Ambulatory Blood Pressure Monitors
Contents
1. 90207 90217 ABP Monitors Monitor Report Condition ECO7 EC78 Clogged luer filter ECO08 EC18 Too few data entries to accurately determine blood pressure The message may indicate that the cuff is not being worn by the patient taken off but left connected to the monitor The message may also indicate that motion artifacts cause the majority of the incomplete data EC28 Diastole above 200 mmHg EC38 Pulse pressure less than 16 mmHg EC48 A Movement artifact at mean arterial pressure B Heart rate arrhythmia EC58 A Movemeni artifact at diastole B Heart rate arrhythmia EC68 Division by zero ECO09 EC19 Contradictory instructions sent to hardware e g pump on and valve open EC29 Diastolic pressure value cannot be obtained from the data available EC39 90207 Systolic pressure cannot be obtained from the data available 90217 Algorithm could not process input data quickly enough resulting in an input queue overflow EC49 90207 Mean arterial pressure cannot be obtained from the data available 90217 This monitor must be initialized EC59 Heart rate value cannot be obtained from the data available EC69 Heart rate value cannot be obtained from the data available EC79 Bleed steps were too small This may be caused by a partially obstructed air hose All blood pressure attempts following this message are inhibited Attempts can be enabled by turning the power sw2. Base Station via Modem For a modem connection to a remote IBM XT AT PS2 or equivalent base station refer to the following figure MODEM CONNECTION CONFIGURATION cable to TO PUBLIC serial port BASE TELEPHONE ABP STATION NETWORK Monitor MODEM e The actual initialization procedure is discussed in the 90219 ABP PC Interface Base Station Operations Manual P N 070 0238 XX e 1 4 Modem Speed and Compatibility Issues Operation The 90207 and 90217 operate Hayes compatible modems only You can identify your model type by plugging the communications cable into your 90207 90217 unit and looking at the numbers on the display The acceptable modem types and maximum speeds of 90207 90217 units are summarized below MODEL TYPE MAX SPEED meee DISPLAY Older 90207 1200 1200 only 9999 Newer 90207 1200 Any Hayes 1999 9999 Older 90217 up to 9600 up to 9600 2999 9999 Newer 90217 9600 Any Hayes 0999 9999 Connection Procedure 1 If you are using an older 90207 with a 1200 modem set the switches on the modem as follows SETTING AT MONITOR SITE down up down down down up up down up 0 up SWITCH CO JJOO BALON 2 Connect the serial port cable P N 012 0096 00 between the monitor and the modem e If call waiting or call forwarding are options on a telephone used to transfer data ensure that both are deact
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4. Saturation Systolic m Sys SvOs T1 Temperature 1 T2 Temperature 2 a M 2 T3 Temperature 3 UA Uterine Activity or Umbilical Artery T4 Temperature 4 VAC Vacuum connection BirthNet Caremaster Chartmaster CVScan Data Shuttle FT1000 FT3000 Flexchart Flexform Flexport Flextable Flextool Flexview Global Participant Index Intesys Multiview Neochart Neoscan OR Chart PCMS PrintMaster Quicknet Spaceview Sensorwatch TRU CAP TRU CUFF TRU LINK UCW Ultralite Ultraview Ultraview Care Network Ultraview Clinical Messenger Uni Pouch Universal Flexport Varitrend Vita Stat Web Source and WinDNA are trademarks of Spacelabs Medical Inc Other brands and product names are trademarks of their respective owners 1 8
5. Spacelabs Ambulatory Blood Pressure Monitors 90207 90217 Operations Manual 070 0137 03 Rev F Copyright 2002 Spacelabs Medical Inc All rights reserved Contents of this publication may not be reproduced in any form without the written permission of Spacelabs Medical Inc Products of Spacelabs Medical are covered by U S and foreign patents and or pending patents Printed in U S A Specifications and price change privileges are reserved Spacelabs Medical considers itself responsible for the effects on safety reliability and performance of the equipment only if assembly operations re adjustments modifications or repairs are carried out by persons authorized by Spacelabs Medical and the electrical installation of the relevant room complies with the requirements of the standard in force and the equipment is used in accordance with the operations manual Spacelabs Medical will make available on request such circuit diagrams component part lists descriptions calibration instructions or other information which will assist appropriately qualified technical personnel to repair those parts of the equipment which are classified by Spacelabs Medical as field repairable Spacelabs Medical Inc 15220 N E 40th Street P O Box 97013 Redmond WA 98073 9713 U S A Telephone 425 882 3700 Fax 425 885 4877 Telex 4740085 SPL UI Spacelabs Medical Products Pty Ltd Macquarie View Estates Unit 1 112 118 Talavera
6. deactivate the following features e Display the cuff pressure at each bleed step e Display the systole diastole and heart rate at the end of each measurement e Bleed to 40 mmHg rather than stopping at the diastolic value Beep before and after each reading 1 1 90207 90217 ABP Monitors Front Panel The 90207 and 90217 front panels include the LCD display cuff hose connector and a START STOP switch Rear Panel The rear panels of both monitors contain program input and data output communication ports On the 90207 the power ON OFF switch is also located on the rear panel On the 90217 the ON OFF Switch is located on the top panel Replacing the Batteries AA batteries provide the main power source for the monitors The 90207 uses four batteries and the 90217 uses three These batteries should be replaced or recharged before the start of each patient monitoring Use either alkaline or NiCad batteries In the 90207 a lithium battery P N 146 0008 XX is used to back up the monitor memory and should be replaced periodically The 90217 backup battery should not require replacement Main Battery Replacement replacement must be accomplished within one minute to ensure successful e if the main AA batteries must be replaced during patient monitoring this e resumption of the test 90207 only 1 Turn the monitor off and remove the door over the battery compartment 2 Replace the AA alkaline or NiCad batterie
7. ead en a ead eagle RC a OUR PUR ate oe 12 CIC ANING saci cise ake REN Ae eS eo db REI ep ae Ws ae eie en ce s 12 Event Codes facia te sete T a gelu mE et a ahi eA Ri Acie ante 14 Overview The Spacelabs Medical Models 90207 and 90217 Ambulatory Blood Pressure ABP monitors are small lightweight battery powered units designed to take blood pressure and heart rate measurements for 24 or 48 hours or for longer periods of time These measurements are recorded in the monitors and may be transferred to an ABP Analysis System FT1000A FT2000A or equivalent the PC Interface the Base Station or a Report Generator for data analysis report printing and archiving Each monitor and a base station can operate in a direct connect mode when both units are in the same location or in a remote connection mode using modems ABP Monitor The monitors have the following features e 4 digit LCD display e Battery powered e Serial communications port e Power ON OFF switch e Reading START STOP button e Blood pressure cuff The monitors are carried in pouches that are strapped and or belted to the side of the patient Blood pressure and heart rate measurements are taken using a blood pressure cuff attached to the patient s arm This information is recorded in the monitors and can be transferred over a modem link or by direct connection between the monitors and one of the ABP analysis systems The monitors can be programmed to either activate or
8. al Microphone Battery Status Universal Serial Bus c e o o D Y Stand by Low Battery 1 6 Abbreviations used as symbols are shown below Symbols Symbol Description Symbol Description Access Codes lose 1 Through 32 nn Air ANT 1 Diversity Antenna System 1 Arri Arrhythmia Net 1 ANT 2 Diversity Antenna System 2 ArrNet2 Arrhythmia Net 2 CH EEG EMG or ECG Channel ch EEG Channels CH1 CH2 CH3 CH4 cmH 0 Centimeters of Water EMG Channel CH5 C O CMV Controlled Mechanical Ventilation co Cardiac Output co DIA Diastolic oo Electrocardiogram dia ecg EEG Electroencephalogram EMG Electromyogram eeg emg ESIS Electrosurgical Interference EXT External Suppression FHR1 Fetal Heart Rate Channel 1 FECG Petal Electocardiogran FHR2 Fetal Heart Rate Channel 2 ene Patient Isolated Ground HLO High Level Output gnd hlo LE Inspiration Expiration Ratio MULTIVIEW Multi Lead Electrocardiogram nlb Non Invasive Blood Pressure N20 Nitrous Oxide O5 Oxygen PEEP Positive End Expiratory Pressure 1 7 90207 90217 ABP Monitors Symbol Description Symbol Description PRESS press Pressure Pmin Minimum Inspiratory Pressure PRS Ppeak Peak Inspiratory Pressure En Respiration SPO2 SpO2 Arterial Oxygen Saturation SDLC Synchronous Data Link Control SpO as Measured by Pulse Oximetry SaO SVO2 sys SvO2 Mixed Venous Oxygen
9. ate arrhythmia EC70 Systole was found to be above the highest cuff pressure However this result appears to be an error caused by motion artifact Therefore the cuff will not be inflated to a higher pressure on the next measurement attempt EC80 A Movement artifact B Heart rate arrhythmia EC90 A Movement artifact B Heart rate arrhythmia ECO01 EC11 Did not pump above the mean arterial level EC21 Did not pump above systolic pressure EC91 Systole appears higher than the selected maximum cuff pressure limit EC02 EC12 Did not reach initial cuff pressure The cuff may have been improperly applied or there may be an air leak EC22 Overpressure EC32 Overpressure EC42 No cuff attached EC52 Kinked hose EC62 Cuff applied too loosely Operation Monitor Report Condition EC82 Kinked hose EC03 EC03 Patient canceled reading by pressing STOP key No retry attempt is made following an ECOS3 code EC13 The Office Check Mode has been reinstated No retry attempt is made following an EC13 code EC04 EC04 Blood pressure measurement not completed in the maximum time allowed Occasional EC04 messages may result from excessive patient movement Frequent EC04 messages would indicate an improperly applied cuff or a monitor malfunction which requires service ECn4 where n 1 to 9 Indicates that one or more of the blood pressure results have been corrupted and subsequently recov
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11. cial laws regarding disposal or recycling gt Caution hazardous voltages To reduce risk of electric shock do not remove the cover or back Refer servicing to a qualified service personnel U S A DANGER High Voltage International PAUSE or INTERRUPT Slow Run Replace Fuse Only as Marked Fuse Power supply jack polarity Signs May be Reversed Equipotentiality Terminal Battery Replace only with the appropriate battery Replace only with the appropriate battery Signs May be Reversed Alternating Current Direct Current lt gt A DE Screen Indicators Both Direct and Alternating Current y AC DC Input Amperes H Z Hertz Volts W Watts KA A Temporary Shut Off of Alarm Tone or A Aia 1 2 Description ENTER Key Symbols Description PRINT REPORT Key Attention Consult Operations or Service Manual for Description Risk of Explosion if Used in the Presence of Flammable Anesthetics NAM Indicator Remote control Indicator Local Control ma w Return Unit to Monitor Mode Indicator Out of Paper 3 ii Activate Recorder for Graphics Recorder Paper Indoor Use Only Auto Mode NIBP Output No Output Terminated Data Input Output gt eap ecl HELP Explain Prior Screen Key Clock Time Setting Key Input Output on Monitor Setup Sele
12. ct Program Options ona Set Initial Conditions Menu ona Access Special Function Menu Normal Screen w lllo sp Return to Prior Menu Zo AIl TREND TIMER Key 1 3 90207 90217 ABP Monitors Symbol T Description Symbol Description Gas Exhaust Electrocardiograph or Defibrillator Synchronization Arterial Pulse IEC 601 1 Type BF equipment The unit displaying this symbol contains an F type isolated floating patient applied part providing an adequate degree of protection against electric shock IEC 601 1 Type BF equipment which is defibrillator proof The unit displaying this symbol contains an F type isolated floating patient applied part which contains an adequate degree of protection against electric shock and is defibrillator proof IEC 601 1 Type CF equipment The unit displaying this symbol contains an F type isolated floating patient applied part providing a high degree of protection against electric shock IEC 601 1 Type CF equipment The unit displaying this symbol contains an F type isolated floating patient applied part providing a high degree of protection against electric shock and is defibrillator proof ETL Laboratory Approved IEC 601 1 Type B equipment The unit displaying this symbol contains an adequate degree of protection against electric shock Canadian Standards Association Approve
13. d loo gt B ooo SE Keypad Enlarge Zoom nun Menu Keys x Delete Waveform Parameter Keys PCMCIA Card _ Keep Dry Fragile handle with care Foot Switch This Way Up Environmental Shipping Storage Temperature Limitations Environmental Shipping Storage Humidity Limitations 1 4 Symbol Description Symbols Symbol Open Padlock Description Closed Padlock Down Arrow N Up Arrow Event TEMP Temperature temp ais Environmental Shipping Storage 12 200 m Altitude Limitations B y F Y E Network Connection Audio Output Speaker S LES A Remote Alarm Nurse Alert Nurse Call Mm gt 1 Serial Port 1 y 2 Serial Port 2 External marker push button connection SDLC SDLC Port X 1 5 90207 90217 ABP Monitors Symbol Description Symbol Q Microphone Description b Mermaid Connector Note Video Output Warning About Potential Danger to Human Beings Caution About Potential Danger to Equipment Non Invasive Blood Pressure NIBP Neonate Fetal Monitor Connection Analog Fetal Monitor Connection RS232 Digital Physiological Monitor Connection RS232 Digital Input D Reset v Y Hard Drive Power Indicator LED d N Activate Telemetry Recorder Omnidirection
14. edical products No one product contains every symbol Description Symbol UCW or Ultraview 1700 HELP Key Mt SETUP Description UCW or Ultraview 1700 MONITOR SETUP Key SPECIAL FUNCTIONS UCW or Ultraview 1700 SPECIAL FUNCTIONS Key UCW or Ultraview 1700 ALARMS Key UCW or Ultraview 1700 RECORD Key PREVIOUS MENU UCW or Ultraview 1700 PREVIOUS MENU Key UCW or Ultraview 1700 NORMAL SCREEN Key UCW or Ultraview 1700 mouse connection UCW or Ultraview 1700 Keyboard Connection ON Power Connection to Mains OFF Power Disconnection from Mains On Position for Push button Power Switch Off Position for Push button Power Switch STOP or CANCEL Key CONTINUE Key START STOP Key START STOP START NIBP Key On Direction ON OFF Television Video Display Recycle Protective Earth Ground Oeo ooh G iji Functional Earth Ground 90207 90217 ABP Monitors Symbol Description Symbol ON Part of the Instrument Only Description OFF Part of the Instrument Only TO Partial ON OFF G STAND BY Key TX All batteries should be disposed of properly to protect the environment Lithium batteries should be fully discharged before disposal Batteries such as lead acid Pb and nickel cadmium Ni Cd must be recycled Please follow your internal procedures and or local provin
15. en simultaneously with the monitor readings interpolation is required to accurately correlate monitor systolic and diastolic pressure values with the manual auscultatory pressures e For systole record the first pressure at which a Korotkoff sound is heard Actual systolic pressure is somewhere between the pressure when the sound is heard and the previous higher pressure where no sound was heard The interval of uncertainty can be reduced by half by adding one half of the bleed step size 4 mmHg to the manual systolic pressure e For diastole record the cuff pressure at which the last Korotkoff sound was heard Actual diastolic pressure is somewhere between that pressure and the next lower pressure Thus you must subtract one half of the bleed step size 4 mmHg from the manual diastolic pressure Patient Instructions If the cuff becomes uncomfortable during a reading make certain the patient knows how to terminate the readings by pressing the STOP key on the front of the monitor If the cuff slips out of place make certain the patient understands correct repositioning of the cuff for successful readings If the cuff is not properly positioned event codes may appear on the monitor e The patient should make every effort to keep the monitor dry However there is no hazard if the monitor does get wet If this occurs turn the monitor off and return e it to Spacelabs Medical for service 90207 90217 ABP Monitors Data Transfer and R
16. eports After monitoring is complete connect the monitor to either a PC Direct or Base Station interface to transmit patient data and generate blood pressure reports Refer to 90121 ABP Report Management 90219 02 03 ABP PC Interface Base Station or 90239 ABP Report Generator Operations Manuals for more details e Any pulse rate obtained from the ABP cuff should be used only as a guideline for the heart rate e Cleaning Visually inspect the monitor air hose and pressure cuff for dirt debris frayed or worn areas etc prior to patient use Cleaning the Monitor Use a soft damp cloth and mild detergent mixed with water to wipe the exterior of the monitor Clean the air hose with isopropyl alcohol Cleaning the Cuff and Carrying Pouch Small soiled or stained areas may be cleaned by gentle scrubbing with a sponge or cloth soaked in a mild soap and water solution The cuff wrap with the air bladder removed and the pouch are machine washable on delicate cycle only Do not wash in large commercial type washers or with bed linens or gowns Ensure that the carrying pouch is dry before re use Removing Installing the Bladder To remove the bladder follow the steps listed below 1 Using fingers only fold or roll up the bladder inside the cuff Do not use pencils pens or other hard objects as these may damage the bladder 2 Remove the bladder through the hose exit opening Once the bladder has been removed mate togethe
17. ered Frequent occurrence of this message would indicate a malfunction which requires service EC05 The individual blood pressure result has been corrupted and cannot be recovered EC15 Equipment malfunction Return to Spacelabs Medical for service EC25 Unit failed to initialize Please initialize 90207 EC35 At least one of the blood pressures or time readings obtained before the event code is erroneous Interpret all readings with caution 90217 The monitor needs to be reinitialized EC05 ECO5 amp EC45 Invalid bleed size The monitor automatically has changed the bleed size EC45 to 8 mmHg ECO5 amp EC55 An unexpected loss of power possibly caused by a removal of the EC55 batteries during a blood pressure measurement b hardware overpressure or c a hardware time out Frequent EC55 messages would indicate a malfunction which requires service ECO5 amp EC65 90207 EC65 Equipment malfunction Return to Spacelabs Medical for service 90217 Extremely large artifact EC05 EC75 Equipment malfunction Return to Spacelabs Medical for service EC75 EC05 EC85 Equipment malfunction Return to Spacelabs Medical for service EC85 EC05 EC95 Cuff pressure baseline out of bounds The monitor should correct the EC95 baseline automatically within 10 minutes or it can be set by initialization of the monitor If initialization does not correct the condition the monitor must be returned to Spacelabs Medical for calibration
18. hi 110049 INDIA Telephone 911 1464 5002 Fax 911 1464 5007 Spacelabs Medical S r l Via Montecatini 13 20144 Milano ITALY Telephone 39 0 2 48958203 Fax 39 0 2 48958204 Spacelabs Medical Ltd 2F 3 No 161 Sung Te Road Taipei Taiwan R O C TAIWAN Telephone 8862 2759 7228 Fax 8862 2759 9060 Spacelabs Medical B V Ringveste 94 3992 DD Houten THE NETHERLANDS Telephone 31 0 30 638 5050 Fax 31 0 30 638 5059 Spacelabs Medical Ltd Eskdale Road Winnersh Triangle Wokingham Berkshire RG41 5TS UNITED KINGDOM Telephone 44 1189 448411 Fax 44 1189 448006 US Federal law restricts the devices documented herein to sale by or on the order of a physician Contents Chapter Page Contents Operation OVEGIVIGW i 62 cus SSPE Sh Ve ee EDU A De ne a Be LE e roe ee 1 1 Preparing the Patient and Precautions for Use liliis 1 8 Data Transfer and Reports 0 0 cect teens 1 12 Event Codes s x ot ketene eek tak RUPEM EE LAE aga gota ane eae 1 14 Accuracy Checking ACCUFaCy tido winter bet etn ta iE RO drame ies Rage tet each 2 1 Troubleshooting Problem Solving Checklist llle I 3 1 SEIVICING Aes kd ee baie ae wea t et ea Ee det resi doas dente edem sper Steed cn De ihe 3 2 Symbols Spacelabs Medical is committed to providing comprehensive customer support beginning with your initial inquiry through purchase training and service for the life of your Spacela
19. ient diary Make sure the patient knows what to do if the cuff becomes very uncomfortable during a measurement slips out of place or event codes are displayed on the monitor screen refer to Patient Instructions on page 11 In addition ensure the patient knows how to care for the monitor When you are satisfied the monitor is operating properly the remaining measurements in the check mode can be canceled Refer to Office Check Mode on page 7 Using Cuff Support e Keeping the blood pressure cuff in place is very important both for patient comfort and for accuracy of the readings This becomes particularly challenging e when the arm has considerable taper as is often the case with obese patients Once the cuff is successfully applied to the patient put the large loop of the support around the opposite arm Adjust the length so the junction of the straps fits well back on the shoulder towards the neck Fasten the rear short strap to the rear of the arm pit Be careful to clip to the material only and not to the bladder Fasten the front strap to the top layer of the cuff material at the location where the hose exits the cuff Adjust the length of these straps to apply a minor amount of tension to hold the cuff in position Operation Correlating with Manual Readings The monitor bleeds pressure in discrete steps not continuously using the oscillometric method of blood pressure determination If manual pressure readings are tak
20. improper cuff size cuff not properly attached to the monitor Isolate cause and correct Monitor displays LLL and alarm sounds Low main battery condition Turn off monitor immediately Replace batteries within 60 seconds after removal to continue monitoring Monitor displays event code Lbb during self testing 90207 only Low backup battery condition Replace backup battery before continuing Cuff too tight Cuff placed on the patient too tightly Reposition the cuff Air pump staying on too long Return unit to Spacelabs Medical for service Cuff too loose Cuff placed on the patient too loosely Reposition the cuff Air pump not staying on long enough Return unit to Spacelabs Medical for service Incorrect time dis played Batteries removed for more than one minute 90207 only Re initialize monitor 3 1 90207 90217 ABP Monitors Servicing There is a 12 month warranty on this product Field service of the ABP monitor is limited to replacing batteries and accessories If other repair is required return the monitor to Spacelabs Medical Contact your Spacelabs Medical Customer Service Representative for shipping details CAUTION e Any attempt to perform service or repair to the monitor will result in cancellation of the warranty 3 2 Symbols The following list of international and safety symbols describes all symbols used on Spacelabs M
21. itch off then on EC99 Unexpected or contradictory data such as a negative cuff pressure LLL EC16 Low battery detected prior to start of measurement EC26 Low battery detected after measurement started Usually caused by the pump drawing enough current to lower the battery voltage Lbb The report does not print an event code for this condition which is a low backup battery Contact Spacelabs Medical for replacement of the battery Accuracy Contents Checking Accuracy is eeu UP vue REICH da dae 1 Checking Accuracy Accuracy of the monitor pressure readings should be checked annually Recalibration is necessary only if the unit is not within the accuracy limits Required Equipment 1 A full size mercury sphygmomanometer or aneroid gauge e Ensure the mercury sphygmomanometer or aneroid gauge is calibrated and indicates 0 with no pressure e 2 T tube P N 016 0040 00 3 A pressure cuff and a rigid cylinder sized to fit the pressure cuff Accuracy Procedure To check the accuracy of the monitor 1 Disconnect the cuff hose from the monitor Connect the T tube splitter to the monitor Luer Lok connector and the sphygmomanometer 2 Wrap the pressure cuff around the rigid cylinder and fasten the cuff Connect the cuff hose to the remaining connection on the T tube splitter The test setup should appear as shown below 3 Press START STOP on the monitor the monitor should read approximately 165 C
22. ivated or modem communications may be interrupted In addition telephone systems such as CBX or PBX can cause interference with the modem or the modem can cause interference with the switching system e To initialize the monitor for remote connection 1 Contact the base station by telephone for remote operation only 2 Askthe base station operator to initialize the monitor Give the following information to the operator Patient s name Patient ID number Whether monitor display is to be active or not Time of day 12 or 24 hour format Whether to display measurement systolic diastolic and heart rate 1 5 90207 90217 ABP Monitors Multiple or single cycle times If using a single cycle for the 24 hour monitoring period indicate the cycle interval and whether the tone is on or off For multiple cycle time specify each cycle interval and whether the tone is on or off for each cycle Any other information the base station operator may request 3 The base station operator enters the patient information in the computer 4 Prepare the monitor to receive the patient data from the base station Turn on the modem When instructed by the base station operator turn the ABP monitor on e The modem link must be established within 10 to 20 seconds for the 90207 and 45 seconds for the 90217 If this does not occur turn the monitor off and then e on again to retry 5 When the transfer of informati
23. n the stage of operation When the monitor is turned on the RD Receive Data and SD Send Data lights will flash for several seconds The OH On Hook indicator becomes lit when the monitor starts communicating with the remote modem When the modems connect the CD Carrier Detect is lit The SD and RD lights flash as data is being transferred 1 6 Operation After the transmission is complete and the monitor is turned off the HS TR and MR indicators will always remain lit at the local modem Setup Test e Verify that cable connections are secure Turn on the ABP monitor It will display 9999 When the monitor is being read or initialized the digits will change to indicate that communication is taking place between the monitor and the analysis system When communication is complete the digits will stop changing Office Check Mode The monitor automatically enters an office check mode for the first five measurements immediately following initialization This allows you to verify the performance of the monitor on an individual patient without the need for re initialization to reset the display features While in the office check mode the monitor will operate as follows e Display the cuff pressure on each bleed step e Display systole diastole and heart rate at the end of the measurement e Bleed one step below the diastolic value as determined by the monitor Terminating Office Check Mode For the 90207 versions earlier
24. o the range of appropriate circumferences in centimeters specified on each cuff refer to the table below LIMB CUFF SIZE CIRCUMFERENCE Pediatric 13 to 20 cm Small Adult 17 to 26 cm Average Adult 24 to 32 cm Large Adult 32 to 42 cm Extra large Adult 38 to 50 cm 4 Position the cuff so that the center of the inflatable bladder is directly over the brachial artery The center of the bladder location is marked on the outside of the cuff Once the proper position is determined the cuff must be tightened to ensure that it is equally snug at the top and bottom edges and that it is not kinked This is especially important on larger arms Insert a finger between the cuff and the limb to ensure it is not too tight It may be necessary to wrap the cuff with its tail at an angle to achieve uniform tightness If the cuff is not equally snug at the top and bottom edges the number of readings available will be limited and the monitor may indicate that the cuff is improperly applied e Use only Spacelabs Medical cuffs with this monitor Using other manufacturer s cuffs may result in inaccurate readings even if the manufacturer s recommended e size is observed e Ifthe cuff is too small pressure readings may be falsely high a cuff that is too large produces a falsely low reading The bladder can be positioned in the cuff for either the left or right arm CAUTION e Avoid compression or restriction of pressure in the NIBP
25. omated sphygmomanometers The fifth Korotkoff sound was used to determine overall efficiency Asin manual auscultatory methods accurate readings might not always be achieved under some conditions Patient movement the position of the cuff relative to the level of the heart extreme heart rates and blood pressures various arrhythmias and the subject s physiological condition and other factors can hinder an accurate reading Vibration such as that in a moving automobile is an environmental problem that can affect readings e When some of the above factors prevent an accurate reading an event code is provided to indicate the reason for the missed blood pressure reading When only a single blood pressure parameter systole diastole or mean arterial pressure is obscured and the other two parameters are measured the obscured parameter can be replaced with a computed value e Ifsuch a value is computed in the 90217 it appears on the report in angle brackets e g value On the monitor display dashes are displayed instead of the estimated value The ratio used in the formula is determined by the previous successful measurements of the pressure rather than a fixed ratio e Consult a physician for interpretation of pressure measurements CAUTION e The ABP unit is not for use with defibrillators Please remove the ABP unit prior to use with a defibrillator e For patients in shock indirect methods of measuring pressure auscultat
26. ompare the readings on the monitor and the manometer as the pressure bleeds down The monitor reading should be within three millimeters of the manometer reading or 2 of the reading whichever is greater the accuracy of the manometer e Ifthe monitor pressure values fall outside of the allowed tolerance call your local Customer Service Representative or Spacelabs Medical for servicing e 4 Atthe end of the procedure the monitor displays an event code indicating that no dynamic blood pressure measurements were obtained 2 1 90207 90217 ABP Monitors 5 2 2 300 280 Dux xli 260 240 220 200 180 160 140 p lt 120 See 100 80 60 m 40 LLL 8 O S EE 290 270 250 230 210 Disconnect the T tube splitter from the monitor Disconnect the air hose and sphygmomanometer Troubleshooting Contents Problem Solving CheckliSt oooooooooocononrr RR hh 1 SOIVICIA it LEE MET 2 Problem Solving Checklist Problem Monitor display is incorrect Possible Cause Data not retained Solution Replace backup battery Low or no power Check the batteries for a full charge if needed replace or recharge the batteries May be one of the following time out no reading due to air leak in the system
27. on is complete the ABP monitor will beep Voice communication is restored after the monitor beeps Turn off the monitor Disconnect the monitor from the modem f direct connection between the monitor and the base station is used turn the monitor off and disconnect it from the ABP data interface unit To transfer readings from the monitor to the base station 1 Contact the base station by telephone for remote operation only 2 Askthe base station operator to read the monitor Give the following information to the operator Patient s name Patient ID number Any other information the base station operator may request 3 The base station operator enters the patient information in the computer If the monitor is in a remote location the operator turns the base station modem on 4 Prepare the monitor to transfer data to the base station Turn on the modem When instructed by the base station operator turn the ABP monitor on for remote operation only e The modem link must be established within 10 to 15 seconds for the 90207 and 45 seconds for the 90217 If this does not occur turn the monitor off and return to e step 1 5 When the transfer of information is complete the ABP monitor will beep Voice communication is restored after the monitor beeps Turn off the monitor Disconnect the monitor from the modem Modem Indicator Lights Modem indicators at the local modem are lit flashing or unlit depending o
28. or call your local office To answer specific questions on arrhythmia products and clinically related issues To call for service or to contact your assigned customer service representative For technical support of all Ultraview Care Network monitoring products and anesthesia products For technical support of BirthNet Caremaster Chartmaster QuIC and WinDNA products For parts ordering and pricing information To arrange training of hospital biomedical and anesthesia personnel To obtain answers to general questions concerning service issues and service contracts Contacting Your Local Offices Outside the U S Mississauga Ontario M nchengladbach Kowloon Taipei Canada Germany Hong Kong Taiwan 905 670 5880 49 2161 8209 0 852 2376 1370 8862 2759 7228 Cr teil Vienna Milano Beijing France Austria Italy China 33 0 1 45 13 22 44 43 1 616 52 37 39 0 2 48958203 86 10 6438 1705 Wokingham New Delhi Diegem Berkshire U K India Belgium 44 1189 448411 911 1464 5002 32 2 7164026 Operation Contents OVGIVIOW cius ve RR ub Bet vL Aden epu Yu NA WADE ee 1 Replacing the Batteries onc lec err wet M ed FER HAM OA e Eden e P Ren pui 2 Initializing the Monitor scone REDUCE Ee ENRICO ES eui eue WE Rs xg Seta ERR E a tire 3 Preparing the Patient and Precautions for Use 0 0 0c eect tte ete 8 Patient InstructlOns 2 4 uo prm howe a da DSi eed dans 11 Data Transterand Reports oes Shee pex RR ace
29. ory oscillometric Doppler may not be reliable due to peripheral vascular changes In some cases peripheral pulses or Korotkoff sounds may be diminished or disappear in spite of adequate blood pressure Direct blood pressure measurements invasive should be considered in patients with signs of shock or for any patient who becomes unstable for unknown reasons The ABP unit might not perform to specifications if stored or used outside the following ranges Operating temperature between 0 and 40 C and relative humidity between 10 and 95 Storage temperature between 30 and 65 C and relative humidity between 10 and 95 After the monitor has been initialized prepare the patient for monitoring as follows T 1 8 Turn on the monitor wait for the monitor to perform self tests When the LCD displays the current time the monitor is ready for operation Strap the monitor to the patient on the hip opposite the side on which the cuff is worn Secure the monitor using the patient s own belt or the ABP pouch strapped over the opposite shoulder When using the shoulder strap use the belt supplied with the monitor or the patient s belt to provide additional security Operation 3 Proper cuff selection and application is essential in ensuring the accuracy of blood pressure measurements To select the proper cuff first measure the circumference of the limb at the point where the cuff is to be applied Match the limb measurement t
30. patient connector tubes Check that operation of the equipment does not result in prolonged impairment of circulation e Do not apply cuff to areas of breached or injured skin Cuff hose connections use luer fittings Be careful not to connect the ABP monitor into an intravenous fluid line when working close to them e This product contains natural latex rubber components to which some people may be allergic These components include the bladder and the first four inches of tubing extending from the cuff 5 Once cuff is applied the arm should be relaxed at the patient s side To avoid reading errors due to hydrostatic pressure differences the level of the cuff on the arm should be near the level of the heart 1 9 90207 90217 ABP Monitors 6 10 Lead the hose up the arm with the cuff and place it across the back of the patient Drape the hose So it does not cause the patient discomfort and is not pinched shut by too tight a radius The following figure shows the most common positions for the cuff hose r ALTERNATIVE 1 a ALTERNATIVE 2 Connect the hose to the monitor To verify proper monitor operation take one or more blood pressure readings Push the START STOP key to begin a measurement Spacelabs Medical recommends taking three readings in the office so that the patient becomes comfortable with operation of the monitor and the measurement process Show the patient how to enter information in the pat
31. r the hook and loop surfaces of the velcro attachment before washing Operation Re install the bladder into the cuff wrap in reverse order Make certain that all folds in the bladder have been removed and that the long end of the bladder fits into the long end of the cuff see the figure below OPENING FOR OPENING FOR RIGHT ARM LEFT ARM BLADDER shown inserted into cuff wrap i for left arm application i ARTERY e The cuff hose can exit from either opening in the cuff depending on whether you plan a right arm or left arm application e 90207 90217 ABP Monitors Event Codes The monitor will display an event code whenever an event prevents the unit from successfully completing a blood pressure measurement The two numerical digits of the event code indicate the reason the measurement was aborted The table below lists event codes that are displayed on the monitor as well as event codes that appear on the Event Code Report Monitor Report Condition ECO0 EC10 Excess movement artifact Frequent EC10 messages may indicate an air leak EC20 A A very large number of movement artifacts B Heart rate arrhythmia EC30 A Movement artifact at mean arterial pressure B Heart rate arrhythmia EC40 A Movement artifact at asystole B Heart rate arrhythmia EC50 A Movement artifact at diastole B Heart rate arrhythmia EC60 A Movement artifact B Heart r
32. s being careful to observe polarities CAUTION The monitor will not operate if the alkaline nickel cadmium or lithium batteries are incorrectly installed If the monitor is going to be stored for an extended period of time remove the batteries to prevent the possibility of leakage or discharge e Spacelabs Medical is not responsible for product damage incurred as a result of AA battery leakage In the event your unit has been damaged by a leaking battery contact the battery manufacturer for any recoverable repair or replacement costs Spacelabs Medical will assist you in determining those costs 3 Gently replace the battery cover and secure the latch 4 Turn the monitor power switch on Check that the LCD display is on If there is no display turn the monitor off and review the problem solving checklist in Troubleshooting in Chapter 3 1 2 Operation Lithium Battery Replacement 90207 only The lithium battery is located in the battery compartment under a pry off cover to the right of the AA batteries 1 Turn the monitor off and remove the door over the battery compartment 2 Remove the pry off cover and note the polarity of the battery and socket indicators 3 Remove the old lithium battery by carefully prying it out curved forceps are recommended 4 Install the new lithium battery and replace the pry off cover The underside of this cover is divided into two unequal sized compartments Install the cover with
33. than 2 14 press the START STOP key twice to cancel each of the remaining readings The office check mode is terminated when the sum of the canceled and successful measurements equals five For the 90217 and 90207 version 2 14 and later press the START STOP key twice to cancel a single blood pressure reading The office check mode is terminated when a blood pressure reading is cancelled Any event that prevents a successful blood pressure measurement other than a manual cancel is not counted as one of the five office check mode readings Reinstating Office Check Mode The office check mode can be reinstated in the 90217 and in versions 2 14 and later of the 90207 To reinstate the office check mode without initialization of the monitor follow the steps below 1 Turn the power on to the monitor 2 When the version is displayed on the LCD press and hold the START STOP key 3 Release the START STOP key when ECOS is displayed on the LCD An EC13 will be logged to indicate the time at which the office check mode was reinstated The office check mode will be enabled for five additional successful measurements 1 7 90207 90217 ABP Monitors Preparing the Patient and Precautions for Use e Blood pressure measurements determined with this device are equivalent to those obtained by a trained observer using the cuff stethoscope auscultation method e within the limits prescribed by the American National Standard Electronic or aut
34. the smaller compartment oriented over the lithium battery 5 Gently replace the battery compartment cover and secure the latch e Once the lithium battery has been completely discharged it is considered non hazardous and can be safely discarded e Initializing the Monitor The ABP monitors must be initialized prior to the start of patient monitoring Initialization specifies the monitoring period patient information time format measurement interval monitor tone on off during selected periods event code display and whether or not to display pressure values To initialize the monitor connect it to one of the following analysis systems Connecting Directly to a Local Report Generator For a direct connection to the 90207 or 90217 monitor place the monitor into the chute on the Report Generator Model 90239A or equivalent as shown below 1 3 90207 90217 ABP Monitors Connecting Directly to the PC Interface For a direct connection to a PC compatible computer via a Model 90121 90219 02 or 90219 03 Connect the ABP interface cable to the serial port on the 90219 or 90121 system and to the monitor Refer to the 90121 ABP Report Management System Operations Manual for more information on the report management system PC INTERFACE DIRECT CONNECT CONFIGURATION 90219 or 90121 System e cable to serial port lA ABP Monitor Connecting to the
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