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Zoll 1200 Operators Manual

1. Check for adequate supply of paper CHANGING PAPER Press the recorder release button the door and paper carriage will tilt up Remove the empty or low paper roll from the spindle 41 OPERATOR S GUIDE L a aa n eaa e Place a new roll of thermal paper on the spindle with the paper coming off the top of the roll and the grid facing down e Drop the new roll on the spindle down into the paper cavity e Press recorder START so that the light within the switch goes on Note that the recorder motor will not start until the paper is inserted e Insert the paper grid face down into the lower slot until the motor starts and the paper begins to pull through The paper will soon come through the top slot grid facing up e Press STOP to stop the recorder e Close cover door RECORDER PAPER JAM If the recorder stops printing and there is still paper on the spindle the paper may be wrapped around the recorder feed roller To correct this e Pry the paper tear bar out with a screw driver Pry on one side then the ot
2. Ti E ji PACER LEAD FAULT The message PACER LEAD OFF appears on the monitor when in PACER mode whenever e the pacer cable is not connected e there is a defect in the cable e the pacer electrodes do not make good skin contact 26 NONINVASIVE TEMPORARY PACING NTP STANDBY PACING For certain patients at risk of developing symptomatic bradycardia it may be advisable to use the ZOLL PD in standby When used in standby mode the ZOLL PD will automatically provide a pacing stimulus whenever the patient s heart rate drops below a predetermined level To use the ZOLL PD in standby mode 1 Establish effective pacing see instructions on previous pages Note the mA output at capture and run an ECG strip to document ECG morphology at capture 2 Set the mA output 10 higher than the minimum mA output necessary to effect consistent ventricular capture 3 Turn the pacing rate below the patient s heart rate This will suppress pacing unless the patient s own rate drops below the set pacing rate The pacing rate should be set at a level needed for adequate cardiac output 4 Check the threshold periodically SPECIAL PACING APPLICATIONS Noninvasive Temporary Pacing may be performed in the Cardiac Cath Lab either for emergency pacing or in standby mode The pacing electrodes are essentially radiotransparent except for steep imaging angulations where slight shadows may be observed Noninvasive Te
3. Check LED SYNC MONITOR ON Check LED START STOP Check LED If using paddles set the SELECTOR SWITCH to 2 joules and check the CHARGE button and LED on the apex paddle This concludes the basic PD 1200 functional checkout For additional tests and calibration checks refer to the EXTENDED DIAGNOSTICS found in Section IX in this Operator s Guide U S A customers If your instrument needs calibration adjustment refer to the PD 1200 Service Manual or contact ZMI Service at 1 800 348 9011 in Mass 1 617 933 9150 International customers If your instrument needs calibration adjustment refer to the PD 1200 service manual or contact your nearest authorized ZMI service center REAR PANEL e The auxiliary input output connector is located on the instrument s rear panel This 15 pin connector provides an additional ECG signal Pin 3 e The Line and Battery circuit breakers are located on the instrument s rear panel These should be checked and reset as necessary if any of the following conditions occurs The CHARGEINDICATOR LIGHT does not appear when connected to AC power Unit does not turn on Unit turns on but there is no display on the monitor 45 OPERATOR S GUIDE LOW BATTERY message is displayed when connected to AC power e ZMI supplies an interface cable Part No NTP 3007 for the 15 pin connector The opposite end of the cable is left unterminated bare wires It is the customer s responsibility t
4. Verify that no one is in contact with the patient monitoring cable or leads bed rails or any other potential current pathway 21 OPERATOR S GUIDE Press and hold both DISCHARGE buttons one on each paddle simultaneously The defibrillator will discharge with the next detected R wave If you are using multi function electrodes simultaneously press and hold both DISCHARGE buttons located on the cable connector assembly If additional countershocks are necessary readjust the energy level as necessary and repeat Note that SYNC must be selected after each discharge NOTES Should you need to disarm the charged defibrillator if countershock is not needed turn the SELECTOR SWITCH to MONITOR ON or any other position Any stored energy will be dumped internally and the monitor delivered energy display will disappear If the defibrillator is not discharged within 60 seconds of reaching the selected energy level it will automatically dump the stored energy internally During the ten seconds just prior to this internal disarm the CHARGE READY tone will beep intermittently When the internal dump is complete the CHARGE READY tone will terminate the CHARGE INDICATOR LIGHT will go off and the monitor delivered energy display will go off A PADDLE FAULT message will appear on the monitor whenever the paddles or multi function cable are not connected or are improperly seated in the unit The unit will disarm itself if such a fa
5. gelled disposable electrodes They are applied to the patient in the same manner and location as ZOLL NTP 2000 electrodes The multi function electrodes can only be used with a multi function cable ZOLL NTP 2000 pacing electrodes can only be used with a standard pacing cable When using a multi function cable it is important that the operator check to be sure that the electrode packaging says Pacing Defibrillation Electrodes The labels on the electrodes themselves must have the words PACE printed in green and DEFIB printed in red MULTI FUNCTION ELECTRODES Note The ZOLL PD 1200 cables and electrodes are designed and tested as a unit to provide maximum patient safety and comfort PLACEMENT Anatomical placement of the multi function electrodes is identical to placement of ZOLL NTP 2000 pacing electrodes e Remove the electrodes from the storage pouch Remove the protective cover exposing the gel area and adhesive e Place the round electrode labelled FRONT directly over the cardiac apex beneath the breast on females See the diagram on the package e Place the rectangular electrode labelled BACK on the back between the patient s left scapula and spine at heart level Note The back electrode may be placed over the patient s right sternal area if it is not possible to access the patient s posterior Effective defibrillation will result but pacing will usually be less effective e When placing the e
6. electrodes PADDLES or ELECTRODES is automatically selected when the instrument powers up in DEFIB ON or MONITOR ON Lead II is automatically selected when the instrument powers up in PACER ON ECG monitoring through the paddles is accomplished by selecting PADDLES PADDLES monitoring may not be used in PACER ON mode or with the optional PD 1210 in EXT TRIG mode ECG monitoring through multi function electrodes is accomplished by selecting ELECTRODES Note When using multi function electrodes the word PADDLES is replaced with the word ELECTRODES ALARM ON The ALARM ON button is used to activate and deactivate the Heart Rate Alarm A bell symbol appears on the monitor when the alarms are activated and the light within the button is illuminated When the ALARM ON is deactivated the bell symbol disappears and the light within the button goes off When the ALARM ON is active and an alarm condition is detected an audible alarm sounds and the bell symbol flashes To avoid possible confusion with the DEFIBRILLATOR CHARGED tone the Heart Rate Alarm tone is suppressed when the defibrillator is on SELECTOR SWITCH is turned to any of the defib settings ECG SIZE This control allows the operator to vary the size of the ECG signal at 5 1 0 and 2 0 cm mV and is indicated on the monitor in the upper left center of the display FREEZE The freeze control allows the operator to capture and hold on the display a full four 4
7. is pressed Notes e The paper supply should be checked at the beginning of each shift and the end of each use to ensure adequate recording capability A red stripe on the paper means that the paper supply is low and should be replaced e A NO PAPER message appears on the monitor when the recorder is activated without paper 32 MULTI FUNCTION ELECTRODES SECTION VII OPERATION WITH MULTI FUNCTION ELECTRODES This section provides condensed instructions for the safe use of ZOLL PD 2200 Multi Function Pacing Defibrillation Electrodes It is intended to be an update for operators already experienced with the use of the PD 1200 paddle defibrillation and NTP 2000 electrode pacing If you are not completely familiar with the operation of the PD 1200 read the complete operator s guide before proceeding ZOLL PD multi function electrodes allow the operator to defibrillate to do noninvasive pacing and to ECG monitor with the use of only two electrodes The PD 1200 has been designed to perform either paddle defibrillation and NTP 2000 electrode pacing or defibrillation and pacing with multi function electrodes The method available is determined by the use of the multi function electrode cable When connected to the PD 1200 it restricts access to both the NTP pacing cable connector and the standard paddles connector To change pacing defibrillation methods simply change cables 33 OPERATOR S GUIDE MULTI FUNCTION C
8. not in use Certain arrhythmias such as Ventricular Tachycardia VT atrial fibrillation and atrial flutter require synchronizing the defibrillator discharge with the ECG R wave to prevent the induction of ventricular fibrillation In this case a synchronizing SYNC circuit within the instrument detects the patient s R waves When the DISCHARGE buttons are pressed and held the unit will discharge with the next detected R wave thus avoiding the vulnerable T wave segment of the cardiac cycle During SYNC the ZOLL PD places a marker pulse on the ECG as it appears on the monitor to indicate the point in the cardiac cycle where discharge will occur This marker pulse appears as an intensified dot or line on the ECG waveform For documentation a marker also designates this discharge point above the waveform on the ECG recorder strip Select Monitor On e Connect ECG leads Select desired ECG lead by pressing LEAD button Note The warning USE LEADS will briefly appear whenever PADDLES or ELECTRODES is selected as the ECG source during cardioversion Standard ECG leads are recommended during cardioversion since they provide signal quality that is typically superior to that of paddles Multi function electrodes may be used as ECG source and signal quality will be equal to that of standard ECG leads except immediately following a discharge when there may be more noise due to muscle tremors especially if an electrode is not in comp
9. pressed move the SELECTOR SWITCH to the new energy level and press CHARGE again After 6 10 seconds of charging to the selected level the CHARGE INDICATOR LIGHT will light on the apex paddle or the multi function cable connector A distinctive audible tone will go on and the energy selected will be displayed on the monitor The defibrillator is now ready All persons attending patient should be warned to STAND CLEAR 3 DISCHARGE DEFIBRILLATOR Verify that no one is in contact with the patient monitoring cable or leads bed rails or any other potential current pathway Simultaneously press and briefly hold both DISCHARGE buttons one on each paddle to deliver energy to the patient If you are using multi function electrodes simultaneously press and briefly hold both DISCHARGE buttons located on the cable connector assembly NOTES If the defibrillator is not discharged within 60 seconds of reaching the selected energy level it will automatically dump the stored energy internally During the ten seconds prior to this internal dump the CHARGE READY tone will beep intermittently When the internal dump is complete the CHARGE READY tone will stop the CHARGE INDICATOR LIGHT will go off and the monitor delivered energy display will go off Should you need to disarm the defibrillator when it is charged simply turn the SELECTOR SWITCH to MONITOR ON or any other energy setting This will cause the defibrillator to dump its char
10. seconds of ECG trace for viewing important or interesting ECG morphology Normal monitoring is continued when the control is released START STOP RECORDER This pushbutton starts and stops the hard copy recorder MARK RECORDER The MARK control places a distinctive mark on the recorder margin the instant the button is pressed MARK also triggers a 15 second recorder run if the recorder had been off ECG BEEPER VOLUME The VOLUME control at the left front of the instrument below the recorder allows manual adjustment of the systole beeper tone from maximum volume to inaudible The Heart Rate Alarm and Charge Ready volumes are not adjustable 13 OPERATOR S GUIDE 16 17 18 19 20 21 ECG OUT The ECG out phone jack provides a high level l volt ECG signal from the Pacemaker Defibrillator and is configured to provide the analog ECG signal on the jack tip with the jack sleeve as signal ground reference ECG jack is located on the back panel PAPER COMPARTMENT Opens recorder paper storage Heart Rate Alarm adjustment controls are located within the paper compartment ALARM SET This control allows the user to change the High Heart Rate Alarm setting pre set at 150 and Low Heart Rate Alarm setting pre set at 30 The A button increments the displaved value The W button decrements the displaved value Alarm set button is located inside the recorder paper compartment PEDIATRIC PADDLES Pediat
11. to pace for more than 30 minutes caution and periodic inspection of the underlying skin is strongly advised 27 ECG MONITORING SECTION VI ECG MONITORING The ZOLL PD Pacemaker Defibrillator can be used for either short term or long term cardiac monitoring A fully charged battery pack provides 2 hours of continuous monitoring The power cord may be connected to AC power at any time for indefinite periods of monitoring The ZOLL PD has built in protection circuitry to allow patient monitoring to continue during a defibrillation attempt Monitoring electrodes may become polarized during defibrillation discharge causing the ECG waveform to briefly go off scale High quality silver silver chloride Ag AgCl electrodes minimize this effect and circuitry in the instrument will return the trace to the monitor display within a few seconds ECG monitoring may be accomplished through paddle electrodes or through multi function electrodes However this is typically done only for emergency evaluation of patient condition when ECG leads are not attached to the patient PREPARATIONS Proper application and placement of electrodes is essential for quality ECG monitoring Good contact between the electrode and skin minimizes the negative effects of motion artifacts and signal interference ELECTRODE PLACEMENT RA White Electrode Place near right mid clavicular line directly below clavicle LA Black Electrode Place near left mid clavicular line di
12. 25 mm sec for a period of 4 seconds Also displayed on the monitor are heart rate derived from measuring R to R intervals lead selections I II IH PADDLES or ELECTRODES ECG size 0 5cem mV lem mV 2cm mV pacemaker output in milliamps defibrillator output in joules other operational prompts messages and diagnostic codes The hard copy recorder is used to document events The recorder normally operates in the delay mode 4 seconds to insure capture of critical ECG information It may be activated manually by pressing the recorder START STOP or MARK buttons It will also be activated automatically whenever the defibrillator DISCHARGE buttons have been pressed or a Heart Rate Alarm goes off ELECTRODES replaces PADDLES when the multi function electrode cable is connected 4 GENERAL INFORMATION BATTERIES The ZOLL PD uses special medical grade sealed lead acid batteries that when fully charged can provide up to two hours of monitoring Use of the defibrillator pacemaker and recorder will reduce this time A LOW BATTERY message appears on the monitor when the instrument must be plugged into an AC power source to ensure continued proper operation INSTRUMENT DIAGNOSTICS The computer contained within the ZOLL PD performs self diagnostic tests on critical circuits when the instrument is initially turned on and periodically during operation The READY message that appears briefly on the monitor during initial pow
13. 720 PD 120 Pacemaker Defibrillator kissret uae ZOLL Medical Corporation 500 West Cummings Park Wobum Massachusetts 01801 6516 800 348 9011 ZOLL 617 933 1807 Telefax 617 933 9150 U S A Akis TABLE OF CONTENTS SECTION DESCRIPTION PAGE I GENERAL INFORMATION 1 II OPERATING CONTROLS AND INDICATORS 11 III EMERGENCX DEFIBRILLATION PROCEDURE 15 IV SYNCHRONIZED CARDIOVERSION 19 V NONINVASIVE TEMPORARV PACING NTP 23 VI ECG MONITORING 29 VII OPERATION WITH MULTI FUNCTION ELECTRODES 33 VIII OPERATIONAL CHECKS AND PROCEDURES 39 IX EXTENDED DIAGNOSTICS 47 X TROUBLESHOOTING GUIDES 51 GENERAL INFORMATION SECTION I NER MATION This operating guide provides instructions for the safe use and proper care of the ZOLL PD 1200 Pacemaker Defibrillator PD Before using the instrument CAREFULLY read this entire manual SAFETY CONSIDERATIONS The ZOLL PD is a high energy device and is capable of delivering up to 360 joules Disconnecting the line cord of an operating PD from an AC power outlet will not remove power since the instrument is battery powered To completely deactivate the PD you must turn the SELECTOR SWITCH to the OFF position In order to disarm a charged defibrillator e Turn the SELECTOR SWITCH at least one position in either direction or e If using paddles place them in their holders and depress both DISCHARGE buttons As a safety feature the ZOLL PD will automatically disch
14. 8 7 Rate ppm Sets rate of pacemaker 12 24 40 45 47 4 1 Every 4th beat is paced beat 12 26 40 Lead Selects ECG source I II II PADDLES ELECTRODES 13 16 29 30 45 10 Alarm On Activates or deactivates heart rate alarms Alarm limit 13 30 41 45 controls are inside recorder paper compartment 11 ECG Size Varies size of ECG 0 5 1 0 2 0 cm mV 13 30 45 12 Freeze Holds ECG trace stationary 13 31 45 13 Start Stop Starts and stops recorder 13 31 39 41 42 43 44 14 Mark Places mark on recorder paper Starts recorder if off 13 31 32 40 41 15 ECG Beeper Adjusts audible tone of detected beat 13 16 ECG Out 1 volt output Located on back panel See photo page 45 14 17 Paper Recorder paper storage and alarm limit controls 14 41 42 Compartment 18 Alarm Set Changes heart rate alarm limits Sets time and date 14 31 41 43 A increments limit V decrements limit Located inside paper compartment See photo page 31 19 Pediatric Located under adult paddles Push PEDI button and 14 Paddles slide adult paddles off 20 Battery Charge Indicates batteries are charging 14 Indicator Light 21 Multi Function Tests defibrillation output when using multi function 14 34 40 kal Electrode Test electrodes Load Port 10 CONTROLS AND INDICATORS SECTION II OPERATING CONTROLS AND INDICATORS SELECTOR SWITCH The SELECTOR SWITCH allows selection of any of the three operating modes 1 MONITOR ON 2 DEFIB ON with various energy selections and 3
15. 8 mm x 85 mm viewing area 25 mm sec 4 seconds Digital display on monitor 0 300 BPM Digital display on monitor 0 140 mA Display on monitor 5x 1x 2x display on monitor Display on monitor Message display on monitor Message display on monitor Defibrillator Paddle Fault Message display on monitor Defibrillator Electrode Fault Message display on monitor Recorder Paper Out Low Battery Voltage Message display on monitor Message display on monitor Battery Charger Operational Extended info Self test mode Defibrillator Charge Time Extended info Self test mode Peak Delivered Defib Current Extended info Self test mode Pace Rate and Output Extended info Self test mode Recorder Type Single wave form channel Paper Standard 40 mm thermal grid width 50 mm paper width Speed 25 mm sec Delay 4 seconds Annotations Time date energy heart rate pacer output sync event marker Writing Method Print out Modes Automatic Function ECG size lead alarm defib test OK Fail High resolution thermal array print head Manual automatic 15 second recording initiated by alarm conditions and defibrillator discharge Batteries Type Voltage Recharge Time Charger Service Low Battery Indicator Operating Time GENERAL INFORMATION Rechargeable sealed lead acid medical grade 2 5 V cell 6 cells Two 2 hours for depleted pack to 90 of battery capacity Uni
16. ABLE The ZOLL PD 3300 Multi Function Cable connects to the standard paddles receptacle on the right front of the unit CAUTION Remove the NTP pacing cable before installing the multi function cable There is a defibrillator CHARGE INDICATOR LIGHT located on the top of the multi function cable connector The light illuminates as soon as the defibrillator has charged to the energy level set by the SELECTOR SWITCH Also located on the multi function cable connector are two orange DISCHARGE buttons When pressed simultaneously they will discharge the defibrillator ELECTRODES OFF Message If the operator attempts to defibrillate with multi function electrodes and the electrodes are not properly installed an ELECTRODES OFF message will appear on the monitor Check to see that all connections have been properly made before continuing OPERATIONAL CHECKS WITH THE MULTI FUNCTION CABLE To test the defibrillator delivered energy and charge time while using the multi function cable connect the electrode end of the cable to the TEST LOAD port located on the front left bottom of the unit This is the equivalent of placing the standard paddles in their holders It is now possible to safely discharge the defibrillator as necessary to perform all required instrument checks See Section VIII for recommended tests and procedures MULTI FUNCTION ELECTRODES ZOLL PD 2200 Multi Function Pacing Defibrillation Electrodes are anterior posterior pre
17. Defibrillator Tester Damped sinusoid Selectable at 2 3 5 7 10 20 30 50 100 150 200 300 360 joules Less than 10 seconds Depleted batteries will result in a longer defibrillator charge time Monitor displays energy Synchronizes defibrillator pulse to patient s R wave SYNC message displayed on monitor Marker on monitor and on recorder identifies R wave Control on apex paddle and on front panel Standard paddles are anterior anterior adult and pediatric Adult paddles slide off to expose pediatric paddles Specifically designed anterior posterior or anterior anterior pre gelled ZOLL PD multi function pacing defibrillation electrodes packaged in pairs Integral circuitry allows complete test of defibrillator charge and discharge without removing paddles from storage wells Identical circuitry allows complete test of unit configured with multi function electrode cable OPERATOR S GUIDE Monitor and Display Patient Connection Input Protection Bandwidth Display Format Screen Size Sweep Speed Viewing Time Heart Rate Output Current Lead Selection ECG Size Alarm On Off Status ECG Lead Fault Pacer Electrode Fault Via 3 lead ECG cable and paddles electrodes Selectable by front panel switch Fully defibrillator protected Special circuit prevents distortion of ECG by pacer pulse 0 3 40 HZ 3dB standard Non fade moving trace with freeze capability 5 inches diagonally 10
18. ECG size should be 1x PADDLES or ELECTRODES should be displayed in upper left of display screen The message ECG LEAD OFF will be displayed anytime leads I II or III have been selected and no ECG cable has been connected or the lead wires are not attached to a patient 39 OPERATOR S GUIDE PACER OPERATION BASIC e Turn the SELECTOR SWITCH to PACER ON e Tum RATE knob to 150 ppm and press the MARK button to generate a strip e Verify that the pace pulses occur approximately every 10 small divisions 2 large divisions 1 cm e Press the 4 1 button and verify that the frequency of pulses decreases 8 large divisions 4 cm per pulse e Turn the OUTPUT knob to 0 mA There should be no PACE LEAD OFF message e Slowly turn the knob up to 15 mA The PACE LEAD OFF message should appear The above tests quickly verify basic pacer functions If you have ZMI s PACEMAKER TEST LOAD Part No NTP 4450 you can further test the pacer output cable and verify pacer calibration DELIVERED ENERGY AND DISCHARGE BUTTONS CHECK e Perform this check once a week e Place the SELECTOR SWITCH in the 200 joules position e Verify that the adult paddle electrodes or multi function electrode cable is installed e Leaving the paddles in their holders or as appropriate plugging the multi function electrode cable into its test jack press either CHARGE button Wait for the CHARGE READY tone to sound and the CHARGE INDICATOR LIGHT to li
19. PACER ON It also turns the power off The monitor is always on except in the OFF position CHARGE Press the CHARGE button on the front panel or if using paddles on the apex paddle handle to charge the defibrillator to the energy level selected with the SELECTOR SWITCH control When the CHARGE button is pressed the defibrillator charges to the selected energy level in 10 seconds or less when the batteries are fully charged To change the selected energy level after the CHARGE button has been pressed simply reposition the SELECTOR SWITCH and press CHARGE again 11 OPERATOR S GUIDE ea ea at Te CHARGE INDICATOR LIGHT Located on the apex paddle this light turns on when the defibrillator is charged and ready When using the multi function electrode cable the indicator light is located on the cable connector DISCHARGE Each paddle has a DISCHARGE button located near the forward end of the handle Press and briefly hold both buttons simultaneously to discharge the defibrillator The multi function electrode cable not shown has two DISCHARGE buttons mounted in the instrument connector Both must be pressed to discharge the defibrillator See Section VII SYNC In SYNC mode the unit synchronizes defibrillator discharge with the first detected R wave after both DISCHARGE buttons are pressed and held down This mode is typically used for cardioversion procedures The SYNC button can be used in the DEFIB ON or the MONITO
20. R ON mode For synchronized operation press the SYNC button once the SYNC DEFIB or SYNC MONITOR message appears on the display and the light within the SYNC button is illuminated A distinctive marker appears on the monitor with each detected R wave To return to standard defibrillation mode for instant discharge press the SYNC button again The ZOLL PD is designed to leave SYNC mode and revert to standard defibrillation mode after discharge OUTPUT mA PACEMAKER OUTPUT This switch is used to control the amount of current to the pacemaker electrodes For conscious patients it should be gradually increased until capture is recognized The output is displayed digitally on the monitor RATE ppm When pacing is selected this control sets the rate at which the pacemaker will operate It must be set above the patient s intrinsic rate in order for the pacemaker to provide stimulation 4 1 BUTTON This control is used optionally to test for threshold or to determine the underlying rhythm When depressed approximately every 4th beat is a paced beat Releasing the control will cause the instrument to resume normal operation 12 10 11 12 13 14 15 CONTROLS AND INDICATORS LEAD Selection of the ECG source is accomplished through the LEAD button Pressing the button will sequentially select and display each option on the monitor I II III PADDLES defibrillator paddles or ELECTRODES multi function
21. Recorder makes a stuttering sound when activated 16 0 Check paper path of recorder 16 1 Check paper feed roller for 17 SYNC marker 7 not annotating at top edge of paper 17 0 Ensure SYNC switch green indicator is lit 17 1 Ensure high intensity dot or line is displayed on ECG signal on monitor 17 2 Change ECG lead selection 17 3 Paper too narrow It should be 50mm wide 18 Light or poor quality tracings annotations on paper 18 0 Ensure correct paper is in use 18 1 Ensure paper is installed thermal side down into lower slot of recorder 18 2 Recorder print head requires cleaning by trained personnel 53 OPERATOR S GUIDE NON INVASIVE PACING WARNING Be sure that pacer output current mA is set to 0 mA when connecting and disconnecting a patient from the PD 1200 19 Pacer LEADS OFF message is 19 0 Ensure pacing electrodes or multi function displayed on monitor electrodes are connected to appropriate cables 19 1 Ensure electrodes are not dry Do not use ECG or defibrillator gel Replace electrode if necessary 19 2 Ensure good electrode to patient contact no buckling or falling off CAUTION Turn OUTPUTmA to 0 while checking 19 3 Check integrity of pacing cables For multi function cable plug into load test connector on front handle Pacer Lead Off should disappear For standard Pace Cable connect to Zoll NTP 4450 Pace Check Pacer Lead O
22. able e 1 set adult pacer electrodes e 1 set pediatric pacer electrodes e 1 roll recorder paper e 2 Operator s Guides e Service Manual not included in shipment supplied on request Other Accessories e NTP 2000 Adult pacing electrodes 12 pair box e NIP 2100 Pediatric pacing electrodes 6 pair box e NTP 3002 Pacer output cable e NTP 3007 External interface cable e NTP 4450 Test Load for Noninvasive Pacer e PD 2200 Multi function pacing defibrillation electrodes 12 pair box e PD 3201 Standard Apex Sternum defibrillator paddles e PD 3202 Electrophvsiologv external interface cable e PD 3300 Multi function cable assemblv for pacing defibrillation electrodes e 9145 0003 Batterv Pack e 9500 0002 AAMI Standard 3 wire ECG cable Pacemaker Type Pulse Type Pulse Duration Pulse Amplitude Pacing Rate Output Protection Pacer Electrodes Defibrillator GENERAL INFORMATION VVI demand asynchronous when used without ECG leads Rectilinear constant current 40 milliseconds Variable to 140 mA Variable from 30 to 180 ppm Fully defibrillator protected and isolated Specifically designed anterior posterior pre gelled ZOLL NTP or ZOLL PD multi function pacing defibrillation electrodes pack aged in pairs Pediatric electrodes are available Waveform Output Energy delivered Charge Time Delivered Energy Display Synchronized Mode Charge Control Paddles Defib Electrodes Integral
23. acing longer than eight 8 hours For continuous pacing longer than eight 8 hours change electrodes or use ZOLL NTP 2000 pacing electrodes Avoid touching the gelled area of the electrode while pacing A minor electrical shock hazard exists Note The procedure for applying and pacing with multi function electrodes is identical to the NTP 2000 electrode pacing procedure SELECT MONITOR ON e Set output to 0 mA APPLY ELECTRODES e Apply ECG and multi function electrodes to patient e Connect electrodes to appropriate cables Note The instrument will pace asynchronously when ECG leads are not connected The instrument will not monitor through the multi function electrodes in PACER ON mode SELECT PACER ON e Set pacing rate e Increase output mA until stimulation is effective MONITORING WITH MULTI FUNCTION ELECTRODES See Section VI for more detailed information ECG monitoring can be easily accomplished through the multi function electrodes The following key points should be observed e Monitoring through the multi function electrodes is available during monitor or defib operation e When multi function electrodes are selected as the ECG source the message ELECTRODES will appear on the screen in place of LEAD I II or III e During pacer operation if ECG leads are not connected the monitor screen will display a flat line and the message ECG LEADS OFF will be displayed The PD will pace asynchronously in this c
24. alified medical personnel for the purposes of converting ventricular fibrillation VF a cardiac rhythm incompatible with life to sinus rhythm or other cardiac rhythms capable of producing hemodynamically significant heart beats In addition this product may be used in the synchronized mode to terminate certain atrial and ventricular tachycardias and other arrhythmias resistant to drug therapy A qualified physician must decide when synchronized cardioversion is appropriate Defibrillator Complications Inappropriate defibrillation or cardioversion on a patient e g with no malignant arrhyth mia may precipitate ventricular fibrillation asystole or other dangerous arrhythmias Defibrillation without proper application of paddle electrolyte gel may be ineffective and cause burns particularly when repeated shocks are necessary Defibrillator Output Energy The ZOLL PD delivers up to 360 joules into a 50 ohm impedance The energy delivered through the chest wall however is controlled by skin impedances An adequate amount of electrolyte gel must be applied to the paddles and a force of 10 12 kilograms must be applied to each paddle in order to minimize skin impedance If multi function electrodes are used make sure that they are properly applied See Section VII MONITOR AND RECORDER FUNCTION This product contains a non fade monitor for observation of the patient s cardiac rhythm The monitor displays the ECG in moving trace mode at
25. always available To reactivate SYNC mode press the SYNC button again Prepare Paddles For multi function electrodes see note below or Section VII e Remove paddles from their holders by grasping the handles and lifting the paddles straight up 20 SYNCHRONIZED CARDIOVERSION Apply a liberal amount of electrolyte gel to the electrode surface on each paddle To avoid risk of electrical shock to the operator do not allow electrolyte to accumulate on the hands or the paddle handles Rub the electrode surfaces together to evenly distribute the applied gel Apply Paddles to Chest Apply the paddles firmly to the anterior wall of the chest The sternum paddle should be placed to the right patient s right of the sternum just below the clavicle The apex paddle should be placed on the chest wall just below and to the patient s left of the left nipple along the anterior axillary line If external pacing electrodes are in place it is not necessary to remove them Simply ensure that the paddles contact skin and not the electrode s external surfaces Rub the paddles against the skin to maximize the paddle to patient contact Do not permit gel to accumulate between the paddles gel bridge on the chest wall this could cause burns and reduce the amount of energy delivered to the heart Note If you are using multi function electrodes do the following Remove electrodes from the storage pouch and place the round one marked FRONT
26. arge internally if it has been left charged for more than 60 seconds WARNINGS This instrument is for use by authorized personnel only Do not use the ZOLL PD in the presence of flammable agents such as gasoline or anesthetics Using the instrument near the site of a gasoline spill may cause an explosion Do not discharge with paddles shorted together or in open air Stand clear of patient when defibrillating Do not discharge into multi function electrodes that are not properly placed on a patient Using the device near or within puddles of water is a shock hazard to the operator patient and nearby personnel Internal pacemakers may cause the heart rate meter to count the pacemaker rate during incidences of cardiac arrest or other arrhythmias Pacemaker patients should be carefully observed Do not rely solely on heart rate meters OPERATOR S GUIDE PRODUCT DESCRIPTION The ZOLL PD 1200 Pacemaker Defibrillator combines a patented noninvasive temporary pacemaker a DC defibrillator a non fade monitor and an annotating strip chart recorder in an integral self contained instrument The PD 1200 is lightweight compact and can be transported with a patient It can be operated by either an AC line or batteries Built in batteries are kept at full charge when the unit is connected to line power The batteries are rechargeable and can be easily replaced by the user PACEMAKER FUNCTION Noninvasive temporary pacing NTP is an
27. cording RECORDER Operation The Recorder will document the ECG trace with a 4 second delay at all times unless FREEZE is activated To start the recorder press the START STOP button on the front panel The recorder will run continuously until the button is pressed again The recorder will automatically run for 15 seconds when Heart Rate Alarms have been violated or the defibrillator has been discharged or when MARK has been depressed when the recorder is not running Each time the recorder is started the time date ECG lead size and heart rate are printed on the top part of the paper If the pacer is operating the output current will also be printed Similarly if the defibrillator has been discharged the delivered energy will be printed 31 OPERATOR S GUIDE Recording shows annotations during monitoring Marker Symbol 16 13 15 AUG 88 LEAD I SIZE 1 HR 68 Recording shows MARK k operation e The MARK button is an event marker control that places a distinct mark A on the trace each time it
28. ct pacer electrodes to output cable i e either the standard pacing cable or multi function cable SELECT PACER ON ENERGY PA SELECT 39 JOULES 5 MON bi PACER ON e Set pacing rate to a value 10 20 ppm higher than patient s intrinsic rate If no intrinsic rate exists use 60 ppm e Observe the pacing artifact stimulus markers LI and verify that it is well positioned in diastole 24 NONINVASIVE TEMPORARY PACING NTP T Pacing Stimuli Pacing below threshold e Increase output mA until stimulation is effective capture Pacing above threshold Effective Pacing DETERMINING CAPTURE e Itis important to recognize when stimulation has produced a ventricular response Ventricular response is normally characterized by suppression of the intrinsic QRS complex The following tracings are typical Effective Pacing Note the widened positive QRS which looks like an ectopic beat A paced beat is by definition an ectopic beat OPERATOR S GUIDE mi Min ti Effective Pacing Note the inverted T waves and absence of P waves e Changing leads can sometimes be helpful in determining capture Note Shape and size of the stimulated waveforms can vary depend
29. directly over the cardiac apex as shown on the diagram on the pouch Place the rectangular electrode marked BACK on the back between the patient s left scapula and the spine at heart level see diagram on pouch Note The BACK electrode may be placed over the patient s right sternal area if it is not possible to access the patient s posterior Effective defibrillation will result but pacing will usually be less effective When placing electrodes be sure to press firmly on the adhesive area around the electrode periphery Gently press the gel area to remove any trapped air This ensures good skin coupling Connect the electrodes to the multi function cable 2 CHARGE DEFIBRILLATOR Press the CHARGE button on the front panel or if using paddles on the apex paddle handle To increase or decrease the selected energy after the CHARGE button has been pressed move the SELECTOR SWITCH to the new energy level and press CHARGE again After 6 10 seconds of charging to the selected energy level the CHARGE INDICATOR LIGHT will illuminate on the apex paddle or on the multi function cable connector A distinctive audible tone will go on and the energy selected will be displayed on the monitor The defibrillator is now ready All persons attending the patient should be warned to STAND CLEAR 3 DISCHARGE DEFIBRILLATOR Verify again that the ECG waveform is stable and that a marker pulse appears ONLY with each R wave of the cardiac cycle
30. e cycling In addition it has no memory and can be recharged rapidly 2 3 hours To ensure a fully charged battery always keep the ZOLL PD 1200 plugged into AC power when not in use Depleted batteries will result in slower defibrillator charging times The monitor will display the message LOW BATTERY indicating the instrument must be plugged into AC power to ensure proper operation Fully charged batteries will keep 80 of their charge for several weeks with the instrument turned off and not plugged into AC Avoid periodic deep discharge cycling A battery left uncharged for excessive periods 4 to 6 months may become damaged and require replacement CHANGING THE BATTERY PACK e Stand the instrument vertically on end So that it rests on the cord storage area e Open the battery compartment door by removing the two screws at the bottom of the door on either side of the rubber support foot e Remove the old battery pack by pinching the lever on the white connector that attaches the battery pack to the unit e Replace with a new pack and close the compartment door ensuring that no wires are crimped or pinched by the door e Check date and time FE ERAON sa St tursin 44 CHECKS AND PROCEDURES BUTTONS AND LEDs Light Emitting Diodes Check all remaining buttons and LEDs for basic functions ECG Size Display 2x 5x 1x LEAD Display I II III PADDLES or ELECTRODES FREEZE Monitor trace freezes ALARM ON
31. e used for ECG monitoring Use of paddles for ECG monitoring is for emergency situations when time does not allow connection of monitoring electrodes The unit automatically pre selects PADDLES when it is initially turned on Pressing the LEAD button will allow selection of the desired ECG source I II II PADDLES ELECTRODES Paddles monitoring is NOT possible when in PACING mode Note If you are using multi function electrodes do the following Remove electrodes from the storage pouch and place the round one marked FRONT directly over the cardiac apex as shown on the diagram on the pouch Place the rectangular electrode marked BACK on the back between the patient s left scapula and the spine at heart level see diagram on pouch Note The BACK electrode may be placed over the patient s right sternal area if it is not possible to access the patient s posterior Effective defibrillation will result but pacing will usually be less effective 16 EMERGENCY DEFIBRILLATION PROCEDURE When placing electrodes be sure to press firmly on the adhesive area around the electrode periphery Gently press the gel area to remove any trapped air This ensures good skin coupling Connect the electrodes to the multi function cable 2 CHARGE DEFIBRILLATOR Press the CHARGE button on the front panel or if using paddles on the apex paddle handle To increase or decrease the selected energy after the CHARGE button has been
32. er up verifies proper operation of these circuits During operation an ERROR message will indicate if a problem has been detected If this occurs contact authorized service personnel In the U S A contact ZMI service telephone 1 800 348 9011 Special tests are also available through an extended diagnostic mode see Section IX INITIAL INSPECTION Carefully inspect each container for damage If the shipping container or cushion material is damaged it should be kept until the contents have been checked for completeness and the in strument has been checked for mechanical and electrical integrity The contents of the ship ment should be as shown on the following pages Procedures for installation and initial checks are presented in Section VIII If the contents are incomplete there is mechanical damage or the instrument does not pass its electrical self test U S A customers should call ZMI Corporation 1 800 348 9011 International customers should contact the nearest ZMI authorized representative If the shipping container is damaged also notify the carrier SERVICE The ZOLL Pacemaker Defibrillator will provide trouble free operation without periodic re calibration or adjustment However it is suggested that the hospital biomedical engineering department perform a routine test of the device to verify proper operation See Section VIII U S A customers Should the ZOLL PD require service it should be returned in its original c
33. established and proven technique This therapy is safe and is easily and rapidly applied in both emergency and non emergency situations when temporary cardiac stimulation is indicated The ZOLL Pacemaker Defibrillator PD contains a demand pacemaker consisting of a pulse generator and ECG sensing circuitry The output current of the pacemaker is continuously variable up to 140 mA and the rate is continuously variable from 30 to 180 pulses per minute ppm The pacing output pulse is delivered to the heart by specially designed ZOLL NTP pacing elec trodes or ZOLL PD multi function electrodes placed on the back and the precordium Only ZOLL NTP or ZOLL PD electrodes should be connected to this instrument The characteristics of the output pulse together with the design and placement of the elec trodes minimize cutaneous nerve stimulation lower cardiac stimulation thresholds and reduce discomfort due to skeletal muscle contraction The unique design of the ZOLL PD allows clear viewing and interpretation of the electrocardi ogram ECG on the monitor during external pacing without offset or distortion Intended Use Pacemaker This product may be used for cardiac pacing for any purpose in conscious or unconscious patients for up to a few hours duration as an alternative to endocardial stimulation The purposes of pacing include 1 Resuscitation from standstill or bradycardia of any etiology Noninvasive pacing has been used for resusc
34. ff should disappear 19 4 Replace pace cables 20 No stimulus marker U present 20 0 Ensure PD 1200 is in Pacer ON position on ECG trace displayed on monitor 20 1 Ensure Pacing Rate ppm dial is set greater than patient rate No ventricular capture beat after 21 0 Increase output current level stimulus marker on ECG monitor display 21 1 Change ECG Lead select 21 2 Review pacing electrode placement 21 3 Verify that pacemaker is delivering the proper current using the ZOLL Pace Check tester or have Biomedical Engineering check output 21 4 Check for pulse of patient TROUBLESHOOTING PACING symptom Recommended Action 22 Patient on Standby pacing gets 22 0 Ensure good ECG electrode and placement paced intermittently 22 1 Check ECG cable for wear and tear or bad NOTE If ECG lead wire comes off connections pacer will automatically pace asynchronously 22 2 Patient R wave to R wave interval varying Pace rate close to patient rate 23 Heart rate is 0 with proper pacing 23 0 Change ECG Lead Selection capture displayed on ECG trace patient s pulse remembering check 23 24 Bedside Central Station monitor 24 0 Patients cannot be double patch ECG monitored display becomes erratic when while pacing Use Zoll adapter cable NTP 3007 pacing 55 OPERATOR S GUIDE DEFIBRILLATOR symptom Recommended Action 25 PADDLE FAULT message on 25 0 Remove and reinstall paddle cable
35. ge internally 17 OPERATOR S GUIDE e A PADDLE FAULT message will appear on the monitor whenever the paddles or multi function cable are not connected or are improperly seated in the instrument The instrument will also disarm itself if such a fault occurs during charge or after the charge is ready e An ELECTRODES OFF message will appear on the monitor if on an attempt to discharge with multi function electrodes the electrodes are not connected or contact with the patient is poor e CAUTION The unit does not disarm itself for an ELECTRODES OFF failure As a safety feature the operator must press the DISCHARGE buttons again after correcting the ELECTRODES OFF condition to discharge the defibrillator e Paddle Cleaning Paddle plates and handles must be thoroughly cleaned after each use 18 SYNCHRONIZED CARDIOVERSION SECTION IV SVNCHRONIZED CARDIOVERSION Before proceeding CAREFULLX read the following Synchronized cardioversion should only be attempted by skilled personnel trained in advanced cardiac life support ACLS and familiar with equipment operation The precise cardiac arrhythmia must be determined before attempting defibrillation Do not touch the bed patient or any equipment connected to the patient during defibrillation All persons in attendance of the patient must be warned to STAND CLEAR prior to defibrillator discharge In order to maintain battery charge keep unit plugged in when
36. ght and verify that the DELIVERED ENERGY display on the monitor registers 200 joules WARNING When performing this check using paddles place hands on the paddle handles as shown in the picture below Use your thumbs to operate the discharge switches No portion of the hand should be on the top surface of the unit near the paddle plates e Press each DISCHARGE button individually and verify that the unit does not discharge 40 CHECKS AND PROCEDURES Press and briefly hold both DISCHARGE buttons simultaneously The message TEST OK or TEST FAILED should appear on the display A brief automatic recorder run also provides documentation of the test indicated by TEST OK if the unit is providing delivered energy within specifications If TEST FAILED appears contact your hospital s technical personnel or ZMI immediately RECORDER CHECK Press the MARK button The recorder will run for 15 seconds While the recorder is running press and hold the UP and DOWN ARROWS located inside the paper compartment This will generate calibration pulses Inspect the recorder waveform for uniformity and darkness Inspect for uniformity of annotation characters and completeness of words Check for down arrow printed below annotation Check recorder speed by verifying that a new calibration pulse appears approximately every 13 small divisions 1 3 cm
37. her until the bar snaps out e Cut and remove all paper that may have wrapped around the feed roller e When paper path is clear test feed approximately one foot of paper If paper feeds properly reinstall tear bar Flat edge of bar positioned to the bottom 42 CHECKS AND PROCEDURES SETTING TIME AND DATE Check the time and date on the recorder annotation If it is not correct set as follows Turn the SELECTOR SWITCH to OFF Open the recorder door by pressing the paper latch Press and hold the ALARM SET button under the recorder door With the ALARM SET button pushed turn the SELECTOR SWITCH to the MONITOR ON position When the date display appears on the monitor release the ALARM SET button Observe the DATE message on the lower portion of the screen with the current day month and year displayed along with flashing cursors ___ under the value to be changed The cursors appear beneath the current day Use the A switch to increase the value and use the W switch to decrease the value Observe that holding the A switch will increment repeatedly while holding the W switch will decrement repeatedly The range of acceptable values is 1 through 31 Set the value to the current day Press the ALARM SET button again and observe that the cursors now appear under the current month Repeat above steps The range of acceptable values are JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Set the value to the c
38. ing on lead chosen variation from patient to patient can be expected DETERMINING OPTIMUM THRESHOLD The ideal output current is the lowest value that will maintain capture This is usually about 10 above threshold Typical threshold currents are usually between 40 and 80 mA The electrode placement that offers the most direct current pathway to the heart while avoiding large chest muscles will usually produce the lowest threshold Low stimulation currents produce less skeletal muscle contraction and are better tolerated Placement of the electrodes will affect the current required to obtain ventricular capture Testing for optimum electrode location may be done with electrodes with a two part protective cap Remove the center cap from the front electrode to expose the gelled area while keeping the adhesive covered Once the best location has been determined the electrode should be removed and the area cleansed of salt or other conductive materials such as defibrillator gel The electrode may then be secured after removing the adhesive backing 4 1 TEST MODE The 4 1 test mode can be used optionally to test for threshold In this mode a stimulus is delivered to the patient approximately every fourth pace beat The stimulus is demand synchronized to the patient s intrinsic beat Releasing the control will cause the instrument to resume normal operation gartes seek fuses SSERS REBA tute Spori seneeersaccave
39. itation from standstill or temporary accel eration of bradycardia in Stokes Adams disease sick sinus syndrome reflex vagal standstill and drug induced standstill due to procainamide quinidine digitalis b blockers verapamil etc and unexpected circulatory arrest due to anesthesia surgery angiography and other therapeutic or diagnostic procedures It is safer more reliable and more rapidly applied in an emergency than endocardial or other tempo rary electrodes 2 As astandby when standstill or bradycardia might be expected As a stand by when arrest or symptomatic bradycardia might be expected the external pacer is used especially in pacemaker procedures e g acute myocardial infarction drug toxicity anesthesia or surgery especially when disturbances of rhythmicity or non May also be referred to as transcutaneous pacing noninvasive external pacing or transcutaneous cardiac stimulation GENERAL INFORMATION conduction are present Prophylactic placement of endocardial electrode which car ries risks of displacement infection hemorrhage embolization perforation phlebitis and mechanical or electrical stimulation of ventricular tachycardia and fibrillation can be avoided 3 Suppression of tachycardia An increase in heart rate from external pacing often suppresses ventricular ectopic ac tivity and may prevent tachycardia Pacemaker Complications Ventricular fibrillation will not respond to
40. larms activated heart alarms When an alarm occurs the recorder will automatically run for 15 seconds the bell shaped character will flash the heart character freezes for easier identification and the audible alarm tone will sound Deactivating the alarms turns off the tone and the flashing bell and reactivates the heart character to flash with a detected R wave 30 ECG MONITORING SETTING ALARMS Heart rate alarms have been preset at 30 low and 150 high To change the lower or upper alarm set points 1 Lift the recorder paper latch The alarm set controls are located in the lower right portion of the recorder paper space Push ALARM SET Cursor flashes under low alarm limit To change push A to raise W to lower Push ALARM SET Cursor flashes under high alarm limit To change push A to raise W to lower Push ALARM SET to return to ALARM MONITORING mode FREEZE Pressing this control momentarily stops the trace on the screen When this is done the real time ECG trace is no longer visible but the R wave indicator heart symbol and Heart Rate Meter continue to operate Pressing the recorder START button when FREEZE is depressed will result in a non delay real time recording Releasing the FREEZE control resumes normal monitoring If the recorder is running when the FREEZE control is released the real time recording will be followed by the 4 second frozen section followed by the normal delayed re
41. lection 32 2 Alter ECG lead wire placement TROUBLESHOOTING Defibrillator continued Recommended Action 33 No apparent energy delivery to 33 0 Perform defibrillator self test as described in patient Operator s Guide pages 40 48 For devices shipped before 11 89 refer to page 34 33 1 If test fails have the unit serviced promptly 33 2 If Defib Pace electrodes are used ensure proper placement and contact 57
42. lectrodes be sure to press firmly on the adhesive area around the electrode periphery Gently press the gel area to remove any trapped air This ensures good skin coupling e If placing both electrodes on the chest back of patient is not accessible do not allow electrode gel to accumulate on the chest wall This could produce a gel bridge and cause burns or reduce the amount of energy delivered to the heart 35 OPERATOR S GUIDE DEFIBRILLATION WITH MULTI FUNCTION ELECTRODES For more detailed information see Section III WARNING Do not discharge the defibrillator if the electrodes are attached to the multi function cable and are not properly applied to a patient e Attach electrodes to patient e Connect electrode connector to multi function cable 1 SELECT ENERGY e Turn SELECTOR SWITCH to desired energy level 2 CHARGE THE DEFIBRILLATOR e Press the CHARGE button on the front panel e After 6 10 seconds the CHARGE INDICATOR LIGHT will illuminate and the Charge Ready tone will sound e All persons attending the patient should be warned to stand clear 3 DISCHARGE THE DEFIBRILLATOR e Simultaneously press and briefl hold the two orange DISCHARGE buttons located where the multi function cable connects to the PD 1200 MULTI FUNCTION ELECTRODES PACING WITH MULTI FUNCTION ELECTRODES See Section V for more detailed information WARNINGS Multi function electrodes should not be used for continuous p
43. lete contact with the skin The use of ECG leads also provides the choice of three leads for ECG source multi function electrodes provide only one Press SYNC Button e An intensified dot or line will appear on the monitor at each detected R wave to indicate where discharge will occur e Verify that the intensified dot or line marker is clearly visible on the monitor and is consistent from beat to beat If necessary use the LEAD button to select the lead which yields the best display 19 OPERATOR S GUIDE 1 SELECT ENERGY e Select the desired energy level with the SELECTOR SWITCH e A SVNC DEFIB message will appear on the monitor If DEFIB ON appears press the SYNC button e A USE LEADS message will briefly appear if PADDLES or ELECTRODES has been selected as the ECG source e Synchronized discharge with PADDLES as ECG source is discouraged since artifacts induced by moving the paddles may resemble an R wave and trigger defibrillator discharge at the wrong time e An ECG LEAD OFF condition if standard leads are selected as ECG source will prevent synchronized discharge Note This does not prevent the use of the defibrillator it simply prevents use in a synchronized manner e The unit automatically goes out of sync mode after 1 Each discharge 2 the SELECTOR SWITCH has been moved to PACER ON After each discharge the unit reverts to DEFIB ON where standard non synchronized defibrillation is
44. ls or if using the multi function cable into the test connector located in the lower left front of the device PEAK DELIVERED DEFIBRILLATION CURRENT DEFIB ON After a discharge into the PD 1200 s own self test circuit the unit will measure and display a number for the peak current delivered e Select 200 joules Charge and discharge the defibrillator into the paddle wells or multi function test connector e The display should read approximately 100PEAK This feature works at all energy levels Repeat as desired and compare the number displayed to the PEAK value in the table below to determine if the unit is delivering energy within AAMI specifications 48 EXTENDED DIAGNOSTICS Energy Selected Allowable Range 19 20 Note The PD 1200 self test circuit should be periodically tested against a calibrated defibrillator tester Instructions for performing this test are in the Service Manual 49 TROUBLESHOOTING SECTION X TROUBLESHOOTING GUIDES The troubleshooting guides provided on the following pages are intended for use by non technical medical personnel during PD 1200 operations This section answers many of the common problems or questions that arise during operation If trouble persists after consulting this guide call your Biomedical Engineering department or ZMI Service Operations A more technical troubleshooting guide is found in the PD 1200 Service Manual MONITOR symptom O Recomme
45. monitor critical components throughout normal operation In addition all units shipped after October 1989 offer an EXTENDED DIAGNOSTICS MODE In the extended mode the unit remains fully operational but presents information on the monitor which can be used to calibrate and otherwise verify proper operation of the unit The type of information presented will vary depending on the setting of the SELECTOR SWITCH MONITOR ON PACER ON or DEFIB ON ENTERING EXTENDED DIAGNOSTICS MODE e Hold the SYNC button down for at least three 3 seconds while powering on the unit The PD 1200 will acknowledge EXTENDED DIAGNOSTICS MODE by beeping an additional two times after the normal three power on beeps BATTERY CHARGER OPERATIONAL CHECK MONITOR ON With the SELECTOR SWITCH set to MONITOR ON battery voltage is displayed on the monitor e g 125V for 12 5 volts e Unplug the PD 1200 from the wall Battery voltage will slowly drop and settle between 11 0 and 12 5 volts 110V 125V e Plug the unit back into the AC wall outlet The battery voltage display will begin to climb eventually settling between 13 5 and 14 2 volts 135V 142V This indicates proper charger operation PACE RATE CHECK PACER ON In PACER ON mode the measured heart rate in the upper right corner of the monitor is replaced with the reading from the RATE knob The number is clearly marked ppm and must match within 5 the printed value selected by the rate knob e T
46. mporary Pacing may also be performed in the Operating Room provided the electrodes do not interfere with the surgical field While the ZOLL PD exceeds industry standards for resistance to interference from electrosurgical apparatus under certain conditions it may not be possible to properly monitor or pace while electrosurgical apparatus is operating ASYNCHRONOUS PACING The ZOLL PD is a VVI demand pacemaker the safest and most effective design for Noninvasive Temporary Pacemakers Proper demand pacing requires a reliable high quality surface ECG If ECG electrodes are not available or there is some circumstance which prevents or interferes with the surface ECG it may be necessary to operate the pacemaker asynchronously To pace asynchronously simply detach the surface ECG electrodes or remove the ECG cable and set the rate and the mA at the known capture level or high enough 100mA to presume capture You should be aware that there will be no ECG activity on the ZOLL PD monitor and other means of determining capture such as the patient s pulse will be necessary Asynchronous pacing should only be performed in emergency situations where there are no other alternatives PEDIATRIC PACING Noninvasive pacing on pediatric patients is done in an identical manner to adult pacing Smaller size pediatric pacing electrodes Part No NTP 2100 are available for patients less than 15 kg Continuous pacing of neonates can cause burns If it is necessary
47. nd may limit contin uous use to a few hours Erythema of the skin under the electrodes often occurs but is inconse quential There are reports of transient inhibition of spontaneous respiration in unconscious patients with previously available units when the anterior electrode was placed too low on the abdomen Pacing can be performed on pediatric patients using special electrodes ZMI Part No NTP 2100 Prolonged pacing in excess of 30 minutes particularly in neonates could cause burns Caution and periodic inspection of the underlying skin are recommended This device may not be connected to internal pacemaker electrodes in contact with the myocar dium Only electrodes supplied by ZMI Corporation should be used There have been rare reports of burns under the anterior electrode when pacing adult patients with severely restricted blood flow to the skin Prolonged pacing should be avoided in these cases and periodic inspection of the skin is advised OPERATOR S GUIDE DEFIBRILLATOR FUNCTION The ZOLL Pacemaker Defibrillator PD contains a standard DC defibrillator capable of delivering up to 360 joules of energy It may be used in synchronized mode for performance of synchronized cardioversion by using the R wave of the patient s ECG as a timing reference The ZOLL PD uses conventional paddles or disposable pre gelled multi function electrodes for defibrillation Intended Use Defibrillator This product is to be used only by qu
48. nded Acton 1 No battery charging light when 1 0 Check red circuit breakers on rear panel push in plugged into wall outlet 1 1 Check that battery connection is secure 1 2 Use another A C wall outlet 2 Unit does not turn on 2 0 Check red circuit breakers on rear panel push in No 3 audible beeps 2 1 Check that battery connection is secure 2 2 Check that power cord is plugged into wall outlet 3 Unit turns on with 3 beeps butno 3 0 Check red circuit breakers on rear panel push in display on monitor 3 1 Press SYNC button if green indicator in button comes on call for service 3 2 Have battery checked 4 If any Error message appears on 4 0 Call for Service monitor display 5 Date time message displayed on 15 0 Reset all values by first incrementing through all monitor when turning on unit values then set to correct value i e day 1 31 then set to correct day 6 Set clock is annotated on recorder 1 6 0 Perform step 5 0 chart paper 51 OPERATOR S GUIDE Monitor continued ECG LEAD OFF message displayed 7 0 Check that the ECG cable is connected to patient on monitor and instrument Check that ECG electrodes are not dry Replace ECG cable Noisy ECG display when using 0 Ensure PADDLES is selected paddles as ECG source Clean paddle surface Check cable s for wear Poor ECG signal level calibration 19 0 Set size to x2 pulse normal 10mm 1 mV 9 1 Change to a
49. nother lead I II III Electrodes or Paddles 9 2 Ensure ECG electrodes are not dried out and are making good contact 9 3 Install new electrodes using different placement NO SYSTOLE SOUND beat 10 0 Increase beeper volume at front handle detection 10 1 Change ECG lead selection 10 2 Alter ECG electrode placement Heart rate and flashing heart are 11 0 Change ECG lead selection not being displayed on monitor 11 1 Alter ECG electrode placement 11 2 Patient heart rate less than 20 BPM No SYNC MARKER displayed on 12 0 Ensure SYNC switch green light is lit SYNC ECG SIGNAL ON MONITOR or ON intermittently displayed on R wave 12 1 Change ECG lead selection 12 2 Alter ECG electrode placement LOW BATTERY message 13 0 Check circuit breakers on rear panel push in displayed while plugged in A C wall outlet 13 1 Try another wall plug 13 2 Check that wall plugs are not controlled by a wall switch 52 TROUBLESHOOTING RECORDER Recommended Action 14 0 Recorder out of paper 14 No paper displayed on monitor 14 1 Wrong type of paper used 14 2 Recorder needs adjustment 15 Paper won t feed into recorder 15 0 Ensure green indicator light in START STOP switch is lit 15 1 Wait ten seconds after first failed attempt to reload 15 2 Check to see if paper is jammed on feed roller see Operator s Guide pg 42 Devices shipped after 11 89 16
50. o connect the interface cable to the ancillary monitor Depending on the type of monitor it may be necessary to build a 1000 1 attenuator See the diagram on the next page PD 1200 REAR PANEL KEE ECG 15 PIN D CONNECTOR CONNECTOR 3007 CABLE 10 FEET LONG SUPPLIED BY ZMI J CUSTOMER RESPONSIBILITY 6 PIN CONNECTORS ARE RECOMMENDED EXTERNAL MONITOR A 1000 1 attenuator may have to be built into the 6 pin female plug as the output signal is 1 V nom SIGNAL ECG PD 1200 SERN PIN OUTS Saas pins 1 2 3 l PINS l 4 5 6 47 uf CAP L REFERENCE RETURN GENERAL INSTRUCTIONS Connect leads from the ECG connector to the pins of the suggested 6 pin male connector plug to give the desired presentation on the remote monitor Some experimentation may be necessary to obtain the correct combination of leads When correct presentation is obtained solder the leads to the appropriate pins and assemble the male connector to the ECG cable stub Note For recent HP monitors disregard the above Purchase HP cable 14482A and wire a 1 4 inch phone jack to the NTP 3007 For further information in the U S A please call 1 800 348 9011 and ask for Service Customers outside the US please call 1 617 933 9150 FAX 1 617 933 1807 TELEX 95 1417 TX NETWORK BSN REF EXCL 46 EXTENDED DIAGNOSTICS SECTION IX EXTENDED DIAGNOSTICS All PD 1200 units perform a thorough self test upon power up and continue to
51. odes should be attached to the patient before connecting the output cable Avoid touching the gelled area of the electrode while pacing A minor electrical shock hazard exists The ZOLL Pacemaker Defibrillator and NTP 2000 electrodes or PD 2200 multi function electrodes are intended for use as a system In order to maintain battery charge keep unit plugged in when not in use The use of external pacing defibrillation electrodes and adapter devices from sources other than ZOLL is not recommended ZOLL makes no representations or warranties regarding the performance or effectiveness of its products when used in conjunction with pacing defibrillation electrodes and adapter devices from other sources If device failure is attributable to pacing defibrillation electrodes or adapter devices not manufactured by ZOLL this may void ZOLL s warranty SELECT MONITOR ON e Set output to 0 mA APPLY ELECTRODES e Apply ECG electrodes see Section VI Connect to ECG cable Adjust ECG size and lead for a convenient waveform display Verify proper R wave detection The heart shaped R wave detector flashes on the monitor when proper detection of R wave is taking place e Apply back pacer electrodes between scapula and spine at level of heart See diagram below OPERATOR S GUIDE e Apply front pacer electrode to precordium beneath breast on females Anatomical position is identical for either NTP 2000 or multi function electrodes e Conne
52. ondition but no ECG can be displayed until the ECG leads are connected 37 CHECKS AND PROCEDURES SECTION VIII OPERATIONAL CHECKS AND PROCEDURES Resuscitation equipment must be maintained at peak performance The following operational checks should be performed periodically once a day to once a week to ensure proper equipment operation INSPECTION Assure that the unit is clean with no fluid spills and nothing is stored on the unit Check that paddle surfaces are clean Inspect all cables cords and connectors for good condition Verify presence and proper condition of all disposable supplies electrode gel monitor electrodes recorder paper alcohol swabs razors antiperspirant Assure that two sets of pacing or multi function electrodes are available in sealed packages POWER UP SEQUENCE CHECK With unit plugged in and SELECTOR SWITCH in the OFF position observe the following Battery charging light is lit As long as the power cord is connected to AC and the battery is in place this light should remain lit even when the unit is operating Turn the SELECTOR SWITCH to the MONITOR ON position and observe the following A 3 beep tone indicates the power up sequence Simultaneously the ALARM ON recorder START STOP paddle CHARGE and SYNC indicator lights should briefly go on and then off again The word READY will be briefly displayed followed by MONITOR ON in the lower left of the display screen The
53. ontainer to ZMI Corporation 500 West Cummings Park Woburn MA 01801 Attn Service Manager Loan instruments are available for use while repairs are being completed To request loan equipment contact ZMI at 1 800 348 9011 in Mass 1 617 933 9150 Please try to have the fol lowing information available to expedite service A description of the problem Department where equipment is in use Sample ECG strips documenting problem if available A hospital Purchase Order to allow tracking of loan equipment International customers Should the Zoll PD require service it should be returned in its original container to the nearest authorized ZMI service center OPERATOR S GUIDE SPECIFICATIONS General Size 18 cm high x 32 cm wide x 42 cm long 7 in x 12 6 in x 16 5 in Weight 12 kg 27 Ibs Power 115 VAC 60 HZ input Maximum consumption 50 watts North American version Warranty In North America 5 years including use of a loaner Outside North America consult ZMI authorized representative Design Meets or exceeds all AAMI specifications for defibrillators Standards Meets UL 544 and CSA standards for medical equipment Patient Safety ECG patient connection is electrically isolated Environmental Temperature 0 C to 55 C operating 40 C to 75 C storage and shipping Humidity 5 to 95 relative humidity Accessories standard e Standard Apex Sternum defibrillator paddles e 1 ECG cable e 1 pacer c
54. or ELECTRODES when using multi function electrodes is selected as the ECG source when the instrument is turned to MONITOR ON or DEFIB ON You may then select any of the ECG leads I I IM 15 OPERATOR S GUIDE Prepare Paddles For multi function electrodes see note below or Section VII Remove the paddles from their holders by grasping the handles and lifting the paddles straight up Apply a liberal amount of electrolyte gel to the electrode surface of each paddle To avoid risk of electrical shock to the operator do not allow electrolyte gel to accumulate on hands or paddle handles Rub the electrode surfaces together to evenly distribute the applied gel Apply Paddles to Chest a4 Apply the paddles firmly to the anterior wall of the chest The sternum paddle should be placed to the right patient s right of the sternum just below the clavicle The apex paddle should be placed on the chest wall just below and to the left of the patient s left nipple along the anterior axillary line If external pacing electrodes are applied it is not necessary to remove them Simply ensure that the paddles contact skin There should be ample room for the apex paddle Rub the paddles against the skin to maximize the paddle to patient contact Do not permit gel to accumulate between the paddle electrodes on the chest wall This could cause burns and reduce the amount of energy delivered to the heart The paddles may b
55. pacing and requires immediate defibrillation See Section III Emergency Defibrillation Procedure The patient s dysryhthmia must therefore be determined immediately so that appropriate therapy can be employed If the patient is in ventricular fibrillation and defibrillation is successful but cardiac standstill ensues asystole the pacemaker should be used Ventricular or supraventricular tachycardias may be interrupted with pacing but in emergency or circulatory collapse synchronized cardioversion is faster and more certain See Section IV Synchronized Cardioversion Electromechanical dissociation may occur following prolonged cardiac arrest or in other disease states with myocardial depression Pacing may then produce ECG responses without effective mechanical contractions and other treatment is required Pacing may evoke repetitive responses tachycardia or fibrillation in the presence of general ized hypoxia myocardial ischemia cardiac drug toxicity electrolyte imbalance and other cardiac diseases Pacing by any method tends to inhibit intrinsic rhythmicity Abrupt cessation of pacing par ticularly at rapid rates can cause ventricular standstill and should be avoided The Noninvasive Temporary Pacemaker may cause discomfort of varying intensity which may occasionally be severe and preclude its continued use in conscious patients Similarly unavoid able skeletal muscle contraction may be troublesome in very sick patients a
56. plug into monitor receptacle on front of PD 1200 26 0 Press and firmly hold paddles against patient 26 Noisy ECG signal when paddles selected as ECG input 26 1 Clean paddle surface 26 2 Check cables for wear 27 ANY ERROR displayed 27 0 Have instrument serviced promptly by trained personnel 28 0 Check that discharge switches in Paddles or in multi function cable are not stuck in 28 Defibrillator won t charge energy level does not increment on display 28 1 Have battery checked 29 Charge time to 360J exceeds 10 seconds 29 0 Normal if operating in low battery condition 29 1 Charge battery 29 2 Have device serviced 30 0 Device is in SYNC mode and no QRS complex is detected 30 Energy will not discharge when both discharge buttons are pressed 30 1 Sixty 60 seconds had elapsed after initial charge Energy was internally discharged 30 2 Energy internally discharged because energy selector dial was moved to another energy selection 30 3 Wait for Charged and Ready tone 31 Displayed energy value does not 31 0 Defibrillator is out of adjustment Have it match energy selected serviced promptly 32 Unable to SYNC cardioversion discharge 32 0 Ensure green indicator located in SYNC switch is lit 32 1 Check for SYNC marker high intensity dot or line on R wave If not present change ECG lead se
57. rectly below clavicle LL Red Electrode Place between 6th and 7th intercostal space on left mid clavicular line LEAD CONFIGURATIONS 29 OPERATOR S GUIDE ATTACH DISPOSABLE MONITORING ELECTRODES Peel the protective backing from the electrode Be careful to keep adhesive surface free of electrolyte gel Apply the electrodes firmly to the patient s skin pressing around the entire perimeter of the electrodes Attach snap on leads and check for good contact between the electrode and the lead termination Plug the patient cable connector into the ECG input connector located at the front right of the instrument SET THE CONTROLS Set SELECTOR SWITCH to the MONITOR ON position inspect the electrodes patient cable lead wires and associated connections Press the LEAD button until the desired lead is selected selected lead is indicated at upper left monitor If the ECG LEAD OFF message appears on the monitor inspect the electrodes patient cable lead wires and associated connections Press the ECG SIZE button until the desired waveform size is displayed Adjust R wave beeper volume to suitable level Activate Heart Rate Alarm by pressing the ALARM ON button Refer to the next page for instructions on changing preset settings When the alarm is activated the switch will light and a bell shaped character will be displayed on the monitor Alarm Indicator Press ALARM ON switch to activate Heart rate a
58. ric size paddles are built into the paddle assembly They lie directly under the adult electrode surface and are accessed by pushing the PEDI button on the side of each paddle and sliding the adult surface forward Adult paddles slide off to expose pediatric paddles BATTERY CHARGING INDICATOR LIGHT This light indicates that the batteries are charging It should always be lit when the unit is connected to an AC power source TEST LOAD PORT The test port is used to test the defibrillator output circuitry when using the multi function electrode cable 14 EMERGENCY DEFIBRILLATION PROCEDURE SECTION III EMERGENCY DEFIBRILLATION PROCEDURE WARNINGS Before proceeding CAREFULLY read the following Emergency defibrillation should only be attempted by skilled personnel trained in advanced cardiac life support ACLS and familiar with equipment operation The precise cardiac arrhythmia e g ventricular fibrillation must be determined before attempting defibrillation Do not touch the bed patient or any equipment connected to the patient during defibrillation All persons in attendance of the patient must be warned to STAND CLEAR prior to defibrillator discharge e In order to maintain battery charge keep instrument plugged in when not in use 1 SELECT ENERGY e Turn the SELECTOR SWITCH to the desired energy level This action automatically turns the power ON Note Defibrillator PADDLES
59. t off and plugged into AC power Integral to instrument no separate charger unit required Battery pack is easily removed as a unit Message displayed on monitor The time from display of the LOW BATTERY message until the instrument shuts down will vary depending on the battery condition For a battery in good condition fully charged prior to initiating battery operation the message display to shut down time will be approximately 20 minutes The instrument will operate on AC when batteries are depleted Defibrillator charge time may be extended when batteries are depleted 50 Defibrillator chargings to maximum energy 360J or 2 hours of continuous monitoring or 1 5 hours of continuous monitoring pacing at 60 mA 80 beats min OPERATOR S GUIDE CONTROL DESCRIPTION PAGES Selector Switch Tums power on selects defibrillator energy turns pacer on 1 11 15 17 20 simultaneously turns on monitor 21 24 30 34 36 37 39 40 43 45 47 48 2 Charge Charges defibrillator Located on apex paddle and front 11 17 21 36 panel 39 40 45 48 3 Charge Indicates defibrillator is charged and readv 12 17 21 22 Indicator Light 33 34 36 40 4 Discharge Located on each paddle press simultaneously See 12 17 22 34 Section VII for defibrillation discharge with multi 36 40 48 function electrodes 5 Sync Synchronizes discharge to patient s R wave 12 19 20 45 47 6 Output mA Controls amount of current to pacing electrodes 12 25 40 4
60. ult occurs Note The ELECTRODES OFF message which indicates whether the multi function electrodes are actually connected and making good contact will not appear during synchronized cardioversion Paddle Cleaning Paddle plates and handles must be thoroughly cleaned after each use 22 NONINVASIVE TEMPORARY PACING NTP SECTION V NONINVASIVE TEMPORARY PACING NTP WARNINGS Before proceeding CAREFULLY read the following Noninvasive pacing can be accomplished by using either the standard NTP 2000 electrodes and pacing cable or PD 2200 multi function pacing defibrillation electrodes and multi function cable Anatomical placement of either type is identical Operation with either type is identical Multi function electrodes should be used no longer than eight 8 hours for continuous pacing Standard pacing electrodes NTP 2000 use high impedance gel and cannot be used for defibrillation The connector will only mate with the pacing cable For continuous pacing that exceeds eight 8 hours this type of pacing electrode is recommended The PD 1200 is designed to allow either standard pacing or pacing with multi function electrodes but not both When the multi function electrode cable is connected to the instrument you cannot do standard pacing as the standard pacing connector is covered by the multi function cable connector Removing the multi function cable allows use of standard pacing electrodes e Both pacing electr
61. urn the rate knob and verify that the display changes e Turn the knob to 100 The monitor should read between 95 ppm and 105 ppm Note The unit is still detecting heart beats if connected to a patient or ECG simulator as evidenced by the flashing heart and tone Also the actual measured heart rate will appear on the strip chart annotation 47 OPERATOR S GUIDE PACE OUTPUT CHECK PACER ON The number on the OUTPUT dial and the mA display at the lower right corner of the monitor must be within 7 mA of each other at all settings e Turn the output knob to 0 Verify that the display reads 0 mA e Turn the knob to 70 Allowable display range 63 to 77 mA e Turn the knob to 140 Allowable display range 133 to 140 mA DEFIBRILLATOR CHARGE TIME DEFIB ON With the unit charged and ready to fire the display indicates the time to the nearest half second that it took to charge Like the battery voltage display there is an implied decimal point i e 75S means 7 5 seconds Perform this test with the PD 1200 plugged into an AC wall outlet or with a fully charged battery A depleted battery may extend defibrillator charge time Select 360 joules and charge the defibrillator When the ready tone sounds the time should read less that 10 seconds Typically a PD 1200 with a fully charged battery will take 6 5 to 8 0 seconds displayed as 65S to 80S to charge to 360 joules Carefully discharge the unit into the paddle wel
62. urrent month Press the ALARM SET button again and observe that the cursors now appear under the current year Repeat above steps The range of acceptable values are 00 through 99 Set the value to the current year Press the ALARM SET button again and observe that the DATE message has been replaced by a TIME message indicating the current hour and minute Observe that cursors appear under the displayed hour Repeat above steps The range of acceptable values are 00 through 23 Set the value to the current hour Press the ALARM SET button again and observe that the cursors now appear under the displayed minute Repeat above steps The range of acceptable values are 00 through 59 Press the ALARM SET button again and observe that the lower portion of the screen returns to the normal MONITOR ON display 43 OPERATOR S GUIDE 2i N IM e Verify that the time and date have been correctly set by generating a strip chart recording Press the RECORDER START STOP button and observe that the strip chart is correctly annotated with the current time and date PADDLES or ELECTRODES size 1 0 HR 0 e Verify that the real time clock is operating correctly by waiting for several minutes before running the recorder again Note Time and date may require resetting if batteries have been depleted BATTERY CARE A medical grade sealed lead acid battery is used which unlike nickel cadmium Nicad batteries requires no periodic maintenance or charg

Zoll 1200 Operators Manual

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