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PROCARE* Monitor B40/B20 User`s Reference Manual

1. Monitor Screen Setup Setup gt r Dight Fields Lower Field 1 Resp More OFF Lorr Lower Field 2 NIBP CO2 HR Lower Field 3 T1 T2 Resp ST Lower Field 4 CO2 T1 T2 IBP1 Previous Menu Temp IBP2 Ti NIBP T2 SpO2 Battery CO2 OFF More Change contents of lower digit field 1 Select OFF to clear gt field Changing the digit field may also change the waveform field setup If you choose the same measurement in the digit field that is currently in the waveform field this measurement is removed from the waveform field If a digit field is turned OFF the remaining digit fields are enlarged to fill the space 6 9 B40 B20 Patient Monitor Modifying split screen You can split Normal Screen so that one part continuously displays trend data To select a split screen view 1 Press the Monitor Setup key 2 Select Screen Setup 3 Monitor Setup gt 128 81 91 Figure 6 3 Split screen view Select Split Screen and choose from the options Trend or None nm ave 4 ma lm Modifying the minitrend length Oo BTEP DOWN 14 26 ECG Arh analys 88 Severe min mm av 2 8 vs 2 8 Ur ug M i c02 15 Amin 5 ET 5 0 0 ES 15 nin 12 12 11 20 5 18 3 You can choose to view minitrend data from the last 5 minute or 30 minute period next to the parameter s waveform field The 5 minute minitrend is updated every 10 seconds and the 30
2. Infrared 22 5 mW max Red 30 mW max Masimo SpO specifications Measurement and display range 1 to 100 Measurement accuracy Without motion Adult Pediatric 100 to 70 2 digits Neonate 100 to 70 3 digits With motion Adult Ped Neo 100 to 70 3 digits Low perfusion 100 to 70 2 digits 0 69 unspecified Display resolution 1 of SpO Display averaging 2 to 16 seconds Pulse rate Measurement and display range 25 to 240 bpm Display resolution 1 bpm Measurement accuracy Without motion With motion 3 bpm 5 bpm System description Sensor Light Source Wavelength Infrared 905 nm nominal Red 660 nm nominal Power Dissipation Infrared 22 5 mW max Red 27 5 mW max NIBP Measurement technique Oscillometric with step deflation Supported modes Manual automatic and stat Measurement time Adult Pediatric inflate duration time less than 120 s Neonate cycle time less than 85 s Measurement ranges Systolic Adult Pediatric 30 to 290 mmHg Neonate 30 to 140 mmHg MAP Adult Pediatric 20 to 260 mmHg Neonate 20 to 125 mmHg Diastolic Adult Pediatric 10 to 220 mmHg Neonate 10 to 110 mmHg Accuracy According to AAMI SP10 2002 4 4 5 2 B accuracy of NIBP parameter was validated against the intra arterial method Default initial inflation pre
3. Print gt Record amp Print Record Record Waveforms Record to Net Record to Local Waveform 1 Waveform 2 Waveform 3 Start on Alarms Delay Paper Speed Length Previous Menu Change waveform recorded in upper field gt Select OFF to clear field 8 3 B40 B20 Patient Monitor Changing the paper speed To see the waveforms more clearly or more generally you can change the paper speed The recorder speed can be 1 6 25 12 5 or 25 mm second 1 Press the Print Record key 2 Select Record Waveforms 3 Select Paper Speed Print Record amp Print Record Record Waveforms Record to Net Record to Local 1 Waveform 1 ECG1 6 25 Waveform 2 OFF 12 5 Waveform 3 OFF Start on Alarme NO Delay 12 8 Paper Speed 25 mms Length 30 s Previous Menu Change paper speed 1 425 12 5 0r25 mm s 2 8 4 Print and record Controlling the recording time Print Record You can adjust the recording time to be 30 seconds or continuous which means that the recording continues until the recorder runs out of paper 1 Press the Print Record key 2 Select Record Waveforms 3 Select Length and choose 30 s or Cont The default setting for the recording time is 30 seconds NOTE When recording is activated by alarms the recording time is always 30 seconds gt Record amp Print Record Waveforms Record to Net Recor
4. Start up labels are Art and CVP Other labels are IBP1 IBP2 PA RAP RVP LAP ICP ABP UAC and UVC Assigning the appropriate label automatically changes other pressure settings accordingly Scales are assigned by the monitor when the channel is labeled Scales can also be individually adjusted between 10 and 300 mmHg in steps of 10 With the numeric display format you can choose either the Systolic Diastolic numbers S D or the Mean pressure value Mean in large size to the screen You can also choose all values S D M to the screen If the label is ICP also the CPP selection is available see also page 15 7 Use the Trim Knob to change the invasive blood pressure averaging time The available values are Normal and B TO B beat to beat With selection Normal normal averaging is used Depending on the label the values are updated approximately every five seconds With selection B TO B no averaging is used and the values of the last detected pulse are displayed These values can change up to three times per second This feature is useful when it is necessary to detect fast pressure changes NOTE This setting affects only the displayed values not the averaging of invasive pressure trends Filter FrequencyMeasured signal is filtered to remove noise and artifacts Use the Trim Knob to adjust the filter HR Source IBPX Alarm between 4 and 22 Hz If the ECG signal is affected by too much noise for a reliable heart rate calculation
5. The audible alarm signal may be paused temporarily from a central station ALARMS Do not rely exclusively on the audible alarm system for patient monitoring Adjustment of alarm volume to a low level or off during patient monitoring may result in a hazard to the patient Remember that the most reliable method of patient monitoring combines close personal surveillance with correct operation of monitoring equipment After connecting the monitor to the central station and or nurse call system verify the function of the alarm system The functions of the alarm system for monitoring of the patient must be verified at regular intervals Make sure alarm light brightness is adequate for care environment Make sure alarms are active and set according to patient condition Only the highest priority alarms are sent on Unity Network ACCURACY If the accuracy of any value displayed on the monitor central station or printed on a graph strip is questionable determine the patient s vital signs by alternative means Verify that all equipment is working correctly Alarm indications When the monitor is turned on you will hear a beep this tells you that the alarm audio signal is working Also the alarm light are lit up in red gellow and cyan You can also check the functioning of the audio signal through Alarms Setup Alarm Volume f alarms are turned off or a power interruption occurs when there is no battery backup for up to 15 minutes check the a
6. Weight kg Blood Pressure mmHg Previous Menu Change height unit 4 Lem ar inch Set the units for height weight and blood pressure 6 3 B40 B20 Patient Monitor Changing alarm options 1 Press the Monitor Setup key select Install Service and enter the password 2 Select Installation Alarm Options e Select Show limits and YES to show alarm limits in digit fields NO is the default e Select Show Audio ON OFF and YES to enable alarm silencing Selecting NO default disables silencing options in the Audio ON OFF menu in Alarms Setup NOTE The Show Audio ON OFF setting should be changed only by the system administrator e Select Latching Alarms and YES to keep alarm messages on screen until Silence Alarms key is pressed NO is the default e Select Reminder Volume and adjust the volume of the audible alarm reminder tone e Select Alarm Tones and IEC ISO ISO2 default or General Other alarm settings alarm limits and alarm volume can be changed in the Alarms Setup menu To make the changes permanent save them in user modes see section Saving changes in user modes Changing printer settings 1 Press the Monitor Setup key 2 Select Install Service and enter the password 3 Select Installation Printer e Select ECG Printout Type and 2x6 25 mm s 2 columns 6 lines 25 mm s default 2x6 50 mm s 2 columns 6 lines 50 mm s or 3x4 25 mm s 3 columns 4 lines 25 mm s e Select Printer
7. 3 Installation Safety precautions Warnings Cautions The monitor or its components should not be used adjacent to or stacked with other equipment If adjacent or stacked use is necessary the monitor and its components should be observed to verify normal operation in the configuration in which it will be used After transferring or reinstalling the monitor always check that it is properly connected and all parts are securely attached Pay special attention to this in case of stacked mounting Do not use without manufacturer approved mounting Never install equipment above the patient The monitor display is fragile Ensure that it is not placed near a heat source or exposed to mechanical shocks pressure moisture or direct sunlight Unpacking instructions 1 Confirm that the packing box is undamaged If the box is damaged contact the shipper Open the top of the box and carefully unpack all components Confirm that all components are undamaged If any of the components is damaged contact the shipper Confirm that all components are included If any of the components is missing contact your GE Healthcare distributor Choosing location Consider the following aspects Lighting Space Connections Electromagnetic and radio frequency interference For details see ElectroMagnetic Compatibility section in User s Guide Environment Mounting the monitor Mounting of monitor to the Wall Mount Rollstand W
8. alpha frequency band Anesthesia Monitor amplitude anterior apnea arrhythmia arterial pressure asystole atmospheric pressure atmospheric ambient temperature and pressure dry gas ambient temperature and pressure saturated gas atrioventricular left foot augmented lead average left arm augmented lead right arm augmented lead airway axillatory temperature brainstem auditory evoked potential balance gas 1 atmosphere beta frequency band bigeminy bispectral index bladder temperature blood temperature C O measurement System description Body BP Brady BSA BSR B to B BTPS C C Cla v O C C O CFI Gl CO cal Calc Calcs CAM CaO Casc cc CCCM CCM CcO CCU CEL CFI CISPR cmH O CMRR CO CO COHb Compl Cont Contrl Core Count CPB CPP CSA CT CvO body temperature blood pressure bradycardia body surface area burst suppression ratio beat to beat body temperature and pressure saturated gas calculated derived value chest arteriovenous oxygen content difference continuous cardiac output cardiac function index cardiac index cardiac output calibration calculated derived value calculations Compact Anesthesia Monitor arterial oxygen content cascaded ECG cubic centimeter Compact Critical Care Monitor Critical Care Monitor capillary oxygen content cardiac coronary care unit Celsius degree cardiac function index International Special Committee on R
9. e Adjust the alarm limits Table 10 2 Other problems related to airway gas measurement Symptom Possible cause and solution Airway gas values e Check the sampling line and connectors for leakage are too low Table 10 3 Other problems related to arrhythmia measurement Symptom Possible cause and solution Extra arrhythmia alarms The morphology of the ECG signal has changed e Start relearning manually through the ECG menu Extra Ventricular Fibrillations are detected Patient s medical condition e Check the patient status Low amplitude signal in some ECG leads e Leads and Il Select the one with the largest amplitude to ECG1 e After selecting the leads start relearning manually 10 5 B40 B20 Patient Monitor 10 6 Table 10 4 Other problems related to batteries Symptom Possible cause and solution Battery operation e Condition the batteries according to the instructions in this time is markedly manual shortened Table 10 5 Other problems related to ECG measurement Symptom Possible cause and solution ECG signal is e Ensure that the patient is not shivering noisy or no QRS is detected Incorrect ECG filter e Check the filter through ECG ECG Setup Filter Poor electrode quality or wrong positioning e Check the electrodes and cables and their placement See section ECG for details e Change the lead e Remo
10. 15 Invasive blood pressure Safety precautions Warnings e Allinvasive procedures involve risks to the patient Use aseptic technique Follow catheter manufacturer s instructions e Make sure that no part of the patient connections touches any electrically conductive material including earth e Mechanical shock to the invasive blood pressure transducer may cause severe shifts in zero balance and calibration and cause erroneous readings e Wheninitializing the IBP parameter Invasive blood pressure alarm activation criteria may result in inactive limit alarms Overview You can measure and monitor two invasive blood pressures at the same time using a dual invasive blood pressure cable To measure invasive blood pressure you need the IBP configuration in monitor During the invasive blood pressure measurement the transducer converts pressure variations into electrical signals The electrical signals are amplified and displayed as numeric pressure values and waveforms Invasive pressures connector Figure 15 1 Invasive pressure measurement connector B40 B20 Patient Monitor Direct function keys There is a key for zeroing IBP on the Command Board IBP Zeros all pressure transducers Zero All NOTE Selecting Zero ALL does not zero ICP Zero it separately Display of invasive blood pressure Not zeroed 12 15 10 Figure 15 2 InvBP display 1 2 3 4 5 Invasive blood pressure wavefor
11. A failure Both batteries failed Battery A missing Submenu Selecting a menu item with this symbol opens a new menu The monitor is connected to Network A blinking heart next to the heart rate or pulse rate value indicates the beats detected A lung next to the respiration rate value indicates that respiration rate is calculated from the impedance respiration measurement Do not reuse Use by Indicates the last use day System description dl EN SSI ro C US 3269 Date of manufacture Do not immerse the sensor in liquids Medical Equipment No 601 1 With respect to electrical shock fire and mechanical hazards only in accordance with IEC 60601 1 UL 60601 1 IEC 60601 2 27 IEC 60601 2 30 IEC 60601 2 34 IEC 60601 2 49 CAN CSA C22 2 B40 B20 Patient Monitor Abbreviations min E SF Hg A A a a AO AaDO AA AAMI ABG ABP ADU AEP AirW Alpha Al AM Amp Ant APN Arrh Art ASY ATMP ATPD ATPS AV avF avg aVL aVR aw Axil BAEP Bal bar Beta Be Bigem BIS Blad Blood beats per minute breaths per minute Celsius degree Fahrenheit degree microgram arm describing location alveolar arterial arterio alveolar PO ratio alveolo arterial oxygen difference anesthetic agent Association for the Advancement of Medical Instrumentation arterial blood gases arterial pressure Anesthesia Delivery Unit auditory evoked potential airway temperature
12. CO measurement If you select AUTO the rate is automatically calculated from the measured CO If impedance measurement is present and the source is AUTO the respiration rate calculation switches back to impedance respiration if you press the Silence Alarms key during an Apnea alarm Opens the CO alarm adjustment menu to change the CO alarm limits Resp Rate Alarm Opens the Resp Rate alarm adjustment menu to change the respiration rate alarm limits Previous Menu Returns to the previous menu Selecting alarm sources To select alarm sources go to the CO2 Setup menu s submenu CO2 Alarm The selections are Fl or ET as the high and low alarm limit 17 5 B40 B20 Patient Monitor Calibrating NOTE Ensure that the calibration gas and regulator are functioning properly before calibration Perform annual maintenance of the regulator as required NOTE Do not wash or disinfect calibration gas sampling lines The airway module should be calibrated once every six months or whenever there are indications of errors in the gas readings Calibrate the gas measurement with the GE Healthcare calibration gas Do not use any other calibration gases Use the regulator 755534 or equivalent Use the gas 755580 only and set the CO concentration to 20 If you do not use the recommended calibration gases the calibration does not succeed During gas calibration units are always used for CO regardless of selected measuring u
13. Figure 12 3 Impedance respiration waveform and numeric respiration rate value B40 B20 Patient Monitor Patient connections The setup is the same as for the ECG measurement For more information see section ECG R RED IEC L YELLOW IEC R RED IEC RA WHITE AAMI LA BLACK AAMI RA WHITE AAMI L YELLOW IEC LA BLACK AAMI x SON C WHITE EC SSS V BROWN AAMI N BLACK IEC gm RL GREEN AAMI jedem F GREEN IEC pm LL RED AAMI Figure 12 4 Impedance respiration setup 1 ECG connector 2 Multi link 5 lead standard cable 3 Multi link leadwire set 3 or 5 leads ECG electrodes pre gelled electrodes are recommended Check the expiration date NOTE For a comprehensive list of accessories see the Supplies and Accessories catalog 12 4 Impedance respiration Activating measurement Select respiration in a waveform or a digit field otherwise the respiration information is not included in the trends and the alarms are not operative Monitor Screen Setup Screen Setup Setu 5 Sep Waveform Fields Dight Fields Lower Field 1 Lower Field 1 Resp More Lower Field 2 Resp Lower Field 2 NIBP Lower Field 3 IBP1 Lower Field 3 T1 T2 Lower Field 4 IBP2 Lower Field 4 CO2 Lower Field 5 Pleth Previous Menu Lower Field 6 CO2 Combine Pressures NO Previous Menu Change waveform in field 2 pr Change con
14. Turnthe Trim Knob until the displayed value matches the desired value in the gas bottle and push it again Repeat these two steps for each gas Airway Gas Gas Calibration Coe 5 00 Previous Menu Last calibration Adjust values to match calibration gas gt The use of an old regulator with the new aerosol cylinders requires an adapter available from GE Healthcare For ordering details see the Supplies and Accessories catalog If the message Zero error is displayed press the Normal Screen key and repeat the calibration procedure If the problem persists contact authorized service personnel The monitor performs autozeroing after start up The autozeroing intervals are 4 min 15 min 30 min and 60 minutes after start up thereafter every 60 minutes NOTE If you are using separate gas cylinders calibrate each gas separately The time of the last calibration is shown at the bottom of the menu page 17 7 B40 B20 Patient Monitor Interfering gases Non disturbing gases are those with a maximum effect on the CO reading lt 0 2 vol The effect is valid for specific concentrations shown in parentheses of the non disturbing gas Ethanol C H OH lt 0 3 Acetone lt 0 1 Methane CH 0 296 Nitrogen N3 water vapor Dichlorofluoromethane 196 Tetrafluoroethane 196 Disturbing gases and their effect on the CO reading at 5 0 vol 96 CO are shown below Errors listed refle
15. You can do this for the duration of monitoring or save the changes in the user mode To make the changes permanent save them in the user mode through Monitor Setup Install Service Save Modes Alarms message field Waveform waveforms or trends Digit Field 1 Digit Field 2 Digit Field 3 Digit Field 4 Figure 6 1 Display fields To change the Normal Screen page 1 Press the Monitor Setup key 2 Select Screen Setup 3 Select Waveform Fields Digit Fields split Screen or Minitrend Length Monitor Monitor Setu Setup Screen Setup Waveform Fields Digit Fields Split Screen None Minitrend Length 30 min Previous Menu Set waveform fields and related digits displayed on Normal Screen O 4 NOTE Choosing the same parameter in the waveform and digit field makes the previously chosen field disappear 6 7 B40 B20 Patient Monitor Modifying waveform fields 6 8 E 40 160 fe hf min Arrh analys Severe 1 Press the Monitor Setup key 2 Select Screen Setup 3 Select Waveform Field Up to six waveforms can be displayed at a time Monitor Setup Screen Setup Waveform Fields Lower Field 1 Lower Field 2 Lower Field 3 Lower Field 4 Lower Field 5 Lower Field 6 Combine Pressures Previous Menu Change waveform in field 2 Select OFF to clear field gt O Lo When waveforms are configured to be disp
16. of this directive The country of manufacture can be found on the equipment labeling The product complies with the requirements of standard IEC 60601 1 2 Medical Electrical Equipment Part 1 2 General requirements for safety Collateral standard Electromagnetic compatibility Requirements and tests The product meets Class A EMC limits in accordance with CISPR 11 Product Compliance 1 2 The B40 B20 Patient Monitor is classified in the following categories for compliance e This equipment is suitable for connection to public mains as defined in CISPR 11 e This Monitor conforms to general safety standard for medical devices to IEC 60601 1 e This Monitor conforms to EMC safety standard to IEC 60601 1 2 e This Monitor conforms to usability safety standard for medical devices to IEC 60601 1 6 e Software is developed in accordance with IEC 60601 1 4 e _ The application of risk management analysis to medical device conforms to ISO 14971 e TheSpO Parameter conforms to ISO 9919 e The TEMP parameter conforms to EN 12470 4 e The CO parameter conforms to ISO 21647 e This Monitor conforms to particular safety standard for multifunction patient monitoring equipment to IEC 60601 2 49 e The invasive blood pressure parameter conforms to the IEC 60601 2 34 e The ECG parameter conforms to IEC 60601 2 27 ANSI AAMI EC13 e TheNIBP parameter conforms to IEC 60601 2 30 EN 1060 1 EN 1060 3 ANSI AAMI SP10 e Thealarm systems
17. Beat Sound Volume HR Source SpO2 Alarm Adjusting the SpO beat volume also affects the beat volume of ECG When SpO is monitored the monitor provides a variable pulse beep so that the tone of the pulse beep rises with increasing oxygen saturation and falls as saturation decreases You can select the volume from 1 soft to 10 loud With selection 0 there is no audible sound Selects the heart rate source If the ECG signal is affected by too much noise for a reliable heart rate calculation heart rate can also be calculated from invasive pressure Art ABP or plethysmographic pulse waveform Pleth The selected heart rate source is displayed above the numerical display of the heart rate The color of the heart rate is the same as that of the source parameter The AUTO selection priorities for heart rate calculation are ECG the lead with highest R wave pressure Art ABP and plethysmographic pulse waveform Alarms can be adjusted in this menu or in the Alarms Setup menu which opens by pressing the Alarms Setup key 14 5 B40 B20 Patient Monitor During monitoring Patient condition or prolonged use may require changing the sensor site periodically Check skin integrity circulatory status and correct alignment and change sensor site at least every four hours For patients with poor peripheral blood circulation or sensitive skin change the site at intervals of 30 minutes to one hour To confirm the circulatory status obse
18. EE CEU o PDC B Ov o Orate 5 1 SO io a TIO Sco x end eraan eenen cdd e obice DIA IUE 5 2 Vel nale een an steak ODE T DECRE ROREM 5 2 Alarm Categories ues be Moe 5 bc ion Yee ieri Dub ee Piper Gees bos bet bende ln 5 3 Alar e a cus na cu cad UEM S Ce A Manis M LE EDEN E 5 3 A A sei OM 5 4 Alei eet ab ea tee AS E ee A 5 4 Alarms Set MEAN iiec Pre PRODI PPP eden elie derbi deed 5 5 Adj sting alarm MSS uso cer aaa es 5 7 ANSEMS ee 5 7 Choosing UTOR UIC NETS soa ae ee 5 7 Returning to default limits sr c ter QUT C OO e e da e el 5 7 Changing alar sources ar ea a er e ee Erb etta 5 8 SI I ola e a ER TS NE A 5 9 Silencing audible alarms temporarily eenen 5 9 Reactivatihg gole an gE 5 9 Silencing audible alarms permanently eeen 5 10 Reactivating alarme COTE 5 11 Dedctivating AMS tin eier 5 11 Automatic recording On AIG Sane ee 5 12 sl REET od dte Dis I RR 5 13 Other adjustable features ru teer ets tat SHE EH ROLE ea HES 5 13 Displaying ADT REG iod ies AR EE An ine 5 13 Enabling or disabling alarm Se Iesse vue Ace x coude eb te ens 5 14 GORE c rr CE 5 15 Reminder MOUS seren tenders a peter ee ee bees tute v eng 5 16 Changing trie TORE patterns e mer sace da can de HEU ERE 5 16 6 Monitor setup EVR LOWY eno Ca eibi a Bele bu sr icd dre Eno Od RCM ans 6 1 Configuration and Passwords iss comete epu tse a ERREUR EST 6 1 a o ae eae ae Ue TR E ae cir dee 6 2 Battery Setups bilem ie ae dee Mathis b desi Do as 6 2 Changing monit
19. EtAA EtBal EtCO EtN O EtO ET tube ETT EVLW EVLWI Exp FAH FEMG FFT FI Fi FIAA Fib FiBal FiCO FiN FiN O FiO Flow Freq ft FVloop GEDI GEDV GEF Graph Hal Hb Hbtot HCO3 Hemo end systolic volume end systolic volume index end tidal concentration end tidal anesthetic agent end tidal balance gas end tidal carbon dioxide end tidal nitrous oxide end tidal oxygen endotracheal tube extravascular lung water extravascular lung water index expiratory foot describing location Fahrenheit degree frontal electromyogram fast Fourier transform fraction of inspired gas fraction of inspired anesthetic agent fibrillation fraction of inspired balance gas fraction of inspired carbon dioxide fraction of inspired N fraction of inspired nitrous oxide fraction of inspired oxygen airway gas flow frequent foot feet flow volume loop Gauss gram global enddiastolic volume index global enddiastolic volume global ejection fraction graphical hour hand describing location halothane hemoglobin total hemoglobin bicarbonate hemodynamic B40 B20 Patient Monitor Hemo Calcs HHb HME HMEF hPa HR HRdiff ht HW Hz EC E ABP CP CU mped nf nfl nsp nv nv BP rreg SO SO SM TBV VR kcal kJ kPa hemodynamic calculations reduced hemoglobin heat and moisture exchanger heat and moisture exchanger with filter hectopascal heart rate heart rate d
20. Measurement accuracy 5 or 5 resp min whichever is greater Nomalized respiration sensing current 5 0 HA mpedance respiration 31 25 kHz carrier frequency GE SpO specifications Measurement and display O to 100 range Calibrated against functional oxygen saturation Measurement accuracy 100 to 7096 2 digits 69 to 096 unspecified Display resolution 1 digit 196 of SpO Display averaging 5 to 20 seconds Wavelength of SpO probe Infrared LED 940 nm LEDs RedLED 660 nm Maximum energy of SpO Infrared LED 42 uJ pulse probe LEDs Red LED 62 uJ pulse Artifact rejection SpO values 3 and PR values 5 when trapping with a finger for 10s Pulse rate Measurement and display range 30 to 250 bpm Display resolution 1 bpm Measurement accuracy 5 or 5 bpm whichever is greater B40 B20 Patient Monitor Nellcor SpO specifications Measurement and display 1 to 100 range Measurement accuracy Adult 100 to 70 2 digits Neo 100to 70 3 digits Low perfusion 100to 70 2 digits Display resolution 1 of SpO Display averaging 2 to 7 seconds Pulse rate Measurement and display range 20 to 250 bpm Display resolution 1 bpm Measurement accuracy 3 digits Sensor Light Source Wavelength Infrared 890 nm nominal Red 660 nm nominal Power Dissipation
21. Mera o Mode cM o a dl 7 1 ended parameters anne teen de 7 1 MESES MiS Aen e e e Mia te VEM TANE E o 7 2 A AAA O E 7 3 Mitre nara Hat yace O Ms Out de eek Dt ade 7 4 Removing minittend A potiti xD eine 7 4 Graphical Trend VIBU e varna aperta anke nent ern er armer pad EX 7 5 O est 7 6 Aracena oo on d 7 7 Changing trend length and ressl tion 34 a n 7 7 Moving on graphical trend pates u ae nen 7 8 Recording and PRINTING Areas 7 8 Factor detanit parameters dnek lined 7 8 Numerical trend MEW rd e ee li dle de Ne 7 9 Numerical trend PAGES su es alte 7 10 Moving between numerical trend pages neee 7 10 Recording did PRAAG a Brass 7 10 Factory default parameters ri ara re 7 10 Erasmo AAE ne et es estate 7 11 8 Printand record OVINTE E EA A O NEE 8 1 jaa e A RA A date Bis atl a 8 1 Direct function KEUS aussen ia 8 1 Recording WAVEIOEMIE or c3 LEM a seco ee Wa Manan a oot 8 2 Sample of Waustorm Tecordia nee 8 3 Selecting waveforms for recording naar 8 3 iv Document no 2050801 001 Changing the paperspeed 5 e e e IL eet eode 8 4 Controlling the recording UMB uos see bewer a ia 8 5 Selecting the recording delay UMB vete veran ea ONT pU 8 5 Recording BAGS eher ei ida alsde Pei dde a o AN 8 6 Recording tiendss insine A AA ee el 8 7 Recording numerical trends asus ea 8 7 Tabular trend TONOE a ae en ke ur ee re es 8 8 Selecting graphical Ends AO nn 8 8 INSertingTecorder PA NE doce 8 9 A O 8 10 Print
22. Previous Menu Select YES for automatic start of recording when serious arrhythmias occur Recording time is 30 seconds consisting of 12 seconds recording from the recorder memory and 18 seconds real time recording The alarm source is always marked to the alarm recordings The following alarms start the recording Alarm Recorded parameters Asystole ECG1 Art waveforms 25 mm s Tachy Brady ECG1 Art waveforms 25 mm s Art High Low ECG1 Art waveforms 25 mm s V Fib ECG1 Art waveforms 25 mm s V Tachy ECG1 Art waveforms 25 mm s Alarming level Alarms which start the recording Severe Asystole Tachy Brady Art High Low V Fib V Tachy Alarms Showing alarm history e Pressthe Pt Data Trends key and select Alarm History This displays a list of the last 20 alarms that have reached the yellow red and cyan alarm level The time and type of occurrence are displayed next to the alarm list items Other adjustable features NOTE This section describes the rest of the adjustable features regarding the alarms You can adjust each feature if you know the required password for entering the Install Service menu If you wish to adjust the settings we recommend that you contact the person responsible for the entire configuration Displaying limits You may select the alarm limits to be displayed next to the numerical parameter value 1 Press the Monitor Setup key 2 Select Install
23. RL R RA ULA F LL C5 B40 B20 Patient Monitor Color and letter coding IEC standard 3 lead ECG Position 5 lead ECG Position Position on on body on body surface surface surface R red right arm R red right arm right arm L yellow left arm L yellow left arm left arm F green left leg F green left leg left leg N black right leg neutral right leg neutral C white chest 4th intercostal space at right border of sternum AAMI standard 3 lead ECG Position 5 lead ECG Position Position on on body on body surface surface surface RA white right arm RA white right arm right arm LA black left arm LA black left arm left arm LL red left leg LL red left leg left leg RL green right leg neutral right leg neutral V brown chest 4th intercostal space at right border of sternum ECG ECG Setup menu ECG ECG ECG ECG Setup 3 HR Source AUTO ECG1Lead II ECG2Lead v5 ECG3 Lead aVL ECGSize 10 Display with HR None Adjust ST Filter Monit Relearn N Pacemaker Hide QRS width Normal ECG Alarms Grid OFF Screen Setup 5 lead cable 5 elect Normal Scrren Vlead V5 et beat sound volume Previous menu HR source filter and Adjust volume of pulse heart gt beat sound pacemaker Beat Sound Volume HR Source Adjusts the pulse heart beat sound volume 0 to 10 When the mo
24. You can also check the battery status through Monitor Setup Battery Setup The internal battery capacity is up to 4 5 hours with fully charged batteries gt Monitor Setup Screen Setup B Battery Setu p Sweep Speeds E Previous Menu Display brightness 70 Remaining time Time and Date Battery amp 02 50 Help BatteryB 02 38 Battery Setup Total 05 28 Battery Quality Instal 1 Service Battery A OK Mormal Screen BatteryB OK Show remaining battery time and battery status Return to previous menu gt NOTE When the monitor is battery powered the green battery LED is on When the monitor is mains powered the green mains LED is on When the monitor is battery charging the orange battery LED is on If you wish to have the battery charge visible at all times select it in one of the digit fields Monitor Setup Screen Setup Digit Fields Battery You can now see how much charging time is left for each battery separately both in numbers and as symbols and the total charging time in numbers Battery Time 5 20 A B h min 2 7 B40 B20 Patient Monitor Battery indicators The B40 B20 messages screen symbols and front panel LED indicators tell the user about the status of the batteries For screen symbols see page 2 14 For LED indicators consult the table below and for messages see section Troubleshooting Table 2 1 Battery indicators Screen symbo
25. _ Avoid excessive use of liquids e Disinfect when necessary e Allow the product to dry completely after cleaning Pulse oximetry sensors The GE Healthcare pulse oximetry sensors are latex free Take possible patient allergies into account also when selecting the cleaning agent 1 Detach the sensor from the patient and the monitor 2 Wipe the sensor with mild detergent solution Allow it to dry completely before use Sensors can be disinfected with chlorite compounds The sensors may be sterilized using an ethylene oxide mixture at 50 to 60 C 120 to 140 F NOTE After ethylene oxide sterilization sensors must be well aerated in a ventilated place Temperature probes e Clean with mild detergent solution and rinse with water e Disinfect or sterilize when necessary NIBP cuff hose e Thecables and hose can be wiped with mild detergent solution e Disinfect when necessary NIBP cuff The NIBP cuffs listed in the Supplies and Accessories catalog are latex free Take possible patient allergies into account also when selecting the cleaning agent e Clean only when necessary Wash the cuff in mild detergent solution Do NOT use alcohol Invasive blood pressure cables e Wipe the cables with sterile alcohol based detergent After cleaning rinse surfaces by wiping them with a cloth damped with sterile water Dry with a dry cloth Airway adapter e Replace the single use adapter after each patient A reusable adapt
26. correct type and rating NOTE Only a qualified medical personnel allow to operate Cleaning The appropriate cleaning procedure depends on where and how the part or accessory is used and on the patient s condition Permitted detergents and disinfectants Tap water Distilled water Ethyl alcohol 99 5 Ethyl alcohol 95 to 96 Ethyl alcohol 90 methyl alcohol 10 Ethyl alcohol 80 Isopropyl alcohol 60 Phenol 2 Purified benzine Chloramine 5 Glutaraldehyde 2 Monitor casing e Wipe with mild hospital detergent solution Make sure not to leave any liquid spills on any metal part e letdry completely before connecting to power source e Checkventilation holes and clean if necessary Modules e Wipe the front panel as any monitor casing e Donot wash or immerse module in any liquid The internal sampling system of the airway module does no cleaning nor sterilization The water trap functions as a bacteria filter and there is no reverse flow back to the patient If the measuring chamber is suspected to be contaminated for example gas zero error the airway module should be serviced by authorized service personnel Display e Wipe all splashes immediately with a dry cloth e Wipethe LCD display after use with a cloth moisturized with mild detergent solution ECG cables e Wipe the cables with mild detergent solution 9 5 B40 B20 Patient Monitor 9 6 e
27. cuff pressure are measured to determine the mean pressure and calculate the systolic and diastolic pressures During an NIBP determination the parameter deflates the cuff one step each time it detects two pulsations of relatively equal amplitude The time between deflation steps depends on the frequency of these matched pulses pulse rate of the patient However if the monitor is unable to find any pulse within several seconds it will deflate to the next step The process of finding two matched pulses at each step provides artifact rejection due to patient movement and greatly enhances the accuracy of the monitor In stat mode some steps may require only one pulse Pump Up Pressure 180 Target Pressure 13 CUFF PRESSURE H TIME 1 Figure 13 4 Full NIBP Determination Sequence for Adult At each step the microprocessor stores cuff pressure the matched pulse amplitude and the time between successive pulses The stepped deflation and matched pulse detection continues until diastolic pressure is determined or total cuff pressure falls below 8 mmHg The parameter then deflates the cuff to zero detected pressure analyzes the stored data and updates the screen Non invasive blood pressure The operating cycle is composed of four parts inflation time deflation time evaluation time and wait time Wait time which varies from mode to mode is affected by the cycle time auto mode or operator intervention manu
28. display 11 12 monitoring ST segment 11 12 setting alarm limit 11 14 Surface temperature 16 3 Sweep speed changing waveform sweep speed 6 11 Symbols trend 7 6 System configuration 6 1 messages 10 2 T Temperature changing label 16 3 changing units 16 4 checklist 16 4 cleaning the probes 9 6 combining temperatures 16 4 display 16 2 label 16 3 testing 16 4 Temperature measurement setup 16 2 Time setup 6 2 Trend configuring 6 13 graphical pages 7 7 graphical trend view 7 5 printing numerical 7 10 recording numerical 7 10 symbols 7 6 trended parameters 7 1 Tympanic temperature 16 3 U Unit changing for different parameters 6 3 temperature 16 4 User leads 11 9 User mode renaming 6 6 W Water trap 9 6 care 9 6 Waveform 6 8 modifying the field 6 8 Index Installation and checkout form B40 B20 APPENDIX A Installation and checkout form B40 B20 Customer Service Service engineer Date OK Test OK N A Test not applicable Fail Test failed NOTE Refer to the Technical reference manual for Electrical Safety tests procedure Chapter Maintenance Electrical Safety Tests OK N A Fail 2 4 Power Outlet Test 2 5 Power cord and plug 2 6 Ground Earth Integrity m 0 1 ohms Ground continuity tes
29. from the balloon pump device GE Healthcare monitors are designed for use with dual hose cuffs and tubing The use of single hose cuffs with dual hose tubing can result in unreliable and inaccurate NIBP data If a patient s beat to beat pulse amplitude varies significantly e g because of pulsus alternans atrial fibrillation or the use of a rapid cucling artificial ventilator blood pressure and pulse rate readings can be erratic and an alternate measuring method should be used for confirmation If Luer lock connectors are used in the construction of tubing there is a possibility that they might be inadvertently connectd to intravascular fluid systems allowing air to be pumped in to a blood vessel Devices that exert pressure on tissue have been associated with purpura skin avulsion compartmental syndrome ischemia and or neuropathy To minimize these potential problems especially when monitoring at frequent intervals or over extended periods of time make sure the cuff is applied appropriately and examine the cuff site and the limb distal to the cuff regularly for signs of impeded blood flow B40 B20 Patient Monitor e Periodically check patient limb circulation distal to the cuff Check frequently when using Auto NIBP in one and two minute intervals The one and two minute intervals are not recommended for extended periods of time e The monitor sets the inflation pressure automatically according to the previous measurement
30. heart rate can be calculated mechanically from the pressure Art or plethysmographic pulse waveform The selected heart rate source is displayed above the numerical display of the heart rate The color of the heart rate is the same as that of the source parameter Auto selection prioritizes the heart rate calculation in a specified order ECG the lead with highest R wave pressure Art and plethysmographic pulse waveform Alarms can be adjusted in this menu or in the Alarms Setup menu which opens by pressing the Alarms Setup keu 15 5 B40 B20 Patient Monitor Determining pressure values visually By moving the horizontal cursor across the pressure waveform you can get accurate pressure values at selected points This may be useful for example if the patient s breathing pattern is irregular The cursor is not available for pressures shown with a combined scale 1 Press the IBP key 2 Select Px Setup Px Cursor 3 Move the cursor up or down by turning the Trim Knob Every time the cursor is moved the time hours and minutes and pressure values are displayed on the screen This way you can keep track of the changes made 4 You can remove the cursor by selecting Remove cursor Note that if the cursor is not removed it remains visible in the Normal Screen Labeling channels The label of the pressure channel sets its display scale color filter alarm source and alarm IBP limits The label descriptio
31. in the relevant section If gas measurement is in extensive use calibration is recommended every two months NOTE Do not wash or disinfect calibration gas sampling lines Conditioning the batteries Condition batteries regularly to maintain after their useful life This is best done on an external charger Condition a battery every six months or when the message Replace Battery x appears status You can also check the status through Monitor Setup Battery Setup If you do not have an external charger proceed according to the following instructions NOTE You cannot condition batteries during patient monitoring Always disconnect the modules first Save the patient data and mode settings if necessary 1 Continue normal battery use until the green bar of a battery charge indicator in screen is less than 3 4 of the full height After this remove the battery Continue monitoring with one battery until its charge is less than 3 4 of the full capacity 2 Insert both batteries and connect the monitor to the power supply The monitor starts charging both batteries and the capacity indicators scroll accordingly Keep charging the batteries until both capacity indicators are full height 3 Continue charging for another two hours After this check that the orange battery LED in the panel is no longer on If it is continue charging until it goes off 4 Disconnect the monitor from the power supply and leave it on until the batteries r
32. memory when less than 15 minutes has elapsed from the turn off Contin Previous NOTE This selection is available if the patient is already admitted on this monitor During monitoring e Ifyou need to avoid audible alarms press the Silence Alarms key e Empty the water trap container of the E miniC module whenever it is more than half full Automatic saving of patient data The monitor continuously and automatically collects and saves patient data such as trends Saving is activated once the patient is admitted or the monitor receives vital data If the monitor is not connected to the network patient data is saved to the monitor memory If the monitor is connected to the network patient data is automatically saved to the network The network saves data from up to 2 to 90 days The amount depends on the network configuration Discharging the patient When you end monitoring discharge the patient The monitor erases screen layout trend data and alarm and parameter settings that were active during monitoring and returns to the starting mode and its settings 1 Press the Admit Discharge key 2 Select Discharge Yes 4 6 Monitoring basic Automatic discharge of the patient The monitor will discharge a patient automatically after 24 hours when vital signs for some parameters ECG Art NIBP SpO Resp and CO with E miniC only are not available When this happens all trend data will be cleared and alarm limits
33. minute minitrend once every minute To modify the minitrend length 1 Press the Monitor Setup key 2 Si Select Screen Setup Select Minitrend Length and choose 5 min or 30 min Monitor setup Other adjustable screen features Changing sweep speeds You can change the speed of the waveforms on the screen For CO and Resp parameter the selections are Fast 6 25 mm s and Slow 0 625 mm s For hemodynamic parameters the selections are 12 5 25 and 50 mm s Slow waveforms have a sweep speed one tenth of normal for a full screen sweep Slow waveforms show amplitude changes better than fast waveforms 1 2 Press the Monitor Setup key Select Sweep Speeds select the parameter and adjust the value Displaying pulse rate Combined heart rate and pulse rate can be displayed next to the ECG waveform The current HR source is displayed with bigger font and the heart rate symbol flashes next to it ECG art H 5 8 min 58 ai 1 2 3 Press the ECG key Select ECG Setup Select Display with HR and PR PVC or None Changing parameter colors You can select the color of each parameter to be yellow white green red or blue For some parameters also violet is possible To change the color 1 Za 3 4 Press the Monitor Setup key Select Install Service and enter the password Select Colors Selectthe desired parameter and the color B40 B20 Patient Monitor Changing the recorder and printer setti
34. mode to meet the need of your clinical situation Autocycling is synchronized to real time for example if the first measurement was at 12 02 the next measurement is at 12 05 and again at 12 10 5 min interval Setting cycle time The possible intervals for autocycling are 1 2 3 4 5 10 15 20 30 60 90 120 minutes and the custom option To set the cycle time e _ Press the NIBP key on the Command Board and select Cycle Time e Select the alternative with the Trim Knob NIBP Cyde Time 5min Custom Start Cycling 1 min Start STAT 2 min Start Manual 3 min Custom Setup 4 min NIBP Setup 5 min NIBP Alarm 10 min Screen Setup 15 min Normal Screen More Change interval between automatic cuff inflations gt NOTE When you select the custom option the NIBP measurements will follow custom mode You need configure or verify the custom mode s set up before start the automatic measurements 13 7 B40 B20 Patient Monitor Setting custom mode NIBP You can set up to 4 separate steps for auto NIBP determinations by setting the time interval and how many times this interval is repeated To set the custom mode Press the NIBP key Select Custom Setup Set up time interval and repeat times for every series The cycle time can be set to 1 to 120 min or OFF The repeat option can be set to 1 to 25 times or OFF or cont Custom Setup Ist BP Series q5min repeat X4 2nd B
35. of the Monitor conform to IEC 60601 1 8 Introduction Warranty This Product is sold by GE Healthcare GE under the warranty set forth in the following paragraphs Such warranty is extended only with respect to the purchase of this Product directly from GE or GE s Authorized Dealers as new merchandise and is extended to the Buyer thereof other than for the purpose of resale For a period of twelve 12 months from the date of original delivery to Buyer this Product other than expandable parts is warranted against functional defects in materials and workmanship and to conform to the description of the Product contained in this manual and accompanying labels and or inserts provided that the same is properly operated under the conditions of normal use that regular periodic maintenance and service is performed and that the replacements and repairs are made in accordance with the instructions provided using genuine parts and performed by a trained person The foregoing warranty shall not apply if the Product has been repaired by anyone other than GE or otherwise than in accordance with written instructions provided by GE or altered by anyone other than GE or if the Product has been subject to abuse misuse negligence or accident GE s sole and exclusive obligation and Buyer s sole and exclusive remedy under the above warranty is limited to repairing or replacing free of charge at GE s option a Product which is telephonically
36. parameter sections Check that The monitor and its module do not have any visual defects such as cracks or loose parts The batteries are inserted and charged The power cord is connected to an electrical wall outlet and to the monitor The module are pushed properly into the frame and the monitor recognizes the module parameter is displayed on the screen and menu selections are active Patient connection cables are attached to the module connectors Trends of the previous patient are erased Alarm limits are suitable for the patient The desired measurements have been selected for screen through Monitor Setup Screen Setup Waveform Fields or Digit Fields Disposable accessories are not reused Sensors are not expired Power interruption If the monitor is turned off trend data and the latest user made settings remain in the monitor memory for 15 minutes even if the power mains is interrupted After 15 minutes trend data is lost and the monitor returns to the user default settings start up mode 10 1 B40 B20 Patient Monitor Messages Table 10 1 Messages Message Explanation What to do Alarms acknowledged from Central Silenced alarms remain silent New alarms will have an audible sound Can be done using the Central e f required turn on the alarms through Alarms Setup Audio ON OFF Activate Alarms Alarm setup changed from Central Alarm limits or arrhythmia alarm pri
37. patient and placing the electrodes enn 11 4 PREM ORO AG DCIS a e NEE LE M Ad 11 4 Placing the Bleetr des inne beren re see 11 4 Aaa a A A DERE 11 5 Lesdhrnensuremient Rm 11 5 Color and letter eddiNg anne een 11 6 ECG Set p Thenll eos Rn ee bee bee 11 7 Selecta Ee le MERER en a ee 11 8 A e CAAS ee Be 11 9 Viewing dcdscdded BES ves ee ee aaa 11 9 Adiustingthe ECG SEE ne ae 11 9 Starting relecdpblb Oct d Ol 255 lese ee u has 11 10 Setting heart rater m MIES Los Ou Pe ee us 11 10 Setting PC GANS occ pe cenobio p hoo Pride Me t P Ideo Hed d ipd glos 11 11 ST SEIMERFANGI SR eto edo EAR e E Pe 11 12 Qi RU MUERTE EE M en E e de ccc acacia 11 12 li Eo e SR Ts DU MED UR DEM 11 12 Monitoring the ST segment ioa e wets ee a Rp PCR PR E HORS 11 12 Setting the ST measurement POIS a see a 11 13 Setting STAEL IENS er ra tie 11 14 Description of the ST segment measurement algorithm 11 15 Test results of ST segment measurement algorithm testing 11 15 Monitoring ac P MMOs uso een Pho dO Qiu dd ibus 11 16 VVOG ta cm ig e tu M he v ee Pe Mus ise ia DE TU LES 11 16 Adjusting arrhythmia alarm settings sen ee Mo Rer ledere s 11 17 Detecting the ECG arrhythmia alarms 2i sss ett an 11 17 Selecting leads for the arrhythmia analysis o ooooooococcccocococo 11 18 Description of the arrhythmia algorithm s reen ea 11 18 Test results of arrhythmia algorithm testing nn 11 18 Monitorin
38. reported to the nearest GE office or GE s Authorized Dealers office and which if so advised by GE is thereafter returned with a statement of observed deficiency not later than seven 7 days after the expiration date of the applicable warranty to the GE office or GE s Authorized Dealers office during normal business hours transportation charges prepaid and which upon GE s examination is found not to conform to the above warranty GE shall not be otherwise liable for any damages including but not limited to incidental damages consequential damages or special damages There are no express or implied warranties which extend beyond the warranty hereinabove set forth GE makes no warranty of merchantability or fitness for particular purpose with respect to the product or parts thereof B40 B20 Patient Monitor About this manual This User s Reference Manual describes the functions offered by the B40 B20 patient monitor running the software license VSP A As the monitor setup may vary some menus displays and functions described may not be available in the monitor you are using This manual is an integral part of the product and describes its intended use Keep it always close to the equipment Observance of the manual is a prerequisite for proper product performance and correct operation and ensures patient and operator safety NOTE Before using your monitor please read the User s Guide or this manual thoroughly This User
39. s Reference Manual gives you more specific information about the clinical and technical aspects Pay special attention to WARNING and CAUTION statements The new user of the monitor should begin with sections Safety precautions System description and Monitoring basic These sections describe the system and the basic operation ofthe monitor The measurement sections describe the measurement technique setup and how to adjust displays and menus for patient monitoring and special views Section Monitor setup gives instructions about setting up the system and making changes in the default settings Section Cleaning and care describes cleaning and daily maintenance procedures Illustrations and names All illustrations in this manual are only examples and may not necessarily reflect your system settings or data displayed in your system If a particular selection is not available in your system the selection is shown grayed in the menu Allnames used in examples and illustrations are fictitious Conventions used in this manual To help you find and interpret information easily the manual uses consistent text formats Hard keys Names of the hard keys on the Command board are written in the following way Others Menu items Software terms that identify window parts or menu items are written in bold italic Monitor Setup Menu access Menu access is described from top to bottom For example the selection of the Monitor Setup hard ke
40. will be set to default values Ending monitoring 1 Print necessary data Press the Print Record key Wait until the printing is finished Then clear patient data and return settings including alarm limits to their defaults by discharging the patient Press the Admit Discharge key Select Discharge and Yes Turn off the monitor from the ON standby key if the monitor will not be used Clean the monitor according to the instructions see section Cleaning and care 4 7 B40 B20 Patient Monitor Using modes The B40 B20 monitor has seven user modes These user modes are predefined combinations of settings They determine for example what is displayed on the screen and in trends and what the alarm limits are In other words by choosing a specific mode you get suitable settings on the screen without having to choose all features one by one Modes can be hospital specific The monitor starts in start up modes which is one of the user modes chosen during configuration The default modes are STEP DOWN ED PACU CCU NEURO PEDIATRIC and NEONATAL Please refer to the Default Configuration Worksheet delivered with the monitor for more information For more information about the installation settings and using modes see section Monitor setup Setup monitor before use 4 8 For more information about the how to setup monitor see section Monitor setup 5 Alarms Alarms 5 Alarms Ove
41. 5 AA ses E A EEE A E E EEEE 13 6 BITE oe Waar is IL EN 13 6 AUWLOCUCIING ss odor or oe Metti bend lee Heli 13 7 e aas cc t Re e 5 atte at Sach rea TTE RR ERE RET 13 7 Setting custom Mode sssi 22 euo b setis t Rede Anti te tulo 13 8 Starting and stopping GULOCUCIING ssa te Meee ee ee 13 8 Starting and stopping a single manual measurement neen 13 9 Starting and stopping a continuous measurement STAT onee 13 9 Principles of SuperSTAT Noninvasive Blood Pressure Determination 13 10 SUSO MESE Mide dE ANO AE AP EO S EI ca 13 11 te o CHEER un ar Sea 13 12 Checklist os ue ten arenden en EP Ete daa Ge Ho AEL wig ARS 13 12 14 Pulse oximetry Sore FSCO OMS ern 14 1 Warning Ss tene Na ER ee uet a 14 1 O RAAR ERA NBAT IE DEED EE RE 14 2 VEL VIGU cacy EA RP AA ER RO a EP STE EE EEA S SU DR Er 14 2 BE E OR aes 14 3 Patient CORNNECHONS a rie AE ARAS 14 4 Connecting UNE patient zoe arne enkele pides pri 14 4 A A E ear ee 14 5 DURINOSMONITONING ensen id ia hacia 14 6 Removing the SENSOR u Hat le a dd RE desd es MeL eA des 14 6 Measurement limitations u une ee a 14 7 BIS ER EEEN 14 7 vii Document no 2050801 001 B40 B20 Patient Monitor 15 Invasive blood pressure SEI precdadliofiSes ee en endet teven 15 1 Vo ATIA TE EARRAS ee EE 15 1 OVERVIEW Ne ea ene Wate seele 15 1 Directtuncton KEUS marters teile a ee 15 2 Display of invasive blood pressure ennen 15 2 Patent A Aid S e A eet 15 3 Starting W
42. B20 Patient Monitor Combining different temperatures The monitor displays the difference between different temperatures if they are displayed in the same digit field differences T2 T1 are displayed in the temperature digit field if you choose them in the same digit field For example to display T1 T2 1 Press the Monitor Setup key and select Screen Setup 2 Select Digit Fields 3 Select T1 T2 to one of the lower fields Testing temperature The temperature measurement functioning is automatically tested periodically During the test the message Performing temp test is displayed If the test fails the monitor displays the message Temperature error Changing temperature units You can select the temperature unit to be either degrees Centigrade or degrees Fahrenheit 1 Press the Others key 2 Temp Setup Unit 3 Select the unit C or F with the Trim Knob Checklist Check that e Temperature adapter cable is properly inserted into the connector in the module and the probe is inserted into the adapter cable e Temperature probe is positioned correctly e Temperature is selected for screen through Monitor Setup Screen Setup 16 4 17 Airway gas Airway gas CO2 17 Airway gas CO2 Safety precautions Warnings Cautions Notes Always check the airway adapter for a tight connection and proper operation before attaching it to the patient Remove the airway sampling line from
43. Basis A EE 17 9 viii Document no 2050801 001 Index Index 1 Appendix A Installation and checkout form B40 B20 A 1 ix Document no 2050801 001 B40 B20 Patient Monitor x Document no 2050801 001 1 Introduction Introduction 1 Introduction About this device Intended purpose Indications for use This device is a portable multiparameter unit to be used for monitoring and recording of and to generate alarms for multiple physiological parameters of adult pediatric and neonatal patients in a hospital environment and during intra hospital transport The B40 B20 Patient Monitor is intended for use under the direct supervision of a licensed health care practitioner The B40 B20 Patient Monior is not intended for use during MRI The B40 B20 Patient Monior monitors and displays oscillometric non invasive blood pressure systolic diastolic and mean arterial pressure invasive blood pressure end tidal carbon dioxide heart pulse rate respiration rate ECG including arrhythmia and ST segment analysis temperature with a reusable or disposable electronic thermometer for continual monitoring Esophageal Nasopharyngeal Tympanic Rectal Bladder Axillary Skin Airway Room Myocardial Core Surface temperature and functional oxygen saturation SpO and pulse rate via continuous monitoring including monitoring during conditions of clinical patient motion or low perfusion Intended audience This manual is intend
44. Connection and Net1 Net16 None default e Select Paper Size and A4 default or Letter NOTE Network printer only Other printer settings can be changed in the Record amp Print menu To make the changes permanent save them in user modes Changing the monitor settings 6 4 1 Press the Monitor Setup key 2 _ Select Install Service and enter the password 3 Select Installation Monitor Settings e Select Parameter Settings and select Humidity compensation type CO2 Numbers Dry default Wet Monitor setup Changing the user modes You can change the settings in each user mode to suit your specific needs User modes are predefined combinations of settings that include both general and measurement specific settings A user mode defines for example what is displayed on the screen and in the trends General settings can be changed in the Monitor Setup menu other settings in the parameter setup menus You need a password to make changes through Monitor Setup Install Service menus and to enter the Save Modes menu for details see Configuration and passwords page 6 1 This section describes the following changes that can be saved in user modes Changing the Normal Screen layout on page 6 7 Changing sweep speeds on page 6 11 Displaying pulse rate on page 6 11 Changing parameter colors on page 6 11 Changing the recorder and printer settings on page 6 12 Saving changes in user modes The modifications are valid only
45. Cyan Advisory LOW PRIORITY ALARM Solid Cyan Thin Cyan boundary blue gray background Require you to be aware of this condition White Message No blue gray background field Provide additional information Alarm light In addition to the audible the B40 B20 has an alarm light located in the top of the monitor The alarm light flashes red yellow and cyan according to the currently active highest priority alarm The brightness of the light is fixed 5 3 B40 B20 Patient Monitor Alarm tones The monitor has four options for alarm tones and patterns ISO ISO2 General and IEC The ISO2 and ISO patterns are very similar The difference is the rising sound of the tone pattern The following frame colors and tones identify the alarm categories Table 5 2 Alarm tones Visual ISO pattern ISO2 pattern Gerenal pattern IEC pattern Red 11 beeps every 5 10 beeps every 5 seconds Continuous beep 10 beeps every 5 seconds or or continuous beep seconds or continuous continuous beep rising tone beep md VERE rising tone Yellow Triple beep every 19 Triple beep every 19 5 Double beep every Triple beep every 19 seconds seconds 5 seconds seconds 19 19 5 5 T 7 195 195 Sades Cyan Single beep Single beep Single beep Single beep White No No No No Alarm activation To enable the alarms connect patient
46. ECG After connecting ECG cable leads off will display in the Waveform Field NIBP After connecting NIBP hose to module Adult Pediatric or Neonatal will display in NIBP Digital Field for several seconds SpO After connecting SpO cable and sensor SpO sensor will be lit Temperature After connecting Temp cable and sensor Performing temp test will display in Temp Digital Field for several seconds IBP After connecting IBP cable and transducer InvBP s not Zeroed will display in Message Field CO2 After installing the E miniC module Calibration gas sensor will display in CO2 waveform field for about 1 minutes ES Recorder 1 2 Press the Recorder Start Stop key and check that the module starts recording the selected waveforms Press the Recorder Start Stop key again to stop recording Check that the quality of the recordings is acceptable ES Network connection 1 Check that the CAT 5 cable connector is clean and intact then connect it to the Network connector on the backside of the monitor Check that the monitor connects to the network i e the network symbol appears on the upper right hand corner of the screen H H H NOTE Pre configure the network when install the monitor Conclusion Power off the monitor Perform final cleaning Fillin all necessary documents ES 4 Monitoring basic Monitoring basic 4 Monitoring basic Warnings e _ Connect on
47. ECG filter magnetic resonance imaging multiple multifocal PVCs minute volume expired minute volume l min expired minute volume in BTPS conditions expired minute volume in STPD conditions inspired minute volume l min spontaneous minute volume myocardiac temperature neutral nitrogen nitrous oxide sodium nasopharyngeal temperature neonate network B40 B20 Patient Monitor NIBP Ni Cd Ni MH NMT NO NTPD Num Oz OER O Hb OR Oxy Oxy Calcs P P P BTPS Plg alCO P g ET CO P STPD P1 P2 PA Pa Paced Paco PAO PaO PAOP PA Paw Pbaro PCWP PE pedi PEEP PEEPe PEEPe i PEEPe PEEPi PEEPI PEEPtot PgCO non invasive blood pressure nickel cadmium nickel metal hydride neuromuscular transmission nitric oxide normal temperature and pressure dry gas numerical oxygen oxygen extraction ratio oxygenated hemoglobin operation room oxygenation oxygenation calculations partial pressure pressure pressure in BTPS conditions difference between gastrointestinal carbon dioxide and arterial blood carbon dioxide concentration difference between gastrointestinal carbon dioxide and end tidal carbon dioxide concentration pressure in STPD conditions invasive pressure channel identification on module pulmonary artery Pascal unit of pressure paced beats partial pressure of carbon dioxide in the arteries partial pressure of oxygen in the alveoli partial pressure of ox
48. ECG waveform accordingly ECG ECG Lead II ECG lead 4 ECH Lead avl Adjust ST Releam EGG Setup ECG Alarms Screen Setup Normal Serer Change size of ECG waveforms by adjusting scale height OD B40 B20 Patient Monitor Starting relearning manually When the patient s ECG pattern changes considerably the monitor should start relearning a new ECG pattern The pattern changes for example when changing the patient s position To start relearning manually 1 Press the ECG key 2 Select Relearn ECG ECG ECGilead II ECG2Lead v5 ECG3 Lead aVL ECGSize 1 0 AdustST E ECG Setup ECG Alarms Screen Setup Normal Scrren Select Relearn to enable gt monitor to learn new ECG pattern Setting heart rate alarm limits To set the heart rate alarm limits 1 Press the ECG key 2 Select ECG Alarms 3 Select Adjust Limits You can also adjust the limits through Alarms Setup Adjust Limits For detailed instructions see section Alarms ECG ECG ADJUST ALARM LIMITS ECG ECG1Lead II adjust Limits ECG2Lead v5 HE Alarm ON ECG3lead aVL PVC Alarm OFF ECGSize 1 0 st Alarms WE Adjust ST Arth Alarms B 250 Releam Alarms Setup El 160 ECG Setup E P Previous Menu ECG Alarms 40 Screen Setup Normal Scrren min Change high and low HR and ST alarm limits Change arrhythmia alarm settings Push ComWhee
49. GE Healthcare PROCARE Monitor B40 B20 User s Reference Manual PROCARE Monitor B40 B20 English 2050801 001 D Paper O 2011 General Electric Company All Rights Reserved PROCARE Monitor B40 B20 User s Reference Manual Related to software license VSP A Monitoring functions C 0459 Conformity according to the Council Directive 93 42 EEC concerning Medical Devices All specifications are subject to change without notice Document no 2050801 001 D July 18 2011 GE Medical Systems Information Technologies Inc 8200 West Tower Avenue Milwaukee WI USA Zip 53223 Tel 1 414 355 5000 outside US 800 558 5102 US only Fax 1 414 355 3790 www gehealthcare com Copyright 2011 General Electric Company All rights reserved GE Healthcare 3F Building 1 GE Technology Park 1 Huatuo Road Shanghai PRC 201203 Tel 86 21 3877 7888 Fax 86 21 3877 7451 Classifications In accordance with IEC 60601 1 Class and internally powered equipment the type of protection against electric shock Type BF or CF equipment The degree of protection against electric shock is indicated by a symbol on each parameter module Equipment is not suitable for use in the presence of a flammable anesthetic mixture with air or with oxygen or nitrous oxide Continuous operation according to the mode of operation Portable Monitor In accordance with IEC 60529 IP21 degree of protection against harmful ingress o
50. I gas values Respiration rate Scale NOTE When the measured CO value is outside the specified measurement range the numeric value is gray el 15 Figure 17 3 Lower digit field for gases B40 B20 Patient Monitor Patient connections 1 Insert the E miniC module in the monitor and push until it clicks 2 Check visually that the airway adapter connections are tight and that the adapter is operating properly then attach it to the patient 3 Make sure that the water trap container is empty and properly attached The water trap should be changed between patients and emptied whenever it is more than half full 4 Connect the gas sampling line to the sampling line connector on the water trap Turn on the monitor The monitor performs a self check Before connecting the patient wait until the message Calibrating gas sensor disappears Then make the patient connections as described below and connect the sampling line to the airway adapter 7 Position the adapter with sampling port upwards This prevents any condensed water from entering the sampling line If E miniC module is used with O and or N O contents higher than 40 make sure that FiO2 Level and N20 Level are set accordingly through Airway Gas CO2 Setup to enable O and or N 0 compensation Take the gas sample as close to the patient s airway as possible as shown in the illustrations and connect the sampling line to the patient
51. IEN OCEUrStEVAeS ee ie es end er 15 4 Invasive Pressures Men dad sehen eek 15 5 IBPX Setup Menu penria vanen nase name ine means 15 5 E on renden ine 15 6 Cerebral SS a a Ne 15 7 Adjusting alarm sources and limits aa re etn 15 7 Smart me Brand MUSMAG raso Derio eG idas 15 8 la EE E e 15 8 16 Temperature Safety Precautions etna a a o a LIT A M c 16 1 WANG Ser ern mean verser menne teerd CDI PES IAGUD GENE 16 1 VOL VIEW eere OER RUE NE RARA ee 16 1 Displaying temperature mr aa elves a ADR DEN CE ACN 16 2 P tient COMMECHOMS N ee a er ee nee 16 2 Temp Set pmenu u tet denten en bib pen EAD ee pe bee 16 3 Chand Rd tempera ana vr nee an Re 16 3 Combining different temperatures nnen eeen enne eeen 16 4 Testing temperatis aeron N a aN aa ae te DI e terre us 16 4 Changing temperature units terror sn anode eed a a a 16 4 Checklist NC clack Mean on de AE om NER NE Re dn ad Et 16 4 17 Airway gas Safety pre cationes Mede o aa lead Ce en a ae 17 1 o TRAITA E osse A A dateen 17 1 A E a ip 17 1 A un oa neds 17 1 EI Er AR RSE NS Rat een c aciei bolt a deae acean 17 2 MOES a cades eos Dia oe bata a a D a s 17 2 Display Of GASES sei Leid ATEM E EM Baer ew S AREE S 17 3 Patient CONRCCTION Sic oes a ae dieere tee e d Scu a ie eo br eO D exec te 17 4 CO Setup Menu ra sn ae here eene 17 5 Selecting CON MT SOURCES E AA ROE A E Bie 17 5 allier ge alge A ae ERE TEE D han 17 6 GESSI Cs OS ack td ee Ane 17 8 Biar De EE A O 17 8
52. No SpO2 probe There is no SpO probe Check connection between the SpO sensor and module Printer error Printer is not working properly Check that the network printer is operational Printing Printing network printer has started Please wait until the printing is finished Printing ready Monitor has completed sending printing data to the printer Please wait until the printing is finished Recorder module removed There is no recorder module Reconnect the recorder module if you need a recorder Recorder system error 29 It s a data transfer delay between frame and recorder the current recording will stop also Press the Recorder Start Stop key again Replace Battery A Replace Battery B There is hardly any charge left in one of the batteries Also check the symbol on screen Replace the battery as soon as possible Replace D fend Water trap is partially blocked This decreases air flow Replace the water trap Sample line blocked The sampling line inside or outside the monitor is blocked or the water trap is occluded Change the sampling line and water trap Select inflation limits You are using a hose without an automatic identification When you try to start the measurement the monitor goes automatically to the selection NIBP Setup Inflation Limits Select appropriate inflation limits NOTE Auto option is not available for these h
53. P Series repeat X4 3rd BP Senes repeat X2 4th BP Senes repeat X1 Previous Menu Adjust interval between determinations of this step gt Starting and stopping autocycling To start the autocycling do one of the following Press the NIBP Auto On Off key or press the NIBP key and select Start Cycling NIBP mmHg Sys Tia 128 81 The bar at the bottom of the NIBP field shows the time remaining to the next measurement To stop autocucling Press the NIBP Auto On Off or press the NIBP key on the Command Board and select Stop Cycling Non invasive blood pressure Starting and stopping a single manual measurement To start the measurement do one of the following e Press the NIBP Start Cancel key or press the NIBP key and select Start Manual Sys Mean ar 2 min 390 To cancel any NIBP measurement do one of the following e Press the NIBP Start Cancel key or press the NIBP key and select Cancel Starting and stopping a continuous measurement STAT The STAT mode initiates continuous measurement for five minutes Anew NIBP measurement starts immediately after the previous one After five minutes the monitor automatically returns to the previously selected cycling interval or to manual mode To start and stop the measurement do one of the following e From the keyboard Tostop the measurement press the NIBP Start Cancel button again i From NIBP menu Press
54. P2 CO2 Fl or ET with Configuration you can select which measured values trigger the alarm One or several alarm sources may be active at a time Parameters Alarm triggered off by Blood pressure Systolic diastolic and or mean pressure or off Alarms Setup 5 8 NIBP P1 P2 with off there is no 10 minute trend on display co2 Flor ET 1 Press the Alarms Setup key 2 Select Adjust Limits 3 Select the measurement If the desired measurement is not displayed select Next Page 4 Push the Trim Knob An adjustment window is displayed 5 In the adjustment window turn the Trim Knob to change the selection OFF or ON 1 Select X Alarm in parameter s menu and push the Trim Knob to change the selection OFF or ON CUP Adjust Limits Sys Alarm ON Dia Alarm OM Mean Alarm OH Alarms Setup Previous Menu Push wheel to turn alarm ON OFF ADJUST ALARM LIMITS Alarms Silencing alarms Silencing audible alarms temporarily NOTES e The bedside alarms can also be silenced and acknowledged from the Central if this feature has been enabled in the Central configuration In this case the message Alarms silenced from Central or Alarms acknowledged from Central is displayed on the bedside monitor display If the monitor is connected to the network and the network connection is lost the silenced alarms are reactivated and the volume level is automatically se
55. Park Pudong ee USA Pe 9 Shanghai P R China 201203 Est Tel 86 21 3877 7888 1 800 558 5120 US only Vel MI Wil 45 43 6 Fox 86 21 3877 7451 Fax 1414 355 3790 Fax 49 761 45 43 233 GE Medical Systems Information Technologies a General Electric Company going to market as GE Healthcare www gehealthcare com 0459
56. R in settings where anesthesia gas monitoring is not required It can also be used during transportation within the hospital The modular design makes the system flexible and easy to upgrade Functional options 2 2 Basic Optional 3 5 lead ECG NIBP RESP GE Nellcor or Masimo SpO Two channel IBP Two channel Tempertures CO Recorder Unity or S 5 Network 1 or 2 batteries System description System introduction The B40 B20 monitor system may consist of the elements shown below NOTE Your system may not include all these components Consult your local representative for the available components Figure 2 1 B40 B20 patient monitor system FW NP B40 B20 monitor frame E miniC module This module measure CO parameter Software VSP A Other monitors in the network NOTE You cannot view other monitors on the B40 B20 monitor CIC Pro central station for Unity network The CARESCAPE Network MC establishes communication and allows patient data to be sent to an optional CIC Pro central station See the CIC Pro Clinical Information Center Operator s Manual for operating instructions iCentral station for S 5 network The S 5 network establishes communication and allows patient data to be sent to an optional Central station See the Central User s Reference Manual for operating instructions Laser printer This device may be connected to the
57. Reset the case or discharge the patient to reset the inflation limits before measuring NIBP on a new patient Overview The non invasive blood pressure NIBP measurement uses the oscillometric measuring principle The cuff is inflated with a pressure slightly higher than the presumed systolic pressure then slowly deflated at a speed based on the patient s heart rate collecting data from the oscillations produced by the pulsating artery Based on this data the unit calculates values for systolic mean and diastolic pressures Blood pressure measurements determined with this device are equivalent to those obtained by an intra arterial blood pressure measurement device Multiple intra arterial sites were used You can set the NIBP module into an automatic cycling mode to make measurements at desired time intervals You can also measure NIBP continuously for five minutes in STAT mode or take separate single measurements NOTE Intervals below 10 minutes and STAT measurements are not recommended for extended periods of time NIBP connector Figure 13 1 Non invasive blood pressure measurement connector Non invasive blood pressure Direct function keys There are two keys for starting NIBP on the Command Board NIBP Starts and stops autocycling measurements Auto ON OFF NIBP Starts a single measurement and cancels any measurement Start Cance Displaying non invasive blood pressure NIBP can be display
58. S D Mean Mean CPP S D S D S D Mean Filter Hz 22 9 9 9 9 9 14 14 Response normal normal normal normal normal normal normal normal Cerebral perfusion pressure Cerebral Perfusion pressure CPP is calculated by subtracting ICP mean pressure from Art mean Adjusting alarm sources and limits pressure CPP mean is displayed next to the ICP value NOTE Set the Label of the channel to ICP and the Digit Format to CPP You can adjust or turn off pressure alarm limits in the Alarms Setup Adjust Limits menu Enter the menu by pressing the Alarms Setup key For each pressure channel you can choose as a source Sys Systolic Dia Diastolic Mean or Off Note that you can choose one or both sources to be active at a time 15 7 B40 B20 Patient Monitor Alarms Setup Alarms Setup ALARM LIMITS AND 10 MIN TRENDS IBP1 ADJUST ALARMLIMTS sys Alarm ON Auto Limits Baar OF E Default Limits Mean Alarm OFF y E Ich Alarms Setup 320 a icd Previous Menu Hi 9 180 Arrh Alarms N Alarm volume 5 Low 80 FT Alarm Light 100 40 2 01 80 40 mmHg Remove Menu Push ComWhed to turn alarm Normal Screen ON OFF Push CamWheel to adjust alarm limits manually Of For more information about alarms and adjusting see section Alarms Smart InvBP and flushing Flushing is performed to keep th
59. STAT Start Manual Custom Setup NIBP Setup NIBP Alarm Screen Setup Normal Screen Start automatic cuff infa gt tions at cycle time interval In the beginning of the measurement sys and dia labels are replaced by the inflation limit indication Adult Pediatric Neonatal for five seconds The cuff pressure is displayed in the mean pressure value field If motion artifacts are detected the monitor automatically holds deflation until the motion stops maximum of 30 seconds If the artifacts prevent proper measurement a new measurement starts automatically When the measurement is ready you can hear a short beep and see the result numbers flashing During measurement e Observe the cuffed limb frequently Measurement may impair blood circulation Intervals below 10 minutes and STAT measurements are not recommended for extended periods of time e Make sure that the tubes are not bent pressed or stretched Measurement may be impaired e Blood pressure values may be affected by a change in the patient s position e The presence of some arrhythmias during NIBP measurement may increase the time required for the measurement Non invasive blood pressure Autocycling The NIBP Auto On Off key sets automatic NIBP measurement at selected intervals on and off To automatically measure NIBP at set time intervals you must first set the cycle time before setting the automatic measurements You also can configure a custom auto
60. Service and enter the password 16 4 34 3 Select Installation Alarm Options 4 Select Show Limits and YES or NO Monitor g Eu gt Installation Alarm options Show Limits YES Show Adiuo OMA FF YES Latching Alar No Reminder Volume 5 Alar Tones Previous enu Select TES to show alam limits in digit fields gt The alarm limits become visible when patient monitoring begins and the monitor receives patient data The default setting will be NO B40 B20 Patient Monitor Enabling or disabling alarm silencing With this selection you can determine whether the audible alarms can be turned off or not 1 Press the Monitor Setup key 2 Select Install Service and enter the password 3 Select Installation Alarm Options 4 Select Show Audio ON OFF and YES to enable alarm silencing or NO to disable it Monitor j Installation Setup Alarm options Show Limits YES Show Adiuo OMA F F YES Latching Alarms No Reminder Volume 5 Alarm Tones 1502 Previous hen Select NO to disable alarm silencing Silence options in gt O Audio OMOFF menu are hidden The default setting will be NO Alarms Latching alarms If the Latching Alarms selection is active the alarm messages stay on the screen even if the initial alarm condition goes away This enables unattended monitoring You will also hear a reminder beep every 10 seconds To clear the message field of the no l
61. THER EQUIPMENT Devices may only be interconnected with each other or to parts of the system when it has been determined by qualified biomedical personnel that there is no danger to the patient the operator or the environment as a result In those instances where there is any element of doubt concerning the safety of the connected devices the user must contact the manufacturers concerned or other informed experts for proper use In all cases safe and proper operation should be verified with the applicable manufacturer s instructions for use and system standards IEC 60601 1 1 EN 60601 1 1 must be complied with Verify compatibility of all system components prior to installation Do not use multiple modules with identical measurements in the same monitor The parameter modules are not able to withstand unpacked drops from a height of 1 m without damaging the module latches If the device is dropped please service the device before taking it back into use Do not use with iCentral software V5 0 2 and earlier or Mobile Care Server software earlier of V5 2 2 1 B40 B20 Patient Monitor Principles of functions The B40 B20 monitor is a modular multiparameter patient monitor The monitor is especially designed for monitoring in PACU ED Wards Step down units Intra hospital transport Private sectors Alternative care in mature markets PACU ED Wards Step down units low mid critical care Intra hospital transport ICU amp CCU O
62. V Fib Fibrillatory waveform caused by ventricular fibrillation V Tachy Five or more consecutive PVCs and rate of successive beats over 100 bpm 11 17 B40 B20 Patient Monitor Selecting leads for the arrhythmia analysis When measuring 5 lead ECG you can affect the selection of the two ECG leads used for detecting beats and ventricular fibrillation The selection of user leads ECG1 ECG2 ECG3 on the monitor affects the leads used for detection The first lead used for detection is lead or Il The algorithm uses the lead appearing first in user leads The second lead used for detection is one of the precordial leads V1 V6 The algorithm uses the precordial lead appearing first in the user leads To change the user lead 1 Press the ECG key 2 Selecta lead for ECG1 Lead ECG2 Lead ECG3 Lead The monitor starts relearning the new ECG pattern automatically NOTE With the 3 leadwire trunk cable the algorithm uses the only one available lead ECG1 Lead which is Il or Ill depending on the selected user lead Description of the arrhythmia algorithm The bedside arrhythmia algorithm is based on template matching A template is a group of beats matching the same morphology The algorithm detects QRS complexes generates QRS templates and performs beat labeling Parallel to this process there is an algorithm for detection of ventricular fibrillation Detection of ventricular fibrillation is based on waveform analy
63. W IEC RA WHITE AAMI LA BLACK AAMI FIL F GREEN IEC LL RED AAMI Figure 11 3 Electrode positioning with 3 lead ECG R RED IEC RA WHITE AAMI L YELLOW IEC LA BLACK AAMI C WHITE IEC E 2 V BROWN AAMI o N BLACK IEC Qo F GREEN IEC RL GREEN AAMI LL RED AAMI Figure 11 4 Electrode positioning with 5 lead ECG ECG Patient connection NOTE Keep the ECG cable lead set and connectors dry Avoid excessive use of liquids when cleaning the cables and connectors R RED IEC L YELLOW IEC R RED IEC RA WHITE AAMI LA BLACK AAMI RA WHITE AAMI L YELLOW IEC LA BLACK AAMI D C WHITE IEC V BROWN AAMI N BLACK IEC V F GREEN IEC RL GREEN AAMI LL RED AAMI F GREEN IEC LL RED AAMI Figure 11 5 ECG setup 1 ECG connector 2 ECG trunk cable or 3 lead ECG cable with integrated leadwires 3 3 or 5 leadwire set ECG electrodes pre gelled electrodes are recommended Check the expiration data NOTE For a comprehensive list of accessories see the Supplies and Accessories catalog Lead measurement The following table lists the electrodes needed to measure different ECG leads Lead Electrodes needed R RA L LA F LL or N RL I R RA F LL L LA or N RL Il LL LA F LL R RA or N RL aVR N RL R RA L LA F LL aVL N RL R RA L LA F LL aVF N RL R RA L LA F LL V5 N
64. You can adjust the volume of the reminder beep through Monitor Setup Install Service Installation Alarm Options Reminder Volume a password is required for this operation For more information see Reminder volume page 5 16 Alarms Reactivating alarms T 2 Si Press the Alarms Setup key Select Audio ON OFF menu Select Activate Alarms to turn on audible alarms Deactivating alarms You can set the alarm limits temporarily to OFF for the following parameters HR SpO and respiration rate This way you can silence a parameter without having to adjust the alarm limits 1 2 3 4 Press the Alarms Setup key Select Adjust Limits Turn the Trim Knob to highlight the measurement Select and push the Trim Knob to change the selection Off The symbol XX appears in the digit field When you select the alarm limit ON again the previous alarm limits will be active B40 B20 Patient Monitor Automatic recording on alarms An automatic local recording is possible when Asystole Tachy Brady Art High Low V Fib or V Tachy alarms reach the red alarm level When the red alarm level is reached the recorder prints the ECG Art waveforms 1 Press the Print Record key 2 Select Record Waveforms 3 Select Start on Alarms and Yes nd Record amp Print Record Waveforms Record to Net Record to loca Waveform 1 Waveform 2 Waveform 3 Start on Alarms Delay Paper Speed Length
65. a cetus 44 a ea earn eed 3 1 Mounting the MONO ci dido ee 3 1 GONNEEHOMLOMNOINS an sos ea re dd ee ea pd aer 3 2 Mess AAA err ne ane EN A 3 2 Mistalkthe ole he TC 3 2 Inserting and removing the E miniC module oon cnet e eenen 3 3 o mantra aren En ane ER a een BAAR 3 3 Toremove mod le ctos ea 3 3 MISNGIHAIEATGES de eer ena re fam tee dearer EEE bas P RUE 3 3 llo es o ey A ee ee ehe 3 4 Recommended tools nio eo pope n LC obi bre Eco dE Mp pes 3 4 Visual INSPECCION a Lax oid ur o Acht wa an AER a en LIS EE e 3 5 Functional INSPEC uot een o sl 3 5 Monitoring basic WANNA en Areata oan la regat alpes te ides 4 1 UNAM riet ERREUR EE te 4 1 Startingiand CMGI Ge ss Lele ede once Cubo ate Ge eli ose Gees hi tts drive 4 4 Ms enne ce EM REL 4 4 SAA dto ee beoe ned ad Madera kend 4 4 PrePAEAUOAS RETE EE See uM S LN E MEUM AE Ee 4 4 Starting TOORICORNIO enten eat b eat sce etiem u EN 4 4 AENA BOISE EEEN 4 5 Add ng demedraphier eund cct ecu het eet edo ib Qi debe bonc HE 4 5 Loading previaus date oo cuentos nr piece tete ttp e iet ERI bI ISO 45 4 6 CONTIN PREVIOUS oves Y OO PURUS ORE P gue e ed hr rdg 4 6 DUNG monitonng ner mee 4 6 Automatic saving of patient data sco eo ur 4 6 Discharging the patient san ee ea 4 6 Automatic discharge of the patient rar anna 4 7 Ending MONITORO A lds oct een 4 7 UA A A A AN 4 8 Setup monitor before USO ssc botar 4 8 Document no 2050801 001 5 Alarms OVEEVIGU vob dra v a
66. adio Interference centimeter of water common mode rejection ratio carbon monoxide carbon dioxide carboxyhemoglobin compliance continuous controlled ventilation core temperature count of responses cardiopulmonary bypass cerebral perfusion pressure compressed spectral array computer tomography mixed venous oxygen content B40 B20 Patient Monitor CVP d dB DBS DEL Delta De depr Des Dia Diagn DIFF DIS DO DO l DSC dyn e ECG ECG1 ECG1 r ECG2 ECG3 ED EDV EDVI EE EEG EEG1 EEG2 EEG3 EEG4 EEMG EEtot elect elev EMC EMG Enf Entr EP ESD ESO central venous pressure day decibel double burst stimulation NMT delete delta frequency band depression desflurane diastolic pressure diagnostic ECG filter difference S 5 Device Interfacing Solution oxygen delivery oxygen delivery index digital signal converter dynamic estimated electrocardiogram first ECG waveform top real time ECG second ECG waveform third ECG waveform emergency department end diastolic volume end diastolic volume index energy expenditure kcal 24h electroencephalogram first EEG waveform second EEG waveform third EEG waveform fourth EEG waveform evoked electromyogram total energy expenditure electrode elevation electromagnetic compatibility electromyogram enflurane entropy evoked potential electrostatic discharge esophageal temperature System description ESV ESVI ET Et
67. al mode The figure shows the basic operating cycle for an NIBP determination Inflation Time Wait Time Evaluation Time CUFF PRESSURE Deflation Time Determination Time Cycle Time TIME Figure 13 5 NIBP Auto Mode Systolic Search If systolic pressure is not found the NIBP parameter can search at cuff pressures higher than the initial target pressure The parameter will inflate the cuff above the initial target pressure to get better data in the systolic region The maximum pressure allowed in systolic search is limited by the normal range for cuff pressures In any operating mode if a patient s systolic pressure exceeds the inflation pressure the parameter will begin normal deflation sequence detect the absence of a systolic value stop deflation reinflate to a higher than initial inflation pressure 290 mmHg maximum in adult mode 145 mmHg in neonatal mode and resume the normal deflation sequence If it has been 16 minutes or less since the last determination and the current blood pressure is similar to the previous reading the monitor will try to make an accelerated determination of blood pressure During irregular rhythms only pulses from the current determination are used in calculating the blood pressure values In order to ensure adequate artifact rejection capability and optimal SuperSTAT NIBP performance several criteria used to match and qualify the oscillometric pulses at each pressure step are relaxe
68. all Mount with standard arm or Counter Top Mount is described in a separate instruction sheet delivered with each mount 3 1 B40 B20 Patient Monitor Connection to mains WARNING Connect the power cord to the mains power inlet at the back of the monitor and to the wall socket NOTE Before taking the monitor into use for the first time the batteries should be fully charged Keep the monitor connected to the mains until the Battery charging symbol disappears may take up to 5 hours if the batteries are fully discharged E Battery charging symbol The power cord may only be connected to a three wire grounded hospital grade receptacle Install the network NOTE To install network please ask the GE service personnel to support Install the batteries 3 2 1 Open the lid ofthe battery compartment by the side ofthe monitor Move the latch up or down 2 Putin the new battery Make sure that the charging indicator is facing to the back side of the monitor then push the battery in all the way move the latch and close the lid Power on the monitor check the monitor indicators see above Lar OE Installation Inserting and removing the E miniC module To use the E miniC module your monitor need pre configure the extension rack from manufacture To insert module 1 Align the module with the insertion guides 2 Push the module into the monitor frame until it clicks and stops 3 Pull the module o
69. and make necessary changes You need passwords for making the changes see Configuration and passwords below This User s Reference Manual describes most of the configurable features More detailed lists of the options and also of the factory settings can be found in the Default Configuration Worksheet delivered with each monitor NOTE If you wish to make permanent changes we recommend that you contact the person responsible for the configuration who is familiar with the configuration architecture When new settings are saved they should be marked in the Default Configuration Worksheet Configuration and passwords NOTE If you want to make changes that require a password we recommend you contact the system administrator The default password for entering the Install Service menu is 16 4 34 Press Monitor Setup and select the Install Service menu turn the Trim Knob in the opened adjustment window until you hit the desired number then push the Trim Knob to accept and select the number Continue until all three numbers are selected After entering the third number the Install Service menu is displayed Most of the modifications are valid only temporarily unless you accept them in the Save Modes menu which is a submenu of the Install Service menu A password is also required for entering the Save Modes menu The default password for entering the Save Modes menu is 13 20 31 6 1 B40 B20 Patient Monitor Sett
70. ape e A pacemaker pulse can be counted as a QRS during asystole in either pace mode Keep pacemaker patients under close observation e Theshape of QRS complex may be changed so much because of the pacemaker that QRS detection may be affected e _ The monitoring of pacemaker patients can only occur with the pace program activated PACEMAKER PATIENTS Rate meters may continue to count the pacemaker rate during occurrences of cardiac arrest or some arrhythmias Do not rely entirely upon rate meter alarms Keep pacemaker patients under close surveillance See ECG specifications for the pacemaker pulse rejection capability of this instrument The monitor detects and rejects pacemaker pulses see selection Pacemaker in the ECG Setup menu Sometimes this may lead to unnecessary asystole alarms NOTE The shape of QRS complex may be changed because of the pacemaker so much that QRS detection may be affected NOTE If the patient has an atrial pacer ST calculations can be performed if the pacer does not coincide with the ISO point s adjustment range NOTE Pacemaker detector may not operate correctly during the use of high frequency HF surgical equipment The disturbances of HF surgical equipment typically cause false positive pacer detection 11 19 B40 B20 Patient Monitor Other adjustable features NOTE This section describes the rest of the adjustable features related to ECG measurement To adjust the following feature
71. bels or cause equipment failures Do not pour or spray any liquid directly on cables or leadwires or permit fluid to seep into connections or openings Never use conductive solutions solutions that contain chlorides wax or wax compounds to clean devices cables or leadwires Do not immerse any part of the device in liquids or allow liquid to enter the interior The decision to sterilize must be made per your institution s requirements with an awareness of the effect on the integrity of the cable or leadwire Clean the surface of the probe before and after each patient use CABLE SENSOR AFTER CARE Donot immerse sensors or patient cables in water solvents or cleaning solutions Do not reuse sensors intended for single patient use Do not sterilize sensors or patient cables by irradiation steam or ethylene oxide Clean the surface of the probe before and after each patient use Allow sensor and cable to dry completely after cleaning Moisture and dirt on the connector can affect the measurement accuracy If a probe is damaged in any way discontinue use immediately Inaccurate SpO data can result if a sensor is past its useful life J A damaged sensor or a sensor soaked in liquid may cause burns during electrosurgery Since calibration gas contains anesthetic agents always ensure sufficient ventilation of the room during calibration Inaccurate readings due to use of unapproved acce
72. cables If the alarm source is selected the alarms are active also when the measurement is not displayed except the impedance respiration alarms When an alarm becomes active messages appear in order of priority See default settings presented in the Default Configuration Worksheet Individual alarms have their own specific requirements before they become active for example Apnea requires five breaths to be activated Invasive pressures need to be within alarm limits for 20 seconds after zeroing 5 4 Alarms Alarms Setup menu You can view and adjust patient alarm limits in the Alarms Setup menu Alarms Setup Adjust Limits Auto Limits Default Limits Alarms Setup ALARM LIMITS AND 10 MIN TRENDS Adjust Limits Exit Auto Limits HR ST NIBP Art CVF ept coz T Lat Sys Sys Mean ET Default Limits Eolo iso liso 15 Tea N Cancel Changes Arh Alarms E Alarm Volume 5 Alarm Light 100 Audio ON OFF E Resp Rate 20 28 0 Remove Henu man n Bro Normal Screen Push ComWheel i to adjust alarm emp limits manually 411 1 Listof selections 2 Exit from the alarm limit adjustment area back to Alarms Setup menu 3 Parameter box with high and low limit values and a 10 minute trend showing the current status Adjusts individual measurement alarm limits Yo
73. cally searches for the J and ISO points The distance between the ST and J point is set according to the heart rate Ifthe heart rate is less than 120 bpm the ST point is set at J 80 ms Ifthe heart rate is more than 120 bpm the ST point is set at J 60 ms Setting the J ST and ISO points manually You can also set the J ST and ISO points manually If any of these points is manually set the other two are set at their current values Select Adjust ST and Set ISO point Set J point or ST point e Setting the J point manually The J point is the point on the ECG trace where the S wave transitions to the ST segment Adjust the J point by turning the Trim Knob and confirm by pushing the Trim Knob If the J point setting is changed the original point is shown as a dashed line When you adjust the J point also the ST point is set according to the selected ST point setting J 20 J 40 J 60 or J 80 The manually set J point remains until the monitor is turned off or reset After a turn off or reset the J point is set automatically e Setting the ST point manually ST segment is the component of the ECG trace between the end of the QRS complex and the T wave Manual ST point adjustment sets the distance between ST and J points in ms Selection values are J 20 J 40 J 60 J 80 The manually set ST point remains until the monitor is turned off or reset After a turn off or reset the ST point is set automatically according to the hea
74. can print to a laser printer Graphical or numerical trends You can print several pages or trend data through the Print Record menu NOTE Before you start printing check that the printer is operational Printing currently displayed screen contents To print a trend view 1 Pressthe Pt Data amp Trends key 2 Select Trends Graphical Numerical 3 Select the desired trend page with Scroll Pages 4 Select Print Page Printing all the information To print several pages of graphical trend data 1 Press the Print Record key 2 Select Print Graphical Changing the printer If you need to change the printer connection 1 Press the Print Record key 2 Select Printer Connection 3 Select the printer from the list The default printer is set during configuration see section Monitor setup Other adjustable features To adjust the ECG printout type default printer connection or default paper size please see section Monitor setup 9 Cleaning and care Cleaning and care 9 Cleaning and care Safety precautions Warnings Disconnect equipment from power line before cleaning If liquid has accidentally entered the system or its parts disconnect the power cord from the power supply and have the equipment serviced by authorized service personnel Regular preventive maintenance should be carried out annually Do not use unspecified cleaners materials or chemicals as they may damage device surfaces la
75. cates an alarm after a pre determined time since the last breath detection Do not attempt to use it for detecting obstructive or mixed apneas since respiration movements and impedance variations may continue in these cases The impedance respiration measurement is inherently very sensitive as it measures very small physiologic signals changes of impedance of the patient s chest area Conducted RF current above 1 Vrms may cause erroneous measurements at various frequencies for example interference with the signal waveform leads to respiration rate readings inconsistent with the patient s true respiration rate If you notice this use another form of respiration monitoring For further information see the Technical Reference Manual Electrical interference Electrical devices such as electrosurgery units and infrared heaters that emit electromagnetic disturbance may cause artifacts or disable the respiration measurement completely Movement artifacts Changing position moving the head moving the arms or shivering may result in movement artifacts Also the heart may cause noticeable movement and sometimes this may interfere with the respiration measurement Intermittent mechanical ventilation During spontaneous breathing the ventilator may at times support the patient s ventilation with an extra inspiration If these ventilator inspirations are substantially larger than the spontaneous breaths the respiration calculation may mistakenl
76. cord to Net Record to Local Waveform 1 Waveform 2 Waveform 3 Start on Alarms Delay Paper Speed Lenght Previous Menu Select YES for automatic start gt of recording when senous arrhythmia occurs The following alarms start recording 8 6 Alarm Recorded parameters Asystole ECG1 Art waveforms 25 mm s Tachy Brady ECG1 Art waveforms 25 mm s Art High Low ECG1 Art waveforms 25 mm s V Fib ECG1 Art waveforms 25 mm s V Tachy ECG1 Art waveforms 25 mm s Arrhythmia analysis Alarms which start the recording if the alarm is set on level red Severe Asystole Tachy Brady Art High Low V Fib V Tachy All alarm recordings are marked with the alarm source Print and record Recording trends To record trends 1 Press the Print Record key 2 Select Record Trends Record Numerical or Record Graphical 3 Stop recording by selecting Stop Numerical or Stop Graphical You can record numerical graphical or tabular trends Recording numerical trends Since the contents of the numerical trends are preconfigured you cannot choose the parameters or change their order The following parameters are printed in the numerical trend record Parameter Printed values and units HR and SpO2 bpm SpO2 NIBP Sys dia or mean mmHg IBP1 Art Sys dia or mean mmHg IBP2 CVP Sys dia or mean mmHg T1 T2 Celsius or Fahrenheit Tblood Not supported by B40 B20 monito
77. ct Clean the device as described in the Cleaning part of this section When you start monitoring check that the module is firmly in place the accessories are intact and properly connected and that you have selected desired parameters to be displayed in digit and waveform fields Check note the following points regarding different parameters Cleaning and care Regular checks If the monitor does not work as described see section Troubleshooting first When you start monitoring check that The module is firmly in place Accessories are intact and properly connected You have selected desired parameters to be displayed in the digit and waveform fields ECG and impedance respiration e Checkthat the message Leads off disappears and the waveforms are displayed when the cable is connected to the patient Pulse oximetry e Check that the red light is lit in the sensor e Check that the SpO value is displayed and the message SpO probe off disappears when the sensor is connected to the patient Temperature e Checkthat the temperature value is displayed when the probe is connected to the patient InvBP e Checkthat the monitor recognizes cable connections activates the display for all the pressure channels used and the pressure values are shown e Make sure all transducers are zeroed correctly NIBP e _ Ensure that you are using correct cuff size and have selected correct inflation l
78. ct Trend Scales Printing trends To print the currently viewed trend data select Graphical or Numerical and then Print Page To print all the graphical trend data press the Print Record key and select Print Graphical select page Print Graphs Recording trends To record numerical trends press the Print Record key and select Record Trends Record Numerical To record graphical trends press the Print Record key and select Record Trends Record Graphical Erasing trend history Press the Admit Discharge key Select Discharge Yes Selecting minitrend as split screen option Don spo E Press the Monitor Setup key Select Screen Setup and Split Screen Trend Trends Minitrend view al Last El my 128 81 91 STEP DOWN 14 26 ECG Arrh analys 88 Severe min E racc mn a0 A HHo H 33 Parar cococa ho oo 7 97 a wc mma dis im af 5 07 0 0 HP 15 Amin Figure 7 1 Minitrend view You can split the Normal Screen page so that one fourth of the screen on the left hand side continuously shows graphical minitrends beside waveforms Note that the split screen option is available only when the Normal Screen page shows waveforms 7 3 B40 B20 Patient Monitor To select a split screen view 1 Press the Monitor Setup key 2 Select Screen Setup 3 Select Split Screen and Trend Monito
79. ct the effect of specific concentrations shown in parentheses of an individual disturbing gas and should be combined when estimating the effect of gas mixtures Halothane 496 increases lt 0 3 vol Isoflurane 5 increases 0 4 vol Enflurane 596 increases 0 4 vol96 Desflurane 2496 increases 1 2 vol Sevoflurane 6 increases 0 4 vol Helium 5096 decreases 0 3 vol96 If O compensation is not activated O 40 to 9596 decreases 0 3 vol If O compensation is activated O 40 to 95 error lt 0 15 vol If N20 compensation is not activated N O 40 increases lt 0 4 vol N O 40 to 80 increases 0 8 vol96 If N O compensation is activated NO 40 to 80 error lt 0 3 vol Unit conversions Relationship between gas concentration and its partial pressure Reading in mmHg dry gas ambient pressure in mmHg x gas concentration in 100 Reading in mmHg water vapor saturated gas ambient pressure in mmHg 47 mmHg x gas concentration in96 100 Reading in kPa dry gas ambient pressure in mmHg x gas concentration in 750 Reading in kPa water vapor saturated gas ambient pressure in mmHg 47mmHg x gas concentration in 750 NOTE 47 mmHg is the partial pressure of the saturated water vapor at 37 C Airway gas CO2 Checklist Check that Water trap is locked into the module Water trap container is empty A new sampling line is used a
80. ction purposes HR calculated from pulsatile SpO waveform may differ significantly from ECG HR measured values Users should be aware that the SpO2 probe off and No SpO2 pulse technical alarms escalate no higher than a Medium priority VFIB VTAC should not be considered a substitute for the V TACH arrhythmia call The Severe arrhythmia analysis mode used by the B40 B20 detects asystole bradycardia tachycardia ventricular fibrillation and ventricular tachycardia ECG Adjusting arrhythmia alarm settings To open the adjustment menu 1 Press ECG 2 Select ECG Alarms Arrh Alarms In the adjustment menu turn and push the Trim Knob to select the priority for all alarms except asystole and ventricular fibrillation which are always red high priority and ventricular tachycardia which cannot be selected OFF NOTE Alarm priorities can also be set using the Central depending on its configuration ECG ECG ECG ECGiLead II Adjust Limits ECG2 Lead V5 HR Alarm ON rub bs STAlarms AdustST Releam Arrh Alarms ECG Setup Alarms Setup ECG Alarms Previous Menu Screen Setup Normal Scrren Change high and low HR and ST Configure demme Cae arte rhyme 10 3 alarm settings Detecting the ECG arrhythmia alarms Alarm Criteria Asystole Cardiac arrest no QRS complexes for five seconds Brady HR below the HR alarm limit Tachy HR over the HR alarm limit
81. d to Local Waveform 1 Waveform 2 Waveform 3 Start on Alarms Delay Paper Speed Lenght Previous Menu Selecting the recording delay time If the recording delay time is set to OFF the recording starts when an event occurs and continues for 30 seconds or until it is manually stopped or until the recorder runs out of paper If the delay time is set to 12 seconds default the recording starts when an event occurs and the 12 seconds prior to the event are recorded from the recorder memory The recording continues for 18 seconds if the length has been set to 30 seconds or until the recorder runs out of paper To change the delay 1 Press the Print Record key 2 Select Record Waveforms 3 Select Delay and OFF or 12 s The recording can be started manually or automatically when certain alarms occur The automatic alarm recording is explained in the following NOTE When recording is activated by alarms the delay is always 12 seconds 8 5 B40 B20 Patient Monitor Recording on alarms An automatic strip chart recording is activated when the following alarms reach the red level Asystole Tachy Brady Art High Art Low V Fib and V Tachy When recording is activated by alarms the recording time is always 30 seconds and the delay always 12 seconds 1 Press the Print Record key 2 Select Record Waveforms 3 Select Start on Alarms and Yes Print gt Print amp Record Record Record Waveforms Re
82. d while supplementing the criteria with additional information from ECG NOTE Adult Pediatric only When ECG is monitored SuperSTAT NIBP is able to determine blood pressure in the presence of irregular heart rhythms At the beginning of a SuperSTAT NIBP determination the coefficient of variation from the previous 120 ECG R R intervals is used to determine if an irregular rhythm is present Accuracy of the NIBP parameter was validated against the intra arterial method Do not use the auscultatory method to verify the accuracy of the NIBP parameter Auscultatory method using cuff and stethoscope calculates the mean pressure value from audible sounds at systolic and diastolic but the NIBP parameter method detects all three values 13 11 B40 B20 Patient Monitor Automatic NIBP double check If the NIBP value exceeds the alarm limits a low level alarm will be given and the auto measurement takes place if the alarm situation persists the alarm will be raise to yellow level Checklist Check that 13 12 The hose is correct grey NIBP hose for adults and pediatric and light blue for neonatal The O ring on the hose connector is intact The connector is firmly pushed inside the cuff tube The NIBP hose is properly connected to the module and will not detach if pulled The NIBP cuff is correct for the patient size There are no holes or cracks in the cuff bladder or cuff tube The symbol indicating the center of the bladder is
83. dministering nebulized medication disconnect the gas sampling line from the patient circuit for 30 minutes If the message Sample line blocked alarm occurs e Replace the sampling line e Emptythe water trap container It may be full Figure 9 1 Emptying the water trap container To remove the water trap push the trigger above the water trap The water trap is spring loaded The message Check D fend is displayed e Detach the container from the water trap cartridge by pulling it carefully downward e Empty and clean the container e Attach the container tightly back into the cartridge e Push the whole unit into its housing on the front panel until the latch is set e Press the Normal Screen key to restart monitoring Check that the message Check D fend disappears Other accessories See the accessory package for instructions for how to clean and check them Do not reuse single use disposable accessories B40 B20 Patient Monitor 9 8 10 Troubleshooting Troubleshooting 10 Troubleshooting Overview The troubleshooting section consists of two parts which together should help you resolve the most common monitoring problems The parts are Checklist and Messages Checklist Check the following things before monitoring to ensure that you have remembered to make all essential preparations and if any problems occur during monitoring Parameter specific checklists can be found in the respective
84. dow or a submenu Turn the Trim Knob to choose the desired option or selection in the window Push the Trim Knob to confirm the selection ECG ECG Lead ECG Lead ECG Lead ECG Size Adjust ST Releam ECG Setup EGG Alanna Screen Setup Normal Seren Change size of ECG waveforms by adjusting scale height Press the Normal Screen key to return to normal monitoring display Submenus are indicated by a symbol They function just like the main menus and contain less frequently used functions 4 3 B40 B20 Patient Monitor Starting and ending Warnings e _ Always make sure that necessary alarm limits are active and set according to the patient s clinical condition when you start monitoring a patient e _ Connect only one patient to the monitor at a time Overview The monitor continuously saves patient data such as trends Saving is activated once the patient is admitted The monitor saves automatically Inthe monitor memory the most recent patient data up to 72 hours if the network is not in use nthe network the most recent patient data up to 72 hours from 2 to 90 days depending on the configuration Allthe data can be printed through network and saved to the network for monitor memory Preparations 1 Check that the monitor accessories and monitor parts are clean and intact 2 Plugin the desired measurement module 3 Turn on the monitor from the ON standby key The mo
85. e 2 5 Command Board keys 1 ON standby key 2 Mains power ON lit or OFF dark indicates mains 3 For admitting or discharging a patient for selecting user modes 4 For setting up the monitor and for activating the menu 5 For printing and recording different trends and waveforms 6 For activating parameter specific menus NOTE All modules do not measure all of these parameters 7 For starting or stopping the NIBP auto cycling 8 For starting or stopping local recording NOTE Functional with the recorder only 9 For silencing the alarms 10 For returning the Normal Screen view to the screen 11 For zeroing the invasive pressure channels NOTE Functional with the IBP only 12 For starting or stopping the NIBP manual cycling 13 For activating the Alarms Setup menu 14 For viewing trends and alarm history 2 6 System description Batteries Monitor Setup The monitor can be run either on mains power or batteries Battery operation is initiated when the power cord is disconnected or when the mains power is lost during monitoring NOTE Before using the monitor for the first time charge the batteries to their full capacity Charging time is two hours per battery pack The B40 B20 has two lithium ion batteries at most located in the battery compartment They can be charged separately and screen symbols and monitor frame LEDs indicate their charging level and possible failure see below
86. e and reinstall it 10 8 11 ECG ECG 11 ECG Safety precautions Warnings Cautions Make sure that the leadwire set clips or snaps do not touch any electrically conductive material including earth Whenever patient defibrillation is a possibility use non polarizing silver silver chloride construction electrodes for ECG monitoring The Display filter may alter the displayed ECG morphology Do not make measurements from the displayed or printed ECG when this filter is selected Displayed ST values are calculated before applying the Display filtering and may differ from values measured from the displayed or printed ECG Single use devices and accessories are not designed to be reused Reuse may cause a risk of contamination and affect the measurement accuracy Proper placement of defibrillator paddles in relation to the electrodes is required to ensure successful defibrillation To ensure proper defibrillator protection use only defibrillator proof transducers and cables Set the pacemaker rate responsive mode off or turn off the impedance respiration measurement on the monitor Do not use equipment for positioning floating temporary pacemaker leadwires performing pericardiocentesis or other internal applications HEART RATE ALARM INTERFERENCE Poor cable positioning or improper electrode preparation may cause line isolation monitor transients to resemble actual cardiac waveforms and thus inhibit hear
87. e lines open It prevents blood from clotting and occluding the lines and measurements Infusion that is used for flushing goes through the dome into the patient s artery Two types of flushing are used simultaneously flushing with continuous infusion and manual flushing Flushing with continuous infusion uses a higher pressure than the patient s blood pressure and contains Heparin to prevent blood from clotting Manual flushing is always used after having taken a blood sample and every now and then to ensure that the lines remain open The monitor detects the pressure used for infusion to flush the invasive blood pressure line There is a 40 second time out for performing the flushing The digits change to dashes and there are no alarms After 40 seconds or when flushing is completed and patient s pulse detected the pressure digits are displayed and alarms become active If pressure values are outside the alarm limits an alarm is given The monitor functions the same way when blood samples are taken Checklist 15 8 Check that e Invasive blood pressure transducer cable is plugged to the adapter cable and this is connected to the red connector in the module e Pressure transducer is connected to the cable e Patient catheter is connected to the pressure line e There is no air in the transducer dome or catheter line and transducer is at mid heart level o Pressure transducer is zeroed Invasive blood pressure is
88. e same for Graphic Trend 2 These settings define the graphical trends recorded in upper field and lower field You can record graphical trends of two parameters Printer settings Press the Print Record Select Print Graphical Select Page 1 default 2 5 4 the ones you want to print Select Hours Page for how many hours will be printed on one page 1 2 default 4 6 8 10 12 24 36 48 or 72 hours on one page Select End Time printing starts from selected end time 6 Select Trend Length and select hours to be printed 1 2 4 6 8 default 10 12 24 36 48 or 72 hours PD en Monitor setup Configuring trends Configuring trend pages You can change the parameters on the trend fields 2 3 4 5 6 Press the Monitor Setup key Select Install Service and enter the password Select Trends and set up the Default Trend to Graph Select Graphical Trends Select the trend page that you want to change Select graphical parameters for each field The field numbers start from the top of the screen Select one parameter for each field on the trend page or turn the field OFF When all the fields are OFF the page is displayed with empty fields The time scale and page number appear at the bottom of the page If several similar fields are selected on top of each other they form one higher field Equal fields cannot be defined separate to each other NOTE You cannot make changes in numerical trend page c
89. e touched a grounded wrist strap intended for use with ESD sensitive equipment should be worn Refer documentation provided with the wrist straps for details of proper use ESD precautionary procedure training It is recommended that all potential users receive an explanation of the ESD warning symbol and training in ESD precautionary procedures The minimum content of an ESD precautionary procedure training should include an introduction to the physics of electrostatic charge the voltage levels that can occur in normal practice and the damage that can be done to electronic components if they are touched by an operator who is electrostatically charged Further an explanation should be given of methods to prevent build up of electrostatic charge and how and why to discharge one s body to earth or to the frame of the equipment or bond oneself by means of a wrist strap to the equipment or the earth prior to making a connection At the end of lifetime the product and its accessories must be disposed of in compliance with the guidelines regulating the disposal of such products If you have questions concerning disposal of the product please contact your local GE representatives 2 System description System description 2 System description Safety precautions Warnings All system devices must be connected to the same power supply circuit EXCESSIVE LEAKAGE CURRENT Do not use a multiple socket outlet or extension cord INTERFACING O
90. ed for clinical professionals Clinical professionals are expected to have a working knowledge of medical procedures practices and terminology as required for monitoring critically ill patients Responsibility of the manufacturer GE Medical Systems Information Technologies Inc is responsible for the effects on safety reliability and performance of the equipment only if e Assembly operations extensions readjustments modifications or repairs are carried out by persons authorized by GE e The electrical installation of the relevant room complies with the requirements of the appropriate regulations e The equipment is used in accordance with the instructions for use e The equipment is installed maintained and serviced in accordance with the instructions provided in the related technical manuals Product availability Some of the products mentioned in this manual may not be available in all countries Please consult your local representative for the availability 1 1 B40 B20 Patient Monitor Printed copies of this manual A paper copy of this manual will be provided upon request Contact your local GE representative and request the part number on the first page of the manual CE marking information CE compliance The B40 B20 Patient Monior bears CE Mark CE 0459 indicating its conformity with the provisions of the Council Directive 93 42 EEC concerning medical devices and fulfills the essential requirements of Annex
91. ed in the digit field Figure 13 2 NIBP digit field display 1 2 3 4 5 Systolic and diastolic pressure value of non invasive blood pressure Label Mean pressure value of NIBP Time since the last autocycle measurement NIBP autocycle time indicator NOTE When 60 minutes has passed from the latest NIBP measurement the NIBP numeric value digits turn gray When 245 minutes has passed from the latest NIBP measurement the gray numeric value digits are replaced by a dashed line 13 3 B40 B20 Patient Monitor Patient connections Figure 13 3 NIBP setup 1 NIBP connector in monitor 2 Cuff hose 3 Cuff of correct size Place the arrow 4 over the brachial artery Check that the index line 5 falls within the range markings on the cuff and wrap the cuff around the upper arm For a comprehensive list of accessories see the Supplies and Accessories catalog The listed NIBP cuffs are latex free Selecting a cuff and a cuff hose Two different cuff hoses with different cuff connections are available BLACK hose for adults and pediatric corresponding inflation limits A P including cuff identification LIGHT BLUE hose for neotatal corresponding inflation limit NEO without cuff identification To set up the inflation limits 1 Press the NIBP key and select NIBP Setup Inflation Limits 2 Select the limit according to the hose with the Trim Knob NOTE The monitor automatically ident
92. een selections by turning the Trim Knob To return to the Alarms Setup menu to select more measurements push the Trim Knob until the cursor is in the adjustment menu then select Previous Menu or Alarms Setup Press the Normal Screen key to return to normal monitoring view You can enter the alarm limit adjustment window also through the measurement menus When you are in an XX parameter menu select XX Alarm or enter XX Setup and then select XX Alarm NOTES ST high low alarms will reach the cyan low priority level only In NIBP measurement the alarm limits change automatically according to the cuff hose type used If the monitor is connected to the network the alarm limits can also be adjusted using the Central if this feature has been enabled in its configuration If alarm limits are adjusted using the Central the message Alarm settings changed from Central is displayed in the bedside monitor Choosing automatic limits To activate automatic patient specific alarm limits enabling close patient control select Auto Limits in the Alarms Setup menu Limits are then calculated from the displayed patient reading at the point of time when auto limits are selected Returning to default limits Select Default Limits to set the alarms to the default alarm limits The factory default alarm limits are listed in the Default Configuration Worksheet 5 7 B40 B20 Patient Monitor Changing alarm sources For NIBP IBP1 or IB
93. elected lead label 5 ECG gain bar 1 mV reference 6 Heart rate HR label 7 Heart rate pulse rate source ECG Art ABP Pleth 8 HR PR value 9 Heart beat detector is flashing with every detected heart beat 10 ST values are always displayed next to ECG2 11 Fourth ST value showing the largest absolute ST value 12 Selected ST leads 13 ST label 14 Message field for parameter messages NOTES You can change the number of ECG waveforms on the screen in the Monitor Setup menu by selecting Screen Setup and Waveform Fields The ECG leads can be chosen in the ECG menu The input circuits are protected against the effects of electrosurgery and defibrillation However the ECG waveform on the monitor screen may be disturbed during electrosurgery 11 3 B40 B20 Patient Monitor Preparing the patient and placing the electrodes Preparing the patient Prepare the skin properly to ensure optimal signal quality Shave any hair from the electrode site Gently rub the skin surface to increase capillary blood flow and remove dead skin cells and oil Clean the skin using a mild soap and water solution Dry the skin completely before applying the electrodes Pre gelled electrodes are recommended Check that the electrodes are moist and have not dried out during storage Placing the electrodes When placing the electrodes avoid bones close to the skin obvious layers of fat and major muscles R RED IEC L YELLO
94. eling alarm limit changes 5 5 Capacity batteries 2 7 Central setting time 6 2 Changing the water trap 9 7 Checklist temperature 16 4 children 13 4 Cleaning airway adapters 9 6 ECG cables 9 6 NIBP cuff andhose 9 6 parameter cables 9 6 temperature probes 9 6 color 13 4 Colors changing parameter colors 6 11 Command Board keys 2 6 Configuration digit fields 6 9 installation settings 6 3 splitscreen 6 10 trends 6 13 units 6 3 user modes 6 5 waveform fields 6 8 Connecting patients 4 4 Core temperature 16 3 Cuff cuffhose 13 4 D Date setup 6 2 Digit field modifying 6 9 Display Index airway gases 17 3 ECG 11 3 heartrate 11 3 invasive blood pressure 15 2 SpO2 14 3 ST 11 12 temperature 16 2 E ECG 3 lead 11 4 5 lead 11 4 adjusting size 11 9 cascaded waveforms 11 9 changing waveform sweep speed 6 11 cleaning of cables 9 6 filter 11 7 monitoring the ST segment 11 12 setup 11 7 starting relearning manually 11 10 user leads 11 9 Electrodes ECG 11 4 Emptying the water trap 9 7 E PSM 16 2 E PSMP 16 2 Esophageal temperature 16 3 F Filter ECG 11 7 Functioning ofthe alarms 9 3 G Gas calibrating 17 6 Graphical trends 7 7 H Half annual maintenance 9 4 Heart rate display 11 3 HRSource 11 7 setting limits 11 10 Hose adult 13 4 children 13 4 color 13 4 infant 13 4 HR 11 7 Impedance respiration setup 12 4 infant 13 4 Installation checkout 3 4 Invasive blood p
95. enu To select the parameters for graphical trend recording 1 Press the Print Record key 2 Select Record Trends 3 Select Graphic Trend 1 and choose the parameter in the opened adjustment menu 4 Select Graphic Trend 2 and choose the parameter in the opened adjustment menu Printing You can print all the graphical trends gathered 1 Press the Print Record key 2 Select Print Graphical 3 Select the page and Print Graphs Factory default parameters 7 8 The default graphical trend setup varies according to mode types For details refer to Default Configuration Worksheet To change these settings see section Monitor setup Trends Numerical trend view STEP DOWN 15 27 Trends eae RA analys Scroll Pages Severe eh Page 4 Temperatures and saturations Mf rin age Mass Toood_ spo2 ursor Time Scale 20 Graphical O Numerical Trend Scales Previous Menu Spo2 aUR 2 8 y5 I 2 8 28 II 2 8 D 2 Rp Sys Dia 97 128 81 13 Mean 91 Mar ual Figure 7 3 Numerical trend page 1 2 3 4 Trend menu Page name and number Real time ECG Real time digit fields if the Normal Screen shows waveforms 7 9 B40 B20 Patient Monitor Numerical trend pages Numerical trends contain four pages of maximum 72 hours trend information real time ECG on top of each page Resolution is five minutes Moving between numerical trend page
96. er can be disinfected with glutaraldehyde or alcohol If you want to clean the adapter before use submerge the adapter in 70 alcohol solution for 30 seconds and rinse carefully with water Make sure that all traces of alcohol or detergent are rinsed away or dried before connecting to the patient Sampling line e Do not reuse the sampling line Reusing a cleaned sampling line may affect measurement results NOTE Do not wash or disinfect calibration gas sampling lines Water trap The water trap is based on a hydrophobic membrane which prevents water and secretions from entering the measuring chamber Condensed water and saliva are collected into a washable container Replace the water trap every 24 hours or when the message Sample line blocked or Replace D fend persists Cleaning and care The water trap container can be cleaned with disinfecting solutions or sterilized using cold chemicals or ethylene oxide To lengthen the lifetime of the monitor and minimize downtime e _ Empty the water trap container whenever it is more than half full e Donotopen wash or sterilize the water trap cartridge e After washing or disinfecting the water trap container make sure there is no alcohol nor detergent left when used again Traces of alcohol or other organic cleaning solutions may affect measurement e Do not force air or oxygen through the water trap e Donotallow smoke and dust to enter the water trap e While a
97. eria of ST segment changes are measured at 60 ms after the J point For monitoring purposes it is important to keep the measurement point fixed during monitoring to notice the ST changes on the respective trends The sophisticated algorithms of B40 B20 monitor search the J and isoelectric ISO points The system learns the ECG and stores the reference QRST complex The algorithm sets the ISO and J points Due to the large variation with QRST complexes the user has possibility to adjust the ST measurement points manually The QRS analysis classifies each beat by using several criteria and rejects distorted complexes from the ST calculation NOTE The ST algorithm has been tested for accuracy of the ST segment data The significance of the ST segment changes needs to be determined by a physician Test results of ST segment measurement algorithm testing The algorithm testing has been performed by using The European Society of Cardiology ST T Database ESC DB Average results from ischemic ST detection Episode sensitivity 84 Episode positive predictive accuracy 70 Duration sensitivity 64 Duration positive predictive accuracy 74 11 15 B40 B20 Patient Monitor Monitoring arrhythmia Warnings 11 16 LOSS OR DETERIORATION OF ARRHYTHMIA DETECTION Automated arrhythmia analysis programs may incorrectly identify the presence or absence of an arrhythmia A physician must therefore interpret the arrhythmia info
98. ero mte ky Cen coe fer vn 1 4 Related documentations nern 1 5 Safe precautions cad sparen ny idiota ados ada 1 6 ie rater Od EE Er REE 1 6 ORG Se renta ER REA NANDA ARR 1 6 CAMU Herten tee tete e aus 1 7 Notes er ee ee en ee NE 1 7 ESD precautionary procedures se ent Lire CE ERR ET eA EM 1 8 BIT EMT 1 8 2 System description SPEEL pre cOn cte cir otros er ET ionic 2 1 eene TC M MT le 2 1 PhincIpISS OF THOSE Los boo ret tec iut br DIU pod oe DES EN et dedi Gees 2 2 RICAS s Roe Saa A ene E MU Be 2 2 Sustento duce ts Bos ee odes Bas elan rae d 2 3 COMPONENTS Ut e e late as e A te 2 4 Optional componentes eaei Ae tte enten TU biddend Mats 2 4 Reurqadel CORO OS C LUNA rd E 2 5 EMM tte edere eeen loen ee 2 5 REY BOGIES te ote en E MO EE MC 2 6 Command BONA AUS ie tt tte eet endet et ae 2 6 BONOS vana tar nev vendere ra en art era ARR EN Alsk nae 2 7 Bae Indicator ae edna ee oa beid 2 8 COMGIMO RICE DOL RENNEN 2 9 Hen NN 2 9 A Len ee ende eeen anda irene 2 10 BE VIEL DEI ee a io AS e a ee 2 14 l Document no 2050801 001 B40 B20 Patient Monitor 3 4 Techniealspeeitieahon ea el ed en Al on 2 25 General Specifications ni lie edie reip OU Pee be eed eds 2 25 PATameterss BeciiIcalONS Leren ne ee dE 2 27 Installation Safety precdautlolis staren tte doeet LA oe bon 3 1 WORAINGS a sneren Dente de ER ERAAN AA ea TOR teta lese s 3 1 AUN rd e EET De 3 1 Unpacking instructions 1 hoet ud hacia card Nos 3 1 CHOOSING EQU
99. f water In accordance with EU Medical Device Directive IIb In accordance with CISPR 11 Group 1 Class A e Group 1 contains all ISM Industrial scientific and medical equipment in which there is intentionally generated and or used conductively coupled radio frequency energy which is necessary for the internal functioning of the equipment itself e Class A equipment is equipment suitable for use in all establishments other than domestic and those directly connected to a low voltage power supply network which supplies buildings used for domestic purposes Trademarks Dash PROCARE DINAMAP EK Pro Trim Knob Unity Network Datex Ohmeda S 5 D fend D fend Mini D fend OxyTip EarSat FingerSat FlexSat are trademarks of GE Healthcare All other product and company names are property of their respective owners Table of Contents 1 Introduction POWERS CY CS tice vere ee a ne IN 1 1 Intended purpose Indications for use cece cece cece eee eee eens 1 1 intended audience i er ace Feb etr EE ee M MORE Et 1 1 Responsibility of the manufdelurer at ri a eve tuere tee 1 1 Product evelli o ce c te foL scc f E seo n 1 1 Printed copies OF this manual tet otn ER o er ie SER tta 1 2 CE marking information cic 4 030028 Lus dua tees idee d b REC Le hen 1 2 Produc pia te rn erat ne a Oa a ee 1 2 Warfantii is ii 1 3 a AA O 0 NA A Mar 1 4 Illustrations names ee PIE ede 1 4 Conventions Used in this Manual ren b
100. fixed can t be adjusted Opens a menu to select Silence Apnea Silence ECG Silence Apn amp ECG or Silence All NOTE The silencing selections that is all other selections than the Activate Alarms are available only if alarm silencing has been enabled by selecting Monitor Setup Install Service Installation Alarm Options Show Audio ON OFF Yes By default it is disabled For more details see Enabling or disabling alarm silencing page 5 14 Activate Alarms Activates silenced alarms This selection is always available for activating alarms that have been permanently silenced using the Central Silence Apn Silences apnea and disconnection alarms as well as CO respiration rate Silence ECG Silences arrhythmia alarms and also HR limit alarms Silence Apn amp ECG Silences both of above Silence ALL Silences permanently all alarms except FiO 1896 Ppeak gt 70 cmH O Clears the menu selections from the display so that only 10 minute trends and limits are displayed push the Trim KnobTrim Knob to return the selections on the screen Alarms Adjusting alarm limits Adjusting limits 1 2 51 d Press the Alarms Setup key Select Adjust Limits Turn the Trim Knob to highlight the measurement If the desired measurement is not displayed in the window select Next Page Push the Trim Knob to open an adjustment window Turn the Trim Knob to change the limits and accept them by pushing it Move betw
101. fter each patient Sampling line is connected to the water trap Monitor is turned on and self check is performed with the sampling line attached Sampling line is connected to the airway adapter The humidification and or bacteria filter are in correct place Breathing circuit or accessories have no residuals of alcohol based disinfectants Desired gas parameter is selected for screen through Monitor Setup Screen Setup B40 B20 Patient Monitor 17 10 Index Index A Abbreviations 2 14 Adjusting alarm light brightness 5 6 Admitting 4 5 Adults cuff hose detection 9 3 inflation limit 13 5 Airway adapter cleaning 9 6 Airway gases calibrating 17 6 checklist 17 9 CO2 setup menu 17 5 display 17 3 samplingline 9 6 Airway sampling line 9 6 Airway temperature 16 3 Alarm activation 5 4 AUDIO OFF 6 4 categories 5 3 changing the tone pattern 5 16 changing tone 6 4 deactivating 5 11 displaying limits 5 13 enabling and disabling silencing 5 14 latching alarms 5 15 PVC alarm limits 11 11 reactivating temporarily silenced 5 9 recording 5 12 reminder volume 5 16 Setup menu 5 5 silencing permanently 5 10 ST limit 11 14 Alarm tones 5 4 Arrhythmia alarm settings 11 17 arrhythmia algorithm 11 18 detecting 11 17 selecting leads 11 18 Axillary temperature 16 3 B Batteries capacity 2 7 conditioning 2 9 indicators 2 8 Bladder temperature 16 3 C Calibration airway gas 17 6 NIBP 13 5 Canc
102. g pacemaker patlehts s ous wea abad 11 19 WarmingS nr ue mesh EN E PR NU PR t iat PE us 11 19 Other adjustable tear u an qua pr e een S leien land 11 20 ECS printout LEDE be arare tara S ICM Reha gue CM t C dO ARN A 11 20 ECG waveform sweep speed s ug OPEN ACORDES Adice PIS 11 20 Was MEER CEMETERIES 11 20 Impedance respiration Safety Precautions nen egentem rimo oet ferte Dess far mede ovest 12 1 Warning S neren neen eN ete eet lara eenn aia 12 1 Worse PAULI E 12 1 Overview vtt thi twn ee LE Ney E b top ve ee t t boa 12 2 Respiration detection o desc Se testo een 12 2 Respiration rate calculation ise ed oed eacus NF dt ctu ee Us 12 3 Displaying Impedahcerespiratl nn au delete 12 3 Patent COMMECHIONS POTES 12 4 Activating MESSEN AS ET EI 12 5 vi Document no 2050801 001 Improving waveform readability En 12 6 Correcting the respiration number neee en eee en 12 7 Measurement liM tationS AAA A ele Rd 12 8 Tdrning ette Measurement ask au a 12 8 BE EEE 12 9 13 Non invasive blood pressure SOMS PESCANONS es eae E EE EE O IT REEL AE 13 1 WANG Sa etc PGi tust ebde ln ates 13 1 SOLO a A a ed ed 13 1 QUEEN A O ea 13 2 Direct function RES ee Nee en 13 3 Displaying non invasive blood pressure senen eneen enen enen 13 3 ROUENECONRECLONS ccm ee et Ae ERNA aga oo et 13 4 Selecting a cuff and a cuff A at 13 4 Connecting the cuff hose vac vs Mese ee 13 5 NIBP Setup melius e ee a UEM E E EET EG 13
103. he connectors e Do not route cables in a way that presents tripping hazard e Route all cables away from patient s throat to avoid possible strangulation e Do not touch the patient table instruments modules or the monitor during defibrillation e To avoid the risk of electric shock this equipment must only be connected to a supply mains with protective earth e Always check that power cord and plug are intact and undamaged e _ Use only approved accessories including mounts and defibrillator proof cables and invasive pressure transducers For a list of approved accessories see the supplies and accessories list delivered with the monitor Other cables transducers and accessories may cause a safety hazard damage the equipment or system result in increased emissions or decreased immunity of the equipment or system or interfere with the measurement e DISCONNECTION FROM MAINS When disconnecting the system from the power line remove the plug from the wall outlet first Then you may disconnect the power cord from Introduction Cautions Notes the device If you do not observe this sequence there is a risk of coming into contact with line voltage by inserting metal objects such as the pins of leadwires into the sockets of the power cord by mistake If liquid has accidentally entered the system or its parts disconnect the power cord from the power supply and have the equipment serviced by authorized service personne
104. he ST segment changes needs to be determined by a physician Display of ST pan fr i AN 1 3 Ta it A P Keun Sf aVR s v T 23 ji ILI 6 v y w l 4 1 3 j Figure 11 6 ST number field 1 Message field 2 ST values of ECG1 ECG2 and ECG3 3 Fourth ST value showing the largest absolute ST value 4 Lead label NOTE ST segment deviations are not displayed if the patient has a ventricular pacemaker in use Monitoring the ST segment 11 12 The monitor analyzes ST for all measured leads and gives ST trends separately for each lead Numerical ST data is shown to the right of the second real time ECG waveform field You can also select numerical ST data to the lower digit field Press the Monitor Setup key and select Screen Setup Digit Fields Select ST data to the field you prefer The ST analysis starts automatically after the leads have been connected and the QRS detection has started During a learning period of 32 accepted beats the median ST values are displayed Also when the cable or the V lead is changed or when an electrode is removed or relearning is started manually the monitor starts to learn the ST segment NOTE If the patient has an atrial pacemaker ST calculations can be performed if the pacer spike does not coincide with the ISO point s adjustment range ECG Setting the ST measurement points Automatic setting of the J ST and ISO points The ST algorithm automati
105. he absolute detection limits When there are lots of artifacts the grids can be adjusted further apart to separate smaller artifacts from larger true respiration peaks The small peaks fall within the grids and are not calculated while the bigger peaks cross the grids and are calculated as true respirations To ensure the correct respiration number adjust the limits closer to each other 1 Press Others 2 Select Resp Setup Detection Limit and adjust the limit Others gt Resp Setup Size Resp Rate Source Measurement Detection Limit Resp Rate Alarm Screen Setup Previous Menu Select detection limit of impedance respiration AUTO wil adjust to signal gt The percentage is the ratio to the 1 O reference bar which is 100 B40 B20 Patient Monitor Measurement limitations Movement artifacts Changing position moving the head moving the arms or shivering may result in movement artifacts Also the heart may cause noticeable movement and sometimes this may interfere with the respiration measurement Electrical interference Electrical devices such as electrosurgery units and infrared heaters that emit electromagnetic disturbance may cause artifacts or disable the respiration measurement completely Intermittent mechanical ventilation During spontaneous breathing the ventilator may at times support the patient s ventilation with an extra inspiration If these ventilator inspirations are s
106. he channel indicated or zero both channels Leads off ECG trunk cable or any of the leads is disconnected Offset voltage between two electrodes is too high e ECG Reconnect the disconnected trunk cable electrode or leadwire e ECG Change the trunk cable leadset and module Long measurement time NIBP measurement time too long e NIBP reduce patient s motion Memory ERROR Contact authorized service personnel Mode data reset Error when loading settings from the flash file Contact authorized service personnel Network down xxx Network cable is not connected The Central is shut down e Check the network cable e Check the Central NIBP manual Autocycling mode is interrupted because of an air leak or loose cuff Check the NIBP setup and restart autocucling No battery backup Replace the batteries 10 3 B40 B20 Patient Monitor Message Explanation What to do Noise Unreliable HR calculation or distorted waveform possibly during defibrillation or because of motion artifacts ECG Check the patient status ECG Check the electrodes Ensure that the patient is not shivering Poor electrode quality or wrong positioning Change the lead Remove the ECG cable from the connector and reinsert it No xx transducer Transducer or channel x cable disconnected Connect the transducer or the cable
107. he dome stopcock to pressure catheter and check the quality of the waveform Figure 15 3 Invasive blood pressure setup 1 2 3 4 5 6 7 Compatible InvBP measurement capability Heparinized fluid bag with pressure infusor Flushing set Disposable catheter Transducer Adapter cable for the InvBP transducer Adapter cable for dual InvBP measurement NOTE Patient connections made according to the picture above using approved accessories are defibrillator proof 15 3 B40 B20 Patient Monitor Starting with accurate values IBP Pressure transducers generally produce a small signal even when no pressure is applied to them Itis necessary to zero the monitor with the transducer to establish an accurate electrical zero point Also the position of the transducer effects the accuracy of the measurement An error of 10 mmHg of static pressure is introduced for every 13 6 cm 5 4 inches difference in height between the mid heart and the transducer To zero the transducer open the transducer to air and do one of the following e Press the IBP Zero All key This starts zeroing immediately Or e Press the IBP key on the Command Board and select Zero Pressures Invasive Pressures Zero Pressures Zero ALL Zero IBP1 Art 0 00 Zero IBP2 CVP 0 00 Previous Menu Zero transducer to almospher ic pressure Before starting gt open transducer to air During the zeroing
108. ic shock Isolated floating applied part suitable for intentional external and internal application to the patient including direct cardiac application When displayed in the upper left corner of the screen indicates that the alarms are audio off When displayed in the menu or digit fields indicates that the alarm source has been turned off or alarm does not meet the alarm specific activation criteria In the front panel battery Equipotentiality Monitor can be connected to potential equalization conductor Alternating current Bell cancel Audio pause Home Return to the main display Standby or power indicator Fuse Replace the fuse only with one of the same type and rating System description S Gas inlet E gt Gas outlet IP21 SN S N e ul Rx Only U S T e Kan 20 90 RH 9 Degree of ingress protection Serial number Date of manufacture This symbol indicates the date of manufacture of this device The four digits identify the year Maunfacturer This symbol indicates the name and the address of the manufacturer European authorized representative European Union Declaration of Conformity Prescriptive Device USA only For use by or on the order of a Physician or persons licensed by state law Fragile Handle with care Keep dry Protect from rain This way up Storage temperature This symbol depicts the transportation and s
109. ifference height hardware hertz International Electrotechnical Comission inspiratory expiratory ratio intra aortic balloon pump inspiratory capacity intracranial pressure intensive care unit identification impedance impedance respiration inch inferior inflation limit inspiratory invasive invasive blood pressure irregular isoflurane International Standards Organisation Industrial Scientific and Medical intrathoracic blood volume idioventricular rhythm joule kelvin kilocalorie kilojoule kilopascal leg describing location left describing location liter liters minute laboratory local area network left atrial pressure System description Lat LCD LCW LED LVEDP LVEDV LVSW LVSWI MAC Max mbar mcg Mean mEq MetHb MF mg min Min ml MLAEP mmHg mol Monit MRI Mult Multif PVCs MV MVexp MVexp BTPS MVexp STPD MVinsp MVspont Myo N2 N0 Na Naso neo Net lateral pound liquid crystal display left cardiac work light emitting diode left ventricular end diastolic pressure left ventricular end diastolic volume left ventricular stroke work left ventricular stroke work index minimum alveolar concentration maximum millibar microgram mean blood pressure milliequivalent methemoglobin median frequency milligram minute minimum milliliter middle latency auditory evoked potential millimeters of mercury mole monitoring
110. ifies the setting of the inflation limits When using hoses without identification the monitor goes to this selection automatically when you try to start the NIBP measurement You must set the inflation limits manually With these hoses AUTO option is not available NOTES You cannot select A P inflation limits when using an infant cuff The NIBP system incorporates a safety circuit to prevent overpressure or prolonged inflation of the cuff The alarm limits change automatically according to the cuff hose type used To determine the correct cuff size check that the index line on the outer edge of the cuff falls between the range lines If not use a larger or smaller cuff Non invasive blood pressure Connecting the cuff hose 1 Connect the cuff hose to the NIBP cuff by placing the opposite connectors in contact and locking them together 2 Plug the NIBP cuff hose to the module NIBP Setup menu Ready Prompt Inflation Limits NIBP gt NIBP NIBP CydeTime 5min NIBP Setup Start Cycling Ready Prompt 5 Start STAT Inflation Limits AUTO Start Manual Calibration Check OFF Custom Setup Previous Menu NIBP Setup NIBP Alarm Screen Setup Normal Screen Set ready prompt volume and Adjust volume of sound N inflation limits indicating completion of NIBP measurement Ready prompt gives an audible tone when the NIBP measurement is ready Adjust the volume of the beep tone from 1 s
111. ignal the sensor is faulty or it is detached from the patient e Check the sensor and connections Check network connectors The virtual plug ID is changing e Check the virtual plug ID 10 2 Troubleshooting Message Explanation What to do Condition Battery A Condition Battery B The batteries need condition e Condition the battery according to the instructions of the external charger Cuff loose NIBP cuff loose Cuff is not attached to the patient or it is too loose The hose is not connected to the module Check cuff and hose Cuff occlusion NIBP cuff occlusion Tubes or hose are kinked e Check tubes and hose Cuff overpressure Cuff is squeezed during measurement and pressure safety limits are exceeded e Check cuff hose and tubes e Restart measurement Default settings returned e Check your power and reset the settings Faulty ECG cable The ECG cable is defective The ECG cable may be electrically damaged or the connectors are wet e Change the ECG cable and the lead set e Change the ECG module if the module connector is wet Keep the connectors dry e Avoid excessive use of liquids when cleaning cables and connectors Gas measurements removed e Reconnect the N FREC or N FCREC module if you want to restart the CO measurement InvBP s not zeroed One or both InvBP channels have not been zeroed e Zero t
112. imits For neonatal infant and when using hoses without identification the inflation limit must be set manually e Checkthat the cuff hose detection works properly e Checkthat the pressure values are displayed Airway gas CO e Check that the water trap is empty e Occlude the sampling line and check that the message Sample line blocked appears within 30 seconds and gas waveforms are showing zero at the same time Functioning of the alarms e Turnon the patient monitor Check that the red yellow and cyan alarm lights are lit momentarily e Check that the speaker gives an audible beep Safety checks for software The GE Healthcare software design controls include performance of a risk analysis using methods consistent with ISO 14971 Medical devices Application of risk management to medical devices The monitor software employs watchdog timers self monitoring activities memory communication and sensor checks and so on and power on self diagnostics for example memory checksums For example for SpO the software continuously monitors the SpO 9 3 B40 B20 Patient Monitor sensor and if excessive sensor current is detected the message Faulty probe is displayed in the SpO number field and SpO2 Faulty in the monitor message field and the old SpO data is removed from the display Every six months Gas calibration Perform gas calibration for airway gas monitoring according to the instructions
113. ing currently displayed screen ContentS oooooooocococcccccrccro o 8 10 Printing Cll PINS ORN do do id tea tadas 8 10 Chang nd RE NA LEEN 8 10 Other djust bleTe tures nn Diet ce bU eed eb bte bo 8 10 9 Cleaning and care Safety qnos oos oreet tns oce ee imum bets aam bunt Crone tet 9 1 VUGIEBIEIOS aa Mora en MO Ae SO o eda d ep OR ORI 9 1 A eh A dee Nac Lace A eis ee 9 2 OVOLVIOWE ics aer ai steden Bate ice dcdit are 9 2 Preventive Manten D e ennen re DO o iu eyes Oats eb ERE 9 2 Daily and between the patients vov sen e oe CH item ex Ya s 9 2 ReduldP 6 HeeNS ua a e dur cn c d Ac ees ad E Nese 9 5 AE o sere Pot pep E 9 4 Every LEONE S Loco eq A RA ENTER IER em a REA 9 4 POWER TETU s HU nee sate La eyes TNA ERU DET E PD O ve 9 4 CHOOSE Seen 2 ati ace AOL RES tico ORE a mota ciet denn 9 5 aeu PL PIU E 9 5 Permitted detergents and disinfectants 0c cece cece cence eee een 9 5 MEA Sit te tanh tite ed ait toda diete 9 7 10 Troubleshooting OVOFVIGW Lco bee ERE SAA CIL e PO dd CH ts 10 1 Checklist case ers vrare ee URE RER ae eh RB 10 1 POW ETDS UP E ES RR DEIN Le ea 10 1 MESSAGES sss nee na Br EEG e TE EE em 10 2 Other situations 8 11 ECG Safety Precaution eL et 11 1 WAFRINGS UE 11 1 Solus RM CU IE III 11 1 OEI eI EIU R BLEDUUSRITU PANIS Pan ada tale UR NER pede d 11 2 V Document no 2050801 001 B40 B20 Patient Monitor 12 Displaying ECG and heart rate leser ndr rei 11 3 Preparing the
114. ing the patient After the patient has been admitted you can start monitoring and trend gathering To admit the patient 1 Press the Admit Discharge key 2 Select Admit Patient and enter the patient data Select letters and numbers by turning and pushing the Trim Knob max 14 characters or numbers for each name and ID Admit Discharge gt Admit Discharge Select Mode Discharge Normal Screen Give patient s last name first name and ID or Demographics O9 NOTE Always observe the monitor and the patient carefully during start up periods Adding demographics 1 Press the Admit Discharge key 2 Select Admit Patient Demographics 3 Enter patient data Height is adjustable from 15 to 250 cm 5 in to 8 ft 2 in Weight is adjustable from 1 to 250 kg 2 to 555 Ib The body surface area BSA is calculated automatically by using du Bois formula The body surface area is used in calculating index values of some parameters 4 5 B40 B20 Patient Monitor Loading previous data If the patient has already been admitted on the same monitor and this monitor has been restarted the Contin Previous will be appeared Admit Admi mit Discharge Discharge gt g Contin Previous Yes Admit Patient Yes Select Mode NO Discharge Normal Screen Give patient s last name gt first name and ID Select this to load the most recent patient trends from the monitor
115. ing time and date The time is shown in the upper right corner of the screen Turning off the monitor does not affect the clock 1 Press Monitor Setup and select Time and date Monitor y Monitor Setup Setup Time and Date Hour Minutes 4 Zero Seconds 16 Day 3 Month Apr Year 2001 Previous Menu os 2 Turn and push the Trim Knob to set the time and date Hours minutes and seconds Day month and year NOTE If the monitor is connected to the Central the monitor follows the Central s time settings and the Time and date menu is not available Battery setup Through this menu you can check the battery status 1 Press the Monitor Setup key 2 Select Battery Setup Battery information is now available 6 2 Monitor setup Changing monitor installation settings Changing units Monitor gt Setup Install Service Installation Alarm Options Printer Monitor Settings Previous Menu Set unit of height weight and blood pressure You can change units for height weight and blood pressure You can change temperature units through Others TempSetup and CO units through Airway Gas CO2 Setup The changes are permanent To change the units Press the Monitor Setup key Select Install Service and enter the password Select Installation Units 1 2 3 Monitor Setup Installation Units Height cm
116. ity of the pulse oximetry monitor sensor and patient cable prior to use Incompatible components can result in degraded performance and or device malfunction SpO readings may be inaccurate for a short time after defibrillation 14 1 B40 B20 Patient Monitor e Change the sensor site immediately if there is evidence of blistering skin erosion or ischemic skin necrosis such as skin discoloration or reddening Otherwise change the site every four hours e A pulse oximeter should not be used as an apnea monitor e _ A pulse oximeter should be considered an early warning device As a trend toward patient deoxygenation is indicated blood samples should be analyzed by a laboratory CO oximeter to completely understand the patient s condition Check that the pulse oximetry waveform is physiological in shape to ensure waveform quality and minimize noise spikes caused by motion conditions Not applicable when monitoring SpO with Masimo SET technology nterfering substances can affect the SpO reading mproper sensor placement can affect the SpO signal and readings Donotallow tape to block the probe light detector e During electrosurgery the SpO measurement results may be incorrect Cautions e Prolonged monitoring or incorrect sensor application can cause skin irritation or impaired circulation Recommend checking probe site every four hours more frequently for poor perfusion or neonate Refer to instructions sup
117. l If service message appears discontinue use as soon as possible and have the device repaired PROTECTED LEADWIRES Only use protected leadwires and patient cables with this monitor When applying devices intracardially never contact electrically conductive parts connected to the heart pressure transducers metal tube connections and stopcocks guide wires etc Do not use the monitor in high electromagnetic fields for example during MRI Do not tilt the monitor to avoid liquid entering Do not touch the electrical connector located within the extension rack housing The following caution safety messages apply to this monitoring system U S Federal law restricts this device to sale by or on the order of a physician SUPERVISED USE This equipment is intended for use under the direct supervision of a licensed health care practitioner Dispose of equipment in compliance with instructions and regulations DATA LOSS No Communication may occur at central station due to RF interference Reset the monitor if loss of monitoring data occurs Leave space for circulation of air to prevent the monitor from overheating Before connecting power check voltage and frequency ratings of equipment System time changes will result in time differences between stored and realtime data The following notice safety messages apply to this monitoring system NOTICE The warranty does not cover damages resulting from the use of accessories a
118. l to adjust alarm O Lo limits manually 11 10 ECG Setting PVC alarm limits To set the PVC alarm limits ECG 1 Press the ECG key 2 Select ECG Alarms 3 Select PVC Alarm ON 4 Select Adjust Limits You can also adjust the limits through Alarms Setup Adjust Limits For detailed instructions see section Alarms ECG ECGiLead II ECG2Lead V5 ECG3Lead aVL ECGSize 1 0 Adjust ST Releam ECG Setup Screen Setup Normal Scrren alarm limits Change arrhythmia alarm settings Change high and low HR and ST 2 ECG ADJUST ALARM LIMITS Adjust Limits PYC Alarm ON ST Alarms HR PYC Arrh Alarme Alarms Setup 250 30 Previous Menu 1 50 2 0 H 40 g min Amin Push ComWheel to adjust alarm limits manually 11 11 B40 B20 Patient Monitor ST segment analysis Overview The ST value analyzed by the monitor shows the difference of electrical activity between ISO and ST points Myocardial ischemia appears in the ECG as an ST segment deviation from the isoelectric line ISO point The ST segment generally rises above the PQ isoelectric line in the presence of transmural ischemia and is pressed below the isoelectric line in the subendocardial ischemia NOTE ST segment changes may also be affected by such factors as drugs or metabolic and conduction disturbances NOTE The significance of t
119. l gt 2 5 M Q from 0 67 to 40 Hz Common mode rejection 90 dB minimum at 50 Hz Tall T wave rejection gt 1 4 mV ECG leads off detection Active patient electrode 30 nA Reference electrode 120 nA Filter modes 60 Hz Monitoring filter 0 5 to 40 Hz ST filter 0 05 to 40 Hz Dagnostic filter 0 05 to 150 Hz 50 Hz Monitoring filter 0 5 to 35 Hz ST filter 0 05 to 35 Hz Dagnostic filter 0 05 to 150 Hz Heart rate Measurement range 30 to 300 bpm Measurement accuracy 5 or 5 bpm whichever is greater resolution 1 bpm Heart rate response time ANSI AAMI EC13 2002 Section 4 1 2 1f Step increase from 80 to 120 bpm average 6 95 6 5 to 7 5 5 Step decrease from 80 to 40 bpm average 8 2 s 7 6 to 10 0 s The heart rate calculation operates with irregular rhythms of ANSI AAMI EC13 2002 Section 4 1 2 1e the heart rate after a 20 second stabilization period is Figure 3a 80 bpm Figure 3b 59 bpm Figure 3c 122 bpm B40 B20 Patient Monitor Figure 3d 117 bpm Heart rate averaging computation ANSI AAMI EC13 2002 Section 4 1 2 1d Average of 10 second median values The average time and time range to alarm VFib or VTachy for tachycardia waveform are as follows ANSI AAMI EC13 2002 Section 4 1 2 1g Figure 4a halved 9 9 s 8 4 to 11 5
120. l Explanation Front panel battery LED indicators Monitor is battery Orange dark A N powered Batteries are fully N Green lit charged the size of the green bar indicates the Li A charging level A Monitor is battery Orange dark powered Battery A is Green lit empty battery B charge is ok Monitor is battery Orange flashing 41 DOE ELT powered Battery A failure 7 Green lit ps battery B is full NOTE If both batteries fail the green battery LED is dark Monitor is mains powered Orange lit Battery A is being charged N Green dark white bar battery B is already charged N Monitor is mains powered N Orange dark no screen symbol Green dark 2 8 System description Checking the battery charge when the monitor is turned off When the monitor is turned off you can check the battery charging level by pressing the test button on the battery as indicated in the drawing on the left The charging indicator bar 1 lights up and the number of lit segments indicates the charging level the more lit segments the higher the charging level Figure 2 6 Charging indicator on the battery Conditioning a battery Batteries should be conditioned regularly to maintain their useful life Condition a battery every six months when its run time becomes noticeably shorter or when the message Condition Battery x appears on the screen Conditioning a battery is best done on an exte
121. larm setting Also in Unity network B40 B20 support to set up parameters and waveforms on CIC remotely 2 9 B40 B20 Patient Monitor Symbols A Al eosa as siee On the rear panel this symbol indicates the following warnings and cautions Electric shock hazard Do not open the cover or the back Refer servicing to qualified personnel Forcontinued protection against fire hazard replace the fuse only with one of the same type and rating Disconnect from the power supply before servicing Donottouch the monitor during defibrillation Donotuse the monitor without manufacturer approved mounting attached Electrostatic sensitive device Connections should not be made to this device unless ESD precautionary procedures are followed Type BF IEC 60601 1 protection against electric shock Isolated floating applied part suitable for intentional external and internal application to the patient excluding direct cardiac application Type BF IEC 60601 1 defibrillator proof protection against electric shock Isolated floating applied part suitable for intentional external and internal application to the patient excluding direct cardiac application Type CF IEC 60601 1 protection against electric shock Isolated floating applied part suitable for intentional external and internal application to the patient including direct cardiac application Type CF IEC 60601 1 defibrillator proof protection against electr
122. larm status before you start monitoring again f the monitor is connected to the network the alarms can be heard and seen on the Central as well Please consult the Central User s Reference Manual Alarms or CIC Pro Clinical Information Center Operator s Manual for details fthe monitor is connected to the network the alarms can also be silenced using the Central if this feature has been enabled in Central configuration Alarms Alarm categories The alarms are classified into three categories according to the priority HIGH PRIORITY RED ALARM MEDIUM PRIORITY YELLOW ALARM LOW PRIORITY CYAN ALARM MESSAGE WHITE NOTE NOTE Asystole and ventricular fibrillation alarms are always high priority alarms The priority of an alarm depends primarily on the cause and the duration generally minimum 20 seconds of the alarm condition the priority increasing with the duration and according to the physiological significance Thus for example brady advances rapidly to high priority whereas apnea is allowed a slightly longer duration Table 5 1 Alarm categories Visual Meaning Alarm light if Alarm in Message enabled Field Red For life threatening situations flashing red Solid red background HIGH PRIORITY ALARM Require an immediate response Yellow For serious but not life flashing yellow Thick yellow boundary threatening problems MEDIUM blue gray background PRIORITY ALARM Require a prompt response
123. layed they appear and disappear automatically when module is connected or disconnected The invasive pressure waveforms are displayed only when the transducer is connected to the module Waveforms are always evenly spread to fill the entire waveform area Whenever there are less than 6 waveforms configured on the screen the remaining waveforms are enlarged Changing the waveform to another also changes the numerical field to the right of the waveform It may also change the digit fields at the bottom if you choose the same measurement in the waveform field that is currently in the digit field the digit field disappears Selecting Combine Pressures in the Waveform Fields menu displays invasive pressures in the same waveform field with individual scales When you use 5 lead ECG measurement up to three different ECG leads can be displayed simultaneously in different fields Monitor setup Modifying digit fields Patient data may be displayed in up to four digit fields located in the lower part of the screen The fields are numbered from left to right Sp02 Ed mmHg Sy Dia 97 128 81 Mean 31 Manual Figure 6 2 Digit fields You may change the contents of each field or turn them off individually Before modifying the digit fields remember to check that the desired parameter module is plugged in 1 Press the Monitor Setup key and select Screen Setup 2 Select Digit Fields and change the field contents
124. lect YES to discharge p O Lo current patient Select NO to cancel B40 B20 Patient Monitor 8 Print and record Print and record 8 Print and record Overview You can manage recording and printing via the Print Record menu For recordings you need a extension rack with recorder and for printouts you need connect to network and a laser printer PCL5 compatible min 2 MB memory The monitor is connected to a laser printer via network Recording Recorder The recorder Near real time recording of up to three user selectable waveforms simultaneously Selectable paper speed Prints up to 72 hours of graphical and numerical trends Numerical printout with annotation when one or two waveforms are printed Numerical trend resolution selectable Configurable to create a 30 second recording automatically on alarm NOTE Recording on thermal paper may be destroyed when exposed to light heat alcohol and so on Take a photocopy for your archives Direct function keys There is a key for starting and stopping recorder on the Command Board Recorder For starting or stopping recording waveforms to local Start Stop NOTE Functional with the recorder only 8 1 B40 B20 Patient Monitor Recording waveforms Print Record You can record three waveforms to a local recorder as you set up To start the recording do one of the following e _ Press the Recorder Start Stop key or Pres
125. lude fewer respirations than indicated by the gridline Impedance respiration Respiration rate calculation Respiration rate is calculated automatically when ECG or CO is measured unless the respiration measurement is turned off When CO is measured the respiration rate is automatically calculated from CO Respiration rate calculation switches back to impedance respiration if you press the Silence Alarms key during an Apnea alarm The respiration rate source is displayed above the respiration numeric value Imped coz if 20 D 18 Figure 12 2 Respiration rate source indication for impedance and CO T da Im AT om 7a The impedance respiration waveform is displayed next to the RR value also when the RR value is calculated from CO To manually select impedance respiration as respiration rate source 1 Select respiration in a waveform or a digit field 2 Press the Others key 3 Select Resp Setup 4 Select Resp Rate Source and select AUTO CO2 or Imped Others gt Others Resp Setup Temp Setup Size 20 Resp Rate Source Imped AUTO Normal Screen Measurement c02 Detection Limit Resp Rate Alarm Screen Setup Previous Menu Sel size Resp rate source and alarm Enable or disable Resp hange source of repiration measurement rate AUTO CO2 or Impedance gt be received from ECG electrodes Displaying impedance respiration Imned Imped R IS EA 20 5 p Amin
126. ly one patient to the monitor at a time e Always make sure that necessary alarm limits are active and set according to the patient s clinical condition when you start monitoring Using menus A menu is a list of functions or commands displayed on the monitor screen To display a menu press one of the Command Board keys STEP DOWN 15 27 ECG avR re 1 ro ALLE SS fs I min N20 Level 0 40 Unit Resp Rate Source AUTO Measurement ON CO2 Alarm Resp Rate Alarm Figure 4 1 Example of a menu 1 Menu header 2 List of menu selections 3 Indicates the present selection 4 Adjustment window with other options 5 Short instructions 6 Entry indicator to submenus B40 B20 Patient Monitor Select items in the menus with the Trim Knob For example to change what is displayed in the ECG display Select the desired ECG gt ECG function by pressing I the menu key ECG lead V5 ECG lead aVL ECG Size 141 Adut ST B Relearn EGG Setup E ECG Aam E Screen Setup E Normal Seren Change lead displayed as EC G waveform Turn the Trim Knob to move the highlight ECG down in the menu to ECG lead 11 the desired selection ECG lead VE EGGS Lead al Adjust ST Releam ECG Setup ECG Alarma Screen Setup Normal Seren Change size of ECG waveforms by adjusting scale height Monitoring basic Push the Trim Knob to enter an adjustment win
127. m e Use cuffs of correct size unstable Table 10 9 Other problems related to temperature measurement Symptom Possible cause and solution Temperature e Check that you are using a correct probe measurement fails e Try another probe Table 10 10 Other problems related to SpO measurement Symptom Possible cause and solution SpO signal is e Check the sensor and sensor positioning poor e Change the averaging time from slow to normal e Note that skin pigment causes differences e Make sure that the patient is not shivering 10 7 B40 B20 Patient Monitor Other situations The following table lists some other situations that may occur during monitoring and possible explanations Table 10 11 Other operation problems Symptom Possible cause and solution Printing is not e Printer selection is None change it through Print Record Printer possible connection Printer is not connected to the network Check printer cable The measured Check that you have selected the desired parameter to a waveform values are not or digit field displayed The monitor does e Check that the power cord is properly connected not start e Check that all cables are properly connected e Check the fuses and replace them if necessary You cannot e Check that the measurement module is properly installed perform a pedem ab Check that all cables are properly connected a function e Remove the modul
128. mode All Preconfigured settings are loaded into rronitor Give patient s last name first name and ID 4023 The selected mode is marked with a circle You can return to the previous mode by selecting Return to X During monitoring you can make additional changes to the mode settings and to make the changes permanent save them through the Save Modes menu Changing the startup mode 1 Select Monitor Setup Install Service Save Modes Enter the password 2 Select Startup Mode 1 2 3 4 5 6 or 7 Renaming a mode 1 Select Monitor Setup Install Service Save Modes Enter the password 2 Select the mode select Name and give a new name Loading modes 1 Select Monitor Setup Install Service Save Modes Enter the password 2 Select Load Modes and one of the following e From Network Loads all modes from network and saves them in monitor s permanent memory e ToNetwork Copies all modes from monitor s permanent memory to network This selection is available only if saving modes to network is enabled in Central NOTE Make a discharge before loading modes 6 6 Monitor setup Changing the Normal Screen layout At startup the screen is arranged according to the startup mode definitions Parameters that are not used are not displayed and no space is reserved for them You can decide which waveforms and numerical information are displayed and where on the screen they are arranged
129. monitor network or to a central station on the network The laser printer can print waveforms alarm waveforms numeric trends and reports See the Print and record chapter for more details 2 3 B40 B20 Patient Monitor Components The basic components of the B40 B20 are the monitor frame with hemo module Figure 2 2 B40 B20 monitor front panel 1 Transportation handle 2 Alarm light 5 TheTrim knob 4 Command board keys 5 Battery compartment 6 Guide rail for GCX mounting 7 Mains power and battery LEDs 8 On standby key 9 Hemo connectors 10 E miniC module 11 Recorder module Optional components Optional components are e Extension rack e interchangeable E miniC module e Multi I O connector 2 4 System description Rear panel connections Figure 2 3 Rear panel connections 1 2 3 4 5 6 7 Receptacle for power cord Serial port Defibrillator connector Nurse call connector Network connector Equipotential connector Multi I O connector NOTE The Multi I O with ports 2 3 4 are optional parts for customer E miniC module Figure 2 4 E miniC 1 2 3 Water trap Sample gas inlet Gas outlet B40 B20 Patient Monitor Keyboards You can control monitoring through the keys on the Command Board For more information see section Monitoring basic Command Board keys n O 2050506 002 Ce EN ei 1 OH HS Figur
130. ms with zero and reference lines Selected pressure label Selected pressure scale Field for messages and alarm limit settings Systolic diastolic and mean pressure values of invasive blood pressures You can have a combined display of all those waveforms that are selected on the screen This combined display uses the whole waveform field area and the same zero line for all waveforms To select 1 2 3 Press the Monitor Setup key and select Screen Setup Select Waveform Fields To combine all waveforms in one field select Combine Pressures and Yes Invasive blood pressure Patient connections 1 Connect the pressure transducer to the transducer adapter cable Connect the cable to the red connector in the module or to the dual invasive blood pressure adapter cable NOTE Invasive pressures need to be zeroed after reconnecting the pressure transducer or cable and whenever the patient s position is changed The transducer is always leveled to the mid right atrium 2 omms Prepare the transducer kit according to the manufacturer s instructions Mount the kit with the transducer zeroing port at mid heart level Ensure that there is no air in the line Refer to transducer manufacturer s instructions on how to remove trapped air from the transducer Connect the patient catheter to the pressure line Open the dome stopcock to room air Zero the transducer See Starting with accurate values on page 15 4 Open t
131. nal silencing period is over 5 9 B40 B20 Patient Monitor Silencing audible alarms permanently A Silencing certain audible alarms entirely may be desirable for special cases NOTES e _ The following silencing selections that is all other selections than Activate Alarms are available only if alarm silencing has been enabled Monitor Setup Install Service Installation Alarm Options Show Audio ON OFF Yes By default it is disabled You need a password to enter the Install Service menu For details see Changing alarm options page 6 4 e lfthe monitor is connected to the network the bedside alarms can also be silenced using the Central if this feature has been enabled in its configuration Choosing silence selections 1 Press the Alarms Setup key 2 Select Audio ON OFF menu Silence Apnea Silences apnea and disconnection alarms as well as CO respiration rate Silence ECG Silences arrhythmia alarms and also HR limit alarms Silence Apn amp ECG Silences both of the above Silence ALL Silences permanently all alarms Alarms Setup MIN TRENDS APN ECG Audio ON OFF Activate Alarms Silence Apnea Silence ECG Silence ALL Previous Menu silence audible apnea COZ respiration rate and ECG alarms permanently Selecting a choice displays a warning symbol If an active alarm is silenced the monitor gives a reminder beep every two minutes
132. ncing seizures or tremors Arrhythmias will increase the time required by the NIBP parameter to determine a blood pressure and may extend the time beyond the capabilities of the parameter Do not apply external pressure against the cuff while monitoring Doing so may cause inaccurate blood pressure values Do not place the cuff on a limb being used for A V fistulas intravenous infusion or on any area where circulation is compromised or has the potential to be compromised Accuracy of NIBP measurement depends on using a cuff of the proper size It is essential to measure the circumference of the limb and choose the proper size cuff The cuff size selected in the NIBP menu and the cuff size used must be correct to obtain reliable NIBP data and to prevent overpressure in neonatal or pediatric use For SuperSTAT NIBP Only It takes one to three minutes for the NIBP parameter to identify an irregular rhythm after ECG is connected For patients with irregular rhythms simultaneous monitoring of ECG will enhance NIBP performance Wait three minutes after ECG has been connected and ECG heart rate is present on the monitor screen before performing an NIBP determination NIBP READINGS MAY TIME OUT WHEN USING IABP An IABP balloon pump creates non physiological arterial waveforms These waveforms create an oscillometric signal that may not be interpreted by the NIBP algorithm causing NIBP to time out The patient blood pressure can be monitored
133. nd consumables from other manufacturers If the device has been transported or stored outside operating temperature allow it to stabilize back to operating temperature range before applying power Medical electrical equipment needs special precautions regarding electromagnetic compatibility EMC and needs to be installed and put into service according to the EMC information provided in the Technical Reference Manual by qualified personnel Portable and mobile RF communications equipment can affect the medical electrical equipment The equipment is suitable for use in the presence of electrosurgery Please notice the possible limitations in the parameter sections and in Technical specification on page 2 25 Service and repairs are allowed for authorized service personnel only B40 B20 Patient Monitor ESD precautionary procedures Disposal 1 8 To avoid electrostatic charges to build up it is recommended to store maintain and use the equipment at a relative humidity of 30 or greater Floors should be covered by ESD dissipative carpets or similar Non synthetic clothing should be used when working with the component To prevent applying a possible electrostatic discharge to the ESD sensitive parts of the equipment one should touch the metallic frame of the component or a large metal object located close to the equipment When working with the equipment and specifically when the ESD sensitive parts of the equipment may b
134. ngs Recorder settings 1 Press Print Record 2 Select Record Waveforms e Select Waveform 1 and select a parameter or select OFF Then select Waveform 2 and Waveform 3 and their parameters You can record up to three waveforms simultaneously If you wish to record only one waveform select the other waveform fields OFF e Select Start on Alarms Yes to start automatic strip chart recording when the following alarms reach the red alarm level NO is the default with VSP software license bradycardia tachycardia asystole Art high low V Fib V Tachy e Select Delay and OFF or 12 s If the recording delay is OFF the recording starts when an event occurs and continues for 30 seconds or until manually stopped or until the recorder runs out of paper If the delay is 12 seconds default the recording starts when an event occurs and the 12 seconds prior to the event are recorded from the recorder memory The recording continues for 18 seconds if the length has been set to 30 seconds or until the recorder runs out of paper e Select Paper Speed and 1 6 25 12 5 or 25 mm s default e Select Length and choose 30 s default or Cont 3 Select Record Trends Select Trend Resolution and every 1 min 5 min 10 min default or 50 min This setting is for numerical trends e Select Num Trend Type and Num default or Tab as the format of the numerical trend recorded Select Graphic Trend 1 and select the parameter and then do th
135. nings Safety message signal words designate the severity of a potential hazard DANGER Indicates a hazardous situation that if not avoided will result in death or serious injury No danger messages apply to this system WARNING Indicates a hazardous situation that if not avoided could result in death or serious injury CAUTION Indicates a hazardous situation that if not avoided could result in minor or moderate injury NOTE Indicates a hazardous situation not related to personal injury that if not avoided could result in property damage The following warning safety messages apply to this monitoring system e Read all the safety information before using the monitor for the first time e Equipment is intended for clinical professionals e _ For continued safe use of this equipment it is necessary that the listed instructions are followed However instructions listed in this manual in no way supersede established medical practices concerning patient care e Single use devices and accessories are not designed to be reused Reuse may cause a risk of contamination and affect the measurement accuracy e There are hazards associated with the reuse of single use sample tubing and adapters nspect the sensor for signs of physical damage Discard a damaged sensor immediately Never repair a damaged sensor never use a sensor repaired by others _Do not sterilize or immerse the sensor or cable in liquid Do not spray or soak t
136. nit monitor filter effectively filters the artifacts caused by for example the electrosurgery unit and respiration STfilt ST filter permits more accurate information of the ST segment It filters the high frequency artifacts caused by the electrosurgery unit but catches the slow changes in the ST segment The ST filter is more susceptible to baseline wander than the monitor filter 11 7 B40 B20 Patient Monitor Pacemaker ORS width Grid 5 lead cable VLead Diagn diagnostic filter is used if more accurate information of the waveform is needed for example ofthe P wave or AV block The diagnostic filter is more susceptible to both high frequencies and baseline wander than the monitor filter Selects how to display the pacing spike of cardiac pacemaker The selections are Hide The pacing spike is filtered away from ECG data Show The pacing spike is filtered away from ECG data but the spike is displayed as a constant height marker Sensit This selection uses a more sensitive pacemaker detection Pacing spike is displayed on ECG Selects the QRS complex widths for ECG rhythms Normal option is suitable for adult pediatric between 70 to 120 ms Narrow option is suitable for neonatal between 40 to 120 ms Selects the ECG gridlines to be displayed or not If you select ON you can view the ECG waveforms over gridlines Selects five or three electrodes Selects the label for V lead according to the placement
137. nitor has detected a QRS complex or a pleth or pressure pulse a beep tone is produced You can raise lower or turn off the volume Adjusting beat sound volume affects also the beat sound volume of the HR source ECG Art or Pleth When Pleth is monitored the monitor provides a variable pulse beep so that the tone of the pulse beep rises with increasing oxygen saturation and falls with decreasing saturation This affects also the ECG tone Selects the heart rate source AUTO ECG Art ABP or Pleth When ECG is selected HR is always calculated from ECG If the ECG signal is affected by too much noise for a reliable heart rate calculation pulse rate can be calculated from pressure Art and ABP or plethysmographic pulse waveform The selected heart rate source is displayed above the numerical display of the heart rate The color of the heart rate source indicator is the same as that of the source parameter The AUTO selection priorities for heart rate calculation are ECG pressure Art or ABP plethysmographic pulse waveform The first heart rate source available is selected Display with HRSelect PR PVC or None to display combined heart rate and pulse rate or heart rate and PVC Filter rate next to the ECG waveform The current HR source is displayed with bigger font and the heart rate symbol flashes next to the reading ECG Art 58 min 58 min Filters the ECG signal high frequency noise and slow respiratory artifacts Mo
138. nitor performs a self test to ensure correct functioning 4 If necessary change the user mode Press the Admit Discharge key and select Select Mode The mode defines what is displayed on screen and in the trends Note that changing the mode also changes settings such as alarm limits The monitor automatically reconfigures the display when modules are inserted Reconfiguration of the display may take up to 5 seconds Starting monitoring 1 Prepare the patient connections according to the setup picture in the measurement section Use only approved supplies and accessories see the Supplies and Accessories catalog The alarms and parameter default settings become active 2 Check that you have the desired waveforms and digits in the fields If necessary adjust the selections Press the Monitor Setup key Select Screen Setup Select Waveform Fields or Digit Fields 3 Zeroinvasive blood pressure lines Check the alarm limits Press the Alarms Setup key The alarms are operative and the parameter default settings are active when the patient is connected to the monitor 5 Start the measurement according to the instructions in the measurement section Monitoring basic For example zero the invasive pressure channels by pressing the IBP Zero All key and start NIBP measurement to get reference values 6 Enter or load patient data Admitting a patient Monitoring of a new patient is started by admitt
139. nits Figure 17 4 Attaching regulator to calibration can 1 Attach the regulator to the gas container 2 Attach a new sampling line to the water trap Connect the loose end of the sampling line to the regulator on the gas container Figure 17 5 Connecting sampling line to the gas valve and feeding gas Airway gas CO2 3 _ Turn on the power For maximum accuracy let the monitor warm up for 30 minutes The menu item Gas calibration remains gray as long as the message Calibrating gas sensor is displayed 4 Press the Airway Gas key and select Gas calibration 5 Wait until Zero ok and then Feed gas messages are displayed after each gas on the screen 6 Open the regulator and feed calibration gas until the message Adjust is displayed then close the valve If you use an older brass regulator the feeding pressure should be adjusted between 5 and 7 psi 7 Check that the displayed gas values match the values on the calibration gas container NOTE Set the CO level according to the gas for example with 755580 set the CO level to 20 NOTE If an error occurs during calibration or if no gas is fed the highlight goes automatically over the item Recalibrate and the text Calibr error is displayed after each gas Push the Trim Knob to perform a new calibration If adjustments are required Turnthe Trim Knob to highlight the first gas to be adjusted and then push the Trim Knob e
140. not be used to assess the accuracy of pulse oximeter for monitor Table 3 1 Recommended accessories and tools Accessories A rigid culinder or pipe NIBP cuff Adult NIBP cuff hose with cuff ID Infant NIBP cuff hose with cuff ID Tubing parts to connect a manometer and a pump to the NIPB cuff and hose Dual invasive pressure adapter cable ECG accessories IEC or AHA Multi link 3 lead integrated cable and leadwire Multi link 5 leadwire set Multi link 3 5 lead ECG trunk cable SpO finger probe SpO Interconnect Cable Temperature dual cable CO Sampling line 3m 10 ft Tool A multiparameter patient simulator with IBP Temp adpter cables NOTE For details on recommended accessories see Supplies and Accessories catalog Installation Visual inspection Perform the following visual inspection to the installed monitoring system e Carefully inspect the patient monitor if any damage e Verify that the patient monitor is properly mounted with specified mounting solutions e Verify that the cables between the patient monitor and the connected peripheral devices are intact and properly connected to the right connectors e Verify that the modules are properly connected and locked e Verify that the battery door are properly locked The cleaning precautions cleaning requirements cleaning procedures and recommended cleaning solutions for the monit
141. ns 4 Select Alarm Tones and ISO ISO2 IEC or General Monitor gt Installation Setu E Alarm options Show Limits YES Show Adiuo OMOFF YES IEC a 180 Latching Alarme NO General Reminder Volume 5 1202 Alarm Tones a Previous Menu Alarmtones according tol50 L 150 9703 2 standard with rising frequency O 49 6 Monitor setup Monitor setup 6 Monitor setup Overview The B40 B20 monitor has numerous setup options for screen parameters alarms etc There are two types of settings User mode settings Some of the monitor setup options are preconfigured to be effective The preconfigured default settings so called factory settings form seven sets of user modes The monitor starts in the startup mode which is one of the user modes You can change to another user mode see Changing the user mode page 6 5 The changes you make in the user mode settings are valid only temporarily until you discharge the patient or change a mode or until more than 15 minutes has elapsed from the turn off of the monitor The changes need to be saved in the mode to become permanent Monitor installation settings the monitor installation settings are the same in all user modes The changes are permanent and preserved until changed again Before starting to use the monitor check the monitor installation settings and what is configured in the different user modes
142. ns are preconfigured To change the label 1 _ Press the IBP key 2 Select IBP1 Setup 3 Select Label Invasive Pressures Zero Pressures IBP1 Art Setup IBP1 Art Setup Label Invasive Pressures IBP2 CVP Setup Scale Ventilation Mode Contri Digit Format Screen Setup Response Normal Screen Fitter Frequency HR Source IBP1 Art Cursor IBP1 Arf Alarm Previous Menu Setlabel scale digit format Change label Scale caor HR source and alarm filter alarm source and limits return to default settings The labels are the following IBP1 IBP2 Standard labels Art Arterial pressure CVP Central venous pressure PA Pulmonary arterial pressure RAP Right atrial pressure RVP Right ventricular pressure LAP Left atrial pressure ICP First intracranial pressure ABP Arterial blood pressure UAC Umbilical artery catheters UVC umbilical venous catheters More PA RVP LAP ICP ABP UAC UVC O9 Invasive blood pressure Both Art and ABP labels are available for situations when two arterial lines are desired but you want to use different settings or alarm labels Table 15 1 Invasive blood pressure labels and descriptions LABEL P1 Art P2 CVP RAP ICP PA RVP UAC UVC ABP LAP Scale mmHg kPa 200 30 20 4 20 4 20 4 60 8 60 8 100 14 10 4 Color Red Blue White White Yellow White Red White Alarm source Sys Off Off Off Off Off Sys Dia Mean Mean Digit format
143. o the left The gap shows the blood pressure mean value NIBP trend bar Dotted vertical line across the trend field indicates change such as ST relearning or zeroing of an invasive blood pressure channel changing a label A blue white or red line above the marker field indicates the following things Blue line indicates the amount of data on the screen the left end of the line shows the starting point of the trend data gathering The right end of the line shows the last moment the data has been gathered White line indicates which proportion of the data you see on the screen If the line is on the left there is more data to see after the current view If the line is on the right there is more data to see before the current view If the line is in the middle there is more trend data to see towards the beginning and the end of the case Red line indicates the availability of trend data with 10 second resolution available for the last 30 minutes only Trends Graphical trend pages Graphical trends contain Four pages Six fields on each page Five fields are usually visible The lowest sixth field is replaced by digit fields on the screen All six fields are printed Scale label unit and color of the parameter follow the real time waveform setting for each parameter For HR ST PVC CPP SpO and temperature you can select the scale through Pt Data amp Trends Trends Trend Scales Changing trend leng
144. of the 5th electrode see Placing the electrodes on page 11 4 NOTE Selectable with the 5 lead trunk cable only Selecting a lead ECG The following lead selections are possible with 3 leadwire set Il or III with 5 leadwire set Il Ill aVL aVF aVR or V For channels ECG2 and ECG3 also a cascaded lead selection Casc is available To select the ECG1 lead e _ Press the ECG key and select ECG1 Lead You can select all leads ECG1 ECG2 and ECG3 in the ECG menu ECG1 Lead ECG2 Lead ECG3 Lead ECG Size Adjust ST Releam ECG Setup ECG Alarms Screen Setup Normal Seren The label of the lead is displayed in the ECG field ECG Selecting user leads 1 Press the ECG key 2 Selecta lead for ECG1 3 Lead With 3 lead ECG you can select only one user lead ECG1 Lead With 5 lead ECG you can select three user leads Viewing a cascaded ECG With a 3 leadwire set ECG2 and ECG3 leads are automatically shown as cascaded The same ECG will be displayed in each waveform field Thus more QRS complexes are displayed at the same time With a 5 leadwire set either a cascaded ECG or different leads can be displayed Select the leads in the ECG menu e Tocascade a lead press ECG and select ECG2 ECG3 Lead Casc Adjusting the ECG size ECG Increasing or decreasing the ECG gain affects the size of the 1 mV bar at the left end of the ECG waveform and the size of the
145. oft to 10 loud or to 0 OFF When this selection is Auto the monitor automatically identifies the cuff hose and selects the right inflation pressure and alarm limits for different cuff size This selection allows you to override the automatic safety limit feature for the hose cuff being used The selections are Auto A P and NEO The selection AUTO is not available when using hoses without identification NOTE You cannot select adult limits with an infant cuff hose NOTE When using very large adult cuffs use Adult limits to prevent Cuff loose message from displaying Calibration Check Previous Menu Enables the calibration check with an external manometer Remove cuff from the module connector before entering the menu When the menu is displayed attach an external manometer with pump to the connector Pump approximately 200 mmHg and compare the readings of the manometer and screen If the difference is more than 3 mmHg calibration by authorized service personnel may be necessary Returns to the NIBP menu level 13 5 B40 B20 Patient Monitor Starting NIBP Note that the measurement unit may be mmHg or kPa The unit is selected during configuration through Monitor Setup Install Service Installation Units You can start the NIBP measurement using either the direct function keys or from the NIBP menu by pressing the NIBP key NIBP Cycle Time 5 min Start
146. onfiguration Setting trend length Ts e Press Pt Data amp Trends Select Trends Graphical Time Scale and select 20min 1h 2h default 4h 6h 8h 10h 12h 24h 36h 48h or 72h Setting trend scales You can change the scale for HR ST PVC CPP SpO and temperature trends 1 Press Pt Data Trends 2 Select Trends Graphical Trend Scales and adjust the scales Setting the default trend You can select graphical or numerical trends to be displayed by default 1 Press the Monitor Setup key 2 Select Install Service and enter the password 3 Select Trends 4 Select Default Trend and Graph or Num B40 B20 Patient Monitor Using Network Use the CAT 5 network cable to connect the monitor to the network 1 2 3 4 Make sure that the power is switched off Connect one RJ 45 connector to the network port at the back of the monitor Connect the other RJ 45 connector to the corresponding port on the wallbox Switch on the power Confirm that the network symbol and Connected to Network message are displayed in the upper part of the screen Soe H H NOTE If any problems or need advanced configuration please ask the GE service personnel to support 7 Trends Trends 7 Trends Overview The monitor displays two types of trend data graphical and numerical The monitor collects graphical and numerical trend data automatically from trended variables You can select the trend
147. onger active alarm messages and to clear the beep press the Silence Alarms key once To clear the message field of all the alarms enabling only new upcoming alarm messages press the Silence Alarms key twice To select latching alarms 1 Press the Monitor Setup key 2 Select Install Service and enter the password 3 Select Installation Alarm Options 4 Select Latching Alarms Yes Monitor hie Installation Alarm options Setup Show Limitz YES Show Adiuo ONJOFF Latching Alarms Reminder Volume Alarm Tones Prewous Menu Alarm messages remain on screen until Silence Alarms key is gt O pressed The default setting will be NO B40 B20 Patient Monitor Reminder volume 1 Press the Monitor Setup key Select Install Service and enter the password Select Installation Alarm Options Select Reminder Volume and adjust the alarm reminder volume with the Trim Knob Monitor gt Installation Setup Alarm options Shows Limits n Show Adiuo ONIOFF Latching Alarms Reminder Volume Alarm Tones Previous Menu Adjust wolurne of audible gt Hd reminder tone The default setting will be 5 Changing the tone pattern The monitor has four choices of alarming tone patterns ISO ISO2 General and IEC To change the tone pattern 1 Press the Monitor Setup key 2 Select Install Service and enter the password 3 Select Installation Alarm Optio
148. or are described in section Cleaning and care For details about cleaning disinfecting and sterilizing the accessories see the instructions for use in the accessory package Functional inspection Start up 1 Turn on the patient monitor Verify that the monitor starts up normally e The red yellow and cyan alarm lights are lit momentarily e The speaker gives an audible beep e Checkthat the GE logo screen is displayed followed by the notes screen and the normal monitoring screen appears e Checkand there are no error messages on the screen NOTE Refer to section Conditioning the batteries to see the procedure for battery conditioning if you receive a a Condition Battery X message NOTE Before taking the patient monitor into use for the first time the battery should be fully charged Keep the monitor connected to the mains until the battery is fully charged ES Display 1 Verify that all text is readable and all images are clear 2 Verify that the brightness is good Adjust if necessary ES Frame unit 1 Check that the clock on the screen shows correct time Readjust the time and date if necessary NOTE The B40 B20 can t be set as the TIME MASTER in network You should adjust the time and date from the central station ES Parameters measurements Connect the accessories no need connect simulator patient check the following phenomenon will appeared 3 5 B40 B20 Patient Monitor 3 6
149. or installation settags vr Coe ER ct 6 3 CHANGING nile s oo eo Norte tes pero ee Era POR gn Seed KU 6 3 Changing CGRP options pos teatros genen Lx ean RTL 6 4 Changing printer Settings zc ede PRO end o iss 6 4 Changing the monitor settings i ode st PICS re 6 4 Changing the userTibdes ccs Lo MEER Re LEE A eR S A taa t 6 5 Saving changes in user modes en una nere de etus ser 6 5 Charging the ser mode a eltern 6 5 Changing the startup mode de e redit e te 6 6 Ea re ee ea Dune 6 6 lere Magie AAA t EIS SEDI CUIU EURO bowels ata dis eg 6 6 Changing the Normal Screen layout a orm ese ent pete een 6 7 Modifying waveform ds E oU 6 8 iii Document no 2050801 001 B40 B20 Patient Monitor Moatu ng digital Se e uo need e Lan a Ce dl 6 9 Modifying split Sra cia ida c bed buds 6 10 Modifying the minitrend ent aleen Be 6 10 Other adjustable Screen fe t ress es ue es a ar oe ce ed 6 11 Ghanging SsWweepspeede 5x Cae are ne 6 11 Displaying pulse rate 4 042282 ee neet dette Lese oe 6 11 Changing parameter l sen ne ee 6 11 Changing the recorder and printer settings ne 6 12 RECORIERSOMINOS a erna E EEEE 6 12 Printers MOS rt roet enten riefen nie 6 12 CORTIGUIMNG tfends vere ereen et Han 6 13 Contig ringitrend PAS eten 6 13 Sed Ren NEMON ernten 6 13 Setting end scales rr dt Summo oi ME orato Oana ee 6 13 Setting the default trend 22 pete Ls Boke nn iei lere ba PES 6 13 SOR o e sa e Sepia Nes o 6 14 7 Trends OVETVIEW isis er a pla ar ted Me
150. orities have been changed using the Central e Check the alarm limits and the arrhythmia alarm priorities see Alarms and Troubleshooting Alarms silenced from Central Alarms have been silenced using the Central e f required turn on the alarms through Alarms Setup Audio ON OFF Activate Alarms alarm limit Apnea No breath detected for 20 seconds e Check the patient status e Check the ventilator and breathing circuit Asustole No QRS detected in ECG e Check the patient status e Check the electrodes Battery low About 20 minutes of battery operation e Replace the battery or connect the time left monitor to power outlet Brady HR is equal to or below the lower e Check the patient status Calibration not protected Unsuccessful calibration e Perform a new calibration Call service Error X NIBP error e Contact authorized service personnel Check D fend The water trap is not attached e Check that the water trap is properly attached to the module If the problem persists contact authorized service personnel Check NIBP NIBP measurement affected by low blood pressure and pulsation or a change in patient s condition e Check the patient status e Check the measurement setup e Check the cuff Check sample gas out Sample gas outlet is blocked e Remove blockage from the sample gas outlet Check SpO2 probe SpO There is no detectable SpO s
151. oses SpO2 probe off The finger or ear lobe may be too thin or sensor halves are not aligned Check connection between sensor and patient Replace the sensor 10 4 Troubleshooting Message Explanation What to do Tachy HR is equal to or above the higher e Check the patient status alarm limit Umbc Error Umbc communication error e Contact authorized service personnel Unable to measure Dia Accurate diastolic pressure not achieved because of artifacts weak pulsation etc e Check the patient status Check the NIBP cuff placement e Perform a new NIBP measurement Unable to measure Sys Systolic pressure probably higher than maximum inflation pressure or artifacts interfere in the systolic area Check the patient status Check the inflation limits Perform a new NIBP measurement Unstable zero pressure Pressure is unstable at start of the measurement Calm the patient and retry Weak pulsation Weak or unstable oscillation signal due to improper cuff position or attachment weak or abnormal blood circulation slow heart rate associated with artifacts moving or disturbed patient during measurement small air leak e Check the patient status e Check the NIBP cuff position and attachments e Check that the cuff is not damaged x Lead off e Check the leadwires and their connections x high low e Check the patient status
152. ours at least You can connect and disconnect airway modules like any other modules For a comprehensive list of accessories see the Supplies and Accessories catalog In the monitoring system use only one module for measuring airway gases 17 1 B40 B20 Patient Monitor e The message Sampling line blocked may result if you attach the sampling line to the water trap after turning the monitor on e When the warning symbol is displayed beside the O value FiO low alarm limit is set below 21 Overview With the E miniC module you can measure and monitor the gases being delivered to the patient and exhaled by the patient The modules are equipped with a water separation system and they measure only CO Respiration rate is the frequency of peak end tidal CO measurements per minute A breath is defined as a change in the CO signal which exceeds 1 8 mmHg All concentrations are measured and displayed breath by breath Module description The airway gas measurement is housed in the E miniC module You can connect and disconnect airway modules like any other modules E miniC module for CO2 measurement Figure 17 1 E miniC module for CO2 measurement Airway gas CO2 Display of gases Figure 17 2 Airway gas waveform display 1 2 3 4 5 6 7 30 minute trend for CO selected in the Monitor Setup menu Gas waveforms Message field for gases Gas label Digit field for ET and F
153. over the artery All residual air is squeezed out of the cuff before wrapping it around the arm The cuff is not loose The cuff is at heart level The cuff tubes or NIBP tube are not kinked or squeezed together Non invasive blood pressureis selected to be displayed through Monitor Setup Screen Setup 14 Pulse oximetry Pulse oximetry 14 Pulse oximetry Safety precautions Warnings Allow sensor and cable to dry completely after cleaning Moisture and dirt on the connector can affect the measurement accuracy To prevent erroneous readings do not use physically damaged sensors cables or modules Discard a damaged sensor or cable immediately Never repair a damaged sensor or cable never use a sensor or cable repaired by others A damaged sensor or a sensor soaked in liquid may cause burns during electrosurgery Inaccurate SpO data can result if a sensor is past its useful life Therefore re evaluate the measurement periodically by performing additional assessment of the patient and equipment including consideration of use of alternate monitoring methods such as direct measurement of arterial oxyhemoglobin saturation Sa0 Conditions that may cause inaccurate readings and impact alarms include interfering substances excessive ambient light electrical interference ventricular septal defects VSD excessive motion low perfusion low signal strength incorrect sensor placement poor sensor fit and or movement of
154. overed under one or more of the following U S A patents 5 758 644 6 011 986 6 699 194 7 215 986 7 254 433 7 530 955 and other applicable patentslisted at www masimo com patents htm Pulse oximetry Pulse oximetry connector Figure 14 1 Pulse oximetry measurement connector Display of pulse oximetry Figure 14 2 Display of SpO value and pleth waveform 1 Scale of plethysmogram 2 Label 3 Oxygen saturation SpO value 4 Pulse oximetry message field 14 3 B40 B20 Patient Monitor Patient connections OXY E UN OxyTip Reusable Sensors OxyTip Adhesive Sensors Figure 14 3 Pulse oximetry setup 1 2 3 4 Compatible SpO measurement capability Interconnect cable Reusable sensors Disposable sensors NOTE The listed sensors are latex free NOTE For a comprehensive list of accessories see the Supplies and Accessories catalog delivered with the monitor NOTE For each SpO accessory refer to the instructions for use in the accessory package for patient weight limits Connecting the patient 14 4 NOTE Use dry and clean sensors only 1 2 Connect the sensor to the blue connector in the module Clean the application site Remove nail polish artificial fingernails earrings etc clip long fingernails Position the sensor correctly For proper sensor positioning see the Instructions for use accompanying each sensor Attach the sensor to
155. patient 2 Connect the adapter cable to the module connector NOTE For a comprehensive list of accessories see the Supplies and Accessories catalog Temperature Temp Setup menu Others Others Others Resp Setup Temp Setup Temp Setup T1 Label More Normal Screen T2Labe T2 Blad Unit C Axil Temp Alarms Skin Screen Setup Gii Room Previous Menu Myo Core Surf Set labels and alarms Change laba of T1 49 T1 2 Label Allows you to label each temperature measurement site Unit Allows you to select the units to be either degrees Celsius or degrees Fahrenheit Allows you to adjust temperature alarm limits for two measurement sites measured by T1 or T2 You can choose one or both sources to be active at a time Temp Alarm Alarms can be adjusted in this menu or in the Alarms Setup menu which opens by pressing the Alarms Setup key Previous Menu Returns to the previous menu level Changing temperature label 1 Press the Others key 2 Temp Setup T1 Label or T2 Label 3 Select the label with the Trim Knob Labels are T1 and T2 or Eso Esophageal temperature Naso Nasopharyngeal temperature Tymp Tympanic temperature Rect Rectal temperature Blad Bladder temperature Axil Axillary temperature Skin Skin temperature AirW Airway temperature Room Room temperature Myo Myocardial temperature Core Core temperature Surf Surface temperature 16 3 B40
156. plied with sensor Overview 14 2 Oxygen saturation SpO is the percentage of saturated hemoglobin compared to total hemoglobin measured by a two wavelength pulse oximeter also called functional or In Vivo oxygen saturation The SpO value is measured by light absorption technique Red and infrared light is emitted from the emitter side of the sensor The light is partly absorbed when it passes through the monitored tissue The amount of transmitted light is detected in the detector side of the sensor When the pulsative part of the light signal is examined the amount of light absorbed by arterial hemoglobin is discovered and the saturation level can be calculated The plethysmographic pulse wave is derived from variations of the intensity of the transmitted light and reflects the blood pulsation at the measuring site Thus the amplitude of the waveform reflects the perfusion The B40 B20 monitor have three options for SpO configuration GE Masimo and Nellcor The set up will be preconfigured by the manufacturer according to your choice Different setup may have different performance please refer to Technical specification for more details For Masimo SpO possession or purchase of this device does not convey any express or implied license to use the device with unauthorized sensors or cables which would alone or in combination with this device fall within the scope of one or more of the patents relating to this device Masimo SpO is c
157. process the message Zeroing is displayed After the transducer is zeroed the message Zeroed is displayed in the digit field After each channel is zeroed the time of zeroing is displayed in the menu NOTE Selecting Zero ALL does not zero ICP Zero it separately NOTE Check zero level after power interruptions NOTE Invasive pressures need to be zeroed after reconnecting the pressure transducer or cable and whenever the patient s position is changed If all channels have not been zeroed the message InvBP not zeroed appears However the alarms advance to yellow and red levels regardless of zeroing Invasive blood pressure Invasive Pressures menu IBP Invasive Pressures Invasive Pressures Zero Pressures IBP1 Art Setup IBP2 CVP Setup Scale Ventilation Mode Contri Digit Format Screen Setup Response Normal Screen Fiter Frequency HR Source IBP 1 Art Cursor IBP1 Art Alarm Previous Menu SID Mean or Sf D M Forlabel Setlabel scale digit format HR source and alarm Change format of digit field gt O lo ICP also CPP is available Zero Pressures Opens a menu to zero both pressures or one of them Ventilation Mode Respiration causes artifacts in invasive pressures At the end of expiration the artifact is at its smallest Select Spont for spontaneous respiration and Contr for controlled ventilation IBPx Setup menu Label Scale Digit Format Response
158. r Monitor Setup Setup Screen Setup Waveform Fields E Digit Fields E Split Screen Trend Minitrend Length 30 min Previous Menu Minitrends of waveforms are permanently displayed with waveforms Minitrend length You can choose to view trend data from the last five minutes or the last 30 minute period The five minute minitrend is updated every 10 seconds the 30 minute minitrend is updated once every minute To modify the split screen trend view 1 Press the Monitor Setup key 2 Select Screen Setup 3 Select Minitrend Length and choose 5 min or 30 min Removing minitrend 7 4 To remove the minitrend from the screen 1 Press the Monitor Setup key 2 Select Screen Setup 3 Select Split Screen and None Trends Graphical trend view STEP DOWN 15 27 ECG Arh analys 8 8 Severe min Trends Scroll Pages Print Page Cursor Time Scale 20 Graphical a Numerical O Trend Scales Previous Menu Show graphical trends Sp02 56 97 NIBP mmHg Sys Dia 128 81 Mean 91 Mar Figure 7 2 Graphical trend page 1 Trends menu 2 Measurement trend field 3 Realtime ECG 4 Numeric value of a measurement at the trend cursor point 5 Trend page number 6 Indication of the amount of data gathered and viewed 7 Time and marker field 7 5 B40 B20 Patient Monitor Symbols 7 6 Ee me Trend bar parameter scale t
159. r CO2 ET FI 96 kPa or mmHg Resp Rate Breaths per minute Date Unit Time 7 Aug 1995 10 24 HR min SpO2 X poe gem NIBP Sys Dia mmHg 128 81 Pi Art Mean mmHg 33 P2 CVP Mean mmHg 14 TI TI ZTT CEL 38 8 720 5 Parameter coz ETFI 33 8 78 8 Parameter value Resp Rate min 15 Figure 8 1 Numerical trend printout For pressures either Sys Dia or Mean are recorded depending on the digit format selected in the pressure setups 8 7 B40 B20 Patient Monitor Selecting the format for the recorded numerical trends You can select the format for the recorded numerical trend to be either Num vertical or Tab horizontal 1 Press the Print Record key and select Record Trends 2 Select Num Trend Type and Num or Tab Changing resolution To select the resolution of a numerical or tabular trend record 1 Press the Print Record key and select Record Trends 2 Select Trend Resolution Choices are every 1 minute 5 minutes 10 minutes 30 minutes Tabular trend format Tabular trend printout Parameter Printed values and units HR bpm SpO 96 NIBP or Art sus dia mmHg CO Et mmHg or kPa Selecting graphical trends Print Record 8 8 You can record graphical trends of two parameters To select the parameters for the graphical trends 1 Press the Print Record key 2 Select Record Trends 3 Select Graphic Trend 1 or Graphic T
160. r Urs with Fick equation ventricular run ventricular tachycardia wireless local area network weight extreme year years System description Technical specification WARNING Operation of the monitor outside the specified values may cause inaccurate results NOTE Information in this section can be especially useful to clinicians General Specifications Genenral specifications Size Monitor Without extension modules 31225 mm H 31225 mm W 158 5 mm D With extension modules 312 5 mm H 35225 mm W 178 5 mm D Weight With extension module recorder and CO 6kg Environment Operating temperature Normal operation 5 to 40 C 41 to 104 F Charging batteries 5 to 35 C 41 to 95 F Storage and transport temperature 20 to 60 C 4 to 140 F Operating humidity 20 to 90 noncondensing Storage and transport humidity 20 to 90 noncondensing Operating atmospheric pressure 700 to 1060 hPa 525 to 800 mmHg Storage and transport atmospheric pressure 700 to 1060 hPa 525 to 800 mmHg Electrical AC input voltage 100 to 240 V AC input frequency 50 60 Hz AC input power 150 VA Power supply Internal battery or AC power Power cord type cord connector IEC EN 60320 1 C13 For USA difference type of plugs should be used for connection to the alternate voltage 13 A 125 Vo
161. r 6 A 250V Fuse 250 V 2 5 Ah Battery Exchangeable lithium ion 2 pcs max B40 B20 Patient Monitor Battery life 300 cycles minimum to 50 capacity Battery information model SM 201 6 11 1 V 3 52 Ah Charging time 2 hours per battery pack Operation time Up to 4 5 hours Recorder Power comsumption Standby lt 1 2 W Printing lt 10 W Recorder type Thermal array Resolution Vertical 8 dots mm 200 dots inch in non waveform mode Horizontal 24 dots mm 600 dots inch mimimum in waveform mode Paper width 50 mm printing width 48 mm Waveforms Selectable 1 2 or 3 waveforms Print speed 1 6 25 12 5 25 mm s Defibrillator synchronization connector Synchronization pulse Pin 5 Pulse width 10 ms positive pulse Delay lt 35 ms R wave peak to leading edge of pulse Amplitude CMOS compatible 3 5 V min at 1 mA sourcing 0 5 V max at 5 mA sinking Output impedance 50 Q Current limit 10 mA System description Parameters specifications ECG specifications Leads available 3 lead configuration I Il III 5 lead configuration II IIl aVR aVL aVF and VA ORS detection range 0 5 to 5mV QRS detection width Qto 40 to 120 ms SJ Defibrillation protection 5000 V 360 J Recovery time 5s Input impedance Common mode gt 10 M Q 50 60 Hz Differentia
162. rend 2 The following figure shows which parameters have graphic trends that you can record gt Record amp Print Record Trends Record Numerical More Trend Resolution 5 min IBP1 Num Trend Type Num IBP2 Record Graphical NIBP Graphic Trend 1 HR SpO2 Graphic Trend2 IBP1 Pleth Previous Menu co Resp T1 T2 Change graphical trend gt O recorded in upper field Print and record Inserting recorder paper To load paper in the reocrder 1 2 3 Open the recorder door by pressing the door latch Remove the paper core Place a new paper roll between the tabs of the paper holder The paper should unroll from underneath the paper roll Begin to close the door while still holding onto and pulling about 6 to 8 cm of paper then close the door completely You should hear a snap as the door latch is engaged Attempt to print out a annotated strip by pressing the Recorder Start Stop key to make sure you load paper in the correct direction Figure 8 2 Inserting recorder paper 8 9 B40 B20 Patient Monitor Printing The B40 B20 monitor support the laser printer in S 5 network The user can directly print the patient data from the laser printer when the monitor and printer are correctly configured on Central Server The B40 B20 monitor don t support the laser printer in CARESCAPE Unity network The user can print the patient data from the CIC central station only You
163. ressure patient connections 15 3 setupmenu 15 5 Invasive blood pressure setup 15 3 L Label ECG lead label 11 8 temperature 16 3 Vleadlabel 11 8 M Maintenance water trap 9 6 Menus 4 1 Messages system 10 2 Monitor installation settings 6 1 Monitoring starting 4 4 Myocardialtemperature 16 3 N Nasopharyngeal temperature 16 3 NIBP cuff and hose cleaning 9 6 patient connections 13 4 setup 13 5 NIBP setup 13 4 Normal Screen digit fields 6 9 minitrend length 6 7 waveform fields 6 8 Numerics 6 9 p Parameter colors 6 11 trended parameters 7 1 Patient connections invasive blood pressure 15 3 NIBP 13 4 Preparations 4 4 Index Printing numerical trends 7 10 Printout tabular trend printout 8 8 Problems messages 10 2 other situations 10 8 Pulse oximetry setup 14 4 Pulse rate display 11 7 R Recording delaytime 8 5 numerical trend format 8 8 numericaltrends 7 10 selecting graphicaltrends 8 8 selecting recorded waveforms 6 12 Rectaltemperature 16 3 Removing water trap 9 7 Room temperature 16 3 S Sampling line 9 6 Scale pleth 14 5 trend time scale 6 13 Screen setup digit fields 6 9 parameter colors 6 11 waveform fields 6 8 Setup changing units 6 3 digit field 6 9 ECG 11 7 NIBP 13 5 parameter colors 6 11 SpO2 14 5 temperature 16 3 temperature units 16 4 time and date 6 2 trends 6 13 waveforms 6 8 Size ECG 11 9 impedance respiration waveform 12 6 Skin temperature 16 3 ST
164. rmation in conjunction with other clinical findings Please take special note of the following ECG waveform conditions Noisy waveforms Noisy portions of ECG waveforms are typically excluded from analysis The exclusions are necessary to reduce the occurrence of inaccurate beat interpretations and or rhythm alarms If the excluded noisy portions of the ECG waveform contain true arrhythmia events those events may remain undetected by the system Beat amplitude and duration Accurate detection and interpretation of beats becomes increasingly difficult as the amplitude and or duration of those beats approach the design limits of the analysis program Thus as beats become extremely wide or narrow or especially as beats become small arrhythmia interpretation performance may degrade Other morphology considerations Automated arrhythmia detection algorithms are designed fundamentally to detect significant changes in QRS morphologu If an arrhythmia event is present and does not exhibit a significant change from the patientis predominant morphology it is possible for those events remain undetected by the system SUSPENDED ANALYSIS Certain conditions suspend arrhythmia analysis When suspended arrhythmia conditions are not detected and alarms associated with arrhythmias do not occur The messages which alert you to the conditions causing suspended arrhythmia analysis are LEADS OFF and DISCHARGED Always monitor ECG for arrhythmia dete
165. rnal charger Please refer to instructions provided with the charger If you do not have an external charger see section Cleaning and care Conditioning the batteries Network The B40 B20 monitor has been verified to be able to work in CARESCAPE Network and S 5 network environments Other network infrastructures are not supported The monitor have the capability to communicate with GE CARESCAPE pro CIC version 4 0 8 4 1 1 and 5 1 0 communication with iCentral version 5 0 3 and 5 1 1 The monitor can talk to Aware Gateway Server V1 6 in Unity network and talk to Mobile Care Server V5 2 in S 5 network The B40 B20 monitor work with S 5 Collect V4 0 The monitor can talk to at most 4 CIC Central stations 1 Aware Gateway Server and 1000 other devices simultaneously in one CARESCAPE MC network The monitor can t act as the Time Master in Unity network The B40 B20 monitor does not support Patient Data Server B40 B20 realtime patient data can t be viewed on other monitors e g Dash 3000 4000 5000 Solar 8000 B850 B650 except unit name bed name and alarm message The monitor s information transfer to central station as following e All B40 B20 available parameters 3 5 lead ECG NIBP IBP SpO2 Resp Temp CO2 e Real time multi parameter waveforms e Graphic tabular trends e Real time Alarm including Arrhythmia alarms ASYSTOLE VFIB VTAC VTACH e Patient admit discharge amp patient name update e Multiple parameters a
166. rt rate e Setting the ISO point manually The ISO point is on the isoelectric line Adjust the ISO point by turning the Trim Knob and confirm by pushing the Trim Knob If the ISO point setting is changed the original point is shown as a dashed line The manually set ISO point remains until the monitor is turned off or reset After a turn off or reset the ISO point is set automatically 4 gt P R interval Q T interval 11 13 B40 B20 Patient Monitor Setting ST alarm limits To set the ST alarm limits ECG 11 14 1 2 3 4 Press the ECG key Select ECG Alarms Select ST Alarms Select Adjust Limits You can also adjust the limits through Alarms Setup Adjust Limits ECG ECG1Lead II ECG2Lead v5 ECG3 Lead aVL ECGSize 1 0 Adjust ST Releam ECG Setup Screen Setup Normal Scrren Change high and low HR and ST alarm limits Change arrhythmia alarm settings ECG Adjust Limits HR Alarm OM PVC Alarm OFF Arh Alarms B Alarms Setup E Previous Menu Change high and low ST alarm limits ST ADJUST ALARM LIMITS En Lat Adjust Limits Lat Alarm ON Inf Alarm FF Ant Alarm OFF Alarms Setup Previous Menu High Push ComMiheel to adjust alarm limits manually aYL Y5 OS ECG Description of the ST segment measurement algorithm The ST segment begins at the point where the QRS ends J point Diagnostic crit
167. rve the size of the plethysmographic waveform with a fixed pleth scale Take special care of this when monitoring small children If possible do not attach the SpO sensor on a limb that is used for NMT measurement or for administrating cold infusions NIBP measurement and arterial blood pressure measurement To avoid erroneous readings do not use a blood pressure cuff or arterial blood pressure measurement device on the same limb as the sensor Plethysmographic pulse wave To get an optimal pulse wave use smaller scale indicators when using measuring sites with poor perfusion Asmall pulse wave may be a sign of impaired circulation that may require increased attention Higher scale indicators together with a well defined pulse wave indicate strong circulation and a relaxed patient Removing the sensor 14 6 e _ Open the sensor Do not pull the sensor from its cable Pulse oximetry Measurement limitations Checklist The B40 B20 monitors are designed to minimize the interference of electrosurgery Under some circumstances electrosurgery may cause noise on the screen Therefore be careful in interpreting the results especially the plethysmographic pulse waveform during electrosurgery The saturation values may be somewhat higher for smokers Special care should be taken with patients who have burns or carbon monoxide CO intoxication When carbon monoxide intoxication is suspected always confirm the pulse oximetry reading
168. rview When an alarm for the monitored parameter becomes active E Brady E 40 160 CG t e de de LE PI Ad en gt 29 min e 1 Alarm messages appear in the message field in the order of priority 2 Themeasurement value flashes The color red yellow indicates the alarm category high priority medium priority If the alarm is a low priority the measurement value is not flashing 3 In some cases a message in the digit or waveform field gives more detailed information using the color of the parameter An audible alarm is also triggered If enabled also the alarm light flashes red high priority yellow medium priority cyan low priority according to alarm levels Refer to Default Configuration Worksheet for more information about priorities and escalating no wl Figure 5 1 View of alarms 5 1 B40 B20 Patient Monitor Safety precautions Warnings Verify alarm processing is active and no arrhythmia occurred during power interruption Latched alarms are not retained through monitor reset if alarm condition is been removed Do not rely on secondary alarm system for receipt of alarm signal Observe patient frequently while alarms or audio are paused or off No alarm sound and no remote alarms during Audio Pause Alarms do not sound alarm histories are not stored alarm graphs do not print and alarms are not sent to the central station during an alarm pause
169. s Use the Trim Knob to scroll the trend in vertical direction When the highlight reaches the top or the bottom of the view next five minutes of information appear Recording and printing Recording Parameters for recording are chosen during configuration To change the parameters see section Monitor setup 1 Press the Print Record key 2 Select Record Trends 3 Select Record Numerical Printing 1 Press the Pt Data Trends key and select Trends 2 To print all the numerical trend data select Numerical Print Page Factory default parameters You cannot change the contents of numerical trend fields The parameter units follow the real time waveform settings of each parameter Page 1 Vital parameters Mark Time HR SpO2 NIBP NIBP Art Art CVP CO2 sys dia mean sys dia mean mean ET Page 2 Hemodynamics Mark Time IBP1 IBP2 C O REF PCWP Art CVP Page 3 Gases Mark Time CO2 RR ET FI Page 4 Temperatures and saturations Mark Time T1 T2 Tblood SpO2 SvO2 Trends Erasing trend data Trends are erased when you discharge the patient 1 Press the Admit Discharge key 2 Select Discharge 3 In the opened window select Yes to erase the trends and to discharge the patient Admit gt Admit Discharge Discharge Admit Patient Select Mode NO Discharge Normal Screen Se
170. s amplitude Figure 4a 7 1 s 5 8 to 8 2 s normal amplitude Figure 4a 4 4 s 4 2 to 4 6 s doubled amplitude Figure 4b halved 7 0 s 6 1 to 7 5 s amplitude Figure 4b 5 8 s 4 5 to 7 45 normal amplitude Figure 4b 6 1 s 5 1 to 7 0 s doubled amplitude ST ST numeric range 9 to 9 mm 0 9 to 0 9 mV ST numeric accuracy 0 2 mm or 1096 whichever is greater within the range of 8 to 8 mm ST numeric resolution 0 1 mm Pacemaker detection Input voltage range 2to 700 mV Input pulse width 0 5 to 2 ms Input overshoot Specified for both Method A and Method B required in ANSI AAMI EC13 2002 Section 4 1 4 2 Pacer pulse rejection of 2 0 V s according to the test defined in ANSI AAMI fast ECG signals EC13 2002 Section 4 1 4 3 NOTE Pacemaker detector may not operate correctly during the use of high frequency HF surgical equipment The disturbances of HF surgical equipment typically cause false positive pacer detection Direct cardiac application The display area reserved for the ECG measurement in the monitoring system screen may not be adequate for displaying the complete ECG amplitude when measuring ECG direct from the surface of the heart Clipping of the signal can be reduced by adjusting the size of the signal on the screen for example from the default 1 0 to 0 2 in the ECG menu System description Impedance respiration specifications Measurement range 4 to 120 resp min
171. s you need a password If you wish to adjust the settings of the features we recommend that you contact the person responsible for the entire configuration ECG printout type See Changing printer settings on page 6 4 ECG waveform sweep speed To change the waveform sweep speed Monitor Setup Sweep Speeds Select Hemodynamics and adjust the value Checklist Check that 11 20 Electrode gel is moist Electrodes have good skin contact Electrodes are positioned correctly Correct leadwire set is selected The trunk cable is connected properly Leadwire set is properly connected to the trunk cable Correct leadwire type is selected in the ECG Setup menu Pacemaker selection in the ECG Setup menu is Show when a pacemaker is used ECG is selected for screen through Monitor Setup Screen Setup 12 Impedance respiration Impedance respiration 12 Impedance respiration Safety precautions Warnings Cautions Make sure that the leadwire set clips or snaps do not touch any electrically conductive material including earth The monitor may not detect all episodes of inadequate breathing nor does it distinguish between central obstructive and mixed apnea events ELECTRODE CONFIGURATION Impedance respiration monitoring is not reliable when ECG electrodes are placed on the limbs This device is not an apnea monitor system intended to alarm primarily upon the cessation of breathing In central apnea it indi
172. s airway adapter Position the adapter s sampling port upwards to prevent any condensed water from entering the sampling line NOTE The message Sampling line blocked may result if you attach the sampling line to the water trap after turning on the monitor Airway gas CO2 CO setup menu Airway Gas Scale FiO2 Level N20 Level Unit Airway Gas Airway Gas C02 Setup Scale s Calibration 3 Fi02 Level Screen Setup N20 Level Normal Screen Unit Resp Rate Source Measurement c02 Alarm Resp Rate Alarm Previous Menu Set scale Resprate source and alarms Change size of C02 waveform by changing scale height gt O Lo Allows you to select the following scales scale options for scale options for kPa scale options for mmHg 0 6 0 6 kPa 0 50 mmHg 0 10 0 10 kPa 0 80 mmHg 0 1596 0 15 kPa 0 100 mmHg 0 2096 0 20 kPa 0 160 mmHg Selects the FiO level The FiO level is used in gas compensations of the CO measurement to increase the measurement accuracy Make sure the level is set if the FiO level is higher than 4096 Selects the N O level The presence of NO causes the CO value to appear higher than the actual value Use this option to compensate for the presence of N O Selects the CO display unit 96 kPa or mmHg Resp Rate Source CO2 Alarm You can select the rate to be calculated from the ECG leads impedance measurement or the
173. s the Print Record key and select Record Waveforms Record to Local To stop the recording e _ Press the Recorder Start Stop key or Press the Print Record key and select Record Waveforms Stop Waveforms You can also use the network recorder by selecting Record to Net The network recorder uses the settings of the Central gt Record amp Print Record amp Print Record Waveforms B Record Waveforms Record Trends E Record to Net Print Graphical Waveform 1 Printer Connection Mone Waveform 2 Normal Screen Waveform 3 Start on Alarms Delay Paper Speed Lenght Previous Menu Record waveforms Start recording of sdected gt waveforms to local recorder Print and record Sample of waveform recording 4 5 7Aug9S 18 24 ECG aVR rd m div f In I Pleth 20 ee o 6 E coz x Cp o 1 Speed 12 5mm s a 1 Recorder speed mw 2 Scale 3 Selected waveform 4 Date 5 Time NOTE Waveform scaling follows the displayed parameter scaling when applicable Selecting waveforms for recording You can select which waveforms and how many of them you want to record 1 Press the Print Record key 2 Select Record Waveforms 3 Select Waveform 1 and a parameter for it or select OFF 4 Select Waveform 2 and 3 and their parameters You can record simultaneously up to three waveforms The following menu figure shows which parameters have recordable waveforms
174. selected for screen through Monitor Setup Screen Setup 16 Temperature Temperature 16 Temperature Safety precautions Warnings e Temperature measurement response time is affected by use of esophogeal stethoscope with certain temperature sensors Overview You can simultaneously measure and monitor temperature of two sites with TEMP configuration As a measuring probe use only GE Healthcare temperature probes or defibrillator proof YSI 400 series probes You can measure for example esophageal nasopharyngeal rectal and skin temperature NOTE Monitoring of perioperative body temperature is recommended when inducing hypothermia or if unexpected temperature changes occur Temperature connector Figure 16 1 Temperature measurement connector 16 1 B40 B20 Patient Monitor Displaying temperature ct Tl OE 1 38 8 T2 T 12 20 5 18 3 Figure 16 2 T1 T2 digit display 1 Labels 2 Temperature measurement value 3 Calculated T2 T1 difference The other options are individual T1 and T2 readings in a digit field Patient connections lt NT Figure 16 3 Temperature measurement setup 1 Compatible temperature measurement capability 2 Adapter cable for temperature probes 3 Reusable temperature probe 4 Adapter cable for disposable temperature probe 5 Disposable temperature probe To connect the patient 1 Attach the temperature probe to the
175. sis NOTE A physician must analyze the arrhythmia information in conjunction with other clinical findings Test results of arrhythmia algorithm testing 11 18 The algorithm testing has been performed by using the following databases AHA The American Heart Association Database for Evaluation of Ventricular Arrhythmia Detectors MIT BIH The Massachusetts Institute of Technology Beth Israel Hospital Arrhythmia Database NST The Noise Stress Test Database CU The Creighton University Sustained Ventricular Arrhythmia Database Gross results for beat by beat detection AHA Test Gross QRS Sensitivity 99 84 QRS positive preductive 99 88 accuracy VEB sensitivity 95 24 VEB positive predictive 97 24 accuracy VEB false positive rate 0 274 ECG Gross results for sample by sample detection of ventricular fibrillation AHA Test Gross VF Sensitivity duration 99 VF positive preductive accuracy 10096 episode The gross results are calculated as overall results of all records Abbreviations VEB Ventricular ectopic beat ORS The waveform presented in an ECG during ventricular depolarization VF Ventricular fibrillation or ventricular flutter ST Segment of the ECG between the end of the QRS complex and the start of the T wave Monitoring pacemaker patients Warnings e _Do not diagnostically interpret pacemaker spike size and sh
176. ssories reuse of single use accessories affect on pressure strong scavenging suction The user may only perform maintenance procedures specifically described in this manual On the E MiniC module indicates that airway gases should be calibrated every six months in normal use and every two months in continuous use B40 B20 Patient Monitor Cautions Overview Dispose of packaging material by observing applicable waste control regulations For safe and reliable function and operation of the monitor regular care has to be carried out according to the instructions in this manual and to the maintenance procedures described in the Technical Reference Manual If the monitor does not function as it should and troubleshooting cannot solve the problem contact your service or sales representative Do not perform any other cleaning or maintenance procedures than those described in the monitor manuals NOTE Refer to the accessory package for detailed cleaning instructions Preventive maintenance Daily and between the patients 9 2 Wipe the monitor and module surfaces Wipe the ECG trunk cable and leadwires NIBP cuff and cables and SpO sensors Avoid excessive use of liquids Change or sterilize all airway and invasive patient accessories Clean disinfect or sterilize reusable temperature probes Empty the D fend water trap whenever half full Check that all accessories cables and monitor parts are clean and inta
177. ssure Adult Pediatric 135 15 mmHg Neonate 100 15 mmHg Over pressure allowed by independent safety controller Adult Pediatric 300 to 330 mmHg Neonate 150 to 165 mmHg 1 Blood pressure measurements determined with this device are equivalent to those obtained by an intra arterial blood pressure measurement device within the limits prescribed by the American National Standard Manual electronic or automated sphygmomanometers B40 B20 Patient Monitor Invasive blood pressure Measurement range 40 to 320 mmHg 5 3 to 42 7 kPa Measurement accuracy 5 or 2 mmHg whichever is greater Frequency response 4to 22 Hz Transducer sensitivity 5 uV V mmHg Pulse rate Range 30 to 250 bpm Accuracy 5 or 5 bpm whichever is greater Display resolution 1 bpm Zero adjustment range 150 mmHg Temperature Measurement units Fahrenheit F Celsius C Measurement range 10 to 45 C 50 to 113 F Measurement accuracy 0 1 C without temperature sensor Display resolution 0 1 C at 25 to 45 C with reusable probes Probe types supported Use only GE Healthcare recommend temperature YSI probes Temperature self check At start up and then every 10 minutes Probe type time response temperature probe 9F Reusable skin temperature 3 s probe Reusable adult central 65 tempera
178. t 0 2 ohms 0 1 ohms Impedance of protective earth connection 0 2 ohms 2 7 Ground earth wire leakage current tests 500 uA Normal Condition NC gt i lt 300 HA Single Fault Condition SFC lt 1mA 2 8 Enclosure Touch leakage current test Normal Condition NC lt 100 uA lt 500 uA Single Fault Condition SFC lt 300 uA 2 9 Patient source leakage current test Normal Condition NC lt 10 uA 2 1 Document no 2050802 001 B30 Patient Monitor Electrical Safety Tests OK N A Fail Single Fault Condition SFC lt 50 uA 2 10 Patient sink leakage current test mains voltage on the applied part lt 50 uA Notes Visual Inspection OK N A Fail Visual inspection Functional Inspection OK N A Fail Start up Display Frame unit Parameters measurements Recorder Network connection Conclusion Notes Signature 2 2 Document no 2050802 001 wal Asian Headquarters GE Medical Systems GE Medical Systems _ GE Medical Systems _ Information Technologies Asia Information Technologies Inc Information Technologies GmbH een 8200 West Tower Avenue in a Zhangjiang Hi tech
179. t atrial pressure airway resistance right cardiac work right cardiac work index Response Entropy rectal temperature right ventricular ejection fraction reference respiration rate total set respiration rate total measured radio frequency average root mean square power B40 B20 Patient Monitor Room RQ RR rtm RV RVEDV RVESV RVP RVSW RVSWI SA SaO S A R SD SE SEF SEMG Sev S Skin SN S N Spiro SpO Spont SQI SR SR SSEP ST ST stat STAT STBY Stfilt STPD Surf SV SVC SVI SvO SVR SVRI room temperature respiratory quotient respiration rate total measured rhythm residual volume right ventricular end diastolic volume right ventricular end sustolic volume right ventricular pressure right ventricular stroke work right ventricular stroke work index second sinoatrial arterial oxygen saturation specific absorption rate standard deviation State Entropy spectral edge frequency spontaneous electromyogram sevoflurane stroke index skin temperature serial number patient spirometry oxygen saturation spontaneous breathing signal quality index suppression ratio sinus rhythm somatosensory evoked potentials single twitch NMT ST segment of electrocardiograph static continuous NIBP cuff inflation for five minutes standby ST filter ECG standard temperature and pressure dry gas surface temperature stroke volume supraventricular contraction stroke
180. t rate alarms To minimize this problem follow proper electrode placement and cable positioning guidelines provided with this product When using the electrosurgery unit ensure proper contact of the ESU return electrode to the patient to avoid possible burns at monitor measurement sites Also ensure that the ESU return electrode is near the operating area Patient s skin may become irritated after long contact with electrode gel or adhesive The impedance respiration measurement may cause rate changes in Minute Ventilation Rate Responsive Pacemakers B40 B20 Patient Monitor Overview The electrocardiography ECG reflects the electrical activity generated by the heart muscle ECG monitoring is used for a heart rate measurement for arrhythmia analysis and for detecting pacemaker function and myocardial ischemia In Normal Screen when measuring 5 lead ECG you can simultaneously monitor the waveforms of up to three different ECG leads In 3 lead ECG the monitor displays one ECG lead When monitoring the ECG the monitor simultaneously analyzes ST segment changes ECG and impedance respiration connector Figure 11 1 Electrocardiographic ECG measurement connector ECG Displaying ECG and heart rate t nE t EM V a Y 7 Nie Er TH qu qu qu 1 ve dede ded O Figure 11 2 Display of ECG and HR 1 ECG1 is displayed first 2 ECG2 is displayed below ECG1 3 ECG3 is displayed below ECG2 4 S
181. t to 7 Pressing the Silence Alarms key once e Tosilence all alarms for two minutes press the Silence Alarms key once Pressing the Silence Alarms key once silences the alarms that are currently active and presilences the upcoming alarms of other measurements If the alarms are not active when you press the Silence Alarms key they are pre silenced for 2 The crossed bell symbol with a countdown timer is displayed in the upper left hand corner of the screen to indicate that the alarms are silenced and the message field is cleared of all the previous alarm and note messages The visual alarms in the digit and waveform fields remain as long as they are valid During silencing all new alarms for the same reason and all alarms for a different reason are indicated visually Apnea alarms are activated after five breaths Pressing the Silence Alarms key twice e Tosilence an individual alarm that is currently active press the Silence Alarms key twice This does not pre silence the upcoming alarms The message Alarms acknowledged is displayed to indicate that the alarms that were silenced by pressing the Silence Alarms key twice remain silent whereas other upcoming alarms will have an audible sound Reactivating alarms You can reactivate the alarm sounds of new upcoming alarms by pressing the Silence Alarms key once again during the silencing period The alarms that were active when the key was first pressed will not sound before the origi
182. temporarily unless you accept them by saving them in the modes 1 Select Monitor Setup Install Service Enter the password 2 Select Save Modes Enter the password 3 Select the mode from the list and select Save Temporary modifications are valid until you discharge the patient or change a mode or until more than 15 minutes has elapsed from the turn off of the monitor Changing the user mode The monitor always starts in startup mode The startup mode is one of the user modes and it is chosen during configuration To change from the startup mode to another mode 1 Press Admit Discharge and select Select Mode 2 Select one of the following modes STEP DOWN Mode for intermediate care ED Mode for emergency care PACU Mode for post anesthesia care CCU Mode for ECG and ST care NEURO Mode for neurological monitoring PEDIATRIC Mode for pediatric ICU monitoring NEONATAL Mode for neonatal monitoring NOTE When you want to select NEONATAL mode You should first Press the Admit Discharge and select Patient Type to NEO 6 5 B40 B20 Patient Monitor Adimit Discharge select Mode Retumto STEP D Oui Admit gt Admit Discharge Discharge Admit Patient Select Mode Discharge BTEP DOWN O an 2003 1 3 ED O an 203 Mormal Screen 3 PACU O an 2003 5 NEURO G an 2003 b PEDIATRIC O an 2003 T NEONATAL C an 20103 Previous Menu Activate
183. tents of lower digit Select OFF to clear field field 1 Select OFF to clear field Check that the measurement is on 1 Press the Others key 2 Select Resp Setup 3 Select Measurement and ON Others gt Others Resp Setup Temp Setup Size 20 Resp Rate Source Normal Screen p Measurement Detection Limit Resp Rate Alarm Screen Setup Previous Menu Set size Resp rate source and alarm Enable or disable Resp Select ON to enable measurement impedance respiration 4 O measurement 12 5 B40 B20 Patient Monitor Improving waveform readability To improve readability increase the waveform size 1 Press the Others key 2 Select Resp Setup 3 Select Size and adjust the waveform size Others Resp Setup Size Resp Rate Source Measurement Detection Limit Resp Rate Alarm Screen Setup Previous Menu Change size of waveform by adjusting scale height gt O Lo The bar on the left side of the waveform always indicates a 1 Q reference Impedance respiration Correcting the respiration number Normally we recommend the use of the AUTO detection limit However in some specific cases you may wish to adjust the limits manually When the respirations are weak you can manually adjust the detection limits measurement sensitivity closer to each other to ensure that all respirations are included in the RR value In this case the dotted line represents t
184. th and resolution 1 Press the Pt Data amp Trends key 2 Select Trends Time Scale 3 Select the trend length Table 7 1 Trend length and resolution Trend length on the Resolution Trended time period screen 20 minutes 10 seconds last 30 minutes 1 hour 1 minute last 24 hours 2 hours 1 minute last 24 hours 4 hours 2 minutes last 24 hours 6 hours 3 minutes last 24 hours 8 hours 4 minutes last 24 hours 10 hours 5 minutes last 24 hours 12 hours 6 minutes last 24 hours 24 hours 12 minutes last 24 hours 36 hours 18 minutes last 36 hours 48 hours 24 minutes last 48 hours 72 hours 36 minutes last 72 hours 7 7 B40 B20 Patient Monitor Moving on graphical trend pages To see more parameters on other pages e Select Scroll Pages in the Trends menu Numeric measurement values for trended parameters are displayed next to the cursor The cursor indicates the time when these values have been measured To change the cursor location 1 Inthe Trends menu select Cursor 2 to move the cursor 3 to return to the menu To scroll the time move the cursor past the right or left border of the trend Recording and printing Recording 1 Press the Print Record key 2 Select Record Trends 3 Select Record Graphical The recording time of a trend corresponds to the time scale of the graphical trends You can choose the time scale 20 minutes to 72 hours in the trends m
185. the NIBP key and select Start STAT To stop the measurement select the Stop STAT Sys Cutt 78 B40 B20 Patient Monitor Principles of SuperSTAT Noninvasive Blood Pressure Determination 13 10 The oscillometric method of determining NIBP is accomplished by a sensitive transducer which measures cuff pressure and pressure oscillations within the cuff For the first determination taken on a patient the algorithm stores the pattern of the patient s oscillation size as a function of the pressure steps For subsequent manual determined as such when the previous determination is less than 16 minutes old auto or stat determinations taken of the same patient as few as four pressure steps may be necessary to complete the determination process When employing fewer pressure steps the system uses the stored information from the previous blood pressure determination to decide the best pressure steps to take The algorithm measures the consistency of pulse size to tell if the oscillations taken at a step are good and if more steps are needed The first determination settles at an initial target pressure of 135 mmHg adult mode and 100 mmHg neonate mode depending on initial target pressure preset To allow for rapid settling of cuff pressure the monitor will momentarily inflate to a higher pressure then immediately deflate to the target pressure After inflating the cuff the NIBP parameter begins to deflate The oscillations versus
186. the patient Attach the sensor cable to the wrist or bed clothes to prevent the cable and sensor from moving The message Pulse Search is display in the message field After the pulse search is completed the plethysmographic pulse waveform and the SpO reading are displayed on the screen Pulse oximetry Pulse oximetry menu SpO Pulse Oximetry SpO2 Response Beat Sound Volume HR Source SpO2 Alarm Screen Setup Normal Screen Change size of plethysmograph by changing scale Select AUTO gt to auto scale waveform Pleth Scale GE SpO configuration only If the pleth scale selection is AUTO the scale of the plethysmographic waveform display is automatically set during Pulse Search The scale is then kept constant throughout the case to enable easy detection of changes in the patient s perfusion To adjust the pleth scale further select one of the following 2 5 10 20 50 Auto With automatic AUTO scaling mode the scale changes automatically if the amplitude of the pleth waveform either exceeds the current scale or falls below the maximum value of the next lower scale by 1096 for 30 seconds or more When the scale changes the message Scale changed is displayed The scale indicator number is displayed on the left side of the waveform SpO Response GE SpO configuration only Selects the SpO averaging time The selections are Normal 12 seconds default setting Fast 3 seconds
187. the patient s airway while nebulized medications are being delivered Keep the monitor horizontal when the E miniC module is used Tilting the monitor may cause erroneous results in the E miniC module s readings and damage the module Leak in breathing circuit water trap or sampling line may cause inaccurate readings Blocked gas exhaust may cause inaccurate readings EtCO values may differ from blood gas readings Be sure CO measurement is off before removing water trap Never connect any tubing to reference gas inlet connector The inlet must be open at all times Strong scavenging suction may change the operating pressure of the module and cause inaccurate readings or excessive sample gas flow Do not use gas or CO sidestream sampling modules on patients who may be adversely affected by the specified withdrawal rates e g a neonate with low tidal volume To avoid the spread of infectious disease do not allow the exhaust to discharge in the direction of the patient or user Handle the water trap and its contents as you would any body fluid Infectious hazard may be present CO measurement is intended for patients weighing over 5 kg 11 lb Since sample gas contains anesthetic agents make sure that it is not released in the room Do not apply pressurized air to any outlet or tubing connected to the monitor pressure may destroy sensitive elements Malfunction may cause gases to vent Check the water trap every 48 h
188. the sensor on the patient Physiological characteristics of the patient can affect the SpO signal and readings NEONATAL The display of inaccurate pulse oximetry SpO values has been linked to the presence of poor signal strength or artifact due to patient motion during signal analysis This condition is most likely to be encountered when the monitor is used on neonates or infants These same conditions in adults do not impact the SpO values to the same extent We recommend the application of the following criteria when using the pulse oximetry function on neonates and infants The peripheral pulse rate PPR as determined by the SpO function must be within 1096 of the heart rate and TheSpO signal strength should be adequate This is indicated by the display of two or three asterisks or the absence of a Low Signal Quality message Procedures or devices previously applied in your facility for SpO monitoring should be used in the event the SpO value from the monitor cannot be validated by the above criteria If the accuracy of any measurement does not seem reasonable first check the patient s vital signs then check for conditions that may cause inaccurate SpO readings If the problem is still not resolved check the SpO module or sensor for proper functioning Oximetry performance may be impaired when patient perfusion is low or signal attenuation is high The operator is responsible for checking the compatibil
189. ths min Accuracy 1 breaths min in the range 4 to 20 breaths min 5 in the range 20 to 80 breaths min 2 33 B40 B20 Patient Monitor Resolution 1 breaths min Non disturbing gases are those with a maximum effect on the CO reading at 5 0 vol lt 0 2 vol The effect is valid for specific concentrations shown in parentheses of the non disturbing gas Ethanol C HsOH lt 0 3 Acetone lt 0 1 Methane CH lt 0 2 Nitrogen N 0 to 100 Water vapor 0 to 100 Dichlorofluoromethane lt 1 Tetrafluoroethane lt 1 Disturbing gases and their effect on the CO reading at 5 0 vol CO are shown below Errors listed reflect the effect of specific concentrations shown in parentheses of an individual disturbing gas and should be combined when estimating the effect of gas mixtures Halothane 4 increases lt 0 3 vol Isoflurane 5 increases lt 0 4 vol Enflurane 5 increases lt 0 4 vol Desflurane 24 increases lt 1 2 vol Sevoflurane 6 increases lt 0 4 vol f O compensation is not activated O 40 to 95 decreases lt 0 3 vol fO compensation is activated O 40 to 95 error lt 0 15 vol f N20 compensation is not activated N20 40 increases lt 0 4 vol fN O compensation is activated N20 40 to 80 error lt 0 3 vol NOTE CO measurement is intended for patients weighing over 5 kg 11 Ib 3 Installation Installation
190. time between 20 minutes and 72 hours You can view the trends through Pt Data amp Trends Trends or you can select graphical minitrends to be displayed continuously next to the waveform fields Monitor Setup Screen Setup Split Screen Trended parameters Electrocardiography HR ST nvasive pressures Non invasive blood pressure Oxygen saturation Pleth SpO Gases CO Resp Impedance respiration Resp Temperatures Trend data is stored in the memory for 15 minutes after the power has been turned to standby 7 1 B40 B20 Patient Monitor Most common tasks 7 2 Displaying trends and activating the Trends menu Press the Pt Data amp Trends key and select Trends The most recently displayed trend graphical or numerical is displayed together with the Trends menu Scrolling time with trend cursor e Turn the Trim Knob to move the cursor to the time you want Numeric measurement values of that time are displayed in the graphical trend next to the cursor Push the Trim Knob to return to the menu Scrolling pages to see more parameters Select Scroll Pages and turn the Trim Knob to move from one page to the other Changing the time scale Select Time Scale Select the trend time 20 min or 1 2 4 6 8 10 12 24 36 48 72 hours Selecting numerical or graphical trends to the screen Select Graphical or Numerical Changing trend scales Sele
191. torage atmospheric pressure range of 700 to 1060 hPa Recycled materials or may be recycled B40 B20 Patient Monitor 2 12 This symbol indicates that the waste of electrical and electronic equipment must not be disposed as unsorted municipal waste and must be collected separately Please contact an authorized representative of the manufacturer for information concerning the decommissioning of your equipment The separate collection symbol is affixed to a battery or its packaging to advise you that the battery must be recycled or disposed of in accordance with local or country laws To minimize potential effects on the environment and human health it is important that all marked batteries that you remove from the product are properly recycled or disposed For information on how the battery may be safely removed from the device please consult the service manual or equipment instructions Information on the potential effects on the environment and human health of the substances used in batteries is available at this url http www gehealthcare com euen weee recucling index html This product consists of devices that may contain mercury which must be recycled or disposed of in accordance with local state or country laws Within this system the backlight lamps in the monitor display contain Battery operation and remaining capacity The height of the green bar indicates the charging level Battery A charging white bar Battery
192. ture probe Reusable pediatric central 4s temperature probe Disposable skin 3to6s temperature probe Disposable central 5to8s temperature probe 12F Disposable central 5to8s System description Airway gases Sampling rate 150225 ml min sampling line 2 to 3 m normal conditions Maximum sampling line length 6m Sampling delay 2 1 s typical with a 3 m sampling line Total system response time 2 4 seconds typical with a 3 m sampling line including sampling delay and rise time Warm up time 1 minute for operation 30 minutes for full specification Autozeroing interval 4 15 30 and 60 minutes after start up then every 60 minutes NOTE The drift of measurement accuracy will be cleared after autozeroing Carbon dioxide CO Measurement range 0 to 20 vol Accuracy 0 to 15 vol 15 to 20 vol 0 2 vol 2 of reading 0 7 vol 2 of reading Resolution 0 1 Measurement rise time lt 300 ms with nominal flow Valid for respiration rate lt 40 breaths min at I E ratio of 1 1 Relative error is typically 10 for respiration rate 80 breaths min at I E ratio of 1 1 The accuracy is specified in simulated ventilation With higher respiration rates and with varying ventilation methods the specifications may not be met Respiration rate Breath detection 1 change in CO level Measurement range 4 to 80 brea
193. u can also access the adjustment menu through each parameter menu NOTE If the monitor is connected to the network the alarm limits can also be changed using the Central if this feature has been enabled in its configuration Auto limits are calculated from the displayed patient reading at the time when auto limits are selected Sets the alarms to the default alarm limits NOTE Default limits can be changed and saved to modes For more information see the Default Configuration Worksheet Cancel Changes Returns all the limits to the ones set before entering the Alarms Setup menu if you have not Arrh Alarms exited the menu yet Opens a menu to select and adjust Severe arrhythmia analysis Alarm priorities can be configured in this menu Adjust defines the alarm priorities red yellow cyan off NOTE You can only set the priority for V Tachy NOTE V Tachy alarm cannot be selected OFF NOTE Alarm priorities can also be set using the Central depending on its configuration To redisplay the Alarms Setup menu select Alarms Setup B40 B20 Patient Monitor Alarm Volume Alarm Light Audio ON OFF Remove Menu 5 6 For more information on arrhythmia alarms please see section ECG Adjusts the volume of the audio alarms The range is from 1 soft to 10 loud NOTE Audible alarms cannot be totally silenced with the Alarm Volume function This is a grey option menu The brightness of the alarm light is
194. ubstantially larger than the spontaneous breaths the respiration calculation may mistakenly count only the inspirations and expirations produced by the ventilator You can correct this by adjusting the detection limits manually 1 Press the Others key 2 Select Resp Setup 3 Select Detection limit and adjust the limits Turning off the measurement If the impedance respiration measurement signal interferes with other measurements such as ECG you can turn it off 1 _ Press the Others key 2 Select Resp Setup 3 Select Measurement OFF Others Resp Setup Size 43 Resp Rate Source Measurement Detection Limit Resp Rate Alarm Screen Setup Previous Menu Select ON to enable impedance respiration gt measurement Impedance respiration Checklist Check that Electrode gel is moist Electrodes have good skin contact Electrodes are positioned correctly Correct leadwire set is selected The trunk cable is connected properly Leadwire set is properly connected to the trunk cable Correct leadwire type is selected in the ECG Setup menu ECG Resp are selected for screen through Monitor Setup Screen Setup B40 B20 Patient Monitor 12 10 13 Non invasive blood pressure Non invasive blood pressure 13 Non invasive blood pressure Safety precautions Warnings Cautions The NIBP parameter will not measure blood pressure effectively on patients who are experie
195. un out and the monitor switches off Wait for another 15 minutes 5 Reconnect the monitor to the power supply and turn it on Continue charging the batteries until both capacity indicators are full height and no longer scrolling 6 Keep charging for another two hours After this check that the orange battery LED in the front panel is no longer on If it is continue charging until it goes off to indicate that the battery conditioning is complete Every 12 months Preventive maintenance check The annual check according to detailed instructions of the Technical Reference Manual requires trained service personnel and appropriate testing tools and equipment Calibration check of temperature NIBP and invasive blood pressures Calibration check of temperature NIBP and invasive blood pressures should be performed at least once a year by qualified service personnel as a part of the Maintenance see Technical Reference Manual Power interruption NOTE If the monitor is turned off trend data and the latest user made settings remain in the monitor memory for 15 minutes even if the mains power is interrupted If not 9 4 Cleaning and care contact service personnel After 15 minutes trend data is lost and the monitor returns to the user default settings Changing fuses 1 Remove the power cord if used 2 Remove the fuse holder by pulling the holder out with screwdriver 3 Ifa fuse is blown replace it with a fuse of the
196. utwards to insure the module is firmly seated To remove module 1 Pressing the release latch on the bottom of the module 2 Grasp the module firmly and pull out of the Frame Make sure not to drop it when it comes out WARNING When detaching modules be careful not to drop them Always support with one hand while pulling out with the other Visual indicators Function Specification Explanation External power supply Green LED Indicates when monitor is powered from mains Battery operation Green LED Indicates when monitor is powered from internal batteries Battery condition Orange LED Indicates when monitor is charging batteries solid or battery failure flashing Alarm Light Highly visible Red Ease alarm detection from distance Yellow Cyan light 3 3 B40 B20 Patient Monitor Installation checkout It is recommended to be performed after monitor installation Skip the tests that are not applicable for the installed monitor These instructions include a Installation and checkout form B40 B20 to be filled in when performing the procedures An electrical safety check and a leakage current test should be performed prior to the monitor installation Please refer to Technical Reference Manual for details Recommended tools 3 4 NOTE Use only properly maintained calibrated and traceable measurement equipment for the specified calibrations and adjustments to ensure accuracy NOTE A functional tester can
197. ve the ECG cable from the connector and reinsert it Pacer markersare le Check that oe The pacer markers have been selected ON The pacemaker has been adjusted correctly and not above R The pacemaker functions correctly ECG cables electrodes and setups are correct Thick ECG ECG cable is looped baseline Other electrical power cables are near the ECG leadwires Incorrect ECG filter Incorrect power frequency of the monitor Table 10 6 Other problems related to impedance respiration measurement Symptom Possible cause and solution Respiration e Check the electrode quality and positioning measurement fails Adjust the detection limits During ventilator supported breathing the respiration calculation may count only ventilator produced inspirations and expirations e Other electrical devices may interfere with the measurement Table 10 7 Other problems related to InvBP measurement Symptom Possible cause and solution InvBP readings seem unstable e Make sure there are no air bubbles in the transducer system Flush and zero Place the transducer on the patient s mid heart level and zero Troubleshooting Table 10 8 Other problems related to NIBP measurement Symptom Possible cause and solution NIBP e Check that cuff tubings are not bent stretched compressed or loose measurement does notworkor Prevent motion artifacts values see
198. volume index mixed venous oxygen saturation systemic vascular resistance systemic vascular resistance index System description SW SVV Sys t T BTPS T1 T1 T2 Tab Tachy Tbl Tblood Tcorr Temp Theta Th Tinj TOF TOF Trigem TV TVexp TVinsp Tx Tymp V Q V0 5 V1 0 VA VC VCO Vd Vd Vt Vent Calcs VFib VO VO Calc VO Calcl VO Vol software stroke volume variation systolic pressure time min temperature tesla temperature in BTPS conditions first stimulus as of the reference value NMT temperature channel identification on module tabular tachycardia blood temperature temperature correction temperature theta frequency band injectate temperature train of four NMT ratio of the 4th to the 1st response NMT trigeminy tidal volume expired tidal volume ml inspired tidal volume ml temperature label x being 1 2 3 or 4 or one of the other label choices tympanic temperature venous ventricular volume ventilation perfusion ratio volume expired during the first 0 5 seconds volume expired during the first second alveolar ventilation vital capacity carbon dioxide production dead space dead space ventilation ventilation calculations ventricular fibrillation oxygen consumption calculated oxygen consumption calculated oxygen consumption index oxygen consumption index volume B40 B20 Patient Monitor V Run V Tachy WLAN wt x y
199. with a blood sample measurement Intravascular dyes may cause erroneous readings For example methylene blue indigo carmine indocyanine green or any substances that contain dyes interfere with the SpO measurement Vasoconstrictive drugs such as phenylephrine hydrochloride and dopamine may affect the accuracy of the measurement The pulse oximeter cannot distinguish between oxyhemoglobin and dyshemoglobins for example met or carboxyhemoglobins Poor perfusion may affect the accuracy of measurement when using the ear probe To avoid erroneous readings do not use a blood pressure cuff or arterial blood pressure measurement device or NMT sensor in the same limb as the SpO sensor For Masimo SpO2 loss of pulse signal can occur when Sensor is too tight The patient has hypotension severe vasoconstriction severe anemia or hypothermia There is arterial occlusion proximal to the sensor Check that Only one module with pulse oximetry measurement is inserted Correct SpO sensor is selected for each patient size The sensor is completely dry after cleaning Sensor or interconnect cable is plugged to the blue connector in the module Sensor is properly connected to the interconnection cable if used Sensor is positioned correctly to the patient SpO is selected for screen through Monitor Setup Screen Setup 14 7 B40 B20 Patient Monitor 14 8 15 Invasive blood pressure Invasive blood pressure
200. y the Screen Setup menu item and the Waveform Fields menu item would be shown as Monitor Setup Screen Setup Waveform Fields Messages Messages alarm messages informative messages displayed on the screen are written inside single quotes Please wait References When referring to different sections in this manual or to other manuals manual names and section names are enclosed in double quotes See section Cleaning and care Please refer to Technical Reference Manual Installation The following symbols are also used to distinguish procedures ECG gt Press the menu key described Introduction O7 Turn the Trim Knob Push the Trim Knob Related documentation Installation technical solutions and servicing PROCARE Monitor B40 B20 Technical Reference Manual Options and selections of the software PROCARE Monitor B40 B20 Default Configuration Worksheet Compatible supplies and accessories PROCARE Monitor B40 B20 Supplies and Accessories Other devices closely related to the monitor o Central and Central Client User s Reference Manual e CIC Pro Clinical Information Center Operator s Manual 1 5 B40 B20 Patient Monitor Safety precautions The following list contains all the general warnings and cautions you should know before starting to use the system Warnings and cautions specific to parts of the system can be found in the relevant section Safety message signal words War
201. y count only the inspirations and expirations produced by the ventilator The impedance respiration measurement may cause rate changes in Minute Ventilation Rate Responsive Pacemakers Set the pacemaker rate responsive mode off or turn off the impedance respiration measurement on the monitor When using the electrosurgery unit ensure proper contact of the ESU return electrode to the patient to avoid burns at measurement sites Also ensure that the ESU return electrode is near the operating area 12 1 B40 B20 Patient Monitor Overview Impedance respiration is measured across the thorax When the patient is breathing or is ventilated the volume of air changes in the lungs resulting in impedance changes between the electrodes Respiration rate is calculated from these impedance changes and a respiration waveform is displayed on the monitor screen ECG and impedance respiration connector Figure 12 1 Impedance respiration measurement connector Respiration detection The respiration rate is the sum of the respirations that have exceeded the detection limit The dotted lines present the zero line and the detection limit The signal strength produced by a respiration should thus exceed this minimum limit to be included in the respiration rate calculation Peaks within the grids are not calculated If the detection mode is AUTO the grid lines present the minimum limits The limits in use may be larger The RR value could inc
202. ygen in the arteries pulmonary artery occlusion pressure pulmonary arterial pressure airway pressure barometric pressure pulmonary capillary wedge pressure polyethylene pediatric positive end expiratory pressure extrinsic positive end expiratory pressure total positive end expiratory pressure ICU total positive end expiratory pressure ICU intrinsic positive end expiratory pressure total positive end expiratory pressure anesthesia gastrointestinal carbon dioxide concentration System description pH pHa pHi pHv PIC Pleth PM PM non capt PM non funct Pmax Pmean Pmin Ppeak Pplat PR Prev psi pt PTC pts PVC PVC PVloop PvO PVR PVRI Px QRS Os Qt RAP Raw RCW RCWI RE Rect REF ref Resp Resp Rate RF RMS pH arterial pH intramucosal pH mixed venous pH patient interface cable plethysmographic pulse waveform pacemaker pacemaker non capturing pacemaker non functioning maximum pressure mean pressure minimum pressure peak pressure plateau pause pressure pulse rate previous pounds per square per inch patient post tetanic count NMT patients polyvinylchloride premature ventricular contraction pressure volume loop partial pressure of oxygen in mixed venous blood pulmonary vascular resistance pulmonary vascular resistance index standard pressure label x being 1 2 3 4 5 or 6 QRS complex venous admixture right describing location righ

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