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Infinity Vista XL Instructions for Use

1. 4 Data Transfer Using the Memory Card eese ennt 4 Network Data 6 Discharging a 7 4 ADMISSION TRANSFER AND DISCHARGE Overview The Patient Admit screen allows you to enter and edit a patient s personal data name ID birth date height weight admit date and physician You can admit patients at the bedside monitor or at the central station provided your monitor is networked You can also transfer a patient s data trends and calculations from one monitor to another Transfer procedures differ according to whether or not the source and destination monitors are connected to the Infinity network Discharging a patient deletes all related data both on the monitor and at the central station Monitor and patient settings return to their local default settings and all recordings are cancelled 4 2 VISTA XL VF7 ADMITTING PATIENT Admitting a Patient To admit a patient at the bedside monitor Press the Menu fixed key 2 Clic
2. 10 REPOS aso 11 Quick Reference Reports 12 Status MCSSAGCS lt i wes fa e E E E 13 7 RECORDINGS Overview The monitor can print out a real time record of its monitoring results on a bedside recorder or on centrally located recorder within the monitoring network You can request a recording at the local monitor a remote monitor in the network via Remote View screen or the network s central station Recordings are printed an R50 series recorder which can be connected to the bedside monitor as well as the Infinity network The R50 and R50 N are two channel recorders Recordings are either continuous or timed and they can be triggered manually or automatically depending on their origin The monitor can also print recordings of trends events and OCRG waveforms Alarm recordings may be automatically triggered depending on how they are configured or on the associated condition see Chapter 5 Alarms for more information recordings are identified by the patient name and ID the bed number and the date and time of the recording Recordings Layout Recordings contain one two or three waveforms on 50 mm strips To print a waveform you must first display it on the screen Pressure wave
3. 20 9 Averaging 20 10 HemoMed Calculations 4 44222 11 20 12 Status MESSAGES 20 14 CHAPTER 21 Cleaning and Disinfecting 21 2 Monitor and Peripheral 21 2 Patient E T E E 21 2 GG A 21 3 Reusable ECG 422 0 0 21 3 SU oTe AE E NE 21 3 XVIII VISTA XL VF7 INFINITY VISTA XL USER S GUIDE NIBP m 21 3 m 21 4 lcurpidllcmee 21 4 HemoMed Transducer Plate eere eene 21 4 2 P 21 4 HERE 21 4 sop 21 5 Capnostat Serisor 1i uertit 21 5 Airway Adapter i cere cce eei cccic rer ccce tee ems
4. 3 4 Wireless Network Safety Considerations eese 3 4 Wireless Network Setup 3 5 Wireless 3 6 Wireless 3 7 Network Tran Sten 3 9 Patient 3 9 EMIDVCICNNIOIDIIOMC C LH 3 9 Remote VIEW cieren 3 10 PIVAC nn M 3 13 CHAPTER 4 Admission Transfer and Discharge e mee C ats cat EEN LEa aeaa 4 2 Admitting a Paent 4 3 Transferring Patient 1 eene nennen nnne nennen nennen 4 4 Data Transfer Using the Memory 4 4 Network Data 4 6 Discharging a Patlent 1 ceci eeicccccccecuc ccce a iadi 4 7 CHAPTER 5 Alarms Ua m M 5 2 Alarm Grades icc CEDE 5 2 Alarm Management 5 4 Suspending Alarms e
5. 16 arri get aE SAAE ESAE E B 17 Non Invasive Blood Pressure B 17 Invasive Blood Pressure IBP eere B 19 e B 19 Pulse 5 0 2 19 Pulse Oximetry SpO2 Masimo SET SmartPod B 22 End Tidal CO2 etCO2 via etCO2 module 2222 2222 21 B 23 gor 24 Temperature mee B 24 Overview This appendix contains technical specifications for the physical and functional aspects of the patient monitoring system These specifications apply to adult pediatric and neonatal patients Upon request Drager Medical makes any technical information required to perform maintenance and or calibration of serviceable items available to qualified technical personnel Overall Regulatory Standard Compliance EN 60601 1 and applicable collateral and particular standards EN 60601 1 2 Electromagnetic Compatibility This section is intended to provide information with regard to electromagnetic compatibility for the Drager Delta series of patent monitors hereafter referred to as equipment It
6. B 2 Overall Regulatory Standard Compliance seen B 2 Electromagnetic Compatibility B 2 Electromagnetic Emissions eese eene nnne nnne nnne nnn B 4 Electromagnetic Immunity 5 Recommended separation B 6 System Componentis aeaaeae eean a 7 Vista XL Base 7 External Battery 2 0 9 Battery Charger siie oae aenaran aaaea e Anaea eean ae Aa e Eeee A aeaa e AA Eea aA AEEA AEE EEE B 10 R50 N Infinity B 10 Monitoring 5 B 11 etCO2 Dn me earmer aa rrasa praa Ea KEE a Eaa Erea Han a B 11 anm B 13 Scio Four Scio Four Oxi Scio Four plus Scio Four Oxi plus Module B 13 FIQ2 SCMSOMS meet B 15 Monitoring 15 15 ST Segment Analy Sis
7. 5 Measurement 6 Catheters Comp Constant 2422 222 4 7 Measurement 9 Averaging 10 HemoMed Calculations 12 SJELER EET o n m e 14 20 CARDIAC OUTPUT Overview The monitor uses thermodilution to measure blood flow pumped by the heart A solution of known temperature and volume is injected into the blood stream in the right atrium The injectate mixes with and cools the surrounding blood The blood temperature reaches its minimum relatively quickly and then warms up slowly until it returns to the blood temperature baseline The total drop in the patient s blood temperature is inversely related to the patient s cardiac output the lower the cardiac output the more the injectate cools the blood down and vice versa A thermistor in the catheter tip continuously measures the temperature of the blood as it leaves the heart The monitor restores C O settings to their default values when you discharge a patient or select New Patient after turning on the monitor If you subsequently press the C O Start fixed key or if you
8. 13 4 eR 13 7 limQelg nce 13 7 Display Feat tes one reU i 13 8 game E 13 10 Quick Reference IBP Setup 13 11 Labeling Pressure 13 12 Pressure Conflicts 2 1 RP nnnc rennes 13 13 Pulmonary Wedge Pressure Display eene 13 13 Status Messages 5 meriti nieto Est 13 15 CHAPTER 14 Calculations dj d 14 2 Physiological 14 3 HemoMed Parameters 14 5 Oxygenation and Ventilation 14 7 Driig Calculations eicere 14 7 Titration Tables 2 rrr rn SEE I treten nenne cereis 14 8 Dr g Calculator 14 9 Default Drug Setup Unit 14 11 CHAPTER 15 Pulse Oximetry
9. 7 6 2 7 7 Pending Recordings 11er n nnmnnn nnmnnn nnmnnn nna 7 7 7 7 Quick Reference R50 Series Setup 7 8 Primary and Secondary Recorders eese nnns 7 9 Replacing Recorder Paper esses eene 7 10 pg cime 7 11 Quick Reference Reports Setup eese 7 12 Status MCSSAGES e 7 13 CHAPTER 8 ECG and Heart Rate je 8 2 decuit c E 8 3 S 8 3 3p 8 6 Infusion or Roller Bypass Pumps eene 8 7 Line Isolation Devices 8 8 Transcutaneous Electrical Nerve Stimulators eere 8 8 uirium 8 9 Three and Six Lead TruST Configurations 8 10 Derived Twelve Lead Configuration 5 2
10. 4 lo SS oo eS Ea ee 5 eec EIE 5 2 EE 6 Sensor 6 Pa Eripe 6 Sidestream Sampling Pump etCO2 6 js M E 8 21 CLEANING AND DISINFECTING Overview WARNING Because of the danger of electric shock never remove the cover of any device while it is in operation or connected to power Clean and disinfect the product per hospital approved protocol Agents tested by Draeger and shown to have no harmful effect on the materials utilized in the device include e Diluted alcohol a 1 3 solution of alcohol should be used A 1 10 solution of sodium hypochlorite household bleach e Phenol CAUTION The use of more aggressive reagents suchs as alcohol should not be used on the monitor s glass or the glass may be damaged Draeger makes no claims regarding the efficacy of the listed chemicals their methods as a means for disinfecting the ability of the agents to control infection their environmental impact safe handling or any related precautions in their use Refer to information provided by the manufacturer of the cleaning solution for more information in these areas Monitor
11. 3 Quick Reference ST Analysis Menu sees 4 Measuring c 5 GE C HUCAEL EM 7 Status MCSSAGCS ccs m 8 10 ST MONITORING Overview 10 2 ST segment deviation is defined as the displacement in mm above or below isoelectric level The measurement of deviation compares the isoelectric point to the ST measurement point The isoelectric point defines the point of zero voltage no electrical activity Omm with a default position of 28ms before the onset of the QRS complex on the horizontal time axis The ST point occurs in the ST segment between the QRS offset J point and the T wave at a default position of 80 milliseconds after the QRS offset The following figure illustrates a typical QRS complex Isoelectric Point ST Deviation Default 28 ms before QRS Onset QRS Onset ST Measurement Point Default 80 ms after QRS Offset Fiducial Point 7 lsoelectric Level 4 QRS Offset 8 ST Level The ST analysis feature examines QRS complexes classified as normal beats from up to eight selected ECG leads The monitor learns each ST lead combining the measurements and features of normal beats into a composite or average QRS complex It derives the ST segment deviation from this average When ST monitoring is enabled current
12. Suspending Alarms You can suspend alarms using the fixed keys on the front of the monitor e All Alarms OFF Press to suspend visual and audible alarms for a user determined period of time A banner appears at the top of the screen with the message All Alarms Off Alarms remain suspended until you press the Alarms Off key again or the timeout period expires WARNING Never leave a patient unattended during an indefinite alarm suspension e g after selecting No Time out Always enable the alarms again as soon as possible If you select No Timeout on the Unit Manager menu see page 2 13 alarms are suspended indefinitely and no timer appears NOTE Monitor may be configured to support a feature that allows the Alarms Off fixed key be used to extend Alarms Off time via incremental presses of All Alarms Off fixed key e Alarm Silence Press to silence an alarm for 60 seconds Visual alarm indications remain on the screen The alarm tone resumes if a new alarm occurs during an alarm silence period or if a life threatening or serious alarm condition persists past the one minute silence period Code key on the remote keypad Press once to silence alarm tone in network mode or reduce volume to 1046 in standalone mode and activate and display an event timer Press again to deactivate all active Code functions Press a third time to deactivate the event timer See p
13. 1 8 Other Features and Components esses esee nennen nnn nannten 1 8 lunviEnlc 1 9 Battery Powe m 1 9 cruce 1 12 Turning the Monitor On and 1 12 Accessing the Main 1 12 Using the Rotary 1 13 Remote Cj 1 14 gited ipee D I 1 15 Fast Access 1 15 Main pe 1 15 uo cnc S 1 16 enne Mee 1 16 Data Archive 1 16 amp 1 17 Event Recall 1 18 Navigating the Event Recall 1 20 uhi hp I c 1 21 CHAPTER 2 Mo
14. 10 3 ST Analysis Setup Mem 10 3 Quick Reference ST Analysis ennt 10 4 Measuring Poihts eee 10 5 ST Alarms Table exec cues 10 7 10 8 CHAPTER 11 Respiration e Rl MICI a 11 2 RESP ilc dc 11 3 Patient 11 4 Display 22222421 11 5 RESP nee 11 6 Quick Reference Table Respiration Setup 11 7 OxyCRG OCRG Monitoring 11 10 I e 11 11 CUS OM AED 11 11 Review Summary Screen Overview esee nennt 11 11 Accessing Review Summary Screen eese 11 13 Quick Reference Table OCRG Review Summary
15. 11 17 OCRG Setup Menu ERE Roue 11 17 Quick Reference Table OCRG 11 18 Second and Third Channel Label seen 11 18 Time 8 11 18 Hee P 11 19 Status Messages 11 20 CHAPTER 12 Non Invasive Blood Pressure OW 12 2 Display rU 12 2 alui m 12 3 Safety Considerations 12 3 Cuff Selection and 12 3 VF7 VISTA XL XV INFINITY VISTA XL USER S GUIDE Setup Menu and Quick Reference 2 2 22 12 7 Taking Measurements eene eene nnne enne nnne nennen nan 12 8 VENOUS Stasis MM 12 10 Status MESSAGES 12 11 CHAPTER 13 Invasive Blood Pressure oll 13 2 Pre cautiohs LLLI 13 3 n ieiuECEIR 13 4 uineis enc LU IMS 13 4 jHchrpl S
16. Duane 5 4 PE nen 5 4 Alarm Setup Alarm Limits nnmnnn nnmnnn nnna 5 5 Upper and Lower Alarm nnne nnns 5 7 Modifying Alarm 5 13 Quick Reference Alarm Limits Table 5 14 Alarm Limits Shortcut iieri niece resi ndn du cas uud 5 15 ST and Arrhythmia 5 2 essen 5 15 Alarm History Table cc cceoicee ecce nee eco Ie tirer re xe euuEnnre 5 15 Anesthesia Alarms 5 16 CHAPTER 6 Trends m 6 2 Trend ccce RN oS nm DL LP 6 2 Trend Graphs issii 6 4 VF7 VISTA XL XIII INFINITY VISTA XL USER S GUIDE E E 6 7 TONS ass E 6 8 CHAPTER 7 Recordings m 7 2 FROG ONIN emm 7 2 YOUN esate accede 7 2 7 6 CGONUNUOUS
17. 15 MultiGas 2 2 c 16 XX VISTA XL VF7 INFINITY VISTA XL USER S GUIDE Scio Connecting C 16 ETHNIC 16 AGCCeSSOLIGS accio dro nau 16 VF7 VISTA XL XXI INFINITY VISTA XL USER S GUIDE This page intentionally left blank XXII VISTA XL VF7 Chapter 1 Introduction 1 ejje 2 System 3 Base 3 prune imeee E 6 5 ie 8 Auxiliary Display 8 Other Features and 9 ail cm aoaaa aa Aaa aAa eaae E aaa ade EEEE 10 Battery POWPOL olet AAAA 10 Getting Started Mec Eel 13 Turning the Monitor O
18. B 13 Scio Four Scio Four Oxi Scio Four plus Scio Four Oxi plus Module B 13 119 ER 15 Monitoring 15 liec EE B 15 ST Segment Analysis crecer ci senescence rune cueheccedesatevesseceececuevesteceneaue B 16 RES Pir ath sonas B 17 Non Invasive Blood Pressure B 17 Invasive Blood Pressure 0 B 19 e IIEDSelnine B 19 Pulse Oximetry 2 B 19 Pulse Oximetry SpO2 Via Masimo SET SmartPod B 22 End Tidal CO2 etCO2 etCO2 module eese B 23 gor B 24 VF7 VISTA XL XIX INFINITY VISTA XL USER S GUIDE I 24 APPENDIX Approved Options and Accessories 2 aandaa dee NOCA nE ceded cantecets C 3 Power COLFdS eiii icona caua ce dt du uai cin Va du vnd n d du a C 3 Power Ad aptel s sieniin C 3 Grounding ae reaa C 3 External Battery sninn C
19. module e 60 cc catheter tip syringe e A 2 foot section of 1 8 or 3 16 inch tubing to drain off fluid after it passes through pump receptacle to receive the fluid after it drains 21 6 VISTA XL VF7 Cleaning Sidestream Pump CAUTION e Always use a syringe to flush cleaning solutions through the pump as described in the instructions below e Do not attempt to use the sidestream sampling pump itself to move cleaning solutions through the system This may cause accelerated wear on the pump bearings To clean the sidestream pump 1 Set etCO measurement mode to Side for Sidestream monitoring 2 Remove module from the monitor 3 Remove all sidestream sampling tubing from the module connectors 4 Attach the section of 1 8 or 3 16 inch tubing to the exhaust sidestream output port on the module and run it to a drainage receptacle placed below the module 5 Hill the 60cc catheter tip syringe with cleaning fluid and fix it to the sidestream input connector on the module 6 Flush the fluid slowly through the pumping system and out through the tubing connected to the exhaust port Repeat two more times for a total of 180cc of fluid 7 Remove the syringe Leave remaining fluid in the pumping system for 30 minutes This disinfects the system 8 After 30 minutes fill the syringe with distilled water and flush through the system Repeat two more times
20. S 2 e PE 3 id ge dl rec M 3 SCIO 4 MEI ngo pm 4 SCIO ROUT c 5 H rdware Set p cavaversnseuteveamaseucudates 8 LIA 9 Installing the Water Trap 11 Cable 11 TUBING Connections en ac ere Pede 12 Wario 14 Calibrati i ancl beacaudluceiessecuacers 14 SCIO EM C 14 etCO2 Monitoring ence Le Irene tien rrt 15 O2 N20 Monitoring Scio Four Oxi plus and Scio Four Oxi only 17 Agent Monitoring 19 MANU I 20 Combined Display O2 Agent N20 Scio Four Oxi plus only 24 Dual Agent Display Scio Four Oxi plus amp Scio Four plus only 26 Maintenance and 26 Status Messages en
21. Inflation Adult Pediatric Neonatal Initial and Maximum 80 5 60 4 40 3 Inflation Pressure mmHg Inflation Time secs 120 5 120 5 60 2 5 NOTE Perform Venous Stasis on a different arm from that used to measure to assure proper SpO monitoring Status Messages Message Possible Cause Suggested Action s d m gt s d m lt value systolic diastolic mean exceeds alarm limits Check the patient and treat if necessary Change current alarm limits for patient NBP Low The patient s systolic Select the next higher NBP inflation Inflation Limit pressure is higher than the limit setting maximum allowed inflation limit NBP Patient s pulsations are too Check the cuff size Check Cuff Size small to determine blood Move the cuff to another limb pressure VF7 VISTA XL 12 11 Possible Cause Suggested Action NBP Venous Venous stasis mode is No action is required stasis started active NBP Venous There are 10 seconds No action is required stasis ending remaining of Venous stasis mode NBP Venous Venous stasis mode is No action is required stasis ended disabled or completed NBP Check Pressure cannot be Check connection between cuff and Hose maintained in the cuff hose for debris Connection Inflation time is too short due Check hose and cuff
22. 9 alu D 10 oobis LL EIDEM 14 3 NETWORK APPLICATIONS Overview By connecting your bedside monitor to a network you can access a patient s information from any other networked monitor or from a central workstation Each of these devices can present Main Screen information for remote viewing The Infinity Network links monitors and other devices to a central station and to each other providing a wide range of monitoring functions On the MultiView you can display information from up to 16 networked monitors simultaneously For more information on the central station see the Infinity CentralStation Instructions for Use WARNING Loss of communication between the Infinity CentralStation and the bedside monitor is possible Drager recommends using the bedside monitor for primary diagnosis and the Infinity CentralStation for patient viewing The DirectNet feature allows you to connect your monitor directly to the Infinity network see page 3 3 Your monitor s Remote View function allows you to display other networked monitor screens print remote recordings and silence remote alarms see page 3 10 Via the Remote Control function on the MultiView you can perform the following tasks at the central station for any bedside monitor e Initiate recordings e Modify alarm limits e Silence alarms Initiate an Arrhythmia or Res
23. To access the ST Alarms setup table Press the Alarm Limits fixed key on the front of the monitor Click on the ST control key at the lower right of the screen 1 2 3 Follow the guidelines for modifying alarm limits on page 5 5 4 Use the control keys at the top of the parameter list Auto Set and bottom of the screen Event Duration Relearn to perform other ST alarm functions VF7 VISTA XL 10 7 10 ST MONITORING Status Messages Message Possible Cause Suggested Action ST x Out of The ST algorithm has Check the isoelectric and ST Range High calculated values 15mm measuring points ST lt x gt Out of or 1 5mV outside the Observe the patient and treat if Range Low high or low end ofthe ST clinically indicated measurement range Cannot Analyze The monitor cannot Perform a Relearn ST determine ST values owing Calm the patient i Check electrodes re apply if Ab beat necessary sence of normal beats Ensure that the patient s skin is Artifact properly prepped Isolate the patient from auxiliary equipment if possible ST x gt ii ST value is outside the Observe the patient carefully and upper or lower alarm limit treat if clinically indicated ST x lt ii Change the alarm limits ST x Lead Bad electrode contact or Inspect and replace defective cables Invalid faulty lead wire and wires Reapply gel on reusable electr
24. D Ric wi C 11 Non Invasive Blood Pressure C 12 NBP Cutt 12 Connecting 12 Invasive Blood Pressure IBP 1 2 22 11 12 Vista XL IBP Options ELM 12 POG eee 12 Connecting Cables leer Leser te erede C 12 IBP Accessories C 14 IBP Accessories Abbott Medex 442222222 4 4 C 14 IBP Accessories Edwards Baxter 2 442222222 44 C 14 IBP Accessories SensoNor 22 4 1 11 eene sanae anna nnn nnn C 14 E d Tidal CO2 2 D C 14 etCO2 Module 4 ce aee nr ie edu au ind d c C 14 SONSOMS aw vg RR d ua ua D a a A V RE D Duc RD Ri da C 15 Main Stream Accessories 15 Side Stream 15 gere
25. 1 Lead Processed for and Pacer Pulse Rejection None Il Ill aVR aVL aVF gt lt lt VISTA XL VF7 RECORDINGS Position 2 Description ECG Filter Values Definition Monitor Off ESU Pacemaker Detection On Artifact Rejection lt Medium gt Off Artifact Rejection lt Medium gt QRS ARR processing N MOE ECG1 ECG2 ECG1 Patient Category QRS Classification lt Space gt 5 Wn Adult Neither lead completed learn Adult ECG1 lead completed learn Adult ECG2 lead completed learn Adult ECG1 amp ECG2 leads completed learn Neonate Leads available for processing No valid lead to process ECG1 lead valid to process ECG2 lead valid to process ECG1 amp ECG2 lead valid to process VT Count Value VT Count where A F corresponds to 10 15 VT Rate Value VT Rate 100 10 where A corresponds to 10 SVT Count Value SVT Count where A corresponds to 10 SVT Rate Value SVT Rate 100 10 where A corresponds to 10 TACH Count Value TACH Count where A F corresponds to 10 15 TACH Rate Value TACH Rate 100 10 where A corresponds to 10 BRDY Rate Value BRDY Rate 30 5 where A F corresponds to 10 15 PAUS Rate Value PAUS R
26. 9 Empty the syringe and use it to push several volumes of air slowly through the system This clears most of the solution from the pump 10 Repeat step 9 one or more times to ensure as much fluid as possible has been cleared from the system 11 Remove the syringe from the module but keep the drain tubing in place Drying the Sidestream Pump Subsystem After you have cleaned and removed most of the fluid it is important to dry the pump subsystem completely To dry the sidestream pump subsystem VF7 VISTA XL 21 7 21 CLEANING AND DISINFECTING 1 Reattach module to the monitor The sidestream sampling pump starts running and there is suction at the input port on the face of the module NOTE Ifthe sidestream pump fails to start make sure Capnostat sensor is disconnected The pump is designed to shut down while a connected sensor is warming up 2 With the input sidestream port still open and the drain tubing still connected let the pump run for several minutes to remove any water still trapped in the system 3 Block the sidestream input port with your finger for several seconds and then unblock it Repeat at least ten times 4 Move your finger to the sidestream output port and block the port with your finger for several seconds and then unblock it Repeat at least ten times 5 Remove the drain tubing and allow the sidestream pump to continue running for at least 30 minutes FIO Clean th
27. Central Venous Mean RA Right Atrial Mean LA Left Atrial Mean ICP Intercranial Mean GP1 Generic Pressure 1 Systolic Diastolic Mean GP2 Generic Pressure 2 Systolic Diastolic Mean Notes During PWP measurements the monitor displays only mean PA pressure f the monitor detects static pressure the algorithm computes mean pressure only A static pressure condition occurs when the maximum and minimum values of a pulsatile pressure signal differ by less than 3 mmHg If both ART and ICP are connected the algorithm computes the difference between ICP and mean ART and reports it as Cerebral Perfusion Pressure CPP VISTA XL VF7 PRECAUTIONS Precautions The following precautions apply to IBP procedures Refer to your institution s clinical guidelines for further information For general precautions regarding the use of accessories and peripheral devices see Safety Considerations on page VII of this Instructions for Use Refer to Appendix C for a list of transducers adapter blocks pods and cables approved for use with the monitor Any use of non approved transducers may compromise the correct functioning of the device WARNING e Never reuse a single use transducer e Alarms for systolic diastolic and mean invasive pressures are disabled during Wedge pressure measurements however the crossed bell icon does not appear in the parameter box e For the safety of the patient during Wedge measureme
28. or SpO5 Not both are connected 1 SpO and SpO are displayed on their own trend graphs 2 PLS and PLS are displayed on their own trend graphs The Trend Setup menu has separate selections for each channel in Manual Display mode for SpO SpO5 PLS and PLS VF7 VISTA XL 15 13 15 PULSE OxIMETRY SPO2 Status Messages 15 14 Message Possible Cause Suggested Action gt Patient s falls Observe patient and treat if SpOs lt outside the current upper necessary or lower alarm limits PLS gt Patient s pulse rate falls Observe patient and treat if PLS lt outside the current upper necessary or lower alarm limits PLS Out of Pulse rate is outside the Observe the patient and treat if Range High measuring range of the monitor necessary ASpOs gt UL 296 is greater than the upper limit Observe patient and treat if necessary SpO gt Too much light is Check to ensure that the Transparent reaching the sensor s sensor is properly attached to light detector the patient s finger Hoc aue Remove light source condition usually occurs because the sensor is off 2 sensor with opaque the finger Another cause is that too much ambient Check to ensure that no light is reaching the ambient light can reach the sensor s light detector detector Contact Medical Technical Support 5 The detected s
29. Low 20 bpm High 60 bpm VF7 VISTA XL 5 11 Defaul Default Alarm Parameter Predefined Alarm Range t State Setting RV S M D 5 to 300 mmHg 0 6 to 40 kPa Off S Low 10mmHg 01 kPa High 35 mmHg 05 kPa M Low 07 mmHg 0 9 kPa High 17 mmHg 02 kPa D Low 02 mmHg 0 26kPa High 13 mmHg 1 7 kPa SpO2 SpO gt 20 to 100 Adult Adult Pediatric Off Low 90 High 100 Ped Neonatal Neo Low 85 High 95 On 5 02 1 to 100 Off Adult Pediatric High 2096 upper limit only Neonatal High 1096 upper limit only ST Alarms Adult and Pediatric 15 0 to See ST Alarms Table on 15 0mm page 10 7 1 5 to 1 5 mV Note For all except STVM and STVCM Temperature 5 to 50 C 25 to 120 F Off Low 34 C Ta b 93 2 F High 39 C 102 2 F ST Leads Adult and Pediatric 15 0 to See when TruST is 15 0mm ST ON 1 5 to 1 5 mV Alarms Table on 10 7 AT 32 to 35 C 0 to 95 F Off fe 00 C 32 High 02 C 35 6 F 5 12 VISTA XL VF7 ALARM SETUP ALARM LIMITS TABLE Modifying Alarm Functions 1 Access the Alarm Limits table see page 5 5 2 Scroll to the parameter whose alarm functions you wish to configure and click 3 Scroll to the alarm function you wish to modify the first column Alarms is highlighted when you first click on the parameter NOTE e Turning an alarm ON allows those parameters to alarm whether the parameters
30. Temperature of the injectate solution acquired from the HemoMed pod being used for C O measurements Below is a typical C O parameter box 1 Last saved C O average 2 Blood temperature reading and alarm limits 3 Injectate temperature Time of last saved C O average NOTE If no new measurements have been taken for 24 hours the C O average and time stamp are blanked 20 4 VISTA XL VF7 Setup Hardware The HemoMed pod is used with the monitor for cardiac output monitoring Setup Menu To access the C O setup menu or 1 2 3 4 Click parameter box on main screen Press the Menu fixed key to display the Main Menu Click on Patient Setup Click on Parameters Scroll to C O and click to display the C O setup menu Quick Reference Setup WARNING Always confirm that the settings you enter on the C O setup menu accurately represent the catheter you are using to measure cardiac output An incorrect entry can put the patient at risk by compromising C O measurements Menu Item Description Available Settings C O Start 509 C O measurement see page VF7 VISTA XL 20 5 20 CARDIAC OUTPUT Menu Item Description Available Settings Catheter Type Displays the currently selected Click on one of the catheter type following to change the catheter type BD Oh
31. You can change the scale of an individual trend graph for easier or more detailed viewing 1 2 Highlight the scale icon E Scale values are simultaneously highlighted Using the rotary knob to scroll through the trend scales click on the value you wish to change Dial to the desired value Click to confirm your choice Reviewing Graphs in Time To review a specific point on the trend graphs Select the vertical bar at the left of the screen and click the rotary knob Scroll through the trended parameters and click to select the graphs to be viewed Click repeatedly on either pair of arrows below the trend graphs or click on the horizontal bar at the bottom of the screen and dial to the desired time Click on Hours dial to the desired trend duration 1 2 4 8 12 or 24 hr and click again to confirm your choice This function also affects scrolling intervals when you use the horizontal bar or arrows as described above NOTE The monitor s clock controls the time scale When you adjust the clock a vertical yellow marker appears at the base of the trend graph If you adjust the clock more than once in a 24 hour period only the most recent change is marked Click on Cursor to display a vertical white line a corresponding date and time stamp and cursor time parameter values at the right of the screen Use the rotary knob to move the cursor to the time you wish to delineate If no data is stored for that point in ti
32. concentration Mechanical shocks during measurement or the presence of other paramagnetic agents can distort the measurement of oxygen concentration Due to the response time of the sensors and the gas sample flow rate the stated accuracy of CO and anesthetic agents is limited by respiratory rate and inspiratory to expiratory I E ratio Scio Four Oxi plus and Scio Four Oxi only For measurements stated accuracy of Scio is maintained to a respiratory rate of 60 BPM with an I E ratio of 1 2 18 6 VISTA XL VF7 OVERVIEW e For CO measurements accuracy is maintained to a respiratory rate of 75 BPM with ratio of 1 2 For N5O measurements accuracy is maintained to a respiratory rate of 75 BPM with an LE ratio of 1 2 e For anesthetic agents accuracy is maintained to a respiratory rate of 60 BPM with an I E ratio of 1 2 The effect of respiratory rate and I E ratio settings on accuracy were determined in a simulated breathing system using square wave gas concentration waveforms WARNING e The presence of aerosols in the breathing circuit should be avoided displayed agent concentration may be affected and or watertrap membrane may be affected e The presence of organic cleaning solutions or gases containing freon will impare the accuracy of the Scio module CAUTION e The Scio module purges and zeroes itself approximately once every two hours The typical zeroing cycle lasts no
33. e Dry thoroughly with a lint free cloth CAUTION Do not use phenol based disinfectants which vinyl absorbs Do not use strong aromatic chlorinated ketone ether or ester solvents Do not immerse the cables for any prolonged period in alcohol mild organic solutions or highly alkaline solutions Do not immerse the Procal cable in any liquid Do not use excessive pressure or flex cables unnecessarily when cleaning Excessive pressure can damage the cables Never boil or autoclave the cable Vinyl can withstand temperatures up to 100 C but begins to soften around 90 C Handle gently when hot and wipe away from the tip toward the cables ECG Reusable ECG Electrodes Periodically clean the electrode cup with a toothbrush Use a soft brush under running water to remove any gel residue Wipe electrodes with a gauze pad moistened with a soap solution VF7 VISTA XL 21 3 21 CLEANING AND DISINFECTING Disinfect electrodes by wiping with a cloth moistened with diluted alcohol or a gluteraldehyde based disinfectant Dry thoroughly with a lint free cloth ESU Block Do not immerse or rinse the ESU Block Clean with a cloth moistened with soap solution Read the operating instructions accompanying the ESU for additional information NBP Wipe the NBP cuff with a cloth moistened with soap and water or a solution based on household bleach 1 10 gluteraldehyde alcohol or phenol CAUTION The NBP cuff can b
34. exceeded by value necessary Change alarm limits lt Check equipment and replace if gt necessary RRc lt Check ventilator for RRc gt Inspiratory flow Expiratory time Faulty expiratory valve RRc Apnea No breath is detected for a Check the patient and treat if period exceeding the RRc necessary apnea time set by the user etCOs Hardware malfunction e Disconnect the module then H W Failure reconnect it If the message persists Return the device to Biomed and try a new one Corrupt EEPROM Shift to Manual mode and dial in pressure If automatic pressure required return to Biomed Sensor Unplugged sensor has been disconnected e Disconnect then reconnect the sensor If the message persists try another sensor Sensor Warming Up Sensor Failure CAPNOSTAT has not yet reached a stable temperature CAPNOSTAT Source current is out of range or sensor did not warm up within 8 minutes Wait for sensor to warm up up to three minutes at room temperature If message fails to clear call Biomed Try sensor again If the message persists try a new sensor Sensor External heat source is Replace the sensor this device Too warm warming the sensor e Remove heat source If the problem persists disconnect and reconnect the sensor Place Last senso
35. 0 40 mmHg 2 mmHg 41 70 mmHg 5 of reading Accuracy 71 99 mmHg 8 of reading Stable over 24 hours over full range of readings at atmospheric pressure Verify once a day Calibrate when moving the sensor from one module to Calibration another Calibration time lt 20 5 Balance User selectable Compensation Atm pressure Automatic or user selectable 540 800 mmHg Sampling flow rate 180 12 ml min Sidestream measuring mode Module Adult and Pediatric No Neonatal Yes Pod Yes in all three patient categories Apnea detection VF7 VISTA XL B 23 Mainstream 0 149 breaths min RRc range Pod Sidestream 0 69 breaths min Accuracy t1 breath min rp Mainstream 100 ms Rise time Sidestream 200 ms NN Mainstream 100 ms Delay time Sidestream lt 450 ms Total system response Rise time plus delay time time FiO Oxygen measurement 5 100 O2 range One point calibration 14 296 FS at RTP Two point calibration lt 3 FS at RTP Warm up Value available immediately after calibration Nominal response time 97 in 30 seconds flow rate 2L min at RTP Alarm limit range 18 100 Stability of accuracy 3 over 8 hour interval Protection against electric CF shock Standards IEC 601 1 ISO 7767 applicable sections only Oxygen analyzers for monitoring patient breathing mixtures Note RTP
36. 12 Pressure Label Conflicts 13 Pulmonary Wedge Pressure Display 13 6 15 13 INVASIVE BLOOD PRESSURE Overview The monitor acquires invasive blood pressure IBP signals from Y cables HemoMed pod or a combination of these devices A transducer connected to the cable or Hemomed converts pressure data into electronic signals for monitor use These signals are automatically filtered to reduce the artifact generated by the fluid filled catheter and tubing system as well as by motion and catheter fling The monitor detects individual beats by establishing thresholds based on running averages of systolic and diastolic pressures The monitor can process up to four IBP signals to which it assigns standard generic or automatic pressure labels See page 13 12 to assign pressure labels Description of standard and automatic IBP labels follows 13 2 IBP Labels Label Pressure Type Measured Pressures Measurement Range ART Arterial Systolic Diastolic 50 to 400 mmHg Mean LV Left Ventricular Systolic Diastolic Note see status Mean messages page 13 15 PA Pulmonary Arterial Systolic Diastolic Mean RV Right Ventricular Systolic Diastolic Mean
37. High 110 mmHg 15 kPa S Pediatric Low 50mmHg 07 kPa High 120 mmHg 16 kPa M Pediatric Low 40 mmHg 05 kPa High 85 mmHg 11 3kPa D Pediatric Low 35 mmHg 4 6 kPa High 80 mmHg 11 kPa S Neonatal Low 50mmHg 07 kPa High 80 mmHg 11 kPa M Neonatal Low 40 mmHg 05 kPa High 70 mmHg 9 3kPa D Neonatal Low 25 mmHg 3 6 kPa High 60 mmHg 08 kPa Parameter Predefined Alarm Range 5 10 VISTA XL VF7 ALARM SETUP ALARM LIMITS TABLE Defaul Default Alarm Parameter Predefined Alarm Range t State Setting PA S M D 5 to 300 mmHg 0 6 to 40 kPa Off 5 Low 10mmHg 01 kPa High 35 mmHg 05 kPa M Low 07 mmHg 0 9 kPa High 17 mmHg 02 kPa Low 02 mmHg 0 26kPa High 13 mmHg 1 7 kPa PLS PLS 30 to 300 beats per minute Off Adult Low 45 bpm High 120 bpm Pediatric Low 50 bpm High 150 bpm Neonatal Low 80 bpm High 180 bpm PVC min Adult and Pediatric 1 to 50 PVC On High 10 PVC per per minute upper limit only minute upper limit only RA 5 to 300 mmHg 0 6 to 40 kPa Off Low 02mmHg 0 26 kPa High 12 mmHg 1 6 kPa RESP Adult 5 to 100 breaths per minute Off Adult Pediatric and Neonatal 5 to 145 Low 05 bpm breaths per minute High 30 bpm Pediatric Neonatal Low 20 bpm High 80 bpm RRc 5 to 145 breaths per minute Adult Adult Off Low 05 bpm Ped 30 bpm Neo Pediatric Neonatal
38. You can also use the rotary knob to enter letters or numbers VISTA XL VF7 GETTING STARTED 1 Click on a field e g Physician The monitor displays a data entry screen similar to the following 2 Use the rotary knob to select each character or number then click to confirm Use the control buttons at the bottom of the screen for editing 3 Click on Accept to confirm the entire entry or on Cancel to exit the data entry screen Remote Keypad The remote keypad has all of the fixed keys that are on the monitor and additional keys that perform the following Trends Displays trend graphs Freeze Freezes waveform display Calcs Activates Calculations menu ECG Displays Show Leads screen Remote View Displays Remote View menu Recall Setup Displays Restore Setups menu View Toggles from monitor to secondary display screen To connect the remote keypad to the Vista XL monitor Plug one end of the keypad cable into the keypad and the other into the connector marked RS232 on the right side of the monitor VF7 VISTA XL 1 15 1 INTRODUCTION Menu Access There are two ways of accessing the menus The Fast Access menu allows you to open commonly used menus quickly The Main Menu lists the primary menus Patient Setup Monitor Setup etc which allow you to access other menus Fast Access Menu The Fast Access menu accesses the following submenus and screens directl
39. event data included in the timed recording You cannot enter a Delay value which exceeds the selected Duration time Determines the length of a timed recording You cannot enter a Duration value less than the selected Delay time Determines the recording speed 6 10 155 6 10 15 20 5 1 6 25 12 5 25 50 mm s Alternate Speed Determines the recording speed when you press the Alternate Speed mm s key on R50 Series recorder 1 6 25 12 5 25 50 mm s Waveform Selection Determines whether waveforms to be printed are selected automatically or manually Auto The topmost displayed waveforms are automatically selected for recordings Manual The waveforms that you have selected see Waveform 1 and Waveform 2 are printed VISTA XL VF7 RECORDER SETUP Menu Selection Description Available Settings Waveform 1 Assigns the top waveform for 50 ECG1 ECG2 RESP ART recordings provided Waveform PA RV LV RA LA CVP Selection is set to Manual a GP2 5 et Waveform 2 Assigns the waveform for channel 2 on R50 recordings provided Waveform Selection is set to Manual Recording mode Displays current recorder N A This setting is read only and cannot be modified Alarm Waveform Gives priority to an alarmed ON Places waveform parameter which if Alarm associated with alarming Waveform is enabled appears in condition in lower th
40. 222 22222 8 11 ECG Signal Processing and 8 12 TRUST 12 ccc 8 13 Alarms and Alarm 4 4 00222 8 14 ECG MOM m 8 15 Quick Reference Table ECG Setup eese 8 15 Status Messages E e 8 21 CHAPTER 9 Arrhythmia Monitoring 9 2 About the Arrhythmia 9 2 Beat and Rhythm Classification essent 9 3 Automatic Learning and Relearning eren 9 4 XIV VISTA XL VF7 INFINITY VISTA XL USER S GUIDE Arrhythmia Setup 9 4 Modes Full Basic OFF 5 iode eoa sia Resende 9 4 Channel Lead Selection eese essen seen nennen nnn 9 5 Arrhythmia Setup 9 6 Status MCSSAGES M 9 9 CHAPTER 10 ST Monitoring IL m 10 2 MultiMed Pods for ST nananana 10 3 tyr o EA
41. ARR ST ART CVP RA RESP etCOs C O TEMP GP1 GP2 O2 fiO Note There may be other possible selections depending on the monitor configuration and connected devices Click on Exit to return to the first column of the Main Menu Alarm Limits Opens alarm limits table N A see page 5 5 VF7 VISTA XL 2 MONITOR SETUP The Main Menu Menu Item Description Available Settings The Monitor Setup Submenu Main Screen This submenu allows you to lay out the main screen display by configuring the functions outlined below To access second page of the Main Screen menu click on the down arrow at the bottom of the screen Click on the up arrow to return to the Main Screen menu first page Parameter Allows you to modify the order of To change the display order of a Priority parameters displayed on the parameter whether or not the Main Screen associated device is connected Notes 1 Scroll to Display Mode Parameters must be assigned 2 Select Manual a priority whether they appear 3 Click on Parameter Priority on the main screen depends on to highlight the first listed their priority and on the number parameter of channels configured to Note Parameters are display waveforms see Max numbered according to their Channels priority The display is color In Automatic display mode coded A green parameter label connected parameters are indicates that the associated di
42. Age and other factors are not taken into account e The monitor s standard MAC values cannot be applied to children or neonates e The MAC value applies only to the end tidal respiratory gas agent concentrations 1 standard MAC minimum alveolar concentration is equal to the alveolar anesthetic concentration at one atmosphere 760 mmHg at which 50 of all patients no longer respond to noxious stimuli and corresponds to the following expiratory agent concentrations Agent Concentrations 1 MAC Agents HAL ENF ISO SEV DES Values via a Scio 0 77 1 7 1 15 2 196 6 65 105 connecting cable Original MAC value from ASTM F 1452 is 7 3 however this is based on an average age of 25 years The value of Desflurane shown here has been compensated to age 40 according to the Mapleson formula The table below shows typical Agent parameter box displays when using standard MAC values Parameter Box Description Agent identified iHAL etHAL 1 0 0 75 18 20 VISTA XL VF7 Scio SETUP Age Based MAC Values VF7 Age based MAC takes the impact of the patient s age on MAC values into consideration NOTE Age based MAC values are used when the Scio module is connected via a Scio connecting cable PN 78 76 878 or 78 76 886 in the X3 or Scio ISD connector and Age based MAC setting is chosen on the MAC Calc menu Age based MAC
43. Agent not yet identified in automatic identification mode To access the Agent setup menu or 1 2 3 4 Click on any Agent parameter box if displayed Press the Menu fixed key Click on Patient Setup Click on Parameters to display a list of available parameters Click on AGENT to display the Agent menu Quick Reference Table Agent Setup Click on the following items to execute Agent setup functions The Agent Setup Menu Menu Item Description Settings Agent Scale Sets Agent waveform scale 1 2 3 5 10 20 Agent Display Displays a separate Agent parameter OFF box Note Ghosted if the monitor is displaying combined MultiGas parameter box 18 24 18 22 VISTA XL VF7 Scio SETUP The Agent Setup Menu Menu Item Description Settings Agent ID Configures Scio Four Oxi or Scio Four HAL Scio Four module to measure the concentration Oxi and Scio levels of a user specified anesthetic SEV Four only agent Note The Use care when setting agent ID ENF Agent ID manually If incorrect agent ID DES resets to blank is selected incorrect upon a power measurements will occur cycle or Scio Four Oxi amp Scio Four patient cannot recognize anesthetic discharge gas mixtures If anesthetic gases are mixed incorrect measurements will occur Note If the user has not selected an anesthetic agent yet AA is displayed in the par
44. Intended Use The Infinity Masimo SET SpO SmartPod is intended for use under the direct supervision of a licensed heathcare practitioner i e Physicians Nurses and Technicians It is indicated for the continuous noninvasive monitoring of functional oxygen saturation of arterial hemoglobin SpO and pulse rate measured by an SpO sensor The Infinity Masimo SET pod is indicated for use with adult pediatric and neonatal patients The Infinity Masimo SET pod and accessories are indicated for use during both motion and non motion conditions and for patients who are well or poorly perfused in hospitals and hospital type facilities 15 2 VISTA XL VF7 OVERVIEW Overview Drager Medical s integrated SpO technologies OxiSure and Infinity Masimo SET SpO SmartPod enhance the quality of SpO monitoring allowing you to measure accurately and effectively the percentage of functional hemoglobin saturated with oxygen SpO in the patient s arterial blood A light sensor on the patient s finger measures the absorption levels of red and infrared light The monitor uses the difference between the two measurements to calculate the percentage of saturated hemoglobin Because light absorption varies with blood volume and blood volume varies with pulse rate the monitor can also derive a pulse rate PLS The light sensor available for adult pediatric and neonatal patients see Appendix C Approved Options and Acces
45. NOTE For information about events and procedures that automatically trigger a Relearn operation please see page 9 4 The following table describes procedures for changing the ISO isoelectric and ST points on the Measuring Points screen Changing the isoelectric measuring point Changing the ST measuring point 1 Click on ISO The current ISO measuring point position in milliseconds is highlighted The vertical ISO line changes to yellow 2 Use the rotary knob to move the vertical ISO line along the horizontal axis As you move the line the value also in yellow changes The changing ST deviation values are displayed in yellow beneath the current values 3 When you reach the desired position on the average S T complex click to confirm the new ISO measuring point The vertical line and the ISO value change from yellow to white For each average S T complex displayed the value in millimeters for ST deviation changes to reflect the new ISO measurement point The ISO and ST labels are ghosted if no ST complex is valid The ST parameter box 1 Click on ST The current ST measuring point position in milliseconds is highlighted The vertical ST reference line changes to yellow 2 Use the rotary knob to move the ST vertical line along the horizontal axis As you move the line the ST value also in yellow changes The changing ST deviation values are displayed in yellow beneath the current valu
46. NOTE If fan filter has been in use for 1 year it should be replaced See Replacing the Fan Filter below To clean the fan filter 1 2 3 4 Locate the fan on the rear of the module see drawing on page 18 8 Grasp the plastic fan filter and remove it from its holding slots Vacuum up any accumulation of dust at the fan port and inside the filter Reinsert fan filter Replacing the Fan Filter To change the fan filter 1 2 3 4 18 28 Locate the fan on the rear of the module Grasp the plastic fan filter and remove it from its holding slots Vacuum up any accumulation of dust at the fan port Insert a new filter VISTA XL VF7 STATUS MESSAGES Status Messages Message Condition Suggested Action i parameter gt et parameter lt The inspired or expired concentrations of the parameter fall outside the current upper or lower alarm limits for that parameter Observe the patient and treat if necessary Adjust the alarm limits for that parameter i parameter out of range high i parameter out of range low The inspired concentrations of the parameter fall outside the monitor s measuring range et parameter out of range high et parameter out of range low The expired concentrations of the parameter fall outside the monitor s measuring range Observe the patient and treat if necessary Check connections Unplug a
47. Physical Attributes Size H x W x D with watertrap 115 x 190 x 270 mm 4 80 x 7 5 x 10 5 in Scio Four 3 024 Kg 6 66 Ibs Weight Scio Four Oxi 3 444 Kg 7 59 105 gnt Scio Four plus 3 037 Kg 6 69 Ibs Scio Four Oxi plus 3 457 Kg 7 62 1 5 Cooling Fan Mains frequency 50 60 Hz Power requirement lt 0 8 A at 100 120 Vac lt 0 4 A at 200 240 Vac VF7 VISTA XL B 13 Chassis Leakage Current lt 300 uA per UL 544 lt 500A per IEC 60601 1 Electric Shock Protection BF Protection Class Class 1 Continuous Mode of operation Power from specified power supply Sound Pressure level lt 45 dB A Air Ingression leakage lt 45 ml during zeroing lt 10 ml min leakage Sample Flow rate 150 ml min 20 ml min or 200 20 m min if so specified on back panel Environmental Requirements Temperature range Relative humidity Operating 10 C to 40 C 50 F to 104 F Storage 20 C to 70 C 4 F to 158 F Operating 5 to 90 Storage 5 to 95 Atmospheric pressure Operating 525 to 795 1 mmHg 70 to 106 kPa Storage 375 to 795 1 mmHg 50 to 106 kPa Notes Readings comply to ATPS conditions This device is not intended for use in the presence of flammable gases B 14 VISTA XL VF7 MONITORING SPECIFICATIONS FiO Sensors Physical Attributes Size H x D 40 x 30 mm 1
48. Respiratory Sets waveform sweep speed on screen 6 25 mm s Sweep Speed display 12 5 mm s 25 mm s 50 mm s Agent Display Displays a separate Agent parameter ON OFF box Ghosted if the monitor is displaying combined MultiGas parameter box see 18 24 Pressure Sets compensation for ambient Auto Comp atmospheric pressure 760 mmHg RRc Apnea Sets time that the monitor waits before OFF 10 15 20 25 Time reporting a cessation of breathing as an 30s apnea event Apnea Allows you to store and or record OFF Record Store Archive automatically an alarm event for apnea default Str Rec You can later review stored alarms on the Event Recall screen MultiGas Zero Auto Zero Delay Manually zeroes the Scio module Note During zeroing the monitor temporarily blanks Scio parameter values Delays automatic zeroing for 5 minutes for uninterrupted monitoring WARNING Delaying the auto zero may inpact the accuracy of the device Note Gas sensors in the Scio module are automatically zeroed and calibrated against room air During zeroing the monitor temporarily blanks Scio parameter values One minute before automatic zeroing the monitor sounds an attention tone and displays the message Auto zero in 1 minute N A N A Alarms Accesses alarms in Alarm Limits table see this Instructions for Use Chapter 5 Monitoring Scio Four Oxi plus an
49. Reusable MASIMO LNOP DCI adult 7270312 SpO adult sensor for finger application Patient weight 30 kg 66 Ib MASIMO LNOP DCIP pediatric 7270304 SpO pediatric adult sensor for finger application Patient weight 10 50 kg 22 110 Ib MASIMO LNOP YI 7497014 SpO multisite sensor finger application Patient weight 10 kg 22 Ib great toe application Patient weight gt 3 10 kg gt 6 6 lt 2 Ib across foot or palm and back of hand Patient weight lt 3 kg 6 6 Ib MASIMO LNOP 7497006 SpO ear sensor for application on earlobe or pinna Patient weight 30 kg 66 Ib Adhesive Single Patient Use MASIMO LNOP ADT adult 20 pcs 7496990 5 adult sensor for finger application Patient weight gt 30 kg 66 Ib MASIMO LNOP PDT pediatric 20 pcs 7496982 SpO pediatric sensor for finger application Patient weight 10 50 kg 22 110 Ib MASIMO LNOP NEO neonatal 20 pcs 7496974 SpO neonatal sensor for application across the foot Patient weight 10 kg 22 Ib 10 VISTA XL VF7 PULSE OXIMETRY 2 MASIMO LNOP NEO SS neonatal 20 pcs 7496966 SpO neonatal sensor for preterm application across the foot Patient weight lt 10 kg 22 Ib Nellcor Sensors Reusable Nellcor Durasensor DS 100A SpO Sensor adult 7262764 SpO adult sensor for finger application Patient weight 40 kg 88 Ib NOTE Not for use with MicrO2 Adhes
50. Scroll through the numbers and click successively on the single digits of the clinical password If you make a mistake click on Backspace and try again 5 Click on Accept to open the Unit Manager menu Available functions are described in the table that follows The Unit Manager Menu Menu Item Description Available Settings The Alarm Control Submenu This menu allows the unit manager to configure alarm annunciation Open the Unit Manager menu click on Alarm Control then follow the procedures outlined in this table to execute the indicated functions selection will only appear if monitor is configured to support this feature Contact your biomed for more information the All Alarms Off time All Alarms OFF Determines whether clinical Pressing All Alarms Off Key personnel can suspend alarms fixed key suspends alarms by using the Alarms Off OFF Pressing Alarms fixed key on the front of the Off fixed key triggers an error monitor tone All Alarms OFF Sets alarm suspension time 1 2 3 4 or5 min A timer at Time ue top of isi 277 indicates WARNING Never leave patient unattended during ORE hin in All Alarms an indefinite alarm i suspension e g after selecting No Timeout No Timeout Alarms Always enable the alarms suspended indefinitely no again as soon as possible timer appears Extend All Determines whether clinical Enabled Al
51. The variables and b denote the first or second probe connector from the MultiMed with Y cable or NeoMed AT1 The symbol AT represents the absolute value of the difference between the two direct values Ta Tb I The bottom half of the temperature parameter box displays either the second Vista XL temperature probe reading or the delta temperature AT 36 55 Delta temperature Difference between T1a and T1b VF7 VISTA XL 19 3 19 TEMPERATURE Temperature Setup To access the temperature setup menu or 1 2 3 4 Click on the desired temperature parameter box if displayed Press the Menu fixed key Click on Patient Setup Click on Parameters Click on TEMP to monitor the temperature signal see page 19 3 The TEMP setup menu displays only two items TEMP Display Configures the bottom half of the parameter box to display either the reading of the second temperature probe b or the difference between the first probe s reading and the second AT the delta value TEMP Alarms Accesses temperature alarm settings on the Alarm Limits table see page 5 5 ESU and Defibrillator Precautions 19 4 The monitor and MultiMed NeoMed and HemoMed are protected against high frequency interference from defibrillators and electrosurgical units and against 50 and 60 Hertz power line interference Place a protective rubber sheath over the probe to prevent the
52. VT 100 to 200 increments of which an event call is triggered 10 Notes RUN Same as VT Rate You cannot modify the rate UN AIVR lt VTRate 1 the following parameters ASY 2 VF CPT BGM or ARTF i 120 to 200 increments of RUN and AIVR derive their E settings from VT and cannot be bora 100 to 200 increments modified They are included to quantify their derivation based BRDY 30 to 105 increments of on current VT values 5 PAUS 1 0 to 3 55 increments of 0 5s VISTA XL VF7 STATUS MESSAGES Function Description Available Settings Count With rate determines the point at VT 5to 15 increments of 1 which an event call is triggered RUN 3 to VT count 1 Notes AIVR Count 23 You cannot modify the count for the following parameters ASY SVT 3 to 10 VF CPT BGM or ARTF TACH 5 to 15 increments of 1 RUN and AIVR derive their BRDY n a settings from VT and therefore PAUS n a cannot be modified They are included in order to quantify their derivation based on current VT values Archive Determines whether the selected Store event is stored recorded Stores selected arrhythmia event automatically or both You can Record view stored events on the Event Automatically generates an Recall screen see page 1 19 alarm recording of selected event Note The Archive function for Str Rec ASY Asystole and VF Event store
53. be used to display additional parameter boxes see Bottom Channel on page 2 7 Parameter boxes show values alarm limits and special icons for selected parameters NOTE e You can access parameter setup menus by scrolling through the parameter boxes using the rotary knob and clicking on the parameter you wish to configure See Quick Reference Main Menu Setup on page 2 3 to access parameter setup menus Parameters and their associated waveforms are color coded for easy recognition NOTE e You can change the default color coding for each parameter by accessing the Parameter Colors menu See page 2 19 e For alist of default parameter colors see Quick Reference Parameter Colors Menu on page 2 20 Messages appear along the top of the screen in either the Local Message left or Network Message right area When there is no local message the monitor displays the patient s name and bed label When there is no network message the monitor displays the date and time Using the Rotary Knob The rotary knob allows you to browse menus choose settings and execute menu functions Scroll through menu items by turning the knob Press the knob or click to confirm To set or execute menu items with the rotary knob 1 Select the required function by dialing the knob 2 Press the knob and click to confirm your selection A list of choices appears or the field switches to its alternate value e g ON to OFF
54. connector into the socket on the front of the COSY Fabius GS until it clicks into place For other breathing systems Use Sample Gas Return kit with an integrated bacterial filter and connect it to the breathing system used adjacent to the expired gas valve so that the returned sample gas is routed through the CO2 absorber CAUTION Replace Sample Gas tubing Bacterial filter every 6 months NOTE The exhaust port is a hose barb type connector VISTA XL VF7 HARDWARE SETUP Strtrictly follow the instructions for use of the breathing system Bacterial Filter 2 To Sample Gas recirculation sys tem or Gas Scavenging system 3 Sample Gas Return tubing Exhaust port 5 External Power Supply connec tor 6 X2 connector RS232C connector X2 9 pin 4 Connect one end of the Scio connecting cable to X2 connector at the rear of the module and the other end to the IDS connector marked X3 See Cable Connections on page 18 11 If you are using a breakout box connect the end to the connector on the breakout box 5 Connect the power supply to the external power supply connector at the rear of the module 6 Connect the power supply cord to a hospital outlet for the US a hospital grade outlet VF7 VISTA XL 18 13 18 Scio FouR MODULES Warm Up Upon star
55. nt dlisads If monitoring augme Wrong lead verify the number of leads selected Dried out gel in the menu electrode s ECG Artifact Patient s movement Calm the patient shivering tremors Check electrodes and reapply if Bad electrode contact necessary Excessive signal noise Ensure that the patient s skin is Interference from auxiliary properly prepped equipment Isolate the patient from auxiliary equipment if possible VF7 VISTA XL 8 21 8 ECG AND HEART RATE Definition and or Possible Cause Suggested Action ECG Leads QRS processing leads are Inspect and replace defective Invalid invalid for gt 10 sec cables and wires Bad electrode contact or Reapply gel on disposable faulty lead set electrode s Unplugged lead set lead or electrode cannot be Wrong Cable Type selected replaced select another ECG lead on ECG Lead Setup menu for processing See page 8 17 Verify that the number of leads selected in the ECG Lead Setup menu matches the applied lead set see page 8 17 ECG Report Infinity CentralStation Wait a few minutes then try again Server Busy currently processing a report Try Later ECG ECG hardware failure Contact Biomed or Medical H W Failure detected by 1 mV test at Technical Support startup MultiMed Pod The MultiMed is not Check cables and connection Disconnected connected to the monitor repl
56. physiological calculations 3 lead ST segment analysis e Waveform channel upgrades e Aries Advanced Review of Ischemia Event System e Wireless Networking e OR mode VISTA XL VF7 SYSTEM COMPONENTS System Components NOTE Monitor configuration may vary See your Biomed for more information Base Unit Monitor Front View Vista XL Dr ger Infinity Vista XL Fixed keys Main Menu fixed key Main Screen fixed key Battery Charge indicator oy A O N Power switch VF7 VISTA XL 1 3 1 INTRODUCTION Monitor Rear View Vista XL 1 External lead acid battery compartment Remote Display x5 R50 x7 Connector for AC adaptor Slot for module 1 4 VISTA XL VF7 SYSTEM COMPONENTS Monitor Left Side Vista XL 1 HemoMed connector MultiMed connector NBP connector VF7 VISTA XL 1 5 1 INTRODUCTION Monitor Right Side Vista XL PCMCIA slot Network connector QRS Sync connector RS 232 connector X8 oa Analog connector X10 Device Markings The following table describes the symbols on the monitor and its accessories OO Monitor on off Remote keypad in HO Battery operated RS 232 equipment lt gt Attention Consult the Analog out accompanying document 1 Defibril
57. reaching the sensor s properly attached to the patient s light detector finger Remove light source condition usually occurs 4 because the sensor is off 1215 sensor with opaque the finger Another cause is that too much ambient Check to ensure that no ambient light is reaching the light can reach the detector sensor s light detector Contact Medical Technical Support The monitor does not Check for defective or unapproved Unrecognized recognize the sensor sensor Sensor connected as valid Replace the sensor Contact Biomed or Drager Medical Technical Support 15 Light Insufficient light is Check to ensure that the light Blocked reaching the sensor s sensor is properly attached to the light detector patient s finger and that the finger Note With detached or Is free of blocking substances partially detached Check for defective sensor and disposable sensors the replace if necessary light emitters and detectors may have become misaligned SpO Artifact A persistent artifact is Ensure the SpO sensor is detected properly attached to the patient the monitoring site is free of patient motion and all cables are properly connected Contact Drager Medical Technical Support SpO Weak signal Pulse amplitude is too Check patient s condition low Ensure the SpOz sensor is Physiological properly attached to the patient Poor perfusion shock and all cables
58. same color as waveform ST complexes follow the color selected for ECG Reference curves remain purple ART Red Red White Yellow Green Lt Blue Blue Purple Orange PA Yellow Red White Yellow Green Lt Blue Blue Purple Orange CVP Lt Blue Red White Yellow Green Lt Blue Blue Purple Orange RA Orange Red White Yellow Green Lt Blue Blue Purple Orange LA Purple Red White Yellow Green Lt Blue Blue Purple Orange LV Yellow Red White Yellow Green Lt Blue Blue Purple Orange ICP Lt Blue Red White Yellow Green Lt Blue Blue Purple Orange RV Orange Red White Yellow Green Lt Blue Blue Purple Orange GP1 and or GP2 Red Red White Yellow Green Lt Blue Blue Purple Orange VISTA XL VF7 SPECIALTY MENUS VF7 Default Parameter Color Possible Selections P1a and or P1b and or P1c and or Red Red White Yellow Green P1d Lt Blue Blue Purple Orange P2a and or P2b and or P2c and or Red Red White Yellow Green P2d Lt Blue Blue Purple Orange P3a and or P3b and or P3c and or Red Red White Yellow Green P3d Lt Blue Blue Purple Orange TEMP White Red White Yellow Green Lt Blue Blue Purple Orange EtCO inc iCO2 RRc and or Yellow Red White Yellow Green EtCO inc iCO2 RRc Lt Blue Blue Purple Orange SpO inc PLS and or SpOs no White Red White Yellow Green waveform but inc PLS
59. take the monitor out of interval mode press Start Stop fixed key twice within one second If a series of measurements is already in progress setting a new interval time resets the timer After the first measurement the NBP parameter box 2 5 0 displays results A countdown bar indicates 1 33 100 amount of time left before next measurement You can take additional single or continuous 55 62 measurements without affecting the interval cycle The minimum interval is 30 seconds between the end of one measurement and the start of another to ensure reperfusion of the limb To stop an interval measurement in progress press the NBP Start Stop fixed key The monitor stops the current 1 measurement and resumes the cycle on schedule with the next interval measurement Time remaining Time elapsed Interval Time Continuous Measurements In continuous mode the monitor takes NBP measurements continuously over a period of five minutes To start continuous measurements 1 Open the NBP menu see page 12 7 2 Click on Continuous Mode Click to toggle the mode ON The monitor takes NBP measurements for five minutes and continuously updates the NBP parameter box The previous measurement displays until the current one is complete The monitor waits at least two seconds between the end of one measurement and the start of another to ensure reperfusion of the limb Th
60. 3 m C 3 Monitor Connecting C 3 R50 Recorder 4 seassties 4 Vista XL Monitor C 4 ECG EEE C 6 and NeoMed Pods 22 2 2 22 2 0027 C 6 e C 6 42 dad va n i due du du C 8 Pulse Oximetry SpQ2 re ca aae c eur iure C 9 eL 9 Masimo Sensors nece inn ad cx uuu da cd o caua c a RC RE dui d a C 9 Nellcor Sensors Guinea du sx ie ic isa ea e d n n n PU du uu gU du d a sti C 10 pnt X C 10 O o mee C 10 luget mmee C 11 Core gt c a dite e d ua e ru v NV E cg C 11 Skin
61. 4DRAGER 800 437 2437 FAX 215 723 5935 http www draeger com MS 20 658 Drager Medical Systems Inc April 2007 Dr ger reserves the right to make modifi cations to the equipment without prior notice Distributed in US by m pj FAX Drager Medical Inc 3135 Quarry Road Telford PA 18969 U S A 215 721 5400 800 4DRAGER 800 437 2437 215 723 5935 http www draeger com In Europe Canada Middle East Africa Latin America Asia Pacific distributed by Drager Medical amp Co KG ae Moislinger Allee 53 55 D 23542 L beck Deutschland FR 49 451 8 82 0 FAX 49 451 8 82 20 80 http www draeger com
62. 5 2 Lt Blue Blue Purple Orange NBP White Red White Yellow Green Note During NBP measurement Lt Blue Blue Purple NBP p box becomes white Orange background with black letters numerics regardless of color selected in this menu RESP Blue Red White Yellow Green Lt Blue Blue Purple Orange O2 N20 White None FiO White Red White Yellow Green Lt Blue Blue Purple Orange VISTA XL 2 21 2 MONITOR SETUP This page intentionally left blank 2 22 VISTA XL VF7 Chapter 3 Network Applications SSSR e 2 Connecting to 3 Connecting the Vista XL to the Network eere enne 3 hLUPBIAaULLrIs 3 Disconnecting the Vista XL from the Network eren 3 Wireless D SEP 4 Wireless Network Safety Considerations esee 4 Wireless Network Setup 5 Wireless 6 Wireless Messages 7 2 M 9 m 9 Software Licenses
63. Data Invalid Communication problem Unplug and re plug Scio module Power cycle monitor or un dock and re dock monitor If message persists call Manufacturer MultiGas Scio module is warming up Do not rely on Scio Module Warming Up and is operating at reduced values accuracy MultiGas Scio H W or S W Check version numbers Incompatible incompatibility e Call Manufacturer MultiGas Device initializing Wait Initialization MultiGas Scio module has become Check the connection and Unplugged disconnected reconnect if necessary f message persists call Manufacturer MultiGas H W Loss of communication or Check connections failure hardware problem detected Unplug and re plug Scio module Power cycle monitor or un dock and re dock monitor Call Manufacturer VISTA XL VF7 Chapter 19 Body Temperature ej Temperature Display annnm nunnana nnmnnn nnmnnn nnmnnn lt 22 4 ESU and Defibrillator 5 CCrtpp rs 19 TEMPERATURE Overview 19 2 The monitor measures core and surface body temperature by means of a tempe
64. Fixed AUT Key Description Key Description Alarm Silences the active alarm Main Activates the main screen Silence tone for one minute Screen Alarm Opens a table from which Menu Activates the Main Menu Limits you can set upper and lower alarm limits All Suspends all alarms for a NBP Starts or stops non invasive Alarms pre selected time or cancels Start blood pressure NBP Off the suspension Sto measurement p Fast Displays the Fast Access Record Toggles a timed recording Access Menu on or off Control Buttons Control buttons are located along the bottom of the various screens trend tables graphs loop displays etc They permit additional screen specific settings Data Archive Applications The monitor can store events alarms and trends automatically or at the user s request depending on the type of information you wish to store Some events are automatically recorded and stored The monitor automatically stores alarm conditions and arrhythmia events that you have configured for storage in the Alarm Limits table see page 5 5 and in the Arrhythmia setup table see page 9 6 NOTE Youcannot disable event storage for asystole and ventricular fibrillation calls The monitor stores these events automatically You can access archived information in one or more of the following databases e Trends VF7 VISTA XL 1 17 1 INTRODUCTION e Calculations e Alarm History e Event Recall Each database indicate
65. Label screen N A see page 13 12 lt Parameter Displays alarms for parameter and N A Alarms associated variable on Alarm Limits Table Large Mean Increases size of all IBP Mean ON values OFF VISTA XL 13 11 13 INVASIVE BLOOD PRESSURE Labeling Pressure Channels The pressure label determines how a signal is analyzed and reported to the monitor When you assign a new label to a pressure channel the monitor clears the parameters and conditions set for the previous label including alarms and waveform scales and replaces them with settings for the new label Trends are stored according to the assigned label NOTE Zero Cal Factor and Cal Date amp Time settings are associated with the pressure channel and are kept despite a label change The Pressure Labels screen can display up to twelve IBP sources in a 3 X 4 matrix The monitor assigns an automatic pressure label P 1 3 a d to each box WARNING During Wedge measurements the PA catheter may move into the wedge position before the balloon is inflated One sign of this catheter drift is that the PWP waveform becomes wedge shaped Follow your hospital s clinical guidelines to correct catheter position Signal sources are displayed in rows 1 3 with Row 1 representing data received from the HemoMed pod or Y cableThe letters a d identify the transducer location on the pod Vista XL Transducer location letter HemoMed or Y cab
66. Mean CVP dynes x sec Resistance Index cm m TPR Pulmonary 80 x PA mean CO dynes x sec Resistance cm TVR Vascular 80 x ART Mean CO dynes x sec Resistance VISTA XL VF7 DRUG CALCULATIONS Oxygenation and Ventilation Parameters The monitor uses the following parameters to calculate oxygenation and ventilation values Label Parameter Description Derivation Units Hgb Hemoglobin concentration Input data g dl iO Inspired Oxygen Input data Arterial 2 Pressure Input data mmHg 2 Arterial Oxygen Pressure Input data mmHg PAUSE Pause Plateau Pressure Input data cmH20 Pb Barometric pressure Input data mmHg PeCO2 Mixed Expired CO2 Input data mmHg Pressure PEEP Peak End Expiratory Input data cmH2O Pressure PIP Peak inspiratory Pressure Input data cmH20 RRc RRc Respiratory Rate Input data RRv SaC2 Arterial Oxygen Saturation Input data 96 SaO2 SvO2 Venous Oxygen saturation Input data 96 TVe Expired Tidal Volume Input data ml breath Drug Calculations The monitor calculates the infusion rates of up to 44 drugs and displays the results in titration tables You can assign and calculate up to four drugs per patient or monitoring session Information pertaining to patient specific drugs is automatically deleted when you discharge the patient from the monitor To meet the dema
67. Only 16 3 Display Featur S 16 5 Paramel S crena 16 6 REPETIT 16 7 2 16 8 Quick Reference Table etCO2 16 9 Cleaning Calibration and 16 12 erre 16 12 Adapter nana 16 12 Sensor Calibration and Verification eese 16 12 Status Messages eiie cael ssec c et tessera tee et 16 14 CHAPTER 17 FiO2 Fractional Inspired O2 Monitoring OET a EAn a EEE EE E EE dr vua dul a CU w ac na Gud cu d D B od did 17 2 PRECAUTIONS sicaccicsceccccetexccasaccnesteceecucatcacetsucnsdacecccdss caeecacnnaasencocceatgaecsvedeaseraneteasacsenssenseece 17 3 Display Features 17 3 die PA c 17 4 Menu ACCeSS iii nicer intere casa vex EIN satus tardar Ea nna LN Gu en MEE UN Ru EUR 17 4 CalibraltiOni 02 dun Fara v ER
68. PROCESSING AND DISPLAY TruST 12 Lead ECG Pod Cable Set Channels Leads Available MultiMed 6 6 lead I Il IIl VR AVL aVF Vi V V22 V5 ECG23 Il IIl aVR aVL aVF Mt V V22 V5 ECG3 1 II IIl AVR aVF V V dV1 42 V5 dV6 NOTE TruST leads are indicated by a prefix before the V lead Cable Selection unavailable ghosted when TruST 12 Lead is ON 2Selection unavailable ghosted when TruST 12 Lead is OFF 3Channel does not support display of any TruST leads The monitor identifies QRS complexes with amplitudes between 0 2 and 5 0 mV and a QRS width of 70 to 120 ms for adults or 40 to 100 ms for neonates see note on page 8 16 It calculates heart rates within a range of 15 to 300 beats per minute using the R R intervals of the last 10 seconds and disregarding the two longest and two shortest R R intervals It averages the remaining intervals and displays the result as the current heart rate in the HR parameter box on the main screen When you enable arrhythmia monitoring the HR parameter box display changes accordingly If you select Basic the four basic arrhythmia calls ASY VT and ARTF are available for display If you select Full and you configure the main screen to display two or more ECG channels a separate ARR parameter box appears under the HR parameter box see page 9 4 for information about selecting a
69. Pediatric Patients 22 222 1 3 Display Featutes eene ione ue etr 5 Parameters 6 7 es m 8 Quick Reference Table etCO2 9 Cleaning Calibration and 12 12 Adapter Calibration ence erre rene terere trae 12 Sensor Calibration and Verification nnns 12 Stats mw 14 16 2 END TIDAL CO2 MONITORING Overview End tidal is the level of carbon dioxide in the airway at the end of expiration The monitor reports etCO and its associated parameters Inspired CO and RRc Respiration Rate via an optional free standing multigas unit an module module acquires signals from a Capnostat sensor For mainstream monitoring the sensor fits over a specially designed adapter in the intubated patient s airway or breathing circuit For sidestream detection a sampling
70. ST values are trended and can be reviewed on the trend display VISTA XL VF7 MultiMed Pods for ST Analysis TruST Twelve Lead ST Monitoring For the Vista XL monitor Infinity TruST is a Twelve lead ECG obtained through the MultiMed pod TruST twelve lead ST processing requires installation of ARIES 12 lead Rest ECG software TruST allows you to view the same number of leads as a six lead monitor with an additional four TruST leads NOTE If ARIES software is installed the monitor issues an ST alarm even for those leads not displayed in the ST parameter box TruST is part of the ARIES option ST Display When ST Monitoring and ECG monitoring are enabled the ST parameter box appears just below the HR parameter box on the Main Screen You can enable and disable ST monitoring on the ST Analysis menu or ECG setup menu page 8 15 ST deviation values are displayed in the same format as strip recordings where 1 millimeter mm on the grid corresponds to 0 1 millivolt mV ST Analysis Setup The ST Analysis menu allows you to execute most of the functions involved in analyzing the ST segment To open the ST Analysis menu e Click on the ST parameter box if displayed or 1 Press the Menu fixed key on the front of the monitor 2 Click on Patient Setup 3 Click on Parameters A list of available parameters appears NOTE If ST monitoring has been disabled ST does not appear in the parameter list 4 Cl
71. Type setting whenever you begin ECG monitoring the monitor retains a previous Cable Type setting ECG Determines the number and Click on ECG1 to display primary Channels format of displayed ECG ECG signal waveforms Click on ECG1 amp 2 to display 2 ECG Note ECG1 and ECG2 do not signals support the display of any Click on ECG1 amp 2 amp 3 to dis i 3 derived leads ECG channels Click on Cascade to cascade ECG1 data into second channel Channel 1 Selects leads for continuous Click on Channel 1 Channel 2 or Channel2 display in ECG channel s on the Channel 3 then scroll list of Channel 3 main screen available leads and click to select for display Cable Type Detects automatically the Click on Auto Detect for automatic detection of the number of leads in a cable set The monitor compensates automatically for one disconnected neutral lead This feature is available only on this setting Click on 5or 6 Lead if you are using a 5 lead or 6 lead ECG cable Click on 3 Lead if you are using a 3 lead ECG cable This submenu The ECG Options Submenu allows you to configure the following functions Filter Controls the channel bandwidth and displays a banner in the ECG1 channel if the setting is OFFor ESU No banner is displayed if you select Monitor default setting CAUTION The ESU setting when enabled automatically disables pacer detection Click on OFF for maxi
72. Ventilator Circuit Valve Rebreathing see above etCO Setup Accessing Setup Menu e Click on the main screen etCO parameter box to open etCO setup menu Or 1 Press the Menu fixed key on the front of the monitor The Main Menu appears 2 Click on Patient Setup A list of available patient setup functions appears 16 8 VISTA XL VF7 ETCO2 SETUP 3 Click on Parameters in the second column A list of available parameters appears 4 Click on The etCO setup menu appears Quick Reference Table etCO Setup The following table explains setup functions Function Description Settings Calibration Sensor Cal Displays date and time of last N A Capnostat sensor calibration Adapter Cal Initiates airway adapter calibration N A Gas Compensation Gas compensation offsets inappropriate levels of anesthetic agents by ensuring that gas percentages in each respiratory phase add up to 100 Each gas in any gas mixture exerts a partial pressure of the total Room air for example is made up of approximately 79 nitrogen and 21 oxygen Gas concentration is usually expressed as a percentage while partial pressure is measured in mmHg or kPa N20 Compensation module only Compensates for presence of nitrous oxide not normally present in room air but typically used in the operating room Significant concentrations of nitrous oxide can cause the monitor to overestima
73. accessories may adversely impact safety performance and electromagnetic compatibility increased emission and decreased immunity The equipment should not be used adjacent to or stacked with other equipment if adjacent or stacked use is inevitable the equipment should be observed to verify normal operation in the configuration in which it will be used e When using wireless networking be aware that the system operates at 2 4 GHz range Other equipment even if compliant with CISPR emission requirements could interfere with reception of wireless data When selecting new wireless systems e g cell phones pager systems cordless phones etc for use in installations where wireless networking is used care should always be used to insure that operating frequencies are compatible For example selecting cordless phones that operate at 2 4 GHz will likely cause difficulty with the phones and networking components Low level signals such as EEG and ECG are particularly susceptible to interference from electromagnetic energy While the equipment meets the testing described below it is not a guarantee of perfect operation the quieter the electrical environment the better In general increasing the distance between electrical devices will decrease the likelihood of interference VF7 VISTA XL B 3 Electromagnetic Emissions This equipment is intended for use in the electromagnetic environment specified below The user of this equi
74. affected by absorption andreflection from structures objects and people 6 VISTA XL VF7 SYSTEM COMPONENTS System Components Vista XL Base Unit Physical Attributes Size H x W x D 224 x 330 x 102 mm 8 8 x 13 0 x 4 0 in without modules Weight Without external battery 7 0 kg 15 5 1 With external battery 7 7 kg 16 9 Ib Cooling Convection Enclosure Plastics ABS PC FR 110 Printed circuit boards Board Glass epoxy Fr4 Solder Lead tin Copper etch Lithium battery Heatsink assemblies Cast magnesium alloy Internal Battery Lithium lon NBP assembly Silicon tubing steel copper wire Packaging Corrugated cardboard Urethane foam Electrical Specifications Input voltage 11 to 15 V DC Power consumption x70 Watts fully loaded Protection class Internally powered per IEC 601 1 and for use with specified Class power supplies Battery life 180 minutes 230 minutes with optional External Battery Note Battery life varies with parameter configuration The battery charge specified above is under the following load conditions MultiMed with ECG leads and sensor 2 temp probes HemoMed pod with 4 IBP transducers NBP taking measurements every 15 minutes LCD Transport Brightness at 5095 Battery charge time Internal 4 5hrs at 25 C External Optional 3 5hrs at 25 C Patient leakage current lt 10 pA Mode of operation Contin
75. and Disinfecting Adapter Calibration Calibrate the adapter every time you switch adapter types for example when you switch from a mainstream to a sidestream adapter or from an adult to a neonatal adapter You do not normally have to calibrate an adapter if you are replacing it with another of the same type To calibrate an airway adapter Click on etCO parameter box to access the setup menu 2 Click on Adapter Cal A popup message appears etCO Place Adapter in Room Air Connect the CO sensor onto the airway adapter and hold them away from any source of including the patient s mouth and your own 3 Click on Continue The calibration takes approximately 15 seconds during which the following message appears etCO Calibrating Adapter 4 When calibration is successful the monitor displays the message Adapter Cal Accepted If calibration fails the monitor displays a status message see Status Messages on page 16 14 Sensor Calibration and Verification To ensure accurate readings calibrate the Capnostat every time you connect it to a different etCO module Calibration is unnecessary if you disconnect the sensor and later reconnect it to the same device You can display the date and time of the last Capnostat sensor calibration by clicking on Sensor Cal in the menu Verify the sensor calibration periodically to ensure it is functioning correctly or when you suspect changes or
76. and Peripheral Devices Moisture can damage the monitor and its peripherals e g the MultiMed pod battery charger Please read the following instructions carefully before you clean the base unit or peripheral devices Special instructions for cleaning particular devices and accessories are provided in the following pages e Do not spray cleaning agents on the monitor or peripherals Wipe them with a cloth moistened with a soap solution e Disinfect the surfaces with a gauze moistened with diluted alcohol or a gluteraldehyde based disinfectant 21 2 VISTA XL VF7 Dry thoroughly with a lint free cloth CAUTION Do not immerse or rinse the monitor and its peripherals If you accidentally spill liquid on a device disconnect the unit from the power source Contact your Biomed regarding the continued safety of the unit before placing it back in operation Do not use disinfectants that contain phenol which can leave spots on plastic surfaces Do not autoclave or clean the monitor or its peripherals with strong aromatic chlorinated ketone ether or ester solvents sharp tools or abrasives Never immerse electrical connectors in water or other liquids Patient Cables e Clean the patient cables with a gauze pad moistened with a soap solution e Dry thoroughly with a lint free cloth e disinfect patient cables wipe the cables with a gauze moistened with diluted alcohol or a gluteraldehyde based disinfectant
77. and umbilicus Avoid the liver area and ventricles of the heart to prevent artifacts caused by pulsatory blood flow The following figure illustrates the recommended placement of ECG leads for impedance respiration on an adult and a neonate Respiration Lead Placement 11 4 VISTA XL VF7 DISPLAY FEATURES Display Features Impedance changes are reflected in the respiratory waveform displayed to the left of the RESP parameter box Waveform morphology differs depending on whether the patient is breathing with or without a ventilator as shown below Respiration Waveforms Patient breathing independently inspiration expiration Patient breathing with ventilator assistance expiration inspiration In the RESP parameter box a lung symbol blinks whenever a breath is detected The display of respiration alarms alarm limits and parameter values follows the standard display of other parameters Alarm limits Respiration rate Breath is detected VF7 VISTA XL 11 5 RESP Setup Menu 11 6 impedance respiration functions are controlled from the RESP setup menu which you can open in one of two ways or Click on the RESP parameter box on the main screen Press the Menu fixed key on the front of the monitor Click on Patient Setup A list of available patient setup functions appears Click on Parameters in the second column A li
78. are properly Low body temperature connected Relocate sensor to another extremity Contact Medical Technical Support SpO No The monitor has notbeen Ensure the SpO sensor is Measurement able to compute a valid properly attached to the patient at measurement within the last 30 seconds because of unstable measurement conditions a site free of patient motion and all cables are properly connected Contact Medical Technical Support 1 This message does not appear when the Masimo SET SmartPod is in use 15 10 VISTA XL VF7 STATUS MESSAGES Message SpO Regulation Error Possible Cause Inconsistent light level detected by sensor Excess Ambient light detected Suggested Action Ensure the SpO sensor is properly attached to the patient Remove or shade any external sources of light entering the sensor Contact Medical Technical Support SpO Unplugged Sensor cable not connected to the MultiMed pod Check to ensure that cables are securely connected Check for defective sensor SpO s non Masimo compatible sensor Monitor is configured for Masimo and a non Masimo compatible sensor is connected Note SPO compatibility is a locked option Contact your biomed for more information Replace with Masimo compatible sensor Contact Biomed 5 non Nellcor compatible se
79. as the pulse tone source see page 15 8 below VF7 VISTA XL 15 7 5 Setup To access 5 menu e Click on the SpO parameter box or 1 Press the Menu fixed key 2 Click on Patient Setup 3 Click on Parameters to display a list of available parameters 4 Click on Quick Reference Table SpO Setup Click on the following items to execute SpO setup functions Menu Item Description Settings Pulse Tone Source Selects source for the pulse tone ECG Monitor uses the and displays a blinking heart v in ECG signal as the pulse the ae tone source The higher the pitch the higher the soo Monitor uses heart rate HR or SpO saturation the signal as the percentage pulse tone source Note You can also set the pulse tone source from the ECG setup menu Pulse Tone Volume Sets the volume of the pulse tone OFF 5 10 20 30 40 Note You can also set the pulse 50 60 70 80 90 or tone volume from the ECG menu 10 Waveform Size Determines the size of the pulse 10 100 plethysmogram waveform increments of 10 Note If the waveform height exceeds the display channel s size the waveform is clipped SpO signal processing is not affected 15 8 VISTA XL VF7 STATUS MESSAGES Menu Item Description Settings Averaging Mode Determines speed of calculation Normal for the average value Via Mul
80. by the IEC and the AHA US Three Lead Standard Five Lead Standard Five Lead Six Lead Standard Paced Patients Infinity TruST NOTE For Infinity TruST 12 i Lead Monitoring recommended lead placements for V and are V2 and V5 Chest Lead 8 10 VISTA XL VF7 PATIENT PREPARATION Lead color coding for 3 5 6 lead monitoring ECG Lead AHA US IEC LA Black Yellow LL Red Green RA White Red RL Green Black V Brown White Gray and Brown Gray and White Derived Twelve Lead Configuration TruST Overview NOTE e Infinity TruST is intended for 12 lead ECG monitoring with a reduced electrode set Reconstructed leads are intended for real time assessment of ST segment changes TruST is not available in neonatal mode For the Vista XL monitor Infinity TruST is a 12 lead ECG obtained through a MultiMed pod In general the signal from a measured lead provides information common to other leads When this information is appropriately combined the signal of leads not otherwise configured can be inferred This type of lead derivation has a high correlation with measured leads TruST is available in adult and pediatric mode TRUST electrodes are placed in the six lead standard configuration As with the six lead pod waveforms from eight leads can be viewed on the Vista XL monitor but TRUST also processes and displays four additional lead waveforms These T
81. calculates the patient s age based on the Birth Date entered in the Patient Admit menu Once it has identified an agent the parameter box shows a value for the minimum alveolar concentration of the agent Age Based MAC value WARNING e Age based MAC values only apply if the patient s age is greater than or equal to 1 year e If the patient s age is less than 1 year age based MAC for 1 year shall apply e If user does not enter patient age 40 yrs is the default setting e Please consult packaging information regarding MAC and age for inhaled anesthetics 1 age based MAC minimum alveolar concentration is equal to 1 MAC see below x 105 where mb 0 00269 yr7 negative factor slope of 102 1 MAC unit years and mx age 40 The following values are used as a basis for all MAC calculations related to the age of the patient Agent Concentrations 1 MAC Agents HAL ISO SEV DES Values via a Scio con 0 77 1 7 1 15 2 1 6 65 105 necting cable X3 or Scio ISD VISTA XL 18 21 18 Scio FouR MODULES The table below shows typical Agent parameter box displays when using Age based MAC values Parameter Box Description I Via a Scio connecting cable X3 or Scio ISD only Agent iHAL identified Age based MAC values displayed MAC etHAL 1 0 075 A Via a Scio connecting cable X3 or Scio ISD only Agent
82. calibration OFF ON Caution Only qualified service personnel should access this function If you leave Cal Mode ON accidentally NBP will default to an NBP inactive state To restore NBP to normal operating mode power cycle the monitor NBP Alarms Accesses NBP alarms and N A associated variables on Alarm Limits table NBP Chime Produces a tone when NBP OFF measurement is complete Taking Measurements Single Measurements To perform a single measurement e Push the NBP START STOP fixed key on front of monitor The cuff inflates then deflates When an NBP measurement is in progress the background turns white and the foreground turns black When the measurement is complete a chime sounds if selected by user and new data appears To stop a single measurement in progress push the NBP START STOP fixed key NOTE NBP reading is undetermined the value of the previous reading in the p box is blanked or displays Interval Measurements You can take a series of single measurements at specific intervals The interval time is measured from the start of one measurement to the start of the next To take a series of measurements 1 Open the NBP menu see page 12 7 2 Click on Interval Time 12 8 VISTA XL VF7 SETuP 3 Dial to the time interval you want to use 4 Click on the interval to confirm it 5 Press the NBP Start Stop fixed key NOTE
83. carefully e Some pacemakers especially external pacemakers with body surface electrodes emit pulses with amplitudes far exceeding the 700mV maximum amplitude specified for the monitor The monitor may therefore misinterpret the pulses of such large amplitude pacers as valid QRS complexes and may fail to detect cardiac arrest e Take extra precautions with patients who have rate adaptive implantable pacemakers Patient monitors may cause interference with some rate adaptive implantable pacemakers This could cause unnecessarily high paced rates Pacer Detection When Pacer Detection is enabled the monitor identifies as a pacer pulse any pulse that meets the following specifications Amplitude 2 to 700 mV Width dy 0 2 to 2 0 ms Rise Fall times min 0 1 dp 100 ms Overshoot min 0 025 5 mV Recharge time constant 4 to 100 ms The monitor identifies detected pacer pulse by a blue mark on the patient s ECG in channel ECGI If a QRS complex occurs within 250 ms of a pacemaker pulse that QRS complex is identified as a paced beat In the HR parameter box paced beats are identified by the icon Py Regular beats continue to be identified by the flashing heart symbol V VISTA XL VF7 ECG PRECAUTIONS When Pacer Detection is OFF the message Pacer Off appears in the ECG1 channel Configuring the monitor for neonatal monitoring see page 2 5 or for protection from electrosurgery see page 8 7 automat
84. clean and dry Clean or replace the adapter if necessary Align the marks on bottom of the adapter with the sensor Snap firmly into place module or Capnostat pod Insert the adapter in a vertical position sengor between the elbow and ventilator circuit ventilator gt Position sensor cable away from patient Confirm proper connection on the etCO setup menu Mainstream 25 airway adapter L To patient intubated patients or for intubated patients who are breathing independently A pump in etCO device samples the patient s VF7 VISTA XL 16 3 16 2 END TIDAL CO2 MONITORING inspired and expired air as it passes a nasal sampling cannula You cannot measure flow volume or pressure via sidestream monitoring NOTE Sidestream monitoring is not intended for use on neonates and is therefore disabled in Neonatal mode Capnostat sensor Nasal sampling cannula not to scale 2 sidestream input port dehumidification tubing Sidestream airway adapter Sidestream Monitoring Setup 1 Click on etCO parameter box to access the setup menu 2 Click on Measurement Mode 3 Click on Side 4 Make sure the sidestream pump in device turns and that you feel suction at the input port 5 Select a sidestream airway adapter Make sure the windows are clean and d
85. cuff to the monitor which determines systolic diastolic and mean blood pressures for adult pediatric or neonatal patients The monitor can initiate blood pressure measurements singly at set intervals or continuously over a 5 minute period NOTE NBP functionalities should be calibrated yearly by your Biomed or other qualified personnel as described in the monitor s Service Manual see Safety Considerations of this Instructions for Use The monitor can be configured to sound an attention tone whenever an NBP measurement is completed see page 2 10 for information Display Features 12 2 The monitor displays non invasive blood pressure in form of numerical values and trends There is no NBP waveform For information on trended data see Chapter 6 Trends The NBP parameter box shows the latest readings for mean systolic and diastolic pressure See page 2 5 for more information on prioritizing and displaying parameter boxes Systolic pressure Alarm limits crossed bell icon if alarm is disabled Diastolic pressure Mean pressure VISTA XL VF7 SETuP Setup Safety Considerations WARNING Obstructions may cause the cuff to inflate and deflate improperly and result in inaccurate readings Check the hose and cuff for damage and dirt Do not allow the hose and cuff to get in contact with fluids and make sure that they are not compressed or kinked NOTE e Place
86. data at the time of the recording request For continuous recordings however the monitor saves only the recording request and not the actual data Recorder Setup The monitor prints recordings on a bedside R50 recorder or on a networked R50 N recorder The figure at right shows an R50 recorder The R50 N recorder used for printing recordings over the network looks similar but is slightly larger The mm s fixed key on the recorder s front panel Alternate Speed on older recorders allows you to change the recording speed while a recording is in progress The recorder stops briefly and then restarts automatically at the new recording speed The Stop fixed key also on the recorder s front panel stops a recording in progress VF7 VISTA XL 7 7 7 RECORDINGS NOTE The mm s or Alternate Speed key only functions while a recording is in progress The monitor prints recordings on a bedside 50 recorder or on a networked R50 N recorder On the R50 Setup menu you can customize a variety of recorder functions To access the R50 series Setup menu Press the Menu fixed key to display the Main Menu Click on Monitor Setup 1 2 3 Click on Recordings 4 Click on R50 Setup to display the Setup menu Quick Reference R50 Series Setup Menu The functions listed on the R50 Setup menu are described below Menu Selection Description Available Settings Delay Duration Speed Determines the amount of pre
87. detected temperature change was lt 0 1 because C O START was pressed but no injection was made Injectate volume too small Defective catheter Injectate temperature too warm Repeat the measurement Use a larger injectate volume Repeat the measurement If problem persists replace the catheter Use colder injectate VISTA XL VF7 STATUS MESSAGES Message Possible Cause Suggested Action C O Use Difference between patient s Use a cooler injectate Cooler blood temp temperature and Injectate injectate temperature of less than 5 C The injectate temperature of greater than 30 C C O C O START has been pressed No injectate probe is Injectate Set but no injectate probe is connected assume that the to IT connected The monitor injectate temperature is at 20 value assumes a temperature of 20 C C default C O The C O average has been None required Average saved Saved C O A cable or transducer has Reconnect the cable or Transducer become disconnected transducer Unplugged f message persists replace defective part C O Poor The baseline temperature curve Follow hospital procedures Baseline did not return to baseline within Repeat the measurement If 30 seconds of pressing C O message persists replace START because of the defective components Unstable patient temperature Defective catheter cable or cartridge C O
88. enable full Chapter 9 Arrhythmia arrhythmia monitoring Monitoring Click on BASIC to enable basic arrhythmia monitoring RESP Enables disables respiration Select ON to enable respiration Monitoring monitoring monitoring For detailed information refer to Select OFF to disable respiration Chapter 11 Respiration monitoring Relearn Creates a reference template Click on Relearn to initiate a based on identification of relearning process See Chapter 9 dominant QRS pattern Arrhythmia Monitoring for more Note This function is ghosted information about relearning a when the monitor is not reference template processing ECG signals Status Messages Definition and or Range High the upper measurement range 300 bpm Message Possible Cause Suggested Action HR gt Patient s heart rate outside Observe the patient and treat if HR lt the current alarm limits necessary Change the alarm limits HR Out of Patient s heart rate outside Observe the patient and treat if necessary LA Lead OFF LL Lead OFF Lead off condition for the indicated lead detected Inspect and replace defective cables and wires RA Lead OFF Cause could be one or more Reapply gel on disposable RL Lead OFF Of the following electrode s Chest Lead Broken cable lead or electrode cannot be OFF Loose lead wire replaced select another ECG lead Faulty lead wire
89. ghosted until user presses Stop key To EXIT the Cursor tool Press click the Rotary Knob to exit cursor control or Press the Menu Main Screen Alarm Limits or Fast Access fixed key Review Provides access to submenus of Click on Review to open the the Main Menu display following submenus and displays Alarm History Trend Graphs Trend Table Event Recall Calc Results OxyCRG neonatal mode only Show All Leads and Reports Click on Exit to return to the first column of the Main Menu 2 4 VISTA XL VF7 CONFIGURING THE MONITOR The Main Menu Menu Item Description Available Settings The Patient Setup Submenu This submenu allows you to configure the following functions Patient Determines availability of e Adult Category monitoring features such as Pediatric apnea detection neonates only and ventilation Neonatal Notes When you click on a setting a popup message warns you that algorithms and alarm settings are about to change In the popup window click again on the category of your choice f you change a patient s category the weight selection is cleared and must be selected again Pressure Assigns IBP pressure channel ART PA CVP LA LV RV RA Labels labels ICP GP1 GP2 See Chapter 13 Invasive Blood Pressure for detailed information Parameters Accesses parameters setup Click on one of the listed menus parameters to access its setup menu e g ECG
90. inaccurate readings To calibrate and verify the Capnostat sensor 1 Make sure the monitor is turned on and properly connected to the module 2 The monitor displays a message informing you that the sensor is warming up 2 minutes at room temperature 16 12 VISTA XL VF7 CLEANING CALIBRATION AND VERIFICATION 3 When the sensor reaches a stable temperature the monitor instructs you to place the sensor on the Zero cell 4 Locate the Zero and Reference cells on the sensor cable see figure right Place the sensor on the Zero cell The calibration process begins automatically and takes about 20 seconds 6 When calibration is complete the monitor instructs you to place the sensor on the reference cell 7 Place the sensor on the Reference cell The monitor displays the message Verifying Sensor Cal 8 When the verification is complete the monitor displays the message Sensor Cal Verified You can now use the sensor If verification fails the monitor again displays the message Place Sensor on Zero Cell In this case repeat the process from Step 5 A status message appears if calibration fails again see table at the end of this chapter VF7 VISTA XL 16 13 16 2 END TIDAL CO2 MONITORING Status Messages Calibrate Atm Press Message Condition Suggesied Action etCO lt Upper or lower alarm limits Check the patient and treat if etCO gt
91. is calibrated to two different measurements 17 4 VISTA XL VF7 FiO2 SETUP One Point calibration should be performed daily Two Point calibration should be performed weekly You should also calibrate the monitor as follows Periodically to verify the correct functioning of the sensor Daily if you are monitoring a patient s FiO on a daily basis When you suspect that sensor characteristics have changed When the accuracy of the monitor is in question When there is a change in humidity or barometric pressure of the monitoring site 1 Point Calibration Room Air A one point calibration of the sensor to room air 2190 oxygen should be performed on a daily basis 1 Make sure monitor is turned on and that NeoMed and monitor are set up for FiO monitoring see page 17 4 Expose the sensor to room air Open the FIO menu see page 17 4 Click on 1 Point Cal A message appears 21 Calibration in Progress Calibration may take from 1 10 minutes Wait for the message 21 Calibration Complete to appear A message informs you of a failed calibration Try calibrating again if the message persists try a new sensor Return the sensor to the incubator or oxygen hood 2 Point Calibration Cal Gas NOTE Contact your Biomed for help with 2 point calibration A two point calibration of the system to 100 dry oxygen and room air 21 oxygen should be performed every week VF7 1 Make sure m
92. is used Emptying the Water Trap The water trap should be emptied if the contents have reached the full mark NOTE If water trap has been in use for 4 weeks it must be replaced See Replacing the Water Trap below To empty the water trap 1 Disconnect the sampling tubing 2 Remove the trap from its connector by holding it firmly on the ridged surfaces and pulling it out from the Scio module 3 Connect an empty syringe size gt 20 ml and without a needle to the port on the back of the water trap 4 Aspirate water trap contents into syringe Remove syringe and discard NOTE Do not attempt to clean water trap 6 Reseat water trap by pressing it against the Scio A click will indicate that it is seated properly 7 Reconnect the sampling tubing Before monitoring a new patient exchange the tubing and T connector See page 18 27 VF7 VISTA XL 18 27 18 Scio FouR MODULES Replacing the Water Trap To replace the water trap 1 2 Disconnect sampling tubing Remove the trap from its connector by holding it firmly on the ridged surfaces and pulling it out from the Scio module Insert the new trap by pressing it against the Scio A click will indicate that it is seated properly Connect the sampling tubing Before monitoring a new patient exchange the tubing and T connector See page 18 27 Cleaning the Fan Filter The fan filter should be cleaned 1 time per month
93. message persists contact biomed or technical support VISTA XL 12 NoN INVASIVE BLOOD PRESSURE VF7 STATUS MESSAGES number of pulsations of adequate amplitude within two minutes Message Possible Cause Suggested Action NBP Blocked The inflation rate is too high Select a different cuff Line during the inflation cycle or Check the hose and cuff for the time to dump the residual damage cuff pressure at the end of the deflation cycle is too Restart the measurement If the short message does not clear contact Biomed or Dr ger Medical Technical Support NBP Cannot Monitor is unable to zero Check the patient and treat if Zero transducer within 30 seconds necessary from start of NBP program Move cuff to a limb with less usually because of motion movement artifact If the message does not clear contact Biomed NBP A measurement lasted Repeat the measurement Measurement longer than two minutes Timeout Adult or Pediatric or 90 seconds Neonatal and was aborted usually because of motion artifact NBP No Weak signal Monitor is Check the patient and treat if Pulsation unable to detect a sufficient necessary Check the hose and cuff Check for proper size placement of cuff NBP Open Line Inflation time during cuff inflation cycle is too long or inflation rate is too low Check to ensure that the hose and cuff are properly connected to the monitor
94. page 3 10 Monitors connected to the network automatically relay alarms to the central station If the central station cannot acknowledge an alarm within 10 seconds because of a network interruption for instance the monitor displays the message Network Alarm Error and sounds a tone at maximum volume 100 The alarm volume remains set at 100 until you change it on the Alarm Limits menu page 5 5 Alarm Grades The monitor has three alarm levels life threatening serious and advisory Each alarm grade has its own distinctive alarm tone and alarm color If more than one alarm occurs simultaneously the parameter boxes continue to blink but the monitor sounds only the highest grade alarm The cause of an alarm is displayed in the local message area at the top left of the screen If life threatening and serious alarms occur simultaneously the monitor displays the associated alarm messages in sequence alarm grades activate any external alarm system which is connected to the monitor 5 2 VISTA XL VF7 ALARM GRADES You can define alarm grades for arrhythmia and ST parameters only using the arrhythmia setup table see page 9 6 or the ST alarms table see page 10 7 Some alarms are latched they continue to annunciate visually and audibly until you acknowledge them manually even if the condition that caused the alarm no longer exists Other alarms may be latched only partially as indicated in the following table To ack
95. possibility of burns during electrosurgery or defibrillation Do not use surface probes VISTA XL VF7 STATUS MESSAGES Status Messages Message Possible Cause Suggested Action gt Temperature exceeds Check the patient and treat if cd upper or lower alarm limits necessary Check equipment and replace if necessary Out of Range High Out of Range Low Temperature value greater or less than measuring range Check the patient and treat if necessary Check equipment and replace if necessary Can t Derive Cable defective or unplugged Check equipment and replace if necessary Connect 2nd temperature probe failure Unplugged Cable defective or Check equipment and replace unplugged if necessary H W Failure Temperature circuitry Contact Medical technical support VF7 VISTA XL 19 5 19 This page intentionally left blank 19 6 VISTA XL VF7 Chapter 20 Cardiac Output EES SSS 2 PED 3 Screen Dis play emt 4 exer md 5 HardWare isrener aa oneen aaa aanas aeaa a a o cxxnvennspaaunceasoemuenestvetidadnonnoenseeaese 5 CO Setup ea 5 Quick Reference C O
96. pump delivers signals from the adapter to the module NOTE readings assume body temperature of 37 C and humidity of 100 otherwise readings may vary Ports and outlets are clearly marked on the front of the module Use these labels as a guide when connecting the module to the monitor and peripherals cU e Slide into slot on rear of monitor until the module rests securely 1 Sidestream output port 2 Sidestream input port 3 Capnostat sensor cable 16 2 VISTA XL VF7 SAMPLING METHODS Sampling Methods Mainstream For mainstream detection the sensor is located within the patient s airway or breathing circuit allowing you to monitor individual breathing cycles of the intubated patient This method is appropriate for neonatal as well as adult and pediatric patients CAUTION e Always position the airway adapter vertically to prevent patient secretions from obscuring the adapter windows Ifyou are switching adapter types e g from sidestream to mainstream or adult to neonatal you must calibrate the adapter as described on page 16 12 Mainstream Monitoring Setup 1 2 3 4 Sidestream Adult and Pediatric Patients Only Sidestream monitoring is appropriate for non Click parameter box to access etCO setup menu Click on Measurement Mode Click on Main Select a mainstream airway adapter Make sure the windows are
97. signal clarity and display Clicking on Test Pulse Injects a 300 ms pulse into the ECG waveform 1 mV on leads and IIl 2 mV on lead Il 2 18 VISTA XL VF7 SPECIALTY MENUS Parameter Colors The Parameter Colors menu allows the user to assign a color to an individual parameter waveform To open the Parameter Colors menu Press the Menu fixed key to open the Main Menu Click on Monitor Setup Click on Monitor Options Click on Parameter Colors Gr ge cg Enter clinical password NOTE clinical password menu will time out after approximately 5 minutes It will stay active that long unless the user clicks Accept 6 Click on Accept Parameter Colors 7 Click on parameter and select color desired 8 Click on desired color Parameter Colors functions are described in the following table VF7 VISTA XL 2 19 2 MONITOR SETUP Quick Reference Parameter Colors Menu 2 20 Parameter Default Color Possible Selections NOTES color change set in this menu changes all uses of the parameter parameter box waveform trends parameter list is not limited to only parameters connected e Agent parameters HAL ISO ENF SEV DES 2 2 cannot change color ECG inc ST ARR Green Red White Yellow Green Notes Lt Blue Blue Purple ECG lead label on Main Screen is
98. the READY signal If no injectate is detected within four minutes the Averaging screen closes and you must repeat steps 1 and 2 for additional C O measurements To measure C O in manual mode 1 Press the Start fixed key on the HemoMed pod or select Start on the C O setup menu The READY message becomes visible for 30 seconds or until a C O waveform is detected 2 Immediately inject the saline solution and wait for the monitor to calculate a C O value The monitor begins to calculate a C O value as soon as it detects a blood temperature drop NOTE manual mode the READY signal is informational only Do not wait for the READY signal before injecting the solution VF7 VISTA XL 20 9 20 CARDIAC OUTPUT 3 Ifthe monitor fails to detect the temperature drop caused by the injectate the waveform disappears after 30 seconds An attention tone sounds an error message appears in the local message area and three asterisks appears in the Save AVG field Repeat steps 1 and 2 for additional measurements NOTE Start is available as a menu item only when you are in manual C O measurement mode As soon as you initiate a C O measurement in either mode the C O Start key is disabled and the C O Start menu item is ghosted until a value is reported Averaging C O Measurements Differences in injection technique can cause variations in measurements performed on the same patient To compensate for such d
99. the cuff so that it does not apply pressure to joints e Reliable NBP measurements may be difficult to obtain from patients experiencing convulsions tremors and various arrhythmias Software and Hardware Cuff Pressure Cutoffs The cuff deflates automatically if a measurement takes longer than 2 minutes in Adult Pediatric mode or 90 seconds in Neonatal mode To protect the patient from excessive pressure inflation limits have been established in all patient categories see Appendix B Technical Data for more information Cuff Selection and Placement The quality of NBP monitoring depends largely on the quality of the signals received by the monitor For this reason it is important to select the correct cuff size for your patient Cuff sizes are clearly marked on the cuff Measure the circumference of your patient s limb Use only Drager provided cuffs with your monitor otherwise the correct functioning of the device may be compromised see Appendix C Approved Options and Accessories WARNING The accuracy of the NBP measurement is based upon the correct sizing of the blood pressure cuff in relation to the patient s arm circumference The wrong sized cuff or cuffs falling outside the range or size manufactured by Drager Medical may cause inaccurate measurements Use only Drager Medical provided cuffs and ensure patient s limb circumference falls within the designated range on the cuff Use of any non approved cuffs may compromise t
100. the factory to the monitor s default value of 100 Prolonged use of reusable transducers however may adversely affect accuracy When using reusable transducers you must re enter the calibration factor periodically as follows VF7 1 Open the setup menu of the IBP parameter you wish to monitor see pages 13 2 and 13 10 2 Scroll to Cal Factor and click Dial the calibration factor and click to confirm CAUTION Always zero the transducer before calibration You must calibrate the transducer within five minutes of a zero to obtain accurate measurements VISTA XL 13 5 13 INVASIVE BLOOD PRESSURE You or your Biomed can obtain the calibration factor using one of the following methods Using either method you must first zero the transducer Always record the new calibration factor and ensure that it is available to future users of the transducer Calibration Using a Manometer or Simulator To recalculate the calibration factor using a manometer or a pressure simulator 1 Open the setup menu of the IBP parameter you wish to monitor see page 13 10 Connect manometer or pressure simulator to the transducer Close transducer to the patient and open it to the manometer Use the manometer or simulator to create a pressure on the transducer within the associated pressure range Click on Manometer Cal when the pressure on the transducer is stable Use the rotary knob to highlight the reading on the manometer or s
101. the same patient To transfer data over the network 1 Press the fixed key Menu The Main Menu appears 2 Scroll to Standby and click The Main Screen goes blank except for the following message Standby Press Main Screen to resume monitoring Go to the destination monitor and press the Menu fixed key 4 Click on Admit Discharge Click on Transfer to display the Transfer Patient Data menu If you are transferring data from outside the destination care unit go to Step 6 Otherwise go to Step 8 6 Click on Select Care Unit to transfer from A list of care units appears If you are monitoring only one care unit this item is ghosted 7 Click on the care unit from which you are transferring data The selected unit appears next to Care Unit Click on Select Bed to transfer from to display beds currently in standby 9 Click on the source bed to display it on the menu 10 Click on Start Transfer to this bed The following warning screen appears 11 Click on Transfer to this bed to transfer patient data and display the banner Transfer In Progress or on Cancel to return to the previous menu 12 Press the Main Screen fixed key on the source monitor to exit Standby mode 4 6 VISTA XL VF7 DISCHARGING A PATIENT Discharging a Patient You must discharge one patient before admitting another The monitor otherwise appends existing data to the subsequently admitted patient You can discharge a patient only at the bedside moni
102. waveform values for 10 seconds and calculates a wedge pressure value PWP During the measurement the PA parameter box shows no systolic or diastolic values and PA alarms are disabled VF7 VISTA XL 13 13 13 INVASIVE BLOOD PRESSURE Follow your hospital s procedures for setup then take a PWP measurement as follows 1 Verify that a PA catheter has been properly inserted and the catheter tip is situated in the pulmonary artery Press the Wedge fixed key on the HemoMed pod acquiring the PA signals or Open the PA setup menu scroll to Wedge Start and click The following screen appears 7 Inflate Balloon Press Wedge to Start EETTEN Click on Scale Scroll to the desired waveform scale 5 10 15 20 25 30 35 40 50 75 100 125 150 175 200 225 250 or 300 mmHg and click Click on Sweep Speed Scroll to the desired sweep speed 6 25 12 5 25 or 50 mm s and click Inflate the balloon and click on Wedge to start the measurement The message Wedge in Progress appears When the calculation is complete the PA and RESP waveforms stop a horizontal cursor line through the PA waveform indicates the new PWP value and the monitor instructs you to deflate the balloon 13 14 Control keys at the bottom of the screen allow you to save navigate or quit the display After four minutes the monitor automatically saves the PWP value and exits to the main screen The PA and RESP w
103. waveforms of all connected ECG leads Note Also accessible from the Main Menu Review submenu and from the Remote Keypad All ECG fixed key With an active Show All Leads screen Leads are displayed on a single page Parameter box display alarm and recording functions are not affected Rotary knob can only scroll Show Leads menu items Parameter boxes are visible but inaccessible Measuring Displays average S T complex for ISO Changes the point that Points each monitored ST lead defines the isoelectric point ST Changes the point that Note See page 10 5 for more defines the S T measurement information point Recalculates the QRS complex ST Alarms Opens ST Alarm Limits Table See page 10 7 VISTA XL VF7 ST ANALYSIS SETUP Measuring Points The Measuring Points Screen The starting and ending points for the QRS complex are automatically determined In practice however the accurate determination of the isoelectric and ST measuring points requires careful clinical evaluation On the Measuring Points screen accessible via the ST Analysis menu page 10 3 you can change the isoelectric and ST measuring points to ensure an accurate ST deviation measurement Measuring Point Screen 3 Lead Large Format Zoom Screen Relearn Relearn New Reference View OF Zoom Create reference template Dial to the desired ST lead and click Changing the I
104. zeiprprIme IX Electromagnetic Table Of Contenls coiere ues sees anc INFINITY VISTA XL USER S GUIDE Intended Use The Infinity Vista XL monitors are intended for multi parameter patient monitoring The devices will produce visual and audible alarms if any of the physiological parameters monitored vary beyond preset limits and timed or alarm recordings will be produced These devices will connect to R50 recorders either directly or via the Infinity network VISTA XL VF7 INFINITY VISTA XL USER S GUIDE Indications For Use The Infinity Vista XL monitors are capable of monitoring e Heart rate e Respiration rate e Invasive pressure e Noninvasive pressure e Arrhythmia e Temperature e Cardiac Output e Arterial oxygen saturation e Pulse rate e Apnea e ST Segment Analysis 12 Lead ST Segment Analysis e FiO The devices are intended for use in the environment where patient care is provided by Healthcare Professionals i e Physicians Nurses and Technicians who will determine when use of the device is indicated based upon their professional assessment of the patient s medical condition The devices are intended to be used on Adult Pediatric and Neonatal populations with the exception of the parameter cardiac output ST segment analysis and arrhyth
105. 13 Hemodynamic Pod Connecting Cables esee C 14 IBP AcCCesSOLF GS eid coena ts ute ea ara C 14 IBP Transducer Plates 15 e Ie rrenipae 15 End Tidal CO2 6 02 2 16 etCO2 Module and Pods er cun arcana gu aar au arr a RR du C 16 50 EE E E 16 Main Stream Accessories en crecen ac iran pe RO OCC En Bo da un C 16 Side Stream 1 16 16 MultiGas 17 Scio Four i i d we da Eo C 17 MultiGas 442 enne nenne C 17 Scio Fout AGCCeSSOFlGS cosi wo eer oc iu du nau CR DX ue a da a i d C 17 Scio Connecting Cables rti idein Linden esee udin C 17 2 VISTA XL VF7 Power Supply Power Cords Power cord Cont Eu
106. 19 To open the Reports setup menu 1 Press the Fast Access fixed key to display the Fast Access menu 2 Click on Reports to display the Reports menu Available functions on the Reports setup menu are described in the table Quick Reference Reports Setup on page 7 12 A typical monitor ECG report follows VF7 VISTA XL 7 11 10 240 2090 12 34 54 Quick Reference Reports Setup T Available Menu Item Description settings ECG Report Prints ECG report Click on printer Notes The Vista XL with TruST can print 12 lead reports that are not diagostic quality Timed Waveforms Prints timed recording report See page 7 6 icon to request report Continuous Waveforms Prints continuous recording report See page 7 6 Click on icon to request report Click again to stop printing Waveform Delay Determines the amount of pre event data e 6 10 15s included in the timed recording Waveform Duration Determines length of timed report 10 206 Prints graphical trend report See Chapter 6 Trends for more information Trend Table Prints tabular trend report See Chapter 6 Trends for more information Click on printer icon to request report 7 12 VISTA XL 7 RECORDINGS VF7 Description Available settings Trend Duration Determines l
107. 3 digits Pulse Rate bpm During Motion Conditions 3 Adults Pediatrics Neonates 25 240 bpm 5 digits 1 The Infinity amp Masimo SET SpO SmartPod pulse oximeter with LNOPoAdt sensors has been validated for no motion accuracy in human blood studies on healthy adult volunteers in induced hypoxia studies in the range of 70 100 SpO against a laboratory co oximeter and ECG monitor This variation equals plus or minus one standard deviation 2 The Masimo SET pod with LNOP Adt sensors has been validated for motion accuracy in human blood studies on healthy adult volunteers in induced hypoxia studies while performing rubbing and tapping motions at 2 to 4 Hz at an amplitude of 1 to 2 cm and a non repetitive motion between 1 to 5 Hz at an amplitude of 2 to 3 cm in induced hypoxia studies in the range of 70 100 SpO against a laboratory co oximeter ECG monitor This variation equals plus or minus one standard deviation 3 The Masimo SET pod with LNOP Neo and Neo Pt sensors has been validated for motion and no motion accuracy in human blood studies on healthy adult volunteers in induced hypoxia studies while performing rubbing and tapping motions at 2 to 4 Hz at an amplitude of 1 to 2 cm and a non repetitive motion between 1 to 5 Hz at an amplitude of 2 to 3 cm in induced hypoxia studies in the range of 70 100 SpO against a laboratory co oximeter and ECG monitor 1 has been added to the results to account for the effect
108. 3 mmHg Pediatric 180 215 3 mmHg Neonatal 140 153 3 mmHg Hardware safety cut off Adult 270 300 30 mmHg Pediatric 180 300 30 mmHg Neonatal 140 157 8 mmHg Static cuff accuracy 3 mmHg Calibration range Adult and Pediatric 10 260 mmHg 3 mmHg Neonatal 10 150 mmHg 3 mmHg Degree of protection against Type CF electric shock Defibrillation protection per EN 60601 2 30 IEC 601 2 30 B 18 VISTA XL VF7 Invasive Blood Pressure Measuring method Resistive strain gauge transducer Display resolution 1 mmHg Measuring range 50 to 400 mmHg Frequency ranges DC to 8 Hz DC to 16 Hz and DC to 32 Hz user selectable Accuracy 1 mmHg or 3 exclusive of transducer whichever is greater Zero balance range 200 mmHg Transducer specifications Degree of protection against electric shock Drager Medical approved transducers with a resistance of 200 to 30000 and an equivalent pressure sensitivity of 5uV V mmHg 10 Type CF Defibrillation protection per IEC 601 2 34 Cardiac Output Parameter display Cardiac output Blood Temperature Injectate Temperature Measuring method Thermodilution Measuring range Cardiac output 0 5 to 20 l min Blood temperature 25 to 43 C 77 F to 109 F Injectate temperature 5 C to 30 C 23 F to 86 F Cardiac output 5 with 0 C in
109. 400 00 mg Volume 200 Conc 1 60 mcg ml Dose 78 00 mg hr 16 00 Duration 1 00 hr Total Dose 78 00 mg Total Volume 200 Numbered labels Untitled 1 4 on the Drug Dosage setup menu are reserved for drugs specific to the current patient or monitoring session while default drugs are listed simply as Untitled After you have assigned a drug on the Drug Dosage menu you can enter its infusion parameters perform calculations and view a titration table using the Drug Calculator menu When you assign a drug to the Drug Dosage menu its name automatically appears on the Drug Calculator menu where you can quickly calculate a new infusion rate see page 14 9 VISTA XL VF7 DRUG CALCULATIONS Drug Calculator Setup The following table summarizes tasks you can perform using the Drug Calculations function Drug Calculation Task Menu Initial Step Patient Specific Drugs Slots 1 4 Calculate a drug Drug Dosage New Drug Default Drugs Unnumbered slots 5 40 Assign a default drug Unit Manager Drug List Setup Enter amount volume and dose units for default Unit Manager Drug List Setup drug Assigning Drugs After you assign a drug its name appears on both the Drug Dosage menu and the Drug Calculator menu To assign a drug 1 Press the Fast Access fixed key The Fast Access menu appears 2 Click on Drug Dosage Click on New Drug to display drug or drug fields 4 Cl
110. 59 x 1 2 in Weight 35 g lt 1 2 02 Connections NeoMed Pod interface cable Mounting 16 mm thread x 1 mm pitch Sensor type Galvanic fuel cell partial pressure Useful life Approximately 1 year Note This sensor contains lead and caustic material Dispose of or recycle properly and in accordance with local regulations Environmental Requirements Temperature range Operating 10 C to 40 C 50 F to 104 F Storage 10 C to 50 C 14 F to 122 F Relative humidity Operating 20 to 90 non condensing Storage 10 to 95 with packaging Atm pressure 600 to 900 mmHg 80 to 120 kPa Monitoring Specifications WARNING The following parameters are not monitored in neonatal mode arrhythmia sidestream cardiac output and ST ECG Display Up to 8 leads Available leads Adult and Pediatric regular with TruST OFF I aVR aVL aVF V V V1 V6 aVR aVL aVF V only with 5 lead set V only with 6 lead set Adult and Pediatric I Il aVR aVL aVF V2 V5 dV4 dV6 with TruST ON Note TruST leads are indicated by a prefix d before the V lead Neonatal I aVR aVL aVF V V aVR aVL aVF V only with 5 lead set V only with 6 lead set Measuring range 15 300 1 min VF7 VISTA XL B 15 2 1 min
111. AC Mains frequency 50 60 Hz nominal Power consumption 2A 100 Vac 1A 9 240Vac max fully loaded Protection class Class per IEC 601 1 Environmental Requirements Operating 10 C to 40 C 50 F to 104 Temperature range Storage 40 C to 85 C 6 F to 185 Operating 20 to 90 non condensing Storage 10 to 95 with packaging Operating 525 to 795 mmHg 70 to 106 kPa Atmospheric pressure Storage 375 to 795 mmHg 50 to 106 kPa Regulatory Approvals UL 544 IEC 601 1 This device bears the CE label in accordance with the provisions of the Directive 89 336 EEC of May 3 1989 concerning electromagnetic compatibility Modified by Council Directive 91 263 EEC 92 31 EEC and 93 68 EEC Relative humidity R50 N Infinity Recorder Physical Attributes Size H x W x D 180 x 120 x 222 mm 7 1 x 4 72 x 8 74 in Weight 1 64 kg 3 6 Ib AC Power Connector X14 Infinity Network X7 R50 Recorder Potential Equalization Connector Connections B 10 VISTA XL VF7 Cooling Convection Type Transportable equipment Electrical Specifications Input voltage range 100 240 VRMS Mains frequency 50 60 Hz Power consumption 1 0 A max Protection class Class Chassis leakage current lt 300 120 lt 500 pA 220VAC Mode of operation Continuous Protection against water ing
112. Drager medical A Drager and Siemens Company Infinity Modular Monitoring Series Infinity Vista XL Instructions for Use WARNING For a full understanding of the performance characteristics of this device the user should carefully read this manual before use of the device Manufactured by Draeger Medical Systems Inc 3135 Quarry Road Telford PA 18969 Infinity Vista XL Instructions for Use Software VF7 Medical Systems Inc 2007 All rights reserved Printed in the United States of America This device bears the label in accordance with the provisions of the C 5 Directive 93 42 of 14 June 1993 concerning medical devices this label is not applicable for US devices Distributed By Drager Medical AG amp Co KG Moislinger Allee 53 55 D 23558 L beck Germany Dr ger reserves the right to modify the design and specifications contained herein without prior notice Please contact your local Dr ger Sales Representative for the most current information Reproduction in any manner in whole or in part in English or in any other languages except for brief excerpts in reviews and scientific papers is prohibited witout prior written permission of Dr ger Medical AG amp Co KG All Dr ger devices are intended for use by trained medical personnel only CAUTION In the United States Federal Law restricts these devices to sale by or on order of a physician Before
113. EiDbIndlcebmeE 15 ST and Arrhythmia 15 Alarm History Table 2 etre reete ciens ee reset centes oee 15 Anesthesia a iii citer SNR VR RCM 16 Overview You can configure the monitor to display alarm limits parameter thresholds which if violated trigger an alarm Limits are displayed both on the alarm limits table and in parameter boxes where visual or audible alarms alert you to limit violations Depending on the alarm condition the monitor announces alarms using one or more of the following indicators e Audible tones that reflect the severity of the alarm e Color changes in the parameter box of the alarm parameter e Alarm messages in the local message area External alarm devices such as a nurse call system e Activation of an alarm recording The monitor issues alarms for parameters turned ON in the Alarm Limits table see page 5 5 It is not a prerequisite for the parameter to be on display or connected for a parameter to alarm The monitor does not alarm for Injectate Temperature IT Paced beats 90 Paced or Cerebral Perfusion Pressure CPP or N2O Networked Alarms The network can broadcast alarm messages to any monitor or central station within the network In the Infinity network you can also group monitors into separate alarm groups to limit the number of messages posted at a given device see
114. G Arrhythmia Setup Table When the monitor is operating in Full arrhythmia mode the ARR Setup table allows you to configure arrhythmia monitoring according to your patient s needs The monitor can detect all events listed in the first column of the table Using the remaining columns you can modify the attributes of each event Fields that are not applicable for a certain event category are blank while those that cannot be modified are ghosted NOTE The PVC min limit is set in the Alarm Limits table The PVC min current value is only displayed if the monitor is in Full arrhythmia mode Refer to Chapter 5 Alarms for more information on setting alarm limits To access the ARR Setup table e Click on the ECG parameter box on the main screen or 1 Press the Alarm Limits fixed key 9 6 VISTA XL VF7 ARRHYTHMIA SETUP 2 Click on ARR at the bottom right of the Alarm Limits table The Arrhythmia Setup menu appears 7 Archive Str Rec Str Rec Str Rec 6 Str Rec OFF Record OFF OFF OFF ARR Monitoring Set rate and count Store or record events alarms Arrhythmia mode settings Set arrhythmia mode Click on arrow to access second page List of parameters Manual relearn 5o N Configure alarms Modifying Arrhythmia Functions 1 Access the ARR setup table see page 9 6 2 Scroll to the parameter whose arrhythmia functions you
115. IRATION 5 Press knob and Event Recall menu for this event displays 11 16 NOTE If event cannot be viewed error tone will sound and Event Data Not Available will display For more information on the Event Recall screen see p 1 29 If you have difficulty displaying the trigger event with the cursor set the time interval scale to a shorter time interval see p 11 14 If cursor is not overlapping an event pressing the rotary knob cancels cursor mode VISTA XL VF7 OCRG MONITORING Quick Reference Table OCRG Review Summary The OCRG Review Summary Menu Menu Item Description Settings Left Paging button Scrolls left through OCRG N A Double Arrows Review Summary data without blanking data Right Paging Scrolls right through OCRG N A button Review Summary data Double Arrows without blanking data Horizontal Scroll Turning the knob moves N A Bar horizontal boxcar within scroll window This updates the Time bar blanking data Pressing knob after time bar update restores review screen data Hours Changes time interval for data 1 min on OCRG Summary screen min Press knob to select Hours button Turn knob to select 4min time interval setting 6 min Press knob again for new time 12 min interval data to display 24 min Displays Cursor and Cursor date time Turning knob moves cursor When cursor rests on an event pres
116. OR Mode at the end of the countdown period alarm silence or alarm off if the alarm condition is still active the parameter box will flash and an appropriate SER LT or ADV reminder tone at 5096 volume sounds every 30 sec OFF There is no reminder tone when Alarm Volume is turned OFF SpO Alarm Delay Validates an SpO alarm condition by requiring that violation persist for 10 seconds lower limit before sounding an alarm Note Alarm validation must be turned ON ON SpO or PLS lower limit alarm condition annunciated after it persists for a period of 10 seconds OFF SpOe PLS lower limit alarm condition is not validated before annunciation The Code Setup Submenu This menu allows the unit manager to configure the monitor for quick emergency response Open the Unit Manager menu page 2 13 click on Code Setup then select and execute functions as described in this table For more information see page 5 4 Continuous Note If no recorder is Yes Allows continuous Record available the recording recording when you press the request remains pending for Code key on the remote later printing The default keypad setting is Yes No No recording can be initiated when Code key is pressed VF7 VISTA XL SPECIALTY MENUS 2 15 2 MONITOR SETUP The Unit Manager Menu parameter box before requesting NBP measurements The default setting i
117. PNOSTAT sensor to the bedding or to the patient s bedclothing 15 Make sure the sensor cabling and nasal cannula tubing are secured and out of the patient s way NOTE Always position the airway adapter vertically to prevent patient secretions from obscuring the adapter windows Display Features The monitor reports data as waveforms and parameter values Current parameter values appear in the etCO parameter box For information on displaying trended values see Chapter 6 Trends VF7 VISTA XL 16 5 16 2 END TIDAL CO2 MONITORING Parameters The etCO parameter box displays the following parameters and their current values End tidal value Highest Inspired value Minimum average the airway average value of the airway during expiratory period over the inspiratory period Upper alarm limit Respiration rate Lower alarm limit Respiration icon blinks with each breath Disabled alarm icon WARNING EtCO alarms do not activate until the first breath is detected after turning on the monitor or discharging a patient 16 6 VISTA XL VF7 DISPLAY FEATURES Capnograms The monitor also displays an instantaneous CO reading as a waveform or capnogram A typical capnogram is shown below 1 Expiratory plateau level of CO2 in lungs ceases to increase significantly 2 End tidal concentration point end of expiration phas
118. Pa High 160 mmHg 21 kPa M Adult Pediatric Low 60 mmHg D Adult Pediatric Low 50 mmHg 07 kPa High 110 mmHg 15kPa S Neonatal Low 50mmHg 07 kPa High 120 mmHg 16 kPa M Neonatal Low 40 mmHg 05 kPa High 85 mmHg 11 3kPa D Neonatal Low 35 mmHg 4 6 kPa High 80 mmHg 11 kPa 5 8 VISTA XL VF7 ALARM SETUP ALARM LIMITS TABLE Defaul Default Alarm Parameter Predefined Alarm Range t State Setting HR 20 to 300 beats per minute On Adult Low 45 bpm High 120 bpm Pediatric Low 50 bpm High 150 bpm Neonatal Low 80 bpm High 170 bpm 2 to 10 mmHg 0 3 to 1 3 kPa Off High 4 mmHg 0 5 upper limit only kPa upper limit only ICP 25 to 300 mmHg 3 to 40 kPa Off Low 02mmHg 0 26 kPa High 20 mmHg 03 kPa LA 5 to 300 mmHg 0 6 to 40 kPa Off Low 00 mmHg 00 kPa High 20 mmHg 03 kPa LV S M D 5 to 300 mmHg 0 6 to 40 kPa Off S Low 75 mmHg 10 kPa High 160 mmHg 21 kPa M Low 40 mmHg 05 kPa High 80 mmHg 11 kPa D Low 02 mmHg 0 26kPa High 25 mmHg 03 kPa VF7 VISTA XL 5 9 Defaul Default Alarm t State Setting NBP S M D Adult 10 to 250 mmHg Off S Adult 1 5 to 33 3 kPa Low 90mmHg 12 Pediatric 10 to 170 mmHg kPa 1 5 to 23 kPa High 160 mmHg Neonatal 10 to 130 mmHg 21 kPa 1 5 to 17 kPa M Adult Low 60 mmHg 08 kPa High 125 mmHg 17 kPa D Adult Low 50 mmHg 07 kPa
119. Pediatric 180mmHg Heart rate 30 240 bpm Systolic NBP 30 170 mmHg Mean NBP 20 150 mmHg Diastolic NBP 10 130 mmHg Measuring range Neonatal 140mmHg Heart rate 30 240 bpm Systolic NBP 30 130 mmHg Mean 20 110 mmHg Diastolic NBP 10 100 mmHg VF7 VISTA XL MONITORING SPECIFICATIONS B 17 Connections Quick release hose connector with single airway Default inflation pressure Adult 270 160 mmHg 10mmHg Pediatric 180 120 mmHg 10 mmHg Neonatal 140 110 mmHg 10 mmHg Inflation pressure after a Adult 270 Previous NBPsys 25 mmHg valid measurement Pediatric 180 Previous NBPsvs 25 mmHg 10 mmHg Neonatal C140 Previous NBPsyg 30 mmHg Inflation pressure Adult 270 160 mmHg 10 mmHg after an alarm Pediatric 180 120 mmHg 10 mmHg Neonatal 140 110 mmHg 10 mmHg Maximum inflation Adult 270 265 mmHg 5 mmHg pressure Pediatric 180 180 mmHg 10 mmHg Neonatal 140 142 mmHg 10 mmHg Minimum inflation Adult 270 110 mmHg 10 mmHg pressure Pediatric 180 90 mmHg 10 mmHg Neonatal 140 70 mmHg 10 mmHg Maximum measurement Adult 270 2 min 1 sec time Pediatric 180 2 min 1 sec Neonatal 140 90 sec 1 sec 60s French homologation Maximum measurement Adult 270 3 min 1 sec time including a retry Pediatric 180 3 min 1 sec Neonatal 140 90 sec 1 sec 60s French homologation Software safety cut off Adult 270 273
120. Pediatric or 140 mmHg Neonatal Cuff deflates automatically NBP Out of Values are reported but are No action is required Range out of specified range NBP Cuff pressure is over 270 Check the patient and treat if Overpressure mmHg Adult 180 necessary Check cuff for obstructions Retry the measurement NBP Retrying Monitor failed to detect sufficient pulsations aborted measurement and started a new one No action is required NBP Overpressure Circuit Failure Cuff overpressure circuit has failed Call Biomed or Medical Technical Support VF7 VISTA XL 12 13 12 NON INVASIVE BLOOD PRESSURE This page intentionally left blank 12 14 VISTA XL VF7 Chapter 13 Invasive Blood Pressure 9j n 2 3 Hardware 1 4 ESL 4 Transducels onustus MIN III I ML INL 4 rupi A 7 IBP 7 Display F atures p 8 IBP SetU 10 Quick Reference IBP Setup mannna nna 11 Labeling Pressure
121. Pod The pod reference resistance is Remove and reconnect the Fault either too high or too low Hemo pod Repeat the Bad Ref measurement If message persists replace the pod and contact Dr ger Medical Technical Support C O The catheter reference Check the catheter and Catheter resistance is too low replace if defective Fault Bad Unknown catheter type Contact Biomed or Dr ger Ref Medical Technical Support C O Check Injectate temperature probe not Connect the probe and Injectate connected or disconnected repeat the measurement Probe during a measurement VF7 VISTA XL 20 15 20 CARDIAC OUTPUT This page intentionally left blank 20 16 VISTA XL VF7 Chapter 21 Cleaning and Disinfecting eji em 2 Monitor and Peripheral Devices 2 ILTRICIES H 3 53 3 Reusable ECG Electrodes esee 3 ESU BIOCK qe 4 4 4 Ich A 4 HemoMed Transducer
122. R50 Recorders and Recorder Cables eese C 6 Vista XL Monitor OptiOns enne riore onere toten ice neue E Een ese peg ced C 6 decem 7 and NeoMed Pods 22 1111 7 ECO Leads 8 Pulse Oximetry 2 irren cree nere 10 Drager Sensors eerie euet antep lene C 10 Masimo Sensors RNN nonne ce C 10 Nellcor Sensors 2 2 2 1 1 40 00 ener eco rn Senda C 11 amp RENE C 11 erre M C 11 5 2 m P C 12 Temperature 2 2 AE C 12 Core Probes E C 12 Elide qe C 12 Non Invasive Blood Pressure C 13 abge rp 13 Connecting 13 Invasive Blood Pressure C 13 Vista XL IBP Options em 13 Hemodynamic Pods ccce eene eere rennen renidet trn nr anne C
123. RK APPLICATIONS Wireless Mode NOTE Wireless networking is a locked option Contact your biomed for more information To access wireless settings for the monitor Press the Menu fixed key Click on Admit Discharge Click on Wireless Click on Care Unit to select from a list of available care units Click on Exit to return to the Wireless menu 9v pao P9 Click on Bed Label to select from a list of available beds NOTE Bed Label selection is ghosted until a valid care unit is selected Wireless During DirectNet mode To change the monitor to wireless mode consult your Biomed or service and installation documentation 2 When the wireless mode is active an icon appears with the date time icon to reflect signal strength The icon and the date time icon alternate with other secondary messages in the network messaging area There are five different signal strength icons H P1 P2 D z0 1 25 z 26 50 251 75 76 100 VISTA XL VF7 WIRELESS NETWORK Y Wireless Monitor AP z Access Point MVWS Infinity CentralStation If a wireless monitor loses contact with all access points and wireless transmission is interrupted i e you remove the wireless card or the monitor is out of range the network generates an offline message and the monitor operates as a standalone device If a wireless monitor regains contact with any access point i e you
124. Room temperature pressure 23 C 3and ambient barometric pressure B 24 VISTA XL VF7 MONITORING SPECIFICATIONS Temperature Absolute temperature delta temperature with HemoMed pod Absolute 5 C to 50 C 23 F to 122 F Delta 0 C to 55 C 32F to 131 Parameter display Measuring range Resolution 0 1 C Absolute 0 1 C Accuracy Delta 0 2 C Average Response Time lt 2 5 seconds Probe Accuracy 0 1 C OT to 50 C Degree of protection Type CF against electric shock Defibrillation protection In accordance with IEC 601 1A2 Note Range and accuracy values are also applicable to HemoMed pod VF7 VISTA XL 25 VISTA XL Approved Options and Accessories Power 50 C 3 C 3 Power Adapters C 3 Grounding Cable a C 3 Mounting DE EU C 4 External Battery eiue dietis aei C 4 Internal Battery o eee dee este C 4 Mm 4 External Connection C 5 Remote Keypad AENA e C 5 Network Patch Cables D Ca RUN Tro cu tenet 5
125. SO and ST Points When you change the ST and ISO measuring points on the Measuring Points screen the monitor recomputes the ST deviation value accordingly see page 10 6 for directions on changing the ST and ISO points During this procedure the changing ST deviation values are displayed in yellow beneath the current values which appear in green At the bottom of the screen the placement of the ISO measuring point in milliseconds before QRS onset is displayed next to the label ISO while the placement of the ST measuring point in milliseconds after QRS offset is displayed next to the label ST NOTE tis good clinical practice to check the position of the isoelectric and ST measuring points before starting ST monitoring After a Relearn is complete the QRS onset and offset are locked until you initiate another Relearn On all trend displays markers indicate changes in the placement of measuring points as well as Relearn operations The labels CHG Change and LRN Relearn appear in time stamped columns in the Trend Table and in the ST Trend Graphs Also in the Trend Graphs a solid white vertical line in the ST trend graphs marks the time of a VF7 VISTA XL 10 5 10 ST MONITORING measuring point change while a dotted vertical line marks the time a Relearn operation was initiated Use the cursor to pinpoint the time of marked changes and Relearn operations see page 6 4 for instructions on using the cursor in trend graphs
126. Scio Four plus only 18 26 Maintenance and 18 26 Status MESSAGES cao vccc te Dm 18 29 CHAPTER 19 Body Temperature OV ON VI OW 19 2 Temperature Display 19 3 me 19 4 ESU and Defibrillator 19 4 SATUS 222 321 T 19 5 CHAPTER 20 Cardiac Output OV ON VIG 20 2 PAOCCUTACV oa 20 3 Main Screen Display 20 4 SOUP c 20 5 HardWare Lt 20 5 C O Set p Ment me 20 5 Quick Reference 20 5 Measurement 20 6 Catheters Comp Constant 2422222222 22 2 2 20 7 C O Measurement
127. SpO2 Intended JSe 15 2 Sid ee 15 3 15 3 Patient 15 5 Display Features ciere cire ee rr err nain nennen unis 15 7 SPO2 Setup m 15 8 Quick Reference Table SpO2 15 8 MCSSAGES E 15 9 SpO2 de m 15 12 oe RES 15 12 VISTA XL VF7 INFINITY VISTA XL USER S GUIDE Parameters icisscveccicessecssnecceseccncvedecuveusnasteceniteeteedscndcaceenseececnieesvaveredsauddesseeceer teenies 15 12 SpO2 MicrO2 Setup 15 12 SpO2 2 Trends 15 13 seein eee cise teense 15 14 15 15 CHAPTER 16 etCO2 End Tidal CO2 Monitoring eas 16 2 Sampling Methods niae tui e ea uae aua ER nma 16 3 Mal NStre aim m 16 3 Sidestream Adult and Pediatric Patients
128. The following table illustrates the function of the battery charge bar graph at the top of the screen NOTE When power is disconnected the battery charge display can take up to 15 seconds to reflect actual internal battery capacity and up to 60 seconds to reflect actual external battery capacity VISTA XL VF7 SOURCES Battery Charge Display Display Charge Action Battery in use is fully charged N A Internal 100 mam Battery in use is half full Connect AC adapter External 50 External battery is very low lt Replace with fully charged External 25 external battery External battery is depleted Replace with fully charged External 0 external battery Internal battery is very low Immediately connect monitor to Internal lt 25 AC adapter Replace external battery Internal battery is depleted lt 5 Internal o minutes of power remaining LITT 1 sounds single attention tone Monitor sounds attention tone every 5 seconds WARNING Actual time available on the internal battery can be significantly reduced with worn out or defective batteries The Internal Battery Percentage value on the Battery Status screen is accurate only if the batteries are in normal working condition CAUTION VF7 DO NOT use the monitor for transport if the internal battery charge is at 2596 or less unless you are using a fully charged external batter
129. Third Channel Label esee eene ennt 18 Time BaSe M 18 19 Status 5 ae a AEE AA ea 20 11 RESPIRATION Overview 11 2 The monitor measures impedance respiration by passing a harmless high frequency current between two ECG electrodes on the patient s chest Electrical resistance impedance between the electrodes varies with the chest s expansion and contraction during inspiration and expiration You can derive a respiration waveform and rate from these impedance changes The monitor can use ECG leads I or II for breath detection regardless of the lead selected for QRS processing The measurement range for impedance respiration monitoring is 0 to 155 breaths per minute The range for alarm settings is 5 to 150 breaths per minute In neonatal and pediatric mode the monitor can detect central apnea WARNING This device does not monitor obstructive apnea Using the appropriate accessories you can also monitor heart rate and SpO and display associated values on an oxycardiorespirogram See page 11 10 for more information VISTA XL VF7 RESP PRECAUTIONS RESP Precautions VF7 WARNING For general safety precautions regarding electrosurgery see Safety Considerations on page VII of this Instructions f
130. Waveform and breath detection threshold Current upper and lower threshold settings are bracketed on the scale bar 5 100 in 5 increments VF7 VISTA XL 11 RESPIRATION The Respiration Setup Menu Menu Item Description Settings RESP Superimposes a vertical line marker on RESP waveform when OFF monitor detects a breath Note The monitor may display the RESP marker in cases of A artifact or other interference Cautions set breath detection _ RESP markers are not transmitted thresholds so that only valid over the network and do not appear breaths are counted on remote views or recordings 1 Set the mode to Manual RESP marker indicates the 2 Enable RESP Marker time of breath detection not the 3 Click on Size beginning or end of respiration 4 Set the Size value at the lowest value where the RESP marker appears Coincidence Identifies respiration rate which ON Monitor displays message Detect lies within 20 of the heart RESP Coincidence whenever rate indicating that the monitor respiration heart rate coincidence is may be counting heart beats detected default for Neonatal as respiration patient monitoring A OFF Monitor does not detect Caution Respiration respiration heart rate coincidence heart rate coincidence could default for Adult and Pediatric mask an apnea condition patient monitoring Note Enable res
131. able OR Menu OR Function Description Settings The OR Menu OR Activates OR menu ON OR functions are functions enabled Note This function is alocked OFF The monitor reverts to option It is installed at the normal functions time of purchase from Cardiac Bypass and NBP perioperative care unit or it Chime are ghosted can be installed locally by Dr ger Service or local Biomed Cardiac Bypass Configures monitor for use ON Suspends all patient during cardiac surgery monitoring alarms NBP interval measurements and arrhythmia detection OFF The monitor reverts to normal functions VF7 VISTA XL 2 11 OR Function Description Settings NBP Chime Enables and disables attention tone for NBP measurements For more information see Chapter 12 Non Invasive Blood Pressure ON Monitor sounds an attention tone when NBP measurement is complete OFF No tone sounds when you complete an NBP measurement Alarm Volume Large IBP Mean Display Sets alarm volume Note Minimum setting is OFF if OR is enabled or if monitor is connected to a central station Minimum setting is 1096 if OR is disabled Determines the relative size of the mean pressure value in invasive pressure parameter boxes 20 100 in increments of 10 OFF or 1096 ON Enlarges mean IBP display OFF Reduces mean IBP display to match systoli
132. able 5597898 sensor cell with O ring 9004979 16 VISTA XL VF7 MultiGas Monitoring MULTIGAS MONITORING Scio Four Gas Modules Scio Four Oxi plus Module Scio Four Oxi Module Scio Four plus Module Scio Four Module Power supply MultiGas Accessories Water Trap disposable 30 pcs Disposable water trap to capture bulk fluids For use with sampling line 8290286 External airway filter 10 pcs 0 8 m airway filter Sample Gas Return Kit Scio Four Accessories Water Trap Set of 12 Sample line Set of 10 Scio Connecting Cables Scio direct connect cable X8 1 8m Cable to connect Scio Module to Vista XL X8 connector Scio Y cable X8 X3 Cable to connect Scio Masimo SET SpO SmartPod VF7 VISTA XL 6871801 6871803 6871802 6871804 5953539 or MS18508 MS13826 1276695 M32692 6870567 8290286 6871581 MS16989 These Instructions for Use only apply to Infinity Vista XL VF7 with the Serial No If no Serial No has been filled in by Drager these Instructions for Use are provided for general information only and are not intended for use with any specific machine or device This document is provided for customer infor mation only and will not be updated or exchanged without customer request Directive 93 42 EEC for medical devices Manufactured by Draeger Medical Systems Inc 3135 Quarry Road Telford PA 18969 U S A 4 215 721 5400 800
133. access the parameter menu as follows 1 Press the Menu fixed key to display the Main Menu 2 Click on Patient Setup 3 Click on Parameters 4 Scroll to the desired parameter and click 4 Click on Zero Simultaneous Smart Zero 3 b Press the key on the hemomeddynamic pod you wish to zero The monitor determines which of the pod s transducers are open to air and then zeroes them Note If you use this step 3 b and are unable to zero a particular IBP with the key use the associated parameter box as described in 3 a This method can be more effective Note If the procedure is successful the monitor displays the message IBP zero accepted If the procedure fails the monitor displays the message lt gt did not zero Check the waveform If spikes exceed three millimeters repeat the procedure If procedure fails after two attempts replace the transducer or consult your Biomed WARNING In the rare circumstance that a pressure waveform is nearly static flat do not use the Smart Zero function otherwise inaccurate measurement readings and misdiagnosis may result If this is the case open all stopcocks to air before pressing the key Calibration Procedures Calibration procedures differ depending on whether you are using a disposable single use or reusable transducer You do not need to calibrate disposable transducers which are already calibrated at
134. ace cables if necessary during 3 5 or 6 lead If MultiMed pod is not in use press monitoring Alarm Silence fixed key 8 22 VISTA XL VF7 Chapter 9 Arrhythmia Monitoring jjj About the Arrhythmia Beat and Rhythm Classification eee eene nennen nnns Automatic Learning and Relearning eese eere Arrhythmia Setup E Modes Full Basic OFF 2 AANER Channel Lead Selection Arrhythmia Setup Status gt 9 ARRHYTHMIA MONITORING Overview Arrhythmia monitoring is available for adult and pediatric patients The mode you select Full Basic or OFF determines the events processed Full arrhythmia is a locked option which must be activated by your Biomed Arrhythmia monitoring is not available for neonates The monitor matches incoming beats against beats previously recorded and stored in a reference template Through this process the monitor can verify an arrhythmia event s occurren
135. age 2 16 for more information Alarm Control Many alarm functions including alarm suspension validation and the display of alarm limits can be configured only on the Alarm Control menu which in turn is accessible only via the password protected Unit Manager menu For a description of available functions on the Alarm Control menu see page 2 10 VISTA XL VF7 ALARM SETUP ALARM LIMITS TABLE Alarm Setup Alarm Limits Table The alarm limits table allows you to modify the alarm limits of multiple parameters in a single location The Alarm Limits Table displays values only if the associated parameter has been prioritized see page 2 6 or the associated monitoring device e g the NBP cuff is connected VF7 VISTA XL 5 5 e Press Alarm Limits fixed key The Alarm Limits table appears Alarm Upper Current Lower Archive 60 45 Str Rec 0 Str Rec Str Rec Str Rec Str Rec Str Rec Str Rec Str Rec Str Rec Set alarm limits Store and or record alarms Storage recording options Access Arrhythmia setup Access ST alarm limits Alarm volume On line help message Click on arrows to scroll up or down List of parameters Auto set O CO N 0 A O N Enable alarms 5 6 VISTA XL VF7 Upper and Lower Alarm Limits ALARM SETUP ALARM LIMITS TABLE Alarm limits should be set according to your
136. ailable recorders Click on the desired recorder Click on Secondary Recorder 10 Click on the desired recorder NOTE Recording Mode is a read only setting you cannot modify it manually Recorder names are assigned by service personnel when the Infinity Network is configured If your monitor and recorders not networked R50 Assign is ghosted To connect the R50 N recorder to the network and to a secondary recorder see the R50 N Installation Instructions Replacing Recorder Paper When the recorder is about to run out of paper a red line appears on the recording strip Replace the paper as soon as possible to ensure continued operation 7 10 To replace the recorder paper 1 2 3 4 en Open the paper door Pull out the paper roll from the spool holder Remove any paper remaining in the printing mechanism Place the new paper roll into the spool holder Unroll a few inches of paper from the bottom The printed side should be facing up Align the paper roll with paper guides If not aligned paper could jam Close the paper door To verify positive results generate a timed recording see page 7 6 VISTA XL VF7 Reports If the monitor is connected to an Infinity network you can generate reports on a laser printer In addition to trends ECG and standard waveforms you can also print reports of events and conditions stored in the Event Recall database For more information see page 1
137. ain Menu features by configuring the following functions Menu Item Description Available Settings Split Screen Reserves a portion of the main Click on one of the following screen for display of trend OFF 60 Min Trends 10 Min Trends Display Options This submenu allows you to access and modify waveforms and other display Monitoring Determines waveform speed Click 6 25 12 5 25 or 50 Sweep Speed Higher sweep speed moves mm s waveform more quickly Respiratory Allows you to set monitoring Click on 6 25 12 5 25 or 50 Sweep Speed sweep speed for Respiration mm s waveform independently Pressure Displays up to 4 overlapping IBP Select ON to display IBP Overlap waveforms in single oversized waveforms in overlapping channel format Overlapped waveforms sharea Select OFF to cancel display common zero point but each of waveforms in overlapping retains original scale format configuration see page 13 11 Pressure Displays pressure waveforms Click on 5 10 15 20 25 30 Common with a common scale making it 40 50 75 100 150 200 250 Scale easier to compare them 300 mmHg or OFF Monitor Sets brightness of monitor Click on Auto ambient light Brightness 20 40 60 80 or 100 SC 9015 Sets brightness of SC 9015 Brightness Help Line Shows contextual help line at Select ON to display help Display bottom of menu Select OFF
138. al ccepted zeroing in room air required completed Adapter Airway adapter cal Make sure the adapter is properly Cal Failed zeroing in room air failed attached to the sensor and that its windows are clean If the problem persists try another adapter etCO Adapter Sidestream measurement Calibrate the new adapter Cal Required mode was initiated requiring air way adapter cal zeroing in room air to calibrate pump Tubing Sidestream tubing Clear blockage in the tubing Blocked obstructed or filter is Replace the module clogged Tubing Sidestream tubing has a Change the tubing Leak leak module Disconnected The module is not connected to the monitor Check cable and connection Replace cable if necessary module Incompatible Corrupt EEPROM Wrong software or hardware version Try anew module Consult your hospital s Biomed 16 16 VISTA XL 16 ETCO2 END TIDAL CO2 MONITORING VF7 Chapter 17 FiO Fractional Inspired Monitoring 5 WR CUN A E 2 3 3 ieri e 4 ACCeSS ioni
139. alarm conditions and arrhythmia events on the Event Recall screen You can view up to 50 stored events each containing 20 seconds of data with associated date and time stamps Events are stored on a first in first out basis When event storage is full the monitor deletes the oldest events to make room for new ones All stored events are deleted whenever you discharge a patient reset the monitor or temporarily lose power To access the Event Recall screen 1 Press the Fast Access fixed key 2 Click on Event Recall to display the Event Recall screen VF7 VISTA XL 1 19 1 INTRODUCTION Report Time of capture Parameter values at time of capture Print report Requests recording Saves Deletes events N View All displays all stored events Manual displays manually stored events Alarm displays alarm events only BRDY displays bradycardia events only Desat Neonatal only displays desaturation events only 7 Parameter display Prev displays previous set of 2 parameters Next displays next set of 2 parameters Parameter labels of displayed waveforms Waveform delay and speed 1 20 VISTA XL VF7 DATA ARCHIVE APPLICATIONS Navigating the Event Recall Screen To scroll forward and back through 20 seconds of waveform data click on arrows at either side of scroll bar at the bottom of the screen To scroll through the list of paramet
140. ameter box MultiGas Zero Manually zeroes the Scio module N A Note During zeroing the monitor temporarily blanks Scio parameter values Auto Zero Delays automatic zeroing for 5 minutes N A Delay for uninterrupted monitoring WARNING Delaying the auto zero may inpact the accuracy of the device Note Gas sensors in the Scio module are automatically zeroed and calibrated against room air During zeroing the monitor temporarily blanks Scio parameter values One minute before automatic zeroing the monitor sounds an attention tone and displays the message Auto zero in 1 minute Agent Alarms Accesses Agent alarms in Alarm Limits table see this Instructions for Use Chapter 5 VF7 VISTA XL 18 23 18 Scio FouR MODULES Combined Display O2 Agent N2O Scio Four Oxi plus only The and Agent parameters can be combined to share a single waveform channel and MultiGas parameter box Typical combined MultiGas parameter boxes are shown below Parameter Box Description The Scio module has identified an 02 150 N20 agent and displays concentration levels for Os isoflurane and 35 1 5 64 33 1 3 58 To enable the combined MultiGas parameter box display 1 Open the Main Screen setup menu see page 2 2 2 Click on More to go to the Main Screen menu s second page 3 Select MultiGas Parameter click the knob to select ON NOTE You can als
141. ank 11 22 VISTA XL VF7 Chapter 12 Non Invasive Blood Pressure 2 Display Features P 2 ct E 3 Safety Considerations 3 Cuff Selection and 3 Setup Menu and Quick Reference Table cese 7 Taking enne nnnm nennen nnne nennen 8 Anto LEESI E I A E A 10 Stats MCSSAGCS ia Aeae ean atest 11 12 NON INVASIVE BLOOD PRESSURE Overview The monitor can acquire and process non invasive blood pressure NBP signals and display the results Blood pressure measurements are determined by the oscillometric method and are equivalent to those obtained by intra arterial methods within the limits prescribed by the Association for Advancement of Medical Instrumentation Electronic Automated Sphygmomanometers AAMI ANSI SP 10 The monitor s NBP system inflates and then deflates a pneumatic cuff wrapped around the patient s arm or leg A hose links the
142. anty status of any connection made to another manufacturer s equipment Electrosurgery WARNING e Keep ECG temperature pressure SpO transducers and intermediate cables off earth ground and away from ESU knife and return wires e Use only Dr ger blue ECG lead wires or the ESU block with conventional leads see page 8 7 They are designed to provide resistance to interference from the ESU and to protect the patient from burns caused by ESU induced current flowing through the leads e Impedance respiration monitoring and pacemaker spike detection are inoperative when you are using the ESU Block VF7 VISTA XL IX INFINITY VISTA XL USER S GUIDE NOTE Use or ART instead of the ECG parameter to determine heart rate Use rectal temperature probe sheaths to cover internally placed temperature sensors e Always use accessories designed for ESU environments VISTA XL VF7 INFINITY VISTA XL USER S GUIDE Electromagnetic Compatibility The monitor has been designed and tested for compliance with current regulatory standards EN55011 Class B and EN60601 1 2 regarding its capacity to reduce electromagnetic emissions EMI and to block EMI from external sources Drager Medical recommends these procedures to reduce electromagnetic interference e Use only Drager Medical provided accessories otherwise the correct functioning of the device may be compromised see Appendix C Approved Options and Accessorie
143. arameter box on the main screen or 1 Press the Menu fixed key on the monitor 2 Click on Patient Setup 3 Click on Parameters in the second column 4 Click on NBP The NBP menu appears The following table briefly describes functions available on the NBP menu Function Description Settings Interval Time Sets interval for series of single OFF 1 2 2 5 3 5 10 15 NBP measurements 20 25 30 45 60 120 240 min Venous Stasis Stops blood flow to lower part of OFF cuffed limb for a fixed time Continuous Initiates successive NBP OFF Mode measurements for 5 minutes ON Inflation Limit Sets threshold for maximum cuff Neonatal patient category inflation initial inflation will be 140mmHg less Pediatric patient category Pediatric 180mmHg Neonatal 140mmHg CAUTION A blood Adult patient category pressure systolic value Adult 270 mmHg higher than the inflation Pediatric 180mmHg range may trigger an NBP Neonatal 140mmHg low inflation limit Note User can select message In this case inflation limit equal to or manually check the lower than the patient patient s blood pressure category selected and select the next higher See above No other inflation limit if parameter functions appropriate are effected VF7 VISTA XL 12 7 12 NON INVASIVE BLOOD PRESSURE Function Description Settings Calibrate Mode Configures
144. are displayed or not It is not a prerequisite for the parameter to be on display or connected for a parameter to alarm e Turning an alarm OFF prevents those parameters from alarming 4 Choose the new setting and click to confirm your selection 5 Repeat steps 2 4 for each change VF7 VISTA XL 5 13 Quick Reference Alarm Limits Table Setup Alarm Limits Table Function Description Available Settings Auto Set Sets alarm limits based on current N A values Paramet Upper Lower Limit ee ers Limit monitor recalculates the Ta 1 lt 107 of lt 93 of upper and lower alarm limits current current based on the parameter value value values in the Current column 1 No change change Auto Set applies to all 9 9 displayed parameters and ST 5 Adults 100 Current parameters only SpO2 Neonates value If a calculated limit value falls 98 value x outside the range for that 5 parameter the parameter s larm limits will remain ASpOo Current None ie unchanged 20 ST Current Current value 2 0 value mm 2 0 mm MultiGas 100 21 02 All lt 120 of lt 80 of Others current current value value Alarms Enables or disables the alarm function ON for the selected parameter Alarm off icon Upper Determines upper alarm limit Settings are parameter specific Current Read only cannot be mo
145. arity of these waveforms the monitor may classify such types of ventricular tachycardia as ventricular fibrillation the more serious of the two conditions 2 N is the event count set in the Arrhythmia setup table s count column PVC or other abnormal beat breaks the analysis sequence and restarts analysis Automatic Learning and Relearning After you connect ECG cables to the patient the monitor begins to learn a reference template whenever you execute any of the following tasks e Turn on the monitor e Exit Standby mode e Click on ARR Monitoring or QRS ARR Select e Change the top channel lead ECG 1 or change the ECG2 channel lead during ECGI amp 2 processing Arrhythmia Setup Modes Full Basic OFF You can configure the monitor to process arrhythmia according to the number and variety of events you wish to observe 1 Click on the ECG parameter box to display the ECG menu 2 Click on ARR Monitoring WARNING When HR Alarm is OFF and ARR monitoring is OFF ASY VF alarms do not sound unless reset manually by the user 3 Scroll through the available settings Basic Full or OFF and click to verify your selection NOTE f Full monitoring is installed as a locked option you can select Full Basic or OFF If not the choices are Basic and OFF 4 As shown in following table the monitor reports certain arrhythmia events even if you set ARR Monitoring to OFF Basic arrhythmia mo
146. arms OFF personnel can use the All Di faul Note This Alarms Off fixed key to extend VF7 VISTA XL 2 13 2 MONITOR SETUP The Unit Manager Menu Alarm Validation is ON the time to alarm from the onset of a limit violation will equal the time for detection the designated Alarm Validation signal delay For HR this time may exceed AAMI EC13 requirement of a maximum of delaying time to alarm Alarm validation times are Upper Lower HR 6 sec 6 sec RESP 14sec 14sec IBP 4 sec 10 sec Sp0 6sec 10sec PLS 6sec 10sec 50 4sec 4sec PLS 4sec immediately AllOther Parameters immediately See SpO2 Alarm Delay Menu Item Description Available Settings Alarm Validates alarm conditions to ON Enables Alarm Validation limit nuisance alarms due to Validation Note When artifact or motion movement by OFF Disables Alarm Validation 10 seconds SpO Alarm Validates an alarm ON or PLS lower limit Delay condition by requiring that alarm condition annunciated violation persist for 10 seconds after it persists for a period of lower limit before sounding an 10 seconds alarm 2 TE OFF SpOe PLS lower limit EE validation must be alarm condition is not validated before annunciation ASY VF Alarms Allows user to prevent disabling Always ON ASY and of ASY and VFIB alarms alarms a
147. ase The default time base is three minutes To change the OCRG time base to six minutes 1 Click the Setup button on the OCRG screen 2 Click Time Base 3 Click on 6 min 11 18 VISTA XL VF7 OCRG MONITORING 4 Enter clinical password NOTE e The clinical password menu has no time out It will stay active until the user clicks Accept e After the clinical password is entered the new OCRG Time Base takes effect and is displayed on the lower left of the OCRG menu Recordings The monitor prints OxyCRG alarm and manual Timed recordings only when the oxycardiorespirogram is displayed If no recorder is connected the monitor stores OxyCRG alarm recordings for later printing For more information about manual and alarm recordings see Chapter 7 Recordings A typical OCRG recording follows 200 44 Jan 80 OCRG 150 100 1 bbHR Spo 9 cul REC177 100 75 re 05 10 1 1 I 1 72s 54s 36s 188 as Respiration waveform Oxygenation data or tpO2 tpO2 bbHR data VF7 VISTA XL 11 19 11 RESPIRATION Status Messages Message Possible Cause Suggested Action RESP gt The respiration rate is Check the patient and treat if above the upper alarm necessary limit Check the placement of electrodes Change their position if necessary Move
148. ate 1 0 0 5 where A F corresponds to 10 15 HR Source num ECG is HR Source IBP AP is HR Source SpO gt is HR Source VF7 VISTA XL 7 5 7 RECORDINGS Position Description Values Definition 16 RESP Mode Resp Monitoring M Manual A Automatic 17 RESP Size 1 K Value RESP Size 5 where A K corresponds to 10 20 18 19 minutes since breath 00 99 Number of minutes that have detector initialization elapsed since the breath detector was initialized where 99 corresponds to gt 99 minutes 20 Not Used lt Space gt N A 21 Monitor Model B Vista XL Infinity Telemetry 22 26 Software Version XXXX First 5 characters of base ASCII software i e VA1 1 Timed Timed recordings are strip recordings of a specified duration from 6 to 20 seconds They contain delay data that originated before the recording was initiated and real time data that was acquired after the recording started Alarm limit violations and arrhythmia events trigger a timed recording automatically if the recording and or alarm function has been enabled on the Alarm Limits table the ST Alarms menu or the Arrhythmia Setup menu see Chapter 5 Alarms To request a timed recording Press the Record fixed key the front of the monitor To cancel a timed recording e Press the Record fixed key again or the recorder 5 Stop fixed key Continuous Unlike timed recordi
149. aveforms resume their pre vious size and sweep speed PA systolic and diastolic values are restored and PA alarms are automatically enabled VISTA XL VF7 STATUS MESSAGES Status Messages Message Possible Cause Suggesied Action lt gt S lt gt Pressure value outside Check patient and take appropriate xx D alarm limits action lt gt Access the Alarm Limits menu and lt gt change the alarm limits lt gt Check equipment and replace if necessary xx Out Pressure signal out of Check patient and treat if necessary of measurement range Access the Pressure Labels menu high and assign the correct label 9 Check equipment and replace if necessary xx Out of Range Low lt XX gt The IBP zero stored Zero the transducer Please monitor may not Check correspond to the Zero peripheral device lt XX gt Static pressure detected Check patient and treat if necessary Static on a pulsatile signal Open the system to the patient by Pressure owing to turning the stopcock A physiological Follow hospital procedures for condition e g asystole dislodging catheters Transducer turned offto Follow hospital procedures for clotted the patient catheters A catheter tip lodged against a vessel wall A clot on the catheter tip xx Pressure transducer for Active pressure Reconnect or Unplugged specified parameter i
150. ble 2 Temperature probes 1 5 extension cable 1 sensor cable Pod includes mount for incubator NeoMed ECG adapter cable 5592162 1 5 m interface cable for connection of neonatal leads only not for OR use ECG ESU BLOCK 5 lead 5947226 Only for use during electrosurgery can use with 3 or 5 lead ECG lead sets ECG ESU BLOCK 6 lead 7486140 Only for use during electrosurgery can use with 3 5 or 6 lead ECG lead sets ECG electrodes disp 50 pcs 4527750 Adult pregelled not for ambulatory use Adapter pin neonatal ECG electrodes 10pcs 5194779 For connection of neonatal electrodes to the MULTIMED pod and ECG intermediate cables Neonatal ECG electrodes disposable 300 pcs 100 packages 5195024 of 3 electrodes VF7 VISTA XL 7 ECG Leads IEC Color Code 1 IEC1 is the European color scheme 3 lead RA red LL green LA yellow 5 lead RA red LL green LA yellow RL black V white 6 lead RA red LL green LA yellow RL black V white V gray amp white IEC Color Code 2 IEC2 is the AHA US color scheme 3 lead RA white LL red LA black 5 lead RA white LL red LA black RL green V brown 6 lead RA white LL red LA black RL green V brown V gray amp brown Note Unless otherwise specified all lead set lengths are 1 meter 1 m Standard ECG Leads and Lead Sets ECG 3 lead grabber set IEC1 5956433 ECG 5 lead grabber set IEC1 5956466 ECG 6 lead grabber set IEC1 5956482 ECG 3 lea
151. bt as to the identity of the accessories Hemo pod adapter Ohmeda 3375941 Adapter block to connect Ohmeda Abbott Medex pressure transducers to the HemoMed pod Two for each HemoMed pod Hemo pod adapter SensoNor Memscap 4329160 Adapter block with 7 pin shielded input connectors for HemoMed pod to provide connectivity with 7 pin pressure transducer cables including SensoNor 840 Two for each HemoMed pod Hemo pod adapter 10 pin 3375958 Adapter block to connect 10 pin connectors to HemoMed pod Two for each HemoMed pod IBP SensoNor Memscap Cables and Transducers IBP intermediate cable SensoNor 3 7m 4321563 14 VISTA XL VF7 CARDIAC OUTPUT Dome for SensoNor 840 50pcs 4529954 IBP set disp SensoNor 840 10pcs 4530226 Disposable monitoring kit for SensoNor 840 pressure transducers sterile IBP Transducer Plates IBP4 transducer plate 4721424 HemoMed pod transducer plate for IBP transducers fits most transducers IBP4 transducer plate Medex SensoNor 4721416 HemoMed pod transducer plate for Medex SensoNor transducers Hemo transducer plate Abbott Braun 5192112 For HemoMed pod Holds Abbott Braun transducers Hemo transducer plate Abbott Transpac IV 7270460 For HemoMed pod Holds Abbott Medex Transpac IV transducers Cardiac Output C O intermediate cable 1m 3368458 Connects C O accessories to HemoMed pods catheter cable 8419160 Connects catheter to intermediate cable C O thermistor cabl
152. by a hospital grade outlet with AC adapter or battery In case of a line outage or disconnected cable the monitor automatically switches to battery power to ensure continued patient monitoring WARNING Read Safety Considerations page VII in the Overview of this Instructions fo Use before connecting the monitor to a power source CAUTION Make sure all power cords are properly connected or batteries may be drained unintentionally Battery Power The Vista XL monitor operates on an external sealed Insert lead acid battery and an internal lithium ion battery The external battery which can easily be replaced when depleted can power the monitor for 50 minutes If it runs low or you remove it from a monitor that has been using battery power the monitor automatically switches to an internal battery which can power the monitor for 180 minutes See Electrical Specifications on page B 7 When both batteries run low the monitor sounds an alarm and a status message appears in the network message area If both batteries are depleted the monitor turns off automatically The external battery fits into a compartment on the monitor s left side When depleted or removed replace it immediately or connect the monitor to a power supply Whenever the monitor is connected to power the battery is charged as indicated by the battery charger LED on the front panel The internal battery is charged first then the external battery
153. c and diastolic display size Attention Tone Sets attention tone volume 20 100 in increments of 10 Volume Notes OFF or 596 Minimum setting is 596 if OR is enabled or if monitor is connected to a central station Minimum setting is 10 if OR is disabled HR Source Derives heart rate from Click on one of the following various sources settings to determine the Heart Rate source Note This function is useful ECG during electrosurgery when ART artifact makes ECG channel spo unavailable See page 8 20 ps for more information AUTO Filter Determines sensitivity to OFF noise artifact and other ESU signal distortion M ntor Note The ESU setting automatically disables pacer detection See page 8 17 for detailed information on Filter and its settings ARR Monitoring Determines number of OFF arrhythmia events you Basic monitor Note For detailed information see page 9 1 Pulse Tone Volume Sets pulse tone volume See page 2 9 Off 100 2 12 VISTA XL 2 SETUP VF7 SPECIALTY MENUS Unit Manager The Unit Manager menu lets supervisory personnel configure monitoring functions for the clinical staff Access to this menu is restricted by a password To open the Unit Manager menu Press the Menu fixed key to open the Main Menu Click on Monitor Setup 1 2 3 Click on Unit Manager A data entry box appears 4
154. c cusan Coreano Rec nnmnnn nenna 21 5 Sidestream Sampling Pump etCO 2 only eese 21 5 FIO 2 21 7 Temperatur senne 21 7 APPENDIX A Glossary APPENDIX B Technical Data rua m B 2 Overall Regulatory Standard Compliance eese B 2 Electromagnetic 2 Electromagnetic Emissions ener enne B 4 Electromagnetic Immunity B 5 Recommended separation distances eene B 6 System Components creer ce nionane aa uet te cux naue ca acc B 7 Vista XL Base Unit cric ene e cte ce ee B 7 External Batltety 1 a Rn RIDE crx Rea OPERIS B 9 EE B 10 R50 N Infinity 10 Monitoring 11 etCO2 Module ix cioe iuc rende nane a necu Ande Ca dS eda B 11 HomoMed eec
155. ce classify it and draw clinically useful conclusions based on the frequency and morphology of the signal The monitor considers all beats questionable if a baseline shift exceeds specified limits WARNING Electrical artifacts of non cardiac origin such as seizure may prevent detection of certain arrhythmias Do not rely solely on ECG with seizure prone patients NOTE Arrhythmia detection may not work properly in all patients The monitor classifies only QRS complexes gt 0 25mV for widths gt 70ms An artifact condition ARTF may occur when the ECG signal does not meet these minimums While continuing to monitor HR you can turn off ARR Monitoring for patients whose QRS complexes do not meet these minimums The monitor uses the results of QRS processing for arrhythmia analysis During multiple lead arrhythmia processing each lead s QRS complexes are measured and compared against its learned dominant normal beat The monitor classifies beats based on information acquired from all available leads About the Arrhythmia Template The monitor creates a reference template based on its identification of the patient s dominant QRS pattern It then classifies individual beats by comparing them with the learned reference template In the third and final phase of arrhythmia processing the monitor compares sequences of valid beats with the template In most situations the learning phase takes about 30 to 40 seconds If the monitor dete
156. cio FouR MODULES Quick Reference Table 2 20 Setup Click on the following items to execute O5 N5O setup functions The N5O Setup Menu Menu Item Description Settings MultiGas Enables combined MultiGas ON OFF Parameter parameter box display see 18 24 O2 Scale Sets waveform scale 50 96 100 96 N20 Display Displays N2O values ON OFF Notes This selection is ghosted and not available if the monitor is configured to display a combined Scio parameter box see page 18 24 There is no alarm function for N5O and the parameter box does not show alarm limits MultiGas Zero Manually zeroes the Scio N A module Note During zeroing the monitor temporarily blanks Scio parameter values Auto Zero Delay Delays automatic zeroing for 5 N A minutes for uninterrupted monitoring see 18 16 for information 1 Point Cal See 18 14 for further information on calibration functions 2 Point Cal Last O2 Cal 2 Alarms Accesses Limits table see this N A Instructions for Use Chapter 5 Agent Monitoring You can identify agent waveforms and parameters by color Halothane Red Desflurane Light blue Enflurane Orange Sevoflurane Yellow Isoflurane Purple The Agent parameter box shows the inspiratory and end tidal values for the currently monitored agent 18 18 VISTA XL VF7 Scio SETUP Scio Four Oxi plus amp Scio Four plus only If the mod
157. cipal collection points for waste electrical and electronic equipment Drager Medical has authorized a firm to dispose of this device in the proper manner For more detailed information please contact your local Drager Medical organization Overview 2 INTENDED USC IV Indications For USC V Documentation Features VI Notes Cautions Warnings VI Gross referernces Ra cere eesti eid VI Quick Reference Tables iua ee ccc tecnica VI large VI Applicablility 5 Vi Safety aa unde VII es Vil Inspection and Vil General Electrical ennnen IX PACOMAK CMS 65 one eL E ET IX Peripheral Devices _ IX Id
158. ck The setup menu appears with the name of the parameter you have selected displayed at the top of the menu 13 10 VISTA XL VF7 IBP SETUP Quick Reference IBP Setup Available functions present on all IBP setup menus are described in the following table IBP Setup Menus Menu Item Description Available Settings Zero Zeroes the transducer and displays N A read only time and date of last zeroing operation see page 13 4 Scale Sets the upper values of the IBP For ART CVP LV waveform scale GP1 GP2 ICP LA P1 3 a d PA RA and RV 5 10 15 20 25 30 35 40 50 75 100 125 150 175 200 225 250 and 300 mmHg Filter Adjusts filter applied to the IBP 8 16 and 32 Hz signal Cal Factor Determines calibration factor 80 120 Last Cal Factor Displays the time of the last successful calibration Not modifiable Manometer Cal Allows you to enter the manometer 10 300 or simulator reading and start calibration see page 13 6 Pressure Overlap Allows you to view up to four IBP ON parameters on a single baseline OFF Common Scale Sets the waveforms to one scale OFF 5 10 15 20 25 30 35 40 50 75 100 125 150 175 200 225 250 and 300 VF7 Wedge Start Starts a wedge pressure N A PA setup menu measurement Same function as the only Wedge fixed key on a hemodynamic pod see page 13 7 Pressure Labels Displays Pressure
159. cted emissions classification suitability for flammable locations and water ingress protection must be considered based on the intended use of the system 1 8 VISTA XL VF7 SYSTEM COMPONENTS Other Features and Components VF7 Remote Keypad The optional Remote Keypad allows you to operate the monitor from a distance A rotary knob and fixed keys duplicate those of the monitor while a numeric keypad allows you to enter data See page 1 15 for more information Export Protocol Allows you to share data with other Drager Medical and third party devices e g Clinical Information and Anesthesia Record Systems and Data Loggers see Drager Medical publication Infinity RS 232 Export Protocol Reference Booklet Arrhythmia Classification Expert ACE Detects cardiac events reduces false alarms and filters out misleading or erroneous arrhythmia data R50 Series Recorders Produce alarm timed continuous and trend recordings See Chapter 7 Recordings for more information about R50 and R50 N recorders PCMCIA Card Allows you to transfer data upgrade software store setups download setups and store diagnostic logs QRS Sync Output Allows you to synchronize defibrillators to the patient s heart beat during cardioversion Balloon Pump Interface Permits interaction with a balloon pump by providing two analog output signals ECG and ART VISTA XL 1 9 1 INTRODUCTION Power Sources The Vista XL monitor can be powered
160. ction Description Available Settings Show All Leads Displays all active ECG leads Notes While Show All Leads is displayed other parameter boxes remain visible and working and both alarms and recordings continue to operate but you cannot use the rotary knob to access other menus You can also access Show Leads using the fixed keys Fast Access monitor or All ECG remote keypad You can print an ECG report that depicts each waveform if the monitor is on a network and a laser printer is available Click on Show Leads to display all connected ECG leads Click on the Report at control button at the bottom of the screen to print an ECG report on a network laser printer Click on Notes at the bottom of the screen to display remarks about the patient s physiological condition Scroll to the appropriate note and click again Notes are displayed on the screen and printed on generated reports Press the Main Screen fixed key to return to the main screen VF7 VISTA XL 8 ECG AND HEART RATE Menu Selection The Size ECG Submenu This submenu allows you to configure the following functions Size ALL Changes display amplitude of Click on Size ALL ECG to change ECG ECG waveforms the amplitude of a waveforms on Notes the Show All Leads and the main screen Description Available Settings f you connect a three lead cable to the monitor Chann
161. ctions for Use assumes a working knowledge of patient monitors To support proper safe and accurate operation of equipment read all operating instructions carefully before you use the monitor The monitor complies with IEC 60601 1 and applicable collateral and particular standards Site of Operation WARNING e Connect the AC Adapter to hospital grade electrical outlets with medical power cords e Monitor operation is not currently supported in the following environments magnetic resonance imaging MRI environments aircraft ambulance home or hyperbaric chamber environments e Do not operate the monitor or its remote displays in the presence of flammable gases e Do not use the monitor near devices with microwave or other high frequency emissions These emissions may interfere with the monitor s operation e Position the monitor and accessories with at least 2 in 5 cm of space around all sides to prevent overheating e Do not allow fluids to come in contact with monitor or peripherals If fluids are accidentally spilled on equipment remove affected unit from service as soon as possible Contact your biomed to ensure that there is no compromise in electrical safety CAUTION e The site of operation must meet the environmental requirements outlined in Appendix B Technical Data e To avoid patient injury ensure patient is disconnected from all sensors etc before moving patient Inspection and Maintenance Regular e
162. cts more than 100 QRS complexes and less than 16 matching beats it displays the message lt Unable to learn gt While the monitor is in the learning phase all arrhythmia alarms and trend collection are suspended LRN appears in the parameter box and the message Relearning displays in the local message area 9 2 VISTA XL VF7 ABOUT THE ARRHYTHMIA TEMPLATE Beat and Rhythm Classification Beat classification refers to the analysis of individual beats If the new beat s features do not match those of the reference template the new beat is classified as abnormal paced or questionable The monitor uses all detected beats to calculate the heart rate eliminating questionable beats from arrhythmia classifications Rhythm classification refers to the analysis of sequences of beats The monitor compares the sequence of the last eight beats with the sequences stored in the monitor s memory If it detects two or more events simultaneously the monitor alarms in order of event priority The following table describes available beat classifications Label Event and Beat Classification ASY Asystole 4 seconds pass without the detection of a valid QRS complex VF Ventricular Fibrillation The monitor identifies a sinusoidal waveform with fibrillation characteristics VT Ventricular Tachycardia N or more PVC s are detected in a time interval T 60 N 1 R where N is defined as the VT count and R is defined as the VT
163. d Accessing Allows you to modify setups To enter the password the Unit Manager on password protected 1 Press the Menu fixed key to Menu Unit Manager menu display the Main Menu 2 Click on Monitor Setup Note For information on 3 Click on Unit Manager A other Unit Manager functions see page 2 13 data entry box appears 4 Click on each number of the appropriate password If you make a mistake click on Backspace and try again 5 Click on Accept to open the Unit Manager menu Restoring Factory Defaults Consult your Biomed to restore settings shipped with the monitor to their original configuration For detailed information on password protected Biomed setup functions please consult service and installation documentation 2 10 VISTA XL VF7 SPECIALTY MENUS Specialty Menus OR Mode OR mode is designed specifically for the operating room environment allowing you instant access to a particular set of parameters and functions In addition you can disable audible alarms without affecting visual alarms even when the monitor is not connected to a network WARNING Do not set monitor to OR mode outside operating room environment because OR alarms behave differently than regular alarms NOTE Life Threatening and Serious alarms do not latch when OR mode is ON To access the OR menu 1 Press the Fast Access fixed key 2 Click on OR to display the OR menu Quick Reference T
164. d Scio Four 18 16 VISTA XL VF7 Scio SETUP only The waveform indicates O concentrations calculated by the Scio module The O parameter box can display the current concentration values for the following parameters Inspired 102 The level of in the airway during the inspiration phase Expired etO5 The level of in the airway during the expiration phase N20 The concentration of N5O in the patient s airway The appearance of parameter box varies depending on whether or not N5O display is turned on in the menu Typical parameter box displays are shown below Parameter Box Description 102 m ScioModule 35 N5O display turned off This module calculates both and etO values etO2 332 02 N20 Scio Module display turned on i 35 64 This module calculates both iO and values et 33 2 58 Notes The N symbol in the parameter box indicates that the Os lower alarm limit has been set to a value less than 2196 the percentage of in room air O parameter box does not show 0 alarm limits because NoO does alarm To access the O5 N5O setup menu e Click on the O N O parameter box or 1 Press the Menu fixed key 2 Click on Patient Setup 3 Click on Parameters to display a list of available parameters 4 Click on O2 VF7 VISTA XL 18 17 18 S
165. d and alarm recorded Fibrillation cannot be even when event alarm is turned isabled off OFF Status Messages Message Event Definition Suggested Action PVC min gt UL The PVC min value is above the Check patient upper alarm limit Cannot Learn At the end of the Learning phase the Check leads Lead X dominant normal complex could not Choose another lead for be determined for Lead X one of QRS processing the two leads selected for QRS processing Arrhythmia analysis proceeds using the other lead as a source Lead lt X gt is ignored until a Relearn is initiated Relearning Monitor is learning a normal QRS complex as reference template Unable to After 100 beats monitor cannot Check electrode Learn determine the dominant normal preparation complex on any lead selected for QRS processing Learning continues Baseline Artifact is blocking arrhythmia Check electrode Artifact classification preparation VF7 VISTA XL 9 9 9 ARRHYTHMIA MONITORING This page intentionally left blank 9 10 VISTA XL VF7 Chapter 10 ST Monitoring a ejje L 2 MultiMed Pods for ST 3 ST Display Esel 3 ST Analysis Setup
166. d grabber set IEC2 5956441 ECG 5 lead grabber set IEC2 5956458 ECG 6 lead grabber set IEC2 5956474 MonoLead One Wire ECG Lead Set Solution ECG MonoLead 3 IEC1 MS14555 ECG MonoLead 3 IEC2 MS14556 ECG MonoLead 5 IEC1 MS14559 ECG MonoLead 5 IEC2 MS14560 ECG MonoLead 6 IEC1 MS14683 ECG MonoLead 6 IEC2 MS14682 Adapter MonoLead 3 5 to MultiMed 5 pod MS14679 to connect the MonoLead 3 5 to the MultiMed 5 pod NOTE The ESU 5 lead block is compatible with this adapter This adapter does not replace the ESU block Adapter MonoLead 3 5 6 to MultiMed 6 pod MS14680 Required to connect the MonoLead 3 5 6 to the MultiMed 6 pod NOTE The ESU 6 lead block is compatible with this adapter This adapter does not replace the ESU block C 8 VISTA XL VF7 MonoLead dual pin version ECG MonoLead 3 Dual Pin IEC1 2m ECG MonoLead 3 Dual Pin IEC2 2m ECG MonoLead 5 Dual Pin Limb IEC1 2 5m ECG MonoLead 5 Dual Pin Limb IEC2 2 5m ECG MonoLead 5 Dual Pin Chest IEC1 2 5m ECG MonoLead 5 Dual Pin Chest IEC2 2 5m VF7 VISTA XL MS16160 MS16233 MS16161 MS16229 MS16232 MS16230 ECG 9 Pulse Oximetry 2 NOTE SpO compatibility is a locked option Contact your biomed for more information Drager Sensors Reusable Drager Reusable 5 Sensor adult MS13235 SpO adult sensor for finger application Patient weight 40 kg 88 Ib NOTE Not for use with MicrO2 Masimo Sensors
167. d potential devices may produce interference in ECG monitoring Pacemakers Difficulties inherent in ECG monitoring require special attention for patients with pacemakers The monitor errs on the side of caution in cases of uncertain pacemaker performance and may not count QRS complexes in paced patients False low rate alarms may therefore result under the following circumstances e Fused beats and asynchronous pacers when coupling intervals are 10 to 90ms e 700mV pacer pulses followed by QRS complexes smaller than 0 5mV e Asynchronous pacer pulses with overshoot The monitor has been successfully tested for pacer pulse rejection It is not possible however to anticipate every clinically possible waveform characteristic VF7 VISTA XL 8 3 8 ECG AND HEART RATE Consequently for some paced patients the monitor may not count heart rates accurately and may misinterpret rate dependent arrhythmias WARNING e Make sure pacer detection is OFF for patients without pacemakers ON for patients with pacemakers e Rate meters may continue to count pacemaker rate during cardiac arrest or some arrhythmias Do not rely entirely upon rate meter alarms Keep pacemaker patients under close surveillance See page 8 4 for pacemaker pulse rejection capability e Do not rely entirely on the displayed heart rate and respiration rate to assess a paced patient s condition Always observe these patients closely and monitor their vital signs
168. de allows you VISTA XL VF7 ARRHYTHMIA SETUP ARR Mode Available Display Parameters Parameter box OFF ASY Asystole VF Ventricular Fibrillation ARTF Artifact Basic ARR Label to register arrhythmia occurrence ASY Asystole VF Ventricular Fibrillation ARTF Artifact VT Ventricular Tachycardia Full All arrhythmia events See page 9 3 for a complete list PVC Premature Ventricular Contraction Channel Lead Selection Appropriate lead selection is essential for accuracy in arrhythmia monitoring Ideally to expand the list of events reported When ARR Monitoring is set to Full the monitor reports all available arrhythmia events you should assign the two best leads to the top two channels on the monitor See page 8 15 for more detailed information Processing options are ECG1 Single channel option Dedicates processing to the lead that occupies top channel on the monitor screen ECG 1 amp 2 Dual channel option Instructs the monitor to determine heart rate and arrhythmia based on the two best leads that occupy the two top channels on the monitor screen To configure the monitor for single or dual channel monitoring 1 2 Click on Select 3 Select ECG1 or ECG1 amp 2 and click on your choice VF7 VISTA XL Click on the ECG parameter box to display the ECG menu 9 5 9 ARRHYTHMIA MONITORIN
169. dified N A Lower Determines lower alarm limit Settings are parameter specific Archive Allows you to store and or record Store automatically an alarm event forthe Record selected parameter You can later R review stored alarms on the Event Str Rec Recall screen OFF Note You cannot turn the Archive option off for asystole and ventricular fibrillation 5 14 VISTA XL VF7 ALARM HISTORY TABLE Alarm Limits Shortcut Each parameter setup menu has an Alarm menu selection which opens the Alarm Limits table targeting associated parameters on the Alarm Limits table Exiting the Alarm Limits table returns you to the parameter setup screen ST and Arrhythmia Alarms ST and arrhythmia parameters have their own alarm limits configuration screens which you can access by selecting the ST or ARR control button at the bottom of the alarm limits table see page 5 5 Refer to Chapter 10 ST Monitoring and Chapter 9 Arrhythmia Monitoring for more information about ST and arrhythmia tables Alarm History Table The monitor stores up to 50 physiological alarm events for each patient Events are erased when the patient is discharged Data is stored in the monitor Data also survives power shutdowns The Alarm History table records all life threatening and serious alarms every activation and deactivation of cardiac bypass mode every change of patient category and records each activation of All Alarms Off or Alarm Silence To acc
170. digits between indicated saturation levels Accuracy of the SpOsmeasurement is specified within 1 SD standard deviation 2 Accuracy of saturation measurements on neonates is increased by 1 digit as compared to accuracy on adult patients to account for the theoretical effect on oximeter measurements of fetal hemoglobin in neonatal blood High Adjustable 20 to 100 SpO alarms Low Adjustable 20 to 100 Nominal wavelength Nellcor FE 288 20 VISTA XL VF7 MONITORING SPECIFICATIONS Nellcor Red 3 mW max Masimo Red 0 9 mW max 4 mW max IR 0 9 Power mW max Note LED drive is current limited by hardware mechanisms Degree of protection Type CF against electric shock Defibrillation protection In accordance with IEC 601 1A2 VF7 VISTA XL 21 Pulse Oximetry 2 Masimo SET SmartPod Parameter display Saturation 5 pulse rate perfusion 9eSpOs 1 100 Measuring range Pulse rate 25 240 min Perfusion 0 02 20 Measuring accuracy Saturation 96SpO During No Motion Conditions 0 to 69 not specified 70 to 100 Adults Pediatrics 2 digits Neonates 3 digits Saturation SpO gt During Motion Conditions 2 3 0 to 69 not specified 70 to 100 Adults Pediatrics 3 digits Neonates 3 digits Pulse Rate bpm During No Motion Conditions Adults Pediatrics Neonates 25 240 bpm
171. dome then rezero the transducer Replace the transducer xx Cal Mercury calibration failed Make sure the transducer is zeroed Failed because the measured then retry If the retry fails replace the Out of value was too high or too transducer Range low If calibration requires a factor outside this range replace the transducer xx Zero During calibration more Zero the transducer before Cal than 5 minutes have elapsed since last successful zero xx H W IBP channel hardware Check hardware and replace Failure failure Call Biomed or Dr ger Medical Technical Support Pod The pod is not Check cables and connection n connected to the monitor Replace cable if necessary Disconnect ed Note xx represents the IBP parameter message label associated with the displayed VISTA XL VF7 Chapter 14 Calculations HEELS ejl E L 2 Physiological Calculations 3 HemoMed Parameters 5 Oxygenation and Ventilation 7 Cal CUlatiOns E S 7 Titration Tables coru cre eterne tere re tere 8 Drug Calcul tor Set p 1 eer tertio er EH ee 9 D
172. e 2 eicit 3 Pacemake rs sioen a n ecce ek aise es ed oer se 3 r 6 Infusion or Roller Bypass Pumps eere eene nennen nnns 7 Line Isolation Devices eerte innere Ren nnmnnn nnn nn nnmnnn nnmnnn nnna 8 Transcutaneous Electrical Nerve Stimulators esee 8 Patient Preparatlon coercere iretrtren nn entere used amore eux a Ree ecu 9 Three and Six Lead TruST Configurations esses 10 Derived Twelve Lead Configuration TruST esee 11 ECG Signal Processing and Display eese nnne nnns 12 HULINPIEIDMGM 13 Alarms and Alarm 44424200 anas neas unma nasa nua nun 14 MOM m 15 Quick Reference Table ECG 15 Status Messages 21 8 ECG AND HEART RATE Overview The monitor can calculate heart rate detect arrhythmia conditions and display ECG data Lead wires are connected to the monitor via special pods d
173. e MCL Modified Chest Lead Memory card A PCMCIA storage device used for upgrading software retrieving monitor logs for use by service personnel and for storing monitor setups A memory card reader is on the left side of the monitor min Minute mm s Millimeter per Second mmHg Millimeter of Mercury ms Millisecond MultiMed The pod that receives the following patient cables ECG lead set SpO extension cable and a temperature probe VF7 VISTA XL A 3 MV MVWS Network message area NBP NBP hose OxyCRG or OCRG PA Parameter PAUS PeCO2 PEEP PEF PIF PIP PLS or pls Pulse Oximetry SPO gt PVC min PWP R50 RA ECG RA IBP Raw RESP RL Rv RRc RSBI RUN S or Sys Minute Volume Alveolar Minute Volume Infinity CentralStation Along the top right of the main screen displays network messages when the monitor is connected to the network See also Local Message Area Non Invasive Blood Pressure The plastic tube used by the NBP module to inflate the blood pressure cuff Oxycardiorespirogram Pulmonary Arterial pressure A monitored physiological function eg heart rate blood temperature Pause Mixed Expired CO2 Positive end expiratory pressure Peak Expiratory Flow Peak Inspiratory Flow Peak Inspiratory Pressure Pulse Rate as calculated from the SoO measurements A technique for calculating the percentage of functional ie oxygen saturated hemoglobin in the pa
174. e Ohmeda 8420077 Use with thermistor T piece 5741975 C O thermistor T piece 25 pcs 5741975 Ohmeda disposable in line injectate sensor for measure ment of injectate temperatures For use with cable 8420077 C O thermistor cable Edwards Baxter 8539983 Notes Due to corporate mergers Baxter cardiac output catheters and accessories may be labelled as being from Edwards Ohmeda output catheters and accessories may be labelled as being from Becton Dickinson BD Contact Edwards and or BD if there is any doubt as to the identity of the cardiac output catheters or accessories Cardiac output monitoring requires a special tubing set that you must order directly from Ohmeda or Baxter VF7 VISTA XL C 15 End Tidal CO 1 5 1 Module and Pods module 4319310 Sensors Sensor 4322975 Reusable sensor with 2 4 m cable Suitable for adults children and neonates Includes calibration and reference cell adult airway adapter and 5 cable clips Main Stream Accessories airway adapter adult dead space lt 5cc 4721796 airway adapter neonatal dead space lt 0 5cc 4721788 Side Stream Accessories etCO airway adapter sidestream 4714437 Not for use with neonates etCO Nafion tubing 10 pcs 4714429 sampling cannula adult 10 pcs 4714395 sampling cannula pediatric 10 pcs 4714387 sensor c
175. e sensor to a site free of any artificial pigments CAUTION See the page VII of the Overview to this User s Guide for safety considerations about the use of electrosurgery devices with the monitor 15 4 VISTA XL VF7 PATIENT PREPARATION Patient Preparation The accuracy of SpO monitoring depends largely on the strength and quality of SpO signal If a finger is used as a monitoring site remove any nail polish Cut the patient s finger nails if necessary for better sensor placement Use only Drager provided sensors and apply them per the sensor manufacturer s recommendation see page C 10 Ambient light can interfere with pulse oximetry measurements if the sensor is not properly attached causing erratic measurement or missing values Ensure proper sensor placement and cover the sensor with opaque material if interference due to ambient light is suspected CAUTION Read the instructions provided with the sensor for optimal application techniques and for safety information Select the sensor type and size best suited for your patient If the sensor is reusable clean it before and after each patient use Position the sensor correctly and attach it to your patient Connect sensor to patient cable VF7 VISTA XL 15 5 15 PULSE OXIMETRY 2 5 Inspect sensor application site frequently If the sensor is too tight it may damage the tissue and impede blood flow If the sensor is dama
176. e where is measured Onset of inspiration phase Expiration phase Baseline during inspiration You can use capnograms to troubleshoot problems with equipment or monitor configuration as well as to monitor a patient s clinical status The following table shows some of the more common problems identifiable through capnogram analysis VF7 VISTA XL 16 7 16 2 END TIDAL CO2 MONITORING Capnogram Description Immediate and possible causes Alveolar plateau shows downward slope that merges with descending limb Inadequate Seal Around Endotracheal Tube Leaky or deflated endotracheal or tracheostomy cuff Artificial airway that is too small for the patient Elevated waveform baseline with corresponding increase etCOs level Rebreathing Insufficient expiratory time Faulty expiratory valve Inadequate inspiratory flow Malfunction of a absorber system Partial rebreathing circuits Change in slope of ascending limb Possible absence of an alveolar plateau Obsiruction in Apparatus Partial obstruction in expiratory limb of breathing circuit Foreign body in upper airway Partially kinked or occluded artificial airway Herniated endotracheal tracheostomy tube cuff Bronchospasm Elevated baseline with pronounced slope on descending limb Faulty
177. e FiO sensor by wiping external surfaces with a cloth lightly dampened with a mild detergent or isopropyl alcohol Disinfect the external surface of the FiO sensor using a cloth moistened with ethanol or Cidex CAUTION Do not autoclave gas sterilize or irradiate the oxygen sensors Do not clean the sensor with chemicals other than alcohol or a mild cleaning agent Temperature Wash temperature probes in a 3 hydrogen peroxide or 70 alcohol solution Disinfect probes with a gluteraldehyde based disinfectant CAUTION Do not use phenol based disinfectants which vinyl absorbs Do not use strong aromatic chlorinated ketone ether or ester solvents 21 8 VISTA XL VF7 A Glossary Q uA uV PACED AC ACE Airway adapter Airway AIVR Agent ART ARTF ASY aVF ECG aVL ECG aVR ECG Battery backed memory bbhr BGM BRDY BSA BT Ohm Micro Ampere Micro Volt Percentage of pacemaker initiated beats Alternating Current Arrythmia Classification Expert In monitoring a device inserted in a patient s airway tubing to which a capnostat sensor is attached See also Capnostat See Accelerated Idioventricular Rhythm A gas used in anesthesia The MultiGas modules detect and measure five agents Halothane Isoflurane Enflurane Sevoflurane and Desflurane Arterial pressure Artifact Asystole Left leg augmented lead Left arm augmented lead Right arm augmented
178. e entire continuous measurement cycle is aborted if there is an NBP alarm To stop a continuous measurement in VF7 VISTA XL 12 9 12 NON INVASIVE BLOOD PRESSURE progress click again on Continuous Mode in the NBP menu or press the NBP Start Stop fixed key The entire measurement cycle is canceled WARNING e Use Continuous Mode only for short periods and under supervision Clinically verify limb perfusion Take special care when using continuous mode on neonates or hemomedically compromised patients e Rapid prolonged cycling of non invasive pressure measurements have on occasion been associated with petechia ischemia purpura or neuropathy Make sure that the cuff is properly attached and check the cuff site regularly to prevent cuff pressure from impeding the blood flow Retried Measurements If a measurement is unclear the monitor aborts it and tries again provided the inflation limit is set to Adult 180 or 270 mmHg The monitor does not retry at any other inflation limit settings If a second attempt fails the monitor displays an error message Error messages may affect display or measurement as follows Mean Only Monitor displays mean pressure in parameter box and replaces systolic and diastolic values with NOTE In some cases where conditions include very low systolic and diastolic pulse amplitude or significant motion monitor may display a Mean MAP only measurement e Cannot Measure Monitor stops meas
179. e immersed in cleaning solution but do not allow solution to enter the tube as this interferes with the operation of the cuff and the cartridge The warranty is void if cleaning solution is allowed to enter the tubing or the cuff IBP Transducers Always handle transducers and other pressure accessories with great care Do not apply excessive pressure to a transducer diaphragm Do not subject transducers to water steam hot air sterilization ether chloroform or similar chemicals Always protect the connector from moisture Consult the documentation supplied with your transducer for specific cleaning and sterilizing instructions HemoMed Transducer Plate Remove the transducer mounting plate from the front of the HemoMed Wash the plate with hot soapy water 21 4 VISTA XL VF7 SpOs CAUTION e These instructions pertain to reusable sensors only Do not irradiate steam autoclave or immerse the sensor or its cable in water or other liquid See cleaning instructions supplied with the SpO sensor in use for further information Clean reusable 5 sensors by wiping them with a gauze pad moistened with a soap solution To disinfect sensors wipe using a cloth moistened with a 70 alcohol solution Dry thoroughly with a lint free cloth before applying to patient SET Pod 1 clean the SET pod disconnect it from the monitor Clean the pod with a gauze moistened in enzymatic detergent or a solution of green
180. e is labeled simply Scio in the upper right of the front panel then the funtionality of your module will match the Scio Four Oxi plus Scio Scio Four Oxi plus Scio Four Oxi plus The Scio Four Oxi plus continuously measures the li E content of CO N20 and one of the anesthetic on agents Halothane Isoflurane Enflurane Sevoflurane and Desflurane in any mixture It automatically identifies the anesthetic agent that is present in the highest concentration It communicates real time and derived gas wc information to the host system The monitor saves values derived by the modules in its trend storage The Scio Four Oxi plus module calculates both inspiratory and expiratory O values 1O and etO VF7 VISTA XL 18 3 18 Scio FouR MODULES Scio Four The Scio Four Oxi continuously measures the 1 content of and one of the anesthetic Dagr Scio Four agents Halothane Isoflurane Enflurane Sevoflurane and Desflurane in any mixture CAUTION The primary anesthetic agent must be set manually user See page 18 23 1 i iie NOTE Scio Four Oxi displays AA in Agent pbox until user selects agent in the parameter menu Scio Four Oxi communicates real time and derived gas information to the host system The monitor saves values derived by the modules in its trend storage The Scio Four Oxi module calcu
181. e second recording channel recording channel regardless of previous waveform Waveforms are printed assignments according to how you have Note If the alarmed parameter configured Waveform does not have a waveform e g Selection Auto or NBP TEMP the recorder prints Manual the assigned waveform to the OFF second recording channel Primary and Secondary Recorders You can designate a primary and a secondary recorder or a backup recorder on the Infinity Network The monitor prints to the designated recorder on the network or to the local or bedside recorder according to the following criteria e The primary recorder prints the recording if no local R50 recorder is connected to the monitor The secondary recorder prints the recording if the primary recorder is not available e The local recorder if connected prints the requested recording If a local recorder is connected but is not available the secondary recorder executes the print request To designate recorders Press the Menu fixed key to display the Main Menu Click on Monitor Setup Click on Recordings Click on R50 Assign A data entry box appears Uv des Scroll through the numbers and click successively on the single digits of the clinical password If you make a mistake click on Backspace and try again VF7 VISTA XL 7 9 7 RECORDINGS 6 7 8 9 Click on Accept to open the R50 Assign menu Click on Primary Recorder to display av
182. ed on the combined menu You can only access these selections and turn the displays off once you have turned off the combined MultiGas parameter display Agent Scale Sets Agent waveform scale 1 20 in increments of 1 MultiGas Zero Manually zeroes the Scio module N A Note During zeroing the monitor temporarily blanks Scio parameter values Auto Zero Delay Delays automatic zeroing for 5 N A minutes see 18 16 for detailed information O2 Calibration Selects desired O2 calibration 1 Point Cal 2 Point Cal Last O2 Cal See page 18 11 for further information on calibration functions O2 Alarms Accesses alarms in the Alarm Limits table see this Instructions for Use Chapter 5 VF7 VISTA XL 18 25 18 FouR MODULES Dual Agent Display Scio Four Oxi plus amp Scio Four plus only If combined O N O Agent display is selected the primary agent is displayed O2 ISO N20 35 1 5 64 33 1 3 58 NOTE When two Agents are detected one with the higher expired MAC value is the primary If single agent display is selected the inspired and expired concentrations for two agents is displayed The MAC value is the total expired MAC value for the two agents 0 Maintenance and Repair To ensure safety the Scio module requires routine cleaning see Vista XL User s Guide Chapter 21 Cleaning and Disinfecting Monitoring accessories
183. efault Drug Setup Unit 11 14 CALCULATIONS Overview 14 2 The monitor performs physiological calculations using data acquired by the monitor and other devices The monitor stores derived parameters and displays them on the Results Calculations screen or Drug Calculator Available inputs and calculated parameters vary depending on whether you use standard or optional Calculations software The monitor automatically calculates a set of hemodynamic parameters called Mini Cales plus vent and lab values whenever you measure cardiac output see page 20 12 for detailed information The monitor can also be configured to calculate drug related parameters including concentration rate total dose and total volume In addition to these standard calculation features two additional features are available with the PhysioCalcs software option Calcs The monitor calculates HemoMed parameters based on cardiac output invasive blood pressure and patient data e g height and weight Hemo Oxy Calcs This feature provides oxygenation parameters in addition to HemoMed parameters for a complete list of hem oxy vent parameters see page 14 5 VISTA XL VF7 PHYSIOLOGICAL CALCULATIONS Physiological Calculations You can calculate and store hemodynamic and oxygenation parameters for display on the Calculations screen and print them on a laser prin
184. eight Manual entry kg Ib VF7 VISTA XL 14 5 14 CALCULATIONS 14 6 The following hemodynamic parameters are derived using the input parameters described above Label Parameter Derivation Units Description BSA Surface Area Boyd or DuBois Equation m Note Boyd equation for patients whose weight is less than15 kg and whose height is less than 80 cm BSA WT 0 7285 0 0188 x log10WT x HT x 0 0003207 DuBois equation for all other patients BSA WT 425 x 725 x 0 007184 Body weight in grams height in centimeters Cl Cardiac Index CO BSA Vmin m CCl continuous ICI intermittent LHCP Heart Coronary ART D PWP mmHg P Perfusion Pressure LVSW Ventricular Stroke 0 0136 x ART Mean PWP x SV gxm Work LVSWI Ventricular Stroke 0 0136 x ART M x SVI gx m m Work Index PVR Pulmonary Vascular 80 x PAm PWP CO dynes x sec Resistance cm PVRI Pulmonary Vascular 80 x PAm PWP CI dynes x sec Resistance Index cm m RPP Rate Pressure Product ART S x HR mmHg min RVSW Right Ventricular 0 0136 PA M CVP x SV gxm Stroke Work RVSW Right Ventricular 0 0136 x PA M CVP x SVI gx m m Stroke Work Index SV Stroke Volume CO x 1000 HR ml SVI Stroke Volume Index SV BSA 2 SVR Systemic Vascular 80 x ART Mean CVP dynes x sec Resistance cm SVRI Systemic Vascular 80 x ART
185. el 2 Channel lt gt Size and Channel 3 Click on Channel 1 size 2 size or size ghosted 3 size to change the size of the The monitor uses an AAMI individual ECG channels compliant regular QRS threshold when you select a channel size of 1 2 4 or 8 mV cm If you select a channel size of 0 25 or 0 5 mV cm the monitor lowers the detection threshold and the AAMI requirement is not met The normal QRS detection threshold is approximately 0 35 mV depending on the QRS width If you select a channel size of 0 25 or 0 5 mV cm the monitor lowers the detection threshold to approximately 0 2 mV depending on the QRS width In such cases the monitor may include QRS complexes gt 0 2 mV for widths ranging from 70 to 120 ms and include them in the heart rate calculation see page 8 13 for more about QRS detection and channel size 8 16 VISTA XL VF7 ECG SETUP MENU Menu Selection Description Available Settings This submenu The Lead Setup Submenu allows you to configure the following functions number of leads connected via a MultiMed pod Note Sometimes however you may have to select the connected cable type manually If you cannot display ECG waveforms in Auto Detect mode or if the message ECG Leads Invalid appears in the upper left corner of your screen manually select the setting that matches the ECG lead set CAUTION Verify Cable
186. em Description Available Settings The Change Password Submenu This feature allows you to change the password of the Unit Manager menu Open the Unit Manager menu page 2 13 click on Change Password then follow the procedures outlined in this table 1 Scroll through the numbers and click successively on the single digits of the clinical password If you make a mistake click on Backspace and try again 2 Click on Accept to confirm the new password The Pacer Detection Mode Submenu This feature allows you to set pacer detection function Open the Unit Manager menu click on Pacer Detection Mode then follow the procedures outlined in this table Basic default Sets Pacer Detection selections N A in the ECG options submenu to ON OFF only Advanced Sets Pacer Detection selections in the ECG options submenu to ON OFF Fusion Biomed The Biomed menu addresses technical aspects of the monitor To open the Biomed menu 1 Press the Menu fixed key to open the Main Menu 2 Click on Monitor Setup 3 Click on Biomed Quick Reference Biomed Menu Menu Item Description Settings Procedures The Logs Submenu This menu displays clinical and technical diagnostic records Open the Biomed menu and click on Logs then follow the procedures described in this table VF7 VISTA XL 2 17 2 MONITOR SETUP Menu Item Description Settings Procedures C
187. emperature pressure SpO transducers and intermediate cables off earth ground and away from ESU knife and return wires e Use only Drager Medical blue ECG lead wires or the ESU block with conventional leads see page 8 7 They are designed to provide resistance to interference from the ESU and to protect the patient from burns caused by ESU induced current flowing through the leads No other lead wires have been tested for this resistance to interference from ESU e Impedance respiration monitoring and pacemaker spike detection are inoperative when you are using the ESU Block or shielded cables and set the filter to ESU NOTE Place the electrodes as far from the surgical incision as possible while maintaining a clinically useful configuration Place the cable and lead wires as far from the ESU as possible and perpendicular to the ESU cables Use ESU return electrode with largest possible contact area Whenever possible place the ESU return electrode directly under the surgical site avoiding bony protrusions Replace ECG electrodes regularly Read the operating instructions that came with the ESU for additional information Always use accessories designed for ESU environments Use SpO instead of ECG parameter to determine heart rate Use rectal temperature probe sheaths to cover internally placed temperature sensors The monitor s ECG function is protected against high frequency interference from defibrillators a
188. ength of graphical trend report This item corresponds to the Hours setting hr at bottom of Trend Graphs display See Chapter 6 Trends for more information 1 2 4 8 12 24 Table Interval Determines time interval for tabular trend 1 5 15 30 60 report This item corresponds to the Interval min setting at the bottom of the Trend Table display See Chapter 6 Trends for more information Status Messages STATUS MESSAGES Message Possible Cause Suggested Action Check Printer Printer is not connected Check the printer connection Primary Secondary Recorder is disconnected Connect a recorder and verify Recorder not or the connection is poor that it is appropriately connected assigned Inspect cable replace if necessary Primary Secondary You have not specified a Specify a recorder from the Recorder not recorder R50 Assign menu assigned Primary Secondary The paper door is open Securely close the door to the Recorder door open recorder paper compartment Timed recording started Recorder is currently printing Let recorder finish printing Recording not accepted Recorder does not understand print request Try again call Biomed VF7 VISTA XL 7 13 7 RECORDINGS This page intentionally left blank 7 14 VISTA XL VF7 Chapter 8 ECG and Heart Rate COVER V IG m
189. ensor Check for defective or Unrecognized calibration resistor is not unapproved sensor Sensor of an allowable value Replace the sensor Contact Biomed or Drager Medical Technical Support SpO Light Insufficient light is Check to ensure that the light Blocked reaching the sensor s sensor is properly attached to light detector the patient s finger and that the Note With detached or finger is free of blocking partially detached substances disposable sensors the Check for defective sensor and light emitters and replace if necessary detectors may have become misaligned SpO Artifact A persistent artifact is e Ensure the SpO sensor is detected properly attached to the patient the monitoring site is free of patient motion and all cables are properly connected Contact Medical Technical Support VISTA XL VF7 SPO2 MICRO2 Message Possible Cause Suggested Action SpO 2 Weak Pulse amplitude is too Check patient s condition signal low Ensure the SpO sensor is Physiological properly attached to the patient Poor perfusion shock and all cables are properly Low body temperature connected Relocate sensor to another extremity Contact Medical Technical Support No The monitor has notbeen Ensure the SpO sensor is Measurement able to compute a valid properly attached to the patient measurement within the last 30
190. er values at the time of data capture click on the arrow keys above the list of parameters at the right of the screen To scroll through the waveforms displayed at the time of data capture click on the Prev Previous and Next control buttons under waveform display VF7 VISTA XL 1 21 1 INTRODUCTION Help Functions You can display a short description of currently highlighted functions at the bottom of all active menus by enabling context sensitive help 1 Press the Menu fixed key to open the Main Menu 2 Click on Monitor Setup Another column of options appears 3 Open the Display Options menu by clicking on that heading 4 Select Help Line Display and click to choose ON Additional information about the monitor is available in the Main Help menu Press the Menu fixed key 2 Click on Help The Main Help Menu appears Click on the appropriate selection in the table below Menu Item Description Locked Options Displays active software options currently installed on the monitor Fixed Keys Describes functions of Fixed Keys 1 22 VISTA XL VF7 Chapter 2 Monitor Setup E ejje E E E E E 2 Configuring the 2 cit eL M 2 Quick Reference Main Menu 3 Setups Managemenhl reine rite tent
191. ero 29 18 FouR MODULES Intended Use 18 2 The Scio Four modules sample breathing gases from adults and pediatrics The gas modules continously measure the content of CO2 N20 O2 and one of the anesthetic agents Halothane Isoflurane Enflurane Sevoflurane and Desflurane in any mixture and communicates real time and derived gas information to the Infinity monitors With the monitors can measure end tidal carbon dioxide inspired carbon dioxide and respiration rate in either mainstream or side stream measurement mode and with etCO Respratory Mechanics spirometry and carbon dioxide can be monitored The monitors can interface with specific third party devices via an MIB protocol converter VISTA XL VF7 OVERVIEW Overview NOTE Dr ger Medical s MultiGas and MultiGas modules are not supported by VF6 and VF7 software The Scio module is a free standing unit that samples breathing gases from adult and pediatric patients in non partial and total rebreathing systems NOTE The Scio module comes in four different models with four different levels of performance Please note which model you are using All references to the Scio module in this chapter refer to all four models of the Scio module Scio Four Oxi plus Scio Four Oxi Scio Four plus and Scio Four Model specific information is documented as required If your Scio modul
192. es 3 When you reach the desired position on the average S T complex click to confirm the new ST measuring point The vertical line and the ST position value change back from yellow to white For each average S T complex displayed the value in millimeters of ST deviation changes to reflect the new ST measuring point displays the new ST deviation value after changes are completed 10 6 VISTA XL VF7 ST ALARMS TABLE ST Alarms Table The ST Alarms table allows you to modify the alarm limits of multiple ST parameters in a single location ST alarms are subject to the same alarm guidelines as other parameters see Chapter 5 Alarms In addition control keys at the bottom of the screen allow you to execute the following alarm functions at the ST alarm table Menu Description Settings Auto Set Changes the upper and lower limits mm or mV for all active ST leads Note The Auto Set feature on the Alarm Limits menu also uses this calculation to adjust alarm limits of active ST parameters see page 5 14 Upper Alarm Limit Current value 2mm 0 2mV Lower Alarm Limit Current value 2mm or 0 2mV See page 10 4 Event Duration Determines the time that a OFF potential alarm condition must 156 persist on ST leads before the monitor classifies it as a valid 30s alarm condition 455 605 Relearn Initiates a Relearn operation N A
193. esigned to facilitate cable management The MultiMed Pod accommodates either standard 3 lead or 5 lead or optional 6 lead cable sets The optional NeoMed Pod is designed for 3 lead monitoring The MultiMed and NeoMed pods also have connectors for an SpO5 sensor and up to two temperature probes A connector for an FiO sensor is available only on the NeoMed pod Before you begin ECG and heart rate monitoring proceed as follows 1 Connect the appropriate MultiMed NeoMed pod to the side of the monitor KA Vista XL 1 MultiMed 5 pod with accessories NeoMed and MultiMed 3 and 6 pods look identical 2 Plug leads and accessories into designated connectors NOTE The MultiMed 6 pod does not support 3 lead monitoring 3 Attach the lead wires to the electrodes on the patient 8 2 VISTA XL VF7 ECG PRECAUTIONS ECG Precautions This section discusses ECG monitoring precautions See your institution s clinical guidelines for more information WARNING e Do not allow conductive parts of electrodes and associated connectors including neutral electrode to contact other conductive parts including earth e Before attempting cardioversion always verify the timing of the SYNC pulse see page 8 18 e Never place defibrillator paddles over ECG electrodes or cables The discharge can interfere with defibrillation and cause injury to both patient and clinician e Evoke
194. ess the Alarm History table 1 Press the Fast Access key 2 Click on Alarm History to display the Alarm History table VF7 VISTA XL 5 15 Anesthesia Alarms Monitoring may be interrupted or discontinued more frequently during anesthesia than in the course of critical care For this reason some alarms behave differently when the monitor operates in OR mode As shown in the following table certain alarms stop annunciating when the condition ceases one shot alarms while others emit a single attention tone For more information on OR mode see page 2 11 NOTE You cannot set Attention Tone Volume to OFF for anesthesia alarms Message Condition Grade Annunciation 5 Nothing detected between the ADV One shot Transparent sensor s light source and the detector SpO Light Insufficient light for valid ADV One shot Blocked measurement ECG Leads QRS processing leads invalid for ADV One shot Invalid 10 seconds Faulty electrode contact or lead set Unplugged lead set Wrong Cable Type selected on ECG Lead Setup menu see page 8 15 Apnea Breath has not been detected for No Single Apnea Time seconds alarm attention tone Breath has not been detected for No Single x 2 seconds alarm attention tone Breath has not been detected for SER One shot 3 seconds Breath has not been detected for L T One shot x 6 seconds Notes information in thi
195. f multiple alarms the one with the highest alarm grade is displayed For information about the Alarm Silence feature see page 5 4 VISTA XL 3 13 3 NETWORK APPLICATIONS Privacy 3 14 When operating in Privacy mode the monitor blanks the screen and silences audible alarms at the bedside This feature is helpful when such displays and alarms are distracting to patients and visitors All audible alarms are suppressed and the screen is blank except for a banner reading Privacy Press Main Screen to resume monitoring All other monitoring functions remain active and you can continue to monitor the patient at the central station NOTE Privacy mode available only on bedsides connected to a central station The monitor exits Privacy Mode any time it is disconnected from the network or the Infinity CentralStation e Nurse Call option is still supported in privacy mode To activate Privacy mode 1 Press the Menu fixed key 2 Click on Privacy 3 Press the Main Screen fixed key to return to the Main Screen WARNING No audible alarms sound at the bedside when the monitor is in Privacy mode Alarms sound only at the Infinity CentralStation VISTA XL VF7 Chapter 4 Admission Transfer and Discharge o 1 sl e 2 Admitting a Patleht ninkin nanana AARAA AE ERRENKA 3 Transferring Patient
196. f the measured field strength in the location in which the equipment is used exceeds the applicable RF compliance level above the equipment should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as reorienting or relocating the equipment 2Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m Recommended separation distances Recommended separation distances between portable and mobile RF communications equipment and the equipment Rated Separation distance according to frequency of transmitter in meters maximum E output 150 kHz 80 MHz 80 MHz to 800MHz 800 MHz to 2 5 GHz power of d 1 2 V1 Square root of P d 1 2 V1 Square root of P d 1 2 V1 Square root of P transmitter 0 01 0 12 0 12 0 23 0 1 0 38 0 38 0 73 1 1 2 1 2 2 3 10 3 8 3 8 7 3 100 12 12 23 For transmitters rated at a maximum output power not listed above the recommended separation distance din meters m can be estimated using the equation applicable to the frequency of the transmitter where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer 80 MHz and 800 the separation distance for the higher frequency range applies These guidelines may not apply in all situations Electromagnetic propagation is
197. for to a blocked or kinked hose obstructions or kinking Replace if necessary NBP Hose NBP hose is unplugged Reconnect the hose Unplugged NBP Mean Only Patient s pulse is too low for monitor to derive systolic and diastolic pressure values but large enough to report mean pressure value Check the patient and treat if necessary Check the hose and cuff Check size and placement of cuff NBP Cuff Cannot Deflate Pneumatic failure Check hose and cuff for obstructions Replace if necessary If the message does not clear contact Biomed or Drager Medical Technical Support NBP Cuff Deflation Error NBP pump or valves have been energized for longer than 2 minutes Adult or Pediatric mode or 90 seconds Neonatal mode Disconnect and reconnect cuff Check hose and cuff for obstructions Replace if necessary If the message does not clear contact Biomed or Drager Medical Technical Support NBP Cuff Leak The drop in cuff pressure after the end of the inflation cycle is too great Check hose and cuff for leaks Replace if necessary Restart the measurement If the message does not clear contact Biomed NBP Cannot Measure 12 12 Pulse profile is too poor to make a reliable measurement usually owing to persistent motion artifact Check the patient and treat if necessary Move cuff to a limb with less movement Restart measurement If
198. forms are recorded in either standard or overlapped mode depending on your prior configuration of Pressure Overlap display on the Monitor Setup menu see page 2 6 A header displays information about the patient monitor and recorder settings and currently monitored parameters Header Information The header shows parameter values patient name ID date and time and other pertinent information The following illustration shows a typical timed recording strip Continuous recording headers do not show a delay time but are otherwise identical to timed recording headers VISTA XL VF7 RECORDINGS 9259 gt SMITH 12 Delay 10 8 17 495 Same gt CENT TIMED 21 28382358343 0608 Patient name ID and bed label Origin and type of request Date and time of recording request Diagnostic code Recording delay and recording speed Events and alarm conditions NOTE Values and alarm OFF indicators 3 active at time of recording request are printed after the recording header for each parameter if appropriate Diagnostic Code The following table explains the characters which make up the diagnostic code in the header of a strip recording The first column shows each character s position in the string left to right VF7 VISTA XL 7 3 7 RECORDINGS Position Description Values Definition
199. g paper 10 rolls 4711201 R50 Recorder Cables Interface Plate 1 5 m 4721770 Cable to connect an R50 Recorder to the interface plate Recorder Cable 0 6 m 4313586 Cable to connect an R50 Recorder to a monitor equipped with an interface plate Vista XL Monitor Options Vista XL 5 to 6 Channel Option MS15057 Expands display to six channels Vista XL 6 to 8 Channel Option MS15058 Expands display to eight channels ACE Full Arrhythmia Option MS15054 Adds calls for run bigeminy couplet PVC and acceler ated ventricular rhythm 3 Lead ST Analysis Option MS15055 Not required if ARIES option is installed Handle Hook mount Vista XL MS15202 Wireless Option MS15059 OR mode stored in monitor MS17653 TruST Option MS15852 6 VISTA XL VF7 ECG MultiMed and NeoMed Pods WARNING The NeoMed pod is not intended for use during electrosurgery To protect patients from burns do not use this pod in an ESU environment MultiMed 5 pod 2 5m accommodates 3368391 ECG 3 and 5 lead patient cables 1 temperature probe 2 probes with Y adapter 1 5 extension cable MultiMed 5 pod 1 5m accommodates 5950196 ECG 3 and 5 lead patient cables 1 Temperature probe 2 probes with Y adapter 1 SpO extension cable MultiMed 6 pod accommodates 5191221 ECG 3 5 and 6 lead patient cables 1 Temperature probe 2 probes with Y adapter 1 SpO extension cable NeoMed pod 2 5m accomodates 5590539 ECG 3 lead patient ca
200. g use of the Event Recall screen see page 1 17 Trend Setup 6 2 The Trend Setup menu allows you to customize trend functions To open Trend Setup menu 1 Click on the Menu key on the front of the monitor 2 Click on Monitor Setup 3 Click on Trend Setup to display the Trend Setup menu Display Mode There are two modes for determining the order of parameters in Trend Graphs Automatic mode which displays parameters in the order in which they appear on the Main Screen and Manual mode which allows you to determine the order of parameters in the trend display To determine trend display mode 1 Access the Trend Setup menu see page 6 2 2 Select Display Mode and click the rotary knob to switch between Automatic and Manual modes VISTA XL VF7 Channel Assignment You display a parameter trend by assigning parameters to one of twelve display channels To display parameter trends 1 Access the Trend Setup menu see page 6 2 2 Select Display Mode and click the rotary knob to switch between Automatic and Manual modes Click the knob to select Manual mode 4 Scroll to the channel you want to format and click on it A list of available parameters appears 5 Click on the parameter whose trended values you wish to view in Trend Graphs VF7 VISTA XL 6 3 Trend Graphs Trend graphs display stored trend data in the form of individual graphs for each parameter These graphs
201. ged do not use it 7 Trini m MultiMed connector NeoMed pod RS 232 connector O MsinoSET SpO9 Infinity Masimo SET SpO pod MultiMed pod A Ny NOTE e Infinity Masimo pod compatibility is a locked option Contact your biomed for more information e Possession or purchase of the Masimo 5 pod does not convey any express or implied license to use the device with unauthorized sensors or cables which would alone or in combination with this device fall within the scope of one or more of the patents relating to this device e SET SpO pod compatibility requires 510 k review and is not yet commercially available in the US e Masimo SET 5 pod compatibility is not yet licensed in accordance with the Canadian Medical Device Regulations 15 6 VISTA XL VF7 DISPLAY FEATURES Display Features The monitor can display numerical readings in the SpO parameter box and a pulse plethysmogram waveform in the adjacent channel The parameter box displays both the SpO value and the pulse rate as shown below Spo2 99 PLS 103 1 SpO value 2 Alarm limits crossed bell if alarm is disabled SpO source pulse rate Heart icon blinks with each pulse if is tone source NOTE The heart symbol is displayed only if SpO is selected
202. gnal clarity appears any time the monitor Notes registers artifact During brief artifact the heart rate is blanked How the monitor responds to artifact depends on whether irs ed Dont artifact the value ECG monitoring is configured for single or dual channel Click ECG1 amp 2 to determine processing see column at heart rate and arrhythmias based right on the two best leads QRS ARR Select is ghosted in Note The monitor assigns a weight neonatal mode to d me Regardless of your 1 configuration of this setting the cleaner lead or channel When the monitor resumes QRS one channel exceeds processing but does not initiate certain level the channel is excluded relearn when an artifact a from the composite signal and the nea monitor effectively shifts to single channel processing If both channels show excessive noise the monitor indicates artifact until at least one of the leads is sufficiently noise free ST Enables disables ST Monitoring Select ON to enable ST monitoring Monitoring For detailed information refer to i Chapter 10 ST Monitoring 8 20 VISTA XL VF7 STATUS MESSAGES Menu Fann Selection Description Available Settings ARR Selects the Arrhythmia mode Click on OFF to disable arrhythmia Monitoring monitoring For detailed information refer to e Click on FULL to
203. he Drug Calculator menu NOTE access dose units based on patient weight you must enter the patient s Daily Weight on the Drug Calculator menu The monitor recalculates saved drugs automatically whenever you modify the adult or pediatric Daily Weight entry You must enter a Daily Weight whenever you calculate a drug for a neonate The following table lists available ranges for each category on the Drug Calculator menu Drug Calculator Menu Menu Item Range Drug name N A Weight of patient 0 255 0 kg adult pediatric 0 30 000 g neonate Amount of drug 0 100 000 000 000 micrograms mcg m units mEg mmol 0 100 000 000 milligrams mg units mol 0 100 000 grams g k units Volume 0 10 000 ml 14 10 VISTA XL VF7 DRUG CALCULATIONS Drug Calculator Menu Menu Item Range Concentration 0 100 000 000 000 m units ml mEg ml mmol ml 0 100 000 000 mg ml units ml mol ml 00 000 g ml k units ml 00 m units ml Dose per hour 00 000 000 000 mcg hr mEg hr m units hr mmol hr 00 000 000 mg hr units hr mol hr Dose per minute 666 666 666 66 mcg min mEg min m units min mmol min 666 666 66 mg min units min mol min 666 66 g min k units min Dose weight per hour 0 1 0 1 0 1 0 1 0 10 000 g hr k units hr 0 1 0 1 1 1 0 1 00 000 000 000 wt mcg kg hr mEg kg hr m units kg hr mmol kg hr 0 100 000 000 wt mg kg hr
204. he correct functioning of the device VF7 VISTA XL 12 3 12 NON INVASIVE BLOOD PRESSURE 12 4 STEPS Applying the NBP Cuff 1 Ask the patient to sit or lie down The limb should be relaxed extended and placed on a smooth surface for support 2 Place the cuff at 2 to 5 cm above the elbow crease or in the middle of the back of the thigh The cuff label this side to patient must be placed against the skin 3 Place the artery 4 marker over the artery pointing to hand or foot Once the cuff is applied the cuff label index line must fall within the area marked as range 4 Wrap the deflated cuff snugly around the limb without impeding blood flow Caution the patient not to talk or move upon inflation of the cuff 1 Cuff Size Indicators 4 Range Labels 2 Artery Label 5 Label This side to patient VISTA XL VF7 SETuP 3 Index Line To avoid kinks in the hose center the cuff bladder on the artery so that the hose is to the left or to the right of the artery Ideally blood pressure measurements should be taken with the cuff positioned at heart level If the cuff is not placed at heart level adjust the displayed systolic and diastolic readings 8mmHg for each 10cm above the heart and 8mmHg for each 10cm below the heart WARNING e Do not place cuff on a limb with an intra arterial line otherwise interrupted or erroneous measurement readings ma
205. he electrodes Rerouting invasive pressure tubing away from the infusion pump tubing may also improve the signals VF7 VISTA XL 8 7 8 ECG AND HEART RATE Line Isolation Devices To reduce the effect of line isolation devices which may cause temporary disturbances transients in the ECG signal take the following precautions e Choose the lead with the best signal for monitoring e Check the electrodes and replace them if necessary Transcutaneous Electrical Nerve Stimulators Signals from transcutaneous electrical nerve stimulators TENS often resemble pacemaker signals and may be labeled as such by the monitor The monitor may reject valid QRS complexes which follow misinterpreted TENS signals To avoid resulting false asystole or low rate alarms follow the steps outlined for assuring signal clarity see Pacer Detection on page 8 4 If TENS signals continue to register as pacer spikes you may wish to disable pacemaker detection 8 8 VISTA XL VF7 PATIENT PREPARATION Patient Preparation Careful skin preparation and proper electrode placement support strong signals with minimal artifact In case of a technical alarm e g a detached lead re prep the patient according to the following recommendations Follow the clinical techniques approved at your hospital for preparing the patient s skin For a good quality signal change electrodes every 24 to 48 hours Electrodes may have to be changed more freque
206. ically disables Pacemaker Detection To activate Pacer Detection Click on the HR parameter box Click on ECG Options Click on Filter Scroll to OFF and click Scroll to Pacer Detection and click to toggle it ON po Using five lead six lead cable set to maximize your range of signal choices you can further optimize ECG signal acquisition and processing for paced patients as follows 1 Activate Pacer Detection as described above 2 Select the lead with the least interference and highest R wave for display in channel ECGI Scroll again to Filter on the ECG menu 4 Toggle between Monitorand OFF until you determine which setting gives you the clearest signal Impedance Derived Rate Response Pacemakers Pacemakers with impedance derived rate response emit pulses which can adjust the pacer rate to the respiration rate The monitor may interpret the emitted pulses as pacer pulses superimposing a blue pacemaker spike on the ECG waveform For impedance derived rate response pacemakers modify electrode placement until blue spikes on the waveform disappear VF7 VISTA XL 8 5 8 ECG AND HEART RATE Electrosurgery Observe the following precautions during electrosurgery to minimize ESU interference and maximize user and patient safety see Safety Considerations on page VII of this Instructions for Use for general safety precautions during electrosurgical procedures WARNING Keep ECG t
207. ice representative Dispose of all equipment in accordance with local regulations Drager Medical recommends e Maintenance modifications and repairs are carried out by trained personnel e Components are replaced with Drager Medical provided spare parts otherwise the correct functioning of the device may be compromised e Devices are used in accordance with Drager Medical operating instructions as described in this Instructions for Use VISTA XL VF7 INFINITY VISTA XL USER S GUIDE General Electrical Safety CAUTION e Ensure electrical shock classifications for all equipment connected to the patient are suitable for the intended application Leakage current will increase when connecting multiple medical devices to a patient e Itis the user s responsibility to verify that the overall system is connected in accordance with local regulations and your hospital s policies and that it complies with EN 60601 1 1 Collateral Standard Safety Requirements for Medical Electrical Systems Pacemakers NOTE See Pacemakers on page 8 3 for safety precautions when monitoring paced patients Peripheral Devices CAUTION In the interest of patient safety and equipment performance the connection of other manufacturers equipment to the monitor is not authorized unless the connection is explicitly approved by Dr ger Medical It is the user s responsibility to contact Dr ger Medical to determine the compatibility and warr
208. ick on ST VF7 VISTA XL 10 3 10 ST MONITORING Quick Reference ST Analysis Menu 10 4 Menu Item Description Settings ST Monitoring Enables disables ST monitoring ON Note ST Monitoring is ghosted if OFF ECG is disabled or no leads are connected ST Lead1 Selects up to three ECG leads as None I Ul aVR aVL vi sources for ST analysis and V 2 V 4 V5 V6 ST Lead2 display in ST parameter box dV1 dv32 4 4 dV6 VM Note All ST leads are monitored if CVM a Beads ARIES software is installed ST Mini Trend Displays up to one hour of trended None STI STII STaVR ST data in mini trend graphs on left side of main screen Note See page 6 8 for detailed information about mini trends STaVL STaVF STV4 STdV17 STdV32 STdV4 STdV6 Selection unavailable ghosted when TruST 12 Lead is ON Selection unavailable ghosted when TruST 12 Lead is OFF Relearn Purges stored average S T complexes Blanks average S T complexes currently displayed on the Measuring Points screen Learns the patient s arrhythmia and dominant QRS rhythm Identifies the new dominant QRS complex Notes New complexes are displayed on the Measuring Point screen see page 10 5 Relearn is also accessible from the ECG and ARR setup menus All Relearn operations are stored in the trends database Show All Leads Displays the
209. ick on one of the first four display fields on the list Untitled 1 Untitled 4 to assign drugs to a particular patient NOTE Although you can access the Drug Calculator menu by clicking on a default drug you can name or rename default drugs only on the Unit Manager menu see page 14 11 5 Click on Drug Click on Name Drug to display the text entry screen Enter the name of the drug you wish to assign by clicking on the letters under the text entry window Edit your entry using the control buttons at the bottom of the screen 8 Click on Accept to confirm Calculating a Drug Use the following procedures to enter information on the Drug Calculator menu VF7 VISTA XL 14 9 14 CALCULATIONS 1 Press the Fast Access fixed key The Fast Access menu appears 2 Click on Drug Dosage 3 Click on New Drug see page 14 9 4 Click on the new drug of your choice to display the Drug Calculator menu Scroll to a category and click to display the data entry box If you select Conc for Concentration Dose and Total Dose the data entry box displays a field where you can change the units of measure for these categories as follows 1 Click on Change Units 2 Use the rotary knob to select a unit of measure 3 Click to confirm To enter a value for any of the Drug Calculator categories 1 Click successively on single digits to enter a value for the selected category 2 Click on Accept to confirm your choices and return to t
210. ient s skin is coincidence excessive ECG artifact or properly prepped ECG leads are off i Isolate the patient from auxiliary equipment Check electrodes Reapply gel or change the electrode if necessary Inspect and replace defective cables and wires If a lead or electrode cannot be replaced select another lead for processing from the ECG menu RESP Signal RESP signal detected Check patient cable and lead wires Saturated monitor has excessive carefully Replace any cable or lead wire that is suspect Reapply gel or change the electrode Check the MULTIMED pod and replace if necessary RESP Lead Off The cause could be one or more of the following Broken cable Loose lead wire Faulty lead wire Dried out gel on electrodes MULTIMED pod defective Check patient cable and lead wires carefully Replace any cable or lead wire that is suspect Reapply gel or change the electrode Check the MULTIMED pod and replace if necessary RESP The user has turned on None required Relearning respiration monitoring or has clicked on Relearn RESP Artifact Persistent artifact Check patient cable and lead wires detected carefully Check electrode placement Change their position if necessary RESP H W Call your Biomed or Medical Failure Technical Support VF7 VISTA XL 11 21 11 RESPIRATION This page intentionally left bl
211. imulator and click The monitor calculates the new factor and displays it as the Cal Factor value Calibration Using a Water Column To recalculate the calibration factor using a water column 1 Oy Cem 13 6 Add extension tubing if necessary so length of tubing used to connect the transducer to the patient is at least 136 cm 136 cm of HO 100 mmHg Fill the tubing with sterile flush solution ensuring that there are no air bubbles Align the level of the tubing tip and the transducer membrane Open the transducer to the tubing Tape the tubing tip to an IV pole at a level 136 cm above the transducer dome Follow the procedure outlined above for the manometer using 100 mmHg as the manometer value Remove excess calibration tubing before reconnecting the lines to the patient VISTA XL VF7 HARDWARE SETUP HemoMed HemoMed is available for measuring invasive blood pressure Wedge Starts a pulmonary wedge pressure measurement C O Start Starts a cardiac output measurement HEMOMED Pod CONNECTOR SIT xt j Connector to monitor Vista XL Transducer cables plug into adapter blocks on the back of the pod and can be mounted on the front panel Slide the transducer into the slot nearest the associated pod connector 1 Plug one end of the cable into the appropriate monitor connector 2 Connect the other end of the cable into the hemomeddynamic pod c
212. in bbHR value over the last three minutes 50 100 Lowest saturation value over last three minutes Cursor When you click on Cursor a vertical bar appears on the trend area of the screen and cursor time is displayed in the upper right corner The numbers on the left side of the screen no longer represent scale values but rather parameter values at the time marked by the cursor The monitor continues to display current real time values on the right of the screen When you move the cursor to the right or the left with the rotary knob the cursor time values and the cursor time are modified and displayed accordingly Review Summary Screen Overview Use the Review Summary screen to view stored Bradycardia SpO and Apnea events This screen also allows you to access data associated with each event The monitor stores up to 75 total events but only retains associated data from the 50 most recent OCRG events new data overwrites the old VF7 VISTA XL 11 11 11 RESPIRATION When OCRG trigger event occurs an orange bar appears in appropriate parameter graph on the OCRG Review Summary screen Whenever an OCRG event occurs the monitor automatically captures bradycardia SpO and apnea event data Gf available Event data associated with the trigger event appears in the other two rows BRDY 5 or Apnea color coded as follows e Bradycardia Green SpO White Apnea Bl
213. insert the wireless card or the monitor is brought back into range the normal monitoring state will be restored and the offline message cleared within 40 seconds CAUTION Software upgrades saved setups and card data transfers are not possible simultaneously with wireless monitoring Software upgrades saved setups and card data transfers may take place while the monitor is in wireless mode but the patient will not be monitored via wireless at the Infinity CentralStation at that time Wireless Messages In wireless mode the messages in the following table may appear Message Condition Display Area Offline VF7 Monitor travels out of range of AP or Wireless card removed VISTA XL Network 3 NETWORK APPLICATIONS Message Condition Display Area Invalid memory Wireless card is defective Local card Wireless option Wireless card inserted without Local not enabled wireless option enabled Not monitored Connected to network but not Network by central assigned to a MVWS 3 8 VISTA XL VF7 NETWORK TRANSFER Network Transfer Patient Data You can transfer patient data admission trends events and Hemo Oxy calculations from one monitor to another Procedures differ according to whether or not the source and destination monitors are connected to the Infinity network To transfer information involving a non networked monitor you must
214. ion Do not select Fusion mode mode may increase the risk of if you are uncertain what falsely counting pacer spikes as type of pacemaker is in use QRS complexes and may cause or is programmed cardiac arrest to be undetected Select Fusion Mode only in Special surveillance of any situations where it becomes pacemaker patient monitored to suppress with this mode is strongly repeated false asystole and ded or false low heart rate recommenced alarms QRS Sync Displays a vertical white line for Connect device to the output Marker each detected QRS complex marked Sync on the right side of the The monitor continuously monitor generates synchronization Select ON to enable the QRS Sync output pulses with a maximum marker delay of 35 ms between R peak and the synchronization pulse ba to disable the QRS CAUTION Sync output yne marrer pulses can trigger the timing of defibrillators during synchronized cardioversion Pulse Tone Selects the ECG or SpO signal Click on ECG to use the ECG signal Source as the source for the pulse tone as the source for the pulse tone A blinking heart displays in the parameter box e Click to use the SpOs signal as the source for the pulse tone 8 18 VISTA XL 8 ECG AND HEART RATE VF7 Selection Description Available Settings Pulse Tone Regulates pulse tone volume Click on OFF to
215. ion Tone Volume to set the volume of attention tones OFF 100 in increments of 10 after 5 Trend Setup Allows you to configure trend display Submenu see Chapter 6 Trends for detailed clinical logs and service menus information Recordings Allows you to configure and Submenu see Chapter 7 assign recorders Recordings for information Biomed Provides access to technical and Submenu see page 2 17 Unit Manager Allows the unit manager physician or head nurse to configure monitoring functions for the clinical staff Submenu see page 2 13 OR Configures monitor to meet the Submenu see page 2 11 special needs of the operating room environment VF7 VISTA XL 2 MONITOR SETUP Setups Management You can save and restore the current patient and monitoring settings Setups Management Menu function Description Reference Procedures Configuring Setups To save or restore setups configure them as shown in the referenced pages Main screen display Main Screen menu Page 2 6 Parameters Parameter Setup menu s Page 2 5 Note For more information see parameter chapters Alarms Alarm Limits Table Page 5 5 Arrhythmia calls Arrhythmia Setup Table Page 9 6 Trends Trend Setup Page 6 2 Trend Graphs Page 6 4 Trend Table Page 6 7 Naming and Renaming Setups Follow these procedures to name or rename the setups you have configure
216. iscrepancies you can review results of up to five measurements and use them to compute a C O average The C O Averaging screen is displayed whenever you begin a C O measurement The Review Curves screen duplicates the five values displayed on the C O Averaging screen with their corresponding thermodilution curves 20 10 VISTA XL VF7 AVERAGING C O MEASUREMENTS 1 Stable blood temperature detected see page 15 11 C O Averaging Current Injectate Temperature 2 Current average of C O values Click to save displays if values are out of range Current Blood Temperature 3 Exit C O Averaging screen C O value not stored C O measurement values Newest value at right click on value to exclude it from average and mark with slash 4 Access Review Curves screen see below Thermodilution Curve Highest point represents lowest blood temperature measured at exit from the heart Review Curves 1 Current average of C O values Click to save displays if values are out of range 2 Return to ia Averaging screen e 20 11 20 CARDIAC OUTPUT 20 12 Saving a C O Average Click on Save AVG to save the average of all indicated values and end the C O measurement session The average is written to trends and updated in the Main Screen parameter box to the time of the latest measureme
217. isplay up to one hour of trend data for as many as eight parameters while continuing to monitor Main Screen waveforms and parameter boxes Mini trend graphs follow the color coding and display order of the parameters they represent and are updated with new trend data every 60 seconds To display Mini Trends 1 2 3 4 Press the Fast Access fixed key Click on Split Screen Click on 10 Min Trends 60 Min Trends or Off Press the Main Screen fixed key to exit the menu VISTA XL VF7 Mini trend display MAIN SCREEN NOTE Ifa parameter box contains more than one parameter label you can select the individual parameter setup menu for the trend data you want to see This page intentionally left blank 6 10 VISTA XL VF7 Chapter 7 Recordings ej L 2 uidere 2 Layout a uL MM M TENE 2 HE 6 enne M 6 Events and Trends ence aE ere rene ce nnne nni inre e urine cens 7 Pending Recordings eene eee eti d eee 7 SOU MR M 7 Quick Reference R50 Series Setup 8 Primary and Secondary Recorders eese 9 Replacing Recorder
218. ive Single Patient Use Nellcor OxiMAX MAX A adult Latex free 24 pcs MX50065 SpO adult sensor for finger or toe application Patient weight gt 30 kg 66 Ib Nellcor OxiMAX MAX AL adult Latex free 24 pcs MX50071 SpO adult sensor for finger or toe application Patient weight gt 30 kg 66 Ib Nellcor OxiMAX MAX I infant Latex free 24 pcs MX50067 SpO infant sensor for finger or toe application Patient weight 3 20 kg 6 7 44 Ib Nellcor OXiMAX MAX N neonatal adult Latex free 24 pcs MX50068 SpO neonatal sensor for foot application Patient weight 3 kg or 40 kg 6 7 Ib or gt 88 Ib Nellcor OxiMAX MAX P pediatric Latex free 24 pcs MX50066 5 pediatric sensor for finger or toe application Patient weight 10 50 kg 22 110 Ib Pods Masimo SET SpO pod kit MS16901 1 MASIMO SET SpO pod 1 MASIMO SET SpO pod Mount 1 MASIMO Extension cable Extension Cable 3 m MS17041 Connects Masimo SET SpO pod to Masimo LNOP sensor Cables SpO blue latched Nellcor extension cable shielded 1 m 3368433 gt blue latched Nellcor extension cable shielded 2 m 3375834 Masimo ProCal cable 2 m 7492601 NOTE Not for use with Masimo SET pod VF7 VISTA XL C 11 SpO Masimo ProCal cable 1 5 513926 NOTE Not for use with Masimo SET pod Dual SpO MicrOz Pulse Oximeter Masimo 7269686 Pulse Oximeter 7263614 Dual cable with converter 7499614 Tem
219. jectate Accuracy Injectate temperature 0 25 C Degree of protection Type CF against electric shock Defibrillation protection IEC 601 1A2 Pulse Oximetry 5 2 Parameter display Saturation SpO gt pulse rate Measuring method Transmission spectrophotometry Measuring range 5 1 100 Pulse rate 30 250 1 Calibration range 70 100 VF7 VISTA XL MONITORING SPECIFICATIONS B 19 Display range 0 100 Display update period 2 seconds Maximum hold from 30 seconds in the event of artifact or other error previous update Measuring accuracy Adult mode 5 0 to 69 not specified 70 to 100 sensor specific as follows Drager OxiSure Sensor D 2 Nellcor D 25 D 25L D 20 I 20 25 OxiMAX MAX A OxiMAX MAX AL OxiMAX MAX P OxiMAX MAX N OxiMAX MAX I 2 Nellcor DS100A 3 Masimo 23 LNOPADT LNOPPED LNOPNEO LNOPNEO SS LNOP YI 2 Masimo LNOP DCI LNOP DCIP NR125 2 EAR 3 5 Pulse Rate 3 beats min or 3 whichever is greater Measuring accuracy and notes continued on next page Measuring accuracy Neonatal mode 2 SpO gt 0 to 69 not specified 70 to 100 sensor specific as follows Nellcor N 25 OxiMAX MAX N 3 Masimo LNOPNEO LNOPNEO SS LNOP YI 3 Pulse Rate 3 beats min or 3 whichever is greater Notes 1 accuracies are expressed as X
220. k on Admit Discharge 3 Click on Admit to display the Patient Admit menu 4 Click on a field in the example below Physician A data entry screen appears 5 Click successively on the letters of the word you would like to enter If you make a mistake click on Backspace and try again 6 Click on Accept to confirm your entry Click on the next field and repeat steps 5 and 6 NOTE change the patient s category Adult Pediatric or Neonatal you must access the Patient Setup menu see pag 2 5 Ifyou change a patient s category the weight selection is cleared and must be selected again In Neonatal mode additional selections Gestational Age Birth Weight Day of Life and Corrected GA are available Entries and changes regarding a patient s height and weight affect all other monitor menus and displays that use this information e Ifthe monitor is connected to the Infinity Network you can enter additional patient data such as sex religion blood type and telephone number when you admit the patient at the central station You cannot however view this additional data at the monitor For information on admission at the central station see the Instructions For Use for the MultiView WorkStation VF7 VISTA XL 4 3 4 ADMISSION TRANSFER AND DISCHARGE Transferring Patient Data You can transfer patient data including trends calculations and event recall data to or from another monitor To t
221. lates both inspiratory and expiratory O values iO and etO Scio Four plus 18 4 The Scio Four plus continuously measures the content of N20 and one of the anesthetic Wager ScoFow plus agents Halothane Isoflurane Enflurane Sevoflurane and Desflurane in any mixture It automatically identifies the anesthetic agent that is present in the highest concentration e 19 CAUTION Scio Four plus does not measure NOTE 5 Four plus blanks the O2 label and data in pbox Scio Four plus communicates real time and derived gas information to the host system Except for N5O the monitor saves values derived by the modules in its trend storage VISTA XL VF7 OVERVIEW Scio Four The Scio Four continuously measures the content of 1 0 and of the anesthetic agents Scio Fou Halothane Isoflurane Enflurane Sevoflurane and Desflurane in any mixture CAUTION ez Scio Four does not measure Pon I e The primary anesthetic agent must be set manually by the user See page 18 23 NOTE e Scio Four displays AA in Agent pbox until user selects agent in the parameter menu e Scio Four blanks the O2 label and data in pbox Scio Four communicates real time and derived gas information to the host system The monitor saves values derived by the modules in its trend storage VF7 VISTA XL 18 5 18 FouR MODULES Quick Reference Table Scio models Scio Model Func
222. lator proof equipment Analog out g Type CF 1 6 VISTA XL VF7 SYSTEM COMPONENTS Direct current gt Analog out Danger Risk of explosion if used in presence of flammable anesthetics Push battery all the way into compartment Isolated patient connection Type CF 2 Close battery compartment door Complies with the European Medical Device Directive 93 42 EEC I This end up Dispose of properly Manufacturing date REF Type BF defibrillator ARTERY Artery symbol and arrow protected mg should be placed over brachial or femoral artery Gas in Contains no latex material gt Gas out LOT Manufacturer s lot number Certain cuff codes are ethylene oxide sterile Manufacturer s reorder code Alarm out Does not provide isolation between connected devices Monitor is receiving AC power 9 Potential equalization terminal Observe WEEE Waste Electrical and Electronic Equipment disposal requirements VF7 VISTA XL 1 INTRODUCTION Modules MultiMed and NeoMed Pods The MultiMed houses connectors for ECG and impedance respiration leads an SpO sensor and a temperature probe The optional NeoMed specifically designed for neonates has connectors for a 3 lead ECG cable set an SpO sensor and two temperature probes See page 8 2 for more information HemoMed Pod The monitor acquires invasi
223. le connector 13 12 VISTA XL VF7 PULMONARY WEDGE PRESSURE DISPLAY To assign a label to a pressure channel Access an IBP setup menu see page 13 10 2 Scroll to Pressure Labels and click 3 Scroll to the channel you wish to label and click The first label in column on the right side of the menu is highlighted 4 Scroll to the desired label and click 5 Repeat steps 3 and 4 to assign other pressure labels NOTE For detailed information about types of pressure labels see page 13 2 Pressure labels are color coded to indicate their status In order to assign a label you must ensure that the HemoMed or Y cable is connected to the monitor Color Coding for Pressure Labels Background Text Status Black Green HemoMed or Y cable connected to monitor Transducer connected White HemoMed or Y cable connected to monitor Transducer not connected Gray White HemoMed or Y cable not connected to monitor Transducer not connected Pressure Label Conflicts Each pressure label can be assigned to one location at a time If you try to re use a label the monitor displays a caution informing you that the label is in use and asks if you want to continue If you choose YES the monitor puts the label in the currently selected box and places an automatic pressure label 1 P3d in the previous location Pulmonary Wedge Pressure Display The monitor averages the PA
224. lead The circuits inside the monitor that retain information after turning off the monitor Patient settings for example are saved in battery backed memory beat to beat Heart Rate Bigeminy Sinus Bradycardia Body Surface Area 2 Blood Temperature Capnostat 2 D or Dia Desflurane EEF End Tidal Enflurane ESU etCOs Exit arrow External battery Fixed keys Gorg Generic Pressure parameter GP1 GP2 Halothane HemoMed hr HR A 2 A waveform indicating the changing levels of measured in the patient s breathing cycle A sensor used to measure levels in a patient s expired and inspired air Continuous Cardiac Index Dynamic Compliance Cardiac Index Cardiac Output Minute Elimination Cerebral Perfusion Pressure Ventricular Couplet Central Venous Pressure Diastolic pressure An anesthetic agent End Expiratory Flow The carbon dioxide level measured at the peak of the exhalation phase of the breathing cycle See also and RRc An anesthetic agent Electro Surgical Unit End Tidal A left pointing arrow found at the top left of each menu and at the end of certain menu lists Click on the arrow to return to the previous menu An optional battery capable of powering the monitor for up to 50 minutes See SLA Fractional inspired oxygen Function buttons located on the fron
225. lectromagnetic environment device electrostatic contact discharge 6 6 kV Floors should be wood concrete discharge ESD air discharge 8 kV or ceramic tile If floors are IEC 61000 4 2 covered with synthetic material the relative humidity should be kept at levels to reduce electrostatic charge to suitable levels electrical fast power supply lines 2 t2kV Mains power quality should be transients bursts kVlonger input output that of a typical commercial or IEC 61000 4 4 lines 1 kV 1kV hospital environment surges on AC Common mode 2 kV 2 kV Mains power quality should be mains lines differential mode 1 kV 1 kV that of a typical commercial IEC 61000 4 5 hospital environment power frequency 13 3 Equipment which emits high levels of power line magnetic fields in excess of 3A m should be kept at a distance to reduce the likelihood of interference voltage dips and short interruptions on AC mains input lines IEC 61000 4 11 dip gt 95 0 5 periods dip 60 5 periods dip 30 25 periods dip gt 95 5 seconds gt 95 0 5 per 60 5 per 30 25 per gt 95 5 SEC Mains power should be that of a typical commercial or hospital environment If user requires continued operation during power mains interruptions insure that batteries are installed and charged Insure that battery life exceeds longest anticipated power outages or provide and additional unin
226. level of in the airway during the inspira tion phase End tidal CO The level of in the airway at the end of expiration 18 14 VISTA XL VF7 Scio SETUP Respiration Rate RRc The patient s respiration rate derived from etCO signal by calculating an average rate over the two most recent breaths end tidal value Alarm limits Alarm limits iCO2 inspired label Respiration rate value Respiration rate label label Oo Alarm limit Upper limit only iCO2 value A O N WARNING EtCO alarms do not activate until the first breath is detected after turning on the monitor or discharging a patient NOTE The monitor does not alarm for or inspiratory and expiratory agent limit violations until it has established a valid respiratory rate To access the Scio etCO setup menu e Click on parameter box or 1 Press the Menu fixed key 2 Click on Patient Setup 3 Click on Parameters to display a list of available parameters 4 Click on etCO VF7 VISTA XL 18 15 18 Scio FouR MODULES Quick Reference Table Setup Click on the following items to execute setup functions The Setup Menu Menu Item Description Settings Scale Sets waveform scale 40 60 80
227. longer than 25 seconds Waveforms flatline and P box values blank from the screen during this cycle Multigas Zero in Progress appears in the message area Note An extended zeroing cycle may be performed after initial power up of unit e To prevent damage to the watertrap and measuring system Do not use the water trap with nebulizers Do not allow alcohol or cleaning agent disinfectant to enter the water trap Do not wash or sterilize the water trap VF7 VISTA XL 18 7 18 Scio FouR MODULES Hardware Setup Scio Four P os A OO XXX SN Scio Module 6871450 Back Panel 1 Water trap 8 External Power Supply connector 2 External Power indicator 9 ON OFF switch 3 Fan exhaust screen 10 Flow Rate label 4 X2 connector 11 Software version label 18 8 VISTA XL VF7 HARDWARE SETUP 5 Safety label Attention Consult 12 RS232C connector X2 9 pin the accompanying document 6 Exhaust port 13 Medibus connector Safety label Gas out 14 Hardware version label 15 Model name example only Site of Operation The site of operation must meet the temperature humidity and atmospheric pressure requirements listed in Appendix C In addition observe the following guidelines Make sure that the platform which supports the module is large enough level and stable e Make sure that the fan exhaus
228. m 4714346 QRS Sync Cable 3 m 4314667 One end unterminated Analog Output Cable 5 m 4314618 One end unterminated Alarm Output Cable 5 m 5194928 For connecting an IDS to a nurse call system 5 m cable with one end unterminated Alarm Output Cable Interface Plate 5 m 4314626 For connecting to a nurse call system 5 m cable with one end unterminated Y cable recorder and alarm output 4313578 For simultaneous recorder and alarm output connection from an Interface Plate Transmitter Analog ECG cable 4316621 Connects transmitter to MultiMed cable to display lead ll For use with Infinity Telemetry or TruST Telemetry transmit ter Vital Connection cable MS15421 Connects Infinity Telemetry transmitter to monitor via the X8 connector CPS cable 25 m 5194910 Export Protocol cable MS15045 Remote Keypad Remote Keypad 5203042 Keypad for remote control of the Infinity Vista XL monitor Network Patch Cables Patch cable 1 2 m 4726373 Shielded cable to connect to a network wallplate Patch cable 2 4 m 4726381 Shielded cable to connect to a network wallplate Patch cable 4 9 m 4726399 Shielded cable to connect to a network wallplate Patch cable 20 m 4725557 Shielded cable to connect to a network wallplate Comes with extra connector for field termination VF7 VISTA XL 5 R50 Recorders and Recorder Cables R50 recorder includes paper 5952630 R50 N recorder includes paper and a mounting plate 5740068 Recordin
229. m limits owing to necessary A physiological condition Change alarm limits Inappropriate alarm limits Check equipment and A defective sensor or cartridge replace if necessary BT Out of Blood temperature is outside the Check equipment and Range measurement range 25 to replace if necessary High 43 C owing to a defective BT Out of sensor or cartridge Range Low C O Out of Cardiac Output is greater or Check the patient and treat if Range less than 20 liters min because necessary High of Use cooler injectate C O Out of A physiological condition Range Low Unstable baseline Incorrect injectate volume catheter size or Comp Constant Defective catheter cable or cartridge Enter the correct values in the C O menu Repeat the measurement If message persists replace defective components C O Injectate Too Cold C O Injectate Too Warm Injectate is cooler than 5 Usean injectate within the allowable range of 5 to 30 Defective cable HemoMed Injectate is warmer than 30 C Check equipment and replace if necessary Use an injectate within the allowable range of 5 to 30 Injectate probe connected Check probe connection If problem persists replace the probe Defective cable Repeat the measurement If problem persists replace defective part C O No Temperature Change The
230. me no value is displayed VISTA XL VF7 Trend Table The Trend Table arranges stored trend data in an easy to read tabular format Up to eight columns are displayed and updated every 60 seconds A time stamp above each column marks the interval during which that column of data was trended The value displayed is the last acquired during that interval with the rightmost column reserved for most recent data To view the Trend Table 1 Click on the Fast Access key on the front of the monitor 2 Click on Trend Table NOTE The time stamp indicates the end of the interval If the Interval option is set to 15 minutes then the time stamp 11 15 marks a column of data trended between 11 00 00 and 11 14 59 12 00 13 00 14 00 HR 72 72 72 5 133 133 133 ART 88 88 88 6 62 62 62 S 22 125 125 125 80 80 NBP D 7 70 PAS 38 PAM 12 PAD 5 3 2 3 2 3 2 3 2 3 2 RESP 12 etCO2 kPa 20 20 20 Interval 60 Trend Graph Request trend report Request trend recording Access trend graphs Set intervals Scroll intervals Scroll trends VF7 VISTA XL 6 7 The Interval key at the bottom left of Trend Table display functions similarly to Hours feature in Trend Graphs see page 6 5 Settings are 1 5 15 30 or 60 min NOTE The monitor always marks an NBP measurement and a C O average with a time stamp in the trend table Mini Trends You can d
231. meda Edw Baxter Arrow Other Note Due to corporate mergers Baxter cardiac output catheters and accessories may be labelled as being from Edwards Ohmeda output catheters and accessories may be labelled as being from Becton Dickinson BD Contact Edwards and or BD if there is any doubt as to the identity of the cardiac output catheters or accessories Catheter Size Displays the currently selected Click on one of the catheter size following to change the Note If Other is selected for Catheter catheter size Type this field is ghosted 5 7 0r 7 5 Injectate Displays the currently selected volume 3 0 5 0 or 10 0 cc Volume of the injectate used to measure cardiac output Note If Other is selected for Catheter Type this field is ghosted Comp Compensates for discrepancies in N A Constant catheters see page 20 7 for more detailed information Mode Determines the mode of measurement Auto for cardiac output see page 20 6 for e Manual more detailed information BT Alarm Opens Alarm Limits table beginning N A with temperature parameters Measurement Mode Procedures for measuring cardiac output differ according to the mode of measurement you select You ordinarily measure C O in automatic mode If unstable blood temperatures artifact or other conditions prevent an automatic measurement you can still take C O measurements by selecting manual mode Manual is the default setting on the C O setup men
232. mia which are intended for use in the adult and pediatric populations only The Infinity Modular Monitors are not compatible for use in a MRI magnetic field VF7 VISTA XL lt INFINITY VISTA XL USER S GUIDE VI Documentation Features Warnings Cautions Notes WARNING A warning statement provides important information about a potentially hazardous situation which if not avoided could result in death or serious injury CAUTION A caution statement provides important information about a potentially hazardous situation which if not avoided may result in minor or moderate injury to the user or patient or in damage to the equipment or other property NOTE note provides additional information intended to avoid inconvenience during operation Cross references Cross references specify chapter and page e g page 16 3 refers to Chapter 16 page 3 Chapter number and title are given when text refers to an entire chapter e g Chapter 1 Introduction Quick Reference Tables Wherever possible a quick reference table is provided for easy access to information about monitor functions Footer The current software version appears at the bottom of each page together with the chapter and page number and the device name Applicability references to monitor in this manual refer to the Vista XL patient monitor VISTA XL VF7 INFINITY VISTA XL USER S GUIDE Safety Considerations This Instru
233. moval from the ice bath and injection Use an in line temperature sensor to eliminate this source of error e If you hand fill your syringes fill them with the same volume each time The recommended amount is 10cc for adults and 5cc for pediatric patients Avoid touching the body of the syringe The warmth of your hand will warm the injectate very quickly Inject the entire volume in one swift continuous motion e Perform the injection at end expiration Taking successive cardiac output measurements at different points in the respiratory cycle can give different measurements especially for patients on mechanical ventilators e Discard results that are widely different from the general trend and those associated with irregularly shaped e g notched curves NOTE If you use a room temperature injectate use 10 cc for the injectate volume unless clinically contraindicated VF7 VISTA XL 20 3 20 CARDIAC OUTPUT Main Screen Display When Cardiac Output C O measurements are active the most recently saved C O average appears in the upper right of the C O parameter box on the main screen Cardiac Output Average of the last series of measurements saved in liters per minute L min Blood temperature BT Patient s blood temperature acquired from the HemoMed pod currently used to measure C O Time of the C O Average Time the currently displayed C O average was taken Injectate temperature IT
234. mum bandwidth and greatest sensitivity to noise or artifact Click on Monitor to reduce baseline drift muscle artifact and power line interference recommended for standard monitoring display recording and analog output Click on ESU to reduce signal distortion from electrosurgical units See page 8 6 for information on electrosurgical safety VF7 VISTA XL 8 17 Description Available Settings Pacer Determines the monitor s ability to In Basic mode Detection pacemaker pulse Allows Select ON to enable pacemaker Note See 2 to bon ipud pacer detection page 8 4 jor _ dstection or choose more Select OFF default to disable more on pacemaker detection pacemaker Caution Fusion mode pacer In Advanced mode detection detection is not intended for Select ON to enable pacemaler use with large voltage detection unipolar pacemakers It is intended for use only with Select OFF default to disable biphasic pacemakers Please pacemaker detection observe the following Select Fusion to enable pacer Before selecting Fusion detection but minimize pacer tail mode be certain that the rejection to reduce missed patient has a biphasic detection of pseudo fused paced pacemaker external or beats which results in false implanted and that it is asystole alarms accurately programmed as appropriate for that patient WARNING Selection of Fus
235. n and Off eese esses seen nnne nnne 13 Accessing the Main 13 Using the Rotary 14 Remote Keypad erret Eee eee nene e 15 Men ACCESS oett cui INI MI MINI 16 Fast erra mee 16 Main 16 C lem 17 Control Buttons fece 17 Data Archive Applications 17 iepihr mi cmemctec 18 auge 19 Navigating the Event Recall 21 aal mete 22 1 INTRODUCTION Overview The patient monitor is intended for adult pediatric and neonatal monitoring It can be used as a standalone device or can be connected to the Infinity network Monitor use is restricted to one patient at a time The following optional software features are available ACE full arrhythmia Arrhythmia II e HemoMed amp oxygenation ventilation calculations
236. n arrhythmia mode Basic Arrhythmia Mode Full Arrhythmia Mode HR e 72 PVC min 0 VF7 VISTA XL 8 13 8 ECG AND HEART RATE Alarms and Alarm Conditions 8 14 Asystole and Ventricular Fibrillation If ECG monitoring is active and the monitor displays at least one ECG waveform it annunciates asystole and ventricular fibrillation alarms even when arrhythmia monitoring is set to OFF High P Waves and T Waves High amplitude gt 0 2 mV P or T waves of long duration may register as integral QRS complexes To ensure that the monitor detects low heart rate in such cases place the lead with the highest R wave relative to the T and or P wave in channel ECGI If the monitor continues to misinterpret P or T waves reposition the electrodes or use a pulse sensor to monitor the patient Disconnected Electrodes If more than one electrode is disconnected messages are cycled When any lead is reconnected all lead data shows a 1 mV pulse in each waveform The monitor displays the following messages depending on whether the electrode is essential for QRS processing ECG Leads invalid Disconnected electrode is essential XX Lead Disconnected electrode is not essential VISTA XL VF7 2 ECG SETUP MENU ECG Setup Menu ECG SETUP MENU Click on the HR parameter box to access the ECG setup menu Items and settings are described in the following table Quick Reference Table ECG Setup Menu Sele
237. n you are done To calculate an assigned drug 14 12 Qv UM Open Drug List Setup menu see page 14 11 Click on the data category A text entry box appears Click successively on single digits to enter the desired value Click on Change Units to modify units of measure Scroll through available units of measure and click to select Click on Dose Units Scroll through available dose units and click to confirm Click on Accept to confirm your choices VISTA XL VF7 Chapter 15 Pulse Oximetry SpO uin Bp 2 Ee eer 3 PRECAUTIONS ee 3 Patient PreparatlODn e eene reor rettet reden erben 5 Display Fealtules eee Petre ie 7 2 SCT mc 8 Quick Reference Table SpO2 8 Stats DIrrpp ree 9 5 2 MicrO 20 12 me M 12 P a Megs nene 12 SPO2 dierum 12 SpO2 MicrO2 Tretids iin oe ioo dre SES deck SERES CE 13 Status MESSAGES Ic 14 15 PULSE OXIMETRY 2
238. nd electrosurgical units 8 6 VISTA XL VF7 ECG PRECAUTIONS To minimize interference from the electrosurgical unit 1 Click on the HR parameter box on the main screen 2 Click on ECG Options Click on Filter 4 Scroll to ESU and click ESU Block MultiMed pod 6 Ld gt ESU Block The ESU Block enhances monitor performance during electrosurgery Compatible with 3 and 5 wire ECG lead sets it reduces noise on ECG waveforms and protects the patient from burns See Chapter 21 Cleaning and Disinfecting for information on cleaning the device To use the ESU Block 1 Click on the HR parameter box on the main screen 2 Click on ECG Options 3 Click on Filter 4 Scroll to ESU and click 5 Plug a standard white ECG lead set into ESU Block as shown Do not use the shielded blue leads use only standard white ECG lead sets with the ESU Block NOTE Do not use the ESU Block except during electrosurgery Infusion or Roller Bypass Pumps Infusion or roller bypass pumps may cause artifact in the monitor s ECG signals Such interference may cause the monitor to display pacemaker spikes even though the ECG waveform appears normal To determine if the pump is the source of the electrical disturbance turn it off if possible If the artifact disappears the pump is the probable cause To minimize such artifact choose the lead with the best signal for monitoring or replace t
239. nd re plug Scio module Power cycle monitor or un dock and re dock monitor Call Manufacturer Agent The module has not yet identified or cannot identify agent because Agent is unknown ie not HAL DES ISO SEV or ENF Agent concentration is too low Vaporizer is leaking Traces of disinfectant are present For Scio Four Oxi or Scio Four select agent manually Check replace vaporizer etN20 gt 8290 2 gt 82 Check 2 concentration in the fresh gas flow Flush MultiGas Scio module sample line Check sample line and Sample Line occluded replace if necessary Occlusion Watertrap full defective or Check watertrap replace or not installed install if necessary MultiGas Zero Scio module zero in progress Wait in Progress MultiGas Zero Zero successful None Accepted VF7 VISTA XL 18 29 18 Scio FouR MODULES 18 30 Message Condition Suggested Action MultiGas Zero Zero performed using the Verify surrounding Failed wrong gas environmental atmosphere is Occlusion or leak present not contaminated HW problem Check for leaks and occlusions Call Manufacturer Check Watertrap is full or sample Replace sample line Watertrap line is blocked Empty or replace watertrap Sample Line see 18 27 MultiGas Too Fan port blocked Clear unblock port Warm Hardware problem Call Manufacturer MultiGas
240. nds of a larger patient group it is also possible to configure up to 40 default drugs These drugs can be assigned only by the unit manager or by others who have access to the password protected Unit Manager menu Nurses can however edit and recalculate default drugs from the unrestricted Drug Dosage menu Data pertaining to default drugs is not deleted when a patient is discharged from the monitor VF7 VISTA XL 14 7 14 CALCULATIONS Titration Tables 14 8 After you have entered the appropriate information the monitor displays a titration table showing the units of measure you have specified on the Drug Calculator or Drug List Setup menu Rates are displayed in green in the right column Whenever you change an entry on the Drug Calculator menu the monitor automatically updates titrated values To display a titration table follow the instructions for calculating drugs on page 14 9 If you click on a new drug you will display the drug calculator menu 1 Click on the drug whose titration table you wish to display 2 Click on information category e g Daily Weight 3 Enter data as described on page 14 10 The Dose and Rate are titrated if you have entered the appropriate input data for the calculation The table is titrated again when you change any of the settings on the Drug Calculator menu An example of a calculated titration table is shown below Dose Drug Dobutamine 250 Daily Weight 65 0 kg Amount
241. neously in approximately 3 5 hours To start a fast charge insert the batteries into the slots of the battery charger with the metal contacts facing down CAUTION This charger is intended for charging the monitor batteries only Do not use other chargers or batteries When the monitor receives DC power batteries recharge automatically 1 12 VISTA XL VF7 GETTING STARTED Getting Started Turning the Monitor On and Off To turn the monitor on e Press the power key QO located on the bottom left of the Vista XL monitor s front panel The monitor turns on the power indicator light lights up the screen performs a self test and displays the main screen To turn the monitor off e Press and hold the power key for two seconds The power indicator light turns dark and the monitor emits a power down tone Accessing the Main Screen After you power up the monitor the main screen appears To return to the main screen from a menu or other display e Press the Main Screen fixed key located just above the rotary knob on the front panel of the monitor The main screen appears as shown in the following illustration Network message Parameter boxes Waveforms A O N Local message VF7 VISTA XL 1 13 1 INTRODUCTION The standard monitor provides five waveform channels with adjacent parameter boxes Channels can be added to display up to six waveforms The bottom channel can
242. ngs which run only for a specified time continuous recordings run until you stop them manually To request a continuous recording 1 Press the Menu fixed key to open the Main Menu 2 Click on Cont Record 7 6 VISTA XL VF7 RECORDER SETUP To stop the recording e Click on Cont Record again or press the recorder s Stop fixed key Events and Trends The monitor can store waveforms and parameter values for up to 50 events parameter alarms arrhythmia events marked events These are displayed on the Event Recall screen see page 1 19 You can print a recording of stored events as well as trends as follows 1 Press the Fast Access fixed key 2 Click on Trend Graphs Trend Table or Event Recall 3 Click on Record at the bottom of the displayed screen Pending Recordings Recorders connected to the monitor may be temporarily unavailable to print for example during a paper change If another recorder is available the recording is rerouted to that recorder and printed there in its entirety If no recorder is available the data becomes a pending recording and is printed as soon as a recorder is available The monitor can store up to six timed recordings and one request for a continuous recording Print order is determined by the type of recording Continuous recordings have the highest priority followed by timed and then alarm recordings NOTE When the monitor stores a timed recording it saves the actual monitoring
243. ngth 892msec 225 samples ST complex Frequency response 0 05 to 40 Hz Update interval 15 seconds 1 normal beat required Trend intervals 1 2 4 8 12 24 hours 16 VISTA XL VF7 Trend resolution One data point every 30 seconds ST level alarm adjustment range 1 to 15mm ST event alarm duration OFF 15 30 45 60 seconds Alarm severity Serious Alarm Auto Set Current value 2mm Respiration Sensing leads Il user selectable Measuring method Impedance pneumography Detection threshold 0 150 4 00 in manual mode user adjustment Adult and Pediatric 0 20Q 10 50 in auto mode automatic adjustment Neonatal 0 20Q 1 5Q in auto mode automatic adjustment Measuring range 0 155 breaths per min Measuring accuracy 1 1 min or 2 of rate whichever is greater Apnea Detection Adult and Pediatric No Neonatal Yes Non Invasive Blood Pressure NBP Parameter display Systolic Diastolic Mean Measuring method Modes of operation Oscillometric technique Manual single measurement Continuous 5 minutes or Interval Interval times 1 2 2 5 3 5 10 15 20 25 30 45 60 120 and 240 min Measuring range Adult 270mmHg Heart rate 30 240 Systolic NBP 30 250 mmHg Mean NBP 20 230 mmHg Diastolic NBP 10 210 mmHg Measuring range
244. nitor Setup ell 2 2 Configuring the 2 2 DESIT m 2 2 Quick Reference Main Menu 2 3 Setups 2 10 Specialty grec 2 11 2 11 Unit Marnaget io eee eec c enun 2 13 BlOMOG P 2 17 Parameter 1 22 2 22 toI itcr kie Eat rea eed decem 2 19 CHAPTER 3 Network Applications je me 3 2 XII VISTA XL VF7 INFINITY VISTA XL USER S GUIDE Connecting to the 3 3 Connecting the Vista XL to the 3 3 Network nnmnnn neunana nnmnnn nnmnnn nana 3 3 Disconnecting the Vista XL from the Network eene 3 3 Wireless
245. nowledge or silence a latched alarm press the Alarm Silence or the All Alarms Off Alarm Grade Latching and Recording Behavior Visual Audio L T Life Life threatening alarms are latched Flashing Continuous Threatening and initiate an alarm recording if the red two tone recording function is enabled in the sequence alarm limits table Note Life Threatening and Serious alarms do not latch in OR mode see page 2 11 for more information SER Serious Only the alarm message is latched it Flashing Two tones e g neonatal continues to display when the alarm yellow then pause apnea patient safety Condition ceases while the parameter conditions during box stops flashing and the alarm tone measurements Serious alarms initiate an Note Life alarm recording if the recording Threatening and function is enabled in the alarm limits Serious alarms do table not latch in OR mode ADV Advisory Alarms cease as soon as the cause Flashing Low tone technical conditions of the alarm disappears or you white once every e g misapplied acknowledge the alarm Advisory ten transducer or alarms initiate an alarm recording for seconds VF7 disconnected lead events whose recording function is enabled in the arrhythmia or ST table Note Some advisory alarms will cease during an Alarms Off alarm timeout but will return after the timeout if the condition persists VISTA XL
246. nsor Monitor is configured for Nellcor and a non Nellcor compatible sensor is connected Note SPO compatibility is a locked option Contact your biomed for more information Replace with Nellcor compatible sensor Contact Biomed Incompatible SpO cable part 33 78 e Replace with compatible SpOs SpO Cable 614 is no longer cable see Appendix C Approved supported Options and Accessories Duplicate Device MultiMed pod with Disconnect duplicate device For Connected sensor and Infinity a complete list of Drager Medical Masimo SET pod are provided SpO accessories connected available with this product see simultaneously Appendix C Approved Options and Accessories VF7 VISTA XL 15 11 15 PULSE OxIMETRY SPO2 2 Overview SpO MicrO2 can be used as a second SpO in all modes It is a small battery operated pulse oximeter that is supported via RS232 cable using the X8 connector on the monitor SpO MicrO2 connector The 5 MicrO2 parameter box is labeled SpO No waveform is displayed with SpO but alarms are set on the Alarm Limits menu See Chapter 5 SpO is not supported for OCRG NOTE You cannot use the keypad and 5 he MicrO2 simultaneously Vista XL right side Parameters Parameter Label Units Range SpO5 5 1 to 100 PLS PLS b min 30 to 250 Delta A SpO2 6 0 t
247. nstalled in the Memory Card slot on the monitor The wireless card communicates with access points which are strategically placed within a monitoring unit in order to cover the desired transmission area NOTE Wireless networking is a locked option Contact your biomed for more information A wireless network offers the following Seamless Patient Relocation Patient and monitor can be moved to a different room or care unit within the same monitoring unit without ever losing contact with the Infinity network Simplified Network Setup Wireless monitors can be networked without the need of hard wired hub connectors which reduces the need for network cables within the hospital Note Central station access points and recorders printers are connected to the network by cable WARNING Before operating the monitor in a wireless network configuration please read the Wireless Network Safety Considerations below Wireless Network Safety Considerations When operating the monitor in a wireless network please observe the following Before using the wireless monitoring equipment read the instructions and safety warnings supplied by the wireless equipment manufacturer While the unit is transmitting or receiving signals do not hold the transmitting receiving unit close to exposed body parts especially the face or eyes The antenna wireless card should be at least 2 5 cm away from the body Operation of the wireless network
248. nt included in the average You also save the calculated average any time you quit the C O Averaging screen by accessing another menu or the Main Screen or whenever four minutes to pass without a C O measurement HemoMed Calculations MiniCalcs MiniCalcs are a standard feature with your monitor Whenever you measure cardiac output the monitor automatically calculates a set of related HemoMed parameters marks them with a time stamp and stores them in a special database You can later view these derived parameters on the Calculation Results screen and print them on an Infinity network laser printer HemoMed calculations are not trended NOTE The Mini Calcs function is a reduced version of the locked options Hemomeddynamic and Hemomeddynamic Oxygenation Ventilation calculations For more information see Chapter 14 Calculations To ensure accurate calculations e Be sure the patient s current height and weight are entered in the Patient Admit Screen Incorrect or missing height and weight result in incorrect or blank output values e Foracomplete set of calculations perform both a pulmonary wedge PWP measurement and a C O measurement Blank values on the Calculations Results screen result from failure to perform both measurements HemoMed Parameters NOTE Fora more detailed list of input and derived parameters including units of measure and derivation see page 14 5 WARNING Check that the weight you enter reflects the
249. ntly under the following conditions e ECG signal degradation e Excessive patient perspiration e Patient skin irritation A wide selection of reusable and disposable electrodes is available Select the best electrode for the monitoring situation Drager Medical recommends Ag AgCl disposable electrodes If you are using pre gelled electrodes verify that there is enough gel in the electrode gel filled area Never use disposable electrodes after their expiration date or when the gel has dried out Choose electrode sites in the configuration that will provide best P and wave amplitudes should be no more than one third of the QRS amplitude Select flat non muscular sites to maximize electrode contact and minimize muscle artifact Avoid joints or bony protrusions Consider the following special conditions when selecting sites for electrode placement Surgery Keep the electrodes as far from the surgical site as possible Burn Patients Use sterile electrodes Clean the equipment thoroughly Follow hospital infection control procedures Use a piece of waterproof tape 2 inches wide or steri drape to secure electrodes and protect them from fluids Form a small loop with the lead wire directly beneath connection and secure with tape VF7 VISTA XL 8 9 8 ECG AND HEART RATE Three Five and Six Lead TruST Configurations The following illustrations show typical ECG lead configurations and color codes designated
250. nts keep the balloon inflation time to the minimum necessary to acquire an accurate PWP value Prolonged inflation of the balloon can result in pulmonary hemorrhage or infarction e Do not over inflate the balloon during Wedge measurements An over inflated balloon can rupture the pulmonary artery e During Wedge measurements the PA catheter may move into the wedge position before the balloon is inflated One sign of this catheter drift is that the PWP waveform becomes wedge shaped Follow your hospital s clinical guidelines to correct catheter position ESU and Defibrillator Protection WARNING The monitor and Drager Medical hemodynamic pods are protected against 50 and 60 Hertz line interference Drager Medical provided transducers offer protection for the patient against burns during electrosurgery or defibrillation Use of non approved transducers may compromise this protection Refer to Appendix C for a list of approved transducers VF7 VISTA XL 13 3 13 INVASIVE BLOOD PRESSURE Hardware Setup For information and precautions regarding the use of HemoMed cables and transducers see page 13 3 Tubing For maximum signal strength choose the shortest possible length of high pressure tubing for connection to the patient Shorter tubing reduces signal attenuation and the effects of motion artifacts High pressure tubing limits signal dampening Follow your hospital s clinical procedures in assembling the tubing s
251. o 99 NOTE ASpO is the absolute value of SpO5 Both SpO and SpO must be connected to geta ASpO value e If PLS and PLS are not within 6 bpm the ASpO parameter field will be blank 5 MicrO2 Setup To access the 5 MicrO2 menu e Click on the SpO5 parameter box or 1 Press the Menu fixed key 2 Click on Patient Setup 3 Click on Parameters to display a list of available parameters 15 12 VISTA XL VF7 SPO2 MICRO2 4 Click on SpO Click on Label to set the label in the parameter box Choices are None Pre ductal and Post ductal If you choose None the SpO parameter box will have no label Click on SpO Alarm to go to the SpO entry in the Alarm Limits menu SpO MicrO2 Trends The SpO2 PLS and ASpO2 trends be seen in trend graph table see Chapter 6 e SpO and SpO are connected 1 SpO and SpO are displayed on the same trend graph with both parameter labels The SpO trend is white and SpO trend is blue 2 PLS and PLS are displayed on the same trend graph with both parameter labels The PLS trend is white and PLS trend is blue 3 Click on the Cursor to see the SpO SpO and ASpO2 values NOTE ASpO2 does not appear if there is no delta for that data point 4 The Trend Setup menu has combined selections for the channel in Manual Display mode for 5 2 5 2 and also for PLS PLS e 5
252. o enable MultiGas Parameter from menu see 18 17 The combined MultiGas parameter box takes the place of the parameter box on the Main Screen Make sure that the O5 or the MultiGas parameter is appropriately assigned on the parameter priority list see Chapter 2 e When you select the combined MultiGas parameter 0 values are automatically enabled for display To access the combined O Agent N5O setup menu 1 Ensure that MultiGas Parameter is ON 2 Return to the Main Screen 3 Click on the O Agent N5O combined parameter box Quick Reference Table Combined Display Setup Click on the following items to execute setup functions for Combined O2 Agent N20 MultiGas monitoring and display The Combined O5 Agent N5O Setup Menu Menu Item Description Settings Waveform Selects waveform for display Oo Agent 18 24 VISTA XL VF7 Scio SETUP The Combined 0 Setup Menu Menu Item Description Settings MultiGas Enables combined MultiGas OFF Parameter parameter box display see 18 24 2 Scale 15 waveform scale see 18 50 96 100 16 N20 Display Displays N2O values in O2 N2O ON OFF parameter box see 18 18 Agent Display Displays a separate Agent ON OFF parameter box see 18 22 Note During the combined display the and Agent displays are automatically turned on and their selections are ghost
253. o utut eroe De sooo 10 cd UA 11 OR MOG MI 11 Bhd rure 13 MINIM MINI 17 Parameter Colors ccc cidccccecscndecslcescasncdcceuesteasasnondeanasseneccneienva censuceseacecstenssudetenescusscens 19 2 MONITOR SETUP Overview This chapter describes how to configure the monitor Configuring the Monitor Main Menu Setup The Main Menu allows you to access submenus display screens and execute certain monitor setup functions Press the Menu fixed key to display the Main Menu 2 Click on a page icon 3 to open Main Menu submenu or Click on arrow icon to display another column of submenu options Click on desired setting to execute functions or access further submenus 4 Click on Exit at the bottom of a submenu list or on the white arrow in upper left corner of the screen to return to prior menu or screen 2 2 VISTA XL VF7 CONFIGURING THE MONITOR Quick Reference Main Menu Setup The Main Menu The Cursor Tool and a vertical cursor Submenu Menu Item Description Available Settings Cursor Tool Provides access to Cursor Tool Setup submenu which allows user to Horizontal Cursor select three waveforms S displayed with horizontal cursors Stop Hemo Calcs Vertical Cursor Note See Cursor Tool Submenu below This submenu allows yo
254. ode s Reapply electrodes Make sure the patient s skin is properly prepped If a lead or electrode cannot be replaced select another ST lead for processing MultiMed Pod The MultiMed is not Check cables and connection replace Disconnected connected to the monitor cables if necessary during 3 5 or 6 lead If MultiMed Pod is not in use press monitoring Alarm Silence key 10 8 VISTA XL VF7 Chapter 11 Respiration HEELS ejl P 2 RESP Precautlons inire rude ee 3 Patient PreparatlOnh ecc rere Dette Ere donne AAR 4 Display Features X M 5 assum 6 Quick Reference Table Respiration Setup 7 OxyCRG OCRG Monitoring 10 mon 11 ieri oT a 11 Review Summary Screen 11 Accessing Review Summary Screen eese senes 13 Quick Reference Table OCRG Review Summary 17 OCRG Setup Meri ce intuere x Lis Dux Rae rcrum 17 Quick Reference Table OCRG Setup nennen 18 Second and
255. omponent Log The monitor maintains read only logs for principal components or devices These logs include a part and revision numbers serial numbers software version and compatibility information 1 Scroll to the component you wish to inspect and click on it The log appears with the exit arrow already selected 2 Return to the Logs submenu by clicking again Status Log Displays information about your current software and hardware versions Display is read only Diagnostic Log Captures data about hardware and software performance relating to the monitor s operation Display is read only Click on the down arrow at the bottom of screen to scroll through the display FE Diag Log Captures and displays data Display is read only about front end performance Click on the down arrow at related to the monitor s the bottom of screen to operation scroll through the display Copy All Logs Downloads status logs Click on Copy Logs diagnostic logs to a memory confirmation message card appears in the message area to indicate the download is complete Print Log Prints an expanded version Click on Print Log of the Diagnostic Log to an INFINITY network laser printer only The Service Submenu The Service menu is password protected and intended for the hospital s biomedical or Dr ger Medical service personnel Test Pulse Test Pulse Tests ECG
256. on the time bar use the Hours button on the OCRG Review Summary screen 1 Turn rotary knob until the Hours button is highlighted 2 Press knob to click the Hours button 3 Turn knob to select time interval NOTE e Default time interval is 4 hours e Time intervals available on this screen are 1 2 4 6 12 or 24 hours 4 Click knob and the screen will update to new time interval Using the cursor To view the Event Recall menu use the Cursor button on the OCRG Review Summary screen 11 14 VISTA XL VF7 OCRG MONITORING ON OxyCRG Review Summary Desat Cursor Time 13 Jan 1995 947 10 00 gt gt Cursor 1 Number of apnea events fordataon 7 Apnea time display 2 Cursor date time 8 Cursor Button BRDY high low values 9 Associated data green 4 Trigger event orange 10 Number of desaturation events for data on display 5 5 high low values 11 Number of bradycardia events for data on display 6 Cursor To access the Event Recall menu from the OCRG Review Summary screen Turn rotary knob until Cursor button is highlighted Press knob to click Cursor button Cursor and Cursor time appear on screen Turn knob to move cursor along the data graphed Move cursor until it overlaps a trigger event BRDY and 5 high low data if available displays Apnea time if available displays VF7 VISTA XL 11 15 11 RESP
257. onitor is turned on that NeoMed pod is properly connected and set up for FiO monitoring Set up the sensor for O calibration following your hospital s guidelines Open the FiO menu see page 17 4 Click on 2 Point Cal VISTA XL 17 5 Supply 100 when instructed by monitor 17 2 FRACTIONAL INSPIRED O2 MONITORING 6 Click on Continue A message appears informing you that the calibration is in progress and requesting you to wait until calibration is complete before proceeding with room air calibration 7 Waitfor the system to calibrate When calibration is finished the following message appears 10096 Calibration Complete 8 Follow the instructions on page 17 5 to calibrate the system to room air 1 Point Calibration 9 Return the sensor to the incubator A status message appears if calibration fails Refer to the table at the end of this chapter for status messages Status Messages Message Condition Suggested Action FiO lt O2 value exceeds Check the patient and treat if alarm limits high necessary Recalibrate the system gt value exceeds set alarm Check the patient and treat if The calibration has been Cal Canceled Cal Failure Recalibrate If the message limits low stopped The monitor could not calibrate the FiO sensor necessary Recalibrate the system Try to calibrate again persists
258. onnection port IBP Y Cables You can use the IBP Y cable to monitor up to two IBP parameters without the HemoMed When plugged into the monitor the Y cable can accommodate up to two transducers letting you take two IBP measurements simultaneously Measurements taken with a Y cable use pressure labels Pla and P1b VF7 VISTA XL 13 7 13 INVASIVE BLOOD PRESSURE IBP Y cable 3 IBP transducers Plug into HemoMed connector on 4 Intermediate cables monitor To connect Y cable to the monitor 1 2 2 4 Plug a transducer into intermediate cable as shown Plug the other end of the intermediate cable into the Y cable 7 or 10 pin Repeat steps 1 and 2 for a second transducer Plug Y cable into a HemoMed pod or into the monitor NOTE See Appendix C Approved Options and Accessories for a list of available cables Display Features 13 8 Special features characterize the display of IBP parameter values and waveforms Parameter boxes vary in appearance according to whether the parameter is pulsatile or non pulsatile Parameter boxes for pulsatile pressures ART LV PA RV GP1 GP2 Pla P3d display systolic diastolic and mean pressure values A typical pulsatile pressure parameter box is shown below VISTA XL VF7 DISPLAY FEATURES Systolic pressure 4 Mean pressure Alarm limits 5 Parameter label Diastolic pressure NOTE Yo
259. or 1 whichever is greater Amplitude 0 5 5 0 mV QRS detection Duration 70 120 ms Adult and Pediatric 40 120 ms Neonatal filter Monitor 0 5 40 Hz filter ESU 0 5 16 Hz Frequency ranges filer OFF 0 05 40 Hz Note Printed ST and Rest ECG reports conform to EC 11 diagnostic bandwidth requirements Degree of protection Type CF against electric shock Defibrillation protection In accordance with IEC 601 2 27 Adult and Pediatric Yes Arrhythmia detection Neonatal No Adult and Pediatric Yes on leads Il or Ill Pacer detection Neonatal No Unit will detect pacers with the following characteristics Amplitude 2 to 700 mV Width dp 0 2 to 2 0 ms Rise Fall times min 0 1 dp 100 ms Overshoot min 0 025 ap 2 mV Recharge time con 4 to 100 ms stant ST Segment Analysis lead cable l Il or Ill user selectable 5 lead cable choice of leads 1 11 III aVR aVL aVF or V 6 lead cable choice of leads 1 11 111 aVR aVL aVF Sensing leads w TruST Off V V 6 lead cable choice of 3 leads I Il Ill aVR aVL aVF w TruST On V1 V6 dV1 dV4 d V6 Note TruST leads are indicated by a prefix d before the V lead Adjustment range Complex start to fiducial point Default QRS onset 28msec Adjustment range Fiducial point to complex end Point default QRS offset 80msec ISO point ST measurement point Le
260. or Use Impedance respiration monitoring is inoperative when you are using the ESU Block see page 8 7 or ESU shielded cables Do not rely on impedance respiration monitoring as the sole method for detecting cessation of breathing Patients at risk for respiratory crises should be observed closely Heart rate limit alarms should be enabled and set appropriately Drager Medical recommends the monitoring of additional parameters that indicate the patient s oxygenation status such as SpO Large amplitude pacer spikes 100mV or greater interfere with the monitor s ability to measure or detect respiration VISTA XL 11 3 11 RESPIRATION Patient Preparation Proper skin preparation and careful electrode positioning are essential for reliable results in impedance respiration monitoring Follow the same recommendations as those for ECG monitoring see page 8 15 As a rule place electrodes so that they generate the clearest possible signals with a minimum of artifact Electrodes that adhere tightly and have a large conductive area give the best results Use a 5 lead cable set with RL as a neutral electrode to improve the RESP signal You may want to position the electrodes to span the maximum expansion and contraction of the lungs especially in the case of deep abdominal breathers For neonates place the RA and LA electrodes at nipple level midaxillary line Position the LL electrode below the diaphragm
261. orrect or loose connection of tubing may allow gas leakage Leakage can result in erroneous readings CAUTION Do not use the module without a watertrap otherwise the correct functioning of the device may be compromised VF7 VISTA XL 18 11 18 Scio FouR MODULES Connect the module and tubing as follows 18 12 1 Connect one end of the sampling tubing to the water trap and the other end to the airway T connector For information on changing sampling tubing and T connector see page 18 27 If return of sample gas is not possible connect one end of the exhaust tubing to the exhaust port at the rear of the module see drawing on page 18 8 and the other end to the hospital s gas scavenging system NOTE If possible use sample gas recirculation to prevent increased anesthetic agent concentration in the operation room conserve anesthetic agents eto prevent undesired losses of volume during low flow application WARNING Accumulation of exhaled metabolic products may occur during low flow anesthesia therefore monitoring of oxygen concentration is mandatory Flushing the circuit with fresh gas at regular intervals may be necessary particularly if decreasing oxygen concentrations are measured 3 Connect Recirculating sample gas tubing as follows For Drager COSY breathing system Fabius GS Use Sample Gas Return kit Push the rubber sleeve on to the exhaust port on the back of Scio and plug the
262. patient s prevailing condition within the predefined ranges of the monitor listed in the following table Parameter Predefined Alarm Range Defaul t State Default Alarm Setting ARR See Arrhythmia Setup Table on page 9 6 ART S M D 5 to 300 mmHg 0 6 to 40 kPa Off S Adult Low 90mmHg 12 kPa High 160 mmHg 21 kPa M Adult Low 60 mmHg 08 kPa High 125 mmHg 17 kPa D Adult Low 50 mmHg 07 kPa High 110 mmHg 15 kPa S Pediatric Low 50mmHg 07 kPa High 120 mmHg 16 kPa M Pediatric Low 50 mmHg 07 kPa High 80 mmHg 11 kPa D Pediatric Low 30 mmHg 11 kPa S Neonatal Low 50mmHg 07 kPa High 120 mmHg 16 kPa M Neonatal Low 40 mmHg 05 kPa High 85 mmHg 11 3kPa D Neonatal Low 35 mmHg 4 6 kPa High 80 mmHg 11 kPa VF7 VISTA XL 5 7 Defaul Default Alarm Parameter Predefined Alarm Range t State Setting BT 25 to 43 C 77 to 109 F Off Low 34 C 93 2 F High 39 C 102 2 F CPP 25 to 300 mmHg 3 to 40 kPa Off Low 70 mmHg 09 kPa High 100mmHg 13 kPa CVP 5 to 300 mmHg 0 6 to 40 kPa Off Low 00 mmHg 00 kPa High 20 mmHg 03 kPa etCOs 5 to 95 mmHg 0 7 to 12 6 kPa Off Low 30 mmHg 04 kPa High 50 mmHg 07 kPa 18 to 100 96 Low 18 High 100 GP1 GP2 5 to 300 mmHg 0 6 to 40 kPa Off S Adult Pediatric S M D Low 90mmHg 12 k
263. patient s current weight and not his or her admit weight Failure to enter accurate weight for a patient could result in inaccurate calculations and seriously compromise the patient s treatment The monitor uses the following parameters to calculate derived HemoMed Hemo values e HAR Current Heart Rate VISTA XL VF7 CALCULATIONS MINICALCS ART M Current Mean Arterial Pressure e PAM Current Mean Pulmonary Artery Pressure e PWP Most recent Pulmonary Capillary Wedge Pressure e CVP Current Central Venous Pressure Most recent Cardiac Output ARTS Current Systolic Arterial Pressure Current Diastolic Arterial Pressure e HT Patient s height length as entered WT Patient s weight as entered The monitor calculates the following HemoMed parameters automatically using units of measure indicated in parentheses e SV Stroke Volume ml e SVR Systemic Vascular Resistance dynes x sec cm e CI Intermittent Cardiac Index liters min m e SVI Stroke Volume Index ml m SVRI Systemic Vascular Resistance Index dynes x sec cm m e BSA Body Surface Area m2 e Continuous Cardiac Index liters min m2 VF7 VISTA XL 20 13 20 CARDIAC OUTPUT Status Messages 20 14 Possible Cause Suggested Action BT gt UL Blood temperature is outside Check the patient and treat if BT lt LL alar
264. pcs NBP Connecting Hoses NBP connection hose child adult 3 7 m 12 75 275 connection hose neonatal 2 4 28 70 298 Invasive Blood Pressure IBP Vista XL IBP Options Vista XL IBP option MS 15 0610 Provides HemoMed and IBP Y cable connection on the Vista XL monitor Hemodynamic Pods HemoMed pod includes 3 m connection cable and universal 5588822 pole mount VF7 VISTA XL C 13 Hemodynamic Pod Connecting Cables HemoMed intermediate cable 3 m 5591925 Cable to connect HemoMed to monitor HemoMed intermediate cable 5 m 5591933 Cable to connect HemoMed to monitor IBP Y cable 7 pin 0 3 5592147 Cable for monitoring 2 pressures without hemopod Requires specific intermediate cable for each IBP trans ducer IBP Y cable 10 pin 0 3m 5731281 Cable for monitoring 2 pressures without hemopod Requires specific intermediate cable for each IBP trans ducer IBP adapter 10 pin to 7 pin 3368383 Connects pressure transducer cables to the monitor with 7 pin connectors IBP Accessories Hemo pod adapter Abbott Medex 5196998 Adapter block to connect Abbott Medex pressure transduc ers to the HemoMed pod Two for each HemoMed pod Hemo pod adapter Edwards Baxter 5196980 Adapter block to connect Edwards Baxter pressure trans ducers to the HemoMed pod Two for each HemoMed pod Note Due to corporate mergers Baxter accessories may be labelled as being from Edwards Contact Edwards if there is any dou
265. perature Temp adapter cable 1 5 5198333 Temp Y cable MultiMed 5 6 5592154 Core Probes For use in electrosurgery esophageal and rectal applications Temperature probe adult 1 5m 4329889 Temperature probe adult 3m 5204644 Temperature probe pediatric 1 5m 4329848 Temperature probe pediatric 3m 5204651 Temp protective covers 10 pcs 7014616 WARNING Covers contain latex Use with all probes except skin probes Skin Probes Not for use in electrosurgery Temperature probe skin adult 1 5m 4329822 Temperature probe skin adult 3m 5204669 Temp skin probe pediatric 10 pieces 7498921 12 VISTA XL VF7 Non INVASIVE BLOOD PRESSURE Non Invasive Blood Pressure NBP NBP Cuffs Reusable Child cuff 12 19 cm arm circumference Latex free MS14430 ae adult cuff adult 17 25 cm arm circumference Latex MS14427 ree Adult cuff 23 33 cm arm circumference Latex free MS14428 Large adult cuff 31 40 cm arm circumference Latex free MS14425 Thigh cuff 38 50 cm thigh circumference Latex free MS14426 Single Patient Use Neonatal cuff 1 3 1 5 7 cm arm circumference Latex free 2870181 10 pcs Neonatal cuff 2 4 3 8 0 cm arm circumference Latex free 2870199 10 pcs Neonatal cuff 3 5 8 10 9 cm arm circumference Latex free 2870207 10 pcs Neonatal cuff 4 7 1 13 1 cm arm circumference Latex free 2870215 10 pcs cuff 5 8 3 15 0 cm arm circumference Latex free 2870173
266. piration Relearn e Print the current monitor screen on a network laser printer via the optional Remote Keypad Enter edit and view patient data WARNING Never rely on the central station to evaluate a patient Always check patient status at bedside 3 2 VISTA XL VF7 CONNECTING THE NETWORK Connecting to the Network Connecting the monitor to the network gives you access to the following e Infinity network e Bedside recorder e Nurse call alarm Connecting the Vista XL to the Network For the Vista XL you can connect to the network via the network connector on the right side of the monitor Network connector Network Message Once the monitor is connnected to the Network the following message may appear Message Condition Display Area Not monitored by central Connected to network but not assigned to an Infinity CentralStation Network Disconnecting the Vista XL from the Network To disconnect the monitor from the network remove the cable from the network connector in the right side of the monitor VF7 VISTA XL 3 3 3 NETWORK APPLICATIONS Wireless Network The Vista XL can operate in a wireless network which allows the monitor to establish and maintain contact with the Infinity network and the central station without being connected by cable A wireless monitor transmits and receives data with the help of a wireless LAN PC card i
267. piration alarms before setting Coincidence Detect to ON RESP Enables and disables ON Monitoring respiration monitoring OFF Note You can also enable and disable respiration monitoring on the Main Screen and ECG setup menus see pages 2 2 and 8 15 Apnea Time Sets the time the monitor waits OFF 10 s 15 s 20 25 5 30 s before reporting a cessation of Note This feature is available in breathing as an apnea event Neonatal and Pediatric patient mode and sounds an alarm only Apnea Allows user to store and or OFF Record Store default Str Archive record automatically an apnea Rec alarm event User can later Note This feature is available in review stored alarms on Event Neonatal and Pediatric patient mode Recall screen only 11 8 VISTA XL VF7 RESP SETuP MENU The Respiration Setup Menu Menu Description Settings Relearn Learns the patient s respiration N A pattern when Mode is setto Note Relearn is ghosted in manual Auto mode Note Initiate a Relearn if electrodes have been repositioned and or if your patient s breathing pattern changes RESP Alarm Displays respiration alarms on N A See page 5 5 for information the Alarm Limits table about the Alarm Limits table VF7 VISTA XL 11 9 OxyCRG OCRG Monitoring The monitor can display an oxycardiorespirogram OxyCRG or OCRG in neonatal mode The OCRG displays three or six min
268. pment should assure that is used in such an environment PEN Compliance according to Electromagnetic environment RF emissions CISPR 11 Group 1 The equipment uses RF energy only for its internal function Therefore its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment CISPR Emissions Class B The equipment is suitable for use in all Classification establishments including domestic 2 1 establishments and those directly connected Harmonic emissions Class A to the public low voltage power supply IEC 61000 3 2 network that supplies buildings used for Voltage fluctuations flicker Complies domestic purposes IEC 61000 3 3 NOTE e Note that when used with the wireless option the equipment emits electromagnetic energy in order to communicate with the Infinity Network Nearby electronic equipment may be affected e Radio frequency characteristics are specified above See the documentation that accompanies the wireless products for further details B 4 VISTA XL VF7 ELECTROMAGNETIC COMPATIBILITY Electromagnetic Immunity This equipment is intended for use in the electromagnetic environment specified below The user of this equipment should assure that is used in such an environment magnetic field 50 60 Hz IEC 61000 4 8 Compliance Immunity against IEC 60601 1 2 test level level of this E
269. press C O Start after a catheter is disconnected the monitor displays the C O setup menu sounds a tone and requests that you confirm current setup data Press the C O Start fixed key within 30 seconds to confirm the current setup data display the C O Averaging screen and begin measuring cardiac output Blood flow is measured in liters per minute In computing cardiac output the monitor takes the following factors into account e Injectate volume temperature density and specific heat e Blood baseline temperature density and specific heat e Temperature changes of the blood injectate mixture e Areaunder the temperature curve 20 2 VISTA XL VF7 ACCURACY Accuracy To optimize cardiac output measurement e Follow the recommendations made the manufacturer Dr ger Medical recommends you place the prefilled syringes or the closed injectate delivery system into an ice bath Check the ice bath regularly and add ice as needed to maintain a temperature between 0 C and 5 C Accuracy of measurements made with the thermodilution method increases as the temperature of the injectate approaches 0 C Verify the injectate volume Verify the computation constant An incorrect computation constant is a common cause of error e Use an in line injectate system Systems that measure the temperature of the injectate in the ice bath may introduce error since the injectate temperature changes in the time between its re
270. quipment inspection and maintenance is required The user should verify that the monitor operates as described in this manual and that all safety labels are legible and should also maintain a record of these and other inspections Safety checks verification calibration and maintenance should be performed at least every two years by trained personnel as described in the Service Manual see individual VF7 VISTA XL Vil INFINITY VISTA XL USER S GUIDE parameter chapters for information about calibration and verification of parameter specific functions and devices All cables alarm functions accessories and associated devices should be checked for damage ground resistance chassis and patient leakage currents on a yearly basis or more frequently based on usage WARNING VIII NOTE Disposable accessories such as disposable electrodes transducers etc are for single use only Do not reuse disposable accessories Do not use cables that appear cracked worn or damaged in any way Such use may contribute to poor monitoring performance or the display of erroneous values Moisture under the front panel can damage the electric circuits and compromise key function Read carefully cleaning instructions on page 21 2 Because of the danger of electric shock never remove the cover of any device while it is in operation or connected to a power outlet The monitor s Service Manual is available from your local Drager Medical serv
271. r calibration Place the sensor on the zero cell and Sensor on failed or sensor is not the wait for zeroing to complete Zero Cell last sensor calibrated on 16 14 VISTA XL VF7 Condition Suggested Action Sensor The sensor temperature is Wait at least three minutes for the Temp Not unstable following warm message to disappear If the message Stable up persists replace the sensor Out of COs value is out of range Check the patient and treat if Range High high necessary Recalibrate sensor Check Airway adapter is dirty Make sure the adapter is properly Airway fully seated or out or seated Clean and calibrate the Adapter Cal calibration airway adapter Calibrating on zero Informational message no action Calibrating required Sensor Cannot Calibration on zero cell Check for any heat sources warming Cal Sensor could not be completed the sensor and remove them because of CAPNOSTAT Wait at least three minutes for the temperature instability temperature to stabilize Adapter Airway adapter is dirty not sure the adapter is properly Failure fully seated or out or seated calibration Clean and calibrate the airway adapter Place Calibration on zero cell Place sensor on the reference cell Sensor On Ref Cell completed succe
272. r to display or select the catheter size and injectate volume Consult documentation included with the catheter for computation constants and select one that corresponds to the injectate volume and temperature that you will be using To enter a computation constant 1 From the C O menu click on Comp Constant A data entry screen appears on the menu s right side 20 8 VISTA XL VF7 C O MEASUREMENT PROCEDURES 2 Enter the computation constant and click on Accept to confirm your entry WARNING An incorrect computation constant may yield incorrect C O measurements which could lead to an inappropriate medical intervention If you have entered a Comp Constant manually confirm it is correct for the catheter you are using NOTE The new computation constant is not displayed until the measurement is completed Measurement Procedures To measure C O in automatic mode 1 Press Start fixed key the HemoMed pod to display the Averaging screen A tone sounds and a READY message appears when the monitor detects a stable blood temperature 2 Inject the saline solution into the patient s bloodstream after you see the READY message A thermodilution curve appears displaying the change in blood temperature NOTE Ifthe READY signal fails to appear or appears only intermittently switch to Manual mode and repeat step 2 3 Repeat step 2 to take an additional measurement making sure you wait for
273. ransfer WARNING e Use electrostatic discharge ESD prevention practices when inserting the PCMCIA card into the monitor In some environmental conditions insertion of the memory card could cause the monitor to reset as the result of an ESD event e The patient s stored event and trend information will be lost after the monitor resets e Monitoring does not occur during data transfer 4 4 VISTA XL VF7 TRANSFERRING PATIENT DATA VF7 CAUTION Do not remove the memory card while a copy is in process If the transfer fails repeat procedure using a new card Insert the card in the memory card slot Press the Menu fixed key on the source monitor Click on Admit Discharge Click on Copy Patient Data ph pups I3 Highlight Copy To Card and click On the right side of the screen a large arrow shows the direction of the data flow 6 Go to step 7 if the patient s name and ID appear in both the upper and lower windows or Click on Patient Admit and follow standard data entry procedures page 4 3 if the upper window instructs you to enter a patient s name or ID A banner informs you that the copy is in process A message appears when the copy is successfully completed 7 Remove the memory card from the source monitor Take the memory card to the destination monitor 9 Press the Menu fixed key on the destination monitor 10 Click on Admit Discharge 11 Click on Copy Patient Data The large arro
274. ransfer information involving a non networked monitor you must use a PCMCIA memory card To transfer information over the network you can use either the Copy Patient Data PCMCIA card required or Transfer options of the menu system see pages 4 4 and 4 6 Certain conditions restrict the transfer of patient data e Both source and destination monitors must have the same software level consult your Biomed for more information e You can only transfer calculations if the destination bed supports the Calculations option see Chapter 14 Calculations CAUTION When you begin a transfer the destination monitor discharges the current patient All patient data currently stored in the destination monitor is overwritten Data Transfer Using the Memory Card Transferring data from one monitor to another with the PCMCIA memory card is a two step process you copy data from the source monitor to the card and then from the card to the destination monitor After the data has been copied to the monitor it is no longer available on the card The monitor displays the current patient s name and ID number at the beginning of a data transfer Because the data on the card overwrites data on the destination monitor you can overwrite one patient s data with another s effectively discharging the former and admitting the latter Make sure you copy information to the destination monitor before you perform significant monitoring functions Memory Card T
275. rate RUN Ventricular Run Series of 3 to N 1 consecutive PVCs with a beat to beat rate gt the VT rate AIVR Accelerated Idioventricular Rhythm Series of 3 or more PVCs with a rate less than the VT rate SVT Supraventricular Tachycardia N or more consecutive normal beats with a beat to beat rate greater than or equal to the SVT setting CPT Ventricular Couplet Sequence of beats with the pattern normal PVC PVC normal BGM Ventricular bigeminy Sequence of beats with the pattern normal PVC normal PVC normal TACH Sinus Tachycardia or more consecutive normal beats with a beat to beat rate gt TACH rate setting BRDY Sinus bradycardia 8 or more consegutive normal beats with an average rate lt sinus bradycardia rate setting Notes When neonatal mode bradycardia is a low heart rate alarm Brady Alarm which is a life threatening alarm can be configured independently of the low HR alarm which is a serious alarm PAUS Pause Sequence of two beats classified as normal or PVC with interval gt pause rate value in seconds 100ms ARTF Artifact More than 50 of beats in the last minute classified as questionable VF7 VISTA XL 9 3 9 ARRHYTHMIA MONITORING Label Event and Beat Classification ventricular tachycardias have sinusoidal waveforms closely resembling those of ventricular fibrillation Because of the simil
276. rature probe connected to the MultiMed or NeoMed pod As part of the cardiac output monitoring function the monitor can also measure blood temperature via the HemoMed see page 20 9 for more information You cannot monitor body temperature with the HemoMed The MultiMed pod houses one connector for a temperature probe With a Y cable however you can process up to two temperature signals The NeoMed pod is equipped with two temperature probe connectors NOTE Temperature functionalities and associated probes should be calibrated at least every two years by qualified personnel to ensure accuracy of 0 1 C To measure body or blood temperature connect the monitor to the appropriate device as shown below Follow the instructions on page 20 9 to monitor blood temperature with one of the HemoMed pod Use the MultiMed to measure body temperature amp _ 2525 NUT du To monitor HEMOMED Pod 24 To monitor 0 Bod and temperature MuLTIMED Pod probes and temperature probe gt VISTA XL VF7 TEMPERATURE DISPLAY Temperature Display All temperature readings appear on the main screen according to their position in Parameter Priority see page 2 6 The following display conventions govern temperature labels and values The monitor displays temperature Temperature signals r1 monitoring results in one parameter and labels box for each pod connector a or b MultiMed
277. re always active Follow HR Alarms default ASY and VFIB alarms follow HR alarm settings WARNING When HR Alarm is OFF and ARR monitoring is OFF ASY VF alarms do not sound 5 Allows user to render SpO ON alarm is inactive Interlock alarm inactive when NIBP when NBP measurement is measurement is in progress taken WARNING Visually default alarm is ensure that NIBP cuff is active when NBP on the same arm as SPO measurement is taken sensor The monitor will not automatically detect that NIBP cuff and SPO sensor are on the same arm 2 14 VISTA XL VF7 The Unit Manager Menu Menu Item Description Available Settings MIB Alarm Control Allows user to activate deactivate MIB disconnect alarm ON default MIB disconnect alarms are active OFF MIB disconnect alarms are inactive Remote View Display Allows user to set Remote View behavior when Remote View is displaying telemetry ECG Always ON Local bed alarm will not cause remote view feature to pull down remote bed display Pull Down on Alarm default Local bed alarm will cause remote view feature to pull down remote bed display Audio Alarm Reminder Allows user to set a reminder when alarm volume is turned OFF ON default When Alarm Volume is turned OFF a reminder tone sounds every 30 sec at 5096 volume Note For
278. relies on uninterrupted signal transmission between the transmitting and receiving components of the network When using the wireless network be aware that certain structural limitations within the hospital building may interfere with signal transmission other devices emitting radio frequencies such as leaky microwave ovens or warmers may interfere with signal transmission VISTA XL VF7 WIRELESS NETWORK the frequencies emitted by the device may interfere with the operation of other medical equipment The installation of wireless equipment must be performed by qualified Service technicians This includes installation placement and configuration of WLAN access points Any changes or modifications to the equipment not expressly approved by the equipment manufacturer may result in equipment malfunction or damage Access points not considered medical equipment and should be kept out of the patient s vicinity e Maximum number of beds per access point in wireless mode is eight Wireless Network Setup Card Slot Release Button Vista XL Memory Card Slot STEPS Installing the Wireless Card 1 Facing the monitor turn the card so that the flat side back label faces you 2 Press the card firmly into the Memory Card slot until the slot s release button protrudes Wireless Card Removal To remove the card press the release button and remove card from slot VF7 VISTA XL 3 5 3 NETWO
279. res outlined on page 3 10 Select Remote Bed to display the Remote View screen VF7 VISTA XL 3 11 3 NETWORK APPLICATIONS John Doe 1 Displays Remote View menu 8 Screen label Display only 2 Local bed display 9 Local bed message 3 Remote View menu bar 10 Remote bed label 4 Remote bed display Remote 11 Exit arrow Restores local bed View display 5 Remote bed alarm message area 12 Local bed label 6 Silences Remote bed alarm for 60 13 Initiate Rremote bed recording seconds see note below 7 Patient name 3 12 VISTA XL VF7 REMOTE VIEW VF7 Recordings print on the recorder assigned to the local monitor and show local settings for recording delay duration and speed The remote patient s name and bed label are printed on the recording strip For more on timed and continuous recordings see Chapter 7 Recordings You cannot select waveforms for remote recordings Waveforms are printed according to the remote bed s recording setup If the remote bed is configured for manual waveform selection see page 7 8 the recording s waveforms may differ from those displayed on the Remote View menu If the local bed alarms while Remote View is displayed the monitor behavior depends upon the Remote View Display selection in the Unit Manager menu If the remote bed alarms the top waveform and the alarming waveform channel are displayed In the presence o
280. ress Fuses Ordinary Replace as marked F2A 250V Note There are no other user replaceable parts for this device Environmental Requirements Temperature range Operating 15 C to 40 C 55 F to 104 F Storage 20 C to 40 C 4 F to 104 F Relative humidity Operating 30 to 95 non condensing Storage 10 to 95 non condensing with packaging Atmospheric pressure Operating 550 to 775 mmHg 73 to 103 kPa Storage 375 to 795 mmHg 50 to 106 kPa CAUTION The Recorder is not suitable for use in the presence of flammable anaesthetic mixtures with air or flammable anaesthetic mixtures with oxygen or nitrous oxide Monitoring Accessories MONITORING ACCESSORIES etCO Module Physical Attributes VF7 VISTA XL B 11 Module 150 x 93 x 65 mm 5 9 x 3 6 x 2 6 in Size H x W x D CapnostatTM III Sensor 33 x 42 x 22 mm 1 3 x 1 7 x 0 9 in Module 0 5 kg 1 1 Ib CapnostatTM 11 Sensor 18 g Weight Sensor connector female luer side stream sampling Connections port male luer sample exhaust port Adult airway adapter dead lt 5 cc space Neonatal airway adapter lt 0 5 dead space Airway adapter can be immersed in water without Moisture resistance damage Note CapnostatTM sensor size and weight exclude cable Electrical Specifications Power source Powered directly from monitor Protec
281. ressure and humidity Do not handle the sensor unnecessarily as your body heat can temporarily cause it to produce error FiO sensors contain lead Dispose of sensors properly and in accordance with local regulations FiO values are trended see Chapter 6 Trends 17 2 VISTA XL VF7 Precautions WARNING Do not use in hyperbaric chambers or in the presence of flammable or anesthetic agent See Chapter 2 Overview Setting alarm limits below 21 may expose patients to low oxygen levels which may compromise primary organ function Secure excess cable away from the patient s head and neck Failure to understand the effects of pressure humidity and temperature on the O2 sensor can result in inaccurate oxygen monitoring see page 17 2 for more information Sensors contain caustic material Avoid contact with eyes skin or clothing Dispose of a leaking sensor immediately in accordance with local regulations Electrical fields from other equipment may cause erratic values You may need to move the sensor away from other devices Display Features FiO values are displayed in a parameter box as shown below 41 UEM 1 value and label 2 Alarm Limits Crossed bell icon if alarm is disabled 3 Attention icon Appears when the alarm value falls below 2190 VF7 VISTA XL 17 3 17 2 FRACTIONAL INSPIRED O2 MONITORING Setup The monitor acquire
282. rope CEE 7 4321712 Power cord North America 5 15R 4321720 Power cord Australia and New Zealand AS 3112 1851705 Power cord Great Britain BS 1363 1851713 Power cord Switzerland SEV 1011 4321613 Power cord China AS 3112 1859714 Power Adapters Infinity Vista XL Power Supply MS18284 This is a replacement for power supply 5955393 volt age is auto switchable Power adapter 5955393 Grounding Cable Grounding Cable 5 m 2171767 Connects monitor chassis to earth ground Has two spring catches VF7 VISTA XL 3 MOUNTING Shelf Mount Docking Station 4720087 Shelf mount for interface plate Wall Mount 4720111 Universal mount for interface plate 23 extending arm Rolling Stand 4722240 Mobile rolling stand for attaching interface plate with bas ket EasiArm Mount Kit 7498913 Includes Mount Mount Plate PGEA and GCX and West brook wall track Rail mount for power supply 4720095 Plate for mounting power supply on horizontal rails R50 countertop plate 5197384 Plate to stabilize R50 Recorder on a countertop For use with Interface Plate 3376493 External Battery External Battery Pack 5592097 Battery Charger 5597377 Charging station for four lead acid battery packs Internal Battery Lithium ion Battery 5732354 Memory Card Data Card 4718248 Memory Data Card for patient data transfer C 4 VISTA XL VF7 EXTERNAL CONNECTION ACCESSORIES External Connection Accessories RS232 UART cable 3
283. ruST leads are viewable in the same fashion as the conventional leads See page 8 10 for Six Lead Standard Infinity TruST electrode placement WARNING e There may be instances where the QRS morphology in one of the four TruST leads differs from that of an equivalent conventional lead In these instances always refer to the conventional lead e Do not select TruST leads for ECG processing VF7 VISTA XL 8 11 8 ECG AND HEART RATE TruST Setup You can select electrode configuration according to TruST twelve lead format TruST twelve lead monitoring is available on the Vista XL monitor only if you are using the MultiMed six lead pod If a five or twelve lead pod is connected the TruST 12 lead selection is ghosted and unavailable To select TruST configuration 1 Click on the HR parameter box 2 Click on ECG Options 3 Scroll to TruST 12 Lead and select ON ECG Signal Processing and Display ECG Pod Cable Set Channels Leads Available NeoMed 3 lead 1 Ill MultiMed 5 3 5 lead ECG1 2 Il aVR aVL aVF V 3 ECG3 MultiMed 6 3 5 6 lead ECG1 ECG2 I Il aVR aVL aVF V ECG3 2 Va3 Two channel ECG and arrhythmia monitoring are not available in neonatal mode ECG3 is available only when HR ARR and ST parameter boxes are on the Main Screen 3V and V are chest leads aVR aVL and aVF are augmented leads 8 12 VISTA XL VF7 ECG SIGNAL
284. ry Clean or replace the adapter if necessary 6 Use the sidestream sampling tubing to connect the airway adapter to the input connector on the face of the module Dr ger Medical recommends NAFION dehumidification tubing set See Appendix C Approved Options and Accessories 7 Connect a nasal sampling cannula to the dehumidification tubing set if one is used Otherwise connect the cannula directly to the sidestream airway adapter NOTE Dehumidification and cannula tubing can affect the calibration of the airway adapter Calibrate the adapter if you change to different combinations or lengths of cannula and dehumidification tubing 16 4 VISTA XL VF7 DISPLAY FEATURES 8 Align the marks on the bottom of the adapter and the bottom of the CAPNOSTAT sensor Snap the airway adapter into the sensor until you hear a click 9 Ifyou are switching adapter types e g from mainstream to sidestream or from neonatal to adult you must calibrate the adapter as described on page 16 12 10 Attach the O tubing to the ventilator and enter the setting to be used 11 Access the menu and select O2 Compensation when using etCO module 12 Dial in the O setting you used in Step10 Click to confirm your choice 13 Insert the cannula tips into the patient s nostrils pass the cannula tubing behind the ears and slide the retaining sleeve up so that the tubing is snug under the chin 14 Secure the CA
285. s FiO signals from the sensor via the NeoMed pod To connect the pod to the sensor Set the patient category on the monitor to Neonatal 2 Plug an FiO sensor cable into the FiO NeoMed connector on the NeoMed pod connector _ Pod 3 Plug the NeoMed pod into the MultiMed connector on the monitor 4 Attach a sensor into FiO sensor cable Push 7 the sensor firmly into cable receptacle until you hear it click 5 Place the sensor in the incubator or under the oxygen hood Menu Access The FiO menu displays the date and time of 1 point and 2 point calibrations see below The menu item Last O2 Cal is informational only It displays the date and time of the last successful calibration either 1 point or 2 point To open the menu e Click on the FiO parameter box on the Main Screen or 1 Press the Menu fixed key 2 Click on Patient Setup 3 Click on Parameters 4 Click on Calibration Every time a sensor is connected to the NeoMed pod you must calibrate the monitor to the sensor The monitor does not display FiO values until it is calibrated There are two types of calibration 1 Point calibration measures the oxygen in room air typically 21 and calibrates the monitor to that measurement 2 Point calibration uses two measurements room air and 100 oxygen to calibrate the monitor 2 Point calibration provides more accurate FiO monitoring because the monitor
286. s No Menu Item Description Available Settings Continuous Note You must attach the Yes Allows continuous cuff and display the measurements when you press the Code key on the remote keypad No No NBP measurements can be initiated when Code key is pressed Alarm Volume OFF The default setting is No Yes Allows you to lower the alarm volume to 10 on non networked monitors or silence alarms completely OFF on networked monitors when you press the Code key on the remote keypad No Alarm volumes are not affected when the Code key on the remote keypad is pressed Menu Setup The Menu Setup Submenu Determines amount of time menus and screens remain displayed Note This setting determines menu display time in Remote View also 1 Click on Menu Setup 2 Click on Menu Time Limit 3 Click on one of the following ON Active menus and screens display for a limited time only approximately 5 minutes OFF Menus and screens remain displayed until you cancel them or select another display The Drug List Setup Submenu This menu allows the unit manager to store up to 44 types of drugs and their dosages for use during drug calculations Open the Unit Manager menu page 2 13 click on Drug Setup then follow the procedures outlined on page 14 9 2 16 VISTA XL VF7 SPECIALTY MENUS The Unit Manager Menu Menu It
287. s eene aen ORE QN Duu ad Us 4 222 E 4 6 5 6 17 2 FRACTIONAL INSPIRED O2 MONITORING Overview The monitor measures fractional inspired oxygen concentration FiO in neonatal mode only via the NeoMed pod and an FiO sensor The FiO sensor is typically placed in the incubator or under the oxygen hood and near the infant s head As varying concentrations of oxygen diffuse into the sensor two electrodes generate a current proportional to the partial pressure of oxygen in the air of the hood or incubator The monitor measures this electrical current and converts it to a percentage which it then displays on the monitor Because the sensor responds to partial pressure of oxygen and not percentage changes in barometric pressure can affect the reading even if the percent of oxygen being monitored stays the same Changes in humidity change the percentage of oxygen in the air but not the partial pressure As a result the reading does not change and may not accurately reflect the concentration of oxygen For example if 100 oxygen is displayed as saturated with 100 humidity the actual concentration of oxygen is 97 The FiO sensor which has a minimal response to gases other than oxygen is sensitive to changes in barometric p
288. s for more information e Ensure that other products in patient monitoring and or life support areas comply to accepted emissions standards EN55011 Class B e Maximize distance between electromedical devices High power devices relating to electrocautery electrosurgery and radiation X ray as well as electrical stimulators and evoked potential devices may produce interference on the monitor e Strictly limit access to portable radio frequency sources e g cellular phones and radio transmitters Portable phones may periodically transmit even when in standby mode e Maintain good cable management Avoid routing cables over electrical equipment Do not intertwine cables e Ensure electrical maintenance is done by qualified personnel e NBP circuits use motors that emit very low level electromagnetic fields that may interfere with other sensitive medical devices e For more information on Electromagnetic Compatibility see B 2 VF7 VISTA XL XI INFINITY VISTA XL USER S GUIDE Table of Contents CHAPTER 1 Introduction Over VIEW 1 2 System Comporients neri eiue cna teu ace aN aaaea a aaaea 1 3 5 UI e 1 3 1 6 LG Ic
289. s knob and Event Recall menu displays for this event If there is no data for the event an error tone sounds and Event Data Not Available appears OCRG Setup Menu Settings for the second and third channel and the Time Base for the Oxy CRG menu are controlled from the OCRG setup menu To Open OCRG Setup 1 Press the Fast Access fixed key 2 Click on OxyCRG to display the OCRG screen 3 Click the Setup button on the OCRG screen NOTE The OCRG setup menu has no time out It will stay active until the user cancels the display VF7 VISTA XL 11 17 11 RESPIRATION Quick Reference Table OCRG Setup The OCRG Setup Menu Menu Description Settings Parameter 2 Displays list of label choices for updating second channel of OCRG menu Parameter 3 Displays list of label choices RESP for updating third channel of OCRG menu Time Displays Time Base choices 3 min Note When Time Base 6 min choice is selected a clinical password menu appears After the password is entered the new OCRG Time Base will take effect Second and Third Channel Label You may set the second and or third channel of the OCRG menu 1 Click the Setup button on the OCRG screen 2 Click Parameter 2 and select Or 3 Click on Parameter 3 and select RESP or etCO Time Base You may select either a three minute or a six minute OCRG time b
290. s of fetal hemoglobin Nominal wavelength Red ns rie Power at 50 mW 215 Hesolutlon Pues rate tonis B 22 VISTA XL VF7 MONITORING SPECIFICATIONS gt 0 02 Pulse Amplitude gt 0 02 Low Perfusion Saturation SpOz 2 digits and Transmission gt 5 Pulse rate 3 digits 4 The Masimo SET pod has been validated for low perfusion accuracy in bench top testing against a Biotek Index 2 simulator and Masimo s simulator with signal strengths of greater than 0 02 and a transmission of greater than 5 for saturations ranging from 70 to 100 This variation equals plus or minus one standard deviation Carboxyhemoglobin may erroneously increase readings The level of increase is approximately equal to the amount of carboxyhemoglobin present WARNING Dyes nail polishes and Interfering Substances Other substances may absorb abnormal amount of red light which can effect the accuracy of the measurement Be sure to apply the sensor to a site free of any artificial pigments End Tidal CO etco module Parameter display iCO2 Respiration Rate RRc Measuring method Dual wavelength non dispersive infrared absorption Adult and Pediatric Mainstream and Sidestream Neonatal Mainstream only Warm up lt 5 min at 25 C Measuring modes Measuring range 0 99 mmHg 2 partial pressure
291. s replace the cable either unplugged or Inactive pressure Turn off alarms defective xx Zero Pressure transducer for Zero the transducer Required specified parameter requires zeroing xx Zero Transducer zeroing None Accepted successful xx Did Transducer zeroing failed Keep all tubing motionless then Not Zero because of rezero Excessive signal noise Change the transducer A non static waveform Check stopcock then rezero VF7 VISTA XL 13 15 13 INVASIVE BLOOD PRESSURE 13 16 Message Possible Cause Suggested Action Note lt xx gt represents the IBP parameter label associated with the displayed message lt xx gt Did Transducer Zeroing failed Rezero the transducer Not Zero because static pressure Loosen and retighten the transducer Offset was too high or too low dome then rezero the transducer Error Replace the transducer lt XX gt Mercury calibration in Complete calibration before you begin Calibrating progress monitoring the patient xx Cal Mercury calibration None Accepted succeeded or user entered calibration factor accepted xx Cal Mercury calibration failed Make sure transducer is closed to Failed because input pressure patient Not Static was not static Check for leaks Keep all tubing motionless Rezero the transducer Refer to calibration procedures page 13 6 Loosen and retighten the transducer
292. s signal artifact caused by cardiogenic oscillations or Baines rebreathing bumps which could cause the monitor to display an erroneously high respiration rate RRc Normal Disables the filter e Special Enables this filtering at the expense of a certain degree of monitor you can set upper and lower alarm thresholds See Chapter 5 Alarms for information about setting and displaying alarm limits responsiveness Apnea Alarm Displays Apnea Alarm menu RRc Apnea Time Apnea Archive Alarm Accesses Alarm Limits table where N A WARNING alarms do not activate until the first breath is detected after turning on the monitor or discharging a patient 16 10 VISTA XL VF7 ETCO2 SETUP Quick Reference Table Apnea Alarm submenu The following table explains apnea alarm submenu functions Function Description Settings RRc Apnea Time Specifies time monitor waits before OFF 10 15 20 reporting a cessation of breathing as 25 and 30s an apnea event Apnea Archive Allows you to store and or record OFF Record automatically an alarm event for Store default apnea You can later review stored Str Rec alarms on the Event Recall screen VF7 VISTA XL 16 11 16 2 END TIDAL CO2 MONITORING Cleaning Calibration and Verification Cleaning For information on cleaning ventilation tubing sensors and adapters see Chapter 21 Cleaning
293. s table applies to apnea detected by etCO monitoring from any source You can set RRc Apnea Time Ar to OFF 10 15 20 25 or 30 seconds on setup menus etCO or etCOs If you press the Alarm Silence key any time after the monitor s first indication of an apnea condition A7 subsequent alarms for that apnea condition do not annunciate 5 16 VISTA XL VF7 Chapter 6 Trends EEG jS Ad E M 2 Mc EI EE 2 4 411219 7 6 22 8 Overview The monitor stores trend data for all connected signals except automatic pressures Pla d P2a d P3a d You can request a trend recording or report and execute a print screen of displayed trends The monitor deletes all trend data once the patient is discharged Automatically stored events are identified on an event summary bar at the top of the trend display as outlined below e Trend Table Anicon 4 over time line marks manually stored events only alarms and arrhythmia calls are not marked see illustration on page 6 7 e Trend Graphs A small yellow vertical line marks manually and automatically stored events see illustration on page 6 4 For information on marking or storing events includin
294. s the time of the data capture and parameter values and or waveforms active at the time of capture Trends Calculations and Alarm History are discussed in the following chapters Event Recall and Storage is explained later in this section e Trends See Chapter 6 Trends Stored events are marked with the time and date of capture as follows Trend Table An icon lt over the time line marks manually stored events only Automatically stored alarms and arrhythmia calls are not marked in the Trend Table Trend Graphs A small yellow vertical line at the top of the screen marks manually and automatically stored events e Calculations See Chapter 14 Calculations e Alarm History See Chapter 5 Alarms Storing Events Automatic Storage The monitor stores events automatically if you have first correctly configured the Alarm Limits and Arrhythmia Setup tables You can enable individual parameter alarms in the Alarms column of the Alarm Limits and or the ARR Setup screens Configure event storage in the Archive column by selecting Store or Str Rec Upper Current Lower Archive Archive Str Rec Str Rec 120 60 Str 10 0 Str Str Rec gt Str Rec 160 Str Str Rec 110 Str OFF Str Rec Record OFF 39 0 Str OFF OFF More v AlarmVolume 100 ST D ARR Monitoring 1 18 DATA ARCHIVE APPLICATIONS Event Recall The monitor stores monitoring data waveforms and parameter values
295. seconds because of unstable measurement conditions at a site free of patient motion and all cables are properly connected Contact Medical Technical Support SpO Searching Searching for valid pulses from which to compute measurements e Ensure the sensor is properly attached to the patient SpO Regulation Error Inconsistent light level detected by sensor Excess Ambient light detected e Ensure the sensor is properly attached to the patient Remove or shade any external sources of light entering the sensor Contact Medical Technical Support SpO Unplugged Sensor or sensor cable not connected to the MultiMed pod Check to ensure that cables and sensor are securely connected Check for defective sensor SpO gt MicrO2 software version Contact Drager Medical Incompatible does not match Technical Support SpO gt MicrO2 is disconnected Reconnect MicrO2 Disconnected SpO H W Front end hardware Contact Drager Medical Failure circuit failure Technical Support VF7 VISTA XL 15 15 15 PULSE 2 This page intentionally left blank 15 16 VISTA XL VF7 Chapter 16 etCQ End Tidal Monitoring eji cC 2 rna 3 gr Li LEE 3 Sidestream Adult and
296. show the behavior of the displayed parameters over a significant time period three channels at a time The parameter label in its identifying color and a scale bar appear to the left of the associated trend channel Vertical lines in each graph mark time divisions Trends are updated automatically with the most recent data entering continuously on the right side To display Trend Graphs 1 Click on the Fast Access key to display the Fast Access menu 2 Click on Trend Graphs to display the Trend Graphs screen VISTA XL VF7 TREND GRAPHS Several features are available to help you navigate the Trend Graphs screen Using the rotary knob scroll to the desired function and click x 11 00 44 4 Hours 8 hr 12 00 13 00 Trend Table Cursor Time 1 Jan 1999 13 04 1 Multiple value parameter display 7 Change scale set of variable values e g ART plotted as a multi layered band below here top layer systolic pressure bottom layer diastolic pressure blank layer in the middle mean pressure Activate cancel cursor Scroll intervals Print Report Scroll trends Request trend recording 10 Vertical marker showing time of alarm arrhythmia or manually marked event 5 Access Trend Table 11 Single value parameter display Single variable value e g HR plotted as a single continuous line 6 Set intervals VF7 VISTA XL Changing the Size of Trend Graphs
297. silence the pulse Volume tone Click on volume 5 to 100 to regulate the pulse tone TruST 12 Allows 12 lead monitoring for the e Select ON to enable TruST 12 lead Lead Vista XL monitor through a monitoring MultiMed 6 pod Select OFF default to disable TruST 12 lead monitoring The Brady Alarm Submenu Visible in neonatal mode only Notes When in neonatal mode bradycardia is a low heart rate alarm The Alarm which is a life threatening alarm can be configured independently of the low HR alarm which is a serious alarm This submenu allows you to configure the following functions Brady Sets Brady Detection limit OFF Detection 20 100 bpm 5 bpm intervals Brady Allows you to store and or record OFF Archive automatically a bradycardia Record alarm event You can later review stored alarms on the Event Store Default Recall screen e Str Rec Other ECG Setup Functions HR Alarm Accesses Alarm Limits table Click on HR Alarm to open the See Chapter 5 Alarms for more Alarm Limits table with HR information about setting and associated alarms prioritized displaying alarm limits WARNING When HR Alarm is DFF and ARR monitoring is OFF ASY VF alarms do not sound unless reset manually by the user VF7 VISTA XL ECG SETUP MENU 8 19 8 ECG AND HEART RATE Menu S Selection Description A
298. sories is connected to the monitor via the MultiMed NeoMed or Masimo SET pods NOTE Certain SpO solutions achieve specified accuracy in the presence of motion See Technical Data section for further information Precautions 5 measurements are particularly sensitive to the pulsations in the artery and the arteriole Measurements may not be accurate if the patient is experiencing shock VF7 VISTA XL 15 3 15 PULSE OxIMETRY 2 hypothermia anemia or has received certain medications that reduce the blood flow in the arteries WARNING e Check the sensor at least every four hours Move the sensor if there is any sign of skin irritation or impaired circulation e Use only Dr ger Medical provided sensors Only Masimo compatible sensors and cables can be used with the Masimo SET pod Other sensors may not provide adequate protection against defibrillation See Appendix for a list of Drager Medical approved sensors e For Nellcor sensors use only blue latched SpOs extension cables for monitoring Do not use other extension cables e A pulse oximeter should not be used as an apnea monitor e Carboxyhemoglobin may erroneously increase readings The level of increase is approximately equal to the amount of carboxyhemoglobin present Dyes nail polishes and other substances may absorb an abnormal amount of red light which can effect the accuracy of the measurement Be sure to apply th
299. splayed according to their parameter device e g an NBP priority in the Parameter hose cuff is connected to the Priority list If all available monitor A white label indicates channels are filled a higher that the device is not connected priority parameter will NOT 4 Scroll the list to the bump lower priority parameter parameter you wish to move boxes off the Main Screen and click when the associated device is connected In order to display a eee the parameter the user must double click on the parameter 6 Click to confirm the in the Parameter Priority list new position on the OR Mode if all available St channels are filled a higher 2 priority parameter will oump Ponty lower priority parameter boxes 8 Scroll to the arrow at the off the Main Screen when the Upper left corner of the menu to associated device is exit or continue to set up other connected Main Screen submenu functions Max Determines number of waveform Click on 4 5 6 7 or 8 Channels channels and parameters Note The number of displayed waveforms you can display depends on the software option you have installed 2 6 VISTA XL VF7 CONFIGURING THE MONITOR The Main Menu page 9 1 Menu Item Description Available Settings Bottom Configures bottom waveform Click on Waveform to display Channel channel to display waveform or a wa
300. ssfully and wait for calibration to complete Sensor Calibration on zero cell Recalibrate If the message persists Cal Failed failed try a new sensor etCO Calibrating on reference Informational message no action Verifying cell required Sensor Cal Sensor Verification completed Informational message no action Cal Verified successfully required etCO Airway adapter cal Informational message no action Calibrating zeroing in room air in required Adapter progress Cal Breaths detected during Make sure the sensor is not Failed the 20 second period connected to the patient s ventilator Breaths following activation of the breathing circuit or close to a Adapter Cal key source Recalibrate VF7 VISTA XL STATUS MESSAGES 16 15 Condition Suggesied Action Cannot Airway adapter cal Recalibrate holding sensor in room air Cal Adapter zeroing in room air could not on zero cell not be completed because wait at least eight minutes for of CAPNOSTAT temperature temperature to stabilize and instability or because the recalibrate CAPNOSTAT was on the zero cell e Remove any heat source warming the sensor and recalibrate Remove sensor from Zero cell place on the adapter and recalibrate Adapter Airway adapter cal Informational message no action C
301. st of available parameters appears Scroll to RESP and click to display the RESP setup menu VISTA XL VF7 RESP SETuP MENU Quick Reference Table Respiration Setup The Respiration Setup Menu Menu Item Description Settings RESP Lead Determines respiration lead Mode Determines processing mode for breath related impedance changes Auto Optimal breath detection threshold calculated at beginning of RESP monitoring Intended for patients with regular breathing patterns Manual No breath detection threshold set by monitor at the beginning of RESP monitoring Instead the adjustments you make to the waveform Size see Size below also adjust the monitor s breath detection sensitivity Intended for adult or pediatric patients whose breathing patterns show excessive variation or for neonates whose breathing rhythms tend to be irregular and whose respiration signals may not be reliably evaluated in Auto mode WARNING Manual Mode if the size of the respiration waveform is set too low shallow breaths may not be counted If set too high cardiac artifact will be counted as breaths Therefore always use the RESP marker to verify breath detection at the desired amplitude Size Adjusts size of waveform and or breath detection threshold according to Mode setting Auto mode Waveform only without affecting the breath detection threshold Manual mode
302. such as sampling tubing T connectors water traps and fan filters are not reusable and need to be replaced at regular intervals General equipment inspection and maintenance is required Once a year check all devices accessories and cables for damage and test the ground resistance chassis and patient leakage currents as well as all alarm functions Make sure that all safety labels are legible Maintain a record of these safety inspections WARNING e Occupational safety Used sampling tubing T connectors and water traps could be contaminated and must be handled and disposed of with care Infection hazard may be present Dispose of these items in accordance with local regulations e Because of the danger of electric shock never remove the cover of any device while it is in operation or connected to a power outlet 18 26 VISTA XL VF7 MAINTENANCE AND REPAIR Changing the Sampling Tubing and T Connector The sampling tubing and T connector that connect the Scio module to the patient s airway are not reusable They must be replaced under the following conditions e Anew patient is connected to the module e The cleanliness of the tubing or connector is suspect or compromised NOTE Use only Drager Medical provided sidestream sampling lines otherwise the correct functioning of the device may be compromised Dr ger Medical does not assume responsibility for the reliability and safety of Scio measurements if non approved tubing
303. supplements the information that already exists elsewhere in the instructions for use Much of the information below is derived from requirements specified in the electromagnetic compatibility standard for medical electrical equipment IEC 60601 1 2 2001 published by the International Electrotechnical Commission and available from a variety of sources While primarily aimed at device manufacturers this contains a large amount of information that may be useful to interested users of medical equipment The information contained in this section such as separation distances is in general specifically written with regard to the Drager patient monitors specified above The numbers provided will not guarantee faultless operation but should provide reasonable 2 VISTA XL VF7 ELECTROMAGNETIC COMPATIBILITY assurance of such This information may not be applicable to other medical electrical equipment older equipment may be particularly susceptible to interference NOTE Medical electrical equipment needs special precautions regarding electromagnetic compatibility EMC and needs to be installed and put into service according to the EMC information provided in this section and the instructions for use which accompanied your monitor e Portable and mobile RF communications equipment can affect medical electrical equipment e Cables and accessories not specified within the instructions for use are not authorized Using other cables and or
304. suuvaueddaduuad uda e 17 4 Status eL 17 6 CHAPTER 18 Scio Four Modules Intended ed 18 2 er mc J I 18 3 Sio prse 18 3 FOUR OX e 18 4 mets 18 4 DAI 18 5 Hardware Setup eu M 18 8 Site of Operation ricorrente redes uou ces secca 18 9 Installing the Water Trap 1 nennen nnne nnn nnn 18 10 Cable Connections cicer reeerc c circ enar ance aoc conu naa auge 18 11 VF7 VISTA XL INFINITY VISTA XL USER S GUIDE T bing Connections Mec 18 11 Warmi UD aE EAE EEEE 18 14 Gali urer 22 22 ANNARA AERAR RENERE 18 14 SOUP EE EE A AT 18 14 etCO2 Peas 18 14 2 2 Monitoring Scio Four plus and Scio Four Oxi 18 16 Agent Monitoring eorr eet 18 18 Valles 18 20 Combined Display O2 Agent N2O Scio Four Oxi plus only 18 24 Dual Agent Display Scio Four plus amp
305. t of the monitor Fixed keys are also found on the HemoMed pod on the NBP module and on the R50 Recorder Gravity force A general purpose blood pressure parameter that enables you to configure pressure channels for later assignment See Generic Pressure parameter An anesthetic agent A module used to mount blood pressur Hour Heart Rate VISTA XL VF7 Hz Hertz IBP Invasive Blood Pressure Inspired ICP Intracranial Pressure Inspiratory Expiratory Ratio Impedance respiration Respiration monitoring based on the measurement of changes in electrical impedance that accompany the expansion and contraction of the chest in inches Inspired In monitoring the level of carbon dioxide measured during the inspiration phase of the breathing cycle InspT Inspiratory Time Internal battery A permanent lead acid battery capable of powering the monitor for up to 75 minutes Isoelectric line In electrocardiology a reference line representing the resting state of the heart IT Injectate Temperature LA ECG Left Arm LA IBP Left Atrial pressure LCD Liquid Crystal Display LL Left Leg Local message area Along the top left of the main screen displays error and status messages See also Network Message Area LV Left Ventricular pressure M or Mean Mean pressure Main menu The top level menu in the Vista XL menu system Press the Menu fixed key to access MAP Main Arterial Pressur
306. t screen at the rear of the module and the ventilation holes on the underside are not obstructed e Place the module at least 25 cm 10 inches from any possible source of ignition such as sparking VF7 VISTA XL 18 9 18 Scio FouR MODULES e Place the module close enough to the patient so that the sampling tubing can reach the airway T connector and the exhaust tubing the hospital s exhaust gas scavenging system without stretching WARNING e Do not use mobile phones within 33 feet 10 m of the Scio module Wireless phones may cause failure e Do not expose the Scio Module to mechanical vibrations or shock during measurement Mechanical vibrations or shock can have adverse effects on gas measurement values e The operation of the Scio module in magnetic resonance imaging environments MRI is not supported e Do not use a Scio module near devices with microwave or other high frequency emissions These emissions may interfere with the modules operation e When placing the module assure adequate ventilation heat dissipation and avoid direct contact of the patient with the pod s exterior surface e Vista XL and the Scio Module must both be connected to a hospital outlet for the US hospital grade outlet within the same medically used room e When the Vista XL is used with the Scio it meets the Class A limits of CISPR11 The system is not intended for connection to public mains e To minimize the risk of injury
307. t up the Scio module passes through an initialization and warm up period During this time etCO in some models and or Agent parameter boxes display a question mark WARNING During warm up reported values might not be accurate To achieve full accuracy a typical warm up period of 7 minutes is recommended Refer to the Technical Data appendix for a detailed description of Scio accuracy Calibration The Scio module is self zeroing and does not need calibration by the clinical staff A yearly check of the Scio calibration components should be performed by authorized technical personnel Scio Setup Scio parameters are displayed in in some models O5 N5O and Anesthetic Agent parameter boxes Each has its own setup menu described in the following pages WARNING Under extreme monitoring conditions and if a network functionality is in use intermittent spikes may be present on the Scio waveform Parameter box data is not affected NOTE Some Scio parameter labels are marked by an asterisk to distinguish them from parameters monitored by module Insome models you can display the and agent parameters in a single combined parameter box see 18 24 Monitoring The waveform displays instantaneous CO measurements calculated the Scio module The etCO parameter box displays the current values for Inspired CO iCO The
308. te the level of by approximately 596 ON OFF O2 Compensation module only Compensates for patient s supplemental oxygen Failure to compensate for supplemental oxygen can also result in inaccurate measurements 2190 100 Other Setup Functions Scale Determines size of currently displayed 40 mmHg waveform 60 mmHg 80 mmHg 100 mmHg pod only Respiratory Sets waveform sweep speed on 6 25 mm s Sweep Speed screen display 12 5 mm s 25 mm s 50 mm s VF7 VISTA XL 16 9 16 2 END TIDAL CO2 MONITORING Function Description Settings Averaging Sets interval for measurements Note The monitor reports the Breath end expiration point 10s compensation Note Atmospheric pressure compensation should be set by qualified personnel only Consult with your biomed service before changing the Atm Pressure Mode setting to Manual maximum value of during the 206 specified sampling interval Atm Pressure Determines automatic or manual setup Auto Mode for atmospheric pressure e Manual Atm Pressure Measurement Mode Specifies current atmospheric pressure This function is ghosted if you have selected Auto under Atm Pressure Mode Configures the monitor for mainstream or sidestream monitoring 540 to 800 mmHg in increments of 5 Main Side Respiration Filter Filter
309. ter NOTE Before initiating a physiological calculation you must measure pulmonary wedge pressure and cardiac output See page 13 13 for PWP measurement and page 20 6 for C O procedures Obtain physiological calculations as follows Press the Menu fixed key to open the Main Menu 2 Click on Calculations Click on Hemo or Hemo Oxy Vent to display the associated calculations menu 4 Click on Capture Values to save the date and time of the capture and display the current values of input parameters You can use captured values immediately or hold them for later calculations 5 Click on Results The Calculations screen appears as shown on the following page NOTE The Calculations screen does not display results for a derived parameter unless all relevant information has been entered VF7 VISTA XL 14 3 14 CALCULATIONS Calculations 1 Date and time 5 Click and scroll to determine type of data displayed in stamps View column Reference Values stored via Save Reference key Normal Range Standard ranges for parameter values Units Units of measure for parameter values 2 View column 6 Save latest set of calculated data for display in View column View category 7 Send report request to laser printer at central station Display labels 8 Click and drag to scroll through list of parameters definitions and ranges You can access the Hemo Ox
310. terruptible power source Immunity test IEC 60601 test level Compliance level Electromagnetic environment guidance Portable and mobile RF communications equipment should be used no closer to any part of the including cables than therecommended separation distance calculated from the equation applicable to the frequency of the transmitter as below Recommended separation distance VF7 VISTA XL Conducted RF 150 kHz 80 MHz 3 V m d 1 2 V1 Square root of P rf coupled into lines IEC 61000 4 6 radiated rf 80 MHz 2 5 GHz 3 V m d 1 2 V1 Square root of P IEC 61000 4 3 d 1 2 V1 Square root of P where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer and d is the recommended separation distance in metres m Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range Interference may occur in the vicinity of equipment marked with the following symbol Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered I
311. the electrodes away from the source of interference RESP lt The respiration rate is Check the patient and treat if below the lower alarm limit necessary Check the placement of electrodes Change their position if necessary RESP Out of The respiration rate is Check the patient and treat if Range High higher than 150 breaths necessary per minute Check the placement of electrodes monitor may be Change their position if necessary counting artifacts as valid Move the electrodes away from the breaths source of interference monitor may be counting interference caused by faulty equipment RESP Apnea No respiration has been Check the patient and treat if neonatal or detected for lt XX gt necessary pediatric mode seconds Check the placement of electrodes only Change their position if necessary Carry out a RESP Relearn or reset breath detection sensitivity in Manual mode RESP The patient s heart rate Observe the patient carefully Treat if Coincidence and respiration rate fall necessary within 20 of each other Check and change the electrode placement if you receive a coincidence message until you obtain a clear respiration signal 11 20 VISTA XL VF7 STATUS MESSAGES baseline shift Message Possible Cause Suggested Action RESP Can t RESP Coincidence is Calm the patient detect enabled but there is Ensure that the pat
312. tiMed Reflects Note Averaging modes are both 90 of an SpOz change defined at a pulse rate of 60 beats within 30 seconds less per minute sensitive to artifact but slower to alarm Via Masimo SET Averaging over eight seconds Fast Via MultiMed Reflects 90 of an SpO change within 15 seconds quicker to alarm but more sensitive to artifact Via Masimo SET Averaging over two to four seconds SpO Alarm Accesses SpO alarms on the Alarm Limits table see page 5 5 Note Set SpO Alarm Validation in the Unit Manager menu see page 2 13 Status Messages Message Possible Cause Suggested Action SpO gt Patient s SpO falls Observe the patient and treat if SpO lt outside the current upper necessary or lower alarm limits PLS gt Patient s pulse rate falls Observe the patient and treat if PLS lt outside the current upper necessary or lower alarm limits Neonatal only Patient s SpO falls Observe the patient and treat if lt ALV 20 below the current lower necessary alarm limit by 2096 or more PLSOutofRange Pulse rate is outside the Observe the patient and treat if Low High measuring range of the necessary monitor VF7 VISTA XL 15 9 15 PULSE OXIMETRY 2 Message Possible Cause Suggested Action Transparent Too much light is Check to ensure that the sensor is
313. tient s blood Premature Ventricular Contractions per minute Pulmonary Wedge Pressure A strip recorder used to print a paper copy of patient data alarms waveforms and trends Right Arm Right Atrial pressure Airway Resistance Respiration Rate as measured by ECG electrodes Right Leg Right Ventricular pressure Respiratory Rate as calculated from the end tidal etCO5 capnograph Rapid Shallow Breath Index Arrhythmia call Second Spontaneous Systolic pressure VISTA XL VF7 SCIO Modules SLA SpO ST deviation Strip chart SV SVI SVR SVRI SYNC or Sync Ta TACH TENS TV TValv TVCO2 V V ECG VCO2 VF7 A peripheral device that provides measurement of respiatory and anesthetic gases Sealed lead acid battery used for the external battery Percentage of oxygen saturated hemoglobin in the blood as measured by pulse oximetry The displacement of the ST segment of the ECG waveform over the isoelectric line The paper copy of patient data printed out from a recorder Stroke Volume Stroke Volume Index Systemic Vascular Resistance Systemic Vascular Resistance Index Synchronization Patient temperature through the MultiMed pod Tachychardia Transcutaneous Electric Nerve Stimulator Tidal Volume Alveolar Tidal Volume Tidal Volume CO2 Volt Chest minute elimination VISTA XL This page intentionally left blank VISTA XL VF7 Technical Data EU 6121121 m
314. tinctured soap and water Dry thoroughly with a lint free cloth CAUTION Do not use organic solvents Do not sterilize by steam heat radiation ETO Do not use sharp objects Make sure that NO liquid enters the pod VF7 VISTA XL 21 5 21 CLEANING AND DISINFECTING etCO Capnostat Sensor Clean sensor surfaces including the sensor windows with a damp cloth Never immerse the sensor or attempt to sterilize it Dry with a lint free cloth Making sure the sensor windows are clean and dry before you use them Airway Adapter Rinse airway adapters in a warm soapy solution then soak them in a liquid disinfectant or in pasteurized or cold sterilized glutaraldehyde Dry with a lint free cloth making sure adapter windows are dry and free of any residue before they are used Sidestream Sampling Pump etCO only The module contains a small pump that draws air from the nasal cannula through the sidestream airway adapter and out the exhaust port see page 16 2 Suggested cleaning procedures are outlined below CAUTION Cannulas and tubing used for nasal sampling of etCO are for single patient use only Dispose of used cannulas and tubing in accordance with your institution s policy The following fluids are acceptable for cleaning e Isopropyl alcohol Cidex or equivalent A5 25 water solution by weight of sodium hypochlorite bleach The following items are required for cleaning
315. tion against Type CF per IEC 601 1 electric shock Mode of operation Continuous Environmental Requirements Operating 10 C to 40 C 50 F to 104 F Temperature range Storage 20 C to 50 C 4 F to 122 F Operating 20 to 90 non condensing Storage 10 to 95 with packaging Operating 525 to 795 mmHg 70 to 106 kPa Atm pressure Storage 375 to 795 mmHg 50 to 106 kPa Relative humidity 12 VISTA XL VF7 MONITORING ACCESSORIES HemoMed User Interface User Controls Fixed keys IBP Zero Displays HemoMed none HemoMed Connections 4 invasive pressures C O single cable connecting pod to monitor Physical Attributes Size H x W x D 140 x 205 x 60 mm 5 5 x 8 1 x 2 3 in Weight HemoMed 0 7 kg 1 6 lb Electrical Specifications Power source Powered directly from the monitor Protection against Type CF electric shock Mode of operation Continuous Defibrillation protection IEC 601 2 34 Environmental Requirements Operating 10 C to 40 C 50 F to 104 Temperature range Storage 20 C to 50 C 4 F to 122 F Operating 20 to 90 non condensing Storage 10 to 95 with packaging Operating 525 to 795 mmHg 70 to 106 kPa Atmospheric pressure Storage 375 to 795 mmHg 50 to 106 kPa Relative humidity Scio Four Scio Four Oxi Scio Four plus Scio Four Oxi plus Module
316. tionality Scio Four Oxi plus Measures and auto agent ID Scio Four Oxi Measures 0 and manual agent ID Scio Four plus Measures and auto agent ID Scio Four Measures NoO and manual agent ID CAUTION e Federal law restricts this device to sale by or on the order of a physician The gas information is intended to be used by trained and authorized health care professionals only Full technical descriptions of the Scio module are available from your local Drager Medical representative WARNING e Sampling of the respiratory gas from the patient breathing circuit can reduce the delivered patient tidal volume and clinicians should adjust the fresh gas supply as necessary e The Scio module samples breathing gases at a sample flow rate of 200 20 150 20 ml min Modules with a sample flow rate of 200 x20 ml min specify this flow rate on the back panel If the flow rate is not specified on the back panel the module has a flow rate of 150 20 ml min The Scio module uses infrared light for the measurement of CO and volatile anaesthetics A small amount of the patient respiratory gas is drawn through a measuring chamber An infrared light is shone through the chamber and the gas sample absorbs different amounts of light A paramagnetic cell is used for the measurement of This cell uses a physical reaction that is proportional to the
317. to cancel display Parameter Displays unit of measure in Select ON to display units Units Display parameter boxes Select OFF to cancel display 2 8 VISTA XL VF7 CONFIGURING THE MONITOR The Main Menu Menu Item Description Available Settings Monitor Options This submenu allows you to configure the following functions attention tones Date amp Time Sets the date and time displayed To set the monitor date and in the lower right potion of the time main screen 1 Click on Date amp Time 2 Click on Current Date A Notes data entry screen appears e An internal battery powers the 3 Click on Day scroll to the monitor s clock even when the correct date and click monitor is turned off 4 Repeat Step 3 for Month and This option is not available Year when the monitor is connected 5 Click on Accept to confirm or to network since network date on Cancel to return to and time are set at the central submenu station 6 Click on Current Time to set Changing the time does not the time using the same affect other time related method described in steps 3 functions such as timers and and 5 time stamps Speaker Allows you to set the volume for Click on Alarm Volume to set Volumes alarms pulse tones and the volume of alarms 10 100 in increments of 10 Click on Pulse Tone Volume to set the volume of the pulse tone OFF 100 in increments of 10 after 5 Click on Attent
318. to patient place the Scio Module and cables carefully and securely CAUTION To avoid damage to this device use only Drager Medical provided accessories See Appendix C Approved Options and Accessories Installing the Water Trap Install the water trap into its receptacle on the Scio module by pushing against the Scio A click will indicate that it is seated properly Confirm that the water trap is empty For information on replacing the water trap see page 18 28 18 10 VISTA XL VF7 HARDWARE SETUP Cable Connections The Scio module connects directly to the Vista XL monitor via the Scio Direct Connect cable in the X8 connector Vista XL Right View 1 Scio Direct Connect cable connector X8 Tubing Connections WARNING e Sampling tubing should be kept as short as possible but not stretched to minimize dead space and optimize response time Long sampling lines degrade the performance of side stream measurements may affect accuracy and result in slower response times e Always use Drager Medical provided Scio sampling tubing polypropylene Never use standard pressure sensor tubing PVC PVC tubing absorbs anesthetic agents which it later releases degassing The use of standard PVC tubing can result in erroneous agent concentration readings e To avoid the risk of explosion do not use flammable anesthetic agents such as ether and cyclopropane with the Scio module e Inc
319. tor You cannot discharge a patient at the central station To discharge a patient via the Main Menu 1 Press the Menu fixed key 2 Click on Admit Discharge 3 Click on Discharge The monitor displays the message Discharge will delete patient data 4 Click on Discharge again The monitor displays the message Discharge In Progress When the patient has been successfully discharged a discharge banner appears with the message Press main screen to resume monitoring or Use the trim knob to click on Cancel to return to the Main Menu without discharging the patient VF7 VISTA XL 4 7 4 ADMISSION TRANSFER AND DISCHARGE This page intentionally left blank 4 8 VISTA XL VF7 Chapter 5 Alarms EE jj 2 Alarm P 2 Alarm 2 4 S sp ndi ng 4 CAEDE EC r AERE EnS 4 Alarm Setup Alarm Limits 5 Upper and Lower Alarm Limits nnne nnns 7 Modifying Alarm eene nennen nnne nnne nennen nnne 13 Quick Reference Alarm Limits Table Setup eere 14 Alarm BID
320. try a new sensor Cal Accepted Informational message only Calibration was successful 21 Cal in Monitor is performing 21 Wait Progress 1 point calibration 100 Cal in Monitor is performing 100 Wait Progress 2 point calibration Cal Required The sensor needs to be calibrated Perform a calibration Cal Paused Monitor is waiting for you to expose the sensor to room air during 2 point calibration Remove the sensor from the T piece and expose it to room air 17 6 VISTA XL VF7 STATUS MESSAGES Message Condition Suggested Action H W Failure Hardware malfunction Disconnect the NeoMed pod then reconnect it If the message persists return the pod to Biomed and try a new one Pod Unplugged The monitor cannot detect a NeoMed pod Check the connections and verify the pod is correctly plugged into the monitor Sensor Unplugged The monitor is not detecting a sensor Check sensor connections Sensor Failure VF7 The sensor is not accurately measuring oxygen VISTA XL Try the sensor again If the message persists try a new sensor 17 7 17 2 FRACTIONAL INSPIRED O2 MONITORING This page intentionally left blank 17 8 VISTA XL VF7 Chapter 18 Scio Four Modules intended USE
321. u 20 6 VISTA XL VF7 In automatic mode you must wait for a READY signal that baseline blood temperature is stable before making a C O injection When the READY signal appears the monitor begins calculating a C O value as soon as it detects the temperature drop caused by the injectate In automatic mode the monitor will not begin to search for a change in blood temperature until the READY signal appears If the blood temperature becomes unstable the signal disappears and the monitor does not attempt to detect a thermodilution curve until the patient s blood temperature is stable again In both manual and automatic modes the monitor sounds an attention tone when the C O value has been computed On the C O Averaging screen the value is displayed in the next available box and the Save AVG field is updated The value in the Main Screen parameter box does not change until you save the C O average To change the measurement mode open the C O setup menu as described on page 20 5 and select the desired mode Procedures for measuring C O in automatic or manual mode are described on the following page Catheters Comp Constant The monitor compensates for discrepancies in catheters used to measure C O The catheter compensation factor is listed as Comp constant on the C O setup menu If you use an Edwards Baxter BD Ohmeda or Arrow catheter the computation constant is automatically chosen for yo
322. u You can however enter a different value whenever for instance you change either injectate volume or temperature Choosing a catheter type determines the available choices under Catheter Size and Injectate Volume The following tables list the computation constants for Edwards Baxter BD Ohmeda and Arrow catheters Sensorconnected 2 7 disconnected epee nes IT 5 to 16 IT 16 to27C 0 7F 10 0 561 0 608 0 542 7F 5 cc 0 259 0 301 0 247 7 5F 10 0 574 0 595 0 564 7 5F 5 cc 0 287 0 298 0 257 SF 5 0 285 0 307 0 270 VF7 VISTA XL 20 7 20 CARDIAC OUTPUT Injectate Temperature IT IT Sensor Sensor connected disconnected Catheter Injectate Size Volume IT 5 to 16 16 27 IT 0T 7 5F 10 0 579 0 628 0 566 7 5F 5 cc 0 281 0 309 0 270 7 5F 3 cc 0 160 0 181 0 151 7F 10 cc 0 579 0 628 0 566 7F 5 cc 0 281 0 309 0 270 7F 3 cc 0 160 0 181 0 151 5F 5 cc 0 291 0 316 0 279 3 cc 0 170 0 188 0 160 Injectate Temperature IT Sensor connected Quee IT 1 C 1 C IT 24 C 1 C 7 5F 10 0 532 0 586 7 5F 5 cc 0 249 0 265 7 5F 3 cc 0 131 0 155 7F 10 0 541 0 601 7F 5 cc 0 250 0 273 7F 3 cc 0 134 0 156 5F 5 cc 0 267 0 303 5F 3 cc 0 157 0 192 If you choose Other as the catheter type you must enter a computation constant in orde
323. u access to the following functions Setup Opens Cursor Tool Setup menu Waveform Up to 3 NOTE In 4 channel mode maximum of 2 waveforms Sweep Speed 6 25 mm sec 12 5 mm sec 25 mm sec Default 50 mm sec Horizontal Cursor One for each waveform on display Displays a horizontal cursor User can scroll up and down each waveform NOTES Cursor value is displayed Cursor and value are on display until user exits window Buttons remain ghosted until user presses Stop key To EXIT the Cursor tool Press click the Rotary Knob to exit cursor control or Press the Main Screen fixed key N A Cursor value is displayed only if a scale is associated with the waveform Waveform scales are the same as parameter main display Stop Halts scrolling of all waveforms in cursor tool display and un ghosts Horizontal and Vertical Cursor buttons N A VF7 VISTA XL 2 MONITOR SETUP The Main Menu Menu Item Description Available Settings Hemo Calcs Opens the hemo calcs screen N A NOTES Button is ghosted unless license is present Advanced calcs menu is available if option is installed Vertical Displays a vertical cursor User N A Cursor can scroll forward and backward across all waveforms NOTES Cursor has no value Cursor remains on display until user exits window Buttons remain
324. u can increase the size of the mean pressure display in the IBP parameter box see page 2 12 for more information Parameter boxes for non pulsatile pressures LA RA CVP ICP display mean pressures only Mean pressures Parameter labels VF7 VISTA XL 13 9 13 INVASIVE BLOOD PRESSURE The CPP parameter is calculated and displayed whenever the ICP and ART parameters are monitored simultaneously CPP ART mean ICP CPP is displayed in the bottom of the ICP parameter box IBP waveforms can be displayed in standard or overlapping format When IBP waveforms are overlapped you can show scale values for the overlapped parameters side by side the order of the display corresponding to the priority of the parameter boxes by setting Common Scale to OFF on the IBP setup menu see page 13 11 The following figure shows overlapped IBP waveforms with Common Scale enabled IBP Setup IBP setup is a two phase process involving the following procedures After configuring individual IBP parameters you must assign them to connected IBP channels These procedures are described in the following pages To access an IBP parameter setup menu e Click on the respective parameter box on the main screen or 1 Press the Menu fixed key to display the Main Menu 2 Click on Patient Setup 3 Click on Parameters 4 Scroll to the IBP parameter you want to configure ART LV PA RV CVP RA LA ICP GP1 or GP2 and cli
325. ue 11 12 VISTA XL VF7 OCRG MONITORING Accessing Review Summary Screen To access the OCRG review screen either e Enter the Alarm History Table and click on quick access key OxyCRG Review or e Click the Summary button on the OCRG screen NOTE e The OCRG Review Summary screen has no time out It stays active until user cancels the display e The OCRG Review Summary screen does not update automatically User must click the back arrow then click Summary button again for updated data Cursor Right Paging button Cursor Button Horizontal Scroll Bar Time interval setting Left Paging button Time bar A N Back Arrow VF7 VISTA XL 11 13 11 RESPIRATION Scrolling through OCRG data You may scroll through data on the OCRG Review Summary screen in two ways e Use the Left or Right paging button 1 Turn the rotary knob until the Left or Right paging buttons are highlighted 2 Click the knob to scroll through OCRG Review Summary data without blanking the data e Use the Horizontal Scroll bar 1 Turn the knob until the scroll bar is highlighted 2 Click once Turn the knob to update the time bar NOTE Updating the time bar blanks the data until the end of the next step Once the time bar shows the time frame desired click the knob again and the data refreshes Time interval setting To change the time interval scale
326. ule has not yet identified or cannot identify the agent the Agent parameter box displays Agent WARNING If the monitor displays a question mark next to an agent s parameter label the displayed agent concentration values may not meet the specified accuracy and should be used with caution Scio Four Oxi amp Scio Four only There is no automatic agent identification with this module User must set desired agent manually See page 18 23 WARNING e Use care when setting agent ID manually If incorrect agent ID is selected incorrect measurements will occur e Scio Four Oxi amp Scio Four cannot recognize anesthetic gas mixtures If anesthetic gases are mixed incorrect measurements will occur NOTE If the user has not selected an anesthetic agent yet AA is displayed in the parameter box e The Agent ID resets to blank upon a power cycle or patient discharge VF7 VISTA XL 18 19 18 Scio FouR MODULES MAC Values Standard MAC Values NOTE Standard MAC values are used when the module is connected via a Scio connecting cable PN 78 76 878 or 78 76 886 in the X3 or Scio ISD connector and Standard setting is chosen on the MAC Calc menu When the monitor has identified an agent the parameter box shows a value for the standard minimum alveolar concentration of the agent Standard MAC value WARNING e Standard MAC values are merely a guideline based on the anesthetic requirements of an average adult patient
327. units kg hr mol kg hr 0 0 100 000 wt g kg hr k units kg hr Dose weight per minute 0 1 666 666 666 66 wt mcg wt min mEg wt min units wt min mmol wt min 0 1 666 666 66 wt mg wt min units wt min 0 1 666 66 g wt min units wt min Rate 0 10 000 ml hr Duration 0 10 000 hr Total Dose 0 100 000 000 000 mcg mEg mmol 0 100 000 000 mg units mol 0 100 000 g k units 1 100 m units Total Volume 0 10 000 ml Default Drug Setup Unit Manager The unit manager can assign up to 40 default setups for the most commonly used drugs To assign default drugs VF7 1 2 3 4 Press the Menu fixed key Click on Monitor Setup Click on Unit Manager A data entry box appears Scroll through the numbers and click successively on the single digits of the Unit Manager password If you make a mistake click on Backspace and try again Click on Accept to open the Unit Manager menu VISTA XL 14 11 14 CALCULATIONS 6 Scroll to Drug List Setup and click The cursor highlights the first in a list of drugs on the right of the screen Click on Untitled or on the name of a drug you wish to change The Drug List Setup menu appears figure at right Click on Name Drug to display a text entry box Enter the name of the drug you wish to assign by clicking on the letters under the text entry window Edit your entry using the control buttons at the bottom of the screen 10 Click on Accept whe
328. uous with external power supply for a limited time with battery backup Note All materials must be disposed of or recycled properly and in accordance with local regulations Environmental Requirements VF7 VISTA XL B 7 Temperature range Operating 10 C to 40 C 50 F to 104 F Storage 20 C to 40 C 4 F to 104 F Relative humidity Operating 20 to 90 non condensing Storage 10 to 95 with packaging Atmospheric pressure Operating 525 to 795 mmHg 70 to 106 kPa Storage 375 to 795 mmHg 50 to 106 kPa Protection against ingress of water EN 60101 2 27 44 3 Analog Output Signals ECG arterial blood pressure ART Delay 25 ms QRS Sync Output QRS Output high for 50 ms every time a QRS is detected User Interface QRS detected 12V 5 560 source impedance Output low no QRS lt 0 8V 30 mA sync current Controls Fixed keys and rotary knob Alarms 3 levels Life threatening Serious Advisory Screen Type Thin Film Transistor Liquid Crystal TFT LCD Display Active Matrix Size Vista XL 264 mm 10 4 in diagonal Viewing area Vista XL 211 x 158 mm 8 3 x 6 2 in Resolution Vista XL 640 x 480 pixels Color capability 512 Trend storage Data storage Data resolution 24 hours of trended parameter information 30 second sampling Trend graphs 1 2 4 8 12 and 24 hour displa
329. urement and replaces all NBP values with No Pulsation Monitor stops measurement Open Line Monitor stops measurement e Measurement Timeout Monitor stops measurement Venous Stasis By inflating and maintaining a constant pressure in the cuff the monitor stops the flow of blood to the lower extremity of the cuffed limb long enough to cannulate the patient The cuff in Venous Stasis mode will occlude the limb for about as long as an 12 10 VISTA XL VF7 STATUS MESSAGES NBP measurement approximately two minutes for adult and approximately one minute for neonatal WARNING e Do not use Venous Stasis on any limb not indicated for NBP measurement e g an arm with catheter e Press the NBP Start Stop fixed key to deflate the cuff rapidly if an adverse effect occurs on the patient To begin cuff inflation click on Venous Stasis Click again to terminate the procedure and deflate the cuff During Venous Stasis the monitor displays the cuff pressure in the upper right corner of the screen while the label STASIS and time remaining are displayed in the NBP parameter box You cannot enable Venous Stasis if you are currently taking continuous measurements Interval measurements are suspended during Venous Stasis but resume immediately after the cuff deflates The monitor determines initial and maximum cuff inflation pressure and inflation time according to the category of the patient as shown in the following table
330. us messages key to return to Main Screen or The remote display click on Select Remote Bed to appears on the bottom return to the Remote View menu half of the screen so that you continue to To access Remote View display the local monitor s functions see the section top waveform s Remote View Screen on page 3 parameter box es and 11 message area Alarm Group Assigns the monitor an 1 Press the Fast Access fixed alarm group number 0 key 255 allowing you to restrict the number of messages received over 2 Click on Remote View the network from the central station or other bedsides 3 Click on Alarm Group 4 Click on the number of the desired alarm group 3 10 VISTA XL VF7 Menu Item Description Settings Auto Dual View Configures the monitor to 1 Press the Fast Access fixed display any remote bed in key alarm that is part of the 2 Click on Remote View local bed s alarm group 3 Click on Auto Dual View 4 Click to toggle ON or OFF Note Beds in the same alarm group continue to post messages in the alarm group s network message area when Auto Dual View is disabled If you do not want to display messages at a particular bed place the bed in its own alarm group by selecting an unassigned Alarm Group number Remote View Screen The Remote View menu bar divides the screen horizontally separating the remote display from the main screen Follow the procedu
331. use a PCMCIA memory card To transfer information over the network you can use menu options See page 4 4 for more information Software Licenses Optional software functions must be unlocked activated with the proper license before you can use them Your Biomed can transfer licenses and optional software from the monitor to the network and vice versa Refer to your Service and Installation Manual for more information on transferring licenses VF7 VISTA XL 3 9 3 NETWORK APPLICATIONS Remote View If the monitor is connected to the Infinity network you can view other networked monitors print their recordings and silence their alarms from your monitor Procedures to display the Remote View screen follow To set menu display time see Main Menu Setup on page 2 2 Quick Reference Remote View Setup Menu Item Description Settings Select Displays up to two 1 Press the Fast Access fixed Remote Bed waveforms and parameter key boxes of a remote bed If the remote bed is not in alarm the top two 2 Click on Remote View waveforms are displayed on local bed otherwise 3 Select Remote Bed to display the alarming waveform a list of all beds in the monitoring occupies the bottom unit channel Notes 4 Click on the label of the bed monitor continuously you wish to view updates the remote bed label patient name and 5 Press the Main Screen fixed alarm or stat
332. using any Dr ger devices carefully read all the manuals that are provided with your device Patient monitoring equipment however sophisticated should never be used as a substitute for the human care attention and critical judgment that only trained health care professionals can provide ACE MultiMed Cardiology Review Station Scio and are registered trademarks of Dr ger Medical AG amp Co KG is a registered trademark of Novametrix Medical Systems Inc Masimo Masimo SET and Signal Extraction Technology SET are registered trademarks of Masimo Corporation SILICON SOFTWARE 1989 90 91 92 93 94 Microtec Research Inc All rights reserved Some graphics courtesy of Novametrix Medical Systems Inc Unpublished rights reserved under the copyright laws of the United States RESTRICTED RIGHTS LEGEND Use duplication or disclosure by the Government is subject to restrictions as set forth in subparagraph c 1 ii of the Rights in Technical Data amp Computer Software clause at DFARS 252 227 7013 MICROTEC RESEARCH INC 2350 MISSION COLLEGE BLVD SANTA CLARA CA 95054 Microstream is a registered trademark of Oridion Medical 1987 Ltd All other brand or product names are trademarks or registered trademarks of their respective companies This device is subject to EU Directive 2002 96 EC WEEE It is not registered for use in private households and may not be disposed of at muni
333. utes of a continuously updated beat to beat Heart Rate trend bbHR 5 and respiration etCO waveform as well as apnea events The monitor continues to update main screen parameters announce alarms and initiate alarm recordings 1 Activate cursor 8 Respiration etCO label Apnea label appears when an apnea event occurs and is displayed Cursor time 9 Respiration etCO waveform Exit OCRG display 10 Time Base Display OCRG Review Summary 11 Values at cursor time Menu see p 12 10 5 Display OCRG Setup Menu See 12 Scale p 12 12 6 Trigger a timed recording of 13 Cursor displayed parameters 7 Current parameter values 14 Eraser bar 11 10 VISTA XL VF7 To display the OCRG screen OCRG MONITORING Set the Patient Type to Neonatal see page 2 5 Connect SpO sensors ECG leads Set the apnea time on the RESP menu see page 11 8 Press the Fast Access fixed key Click on OxyCRG to display the OCRG screen You can change the bbHR scale as follows 1 Using the rotary knob highlight the value at the top left corner of the grid and click 2 Dial to desired scale setting and click Values are shown in the following table you can modify only the HR scale Parameter Scale Definition bbHR 10 180 bpm lowest setting 130 300 bpm highest setting Highest Max and lowest M
334. vailable Settings HR Source Selects the source for the heart Select ECG to derive heart rate rate from ECG signal Select ART to derive heart rate from Notes Arterial Pressure signal HR This is especially useful during label 4 electrosurgery when the ECG ih i 5 RAMS red T channel is unavailable because d 9 sults to ECG f jl of the risk of artifact pr ori Select SpO to derive heart rate when eu 5 from pulse oximetry signal HR network the rest of the system ter box label ch continues to display the HR S on Es abe t in hk label in the ECG parameter and displays values in white box regardless of the source The pulse visual blip and audio tone For example even if you select a n indicating 2 as the HR source the Saturation values monitor the MultiView Select AUTO to derive heart rate WorkStation displays HR in the from ECG signal or other available ECG parameter box signals If an ECG signal is unavailable the monitor switches to ART then SpO The pulse visual blip and audio tone are derived from the same parameter as the selected HR source QRS ARR Facilitates accurate detection of Click on ECG 1 to determine heart Select HR and ARR calls by allowing rate and arrhythmias based on the you to select single or dual single best lead channel processing for maximum Note The message ECG Artifact si
335. ve blood pressure IBP signals from a HemoMed pod For information see Chapter 13 Invasive Blood Pressure A HemoMed pod can also acquire injectate and blood temperature for cardiac output 20 4 Module The monitor processes etCO signals through etCO module For more information on these optional devices see Chapter 16 etCO2 End Tidal CO2 Monitoring Auxiliary Display Components The following devices enable remote viewing of patient data Remote Display Allows you to view but not control monitor functions away from the bedside Dr ger Medical strongly recommends that you use only approved video monitors otherwise the function of the monitor may be compromised For a complete list of approved video monitors contact your Draeger Medical Systems Inc local representative to obtain a catalog Any use of non approved monitors may compromise the correct functioning of the device CAUTION The Remote Display output on the IDS is not galvanically isolated If you use a video monitor other than one specified by Dr ger Medical it must comply with IEC 60601 1 Upon installation the installer must ensure that in normal and single fault conditions the entire system meets the requirements of IEC 60601 1 and IEC 60601 1 1 Medical Electrical Systems Standards Refer to the video monitor s operating instructions to ensure that the interconnection is within its intended use as specified by the manufacturer Radiated and condu
336. veform in the bottom parameter boxes channel Click on Parameters to display 3 parameter boxes instead of a waveform in the bottom channel ECG Determines the number and Click on the following settings Channels format of ECG waveforms ECG1 Displays the primary displayed ECG signal ECG1 amp 2 Displays 2 signals ECG1 amp 2 amp 3 Displays 3 signals Cascade Cascades ECG1 data into second channel ARR Selects the Arrhythmia mode Click on OFF to disable Monitoring For detailed information see arrhythmia monitoring Click on FULL to enable full arrhythmia monitoring Click on BASIC to enable basic arrhythmia monitoring ST Monitoring Enables and disables ST Monitoring For detailed information refer to Chapter 10 ST Monitoring Select ON to enable ST monitoring Select OFF to disable ST monitoring RESP Enables and disables respiration Select ON to enable Monitoring monitoring respiration monitoring For detailed information referto Select OFF to disable Chapter 11 Respiration respiration monitoring Display Mode Reduces Main Screen clutter by Click on Manual to display all displaying only parameters parameters and assign them a associated with a connected priority on the Parameter device Priority screen see Parameter Priority page 2 Click on Automatic to display 6 active parameters only VF7 VISTA XL 2 MONITOR SETUP The M
337. w now indicates that the direction of the data flow is from monitor to card 12 Click on Move To Monitor If the date and time are correct on both monitors the following message appears Current data will be replaced Copy data to Monitor If the date and time are not correct the following messages may appear to indi cate synchronization of monitors is needed Some data on the card is ahead of the monitor s time That data cannot be copied to the monitor Some data on the card is older than the monitor can accept That data cannot be copied to the monitor 13 Click on Yes to initiate the transfer or on No to cancel the transfer and return to the Copy Patient Data menu VISTA XL 4 5 4 ADMISSION TRANSFER AND DISCHARGE Synchronizing the Monitors To ensure the complete and successful transfer of information you must check that the date and time of the source and destination monitors are identical Trend data that is copied from the source monitor 24 hours before or five minutes after the destination monitor time is transferred without interruption If you attempt to transfer data that falls outside this window of time a banner appears requesting you to confirm the transfer Network Data Transfer To transfer data over the network you must interrupt patient monitoring temporarily by putting the source monitor in standby mode The monitor saves both patient and monitor settings until you exit standby and resume monitoring
338. wish to configure and click 3 Scroll to the function you wish to modify the first column Alarm is highlighted when you first click on a parameter 4 Click to access settings of the selected arrhythmia function VF7 VISTA XL 9 7 9 ARRHYTHMIA MONITORING 5 Dial through settings and click to confirm your selection 6 Repeat steps 2 5 to configure additional arrhythmia functions or parameters Quick Reference Arrhythmia Setup Table Function Description Available Settings Relearn Initiates a relearn process Drager To learn or relearn the template Medical recommends that you 1 Set ARR Monitoring to Basic perform a relearn under the or Full following conditions 2 Verify the quality of the ECG A lead is reconnected or signal electrodes are repositioned 3 Ensure that the patient s ECG Eight hours have passed since displays a normal reference last reference complex learned pattern Questionable arrhythmia calls 4 Click on Relearn to begin a new appear on the patient s ECG learning phase Other significant changes appear on the patient s ECG Alarm Sets the alarm grade for an L T Life threatening arrhythmia event SER Serious Note Settings for Asystole ASY and Ventricular Fibrillation VF are Advisory life threatening and cannot be OFF modified Note For more information on alarm grades see page 5 2 Rate With count determines the point at
339. y Fast Access Item See page Fast Access Item See page Remote View 3 10 Calculations 14 1 OxyCRG Neonatal only 11 10 Show All Leads 8 15 Alarm History 5 15 OR 2 11 Trend Graphs 6 4 Reports 7 11 Trend Table 6 7 Split Screen 2 8 Event Recall 1 19 Drug Dosage 14 7 To open the Fast Access menu e Press the Fast Access fixed key on the front of the monitor You can access many of these menus by selecting Review on the Main Screen menu See page 2 4 for more information Main Menu The Main Menu allows you to execute certain functions and access others Icons are used to identify menu items e Page icon e g Restore Setups Accesses submenu e Arrow icon e g Review Displays another column e No icon e g Standby Executes function To display the Main Menu 1 Press the Menu fixed key The primary list of Main Menu options appears 2 Click on a page icon next to a heading to open a Main Menu submenu or on an arrow icon to display another column of Main Menu options see page 2 3 for detailed information on configuring the Main Menu 1 16 VISTA XL VF7 DATA ARCHIVE APPLICATIONS Fixed Keys Fixed keys on the monitor front panel allow you to perform commonly executed functions CAUTION Moisture under the front panel can damage the electric circuits and compromise key function For safe cleaning instructions see page 21 1 Fixed RT
340. y High temperatures may adversely affect batteries For optimal performance charge and use the external batteries at temperatures below 35 C 95 F Follow local regulations for safe disposal of batteries To prevent fire or explosion never dispose of batteries in fire Use only batteries that are provided by Dr ger Medical The use of non approved batteries may damage the device VISTA XL 1 INTRODUCTION NOTE To retain charge during transport leave the monitor connected until you are ready to move the patient Reconnect the monitor immediately after transport Drager Medical recommends replacing lead acid battery after 18 months of continued use e Drager Medical recommends replacing the internal lithium ion battery after 24 months of use e To prevent premature depletion recharge batteries immediately after discharging them Lead acid batteries degrade rapidly if left several days in an uncharged state In storage lead acid batteries discharge slowly over time and may become depleted after several months Batteries stored for use with the monitor should be recharged every six months Charging the Batteries Before using the Vista XL monitor for the first time charge the internal battery for a maximum of 4 5 hours and the external battery for 3 5 hours When the monitor receives DC power batteries recharge automatically The optional SLA Battery Charger can charge four fully depleted external batteries simulta
341. y Vent calculations menu more quickly as follows 1 Click on the Fast Access fixed key 2 Click on Calculations to display the Hemo Oxy Vent calculations menu If a value is missing or suspect e g artifact you can enter or modify its values as follows 1 Highlight the parameter in question and click A data entry keypad appears 2 Click on the digits of the new value 14 4 VISTA XL VF7 PHYSIOLOGICAL CALCULATIONS 3 Click on Accept when you are done The modified value immediately appears on the Calculations screen marked with a pound sign 4 Modified values are not written to Main Screen parameter boxes and waveforms nor are they trended Hemodynamic Parameters The monitor uses the following to calculate hemodynamic values Label Parameter Value Description Derivation Units 5 Systolic Arterial Pressure Monitored input mmHg kPa ART M Mean Arterial Pressure Monitored input mmHg kPa ART D Diastolic Arterial Pressure Monitored input mmHg kPa CCO ICO Cardiac Output continuous Monitored input L min intermittent Cardiac Output continuous Manual entry L min intermittent CVP Central Venous Pressure Monitored input mmHg kPa HR Heart Rate Monitored input bpm HT Patient s height length Manual entry cm in PAM Mean Pulmonary Artery Pressure Monitored input mmHg kPa PWP Pulmonary Capillary Wedge Pressure X Monitored input mmHg kPa WT Patient s current w
342. y formats Trend tables 1 5 15 30 and 60 minute display formats VISTA XL VF7 SYSTEM COMPONENTS External Battery Physical Attributes Size H x W x D 62 x 182 x 24 mm 2 4 x 7 2 x 0 9 in Weight 635g 1 4 Ib Electrical Specifications Battery life 50 minutes Charging time 3 5 hours at 25 C Battery type Lead Acid Notes generated Battery life varies with parameter configuration Specified above is battery life under following load conditions MULTIMED with SPO sensor 2 temp probes HemoMed pod with 4 IBP transducers and a catheter NBP taking measurements every 15 minutes LCD transport brightness at 5096 and no continuous tone being Battery life may diminish after extended use Environmental Requirements Temperature range Operating 10 C to 40 C 50 F to 104 F Storage 15 C to 40 C 20 F to 104 F Relative humidity Operating 20 to 90 non condensing Storage 10 to 95 with packaging Atmospheric pressure Operating 525 to 795 mmHg 70 to 106 kPa Storage 375 to 795 mmHg 50 to 106 kPa VF7 VISTA XL B 9 Battery Charger Physical Attributes Type SLA sealed lead acid Size H x W x D 216 x 393 x 295 mm 5 5 x 10 x 7 5 in Weight 738g 1 6 Ib Convection cooled Cooling Electrical Specifications Input voltage range 100 240 V
343. y result e Do not place cuff on injured or breached skin as it may further injure and or breach the skin NOTE The accuracy of the NBP measurement is based upon the correct sizing of the blood pressure cuff in relation to the patient s arm circumference The wrong sized cuff or cuffs falling outside the range or size manufactured by Drager Medical may cause inaccurate measurements Use only Drager Medical approved cuffs and ensure patient s limb circumference falls within the designated range on the cuff There are separate hoses for Ped Adult and Neonate patient categories Select the appropriate hose based on intended monitoring application Connecting the Hose Push the hose end fitted with the plastic collar firmly into the connector on the left side of the monitor see figure below NBP hose connector ai Vista XL NOTE In selecting a monitoring site make sure patient connections do not interfere with each other Drager Medical recommends that you do not put an NBP cuff on a limb that is already used for other measurements VF7 VISTA XL 12 5 12 NON INVASIVE BLOOD PRESSURE Connecting the Cuff Grasp the hose at the cuff connection and insert it into mating hose connector until it clicks into place To remove cuff retract the metal collar on the NBP adapter hose 12 6 VISTA XL VF7 SETuP Setup Menu and Quick Reference Table To access the NBP setup menu e Click on the NBP p
344. ystem Be sure to remove all bubbles from the system as they dampen the signal and could lead to incorrect systolic pressure measurements Transducers 13 4 Transducers are available in a variety of shapes and sizes see Appendix C Approved Options and Accessories For information on connecting the transducer to the monitor and HemoMed or Y cable Zeroing You can either zero a single transducer at a time or use the hemopod Smart Zero function to zero all static transducers simultaneously You should zero a transducer under the following conditions e Immediately after you introduce the catheter into the patient s vascular system e After you initially connect the transducer to a pressure pod e Before each monitoring session e Before you enter a calibration factor Whenever you change the tubing or transducer dome e When the message lt BP gt Zero Required is displayed The following table outlines zeroing procedures Single Transducer Zero Simultaneous Smart Zero 1 Make sure the transducer is at heart level Drager Medical recommends securing the transducer holders on the front of the hemomeddynamic pod for proper height 2 Close the transducer stopcock to the patient and open it to air VISTA XL VF7 HARDWARE SETUP Single Transducer Zero 3 a Click on the parameter box associated with the transducer you want to zero The parameter setup menu appears Note You can also

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