above RESP Lead While ECG is in Three Lead mode the lead selections available are RA LA RA LL if ECG is in Five Lead mode RA LA RA LL RL LA 62 M1 0 5 15 09 CARDELL MAX 12HD User s Manual RL LL are available for selection RESP Gain x1 x2 are available for selection Through selecting respiration gain the respiration waveform can be zoomed in or out for convenient observation Waveform Speed 6 25 12 5 25 0mm S are available for selection Exit 25 mm s v 12 5 mm s 6 25 mm s Main Menu Rotate the knob gt RESP Press knob Rotate the knob Waveform Speed Press gt 6 25 12 5 25 0 gt the gt Press the knob To fill up RESP waveform Main Menu
28. table or the device e When electrosurgery unit is used make sure the patient lead and cable are far away from the operating table to reduce the risk of burns caused by poor connection e Before using on another patient make sure previous monitoring data is cleared e Before using the monitor make sure it is in normal working condition CAUTION e Use properly grounded power sockets and ensure adequate grounding If there is any doubt about the grounding please use battery operation e Check accessories on regular basis and discard damaged accessories properly e To ensure patient s safety and performance of the product use only the manufacturer recommended accessories e Service parts must be in conformity with IEC 60601 standards The system configuration of monitor must be in conformity with IEC 60601 1 1 medical electric standard otherwise it will reduce the safety of monitor e Even while not being used the battery may also discharge So check battery level every month e ECG cable socket is for connecting ECG lead wires only Please do not connect it to any other signal source Pay attention to the color label and marks of ECG lead wires e Please clean the monitor and accessories according to instructions Always unplug the power cord before cleaning e EMC The device is in conformity with the requirements of IEC 60601 1 2 and related EMC standards But when electromagnetic power is extremely high it may cause
29. the cuff is to wipe it down with a damp soapy cloth A damp detergent free cloth should then be used to rinse the cuff NOTE We do not recommend submersion of the cuff Liquid should not be permitted to enter the cuff bladder because instrument damage may occur The cuff should be allowed to thoroughly dry before use 0 5 15 09 85 Cardell MAX 12HD User s Manual SECTION 11 TEMPERATURE MONITORING 11 1 General Information A continuous temperature monitor is used to measure a patient s core body temperature during the administration of general anesthesia detection and treatment of hyperthermia post surgical recovery and other various cases that may require constant body temperature monitoring The monitor will display continuous electronic temperature readings or the core body temperature via either a rectal esophagel probe or skin temperature with an external probe Temperature monitoring provides numerical information only no waveform As with other parameters data is displayed in the temperature parameter window on the right side of the screen TEMP4 TEMP2 RH The signal input is insulated and it is defibrillator proof The insulated input ensures patient safety and protects the device during defibrillation and electrosurgery 86 M1 0 5 15 09 CARDELL MAX 12HD User s Manual 11 2 Temperature Setup Temperature monitoring results are displayed in numeric form only wit
30. to indicate the battery power The more segments the more power remains a When only two segments remain the mark F starts flashing and an audio alarm indicates battery power is low b When only one or no segment remains the mark WR P turns to red and flashes with an audible alarm the power is being used up and the monitor will be powered off within five minutes if not recharged c When AC power plug icon appears in the position of the battery it indicates that the monitor is being powered by AC power and the internal battery is being charged Parameter Area In the parameter area the real time data of the following parameters are displayed HR PR SpO2 Respiration Rate NIBP IBP1 IBP2 CO2 Templ and Temp2 NIBP parameters displayed are the systolic and diastolic values and mean value At the right side of SpO2 data display area there is a red bar indicating the signal strength of SpO2 When an artery pressure is measured IBP parameter area displays the systolic and diastolic readings in red color mean pressure in blue color When VCP is measured in IBP parameter area mean pressure is displayed in red color and its systolic and diastolic pressure readings are displayed in blue The display position can also be exchanged 0 5 15 09 23 Cardell MAX 12HD User s Manual 3 6 Menu Menu offers different selections The key is used to activate main menu of the device The cont
31. to review the theory practice and techniques for direct arterial blood pressure measurement in dogs and cats Equipment needed for direct blood pressure measurement Equipment and supplies Essential equipment and supplies needed for direct blood pressure monitoring include arterial catheters see below side port catheter adapter low compliance extension tubing three way stopcocks pressure measurement device transducer pressure analysis and display device ECG BP monitor heparinized saline and syringes needles For long 0 5 15 09 123 Cardell MAX 12HD User s Manual term placement a constant flush device Intraflowe IV tubing 1L normal saline heparin and pressure infuser device permits continuous flush infusion to prevent clot formation General supplies such as elasticized and regular tape suture scrub solution and assorted needles should be available Local anesthesia 2 lidocaine may be injected in the vicinity of the artery to reduce vasospasm during the procedure Catheter selection Either short or long catheters may be successfully used for direct blood pressure measurement The preferred biomaterials for arterial catheters are either PFE or polyurethane In most cases short length catheters 2 3 are used in patients who require short term blood pressure monitoring i e anesthesia short term procedures or are relatively immobile Long length indwelling catheters 4 are pre
32. vascular injury disconnection accidental injection of drugs infection and damage to nearby nerves In the author s experience accidental disconnection and infection are two most common complications Accidental disconnection can produce rapid exsanguination with the risk of hypotension shock and death is possible if not immediately identified Constant monitoring of the extension tubing and connection points is important to avoid this complication Nosocomial infection may lead to bacteremia and sepsis Sources of infection include catheter wound site contamination of tubing and stopcocks during routine maintenance procedures and reuse of non sterile transducers Attention to standard protocols targeted to reduce introduction of pathogens at tubing connection sites or ports is also important to decrease risk in these patients In recent years closed tubing systems which isolate operator maintenance functions from the primary system have become popular in human medicine References Ahrens TS Taylor LA Hemodynamic Waveform Analysis St Louis MO WB Saunders 1992 pp 91 120 Lake CL Hines RL Blitt CD Clinical Monitoring Practical Applications for Anesthesia and Critical Care Philadelphia PA WB Saunders 2001 pp 181 204 Macintire DK Drobatz KJ Haskins SC Saxon WD Manual of Small Animal Emergency and Critical Care Medicine Philadelphia PA Lippincott Williams and Wilkins 2005 pp 73 74 Parbrook GD Davis PD Parbroo
33. 09 CARDELL MAX 12HD User s Manual 5 3 Trend Display The device provides up to 120 hour monitoring history data which can be displayed through trend display function Follow the steps below to enter trend display 4 e Rotate the knob Trend Display Press the knob Trend Displau Disp Time 2HourOMin Work Time O0Hour6Min HR PR bpm 407120 SP02 7 907100 Z o 1010 0 100 0 21015 10 31 12 15 20 Mabel Up Down Page Zoom Fig 5 4 Trend Display In the Trend Display the texts at the left side are monitoring parameter and its upper and lower alarm limits In the time status box under graph the time stamps on the left and right sides indicate the start and end time of the trend The time in the middle indicates the time where the cursor is When the actual monitoring time is not enough to be displayed in the full screen the time at the right side indicates the last trend record time and the time at the left side indicates the start time of monitoring The display status bar at the right side of the trend graph indicates whether all 0 5 15 09 35 Cardell MAX 12HD User s Manual of the trend is displayed on the single page If it is the status bar is full If not it indicates that the trend is not completely displayed and you can press to display the trend in the next page Note In the Temp trend display Temp1 is displayed in blue Temp2 in green In the IBP tre
34. 6 M1 0 5 15 09 CARDELL MAX 12HD User s Manual NOTE Thoroughly wipe off any excess cleaning solutions Care should be taken to prevent water or cleaning solution to run into connector openings or crevices THE DISPLAY CAUTION Use care when cleaning the display Do not use a paper towel to clean the display as this may cause scratches Occasionally as needed clean the display window using a soft lint free cloth sprayed with an alcohol free glass cleaner Do not use either isopropyl alcohol or solvent to clean the display Use of these cleaners can cause damage to the display The use of paper towels is not recommended as it may scratch the surface PATIENT CABLE AND LEADWIRES Prior to each patient use inspect the patient cable and leadwires for damage As necessary clean the patient cable and leadwires using a soft cloth dampened with a germicidal solution CUFFS Prior to each patient use inspect the blood pressure cuff and its hose for damage REUSABLE NYLON CUFFS As necessary for normal cleaning with mild detergents dilute bleach solution 1 2 wipe the cuff with the cleaning solution rinse with water and dry NOTE Midmark does not recommend submersion of the cuff Liquid should not be permitted to enter the cuff bladder because instrument damage may occur The cuff should be allowed to thoroughly dry before use DISPOSABLE VINYL CUFFS In certain situations the cu
35. Average 8 beats 0 5 15 09 111 Cardell MAX 12HD User s Manual ECG Display Channel Pacemaker detection rejection Input voltage range Input pulse width Interface Lead selection Lead fault alarm Input QRS indicator Waveform memory Sweep speed Amplitude selection Trend Frequency response Heart rate alarm duration Defibrillation protection Recovery after defibrillation 2 RESPIRATION Measurement method Respiration rate measurement and alarm range Waveform speed Respiration asphyxy alarm Respiration lead selection 112 8 channels 2mV to 700mV 0 2ms to 2 0ms AAMI 6 pin I II III V avR avL avF 5 lead mode Audible and visual indication 3 or 5 lead ECG cable Audible and visual heart mark flashes 12 minutes 12 5 25 50 mm s X1 4 X1 2 X1 X2 X4 Auto 2 hours gt 4 hours gt 8 hours gt 24 hours gt 48 hours s 72 hours gt 96 hours 2120 hours Monitoring 0 5 35 Hz Diagnosis 0 05 100 Hz Less than 7 seconds Tested with 5kV Less than 5 seconds Thoracic impedance or direct with CO2 0 150 brpm 2brpm 6 25 12 5 25mm s 0 120s RA LA RA LL RL LL RL LA M1 0 5 15 09 CARDELL MAX 12HD User s Manual 3 IBP Optional Measurement and alarm range Scale Channel Resolution Trend storage time Waveform speed Transducer sensitivity Transducer type Update time 4 SpO2 30 300 mmHg mmHg kPa single channels or
36. CTION 10 NIBP MONITORING 75 10 1 GENERAL INFORMATION cccenen enne 15 10 T CUFF PLACEMENT 2 seavensatasncarssanesnsaventedsnuanwseeet 76 10 2 NIBP SETUP eror s ovre ru teet dett 79 10 3 PREPARATIONS BEFORE NIBP MONITORING 81 TO ARAL ARISE TUR ihn hace ac eh 82 10 5 eere aso us t ee dee 84 10 0 MAINTENANCE iere ee eta aso ree eee cag deed 84 SECTION 11 TEMPERATURE MONITORING 86 11 1 GENERAL INFORMATION eene nennen 86 11 2 TEMPERATURE SETUP oes tab tete ed 87 11 3 TEMPERATURE MONITORING eene 88 0 5 15 09 Cardell MAX 12HD User s Manual SECTION 12 CO2 MONITORING 90 12 1 GENERAL INFORMATION Immer 90 12 2 C05 SETUB i OO ars T E 93 12 3 ALARM SETUP ee vau 95 TZ4 PRECAUTIONS cat cco ats uud Ps rat 95 SECTION 13 IBP MONITORING OPTIONAL 96 13 1 GENERAL INEORMATION 34 isis tede eet oec EX de ees 96 13 2 TIRANSDUGERB 2 ecce deret reri seres entes 96 13 3 IBP SETUB arca eco Ede HDI MEL D Run E 97 13 4 TRANSDUCER CONNECTION 103 13 5 ALARM SETUB 33 at Lie E uet a LI der 104 13 0 PRECAUTIONS c ovx cest eth uic a d ame P aO A uoa lad 104 13 7 TROUBLESHOOTING 105 SECTION 14 CLEANING AND MAINTENANCE 105 T4
37. ECG Recall Trend Display v Demo Channel Setup Patient Setup Date and Time Print Setup Uolume amp Brightness Cardiac Measurement Default Setup filarm Setup HR PR Priority Select Interface Central Station COM About Fig 5 1 System Setup Menu 5 1 System Setup Step 1 Press o to enter main menu as Fig 5 1 Step 2 Choose required item to set 32 M1 0 5 15 09 CARDELL MAX 12HD User s Manual 5 2 ECG Waveform Recall Waveform Recall The past 12 minutes of ECG waveforms can be recalled When a patient s ECG waveform is abnormal it can be used to review the waveform The ECG data comes from the channel where heart rate is detected ECG Recall 2006 10 31 11 0 40 oe eee eee 2006 10 31 PE er ver VET HUC TEM TOP a HR ee UNI POUR VIVE Some IN OF WO 11 16 PE uen Hr HEU UIS Vu Wer TS NE E NUT Ne VICIT TE VERI VT BIST Oe Va Sea ee ee at See ee sd eee meee wees Some Woes Sone Went See Weert Were Seat Sees eee No Signal Received 2006 10 31 11 07 40 2006 10 31 11 07 45 Up Down L R Scan Analysis Exit Fig 5 2 ECG Recall
38. ENSOR AND CLIPS CAUTION To avoid damage to the VetSat sensor remove it from the clip before cleaning either piece CAUTION Do not sterilize the sensor or clips by irradiation steam or ethylene oxide Do not immerse the sensors in water or cleaning solution 108 M1 0 5 15 09 CARDELL MAX 12HD User s Manual When necessary the sensor may be surface cleaned by wiping it with an agent such as 70 Isopropyl Alcohol The clip may be cleaned by either wiping it with or soaking it for ten 10 minutes in 70 Isopropyl Alcohol If the clip is soaked be sure to rinse it with water and air dry it prior to use on the next patient After each cleaning and prior to each use inspect the sensor and cable for fraying cracking breakage or other damage Inspect the clip for cracking or breakage or loss of spring tension that would allow slippage or movement of the sensor from its proper position NOTE If defects are noted do not use the sensor or clip Refer to the Directions For Use pamphlet enclosed with the sensor for more information TEMPERATURE PROBES As necessary the probes should be cleaned with a mild detergent and water to remove excess bioburden When necessary the probes may be disinfected using a soft cloth saturated with a 10 1 10 solution of chlorine bleach in tap water or 70 isopropyl alcohol When all of the surfaces have been disinfected wipe the entire surface of the monitor usin
39. LA black Left Hind Leg LL red Refer to Figure 7 2 and Table 7 2 for more information POSITIONING ANESTHETIZED PATIENTS For ECG monitoring during anesthesia it is most important to position patients properly on the table for the procedure If standard lead placement as described below is not possible leads should be attached to the body where they will be least subject to movement and away from the surgical site It is preferable to view an upright QRS complex for monitoring ECG A 52 0 5 15 09 CARDELL MAX 12HD User s Manual heart base to apex lead arrangement will be best if the negative lead is placed at the base point of right shoulder at thoracic inlet and the positive lead at the apex low on caudal left thorax Standard right forelimb lead is negative and standard left hind leg is positive in lead two so if these leads are properly placed and the machine is set to Lead an upright complex should be the result POSITIONING CONSCIOUS PATIENTS Standard position for recording diagnostic ECG in dogs is right lateral recumbency Diagnostic tracings can be obtained in cats in either right lateral or sternal position Limbs should be perpendicular to the spine and parallel with their opposite member In awake cats and dogs it is best to have the patient held by a veterinary technician or veterinary assistant One lead should be applied first to determine comfort level and adjustment made as needed Then the other cl
40. Rotate the knob Adjust the value Press the knob For the defaults of IBP alarm limits see Section 4 Alarm Setup IBP Alarm can be turned On or Off separately Main Menu Rotate the knob IBPI 2 Press the knobRotate the knob IBP Alarm Press the knob To print set the No 2 channel to be IBP1 or IBP2 in the Printing Setup Main Menu Rotate the knob System Setup Press the knob Rotate the knob Printing Setup gt Press the knob Rotate the knob Channel 2 Waveform Press the knob SPO2 IBP1 IBP2 CO2 RESP gt Rotate the knob Press the knob 102 M1 0 5 15 09 CARDELL MAX 12HD User s Manual The above setup will remain after power off 13 4 Transducer Connection 1 When the device is turned on the IBP channel will display No transducer and alarm sound can be heard 2 Plug transducer cable into the IBP or IBP2 socket and alarm will stop indicating the connection is correct The other end of the transducer cable is connected as follows 5 Fig 13 4 IBP Transducer Connection Diagram The T 1 is used to make 2 to be open to the air The T 3 is used to block 2 from 3 and 4 The pressure monitoring tube 4 is to ensure the accuracy of the measurement 4 The 5 in the above diagram 15 to connect patient catheter 1 Fill in the catheter system from T 3 and make sure there is no bubble in the system 2 Connect patient catheter to pressure monitori
41. Type B applied part Defibrillation protection Type CF applied part applied part in Lt conformity with IEC 60601 1 standards Shock protection level higher than BF applied part Note Please check accompanying documents Fuse M1 0 5 15 09 CARDELL MAX 12HD User s Manual xr Equipotentiality 1 Power ON OFF Press Press AC D Protective Earth 2 4 Installation 2 4 1 Unpacking and Check When you unpack monitor and accessories check accessories according to the packing list Check for any damage to the equipment or the external lead wires and accessories In case you have any other questions please contact with Midmark at 800 643 6275 2 4 2 Place Environment Requirements To ensure electric installation safety the environment should be reasonably dust free without corrosive or combustible gas or extreme temperature or humidity Keep the monitor at least 2 from the wall to ensure good air ventilation behind it 2 4 3 Power Supply Requirements The Cardell MAX 12 HD Multiparameter Monitor is a Class I device with 0 5 15 09 11 Cardell MAX 12HD User s Manual internal power supply in conformity with IEC60601 EN60601 requirements It can use AC power or its internal battery Connect AC Power When using AC power the MAX 12 HD may be turned on at any time Before plugging it into line power check the power with the requirements of the device Once plug
42. amps can be placed in position It is important that the patient be kept still A moving patient may cause clips to saw into skin tissue leading to discomfort and change in position of electrodes 7 4 ECG Setup Rotate the knob to press knob then rotate and press ECG knob finally select required item to setup Exit ECG Lead ECG Gain Waveform Speed 1imU Cal Pacemaker Detect R wave Source Lead Mode ECG Mode HR variation analysis HR Upper Limit 120 HR Lower Limit v HR Alarm ST Segment Setup ST Upper Limit ST Lower Limit ST Alarm ARR ON OFF Fig 7 3 ECG Menu 0 5 15 09 53 Cardell MAX 12HD User s Manual User may select and confirm by rotating and pressing the knob ECG Lead Select different leads to display different ECG waveforms of a patient ECG Gain Select different waveform gain User may select x1 4 x1 2 x1 x2 x4 or Auto Waveform Speed Waveform speed options 12 5 25 0 50 0mm s ImV CAL When it is pressed 1mV square wave will be displayed on the ECG waveform for user calibration PaceMaker Detect I II II V Off HR Source each ECG channel ECG Mode surgical monitoring diagnosis Alarm Limit set the upper limit and lower limit of parameters Alarm Sound On Off ECG Setup Procedures Rotate the knob to select and press the knob to confirm For example Rotate the knob to highlight Lead Press the knob and select the desired item Press the knob
43. aning or disinfection solution at any time Do not use an abrasive cloth or cleaner on the accessories Immersing the patient cable or lead wires in any liquid may result in moisture entering This may cause internal damage and reduce the product life Alcohol and organic solvents may cause stiffness and brittleness THE MONITOR On a daily basis examine the monitor s case for damage and check the AC power cord for bent or broken prongs cracks or fraying Neither the monitor nor the power cord should be used if damaged If any damage is noted contact the appropriate service personnel CAUTION Do not spray or pour any water or cleaning solution directly onto the monitor As needed clean the monitor using a soft cloth dampened with a mild dishwashing detergent solution and gently rub the soiled area until clean Use a clean soft cloth to dry the monitor Do not use abrasive cleaners on the monitor Do not use either isopropyl alcohol or solvent to clean the monitor Use of these cleaners can cause damage to the monitor s surface Do not immerse the monitor or power cord in the cleaning solution When necessary the monitor surfaces may be disinfected using a soft cloth saturated with a 10 1 10 solution of chlorine bleach in tap water When all of the surfaces have been disinfected wipe the entire surface of the monitor using a soft cloth dampened with fresh water to remove any trace amounts of residue and or fumes 10
44. arm Mode When abnormal event happens and all alarm functions are on alarm will last for 30 seconds and display alert message in a proper position When blood pressure and temperature values are abnormal out of limits and all the alarm functions are on the alarm sound will last for 30 seconds and automatically turn off but the readings will continue flashing When HR PR SpO2 or respiration readings are abnormal out of limits and all alarm functions are on the device will give real time sound and flashing visual alarm After all alarm setup is completed rotate the knob to Exit and press the knob to exit alarm setup 4 7 Alarm Event Review Rotate knob Alarm Event Review Press the knob The content of alarm event review includes data time HR ST SPO2 PR SYS DIA MAP PR RESP TEMP1 TEMP2 Alarm description 30 0 5 15 09 CARDELL MAX 12HD User s Manual Alarm Event Review Alarm description ECG1 Status alarm Press OK to exit Press Clear to delete all of alarm events 0 5 15 09 31 Cardell MAX 12HD User s Manual SECTIONS MONITORING SYSTEM SETUP Patient monitor setup includes ECG waveform recall Trend display Demo mode Channel setup Patient information setting Date and time setting print setup volume and brightness setting Default setup Alarm setup HR PR priority Select interface and Central Station The system setup menu is as follows _ Exit
45. at a low level reposition the sensor or try a different sensor If normal operation cannot be achieved call a Midmark representative for assistance NOTE In addition to the V SAT sensor and clips that are included with the monitor there is an optional reflectance sensor the MAXFAST 1 that can be used on the base of the tail This is mainly used as an alternative when head neck dental procedures are being performed 9 3 SpO2 Setup To enter SpO2 Setup menu Bit Waveform Speed Main gt Rotate the knob SPO2 Press the knob m v SPO2 Alarm See the menu on the right Enter waveform speed setup By rotating the knob and pressing you can set the sweep speed the SpO2 alarm limits and pulse rate alarm limits and turn the alarm on or off PR On 1 25 nin 2 5 min 5 min For example to set the SpO2 waveform speed ue Fig 10 1 SpO2 Setup Menu Main Menu Rotate the knob O SPO2 Press the knob Rotate the knob Waveform Speed Press the knob 12 5 25 0 50 0mm S Rotate the knob Press the knob Alarm sound On Off To select On Off On To turn on SpO2 alarm sound Off To turn off SpO2 alarm sound To set SpO2 alarm limits Main Menu Rotate the SPO2 Press knob Rotate the 0 5 15 09 69 Cardell MAX 12HD User s Manual knob SPO2 Upper Limit Press the knob Rotate the knob increase or decrease the value Press the knob For alarm limit
46. atically exits this mode 1 0 5 15 09 41 Cardell MAX 12HD User s Manual 5 9 HR PR Priority Setup G ay Rotate the knob HR PR Priority Press the knob First Priority 2 Priorit Rotate the knob Press the knob First priority includes ECG SpOPIBP and 2 priority includes SpO2 ECG IBP When First priority is selected heart rate HR is first displayed in the parameter area in priority When ECG is not detected the parameter area displays SpO2 pulse rate PR or IBP pulse rate PR When no heart rate or pulse rate is detected the parameter area displays When 2 priority is selected the parameter area first displays SpO2 pulse rate PR When SpO2 sensor is not connected the parameter area will display heart rate HR or IBP pulse rate PR When no heart rate or pulse rate is detected the parameter area will display 42 0 5 15 09 CARDELL MAX 12HD User s Manual 5 10 Display Interface Selection e Rotate the knob Select interface Press the knob Rotate the knob Enhanced waveform Big Font Grid On Press the knob OFF EXEC 811 812 313 ST4 32 2 20 IBP1 mmHg NIBP GO 120 85 95 32 2 20 IBP1 120 85 95 37 0 38 0 T 2006 10 31 12 42 08 Fig 5 9 Big Font From the display interface one can select Enhanced Waveform Big font shown as above and Grid these two kinds of displays are convenient for o
47. atient s nose humidification management exchangers HME and the Y piece defined as the terminal end of circuit or noncircle system and inhalation exhalation hose connector in a circle system Exhausted soda lime or malfunctioning one way valves can also contribute to increasing mechanical dead space Dead space also increases in a non rebreathing system when fresh gas flows are inadequate or when certain defects are present in the system for instance when the center tube of a Bain system or F circuit is cracked or broken These dead space contributors can all be controlled through proper system inspection and maintenance 120 M1 0 5 15 09 CARDELL MAX 12HD User s Manual Mechanical dead space gas is the first gas inhaled at the beginning of the each respiratory cycle As the mechanical dead space volume increases less fresh gas moves into the patient s alveoli limiting gas exchange Anesthetic System Norman Elbow Jackson Rees Bain Ped circle Adult circle Adult F Ped F Dead space lt 1 ml 3 ml 4 ml 4 ml 8 ml 8 ml 15 ml Adaptors ET tube Monitor ped Monitor adult Positional Heat amp Moisture Exchanger HME Dead Space 2 ml 2 ml 7 ml 8 ml 2 5 to 90 ml The consequences of excessive mechanical dead space can be substantial and potentially fatal As dead space volume from any cause increases effective alveolar vent
48. bserving the screen from a long distance User can select both or neither The other method to setup Big Font interface Press the knob the menu as follow shown will pop up in the screen rotate the knob and select Big 0 5 15 09 43 Cardell MAX 12HD User s Manual Font Exit Alarm Volume ail HR Volume atl Brightness Std Nights Mode 5 11 Central Station Communication Port The MAX 12HD is capable of communicating with a central station and it can monitor parameter values and waveforms optional software required Serial Port connect with central station by serial connection Network Port connect with central station by ethernet connection Exit Serial Port v None NOTE The central station must be set by Midmark 5 12 About Version v7 01 Fig 5 10 About Enter About from the system setup menu the screen will display 44 M1 0 5 15 09 CARDELL MAX 12HD User s Manual software version 5 13 Choose Language If you have set English as the Language from the System Maintenance menu then here only English can be selected The system display interface will be the English version 0 5 15 09 45 Cardell MAX 12HD User s Manual SECTION 6 PRINTING 6 1 Recorder Introduction Recorder Type The device uses a built in thermal array recorder and the width of recording waveform is 50mm Recorder Function Adjust waveform speed Rec
49. d meet the latest valid standards of IEC60601 1 1 BATTERY Battery Power Supply 12V 4 6Ah Whenever the device is plugged into AC power the two batteries will automatically be charged They should be charged at least for 8 hours before they become full To ensure batteries are fully charged it is recommended to plug the device in AC power even when the device is not being used Note Before the first use the batteries must be charged Note When the device is being stored for a long time make sure the batteries are full Check the battery status at least every month and recharge them Each fully charged battery can support the device continuously working for 1 5 hours however NIBP measurement and printing may accelerate the consumption of battery power When the battery power is almost used up the battery mark at the lower right corner of the screen will flash alerting user to plug the device in AC power as soon as possible When battery power is not enough to support normal operation of the device the device will be turned off automatically and will not start to work until being turned on after it is 20 M1 0 5 15 09 CARDELL MAX 12HD User s Manual plugged into AC power WARNING Even when the device is not on battery power will be discharged slowly 3 4 Before Monitoring Before monitoring a patient please check the following Check if there is any mechanical damage Check the external connections Check if the pa
50. d of exhalation EtCO2 and during inhalation FiCO2 and the Respiratory Rate Infrared spectroscopy is used to measure the concentration of molecules that absorb infrared light Because the absorption is proportional to the concentration of the absorbing molecule the concentration can be determined by comparing its absorption to that of a known standard The Microstream EtCO2 sample tube delivers a sample of the inhaled and exhaled gases from the ventilator circuit or directly from the patient into the monitor for CO2 measurement Moisture and patient secretions are extracted from the sample while maintaining the shape of the CO2 waveform The 50 ml min sampling flow rate reduces liquid and secretion accumulation decreasing the risk of obstruction in the sample pathway in humid ICU environments Once inside the Microstream CO2 sensor the gas sample goes through microsample cell 15 microliters This extremely small volume is quickly flushed allowing for fast rise time and accurate CO2 readings even at high respiration rates The Microbeam IR source illuminates the microsample cell and the reference channel This proprietary IR light source generates only the specific wavelengths characteristic of the CO2 absorption spectrum Therefore no compensations are required when different concentrations of N20 O2 anesthetic agents and water vapor are present in the inhaled and exhaled breath The IR that passes through the microsample cell a
51. d pressure values Support measures such as mechanical ventilation or other procedures which impact on cardiovascular physiology also contribute to accurate measurement The reader is referred to reference material for further discussion of these issues Technical issues also affect accurate measurement Technical issues generally fall into three categories catheter management appropriate set up and management of the measurement apparatus and operator error Arterial catheter management is a critical issue in success Placement should be on a flat surface away from joints or other structures which may intermittently occlude the catheter lumen due to position or movement Continuous flushing of the catheter to avoid intraluminal clots is essential for long term patency and accuracy of measurement 0 5 15 09 127 Cardell MAX 12HD User s Manual Ensuring an uninterrupted fluid interface between the catheter and transducer device is essential Air bubbles in the transducer or extension tubing may dampen the signal producing errors Correct procedural set up with zeroing the system is critical to ensure accurate values are measured Attention to detail of the catheter and operating system by personnel is important to avoid errors and complications Any break in the protocol may contribute to inaccurate measurement and increased patient risk Complications Reported hazards of invasive arterial pressure monitoring include
52. d printing While the alarm triggered printing function is turned ON whenever there is an alarm the recorder will automatically print out the data and waveform of 2 seconds or 5 seconds before the alarm User may also set it to print data and waveform of 8 seconds 16 seconds or 32 seconds after the alarm Or the user may also press the printing start stop key to stop printing Print Time 10seconds 15seconds 20seconds 30seconds Delay Time 3s 2s 1s 0s Exit v None 1 Second 2 Seconds 3 Seconds 48 M1 0 5 15 09 CARDELL MAX 12HD User s Manual Auto Record When selecting auto record interval on Timing Print the monitor will automatically record once after each interval v OFF 15 Minutes 30 Minutes 1 Hour 4 Hours 8 Hours 12 Hours Printing Report Head Each time a waveform is printed a header is automatically printed including the date time print speed and parameter values including blood pressure units Printing Paper The printing paper width is 50mm The paper should be kept in a cool and dry place away from direct sunlight high temperature and humidity MI 0 5 15 09 49 Cardell MAX 12HD User s Manual SECTION 7 ECG MONITORING 7 1 General Information The Cardell MAX 12HD Monitor records heart rate with electrode clips attached to the patient Electrodes detect signals caused by changes of electrical conduction in the heart during the cardiac cycle Heart rate is computed
53. date time 7 2 EtCO2 amp InCO2 Working mode Measurement range Scale Accuracy Resolution CO Respiration Waveform speed 8 Multi gas Optional Measure range and accuracy O5 CO N20 HAL ISO 0 1 C Approx 1 second Measurement standby 0 99 mmHg mmHg kPa 2mmHg 0 39 mmHg 5 40 99 mmHg 0 08 for every ImmHg above 38 1 mmHg 0 150 brpm 2brpm 6 25 12 5 25mm s 5 0 100 Vol 3 Vol 0 10 0 Vol 0 100 Vol 0 8 5 Vol 0 8 5 Vol 0 5 Vol or 12 rel 2 00 Vol 8 rel 0 15 Vol 15 rel 0 15 Vol 15 rel 0 5 15 09 115 Cardell MAX 12HD User s Manual 0 10 0 Vol 0 15 Vol 15 rel SEV 0 10 0 Vol 0 15 Vol 15 rel DES 0 20 0 Vol 0 15 Vol 15 rel Unit mmHg kPa IV Display Display Color TFT LCD Size 12 1 Display Channel 6 or 8 V Recorder Type Thermal recorder Printing mode Real time amp alarm triggered printing of waveform and text Printing channel 2 3 channels Printing speed Auto 12 5 25 0mm s VI Physical Specifications Net Weight 15 8 165 6 5 kg Gross Weight 19 8 Ibs 9 0 kg Dimensions 450x380x390 mm VII Environmental Specifications Temperature 116 M1 0 5 15 09 CARDELL MAX 12HD User s Manual Working 0 40 C Storage and Transportation 20 55 C Relative Humidity Working lt 80 non condensing
54. ding beyond the joint should be selected Appropriate sized cuffs may be selected based on published guidelines that cuff width should be 40 60 of limb circumference The cuff should be wrapped for a snug fit Overlapping the cuff will not affect measurement results Make sure the hook and loop sections of the cuff are fully engaged when it is wrapped around the limb If not fully engaged the cuff will detach during bladder inflation If that happens select the next size bigger cuff Adhesive tape or other material should not be used to secure the cuff Use the following table as a guide to select the correct size Small Animal Cuff Selection Reorder Number Bladder Size Limb Circumference Width Range SV600 kit Includes all of the above eee Large Animal Cuff Selection Cuff Model Number Bladder Size 1 Limb Circumference Width Range SV8 8 cm 13 20 cm SV10 10 2 cm 18 26 cm References Pedersen KM Butler MA Ersboll AK Pedersen HD 2002 Evaluation of an oscillometric blood pressure monitor for use in anesthetized cats JAVMA 221 646 650 Sawyer DC Guikema AH Siegel EM 2004 Evaluation of a new oscillometric blood pressure monitor in isoflurane anesthetized dogs Vet Anaesth Analg 31 27 39 NOTE For species specific reference values see Appendix 2 78 M1 0 5 15 09 CARDELL MAX 12HD User s Manual 10 2 NIBP Setup NIBP setup includes select measurement work mode select cuff siz
55. display IBP in the Display Channel Setup Max 2 channels for IBP you may select the labels in IBP Label Setup so as to identify the measurement location The IBP labeling methods are as follows Main Menu Rotate the konb IBPI 2 23Press knob Rotate the knob IBPLabeling Press the knob IP ART AO RA FA PA CVP ICP Rotate the knob Press the knob NOTE When an artery pressure is selected to be measured the IBP parameter area mainly displays the SYS and DIA displayed in red letters and the mean pressure displayed in blue letters When CVP is measured IBP parameter area mainly displays the mean pressure displayed in red letters and the values of its SYS and DIA are displayed in blue letters IBP Unit The device provides two units for displaying IBP measurements e g mmHg or kPa default is mmHg The unit can be set in Scale Setup Main Menu 5 Rotate the gt 1 2 gt knobRotate the knob luni Press the knob mmHg kPa Rotate the knob Press the knob 0 5 15 09 101 Cardell MAX 12HD User s Manual The change in IBP units will be displayed in all the IBP areas e g parameter area and trend graph Alarm Setup and Printing Setup After the above setup is completed the alarm limits for the SYS and DIA of IBP1 2 need to be set Main Menu Rotate the gt 1 2 gt Press knob Rotate the knob SYS Upper Limit Press knob
56. double channels mmHg 120 hours 12 5 25 50mm s 10 5uV V mmHg Disposable Approx 1 second SpO Measurement and Alarm range SpO Average SpO Accuracy SpO gt Pulse rate SpO Pulse rate average SpO Pulse rate accuracy Update time Pulse rate alarm limits Pulse sound Sensor type Internal LED waveform 0 100 8 beats 2 70 100 3 50 69 30 250bpm 8 seconds 2bpm Approx 1 seconds 0 240bpm Pulse sound indication Finger tip universal Y wrap Infrared 940nm Red light 660nm 0 5 15 09 113 Cardell MAX 12HD User s Manual Light power dissipation Pulse rate indication 5 NIBP Method Parameters Scale Operation mode Repeat cycle Measurement and alarm range Systolic Diastolic Pulse rate range Measurement time Pressure display accuracy NIBP pulse rate accuracy Infrared light 22 5 mW Red light lt 30 mW Digital Auto oscilloscope SYS DIA MAP Pulse rate mmHg kPa Manual Auto Stat 1 10 15 30 60 90 120 240 480 minutes 20 265mmHg 15 220mmHg 0 300 bpm Typical measurement time is 20 seconds STAT Typical measurement time is 20 seconds t5mmHg 2 or 2bpm whichever is greater 6 TEMPERATURE 2 channel Measurement and Alarm range Probe Unit Accuracy 114 0 50 C Rectal Esophageal Celsius Fahrenheit 0 1 C M1 0 5 15 09 CARDELL MAX 12HD User s Manual Resolution Up
57. e select auto measurement time interval change NIBP measurement scale pressure compensation dynamic blood pressure adjust alarm limit and turn the alarm sound on or off Enter NIBP setup Rotate the knob to press knob to confirm Rotate to NIBP press knob to confirm Users can rotate the knob to select items shown in the following figure and press the knob to confirm Exit Work Mode Patient Unit Pressure Test Dynamic Blood Pressure gt SYS DIA larm 20 SYS Upper Limit 160 SYS Louer Limit 100 DIA Upper Limit 100 DIA Lower Limit 60 NIBP Alarm Fig 10 1 NIBP Setup Menu Select cuff size Large Small Select work mode Manual Auto and Stat Select time interval for auto NIBP measurement Change NIBP measurement scale mmHg or kPa Press Test test static press Dynamic Blood Pressure Start Stop dynamic blood pressure monitoring Alarm limit adjust alarm upper and lower limits Alarm On Off Turn on or off NIBP alarm sound 0 5 15 09 79 Cardell MAX 12HD User s Manual Operation Method Rotate the knob to select required function then confirm by pressing the knob Select cuff size The current cuff size is displayed near the blood pressure value on the screen Large or small can be selected corresponding to the type of cuff selected for your patient When using one of the two large nylon cuffs SV8 or SV10 select Large Otherwise the cuff size should be set to Small
58. e or the wire inside the cable may have grown frayed over time Try it on your finger or earlobe and if no reading is obtained it may indicate that the V SAT sensor must be replaced If No signal received is displayed on the screen then there is a communication problem between the SpO2 module and the host Turn off the machine and turn it on again If the problem still remains consult Midmark CAUTION Certain drugs including alpha 2s are vaso constrictive and may cause difficulty in obtaining readings on patient extremities Moving the sensor further back on the patient s tongue or exploring alternate sites lip ear toe webbing prepuce vulva may restore the readings 9 8 2 Intermittent SpO2 value Failure Phenomenon When patient SpO2 is measured the SpO2 value is not continuous 0 5 15 09 73 Cardell MAX 12HD User s Manual Inspection method 1 Patient motion 2 SpO2 extension cable connection or V SAT sensor Solution Keep the patient as still as possible Value loss caused by patient motion can be considered normal 74 M1 0 5 15 09 CARDELL MAX 12HD User s Manual SECTION 10 NIBP MONITORING 10 1 General Information The MAX 12HD uses oscillometric principles to calculate the systolic diastolic and mean arterial pressure MAP values The MAP is calculated as the lowest cuff pressure that provides the maximum cuff oscillations Therefore MAP is the largest signal received a
59. e 131 x 14 75 12 101 21 King Charles Spaniel 131 16 72 14 124 24 German Shepherd 132 13 75 10 108 23 Terrier 136 16 76 12 104 16 Bullterrier 1344 12 77 17 122 6 Chihuahua 134 9 84 12 109 12 118 M1 0 5 15 09 CARDELL MAX 12HD User s Manual Miniature Breeds 136 13 74 17 117 13 Pomeranian 136 12 76 13 131 14 Beagle 140 15 79 13 104 16 Dachshound 142 10 85 15 98 17 Saluki 143 16 88 10 98 22 Greyhound 149 20 87 16 114 28 Pointer 145 17 83 15 102 14 GUIDELINES Mean Arterial Pressure MAP Minimum to adequately perfuse all peripheral tissue beds 60 70 mmHg Hypertension Suspect with systolic pressure greater than 150 mmHg affirmed when above 160 170 mmHg also affirmed in cats when diastolic pressure is above 100 mmHg Hypotension During anesthesia generally maintain systolic pressure above 80 mmHg 2 Info per Dr Donald Sawyer Michigan State University 0 5 15 09 119 Cardell MAX 12HD User s Manual APPENDIX 3 DEAD SPACE Cause Effect amp Control in Small Animal Anesthesia Robert M Stein D V M DAAPM Founder www VASG org Dead space is an often misunderstood and overlooked aspect of veterinary anesthesia patient management Dead space is always present as a component of the patient s airway and to a variable degree as a component of the anesthetic
60. e NIBP measurement scale Use this to change the NIBP measurement scale between mmHg and kPa NOTE The measurement scale is shown in the parameter display 10 3 Preparations before NIBP Monitoring 1 Use cuffs of proper sizes 2 Ensure the cuff has been completely deflated 3 Place the cuff on the patient s limb 0 5 15 09 81 Cardell MAX 12HD User s Manual 4 Install the cuff hose to the NIBP connector of the patient monitor 5 Make sure there 15 no block between the monitor and the hose 6 Set blood pressure measurement correctly in the setup menu 7 The cuff on patient s limb should be at the same level as the heart 8 Press the blood pressure start key and start measuring blood pressure WARNINGS 1 Make sure there is no other pressure on the cuff Wrong cuff size may result in inaccurate measurements 2 3 Make sure monitor is set to Large Small corresponding to cuff used 4 To ensure the patient s safety never use cuff on the same limb where an infusion is going on Do not measure SpO2 or other parameters on the same limb where blood pressure is measured Do not apply cuff on an injured limb Do not measure a patient s blood pressure continuously or repetitively for a long time 10 Use only accessories recommended by the manufacturer 11 Remove the cuff after turning the power off 10 4 Alarm Setup 10 4 1 NIBP alarm ON OFF and alarm limits setup 82 0 5 15 09
61. e knob and press the knob and you can change the date and time When the date and time are set please rotate to ox and press the knob to exit the setup if OK is not selected the change will be regarded as canceled If a change is completed and you want to cancel it then rotate the knob to Cancel press the knob and exit Then the screen will still display the original date and time Date and Time Year Hour 12 Month 10 Min 139 Day 31 Sec 12 OK Cancel Fig 5 6 Date and Time 40 0 5 15 09 CARDELL MAX 12HD User s Manual 5 8 Volume and Brightness Setup Volume amp Brightness Setup menu can also be displayed when the knob is pressed at the following hot keys Alarm Volume ETT HR Uolume ETT Brightness Std Big Font Nights Mode Work Mode The Alarm and Heart Rate volumes have 7 levels The Brightness adjustment is used to adjust the screen brightness When Standard is selected the screen is bright suitable for monitoring in daytime When Soft is selected the screen is slightly dark suitable for monitoring during nighttime WARNING If you select Night mode the monitor display screen becomes dark and all volumes turn off Before selecting please consider your patient s status NOTE Night Mode cannot be selected during alarm status Press any button except knob on front panel to exit Nights Mode When a new alarm event occurs the monitor autom
62. e menu will disappear Power indicator AC indicator When the monitor is connected to Mains power no matter if the patient monitor is turned on or not the yellow indicator will remain on When the patient monitor is working the indicator becomes green Red Yellow dual color alarm indicator The red LED flashes during an emergency alarm life 15 endangered The yellow LED flashes during a warning alarm The yellow LED stays on during an alerting alarm 0 5 15 09 15 Cardell MAX 12HD User s Manual 3 2 Rear Panel The rear panel of MAX 12HD multi parameter patient monitor is as shown in Fig 3 2 3 4 D B 4 39 Fig 3 2 MAX 12HD Rear Panel 1 Fan For heat dissipation 2 Speaker 3 RS422 Central Station Interface 4 Ethernet port 16 M1 0 5 15 09 CARDELL MAX 12HD User s Manual 5 Video Out VGA port 6 USB 7 Label 8 Equipotentiality Ground Post 9 AC power supply socket External display port connect standard color VGA monitor The pins of the Central Station Port RS422 is defined as follows Qu OO o o o o Fig 3 3 RS422 1 N C sign connection 4 signal output 2 N C no signal connection 5 TXD A Signal output 3 N C nosignal connection 6 RXD A Signal input 7 N C nosignal connection 8 Signal input A Devices connecting to the patient monitor shall meet IEC standards Data processing device shall meet IEC950 and
63. e parameter selection menu and turn the knob to highlight the preferred parameter for that channel Then press knob to select parameter Step 3 Press OK The waveforms and parameters will be displayed on screen according to order 38 0 5 15 09 CARDELL MAX 12HD User s Manual Chamel Setup Channel Mode 8 channel ECG1 Channel 2 ECG2 Channel 3 ECG3 1 4 SP02 Channel 5 NONE Channel 6 Channel 7 NONE Channel 8 NONE TEMP Cancel Fig 5 5 Channel Setup 5 6 Patient Information Setup In the monitoring process patient information can be entered for the ease of observation but it will not remain after power off To enter the patient setup dialog box Rotate the gt Information Press the Knob Information Nickname Record Mo 01234567839ab cdefghi jklnmn opqrstuvuxuyz Blank m Del Caps OK Cancel Location Sex Canoe Patient name Record number and Location ID can be entered through rotating and pressing the knob Then select sex species and whether it s a new patient or old patient whether to clear original data 0 5 15 09 39 Cardell MAX 12HD User s Manual 5 7 Date and Time Setup The device displays the real date and time Each time the device is turned on it will display the current date and time To enter time setup O Rotate knob Date and Time Press knob Rotate th
64. e that it has made contact with skin Crocodile clips are supplied with this monitor and they must opened wide enough to firmly but gently grasp the skin 7 3 Attaching ECG Electrodes 7 3 1 Leadwires and Color Table 7 1 5 Lead Color and Coding USA Standard International Standard LA black Left Foreleg L yellow Left Foreleg RA white Right Foreleg R red Right Foreleg green Right Hind Leg N black Right Hind Leg LL red Left Hind Leg F green Left Hind Leg V brown explore C 7 white common Table 7 2 3 Lead Color and Coding USA Standard International Standard LA black Left Foreleg L 7 yellow Left Foreleg RA white Right Foreleg R red Right Foreleg LL red Left Hind Leg F green Left Hind Leg 0 5 15 09 51 Cardell MAX 12HD User s Manual 7 3 2 Lead placement Figure 7 1 5 Lead Placement For a 5 lead system four limb leads can be applied RA LA RL and LL with the exploring lead brown used for diagnostic purposes as needed Otherwise the exploring lead may be left unplugged Refer to Figure 7 1 and Table 7 1 for more information Figure 7 2 3 Lead Placement For a 3 lead system leads should be attached just below the elbow on the front leg and just above the stifle on the hind leg The following lead sequence should be applied for a 3 lead system Right Foreleg RA white Left Foreleg
65. ell MAX 12HD User s Manual structure and may actually feel a pulsation as the needle tip engages the arterial wall At this point a flash may be noted in the needle hub Once the flash is noted stabilize the catheter unit If you are using a guide wire catheter slowly advance the wire stylette It should move easily or only encounter slight resistance if you are in the vessel lumen Once the guide wire is inserted full length slowly advance the catheter until the catheter hub is at the skin surface If using a standard catheter slowly advance the catheter There should be slight resistance due to tissue drag but the catheter should go smoothly After catheter placement is confirmed gently compress over the vessel at the catheter tip remove the stylette and needle and cap the catheter hub with the adapter An initial aspiration should easily produce a blood flash into the saline solution Flush in 2 3 cc of heparinized saline solution to clear blood from the catheter lumen Secure the catheter in place prior to proceeding further Connection to BP monitor Flush the connecting tubing with saline using the flush device embedded in the disposable transducer or by using a saline filled syringe attached to the stopcock immediately adjacent to the extension tubing Be sure that there are no visible air bubbles following the flush procedure Attach the connecting tubing to the catheter adapter extension You should see a pr
66. ent is identified Reported sites for arterial catheter placement in dogs and cats include the dorsal pedal metatarsal popliteal and femoral arteries in the hind limb and the brachial artery in the forelimb In general distal rear limb sites are selected based on ease of identification catheter placement and stabilization following catheter insertion The selected site must be clipped and surgically prepped prior to catheter placement Failure to aseptically prepare the area can lead to systemic infection Catheterization technique The artery is palpated for pulse quality In hypotensive patients peripheral arterial sites may not be detectable due to low blood flow and poor pulse quality Following identification a small amount of 2 lidocaine is infiltrated in proximity to the vessel to reduce vasospasm and desensitize the area for catheter placement Do not remove the filter cap from the needle hub prior to placement You will be entering a high pressure vessel and will have a sudden burst of blood back through the catheter hub if it is uncovered The catheter is initially introduced through the skin In some cases a pilot wound is created if skin is tough and may damage initial catheter insertion Once the catheter is inserted through the skin it is SLOWLY advanced while a finger is kept over the artery to feel when the catheter intersects the vessel You can feel the vessel wall because it isa muscular 0 5 15 09 125 Card
67. ents of the menu change with the channel setup In the main menu line rotate the knob to point to a key see above IBP2 and press the knob to enter the sub menu operations After entering sub menu rotate the knob to point to a key and press the knob You can enter the next menu or select a function directly and press the knob to confirm the selection When finished rotate the knob to BACK and press the knob to confirm to exit Then the setting is saved Volume and Brightness menu may also be displayed by directly pressing the hot key as follows Exit Alarm Volume ETI HR Uolume TI Nights mode on Brightness Std Big Font Nights Mode Work Mode Alarm sound volume has 7 selections Heart rate sound volume has 7 selections Display brightness can be adjusted Under Normal mode the screen is bright suitable for monitoring in daytime When Night mode is selected the screen is darker suitable for monitoring at night NOTE If any alarm occurs the Night mode will be exited NOTE System prevents entering Night mode during alarms 1 In system setup menu press e to return the normal monitoring screen 2 In sub menu mode press to return to the previous menu If this key is held down the monitor will return to the normal monitoring screen When user has not performed any operations for over 30 seconds the menu display will automatically disappear and return to full screen 24 M1 0 5 15 09
68. er adapters in the transducer housing In permanent transducers two stopcocks are required in disposable units only one may be necessary Leave one stopcock open to room air and fill the chamber with heparinized 124 M1 0 5 15 09 CARDELL MAX 12HD User s Manual saline being sure that ALL air bubbles are removed After filling leave the stopcock open and zero the transducer to the machine by pressing the zero control button on the monitor panel This adjusts the electronics to provide accurate measurement This step will be repeated after patient attachment occurs After filling and zeroing the transducer a flush infusion device is attached to one stopcock unless it is embedded in the transducer device An IV bag with heparinzed saline is placed in a pressure sleeve and an IV infusion set microdrip is attached to the flush device and the bag pressurized to 300 mm Hg A 6 12 length of low compliance IV tubing is attached to a stopcock to interface the catheter to the transducer This tubing is flushed and filled with heparinzed saline The stopcock is turned off to prevent fluid drainage once the tubing is filled A catheter adapter with a side port is flushed with heparinized saline filled syringe with the syringe attached after flushing The catheter catheter supplies and prep solution are assembled and organized on a work surface for easy access Catheter placement sites A superficial artery amenable to catheter placem
69. es its intended use It should always be kept with the monitor Observance of the manual is a prerequisite for proper product performance and correct operation and ensures patient and operator safety 1 2 Product Support 1 2 1 Warranty Please fill in and mail the product warranty card After unpacking the system you may want to keep the packing materials for future return for service if necessary The manufacturer is responsible for the safety reliability and performance of the monitor 0 5 15 09 Cardell MAX 12HD User s Manual The warranty applies if the product is used according to the operator s manual instruction The warranty does not apply if the product e has been damaged from improper operation misuse has been damaged because of improper connection to other devices e has been damaged by accident e has been modified without written authorization of the Company has had the serial number removed or defaced 1 2 2 After sale service To obtain service or product support please contact Midmark in Tampa Florida at 800 643 6275 or visit the website at www Midmark com Have the following information available model and serial number of the equipment e date of purchase and distributor name 1 3 Important Information The product is made under 1509001 2000 ISO13485 2003 quality system e Manufacturer address Midmark 10008 N Dale Mabry Hwy Suite 110 Tampa FL 33618 e Phone
70. essure waveform on the monitor screen after opening the stopcocks to the system Level the transducer at the estimated base of the heart point of the shoulder Close the line to the patient and open it up to room air using the stopcock Press the zero button again to recalibrate the system to the patient Close the stopcock to air and open the line to the patient You are now measuring direct blood pressure Blood pressure waveform Arterial waveforms emanate from the pulse pressure created by ventricular systole and diastole The arterial pulse pressure wave begins as left ventricular contraction and forward blood flow stroke volume creates aortic distention within the closed vascular system Peak aortic blood flow produces the initial upstroke in the pressure pulse while continuous ejection of blood from the ventricle during systole fills out or sustains the pulse waveform As pressure and flow reach their maximum values the curve flattens and reaches peak pressure The rounded sustained portion of the pressure wave represents a combined effect of ventricular volume ejection distention of the entire aorta 126 M1 0 5 15 09 CARDELL MAX 12HD User s Manual and runoff into aortic branches Following this point the curve begins to descend until a defined upstroke or notch on the downside of the pressure curve is noted This notch referred to as the dicrotic notch represents closure of the aortic valve and secondary pressure genera
71. ferred for long term monitoring or in mobile patients The gauge of catheter is based on vessel diameter at the placement site In dogs 20 24 G x 2 3 over the needle catheters are used in the dorsal pedal metatarsal and popliteal arteries In cats a 22 24G x 2 catheter is selected for the same arterial sites Large diameter arterial segments femoral and brachial a may accommodate a 20 G x 2 3 over the needle catheter in the dog and a 22 G x 2 3 catheter in the cat Several manufacturers Arrow BD offer an over the needle catheter system with a built in guide wire that is intended to facilitate arterial catheter placement In these systems the guide wire is first advanced and the catheter is then placed over the guide wire This system is helpful when challenging cases are encountered Long catheters are generally selected in large bore femoral and brachial a arteries where stabilization is challenging The additional length of the catheter allows the catheter tip to be located in a more central arterial location and adds additional length that reduces accidental catheter dislodgment Technique for setting up direct blood pressure monitoring Equipment set up and preparation Prior to beginning the procedure all equipment and supplies should be assembled and be ready to use The first step is to attach the pressure transducer to the patient monitor at the appropriate plug site Following attachment connect three way stopcocks to the lu
72. ff may become soiled during its use In 0 5 15 09 107 Cardell MAX 12HD User s Manual these situations a water based detergent is suitable for wiping the cuff As necessary the preferred method for cleaning the cuff is to wipe it down with a damp soapy cloth A damp detergent free cloth should then be used to rinse the cuff NOTE Midmark does not recommend submersion of the cuff Liquid should not be permitted to enter the cuff bladder because instrument damage may occur The cuff should be allowed to thoroughly dry before use PNEUMATIC TUBING Prior to each patient use inspect the NIBP Inflation Hose for proper connection cracks and kinks As necessary clean the pneumatic tubing using a soft cloth dampened with a germicidal solution CONSUMABLES Microstream CO consumables are intended for single patient use in human medicine but in the veterinary setting may be reused as long as any moisture is allowed to dry between uses It is estimated that with fairly regular use the sampling lines should be replaced every 60 to 90 days Do not attempt to disinfect or flush the FilterLine as the monitor can be damaged Refer to the manufacturer s instructions enclosed with each sensor for more information SpO INTERCONNECT CABLE Prior to each patient use inspect the SpO Interconnect cable for damage As necessary clean the cable using a soft cloth dampened with a germicidal solution S
73. g a soft cloth dampened with fresh water to remove any trace amounts of residue and or fumes 14 2 System Calibration Besides the routine cleaning of the monitor and accessories outlined in the previous section and replacement of accessories due to normal wear and tear calibration of the monitor should not be necessary during the warranty period 0 5 15 09 109 Cardell MAX 12HD User s Manual If the monitor is in need of repair it must be referred to the appropriate service personnel Service performed by unauthorized personnel could be detrimental to the monitor and may void the warranty For service contact Midmark 110 M1 0 5 15 09 CARDELL MAX 12HD User s Manual Appendix 1 Product Specifications I Safety Safety Class Classl with internal power supply Device Continuous working non AP APG device II Power Supply Requirements Input Power Supply Voltage 100V a c 242V 50Hz 60Hz Input Power S150VA Battery Capacity 12V 4 6 Ah Charging time28 hours Battery backup working time 22 hours per battery Charging mode Automatically charged with charge protection feature While the device is powered by AC power mains Discharge Protection When powered by battery the device will be automatically powered off when the battery power is almost used up III Performance Specifications 1 ECG CMRR 260dB Heart Rate Measurement and Alarm Range 15 300bpm Accuracy 16 Heart Rate
74. ged in power is indicated on the front panel by a yellow light This shows the monitor is in standby condition and the battery is charging 2 4 4 Combination Of Equipment Both medical and non medical equipment must comply with IEC60601 1 1 standard Warning The use of many devices together can increase the leakage current which may injure the patient and personnel 2 4 5 Operation Press the power switch on the front panel about 2 3 seconds The system will start self test and then start the monitoring screen If the power indicator on the front panel is green it shows that the device is in normal working condition and can be used for vital sign monitoring 12 0 5 15 09 CARDELL MAX 12HD User s Manual SECTION 3 DEVICE DESCRIPTION 3 1 Front Panel The front panel of MAX 12HD multi parameter patient monitor is as shown in Fig 3 1 2002 01 28 11 44 57 Fig 3 1 MAX 12HD Front Panel 0 5 15 09 1 Display 2 Power indicator B 4 5 1 00 6 Cardell MAX 12HD User s Manual Color TFT LCD display for displaying waveform menu alarm status and vital signs When the patient monitor is connected to Mains power or there is enough battery power press this key 2 3 seconds the patient monitor will be turned on or off ECG Menu Press the key to enter the ECG menu Freeze Restore When waveform is swept press the key to freeze the waveform When wa
75. he operator s knee and take measurements from the metacarpus Sites for cuff placement are the metacarpus metatarsus and anterior tibial In anesthetized patients most surgeries are done on the posterior part of the body so the metacarpal area of the forelimb is most convenient In situations where this is not possible the cuff should be wrapped around the metatarsus just proximal to the tarsal pad or around the hind leg just distal to the hock The tail site should not be used for cuff placement during anesthesia It is not necessary to center the cuff over the artery because of the fully encircling bladder design If the hair over the artery site is too thick or matted for good contact it should be clipped NOTE Use metacarpus or metatarsus NOTE To achieve the most accurate readings it is important to keep the cuff on a horizontal plane with the heart Large animals A large animal such as a horse should be in a stock standing still or lying down For horses and cows the cuff can be wrapped around the base of the tail using the coccygeal artery on the ventral surface WARNING When monitoring over an extended period of time or at frequent intervals periodically observe the patient s limb to make sure that the circulation is not impaired for a prolonged period of time Cuff size selections 0 5 15 09 77 Cardell MAX 12HD User s Manual The widest cuff that can be placed on the patient without exten
76. high and out of the measurement range of the patient monitor Calm the patient down and perform the measurement again 0 5 15 09 83 Cardell MAX 12HD User s Manual 4 Measurement Error If the NIBP parameter area displays Measurement Error it may be the result of a system self test error the patient being over excited trembling or air leakage Calm the patient down and perform the measurement again If the message persists please contact Midmark Alarm Sound On Off Turn the alarm sound on or off 10 5 Precautions The following circumstances may affect the measurement results 1 patient motion 2 rapid change in pressure 3 shock or hypothermia 10 6 Maintenance CUFFS Prior to each patient use inspect the blood pressure cuff and its hose for damage REUSABLE NYLON CUFFS As necessary for normal cleaning with mild detergents dilute bleach solution 1 2 wipe the cuff with the cleaning solution rinse with water and dry NOTE We do not recommend submersion of the cuff Liquid should not be permitted to enter the cuff bladder because instrument damage may occur The cuff should be allowed to thoroughly dry before use DISPOSABLE VINYL CUFFS In certain situations the cuff may become soiled during its use In these situations a water based detergent is suitable for wiping the cuff 84 M1 0 5 15 09 CARDELL MAX 12HD User s Manual As necessary the preferred method for cleaning
77. hout a waveform Connect temperature probe to patient and make sure other end of cable is firmly inserted into the socket in the device The screen will then display the temperature reading Fs Main gt Rotate knob TEMPI Press the Tt Upper Limit 42 T2 Lower Limit 30 v T1 Alarm T2 Upper Linit 42 limits and temperature units please operate the knob 12 Lower Limit 30 v T2 Alarm Unit Fig 11 1 Temperature Setup Menu knob Then you can enter the temperature setup menu as shown in the right figure To set the alarm through rotating and pressing it For example to set the temperature unit Main Menu Rotate the knob TEMP Press the knob Rotate the knob Unit Setup Press the knob gt C F gt Rotate knob Press the knob To set the temperature channel and alarm limits Rotate TEMP Press knob Rotate knob Upper Limit Press the knob Rotate the knob Increase or decrease the value Press the knob 0 5 15 09 87 Cardell MAX 12HD User s Manual 11 3 Temperature Monitoring 1 Select temperature probe WARNING Skin surface and rectal probes are not exchangeable 2 Probe may be used either in the esophagus or the rectum of the patient CAUTION To avoid cross contamination we suggest you label the probe with tape indicating which way it s been used 3
78. ilation decreases In patients breathing 100 oxygen there may be negligible initial effect on arterial oxygen tension Arterial CO2 however can reach impressive levels It is possible to have an end tidal CO2 level greater than 110 mmHg in patients with a normal pulse oximeter reading e Increased arterial CO2 causes Respiratory acidosis Sympathetic stimulation Cardiac arrhythmias A mix of sympathetic stimulation and hypoxemic effects Variable peripheral vasoconstriction sympathetic effect followed by peripheral vasodilation as a direct effect on peripheral vessels CNS depressant effect and eventually narcosis PaCO2 levels above 100 mmHg have an anesthetic effect Increased cerebral blood flow and intracranial pressure Tachypnea and an increased work of breathing which can negatively impact a debilitated patient Arterial O2 levels may eventually decrease enough to cause hypoxemia especially in a patient breathing room air e Inadequate ventilation interferes with adjustments in anesthetic levels Controlling mechanical dead space is a simple matter Mechanical dead space is most concerning for patients under 6 kg body weight 0 5 15 09 121 Cardell MAX 12HD User s Manual o Minimize the connectors attached to the endotracheal tube particularly in small patients For example in a 6 kg patient under anesthesia the patient s alveolar ventilation volume wo
79. ing Mode Zeroing has auto and manual modes Menu S Rotate the knob IBPT1 2 Press the knob Rotate the knob Zeroing Mode Press the knob Auto Manuall Rotate knob Press the knob Manual Zeroing If zeroing mode is set to be Manual then the system will automatically enter IBP Setup Menu and IBP status Press the knob and the system will start zeroing Auto Zeroing 0 5 15 09 99 Cardell MAX 12HD User s Manual When the screen prompts Press Zeroing Key if the zeroing mode is set to be Auto then the system will automatically give the command and start zeroing and the user does not need to confirm Enforced Zeroing When the transducer needs to be calibrated please enter IBP Setup Menu and set IBP1 2 Zeroing status to be YES Such manual zeroing mode is also called Enforced Zeroing Follow the steps below Main Menu Rotate the knob gt IBP1 2 Press knob IBP Zeroing Press the knob IBP Labeling IBP Labels IP ART AO RA FA PA CVP ICP IP Invasive blood pressure default label ART Artery Pressure i e the arterial blood pressure being monitored AO Aorta Pressure RA Radial Artery Pressure Femoral Artery Pressure PA Pulmonary Artery Pressure CVP Central Vein Pressure 100 M1 0 5 15 09 CARDELL MAX 12HD User s Manual ICP Intracranial pressure When a waveform channel is set to
80. interference Please ensure any device close to the monitor meets the related EMC requirements Do not use cell 0 5 15 09 Cardell MAX 12HD User s Manual phone or personal telecommunication devices next to the monitor Unknown EMI may be caused by radio transmitter or TV Please remove the patient monitor or add shielding materials INSTRUCTIONS FOR USE For continued safe use of this equipment it is necessary that the instructions are followed However instructions listed in this manual in no way supersede established medical practices concerning patient care Loss of data When the device accidentally loses data please keep patient under close attention until the device returns to normal Other devices connecting to the device should meet IEC standards for example data processing device should meet IEC 950 and medical device should meet IEC60601 1 and the whole system should meet the latest version of IEC60601 1 1 standards Plastic bags and other packaging materials should be disposed of in accordance with related regulations After the device or the accessories are at the end of their life cycle please dispose of them according to local laws and regulations 2 3 Safety Symbols Note Depending on the configuration of your monitor it may or may not hav e the following labels A BF applied part Type F applied part meet the requirements of IEC60601 1 standards Shock protection level is higher than
81. k EO Basic Physics and Measurement in Anaesthesia 3rd ed Oxford UK Butterworths 1990 pp 218 231 3 Reprinted with permission from IVECCS 3 Reprinted with permission from IVECCS 128 M1 0 5 15 09 CARDELL MAX 12HD User s Manual APPENDIX 5 ACCESSORIES The following items are included in the standard monitor kit and can be reordered from your distributor or directly from Midmark using the associated reorder codes Reorder Description incl SV 1 2 0 cm bp cuff for limb circumference 3 6cm white vinyl fabric 1 SV 2 2 5 cm bp cuff for limb circumference 4 8cm white vinyl fabric 2 SV 3 3 5 cm bp cuff for limb circumference 6 11cm white vinyl fabric 3 SV 4 4 0 cm bp cuff for limb circumference 7 13cm white vinyl fabric 3 SV 5 5 0 cm bp cuff for limb circumference 8 15cm white vinyl fabric 2 SV 8 8 0 cm bp cuff for limb circumference 13 20cm white vinyl fabric 1 SV 10 10 2cm bp cuff for limb circumference 18 26cm white vinyl fabric 1 NIBP Tube 6 bp inflation hose with Quick Disconnect 1 ECG C MAX 12 9500 ECG Cable 1 ECG L3 MAX 12 9500 ECG 3 lead wire set 1 MAX 12 9500 ECG banana clips 3 V SAT 6 Nellcor SpO2 lingual sensor and clips large and small 1 NEL EXT 10 Nellcor extension cable 1 01 02 0392 CO2 FilterLine H Set w T tube adapter 2 SV 02 0338 CO2 FilterLine H Set for exotics w T tube adapter 1 590004 MAX 1 MAX 12 9500 Flexib
82. kin to tolerate sensor placement it may be necessary to change the sensor site more frequently with some patients 1 Select a sensor and clip that is appropriate for the patient There are two 2 sizes of VetSat veterinary sensor clips model VSC S small and model VSC L large 2 Clean the VetSat sensor and clip separately before and after each use 3 Open the clip by pressing with the thumb and forefinger 4 Slide one of the sensor s alignment buttons along the clip slot until the sensor pad is fully engaged in the clip 5 Slide the second sensor button along the other clip slot until the second sensor pad is fully engaged in its side of the clip NOTE Check that the VetSat optical sensor pads are facing each other 6 The sensor is now ready to be applied to the patient The preferred sensor application site for canine feline and equine animals is on the tongue with the sensor s optical components positioned on the center of the tongue Alternatively the sensor and clip may be applied to the animal s lip toe ear prepuce or vulva NOTE If the sensor does not track the pulse reliably it may be incorrectly positioned or the sensor site may be too thick thin or deeply pigmented to permit appropriate light transmission If any of these situations occur reposition the sensor or try another sensor site If the sensor site is covered with fur try shaving the site and reapplying the sensor 0 5
83. l 10 1 Cuff Placement Cuff placement for a cat A cat may be left in its owner s lap to keep it calm Measurements are best done in an area of the hospital away from noise and bright lights The animal may be held so that the front limbs are free for cuff placement In conscious patients the tail may be the most appropriate location for placement of the cuff Cats may be most comfortable in sternal recumbency making the tail a more preferable site For the median artery on the foreleg place the cuff around the forelimb between the elbow and carpus It is not necessary to center the cuff over the artery which is on the medial side of the leg because of the fully encircling bladder design Hair need not be clipped except when heavily matted In cats less than five 5 pounds when measurements are difficult to obtain place the cuff around the leg above the elbow to obtain measurements from the brachial artery Measurements from the coccygeal artery may be used by placing the cuff around the base of the tail but not in anesthetized patients Cat Cuff Placement Cuff placement for a dog For measurements in dogs it is preferable to use the right lateral sternal or dorsal recumbent positions That is not a problem in anesthetized patients but it may be difficult to get large dogs to cooperate for proper positioning If the 76 0 5 15 09 CARDELL MAX 12HD User s Manual dog is in a sitting position place the front paw on t
84. lating blood volume Veterinary medicine has embraced blood pressure measurement as an important monitoring tool for a variety of medical and surgical situations In most cases current clinical practice measures blood pressure by an indirect technique which relies on surface pressure occlusion of a superficial artery using a pneumatic cuff and a method to detect blood flow distal to the site of cuff occlusion Accepted detection methods to identify blood flow include auscultation oscillometry palpation ultrasonic and photoelectric methods Although valuable it has long been recognized that all indirect methods have limitations in accurate measurement associated with both patient and operator factors Also indirect blood pressure measurement is not robust meaning that it cannot be accurately measured during low pressure and vasoconstricted states Because there are limits to indirect blood pressure measurement there is increased interest in direct blood pressure monitoring in patients demonstrating abnormal physiology that may render indirect measurement techniques inaccurate or impossible Direct blood pressure measurement requires introduction of a catheter into an arterial or venous lumen and equipment and supplies to transfer pressure from the catheter tip to a measurement device For this reason direct measurement is technically more demanding than indirect techniques but less prone to measurement error The purpose of this presentation is
85. le Esophageal Rectal Temp probe I Paper4F HD Printer paper with gridlines 4 rolls tube 1 PC US MAX 12 9500 Power cord USA 1 Battery7C MAX 12 9500 rechargeable sealed lead acid battery 2 The accessories associated with the optional invasive blood pressure monitoring configuration MAX 12 HDi and MAX 12 HDim are as follows Reorder Description incl 650 208 IBP Interface cable for MAX 1 and MAX 12 series 1 DPT 448A IPB Kit for MAX 1 and MAX 12 series 1 The following are optional accessories for use with the MAX 12HD series Reorder Description SV600 Package of 5 Cardell small animal cuffs 1 of each size MaxFast 1 Nellcor MaxFast Reflectance sensor amp posey wrap Mobile7C MAX 12HD Rolling Stand w basket and mounting plate Mount7C MAX 12HD Wall mount with mounting plate EP S MAX 12 9500 series small esophageal probe ecg temp resp EP L MAX 12 9500 series large esophageal probe ecg temp resp EP XS MAX 12 9500 series extra small esophageal probe ecg temp resp M1 0 5 15 09 129
86. lectrodes to lead wires 3 Attach electrodes to the patient correctly WARNING When connecting the electrodes or patient cable make sure that they do not come in contact with any other conductive material or object a metal exam table for instance 4 Plug the ECG cable into the ECG receptacle on the side panel of the monitor 5 When necessary adjust the ECG setup 6 Set the ECG alarm limits 7 6 Alarm Setup ECG monitoring alarms include parameters out of limit alarms and abnormal status alarms When the monitored parameters are out of the preset limits the monitor will give an audible and visible alarm 7 6 1 Alarm Limit Setup Different parameters have different alarm limits For different patients different limits may be required 1 Rotate the knob in ECG menu 2 Enter the alarm limit setup menu 3 Select the alarm limit of the corresponding parameter WARNING The default alarm limits are designed as general guidelines and for convenience so that values can be reset automatically to common starting points but these should be adjusted with each patient according to their individual circumstances 58 M1 0 5 15 09 CARDELL MAX 12HD User s Manual 7 6 2 Parameter Adjustment Range Parameter Adjustment Range HR Limit 15 300 bpm 7 8 3 Abnormal Status Alarm Abnormal Status alarm includes Asystole and lead off CAUTION When ECG amplitude is too low it may result in inaccurate
87. m In the IBP waveform channel there is a scale on the top and at the bottom and at the right end of the line the IBP reading is displayed NOTE For a thorough discussion see Appendix 4 Direct Blood Pressure Monitoring by Marc R Raffe DVM MS DACVA DACVECC IVECCS proceedings 13 2 Transducer IBP transducers provided are in conformity with ANSI AAMIBP23 1986 standards and with sensitivity 5uV V mmHg Check transducer cable before connecting it to the device WARNING The disposable transducer is for single use only Never attempt to reuse the parts Discard the used transducers properly Transducer zeroing is very important for accurate measurement So zeroing should be performed regularly 1 When the screen prompts Please do calibration user may enter to give command Main Menul Rotate the knob IBPl1 2 Press knob Zeroing Model Press the knob 96 0 5 15 09 CARDELL MAX 12HD User s Manual If the zeroing mode is set to Manual after the system prompts zeroing is correct it will pop out Zeroing Mode Now press the knob and you will enter IBP measurement status If the zeroing mode is set to Auto after the system prompts that zeroing is correct it will automatically enter IBP measurement status without necessity for the user to confirm 13 3 IBP Setup Before IBP monitoring make the following preparations Set IBP channel and labels Select IBP wavef
88. nd display the blue line indicates SYS the green line indicates DIA and the pink line indicates MEAN Note Except for NIBP TEMP CO2 and IBP all other parameters have two horizontal lines respectively indicating the high and low alarm limits The functions of the menu items are as follows Move scale To move the scale and observe different time Up Down To move the trend up and down LR To display previous or next trend Zoom To set the time duration of trend display 2 hours gt 4 hours gt 8 hours gt 24 hours gt 48 72 hours gt 96 hours gt 120 hours When finished press the Main Menu key on the front panel to exit the trend display and return to the main menu screen 36 0 5 15 09 CARDELL MAX 12HD User s Manual 5 4 Demo Mode For the purpose of training the device provides a Demo mode function NOTE Never use this function during patient monitoring To enter demo mode IMain Menul gt Rotate knob System Setup Press knob Rotate knob Demo Mode Press knob A dialog box will pop up at this time as follows you should input the password 8727 then choose ok to enter Demo mode Logging Un 2 56 cdefghijklnmn opqrstuvuxyz OK Cancel Blank E E z Del Caps OK Cancel IMain Menul gt Rotate knob System Setup Press knob Rotate gt Demo
89. nd is the most accurate reading using oscillometric methods Systolic pressure is calculated as the cuff pressure at which an increase in cuff oscillations is perceived The diastolic pressure is the cuff pressure when oscillations are no longer decreasing as pressure is released from the cuff Special veterinary specific algorithms have been designed to ensure reliable and accurate measurements from kittens to horses The patient monitor first inflates the cuff to a pressure of around 20mmHg higher than the systolic pressure then slowly deflates the cuff When the cuff pressure is higher than systolic pressure the artery is blocked and there are small amplitude oscillometric waveforms When the cuff pressure is equal to the systolic pressure the oscillometric amplitude increases With the decrease of the cuff pressure the oscillometric amplitude increases When the cuff pressure reaches a certain value the oscillometric amplitude reaches a maximum value then the cuff pressure is mean arterial pressure It uses the changes of the oscillometric amplitude under different cuff pressures to identify mean pressure and calculate the systolic and diastolic pressure On NIBP socket jmark indicates the signal input part is insulated and defibrillation protected and patient safety can be ensured In defibrillation and electrosurgical procedures the device will not be damaged 0 5 15 09 75 Cardell MAX 12HD User s Manua
90. nd the IR that passes through the reference channel are measured by the IR detectors The microcomputer in the monitor calculates the CO2 concentration by 90 0 5 15 09 CARDELL MAX 12HD User s Manual comparing the signals from both channels Measurement of carbon dioxide is expressed as a partial pressure in mmHg or kPa Intubated consumables The Microstream FilterLine products are comprised of a pre connected sampling line and a tube Airway Adapter There is a FilterLine Set for humid environments with a regular adapter and also one with low dead space Attaching the intubated consumables 1 Slide the protective cover and twist the large end female luer connector into the CARDELL MAX 12 Monitor s Microstream CO2 input connector 2 Firmly connect the small end male of the Microstream Airway Adapter to the female end of the ventilation source 3 Firmly connect the patient s endotracheal tube connector into the large female of the Microstream Airway Adapter For a closed suction system firmly connect the patient s endotracheal tube connector into the large end female of the Microstream Airway Adapter NOTE Ensure the consumable is not twisted or crimped Attaching the Airway Adapter ventilation endotracheal tube source Airway Adapter connector 0 5 15 09 91 Cardell MAX 12HD User s Manual NOTE During nebulization or suction
91. ng tube make sure there is no air in catheter pressure monitoring tube or transducer 0 5 15 09 103 Cardell MAX 12HD User s Manual WARNING If there is bubble in the pressure tube or transducer flush the catheter system with physiological saline 13 5 Alarm Setup IBP monitoring alarm includes parameter limit alarm and abnormal status alarm Alarm is to give alert when the monitoring results are abnormal It is audible and visual with LED indicators and flashing readings Note Adjust default alarm limits according to the circumstances and the patient status Parameter Limit Range Parameter Range SYS Upper Limit lower limit 300 mmHg SYS Lower Limit 30 upper limit mmHg DIA Upper Limit lower limit 300 mmHg DIA Lower Limit 30 upper limit mmHg MAP Upper Limit lower limit 300 mmHg MAP Lower Limit 30 upper limit mmHg NOTE If CVP mode is selected there is no SYS and DIA alarm 13 6 Precautions WARNING If liquid enters the monitor turn it off immediately and contact Midmark WARNING When the monitor is connected to electrosurgical units make 104 1 0 5 15 09 CARDELL MAX 12HD User s Manual sure the transducers and cables do not contact the electrosurgical unit The patient lead and conducting wire must be far away from the operating table and other devices Electrosurgical unit should be properly grounded WARNING When a defibrillator is used make sure patient
92. nt panel 4 3 Alarm Limits Setup Alarm limits include upper and lower limits that are user adjustable The alarm setup for each parameter can be found in the respective parameter setup menus In the main menu rotate the knob to select the parameter and press the knob to confirm Rotate the knob again to look for the soft key and press the knob The original alarm reading turns into yellow Now turn the knob left or right you may increase or decrease the limit until desired limit is obtained Then press the knob to confirm In the NIBP setup menu there is SYS DIA Alarm limit with range from 0 to 40mmHg The system default is 20 mmHg and will be saved after power off If the monitor detects that the difference between the SYS and DIA values are lower than this limit the system will give an emergency alarm Note After parameter alarm limits are set they will remain in the system 0 5 15 09 27 Cardell MAX 12HD User s Manual after power off until next setup 4 4 Alarm Sound Volume To meet the needs of different users the main menu offers selection of Volume amp Brightness jas follows Rotate knob Volume amp Brightness Press the knob Alarm Volume Press the knob Rotate knob 1 2 3 4 5 6 7 Press the knob Or directly press the knob and enter Volume amp Brightness menu to adjust the alarm volume 4 5 Default Alarm Limits To return to the factory alarm setting i e default
93. nu 4 2 Alarm On Off 1 Press the key Bon the front panel to turn on the system alarm sound or silence the alarm within a period of time The alarm has the following 4 statuses L gt Alarm sound is on Alarm sound is off Must be done in the alarm setup menu 2 00 Alarm sound is turned off for 2 minutes The time is counted down But new alarm event may turn the alarm on again 1 00 Alarm sound is turned off for 1 minute The time is counted down But new alarm event may turn the alarm on again Note Press the Silence key on the front panel and at the same time pay attention to the time display at the lower part of the status area until the desired time duration of silence is reached The alarm for different parameters may be turned off on in the parameter setup menus During the silence a new alarm event may trigger the alarm sound and 26 M1 0 5 15 09 CARDELL MAX 12HD User s Manual Silence will become invalid The low battery power alarm is not affected by Silence key It will always alarm whenever battery power is low 2 To turn on or off alarm sound operate the knob as follows 2 Rotate the Knob Alarm Setup Press the Knob Alarm gt Press Knob On Off Rotate Knob Press the Knob When alarm is off disabled you will not hear any sound when new alarm events occur Alarm can be enabled through the alarm setup menu or pressing the Silence key on the fro
94. ode Patient Unit Waveform Speed Waveform Filling LC101 02 Calibration 02 Upper Limit EtC02 Lower Limit v 02 Alarm InC02 Upper Limit InC02 Lower Limit v InC02 Alarm RR Upper Limit RR Louer Limit v RR Alarm Fig 14 1 CO2 Setup Menu 1 CO Mode The modes include Work mode and Standby mode Work mode If the sampling line is connected the system will be in normal measuring mode if not connected the system can t measure at this time Standby mode When CO2 measurement is not required standby mode will conserve power consumption and measurement will cease 0 5 15 09 93 Cardell MAX 12HD User s Manual To change the CO mode MAIN MENU gt Rotate Knob gt Press Knob gt gt Press Knob gt Rotate Knob gt Work Mode Standby gt Press Knob 2 Unit The unit of CO unit of measure is changed using this menu MAIN MENU gt Rotate Knob gt gt Pres Knob gt gt Press Knob gt Rotate Knob gt mmHg kPa gt Press Knob When setup is completed rotate the knob to EXIT key press the knob to confirm and quit the menu 3 Patient The type of patient includes Small or Large and refers to the sampling line used 4 Waveform Speed The speed of waveform can be adjusted Do as follows MAIN MENU gt Rotate Knob gt gt Press Knob gt CO2 Speed gt Press Knob gt Rotate Knob gt 6 25 12 5 25 0 gt Press Knob 94 0
95. ord waveforms on 3 channels Record current parameters and waveforms User can set real time recorded time waveform and delay time User can set timing print interval User can select Alarm triggered printing User can select required printing mode which includes real time waveform printing tabular printing delayed printing alarm triggered printing and automatic printing 46 0 5 15 09 CARDELL MAX 12HD User s Manual 6 2 Recorder Setup In Printing Setup the user can select the print content print speed print channel printing mode alarm triggered printing On Off printing length previous time and auto print time interval Print Content Print speed Channel 1 Waveform Channel 2 Waveform Channel 3 Waveform Print Mode Alarm Trigger Print Time Length Previous Time Setup Timing Printing Print content It is possible to print tabular data or up to three channels of monitoring waveforms When selecting waveform you can start real time waveform printing through alarm triggered printing timing printing or by pressing the shortcut button on the monitor s front panel v Waveforn Data Tabular data printing is limited to the last 20 data sets at 4 minute intervals totals 80 minutes 0 5 15 09 47 Cardell MAX 12HD User s Manual Print Speed Auto 12 5 25 0mm s Auto 12 5 mm s 25 mm s Print Mode Auto Default Exit v Auto Default Alarm triggere
96. orm display scale Set alarm limits Connect transducer Zero the transducer The IBP Setup function is mainly used to set the IBP gain IBP label alarm limits and IBP zeroing The IBP Setup menu is as follows 0 5 15 09 97 Cardell MAX 12HD User s Manual Bit o IBP Gain Label Zeroing Mode IBP Calibration Unit Waveform Speed SYS Upper Limit 598 Lower Limit DIA Upper Limit DIA Lower Limit MAP Upper Limit MAP Lower Limit v IBP Alarm PR On Fig 13 1 IBP Setup Menu Fig 13 2 Label Setup Manual v Auto Fig 13 3 Zeroing Mode IBP Gain Different IBP gains correspond to different waveform display scales The device provides auto selection of optimal waveform gain Auto and manual waveform gain Manual In the IBP waveform channel there is a scale line on the top and bottom At the right end of each line there is an IBP value corresponding to the level The difference between the two IBP values is the 98 M1 0 5 15 09 CARDELL MAX 12HD User s Manual selected gain value 20 40 60 80 120 180 240 330 Auto NOTE Each time the machine is turned on IBP is set to be manual zeroing and gain is set to be 330 The setting can be changed but will not be saved after power off To set the gain Main Menu Rotate the knob IBP1 2 Press knobRotate the knob IBP Gain Press the knob 20 40 60 80 120 180 240 330 Auto Rotate the knob Press the knob Zero
97. pment in general and in most cases apply to all aspects of the monitor There are additional safety statements in the parameter chapters that are specific to that monitored parameter The order in which safety statements are presented in no way implies order of importance There are no dangers that refer to the equipment in general Specific Danger statements may be given in the respective sections of this manual 2 2 Safety Requirements WARNING The Cardell amp MAX 12 HD 15 not intended to be used as an apnea monitor e Do not use it during MRI scans e Please do not rely on the alarm functions of the patient monitor The alarm limits may have been improperly set or the alarm may have been disabled e Alarm functions of the patient monitor must be checked regularly e Before using the cables please check the cable and connectors If any damage is found replace it immediately e Electro surgery circuit must be connected properly to prevent burns or even death e When several devices are used on the same patient leakage current may increase and lead to danger to the patient Before using please consult a professional to do a leakage current test and make sure the leakage 8 M1 0 5 15 09 CARDELL MAX 12HD User s Manual current is within safety limits e When a defibrillator is used make sure patient will not touch the ground metal or other conductor or device During defibrillation never touch the patient
98. r the comfort of the patient and to avoid damaging the sensor do not pull on the cable when removing the sensor and clip from the sensor site but rather unclip the sensor and remove from placement site When SpO2 monitoring is completed remove the sensor from the patient To remove the sensor and clip from the patient press the clip open and remove When the probe is removed from the patient the message SpO2 Probe OFF is displayed and an audible alarm sounds indicating a connection has been lost To acknowledge the alarm press the SILENCE RESET pushbutton The monitor silences the audible and visual alarms and the message SpO2 Probe OFF remains on the display To remove the sensor from the clip grasp the end of each sensor pad and pull it through to the inside of the clip The sensor should pop out of the clip easily DO NOT pull on the cable 9 5 Alarm Setup The SpO2 alarm is for parameter out of limit or abnormal status When the parameter exceeds the limit the monitor will give both visual and audio alarms Alarm Range Parameter Range Spo2 upper limit lower limit to 100 SpO2 lower limit 0 to upper limit Pulse rate upper limit Lower limit to 250 bpm Pulse rate lower limit 30 to upper limit MI 0 5 15 09 71 Cardell MAX 12HD User s Manual WARNING If the SpO2 upper limit is set to 100 then it is equivalent to no alarm limit Abnormal Status Alarm Probe Off alarm 9 6 Precautions
99. system Ignoring the harmful consequences of system dead space can lead to potentially fatal patient outcomes This is especially worrisome when managing small patients There are three different types of dead space anatomic alveolar and mechanical equipment Dead space ventilation involves that component of the respiratory gases that does not participate in gas exchange Simply said there is no patient benefit from dead space ventilation If mechanical dead space volume equals or exceeds alveolar ventilation volume the patient will not be able to clear carbon dioxide at all Ideally your goal should be to minimize dead space through proper patient planning and to detect excess dead space consequences through end tidal CO2 monitoring Anatomic dead space is comprised of the upper airway structures that do not participate in gas exchange This includes the gases in the nasal passages nasopharynx larynx trachea and in the larger airways Alveolar dead space represents those alveoli that are ventilated with fresh gas but not perfused by the pulmonary circulation Mechanical or equipment dead space is made up of any portion of the endotracheal tube extending beyond the patient s incisors patient monitor adaptors ETCO2 apnea alert etc any adaptors used to facilitate patient system positioning right angle or swivel adaptors used to reduce the risk of tracheal trauma during patient rotation the pace within a mask not occupied by the p
100. th resulting from each light source depends on the color and thickness of the body tissue the sensor placement the intensity of the light sources and the absorption of the arterial and venous blood including the time varying effects of the pulse in the body tissues The monitor processes these signals separating the time invariant parameters tissue thickness skin color light intensity and venous blood from the time variant parameters arterial volume and SpO2 to identify the pulse and calculate oxygen saturation Oxygen saturation calculations can be performed because blood saturated with oxygen predictably absorbs less red light than oxygen depleted blood Since measurement of SpO2 depends on a pulsating vascular bed any condition that restricts blood flow such as use of a blood pressure cuff or extremes in systemic vascular resistance may cause an inability to determine accurate pulse and SpO2 readings CAUTION SpO2 sensors are fragile and should be handled with great care 66 0 5 15 09 CARDELL MAX 12HD User s Manual 9 2 SpO2 Sensor WARNING Use only Nellcor veterinary oxygen transducers Use of other oxygen transducers may cause improper performance INSTRUCTIONS FOR USE NOTE Reusable sensors may be used on the same site for a maximum of four 4 hours provided the site is inspected routinely to ensure skin integrity and correct positioning Because individual skin condition affects the ability of the s
101. tient monitor is in good working condition Warning If anything is found abnormal or mechanical damage is apparent please don t use it and contact Midmark Step 1 After power on the system will start self test If the self test is successful then start monitoring your patient If changes are to be made in the operation or settings see the Operation Procedures Step 2 Make sure the patient monitor is connected to the patient through the accessories Step 3 Attach probe and transducer to the patient Note The monitor can be used for a single patient at one time 0 5 15 09 21 Cardell MAX 12HD User s Manual 3 5 Display illustrations Under normal working conditions the display screen is as shown in Figure 3 5 2002 01 28 11 44 57 Fig 3 5 Display Screen The display screen is composed of data area parameter area and waveform area Data Area shows the data about patient and monitor such as patient no location sex and patient mode Parameter Area shows monitoring physiological parameters Waveform Area shows monitoring waveform on each channel and alarm events Note The patient mode includes cat dog horse and other Date and time are displayed on the bottom right of screen In the Status Area you can see battery power status AC power and alarm 22 M1 0 5 15 09 CARDELL MAX 12HD User s Manual status Battery power status The mark L is used
102. tion that occurs by distention and compression of the aortic root following valve closure As pressure falls further during run off of blood into the arterial ranches the pressure curve descends to its lowest pressure point just prior to the next cardiac cycle The arterial waveform varies with the site of catheter placement and its distance from the aortic root The further the distance from the heart the more tented or peaked the waveform appears This is accompanied by a narrower base or distance from the beginning to end of the waveform This appearance change is due to several factors including pressure drop and diameter of blood vessel The important point is that the waveform change reflects a lower mean arterial pressure which is essential for forward blood flow to all tissues and organs When concurrently monitoring electrocardiogram ECG and arterial blood pressure one notes a slight delay between the ECG signal and blood pressure waveform during a cardiac cycle This delay represents the time required to produce electromechanical coupling and isometric ventricular contraction prior to forward blood flow and pressure wave generation Factors affecting measurement Direct blood pressure measurement is affected by both patient and technical factors Physiologic status of the patient including circulating blood volume cardiac contractility neuroendocrine status and peripheral vascular state all contribute to bloo
103. to confirm After setup rotate the knob to the EXIT icon the last one press the knob and exit 54 0 5 15 09 CARDELL MAX 12HD User s Manual Lead selection Lead selection is used to select different leads to display different ECG waveforms User may select I II III V aVR aVL aVF Where I II III are bipolar extremity leads and aVR aVL aVF are voltage added extremity leads The positive and negative polarities of the leads are as follows Lead I II aVR aVL aVF Positive LA LL LL RA LA LL Negative RA RA LA LA LL RA LL RA LL ECG Gain To change the ECG waveform amplitude user may select x4 x2 x1 x1 2 x1 4 and Auto The selected gain is displayed above the waveform channel and the selected value is the amplitude value 0 5 15 09 55 Cardell MAX 12HD User s Manual Waveform speed 50 mm s 25 mm s 12 5 mm s Select ECG waveform display speed User may select 12 5 25 0 50 0 mm s according to the specific needs ImV CAL When it is pressed a 1mV square wave will be displayed on the ECG waveform for user calibration Pacemaker detection User may select I V or Off I III V Detect pacemaker signal according to signals of the corresponding channel and process correspondingly Off Do not detect pacemaker signal HR source User may select ECG1 or ECG 2 or ECG3 or ECG4 ECG 1 to detect heart rate based on
104. tup The respiration temperature alarm includes a parameter out of limit alarm and an abnormal status alarm When the parameter is out of limit the monitor will give an alarm sound automatically and the value displayed on the screen flashes at the same time Set up alarm limits Different parameters have different limits WARNING Alarm limits should be adjusted based on an individual patient s condition Parameter Range Parameter Adjustment Range Respiration upper limit Low limit to 150 bpm Respiration lower limit 1 to upper limit Apnea Alarm Time 5 120 seconds Alarm for abnormal status electrode off 0 5 15 09 65 Cardell MAX 12HD User s Manual SECTION9 SpO2 MONITORING 9 1 Introduction The MAX 12HD continuously monitors and displays arterial blood oxygen saturation SpO2 and pulse rate The monitor beeps with each pulse beat It allows you to choose alarm limits and audible tone volumes You can select the high and low alarm limits for SpO2 and pulse rate and independently choose the volume for alarm and pulse beep tones The MAX 12HD determines SpO2 and pulse rate by passing two wavelengths of light one red 660nm and the other infrared 940nm through body tissue to a photo detector Pulse identification is accomplished by using plethysmographic techniques and oxygen saturation measurements are determined using spectrophotometric oximetry principles During measurement the signal streng
105. uld be 31 5 ml Using a pediatric F circuit with adult ETCO2 monitor and right angle adaptor or apnea alert adaptor could create 30 ml of mechanical dead space effectively eliminating 95 of normal spontaneous alveolar ventilation Make sure you regularly inspect all anesthetic machines and systems paying particular attention to valve function and inner hose integrity Make sure that the ET tube is not excessively long Select your anesthetic system carefully o not use a pediatric circuit as a substitute for conventional pediatric circle hoses or a noncircle system Using no more than one monitor adaptor o Make sure it is a pediatric low volume adaptor for smaller patients to avoid any significant impact on total mechanical dead space Avoid the use of positional right angle adaptors in smaller patients Avoid maintaining anesthesia with a facemask Simply put anesthetized patients should have their end tidal CO2 monitored for maximal patient safety 122 1 0 5 15 09 CARDELL MAX 12HD User s Manual APPENDIX 4 DIRECT BP MONITORING Marc R Raffe DVM MS DACVA DACVECC Pfizer Inc St Paul MN Blood pressure is considered an important component of patient monitoring in emergency and critical care medicine Blood pressure is a product of several cardiovascular parameters including cardiac output stroke volume x heart rate volumetric compliance of peripheral blood vessels systemic vascular resistance and effective circu
106. veform is frozen press the key to unfreeze the waveform sweep Note During waveform freeze status the monitor will automatically restore waveform sweep after 30 seconds Silence Press the key to enable disable the alarm sound When alarm is off the icon at left will appear When pressed once the alarm will be silenced for 1 minute When pressed twice the alarm will be silenced for 2 minutes Knob Under menu display rotate the knob and the required function will appear at the bottom of the 0 5 15 09 CARDELL MAX 12HD User s Manual O D 0 6 ES 10 11 Alarm Indicator 12 Handle screen When the arrow points to a certain function press the knob to select the function Then rotate the knob to change the function When finished press the knob again to confirm and make the selection Under menu display you can press knob to set alarm volume HR volume brightness Big Font Nights Mode and Work Mode Start Stop Printing Press the key to activate the recorder to start printing Press it again to stop printing If not operated after being activated the recorder will print 90 seconds and automatically stop except for alarm triggered printing Start Stop NIBP Press the key to start blood pressure measurement press it again to stop blood pressure measurement System Setup Menu Press the key and the system setup menu will be displayed on the screen Press it again th

Cardell® MAX12-HD - Veterinary Instrumentation

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Cardell&reg; MAX12-HD - Veterinary Instrumentation

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Cardell® MAX12-HD - Veterinary Instrumentation