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Cardell® 9500HD

1. Go To Table Of Contents Cardell 9500HD Series User s Manual Respiration Measurement Mode Thoracic Impedance indirect or through Capnography direct Respiration Rate and Alarm Range 0 150brpm 2brpm Waveform Display Speed 6 25 12 5 and 25mm s Refresh time Approx 2 seconds IV Display Display type Color TFT LCD Size 7 inch Matrix 480 H x 234 V pixels Display channel 4 V Recorder Type 3 channel thermal recorder Printing mode real time or alarm triggered printing of text and graphic Resolution Vertical 400dpi Horizontal 800dp1 Printing channel 3 Printing speed Auto 12 5 25 0 mm s VI Physical Specifications Net weight 3 5kg Gross weight 5 5kg Dimensions 190x230x160mm VII Environmental Requirements Temperature Working 10 40 Storage and transportation 20 to 60 Relative humidity Working lt 80 non condensing Storage and transportation lt 95 non condensing Barometric pressure Working 86 to 106 kPa Storage and transportation 50 to 106 kPa Specifications are subject to change without prior notice 65 Go To Table Of Contents 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 t
2. Step 3 Power off the monitor to exit 5 4 Printing Setup In Printing Setup the user needs to select print mode print speed print channel timing print former time alarm triggered printing On Off and print time Print Mode Timing Print Print Speed Channel 1 Alarm Trigger Channel 2 Former Time Channel 3 Print Time Li Aaa A ae ato n The monitor is used to print history data or three channels of monitoring waveforms Print Mode Track Length Data Print Speed 12 5 25 0mm s Alarm Trigger On Off Former Time 2Seconds 5Seconds Print Time 8Seconds 16Seconds 32Seconds 25 Go To Table Of Contents Timing Print 15Minutes 30Minutes 1 Hour 4Hours 8 Hours 12Hours Print Channel When selecting a waveform to print the monitor will print the waveform in the currently selected printing channel Channel 1 ECG1 RESP SpO2 CO2 waveforms Channel 2 ECGI RESP SpO2 CO waveforms Channel 3 ECG2 RESP SpO2 CO waveforms NOTE Do not select the same waveform for Channels 1 2 and 3 When an alarm occurs the monitor will automatically activate the printer to print out the waveform 5 seconds before the alarm if alarm triggered printing is set to ON Alarm triggered printing can be set On or Off If the alarm triggered printing 1s set to OFF then the monitor will not activate the printing automatically NOTE Alarm triggered printing prints only the waveform 5 6 System Setup Sy
3. 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 8 7 2 Intermittent SpO gt value Failure Phenomenon When patient SpO2 is measured the SpO gt value is not continuous Inspection method 1 Patient motion 2 SpO 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 50 Go To Table Of Contents Cardell 9500HD Series User s Manual SECTION 9 RESPIRATION and TEMPERATURE MONITORING 9 1 General Information The monitor provides two respiration monitoring methods thoracic impedance indirect and through the optional Capnostat mainstream CO probe direct NOTE If the patient is intubated direct respiration monitoring through the CO 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 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 tempera
4. Go To Table Of Contents Cardell 9500HD Veterinary Vital Signs Monitor User s Manual open HD ML AV AN oe 1 9 For Veterinary Use Only 003 2407 00 Rev A Go To Table Of Contents Cardelle 9500HD Series User s Manual Table of Contents SECTION T PHEFACE E IAEE RE 3 CH ele egei OM AEP ANA O N n EIE S SA OO 3 Fo MPOn teg tel ut ai rn 4 SECTION KHN CH WA EE ET ei 5 2 2 Safety Requirements E 6 E oae SV MOOI aa ren 7 SECTION 3 CONTROLS AND CONNECTORS n etnei iene 3 1 Installation ANd CONNEGTHION eee 8 3 2 Before Monitoring 9 SR FON PANE RR RE E EE PINA 10 JA REA Fr NSM RINO O PRIN PANE CIO PIRRO PA PR RE RA 12 SLOTS En RR E EE RE IRINA PIA DA 13 ENEE 13 TOYS aN BUTON EE 14 SNC 15 SRI 15 SAED E e eh AEE EE 16 SECTION A ALARM SETUP 2 1 s0sssssssasansneneeazas inno EE KE KEREN ER E KEEN KR vn Se we H Wl tel du e E 20 42 Alami ON OF EE 20 Aa AUD UND tr 21 SECTION 5 SETTING UP THE MONITOR 0 0 cece ce ceeeeseceeeeceseseeceseeeeeesaeeeeeeas 51 MDS ONL EE 24 52 Trend LR e EE 24 53 Bomo MO EE 25 e Ginter EE 25 Oy SII oe NO EE 26 5 7 Volume and BrighihesSo eil 27 54 34 EE 28 SECTION 6 ECG MONITORING see KN KKK KEEN ENER REENEN EN ENER REENEN EN ENER ENKE EN EN 6 1 General informatio EE 29 EE 29 6 3 Animal Preparation and Lead Contact 29 SEA Lei ae ER tee 20 6 4 3 Positioning Anesthetized Patient i
5. 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 38 Go To Table Of Contents Cardell 9500HD Series User s Manual 7 3 NIBP Setup NIBP setup includes patient mode measurement mode and auto measurement time interval NIBP measurement scale pressure compensation alarm limit and alarm sound on or off 7 3 1 Enter NIBP setup Rotate the knob to and press knob to confirm Rotate to NIBP press knob to confirm Users can rotate the knob to select items shown in the following figure and press the knob to confirm I Cuff Size 1 small SYS Upperlimit Measure Mode SYS Lowerlimit Measure Time DIA Upperlimit Pressure Unit DIA Lowerlimit Calibration Ay SYSDIA Lower limit 20 Alarm Sound x RR ECG SP02 IN IBP a aw NO USER ID RESP TERP C02 03 04 08 20 32 16 NY Select cuff size Large Small Select measurement mode Manual Auto and Stat Select time interval for auto NIBP measurement Change NIBP measurement scale mmHg or kPa Pressure Compensation Auto pressure compensation method Alarm limit adjust alarm upper and lower limits Alarm On Off Turn on or off NIBP alarm sound 7 3 2 Operation Method Rotate the knob to
6. SPECIFICATIONG ccccescsseceeeeneenseensensceseensenseenseaseesenaeensenness Ee 63 Il Power Supply EE 63 ILR Se gert nai n 63 KR 65 Ee 65 VW Physical S lee E 65 VII Environmental Requirements 65 APPENDIX 2 BP REFERENCE VALUES inni APPENDIX3I DEADSPACE a APPENDIX A ACCESSORIES 1122022002200s0 sere rr eee KEE R eni KER REENEN KER KE KENE KEN Go To Table Of Contents Cardell 9500HD Series User s Manual SECTION 1 PREFACE 1 1 General Welcome and thank you for choosing the Cardell Model 9500HD portable multi parameter veterinary monitor The 9500HD continuously monitors and displays the following physiological parameters ECG waveforms arterial blood oxygen saturation of arterial hemoglobin SpO pulse rate respiration rate systolic SYS diastolic DIA and mean arterial pressure MAP and temperature With the addition of the optional Capnostat Mainstream CO probe one can also measure end tidal CO as well as inspired CO2 This operator s manual contains detailed information about the performance specifications operation and maintenance of 9500HD It is designed for use by qualified veterinary personnel Before using the patient monitor please read this manual carefully and thoroughly in order to use the monitor safely and correctly This manual is an integral part of the product and describes its intended use It should always be kept close to the eq
7. and the required item will appear at the bottom of the screen When the cursor points to a certain function press the knob to select it Then rotate the knob to change the item When finished press the knob again to confirm the selection 9 Display Screen Color TFT LCD displaying waveforms menus alarm status and physiological measurement data 10 Alarm Indicator Red Yellow dual color alarm indicator The red LED flashes during an emergency alarm life is endangered The yellow LED flashes during a warning alarm The yellow LED stays on during an alerting alarm 11 Handle Go To Table Of Contents 3 4 Rear Panel The rear panel of 9500HD multi parameter patient monitor is as shown in Fig 3 2 OV 00 JK CN Vi Bb IN WARNING Other equipment connected to the device should be certified according to IEC standards 1 e IEC 950 for data processing equipment IEC 60601 1 for medical equipment and IEC 60601 1 1 for whole system 12 9500HD patient monitor rear panel Fig 3 2 Fan for heat dissipation Reserved Reserved RS422 for connecting to PC or central station monitoring system Model 9503 only FUSE 1 FUSE 2 Equipotentiality Power inlet Label Contact information 0 Label Model Serial No Go To Table Of Contents Cardelle 9500HD Series User s Manual 3 5 Side Panels Side panels Fig 3 4 TEMP 1 2 Rec
8. any moisture is allowed to dry between uses It is estimated that with fairly regular use the adapters should be replaced every 60 to 90 days Refer to the manufacturer s instructions enclosed with each sensor for more information 61 Go To Table Of Contents SpO INTERCONNECTABLE Prior to each patient use inspect the SpO Interconnect cable for damage As necessary clean the cable using a soft cloth dampened with a germicidal solution SENSOR AND CLIPS CAUTION To avoid damage to the VetSat sensor remove it from the clip before cleaning either piece CAUTION Do not sterilize the sensor or clips by irradiation steam or ethylene oxide Do not immerse the sensors in water or cleaning solution When necessary the sensor may be surface cleaned by wiping it with an agent such as 70 Isopropyl Alcohol The clip may be cleaned by either wiping it with or soaking it for ten 10 minutes in 70 Isopropyl Alcohol If the clip is soaked be sure to rinse it with water and air dry it prior to use on the next patient After each cleaning and prior to each use inspect the sensor and cable for fraying cracking breakage or other damage Inspect the clip for cracking or breakage or loss of spring tension that would allow slippage or movement of the 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 informat
9. 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 43 Go To Table Of Contents SECTION 8 SpO MONITORING 8 1 General Information The 9500HD 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 SpO gt and pulse rate and independently choose the volume for alarm and pulse beep tones The 9500HD determines SpO and pulse rate by passing two wavelengths of light one red 660nm and the other infrared 940nm through body tissue to a photo detector Pulse identification is accomplished by using plethysmographic techniques and oxygen saturation measurements are determined using spectrophotometric oximetry principles During measurement the signal strength resulting from each light source depends on the color and thickness of the body tissue the sensor placement the intensity of the light sources and the absorption of the arterial and venous blood including the time varying effects of the pulse in the body tissues The monitor processes these signals separating the time invariant parameters tissue thickness skin color light intensity and venous blood from the time variant parameters arterial volume and SpO to identify the pulse and calculate oxygen satur
10. complete 5 1 2 ECG Waveform Speed The ECG waveform speed can be changed and is displayed on the top of screen 12 5mm s 25mm s 50mm s are options and the default sweep speed is 25mm s 5 1 3 Respiration Waveform Speed 6 25 12 5 25 0 mm s are options 5 1 4 Waveform Mode Standard Single line waveform Enhanced Bold line waveform 5 2 Trend Display Rotate knob to kk and press knob to enter the following interface SPO 100 50 O HR BPH 300 pl 150 03 04 je 50 03 04 12 30 03 04 _ _ Trend dh BAIAT coo Mia de 24 Go To Table Of Contents Cardell 9500HD Series User s Manual The monitor can store up to 48 hours of trend data Each screen displays two parameters trend graphs of up to 48 hours X scale 1s for monitoring time Y scale 1s for the corresponding parameter value The right end is the current time The menu functions are as follows Scale To move the scale and view a different time Up Down To view different parameters Pagel To observe trend curve of the previous or the next page 5 3 Demo Mode For the purpose of training the device provides a Demo mode function CAUTION Never try to use demo mode while monitoring patients To enter Demo mode Stepl Press the power on off button for 2 3 seconds Step2 Press the power button twice quickly before entering the monitor interface Then Demo mode will appear on the upper left corner of the screen
11. distorted in an operating room for example It is not calibration significant 6 5 5 HR source User may select ECG1 or ECG 2 ECG 1 to detect heart rate based on ECG 1 signals ECG 2 to detect heart rate based on ECG 2 signals 6 5 6 Waveform mode Standard Display waveform with single line Enhanced Display waveform with double line bold 6 5 7 Waveform speed Select ECG waveform display speed User may select 12 5 25 0 50 0 mm s according to the specific needs 6 5 8 Alarm sound On Off To turn on or off the ECG alarm sound 6 5 9 Calibration Display waveform amplitude when the input signal is 1mV 6 5 10 Sound priority To select ECG SpO ECG Respond to the heart rate signal SpO Respond to the pulse rate signal 6 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 6 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 individua
12. environment dry 2 Check the electrode quality and whether the skin is clean where the electrode is placed 35 Go To Table Of Contents SECTION 7 NIBP MONITORING 7 1 General Information The 9500HD uses oscillometric principles to calculate the systolic diastolic and mean arterial pressure MAP values The MAP 1s calculated as the lowest cuff pressure that provides the maximum cuff oscillations Therefore MAP is the largest signal received and 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 NOTE See Appendix 5 for a listing of validation studies on the Cardell blood pressure and Nellcor pulse oximetry technology 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 will increase With the decrease of the cuff pressure the oscillometric amplitude inc
13. except when heavily matted In cats less than five 5 pounds when measurements are difficult to obtain place the cuff around the leg above the elbow to obtain measurements from the brachial artery Measurements from the coccygeal artery may be used by placing the cuff around the base of the tail but not in anesthetized patients Cat Cuff Placement Cuff placement for a dog For measurements in dogs it is preferable to use the right lateral sternal or dorsal recumbent positions That is not a problem in anesthetized patients but it may be difficult to get large dogs to cooperate for proper positioning If the dog is in a sitting position place the front paw on the operator s knee and take measurements from the metacarpus Sites for cuff placement are the 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 1s 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 1s too thick or matted for good contact it should be clipped NOTE Use metacarpus or metatarsus NOTE To achieve the most accurat
14. has both a standard alarm mode and an auto alarm mode that can be set as shown in the following fig Rotate knob to Press knob to confirm then enter the following fig Edit Patient NO USER ID New Patient Date Time 04 12 18 20 48 20 Alarm Sound On RestoreDefault Alarm Mode Standard ClearRecords NO USER ID Ak S lt g d EL d A Y 04 12 18 20 3216 A Alarm Mode Setup Standard Alarm Mode When an abnormal event occurs while in the Standard Alarm Mode the alarm will sound in the sequence of priority Automatic Alarm Mode When an abnormal event occurs while in Automatic Alarm mode the monitor s will alarm for 30 seconds then stop but the visual alarm will continue For instance if BP value or Temp exceeds the set limits the monitor will alarm for 30 seconds and stop but the visual alarm will continue However if Heart rate Pulse rate SpO2 value or respiration rate is abnormal exceeds the alarm limits and the alarm is on the monitor will give real time audible and visual alarm 23 Go To Table Of Contents SECTION 5 Setting up the Monitor 5 1 Display Setup 5 1 1 Display Setup Procedures 1 Press Ja on front panel 2 Rotate the Menu Knob until the item to be set is highlighted and press the Knob to select 3 Rotate the knob to change the selection options and press knob to confirm selection 4 Return to the previous menu after setup 1s
15. in general and in most cases apply to all aspects of the monitor There are additional safety statements in the parameter chapters which are specific to that monitored parameter The order in which safety statements are presented in no way implies order of importance Go To Table Of Contents 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 The following warnings and cautions must be read and understood before operation of the patient monitor 2 2 1 WARNINGS e 9500 HD veterinary monitor is not intended to be used as an apnea monitor 9500 HD veterinary monitor is not intended to be used during MRI or CT scan 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 Alarm functions of the patient monitor must be checked regularly Before putting the system into operation visually inspect all connecting cables for s1gns of damage Damaged cables and connectors must be replaced immediately e When several devices are used on the same patient leakage current may increase and lead to danger to the patient Before using please consult a professional to do a leakage current test and make sure the leakage current is within safety limits e When a defibrillator is used make sure patient will not touch the ground metal o
16. is NOT available in Model 9503 which is designed to allow communication with a PC through the serial port This is facilitated with optional software and will allow remote viewing control and history trend archival 10 2 Capnostat Sensor The CAPNOSTAT 5 CO Sensor is a rugged solid state mainstream sensor It is factory calibrated and does not require further calibration CAPNOSTAT 5 CO Sensor 10 2 1 Sensor Connections Connecting the CAPNOSTAT 5 CO Sensor to the Host System 1 Insert the CAPNOSTAT 5 CO Sensor connector into the receptacle of the 9500HD as shown in Figure 1 i O 2 Make sure the arrows on the connector are at the top of y the connector and line up the two keys of the connector _ m with the receptacle and insert p sala pi 3 To remove the connector grasp the body portion of the connector back and remove Figure 1 NOTE Do not remove by pulling cable 55 Go To Table Of Contents Shown below ts the CAPNOSTAT 5 CO Sensor connection to a Respironics Novametrix CO adapter CAPNOSTAT 5 CO Sensor Connect Slides on Clicks into place Remove Slides off Window Shown below 1s the CAPNOSTAT 5 CO Sensor with a patient circuit CAPNOSTAT 5 CO sensor Wye Elbow Airway adapter Patient connector pediatric adult 56 Go To Table Of Contents Cardell 9500HD Series User s Manual 10 3 LoFlo CO Sensor Sidest
17. pure Mucocit 4 Incidin 10 Cidex pure Sporicidin 1 16 Mucaso 3 Buraton pure alcohol pure Alconox 1 84 Cetylcide 1 63 2 Clean the sensor surface with soft cloth and let it dry completely 3 Wipe the receiving part and flashing part of the sensor with soft cloth immersed in the detergent or alcohol 4 Check the sensor and cable each time before use If any damage is found please replace them immediately 6 2 Clean the cable 1 Clean the cable surface with soap water or alcohol Do not let liquid enter the connecting parts 2 Dry it with clean cloth CAUTION Do not immerse the cable or sensor in any liquid or let the liquid enter into the connectors 49 Go To Table Of Contents 8 7 Troubleshooting 8 7 1 No SpO data Failure Phenomenon During monitoring process there is no SpO 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 loose or the wire inside the cable may have grown frayed over time Try it on your finger or earlobe and if no reading is obtained it may indicate that the V SAT sensor must be replaced If No signal received is displayed on the screen then there is a communication problem between the SpO module and the host Turn off the machine and turn it on again If the problem still remains consult Midmark CAUTION
18. sound can be activated automatically 20 Go To Table Of Contents Cardell 9500HD Series User s Manual NOTE Press the Silence key on the front panel and at the same time pay attention to the time display at the lower part ot the status area until the desired time duration of silence 1s reached The alarm for different parameters may be turned off on in the parameter setup menus During the set silence period the occurrence of a new alarm event will trigger a new alarm and the silence setup becomes invalid The low battery power alarm is not controlled by silence key The monitor will begin alerting the user to connect the monitor to AC power supply whenever the battery power is low WARNING When the alarm is turned off there will be no alarm sound so the user should pay close attention to the patient The alarm can be turned ON again by pressing the silence key directly 4 3 Alarm Setup 4 3 1 Alarm ON OFF Setup Rotate the knob to enter each parameter menu to turn the alarm sound ON OFF 4 3 2 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
19. 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 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
20. time gt 1 5 hours Charging mode Continuous charging when being plugged into power with overcharge protection Discharge protection Device is automatically turned off when battery power is almost used up III Performances ECG Heart Rate Measurement and Alarm Range 15 300bpm Accuracy lbpm Heart Rate Average 8 beats Pacemaker suppression on pulse rate Amp 2mV to 9mV Range 0 2ms to 2 0ms Connector AAMI 6 1 pin Lead Selection I II HI V aVR aVL aVF Lead Off Alarm Visual and audible Input 5 lead ECG cable QRS Indicator Visual and audible Sweep Speed 12 5 25 50mm s Amplitude Selection x 1 4 x 1 2 x1 x2 x4 Trend 2 hours 4 hours hours 24 hours and 48 hours Patient Isolation 4000V 50Hz 60 seconds Leakage current lt 10uA Frequency Response Monitoring 0 5 to 35Hz 0 4dB 3 0dB Surgical 0 5 to 25 Hz 0 4dB 3 0dB Patient Drive Current lt 10uA Enclosure Leakage Current lt 0 1mA Heart Rate Alarm Time Less than 7 seconds Aspect Ratio 0 24 0 6sec mV Defibrillation Protection 5kV test Recovery Time after Defibrillation Less than 5 seconds 63 Go To Table Of Contents Pulse Oximetry SpO Nellcor Measurement and Alarm Range 0 100 SpO Average 8 beat average Accuracy 2 70 100 3 50 69 SpO Pulse Rate Range 30 300bpm SpO Pulse Rate Average 8 seconds SpO Pulse Rate Accuracy 3 1 digit Refresh Time Appr
21. 32 16 Menu setup alarm limits waveform mode waveform speed alarm sound On off sound priority Alarm limit setup To set the alarm limits PR Display Mode To select pulse rate to be displayed on the same screen Waveform Mode To select the waveform mode 46 Go To Table Of Contents Cardell 9500HD Series User s Manual Waveform Speed To select the waveform sweep speed Alarm Sound On Off To turn On or Off the alarm sound Priority HR PR To select Heart Rate Pulse Rate Sound Priority SpO Setup Rotate the knob to Ja then confirm Choose Sp and press the knob to confirm Waveform mode To select Standard or Enhanced Standard single line of waveform Enhanced bold line of waveform Waveform speed To select 12 5mm s 25 0mm s 50 0mm s waveform sweep speed Alarm sound On Off To select On Off On To turn on SpO gt alarm sound Off To turn off SpO alarm sound Sound Priority To select ECG SpO2 ECG Heart rate sound corresponding to heart rate signal SpO Pulse rate sound corresponding to pulse rate signal 8 4 Alarm Setup The SpO 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 SpO upper limit lower limit to 100 SpO lower limit 0 to upper limit Pulse rate upper limit Lower limit to 250 bpm Pulse rate lower limit 30 to upper limit Abnormal Sta
22. 500 HD i pn ET IK ET D GO C LEI C LEI t f Iie a Y N d d 3 Fig 3 1 9500HD Front Panel s 1 Power Switch When the monitor is connected to the wall socket or there is enough battery power press this button and the patient monitor will turn on or off After the patient monitor is turned off the battery continues to charge 2 Power indicator AC indicator When the monitor is connected to the Ca wall socket whether the patient monitor is turned on or not the yellow O La amp Ln 4 8 f 4 Go To Table Of Contents Cardell 9500HD Series User s Manual indicator will remain on When the patient monitor is turned on and working the indicator becomes green 3 Freeze Restore When the waveform is sweeping across the screen press this button to freeze the waveform Press the button again to unfreeze the waveform sweep 4 Start Stop BP Press this button to start blood pressure measurement press it again to stop blood pressure measurement 5 Silence Press this button to enable disable the alarm sound 6 Start Stop Printing Press this button to start printing Press it again to stop printing If not pressed after being activated the monitor will print 90 seconds and automatically stop except when using the alarm triggered print setting 7 ECG Menu Press this button to enter the ECG menu 8 Knob To access the menu rotate the knob
23. EMP C02 d iN 03 04 08 20 32 16 A RESP Lead Select proper lead combination RA LA RA LL RA RL LL RL RESP Gain Change respiration waveform amplitude x0 5 x1 0 x2 0 Apnea Alarm Alarm On Off Alarm time 5 120s Within the specified time if there is no respiration waveform apnea alarm will be activated The priority is High Select Turn off apnea alarm function Waveform Mode Standard Enhanced Standard Waveform in single line Enhanced Waveform in bold line Waveform Speed 6 25mm s 12 5mm s 25 0mm s RESP Alarm Sound On Off TEMP Unit Change the temperature unit TEMP Alarm Sound On Off Priority RR To set the priority of respiration measurement between indirect impedance RESP or direct measurement with CO CO 2 53 Go To Table Of Contents 9 5 Alarm Setup 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 0 to upper limit Temp 1 upper limit Lower limit to 50 Temp 1 lower limit 0 to upper limit Temp 2 upper li
24. Hwy Suite 110 Tampa FL 33618 Phone 800 643 6275 Fax 813 264 6218 Go To Table Of Contents Cardell 9500HD Series User s Manual SECTION 2 SAFETY 2 1 Safety Notice 2 1 1 Intended Use The Cardell 9500HD series monitor is used to provide continuous monitoring display and recording of physiological parameters such as ECG non invasive blood pressure Sp CO respiration and temperature 2 1 2 Application Environment This device is for use by trained veterinary personnel in veterinary centers The device is 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 Familiarize yourself with their definitions and significance DANGER is defined as a source of potential injury to a person 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 NOTE provides application tips or other useful information to assure that you get the most from your equipment 2 1 5 Monitor Safety The safety statements presented in this chapter refer to the equipment
25. NIBP parameter area displays Overpressure protection it indicates that the internal inflation circuit results in an NIBP measurement failure Please contact Midmark for service 3 Measurement Pressure out of Limit If the NIBP parameter area displays Measurement Pressure out of limit it is because the patient s blood pressure is extremely high and out of the measurement range of the patient monitor Calm the patient down and perform the measurement again 4 Measurement Error If the NIBP parameter area displays Measurement Error it may be the result of a system self test error the patient being over excited trembling or air leakage Calm the patient down and perform the measurement again If the message persists please contact Midmark 4 Go To Table Of Contents 7 4 Precautions The following circumstances may affect the measurement results 1 patient motion 2 rapid change in pressure 3 shock or hypothermia WARNINGS 1 Make sure there is no other pressure on the cuff Wrong cuff size may result in inaccurate measurements Make sure monitor is set to Large Small corresponding to cuff used To ensure the patient s safety never use cuff on the same limb where an infusion is going on Do not measure SpO gt 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
26. Unit Power Cord Operator s Manual In addition you should have all the accessories and optional parts See Appendix 4 If any damage is found during shipping please keep the package and contact Midmark immediately 3 2 Before Monitoring Before monitoring patient please check the following Check if there is any mechanical damage Check the external connections Check if the patient monitor is in good working condition WARNING If anything is found abnormal or mechanical damage is suspected please do not use the monitor and contact Midmark as soon as possible Step 1 Turn the monitor on and the system will start a self test If the self test is successful you can start monitoring the patient If changes are to be made in the operation or settings see the operation procedures in the Operator s Manual Step 2 Make sure the monitor is connected to the patient with the appropriate accessories Step 3 After connections are in place there should be waveform or data on the screen otherwise a Check the connections to the patient b Check the connections to the monitor Go To Table Of Contents 3 3 Front Panel The front panel of 9500HD multi parameter patient monitor is as shown in fig 3 1 Zeg he d a ra Ke 7 a FA le Sa Pa ng Gemeen ae d i a we k a wn De w i a ral Fi Ta ot oil ei Fa w A d a he Pai d i a f F A a ail i ee LL e i CARDELI Wan Hinia
27. and flashing readings Alarms have three degrees Emergency 5 beeps Warning 3 beeps Alert 1 beep 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 leakage Wrong position Over pressure Range exceeded Other error When sensors or probes are unplugged the screen will display Probe off or No sensor and alarm NOTE When Asystole is displayed on the screen please check for the ECG Gain of the relative channel to see if it 1s too low to detect heart rate If so user can switch the ECG lead or change the source channel for the alarm In order to control the alarm function the alarm on off and alarm tone can be set up in the alarm setup menu 4 2 Alarm ON OFF Press the Silence key on the front panel of the patient monitor to silence the alarm for a certain period of time There are three alarm types A Alarm sound ON Alarm sound OFF turning off the sound forever can only be set up in each item A setup separately for example in ECG menu Silence the alarm sound for 1 minute The time is counted down But when new 01 00 alarm event occurs the alarm sound can be activated automatically Silence the alarm tone for 2 minutes The time is counted down But when new 02 00 alarm event occurs the alarm
28. atient Cable The patient cables consist of the main cable connected to the patient monitor and the lead wires connected to the patient WARNING At ECG receptacle you can see dei 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 6 3 Animal Preparation and Lead Contact Accurate electrode placement is very important for obtaining a clear quality ECG trace Sites where leads are attached to the body must be properly prepared to optimize contact Dogs and cats have enough electrolyte material on their skin and hair so that merely moistening lead sites with 70 isopropyl alcohol is appropriate This will usually be sufficient for ECG recording monitoring 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 is best to first wet the hair at the lead attachment site with alcohol then place paste on the moistened hair and skin It is important that the paste be in direct contact with skin For patients with dense undercoat rub paste with fingers to assure that it has made contact with skin Crocodile clips are supplied with this monitor and they must opened wide enough to firmly but gently grasp the skin 29 Go To Table Of Contents 6 4 Attaching ECG Electrodes 6 4 1 Leadwires an
29. ation Oxygen saturation calculations can be performed because blood saturated with oxygen predictably absorbs less red light than oxygen depleted blood Since measurement of SpO depends on a pulsating vascular bed any condition that restricts blood flow such as use of a blood pressure cuff or extremes in systemic vascular resistance may cause an inability to determine accurate pulse and SpO gt readings CAUTION SpO sensors are fragile and should be handled with great care 8 2 Sensor Placement INSTRUCTIONS FOR USE NOTE Reusable sensors may be used on the same site for a maximum of four 4 hours provided the site is inspected routinely to ensure skin integrity and correct positioning Because individual skin condition affects the ability of the skin to tolerate sensor placement 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 44 Go To Table Of Contents Cardell 9500HD Series User s Manual 4 Slide one of the sensor s alignment buttons along the clip slot until the sensor pad 1s fully engaged in the clip 5 Slide the second sensor button along the other clip slot until
30. calibration every hour Should the Temperature calibration error message 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 the parameter area but without an audible alarm Itis recommended to check the connection of the temperature probe regularly If you use disposable temperature probe please do not try to disinfect and reuse it Do deal with it appropriately 9 3 Respiration Monitoring The monitor provides two respiration monitoring methods thoracic impedance indirect and through the optional Capnostat mainstream CO probe direct 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 32 Go To Table Of Contents Cardell 9500HD Series User s Manual 9 4 Menu Setup The respiration temperature setup menu 1s as depicted in the following figure RESP Lead TEMP1 Upperlimit RESP Gain TEMPI Lowerlimit x cmd RESP Upperlimit TEMP Upperl imit RESP Lowerlimit Apnea Alarm TERP 2 Lowerl imit TEMP Unit Waveform Mode Standard TEMP Alarm Sound Waveform Speed Priority RR O o gt CH RATA zs on RESP Alarm Sound ECG SPOOZ NIBP NO USER ID RESP T
31. cloth to dry the monitor Do not use abrasive cleaners on the monitor Do not use either isopropyl alcohol or solvent to clean the monitor Use of these cleaners can cause damage to the monitor s surface Do not immerse the monitor or power cord in the cleaning solution When necessary the monitor surfaces may be disinfected using a soft cloth saturated with a 10 1 10 solution of chlorine bleach in tap water When all of the surfaces have been disinfected wipe the entire surface of the monitor using a soft cloth dampened with fresh water to remove any trace amounts of residue and or fumes NOTE Thoroughly wipe off any excess cleaning solutions Care should be taken to prevent water or cleaning solution to run into connector openings or crevices THE DISPLAY CAUTION Use care when cleaning the display Do not use a paper towel to clean the display as this may cause scratches 60 Go To Table Of Contents Cardell 9500HD Series User s Manual 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 1s 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
32. ct x 1 4 x1 2 x1 x2 x4 or Auto ECG Mode surgical monitoring diagnosis HR Source ECG1 or ECG 2 PaceMaker Detect I II III V Off Waveform Mode Standard Enhanced Waveform Speed Waveform speed options 12 5 25 0 50 0mm s HR UpperLimit HR alarm upper limit range is from the lower limit to 300bpm HR LowerLimit HR alarm lower limit range is from 15bpm to the upper limit Alarm Sound On Off ImV CAL When it is pressed a 1mV square wave will be displayed on the ECG waveform for user calibration Priority HR PR ECG SpO 6 5 2 ECG Setup Procedures Rotate the knob to select and press the knob to confirm For example 1 Rotate the knob to highlight Lead 2 Press the knob and select the desired item 3 Press the knob to confirm 4 After setup rotate the knob to the EXIT icon the last one press the knob and exit 6 5 3 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 6 5 4 Work Mode The Monitoring Surgical Diagnosis mode gives the user three levels of filters to accommodate different circumstances Diagnosis mode Displays the original ECG waveform unfiltered Monitoring mode Filters out low level interference 32 Go To Table Of Contents Cardell 9500HD Series User s Manual Surgical mode When there is a high degree of interference and the ECG waveform is significantly
33. d Color Table 6 1 5 Lead Color and Coding Table 6 2 3 Lead Color and Coding 6 4 2 Lead placement Figure 6 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 6 1 and Table 6 1 for more information Figure 6 2 3 Lead Placement For a 3 lead system leads should be attached just below the elbow on the front leg and just above the stifle on the hind leg The following lead sequence should be applied for a 3 lead system Right Foreleg RA white Left Foreleg LA black Left Hind Leg LL red Refer to Figure 6 2 and Table 6 2 for more information 30 Go To Table Of Contents Cardell 9500HD Series User s Manual 6 4 3 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 1s preferable to view an upright QRS complex for monitoring ECG A heart base to apex lead arrangement will be best if the negative lead is 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 foreli
34. defined as the terminal end of an F circuit or noncircle system and the inhalation exhalation hose connector in a circle system Exhausted soda lime or malfunctioning one way valves can also contribute to increasing mechanical dead space Dead space also increases in a non 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 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 ism ET ube Monitor ped Monitor adult Positional Heat amp Moisture Exchanger HME Dead Space 2 51090 mi 68 Go To Table Of Contents Cardell 9500HD Series User s Manual The consequences of excessive mechanical dead space can be substantial and potentially fatal As dead space volume from any cause increases effective alveolar ventilation decreases In patients breathing 100 oxygen there may be negligible initial effect on arterial oxygen tension Arterial CO2 however can reach impressive levels It is possible to have an end tidal CO level greater than 110 mmHg in patients with a normal pulse oximeter reading e Inc
35. disconnection Figure 10 Sensor to Interface Cable 9 Plug the Interface Cable into the SpO connector on the side panel of the monitor Push the cable in until you hear an audible click WARNING The indicates that the SpO sensor connector is insulated and defibrillation proof which can ensure patient and monitor safety during defibrillation and electrosurgery 45 Go To Table Of Contents 10 Press the ON STANDBY pushbutton to turn ON the monitor 11 Verify that the sensor is properly positioned by observing at least ten seconds of a continuous pleth waveform being displayed across the screen When a valid signal is detected the monitor displays the SpO and Pulse Rate values Should the perfusion light be at a low level reposition the sensor or try a different sensor If normal operation cannot be achieved call a Midmark Inc 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 8 3 Menu Setup SpO monitoring menu is as follows 5SPO2 Upperlimit 100 Waveform Mode Standard SPO Lowerl imit Waveform Speed 25 0 PR Upper imit Alarm Sound On PR Lowerl imit Priority HR PR EOG ECG P02 INIBP NO USER ID RESP TEMP C02 d e 03 04 08 20
36. e monitor Go To Table Of Contents Cardell 9500HD Series User s Manual e Unknown EMI may be caused by radio transmitters or TVs Please remove the patient monitor or add shielding materials e 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 e Loss of data When the device accidentally loses data please keep patient under close attention until the device returns to normal e 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 e Plastic bags and other packaging materials should be disposed of in accordance with related regulations e 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 Some symbols may not appear on all equipment A BF Applied Part F type applied part floating insulated complying with the specified requirements of IEC 60601 1 Medical Standards to provide a higher degree of protection against electric shock than that provided by Type B applied parts dei Type CF Applied Part F type applied part floating insulated complying
37. e is not excessively long e Select your anesthetic system carefully o Do not use a pediatric F circuit as a substitute for conventional pediatric circle hoses or a noncircle system e Using no more than one monitor adaptor o Make sure it is a pediatric low volume adaptor for smaller patients to avoid any significant impact on total mechanical dead space e Avoid the use of positional right angle adaptors in smaller patients e Avoid maintaining anesthesia with a facemask Simply put anesthetized patients should have their end tidal CO monitored for maximal patient safety 69 Go To Table Of Contents APPENDIX 4 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 cl 2 3 4 5 The following are optional accessories for use with the 9500HD series Nellcor MaxFast Reflectance sensor amp posey wrap EP XS MAX 12 9500 series extra small esophageal probe ecg temp resp 70 Go To Table Of Contents Cardelle 9500HD Series User s Manual 71 Go To Table Of Contents 72 Go To Table Of Contents Cardelle 9500HD Series User s Manual 73 Go To Table Of Contents 13303020000
38. e readings it is important to keep the cuff on a horizontal plane with the heart oT Go To Table Of Contents Large animals A large animal such as a horse should be in a stock standing still or lying down For horses and cows the cuff can be wrapped around the base of the tail using the coccygeal artery on the ventral surface WARNING When monitoring over an extended period of time or at frequent intervals periodically observe the patient s limb to make sure that the circulation is not impaired for a prolonged period of time Cuff size selections The widest cuff that can be placed on the patient without extending beyond the joint should be selected Appropriate sized cuffs may be selected based on 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 Width Range svo00 cit Includes all of the above Large Animal Cuff Selection Cuff Model Number Bladder Size Limb Circumference idth Range SV10
39. echniques 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 pressure readings taken over time Normal feline blood pressure 124 84 Feline Reference Values mmHg mmHg 125 11 Brown et al 1997 123 14 88 15 Curtet 2001 125 12 66 15 Weber et al 2002 Other investigators have reported comparable reference values 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 oscillo
40. ecomes full To ensure battery is fully charged it is recommended to plug the device in AC power even when the device is not used A fully charged battery can support the device continuously working for 1 5 2 hours The frequency of NIBP measurement and printing may accelerate the consumption of battery power When the battery power is almost depleted the battery mark at the lower right corner of the screen will flash an audible alarm is emitted This alerts the user to plug the device into AC power as soon as possible WARNING e Even when the device is not working the battery power will be discharged slowly e When the device is being stored for a long time make sure the battery 1s full e Check the battery status and recharge at least once a month 3 Keys and Buttons The buttons of the device are divided into two types Function keys Waveform freeze unfreeze key Start Stop blood pressure measurement Alarm Silence DO SS GE Printer Start Stop kal ECG menu key Knob Located at the lower right of the front panel it can be used to move left or right through a menu to change menu selections and to confirm the selection by pressing it 14 Go To Table Of Contents Cardell 9500HD Series User s Manual 3 8 Menu Setup 1 Rotate the knob to highlight the menu item and press the knob to confirm the selection and enter the sub menu 2 After entering the sub menu rotate the knob to hig
41. em WARNING Regarding Anesthetics When using the sidestream CO measurement on patients who are receiving or have recently received anesthetics connect the outlet to a scavenging system to avoid exposing the veterinary staff to anesthetics Use an exhaust tube to remove the sample gas to a scavenging system Attach it to the sidestream sensor at the outlet connector 10 4 Menu Setup The CO setup menu is as depicted in the following figure EC Upper limit Apnea Time EC Lower limit Waveform Mode InCO2 Upper imit Waveform Speed InCO2 Lower imit ace Sattar RR Upper limit Priority PR RR Lower limit ECG SPO NIBP NO USER ID RESP TERP 602 Gi 03 04 08 20 32 18 Apnea Time Alarm time 5 120s Within the specified time if there is no respiration detected the apnea alarm will be activated The priority 1s High Select Turn off apnea alarm function Waveform Mode Standard Enhanced Fill Standard Waveform in single line Enhanced Waveform in bold line Fill Waveform filled in Waveform Speed 6 25mm s 12 5mm s 25 0mm s Alarm Switch On Off 58 Go To Table Of Contents Cardell 9500HD Series User s Manual Priority RR To set the priority of respiration measurement between indirect impedance RESP or direct measurement with CO CO2 10 5 Alarm Setup The CO alarm is for parameter out of limit or abnormal status When the parameter exceeds the limit the monitor will give b
42. eptacles for temperature probe extension cables ET CO Receptacle for optional Capnostat Mainstream CO probe SpO Receptacle for SpO extension cable ECG RESP Receptacle for ECG cable NIBP Receptacle for NIBP inflation hose Cardell Blue Racing Stripe Built in 3 channel printer Rechargeable Battery compartment RS RR 3 6 Power AC Power When AC power is used the 9500HD may be turned on at any time Before plugging it into AC power compare the resident power output with the requirements of the device On the rear panel you can see the power supply requirements After confirming all cables are properly connected press the power button on the front panel The system will start a self test which lasts about 15 seconds If the power indicator on the front panel is green it indicates that the device is in normal working condition and can be used for vital signs monitoring communication and battery charging When the device is plugged in to AC power and turned off the power indicator on the front panel is yellow showing the monitor is in standby condition and the battery is being charged 13 Go To Table Of Contents Battery Power When AC power is shut off the 9500HD monitor can still work with the internal battery Before use the battery must be charged Whenever the device 1s plugged into AC power the battery will automatically be charged The battery should be charged for at least for 8 hours before it b
43. etup Procedures Step 1 Enter System Setup Step 2 Click the icon _ in the lower left corner to enter Volume and Brightness Setup 5 7 2 Interface Setup Manual d wt Volume Setup Interface 27 Go To Table Of Contents 60 198 Small mmHg Manual NO USER ID e A 09 07 11 02 26 08 Alarm Volume Setup Interface 60 98 Small mmHg Manual CC ER ID T alll 09 07 11 02 26 08 Brightness Setup Interface 5 8 Big Font 5 8 1 Setup procedures Step 1 Rotate the knob to enter Big Font 17 Step 2 Press the knob to confirm it Step 3 Press the knob again to exit The display can be set up in big front mode as shown in the following figure which is convenient for observing the screen from a long distance HR a SPO2 A 120 98 120 80 39 AL ac d A Y 04 12 18 203246 av Big Font Interface NIBP 100 28 Go To Table Of Contents Cardell 9500HD Series User s Manual SECTION 6 ECG MONITORING 6 1 General Information The Cardell 9500HD 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 1s computed on a beat to beat basis using the R R interval of the QRS complex Itis necessary to make sufficient preparations before monitoring in order to get accurate readings 6 2 P
44. hlight the selected menu and press the knob to confirm the selection 3 Then rotate the knob again to select the desired item 4 When finished press the knob to confirm the selection and validate the setup 5 Rotate the knob to point to the BACK icon and press the knob to return to the original screen 3 9 Printing Recorder The device uses a built in 3 channel thermal array recorder Manually controlled printing Press the printing start stop key z on the front panel to print the physiological parameters history data and monitoring waveforms Press the key again to stop printing Alarm triggered printing While the alarm triggered printing function is turned ON whenever there is an alarm the recorder will automatically print the data and waveform of 2 seconds or 5 seconds before the alarm The user may also set the print duration to last 8 seconds 16 seconds or 32 seconds after the alarm Alternatively the user may press the print start stop key to stop printing l Print Header The Report header includes date time printing speed and parameter values Each time a waveform is printed the above contents will also be printed 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 For long term storage gt 5 yrs it is recommended to make a photocopy Installing Paper To install the paper roll in the printer f
45. i 31 6 4 4 Positioning Conscious EE 31 ood 1C a e E 31 COAT SN E 33 DEMO Sali 34 SR ui lete gleef e 34 AE RR Els Le d e EE 35 SECTION 7 NIBP MONITORING s s s ssseseseenene ENER ENKEN EN ENER ENKE EN EN TeV EH Elte gut re EE 36 EIERE ege 36 Go To Table Of Contents TS E e E 39 TEO UON onora 42 E E de 42 7 6 Maintenance eege 42 SECTION 8 SPO MONITORING 1 1r srrrrrr resine eine 8 1 General Information EE 44 8 2 Sensor Placement ROERO 44 EI RO RIE 46 SEA CINESI RICA 47 8 5 Preparation for Monitoring iii 48 SPICCANO A Sere e sates ce E ai 49 8 6 Cleaning ANG Maintenance 49 dif FOUDIG OOM iaia 50 SECTION 9 RESPIRATION AND TEMPERATURE MONITORING 9 1 General Information soennonnnnnnnssnssneesssnssnessssesssresssessrsssresssrssnressrrssnressrissnresstrssresnrtssrssnressressseessn 51 9 2 Temperature Montormg 51 9 3 Respiration IOMILOMING E 52 GE tye Dee e lai ai E 53 er ARMS 54 SECTION 10 CO MONITORING OPTIONAL ccccceceseeeeeeeeeeeensenseenseneees 10 1 General Information ria 55 10 2 Capnostat Sensor 55 TOS LOFO CO SONSON IGS SS Micaela aiar 57 OEN Ee EE 58 SAR 59 10 6 Cleaning amp Mamtenance sssisirssssiriisiorsissseraridirersiiisareinidi sarirani iEn EEEa raisi 59 SECTION 11 CLEANING AND MAINTENANCE rrsrrrrrrrrrnire inni RES Re CF 60 1142 59 Se e Le EE 62 APPENDIX 1
46. ion 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 using a soft cloth dampened with fresh water to remove any trace amounts of residue and or fumes 11 2 System Calibration Besides the routine cleaning of the monitor and accessories outlined in the previous section and replacement of accessories due to normal wear and tear calibration of the monitor should not be necessary during the warranty period If the monitor is in need of repair it must be referred to the appropriate service personnel Service performed by unauthorized personnel could be detrimental to the monitor and may void the warranty For service contact Midmark Inc 62 Go To Table Of Contents Cardell 9500HD Series User s Manual APPENDIX 1 SPECIFICATIONS I Safety Standard IEC60601 1 1 Type Class I with internal power supply Protection BF CF Category Continuous operation non AP APG common device II Power Supply Requirements Input power supply AC110 230V 50Hz 60Hz Input power lt 90VA Fuse T2 0AL 250V fuse two in the back panel Battery 12V 2 3AH charging time gt 8 hours battery powered working
47. irst lift the smoke colored latch on the printer compartment Place the roll of paper between the two round tabs of the paper holder with the paper coming off of the bottom of the roll Pull enough paper from the roll so it hangs over the door when closed Do not thread paper under black bar You are now ready to print 15 Go To Table Of Contents 3 10 Display Screen ivds2em4 Fig 3 5 In the figure above we can see the waveforms of ECG 1 ET CO2 SpO RESP and the data for ECG1 SpO NIBP RESP and TEMP Press the knob to enter the tabular history screen in Fig 3 6 Date Time SYS DIA SPO2 HR PR RR TEMPI TEMP2 EtCO2 Inco2 12 18 18 57 eee jo 12 18 1853 n ni 12 18 18 49 wore Cat Ke 12 198 19 45 nu ea SIA NO USER ID Se 03 04 08 20 32 16 ha F1g 3 6 In the figure above we can see columns for a date time stamp and corresponding parameter values including systolic blood pressure diastolic blood pressure SpO3 HR PR respiration rate temperature 1 temperature 2 end tidal CO and inspired CO3 The system stores up to 600 sets of history data On each screen there are 10 sets of data On the right side of the readings there is a scroll bar indicating the current location of observation Go To Table Of Contents Cardell 9500HD Series User s Manual Menu Box ALE i amp Er Fig 3 7 The Menu box uses dynamic popup and exit modes When there i
48. l circumstances 33 Go To Table Of Contents 6 6 2 Parameter Adjustment Range Parameter Adjustment Range HR 15 300 bpm 6 6 3 Abnormal Status Alarm Abnormal Status alarm includes Asystole and lead off CAUTION When ECG amplitude is too low it may result in inaccurate heart rate or pseudo asystole We suggest when ECG waveform 1s too low change the lead and adjust to the ECG lead which has maximum amplitude Otherwise the monitor may give Asystole alarm 6 7 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 6 8 Cleaning and Maintenance CAUTION Please always obey the detailed instructions supplied together with the transducer which are more updated than the information here The following instructions shall be treated as general guidance when there is no specific method When the cable is found worn out or damaged please replace the cable at once 6 8 1 ECG cable cleaning In order to keep the cable dust free please clean it with clean cloth
49. 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 4 3 3 Alarm volume and brightness setup The alarm volume and display brightness can be set in A all section of the main menu 21 Go To Table Of Contents 4 3 4 Default Alarm Limit The monitor includes default alarm limits recommended by a member of the American College of Veterinary Anesthesia for general veterinary practice To return to the factory alarm setting 1 e default alarm limits follow these steps Rotate knob to Press knob to confirm then choose Restore Default in the following fig Edit Patient NO USER ID New Patient Date Time Alarm Sound On Restore Default Alarm Mode Standard ClearRecords EK We ESS A Mosse n Alarm Limits Default Setup The following default alarm limits were set in the factory before delivery The default alarm limits of the patient monitor are as follows Resp bpm Temp C Et CO mmHg In CO mmHg 22 Go To Table Of Contents Cardell 9500HD Series User s Manual 4 3 5 Alarm Mode Setup 9500HD
50. mb lead is negative and standard left hind leg is positive in lead two so if these leads are properly placed and the machine is set to Lead II an upright complex should be the result 6 4 4 POSITIONING CONSCIOUS PATIENTS Standard position for recording diagnostic ECG in dogs 1s 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 For awake cats and dogs it is best to have the patient held by a veterinary technician or veterinary assistant One lead should be applied first to determine comfort level and adjustment made as needed Then the other clamps can be placed in position It is important that the patient be kept still A moving patient may cause clips to saw into skin tissue leading to discomfort and change in position of electrodes 6 5 ECG Setup 6 5 1 Rotate the knob to Al press knob to confirm Then choose ECG 1 or ECG 2 ECG Lead HR UpperLimit ECG Gain HR LowerLimit ECG Mode Alarm Sound PaceMaker Detect im CAL Waveform Mode Standard Priority HR PR Waveform Speed ee ere TECH Fro NIBP NO USER ID RESP TEAP C02 4 03 04 08 20 22 18 Du User may select and confirm by rotating and pressing the knob 31 Go To Table Of Contents ECG Lead Select different leads to display different ECG waveforms of a patient ECG Gain Select different waveform gain User may sele
51. metric 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 66 Go To Table Of Contents Cardell 9500HD Series User s Manual Breed Systolic Diastolic Pulse Rate Pt tt femme N 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 SO mmHg 1 Info per Dr Donald Sawyer Michigan State University 67 Go To Table Of Contents APPENDIX 3 DEAD SPACE Cause Effect amp Control in Small Animal Anesthesia Robert M Stein D V M DAAPM Founder www VASG org Dead space is an often misunderstood and overlooked aspect of veterinary anesthesia patient management Dead space is always present as a component of the patient s airway and to a variable degree as a component of the anesthetic system Ignoring the harmful consequences of system dead space can lead to poten
52. mit Lower limit to 50 Temp 2 lower limit 0 to upper limit 99 66 Alarm for abnormal status Temperature self test error electrode off NOTE When there is an alarm for temperature self test error please contact Midmark for Service 54 Go To Table Of Contents Cardell 9500HD Series User s Manual SECTION 10 CO monitoring Optional 10 1 General Information The 9500HD includes the capability to monitor end tidal CO using the optional Capnostat CO sensor This measures CO by using the infrared absorption technique which has endured and evolved in the clinical setting for over two decades and remains the most popular and versatile technique today The principle is based on the fact that CO molecules absorb infrared IR light energy of specific wavelengths with the amount of energy absorbed being directly related to the CO2 concentration When an IR beam is passed through a gas sample containing CO the electronic signal from the photodector which measures the remaining light energy can be obtained This signal is then compared to the energy of the IR source and calibrated to accurately reflect CO2 concentration in the sample To calibrate the photodetector s response to a known concentration of CO is stored in the monitor s memory A reference channel accounts for optical changes in the sensor allowing the system to remain in calibration without user intervention NOTE CO monitoring
53. nt site When Sp 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 SpO 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 SpO 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 48 Go To Table Of Contents Cardelle 9500HD Series User s Manual 8 6 Precautions WARNING Prolonged use or the patient s condition may require changing the sensor site periodically Change sensor site and check skin integrity circulatory status and correct alignment every 2 3 hours If there is any change move the sensor to another site 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 8 6 Cleaning and Maintenance CAUTION Do not autoclave the sensor 8 6 1 Clean the sensor 1 Clean the sensor with a soft cloth moistened in mild soap solution saline 1 or one of the following solutions Microzid
54. or repetitively for a long time 10 Use only accessories recommended by the manufacturer 11 Remove the cuff after turning the power off 7 5 Preparations Use cuffs of proper sizes Ensure the cuff has been completely deflated Place the cuff on the patient s limb Install the cuff hose to the NIBP connector of the patient monitor Make sure there is no block between the monitor and the hose Set blood pressure measurement correctly in the setup menu The cuff on the patient s limb should be at the same level as the heart Press the blood pressure start key and start measuring blood pressure 7 dA 4 7 dA 4 CONN Vi Db UYU N ra 7 7 6 Maintenance CUFFS Prior to each patient use inspect the blood pressure cuff and its hose for damage 42 Go To Table Of Contents Cardell 9500HD Series User s Manual NOTE We do not recommend submersion of the cuff Liquid should not be permitted to enter the cuff bladder because instrument damage may occur The cuff should be allowed to thoroughly dry before use 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 DISPOSABLE VINYL CUFES In certain situations the cuff may become soiled during its use In these situations a water based detergent is suitable for wiping the cuff As necessary the preferred method for
55. oth visual and audio alarms Alarm Range Parameter Range ETCO upper limit lower limit to 100mmHg ETCO lower limit 0 to upper limit INCO upper limit Lower limit to 100mmHg INCO lower limit 0 to upper limit 10 6 Cleaning amp Maintenance 10 6 1 CAPNOSTAT 5 CO Sensor Cleaning the outside of the CAPNOSTAT 5 CO Sensor e Use a cloth dampened with isopropyl alcohol 70 a 10 aqueous solution of sodium hypochlorite bleach disinfectant spray cleaner such as Steris Coverage Spray HB ammonia or mild soap e Wipe down with a clean water dampened cloth to rinse and dry before use Make certain that the sensor windows are clean and dry before reuse 10 6 2 Airway Adapters e Clean by rinsing in a warm soapy solution followed by soaking in a liquid disinfectant such as isopropyl alcohol 70 a 10 aqueous solution of sodium hypochlorite bleach a gluteraldehyde 2 4 solution such as Cidex Steris System 1 or ammonia It should then be rinsed out with sterile water and dried e May be disinfected using the methods listed below Immerse and soak in Cidex or equivalent 2 4 gluteraldehyde solution for a 10 hour soak Immerse and soak in Perasafe or equivalent peracetic acid 26 solution for a 10 minutes Cidex OPA follow the manufacturer s instructions for use e Before reusing the adapter ensure the windows are dry residue free and that the adapter has not been damaged during handling or the cleaning disinfecting p
56. ox 2 seconds Pulse Sound Pulse sound indication Sensor Type Nellcor V SAT digital lingual sensor provided with small and large clip Non invasive Blood Pressure NIBP Cardell Measurement Method Oscillometric Parameters Systolic Diastolic Mean Pulse Unit mmHg or kPa Operation Mode Auto Manual STAT Measurement and Alarm Range 20 265mmHg Cuff Pressure Range 0 280mmHg Initial Cuff Inflation Pressure 150 10mmHg Deflation Pressure 30mmHg 4 0kPa higher than last systolic pressure Auto Cycle Time Is 10s 15 30s 60s 90s 120s 180 240s 480s End tidal CQ Respironics Optional Method Mainstream Capnography Principle of Operation Non dispersive infrared NDIR single beam optics dual wavelength no moving parts Initialization time Displayed in less than 15 seconds full specifications within 2 minutes Measurement range 1 150mmHg 1 to 19 7 1 to 20 kPa at 760mmHg Rise time Less than 60 ms CO Resolution 0 1ImmHg 0 to 69 mmHg 0 25 mmHg 70 to 150 mmHg CO Accuracy 0 40 mmHg 2 mmHg 41 70mmHg 5 of reading 71 100mmHg 8 of reading 101 150mmHg 10 of reading Respiration range 0 to 150 Breaths minute Respiration accuracy 1 breath Calibration No routine user calibration required Temperature 2 channel Measurement and Alarm Limit 0 50 Probe Skin surface or rectal esophageal Unit Celsius Fahrenheit Accuracy 0 1 Resolution 0 1 Refresh time Approx 1 second 64
57. r other conductor or device During defibrillation never touch the patient table or the device e Before using on another patient make sure previous monitoring data is cleared 2 2 2 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 Check battery level every month e The ECG cable socket is for connecting ECG lead wires only Please do not connect it to any other signal source Pay attention to the color label and marks of ECG lead wires e Please clean the monitor and accessories according to instructions Always unplug the power cord before cleaning e EMC The device is in conformity with the requirements of IEC 60601 1 2 and related EMC standards But when electromagnetic power is extremely high it may cause interference Please ensure any device close to the monitor meets the related EMC requirements Do not use cell phone or personal telecommunication devices next to th
58. ream For Sidestream CO the LoFlo CO sensor is provided for your use Connecting the LoFlo CO Sensor to the Monitor l Plug the sensor cable into the monitor s CO input receptacle 2 Wait two minutes to allow the sensor to warm up 3 Connect the airway adapter or sample line to the sensor It will click into place when seated correctly Make sure to Zero your sensor before use See section 9 4 For intubated patients requiring an airway adapter install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y section For intubated patients with an integrated airway adapter in the breathing circuit connect the mail luer connector on the straight sample line to the female port on the airway adapter WARNING Always connect the airway adapter to the sensor before inserting the airway adapter into the breathing circuit In reverse always remove the airway adapter from the breathing circuit before removing the sensor Using the Sidestream Sensor Holder The sidestream sensor holder can be used to clamp the sensor onto an IV pole or a shelf I 27 oF Push the sensor into the holder until it clicks into position Clamp the holder onto an IV pole a shelf or another appropriate location To remove the sensor from the holder release the clip and pull the sensor out of the holder 57 Go To Table Of Contents Removing Exhaust Gases from the Syst
59. reased arterial CO gt causes o Respiratory acidosis o Sympathetic stimulation o Cardiac arrhythmias A mix of sympathetic stimulation and hypoxemic effects o Variable peripheral vasoconstriction sympathetic effect followed by peripheral vasodilation as a direct effect on peripheral vessels o CNS depressant effect and eventually narcosis Pa CO levels above 100 mmHg have an anesthetic effect o Increased cerebral blood flow and intracranial pressure o Tachypnea and an increased work of breathing which can negatively impact a debilitated patient e 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 e Mechanical dead space is most concerning for patients under 6 kg body weight o Minimize the connectors attached to the endotracheal tube particularly in small patients For example na 6 kg patient under anesthesia the patient s alveolar ventilation volume would be 31 5 ml Using a pediatric F circuit with adult ET CO monitor and right angle adaptor or apnea alert adaptor could create 30 ml of mechanical dead space effectively eliminating 95 of normal spontaneous alveolar ventilation e Make sure you regularly inspect all anesthetic machines and systems paying particular attention to valve function and inner hose integrity e Make sure that the ET tub
60. reases When the cuff pressure reaches a certain value the oscillometric amplitude reaches a maximum value and 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 WARNING There is a label LR below the NIBP receptacle indicating that the signal input is insulated and defibrillator proof 7 2 Cuff Placement CAUTION Only accessories recommended by Midmark should be used NOTE Place the patient on a padded surface to provide comfort and warmth Shivering will inhibit the monitor from making a determination 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 36 Go To Table Of Contents Cardell 9500HD Series User s Manual around the forelimb between the elbow and carpus It 1s not necessary to center the cuff over the artery which is on the medial side of the leg because of the fully encircling bladder design Hair need not be clipped
61. rocess 59 Go To Table Of Contents SECTION 11 Cleaning and Maintenance 11 1 Cleaning WARNING Do not under any circumstances perform any testing or maintenance on the monitor while the monitor is being used to monitor a patient The monitor must be turned OFF Unplug the monitor from the AC power source and remove the internal battery CAUTION Do not open the monitor to clean or repair it Contact Midmark for service needs CAUTION Disconnect all accessories from the monitor before cleaning Do not immerse any part of the electrical connector of the cable or accessories in the cleaning or disinfection solution at any time Do not use an abrasive cloth or cleaner on the accessories Immersing the patient cable or lead wires in any liquid may result in moisture entering This may cause internal damage and reduce the product life Alcohol and organic solvents may cause stiffness and brittleness THE MONITOR On a daily basis examine the monitor s case for damage and check the AC power cord for bent or broken prongs cracks or fraying Neither the monitor nor the power cord should be used if damaged If any damage is noted contact the appropriate service personnel CAUTION Do not spray or pour any water or cleaning solution directly onto the monitor 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
62. s 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 40 Go To Table Of Contents Cardelle 9500HD Series User s Manual 7 3 3 Select time interval Select time interval in AUTO displays behind the mode Adjustable ranges in minutes are 1 10 15 30 60 90 120 180 240 480 The time interval means the time between the last NIBP measurement start to the next NIBP measurement start 7 3 4 Change NIBP measurement scale Use this to change the NIBP measurement scale between mmHg and kPa 7 3 5 Alarm Limits Adjust alarm limits 7 3 6 Alarm Sound On Off Turn the alarm sound on or off 7 3 7 Alarm for abnormal status 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
63. s no menu on the screen rotate the knob or press the ECG menu button to activate the menu display When the menu is displayed on the screen press the ECG menu button to exit from the menu When there is no activity for 30 seconds the menu will disappear automatically and return to the original monitoring screen Parameter Box Fig 3 8 The monitor displays the following parameter values in real time heart rate pulse rate SpO Diastolic Systolic Mean non invasive blood pressure NIBP ET CO2 IN CO respiration rate temperature 1 amp 2 and the temperature difference ECG measurement includes 3 modes Monitoring Surgical Diagnosis The user may select different modes for different applications The ECG mode label is displayed on the display channel in small font The NIBP unit can be displayed as either mmHg or kPa The NIBP area will display the cuff setting as Small or Large referring to whether the vinyl small animal cuffs are being used or if the nylon SV8 or SV10 large animal cuffs are being used The NIBP measurement mode can be selected between Manual Auto Stat which is displayed on the right side of screen 17 Go To Table Of Contents Status Box Fig 3 9 In the Status Box you can see battery power status alarm status and patient ID number 1 Alarm status A symbol is used to indicate the alarm status 2 Battery power status The more the segments in the battery
64. select the desired function then confirm by pressing the knob 7 3 2 1 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 39 Go To Table Of Contents of the two large nylon cuffs SV8 or SV10 select Large Otherwise the cuff size should be set to Small corresponding to the white cuffs sizes SV1 SV5 CAUTION Before measurement make sure you have chosen the right cuff size on the monitor 7 3 2 2 Select measurement mode MANU AUTO STAT NOTE The current NIBP Measurement Mode will display to the upper right of the 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 NOTE In Auto mode if no NIBP value can be measured the auto measurement will be stopped automatically STAT Continuously measure patient s NIBP for 5 minutes The mode i
65. stem setup includes patient ID time date alarm tone alarm mode and default setting 5 6 1 System setup procedures 1 Rotate the knob to enter System Setup 2 Select to item to be set n 3 Setup the item 4 Press Back ol to exit 5 6 2 Patient ID The monitor displays patient s ID on the main window Edit Patient To change the patient s ID New Patient If you input a new patient s ID the original patient s ID will be deleted 5 6 3 Set Time The monitor displays the date time Each time the machine is turned on the system will display the current date and time in the time status box 26 Go To Table Of Contents Cardell 9500HD Series User s Manual Rotate the knob left or right to change the hour minute and second The system time will not be updated until you press the knob to confirm the change 5 6 4 Alarm Mode Auto Standard See section 4 3 for description 5 6 5 Alarm Sound ON OFF WARNING When the alarm is turned off please pay close attention to the patient 5 6 6 Restore Default Return to the default setting NOTE When there is a sudden power failure please turn off the machine immediately Do not turn on the machine until the power supply resumes The system will maintain the original configuration That is after the patient monitor is turned on again the configuration set before power off will remain 5 7 Volume and Brightness Setup 5 7 1 S
66. symbol the more the power in the battery a When the battery power is low the battery symbol will flash Please connect the patient monitor to AC power as soon as possible b When there is no segment in the battery indicator the symbol will become red indicating that the battery power is used up If the patient monitor is not connected to AC power within 3 minutes the monitor will be turned off automatically kp 99 be c When the battery symbol changes to It indicates the device is connected to AC power 3 ID shows patient s ID number Waveform Status 60 98 small mmHg Manual NO USER ID Y 09 0 11 02 26 08 Fig 3 10 Waveform speed The waveform displayed 1s physiological waveform and the speed unit is mm s The waveform can be displayed in speeds of 12 5 25 or 50mm s ECG Leads I II III V avL avR avF Go To Table Of Contents Cardell 9500HD Series User s Manual RESP Leads RA LA RA LL LA RL LL RL Time Display Area Il x 25 60 98 Small mmHg Manual TEE _ 2 d GE NO USER ID Y 09 05 11 Uz2 26 Fig 3 11 The current monitoring time is displayed as YY MM DD HH MM SS at the bottom right Go To Table Of Contents SECTION 4 ALARM SETUP 4 1 General Information Alarms are designed to give an alert when the monitoring results are abnormal It is rendered with audible sounds visual LED indicators
67. tially 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 CO 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 ET CO apnea alert etc any adaptors used to facilitate patient system positioning right angle or swivel adaptors used to reduce the risk of tracheal trauma during patient rotation the pace within a mask not occupied by the patient s nose humidification management exchangers HME and the Y piece
68. ture monitoring The monitor will display continuous electronic temperature readings or the core body temperature via either a rectal esophageal 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 9 2 Temperature Monitoring 1 Select temperature probe WARNING Skin surface and rectal probes are not exchangeable 2 Probe may be used either in the esophagus or the rectum of the patient CAUTION To avoid cross contamination we suggest you label the probe with tape indicating which way it s been used 3 Insert the temperature probe into the temperature socket in the side panel WARNING Connect temperature probe with patient and insert the other end of the cable into the temperature socket of the monitor completely The screen will display the temperature reading 4 Set temperature alarm limits 51 Go To Table Of Contents 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
69. tus Alarm Probe Off alarm 47 Go To Table Of Contents 8 5 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 e Do not apply the SpO 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 e Make sure there is no strong ambient light coming into the sensor Cover the site with opaque material 3 Plug the sensor into the SpO connector on the patient monitor 4 Set the upper and lower limits of SpO 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 SENSOR REMOVAL CAUTION For the comfort of the patient and to avoid damaging the sensor do not pull on the cable when removing the sensor and clip from the sensor site but rather unclip the sensor and remove from placeme
70. ty with IEC60601 EN60601 requirements with protective grounding through three pin power plug WARNING To turn off the AC power please unplug the power cord from power socket or unplug the power cord from the AC power receptacle on the monitor The On Off button will not turn off the AC power of the patient monitor Patient Grounding The equipotential or grounding cable may be yellow or yellow and green During heart or head check in order to eliminate the potential difference between different equipment the monitor has a special cable to connect to the grounding system The grounding cable should be used when using high electrical output equipment such as a Go To Table Of Contents Cardell 9500HD Series User s Manual defibrillator or electric cautery or any equipment that may cause interference with the monitor Connect the small end of the grounding cable to the grounding connector on the monitor This 1s the small metal peg on the back of the monitor The large end of the grounding cable should be connected to any metal surface or copper pipes Combination of Equipment Both medical and non medical equipment must comply with IEC60601 1 1 standard CAUTION The use of several machines together can increase the current leakage which risks injury to patient and medical personnel Unpacking After confirming the outside packing is intact please open the box and inspect the contents Patient Monitor Main
71. uipment 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 the product warranty card carefully and mail it to our service center We will keep it for future reference After unpacking the system keep the packing materials for future return for service if necessary The manufacturer shall be responsible for the safety reliability and performance of the monitor The warranty applies if the product is used according to the operator s manual instruction The warranty does not apply if the product has been damaged from improper operation misuse has been damaged because of improper connection to other equipment has been damaged by accident 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 e model and serial number of the equipment e date of purchase and distributor name Go To Table Of Contents 1 3 Important Information e The manufacturer s quality management system complies with the international standards ISO 9001 and EN 46001 and has the certificate issued by TUVps e Manufacturer address Midmark 10008 N Dale Mabry
72. 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 cuff may become soiled during its use In these situations a water based detergent is suitable for wiping the cuff As necessary the preferred method for cleaning the cuff 1s 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 CO2 CONSUMABLES Capnostat airway adapters are intended for single patient use in human medicine but in the veterinary setting may be reused as long as
73. with soapy water or a mild detergent 34 Go To Table Of Contents Cardell 9500HD Series User s Manual 6 8 2 ECG cable disinfection In order to avoid long term damage to the cable we recommend that you only disinfect the cable when it s necessary according to your hospital regulations CAUTION Do not autoclave the cable 6 9 Troubleshooting 6 9 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 6 9 2 No ECG waveform After leadwires are connected but there is no ECG waveform and the screen shows lead off or no signal received 1 Check 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 module has communication problem with the main unit Turn off the machine and turn it on again If problem still remains contact Midmark 6 9 3 ECG baseline shift ECG scan baseline is not stable on the display 1 Check if the working environment is too humid and if the machine has moisture inside If yes keep the machine on for 24 hours and keep the ambient
74. with the specified requirements of IEC 60601 1 Medical Standards to provide a higher degree of protection against electric shock than that provided by Type BF applied parts A Attention Consult accompanying documents Fuse Y Equipotentiality d Power ON OFF x Alternating Current CL Earth connector Go To Table Of Contents SECTION 3 CONTROLS AND CONNECTORS 3 1 Installation and Connection 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 a space for the patient monitor at least 5cm from the wall to ensure good air ventilation If the patient monitor is installed in a cabinet please make sure there is enough space to facilitate service Extreme temperature can affect the accuracy of the monitor and damage accessories or circuits Please ensure that water does not condense in the patient monitor when using the device For instance when the monitor is transferred between buildings there is a risk of condensation because of exposure to humidity and combined with a difference in temperature WARNING Never use the veterinary monitor in an environment with combustible anesthetic gases Power Supply Requirements Power Supply Input AC 110 230V 50 60Hz Input Power S90VA Shock Protection The 9500HD multi parameter monitor is a Class I device in conformi

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