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HP CodeMaster XL+ - Universal Hospital Services

1. patient ARTIFACT Excessive noise was detected by Do not touch move perform CPR DETECTED DO the advisory algorithm during ventilate or transport the patient NOT TOUCH analysis while the advisory algorithm is PATIENT analyzing cardiac rhythms Repeat analysis PADS OFF The electrodes adaptor cable is Attach electrodes to electrodes attached but no electrodes are connected adaptor cable and to patient Performing Diagnostics The following procedure allows complete functional inspection of the CodeMaster XL defibrillator monitor 1 Plug the power cord into an AC outlet Verify that the BATTCHRG and AC POWER lights are on Turn the Energy Select control to the Monitor On position The monitor trace will appear within ten seconds Press Lead Select until Lead I is displayed and verify that the message LEADS OFF appears indicating that one or more leadwires are not connected Press Lead Select to return to the paddles ECG selection WARNING Troubleshooting Performing Diagnostics 5 With the paper installed press Record once to turn on the recorder a Allow the recorder to run for approximately 20 seconds and check that Date Time HR heart rate PADDLES ECG source and AUTOGAIN ECG gain mode are noted on the ECG strip b Press Mark and verify that the mark t symbol is printed It will be delayed 6 seconds if the recorde
2. 6 Press V ECG Size or ECGSizeA to scroll through the available choices for this parameter 7 When the choice you want is displayed press Lead Select to set your choice 8 Press V ECG Size or ECGSizeA until the highlight appears on the next value you wish to change 9 Repeat steps 5 through 8 until you are finished configuring the settings in setup menu 1 10 Depress both sides of the v ECG SizeA key at once to return to the setup diag nostic menu You must depress both sides of the ECG Size key at the same time to return to the setup diagnostic menu A 10 WARNING Installation and Setup Setup 11 To change settings in setup menu 2 select SETUP MENU 2 from the setup diagnostic menu and repeat the above steps 12 Turn the Energy Select control to Off Standby to leave setup diagnostic mode You can use the factory setting for most values by selecting RESTORE FACTORY from the setup diagnostic menu The setting values can have critical impact on how your defibrillator operates RESTORE FACTORY settings does not have a hidden menu under this heading Selecting this line will undo user configured parameters and restore factory defaults If the CodeMaster XL loses your configuration settings it will display the message SETUP LOST on the screen and use the factory settings for all setup
3. If the monitoring ECG lead falls off while pacing in Demand mode the pacer will stop delivering pulses and the messages PACER STOP and LEADS OFF will appear To resume pacing attach a new ECG lead and press Start Stop Pacing in Fixed mode does not require leads to be attached for the pacer to deliver pulses If a pacing electrode comes off during pacing the pacer will stop delivering pulses and the messages PACER STOP and PADS OFF will appear To resume pacing apply a new electrode and press Start Stop HR meters and HR alarms function during pacing but they can be unreliable The HR meter attempts to count ORS activity in both Demand and Fixed pacing modes Observe the patient closely while pacing Do not rely on HR alarms or the indicated Heart Rate as a measure of the patient s health 5 4 Pacing Optional Using the Pacer Defibrillation During Pacing If the patient must be defibrillated during pacing perform the following steps 1 2 Set the desired energy level with Energy Select control Press Charge The defibrillator will automatically turn off the pacer and start charging The pacer status messages will be cleared and replaced with the defibrillator Delivered Energy Display Wait for the Charge Done Indicators Call out Clear to alert personnel to stand away from the patient Simultaneously press and briefly hold both Shock
4. Analyze Button Table 1 6 Getting Acquainted Operating Controls and Indications Advisory Mode Operating Controls Advisory Mode Operating Controls Control Energy Select power control Description The Advisory On position places the CodeMaster XL into Advisory mode Analyze Turns on automatic analysis of ECG waveforms 1 7 Figure 1 8 Charge Done Paddle Contact Indicator Sync Light AC Power Battery Charge Table 1 7 Getting Acquainted Operating Controls and Indications Indicator Lights Indicator Lights Indicator Charge Done Description Indicates that unit is charged and ready to deliver a shock CHARGE DONE lights on key panel and on Apex paddle Paddle Contact Indi cator PCI on Ster Indicates when adequate pressure is applied num paddle SYNC Light Indicates that unit is in synchronized shock mode as opposed to defibrillator mode Flashes off each time an R wave is detected AC Power Indicates that unit is plugged in to AC power Battery Charge Indicates that the unit is plugged into AC power and that the battery is being charged 1 8 Table 1 8 Audible Indicators Indicator Charge Done tone Getting Acquainted Operating Controls and Indications Description Sounds when instrument is charged and ready to deliver a shock Can be disabled in setup Auto
5. M1722B CodeMaster XL Defibrillator Monitor User s Guide Part No M1722 94980 Printed in USA June 2000 Edition 3 Notice About This Edition Publication number M1722 94980 Edition 3 Printed in USA The information in this guide applies to the CodeMaster XL defibrillator monitor This information is subject to change without notice Hewlett Packard shall not be liable for errors contained herein or for incidental or consequential damages in connection with the furnishing performance or use of this material Edition History Edition 1 May 1996 Edition 2 May 29 1998 Edition 3 June 2000 Copyright Copyright 1996 1998 2000 Hewlett Packard Company Andover MA 01810 USA This document may not be photocopied reproduced or translated to another language without prior written consent of Hewlett Packard This information is subject to change without notice Reproduction adaptation or translation without prior written permission is prohibited except as allowed under the copyright laws Medical Device Directive This product complies with the requirements of the Medical Device Directive 93 42 EEC and carries the CE 0123 mark accordingly Authorized EU representative Hewlett Packard Deutschland GmbH Herrenbergerstrasse 130 D 71034 Boeblingen Germany Fax 49 703 1 14 2346 Warranty Hewlett Packard makes no warranty of any kind with regard to this material included but not limited to the i
6. AN buttons located on the cable connector The shock will be delivered through the multifunction elec trodes After the shock the pacer remains off Resume pacing if it is required 5 5 Pacing Optional Using the Pacer 5 6 SpO Monitoring Optional SpO monitoring gives information on both cardiac and respiratory systems and details of oxygen transportation in the body It is widely used because it is non invasive continuous easily applied and painless The quality of SpO measurements depends on careful application of the sensor Read the following section Application Notes page 6 1 to understand the importance of sensor application For more detailed information refer to SpO gt Concepts M1722 93950 You can use the SpO monitor with sensors made by other manufacturers as well as with HP sensors For a list of approved sensors see the Sensor Guide M1722 93970 SaO and SpO Hewlett Packard is adopting the convention of referring to the SpO gt parameter Previously it was referred to as SaO SaO is the term used to indicate the oxygen saturation of arterial blood SpO is the term used to indicate the oxygen saturation of arterial blood as measured by pulse oximetry Application Notes The pulse oximetry method used for measuring SpO uses LEDs light emitting diodes to transmit red and infrared light through suitable peripheral areas of the body typically the foot in
7. CodeMaster XL can act as a semi automatic external defibrillator vi Chapter 8 Troubleshooting Contains information about troubleshooting and performing diagnostics on the CodeMaster XL defibrillator Chapter 9 Maintaining the Defibrillator Contains information about maintaining and cleaning the CodeMaster XL defibrillator Appendix A Installation and Setup Contains information about battery installation and charge paper installation and configuration settings Index vii Contents Getting Acquainted Operating Controls and Indications 1 1 Safety Considerations 1 10 AC Battery Operation 1 12 Battery Life 1 13 Defibrillating Defibrillating a Patient 2 1 1 Select Energy 2 2 2 Charge 2 3 3 Shock 2 4 After Using the Defibrillator 2 5 Defibrillating with Alternate Paddle Sets 2 5 Monitoring Using Leads to Monitor 3 1 Preparing the Leads for Monitoring 3 2 Preparing the Patient 3 4 Monitoring Electrodes 3 5 Monitoring 3 6 Heart Rate Alarms 3 7 Printing the Event Summary Record Optional 3 8 Recording 3 9 Automatic Recordings 3 9 Post Shock Data Optional 3 10 Recorder Errors 3 11 External Monitoring 3 11 Performing Synchronized Cardioversion Performing Cardioversion 4 1 Monitoring During Cardioversion 4 1 Using Paddles for Performing Synchronized Cardioversion 4 3 viii Contents Using External Multi function Defib Electrodes for Performing Synchro nized
8. Defibrillator Monitor Operating Room Paddle Guide Prevacuum Sterilization Preparation Double wrapped in sterilization grade wrap Exposure Temperature 132 135 C 270 275 F Exposure Time 3 minutes Flash Sterilization Preparation Unwrapped Exposure Temperature 132 135 C 270 275 F Exposure Time 3 minutes 9 7 Maintaining the Defibrillator Cleaning and Sterilizing the Internal Paddles Gravity Sterilization Preparation Double wrapped in sterilization grade wrap Exposure Temperature 121 123 C 250 254 F Exposure Time 30 minutes Ethylene Oxide Sterilization Temperature 54 C x 1 C 130 F 2 F Relative Humidity 60 20 EtO Concentration 600 mg L 30 mg L 12 88 EtO Exposure Time 1 hour 45 minutes Aeration Time 18 hours 9 8 Maintaining the Defibrillator Supplies Supplies The defibrillator s warranty is only assured if you use approved accessories and replacement parts In the United States you can order supplies for the defibrillator by calling toll free 1 800 225 0230 You can order 1290C transducers by calling toll free 1 800 934 7372 You can order instrument repair parts by calling toll free 1 877 447 7278 Outside the United States you can order supplies for the defibrillator by contacting your HP regional medical distributor 9 9 Maintaining the Defibrillator Supplies 9 10 WARNING NOTE Installation and Setup Installation The CodeMaster XL is re
9. ECG source and size setting as shown in Table 3 6 Event Summary Record Information The time annotated on the ECG strip is within 8 seconds of the recorded event The message ES is printed at the top of the ECG strip when you print the Event Summary record Event Summary Record Information Event Event Summary Description Shock Shock Delivered energy peak current and patient impedance Heart Rate Alarms Heart Rate alarm limits violation Sp05 Alarms viola SpOz alarm limits tion Mark Mark Marker symbol V annotates strip at point Mark was pressed To print the Event Summary on the recorder press Review The recorder must not be printing to print an Event Summary with this key After printing an event you must wait 10 seconds before printing another event e To stop printing the Event Summary press e Review e or Record To review the Event Summary later turn the unit on and press e Review e 3 8 NOTE Monitoring Recording The Event Summary record is cleared each time the defibrillator is turned off then on and a new event occurs This allows you to turn off the defibrillator and return later to review event information such as code statistics Turn the defibrillator off between uses to ensure that Event Summary records are patient specific Recording To print a record of th
10. Until Shock or Disarm event arm event Shocking the patient 6 seconds 12 seconds 12 seconds Alarms violation 6 seconds 3 seconds 6 seconds Disarm 6 seconds 3 seconds 3 seconds Test discharge N A 3 seconds 3 seconds Post Shock Data Optional As described in Appendix A you can enable or disable the recording of post shock statistics in setup menu 2 f Post Shock Data is enabled the defibrillator will record the shock delivery sta tistics Actual Delivered Energy Patient Impedance Peak Current f Post Shock Data is disabled the defibrillator will record the energy to which it was charged as the delivered energy For example if the unit was charged to 200J the delivered energy annotation on the ECG strip would be DEL 2007 3 10 NOTE CAUTION Monitoring External Monitoring Recorder Errors The message CHECK RECORDER appears if an error occurs while recording If this message appears check the recorder paper supply This message may also appear if the recorder door is open External Monitoring The ECG output provides an analog 1V mV ECG signal for connection to an external monitor Compatible external monitoring divider cables are listed in Table 3 8 External Monitoring Cables Tahle 3 8 External Monitoring Cahles 1000 1 voltage Divider Cahle Part No Connector Type Six Pin M1782A Eight Pin 14482A B Twelve Pin M1783A Do not use the ECG output to synchronize another
11. 11 Press Mode to select the pacing mode Demand Mode Fixed Mode The selected mode is displayed on the monitor When in Demand mode the pacer will only deliver pacer pulses when the patient s heart rate is lower than the selected pacer rate When in Fixed mode the pacer will deliver pacer pulses at the selected pacer rate 5 3 WARNING NOTE WARNING Pacing Optional Using the Pacer Use demand pacing mode whenever possible Use fixed pacing mode asynchronous for cases when reliably monitoring the patient is impractical For example use fixed mode when there is motion artifact or other ECG noise that makes R wave detection unreliable 12 Press Start Stop to start pacing The monitor will now display the message PACING as well as the selected mode rate and output The pacer will not start pacing if there is a problem with either the pacing elec trode connections or the monitoring electrode connections If there is a problem with the pacing electrode connection the message ATTACH PADS will be displayed briefly when you press Start Stop 13 Verify that the pacer pulses are well positioned in the diastole 14 Increase output mA by pressing Output A until the beat is captured Select ing an alternate lead can help you to determine capture 15 To set the lowest possible output level to capture decrease the current by decre ments of 5 mA by pressing V Output
12. 4 8 review 1 4 reviewing Event Summary 3 8 7 15 R wave detection 7 4 in cardioversion 4 1 S safety 1 10 safety symbols iv SaO 6 1 selecting ECG source 3 6 selecting energy 1 2 2 1 2 2 semi automatic external defibrillation 7 1 SETUP LOST 8 2 A 11 SETUP MENU 1 A 9 A 10 A 12 SETUP MENU 2 A 9 A 10 A 11 setup menu 2 3 9 setup menus Advisory mode 7 18 configuring with A 9 setup mode A 11 setup diagnostic menu A 10 A 11 shock 2 4 avoiding while pacing 5 2 button 8 11 event 3 8 recording 3 9 shock buttons defibrillating with during pacing 5 5 performing synchronized cardioversion using ex ternal adhesive pads 4 7 performing synchronized cardioversion using paddles 4 5 shock hazard iv shocking the patient 2 4 recordings 3 10 shutdown warning 1 9 7 4 soap and water for cleaning 9 6 sounds audible indicators 7 4 specifications synchronized shock 4 1 SpO 1 6 compared to SaO 6 1 controls 1 6 1 7 SpO Alarm 1 6 SpO Alarms violation 3 8 SPO2 CABLE OFF 8 6 SPO2 FAILURE 8 6 SPO2 LIGHT INTERF 8 6 SPO2 LOW SIGNAL 8 6 SpO monitoring 6 1 SPO2 NOISY SIGNAL 8 6 SpO On Off 1 6 1 7 SPO2 SENSOR FAIL 8 6 standard paddles 2 5 Start Stop 1 5 steam sterilization internal paddles 9 7 STOP PACER 8 4 supplies 8 9 9 9 switched paddles internal 2 8 2 10 switchless paddles internal 2 9 Sync button A 9 Sync Light 1 8 synchronized cardioversion 4 1 monitoring
13. Advisory Mode Optional Printing the Advisory Event Summary Record If the recorder is already printing other data the e Review e command has no effect To stop printing the advisory event summary press Review e or Record To review the advisory event summary after the instrument has been turned off or is turned to manual mode turn the energy select control to Advisory On and press e Review e The header record lists when power on occurred when the last event occurred and how many shocks were delivered The record also includes areas for you to write in the patient s name the operator s name and any comments about the event The directory lists all events that occurred during the resuscitation attempt and the time of their occurrence 7 15 Table 7 2 Using Advisory Mode Optional Printing the Advisory Event Summary Record The following table lists the events the directory shows Advisory Event Summary Record Information Event Analyzing Description Notes Indicates when the advisory algorithm started analysis Analyze pressed Artifact Detected Indicates that the advisory algorithm detected excessive artifact Shock Advised Indicates when the advisory algorithm detected a ECG strip recorded shockable rhythm and advised a shock No Shock Advised Indicates that the advisory algorithm detected a ECG strip recorded non shockable
14. ECG leads cable falls off or is incorrectly connected the message LEADS OFF appears on the display Monitoring Electrodes Using Electrodes Standard multifunction defibrillator electrodes allow you to monitor through the electrodes for defibrillation and synchronized cardioversion If you wish to use the electrodes for pacing however you must attach separate electrodes for monitoring To use standard electrodes perform the following steps 1 Attach electrodes as instructed on the electrodes package 2 Attach the electrodes adaptor cable to the defibrillator 3 Connect the electrodes to the electrodes adaptor cable 4 PADS is the only selectable ECG source Using Paddles For an emergency evaluation you can monitor a patient s ECG through the paddles when leads are not attached to the patient Do NOT use paddles to monitor the ECG during elective cardioversion procedures when the instrument is in synchronous SYNC mode Refer to Chapter 4 Performing Synchronized Cardioversion for detailed information on performing elective cardioversion 3 5 Monitoring Monitoring Monitoring Figure 3 1 Lead Select button ECG Size button HR Alarm button Review button CodeMaster XL only ECG Output The Monitor Control Panel To monitor a patient s ECG with the CodeMaster XL perform the following steps 1 Prepare the patient for ECG monitoring 2 T
15. The disabled functions include charge key pacing synchronized cardioversion e SpO monitoring lead selection leads monitoring heart rate alarms automatic recordings standard event summary generation NOTE WARNING NOTE Using Advisory Mode Optional Using Advisory Mode recorder delay mode external paddles internal paddles pediatric energy levels Turn the Energy Select control to Monitor On or an energy setting to restore these functions If you turn the Energy Select control to Monitor On or a specific energy setting you place the CodeMaster XL in manual mode and the advisory features are no longer available In Advisory Mode the charge key is disabled and the defibrillator cannot be charged manually To perform manual defibrillation refer to Chapter 2 Defibrillation Do not use advisory mode for long term monitoring Turn the defibrillator to Monitor On for long term patient monitoring The Heart Rate HR meter is the same for manual or advisory mode when displaying or printing HR information The shock advisory algorithm uses a HR meter specifically developed for use by the algorithm for making shock decisions when rate information is required 7 5 WARNING WARNING Using Advisory Mode Optional Using Advisory Mode B Apply External Adhesive Electrodes You must use the electrodes adaptor cable and external adhesive electrodes in the Apex
16. XL defibrillator monitor front panel Wait for the Charge Done indicators If you must disarm the charged defibrillator if counter shock is not needed turn the Energy Select control to Monitor On Any stored energy will be discharged internally and the available energy on the display will return to 0 4 6 NOTE NOTE Performing Synchronized Cardioversion Performing Cardioversion To increase or decrease the selected energy level after Charge has been pressed move the Energy Select control to the new energy level and wait for the Charge Done indicators 9 Depress both Shock AN buttons on the cable connector simultaneously The defibrillator will shock with the next detected R wave 10 If additional counter shocks are required readjust the Energy Select control as necessary and repeat the synchronized cardioversion procedure Depending on how the unit has been configured it will either remain in the synchronized shock mode or it will return to defibrillator mode following a synchronized shock Refer to Table A 1 on page A 12 for instructions on configuring the defibrillator for operation after synchronized cardioversion If the defibrillator does not shock refer to If the Defibrillator does not Deliver a Shock on page 8 3 4 7 Performing Synchronized Cardioversion Performing Cardioversion After Using the Defibrillator If you want to print an Event Summar
17. defibrillator The ECG In to ECG Out delay is 35 milliseconds The connection of external equipment may increase leakage currents Always request that local safety personnel verify that multiple connected equipment comply with local safety standards before putting such equipment into service 3 11 Monitoring External Monitoring 3 12 WARNING Performing Synchronized Cardioversion This chapter contains information about performing synchronized cardioversion on a patient with the CodeMaster XL defibrillator monitor Refer to Chapter 3 Monitoring for information on patient preparation Performing Cardioversion Treatment for certain arrhythmias require synchronizing a defibrillator shock with the ECG s R wave It is essential that this R wave is detected to avoid inducing ventricular fibrillation Monitoring During Cardioversion Using an External Monitor Whenever possible we recommend that you perform synchronized cardioversion procedures while directly monitoring the patient through the defibrillator s electrodes or leads inputs If you use an external monitor as the ECG source require the biomedical technician to verify that the monitor CodeMaster XL combination will deliver a synchronized shock within 60 ms of the peak of the R wave See the service manual for test procedure Use a 1 mV QRS complex with a ORS width of 40 ms This performance cannot be guaranteed with all commercially availab
18. directory print before the stored ECGs ECGs related to events print after the directory record The advisory event summary record which is available only in advisory mode is independent of the event summary described in Printing the Event Summary Record Optional on page 3 8 which is available only in manual mode Passing through the OFF position on the Energy Select switch more than once from Advisory Mode to Manual Mode and the initiation of an EVENT creates a NEW patient summary record which could cause the loss of data 7 13 Using Advisory Mode Optional Printing the Advisory Event Summary Record Figure 7 5 PATIENT COMMENT OPERATOR POWER ON 14 NOV 95 11 34 07 LAST EVENT 14 NOV 95 11 34 11 TOTAL SHOCKS 0 ANALYZING 34 07 ANALYZING ARTIFACT DETECTED 34 07 ARTIFACT DETECTED SHOCK ADVISED 11 34 07 SHOCK ADVISED NO SHOCK ADVISED 34 07 NO SHOCK ADVISED CANNOT ANALYZE 11 34 07 CANNOT ANALYZE NO PADS 11 34 07 NO PADS PADS OFF 34 07 PADS OFF PADS ON 11 34 07 PADS ON CHARGING TO 200J 11 34 07 CHARGING TO 200J SHOCK amp 34 07 SHOCK DISARM 34 07 DISARM L MARK 11 34 07 MARK 14 NOV 95 11 34 07 HR PADS AES 1 34 11 34 1 34 11 1 34 11 34 11 1 3411 11 34 1 34 11 11 34 11 11 34 11 34 1 34 11 MARK Advisory Event Summary Record To print the advisory event summary record press e Review e 7 14 NOTE Using
19. must turn the Energy the ECG Pressing Select Power Control to Advisory On before analyzing Analyze has no effect unless the Energy Select Power On control is set to Advisory On In advisory mode you can use the CodeMaster XL to analyze the patient s cardiac rhythms by pressing Analyze to determine whether a defibrillation shock is needed record events for the advisory mode event summary 7 3 Tahle 7 1 Using Advisory Mode Optional Using Advisory Mode In advisory mode the CodeMaster XL emits distinct sounds as described in Table 7 1 Audible Indicators in Advisory Mode Indicator Charge Done tone Description Continuous tone sounds when the instrument is charged and ready to deliver a shock Auto disarm tone Sounds during the last ten seconds of the Charge Done tone Beeps intermittently until disarmed ORS beeper Sounds whenever an R wave is detected Volume controlled by front panel adjustment CRT Screen alerts Three beeps each time a message appears on the screen and when a shockable rhythm is detected Shutdown warning Alternating pitch sounds for 60 seconds when the system is about to turn off An alert to plug the unit into AC power You cannot disable the charge done tone and CRT screen alerts for advisory mode in setup When you turn the Energy Select control to Advisory On you disable other CodeMaster XL functions
20. recorder door is open Close the recorder door or replace RECORDER or the paper roll as described in The recorder is out of paper If the Defibrillator does not Charge Changing the Recorder Paper page 9 1 If the defibrillator does not charge perform the following steps Troubleshooting Troubleshooting Verify the proper setting of the Energy Select control If it is correct follow these steps a Turn the Energy Select control to Off Standby and then back to the desired energy setting b Press Charge again If the instrument remains unable to charge turn the Energy Select control to Off Standby and use a backup defibrillator Keep any ECG strips from the defibrillator for later evaluation If you have the optional Event Review feature press eReview to print an event summary Alert appropriate service personnel If the Defibrillator does not Deliver a Shock If the defibrillator does not deliver a shock perform the following steps 1 Make sure the unit is not in synchronized shock mode The Sync light is on when the unit is in synchronized shock mode If the unit discharges internally that is the energy display decrements slowly then beeps three times and displays the screen message DEFIB DISARMED verify proper connections from the patient to the defibrillator This includes con nections to the electrodes paddles adaptor cable if one is bei
21. right midclavicular line directly below the clavicle LA Black L Yellow Near the left midclavicular line directly below the clavicle LL Red F Green Below the left pectoral muscle on the left midclavicular line 3 2 Table 3 3 Table 3 4 Table 3 5 Lead Formation Monitoring Using Leads to Monitor Lead ref I LA RA LL I LL RA LA I LL LA RA 5 Wire Patient Cable Table 3 4 5 Wire Electrode Placement describes a typical lead wire placement using the 5 wire patient cable Table 3 5 Lead Configurations shows how the individual leads are formed using the individual leadwires 5 Wire Electrode Placement Electrode AHA IEC RA White R Red Placement Near right midclavicular line directly below clavicle LA Black L Yellow Near left midclavicular line directly below clavicle LL Red F Green Below the left pectoral muscle on the left midclavicular line RL Green N Black Below the right pectoral muscle on the right midclavicular line V Brown C White As appropriate for the V lead to be monitored V1 V6 Lead Configurations Lead Leadwire Combinations I LA RA I LL RA I LL LA aVR RA LA LL aVF TES 3 LA 3 3 Table 3 5 NOTE Monitoring Preparing the Patient Lead Configurations Lead Leadwire Combinations aVL TELE v yv RA zs LL Preparing the Patient Proper application and placement of electrode
22. synchronized shock 1 8 synchronous 3 5 Mode button 1 5 5 3 MONITOR FAILURE 8 1 Monitor Operating Controls 1 4 monitoring 1 4 adhesive pads through 2 6 cables 3 1 leads 3 1 Index 23 Index on AC power 3 1 on battery 3 1 preparing the leads 3 2 with paddles 3 5 monitoring electrodes separate from pacing pads 5 2 monitoring equipment 4 1 multifunction 5 5 N NO PADDLES 5 3 8 1 NO PADS 8 4 non delayed recorder mode 3 10 o operational checks 8 9 Output button 1 5 5 4 output current pacing 1 5 oxygen saturation 6 1 P pacer control panel 5 1 controls 1 5 messages 8 4 output 5 3 PACER FAILURE 8 4 Pacer On 1 5 Pacer On button 5 3 Pacer Output A 12 pacer parameters 5 3 pacer pulse delivery to patient 5 3 positioning in diastole 5 4 Pacer Rate A 12 pacer rate 5 3 PACER STOP 5 3 5 4 PACING 5 4 pacing 3 1 defibrillating during 5 5 demand mode 1 5 external transcutaneous 5 1 fixed mode 1 5 on AC power 5 2 on battery 5 2 output current 1 5 with electrodes 5 2 pacing pad 5 4 paddle connector 2 6 paddle connector lock 2 6 Paddle Contact Indicator 1 8 paddles alternate 2 5 anterior posterior 2 11 applying the 2 2 external 2 5 installing A 4 internal 2 5 2 8 internal switched 2 8 2 10 internal switchless 2 8 2 9 monitoring with 3 5 pediatric 2 5 plug A 5 A 6 preparing the 2 2 pressure 2 3 removing from holders 2 2 using fo
23. the Energy Select control to Off Standby The defibrillator is ready for use if it passes the above checklist A more extensive test of defibrillator monitor functionality can be performed using the diagnostic service mode described in the M1722B CodeMaster XL Defibrillator Monitor Service Manual Operational Checks These checks are intended to briefly verify the proper operation of the CodeMaster XL defibrillator monitor Regularly perform a test routine incorporating the following checks along with visual inspection of all cables paddles and controls Every Shift Perform the following checks every shift e Verify that the instrument is connected to AC power and that the BATT CHRG and AC POWER lights are on Check for adequate thermal paper in the recorder Check for ECG leads electrodes and adequate electrolyte paste or defibrillator electrodes If unit is used for shock advisory check for electrodes and electrodes adaptor cable 8 9 Troubleshooting Operational Checks Every Day Visually check AC power cord for wear Visually check the patient cables paddles cables and electrodes adaptor cables for wear insulation nicks and other damage e Ensure that the BATTCHRG and AC POWER lights are on If the unit is plugged in and the ACPOWER light is not on the power cord may have a broken wire If after checking the AC line the problem persists remove the unit from service e Check that the B
24. the desired ECG lead by pressing Lead Select 3 Press Sync once to place the HP CodeMaster XL defibrillator monitor in Sync mode The message SYNC appears on the display If you select paddles as the ECG source the message USE LEADS will appear on the display Although the HP CodeMaster XL defibrillator monitor will allow synchronized shock in paddles ECG mode leads mode is recommended Artifact induced by moving the paddles may resemble an R wave and trigger defibrillator shock Cardioversion can be performed with the HP CodeMaster XL defibrilla tor monitor in Autogain mode Always inspect the displayed ECG before deliv ering the counter shock and verify that an R wave marker indicating shock point appears only with each R wave If a marker dot does not appear or if a marker dot is viewed on the T wave segment of the ECG follow these instruc tions Adjust the ECG size by pressing v ECG SizeA until the marker dot appears only with each R wave Select a different lead or apply new electrodes if necessary to improve ECG R wave quality 4 Select the desired energy level with the Energy Select control Applying the Paddles 1 Prepare the paddles by performing the following steps a Remove paddles from their holders by grasping the handles and lifting straight up b Holding both paddles in one hand apply electrolyte paste to both paddle electrode surf
25. under close observation Avoid moving a charged defibrillator If the unit is dropped it may discharge NOTE CAUTION Getting Acquainted AC Battery Operation AC Battery Operation The CodeMaster XL defibrillator can be operated on AC line power The following is a list of AC and battery operating instructions The battery will charge when the instrument is connected to AC power even if the Energy Select switch is in the Off Standby position e Battery charging is indicated by the BATT CHRG light being on A fully depleted battery will recharge to 9096 of full capacity in two hours and 100 capacity in 18 hours To preserve battery integrity the battery must be fully recharged each time the battery is depleted A new battery or one that has been stored for an extended period requires 24 hours of charging before use When the unit is not in use connect it to AC power with the Energy Select switch position off This is to maintain a full battery charge and to prolong battery life To operate on internal battery power only disconnect the power cord from the AC outlet A fully charged battery will nominally provide fifty 360 joule charge shock cycles or 2 5 hours of continuous monitoring 15 C 40 C Continuous recording will reduce monitoring time available when you are using the unit on battery power When the LOW BATTERY message is displayed on the monitor plug the unit into AC
26. using the switchless paddles perform the following steps 1 Attach the internal paddles adaptor cable M1740A B to the paddle connector on the front of the defibrillator Slide the paddle connector lock towards the front of the defibrillator to secure the cable Select correct paddle set size from Table 2 1 Switchless Internal Paddles Selection on page 2 10 Attach the internal paddles set to the internal paddles adaptor cable The elec trodes are correctly connected when the locking ring is twisted locking the ears of the connector to the adaptor cable Failure to correctly connect the internal paddles to the adaptor cable can result in a failure to deliver energy to the patient 5 Set the Energy Select control to the desired energy If the energy switch is set to a level greater than 50 joules 507 MAXIMUM will be displayed If Charge is pressed the unit will only charge to 50 joules For safety and sterility when using the paddles do not touch the paddle beyond the fingerguard on the handle Apply the internal paddles Press Charge Wait for the Charge Done indicators Press both Shock buttons at once to defibrillate The Shock AN buttons are on the cable connector housing 2 9 Tahle 2 1 NOTE WARNING Defibrillating Defibrillating a Patient Switchless Internal Paddles Selection Part Number Description M1740A B Internal paddle
27. values To clear the seruP LOST message go to setup menu 1 or setup menu 2 The Setup Lost condition will be cleared when you view the setup menus You do not have to change the values if you want to keep the factory settings Table A 1 Setting Language Upper Alarm Limits UAL Lower Alarm Limits LAL Time Date Armed Tone CRT Alerts Alert Volume Mode after CV Pacer Rate pacer option only Pacer Output pacer option only Installation and Setup Setup Table A 1 Setup Menu 1 Settings on page A 12 and Table A 2 Setup Menu 2 Settings on page A 13 show configurable parameters on the instrument Setup Menu 1 Settings Choices English Dutch Swedish French German Italian Spanish Finnish Danish Norwegian 120 140 160 20 to 280 in increments of 5 40 60 90 20 to 280 in increments of 5 HH MM DD MMM YY ON OFF ON OFF 3 to 15 SYNC DEFIB 70 ppm 40 to 180 in increments of 10 30 mA 10 to 200 in increments of 10 Description Printed and displayed text language Upper heart rate limits LAL to 280 Lower heart rate limits 20 to UAL Current time Current date Beep on Charge done Beep on alert message Alerts volume Specifies mode after cardioversion Sets the pacer rate and the initial power on default rate Sets the pacer current and the initial power on default pacer current Table A 2 Setup Menu 2 Settings Setting Re
28. 4 ECG Input connector with key slot Keyed plug of patient cable M1722 10 Connecting a Patient Cable A 8 Installation and Setup Setup Setup To configure the CodeMaster XL you must use the setup menus The first part of this section describes how to set up CodeMaster for manual mode The second part describes how to set up for Advisory Mode Table A 1 Setup Menu 1 Settings on page A 12 and Table A 2 Setup Menu 2 Settings on page A 13 list the choices you can make on the setup menus for manual mode Perform the following steps to configure the CodeMaster XL 1 Depress Sync HR Alarm while turning the Energy Select control from Off Standby to Monitor On A menu will appear with the following choices CALIBRATE DEFIB SETUP MENU 1 SETUP MENU 2 RESTORE FACTORY SETTINGS PRINT LOG EST DEFIB EST ECG EST CRT EST RECORDER EST CONTROLS EST INDICATORS EST BATTERY EST PACE A 9 NOTE Installation and Setup Setup 2 Select SETUP MENU 1 by pressing v ECG Size SETUP MENU 1 until the highlight appears on 3 Press Lead Select SETUP MENU 1 will appear with the current setup values displayed 4 Press V ECG Size or ECGSizeA until the highlight appears on the value you wish to change 5 Press Lead Select
29. ATTCHRG and ACPOWER lights go off when the unit is unplugged Re connect the unit to AC Power Perform the Delivered Energy and Shock Button Functional Test which follows f your instrument has the external pacing option perform the Quick Pacer Func tionality Test as described in Quick Pacer Functionality Test on page 8 13 f your instrument has the advisory option turn the Energy Select control to Advi sory On and check that the instrument turns on 8 10 WARNING NOTE Troubleshooting Operational Checks Delivered Energy and Shock Button Functional Test To check the instrument with the paddles perform the following steps 1 Turn the Energy Select control to the 100 joules position 2 Verify that the adult paddle electrodes are installed 3 Push the paddles completely into their holders Apex paddle in right pocket Sternum in left and press either Charge button Wait for the Charge Done indi cators Keep hands clear of the paddle electrode edges Use your thumbs to depress the Shock buttons on the paddle handles 4 With the paddles in their holders grasp the paddle handles and press the Apex paddle Shock button Verify that the defibrillator does not discharge 5 Release the Apex paddle Shock button then press the Sternum paddle Shock button Verify that the defibrillator does not discharge 6 Press Sync to place the defibrillator in sync mode 7 Press and hold both Shock buttons
30. Anterior position to analyze patient cardiac rhythms when in Advisory mode You must use the electrodes adaptor cable and external adhesive electrodes when in advisory mode The CodeMaster XL will not analyze patient cardiac rhythms through external or internal paddle sets The message ATTACH PADS CABLE displays if the electrodes adaptor cable is not connected The electrodes allow accurate analysis of the cardiac rhythms and allow the defibrillator shock to be delivered You must make sure the electrodes are correctly placed on the patient and the electrodes adaptor cable is correctly connected to the CodeMaster XL The unit will deliver defibrillator energy levels to a set of electrodes even if they are not attached to a patient The message PADS orr appears when there are no electrodes or there is a poor electrodes to patient contact Check all patient connections if this message appears 1 Attach the electrodes adaptor cable M1750A B to the paddle connector on the front of the defibrillator 2 Slide the paddle connector lock towards the front of the defibrillator to secure the cable 7 6 Figure 7 2 WARNING WARNING Using Advisory Mode Optional Using Advisory Mode Connect Electrodes Adaptor Cable to the CodeMaster XL 3 Attach the external adhesive electrodes to the patient as instructed on the pack age Use the Apex Anterior electrodes application shown on the package This results in the modified Lead I
31. Cardioversion 4 5 After Using the Defibrillator 4 8 Pacing Optional Using the Pacer 5 2 Defibrillation During Pacing 5 5 SpO Monitoring Optional SaO and SpO 6 1 Application Notes 6 1 Using SpO to Monitor a Patient 6 3 Apply the Sensor to the Patient 6 4 Troubleshooting Sensor Application 6 5 Connect the Sensor to the CodeMaster XL 6 6 Start Monitoring 6 7 SpO Readings 6 7 SpO Alarms 6 8 Activating SpO Alarms 6 8 Deactivating SpO Alarms 6 8 Recorder Output 6 9 Using Advisory Mode Optional Using Advisory Mode 7 1 Verify Patient Condition 7 2 A Select Advisory On 7 2 B Apply External Adhesive Electrodes 7 6 C Press the Analyze Button 7 8 D Follow Prompts 7 10 After Using the Defibrillator 7 12 Printing the Advisory Event Summary Record 7 13 Advisory Mode Default Settings 7 18 Troubleshooting Contents Troubleshooting 8 1 Troubleshooting the Defibrillator 8 1 Troubleshooting the Pacer 8 4 Troubleshooting SpO 8 6 Troubleshooting the Advisory Mode 8 7 Performing Diagnostics 8 7 Operational Checks 8 9 Every Shift 8 9 Every Day 8 10 Every Week 8 14 Every Three Months 8 14 Every Six Months 8 14 Maintaining the Defibrillator Changing the Recorder Paper 9 1 Cleaning the Recorder Printhead 9 2 Maintaining the Battery 9 3 Battery Capacity Check 9 4 Replacing the Battery 9 5 Cleaning Exterior Surfaces 9 6 Cleaning and Sterilizing the Internal Paddles 9 6 Steam Sterilizi
32. Charge done tone charge done lamp on apex paddle and available energy indicated on display Paddle Contact Indicator optional 3 color LED bar graph array on STERNUM paddle indicates quality of defibrillator paddle contact before discharge Paddles Standard paddles are anterior anterior adult and pediatric Adult electrodes 83 cm slide off to expose pediatric electrodes 21 cm Paddle cord is 10 ft 3 m Full range of internal paddles available Synchronizer SYNC message appears on monitor and is annotated periodically on recorder while in synchronous mode An audible beep sounds with each detected R wave while a marker on the monitor and sync designator on the recorder strip indicate the discharge point Environmental Operating Conditions 0 to 55 C 15 to 95 relative humidity 15 000 ft altitude Environmental Storage Conditions 20 to 70 C 90 relative humidity for 24 hours at 65 C 15 000 ft altitude Installation and Setup Specifications Monitor Inputs ECG may be viewed through paddles or patient cable Lead I IL HI or PADDLES selectable Additional leads aVR aVF aVL V Leads and PADS are available Monitor and recorder indicate selected ECG source Lead Fault LEADS OFF message and dashed baseline appear on monitor if a lead becomes disconnected Common Mode Rejection Greater than 100 dB measured as per AAMI standards for cardiac monitors EC13 Display Size and Type 5 inch 12 7 cm
33. M1758A To avoid the possibility of hazardous electrical shock unplug the instrument from the AC power source before installing or replacing the battery If the defibrillator will be stored for longer than one month without AC power first charge the battery for 48 hours then remove the battery from the unit Note on the instrument that the battery has been removed Store the battery in a cool dry location Recharge a stored battery for at least 24 hours every six months This will ensure that the battery does not completely discharge while in storage The battery s shelf life is longer with cooler temperatures but the battery must not be stored below freezing After an extended storage period the battery should be tested using the Battery Capacity Check page 9 4 A 2 Figure A 1 Battery Battery compartment Battery plug Battery connector Installation and Setup Installation E eas l M1722 02 Installing the Battery Loading the Recorder Paper The defibrillator recorder uses two inch wide thermal paper HP 40457C D To load the paper refer to the procedure in Changing the Recorder Paper page 9 1 A 3 Installation and Setup Installation Connecting Paddles and Patient Cables The defibrillator has a paddles connector for attaching electrodes pa
34. Master XL in advisory mode for echildren who weigh under 90 pounds epatients who have an implanted pacemaker The advisory algorithm is not designed to detect pediatric cardiac arrhythmias or handle erratic spiking problems caused by a properly or improperly functioning pacemaker The advisory algorithm does not charge the defibrillator to energy levels appropriate for pediatric patients To use advisory mode first verify patient condition Then 7 1 Using Advisory Mode Optional Using Advisory Mode 1 Select Advisory On 2 Apply external adhesive electrodes 3 Stop patient motion Press Analyze If SHOCK ADVISED stand clear 4 When you hear the charge done tone press both electrodes adaptor cable Shock buttons simultaneously Verify Patient Condition Confirm that the patient is in cardiac arrest unresponsive not breathing no pulse A Select Advisory On Turn the Energy Select Power Control to Advisory On to turn on the defibrillator and operate it in advisory mode The monitor displays FOR ANALYSIS 200J PRESS ANALYZE SELECTED where 200J is the first energy setting You can configure the energy settings for the first second and third shocks by using the setup menu refer to the Appendix Installation and Setup 7 2 Figure 7 1 Advisory On NOTE Advisory On Position Using Advisory Mode Optional Using Advisory Mode sf You
35. Master XL and the sensor cable or adaptor cable Dashes appear on display instead of SpO reading Can t derive measurement because The sensor is not on the patient No pulse is detected The sensor is incorrectly positioned The sensor is defective Check the patient for a pulse Reapply the sensor and make sure it is correctly positioned If it doesn t work replace the sensor SPO2 NOISY Irregular pulse patterns Reapply sensor SIGNAL Patient motion Consider using a different sensor site SPO2 LIGHT Too much interference from Reapply sensor INTERF external light Turn off lights in the room Damage to sensor or adaptor cable If other options do not work replace the sensor SPO2 LOW Bad connection to patient or Check the patient for poor SIGNAL patient has poor perfusion perfusion Reapply disposable and semi disposable sensors Readjust reusable sensors Consider using a different sensor site Table 8 5 Troubleshooting the Advisory Mode Advisory Mode Messages Message Cause ATTACH PADS The electrodes adaptor cable is not CABLE connected to the defibrillator Troubleshooting Performing Diagnostics Possible Solutions Connect the electrodes adaptor cable to the defibrillator FOR ANALYSIS ATTACH PADS Electrodes are not attached to the electrodes adaptor cable or electrodes are not attached to the Check electrodes connections
36. OTE Performing Synchronized Cardioversion Performing Cardioversion If you must disarm the charged defibrillator if counter shock is not needed turn the Energy Select control to Monitor On Any stored energy will be discharged internally and the available energy on the display will return to 0 To increase or decrease the selected energy level after Charge has been pressed move the Energy Select control to the new energy level and wait for the Charge Done indicators 9 Depress both Shock AN buttons one on each paddle until shock occurs The defibrillator will shock with the next detected R wave 10 If additional counter shocks are required readjust the Energy Select control as necessary and repeat the synchronized cardioversion procedure Depending on how the unit has been configured it will either remain in the synchronized shock mode or it will return to defibrillator mode following a synchronized shock Refer to Table A 1 on page A 12 for instructions on configuring the defibrillator for operation after synchronized cardioversion If the defibrillator does not shock refer to If the Defibrillator does not Charge on page 8 2 Using External Multi function Defib Electrodes for Performing Synchronized Cardioversion Synchronized cardioversion can be performed with external electrodes PADS can be selected as the ECG source for cardioversion because they are a reliable contact for monit
37. Verify that the defibrillator does not dis charge 8 Press Sync again to remove the defibrillator from sync mode 9 With the paddles in their holders press and briefly hold both Shock buttons at once 10 The recorder will print a test report To check the instrument with the electrodes adaptor cable perform the following steps Notify Service Personnel if the ECG strip does not print TEST 100J PASSED or if any of the shock button tests fail NOTE CAUTION Troubleshooting Operational Checks Electrodes Adaptor Cable Test To check the electrodes adaptor cable perform the following steps 1 Connect the M1781A test load to the M1750A B electrodes adaptor cable 2 Turn Energy Select to 100 joules 3 Press Charge Wait for the Charge Done indicators 4 Press the left Shock AN button on the electrodes adaptor cable connector housing Verify that the defibrillator does not discharge 5 Release the left Shock button and press the right Shock button on the electrodes adaptor cable connector housing Verify that the defibrillator does not discharge 6 Press Sync to place the defibrillator in sync mode 7 Press and hold both Shock buttons Verify that the defibrillator does not dis charge 8 Press Sync again to remove the defibrillator from sync mode 9 Press both Shock buttons on the electrodes adaptor cable connector Verify defibrillato
38. aces 4 3 WARNING CAUTION WARNING Performing Synchronized Cardioversion Performing Cardioversion Do not allow paste to accumulate on your hands the paddle handles or the paddle electrodes on the patients chest to avoid the risk of electrical shock or burns Do not rub the electrode surfaces together to distribute the applied paste Placing the electrode surfaces together increases the risk of an accidental paddle to paddle discharge 2 Apply the paddles to the chest as follows a Place the Sternum paddle to the right of the sternum just below the clavicle b Placethe Apex paddle on the chest just below and to the left of the left nip ple in the anterior axillary line 3 Verify again that the ECG waveform is stable and that a marker dot appears only with each R wave of the cardiac cycle 4 Rub the paddles lightly against the skin to distribute the electrolyte paste and increase the contact between the patient skin and the paddles Do not spread paste between the paddle electrodes on the chest The patient can be burned if the paste forms a path between the electrodes 5 Apply 10 to 12 kg 22 25 lb of pressure per paddle 6 Briefly adjust paddle pressure and placement to optimize contact as registered on the paddle contact indicator 7 Press Charge on either the right Apex paddle or on the instrument front panel 8 Wait for the Charge Done indicators 4 4 NOTE NOTE N
39. ady for operation when the following tasks have been properly performed O Install battery O Charge battery for 24 hours O Install paper O Make sure that the pad paddle set connector is seated and locked O Select configuration settings set date and time Line Voltage Settings The defibrillator automatically adjusts to the line voltage that is supplied from 100 230 VAC at 50 60 Hz No manual setting or adjustment is required Use only three wire power cords with three pronged grounded plugs Make sure that the outlet accepts the three pronged plugs and is grounded Never adapt a three pronged plug to fit a two pronged outlet Installing and Charging the Battery To install the battery refer to the battery replacement procedure in Replacing the Battery page 9 5 After installing the battery connect the power cord to the back of the defibrillator then plug the cord into an AC outlet The green AC POWER and BATT CHRG indicators on the front panel should light up The AC POWER indicator lights when the instrument is plugged into AC power the BATT CHRG indicator is on when the battery is installed and the instrument is plugged into AC power To ensure full battery capacity charge the battery for 24 hours following its installation in the defibrillator WARNING CAUTION Installation and Setup Installation The defibrillator operates from either battery or AC power Use only HP battery assembly
40. arms during pacing 5 4 Heart Rate Alarms violation 3 8 high voltage paddles 1 11 HP Redux electrolyte paste 2 2 HR Alarm button 1 4 3 7 I J K increasing energy level 2 4 indicator lights 1 8 indicators audible 1 9 Charge Done 5 5 8 11 inspection functional 8 7 installation required tasks A 1 installing battery A 1 paddle set A 1 paper A 1 the defibrillator A 1 inter paddles switched 2 10 internal A 4 internal defibrillation 2 8 2 10 energy limit 2 10 energy limits 2 9 internal paddles 2 5 2 8 internal paddles adaptor 2 8 internal paddles adaptor cable 2 8 internal paddles switched 2 8 internal paddles switchless 2 8 2 9 L Language A 12 Lead Select button 1 4 4 6 5 3 A 10 leads forming 3 3 preparing for monitoring 3 2 LEADS OFF 3 6 5 3 5 4 8 1 8 7 lights 1 8 SYNC 8 3 line voltage automatic setting A 1 loading recorder paper A 3 locking paddle set connector A 1 LOW BATTERY 1 12 8 2 Low Battery warning time 9 4 Lower Alarm Limits A 12 M M17814A test load 8 12 M2472A pads adapter cable 8 12 maintaining defibrillator 9 1 Mark button 1 3 3 8 8 8 marker dot 4 3 4 4 4 6 menu SETUP MENU 1 A 12 setup diagnostic A 10 mode defibrillator 1 8 delayed recorder 3 10 Demand pacer 5 3 demand pacing 1 5 5 1 diagnostic A 11 ECG gain 8 8 Fixed pacer 5 3 fixed pacing 1 5 5 1 non delayed recorder 3 10 paddles ECG 8 7 setup A 11
41. choose and after three seconds that alarm will take effect A A symbol replaces the limits to show that the alarm is active To review the limit set press the p0 Alarm button If the SpO level falls below the low alarm limit an alarm sounds and the violated limit is highlighted SpO alarms are automatically turned off when you press Charge Deactivating SpO Alarms Press the Sp0 Alarm button The AN symbol to the right of the SpO display indicates that the alarms are off 6 8 Sp0 Monitoring Optional Sp0 Alarms Recorder Output After an alarm event the recorder prints a strip The bottom of the strip shows the alarm violation and the top of the strip shows the SpO reading With the optional Event Summary you may print an event summary record which contains SpO information as described in Printing the Event Summary Record Optional on page 3 8 6 9 Sp0 Monitoring Optional Sp0 Alarms 6 10 WARNING Using Advisory Mode Optional In advisory mode the CodeMaster XL acts as a semi automatic external defibrillator When in advisory mode the CodeMaster XL can analyze the patient s ECG rhythms advise when a shock should be administered automatically charge the defibrillator when shock advised prompt the user to deliver the shock provide event documentation Using Advisory Mode Do not use the Code
42. corder Delay Recorder BW Advisory Energy Record on Mark Record on Charge Record on Shock Record on Alarms Post Shock Data Power On Lead Patient Cable Notch Filter ECG Trace Choices Delay 6s No Delay Monitor Diagnostic 200 200 360 or 200 300 360 ON OFF ON OFF ON OFF ON OFF ON OFF PADDLES LEAD I LEAD Il LEAD III 3 WIRE 5 WIRE 60 HZ 50 HZ ON OFF SWEEP SCROLL Installation and Setup Setup Description Printout is delayed 6 seconds or immediate Bandwidth recorder only Monitoring bandwidth 0 5 Hz 40 Hz Diagnostic bandwidth 0 05 Hz 150 Hz Sets the desired advisory mode delivered energy sequence Records during mark Records during charge Records during discharge Records during alarms ON prints the delivered energy statistics OFF prints Energy Select control setting Sets the ECG monitoring source that appears when you turn on the instrument ECG trace style Record on Mark and post shock data are configurable with option package only Installation and Setup Specifications Specifications Defibrillator Waveform Damped sinusoidal Lown Output Energy Delivered 2 3 5 7 10 20 30 50 70 100 150 200 300 and 360 joules Charge Control Push button on apex paddle and on front panel Charge Time Less than 5 seconds to 360 joules with battery present Less than 15 seconds to 360 joules on AC only Armed Indicators
43. cribe conditions or actions that can result in personal injury or loss of life Caution statements describe conditions or actions that can result in damage to the equipment or loss of data Notes contain additional information on usage TEXT represents the messages that appear on the display key represents keys on the front panel LIGHT represents lighted indicators on the key panel Preface This manual provides operational basic maintenance and troubleshooting instructions for use and proper care of the Hewlett Packard M1722B CodeMaster XL defibrillator This manual is organized as follows Chapter 1 Getting Acquainted Provides basic maintenance instructions for safe use and proper care Chapter 2 Defibrillating Contains information about defibrillating a patient and using different paddle sets for defibrillating Chapter 3 Monitoring Contains information about preparing and monitoring a patient that apply to the synchronized cardioversion and pacing procedures Chapter 4 Performing Synchronized Cardioversion Contains information about performing synchronized cardioversion on a patient Chapter 5 Pacing Optional Contains information about pacing Chapter 6 SpO Monitoring Optional Contains information on both cardiac and respiratory systems and provides details of oxygen transportation in the body Chapter 7 Using Advisory Mode Optional Contains information on how the
44. ct an appropriate energy level for the pediatric patient There is no energy limit lockout for the pediatric paddle set Defibrillating through External Multi Function Defib Electrodes The CodeMaster XL has an external electrodes adaptor that is optional This adaptor allows defibrillation through external adhesive electrodes External Electrodes have the following advantages They allow hands off defibrillation They provide good quality monitoring You can perform synchronized cardioversion without using an ECG lead set while monitoring through the electrodes f the optional pacer is installed you can switch between the pacing and defibrilla tion modes of operation quickly The defibrillator will deliver energy to an open electrodes set The message PADS OFF appears when there is a poor electrodes to patient contact Check all patient connections if this message appears If possible dry off the patient s chest prior to applying the electrodes 1 Attach the electrodes adaptor cable M1750A B to the paddle connector on the front of the defibrillator 2 Slide the paddle connector lock towards the front of the defibrillator to secure the cable 2 6 WARNING Defibrillating Defibrillating a Patient 3 Attach the electrodes to the patient as instructed on the package 4 Connect the electrodes to the electrodes adaptor cable The electrodes are cor rectly connected when the locking ring is twisted locking the ear
45. d defibrillator 1 10 E ECG gain mode 8 8 ECG Input connecting A 8 ECG Input connector options A 7 uses A 7 ECG output jack 4 1 ECG Size 3 9 ECG size adjusting 3 6 ECG Size button 1 4 3 6 ECG source 1 4 4 6 automatic analysis 7 3 selecting 3 6 ECG strip 3 8 annotating 1 3 light printing 9 2 printing 1 3 reading the 3 9 elective cardioversion 3 1 electrode 8 9 monitoring 5 2 placing 3 wire 3 2 placing 5 wire 3 3 electrolyte using 2 2 electrolyte paste 8 9 energy decreasing 2 4 delivered advisory mode 7 10 increasing 2 4 resetting 2 4 selecting 1 2 2 2 Energy Select control 1 2 1 10 2 2 ES 1 4 Event Summary 1 4 2 5 4 8 Advisory mode 7 13 clearing 3 9 printing 3 8 7 13 reviewing 3 8 7 15 stopping 3 8 7 15 events 3 8 external adhesive pads defibrillator connector A 4 external monitor using with the 4 2 Index 22 Index external paddles 2 5 connecting A 4 A 6 defibrillator connector A 4 external paddles adaptor cable connecting A 4 A 6 connecting to defibrillator A 4 A 6 external pads 2 5 4 5 adaptor 2 6 defibrillating through 2 6 monitoring through 2 6 F factory settings A 11 fixed mode 1 5 5 1 5 3 forming leads 3 3 functional inspection 8 7 G gain bar 3 6 H Heart Rate 5 4 heart rate alarm 1 4 1 9 adjusting limits 3 7 pacemaker patients 1 11 reviewing limits 3 7 symbol 3 7 violated limits 3 7 heart rate al
46. ddles sets and an ECG Input connector for attaching leads Paddles Connector The defibrillator connector accepts external paddles external adhesive electrodes or internal paddles Connecting Paddles or Electrodes To connect external paddles internal paddles or adhesive electrodes to the defibrillator perform the following steps 1 Slidethe paddle connector lock on the paddles plug to the unlocked position To do this push the lock toward the top of the connector 2 Insert the paddles electrodes adaptor cable plug into the paddles connector on the defibrillator as shown in Figure A 2 on page A 5 3 Slide the paddle connector lock to the locked position to latch the plug in place A 4 Installation and Setup Installation Figure A 2 Electrodes plug in paddles connector Connector lock Push the lock in the direction indicated by the arrow to move the lock to the locked position shown MIT22 D3A Connecting External Paddles Adhesive Electrodes or Internal Paddles A 5 Installation and Setup Installation Disconnecting Paddles or Electrodes To disconnect external paddles internal paddles or adhesive electrodes from the defibrillator perform the following steps See Figure A 3 below Figure A 3 Connector lock in the unlocked position Cable Strain Relief M1722 0B8 Disconnecting External Paddles Adhesive Electrodes or Internal Paddles 1 Slidethe connector lock to the unlocked p
47. diagonal CRT for 4 seconds of ECG data on screen non fade fixed trace Scrolling trace is selectable Sweep Speed 25 mm sec nominal Frequency Response 0 5 to 40 Hz Heart Rate Display Digital readout on monitor from 15 to 300 BPM Heart Rate Alarms Three pre set pairs of high and low heart rate alarm limits from 20 to 280 BPM Configurable pairs are optional ECG Output 1V mV Patient Cable Length 10 ft 3 m Installation and Setup Specifications Thermal Array Recorder Event Summary optional Stores and prints 3 seconds pre and 8 seconds post critical event data for up to 28 events Data retained after unit is turned off Annotates Time date HR event marker ECG mode defibrillator mode selected energy actual delivered energy peak current and patient impedance Speed 25 mm sec Paper Size 50 mm by 30 m 100 ft Recorder Mode Automatically documents events and ECG during defibrillation episodes The recorder can be configured to run in either real time or with a six second delay Frequency Response 0 5 to 40 Hz or 0 05 to 150 Hz selectable Size and Weight Dimensions 7 9 in H by 11 8 in W by 15 6 in L 20 cm H by 30 cm W by 39 7 cm L Weight 24 Ibs 10 9 kg Includes external paddles battery and recorder paper Installation and Setup Specifications Battery Type Rechargeable sealed lead acid battery 4 Ah 12 V nominal Charge Time 2 hours to 90 of full capacity 18
48. disarm tone Sounds during the last ten seconds of the Charge Done tone Beeps intermittently until disarmed ORS beeper Sounds whenever an R wave is detected Volume controlled by front panel adjustment CRT alerts Three beeps each time a message appears on the screen Can be disabled in setup HR alarms Sounds if the heart rate is above the higher alarm limit or below the lower alarm limit p0 alarm Sounds if the SpO level is above the high Sp0 alarm limit or below the low Sp0 alarm limit Shutdown alarm Alternating pitch sounds for 60 seconds when the system is about to turn off An alert to plug the unit into AC power Getting Acquainted Safety Considerations Safety Considerations The CodeMaster XL stores high voltage energy and is capable of delivering up to 360 joules of DC energy to a 50 ohm impedance To remove power from the instrument you must turn the Energy Select control to Off Standby Disconnecting the CodeMaster XL from an AC outlet will not remove power because the instrument is battery powered To disarm a charged instrument use one of three methods Turn the Energy Select control from an energy level setting to the Monitor On or Off Standby position or Place the paddles in their holders and depress both Shock buttons or Leave the unit charged for 60 seconds and it will automatically disarm CAUTION Do not leave the instrument turned on when it is no
49. e current ECG and of the monitor status press Record The upper line of the ECG strip contains a periodic report of monitor parameters Date Time Heart Rate ECG Source ECG Size and Recorder mode The lower line of the ECG strip records asynchronous events such as Shock deliv ery or Heart Rate Alarm violations Several graphic symbols are used to annotate events such as Shock HR Alarms Mark or Sync A 1 mV 200 ms calibration pulse can be printed on the ECG strip by pressing both arrows on the v ECG SizeA key simultaneously Appendix A contains a list of configuration settings in setup menu 2 which affect recorder operation The recorder can be configured for either monitor or diagnostic ECG bandwidth data Delayed 6 seconds or non delayed operation is also configurable Automatic Recordings In setup menu 2 you can enable or disable any of the following automatic recordings 3 9 Table 3 7 Monitoring Recording Record on Charge Record on Shock Record on Alarms Record on Mark configurable with option The automatic recordings for both delayed and non delayed recorder modes of operation are defined in Table 3 7 Automatic Recordings Automatic Recordings Delayed mode Delayed mode Non Delayed mode Event Pre event time Post event time Post event time Mark pressed 6 seconds 3 seconds 3 seconds Charge 6 seconds Until Shock or Dis
50. e done tone and available energy indicated on display Advisory Event Summary Stores approximately 200 events and 50 ECG strips Data retained after instrument turned off Waveform Damped sinusoidal Lown Installation and Setup Calling for Service Calling for Service For telephone assistance call the Response Center nearest to you or visit our website at www healthcare agilent com mpgcsd United States of America Medical Response Center Tel 800 548 8833 Canada Eastern Region Central amp Western Regions Tel 800 361 9790 Tel 800 268 1221 Other International Areas Australia France Tel 131147 Tel 0803 35 34 33 Germany Italy Tel 0130 4730 Tel 0292 122999 Netherlands United Kingdom Tel 0 20 547 6333 Tel 44 344 36633 Belgium Tel 322 778 35 31 Installation and Setup Calling for Service A 20 Index Numerics 3 wire patient cable 3 1 3 2 A 7 50J MAXIMUM 2 9 2 10 8 2 5 wire patient cable 3 1 3 2 3 3 A 7 A AC POWER 2 5 4 8 7 12 8 7 8 9 AC power 1 8 1 14 8 9 9 5 operation 1 12 pacing 5 2 adaptor cable internal paddles 2 8 adhesive pads 2 6 5 1 adjusting ECG size 3 6 heart rate alarm limits 3 7 QRS beeper volume 3 7 advisory mode default settings 7 18 energy delivered 7 10 event summary 7 13 using 7 1 alarm battery 1 13 heart rate 1 4 alarms violation recordin
51. e following settings cannot be changed Charge done tone always sounds CRT alert tones always sound Alert tone volume always at the maximum volume Recorder delay no delay Recorder Bandwidth always Monitor bandwidth Automatic Recordings always off Power on Lead always PADS PADDLES Notch Filter always on Tahle 8 1 Table 8 2 Troubleshooting This chapter contains information about troubleshooting and performing diagnostics on the CodeMaster XL defibrillator monitor Troubleshooting This section provides information about messages that appear on the display Failure Messages Message Possible Solutions DEFIB Use a back up defibrillator and call service FAILURE MONITOR Use a back up defibrillator and call service If there is no alternative try to use the FAILURE defibrillator without the monitor Use Charge Done indicators to verify defibrillator functionality SYST FAIL Use a back up defibrillator and call service If there is no alternative try to use the defibrillator Use Charge Done indicators to verify defibrillator functionality C Bl Jj IER Troubleshooting the Defibrillator Defihrillator Messages Message Cause Possible Solutions NO PADDLES Paddle set is not connected to the Attach external paddles internal defibrillator paddles or electrodes adaptor as required LEADS OFF Leads are not securely attached to t
52. ensor CAUTION When non HP SpO sensors are used application must be consistent with the 2 manufacturer s own guidelines 6 4 WARNING Sp0 Monitoring Optional Using Sp0 to Monitor a Patient Prolonged continuous monitoring may increase the risk of undesirable changes in skin characteristics such as irritation reddening blistering or pressure necrosis particularly on neonates and on patients with impaired perfusion and varying or immature skin morphology Specific attention must be given to sensor site inspection for changes in skin quality proper optical path alignment and attachment Check the application site at regular intervals at least every two hours and change the site if any compromise in skin quality should occur More frequent checking may be required due to an individual patient s condition Troubleshooting Sensor Application Failure to apply the sensor properly may cause incorrect measurement of arterial oxygen saturation Do not use a damaged sensor or one with exposed electrical circuits Patient Movement Make sure that the application site chosen does not move excessively which may adversely affect the performance of the sensor You may have to replace the sensor to ensure good adhesion or you may have to choose another application site Inspecting the Application Site Inspect the SpO gt sensor site at least once every 2 hours to ensure adhesion skin integrity and correct align
53. er each use For improved battery life consider ways to reduce the number of instrument uses between full charge cycles When the instrument is not plugged into AC power some current is drawn from the battery to maintain memory and startup logic Remove the battery if the instrument is to be stored for extended periods more than one month without AC power Note on the instrument that the battery has been removed After an extended storage period test the battery according to the battery capacity check as described in Maintaining the Battery on page 9 3 This battery was selected because it provides optimum performance and battery life over a wide range of operating conditions The life expectancy of this battery is dependent on many variables including temperature and usage Periodically check the battery capacity to determine whether to replace it The battery capacity check is described in Maintaining the Battery on page 9 3 When plugged into AC power the CodeMaster XL will function normally with no battery installed however the time required to charge the defibrillator will increase WARNING WARNING Getting Acquainted AC Battery Operation If the CodeMaster XL is operated without a battery installed clearly mark the instrument that it does not have a battery and requires AC power to operate When a CodeMaster XL has no battery installed and is plugged into AC power the front panel AcPowER light will be on a
54. ery Maintaining the Battery The sealed lead acid battery used in the CodeMaster XL will provide optimum life when the unit is continuously connected to AC power and fully charged after each use To fully charge a depleted battery requires 18 hours of continuous charge time Because it is not always possible to allow a full charge cycle between uses the CodeMaster XL was designed to charge a depleted battery to 90 of its capacity in approximately two hours However battery capacity and battery life will be reduced if the battery is not allowed to fully charge after each use For improved battery life applications where the CodeMaster XL is used frequently between full charge cycles consider ways to decrease the number of instrument uses between full charge cycles When the instrument is not plugged into AC power some current is drawn from the battery to maintain memory and startup logic If the battery is to be stored for extended periods more than one month without AC power observe the caution in Installing and Charging the Battery on page A 1 This battery was selected because it provides optimum performance and battery life over a wide range of operating conditions The life expectancy of this battery is dependent on many variables including temperature and usage Periodically check the battery capacity to determine whether to replace it The battery capacity check is described in the next section When plugged into AC p
55. fibrillator to lock the connector in place See Connecting Paddles and Patient Cables in Appendix A for more information 6 Attach the electrodes to the electrodes adaptor cable and turn the twist lock 7 Turn the Energy Select control to the Monitor On position If the message NO PADDLES is displayed check that the electrodes adaptor cable connector is properly seated and latched If the message PADS OFF is displayed check the electrodes connection to the patient and to the electrodes adaptor cable 8 Press Pacer On to turn the pacer on Pacer parameters will now be displayed at the bottom of the display PACER STOP DEMAND MODE 70 PPM 30 MA The rate ppm and output mA settings for when the pacer is turned on can be selected in setup menu 1 The original rate and output settings from the factory are 70 ppm and 30 mA The pacer is always in Demand mode when it is turned on At this point no pacer pulses are being delivered to the patient The pacer must be started before the pacer pulses are delivered at the selected rate ppm and output mA 9 Press Lead Select to select the best lead for monitoring while pacing You can only select Leads as the ECG source when the pacer is on If the message LEADS OFF is displayed check all patient cable connections 10 Press w Rate aj to adjust the rate The selected rate PPM is displayed on the monitor
56. fications or repair are carried out by persons authorized by them and the electrical installation of the relevant room complies with all local regulations and the equipment is used in accordance with the instructions for use Use of accessories other than those recommended by Hewlett Packard may compromise product performance THIS PRODUCT IS NOT INTENDED FOR HOME USE Responsibility of Manufacturer Hewlett Packard only considers itself responsible for any effects on safety reliability and performance of the CodeMaster XL defibrillator monitor if assembly operations extensions re adjustments modifications or repairs are done by persons authorized by Hewlett Packard and the electrical installation of the relevant room or vehicle complies with the IEC or national requirements and the instrument is used according to the instructions for use presented in this manual ii iii Safety Symbols I 4 e p 5 e F6 o Monitor On Do not confuse with 1 Joule Off Standby On Off Ground Shock hazard Caution See operating instructions Meets IEC type BF leakage current requirements and is defibrillator protected Meets IEC type CF leakage current requirements and is defibrillator protected Equipotential rear of unit adjacent to a c input Protective earth ground iv WARNING CAUTION NOTE Conventions Used in This Manual Warning statements des
57. g No electrodes adaptor attached e Paddles attached Internal paddles attached Electrodes Adaptor Cable may be Notify Service Personnel defective PADS OFF Electrodes adaptor cable is attached anda Attach electrode for pacing If elec electrode is off Electrodes Adaptor Cable may be defective trodes are already applied to patient change to a new set of electrodes Notify Service Personnel Table 8 3 Pacer Messages Message ATTACH PADS Cause Electrodes adaptor cable is attached not attached electrodes are not attached Start Stop Charge is pressed and electrodes are is pressed and Electrodes Adaptor Cable may be defective Troubleshooting Troubleshooting Possible Solutions Attach the pacer electrodes Notify Service Personnel Table 8 4 Troubleshooting Troubleshooting Troubleshooting SpO Sp0 Messages Message Cause SPO2 FAILURI Pl The unit detected a failure in Sp0 subsystem hardware This failure does not affect other parts of the instrument Possible Solutions Press SpO On Off twice to power cycle the SpO2 option If the error happens again call for service SPO2 SI FAIL ENSOR The sensor or adaptor cable is bro ken Replace the sensor or adaptor cable SPO2 CABLE P OFF Sensor or cable is disconnected Check Sp0 connections between Code
58. gs 3 10 alcohol for cleaning 9 6 alert volume A 12 anterior posterior paddles 2 11 armed tone A 12 arrhythmias synchronized cardioversion as treatment 4 1 asynchronous events 3 9 ATTACH PADS 5 4 audible indicators 1 9 7 4 auto disarm tone 7 4 AUTOGAIN 8 8 Autogain 3 7 automatic recordings 3 9 available energy 3 10 B BATT CHRG 1 8 1 12 2 5 4 8 7 12 8 7 8 9 battery charging A 1 charging the 1 13 compartment A 3 connector A 3 discharges 1 13 lead acid 9 3 life 1 13 operates without a 1 13 plug A 3 replacing 9 5 A 1 battery alarm 1 13 battery capacity 1 13 check 9 4 of new 9 4 battery door 9 5 battery operation 1 12 bell symbol 3 7 C cable 3 Wire 3 1 3 wire 3 2 5 wire 3 1 3 3 pads adaptor 2 6 4 6 patient 3 1 calibration pulse 3 9 capturing a beat 5 4 cardioversion 3 5 elective 3 1 synchronized 3 1 caution iv changing the paper 9 1 charge 2 3 Charge button 5 5 Charge Done indicators 5 5 8 11 light 1 8 tone 1 9 charge done indicators 2 3 charge done tone 7 4 charging battery A 1 charging the battery 1 13 CHECK RECORDER 3 11 8 2 CHECK SETUP 8 12 checking battery capacity 9 4 checking connections 3 6 checks battery capacity 9 4 operational daily 8 10 operational every shift 8 9 chlorine bleach for cleaning 9 6 cleaning exterior 9 6 paddles 9 6 recorder printhead 9 2 cleaning solutions 9 6 clearing the Even
59. he Attach lead patient or the cable is not connected to the defibrillator USE LEADS Paddles are connected to the defibrillator and e Sync is pressed when Press Sync to remove the PADDLES is selected defibrillator from sync mode 8 1 Table 8 2 Troubleshooting Troubleshooting Defibrillator Messages Message Cause Possible Solutions Defibrillator is in sync mode and Select PADS or LEAD I PADDLES is selected TI or III instead of PADDLES Defibrillator is in defib mode and Select PADS or LEAD I PADDLES is selected when leads ITI or III instead of are attached to the patient PADDLES Defibrillator is in defib mode Select PADS or LEAD I PADDLES is the ECG source when ITI or III instead of attaching leads to the patient PADDLES Electrodes Adaptor Cable may be Notify Service Personnel defective 50J Internal paddles are attached and the CodeMaster XL will charge MAXIMUM Energy Select control has been turned to 50 joules past 50 joules Electrodes Adaptor Cable may be Notify Service Personnel defective LOW CodeMaster XL is not connected to AC Connect the unit to AC power BATTERY power and the battery voltage is below the low battery threshold SETUP LOST Call for service DEFIB CodeMaster XL has internally DISARMED discharged energy and is now disarmed CHECK The
60. hen HR alarms are inactive the monitor will display a bell symbol with a through it AN To select a pair of HR alarm limits press HR Alarm until the pair of limits you wish to use are displayed If you do not press the key again the displayed HR alarm limits become active and the limits are replaced by the bell symbol If the HR alarm limits are violated the HR alarm limits replace the bell symbol and the violated limit is highlighted Pressing HR Alarm at this point will turn off the HR alarms If the HR Alarms are active and you wish to review the limits press HR Alarm The currently active pair of HR alarm limits are displayed momentarily If the HR alarms are active and you wish to select another pair of limits press HR Alarm until the pair of limits you wish to use are displayed Pressing HR Alarm repeatedly cycles through the three pairs of HR alarm limits and the HR alarms inactive choice 3 7 NOTE Table 3 6 Monitoring Printing the Event Summary Record Optional HR alarms are automatically turned off when you press Charge Printing the Event Summary Record Optional During defibrillator usage the monitor stores up to 28 ECG strips of critical information called events Events include all shocks heart rate alarm violations SpO alarm violations and mark events Each event record includes date of event heart rate
61. hours to 100 capacity Repeated charging to less than 100 will reduce useful life of battery Capacity 2 1 2 hours monitoring or fifty 50 full energy discharges or 1 hour monitoring and recording Battery Indicators Illuminated LED indicates battery is charging LOW BATTERY message appears on monitor when limited battery capacity remains External Pacemaker Optional Current Pulse Amplitude 10 mA to 200 mA Pulse Width 20 msec Rate 40 ppm to 180 ppm Modes Demand or fixed rate Refractory Period 40 to 80 ppm 340 msec 90 to 180 ppm 240 msec Installation and Setup Specifications SpO Optional Measurement Range 0 to 100 Accuracy with HP M1190A sensor standard deviation 65 80 2 5 80 100 41 5 resolution 1 Averaging 8 beats SpO alarm limits range 100 90 100 85 100 80 SpO alarm delay ten seconds after value drops below the low alarm setting INOP alerts Triggered by disconnected sensor noisy signal light interference or low signal Pulse rate measurement range 30 to 300 bpm 1 resolution bpm Pulse amplitude indicator Indicates pulsatile activity Advisory Mode Optional Analysis time Seven to ten seconds Output Energy Delivered factory default protocol 200J 200J 360J Analysis Control Push button on front panel Charge Time Less than 5 seconds to 360 joules with battery present Less than 15 seconds to 360 joules on AC only Armed Indicators Charg
62. ing with Anterior Posterior Paddles The M2495A Anterior Posterior Paddles are similar to the anterior anterior paddles but provide a posterior electrode placed on the patient s back Refer to the packaging provided with the paddles for placement and usage guidelines Defibrillating Defibrillating a Patient 2 12 Tahle 3 1 Monitoring This chapter contains information about monitoring a patient with the CodeMaster XL defibrillator monitor This chapter also contains details of patient preparation that apply to the synchronized cardioversion and pacing procedures described later in this manual The CodeMaster XL can be used for either short term or long term cardiac monitoring A fully charged battery pack provides a minimum of two and a half hours of continuous monitoring The power cord can be connected to AC power for unlimited monitoring periods Using Leads to Monitor The CodeMaster XL s monitoring functions can be used for cardiac monitoring elective cardioversion and pacing optional Table 3 1 Cardiac Monitoring Configurations details the different ECG sources that can be used for cardiac monitoring and monitoring applications for which each is suited Cardiac Monitoring Configurations For this ECG Use this cable type In this monitoring source application LEADS 3 Wire ECG Monitoring LEAD III II 6Pin M1731A Synchronized Cardioversion 8Pin M1733A Pacing e 8 Pi
63. ive cleaners such as steel wool or silver polish Do not steam or gas sterilize the external paddle set Cleaning and Sterilizing the Internal Paddles Clean the electrode surface and handle with common cleaning solutions such as Isopropyl alcohol soap and water or chlorine bleach 30 ml water 9 6 Maintaining the Defibrillator Cleaning and Sterilizing the Internal Paddles Do not use acetone enzymatic cleaners ammonia based cleaners or strong alka line cleaners Usea small soft brush with cleaning solution to clean any contamination from the electrode surface and edges Before sterilizing clean any excessive residue which accumulates on the handles or electrode surfaces Do no immerse the connector in cleaning solutions Internal paddle sets can be steam sterilized but the severe conditions of steam sterilization will limit their useful life A one year consumables warranty on the paddles is provided Since the useful life of these paddles is limited replace them when functionality or appearance is questionable When using the sterilization procedures described in this guide the paddles will withstand approximately 200 sterilization cycles This will vary depending on the equipment and the process used Steam Sterilizing the Internal Paddles Hewlett Packard Company recommends the following techniques for sterilizing the internal paddles For additional sterilization methods see the CodeMaster Series
64. l configuration upon which the advisory algorithm was designed and tested 4 Connect the electrodes to the electrodes adaptor cable The electrodes are cor rectly connected when the locking ring is twisted locking the ears of the con nector to the adaptor cable Be sure to correctly connect the electrodes to the electrodes adaptor cable Incorrectly connecting the electrodes to the adaptor cable can result in a failure to deliver energy to the patient 7 1 Figure 7 3 Energy Select power control Analyze Button WARNING Using Advisory Mode Optional Using Advisory Mode C Press the Analyze Button When you place the CodeMaster XL in Advisory mode the monitor displays the following message FOR ANALYSIS 200J PRESS ANALYZE SELECTED Begin analyzing the patient s ECG by pressing Analyze on the instrument front panel Analyze Button When you press Analyze the monitor displays ANALYZING ECG nnnJ DO NOT TOUCH PATIENT SELECTED where nnn is the factory default settings for the energy sequence Do not analyze the patient s cardiac rhythm in a moving vehicle or while the patient is being moved 7 8 WARNING NOTE Using Advisory Mode Optional Using Advisory Mode To perform accurate analysis you must not touch or move the patient during this time Stop CPR ventilation and transport The advisory algorithm needs 7 to 10 seco
65. le monitors There are many ways to monitor ECG for synchronized cardioversion use an external ECG monitor connect ECG electrodes to the CodeMaster XL or use external adhesive electrodes External ECG monitor When the patient is already connected to bedside monitoring equipment there is a cable which plugs into the ECG output jack of the 4 1 Performing Synchronized Cardioversion Performing Cardioversion bedside monitor and connects to the CodeMaster XL for monitoring To use an external monitor with the CodeMaster XL perform the following steps 1 Select Lead I or Lead II on the CodeMaster XL 2 Plugthe cable into the external monitor ECG Output jack and plug the input end of the cable into the ECG input plug on the CodeMaster XL See Table 3 8 External Monitoring Cables for the information on external monitoring cables Using ECG electrodes with the HP CodeMaster XL defibrillator monitor Use a patient cable connected to the patient and select Lead I Lead IL or Lead III choosing the best lead that displays a large QRS complex Using external adhesive electrodes Use the electrodes adaptor cable M1750A B and electrodes selecting PADS as the ECG source 4 2 NOTE Performing Synchronized Cardioversion Performing Cardioversion Using Paddles for Performing Synchronized Cardioversion To start cardioversion perform the following steps 1 Turn the Energy Select control to Monitor On 2 Select
66. ls HR Alarms e Review Prints an Event Summary record The message ES is printed at the top of the ECG strip when you print the Event Summary record The recorder must be off to print an Event Summary with this key ORS Beeper Volume Controls volume of ORS beeper ECG Output Provides analog 1V mV output for external monitoring 1 4 Figure 1 5 Pacer On button Rate button Output button Mode button Table 1 4 Getting Acquainted Operating Controls and Indications ates Ee C Se me Pacer Operating Controls Pacer Operating Controls Control Description Pacer On Turns pacer on or off w Rate A Adjusts pacer rate ppm up or down Start Stop Starts or stops pacing w Output A Adjusts pacer output current mA up or down Mode Changes between fixed or demand pacing modes 1 5 Getting Acquainted Operating Controls and Indications Figure 1 6 2 3 C e Gane Ll XD Sp0 Alarm button Sp0 Input p0 Operating Controls Table 1 5 p0 Operating Controls Control Description Sp0 On Off Turns pulse oximeter on or off Sp0 Alarm Activates selects and deactivates SpO alarms Sp05 input Connector for SpOs sensor or sensor adaptor cable 1 6 Figure 1 7 Energy Select power control
67. ment of the light emitter and photodetector Should alterations of skin integrity occur remove the sensor and reapply at another recommended site Avoid application of the sensor to edematous or fragile tissue Check circulation distal to the sensor site routinely Circulation at Application Site Wrapping the tape too tightly or using supplemental tape can cause venous pulsations that could potentially lead to inaccurate saturation measurements Therefore do not wrap the adhesive too tightly and do not use additional tape to 6 5 Figure 6 3 Sp0 input Sp0 Monitoring Optional Using Sp0 to Monitor a Patient secure the sensor High positive intrathoracic airway pressures valsalva maneuvers or other consequences of impaired venous return may also cause venous pulsations Only use adhesive wraps recommended by Hewlett Packard Avoid placing the SpO sensor on any extremity with an arterial catheter blood pressure cuff or intravascular venous infusion line Connect the Sensor to the CodeMaster XL When you have applied the sensor to the patient plug the disposable and semi disposable sensors into the connector cable and plug this cable into the SpO gt socket on the lower right of the CodeMaster XL Plug the M1190A sensor directly into the SpO gt socket of the CodeMaster XL The plug is keyed and is color coded blue to distinguish it from the white ECG socket 1722 04 Connecting the Sp0 Sensor to the CodeMas
68. ment to its storage location and plug the power cord into an AC power outlet Verify that the BATT CHRG and ACPOWER lights are on 3 Clean all paddles controls and cables Refer to Chapter 9 Maintaining the Defibrillator for cleaning instructions 4 Check that sufficient recorder paper and electrolyte paste or defibrillator elec trodes are available for the next use of the defibrillator Defibrillating with Alternate Paddle Sets The CodeMaster XL will defibrillate with several different electrodes paddles sets Adult Pediatric Anterior Anterior External Paddles Anterior Posterior Paddles External Multi Function Defib Electrodes nternal Paddles Do not switch paddle sets in an environment where water may get in the electrodes paddles connector receptacle Performing Pediatric Defibrillation The CodeMaster XL paddle set comes with pediatric paddles To use the pediatric paddle set depress the release latch at the front of the standard external paddle set while pulling forward on the adult paddle surface This action will remove the adult paddle contact surface and expose the smaller pediatric contact surface When 2 5 WARNING WARNING Defibrillating Defibrillating a Patient pediatric paddles are in use the adult electrode plates may be conveniently stored in the paddle pockets of the defibrillator Refer to Defibrillating a Patient on page 2 1 for defibrillation procedures The clinician must sele
69. mplied warranties or merchantability and fitness for a particular purpose WARNING As with electronic equipment Radio Frequency RF interference between the defibrillator and any existing RF transmitting or receiving equipment at the installation site including electrosurgical equipment should evaluated carefully and any limitations noted before the equipment is placed in service Monitoring during quiescent periods of electrosurgery is possible but electromagnetic interference generated by electrosurgical tools during operation is sufficient to mask cardiac signals A momentary recovery period is required for the monitor to return to normal operation and will be longer if the diagnostic monitoring mode is used Pads or electrodes should be placed as far from the surgical area as reasonable while still performing normal function to minimize the possibility of burns Radio frequency generation from electrosurgical equipment and close proximity transmitters may seriously degrade performance of the CodeMaster XL defibrillator monitor Hewlett Packard assumes no liability for failures resulting from RF interference between HP medical electronics and any radio frequency generating equipment at levels exceeding those established by applicable standards CAUTION The manufacturer importer and seller are responsible for the effects on safety reliability and performance only if assembly operations extensions re adjustments modi
70. n M1735A IEC e 12 Pin M1605A M1500A e 12 Pin M1615A M1510A IEC LEADS 5 Wire optional ECG Monitoring LEAD 6Pin M1732A Synchronized Cardioversion LIM aVR aVL aVF 8 Pin M1734A Pacing and V 8 Pin M1736A IEC 12 Pin M1625A M 1520A 12 Pin M1635A M 1530A IEC 3 1 Tahle 3 1 Table 3 2 Monitoring Using Leads to Monitor Cardiac Monitoring Configurations For this ECG Use this cable type In this monitoring source application Electrodes Electrodes adaptor cable ECG Monitoring M1750A B Synchronized e Multifunction Defib Electrodes Cardioversion You can use these electrodes for pacing however you must select LEADS as the monitor source dur ing pacing PADDLES Standard with instrument M1747A B Emergency ECG Monitoring MONITOR Monitor adaptor cable Synchronized 14482A e 8 2 5m 14482B e 25 7 8m Preparing the Leads for Monitoring The optional 5 wire functionality allows CodeMaster XL to be configured to use either a 3 wire or a 5 wire patient cable Use setup menu 2 as described in Appendix A to select the patient cable type 3 wire 5 wire 3 Wire Patient Cable Table 3 2 3 Wire Electrode Placement describes typical lead wire placement using the 3 wire patient cable Table 3 3 Lead Formation shows how the individual leads are formed using the individual leadwires 3 Wire Electrode Placement Electrode AHA IEC Placement RA White R Red Near
71. n a shockable rhythm is detected the message SHOCK ADVISED displays and the defibrillator begins charging The defibrillator charges to the pre set energy select sequence for the first second and third shocks Subsequent shocks are delivered at the third shock energy level A tone sounds to alert you that the defibrillator is charged and the messages CLEAR PATIENT PRESS SHOCK BUTTONS display on the monitor 7 10 Using Advisory Mode Optional Using Advisory Mode Defibrillating a Patient 1 Verify that no one is in contact with the patient the cable or electrodes the bed rails or other potential current path 2 Callout Clear to alert personnel that a defibrillator shock is about to be deliv ered and to remain away from the patient 3 Press both Shock buttons simultaneously to defibrillate The Shock AN not shock buttons are on the cable connector housing If the defibrillator does refer to Chapter 8 Troubleshooting Figure 7 4 Shock Buttons After the defibrillator charges press the Shock buttons promptly If the shock is not delivered within 30 seconds the CodeMaster XL disarms If the defibrillator disarms before delivering the shock to the patient the energy level remains the same for the next shock NOTE Using Advisory Mode Optional Using Advisory Mode You can disarm the defibrillator by switching the Energy Select control to the Off Standby or Monitor On positions If
72. nd the BATTCHRG light will be off Properly dispose of or recycle depleted batteries according to local regulations Do not disassemble puncture or incinerate the disposed batteries Figure 2 1 Charge button Shock buttons 4 Sync button Energy Select power control Defibrillating This chapter contains information about defibrillating a patient and using different paddle sets for defibrillating Defibrillator Control Panel Defibrillating a Patient The following section describes the three steps to defibrillating a patient 1 Select Energy 2 Charge 3 Shock 2 1 Defibrillating Defibrillating a Patient 1 Select Energy 1 Turn the Energy Select control to the desired energy level The defibrillator is now on 2 Prepare the paddles by following these steps a Remove the paddles from their holders by grasping the handles and lifting them straight up b Holding both paddles in one hand apply electrolyte paste to the electrode surface of each paddle WARNING Do not allow paste to accumulate on your hands or on the paddle handles to avoid risk of electrical shock CAUTION Do not rub the electrode surfaces together to distribute the applied paste Placing the E electrode surfaces together increases the risk of an accidental paddle to paddle discharge 3 Apply the paddles as described in Figure 2 2 a Placethe Sternum paddle
73. nds of continuous artifact free ECG data to decide whether the patient requires shock If excessive artifact due to CPR or patient transport is detected the monitor displays the messages ARTIFACT DETECTED DO NOT TOUCH PATIENT If the artifact ends within 20 seconds analysis continues Otherwise the messages ARTIFACT DETECTED CANNOT ANALYZE appear on the monitor and analysis stops You can restart analysis by pressing Analyze Pressing the Analyze key during analysis will stop analysis The message ANALYSIS STOPPED will be displayed momentarily and then the message FOR ANALYSIS 200J PRESS ANALYZI SELECTED EH appears 7 9 NOTE NOTE Using Advisory Mode Optional Using Advisory Mode If the external adhesive electrodes are not properly attached to the patient when you press Analyze the message FOR ANALYSIS 200J ATTACH PADS SELECTED appears The electrodes must be attached to the patient and the electrodes adaptor cable to start analysis If the electrodes adaptor cable is not connected to the CodeMaster XL the message ATTACH PADS CABLE appears The electrodes adaptor cable must be connected to start analysis D Follow Prompts Look frequently at the monitor and follow the displayed instructions The monitor may display SHOCK ADVISED orNO SHOCK ADVISED Shock Advised Whe
74. near the upper sternum in the patient s right mid clavicular line just below the clavicle b Placethe Apex paddle on the chest just below and to the left of the patient s left nipple in the anterior axillary line 2 2 Defibrillating Defibrillating a Patient Figure 2 2 i A A 2 M2475 06 Paddles placement for defibrillation 4 Rub the paddles lightly against the skin to distribute the electrolyte paste and increase contact between the patient skin and the paddles Then keep the paddles still to reduce motion artifact on the monitor WARNING Do not spread paste between the paddle electrodes on the chest The patient can be burned if the paste forms a path between the electrodes 5 Apply 10 to 12 kg 22 25 Ibs of pressure to the paddles 2 Charge 1 Press Charge on either the Apex paddle or on the instrument front panel 2 Callout Clear to alert personnel to stand away from the patient 3 Wait for the charge done indicators CHARGE DONE light and Charge Done tone When the unit is armed the monitor Delivered Energy display shows the avail able energy in joules 2 3 WARNING NOTE Defibrillating Defibrillating a Patient If the defibrillator does not charge refer to Chapter 8 Troubleshooting Resetting the Selected Energy Level To increase or decrease the selected energy level after pressing the Charge button perform the following steps 1 Move the Energy Selec
75. neonates or the finger in adults The oxygen saturation is gauged by measuring the redness of the blood in the arterial pulse A photodetector positioned opposite the light emitter compares light absorption before and after pulsation to provide measurements that are displayed on the monitor If there is no pulse measurements cannot be made See the following figure 6 1 Sp0 Monitoring Optional Application Notes Figure 6 1 Positioning of the Light Emitters and Photodetector For accurate measurements the following conditions must apply All transmitted light must pass through the extremity to the detector The patient must have at least a minimum pulse The light emitter and the photodetector must be opposite each other 6 2 Sp0 Monitoring Optional Using Sp0 to Monitor a Patient Using SpO to Monitor a Patient There are three types of sensors Disposable Semi Disposable Reusable Disposable sensors should be used once only and then discarded However they can be relocated to a different application site on the patient if the first location does not give the desired results Disposable sensors must not be reused on differ ent patients Semi disposable sensors can be reused but the adhesive wrap must be discarded after each use Semi disposable sensors are recommended for single patient use only Reusable sensors can be reused on different patients Before you star
76. ng the Internal Paddles 9 7 Ethylene Oxide Sterilization 9 8 Supplies 9 9 Installation and Setup Installation A 1 Line Voltage Settings A 1 Installing and Charging the Battery A 1 Loading the Recorder Paper A 3 Connecting Paddles and Patient Cables A 4 Setup A 9 Contents Specifications A 14 Defibrillator A 14 Monitor A 15 Thermal Array Recorder A 16 Size and Weight A 16 Battery A 17 External Pacemaker Optional A 17 SpO Optional A 18 Advisory Mode Optional A 18 Calling for Service A 19 Index xi Getting Acquainted This User s Guide provides operational and basic maintenance instructions for use and proper care of the Hewlett Packard M1722B CodeMaster XL defibrillator monitor Figure 1 1 1722 01 The CodeMaster XL Defibrillator Monitor Operating Controls and Indications The following figures and tables detail the controls and indications on the CodeMaster XL defibrillator monitor 1 1 Getting Acquainted Operating Controls and Indications Figure 1 2 Charge button Shock buttons Sync button Energy Select power control eI e A Axa v Defihrillator Operating Controls Tahle 1 1 Control Energy Select power con trol Defihrillator Operating Controls Description Turns the instrument power on or off and selects energy level Charge button Charges defibrillator to energy level
77. ng used Also check for worn or broken areas along the cables Press Charge again wait for the Charge Done indicators Press the Shock buttons again If the unit remains unable to shock turn the Energy Select control to the Moni tor On or Off Standby position and use a back up defibrillator If the unit is equipped with the optional Event Summary feature press Review to print an event summary and keep any ECG strips from the defibrillator for later evaluation Alert appropriate service personnel as soon as possible 8 3 Table 8 3 Troubleshooting Troubleshooting Troubleshooting the Pacer Pacer Messages Message PACER FAILURI Lt Cause The unit detected a delivered current error Possible Solutions 1 Change electrodes and make sure electrodes adaptor cable is properly connected 2 Restart the pacer IfPACER FAILURE hap pens again use a back up pacer and call for service PACER OUT PUT LOW Pacer current high lighted on the dis play The pacer cannot deliver the required cur rent 1 Stop the pacer 2 Change the electrodes and check the electrodes adaptor cable for proper connection 3 Restart the pacer STOP PACER Anattempt was made to change pacing Stop the pacer before you change mode while pacing the pacing mode NO PADS Pacer is on and one of the following occurs Attach electrodes for pacin
78. or monitor Changing the Recorder Paper 1722 08 Changing the Recorder Paper To change the recorder paper perform the following steps 1 Slide the recorder door to the right of the defibrillator as shown in Figure 9 1 The paper platen will tilt up 2 Pull up on the plastic removal tag to remove the empty or low paper roll 9 1 Maintaining the Defibrillator Cleaning the Recorder Printhead Place a new roll of thermal paper HP 40457C D in the recorder so that the paper unrolls from the top of the roll and the grid faces down as it comes out of the recorder Pull the end of the paper past the recorder platen While holding the recorder door open to the right press the platen down over the paper Allow the door to close over the platen roller Cleaning the Recorder Printhead If the ECG strip has light or varying density printing clean the printhead to remove any possible buildup of paper residue To clean the printhead perform the following steps 1 Slide the recorder door to the right of the defibrillator The paper platen will tilt up Remove the paper roll Clean the printhead surface above the brush with rubbing alcohol and a cotton swab Re install the paper roll While holding the recorder door open to the right press the platen down over the paper Allow the door to close over the platen roller 9 2 NOTE WARNING Maintaining the Defibrillator Maintaining the Batt
79. oring To perform synchronized cardioversion with electrodes perform the following steps 4 5 NOTE Performing Synchronized Cardioversion Performing Cardioversion Applying Electrodes 1 Attach the electrodes adaptor cable M1750A B to the defibrillator 2 Attach electrodes to patient as instructed on the electrodes package 3 Connect electrodes cable connector to the electrodes adaptor cable The elec trodes are correctly connected when the locking ring is twisted locking the ears of the connector to the adaptor cable 4 Turn the Energy Select control Monitor On Ifthe PADS OFF monitor message is displayed check all patient connections 5 Select electrodes as the ECG source by pressing Lead Select 6 Press Sync once to place the CodeMaster XL in Sync mode The message 7 8 SYNC will appear on the display Cardioversion can be performed with the CodeMaster XL defibrillator monitor in Autogain mode Always inspect the displayed ECG before delivering the counter shock and verify that an R wave marker indicating shock point appears only with each R wave If a marker dot does not appear or if a marker dot is viewed on the T wave segment of the ECG follow these instructions Adjust the ECG size by pressing v ECG Sizea until the marker dot appears only with each R wave Apply new adhesive electrodes to improve ECG R wave quality Press Charge on the CodeMaster
80. osition 2 Using the strain relief pull the connector housing up and out A 6 NOTE NOTE Installation and Setup Installation ECG Input Connector The ECG Input connector on the defibrillator is a 6 8 or 12 pin connector depending on the option purchased with the instrument For each connector option several different patient cables can be used for various ECG sources and applications Refer to Table 3 1 Cardiac Monitoring Configurations on page 3 1 for a list of available patient cables and lead sets and their part numbers 3 wire RA LA LL 5 wire RA RL LA LL V C optional Connecting a Patient Cable The 3 wire or 5 wire patient cable connects to the ECG Input connector located on the front of the defibrillator behind the carrying handle The patient cable plug has 6 8 or 12 pins Before installing the patient cable make sure that the pin count of the patient cable plug matches the pin count of the ECG Input connector To install the patient cable 1 Align the keyed cable plug with the slot in the ECG Input connector See Figure A 4 on page A 8 2 Push the cable plug firmly into the ECG Input connector When a lead is selected for monitoring the message LEADS OFF appears on the display if the patient cable falls off or is incorrectly connected Also a dashed line appears on the display in place of an ECG trace A 7 Installation and Setup Installation Figure A
81. ower the CodeMaster XL will function normally with no battery installed however the time required to charge the defibrillator will increase If the CodeMaster XL is operated without a battery installed clearly mark that the instrument does not have a battery and requires AC power to operate When a CodeMaster XL has no battery installed and is plugged into AC power the front panel AcPowER light will be on and the BATTCHRG light will be off 9 3 Maintaining the Defibrillator Maintaining the Battery Battery Capacity Check Perform the battery capacity check at least once every six months If the battery is frequently depleted without adequate time for full charge cycles perform the check more often A new battery will provide a minimum of 2 5 hours of monitoring time Hewlett Packard recommends that you replace the battery when it fails to provide a minimum of 2 5 hours of monitoring time or 10 minutes of Low Battery warning time when starting from a fully charged battery To test the battery capacity perform the following steps This test will require up to 3 5 hours to perform not including battery charge times Allow 30 hours to test the battery and have it ready for use again 1 Charge the battery by plugging the instrument into AC power for eight hours Verify that the AC POWER and BATTCHRG lights are on 2 Verify that there is recorder paper in the recorder 3 Depress Sync HR Alarm while
82. power From the time the LOW BATTERY message is first displayed to when the battery capacity is fully depleted instrument shutdown there is typically enough reserve battery capacity to provide either 30 minutes of monitoring or five 360 joule charge shock cycles NOTE Getting Acquainted AC Battery Operation If a battery is defective there is significantly less monitoring or charge capacity available after the LOW BATTERY message appears than if the battery is merely depleted A unique audible alarm will sound continuously when there are 60 seconds of battery capacity remaining The instrument will automatically shut off after 60 seconds If the battery has been fully depleted plugging the instrument into AC will immediately restore full operation Frequent battery discharges to the low battery level will degrade battery life Battery Life The sealed lead acid battery used in the CodeMaster XL will provide optimum life when the unit is continually connected to AC power when not in use The battery operates best when it is fully charged after each use To fully charge a depleted battery requires 18 hours of continuous charge time Because it is not always practical to allow a full charge cycle between uses the CodeMaster XL can charge a depleted battery to 90 of its capacity in approximately two hours However battery capacity and battery life will be reduced if the battery is not allowed to fully charge aft
83. quarter turn screws counter clockwise Lift out the battery door Disconnect the battery connector and remove the battery Connect the new battery and slide it into the compartment Replace the battery door and secure it by turning the two retaining screws a quarter turn clockwise Perform the Battery Capacity Check above before placing instrument in service 9 5 Maintaining the Defibrillator Cleaning Exterior Surfaces Cleaning Exterior Surfaces The CodeMaster XL and its accessories are chemically resistant to common hospital cleaning solutions and non caustic detergents The following list includes some approved cleaning solutions 90 Isopropyl alcohol except adaptors and patient cable Soap and water e Chlorine bleach 30 ml l water Keep the outside of the instrument clean and free of dust and dirt Clean the pad dles thoroughly to prevent build up of dried electrolyte paste Do not allow any fluids to penetrate the instrument case Avoid pouring fluid on the unit while cleaning Do not use abrasive cleaners or strong solvents such as acetone or acetone based compounds Clean the display screen carefully It is especially sensitive to rough handling and subject to scratching Do not steam sterilize the monitoring leads submerge them for prolonged periods or heat them above 50 C If metallic surfaces become oxidized clean them with a very light abrasive toothpaste Do not use highly abras
84. r discharges The recorder will print a test report which will indicate the delivered energy in Joule the impedance in Ohm and the current in A Notify Service Personnel if the ECG strip does not print TEST 100J PASSED or if any of the shock button tests fail If you see the CHE backup battery CK ETUP message on the screen call service to replace the 10 Disconnect the test load M1781A B from the electrodes adaptor cable M1750A B Troubleshooting Operational Checks Quick Pacer Functionality Test 1 Connect the electrodes adaptor cable M1750A B to the defibrillator and the test load M1781A to the adaptor cable Turn the unit on by turning the Energy Select switch to Monitor On 2 Press Pacer On ignore the LEADS OFF message if it occurs 3 Put the pacer into fixed mode by pressing Mode 4 Adjust the pacer current to 30mA by pressing V Output A Adjust the pacer rate to 60ppm by pressin 5 Start the pacer by pr Record 6 Verify that the pacer g w Rate al essing Start Stop and start the recorder by pressing pulses are shown on the recorder strip approximately every five large boxes if the recorder is in delay mode it will take several seconds before the pacer pulses appear Allow the pacer to run for 10 12 seconds 7 Turn the pacer off by pre
85. r is in the delayed mode c Press Record to stop the recorder 6 Press HR Alarm Verify that the configured alarm limits appear briefly then are replaced by the bell symbol in the upper right of the display With no ECG sig nal an audible alarm tone should sound within four seconds 7 Press HR Alarm to turn off the alarms 8 Verify that the adult paddle electrodes are installed 9 Turn the Energy Select control to 100 joules 10 Leaving the paddles in their holders press either Charge button The Charge Done indicators should occur within two seconds when operated with a fully charged battery The Delivered Energy display should indicate 100 joules Keep hands clear of the paddle electrode edges Use your thumbs to depress the Shock buttons on the paddle handles 11 Grasp the paddle handles and without removing the paddles from their holders press both Shock buttons simultaneously A brief automatic recorder run prints the delivered energy test report 12 Press Sync to place the instrument in Sync mode 13 Verify that the messages SYNC and USE LEADS appear on the display 14 Press Lead Select once to select Lead I and verify that the message USE LEADS no longer appears The message LEADS OFF should now appear indi cating that one or more leads are not connected 8 8 Troubleshooting Operational Checks 15 Turn
86. r synchronized cardioversion 4 3 paddles connector uses A 4 paddles pads installing A 4 A 6 paddles pads connector locking A 4 pads external 4 5 external adhesive 5 1 pacing 5 2 5 4 using for synchronized cardioversion 4 2 pads adaptor cable 2 6 3 2 4 6 PADS OFF 2 6 3 6 4 6 5 3 5 4 paper loading A 3 paper platen 9 1 9 2 patient cable 3 wire 3 2 5 wire 3 2 3 3 connecting A 7 A 8 keyed plug A 8 patient cables installing A 4 pediatric paddles 2 5 Place 2 2 placing electrodes 3 wire 3 2 5 wire 3 3 Post CV Mode A 12 Post Shock Data setting 3 10 power cord worn 8 10 preparing the paddles 2 2 printhead cleaning 9 2 Printing Event Summary 3 8 7 13 printing calibration pulse 3 9 current ECG status 3 9 ECG strip 1 3 Index 24 Index monitor status 3 9 shock delivery statistics 3 10 pulse oximetry 6 1 Q QRS beeper 1 9 7 4 QRS beeper volume 3 7 R Rate 1 5 Rate button 5 3 Record button 1 3 3 9 8 8 recorder changing the paper 9 1 cleaning the printhead 9 2 loading paper A 3 recorder door opening 9 1 9 2 recorder modes 3 10 recorder operating controls 1 3 Recording 3 9 recording automatic 3 9 recording on Alarms 3 10 recording on Charge 3 10 recording on Mark 3 10 recording on Shock 3 10 Redux See HP Redux electrolyte paste removing power from the defibrillator 1 10 replacing the battery 9 5 RESTORE FACTORY SETTINGS A 9 A 11 Review 2 5
87. rhythm and did not advise a shock Cannot Analyze Indicates that the advisory algorithm could not analyze the cardiac rhythm ECG strip recorded Analysis Stopped Indicates that the user stopped the advisor algorithm analysis by pressing the Analyze key during analysis Pads Off Indicates that the external adhesive electrodes were removed from the patient No Pads Indicates when electrodes adaptor cable was discon nected from defibrillator Pads On Indicates when external adhesive electrodes were connected to the patient Mark Marker symbol V ECG strip recorded annotates strip when Mark was pressed Charging to nnnJ Indicates when automatic charge sequence began after advisory algorithm advised a shock Shock Indicates when shock was delivered delivered energy ECG strip recorded peak current and patient impedance Disarm Indicates when the defibrillator performed an internal disarm sequence The CodeMaster XL automatically records 11 second ECG strips for Shock Advised No Shock Advised and Cannot Analyze events You can record other 7 16 Figure 7 6 SHOCK ADVISED 12 MAY 95 10 59 00 PADS NOTE Using Advisory Mode Optional Printing the Advisory Event Summary Record events by pressing Mark For Mark events and shock events ECGs are written from 3 seconds before the event to 8 seconds after the event is over Approximately 200 e
88. s adaptor M1741A Internal paddle set 7 5 cm diameter M1742A Internal paddle set 6 0 cm diameter M1743A Internal paddle set 4 5 cm diameter M1744A Internal paddle set 2 8 cm diameter Switched Paddles To defibrillate a patient internally using the switched paddles perform the following steps 1 Select correct paddle set size from Table 2 2 Switched Internal Paddles Selec tion on page 2 11 2 Attach the switched internal paddles cable to the paddle connector on the front of the defibrillator 3 Slide the paddle connector lock towards the front of the defibrillator to secure the cable 4 Set the Energy Select control to the desired energy If the energy switch is set to a level greater than 50 joules 507 MAXIMUM will be displayed If Charge is pressed the unit will only charge to 50 joules For safety and sterility when using the paddles do not touch the paddle beyond the fingerguard on the handle 5 Apply the internal paddles 6 Press Charge 2 10 Table 2 2 Defibrillating Defibrillating a Patient 7 Wait for the Charge Done indicators 8 Press the Shock button on the right hand internal paddle handle Switched Internal Paddles Selection Part Number Description M1784A Internal paddle set 7 5 cm diameter M1785A Internal paddle set 6 0 cm diameter M1786A Internal paddle set 4 5 cm diameter M1787A Internal paddle set 2 8 cm diameter Defibrillat
89. s is essential for quality ECG monitoring Good contact between the electrode and the skin reduces the effects of motion artifact and signal interference 1 If necessary shave hair from the site to ensure good electrode to skin contact 2 Clean the skin with soap and water or with alcohol then wipe it dry You can safely monitor a patient during defibrillation However monitoring electrodes can become polarized during defibrillation shock causing the ECG waveform to briefly disappear from the display You can reduce this effect by using silver silver chloride electrodes 3 Attach disposable electrodes perform the following steps a Peel the protective backing from the electrode Be careful to keep adhesive surface free from electrolyte paste b Apply the electrodes firmly to the patient s skin pressing around the entire edge of the electrode c Attach snap on or clip on leads assuring good contact between the elec trode and the lead end Tape the lead wire to the skin to prevent the elec trode or lead from loosening d Plug the patient cable connector into the ECG input connector that is in the lower front of the defibrillator behind the carrying handle 3 4 NOTE WARNING Monitoring Preparing the Patient Be careful to correctly align the cable plug when connecting the patient ECG leads cable to the defibrillator monitor Correctly orient the cable plug key with the defibrillator connector slot If the
90. s of the con nector to the adaptor cable Failure to correctly connect the electrodes to the adaptor cable can result in a failure to deliver energy to the patient Ifthe PADS OFF monitor message is displayed check all patient connections 5 Select electrodes as the ECG source by pressing Lead Select until PADS appears on the display under the heart rate 6 Set Energy Select control to desired energy 7 Press Charge 8 Wait for the Charge Done indicators 9 Press both Shock buttons at once to defibrillate The Shock AN buttons for external electrodes are on the cable connector housing 2 7 Figure 2 3 Shock buttons Electrodes adaptor cable connector housing Locking electrodes to electrodes adaptor cable connector Defibrillating Defibrillating a Patient Electrodes Adaptor Cable Performing Internal Defibrillation You can perform internal defibrillation using one of the optional internal defibrillation paddle sets The Switchless paddle sets attach to the internal paddles adaptor cable M1740A B The Shock buttons AN are on the connector housing of the internal paddle adaptor cable The Switched paddle set does not require the internal paddles adaptor cable This paddle set has a single Shock button AN on the right hand paddle handle 2 8 WARNING NOTE WARNING Defibrillating Defibrillating a Patient Switchless Paddles To defibrillate a patient internally
91. set on Energy Select control Administers shock Labelled AN button Changes operating mode between immediate shock normal mode and synchronized with next R wave shock Sync mode 1 2 Figure 1 3 Record button Mark button Getting Acquainted Operating Controls and Indications Recorder Operating Controls Table 1 2 Recorder Operating Controls Control Description Record Starts and stops the recorder Mark When the recorder is on pressing Mark will annotate the ECG at that point If the recorder is not on and the unit is set up to do so pressing Mark will print an ECG strip The Mark event is also stored into memory See Appendix A for information about setting up the Codemaster XL for recording when you press Mark Record on Mark 1 3 Figure 1 4 Lead Select button ECG Size button HR Alarm button Review button ECG Output Table 1 3 Getting Acquainted Operating Controls and Indications JE Mai 1 LE y gt EXf N Monitor Operating Controls Monitor Operating Controls Control Description Lead Select Selects an ECG source to monitor v ECG Size A Changes displayed ECG size HR Alarm Contro
92. ssing Pacer On and stop the recorder by pressing Record Disconnect the test load M1781A from the adaptor cable Notify service personnel if PACER FAILURE is displayed on the monitor NO PADS ATTACH PADS is displayed on the monitor yet electrodes adaptor cable is connected The unit beeps three times The unit displays PACI ER OUTPUT LOW The pacer pulses are not shown on the recorder strip as described in the test 8 13 Troubleshooting Operational Checks Every Week Perform the following checks on the internal paddle set every week O Check for excessive residue from sterilization on the paddle set and clean as needed Oxidation can be an indication the paddle set is old and must be replaced O Check for pitting or discoloration on the electrode surfaces Polish or replace as required O Ensure that the cable connector and electrodes have no cracks in the insulation Every Three Months Have the cable set tested for electrical continuity every three months Every Six Months See the M1722B CodeMaster XL Service Manual for extensive electrical operational and safety tests to be performed by a qualified Biomedical Equipment Technician BMET or equivalent service technician every three to six months 8 14 Figure 9 1 Maintaining the Defibrillator This chapter contains information about maintaining and cleaning the CodeMaster XL defibrillat
93. t SpO monitoring 1 Estimate the patient s weight and determine the best site for the sensor 2 Use the Sensor Guide to select the correct type and size of sensor for the identi fied location 3 Prepare the sensor Disposable Remove protective backing Semi Disposable Apply a new adhesive wrap to the sensor 4 Apply the sensor to the identified location 5 Connect the sensor to the monitor To connect sensors from other manufacturers you need the HP M1900B Connector Cable 6 3 p04 Monitoring Optional Using Sp0 to Monitor a Patient Apply the Sensor to the Patient The CodeMaster XL supports the use of many sensors Use the Sensor Guide to find the sensor which is best for your case Follow the manufacturer s guidelines for applying and using the sensor Application of the Reusable Sensor Figure 6 2 Application of the M1190A Reusable Sensor Push the sensor over the fingertip so the cable lies on the back of the hand and secure the cable to the wrist with the wrist strap supplied Make sure the finger is not pinched in the end of the sensor This ensures that the light sources in the sensor lie over the base of the fingernail giving the best measurement results If the sensor is not in the correct position inaccurate readings result In extreme cases the instrument displays dashes instead of an SpO reading When correctly positioned the end of the finger just touches the end of the s
94. t Summary 3 9 CodeMaster XL defibrillator monitor 1 1 configuring set date and time A 1 settings A 1 configuring the defibrillator monitor A 9 connecting Index 21 Index patient cable A 8 connections checking 3 6 pacing pad 5 4 connector defibrillator A 4 lock 2 6 A 5 A 8 paddle 2 6 controls defibrillator 1 2 2 1 7 3 7 7 7 8 7 11 monitor 1 4 pacer 1 5 recorder 1 3 SpO 1 6 1 7 conventions manual v CRT Alerts A 12 CRT alerts 1 9 7 4 D Date A 12 decreasing energy level 2 4 DEFIB DISARMED 8 2 8 3 DEFIB FAILURE 8 1 defibrillating adhesive pads through 2 6 during pacing 5 5 external pads through 2 6 internally 2 8 2 10 three steps 2 1 through pacer pads 5 1 with alternate paddles 2 5 defibrillator after using 2 5 4 8 7 12 charging 2 3 connector A 4 controls 1 2 2 1 7 3 7 7 7 8 7 11 disarming 1 10 discharging 2 4 maintaining the 9 1 removing power from 1 10 replacing the battery 9 5 turning on the 2 2 defibrillator connector external adhesive pads A 4 external paddles A 4 internal paddles A 4 uses A 4 defibrillator mode 1 8 defibrillator protection iv delayed recorder mode 3 10 delivered energy check 8 11 Delivered Energy Display 5 5 demand mode 1 5 5 1 5 3 diagnostic mode A 11 diagnostics 8 7 diastole pacer pulse position in diastole 5 4 disarm recordings 3 10 disarming automatic 1 10 charge
95. t control to the new energy level 2 Wait for the Charge Done indicators 3 Shock To shock the patient perform the following steps 1 Briefly adjust paddle pressure and placement to optimize patient contact as reg istered on the paddle contact indicator if supplied 2 Verify that no one is in contact with the patient the monitoring cable or leads the bed rails or another potential current pathway 3 Callout Clear to alert personnel to stand away from the patient Keep hands clear of the paddle electrode edges Use your thumbs to depress the Shock buttons on the paddle handles 4 Press and briefly hold both Shock buttons one on each paddle simultaneously to deliver energy to the patient If the defibrillator does not shock refer to Chapter 8 Troubleshooting If you must disarm the charged defibrillator if countershock is not needed turn the Energy Select control to Monitor On Any stored energy will be discharged internally and the available energy on the display will return to 0 2 4 WARNING Defibrillating Defibrillating a Patient After Using the Defibrillator If installed if you want to print an Event Summary now press Review See Printing the Event Summary Record Optional on page 3 8 After you use the defibrillator perform the following steps to prepare the defibrillator for its next use 1 Turn the Energy Select control to Off Standby 2 Return the instru
96. t in use and it is not plugged into AC power Do not discharge the defibrillator with the paddles shorted together To do so can cause burning and pitting of the metal paddle contacts Disconnect any other medical electronic equipment from the patient during defibrillation discharge unless labelled as defibrillator protected Cy and I1 WARNING Getting Acquainted Safety Considerations Avoid open paddle discharges Dangerous high voltage exists on the paddles when the defibrillator is discharged Contact with this high voltage could cause death or serious injury Avoid touching any metal surfaces on the instrument during shock Avoid connecting the patient to several devices at once because leakage current limits can be exceeded e Never touch the bed the patient or any equipment connected to the patient during defibrillation e Keep the CodeMaster XL and the immediate area clean and dry at all times to avoid creating potentially dangerous electrical paths e Never open the instrument case Dangerous high voltages can be exposed Only qualified service personnel can service the instrument e Do not use the defibrillator in a flammable or oxygen rich atmosphere This will cause an explosion hazard eDo not rely entirely upon heart rate alarms Rate meters on patients can continue to count the pacemaker rates during cardiac arrest or some arrhythmias Keep pacemaker patients
97. ter XL 6 6 Sp0 Monitoring Optional Using Sp0 to Monitor a Patient CAUTION Do not force the SpO connector into the ECG input socket Doing so may damage RS the pins on the cable connector Start Monitoring Turn the defibrillator on if necessary by turning the Energy Select control to Monitor On Press the Sp0 On Off button to display the SpO reading in the upper right corner of the display SpO Readings Figure 6 4 N HR 72 LEAD Sp0 reading Pulse rate Pulse amplitude indicator CodeMaster XL Display with Sp05 Reading The pulse amplitude indicator shows the quality of the SpO gt signal Since it is derived from the patient s plethysmograph signal it varies with the pulse of the 6 7 NOTE p04 Monitoring Optional Sp0 Alarms patient If the patient has a very low signal the pulse amplitude indicator does not vary through its full range If the signal is noisy the pulse amplitude indicator does not vary rhythmically with the pulse The pulse rate is derived from the pulse oximeter It should correlate closely with the patient s heart rate SpO Alarms Activating SpO Alarms There are three preset high low SpO alarm limits 100 90 100 85 and 100 80 Press the Sp0 Alarm button repeatedly to cycle through the alarm options and the no alarm option Stop when you see the alarm you would like to
98. to prevent electrical shock Use only HP recommended electrodes with the external pacer option The CodeMaster XL delivers pacer pulses through a low impedance multifunction electrode The CodeMaster XL does not pace effectively with high impedance pace only electrodes Do not use electrodes for more than eight hours of continuous pacing The CodeMaster XL will pace on battery power alone However whenever possible plug the CodeMaster XL into AC power while pacing Using the Pacer To use the pacer perform the following steps 1 Apply the electrodes as instructed on the package 2 Attach monitoring electrodes as instructed in Using Leads to Monitor on page 3 1 3 Attach the patient cable to the CodeMaster XL s ECG Input connector In demand mode pacing always monitor the patient directly with the CodeMaster XL defibrillator If a separate monitor is to be used you must connect the ECG Output from the CodeMaster to the ECG Input of the monitor This is required because the CodeMaster contains blanking circuitry that prevents its ECG from being overwhelmed by the pacemaker spikes A monitor without this circuitry would not allow R waves to be detected 4 Attach the patient cable leads to the monitoring electrodes 5 2 NOTE Pacing Optional Using the Pacer 5 Attach the electrodes adaptor cable M1750A to the defibrillator output con nector Pull the latch connector toward the front of the de
99. turning the Energy Select control from Off Standby to Monitor On The Setup Diagnostic Service menu will appear in a moment 4 Press wECGSize to highlight the Test Battery diagnostic test 5 Unplug the instrument from AC power the ACPOWER and BATTCHRG lights are off 6 Press Lead Select to start the Battery Capacity Test The starting battery voltage the current battery voltage the Monitor elapsed time and the Low Battery warning elapsed time will be displayed When the test is finished the recorder will print the final values of the displayed results just prior to turning off the instrument Replace the battery if the recorded value for elapsed monitor time is less than 2 5 hours or the value for elapsed Low Battery warning time is less than 10 minutes 7 Turn the Energy Select control to the Off Standby position 9 4 CAUTION 8 9 Maintaining the Defibrillator Maintaining the Battery Fully recharge the battery by plugging the instrument into AC power for 18 hours Verify that the ACPOWER and BATTCHRG lights are on The instrument is now ready to be returned to service The battery can be permanently damaged if left uncharged for a prolonged period Replacing the Battery To install a new battery perform the following steps 1 2 3 Remove AC power from the instrument Place the instrument upside down on a workbench Turn the two battery compartment
100. urn the Energy Select control to the Monitor On position 3 Press Lead Select to select the ECG source The selected source appears in the upper right corner of the display For example PADS appears on the display when it has been selected If the message LEADS OFF or PADS OFF appears on the display inspect the electrodes patient cable leadwires and associated connections If the selected ECG source is not connected a dashed line will replace the normal ECG trace 4 Ensure that the ECG size has been automatically adjusted for optimal size If you wish to reduce the ECG size press V ECG Size The gain bar along the left side of the display represents 1 mV of signal amplitude 3 6 NOTE Monitoring Heart Rate Alarms Autogain allows an initial quick setup when the instrument is turned on to automatically size the ECG based on the signal from the patient To remove the instrument from Autogain press ECG Size You then must adjust the ECG size manually Adjust the QRS beeper volume to the desired volume Heart Rate Alarms The CodeMaster XL provides three pairs of preset alarms An optional feature provides three configurable pairs of upper and lower heart rate alarm limits Each pair of heart rate alarm limits can be defined in setup menu 1 as described in Appendix A While monitoring you can select and enable any pair of pre defined limits using HR Alarm W
101. vents and 50 ECG strips can be stored Figure 7 6 shows a sample ECG strip Sample ECG Strip Clearing Advisory Event Memory The instrument retains event information after you turn the instrument off Memory clears when the CodeMaster XL is turned on placed in Advisory Mode and Analyze or Mark is pressed see Table 7 2 Advisory Event Summary Record Information Memory does not clear if the CodeMaster XL is simply turned on or if the instrument is used in manual mode This allows you to turn the instrument off or enter manual mode and later return to advisory mode to print the advisory event summary record Turn the defibrillator off between uses to ensure that the advisory event summary records are patient specific Using Advisory Mode Optional Advisory Mode Default Settings Advisory Mode Default Settings The CodeMaster XL contains default settings for use in Advisory mode Some of the settings can be altered using the Setup Menu see Setup on page A 9 The following setting can be changed Default energy select sequence You can choose to change the sequence from the factory default settings for a sequence of 200 200 and 360 Joules to a sequence of 200 300 and 360 Joules The energy level selected for the third shock is the energy level to which the defibrillator will be charged for all subsequent shocks Post Shock Data ON OFF When operating in Advisory mode th
102. with external adhesive pads 4 2 using paddles 4 3 with pads 4 5 synchronized shock specifications 4 1 synchronized shock mode 1 8 synchronous mode 3 5 SYSTEM FAILURE 8 1 T Telephone assistance A 19 TEST 100J PASSED 8 11 8 12 test discharge recordings 3 10 Index 25 Index Time A 12 tones 7 4 troubleshooting 8 1 U Upper Alarm Limits A 12 USE LEADS 8 1 V ventricular fibrillation avoiding 4 1 W X Y Z Web site A 19 Index 26
103. y now press Review See Printing the Event Summary Record Optional on page 3 8 After you use the defibrillator perform the following steps to prepare the defibrillator for its next use 1 Turn the Energy Select control to Off Standby 2 Return the instrument to its storage location and plug the power cord into an AC power outlet Verify that the BATT CHRG and ACPOWER lights are on 3 Clean all paddles controls and cables Refer to Chapter 9 Maintaining the Defibrillator for cleaning instructions 4 Check that sufficient recorder paper and electrolyte paste or defibrillator elec trodes are available for the next use of the defibrillator 4 8 Figure 5 1 Pacer On button Rate button Output button Mode button Pacing Optional This chapter contains information about pacing with the CodeMaster XL defibrillator monitor 2 C amp CG lt Gon o The Pacer Control Panel The CodeMaster XL with the optional pacer can perform external transcutaneous pacing The pacing option provides demand synchronous and fixed asynchronous pacing modes The patient is connected to the pacer by external adhesive electrodes The patient can be paced and defibrillated through the same set of electrodes 5 1 WARNING NOTE Pacing Optional Using the Pacer While pacing avoid touching the gelled area of the pacing electrodes or the patient
104. you disarm the defibrillator by turning the Energy Select control the energy select sequence is reset No Shock Advised If non shockable rhythm is detected the message NO SHOCK ADVISED displays for about 30 seconds Continue CPR and basic life support as directed by your hospital s protocol At any time you can analyze the patients cardiac rhythm again to determine if shock is needed After Using the Defibrillator If you want to print an advisory event summary now press e Review See Printing the Advisory Event Summary Record on page 7 13 for more details After you use the defibrillator perform the following steps to prepare the defibrillator for its next use 1 Turn the Energy Select control to Off Standby 2 Return the instrument to its storage location and plug its power cord into an AC power outlet Verify that the BATT CHRG and ACPOWER lights are on 3 Clean controls and cables Refer to Chapter 9 Maintaining the Defibrillator for cleaning instructions 4 Check that sufficient recorder paper and external adhesive electrodes are avail able for the next use of the defibrillator NOTE WARNING Using Advisory Mode Optional Printing the Advisory Event Summary Record Printing the Advisory Event Summary Record The advisory event summary record contains information about the resuscitation attempt while in advisory mode When you print the summary a header record and event summary

HP CodeMaster XL+ - Universal Hospital Services

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