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1. Figure 6 3 FSpO Trend 6 10 120 Series Maternal Fetal Monitor Revision C 2015589 001 Fetal Pulse Oximetry Monitoring FS pO Display Area FSpO Display Area Single versus Dual Display of SpO FSpO Status Icons Sensor Unplugged 2 Sensor Lifted Pulse Search If FSpOz is monitored while MSpO is inactive FSpO2 displays in the Additional Parameters Area Refer to Figure 6 4 When dual SpO monitoring occurs FSpO2 information is displayed in the Waveform Area beneath the MSpO area Any waveform labels speed lead scale move to the left of the FSpO area The waveform area which would otherwise display about 4 seconds of information is reduced to show approximately 2 5 seconds of waveform data Refer to Figure 6 5 A status icon may appear above the 6FSpO value to provide additional information Usually the message area will be blank however the icons representing Sensor Unplugged Sensor Lifted or Searching for Fetal Pulse can appear This icon appears whenever the FSpO sensor is disconnected from the fetal patient module cable when the fetal patient module cable is disconnected from the monitor or when an invalid FSpO sensor is connected to the fetal patient module cable This icon appears whenever the sensor is not making adequate contact at the sensor site on the fetus This icon is displayed when the monitor is attempting to loc
2. ALERT PARAMETERS SUMMARY ON FHR SETUP SCREEN TREND SCREEN Parameter Column 1 Column 2 Message Criteria Uterine activity gt 40 relative units for 5 minutes relative units No alert TOCO UA BASELINE SET appears in Uterine Activity Display HYPERTONUS Uterine activity 25 mmHg for 5 minutes 7 minutes at start up UA BASELINE NOSE PRESSURE UA BASELINE SET appears in Uterine Activity Display mmHg IUP va Uterine activity gt 35 mmHg for 5 minutes Alert has not been silenced UA Alert silenced and question resolved The alert is deleted after uterine activity is lt 35 mmHg for 5 minutes TACHYSYST Six uterine contractions completed in 10 minutes any size internal or external No alert of uterine contractions If FHR Alert is present UC UTERINE The alert is deleted if there are lt 6 uterine CONTRACTIONS contractions in 10 minutes IN 10 MIN If blank Start up No contractions detected for ten minutes Continuous Monitoring No contractions detected for 30 minutes RECORDING UA appears in Uterine Activity Display DURATION OF seconds UA Alert has not been silenced LAST UC One uterine contraction with amplitude gt 50 mmHg above baseline for 60 seconds UA Alert silenced The alert is deleted after one normal uterine contraction Revision C 120 Series Maternal Fetal Monitor 2015589 001 Spectra Alerts Alert Parameters SIGNAL QUALITY
3. Item Catalog Number REF Detachable IEC AC Power Cord United Kingdom Plug 1392BAU Remote Event Marker 3919BAO Model 2116B Clinical Notes Data Entry System 2116BAX Model 3116 LDR LDRP Bedroom Style Mobile Cart F inished 3116AA0 Model 3116 LDR LDRP Bedroom Style Mobile Cart Unfinished 3116BA0 Model 146 Fetal Acoustic Stimulator 0146AAY 19 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Supplies amp Accessories Paper Supplies Ordering Information Paper Supplies Ordering Information Table 19 2 Paper Supplies Item Catalog Number REF Z Fold Chart P aper Pack 30 240 BPM Heart Rate Scale 40 carton 4305CA0 Z Fold Chart Paper Pack 50 210 BPM Heart Rate Scale 40 carton 4305DA0 Revision C 120 Series Maternal Fetal Monitor 2015589 001 Supplies amp Accessories Ultrasound Ordering Information Ultrasound Ordering Information Table 19 3 Ultrasound Supplies Item Catalog Number REF Loop Style Ultrasound Transducer Nautilus 8 foot Cord 5700LAX Button Style Ultrasound Transducer Nautilus 8 foot Cord 5700HAX Button Style Ultrasound Transducer Nautilus 10 foot Cord 5700 AX Ultrasound Coupling Gel Bottle 250 ml 12 carton 2434AA0 Ultrasound Coupling Gel Bottle 5 liter 2475AA0 Reusable Belt for Loop Style Transducer Mesh Style 10 carton 4425AA0 Reusable Belt for Loop Style Transducer Velcro Style 10 carton 4425CA0 Reusable Belt for Button S ty
4. Table 19 10 MSpO Supplies and Accessories Item Catalog Number REF Intermediate Cable for Nellcor Sensors 1552AA0 Nellcor Durasensor Adult Reusable Finger P robe 407705 006 Masimo Adult Reusable Finger P robe E9008J C 2002800 001 Revision C 120 Series Maternal Fetal Monitor 19 11 2015589 001 Supplies amp Accessories Peripheral Device Ordering Information Peripheral Device Ordering Information Table 19 11 Peripheral Device Supplies and Accessories Item Catalog Number REF Interface Cable to Nellcor Model N 200 M 400 1557BAO0 Pulse Oximetry Monitor 6 foot Interface Cable to Nellcor Model N 200 N 400 1557AA0 Pulse Oximetry Monitor 1 foot RS 232C Interface Cable to Quantitative Sentinel P erinatal S ystem 1558AA0 19 12 120 Series Maternal Fetal Monitor Revision C 2015589 001 Factory Defaults Factory Defaults are found in the table that follows evision 120 Series Maternal Fetal Monitor 2015589 001 A 1 Factory Defaults Table of Defaults Table of Defaults Table A 1 Summary of Factory Defaults Rieu Field Description Factory Default Default Options Hospital Preference HR Offset Applies to US or US2 Off On Off 10 minutes whichever is FHR2 FHR Volume 5 0 9 FECG or US US2 FHR Alarm Limits High Low 200 140 Off 160 120BPM 60 140 Off Audio Alarms On On Off Volume 5 1 9 Response Time Av
5. 00 0002 ce eee D 3 Alert Indications o c0sis in goa t cae Woe Sebo s ee iei uh eh oa gc RE bea es D 5 Alett Parameters Summary cse Re xr er we ee es D 8 Reset ns AJertS Losses t E eee Eee eee eo ene eS D 11 Tend Scheel sb desiic pedo eet ate seesaw kate D 12 Uterine Contraction Frequenicy cues ER RR REDE D 13 Nurse Call Interface aae ette x der eR sake eh ad D 15 Revision C 120 Series Maternal Fetal Monitor 2015589 001 D 1 Spectra Alerts Important Safety Information Important Safety Information IMPORTANT INSTRUCTIONS FOR USE It is mandatory that you read this chapter prior to operating a 120 Series Monitor with the Spectra Alerts feature enabled Keep this manual available for future reference and for the orientation of new personnel The Spectra Alerts option is designed to assist the perinatal staff in assessing the status of a patient at the bedside by recognizing normal and abnormal FHR and UA pattern features The system does not replace observation and evaluation of the mother and fetus at regular intervals by a qualified care provider who will make diagnoses and decide on treatments or interventions The user should determine the status of the patient at regular intervals see Standards for Obstetric Gynecologic Services 7th edition Washington D C ACOG 1989 by visual assessment of the fetal monitor tracing at the bedside and evaluation of maternal vital signs and progress i
6. Revision C 120 Series Maternal Fetal Monitor 2015589 001 B 1 Alarms Summary Table of Alarms Table of Alarms Table B 1 Summary of 120 Series Alarms Type Condition Visible Advisory Audible Advisory Paper Speed United States 3 cm min 1 3 cm min International 1 cm min An alarm setting audio or high low K limit is turned off displays to the left of the FHR mode title Alarm Defaults Audio on Volume 5 Limits High 160 BPM Low 120 BPM FHR limit high or low actively being FHR numeric flashes Alternating high low tones if violated audio enabled or Unsilenced resolved FHR limit violation the limit was violated but the FHR has since returned to the FHR normal range before clinical acknowledgement Forcontinuous limit violations a high alarm activates after 5 minutes a low alarm activates after 30 Seconds About Latching Alarms The FHR limit alarms are latching alarms which means that a clinician must acknowledge the alarm using the monitor s Alarm Silence button in order to clear the alarm Inadequate FHR signal quality Flashing dashes in place of FHR numeric Alternating high low tones if audio enabled B 2 120 Series Maternal Fetal Monitor 2015589 001 Revision C Alarms Summary Table of Alarms Table B 1 Summary of 120 Series Alarms Type Condition Visible Advisory Audible Advisory An
7. 4 17 Revision C 120 Series Maternal Fetal Monitor 2015589 001 4 1 Setup Procedures Loading Strip Chart Recorder P aper Loading Strip Chart Recorder Paper Refer to Paper Supplies Ordering Information on page 19 3 to order paper required for use with the 120 Series Monitor m HR scale of 30 240 BPM or m HR scale of 50 210 BPM Refer to Chapter 12 Recorder Modes for more information about the different paper styles CAUTIONS LOADING PAPER The instructions for loading paper into the 120 Series Monitor are different than the instructions for loading paper into other Corometrics monitors Improper loading can cause paper jams Follow the instructions carefully PAPER TYPE Do not use non Corometrics paper or paper designed for use with other Corometrics monitors Using paper other than catalog number REF 4305CAO DAO may produce inferior print quality could result in permanent damage to the recorder s print head and may void your warranty STORAGE TRANSPORT Paper should be installed in the monitor s strip chart recorder at all times This reduces particle build up on the printhead and facilitates opening the recorder door 4 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Setup Procedures Loading Strip Chart Recorder P aper To install Corometrics chart paper in the 120 Series Monitor follow these steps 1 Press down on the latch on the right side of t
8. F igure 11 1 Master Maternal Alarm Setup Screen Individual fields enable disable the audio alarm functions for NBP MSpO and MECG The settings are summarized as follows m Off Only a visual indication is provided for an alarm m On Both visual and audible if enabled indications are provided for an alarm condition This field adjusts the temporary silence period An audio alarm is cancelled using the Alarm Silence pushbutton However for MECG and MSpO monitoring and during a paper load error condition an alarm will be re issued if the alarm state continues after a specified amount of time These fields adjust the high and low alarm limits for NBP MHR P and MSpO The available ranges are shown in Figure 11 1 The factory default setting are listed in Appendix A Factory Defaults This field controls the volume of all alarms Revision C 120 Series Maternal Fetal Monitor 11 3 2015589 001 Alarms Alarm Setup Some alarm fields appear on more than one setup screen These fields are automatically updated when a change is made on any one screen CAUTION ALARM SETUP Prior to monitoring each patient it is recommended that you check the alarm limits to ensure they are appropriate for the patient Alarm Limits NOTE For each modality the The alarm limits for each modality are configured by a respective setup screen available ranges of high and low alarm Refer to Chapter 4 Setup Pro
9. Alarm Time for Tachycardia 80 200 BPM Offset Voltage Tolerance Differential Maximum Common Mode Voltage Preamplifier Bandwidth Common Mode Rejection Balanced Unbalanced 5K RA or LA Input Equivalent Noise Input Impedance Differential Common Mode Mains Frequency Rejection Leakage Current Isolation Mains to P atient Leads Off Detection Alarms Audio Visual Limits Technical Tachycardia Response Time Pacemaker Detection R ejection Input Voltage Range Input Pulse Width Pulse Rise Fall Time Overshoot U ndershoot Peak detecting beat to beat cardiotachometer Medtronic 1700 003 or equivalent Il and Il 30 240 BPM 1 BPM 1 second average 1 update per second 0 5 mV to 5 mV peak to peak 0 5 mV RTI 0 8 x QRS amplitude 2 seconds 3 seconds 10 seconds high alarm limit at 100 BP M 300 mVdc maximum 20 V peak to peak 0 6 to 40 Hz 80 dB at mains frequency with patient cable gt 50 dB at mains frequency 30 uV peak to peak gt 2 5 MQ gt 10 MQ gt 40 dB lt 60 uA at 254 VAC with cable electrically isolated gt 4kVAC dc current lt 0 1 pA Alternating 1 5 second chimes 773 Hz and 523 Hz Flashing heart rate numeric or message User selectable high and low maternal heart rate Leads off 8 seconds 2 5 mV to x700mV 0 1 to 2 ms 1096 of pulse width not greater than 100 us 2 mV CAUTION Excessive overshoot time of pacemaker pulse may
10. Functional Versus Fractional Saturation Because the 120 F Series Monitor measures functional SaO it may produce measurements that differ from those of instruments that measure fractional SaO Functional SaO is oxygenated hemoglobin expressed as a percentage of the hemoglobin that is capable of transporting oxygen Because the monitor uses two wavelengths it measures oxygenated and deoxygenated hemoglobin yielding functional SaO It does not detect dysfunctional hemoglobins such as carboxyhemoglobin or methemoglobin In contrast some laboratory instruments such as the Instrumentation Laboratory 282 or 482 CO Oximeter report fractional SaO oxygenated hemoglobin expressed as a percentage of all measured hemoglobin whether or not that hemoglobin is available for oxygen transport Measured dysfunctional hemoglobins are included Revision C 120 Series Maternal Fetal Monitor 6 7 2015589 001 Fetal Pulse Oximetry Monitoring Theory Consequently to compare 120 F Series measurements directly with those of another instrument that other instrument must measure functional SaO If the other instrument measures fractional SaO those measurements can be converted to functional SaO using the following equation fractional saturation functional saturation 2 100 96 carboxyhemoglobin methemoglobin x100 Measured Versus Calculated Saturation
11. INSTRUCTIONS For continued and safe use of this equipment it is necessary to follow all listed instructions However the instructions provided in this manual in no way supersede established medical procedures concerning patient care The monitor does not replace observation and evaluation of the patient at regular intervals by a qualified care provider who will make diagnoses and decide on treatments and interventions INTERFACING OTHER EQUIPMENT Monitoring equipment must be interfaced with other types of medical equipment by qualified biomedical engineering personnel Be certain to consult manufacturers specifications to maintain safe operation LEAKAGE CURRENT TEST The interconnection of auxiliary equipment with this device may increase the total leakage current When interfacing with other equipment a test for leakage current must be performed by qualified biomedical engineering personnel before using with patients Serious injury or death could result if the leakage current exceeds applicable standards The use of accessory equipment not complying with the equivalent safety requirements of this equipment may lead to a reduced level of safety of the resulting system Consideration relating to the choice shall include use of the accessory in the patient vicinity and evidence that the safety certification of the accessory has been performed in accordance with the appropriate EN60601 1 and or EN60601 1 1 harmonized national sta
12. J103 CONNECT TO DATA ENTRY SYSTEMS J102 CONNECT TO CENTRAL SYSTEMS vos ZN Dos AUAM DEREIEIDLSSTBIACIUNRER CONS J101 CONNECT TO TELEMETRY RECEIVERS GE Medical Systems Information Technologies AN sto ELECTI SHOCK HAZARD DO NOT AEREA hee te QUALITIFED PERSONNEL me cain ZN e e Y 1002 so so 100W fenore urs m E GOUT mRS23 C RS23 C RS232C MONETE NIAI LI Figure 3 13 120 Series Rear Panel Connectors Standard and Optional i oo BM IM The Fetal Acoustic Stimulator and Remote Event Marker PORTANT connectors are identical in size and shape Be sure you connect to the proper opening to ensure accurate information 120 Series Maternal Fetal Monitor 2015589 001 Revision C Controls Indicators and Connectors Rear Panel Description NOTE Although the J104 Nurse Call connector is physically present on the optional communications package this connector is only supported as part of the Spectra Alerts option discussed in Appendix D Spectra Alerts Table 3 13 120 Series Rear Panel Standard and Optional Features Name Description Vent Provides ventilation for the monitor s internal circuitry J 101 Telemetr Connector for Corometrics telemetry system Connect y interface Installed as part of an optional communications package J 103 Data Entry Connector Connector for data entry syst
13. Revision C 120 Series Maternal Fetal Monitor 2 3 2015589 001 Introduction Series Overview Series Overview The Model 126 Monitor The Model 126 Monitor provides standard fetal monitoring parameters dual ultrasound fetal ECG and uterine activity The Model 126 has the following features m Dual ultrasonic heart rate monitoring allows for non invasive monitoring of twins m A 20 BPM heart rate offset option is provided for the secondary heart rate HR2 trend when using dual ultrasound or ultrasound and direct FECG to separate overlapping FHR trends for easy interpretation A heartbeat coincidence detection feature can be enabled to inform you when there is the possibility that you may be monitoring a duplicate signal m The strip chart recorder is a quiet easy to load high resolution thermal array printer The recorder prints continuous trends and alphanumeric data on one strip chart User selectable font size for strip chart annotations customizes readability Automatic mode selection is provided simply by inserting the appropriate transducer plug into the front panel receptacle m Theelectroluminescent EL display with circularly polarized filter removes glare its wide viewing angle provides easy viewing at a distance A recorder light allows the room lights to be dimmed without sacrificing visibility of the strip chart recorder Transducer connectors are easy to use color coded and durable
14. SIGNAL QUALITY ALERT PARAMETERS SUMMARY ON FHR SETUP SCREEN TREND SCREEN Parameter Column 1 Column 2 Message Criteria GOOD Alert pending MODERATE Alert has not been silenced POOR UNKNOWN appears when UC is the only active parameter Three minutes of unsatisfactory data FECG Five minutes of unsatisfactory data ultrasound SIGNAL QUALITY Alert silenced The alertis deleted after three minutes of SIGNAL QUALITY Satisfactory data POOR WITH UC Data unsatisfactory with uterine contractions present Alert has not been silenced Data between uterine contractions is acceptable data during contractions is either poor quality or absent Alert occurs after 1 2 or 3 uterine contractions depending on what events preceded it Alert silenced The alert is deleted following two uterine contractions with satisfactory data or 10 minutes of good data no data REPAIR ALERT Message appears if there is a problem with the monitor or the Spectra Alerts option Contact Biomedical Department or Service Representative D 20 120 Series Maternal Fetal Monitor 2015589 001 Revision C GE Medical Systems Information Technologies gemedical com World Headquarters GE Medical Systems Information Technologies Inc 8200 West Tower Avenue Milwaukee WI 53223 USA Tel 1 414 355 5000 1 800 558 5120 US only Fax 1 414 355 3790 European Representative GE Medical Systems In
15. Hydrostatic Effect If the cuff is not at heart level the difference in the reading due to the hydrostatic effect should be noted Add the value 1 80 mmHg to the displayed readings for every inch the cuff is above heart level Subtract the value 1 80 mmHg from the displayed readings for every inch the cuff is below heart level Document the reading Manual Mode In manual mode a single determination is made at a time upon activation of the BP Start Stop pushbutton Depress the BP Start Stop pushbutton to begin a single determination The cuff will inflate to 160 mmHg If this initial inflation pressure is insufficient the unit retries with a higher inflation pressure 30 mmHg The instantaneous cuff pressure is displayed in place of the mean arterial pressure area and is indicated by the title CUFF Refer to Section 7 Maternal Heart Pulse Rate Monitoring for more information Revision C 120 Series Maternal Fetal Monitor 9 9 2015589 001 Maternal Non Invasive Blood Pressure Monitoring NBP Monitoring Automatic Mode NOTE The first automatic determination begins after the expiration of one complete interval time period In auto mode an indefinite series of determinations are made at defined time intervals Upon activation a clock icon displays in the NBP area along with a countdown timer indicating the time remaining until the next scheduled automatic determination the timer already begins to count down
16. Since the first automatic blood pressure reading will not occur until after a complete interval time you may wish to take an initial manual reading by pressing the BP Start Stop pushbutton The first automatic determination inflates the cuff to 160 mmHg For subsequent determinations the cuff reaches an inflation pressure of 30 mmHg greater than the previously determined systolic pressure value If this initial inflation pressure is insufficient the unit retries with a higher inflation pressure 30 mmHg The instantaneous cuff pressure is displayed in place of the mean arterial pressure area and is indicated by the title CUFF Taking a Manual Reading Between Auto Determinations If the BP Start Start pushbutton is pressed during the interval time between automatic readings a new determination is initiated IMPORTANT The countdown timer is not reset whenever a manual blood pressure reading is initiated the next scheduled automatic determination will take place as planned Venous Return in Auto Mode When in auto mode the monitor always waits at least 30 seconds from the end of one blood pressure determination to the beginning of the next This provides a minimum time that pressure around the patient s limb is relieved to allow for venous return At all settings except one minute if a determination ends with less than 30 seconds remaining until the next one that next determination will be cancelled Example 1 The aut
17. US is not associated with any alert 120 Series Maternal Fetal Monitor Revision C 2015589 001 Spectra Alerts Resetting Alerts Resetting Alerts NOTE FHR data is collected over time for analysis Resetting an alert clears all data from the monitor s memory for both FHR1 and FHR2 NOTE It is possible that the Spectra Alerts feature may generate the same alert again If you do not agree with an alert see False Pattern Recognition and Mode Switching you can clear the data being used via the Alert field on the associated setup screen FECG or US US2 To reset an alert 1 Access the setup screen associated with the alert indicated by the flashing FHR numerics Select the mode title softkey FECG or US US2 2 Highlight the Alert field Whenever you display the setup screen this field is set to ON 3 Change the Alert field setting to RESET If you change the field to RESET by mistake and wish to change it back simply set it to ON again 4 Once an alert is reset audio and visual indications are removed and the alert parameters information clears False Pattern Recognition Mode Switching The system may recognize accelerations as baseline During dual FHR monitoring the system may confuse the FHRs following mode switches after delivery of the presenting twin To guard against mode changes prior to delivery of the presenting twin Use US for the presenting twin and US2 for the second twin
18. 7 1 Uterine Activity Monitoring Tocotransducer External Method Tocotransducer External Method Methodology A tocotransducer applied to the maternal abdomen records relative changes in abdominal tension caused by uterine contractions The mode TOCO and value are shown in the UA area of the display The UA value displays in relative units from 0 100 Uterine activity is continuously plotted on the bottom or right grid of the strip chart paper as a plain black line IMPORTANT FOR TRIMLINE TOCOTRANSDUCERS ONLY You must wait at least ten seconds from the time you power the monitor on or connect a tocotransducer before pressing the UA Reference button Establishing a Baseline Initial Referencing Monitoring uterine activity using a tocotransducer provides relative pressure measurements compared to a baseline or UA reference The quality of measurements depends on the following W position of the tocotransducer W belttension W size of the patient and m established baseline All 120 Series Monitors provide a UA Reference pushbutton which sets the baseline When a baseline is established all pressure measurements are relative to that baseline The baseline can be set manually by two different methods or automatically when necessary Whenever the baseline is set the bottom line of the bottom strip chart grid is annotated with UA REF For Trimline Tocotransducers only You must establish an
19. 3 CMIMIN 100 SpO Figure 12 5 FSp02 Data Example Revision C 120 Series Maternal Fetal Monitor 12 11 2015589 001 Recorder Modes On Mode Blood Pressure Annotations A blood pressure reading can print on any of the first three annotation lines depending on which printing line is available A diamond marks the time of the reading m An unfilled diamond indicates the reading was received from the monitor s built in blood pressure module Models 128 and 129 The vital signs print below the diamond See Figure 12 6 E An unfilled diamond with a slash indicates a blood pressure reading was cancelled delayed The marks the time the reading was originally scheduled The annotation NBP D prints below the marker See Figure 12 6 m 4 A filled diamond indicates the reading was received from an external blood pressure monitor connected to the 120 Series Monitor The vital signs print below the diamond Contact your Service Representative for information about connectivity If the top three printing lines are busy printing other data the diamond prints at the time of the reading however the vital signs data prints as soon as a line becomes available j NBP D NBP 126 78 M 94 P 68 9 00 US US2 WX TOCO VY 3CMI MIN Figure 12 6 NBP Vital Signs Data Annotation from Built In Module 12 12 120 Series Maternal Fetal Monitor Revision C 2015589 001 Recorder Modes On Mode Maternal Pulse Oximetry
20. Alarm uico o C a ecce dole oa m oed 10 4 Alarm Volume 2265 iei da perin ue vetede tp bee f we ep queen da 10 5 MSpO Methodology n nen nnns 10 6 Additional Features ccccccscceeccceeeeceeeeeaeeaeeaneareaneaneags 10 7 MSpO2 Pulse Beat Audio isses 10 7 The MSpOz Waveform sies so ee t heme AREE e en etna 10 7 Module and Probe Compatibility seen nn nnn 10 8 Modules and Sensors 10 8 No Implied License rerperr ter erre AE DIR RETE EO MENU T PER ETNEA 10 8 SONS OFS excusi eise Aem abeat e ata ademas a rcu teas 10 8 ll Alois sisi pex ers kan vex ea rirrss aa a a Libel Introduction 0o arco o ORC Qa OECD a ERO QC a ORC OR 11 2 Alarm SetU Dininin cora onore PARIETE GE CREDO ECRIRE OOE CR FECE RE 11 3 Master Alarm Setup Screen 0 cece cee tte n 11 3 Audio A lame ao et ire saa ae Ha Re t 11 3 R Alamy ied Mein dae Mam Sae ee antigo dena A RAS 11 3 Alarmi LIMIS a teres tiec oe sen etek Madea ie 11 3 MU c E 11 3 AIIM L IMIS oso exte too pro EE ER aan oa M n oan 114 Alarm Vome sd n 34 eot tre ien dto tb ete Bb ret iet n 114 Audio AlI as DE 11 4 Alarm S eting Indicators si 2 ne era cpa tee et a EAA A 114 Maternal Alarm Occurring During Setup aa 11 5 AlatmiBeliaviOE ae nas anra dro e ciae oa sce eda heb p 11 5 NBP Display Timer Behavior 0 ccc cece ec eee eee ents tenes 11 6 Fetal Heart Rate Alarms cccccccceeeeececceeaeeaeeaeeaeeaeeaneanegs 11 7 FHR Patient Alarts cera etaed 11 7 Active Patien
21. Chapter 11 Alarms for more information K An alarm setting is turned off A All alarm settings are enabled C FHR Mode Title An abbreviation indicates the monitoring mode in Use FECG US US2 or INOP FECG only displays in the FHR1 area Select the mode softkey to access the respective setup screen See Table 3 4 for FHR connection options D FHR Heartbeat Indicator Flashes with each detected valid heartbeat 3 8 120 Series Maternal Fetal Monitor Revision C 2015589 001 Controls Indicators and Connectors Front Panel Displays Table 3 4 Connectors vs Display Modes Active Connectors FHR1 Area FHR2 Area FECG FECG INOP FECG US FECG US FECG US2 FECG US2 US US INOP US US2 US US2 US2 US2 INOP INOP INOP FECG US US2 FECG US2 fthree FHR transducers are p ugged in the FECG signal overrides the US signal Revision C 120 Series Maternal Fetal Monitor 2015589 001 3 9 Controls Indicators and Connectors Front Panel Displays UA Display The UA area is summarized by Figure 3 5 and Table 3 5 B TOCO 30 Figure 3 5 UA Display Table 3 5 UA Display Name Description Up to three digits indicate the uterine activity A UA Value value mmHg for internal monitoring or relative units for external monitoring An abbreviation indicates the monitoring mode in B UA Mode Title use TOCO IUP
22. Series OVEIVIEW s dac nva e ex Ua a con n t CEA C C RO D wide 2 4 Tih Model 126 MOnItOF s eed eene a en Ce abe a 2 4 The Model 128 MOnltoF 345r erre de einai area AE OTRA RETE RD 2 5 The Model 129 Monitor ccc cece cece e 2 6 Upgrading Your Monitor isses 2 6 Upgrading to the NextLevel oo ccc cect eet e cence eee e ae ened 2 6 Adding Fetal Movement Detection and Spectra Alerts 005 2 6 About the Marual ois va cei eda eee n inc n c a e a cee 2 7 PUPP OSC 5 ones nod edud aca pdex i eed ate aston te t et Ele dct dad pde i n 2 Intended Audience 1 4 rte bct tret te e ence 2 7 I CIERRE 2 7 Controls Indicators and Connectors 3 1 Front Panel Description viarreiiieeireriiianiai nmm 3 2 Front Panel Displays iis crcire rinna enne 3 5 FHRADISDIay eerren enanta een ertt debo De 3 8 UA DISplay creer o ERU E PUER ERUPEM SETS 3 10 Materjal NBP inn RED OR EX CER a 3 11 MARP ATEA ior repere eire rec be e doeet 3 12 FS POD ATCA 1i ceo s tlla icc dee E e rte ore ia ei 3 13 MSpQAT d Jara ted pet oA pde MO Pede 3 14 Waveform Area 5 sse entered de DAR E Rond 3 14 Time and Waveform Message Area 1 eee eee eee 3 14 Battery Backed RAM Status 3 15 SOfIKBy5 o Lascia Dar eter ba ob Codi ted ites ee Moda eed 3 15 Mode Title Softkays iriri tarr rini ek pe MRPee PR age ness 3 15 Waveform S oftkeys 1r n poene CH a re ee 3 15 Dedicated Softkey Area 0 eee cece ete es 3 15 Rear Panel Descri
23. The Model 128 Monitor provides all of the features of the Model 126 Monitor with the addition of integrated maternal pulse oximetry and non invasive blood pressure monitoring The Model 128 has all of the features of the Model 126 plus the following m Built in maternal vital signs monitoring eliminates the need for separate blood pressure and maternal pulse oximetry monitors m Maternal non invasive blood pressure readings can be taken on demand or at pre programmed intervals W Post contraction blood pressure option prevents blood pressure readings from occurring during contractions m Continuous non invasive MSpO oxygen saturation and maternal pulse rate can be reliably monitored using the well known Nellcor pulse oximetry sensors Continuous printing of the maternal pulse rate trend can be enabled Maternal alarm limits are user defined with pre set defaults The audible indicator for each maternal alarm can be temporarily silenced Maternal vital signs storage provides an eight hour history of the maternal vital signs in a spreadsheet format The data can be displayed or printed on demand m A maternal only recording mode is specifically designed for postpartum monitoring of the mother m The MSpO pulsatile waveform can be optionally displayed and can be frozen on the screen for review In addition a six second snapshot can be printed on the strip chart paper The Model 129 Monitor The Model 129 has all of the feat
24. The analysis of deceleration characteristics has recognized features of either variable late mixed or prolonged decelerations or decelerations without uterine activity recorded The baseline FHR anclvariability impact the monitor s ability to analyze patterns as well as the severity of the pattern The monitor attempts to integrate the baseline features with the deceleration features onset size duration etc to determine when to alert The alert message is issued on the basis of 1 2 or 3 decelerations depending on the size shape onset duration etc andrelated baseline rate and variability Examples An alert occurs when Three out of 5 contractions have mild variable decelerations if baseline FHR is in normal range and variability is average Two out of 5 contractions have any decelerations except early if the variability decreased One severe variable deceleration that drops to lt 60 BPM for gt 60 seconds NOTE Alert occurs in approximately 2 minutes Alert silenced DECELERATIONS The alert is deleted when there are 4 contractions without a deceleration or 10 minutes without decelerations if no uterine contractions are present ARTIFACT ARRHYTHMIA PRESENT No alert 5 of data in last minute may be PVCs other arrhythmias or artifact D 18 120 Series Maternal Fetal Monitor 2015589 001 Revision C Spectra Alerts Alert Parameters
25. When switching to FECG for the presenting twin disconnect the US connector which is no longer in use If an alert is generated following delivery of the presenting twin evaluate the tracing to determine if there are any clinical factors contributing to the alert If you feel the alert was generated in error change the Alert field on the associated setup screen to RESET Consider the following m Ifyou continue monitoring the second twin with US2 and you disconnect the FECG transducer which is no longer in use the US2 fetal heart rate now moves to the primary display and the FHR trend which was bold now prints using a normal print density m Ifyou later switch to internal monitoring for the second twin and you disconnect the US2 transducer which is no longer in use the fetal heart rate for the second twin displays as FECG in the primary heart rate area and the FHR trend continues to print using a normal print density Revision C 120 Series Maternal Fetal Monitor D 11 2015589 001 Spectra Alerts Trend Screen Trend Screen Select the TREND softkey from the FHR Setup screen to display the FHR UA trend screen For dual fetal heart rate monitoring you can access it from either mode s setup screen The Trend screen displays m the alert level and message if present m the most recent 10 minutes of FHR and UA trend data reflecting the paper scale and chart speed settings and Wm the current time Figure D 8 show
26. or INOP 3 10 120 Series Maternal Fetal Monitor Revision C 2015589 001 Controls Indicators and Connectors Front Panel Displays Additional Parameters The additional parameters area displays NBP MHR P and MSpO data Maternal NBP The maternal NBP section is summarized by Figure 3 6 and Table 3 6 ANBPO 11 41 130 85 MAP 107 A 03 15 Figure 3 6 NBP Display Table 3 6 NBP Display Name Description The time in 24 hour format of the last blood A HEP emp pressure measurement The systolic diastolic and mean arterial pressures MAP are each indicated by up to three digits representing mmHg B NBP Values m During a determination the instantaneous cuff pressure displays in place of the mean arterial pressure and is denoted by the title CUFF This symbol provides information about the NBP audio alarm andthe NBP high low alarm limit settings See Chapter 11 Alarms for more information K An alarm setting is turned off NBP Alarm Setting Indicator A All alarm settings are enabled Select the mode title to access the NBP Setup Screen D NBP Mode Title The clock symbol represents activation of the auto E NBP Countdown Timer mode The countdown timer indicates the minutes and seconds until the next automatic reading Revision C 120 Series Maternal Fetal Monitor 3 11 2015589 001 Controls Indicators and
27. 2015589 001 Controls Indicators and Connectors This section describes all possible controls indicators and connectors in the 120 Series of monitors The section contains the following Front Panel Description ee Rex ee et demere 3 2 Front Panel Displays iua etus gue grs pone lC ehe 3 5 Rear Panel Description 33 08 ithe ed eee Rer eere 3 18 Revision C 120 Series Maternal Fetal Monitor 2015589 001 3 1 Controls Indicators and Connectors Front Panel Description Front Panel Description Figure 3 1 Model 129 Front Panel 3 2 120 Series Maternal Fetal Monitor 2015589 001 Revision C Controls Indicators and Connectors Front Panel Description Table 3 1 Model 129 Front Panel Name Description The monitor s display is divided into several sections The content and layout of the A Display display can change depending on which functions are installed in the monitor and the modes of operation in use B FHR1 Volume Decrease Button The four Volume buttons raise A and lower x7 the volume of sound emitted by the rear panel speaker The left pair controls the volume for FHR1 The right pair C FHR1 Volume Increase Button controls the volume for FHR2 D FHR2 Volume Decrease Button Volume settings have no effect on the proc
28. 3 4 4 5 ALARMS HIGH Low 5 6 FHR 160 120 BPM 6 7 7 a ON AUDIO ALARMS ON VOLUME 5 8 9 OFF 9 Figure 5 1 US US2 Setup Screen 5 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Fetal Heart Rate Monitoring Ultrasound External Method Fetal Heart Rate Offset Volume FHR Alarm Limits NOTE The FHRI and FHR2 alarm limits are set independently of each other FHR Audio Alarm Master Alarm Volume This field is used to shift the secondary FHR trend 20 BPM to facilitate viewing overlapping trends This field provides an alternative to using the front panel Mark Offset button m On Shifts the secondary FHR trend 20 BPM m 10Min Shifts the secondary FHR trend 20 BPM After 10 minutes the trend automatically returns to the unshifted position m Off Returns the secondary FHR trend to the unshifted position The FHR Offset field is only present on the setup screen when W the heart rate offset option is enabled via the Install Options service screen and W the screen is activated by selecting the mode listed in the FHR2 area of the display This field adjusts the volume for the FHR derived from the selected mode US or US2 This field works in conjunction with the front panel Volume buttons These fields adjust the high and low alarm limits for FHR The available ranges are shown in Figure 5 1 the factory default settings are listed in Appendix A Factory Defaults This field enables disabl
29. 5 8 1 Volume FHR Alarm Limits NOTE The FHRI and FHR2 alarm limits are set independently of each other FHR Audio Alarm Master Alarm Volume FECG Waveform Figure 5 2 FECG Setup Screen This field controls the volume for the FHR derived from FECG This field works in conjunction with the front panel Volume buttons These fields adjust the high and low alarm limits for FHR The available ranges are shown in Figure 5 2 the factory default settings are listed in Appendix A Factory Defaults This field enables disables the audio alarm function for FHR when derived from FECG m On Visual and audible indications are provided during an FHR alarm condition m Off Only a visual indication is provided during an FHR alarm condition This field controls the alarm volume for all alarms When FECG monitoring is employed the FECG waveform can be displayed and printed Refer to Chapter 15 Waveforms Revision C 120 Series Maternal Fetal Monitor 5 5 2015589 001 Fetal Heart Rate Monitoring Dual Fetal Heart Rate Monitoring Dual Fetal Heart Rate Monitoring NOTE In the event that three transducers are plugged into the monitor FECG overrides the primary ultrasound connector US All Corometrics 120 Series Monitors are capable of monitoring two fetal heart rates The discussion in this section is limited to methods of monitoring dual fetal heart rates however it is important to note that MECG monito
30. 80 60 Pre printed HR Scale LLL 60 Primary Annotation Area 1CM 3 CM 100 100 12 Pre printed UA Scale T 80 60 8 60 Bottom Grid 6 40 40 20 20 UA OmmHg UA OmmHg Figure 12 2 Strip Chart Paper with a 50 210 BPM Heart Rate Scale 12 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Recorder Modes Off Mode Off Mode When the recorder is off the yellow Record indicator is off and nothing is automatically printed on the strip chart paper Even with the recorder turned off it is possible to manually print the displayed waveform or the maternal vital signs history Pressing the PRINT or PRINTALL softkey turns places the recorder into a special high speed printing mode After the information is printed the recorder turns off again Refer to Chapter 13 Maternal Vital Signs History and Chapter 15 Waveforms for more information Revision C 120 Series Maternal Fetal Monitor 12 5 2015589 001 Recorder Modes On Mode On Mode Trends Multiple Trends When the recorder is on the yellow Record indicator continuously illuminates and the recorder runs at the selected speed of 1 2 or 3 cm min Multiple trends can be simultaneously printed on the strip chart paper Table 12 3 provides a summary of the different trend types Figure 12 3 provides an example of a strip chart with five traces printed simultaneously Up to three heart pulse rate trends can be printed in the top or l
31. Alarm Press the Alarm Silence button to cancel the audio however the visual indication remains until the condition is resolved For MECG and MSpOz you can only temporarily silence the audio portion of the alarm If the alarm condition remains after expiration of the re alarm time configured on the Master Alarm Setup screen the audio alarm is re issued Refer to page 4 8 11 10 120 Series Maternal Fetal Monitor Revision C 2015589 001 Recorder Modes The 120 Series Monitor has three recorder modes off on and maternal only This section discusses the different features of each mode and provides instructions for changing modes This section also discusses the types of strip chart paper and summarizes the strip chart trends and annotations The section includes the following Strip Chart Paper 4 eR REC PCR EE HC ERU 12 2 Oif Mode RH 12 5 On Mode EPI 12 6 Chart Style Vital Signs Prin ng culi el RR bR IR RE ee ee 12 20 Matermmal Only Mode corrs see erre nr ogo ES RR S RD EE S 12 22 Changing Recorder Modes ose iw sane rr Rx 12 24 Paper Low Paper Out and Paper Load Error Conditions 12 25 Revision C 120 Series Maternal Fetal Monitor 2015589 001 Recorder Modes Strip Chart Paper Strip Chart Paper Instructions for loading the strip chart paper are provided in Chapter 4 Setup Procedures This section discusses the two kinds of strip chart paper available from GE Me
32. Connectors Front Panel Displays MHR P Area The MHR P area is summarized by Figure 3 7 and Table 3 7 C D mE fA MECG 89 Figure 3 7 MHR P Display Table 3 7 MHR P Display Name Description Up to three digits indicate the MHR P in beats per A MHR P Value minute This symbol provides information about the MHR P audio alarm andthe MHR P high low alarm limit settings See Chapter 11 Alarms for more MHR P Alarm Setting information Indicator KK An alarm setting is turned off A All alarm settings are enabled The mode title MECG indicates MECG is the MHR P source the mode title PULSE indicates MSpO or NBP is used as the source Select the mode title softkey to access the MHR P Setup screen C MHR P Mode Title D Maternal Heartbeat Flashes with each detected valid heartbeat for Indicator MECG only 3 12 120 Series Maternal Fetal Monitor Revision C 2015589 001 Controls Indicators and Connectors Front Panel Displays FSpO Area The FSpO area is summarized by Figure 3 8 and Table 3 8 IMPORTANT If FSpO2 is monitored while MSpO is inactive FSpO displays in the Additional Parameters Area When dual SpO monitoring occurs FSpO information is displayed in the Waveform Area beneath the MSpO area Refer to Chapter 6 Fetal Pulse Oximetry Monitoring FSPO2 C D 47 Figure 3 8 FSpO2 Display Ta
33. Current Last Used Settings If you monitor intermittently and configure the monitor for each patient the CURRENT option may be right for you This option causes the monitor to power up with the last used settings stored in battery backed memory Hospital Defaults The NEW HOSPITAL option allows your hospital to configure its own set of preferences to be used each time the monitor is powered on Record your hospital settings in Appendix A Factory Defaults for reference Once the settings have been defined this option changes to read HOSPITAL WIDE You may adjust the setup screen configurations as needed during monitoring however be advised that when you turn off the monitor all user setup screens revert to the hospital defined preferences when the monitor is turned on again 4 12 120 Series Maternal Fetal Monitor Revision C 2015589 001 Setup Procedures Customizing the Power On Settings Volume Exceptions The monitor is shipped from the factory with the FHR volumes set at 5 However the volume on the FECG US US2 or MHR P Setup screen is not stored as part of any power on set Factory Current or Hospital Wide Regardless of how you set the volume using a setup screen or the Volume buttons m Ifthe volume setting at power off is in the range 0 7 that volume remains set at power on m Ifthe volume setting at power off is in the range 8 9 the volume is adjusted to 5 at power on Revision C 120 Series Ma
34. Eight annotation lines are available m Four annotation lines are available Small m Time date modes and annotations all print using m Time date modes and annotations all print using the small font size the small font size m See Figure 12 8 m Four annotation lines are available m Two annotation lines are available m Time date and annotations print using the medium m Time date and annotations print using the medium Medium font size font size m Modes print using the small font size m Modes print using the small font size m See Figure 12 8 m Three annotation lines are available m Annotation print using the large font size Large m Time date print using the medium font size m Modes print using the small font size m See Figure 12 8 NBP 120 85 M9 ANNOTATION LINE 2 ANNOTATION LINE 3 ANNOTATION LINE 4 ANNOTATION LINE 5 ANNOTATION LINE M 96 NBP 120 ANNOTATI ANNOTAT C D Figure 12 8 Multiple Font Sizes Revision C 120 Series Maternal Fetal Monitor 12 15 2015589 001 Recorder Modes Summary of Annotations Summary of Annotations Table 12 3 Summary of Annotations Annotation Explanation Time and date are both printed on the bottom annotation line twenty seconds after the recorder is tumed on and when the date changes after midnight A time stamp automatically prints approximately every ten minutes at the ten minute mar
35. Frequently used functions are controlled by front panel pushbuttons including audio volume UA reference test alarm silence event mark and paper advance System setup options are easily accessed via a front panel Trim Knob control Fetal parameters are continuously displayed even during configuration of system setup options m Annotations from an optional Model 2116B Keyboard are printed on the strip chart recorder paper m The ultrasound mode provides clean accurate traces with few dropouts because of a patented autocorrelation processing Fetal heart rate alarm limits are user defined with pre set defaults Alarm limits are easily set via a front panel Trim Knob control Alarm silencing is controlled by a front panel pushbutton colored for easy recognition m Alarm conditions have audible and visual indications Audible alarms can be disabled Fetal heart rate threshold and signal quality alarms can be cancelled m The data storage and telecommunications capability allows remote or referral tracing assessments m The monitor can be interfaced to the most widely used non invasive blood pressure monitors and pulse oximeters m The FECG waveform can be optionally displayed and can be frozen on the screen for review In addition a six second snapshot can be printed on the strip chart paper 2 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Introduction Series Overview The Model 128 Monitor
36. Introduction Introduction Availability Fetal movement detection is an option which can be installed your 120 Series Monitor to function with the US channel Contact your Sales Representative for information Methodology Fetal movement detection FMD is designed to detect gross fetal body movements and body movements with associated limb movement Corometrics defines gross fetal body movement as the extension flexion or rolling over of the fetal trunk about the longitudinal axis of the body and associated limb movements Movements of the extremities alone may not be detected Eye movements will not be detected CAUTION FALSE DETECTION The following may be automatically detected as fetal movement transducer movement and maternal movement such as coughing laughing repositioning mother poking her abdomen in addition to emesis fetal hiccups or twins During fetal sleep or in the event of a fetal demise some of these detected movements may be confused with fetal movement C 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Fetal Movement Detection Using Fetal Movement Detection While Monitoring Using Fetal Movement Detection While Monitoring Enabling Disabling Fetal Movement Detection Display Indicator The fetal movement detection is available for the US connector only FMD is not available for the US2 connector To enable disable fetal movement detection set the FM Detect field on the
37. Maternal Vital Signs History Screen ccc cece cence a eees 13 4 Printing the Entire Vital Signs History ccc cece ee cence tenes 13 4 Printing a Page of the Vital Signs History ccc cece eee eee 13 5 14 15 16 1 Stopping the Printing of Maternal Vital Signs History 04 13 5 Heartbeat Coincidence e n eno 141 Heartbeat Coincidence Theory ssee nen n n nn n n nnns 14 2 Using the Heartbeat Coincidence Feature enn nn nnn 14 3 Enabling Disabling Heartbeat Coincidence Detection ece ee eeas 14 3 Display lfidiCatoE eorom tete eee tcd Cen eee ev cem f 14 3 Strip Chart Annotation 15 x At e a dori a CERE Pe Rd 14 3 Waveformis i uos bia aka ra a RR ERE NDOR OE 25 1 Waveform Area iicet OCC OE EO CORO ORCI aA 15 2 Selecting the Waveform isis mn 15 2 Waveform Speed s ois tude 2A as aka a a a A Aa a ient 15 2 ECG OZE List tette De t ae IR aii Las addin tad aired nate oe 15 2 MECG Eead Select or e cal Ya paene nae youd nei kena 152 MEGGP acerEabell isi reete ee itenim enden 15 2 Moving Scale Bar acti taut ceste Let renpL vi bn aot 15 3 Freezing Waveforms 5 325 2er tene o one eo C oda esta dt 154 Printing a Waveform Snapshot sse 15 5 Recorder QT cists evertit head paste del Phe S p Rica eat PER e aet 15 5 Recorder in Maternal Only Mode 0 ccc cece cece eee eens 15 6 Recorder Of 4 is duced ewitebaciiebdnaet wa Fon UR AR tes H
38. Monitor Revision C 2015589 001 Fetal Heart Rate Monitoring Dual Fetal Heart Rate Monitoring Enabling Disabling the Fetal Heart Rate Offset Feature NOTE Enabled and active do not The fetal heart rate offset feature can be enabled disabled from the Install Options mean the same thing When the optionis service screen Refer to the 120 Series Monitor Service Manual for more enabled via a service screen you then information have the capability to activate and de activate the function as needed The fetal heart rate offset feature has three settings m disabled users cannot activate the function m enabled on users can activate de activate the function m enabled auto revert users can activate de activate the function in addition the shifted trend automatically returns to the unshifted position after ten minutes Activating the Fetal Heart Rate Offset Feature To shift the secondary FHR trend 20BPM 1 Ensure the recorder is on 2 Press and hold the Mark Offset button for three seconds Or use the US US2 Setup screen m When using dual ultrasound or US2 and FECG the US2 trace is shifted 20 BPM and the US2 20 symbol is printed on the upper portion of the top grid every 4 5 cm m When using US and FECG the US trace is shifted 20 BPM and the US 20 symbol is printed on the upper portion of the top grid every 4 5 cm m A right arrow and a vertical dashed line print to draw
39. Off Waveform Display MECG FECG MECG FSp0 Normal MS p0 Off Operation MECG Waveform Size 1X 1 mV cm 25X 5X 1X 2X 4X Auto Revision C 120 Series Maternal Fetal Monitor A 3 2015589 001 Factory Defaults Table of Defaults Table A 1 Summary of Factory Defaults End Field Description Factory Default Default Options Hospital Preference Audio Alarms NBP On On Off MHR P On On Off MSp0 On On Off Re Alarm 120 sec 30 120 Master MECG and MSpO only in 5 second increments a Alarm Limits High Low High Low p Systolic 160 90mmHg 70 240 Off 50 150 Off Diastolic 90 50mmHg 70 130 Off 30 120 Off MAP 140 50mmHg 70 150 Off 30 120 Off MHR P 120 50BPM 100 250 Off 35 120 Off MSpO 100 95 85 100 Off 80 99 Off Volume 5 1 9 Time Date Setto current local date Setto currentlocal date and and time time Play Song Off Happy Birthday Off Brahm s Lullaby Rock a Bye Baby All Volume 5 0 9 Sp0 Scale 0 100 Auto 0 100 Does not change Paper Speed United States 3 cm min International 1 cm min ES emit enera Paper Chime OutOnly Off Low out Out only Volume 5 1 9 Light on recorder On On Off dM 5 min Off 2 5 10 15 30 60 min RE MEDI 5 min Off 2 5 10 15 30 60 min FSp0 Trace External Monitor on SOIT MUS nintergl Event 1 5 10 15 30 60 Event A 4 120 Series Maternal Fetal Monitor 201558
40. Series Maternal Fetal Monitor Revision C 2015589 001 Alarms Maternal Alarms Maternal Alarms Maternal Patient Alarms Active Patient Alarm Resolved Patient Alarm A maternal patient alarm occurs when a parameter value falls outside of the pre defined alarm limits greater than the high limit setting or less than the low limit setting m For MHR P the value used for analysis comes from the selected MHR P source m ForMSpO the value must be out of range for 8 seconds A patient alarm is indicated both visually and audibly The visual indication is provided by flashing the associated numeric The audio alarm is alternating high low tones For MSpO the MSpO value and accompanying pulse rate are printed on the strip chart paper The visual and audible indications automatically disappear as soon as the condition is resolved Revision C 120 Series Maternal Fetal Monitor 11 9 2015589 001 Alarms Maternal Alarms Signal Quality Alarms If the monitor is unable to detect an acceptable signal a signal quality alarm is provided Active Signal Quality Alarm The following signal quality alarms are indicated both visually and audibly The audio alarm is alternating high low tones The visual indication varies according to the alarm m Asystole Dashes display in place of the MHR P numeric m MECG Leads Off Dashes display in place of the MHR P numeric The following message
41. a transducer while coincidence is detected the overlaid hearts Q stop printing In addition the mode status line prints on the strip chart paper without the HBC annotation indicating the deactivated mode 4305AAO Cc PAGES Coincidence detected i OS remane Uy FHF 240 bpm Coincidence resolved sseecseee seem ae L 180 Simulated trends This annotation prints N every thirty minutes 15 10 26 AUG00 FECG US maa HBC TOCO w along with the modes Coincidence enabled Figure 14 2 Simulated Heartbeat Coincidence Detection Trace 14 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Waveforms The 120 Series Monitor allows you to display and print one the following waveforms FECG MECG FSpO or MSpO This chapter describes the following MaveloMi ATeH eeen rre nne tuU eee gue ae DEM PS 15 2 Preezie Wavefobms i ccs koe oh pte be Agent eee bee 15 4 Printing a Waveform Snapshot 2 02 eee ee 15 5 Stopping a Print Command ssec es 15 6 Revision C 120 Series Maternal Fetal Monitor 2015589 001 Waveforms Waveform Area Waveform Area The waveform area displays approximately four seconds of waveform data FECG MECG FSpO or MSpO2 The wavef
42. alarm setting audio or high low K limit is turned off displays to the left of the NBP mode title Alarm Defaults Audio on Volume 5 Systolic Limits High 160 mmHg Low 90 BPM Diastolic Limits High 90 mmHg Low 50 mmHg MAP Limits High 140 mmHg Low NBP 50 mmHg MHR P Limits High 120 BPM Low 50 BPM Systolic diastolic or MAP pressure NBP numeric systolic diastolic Alternating high low tones if value high or low actively being or MAP flashes audio enabled violated Malfunction with NBP circuitry cuff CHECK CUFF LEAK COMM Alternating high low tones if or air hoses MOTION WEAK SIGNAL or audio enabled REPAIR message displays in NBP area An alarm setting audio or high low K limit is turned off displays to the left of the MHR P mode title Alarm Defaults Audio on Volume 5 Limits High 2 120 BPM Low 50 BPM Re alarm 120 sec MHR P limit high or low actively MHR P numeric flashes Alternating high low tones if MHR P being violated audio enabled The tachycardia response time is lt 8 seconds Asystole Flashing dashes in place Alternating high low tones if of MHR P numeric audio enabled MECG leads off Flashing dashes in place Alternating high low tones if of MHR P numeric and MECG audio enabled LEADS OFF message displays underneath Revision C 120 Series Maternal Fetal Monitor B 3 2015589 001 Alarms Summary Table of Alarms Table B 1
43. annotations received from a central information system A computer marker E prints on the bottom two lines of the heart rate grid marking the time the annotation was made from a remote location See Figure 12 7 Revision C 120 Series Maternal Fetal Monitor 12 13 2015589 001 Recorder Modes On Mode Multiple Annotations Sometimes annotations occur within seconds of each other Consider the following example shown in Figure 12 7 m an automatic NBP reading occurs at 16 51 30 W three annotations are received from a central information system the entries are made between 16 51 40 and 16 52 00 m amanual NBP reading occurs at 16 52 10 Figure 12 7 Multiple Annotations Example 12 14 120 Series Maternal Fetal Monitor Revision C 2015589 001 Recorder Modes On Mode Adjustable Recorder Font Size The 120 Series Monitor offers a choice of font sizes to print annotations Refer to Table 12 2 A larger font size fosters readability a smaller font size increases printing speed Set the font size on the Install Options service screen Refer to the 120 Series Monitor Service Manual for more information CAUTION FONT SIZE If the medium or large font size is selected there is the possibility that messages may be truncated during periods of multiple annotations Table 12 2 Summary of Font Settings Printing Description FontSetting 30 240 BPM Scale Paper 50 210 BPM Scale Paper m
44. bottom grid of the strip chart MSpO2 98 P 70 paper and marks the time of the reading The vital signs data prints in one of the top three lines of the annotation area as soon as a printing line is available The printed pulse rate value is derived from the pulse oximetry module monitor and is independent of the MHR P source selected on the maternal MHR P Setup Screen Revision C 120 Series Maternal Fetal Monitor 12 17 2015589 001 Recorder Modes Summary of Annotations Table 12 3 Summary of Annotations Continued Annotation Explanation 96F SpO data For example FSpO2 47 or FSp02 47 FSpO data is printed at selected intervals according to the FSpO Setup screen built in module or General Setup screen external device m identifies the 120 Series as the source m identifies an external device as the source The diamond prints on the bottom two lines of the bottom grid of the strip chart paper and marks the time of the reading The data prints in one of the top three lines of the annotation area as soon as a printing line is available Remote annotation from a central information system For example E p EPIDURAL GIVEN AROM POS CHG LEFT SIDE This annotation represents notes received from a remote central information system The computer icon B prints in the bottom two lines of the top grid The icon marks the time of the annotation and also indicates that the information comes
45. cloth or paper towel with one of the following products then wring out until only slightly wet Sodium Hypochlorite 5 25 Bleach diluted 10 1 Cidex Sporicidin Soap and water 2 Rub soiled area until clean taking care not to excessively wet the tocotransducer diaphragm seal Rub around the seal 3 Dry with a soft dry cloth UA Strain Gauge Follow the manufacturer s directions to clean the strain gauge Maternal NBP Cuffs and Hoses To clean the pneumatic tubing and cuffs use a soft cloth dampened with a soap and water solution Do not immerse hoses or cuffs in liquids Revision C 120 Series Maternal Fetal Monitor 16 3 2015589 001 Maintenance Maternal S pO Calibration Maternal SpO2 Calibration The 120 Series Monitor automatically calibrates the pulse oximetry module upon power up whenever a new sensor is attached and at periodic intervals during use The intensity of the sensor s LEDs are also automatically adjusted to compensate for differences in tissue density 16 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Troubleshooting This section of the manual provides a troubleshooting guide for the most basic 120 Series Monitor operational problems If the response to a specific question is not found contact the Service Department at one of the following numbers Inside the United States 1 800 558 5120 Outside the United States 1 414 355 5000 or contact your local
46. detection FMD 2 6 120 Series Maternal Fetal Monitor Revision C 2015589 001 Introduction About the Manual About the Manual Purpose This manual documents all possible parameters so that when you upgrade you will not require any new documentation Also the manual provides an opportunity to read about features you may not have to help aid you in your upgrade decisions Some sections will not apply if your monitor is not equipped with MSpO maternal NBP or MECG monitoring capabilities Table 2 1 provides a summary of the 120 Series family of monitors Table 2 1 Summary of Monitoring Modes 120 Series Model 126 128 Parameter I N wo US US2 FECG TOCO e Ce er SEU IUP NBP SUCUS SS SU SIS MSPQ2 Be SUSCI Oy cll By MECG Intended Audience This manual is intended for clinical professionals Clinical professionals are expected to know the medical procedures practices and terminology required to monitor obstetrical patients Illustrations All illustrations are provided as examples only Your monitor may not be equipped with all of the features shown In addition unless explicitly stated the display examples do not represent your equipment setup or displayed data Revision C 120 Series Maternal Fetal Monitor 2 7 2015589 001 Introduction About the Manual For your notes 2 8 120 Series Maternal Fetal Monitor Revision C
47. distributor This section contains the following General Troubleshoott g 2 ove ER ERAS 17 2 Ultrasound Troubleshooting lees 17 3 FECG Troubleshooting ee Bie teed ee AE ge ee pete 17 4 Fetal Pulse Oximetry Troubleshooting 17 5 External Uterine Activity Troubleshooting 17 8 Internal UA Troubleshooting 2 020085 17 9 MECG Troubleshooting 4 epe E nee renee beeen RR 17 10 Blood Pressure Troubleshooting 0 0005 17 11 Maternal Pulse Oximetry Troubleshooting 17 12 Revision C 120 Series Maternal Fetal Monitor 2015589 001 Troubleshooting General Troubleshooting General Troubleshooting Table 17 1 General Troubleshooting Problem Probable Cause Possible Solution No monitoring functions and green Power indicator does not illuminate when Power Switch is placed in the On I position m Monitor is not connected to an AC line receptacle m The AC power cord is defective m The AC outlet is defective m The power cord is not connected to the monitor m Blown fuses m Connectthe power cord to an AC line receptacle m Replace the power cord m Use a different outlet m Connectthe power cord to the monitor m Call Biomedical Engineering Department m Recorder does not function and the Record indicator is off m Recorder does not function and the Record indicator flickers thr
48. etre ed rebat C 3 Using the Remote Event Marker to Complement the Patient Record C 4 Spectra Alerts is ix vx ivan Ca ROS ac os sri neces Del Important Safety Information snnm D 2 Using the Spectra Alert Option enn n n n n n n n nnn D 3 Enabling Disabling Spectra Alerts D 3 Methodology sc oer bees eptese uec epe poen vei ei ree Ever Pd D 3 Alert indications sereni aaa nennen D 5 Active Alerts itc Ot o e b e dod o DO D 5 Silencing Alerts i o sc tetre pere Rr Poke ee whey heh ei fg s D 5 Resolved Alerts 5c nre EC RE rd CR ur ng D 6 Alert Suspension Feature 0 0 cece cette e D 6 Enabling Disabling the Alert Suspension Feature isses D 6 Suspending Audio Alerts and the Nurse Call Interface 05 D 6 Restoring Audio Alerts and the Nurse Call Interface suus D 6 Alert Parameters Summary isse nennen nnn D 8 Resetting AlenS Sna aa ENE E AAA E OETA E DETE D 11 False Pattern Recognition cc D 11 Mode Switching ai nr m rt P AA E eC XR E Ta D 11 Trend Screen wiccccccacceeceeeeeeeeeeeeeeaeeaneaneaeeaneaeeneaneags D 12 Uterine Contraction Frequency sene nennen nnne D 13 Enabling Disabling UC Frequency Display 0 0 cece cee eects D 13 UC Frequency in UA Display Area sisse e D 13 UC Frequency Histogram iisssssssssss me D 14 Enabling Disabling UC Chime 0 cece cece tect e eee ee eeaeeas D 14 Nurse Call Interface ccccccceuececueueue
49. has already been resolved The visual and audible indications remain present until you press the Alarm Silence button This ensures that a clinician is aware that an alarm occurred You may hear this type of alarm described as latching m Resolved Silenced FHR Patient Alarm If you have already silenced a FHR patient alarm the visual indications disappear automatically By comparison the visual and audible indications for a maternal patient alarm automatically disappear as soon as the condition is resolved whether or not you have acknowledged the alarm FHR Signal Quality Alarms A fetal heart rate signal quality alarm occurs if the monitor is unable to detect an acceptable FHR signal Active Signal Quality Alarm A signal quality alarm is indicated both visually and audibly The visual indication is provided by flashing the FHR numeric if available or flashing dashes in place of the FHR numeric The audio alarm is alternating high low tones Resolved Signal Quality Alarm Resolved signal quality alarms function like most other 120 Series alarms As soon as an alarm condition is resolved both the visual and audible indications automatically disappear Revision C 120 Series Maternal Fetal Monitor 11 7 2015589 001 Alarms Fetal Heart Rate Alarms Silencing a FHR Audio Alarm Press the Alarm Silence button to cancel the audio however the visual indication remains until the condition is resolved 11 8 120
50. initial baseline when the tocotransducer is plugged into the monitor but not yet applied to the patient No pressure should be applied to the transducer button For other transducers i e Nautilus The initial reference occurs automatically After you plug in a transducers verify that the display reads less than 30 relative units Make a note of the reading The purpose of establishing a baseline at this point is necessary for consistency when applying and tightening the belt You will have to set the baseline again after tightening the belt 7 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Uterine Activity Monitoring Tocotransducer External Method Accounting for Belt Tension When you adjust the belt on the patient regardless of transducer type you want to ensure a comfortable fit you also want to ensure that the transducer is held securely in place GE Medical Systems Information Technologies recommends adjusting the belt tension so that between contractions the UA display shows approximately 25 relative units above the initial baseline After the belt is adjusted it is important to establish a new baseline This is because you don t want belt tension to be counted as uterine pressure also the pressure readings could tend to go off the scale if you do not account for the belt tension Again the UA Reference pushbutton should only be pressed between contractions More About Referencing Out of Range
51. mode or off Referto Chapter 12 Recorder Modes M Power Indicator The indicator lights green when the monitor is turned on Indicator Status Recorder Status on on N Record Indicator off off flickers maternal only mode flashing error condition Operation of the monitor is controlled by using the front panel pushbuttons in conjunction with the Trim Knob control This control selects softkeys on the display and 0 Trim Knob Control positions a cursor within a setup screen Rotate the Trim Knob control left or right to highlight items on the screen with a bar cursor After highlighting the desired item press the Trim Knob control to make the selection In summary rotate to move cursor press to select an item P Recorder Door Latch Opens the strip chart recorder door to add remove or adjust the paper Revision C 120 Series Maternal Fetal Monitor 3 3 2015589 001 Controls Indicators and Connectors Front Panel Description Table 3 1 Model 129 Front Panel Name Description Sawer Switch Moving the switch to the on position I turns on the monitor moving the switch to the off position O turns off the monitor Annotations and trends are printed on the strip chart paper Two paper styles are Strip Chart Recorder available Refer to Chapter 4 Setup Procedures for instructions on loading strip chart paper into the recorder Refer to Chapter 12 Recorder Modes for additional information about trends and annotati
52. of 1 to 2 cm and a non repetitive motion before 1 to 5 Hz at an amplitude of 2 to 3 cm in induced hypoxia studies in the range of 70 100 SpO2 against a laboratory co oximeter and ECG monitor This variation equals plus or minus one standard deviation Plus or minus one standard deviation encompasses 68 of the population The Masimo SET SpO parameter with LNOP Neo Pt sensors has been validated for neonatal motion accuracy in human blood studies on neonates while moving the neonate s foot at 2 to 4 cm against a laboratory co oximeter and ECG monitor This validation equals plus or minus one standard deviation Plus or minus one standard deviation encompasses 68 of the population The Masimo SET SpO parameter has been validated for low perfusion accuracy in bench top testing against a Biotek Index 2 simulator and Masimo s simulator with signal strengths of greater than 0 02 and a transmission of greater than 5 for saturations ranging from 70 to 100 This variation equals plus or minus one standard deviation Plus or minus one standard deviation encompasses 68 of the population Maternal Vital Signs History Storage R ecall 8 hours maximum Revision C 120 Series Maternal Fetal Monitor 18 7 2015589 001 Technical Specifications Strip Chart Recorder Strip Chart Recorder Table 18 3 Strip Chart Recorder Technical Specifications Heart Rate Scale Domestic International Chart Wi
53. or self test failure m Contact Biomedical Engineering Department Revision C 120 Series Maternal Fetal Monitor 2015589 001 Troubleshooting External Uterine Activity Troubleshooting External Uterine Activity Troubleshooting Table 17 5 External UA Troubleshooting Problem Probable Cause Possible Solution Tocotransducer not recording contractions m Transducer not properly connected to monitor m Transducer not properly placed m Transducer not secured to patient m Defective transducer cable assembly m No maternal contractions m UA Reference range exceeded m Ensure that transducer is securely attached to monitor m Reposition transducer m Secure or re apply transducer to patient m Replace transducer cable assembly m Wait m Loosen belts or remove transducer from patient Press UA Reference pushbutton while no pressure is applied to transducer button Re apply transducer Do not overtighten belt Press UA Reference pushbutton again between contractions See Out of Range Condition on page 7 3 for further information Flashing sign Relative pressure gt 100 Press the UA Reference pushbutton between contractions CHECK TOCO message is shown in UA area of the display area when the UA Reference pushbutton is pressed m UA Reference pushbutton pressed before UA circuits stabilized m UA Reference range exceeded due to over tightening b
54. s Laboratories Inc with respectto fire shock and mechanical hazards in accordance with UL 2601 1 CUL Classified with respect to electric shock fire mechanical and other specified hazards only in accordance with CAN CSA C22 2 No 601 1 UL 2601 1 a Paper operating environmental conditions are for a period of less than one month Paper storage environmental conditions are for extended storage 18 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Technical Specifications Operating Modes Operating Modes Table 18 2 Operating Mode Specifications FECG Mode Technique Heart Rate Counting Range Heart Rate Resolution Artifact Elimination Countable Input Signal Range Offset Voltage Tolerance Differential Maximum Common Mode Voltage Preamplifier Bandwidth Common Mode Rejection Balanced Unbalanced 5kQ RA or LA Input Equivalent Noise Input Impedance Differential Common Mode Mains Frequency Rejection Leakage Current Isolation Mains to P atient Peak detecting beat to beat cardiotachometer 30 240 BPM 1 BPM Selectable 25 BPM artifact rejection 15 uV to 2 mV peak to peak 300 mVdc maximum 20 V peak to peak 1 100 Hz gt 120 dB at mains frequency with patient cable gt 110 dB at mains frequency 10 uV peak to peak gt 10 MQ gt 20 MQ gt 40 dB 60 pA at 254 VAC electrically isolated 4kVAC Ultrasound Mode Technique Transducer Type Pu
55. selectable values are listed in Figure 9 3 The factory default settings are listed in Appendix A Factory Defaults This field enables disables the audio alarm function for blood pressure m On Visual and audible indications are provided during an NBP alarm condition m Off Only a visual indication is provided during an NBP alarm condition This field controls alarm volume for all alarms 9 8 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Non Invasive Blood Pressure Monitoring NBP Monitoring NBP Monitoring Blood Pressure Methodology During a determination the instantaneous cuff pressure is indicated by a numeric value displayed below the title CUFF This information is displayed in place of the mean arterial pressure When a determination is successful the monitor emits two short tones high low and displays the three pressure readings and the maternal pulse if NBP is enabled as the MHR P source Regardless of the mode auto or manual the values remain displayed according to the time period specified in the display timer field The systolic and diastolic pressures are each indicated with two or three digits and separated by a slash The mean arterial pressure is indicated with two or three digits and enclosed in parentheses All pressure values are displayed in mmHg Values are printed on the strip chart paper annotated by an outlined diamond which marks the time of the reading
56. the active FHR mode annotations s and m alert output to a nurse call system is inhibited Refer to Figure D 3 and Figure D 4 D 6 120 Series Maternal Fetal Monitor Revision C 2015589 001 Spectra Alerts Alert Indications Restoring Audio Alerts and the Nurse Call Interface To restore full alert functionality press and hold the Alarm Silence button for approximately three seconds you will hear two beeps as feedback Once restored the alert enable icon A displays next to the FHR mode title s and prints on the strip chart paper along with the active FHR mode annotation s 49 3 UC 10 Alert suspended icon A MSPO2 MECG 15 52 58 PRINT FREEZE ALARMS SETUP VSHX Figure D 3 Spectra Alert Suspended Icon Alert restored Alert suspended US TOCO 3 CM MIN Figure D 4 Spectra Alert Suspend Restore Annotations Revision C 120 Series Maternal Fetal Monitor D 7 2015589 001 Spectra Alerts Alert Parameters Summary Alert Parameters Summary NOTE Parameters displayed in inverse video are contributing to an active alert Items displayed in normal video may indicate an alert is pending The FHR setup screens FECG or US US2 include an Alert Parameters summary presenting an overview of the alert analysis results for FHR and UA Fields shown in inverse video are contributing factors to an alert Some fields contain a second column to provide qualifying information
57. the saturation value the pitch rises as the saturation value increases the pitch lowers as the saturation value decreases If MECG is selected as the MHR P source the MECG audio plink is used instead it will not vary in pitch The MSpO Waveform When MSpO monitoring is employed the MSpO pulsatile plethysmograph waveform can be displayed and printed Refer to Chapter 15 Waveforms Revision C 120 Series Maternal Fetal Monitor 10 7 2015589 001 Maternal Pulse Oximetry Monitoring Module and P robe Compatibility Module and Probe Compatibility Modules and Sensors No Implied License Nellcor and Masimo pulse oximetry modules are calibrated to display functional saturation Other manufacturer s pulse oximetry monitors may be calibrated to display fractional saturation m 120is Series Monitors with Masimo modules are compatible with Masimo LNOP probes m 120is Series Monitors with Nellcor modules are compatible with Nellcor probes The MSpO cable should plug into the monitor s MSpO connector easily and securely Do not use excessive force to connect the cable If the MSpO cable does not easily fit into the MSpO connector on the monitor it is likely that you do not have the appropriate cable The Masimo and Nellcor modules are used to non invasively measure the amount of oxygenated hemoglobin and pulse rate The absorption of selected wavelengths of light is measured with probes Although these modules pro
58. to 60 minutes and the sensor is connected at 9 42 a m Whereas the first real time printing would occur at 10 42 the first chart style printing is done at 10 00 Subsequent values are printed at 11 00 12 00 1 00 2 00 etc Chart Style Seven Minute Exception for NBP If you take a manual blood pressure reading within seven minutes of a chart style interval 15 30 or 60 minutes and then activate automatic blood pressure readings using a chart style interval the first automatic reading will be skipped This rule only applies to the first reading when chart style vital signs printing is enabled on the Install Options service screen Example You take a manual blood pressure reading at 7 10 At 7 13 you then activate automatic blood pressure readings using a 15 minute time interval The 7 15 chart style reading is skipped since a manual reading occurred 5 minutes earlier The first automatic reading is taken at 7 30 Since the rule applies only to the first reading if you take another manual reading at 7 40 the 7 45 automatic reading occurs as scheduled Revision C 120 Series Maternal Fetal Monitor 12 21 2015589 001 Recorder Modes Maternal Only Mode Maternal Only Mode What is the Maternal Only Mode Printing Style The maternal only printing mode sets the recorder to a standby mode turning the recorder on and off as needed to print information such as m maternal non invasive blood pressure m maternal pulse oximet
59. to accommodate the additional information Refer to Figure D 9 US2 TOCO 165 172 v Kn NBP 0215 A MECG 130 85 89 UC Frequency option enabled MAP 107 03 15 03 22 45 PRINT FREEZE ALARMS VSHX Figure D 9 UC Frequency Option Enabled Revision C 120 Series Maternal Fetal Monitor D 13 2015589 001 Spectra Alerts Uterine Contraction Frequency UC Frequency Histogram If the Spectra Alerts option is enabled the UA Setup screen displays a UC Frequency Histogram as shown in Figure D 10 Each bar in the graph represents the number of contractions in a ten minute segment The graph displays up to 10 bars or 100 minutes FECG US TOCO 48v 153 gt 3 UC 10 UC IN 10 MIN gt 10 9 8 7 6 5 4 3 2 1 0 09 44 10 24 11 14 UA UA DISPLAY UA UCF UC CHIME OFF 1 ON UAIUCF EXIT OFF Figure D 10 UC Frequency Histogram The following two messages may display above the UC Frequency Histogram RECORDING UA and UA BASELINE SET For more information refer to Table B 3 Enabling Disabling UC Chime If the Spectra Alerts option is enabled the UA Setup screen contains a UC Chime field When enabled a low frequency chime sounds at the onset of a contraction a high frequency chime sounds at the conclusion This audio contraction indicator is useful to caregivers as well as patients Caregivers are made aware of contractions during in
60. top grid trend source changes all top grid active trend sources are printed If the UA mode changes the active UA trend source is printed A mode change is defined as switching connectors FSp02 connecting to a front panel receptacle disconnecting from a front panel receptacle or enabling disabling a trend on a setup menu MSp02 AA This annotation prints in place of any trend source if the respective connector Seay FECG MECG US or US2 is unused UA INOP This annotation prints in place of the trend source if the UA receptacle is unused This annotation is printed in place of the trend source if the trend is enabled and FSpO2INOP the FSpO receptacle is unused MSp02 INOP This annotation prints if the trend is enabled and the Maternal S pO receptacle is unused 12 16 120 Series Maternal Fetal Monitor Revision C 2015589 001 Recorder Modes Summary of Annotations Table 12 3 Summary of Annotations Continued Annotation Explanation The chart speed prints on the bottom annotation line Chart S peed Example 3 CM MIN m twenty seconds after you turn on the recorder and m when the speed changes This message prints on the bottom line of the bottom strip chart paper grid during active uterine activity monitoring whenever UA REF m you press the UA Reference pushbutton or m whenever automatic re zeroing occurs during tocotransducer monitoring This annotation prints on the bottom line of the bottom strip cha
61. waveform selected on the normal operating screen For example you can select MECG as the MHR P source yet display the MSpO plethysmograph waveform Or you can select MSpO as the source and display MECG as the waveform Revision C 120 Series Maternal Fetal Monitor 8 3 2015589 001 Maternal Heart Pulse Rate Monitoring MHR P Setup Screen MHR P Trace This field enables or disables the printing of the MHR P trace on the strip chart paper m On The MHR P trend is printed in grey annotated with MECG r MSpO Pa whichever parameter is selected in the MHR P source field MHR P data from NBP is not trended since blood pressure determinations are static measurements m Off The MHR P trend is not printed Volume This field sets the volume of the beep sounded with each detected valid heartbeat for MECG and MSpO only Alarm Limits These fields adjust the high and low alarm limits for MHR P in increments of 5 BPM The selectable values are shown in Figure 8 1 The factory defaults are listed in Appendix A Factory Defaults Audio Alarms This field enables disables the audio alarm function for MHR P m On Visual and audible indications are provided during an MHR P alarm condition m Off Only a visual indication is provided during an MHR P alarm condition Alarm Volume This field controls alarm volume for all alarms MECG Lead This field selects the ECG lead configuration The lead c
62. 0 15 20 30 40 45 60 90 and 120 minutes When the desired interval is displayed release the BP Start Stop button The timer reappears and begins to count down from the new value The monitor is factory set with the optional 1 minute interval time disabled For information on enabling the 1 minute interval refer to the 120 Series Monitor Service Manual Revision C 120 Series Maternal Fetal Monitor 9 11 2015589 001 Maternal Non Invasive Blood Pressure Monitoring NBP Monitoring NBP Interval Time replaces the countdown timer while BP Start Stop button is held FMD HBC TOCO 165v 172 30 VANBP 15 00 A MECG i MSPO2 130 85 87 98 MAP 107 03 15 MECG 03 22 45 PRINT FREEZE ALARMS SETUP VSHX Figure 9 4 NBP Interval Time Shortcut Terminating a Determination in Progress A determination manual or automatic can be cancelled by pressing the BP Start Stop pushbutton m The selected mode manual or auto remains in effect m The next scheduled automatic determination takes place as planned 9 12 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Non Invasive Blood Pressure Monitoring Smart BP Feature Smart BP Feature Models 128 and 129 have a Smart BP feature which prevents an automatic blood pressure determination from occurring during a uterine contraction This feature m reduces the chances for erroneous vital signs readings and m reduces
63. 015589 001 Safety Equipment Symbols For your notes 1 10 120 Series Maternal Fetal Monitor Revision C 2015589 001 Introduction This section lists the indications for use for maternal fetal monitors in the Corometrics 120 Series The Corometrics 120 Series is extremely flexible allowing you to mix and match features This section provides information about your monitor in relation to this manual as well as the intended uses of the device Fetal Monitoring Indications for Use 42 2 2 Senes OVERVIEW cu cx ee be ER EE x ae e Seve 2 4 About the Manual ccc cece sr rr ord Re 2 7 Revision C 120 Series Maternal Fetal Monitor 2 1 2015589 001 Introduction Fetal Monitoring Indications for Use Fetal Monitoring Indications for Use A Corometrics 120 Series Monitor is used for fetal surveillance as well as maternal monitoring Surveillance A Corometrics 120 Series Monitor can be used for routine non invasive and invasive fetal monitoring throughout labor and delivery Pulse Oximetry The 120 F Series system continuously monitors intrapartum fetal oxygen saturation FSpO and is indicated as an adjunct to fetal heart rate FHR monitoring in the presence of a non reassuring fetal heart rate pattern It should only be used after maternal membranes have ruptured and on a singleton fetus in vertex presentation with a gestational age greater than or equal to 36 weeks Refer to the Maternal F
64. 100 This option configures the MSpO trend to always plot at a fixed scale of 0 100 even when the maternal trend prints alone This field selects the paper speed of the strip chart recorder This field enables disables an audible tone to indicate a low paper or out of paper condition Refer to Chapter 12 Recorder Modes This field turns the recorder light on and off This light permits the room lights to be dimmed without sacrificing visibility of the strip chart recorder A patient can remain resting without the disturbance of overhead lights while a nurse or physician checks the strip chart IMPORTANT RECORDER LIGHT The recorder light is only available on monitors purchased with Software Version 3 0 or greater Older monitors can be upgraded to Software Version 3 0 or greater however the recorder light will not be available If your monitor has a recorder light the LIGHT field displays on the General Setup screen and a frosted plastic light cover is located above the strip chart recorder This field sets the volume of the paper chime As you adjust the volume a sample tone sounds The 96MSpO trend is plotted over a range of 60 100 on paper with a HR scale of 30 240 BPM The MSpO z trend is plotted over a range of 50 100 on paper with a HR scale of 50 210 BPM 4 10 120 Series Maternal Fetal Monitor Revision C 2015589 001 Setup Procedures Setup Screens MSpO Print Interval This f
65. 20 Series Maternal Fetal Monitor 2015589 001 6 5 Fetal Pulse Oximetry Monitoring Theory Theory Hemoglobin and Oxygen Transport A review of the unique properties of hemoglobin and its role in blood oxygen transport are important in explaining how the 120 F Series Monitor measures fetal oxygen saturation FSpO Hemoglobin contained in red blood cells is a complex protein molecule consisting of four iron containing heme groups and the protein globin each molecule can reversibly bind four molecules of oxygen Once one molecule of oxygen is bound the other three follow rapidly A saturated hemoglobin molecule is commonly called oxyhemoglobin Those hemoglobin molecules without oxygen are referred to as deoxyhemoglobin Oxygen bound to hemoglobin represents approximately 98 of the oxygen in blood thus virtually all of the oxygen in the blood is bound to hemoglobin The hemoglobin molecules saturated by oxygen are reflected in the saturation values of laboratory analyzed blood gases SaOz and pulse oximeters SpO SaO refers to the arterial oxygen saturation as measured by arterial blood sampling SpO gt refers to the arterial oxygen saturation as measured by pulse oximetry The 120 F series Monitor reports the FSpO value which refers to fetal arterial oxygen saturation as measured by pulse oximetry Principles of Operation Operation of the 120 F Series FSpO feature is based on the principles of pulse oximetr
66. 26F Model 128F or Model 129F This chapter describes the following FSpO Indications Contraindications Warnings and Precautions 6 2 Theoy iussi oq beoe bob rs de Std mese gh bed seded eh PA FERE oe 6 6 PSpOs Setup Sefeen a case nba dere HP EHE ORPGCRPPPN EPUM 6 9 EbspOs Display Area 2d psoshb ERRARE EORR e 6 11 Fetal Patient Module e re dca eek be bI e OU dei eee 6 13 ESpO Metbodo OBy iu uerb qe b bep ip eb ERE Rei eee 6 14 P5pO2 Wayelofll 2er eR R3 MRRRP PHERRHRERERRAR PR RR YT RAN E ered 6 15 FSpOz2 Monitoring Basic Operation 0 e eee ee eee eee eee 6 16 Revision C 120 Series Maternal Fetal Monitor 6 1 2015589 001 Fetal Pulse Oximetry Monitoring FSpO Indications Contraindications Warnings and Precautions FSpO Indications Contraindications Warnings and Precautions This chapter contains safety information related to the FSpO feature of the monitor only For overall 120 Series Monitor safety information refer to Chapter 1 Safety Indications for Use The 120 F Series system continuously monitors intrapartum fetal oxygen saturation FSpO and is indicated as an adjunct to fetal heart rate FHR monitoring in the presence of a non reassuring fetal heart rate pattern It should only be used after maternal membranes have ruptured and on a singleton fetus in vertex presentation with a gestational age greater than or equal to 36 weeks Refer to the Maternal Fetal Monit
67. 9 001 Revision C Factory Defaults Table of Defaults Table A 1 Summary of Factory Defaults Setup ield int faul faul ital Pref Screen Field Description Factory Default Default Options Hospital Preference Default Settings Facto Factory Current New y Hospital Hospital wide Line Frequency United States 60 Hz 50 Hz 60 Hz International 50 Hz ECG Artifact Elimination off On Off Scaling United States 30 240 BPM United States 30 240 BPM International 50 210 International 50 210 BPM BPM Language Setaccording to shipping Setaccording to shipping destination destination NBP 1 Minute Interval On On Off HR Heart Rate Offset On with 10 min Install Aiifo Revent Off On 10 min Options Service Default TOCO Reference 5 10 15 20 25 relative 10 relative units units FM Fetal Movement Remote Mark On On Off COROLAN Address Off On Off Checking HBC Heartbeat Coincidence Enable on Qm Ve ial TIS PR Real Time Real Time Chart Style Interval Recorder Font Size Medium Small Medium Large Fetal Alert Alarm Off Off Alarms Alerts Smart BP On On Off NOTE You must cycle power to reset factory defaults Revision C 120 Series Maternal Fetal Monitor A 5 2015589 001 For your notes A 6 120 Series Maternal Fetal Monitor 2015589 001 Revision C Alarms Summary A summary of the 120 series alarms is found in the table that follows
68. Activating the Fetal Heart Rate Offset Feature cc eee ee eee ees 5 7 De activating the Fetal Heart Rate Offset Feature cece ceca 5 7 Fetal Pulse Oximetry Monitoring sss 6 1 FSpO Indications Contraindications Warnings and Precautions 6 2 Indicatioris TOL USB tenet ce eret Rt m POMPIERS EMES 6 2 FSpO Contraindicaons 6 2 FSpOsWatings i Gh yat ake g tas Peni aeedan pes Geek eb roe di fr 6 2 ESO Precautions cte Hp e EET OA se 6 3 Clinical Use Precautions iosep err erem Rr RR em reves 6 3 Technical Precautions c RD Rep bee TS 6 4 Inaccurate Measurements and Loss of Pulse Signal sisse 6 5 Theory ior eser scia en vew v rna eC de Ee o E aoo COE tae Ee P aon 6 6 Hemoglobin and Oxygen Transport iiis 6 6 Principles of Operation 0 cect m 6 6 Automatic Calibration iiis mm 6 7 Functional Versus Fractional Saturation isse 6 7 Measured Versus Calculated Saturation sss 6 8 Normal Range of FSpO Values During Labor and Delivery iussus 6 8 FSpO2 Setup Screen seen nennen ana 6 9 Response TIME ho accent reri ee e ana pr RE TEM er Put 6 9 Print Intervals i ce n te o do RO CAO 6 9 Po Xx TIdCG diste Wr ees odd welt attic de oe e d bates d 6 10 FSpO Display Area isse nemen 6 11 Single versus Dual Display of SpO2 0 cee ccc ete 6 11 Fo pO 2 5 taUs ICONS v or nick trie tb vetu be eter meatier aea 6 11 Sensor Unplugged ue
69. Annotations A maternal pulse oximetry reading prints according to the interval time set on the MSpO Setup screen for built in module or the General Setup screen for external device For the built in module a reading also prints for each alarm generated The reading can print on any of the first three annotation lines depending on which printing line is available A diamond marks the time of the reading m An unfilled diamond indicates the reading was received from the monitor s built in maternal pulse oximetry module The vital signs print below the diamond m 4 A filled diamond indicates the reading was received from an external maternal pulse oximeter connected to the 120 Series Monitor The vital signs print below the diamond Contact your Service Representative for information about connectivity If the top three printing lines are busy printing other data the diamond prints at the time of the reading however the vital signs data prints as soon as a line becomes available The pulse rate value determined by MSpO always prints along with MSpO gt 2 Annotations from a Central Information System The 120 Series Monitor has three built in RS 232C ports which can be used to connect to a central information system which supports Hewlett Packard s Digital Series Protocol Contact your Service Representative for more information The 120 Series Monitor can also be configured via a Communications service screen to print
70. C 120 Series Maternal Fetal Monitor D 15 2015589 001 Spectra Alerts Alert Parameters Alert Parameters Table D 3 Summary of Alert Parameters BASELINE FHR BPM Average rate over past 10 minutes BASELINE ALERT PARAMETERS SUMMARY ON FHR SETUP SCREEN TREND SCREEN Parameter Column 1 Column 2 Message Criteria P Alert has not been silenced ALERT LEVEL We ii Alert has been silenced KK HIGH Alert pending FHR gt 160 BPM for 5 minutes Alert has not been silenced Reflects the detection of baseline FHR gt 160 BPM for 10 minutes Alert silenced BRADY BASELINE BASELINE Alert pending FHR 120 BPM for 5 minutes Alert has not been silenced Reflects the detection of baseline FHR lt 120 BPM fora pre determined period of time The alert occurs in 2 10 minutes depending on how low the rate goes Alert silenced Alertis deleted when baseline FHR is within the normal range for 10 minutes D 16 120 Series Maternal Fetal Monitor 2015589 001 Revision C Spectra Alerts Alert Parameters ALERT PARAMETERS SUMMARY ON FHR SETUP SCREEN TREND SCREEN Parameter Column 1 Column 2 Message Criteria UNKNOWN external Baseline variability is determined to be 5 15 AVERAGE internal beats peak to peak INCREASED Alert pending Approximately 5 minutes of baseline variability which is gt 15 beats peak to peak INCREAS
71. Condition After you press the UA Reference pushbutton if there is insufficient range to provide at least 100 relative units above the reference level probably because the belt is too tight the UA display area flashes the message CHECK TOCO If this happens remove the tocotransducer from the patient re reference with no pressure applied to the button re apply the transducer to approximately 25 relative units above the baseline then re reference one more time If you still receive the CHECK TOCO message try a different tocotransducer or contact your Service Representative Manually Setting the Baseline at the Default Value Briefly pressing the UA Reference pushbutton sets the baseline at the default setting the default is configured on the Install Options service screen The monitor is shipped from the factory with a default setting of 10 relative units Qualified service personnel can access the Install Options service screen to set the baseline default to 5 10 15 20 or 25 relative units Refer to the 120 Series Monitor Service Manual for more information Manually Overriding the Baseline Default Value Pressing and holding the UA Reference pushbutton for more than two seconds causes the UA reference level and display to override the default setting and cycle through all available selections 5 10 15 20 or 25 relative units starting at the default setting until the button is released Once the button is released the UA tr
72. Corometrics 120 Series V3 5 OPERATOR S MANUAL MANUAL P N 2015589 001 REV C A65 172 30 30 85 Sr 98 GE Medical Systems Information Technologies gemedicalsystems com Corometrics 120 Series V3 5 OPERATOR S MANUAL MANUAL P N 2015589 001 REV C A65 172 30 Q 430185 87 98 GE Medical Systems Information Technologies gemedicalsystems com GUARANTEE All equipment sold by GE Medical Systems Information Technologies is fully guaranteed as to materials and workmanship for a period of 1 year GE Medical Systems Information Technologies reserves the right to perform guarantee service operations in its own factory at an authorized repair station or in the customer s installation Our obligation under this guarantee is limited to repairing or at our option replacing any defective parts of our equipment except fuses or batteries without charge if such defects occur in normal service Claims for damage in shipment should be filed promptly with the transportation company All correspondence covering the instrument should specify the model and serial numbers GE MEDICAL SYSTEMS Information Technologies A GE Medical Systems Company GE Medical Systems Information Technologies will make available on request such circuit diagrams component diagrams component parts lists descriptions calibration instructions or other information which will assist the users or appropriately qualified technic
73. Detachable 31 inches 414556 001 Leadwire Adapter 3 Lead Multi Link to 3 Lead DIN 414371 001 Electrodes Round Foam Pouches of 30 Case of 300 9431 004 Revision C 120 Series Maternal Fetal Monitor 2015589 001 Supplies amp Accessories NBP Ordering Information NBP Ordering Information Table 19 9 NBP Supplies and Accessories Item Catalog Number REF Air Hose for Dual Tube Threaded Luer Cuff 12 foot Hose 9461 217 Reusable Single Tube Male Luer Cuff Small Adult 18 26 cm Range 5531CA0 Reusable Dual Tube Threaded Luer Cuff Small Adult 27795 Reusable Single Tube Male Luer Cuff Adult 25 35 cm Range 5522CA0 Reusable Single Tube Male Luer Cuff Large Adult 33 47 cm Range 5523CA0 Reusable Dual Tube Threaded Luer Cuff Adult 25 35 cm Range 5522AA0 Reusable Dual Tube Threaded Luer Cuff Large Adult 34 47 cm Range 5523AA0 Reusable Dual Tube Threaded Luer Cuff Adult Thigh 46 66 cm Range 5524AA0 Single P atient Use Dual Tube Locking Luer Cuff Small Adult 18 26 cm Range 10 carton 900373 003 Single P atient Use Dual Tube Locking Luer Cuff Adult 25 35 cm Range 10 carton 900373 002 Single P atient Use Dual Tube Locking Luer Cuff Large Adult 33 47 cm Range 10 carton 900373 001 NBP Hose Adapter 118 120 Series 414876 001 19 10 120 Series Maternal Fetal Monitor Revision C 2015589 001 Supplies amp Accessories MS pO Ordering Information MSpO Ordering Information
74. ED VARIABILITY Alert is issued if baseline variability remains increased for approximately 10 minutes and there are no other FHR alerts detected INCREASED VARIABILITY Alert silenced DECREASED Alert pending Reflects the detection of baseline variability which is lt 4 5 beats FHR VARIABILITY peak to peak for approximately 10 minutes DECREASED Alert will be issued 20 40 minutes after decreased variability is detected The time to alert depends on whether or not any other alert parameters are outside the normal range DECREASED VARIABILITY Alert silenced FLAT Alert pending Absent variability detected for approximately 4 minutes Alert will be issued approximately 6 10 minutes after flat variability is detected FLAT VARIABILITY Alert silenced Alert is deleted if approximately 5 minutes of better variability is detected DECELERATIONS ABSENT May miss subtle decelerations PRESENT Deceleration with or without a contraction is detected This indication may come and go prior to alert condition Once an alert condition is detected the word present remains until the alert condition is resolved Revision C 120 Series Maternal Fetal Monitor D 17 2015589 001 Spectra Alerts Alert Parameters ALERT PARAMETERS SUMMARY ON FHR SETUP SCREEN TREND SCREEN Parameter Column 1 Column 2 Message Criteria DECELERATIONS DECELERATIONS
75. IS The Spectra Alerts option provides bedside alerts only If you connect the 120 Series Monitor to a Quantitative Sentinel or Spectra 400 Alert and Surveillance Central System you must disable the Spectra Alerts feature in the monitor The Spectra Alerts option when installed is enabled disabled from the Fetal Alarms field on the Install Options Service screen FHR alarms and Spectra Alerts cannot be enabled at the same time You may select one or the other or you can disable them both To effect a change to the Fetal Alarms setting you must turn the monitor off then back on again When the Spectra Alerts option is enabled a solid bell icon A displays next to the FHR mode title s and prints on the strip chart paper prior to the active FHR mode annotation s Refer to Figure D 1 and Figure D 2 This icon indicates that the feature is enabled only it does not indicate the presence of an alert condition The Spectra Alerts feature is designed to assist the perinatal staff in assessing the status of monitored patients by recognizing normal and abnormal pattern features Medically researched pattern recognition techniques are utilized to detect when the pre set limits have been exceeded When abnormal features are recognized by the system these features are displayed on an Alert Parameters area on the FECG US or US2 Setup screen whichever is affected When the abnormal feature s meet the preset criteria for an alert the monitor p
76. Manual for more information When ECG artifact elimination is turned on the monitor does not print any new FHR value which differs by more than 25 BPM from the previously calculated heart rate value The printing inhibition functions on a beat to beat basis by comparing the last calculated rate against the newly calculated rate The rate used for comparison purposes is always the previous rate regardless of whether this rate passed the previous 25 BPM test When ECG artifact elimination is turned off all direct ECG rates are plotted by the recorder without regard to their deviation from previous rates The effect of this function change is that sudden heart rate changes such as certain arrhythmias accelerations or decelerations as well as artifactual changes as when the electrode is disturbed or loosely connected are recorded when ECG artifact elimination is turned off They are not recorded when ECG artifact elimination is turned on instead gaps in the tracing occur 5 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Fetal Heart Rate Monitoring FECG Internal Method FECG Setup Screen Select the FECG softkey to access the FECG Setup screen Figure 5 2 FECG US TOCO FECG SETUP HIGH LOW 140 200 OFF OFF 60 140 VOLUME 5 0 1 1 2 2 3 3 4 4 f ALARMS HIGH LOW 5 7 FHR 160 120 BPM 6 8 ON T g OFF AUDIO ALARMS ON VOLUME
77. Maternal Fetal Monitoring Operator s Manual for instructions on applying the transducers Ensure the setup menus are configured appropriately for use on this patient Refer to Setup Screens on page 4 8 Turn the recorder on Refer to Chapter 12 Recorder Modes for more information CAUTION PAPER MOVEMENT Always ensure that the chart paper is properly moving out the front of the recorder drawer when the Record indicator light is on Press the Paper Advance pushbutton to create a paper leader Press the Test button to run the monitor s self test routines Refer to Self Test Routine on page 4 7 Check the time and date that is printed on the strip chart paper Refer to General Setup Screen on page 4 9 if you need to change the time date setting 10 Annotate the patient name and ID using the optional Corometrics Model 2116B Data Entry Clinical Notes Keyboard if available PT NAME MARY SMITH PT ID 48576 4 PT AGE 32 DR CARTER 44 04 JAN 9 08 nasag E Ss EE Figure 4 13 Annotating Patient Information Revision C 120 Series Maternal Fetal Monitor 4 17 2015589 001 Setup Procedures Preparing the Monitor for Patient Use For your notes 4 18 120 Series Maternal Fetal Monitor 2015589 001 Revision C Fetal Heart Rate Monitoring This section provides a brief overview of the fetal heart rate monitoring methods available o
78. O trending Refer to SpO Scale on page 4 10 No matter which scale is active the scale prints on the paper approximately every 1 5 pages and is annotated with SpO 0 100 Scale This option configures the MSpO trend to plot at a fixed scale of 0 100 like FSpO2 Advantage Eliminates switching back and forth between two different scales Disadvantage The fine details of the maternal trend may not be seen Auto Scale When trending MSpO only the trend plots on an expanded scale of 60 100 or 50 100 depending on the paper At the commencement of FSpOz trending the MSpO trend automatically changes to a scale of 0 100 so that fetal and maternal trends are plotted on the same scale If FSpO2 trending stops the MSpO trend switches back to plotting on an expanded scale Whenever there is a scale changeover a dashed vertical line prints to call attention to the change the new scale prints shortly afterwards Advantage Shows more details of MSpO trend when fetal trending is absent Disadvantage Requires paying close attention to the printed scales The 96MSpO trend is plotted over a range of 60 10096 on paper with a HR scale ranging from 30 240 BPM The 96MSpO trend is plotted over a range of 50 100 on paper with a HR scale ranging from 50 210 BPM 12 8 120 Series Maternal Fetal Monitor Revision C 2015589 001 Recorder Modes On Mode Figure 12 4 shows an example of a MSpO z s
79. Options Screen sse nn n nnns 4 14 Preparing the Monitor for Patient Use ccscsccsecaeeaeeaeeaeeeneans 4 17 D Fetal Heart Rate Monitoring seeese Dl Ultrasound External Method oen n n n n n n n n n n n n nns 5 2 Metriodology asmarae nian ode d air UR et a dure Wine Res a Dep 5 2 USUS S etup Screeri io as Foret itcm Fe trece ni 5 2 Fetal Heart Rate Offset cece cece teeter eee ne 5 3 Volume skis scntnncactansrt ani p MM LE oan aia 5 3 FAR Alarmni Limits ach E een RO OU Ce CCS 5 3 FAR AUNO Ala orsus eost rete ether rb Eus des 5 3 Master Alarm Volume 5 3 FECG Internal Method nnn nn n nnn nnn 5 4 Methodology ix cerebro Ete eoe e oo ESO etre tb Eb ed 5 4 ArtfactElimiliquOD aca ver rite pter ecm Pete eere den 5 4 Enabling Disabling Artifact Elimination iis 5 4 Theory and Methodology isssssssssee e 5 4 RECG Setup SGleGh ition ctae Posee m nine deren bm beeen nen 5 4 Volume rect ee a aaa aaa wt ee epee ees 5 5 F HRPAl artrEINite a 2 3 obe tate et eee teo d ade oa en 5 5 FHR Audio Alarm cente ad ato a ice d 5 5 Master Alarm Volume 5 5 FECGWavefortme mas oct ae oe eet qno Bp Poi ne bern athens 5 5 Dual Fetal Heart Rate Monitoring iseeene nnne n n nnns 5 6 Heartbeat Coincidence cece cece eee tees 5 6 Fetal Heart Rate Offset 00 icici ccc eect terete eee e tent en eenes 5 6 Enabling Disabling the Fetal Heart Rate Offset Feature 0 5 7
80. Reorient or relocate the other receiving device W Increase the separation between the interfering equipment and this equipment m If assistance is required contact your GE Medical Systems Service Representative 1 8 120 Series Maternal Fetal Monitor Revision C 2015589 001 Safety Equipment S ymbols Equipment Symbols The following is a list of symbols used on products manufactured by GE Medical Systems Information Technologies Some symbols may not appear on your unit Table 1 2 Equipment Symbols ATTENTION Consult accompanying documents TYPE B EQUIPMENT Type B equipment is 2 Suitable for intentional external and internal X application to the patient excluding direct cardiac application TYPE BF EQUIPMENT Type BF equipment is suitable for intentional external and internal aN application to the patient excluding direct cardiac application Type BF equipment has an F type applied part DEFIBRILLATOR PROOF TYPE BF EQUIPMENT Type BF equipmentis suitable for intentional external and internal application to the patient IRI excluding direct cardiac application Type BF equipment is type B equipment with an F type isolated floating part The paddles indicate the equipment is defibrillator proof o ALTERNATING CURRENT AC d EQUIPOTENTIALITY 0 POWER OFF disconnection from the mains POWER ON connection to the mains Revision C 120 Series Maternal Fetal Monitor 1 9 2
81. Series Maternal Fetal Monitor 2015589 001 Maternal Vital Signs History Using the Maternal Vital Signs History Screen Using the Maternal Vital Signs History Screen Displaying the Screen 1 Select the VSHX softkey to display the Vital Signs History screen 2 Select the amp VIEW softkey to scroll through the data Scroll right roll towards the oldest data scroll left towards the most recent data 3 Press the Trim Knob control to de activate the VIEW softkey 4 Select the EXIT softkey to return to the main screen Selecting the HX Interval The maternal Vital Signs History screen can be configured to display different columns of data by adjusting the HX Interval field The interval choices are EVENT to display all events and 1 5 10 15 30 and 60 minutes The factory default setting is EVENT The history interval has no effect on the data being stored You can change the interval setting at any time and all data for the most recent eight hours is available for display When the screen is called up for display the previous minute in time is listed at the far right of the screen the preceding values to be displayed are counted backwards from the previous minute in time based on the intervals you have selected m Example The HX interval is set at 5 minutes and the maternal Vital Signs History screen is displayed when the current time is 13 57 When the screen is displayed there will be five columns of dat
82. Summary of 120 Series Alarms Type Condition Visible Advisory Audible Advisory An alarm setting audio or high low K limit is turned off displays to the left of the MS pO mode title Alarm Defaults Audio on Volume 5 Limits High 10096 Low 9596 Re alarm 120 sec 96MSpO limit high or low actively MSpO numeric flashes Alternating high low tones if MSp0 being violated Issued after about8 MSpO value and pulse rate audio enabled seconds Malfunction with MS pO circuitry MS pO intermediate cable disconnected from monitor sensor assembly disconnected from intermediate cable or sensor or cable has a broken wire print on the strip chart COMM or REPAIR message displays in MSpO area Dashes in place of 96MS pO numeric Alternating high low tones if audio enabled Alternating high low tones if audio enabled 8 There is an MECG re alarm There is an MSpO re alarm NOTE You must cycle power to reset factory defaults B 4 120 Series Maternal Fetal Monitor 2015589 001 Revision C Fetal Movement Detection Each monitor in the 120 Series can be upgraded to include fetal movement detection This feature is designed to detect gross fetal body movements and body movements with associated limb movement This chapter discusses the following Revision C 120 Series Maternal Fetal Monitor 2015589 001 C 1 Fetal Movement Detection
83. Table D 2 provides a list of possible results which can appear in the Alert Parameters summary Table D 2 Summary of Alert Parameters Alert Analysis Result Possibilities Parameter Label Column 1 Column 2 ALERT LEVEL HIGH LOW Range BPS NE PERABU For example 145 150 BRADY TACHY UNKNOWN AVERAGE INCREASED DECREASED FHR VARIABILITY FLAT INCREASED DECREASED FLAT ABSENT DECELERATIONS PRESENT PRESENT ARTIFACT ARRHYTHMIA PRESENT UA BASELINE PRESSURE lati it H d L pressure in relative units or mmHg DI HYPERTONUS TACHY SYST UC IN 10 MIN of UCs TACHYSYST DURATION OF LAST UC of d allie or seconds ITETANIC TETANIC GOOD MODERATE SIGNAL QUALITY POOR UNKNOWN D 8 120 Series Maternal Fetal Monitor Revision C 2015589 001 Spectra Alerts Alert Parameters Summary Figure D 5 provides an example of an alert with two columns of information Inverse video indicates the feature is contributing to an alert Some fields are informational Some fields indicate a prealert condition IUP 162 144 29 FECG SETUP VOLUME ALERT LEVEL BASELINE HR BPM FHR VARIARII ITY DECELERATIONS ARTIFACT ARRHYTHMIA UA BASELINE PRESSURE UC IN 10 MIN DURATION OF LAST UC SIGNAL QUALITY ALERT ON ALERT PARAMETERS 160 165 AVERAGE PRESENT 29 HYPERTONUS 8 TACHYSYSTOLE 80 TETANIC POOR WITH UC VOLUME 5 Figur
84. US Setup screen to ON Refer to Figure C 1 This field is only displayed for the US connector and if the option is installed in your monitor and if a transducer is plugged into the US connector Rotating the Trim Knob control alternates between ON and OFF The factory default setting is OFF When fetal movement detection is enabled and a transducer is plugged in the annotation FMD appears in between the FHR1 and FHR2 mode titles Refer to Figure C 1 FECG FMD US TOCO 165v 172 30 US SETUP FM DETECT ON HR OFFSET OFF VOLUME 5 Figure C 1 US Setup Screen Strip Chart Annotation When fetal movement detection is enabled the mode annotation FMD prints following the FHR modes The annotation provides an indication that the feature is enabled it does not indicate detection When fetal movement is detected a solid line is automatically marked on the bottom of the upper grid for the duration of the detected movement Refer to Figure C 2 Revision C 120 Series Maternal Fetal Monitor C 3 2015589 001 Fetal Movement Detection Using Fetal Movement Detection While Monitoring Using the Remote Event Marker to Complement the Patient Record The Remote Event Marker is an accessory that can be used to complement the patient record 1 Connect the Corometrics Remote Event Marker to the Remote Mark f connector on the rear panel of the 120 Series Monitor 2 Instruct the mother to p
85. When SaO is calculated from a blood gas measurement of the partial pressure of arterial oxygen PaO the calculated value may differ from the 120 F Series Monitor FSpO measurement This is because the calculated SaO may not have been corrected for the effects of variables that shift the relationship between PO and SO see Figure 6 1 temperature pH the partial pressure of carbon dioxide PCO and the concentrations of 2 3 DPG and fetal hemoglobin 7 pH 100 Temperature ILES S Pcoe at 7 2 3 DPG x Fetal Hb t T 2 3 DPG 5 ds 2 Temperature 5 50 T Pcoe 3 B G 7 50 100 PO mmHg Figure 6 1 Figure 4 Oxyhemoglobin Dissociation Curve Normal Range of FSpO Values During Labor and Delivery During labor and delivery a healthy fetus has a much lower range of oxygen saturation than that of a healthy air breathing patient The normal oxygen saturation range for a healthy adult is 95 to 100 The normal oxygen saturation range for a healthy fetus during labor is 3096 to 10 6 8 120 Series Maternal Fetal Monitor Revision C 2015589 001 Fetal Pulse Oximetry Monitoring FSpO Setup Screen FSpO Setup Screen OFF 2 MIN 5 MIN 10 MIN 15 MIN 30 MIN 60 MIN Response Time Print Interval SLOW FAST OFF Select the FSPO2 softkey to access the FSpO Setup screen Figure 6 2 IMPORTANT SOFTKEY ACTIVATION The Co
86. a for the following times 13 36 1341 13 46 13 51 13 56 If the screen remains displayed for one minute the columns of data change to 13 37 13 42 13 47 13 52 13 57 Printing the Maternal Vital Signs History Screen NOTE Once the print function is activated you may exit the history screen it need not remain displayed during printing Printing the Entire Vital Sig You can select all or a portion of the maternal vital signs history for printing on the strip chart paper The information is printed in the upper portion of the top or left grid of the strip chart paper at a high speed mode If the recorder is on all other trending is interrupted while the maternal vital signs history is printed If the recorder is in the maternal only mode the recorder interrupts any printing of data to print the vital signs history any pre empted data is printed at the end If the recorder is off it will turn on to print the vital signs history then turn off again ns History Select the PRINTALL softkey to print the entire vital signs history An audible tone provides confirmation 13 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Vital Signs History Using the Maternal Vital Signs History Screen Printing a Page of the Vital Signs History Use the lt VIEW softkey to display a page then select the PRINT softkey to print the selected page An audible tone provides confirmation Stopping the Printing of Mate
87. ace and UA value take on this new value as a baseline for reference Briefly pressing the UA Reference pushbutton reverts back to using the default setting configured via the Install Options service screen Automatic Baseline Zeroing If pressure falls below 0 relative units probably because the belt has loosened automatic UA referencing occurs and a new baseline reference is set at O relative units Revision C 120 Series Maternal Fetal Monitor 7 3 2015589 001 Uterine Activity Monitoring Internal Method IUPC Internal Method IUPC NOTE To secure a strain gauge post for IUPC monitoring refer to the strain gauge manufacturer s instructions Methodology A catheter inserted transcervically into the uterine cavity measures intrauterine pressure You can monitor using either a fluid filled catheter or a transducer tipped catheter The mode IUP and value are shown in the UA area of the display The UA value displays in mmHg from 0 100 Uterine activity is continuously plotted on the bottom or right grid of the strip chart paper as a plain black line Pressure exceeding 100 mmHg is printed as a straight line at 100 mmHg Why You Must Zero the System When you zero the system you are referencing the pressure to 0 mmHg while the system is open to air to ensure an absolute pressure measurement Refer to the Maternal Fetal Monitoring Operator s Manual for more information m f you disconnect the patient from the m
88. ach parameter EE 10 2 MSpO Setup Sereen ioosioseRke eR E ws eee theca Ee 10 3 MSpO Methodology 0 0 806 cess re ERR HERES 10 6 Additional Featres cmi scere tere RE ERR ER GI ys 10 7 Module and Probe Compatibility 5 eese RR 10 8 Revision C 120 Series Maternal Fetal Monitor 10 1 2015589 001 Maternal Pulse Oximetry Monitoring Theory Theory Nellcor Masimo MSp0z2 Technology The 120 Series Monitor measures the maternal oxygen saturation and pulse rate using the principles of spectrophotometry and plethysmography The MSpO sensor is comprised of two light emitting diodes LEDs which are the emitters and one photodiode which is the detector One LED emits red light and the other infrared into the patient s skin The detector receives the amount of light that is not absorbed at the sensor site and the monitor uses the relative absorption of red and infrared to compute the functional percentage of hemoglobin that is combined with oxygen The heart rate is calculated from the pulses measured at the sensor site The Masimo SET MS 5 pulse oximeter as well as traditional pulse oximetry determines SpO by passing red and infrared light into a capillary bed and measuring changes in light absorption during the pulsatile cycle Red and infrared light emitting diodes LEDs in oximetry sensors serve as the light sources a photodiode serves as the photodetector Traditional pulse oximetry assumes that all pulsations in
89. al personnel to repair those parts of the equipment which are classified by GE Medical Systems Information Technologies as repairable Refer to the 120 Series Service Manual for further information A CAUTION In the United States of America Federal Law restricts this device to sale by or on the order of a physician NOTICE Purchase of a 120 Series Monitor confers no express or implied license under any Nellcor Puritan Bennett patent to use the 120 Series Monitor with any fetal oximetry sensor that is not manufactured or licensed by Nellcor Puritan Bennett Corometrics and Marquette are registered trademarks of GE Medical Systems Information Technologies GE is a registered trademark of General Electric Company All other product and brand names are trademarks or registered trademarks of their respective companies 2003 2004 GE Medical Systems Information Technologies All rights reserved No part of this manual may be reproduced without the permission of GE Medical Systems Information Technologies Portions of this manual related to fetal pulse oximetry have been reprinted by permission of Nellcor Puritan Bennett Pleasanton CA CE Marking Information CE Marking Information 0459 Compliance A Corometrics brand 120 Series Monitor bears CE mark CE 0459 indicating its conformity with the provisions of the Council Directive 93 42 EEC concerning medical devices and fulfills the essential requirements of Annex I of
90. al to or greater than 6096 to detect heartbeat coincidence since blood pressure is a static measurement of the detected beats for about 60 seconds the cessation of coincidence is indicated when the phase relationship is inconsistent for greater than 4096 of the detected beats for about seven seconds Heartbeat coincidence detection is most useful when monitoring twins but can also detect when an elevated maternal heart rate is mistaken for a fetal heart rate Table 14 1 summarizes the combinations of heart rate sources that are continuously compared for the possibility of coincidence Table 14 1 Heartbeat Coincidence Comparisons Mode FECG US US2 MECG MSpO FECG v Y Y v US Y v v v US2 v v Y 4 MECG Y v a N C MSpO0 Y Y v A N C means the heartbeats are NOT compared 14 2 120 Series Maternal Fetal Monitor 2015589 001 Revision C Heartbeat Coincidence Using the Heartbeat Coincidence Feature Using the Heartbeat Coincidence Feature Enabling Disabling Heartbeat Coincidence Detection Display Indicator NOTE Although an unlikely scenario if three channels are picking up the same signal the heart rate numerics for all three heart rates display in inverse video This feature is enabled from the Install Options service mode screen Refer to the 120 Series Monitor Service Manual for detailed information about enabling disabling this feature When heartbeat coinci
91. amount of history data has been collected and the monitor must be turned off you may wish to print the data prior to powering off the monitor in order to retain a hard copy for your files The monitor stores up to eight hours of data on a first in first out basis After eight hours of data storage the oldest data begins to be replaced by new data In other words the first in is the first out The monitor stores the following maternal vital signs data Each manual and automatic blood pressure event is stored A blood pressure event includes the systolic pressure diastolic pressure mean arterial pressure and maternal pulse rate derived from the blood pressure cuff An event snapshot of MSpO is taken every minute An MSpO event includes the 70MSpO and the maternal pulse rate derived from the sensor An event snaphot of the MHR is taken every minute A MHR event is the MHR value derived from the MECG electrodes 13 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Vital Signs History What is the Maternal Vital Signs History Screen AUS A US2 TOCO 154v 135 17 VITAL SIGNS HISTORY DATE 24 MAR 24 MAR 24 MAR 24 MAR 24 MAR TIME NBP SYS DIA MAP P MSPO2 2002 P MECG 12 00 12 10 12 20 12 30 12 40 122 125 90 95 94 105 75 81 99 100 75 81 75 81 HX INTERVAL 10 MIN PRINTALL VIEW Figure 13 1 Maternal Vital Signs History Screen Revision C 120
92. an also be selected from the MECG Lead Softkey on the normal operating screen Lead I refers to the potential between the left arm and the right arm Lead II refers to the potential between the right arm and left leg Lead III refers to the potential between the left arm and the left leg Figure 8 2 illustrates which electrodes reference the ECG lead obtained 8 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Heart Pulse Rate Monitoring MHR P Setup Screen Z WHITE RA BLACK LA BLACK LA RED R YELLOW L YELLOW L Hl Hl II RED LL RED LL GREEN F GREEN F NOTE AHA label bolded IEC label italicized Figure 8 2 MECG Lead Selection Guide MECG Pacer This field enables disables pacemaker pulse rejection circuitry m Off Use this setting for a patient without a pacemaker All ECG events are monitored all complexes including pacer spikes may be displayed and may be included in the heart rate calculation m On Use this setting for a patient who has a pacemaker The monitor rejects the pacer spike from the heart rate calculation and replaces the actual pacer spike with a pacer event mark in addition the letter P is displayed prior to the waveform speed Figure 8 3 shows an example of an MECG waveform with the MECG pacer ON P 25 mm s ll AUTO MECG 09 21 41 ECG FROZEN 09 22 06 PRINT Eia ALARMS SETUP VSHX Figure 8 3 MECG Waveform with Pacer Enabled I
93. an emphasized note Itis something you should be particularly aware of something not readily apparent Note A NOTE indicates a particular point of information something on which to focus your attention Revision C 120 Series Maternal Fetal Monitor 2015589 001 1 3 Safety Monitor Contraindications Warnings and P recautions Monitor Contraindications Warnings and Precautions Warnings WARNINGS ACCIDENTAL SPILLS In the event that fluids are accidentally spilled on the monitor take the monitor out of operation and inspect for damage APPLICATION This monitor is not designed for direct cardiac connection CONDUCTIVE CONNECTIONS Avoid making any conductive connections to applied parts patient connection which are likely to degrade safety CONDUCTIVE PARTS Ensure that the conductive parts of the lead electrodes and associated connectors do not contact other conductive parts including earth CONNECTIONS The correct way to connect a patient to the monitor is to plug the electrode leads into the patient cable which in turn connects to the monitor The monitor is connected to the wall socket by the power cord Do not plug the electrode leads into the power cord a wall socket or an extension cord DEFIBRILLATION During defibrillation all personnel must avoid contact with the patient and monitor to avoid a dangerous shock hazard In addition proper placement of the paddle
94. and adjustments the sensor may be damaged or the patient module may be damaged m Check the fetus for other signs of distress m f possible keep the patient still m Assess sensor location and determine appropriate adjustment m Replace the sensor ortry another Corometrics Fetal Patient Module 17 6 120 Series Maternal Fetal Monitor 2015589 001 Revision C Troubleshooting Fetal Pulse Oximetry Troubleshooting Table 17 4 Fetal Pulse Oximetry Troubleshooting Continued Problem Probable Cause Possible Solution Sensor Lifted icon 8 displayed in FSpO area of display m Sensor not making adequate contact at the sensor site on the fetus m Damaged sensor m Assess sensor position relative to fetal head Assess sensor depth relative to the fetal presenting part advance or withdraw the sensor as indicated in the 120 Series Service Manual m If the icon does not respond to advancing or withdrawing the sensor remove the sensor and place a new sensor as directed in the 120 Series Service Manual Sensor Disconnected icon C displayed in FS pO area of display m Sensor disconnected from fetal patient module cable or fetal patient module cable disconnected from monitor m Damaged fetal patient module m Invalid FS pO sensor connected to fetal patient module cable m Ensure fetal patient module cable is firmly attached to sensor assembly and monitor If c
95. anesthetics or inside an oxygen tent Such use may constitute a fire or explosion hazard WATER BIRTHS Do not use the monitor to directly monitor patients during water births in whirlpool or submersion water baths during showers or in any other situation where the mother is immersed in water Doing so may result in electrical shock hazard INTERFACING OTHER EQUIPMENT Monitoring equipment must be interfaced with other types of medical equipment by qualified biomedical engineering personnel Be certain to consult manufacturer s specifications to maintain safe operation MATERNAL INFECTIONS Do not use the FSpO feature in women with active genital herpes or other infection precluding internal monitoring Insertion of the fetal oxygen sensor in these women may result in transmission of pathogens to the fetus MATERNAL HIV Do not use the FSpO feature in women who are seropositive for human immunodeficiency virus HIV Insertion of the fetal oxygen sensor in these patients may result in fetal exposure to the virus MATERNAL HEPATITIS Do not use the FSpO feature in women who are seropositive for Hepatitis B and or Hepatitis E Insertion of the fetal oxygen sensor in these patients may result in fetal exposure to these antigens CAUTIONS TRAINING Physicians and other licensed practitioners who use the FSpO feature should have demonstrated expertise in determining fetal presentation and head position and should b
96. at 9 20 9 35 9 50 10 05 etc 12 20 120 Series Maternal Fetal Monitor Revision C 2015589 001 Recorder Modes Chart Style Vital Signs Printing Chart Style Printing Examples When chart style printing is enabled The 15 minute interval prints on the quarter hour e g 9 00 9 15 9 30 9 45 etc The 30 minute interval prints on the half hour e g 9 00 9 30 10 00 10 30 etc The 60 minute interval prints on the hour e g 9 00 10 00 11 00 12 00 etc The following are examples of chart style printing NBP Example 1 The automatic blood pressure mode is activated at 9 03 with the interval time set to 15 minutes Whereas the first real time reading would occur at 9 18 the first chart style reading is taken at 9 15 Subsequent readings are taken and printed at 9 30 9 45 10 00 10 15 etc NBP Example 2 The automatic blood pressure mode is activated at 9 17 with the interval time set to 30 minutes Whereas the first real time reading would occur at 9 47 the first chart style reading is taken at 9 30 Subsequent readings are taken and printed at 10 00 10 30 11 00 11 30 etc MSpO Example 1 The MSpO print interval time is set to 30 minutes and the sensor is connected at 9 24 a m Whereas the first real time printing would occur at 9 54 the first chart style printing is done at 9 30 Subsequent values are printed at 10 00 10 30 11 00 11 30 etc MSpO Example 2 The MSpO print interval time is set
97. ate the fetal pulse During successful monitoring the message area is blank Revision C 120 Series Maternal Fetal Monitor 6 11 2015589 001 Fetal Pulse Oximetry Monitoring FS pO Display Area TOCO 165v 172 30 util ANBP 02 5 A MECG FSPO2 130 85 899 47 MAP 107 03 15 03 22 45 PRINT FREEZE ALARMS SETUP VSHX Figure 6 4 Display of Fetal Pulse Oximetry EUD US2 NEC TOCO 165 172 30 ANBP Q oz15 fi MECG fi MSPO2 130 85 899 97 MAP 107 03 15 cect ll FSPO2 63 MECG 03 22 45 PRINT FREEZE ALARMS SETUP VSHX Figure 6 5 Simultaneous Display of Fetal and Maternal Pulse Oximetry 6 12 120 Series Maternal Fetal Monitor Revision C 2015589 001 Fetal Pulse Oximetry Monitoring Fetal Patient Module Fetal Patient Module The fetal patient module is shown in Figure 6 6 Fetal oxygen sensor connector Sensor lock Figure 6 6 Fetal Patient Module The fetal oxygen saturation monitoring system consists of three components Corometrics 120 F Series Maternal Fetal Monitor with built in Nellcor FM 401 module Corometrics Fetal Patient Module a modified Nellcor patient module to connect to the monitor m Nellcor OxiFirst Fetal Oxygen Sensor Series FS14 The Fetal Patient Module provides initial amplification of the fetal oximetry signal This patient module has a connector for the sensor and a cable that connects into the 120 F Series front
98. aternal Fetal Monitor 2015589 001 1 7 Safety Monitor Contraindications Warnings and P recautions Electromagnetic Interference This device has been tested and found to comply with the limits for medical devices to the IEC 601 1 2 1993 EN60601 1 2 1994 Medical Device Directive 93 42 EEC These limits are designed to provide reasonable protection against harmful interference in a typical medical installation However because of the proliferation of radio frequency transmitting equipment and other sources of electrical noise in the health care and home environments for example cellular phones mobile two way radios electrical appliances it is possible that high levels of such interference due to close proximity or strength of a source may result in disruption of performance of this device This equipment generates uses and can radiate radio frequency energy and if not installed and used in accordance with these instructions may cause harmful interference with other devices in the vicinity Disruption or interference may be evidences by erratic readings cessation of operation or incorrect functioning If this occurs the site of use should be surveyed to determine the source of this disruption and actions taken to eliminate the source The user is encouraged to try to correct the interference by one or more of the following measures m Turn equipment in the vicinity off and on to isolate the offending equipment m
99. attention to the start of the shifted trend Refer to Figure 5 3 for an example of a shifted trend De activating the Fetal Heart Rate Offset Feature After the FHR patterns have been assessed set the secondary FHR trend back to the normal unshifted position Ensure the recorder is on NOTE If the auto revert 10 MIN 2 Press and hold the Mark Offset button for tree seconds Or use the US US2 setting is selected on the Install Options Setup screen service screen the shifted heart rate trace automatically reverts to normal after 10 minutes A left arrow and a vertical dashed line print to draw attention to the change The trend returns to the unshifted position Setting the FHR trend to the normal unshifted mode does not disable the HR Offset function it de activates it To disable the mode refer to the 120 Series Monitor Service Manual Revision C 120 Series Maternal Fetal Monitor 5 7 2015589 001 Fetal Heart Rate Monitoring Dual Fetal Heart Rate Monitoring e T N Z Y T d 02377 S 02 l US2 20 N E SON J N Y N 7 X t4 X P M 4 9 00 7t LQz120 Hi 160 US TOCO v 3CMIMIN se lL lt Figure 5 3 Fetal Heart Rate Offset Example 120 Series Maternal Fetal Monitor Revision C 2015589 001 Fetal Pulse Oximetry Monitoring A 120 Series Monitor with built in fetal pulse oximetry is called a 120 F Series Monitor Model 1
100. audible indication remain present until you press the Alarm Silence button This ensures that a clinician is aware that an alert occurred You may hear this type of alert described as latching m Resolved Silenced Alert If you have already silenced an alert the visual indications disappear automatically Alert Suspension Feature When a care provider is at the patient s bedside it may be desirable to suspend the audio component of alerts When you suspend alerts the audio indication is inhibited as well as the nurse call interface the visual indications remain active and data continues to be assessed Enabling Disabling the Alert Suspension Feature The alert suspension feature must be enabled disabled on the Install Options Service screen Refer to the 120 Series Monitor Service Manual for more information The alert suspension feature has two settings m off disabled users cannot activate the function m on enabled users can manually activate de activate the function Suspending Audio Alerts and the Nurse Call Interface To suspend alerts press and hold the Alarm Silence button for approximately three seconds you will hear two beeps as feedback While suspended m alerts are only indicated visually on the monitor s display screen m an alert suspension icon m an alert suspension icon A A displays next to the FHR mode title s prints on the strip chart paper along with
101. aults and setting options Revision C 120 Series Maternal Fetal Monitor 10 5 2015589 001 Maternal Pulse Oximetry Monitoring MS pO Methodology MSpO Methodology The maternal oxygen saturation is indicated by up to three digits representing the percentage of oxygen saturation The pulse amplitude indicator is a vertical bar that visually indicates each pulse If MSpO is selected as the MHR P source each pulse beat is indicated with a beep that varies in pitch to reflect changes in the oxygen saturation reading The pitch rises as the saturation values increase the pitch lowers as the saturation values decrease When enabled the MSpO gt trend print in the bottom grid as a grey trace annotated by MSpO2 Values are printed on the annotation area preceded by an outlined diamond which marks the time of the reading If MSpO is selected as the MHR P source and the MSpO response time is set to SLOW the pulse rate area of the display is blank The response time must be set to NORMAL or FAST to display a pulse rate Refer to Chapter 8 Maternal Heart Pulse Rate Monitoring for more information 10 6 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Pulse Oximetry Monitoring Additional Features Additional Features MSpOz Pulse Beat Audio If MSpO is selected as the MHR P source each pulse beat is indicated with a beep the pitch of the beep will vary according to
102. ber pee pO REY er dl 6 11 Sensor Lifted 1x secre cinere nb OI eka nel de ec her ia Pet kA gn 6 11 Pulse Search xau oot de tore aet ion d i b a eR aed 6 11 Fetal Patient Module sene n nennen 6 13 FSpO Methodology isse nnne nennen 6 14 FSpO Waveform i i osivas sees e vaa are e c C LECTOR RE RR n 6 15 FSpO Monitoring Basic Operation s enn n n n n nn 6 16 Uterine Activity Monitoring cccecccseeeeeenveeee Del Tocotransducer External Method nnn nn n n n n n n n n nn nn 7 2 Methodology rn rre RR ebd ere D E de to ds 7 2 Establishing a Baseline ccc cece cece cette tent e 7 2 Initial Referencing 2n t Your ted e ed e ede hit 1 2 For Trimline Tocotransducers Only 0 cc eec eee eene 7 2 For other transducers i e Nautilus 0 0 eee eee eee 7 2 Accounting for Belt Tension 0 ccc cece eu eue ceases eueeaeeas 7 3 More About Referencing 7 3 OutofRange Condition 0 0 eee eae 7 3 Manually Setting the Baseline at the Default Value 00 ee 7 3 Manually Overriding the Baseline Default Value o n 71 3 Automatic Baseline Zeroing 0 cco 1 3 Internal Method IUPC sennnn nnnm 7 4 Methodology isc dose eerte id hpseceiet ror Etre eb ie mbites ATA 7 4 Why You Must Zero the System isse 7 4 Maternal Heart Pulse Rate Monitoring 8 1 MHR P Source sc cc cece e eee c eee eee eeeeeeeeesaeeeeesaeeeeeaeneens 8 2 MHR P Setup Scr
103. ble 3 8 FSpO Display Name Description A FSpO Value This three digit display indicates the FS pO level calculated form qualified optical pulses B FSpO2 Mode Title The FSpO title indicates that fetal oxygen saturation monitoring is in progress C Signal Quality Indicator This indicator shows the average signal quality of pulses being detected at the sensor site according to a software algorithm in the 120 F Series Monitor The presence of all ten bars represents fetal pulses with consistently high signal quality for FS pO measurement Fewer bars represents diminished signal quality The absence of bars represents a lack of fetal pulses with acceptable signal quality Pulse Amplitude Indicator This vertical bar qualitatively indicates pulse amplitude at the sensor site Revision C 120 Series Maternal Fetal Monitor 3 13 2015589 001 Controls Indicators and Connectors Front Panel Displays MSpO Area The MSpO area is summarized by Figure 3 9 and Table 3 9 C D B a J MSPO2 97 Figure 3 9 MSpO Display Table 3 9 MSpO Display Name Description A MSpO Value Up to three digits indicate the percentage of oxygen in the mother s blood MS p02 Alarm Setting Indicator This symbol provides information about the MS pO audio alarm andthe MS pO high low alarm limit settings See Chapter 11 Alarms for more information KK An alarm s
104. c and mean pressures User selectable high and low pulse rate Technical Cuff errors connection errors insufficient signal excessive inflation or determination times overpressure hose errors excessive motion communication problem or self test failure Compliance The 120 Series blood pressure module complies with the American National Standard for Electronic or Automated S phygmomanometers AAMI ANSI SP 10 1992 Blood pressure measurements determined with this device are equivalentto those obtained by a trained observer using the cuff stethoscope method within the limits prescribed by the American National Standard for Electronic or Automated S phygmomanometers Revision C 120 Series Maternal Fetal Monitor 18 5 2015589 001 Technical Specifications Operating Modes Table 18 2 Operating Mode Specifications Continued Fetal Pulse Oximetry Mode Nellcor Technique Sensor Type Saturation Range Saturation Accuracy with Nellcor Puritan Bennett FS 14B Sensor Wavelengths Red Infrared S pectrophotometry and plethysmography Nellcor Puritan Bennett Model FS 14B only 10 10096 96S pO 1 standard deviation Reproducibility is 1 standard deviation 2 696 Nominally 68 of the measurements across the population will be within 1 standard deviation 735 nm nominal 890 nm nominal Maternal Pulse Oximetry Mode Nellcor Technique Sensor Type Saturation Range Pulse Rate Range Saturation Acc
105. cale changeover when AUTO is configured In the example At startup both 70MSpO and FSpO are trended Initially the 0 100 scale is printed on the paper along with the trended data Midway through the example FSpO trending stops The scale switches to 60 100 A dashed vertical line prints noting the change The 60 100 scale prints shorty afterwards 4305CAO 49865 49866 FHR 240 bpm iu J 180 Tti ms 120 NUR T3 9o TR T 60 30 e ded 8 ES eL bee FSpO2 61 MSpOz 97 P 78 FSpO2 61 30 MSpOz 97 P 76 FSpO2 61 15 24 FECG an TOCO MSpO2 FSpOz4 e 3CM MIN MSp02 __d I4 12 a p m L I 75 10 1 75 lsg 50 50 6 25 4 4 L E 25 Tape Aas poppe 1 spes i O kPa a H g 0 100 scale Expanded scale Figure 12 4 MSpO Scale Changeover Revision C 120 Series Maternal Fetal Monitor 2015589 001 Recorder Modes On Mode Annotations Several standard annotations are printed by the monitor to help analyze the strip chart data and complete the patient record Most annotations print in the area between the top and bottom grids of the strip chart paper
106. cause false QRS detection 18 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Technical Specifications Operating Modes Table 18 2 Operating Mode Specifications Continued Maternal Blood Pressure Mode Technique Blood Pressure Range Pulse Rate Range Blood Pressure Accuracy Pulse Rate Accuracy Cuff Inflation Cuff Deflation Safety Features Oscillometric Microprocessor software eliminates most ambient noise and motion artifact 20 255 mmHg 2 7 34 0 kPa 40 240 BPM 5 mmHg 0 7 kPa with a standard deviation no greater than 8 mmHg 1 1 kPa 2 BPM or 2 whichever is greater Initial inflation to 160 mmHg 21 3 kPa Subsequent inflation approximately 30 mmHg 4 0 kPa greater than the previous systolic pressure Automatic Automatic cuff deflation if cuff pressure exceeds the overpressure limit of 285 mmHg 15 mmHg 37 3 2 kPa or maximum reading determination time is exceeded not to exceed AAMI ANSI SP 10 1992 limit of 180 s or safety timer detects microprocessor failure Auto mode minimum 30 second delay from the end of one determination to the beginning of another to allow for venous return Display R ecord Systolic diastolic and mean pressure pulse rate Alarms audible and visual Audio Alternating 1 5 second chimes 773 Hz and 523 Hz Visual Flashing pressure numeric or message Limits User selectable high and low systolic diastoli
107. cedures A Master Alarm screen provides a limits overlap however the monitor summary of most alarm limit settings with the exception of the FHR1 and FHR2 prevents the selection of overlapping limit settings which are set independently alarm limits Alarm Volume The alarm volume can be set on any individual setup screen or on the Master Alarm Setup screen This settings is used for all alarms fetal maternal and signal quality Audio Alarm Each modality has as an individual audio alarm enable disable field The maternal audio alarm fields are also present on the Master Alarm Setup screen Alarm Setting Indicators NOTE The FHR alarms may be An alarm setting indicator displays for FHR1 FHR2 NBP MHR P and MSpO completely disabled from the Install Table 11 1 provides a summary of the two possible states for this indicator Options service screen When disabled the alarm setting indicator is not displayed 11 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Alarms Alarm Setup Table 11 1 Alarm Setting Indicators Mode fX p All of the following are true Atleast one of the following is true m The FHR audio alarm is on m The FHR audio alarm is off FHR m Each of the FHR high low limits is set to a value m The FHR high limit is off m The FHR low limit is off m The NBP audio alarm is off NBP m The NBP audio alarm is on m One or more ofthe NBP high limits systolic m Each of th
108. ceptions The Monitor System EMC Immunity Performance None Revision C 120 Series Maternal Fetal Monitor CE 1 2015589 001 CE Marking Information Be aware that adding accessories or components or modifying the medical device or system may degrade the EMI performance Consult with qualified personnel regarding changes to the system configuration CE 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Contents Salely ios beta xt REVRTREREEPEREEPRGEGEEPEERER dr General Information isse nen nnne nennen 1 2 Generi USC tns er err dieta eeepc P cb wit CR EAR P dp 1 2 Responsibility of the Manufacturer 0 cece cect ete ete eee teens 1 2 Responsibility of the User cc cece cece tect e ete e tenet ete eenes 1 2 Definitions of Terminology snnm 1 3 Monitor Contraindications Warnings and Precautions e 14 Warnings 52 5 317 4 red etd aenea acea rye ea LA A Latch e avs da el et dg 14 Equipment Symbols senem nnns 1 9 INTOCUCTION 2o ovt voe eve Reds dH Fetal Monitoring Indications for Use csccccccseeaeeaeeaeeaeeeneaues 2 2 Surveillance sii Aare en ab NEEN Theta ae RIP MEE aed 2 2 PUIS OXIMOIY is i or nda Pte aat ndo 2 2 Maternal Monitoring Indications for Use cccsceeuaecaeeeeeaeeeneaues 2 3 Blood Pressure cutter Re eph o eh Rua n a ena 2 3 Pulse ximetryss i ec EC tre RE end eet ae he 2 3 Hear Pulse Rate 4 oo veces dept oe qute tpe e aem sebum dns 2 3
109. cess the MSpO measurements differently the function and appearance of MSpO on your monitor is the same Possession or purchase of this device does not convey any express or implied license to use the device with unauthorized replacement parts which would alone or in combination with this device fall within the scope of one or more of the patents relating to this device Sensors Before use carefully read the manufacturer s sensor directions for use Use only Masimo LNOP oximetry probes with the Masimo module use only Nellcor probes with the Nellcor module Other probes sensors may cause improper performance CAUTIONS TISSUE DAMAGE Tissue damage can be caused by incorrect application or use of a MSpO sensor for example by wrapping the sensor too tightly Inspect the sensor site as directed in the sensor s directions for use to ensure skin integrity and correct positioning and adhesion of the sensor Do not use damaged sensors Do not use a sensor with exposed optical components Do not re sterilize single patient use sensors For reusable sensors refer to the manufacturer s instructions for cleaning and sterilization Do not immerse the patient cable in water solvents or cleaning solutions the patient cable connectors are not waterproof Do not re sterilize the patient cable by irradiation steam or ethylene oxide 10 8 120 Series Maternal Fetal Monitor Revision C 2015589 001 Ala
110. d Pressure Troubleshooting Problem Probable Cause Possible Solution High reading Measurement taken during uterine contraction m Annotate chart then take a manual reading in between contractions m f possible cancel reading during contraction m Enable the monitor s Smart BP feature CHECK CUFF message displayed in NBP area of display m improper cuff position m Loose cuff m Air pressure error m Maternal movement m Hose not properly connected to monitor m Neonatal cuff connected m Reposition cuff m Tighten cuff m Contact Biomedical Engineering Department m Restrict patient limb movement m Ensure that hose is firmly attached to monitor m Ensure an adult cuff is connected OVERPRESSURE message displayed in NBP area of display LEAK message displayed in NBP area of display m Cuff pressure has exceeded the overpressure limit of 285 mmHg 15mmHg m Kinked hose m Blocked hose Pneumatic leak air leak or loose cuff m Restrict patient limb movement If this is notthe case contact Biomedical Engineering Department m Check the external cuff for kinks m Perform pneumatic test Check cuff for snug fit Check cuff and hose connections for leaks COMM message displayed in NBP area of display Communication error between the built in NBP module and the remainder of the monitor circuitry Call Biomedical Engineering Department MOTION messag
111. d is picked up by the photo detector photo diode on the sensor Light absorption is first measured by the 120 F Series Monitor at each wavelength when no pulsatile blood is present This reflects the background light absorption of bone tissue and venous blood which are generally considered non pulsating This measurement is analogous to the reference measurement of a spectrophotometer With each fetal heart beat a pulse of arterial blood flows to the oxygen sensor site Red and infrared light absorption are then measured by the monitor at each wavelength when this pulsatile arterial blood is in the tissue The monitor s microprocessor compares the background light absorption measurements to the absorption measured at both light wavelengths during each arterial pulse The ratio of the corrected absorption at each wavelength is used to determine fetal oxygen saturation FSpO Automatic Calibration The 120 F Series Monitor s built in FSpO2 module is automatically calibrated each time the monitor is turned on at periodic intervals thereafter and whenever a new sensor is connected Each fetal oxygen sensor is calibrated when manufactured the effective mean wavelength of the LEDs is determined and encoded into a calibration resistor in the sensor The 120 F Series software reads this calibration resistor when the sensor is connected to determine the appropriate calibration coefficients for the measurements obtained by that specific sensor
112. deflation and matched pulse detection continues until diastolic pressure is determined or total cuff pressure falls below 7 mmHg The Monitor then deflates the cuff to zero detected pressure analyzes the stored data and updates the front panel displays 9 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Non Invasive Blood Pressure Monitoring Oscillometric Theory The operating cycle is composed of four parts inflation time deflation time evaluation time and wait time Wait time which varies from mode to mode is affected by the cycle time Auto mode or operator intervention Manual mode The following figure shows the Basic Operating Cycle Inflation time Wait time Evaluation time Deflation time Determination time Cycle time Cuff pressure Time time Figure 9 2 BP Operating Cycle Systolic Search If systolic pressure is not found the Monitor can search at higher cuff pressures than the initial target pressure If the determination is in a late stage the Monitor will inflate the cuff to 70 mmHg above the initial target to get better data in the systolic region If the determination is in an early stage the Monitor will inflate the cuff to 50 mmHg above the initial target pressure The maximum pressure allowed in systolic search is limited by the normal range for cuff pressures In any operating mode if a patient s systolic pressure exceeds the inflation pressure of the Monitor th
113. dence detection is enabled the acronym HBC appears to the right of the FHR2 mode title See Figure 14 1 If the monitor detects two heartbeats that appear to be coinciding this may indicate that the two channels are picking up the same signal When this coincidence occurs the heart rate numerics for both heart rates display in inverse video as shown in Figure 14 1 Inverse video is an amber background with black numerics As soon as coincidence is resolved the numerics return to standard video Standard video is a black background with amber numerics If you disconnect a transducer while coincidence is detected any value displayed in inverse video returns to standard video US2 HBC TOCO dd 163b MC X TT 12 32 27 ALARMS SETUP VSHX Figure 14 1 Heartbeat Coincidence Example Strip Chart Annotation When heartbeat coincidence detection is enabled the annotation HBC prints in the center margin of the strip chart paper following the active FHR modes Refer to Figure 14 2 Revision C 120 Series Maternal Fetal Monitor 14 3 2015589 001 Heartbeat Coincidence Using the Heartbeat Coincidence Feature As soon as heartbeat coincidence is detected two overlaid hearts q print in the upper portion of the top grid of the strip chart paper the hearts print every 4 5 cm for as long a coincidence is detected Once coincidence is resolved two side by side hearts print qg once Refer to Figure 14 2 If you disconnect
114. dical Systems Information Technologies The two kinds of paper are m Z Fold Chart Paper with Pre Printed 30 240 BPM Heart Rate Scale Refer to Figure 12 1 m Z Fold Chart Paper with Pre Printed 50 210 BPM Heart Rate Scale Refer to Figure Figure 12 2 In the United States of America the most common grid is the 30 240 BPM scale with the recorder speed set at 3 cm min As shown in Figure 12 1 a dark line is printed every 3 cm which represents 1 minute in time at a speed of 3 cm min In other countries the most common grid may be the 50 210 BPM scale with the recorder speed set at 1 cm min As shown in Figure 12 2 every other vertical line measures 1 cm or 1 minute in time at a speed of 1 cm min Regardless of the heart rate scale the uterine activity scale is pre printed from 0 100 mmHg this same scale is used for relative units When SpO and monitoring is in progress the scale is printed on the paper by the recorder Figure 12 1 and Figure 12 2 also call out the top grid bottom grid and the annotation area for each style paper 12 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Recorder Modes Strip Chart Paper PAGES REMAINING Pre printed HR Scale Primary Annotation Area Pre printed UA Scale Figure 12 1 Strip Chart Paper with 30 240 BPM Heart Rate Scale Revision C 120 Series Maternal Fetal Monitor 2015589 001 Recorder Modes Strip Chart Paper 02377 EN
115. displays in the MHR P area MECG LEADS OFF During this type of alarm the MHR P source automatically switches to the next available parameter MSpO then NBP As soon as the alarm condition is resolved and the MECG signal is detected the monitor returns to using MECG as the MHR P source m NBP System Problem When there is a malfunction with the monitor s built in NBP module the cuff or the air hoses the monitor will be unable to make a determination During this type of alarm one of the following messages displays in the NBP area CHECK CUFF OVERPRESSURE LEAK COMM MOTION WEAK SIGNAL or REPAIR Refer to Chapter 17 Troubleshooting for more information about these messages m MSpO System Problem When there is a malfunction with the monitor s built in MSpO module one of the following messages displays in the MSpO area COMM or REPAIR Refer to Chapter 17 Troubleshooting for more information m MSpO Disconnect An MSpO disconnect alarm occurs if the MSpO intermediate cable is disconnected from the monitor the sensor assembly is disconnected from the intermediate cable or the sensor or cable have a broken wire Dashes display in place of the 70MSpO numeric Resolved Signal Quality Alarm Resolved signal quality alarms behave like most other 120 Series alarms As soon as an alarm condition is resolved both the visual and audible indications automatically disappear Silencing a Maternal Audio
116. dth 7 cm 8 cm Scaling 30 BPM cm 20 BPM cm Range 30 240 BPM 50 210 BPM Resolution 1BPM 1BPM Fetal Pulse Oximetry 6FSpO Scale Domestic International Chart Width 4cm 4 cm Scaling 10 cm or 25 cm 12 5 cm or 25 cm Range 0 10096 0 10096 Resolution 1 1 Uterine Activity Scale Strain Gauge Tocotransducer Chart Width 4cm 4cm Scaling 25 mmHg cm 25 relative units cm Range 0 100 mmHg 0 100 relative units Resolution 1 mmHg 1 relative unit Maternal Pulse Oximetry MSp0O2 Scale Domestic International Chart Width 4 cm 4 cm Scaling 10 cm or 25 cm 12 5 cm or 25 cm Range 60 100 or 0 100 96 50 100 or 0 100 96 Resolution 1 1 Recorder Drive Speeds 1 2 and 3 cm min Speed Accuracy 1 NOTE Specifications subject to change without notice 18 8 120 Series Maternal Fetal Monitor Revision C 2015589 001 Supplies amp Accessories This section provides an overall listing of supplies and accessories for use with 120 Series Monitors followed by photographs of some of the most commonly ordered items To order any of the supplies and accessories listed in this manual Inside the United States Call 1 800 558 5120 Outside the United States Call 414 355 5000 or contact your local distributor Revision C 120 Series Maternal Fetal Monitor 19 1 2015589 001 Supplies amp Accessories General Add Ons Ordering Information General Add Ons Ordering Information Table 19 1 General Supplies
117. e proficient in fetal scalp electrode and intrauterine pressure catheter placement DILATION AND ROM Do not attempt to insert the sensor if the patient is dilated less than 2 cm or if amniotic membranes have not ruptured Doing so may result in erroneous FSpO2 measurements and or patient injury Do not attempt to rupture amniotic membranes with the sensor Doing so may result in patient injury and or sensor malfunction Revision C 120 Series Maternal Fetal Monitor 6 3 2015589 001 Fetal Pulse Oximetry Monitoring FSpO Indications Contraindications Warnings and Precautions Technical Precautions CAUTIONS OPERATIVE ASSISTED DELIVERY Do not leave the fetal oxygen sensor in place during vacuum extraction forceps delivery or Cesarean delivery Doing so may result in patient injury Remove the fetal sensor before commencing any form of operative delivery STYLET USE Never attempt to reinsert a stylet into the sensor cable chamber once it has been completely removed during sensor placement Doing so may tear the stylet channel and expose the stylet which might result in serious patient injury Sensor adjustments can be accomplished without the stylet SENSOR ACCURACY Suboptimal sensor placement excessive vernix fetal hair or motion artifact due to uterine contractions or maternal position changes may result in no FSpO values being displayed or erroneous FSpO values FETAL BRADYCARDIA lI
118. e D 5 Alert Parameters Example with Two Columns of Alert Information Figure D 6 shows an example of alert parameters for a level one decelerations alert for FECG TOCO 147 v 138 12 FECG SETUP VOLUME ALERT PARAMETERS Items listed in inverse video are contributing factors to the alert Other items may indicate an alert is pending ALERT LEVEL BASELINE HR BPM EHR VARIABILITY DECELERATIONS ARTIFACT ARRHYTHMIA UA BASELINE PRESSURE UC IN 10 MIN DURATION OF LAST UC SIGNAL QUALITY ALERT ON 145 150 AVERAGE 10 3 60 GOOD VOLUME 5 T1 Figure D 6 Alert Parameters Example FECG is the FHR associated with the alert 120 Series Maternal Fetal Monitor D 9 2015589 001 Revision C Spectra Alerts Alert Parameters Summary Figure D 7 shows an example of alert parameters for the US Setup screen when the FHR is not associated with any alert US SETUP HR OFFSET OFF VOLUME ALERT PARAMETERS The alert level is blank indicating t aLerT LEVEL there is no active alert for this FHR BASELINE HR BPM 135 140 AE FHR VARIABILITY The alert parameter information is DECELERATIONS ABSENT available even if there is no alert ARTIFACT ARRHYTHMIA associated with this FHR UA BASELINE PRESSURE 10 UC IN 10 MIN 3 DURATION OF LAST UC 60 SIGNAL QUALITY GOOD ALERT ON VOLUME 5 Figure D 7 Alert Parameters Example
119. e Monitor will begin normal deflation sequence detect the absence of a systolic value stop deflation reinflate to a higher than initial inflation pressure 290 mmHg maximum and resume normal deflation sequence This additional inflation will occur only once per determination If a previous valid systolic pressure is displayed and the new systolic pressure oscillations are compared with the previous valid determination and the Monitor thinks that the systolic was not obtained the Monitor will inflate the cuff to a pressure of an additional 50 mmHg above the immediately preceding inflation This additional inflation will occur only once per determination Revision C 120 Series Maternal Fetal Monitor 9 5 2015589 001 Maternal Non Invasive Blood Pressure Monitoring Oscillometric Theory Do not use the auscultatory method to verify the accuracy of the Monitor Because of differences in technique and technology values may differ The DINAMAP Technology compares BP values to an invasive arterial BP measurement technology The auscultatory method uses audible sounds heard through a stethoscope and determines BP by the corresponding height of a column of mercury Invasive pressure monitoring directly measures the pressure exerted on a transducer and displays this pressure as a value Noninvasive blood pressure monitoring is dependent on the flow of blood through the peripheral circulation 9 6 120 Series Maternal Fetal Monitor R
120. e NBP high low limits is set to a value diastolic or mean arterial is off m One or more of the NBP low limits is off m The MHR P audio alarm is on m The MHR P audio alarm is off MHR P m Each of the MHR P high low limits is setto a value m The MHR P high limit is off m The MHR P low limit is off m The MSpO2 audio alarm is on m The MSpO audio alarm is off MSpO m Each of the MSpO high low limits is setto a value m The MSpO high limitis off m The MSpO low limit is off Maternal Alarm Occurring During Setup Alarm Behavior If the visual indication of a maternal alarm is inhibited by a setup screen only an audio alarm if enabled is issued As soon as you exit the setup screen the visual alarm indication displays m Example If the NBP Setup screen is displayed the primary labor parameters continue to be displayed as well as the maternal NBP area of the screen Under an alarm condition that affects NBP both a visual and audible if enabled alarm is issued Under an alarm condition that affects MSpOz or MECG only an audio alarm if enabled is given while the NBP Setup screen remains displayed once the setup screen is exited the visual alarm indication for MSpO or MECG is shown Revision C 120 Series Maternal Fetal Monitor 2015589 001 Alarms Alarm Setup NBP Display Timer Behavior The display timer clock symbol reflects the time period in minutes that a blood pressure reading remains displa
121. e a waveform select it again to return to real time display 15 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Waveforms Printing a Waveform Snapshot Printing a Waveform Snapshot Select the PRINT softkey to print a six second snapshot of the displayed waveform regardless of whether the waveform real time or frozen Figure 15 2 provides an example MECG waveform snapshot on the strip chart paper The waveform is printed on the lower portion of the top or left grid A vertical tick mark is printed at the start 3 second mark and end or six second mark for reference If the waveform is frozen six seconds of historical data are printed ending with the time the waveform was frozen on the display If the waveform is displayed in real time six seconds of historical data are printed ending with the time the PRINT softkey was activated 4305CAO 4305CAO Figure 15 2 Example MECG Waveform Snapshot Recorder On If the recorder is on the waveform overlaps the MHR P trace if enabled with no interruption to other trending The recorder speed remains at the selected rate of 1 2 or 3 cm min Revision C 120 Series Maternal Fetal Monitor 15 5 2015589 001 Waveforms Printing a Waveform Snapshot Recorder in Mater
122. e annotated by MSpO P If NBP is selected as the MHR P source there is no trending of the data since these are static measurements 8 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Heart Pulse Rate Monitoring MHR P Setup Screen MHR P Setup Screen NOTE Figure 8 1 provides an Select the mode title softkey MECG or PULSE to access the MHR P Setup screen example of MECG selected as the Figure 8 1 MHR P source as indicated by the MECG mode title When either MSpO or NBP are selected as the MHR P source the mode title changes to PULSE AUTO FECG TOCO MECG 7165 172 30 NBP MHR P SETUP on fi MECG MECG DEN source AUTO LEAD I 4 b l M 0 MHR P TRACE ON 89 v 1 PACER OFF oN 2 VOLUME 5 OFF 3 4 pui 1 5 2 ALARM HIGH LOW OFF 35 120 3 MHR P 120 50 BPM 4 5 AUDIO ALARMS ON VOLUME 5 6 7 8 ON 9 OFF 100 250 OFF Figure 8 1 MHR P Setup Screen NOTE The lead source and pacer fields apply to MECG only Source This field selects the MHR P source When AUTO is selected the monitor checks for parameter availability and use in the following order MECG MSpOz then NBP If a source is not available the next available source is automatically selected IMPORTANT WAVEFORM The MHR P Source field is independent of the
123. e displayed in NBP area of display Excessive maternal movement Restrict patient limb movement Restrain limb if necessary Dashes displayed in NBP area of display and possibly in MHR P area if NBP selected as MHR P source Maximum reading determination time exceeded m Reposition cuff m Check patient for arrhythmia Move cuff to another limb REPAIR message display in NBP area of display System error or self test failure Contact Biomedical Engineering Department WEAK SIGNAL message MOTION message Monitor unable to make a determination due to insufficient signal Excessive maternal movement Assess patient situation Talk to patient about the importance of minimizing limb movement Revision C 120 Series Maternal Fetal Monitor 2015589 001 17 11 Troubleshooting Maternal P ulse Oximetry Troubleshooting Maternal Pulse Oximetry Troubleshooting Table 17 9 Maternal Pulse Oximetry Troubleshooting Problem Probable Cause Possible Solution COMM message shown in MS pO area of display Communication error between the built in MS pO module and the remainder of the monitor circuitry Contact Biomedical Engineering Department Dashes shown in 95M S pO display area m Monitor unable to make a determination due to insufficient signal m improperly applied sensor m Excessive maternal movement m Excessive ambie
124. e only Nellcor OxiF irst Fetal Oxygen Sensors Series FS14 3 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Controls Indicators and Connectors Front Panel Displays Front Panel Displays The monitor s display is divided into five horizontal sections The content and layout of the display can change depending on which functions are installed in the monitor and the modes of operation in use Table 3 2 Display Summary Display Section Item Mode Fetal Heart Rate 1 FHR1 US US2 FECG or INOP Primary Labor Parameters Fetal Heart Rate 2 FHR2 US US2 or INOP Uterine Activity UA TOCO IUP or INOP Maternal Blood Pressure NBP Additional Parameters Maternal Heart P ulse Rate MECG or PULSE Fetal or Maternal SpO FSpO2 or MSpO2 Fetal ECG Waveform Maternal ECG Waveform Fetal FECG MECG FSp02 MSp02 or Waveform S pO Pulsatile Waveform or Maternal SpO Pulsatile OFF Waveform Current Time Label FROZEN Message and Time of Time ME Activation Softkeys System Configuration Softkey Controls Revision C 120 Series Maternal Fetal Monitor 3 5 2015589 001 Controls Indicators and Connectors Front Panel Displays Display Example Figure 3 2 provides an example of a Model 129 display In this example Blood pressure is not active as indicated by the absence of numerics Maternal pulse oximetry is active MECG is selected as the heart ra
125. ea Moving Scale Bar For all waveforms a moving scale bar scrolls along the screen The bar can be thought of as a pen drawing the waveform on the screen and erasing old data along the way The most recent data is displayed to the left of the bar the oldest data is displayed to the right of the bar IMPORTANT SCALE The moving bar can be used as a 1 cm scale reference for waveform interpretation US2 HBC TOCO i65 172 30 ANBPQ o5 f MECG f MSPO2 130 85 899 97 MAP 107 03 15 MECG 09 21 41 ECG FROZEN 09 22 06 PRINT FREEZE ALARMS SETUP VSHX This softkey selects the lead for MECG only I II or Ill E II AUTO 4 Wistelem 09 21 41 ECG FROZEN 09 22 06 PRINT FREEZE ALARMS SETUP VSHX This softkey selects the waveform for display This softkey selects the size for FECG or FECG MECG FSpO2 MSpOz or OFF MECG 0 25X 0 5X 1X 2X 4X or AUTO Figure 15 1 Waveform Area on the Display Revision C 120 Series Maternal Fetal Monitor 15 3 2015589 001 Waveforms Waveform Area Freezing Waveforms The waveform displayed in the waveform area can be frozen on the display for review the most recent data is displayed on the screen for analysis The message FROZEN for any waveform along with the time of activation is displayed at the lower left of the waveform All numerics continue to be updated and the real time clock continues to be displayed Select the FREEZE softkey to freez
126. ecifications Power Requirements Nominal Line Voltage 100VAC 120 VAC 220 VAC 230 VAC 240 VAC Line Frequency 50 60 Hz 50 60 Hz 50 60 Hz 50 60 Hz 50 60 Hz Power Consumption maximum 100W 100W 0 4A 0 4 A 0 4 A Chassis Leakage 300 uA Physical Characteristics Height 6 7 in 17 0 cm Width 16 5 in 41 9 cm Depth 17 3 in 43 9 cm Weight 24 0 Ibs 10 9 kg approx N Environmental Conditions Operating Storage Monitor Ambient Temperature 50 F to 104 F 10 C to 40 C 14 F to 131 F 10 C to 55 C Relative Humidity Atmospheric Pressure Strip Chart Paper Ambient Temperature Relative Humidity Atmospheric Pressure 10 to 95 non condensing 700 1060 mbar 525 795 mmHg 50 F to 104 F 10 C to 40 C 30 to 70 non condensing 700 1060 mbar 525 795 mmHg 0 to 95 non condensing 700 1060 mbar 525 795 mmHg lt 80 F lt 26 5 C 45 to 65 non condensing 700 1060 mbar 525 795 mmHg Certification ANSI AAMI EC 13 1992 Complies with all areas except those listed below 3 12 1e Heart Rate Meter Accuracy and Response to Irregular Rhythm not tested 3 2 6 1 Range of QRS wave amplitude and duration 3 2 7 Range and accuracy of heart rate meter 4 2 7f input rate of 300 BPM 3 2 8 1 Lower Alarm Limit The lowest alarm limit on the 120 Series is 35 BPM 3 2 9 8c Impulse Response 4 2 9 7 Output Display a Channel Width Classified to UL 2601 1 Medical electrical equipment classified by Underwriter
127. ee short flashes every five seconds m Recorder functions however Record indicator flashes on and off every second m Recorder does not function the Record indicator is off the message PAPER INCORRECTLY LOADED RELOAD WITH BLACK SQUARES DOWN is shown in maternal waveform area m Recorder does not function and the Record indicator is on m Recorder is off out of paper or paper is incorrectly loaded m Recorder is in maternal only mode m Paper supply is low m Paper loaded backwards m Service required m Press Record pushbutton or install re install paper see page 4 2 then press Record button m Press Record pushbutton to turn on m Install paper see page 4 2 m Re install paper see page 4 2 m Call Biomedical Engineering Department Incorrect time and date m Time incorrectly set m Clock circuit or battery fault m Access the General Setup screen and reset the time and date m Call Biomedical Engineering Department Battery Low Icon appears H m Data Corruption m Battery needs service m Cycle power Access setup screens and reset last used settings m Call GE Service to report No heartbeat or pulse sounds m Volume settoo low m Transducer not connected or is loose m Press the Volume A pushbuttons or access the respective setup screen s FECG US or US2 to increase the volume m Ensure that each transducer is securely attached to monito
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129. eft channel of the strip chart paper two FHR trends as well as the MHR P trend The primary FHR trend is printed in plain black The secondary FHR trend is printed in bold black The MHR P trend is printed in grey The UA FSpO2 and MSpO trends are printed in the bottom or right grid of the strip chart paper The UA trend is printed in plain black The FSpO trend is printed as a black beaded line The MSpO gt trend is printed in grey The FHR and UA trends are printed continuously The MHR P FSpO2 and MSpO trends must all be enabled via the respective setup screen Table 12 1 Summary of Strip Chart Trends Grid Source Type Trace Description Parameter Trend Source Top Left Fetal Plain Black FHR1 US or FECG A Bold Black FHR2 US orUS2 Maternal Grey MHR P MECG or MSpO2P Fetal Plain Black FS pO FSp02 Bottom Right Maternal Plain Black UA TOCO or IUP A Grey MS pO MSp02 12 6 120 Series Maternal Fetal Monitor Revision C 2015589 001 Recorder Modes On Mode MSpO2 96 P 72 TOCO MSpO2 3 CM MIN 1 T oT CEJ CAT T So BE Figure 12 3 Five Trends Printing Simultaneously Revision C 120 Series Maternal Fetal Monitor 2015589 001 Recorder Modes On Mode MSpOz Trend Scale Two options for setting the MSpO trend scale are available allowing compatibility with FSp
130. ei noU dg ido 15 6 Stopping a Print 6 omimatid 2 55 52 nette baa due baa 15 6 Maintenance o nn n n n n n n n ns LOL GIGANING i5 i cnni dee c ace CC CR aq A EAD EO CER EUR 16 2 Monitor EXteFIOT 5 5 oia e a tace Consenso db oco CR nea 16 2 Electroluminescert P anel 3 2 prie oe cert t ers 16 2 Tocotransducer Ultrasound Transducer and MECG Cables 16 3 UASStialti GAUGE its molto ep rem ete d tread Der btts 16 3 Maternal NBP Cuffs and HOSES cece ccc eee e eee n 16 3 Maternal SpO2 Calibration cccccceeeeeeceeeueeeaeeaneaneaeeeaneags 16 4 Troubleshooting B B NB NOB NOB EB EON B B EH OB EOB EH OE EO B BOB HON BOB NOB B oN 17 1 General Troubleshooting enne 17 2 Ultrasound Troubleshooting enne nen nnns 17 3 FECG Troubleshooting cccccsecceccecceececeuaeeaevaneaneateaneags 17 4 18 19 Fetal Pulse Oximetry Troubleshooting enn nn nnn 17 5 External Uterine Activity Troubleshooting nnn nnn 17 8 Internal UA Troubleshooting enn nmn 17 9 MECG Troubleshooting ccscceeceecceecececeeuaevaneaneeneaeeeauegs 17 10 Blood Pressure Troubleshooting sen n n n n nn nnn 17 11 Maternal Pulse Oximetry Troubleshooting nnn 17 12 Technical Specifications oos 18 1 General Monitor ccs ce cece eee e eee eee eee eeeeeeaeeaneaneaneanegs 18 2 Operating Modes issssssseenen nennen nennen nnn 18 3 Strip Cha
131. elt m Transducer defective m Service required m You must wait ten seconds following powering on the monitor and or connecting to the UA connector m Loosen belts or remove transducer from patient Press UA Reference pushbutton while no pressure is applied to transducer button Re apply transducer Do not overtighten belt Press UA Reference pushbutton again between contractions See Out of Range Condition on page 7 3 for further information m Replace transducer m Call Biomedical Engineering Department 17 8 120 Series Maternal Fetal Monitor 2015589 001 Revision C Troubleshooting Internal UA Troubleshooting Internal UA Troubleshooting Table 17 6 Internal UA Troubleshooting Problem Probable Cause Possible Solution Internal pressure not measuring correctly m Transducer not properly connected to monitor m Air bubble in dome or catheter blocked m Dome is cracked m Strain gauge not at same height as catheter tip m Catheter has fallen out of place m Catheter or strain gauge not zeroed m Service required m Ensure transducer is securely attached to monitor m Flush dome and catheter m Replace dome m Adjust strain gauge height m Replace catheter m Calibrate catheter or strain gauge m Call Biomedical Engineering Department CHECK IUP message displayed in UA area of the display m Blockage in fluid filled catheter m Fetus pressin
132. em cece 12 13 Multiple Annotations 0 ccc cece cece cena eeeeeeenteneeas 12 14 Adjustable Recorder FontSize sss 12 15 Summary of Annotations ccccccceceeeeeeeeeeeseeaeeaeeaeeaneaues 12 16 Chart Style Vital Signs Printing cccccecccecuseuaeeaeeaneeeeaneags 12 20 Enabling Disabling Chart Style Printing eene 12 20 Examples of Printing Styles isses e 12 20 Standard Real Time Printing Example cece cece eee eens 12 20 Chart Style Printing Examples 0 ccc cect ee eee eee e 12 21 Chart Style Seven Minute Exception for NBP cseceeeeeaees 12 21 Maternal Only Mode ssennnnnn nmm 12 22 Whatis the Maternal Only Mode ccc ccc ce cece eee eee eeneeas 12 22 Printing Sile i sa od ete Ae to e Ea Minh cnn e na cand Me teases 12 22 Functionality with a QS System isse 12 23 Paper Versus Electronic Strip Charts 0 0 0 cece eects 12 23 Messages corutokeeri EEE REA OR EEEE TENERTE 12 23 Fetal Heart Rate Alarms 0 0 ccc 12 23 Changing Recorder Modes essen n n n n n n n nnn 12 24 Paper Low Paper Out and Paper Load Error Conditions 12 25 Maternal Vital Signs History i e 13 1 What is the Maternal Vital Signs History Screen csceeeuevaeueeauas 13 2 Using the Maternal Vital Signs History Screen sene 134 Displaying the Screen iiic coes ar rper Ren e eta 134 Selecting the HX Interval isses ne 134 Printing the
133. em interface Installed as part of an optional communications package 104 Nurse Call Connector Connector for standard Nurse Call System interface The connector s maximum output is 50 Vdc at 100 mA the maximum on resistance is 0 5 Q Installed as part of an optional communications package J 102 Central Systems Connector Connector for analog central station system interface Installed as part of an optional communications package Speaker The rear panel speaker emits an audible tone for heart rates MSpO pulse with 02 dependent pitch and alarms Italso provides the sound for the song player feature 108 Corolan Connector This 25 pin connector is used for interfacing to optional Corometrics equipment Contact your Service Representative for more information 109 110 and J 111 RS 232C Communications Connectors Three serial RJ 11 connectors are provided for interfacing to peripheral equipment Contact your Service Representative for more information ECG Out Connector External recorder receptacle for MECG signals The standard output level is 1 V mV Fetal Acoustic Stimulator Connector Receptacle for Corometrics Model 146 Fetal Acoustic Stimulator FAST A music symbol prints on the strip chart paper each time the Model 146 is used Revision C 2015589 001 120 Series Maternal Fetal Monitor 3 19 Controls Indicators and Connectors Rear Panel De
134. eraging Slow Slow Fast Mode FSp02 print interval 5 min Off 2 5 10 15 30 60 min 02 Trace On On Off Display On On 1 2 3 5 10 15 30 min Mode Manual Auto 1 2 3 4 5 Manual 10 15 20 30 40 45 60 90 120 min NBP Reading Done 5 0 9 NBP Alarm High Low High Low Systolic 160 90 mmHg 70 240 Off 50 150 Off Diastolic 90 50 mmHg 70 130 Off 30 120 Off MAP 140 50 mmHg 70 150 Off 30 120 Off MHR P 120 50 BPM 100 250 Off 35 120 Off Audio Alarm On On Off Volume 5 1 9 A 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Factory Defaults Table of Defaults Table A 1 Summary of Factory Defaults Setup Field Descripti F Default Default Opti Hospital Pref S reen ield Description actory Defau efault Options ospital Preference Response Time Nellcor Normal Slow Normal Fast Averaging Time Masimo Wisecohds 2 4 8 10 12 14 16 seconds Sensitivity Masimo Normal Normal Maximum Print Interval Off 2 5 10 15 30 SUUS 60 minutes MSp0 gt 0 Trace Off On Off Alarms High Low High Low MSp0 gt 100 95 85 100 Off 80 99 Off MHR P 120 50 BPM 100 250 Off 35 120 Off Audio Alarms On On Off Volume 5 1 9 Source Auto Auto MECG MSp0 NBP MHR P Trace Off On Off Volume 5 0 9 Alarms High Low High Low MHRJP 120 50 BPM 100 250 35 120 Audio Alarms On On Off Alarm Volume 5 1 9 MECG Lead I 1 Ul LUI Pacer Off On
135. es the audio alarm function for the applicable FHR m On Visual and audible indications are provided during an FHR alarm condition m Off Only a visual indication is provided during an FHR alarm condition This field controls the alarm volume for all alarms This field selects between either on and off or 10 Min and off depending on how this feature is enabled on the Install Options service screen Revision C 120 Series Maternal Fetal Monitor 5 8 2015589 001 Fetal Heart Rate Monitoring FECG Internal Method FECG Internal Method Methodology Artifact Elimination This method uses an electrode attached directly to the fetal presenting part The electrode is connected to the cable legplate secured to the mother The fetal heart rate is computed based upon the interval between successive R wave peaks of the fetal QRS complex The fetal heart rate is displayed in BPM and is continuously plotted on the strip chart recorder paper Refer to Table 5 1 The heartbeat indicator flashes for each detected heartbeat An ECG artifact elimination option is available on all 120 Series Monitors Enabling Disabling Artifact Elimination NOTE This option only affects direct FECG monitoring Ultrasound monitoring is unaffected by this setting Theory and Methodology This option is enabled disabled via the Install Option service screen the factory default setting is off Refer to the 120 Series Monitor Service
136. ese averaging settings are least affected by patient movement m 8 seconds This averaging selection is recommended in cases where the patient is relatively inactive m 2or4seconds These averaging selections are most affected by patient movement This setting determines the time interval for printing the MSpO values on the strip chart paper This setting enables or disables the printing of the 70MSpO trend on the bottom grid of the strip chart paper Wm On The MSpO trend prints in grey and is annotated with MSpO gt 2 m Off The MSpO trend is not printed TREND SCALE Refer to General Setup Screen on page 4 9 for information on the trend scale These fields adjust the high and low alarm limits for MSpO as well as for MHR P in increments of 1 or 5 BPM The selectable values are listed in Chapter 9 Maternal Pulse Oximetry Monitoring Refer to Appendix A Factory Defaults for further information 10 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Pulse Oximetry Monitoring MS pO Setup Screen Audio Alarm Alarm Volume This field enables disables the audio alarm function for MSpO m On Visual and audible indications are provided during an MSpO alarm condition m Off Only a visual indication is provided during an MSpO alarm condition This field controls alarm volume for all alarms Refer to Appendix A Factory Defaults for information on factory def
137. eseeueueeeereueueusurauueas D 15 Al rt Parameters 45i nirien rire eec eee acer how C eek D 16 Safety The information presented in this section is important for the safety of both the patient and operator and also serves to enhance equipment reliability This chapter describes how the terms Danger Warning Caution Important and Note are used throughout the manual In addition Corometrics standard equipment symbols are defined This section includes the following important information General Infarualom sepse tsen n eR ee s eee ee Rae eR Aes 1 2 Definitions of Terminology cic sese et pt dies HER e 1 3 Monitor Contraindications Warnings and Precautions 1 4 Equipment Symbols 6 ng ek RR RRERE DRE a vee ae 1 9 Revision C 120 Series Maternal Fetal Monitor 2015589 001 1 1 Safety General Information General Information General Use If the monitor is cold to the touch or below ambient temperature allow it to stabilize before use To ensure patient safety use only parts and accessories manufactured or recommended by GE Medical Systems Information Technologies Parts and accessories used shall meet the requirements of EN60601 1 1 Disposable devices are intended for single use only They should not be reused Periodically and whenever the integrity of the monitor is in doubt test all functions Refer to the Maternal Fetal Monitoring Operator s Manual for information concerning the l
138. essing used to determine heart rate The volume buttons work in conjunction with the volume control settings on the US US2 E FHR2 Volume Increase Button Setup screen page 5 2 and on the FECG Setup screen page 5 5 F Alarm Silence Button Pressing this button removes the audible indication of an individual alarm Refer to Re Alarm on page 11 3 for information about which modalities re alarm G Test Button Pressing and holding this button for one second starts or stops a monitor self test routine This button starts and stops both manual and automatic blood pressure H BP Start Stop Button determinations It also provides a shortcut for changing the auto interval time see page 9 11 The UA Reference button sets a baseline for uterine activity pressure monitoring UA RereTerice Butai Refer to Chapter 7 Uterine Activity Monitoring The Mark Offset pushbutton is a multi function pushbutton m Mark Pressing this button prints an event mark f on strip chart paper on the Mark Offset Button bottom two lines of the top grid mE J l l m Offset When the Heart Rate Offset mode is enabled pressing and holding this button shifts the secondary FHR trend 420 BPM for visibility purposes Refer to Fetal Heart Rate Offset on page 5 6 Pressing this button advances chart paper at a rate of 40 cm min for as long as the K Paper Advance Button bitten fe held down L Record Button The Record button selects one of three recorder states on maternal only
139. etal Monitoring Operator s Manual for additional information 2 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Introduction Maternal Monitoring Indications for Use Maternal Monitoring Indications for Use Blood Pressure Pulse Oximetry Heart Pulse Rate NOTE A Model 128 provides maternal pulse rate data derived from the NBP and MSpO sections of the monitor Only a Model 129 provides both maternal Aeart rate and maternal pulse rate data the heart rate data is derived from the MECG section of the monitor while the pulse rate data is derived from the NBP and MSpO sections of the monitor A Corometrics Model 128 or 129 Maternal Fetal Monitor is intended for monitoring maternal vital signs to help assess maternal well being The vital signs which can be measured with either of these monitors are summarized below NOTE Maternal vital signs provided by the monitor should only be used as an adjunct to patient assessment and must be used in conjunction with clinical signs and symptoms The monitor is intended for use in the non invasive monitoring of maternal blood pressure NBP This monitor is not intended for use in neonatal or pediatric blood pressure monitoring The monitor is intended for use in the non invasive monitoring of the functional oxygen saturation of maternal arterial blood MSpO The monitor is intended for use in the non invasive monitoring of the maternal heart pulse rate MHR P
140. etting is turned off A All alarm settings are enabled C MSpO2 Mode Title Select the mode title to access the MSpO Setup Screen MS p02 Pulse Amplitude Indicator This vertical bar qualitatively indicates pulse amplitude Waveform Area The waveform area displays approximately four seconds of waveform data for FECG MECG FSpO or MSpO Refer to Chapter 15 Waveforms for more information Time and Waveform Message Area The current time in 24 hour format always displays on the far right When a waveform is frozen the message Label FROZEN displays on the far left along with the time of activation 3 14 120 Series Maternal Fetal Monitor Revision C 2015589 001 Controls Indicators and Connectors Front Panel Displays Battery Backed RAM Status Whenever you turn off a 120 Series Monitor a battery provides power to the RAM random access memory that stores information such as time date default settings etc Figure 3 10 Low Battery Icon The icon shown above will appear in the upper right hand section of the monitor under the following circumstances Table 3 10 Battery Backed RAM Status Icon Appearance Reason Solution Icon appears and then disappears after Data corruption Your monitor has reverted Access setup screens and configure last power cycle to factory settings used settings Icon appears after multiple power cycle
141. evision C 2015589 001 Maternal Non Invasive Blood Pressure Monitoring NBP Setup Screen NBP Setup Screen Select the NBP softkey to access the NBP Setup screen Figure 9 3 FECG US TOCO MANUAL 1 MIN BLANK AUTO 1 MIN 2 MIN BLANK v Y AUTO 2 MIN 3 MIN BLANK 7 AUTO 3 MIN 5 MIN BLANK Nae RR NEFSETUP g AUTO 4 MIN 1omINBLANK A NBP 11 41 d 4 AUTO 5 MIN 15 MIN BLANK 1 20 8 MODE MANUAL 2 AUTO 10 MIN 30 MIN BLANK 5 3 AUTO 15 MIN MAP 107 NBP DONE VOL 5 4 AUTO 20 MIN HIGH LOW ALARM HIGH Low 5 ee SYSTOLIC 160 90 MMHG 1 M a 70 240 OFF OFF 50 150 E 3 z AUTO 45 MIN 70 130 OFF OFF 30 120 j DIASTOLIC a a a AUTO 60 MIN 70 150 OFF OFF 30 120 on s iex i il s 5 AUTO 90 MIN 100 250 OFF OFF 35 120 p i i AUTO 120 MIN AUDIO ALARMS ON VOLUME 5 8 pd EXIT 9 ON OFF Figure 9 3 Maternal NBP Setup Screen Display Timer NOTE Setting this field to a value This field determines the time period in minutes that a blood pressure reading reduces the chance of error Setting this remains displayed before being automatically erased starting from the time the field to ON leaves the blood pressure reading is displayed reading displayed indefinitely and could potentially cause confusion For example if the monitor is configured for manual mode and one hour has elapsed since
142. f patient activity m Slow Uses a 10 to 15 second averaging period and is least affected by patient movement When this setting is selected instead of a pulse value the MHR P area will be blank m Normal Uses a 5 to 7 second averaging period and is recommended in cases where the patient is relatively inactive m Fast Uses a 2 to 3 second averaging period and is most affected by patient movement If the MHR P source is set at MSpO the response time must be set to Normal or Fast If the response time is set to slow no pulse rate will appear Revision C 120 Series Maternal Fetal Monitor 10 3 2015589 001 Maternal Pulse Oximetry Monitoring MS pO Setup Screen Sensitivity Masimo Module Only This menu option appears only when using a Masimo module and sensor m Normal Use the Normal sensitivity setting for normal patient monitoring purposes m Maximum Use the Maximum sensitivity setting for improved low perfusion performance and for faster tracking of rapid MSpO saturation changes Averaging Time Masimo Module Only Print Interval 96O Trace Alarm Limits This menu option only appears when using a Masimo module and sensor Choose a response time in order to compensate for different levels of patient activity 2 4 8 10 12 14 or 16 seconds For the 2 and 4 second averaging settings The actual averaging times may range from 2 to 4 and 4 to 6 seconds respectively m 10 12 14 or 16 seconds Th
143. f patient history and risk factors to properly care for the mother and fetus 120 Series Maternal Fetal Monitor Revision C 2015589 001 Safety Definitions of Terminology Definitions of Terminology Six types of special notices are used throughout this manual They are Danger Warning Caution Contraindication Important and Note The warnings and cautions in this Safety section relate to the equipment in general and apply to all aspects of the monitor Be sure to read the other chapters because there are additional warnings and cautions which relate to specific features of the monitor When grouped warnings and cautions are listed alphabetically and do not imply any order of importance Table 1 1 Definitions of Terminology Danger A DANGER notice indicates an imminently hazardous situation which if not avoided will result in death or serious injury Warning A WARNING indicates a potentially hazardous Situation which if not avoided could result in death or serious injury Caution A CAUTION indicates a potentially hazardous Situation which if not avoided may result in minor or moderate injury Cautions are also used to avoid damage to equipment Contraindication A CONTRAINDICATION describes any special symptom or circumstance that renders the use of a remedy or the carrying out of a procedure inadvisable usually because of a risk Important An IMPORTANT notice indicates
144. f the MECG waveform is enabled for display Revision C 120 Series Maternal Fetal Monitor 8 5 2015589 001 Maternal Heart Pulse Rate Monitoring Maternal ECG Monitoring Maternal ECG Monitoring Theory and Methodology The maternal heart rate MHR is measured via electrodes placed on the maternal chest When MECG is employed the maternal heart rate is computed on a beat to beat basis using the R to R time interval on the maternal QRS complex When MECG is selected as the MHR P source the MHR is displayed on the front panel display in beats per minutes BPM denoted by MECG The heartbeat indicator 9 flashes for each detected heartbeat The rear panel speaker emits an audible tone for each detected heartbeat The maternal heart rate trend when enabled is continuously plotted in the top or left grid of the strip chart paper The MHR trace is a grey line annotated by MECG The beat to beat MHR signal is used for trending on the strip chart paper and for output to external devices such as a central station system The averaged MHR values are used for display and for alarm detection Pacemaker Safety Information MECG Waveform The following safety information applies to patients with pacemakers WARNINGS FALSE ALARMS False low heart rate alarms or false asystole may result with certain pacemakers because of electrical overshoot FALSE COUNTING Be aware that a pacer spike could be falsely counted as a QRS co
145. f the fetal heart rate slows during vaginal exam or sensor insertion stop the procedure Do not proceed with sensor placement as this can cause a reflex bradycardia stimulus Wait for the fetal heart rate to return to the previous range before proceeding DEFIBRILLATION Do not leave the fetal oxygen sensor in place during defibrillation Even though the sensor manufacturer s package labeling indicates that the sensor may be left in place during defibrillation the sensor should be removed when used with a Corometrics monitor MRI EQUIPMENT Do not use a monitor or fetal oxygen sensor during MRI scanning Strong magnetic fields may affect the device causing erroneous FSpO measurements CAUTIONS SENSOR TYPE Do not attempt to use any sensor other than sterile single use Nellcor Fetal Oxygen Sensors FS14 Series with a Corometrics Monitor Use of any other Nellcor oximetry sensor or any sensor from another manufacturer may result in system malfunction erroneous FSpO measurements and or patient injury DAMAGED EQUIPMENT Do not use a damaged sensor Doing so may result in patient injury sensor malfunction and or erroneous FSpO measurements 6 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Fetal Pulse Oximetry Monitoring FSpO Indications Contraindications Warnings and Precautions CAUTIONS CLEANING STERILIZATION Never attempt to clean reprocess or resterilize feta
146. fied Saturation 965 p0 During motion conditions Adults Pediatrics 70 100 3 digits 0 69 unspecified Neonates 70 100 3 digits 0 69 unspecified Pulse Rate bpm During no motion conditions Adults Pediatrics Neonates 25 to 240 3 digits Pulse Rate bpm During motion conditions Adults Pediatrics Neonates 25 to 240 5 digits Resolution Saturation S p02 1 Pulse Rate bpm 1 Low Perfusion Performance gt 0 02 Pulse Amplitude and Transmission gt 5 Saturation 965 p02 2 digits Pulse Rate 3 digits Interfering Substances Carboxyhemoglobin may erroneously increase readings The level of increase is approximately equal to the amount of carboxyhemoglobin present Dyes or any substance containing dyes that change usual arterial pigmentation may cause erroneous readings The Masimo SET SpO parameter with LNOP Adt sensors has been validated for no motion accuracy in human blood studies on healthy adult volunteers in induced hypoxia studies in the range of 70 100 SpO2 against a laboratory co oximeter and ECG monitor This variation equals plus or minus one standard deviation Plus or minus one standard deviation encompasses 68 of the population The Masimo SET SpO parameter with LNOP Adt sensors has been validated for motion accuracy in human blood studies on healthy adult volunteers in induced hypoxia studies while performing rubbing and tapping motions at 2 to 4 Hz at an amplitude
147. formation Technologies GmbH Munzinger StraBe 3 5 D 79111 Freiburg Germany Tel 49 761 45 43 0 Fax 49 761 45 43 233 Asia Headquarters GE Medical Systems Information Technologies Asia GE China Co Ltd 24th Floor Shanghai MAXDO Center 8 Xing Yi Road Hong Qiao Development Zone Shanghai 200336 P R China Tel 86 21 5257 4650 Fax 4 86 21 5208 2008
148. from a remote computer such as a QS P erinatal System The notes print on any lines except the first The first line is reserved from NBP vital signs data This annotation prints on the first annotation line following the active heart rate mode s indicating heartbeat coincidence is enabled This feature is enabled HBC disabled via the Install Options service screen The annotation represents only thatthe feature is enabled it does not indicate that heartbeat coincidence has been detected Vo This annotation prints in the top two lines of the upper grid indicating that the monitor detects heartbeat coincidence OM This annotation prints in the top two lines of the upper grid indicating the cessation of heartbeat coincidence R This annotation prints on the bottom two lines of the upper grid indicating that active telemetry signals are being received The annotation re prints every 30 minutes along with the modes A This annotation prints on the bottom two lines of the upper grid indicating that telemetry signals are no longer being received This annotation can only be seen when dual heart rate monitoring is in progress US 20 or US2 20 gt lt f The offset annotation US 20 or US2 20 prints at the top of the upper grid indicating that the secondary fetal heart rate trend is shifted 20 BPM The right left arrows lt and vert
149. ftkey Selects 0 25X 0 5X 1X 2X 4X or AUTO p MEA Leadgeen Selects Lead I Il or Ill Softkey D VSHX Softkey Displays maternal Vital Signs History screen E SETUP Softkey Displays General Setup screen F ALARMS Softkey Displays Master Alarm Setup screen Freezes waveform for analysis unfreezes x PREE waveform to return to real time display Prints six second snapshot of frozen waveform H pai Oey real time waveform or maternal vital signs history I Waveform Softkey Selects FECG MECG FSpO MSpO or OFF 3 16 120 Series Maternal Fetal Monitor 2015589 001 Revision C Controls Indicators and Connectors Front Panel Displays AUS A US2 TOCO 154v 135v 17 VITAL SIGNS HISTORY DATE 24 MAR 24 MAR 24 MAR 24 MAR 24 MAR 12 00 12 10 12 20 12 30 12 40 125 95 105 81 100 81 81 HX INTERVAL 10 MIN PRINTALL VIEW Figure 3 12 Maternal Vital Signs History Screen Softkeys Table 3 12 Maternal Vital Signs History Screen Softkeys Name Description A PRINT Softkey Prints one page screen of the table B PRINTALL Softkey Prints all pages screens Scrolls through the data C VIEW Softkey m Left for recent data m Right for oldest data D EXIT Softkey Retums to the previous screen Revision C 120 Series Maternal Fetal Monitor 2015589 001 Controls Indicators and Connectors Rear Panel Description Rear Panel Description
150. g the interval time the countdown timer resets to the new value The next automatic reading will occur after the expiration of the new interval Example 1 The interval time is set at 10 minutes and the countdown timer shows 4 minutes until the next reading in other words 6 minutes have elapsed If you change the interval time to 15 minutes the countdown timer will wait another 15 minutes until the next reading Therefore a total of 21 minutes will elapse between readings Example 2 The interval time is set at 15 minutes and the countdown timer shows 2 minutes until the next reading in other words 13 minutes have elapsed If you change the interval time to 10 minutes the countdown timer will wait another 10 minutes until the next reading Therefore a total of 23 minutes will elapse between readings NBP Interval Button Shortcut NOTE Since the intervals are displayed in the countdown timer area they will appear as follows 01 00 02 00 03 00 60 00 etc You can set the interval time from the NBP Setup screen or from the normal operating screen using a front panel button shortcut 1 While the normal operating screen is displayed press and hold the BP Start Stop button on the front panel After holding for approximately two seconds the interval field display in place of the countdown timer Refer to Figure 9 4 Continuous pressure on the BP Start Stop button cycles through the available intervals 1 2 3 4 5 1
151. g directly on catheter m Defective strain gauge or catheter m Service required m Flush catheter Re zero Replace catheter if necessary m Reposition by twisting catheter m Replace strain gauge or catheter m Call Biomedical Engineering Department Revision C 120 Series Maternal Fetal Monitor 2015589 001 Troubleshooting MECG Troubleshooting MECG Troubleshooting Table 17 7 MECG Troubleshooting PROBLEM PROBABLE CAUSE POSSIBLE SOLUTION MECG erratic or not functioning properly m Transducer not properly connected to monitor m Electrodes not properly placed m Clips notattached to electrodes properly m Electrode gel dried m Defective MECG cable m Service required m Selected lead providing inadequate signal m Ensure transducer is securely attached to monitor m Re apply electrodes m Check clip attachments m Check electrodes and re apply gel if necessary m Replace cable m Call Biomedical Engineering Department m Change lead selection on MHR P Setup screen Dashes shown in MHR P area of display Monitor unable to make a determination due to insufficient signal Ensure patient is not asystolic Ensure electrodes are firmly secured to patient 17 10 120 Series Maternal Fetal Monitor 2015589 001 Revision C Troubleshooting Blood Pressure Troubleshooting Blood Pressure Troubleshooting Table 17 8 Bloo
152. g used The music symbol prints each time a clinician presses the button on the stimulator Freestyle annotations For example Entries typed using a Corometrics Model 2116B Data Entry Clinical Notes PT NAME JANET STEVENS Keyboard print in the annotation area The Model 2116B is an optional device PT ID 6535148 that can be connected to the 120 Series Monitor PT AGE 18 DR CARTER Revision C 120 Series Maternal Fetal Monitor 12 19 2015589 001 Recorder Modes Chart Style Vital Signs Printing Chart Style Vital Signs Printing The monitor provides an option for chart style printing of blood pressure and MSpO values on standard clock quarter half and whole hour marks Enabling Disabling Chart Style Printing The chart style feature is enabled disabled from the Install Options service screen Refer to the Maternal Fetal Monitoring Operator s Manual for more information Examples of Printing Styles Standard Real Time Printing Example When chart style printing is disabled standard real time printing occurs m NBP Example The automatic blood pressure mode is activated at 9 03 with the interval time set to 15 minutes The first reading occurs at 9 18 Subsequent readings are taken at 9 33 9 48 10 03 etc m MSpO Example The print interval is set to 15 minutes and the first acceptable pulse signal is detected at 9 05 a m The first printing occurs at 9 05 Subsequent MSpO values are printed
153. greatly between measurements the monitor does not alert the user through audio or visual means to changes in vital signs occurring between measurement cycles OVERPRESSURE After the monitor has been calibrated or repaired perform a final check of the pneumatic system and verify that a pressure greater than the overpressure limit of 285 mmHg 15 mmHg causes the OVERPRESSURE error message to display 9 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Non Invasive Blood Pressure Monitoring Blood P ressure Safety Precautions CAUTION PULSE RATE COMPARISONS The pulse rate measured by the monitor s NBP circuitry may differ from the heart rate measured by the monitor s MECG circuitry or another maternal ECG monitor because the monitor s blood pressure module measures peripheral pulses not electrical signals or contractions of the heart Occasionally the electrical signals at the heart do not produce a peripheral pulse Similarly if a patient s beat to beat pulse amplitude varies significantly blood pressure and pulse rate readings can be erratic and an alternate measuring method should be used for confirmation Revision C 120 Series Maternal Fetal Monitor 2015589 001 9 3 Maternal Non Invasive Blood Pressure Monitoring Oscillometric Theory Oscillometric Theory Principles of Noninvasive Blood Pressure Determination The oscillometric method of determining blood pressure
154. he strip chart recorder door to open the recorder door Figure 4 1 Opening the Recorder Door 2 Fanthe pack of Z fold paper on all sides to loosen any folds and to ensure proper feed of the paper through the recorder i pee CC Opa eem RA Figure 4 2 Fanning the Paper Revision C 120 Series Maternal Fetal Monitor 4 3 2015589 001 Setup Procedures Loading Strip Chart Recorder P aper NOTE The black squares indicate the end of the recorder paper When the black squares appear the strip chart recorder has approximately 20 minutes of paper remaining when running at a speed of 3 cm min NOTE The paper is labelled This 3 Hold the package of paper so that side up in 120 Series Monitors theblack squares are on the bottom of the pack and the Corometrics logo and page numbers are on the left side of the pack UAT 9 mmHg B 59 Di conovenucs MEDICAL SYSTEMS INC Figure 4 3 Orienting the Paper 4 Unfold two sheets from the top of the package so that they extend toward you Figure 4 4 Creating a Paper Leader 4 4 120 Series Maternal Fetal Monitor 2015589 001 Revision C Setup Procedures Loading Strip Chart Recorder P aper 5 Place the pack in the drawer so that
155. however some annotations print in either grid All annotations are listed and explained in 12 3 Standard Annotations The most common of the annotations which print on the bottom line are date time active modes heart rate coincidence enable status fetal heart rate alarm enable status recorder speed telemetry status 12 10 120 Series Maternal Fetal Monitor Revision C 2015589 001 Recorder Modes On Mode Fetal Pulse Oximetry Annotation A fetal pulse oximetry reading prints according to the interval time set on the FSpO2 Setup screen for built in module or the General Setup screen for external device The reading can print on any of the first three annotation lines depending on which printing line is available A diamond marks the time of the reading m An unfilled diamond indicates the reading was received from the monitor s built in fetal pulse oximetry module The vital signs print below the diamond m 4 A filled diamond indicates the reading was received from an external fetal pulse oximeter connected to the 120 Series Monitor The vital signs print below the diamond See Figure 12 5 Contact your Service Representative for information about connectivity If the top three printing lines are busy printing other data the diamond prints at the time of the reading however the vital signs data prints as soon as a line becomes available FSpO 47 9 00 US US2 TOCO FSpO296
156. ical dashed lines bracketing the heart rate grid indicate the start end of the fetal heart rate offset mode respectively gt lt 12 18 120 Series Maternal Fetal Monitor Revision C 2015589 001 Recorder Modes Summary of Annotations Table 12 3 Summary of Annotations Continued Annotation Explanation This annotation prints on the bottom two lines of the upper grid indicating an event Generate the mark by one of the following m Briefly press the monitor s Mark Offset pushbutton T m Press the Remote Marker button The Remote Marker is an accessory that can be connected to the 120 Series Monitor The monitor can be configured to use this arrow annotation or the one shown in the next row of this table Refer to the 120 Series Monitor Service Manual This annotation prints on the bottom two lines of the upper grid indicating that the mother perceives fetal movement The arrow prints each time the mother presses the Remote Marker button Note A horizontal bar prints as a tail on the arrow for as long as the button 1 is held down The Remote Marker is an accessory that can be connected to the 120 Series Monitor The monitor can be configured to use this annotation or the one shown in the previous row of this table Refer to the 120 Series Monitor Service Manual This annotation prints on the bottom two lines ofthe upper grid indicating thatthe J Corometrics Model 146 Fetal Acoustic Stimulator is bein
157. ield sets the time interval for printing MSpO values received from an external maternal pulse oximetry monitor FSpO Print Interval This field sets the time interval for printing FSpO values received from an external fetal pulse oximetry monitor FSpO Trace This field enables disables FSpOz trend trace printing of data received from an external fetal pulse oximetry monitor Revision C 120 Series Maternal Fetal Monitor 4 11 2015589 001 Setup Procedures Customizing the Power On Settings Customizing the Power On Settings The 120 Series Monitor is shipped with factory defaults for the setup screens You can change most of these settings to suit your particular needs The monitor has three options for the monitor s power on settings m Factory Defaults m Current Settings m Hospital Wide Preferences Refer to the Accessing the Install Options Screen next in this chapter for information about selecting the default option set Factory Defaults Factory defaults represent settings chosen to meet the requirements of a typical labor and delivery environment If the monitor is set to the FACTORY option the monitor will power up with the settings that are listed in Appendix A Factory Defaults You may adjust the setup screen configurations as needed during monitoring however be advised that if you turn off the monitor all user setup screens revert to the factory defaults when the monitor is turned on again
158. imitations of internal and external fetal heart rate monitoring techniques Responsibility of the Manufacturer GE Medical Systems Information Technologies is responsible for the effects on safety reliability and performance if m assembly operations extensions readjustments modifications or repairs are carried out by persons authorized by GE Medical Systems Information Technologies m the electrical installation of the relevant room complies with the requirements of appropriate regulations and m the monitor is used in accordance with the instructions of use Responsibility of the User This device is intended for use by clinical professionals who are expected to know the medical procedures practices and terminology required to monitor obstetrical patients This manual documents all possible parameters available in the 120 Series of monitors It is the responsibility of each hospital to ensure that the Labor and Delivery staff is trained in all aspects of the selected model The 120 Series Monitor is only one clinical indicator of fetal status during labor The monitor is designed to assist the perinatal staff in assessing the status of a patient The monitor does not replace observation and evaluation of the mother and fetus at regular intervals by a qualified care provider who will make diagnoses and decide on treatments or interventions Visual assessment of the monitor display and strip chart must be combined with knowledge o
159. is accomplished by a sensitive transducer which measures cuff pressure and minute pressure oscillations within the cuff The first determination sequence initially pumps up to a cuff pressure of about 160 mmHg for adult pediatric patients or 110 mmHg for neonates depending on the initial target pressure preset After inflating the cuff the Monitor begins to deflate it and measures systolic pressure mean pressure and diastolic pressure When the diastolic pressure has been determined the Monitor finishes deflating the cuff and updates the systolic diastolic and MAP displays The Monitor deflates the cuff one step each time it detects two pulsations of relatively equal amplitude The time between deflation steps depends on the frequency of these matched pulses pulse rate of the patient However if the Monitor is unable to find any pulse within several seconds it will deflate to the next step The process of finding two matched pulses at each step provides artifact rejection due to patient movement and greatly enhances the accuracy of the Monitor The figure shows the BP determination sequence 1 o N ow A 98 as I 5 2 91 5 2i x 5 Gil ol 8 a0 9I Oscillation a i arene o Tl ll 3 Ludi Huan H Time Figure 9 1 BP Determination Sequence At each step the microprocessor stores cuff pressure the matched pulse amplitude and the time between successive pulses The stepped
160. is the pause between sets Figure D 2 provides an example of an active alert level one decelerations Alert enabled icon For an active alert the FHR numerics p flash indicating which FHR is associated with the alert For a silenced alert the FECG Li US TOCO numerics continue to flash until the J 1 2 condition is resolved E 4 O 1 o y n For an active unsilenced alert the alert level flashes and displays in inverse A NBP A MECG A MSPO2 Zz video After the alert is silenced the alert 8 7 o level stops flashing and displays in y 98 Yo normal video until the alert is reset or the condition is resolved 25 mm s Il 2X MECG 15 52 58 PRINT FREEZE ALARMS SETUP VSHX Figure D 2 Example of a Level One Decelerations Alert Revision C 120 Series Maternal Fetal Monitor D 5 2015589 001 Spectra Alerts Alert Indications Silencing Alerts Press the Alarm Silence button to cancel the audio The alert level stops flashing and displays in normal video however the associated FHR numerics continue to flash For an active silenced alert the visual indications remain present until the condition is resolved or the alert is reset Refer to Resetting Alerts on page D 11 Resolved Alerts Resolved alerts function similar to the FHR alarms yet differently from the maternal alarms m Resolved Unsilenced Alert You must acknowledge an alert even if the condition has already been resolved The visual and
161. itor alerts you when paper is running low or when the recorder is completely out of paper To protect against paper jams the recorder also contains a paper loading sensor which notifies you if the paper has been incorrectly loaded Refer to page 4 2 through page 4 5 for instructions on loading paper into a 120 Series Monitor The alarms are summarized by Table 12 6 The volume of the alarm tone for all three conditions is configured on the General Setup screen Table 12 6 Recorder Error Conditions Paper Error Recorder Alarm Silence Condition Record Indicar UE Behavior Aupo Stats Button Behavior Flashes on and off once every Continues to Two short tones every 30 Cancels the alarm Paper Low second print until paper seconds runs out Automatically Three short tones every Cancels the alarm Paper Out Off n P stops printing 30 seconds Flashes on and off once every Does notprint Three shorttones every Temporarily silences alarm Second The message PAPER three seconds The alarm is re issued if the Paper Loadin INCORRECTLY LOADED RELOAD condition continues after p 9 WITH BLACK SQUARES DOWN the re alarm time specified displays in the waveform area of the on the Master Alarm Setup display screen The paper chime audio is enabled on the General Setup screen 120 Series Maternal Fetal Monitor 12 25 2015589 001 Revision C Recorder Modes Paper Low Paper Out and Paper Load Erro
162. ixed decelerations m mild bradycardia and flat variability m mild late or mixed decelerations with decreased variability ormild tachycardia m mild variables andflat variability m mild variables andmild tachycardia and decreased variability m prolonged deceleration 80 119 BPM m bradycardia 90 BP M m prolonged deceleration 80 BPM m late variable or mixed decelerations with decreased varia tachycardia orbrady m severe late or variab bility and cardia e decelerations with tachycardia orbradycardia or decreased variability m moderate bradycardi a and flat variability m any deceleration except mild variables and flat variability m late or severe variab uterine contraction es with tetanic D 4 120 Series Maternal Fetal Monitor 2015589 001 Revision C Spectra Alerts Alert Indications Alert Indications Active Alerts When the system detects an alert condition visual and audible indications are provided There is no printed indication of the alert The alert level indicated by asterisks flashes and displays in inverse video between the FHR1 and FHR2 areas in addition the associated FHR numerics flash The audio indication is a pattern of beeps representing the alert level Level 1 Beep Beep Beep Level 2 Beep Beep Beep Beep Beep Beep Level 3 Beep Beep Bep Beep Beep Beep Beep Beep Beep where beep represents audio tone sets and
163. k For example 10 50 11 00 11 10 11 20 11 30 etc If the bottom annotation line is being used to print another annotation the time stamp is delayed For example 10 50 11 00 11 12 11 20 11 30 etc In this example the 11 10 date stamp was delayed until 11 12 Time and Date Example 10 40 12 AUG 97 The time and or date also prints whenever itis changed via the General Setup Screen If the monitor senses a clock circuit fault when the recorder is turned on this SET TIME DATE message replaces the normal time date stamp The message reprints every ten minutes at the ten minute mark until the clock is reset This annotation prints across the width of the top strip chart grid when you press TEST ARE ALL DOTS PRINTED the Test pushbutton The message reminds you to check for a continuous unbroken line of recorder dots This icons prints prior to the FHR trend source annotations if the FHR alarms are ii enabled The FHR alarm option is enabled disabled via the Install Options service screen US orFECG Ar The trend source prints on the bottom annotation line by the following rules US orUS2 mv m All trend sources print twenty seconds after the recorder is turned on including inoperative modes MECG or MSpO P Ar m All trend sources print every thirty minutes m f mode change occurs only those trend sources belonging to the UA A corresponding group print If any
164. l oxygen sensors Doing so may result in sensor malfunction erroneous FSpO2 measurements and or infection or potential tissue injury to mother and or fetus Each fetal oxygen sensor is supplied by Mallinckrodt Inc as a sterile single use disposable device SERVICING Do not remove the monitor cover or attempt to service this monitor yourself Only qualified service personnel should attempt servicing this equipment Refer servicing to a GE Medical Systems Information Technologies Service Representative SENSOR IMMERSION Do not immerse the sensor completely in liquid the plug is not waterproof Immersion of the sensor plug in liquid may result in sensor malfunction and or erroneous FSpO measurements PATIENT MODULE IMMERSION Do not immerse the fetal patient module completely in liquid the unit is not waterproof Fluid damage to the module may result in malfunction and or erroneous FSpO2 measurements Inaccurate Measurements and Loss of Pulse Signal Inaccurate measurements may be cause by incorrect application or use of a sensor excessive fetal or maternal patient movement venous pulsation Loss of pulse signal can occur during uterine contractions if the fetus experiences shock hypotension sever vasoconstriction severe anemia arterial occlusion proximal to the sensor or cardiac arrest significant levels of dysfunctional hemoglobin such as carboxyhemoglobin or methemoglobin Revision C 1
165. le Solution Displayed FSpO does not correlate with the SaO value calculated from a fetal scalp blood sample measurementon a blood gas analyzer m Close correlation requires simultaneous blood sampling and pulse oximeter measurements from the same arterial supply Blood samples exposed to air during the sampling process may not accurately reflect true arterial values The SaO calculation may not have been correctly adjusted for the effects of pH temperature PaCO 2 3 DP G or the presence of fetal hemoglobin In general calculated Sa0 values are not as reliable as direct CO Oximeter or pulse oximeter measurements 120 F Series accuracy can be affected by incorrect sensor application or use significant levels of dysfunctional hemoglobins excessive patient movement venous pulsation or nearby electrosurgical interference Oxygen saturation greater than 8596 and or pulse rate less than 100 could indicate that the values are maternal in origin m Check whether calculations have been corrected appropriately for relevant variables See the P rinciples of Operation on page 6 6 for more information m Observe all instructions warnings and cautions in this manual and in the 120 Series Service Manual m Check sensor placementto ensure that it is properly positioned on the fetus Displayed FSpO does not correlate with the SaQ2 value calculated from a fetal scalp blood sample measurement on a laborat
166. le Transducer Elastic Style 10 carton 4425EA0 Semi Reusable Belt for Loop Style Transducer Velcro Style 4425F AO 2 pack 50 packs carton Single P atient Use Belt for Loop Style Transducer Foam Style with Velcro Closure 8024AA0 19 4 120 Series Maternal Fetal Monitor 2015589 001 Revision C Supplies amp Accessories FECG Ordering Information FECG Ordering Information Table 19 4 FECG Supplies Item Catalog Number REF Qwik Connect Plus Spiral Electrode 50 carton 7000AA0 Legplate for Qwik Connect Plus Spiral Electrode 8 foot Cord 1590AA0 Attachment Pads for Qwik Connect Plus Spiral Electrode Legplate 50 carton 2464AA0 Revision C 120 Series Maternal Fetal Monitor 2015589 001 Supplies amp Accessories FSpO Information FSpO Information Table 19 5 FSpO Supplies Item Catalog Number REF Corometrics Fetal Patient Module 1550AA0 19 6 120 Series Maternal Fetal Monitor 2015589 001 Revision C Supplies amp Accessories Tocotransducer Ordering Information Tocotransducer Ordering Information Table 19 6 Tocotransducer Supplies Item Catalog Number REF Loop Style Tocotransducer Nautilus 8 foot Cord 2264LAX Button Style Tocotransducer Nautilus 8 foot Cord 2264HAX Reusable Belt for Loop Style Transducer Mesh Style 10 carton 4425AA0 Reusable Belt for Loop Style Transducer Velcro Style 10 carton 4425CAO0 Re
167. llowing safety information applies to the non invasive blood pressure NBP of the monitor CAUTIONS ACCURACY As with any non invasive oscillometric blood pressure monitor there are clinical conditions which can affect the accuracy of the measurements obtained For example do not use the monitor s NBP feature on a patient experiencing convulsions or attached to a heart lung machine In addition disregard or stop automatic blood pressure determinations which coincide with maternal contractions Finally be aware that the accuracy of measurements can be affected if readings coincide with maternal uterine contractions Refer to Smart BP Feature on page 9 13 AUDIO ALARM Do not disable the audio alarm or patient safety could be compromised CALIBRATION Do not operate the monitor unless it has been properly calibrated Inaccurate blood pressure readings may result Refer to Chapter 16 Maintenance for details DISPLAY INTERVAL The time period in minutes that a blood pressure reading remains displayed before being automatically erased is selectable via the NBP Setup screen The option can also be set to continuously display the reading until replaced by a new reading The display of old pressure values may cause confusion If a patient s condition changes during the time interval between determinations the monitor will not detect the change or indicate an alarm condition Blood pressure and pulse can fluctuate
168. lse Repetition Frequency Single Ultrasound Mode Dual Ultrasound Mode Pulse Duration Transmitter Frequency Spatial P eak Temporal Average Intensity Spatial Average Temporal Average Intensity Focal 20 dB Beam Area Peak Instantaneous Intensity Peak Negative Acoustic P ressure Heart Rate Counting Range Leakage Current Pulsed Doppler with autocorrelation processing 9 crystal 4 kHz 2 kHz 92 us 1 151 MHz Ispta 10 mW cm Isata 5 mW cm 16 6 cm ata range 7 cm 1 8 mW cm p lt 10 0 kPa 50 210 BPM 10 uA at 120 240 VAC isolated by transducer Uterine Activity Mode Range Resolution Bandwidth Excitation Voltage Zero Set Temperature Drift Leakage Current Strain Gauge Tocotransducer 0 100 mmHg 0 100 relative units 1 mmHg 1 relative unit dc to 0 5 Hz dc to 0 5 Hz 4 0 Vdc 0 1 mmHg C 0 013 kPa C excluding transducer 60 pA at 254 VAC electrically isolated Revision C 120 Series Maternal Fetal Monitor 2015589 001 Technical Specifications Operating Modes Table 18 2 Operating Mode Specifications Continued MECG Mode Technique Maternal ECG Electrode Type Leads Available Heart Rate Counting Range Heart Rate Resolution Heart Rate Averaging Heart Rate Update Rate Countable Input Signal Range Baseline Drift Tall T wave R ejection Heart Rate Meter Response Time 80 120 BPM Step Increase 80 40 BPM Step Decrease
169. minutes and seconds The hour field has a range from 00 23 the minutes field has a range from 00 59 the seconds field is not adjustable It is very important to set the date on your monitor prior to initial use The month field has a range from 01 12 the range for the day field varies according to the selection for month and year the year field has a range of 00 99 A long lasting battery maintains the date even when the monitor is unplugged from AC power i For example February of 1996 has a day range of 01 29 February of 1997 has a day range of 01 28 August of 1997 has a day range of 01 31 Revision C 120 Series Maternal Fetal Monitor 2015589 001 4 9 Setup Procedures Setup Screens Song Player Song Player Volume SpO Scale Paper Speed Paper Chime Recorder Light Paper Chime Volume You can activate a song to be played from the monitor s speaker to celebrate each birth This field sets the volume of the song player Two scale options are available for printing the MSpO trend for compatibility with 6FSpO trending 76FSpO is always trended on a scale of 0 100956 The scale is printed on the paper along with the trend m Auto If only the MSpO trend is printing the trend plots on an expanded scale of 60 10096 or 50 100 depending on the paper Whenever the FSpO2 is being trended the monitor automatically switches to a scale of 0 100 for both 70MSpO and 6FSpO m 0
170. mplex during asystole INTERFERENCE Interference caused by electrosurgical or diathermy instruments will affect the proper operation of the MECG section of 120 Series Monitors PACEMAKER SPIKE Do not diagnostically interpret the pacemaker spike size and shape the spike may be attenuated by the module in order to be displayed or printed PATIENT OBSERVATION Keep pacemaker patients under close observation When MECG monitoring is employed the MECG waveform can be displayed and printed independent of the MHR P source Refer to Chapter 15 Waveforms 8 6 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Non Invasive Blood Pressure Monitoring NOTE Maternal NBP monitoring is The 120 Series Monitor measures the maternal systolic pressure diastolic pressure available on Models 128 and 129 mean arterial pressure MAP and pulse rate Two operating modes are provided manual and automatic This chapter describes the following Blood Pressure Safety Precautions llle eese 9 2 Oseillometne Theory ieebekenkUeAR boa oe bos t RR RR ee 9 4 NBP Setup Screen oi ijn dla Males RR Ce Rite Yala aed 9 7 INBPOGDOFDE se RESPECT ERA 9 9 Smart BP Beat te ccce ope hoes Ur RESG ERA EE epa 9 13 Revision C 120 Series Maternal Fetal Monitor 9 1 2015589 001 Maternal Non Invasive Blood Pressure Monitoring Blood Pressure Safety Precautions Blood Pressure Safety Precautions The fo
171. n 120 Series Maternal Fetal Monitors Refer to the Maternal Fetal Monitoring Operator s Manual for patient application information This chapter describes the following monitoring methods Ultrasound External Method 000s 5 2 FECG Internal Method 5 21 0102 Re AR RR ma 5 4 Dual Fetal Heart Rate Monitoring 2 005 5 6 Revision C 120 Series Maternal Fetal Monitor 2015589 001 5 1 Fetal Heart Rate Monitoring Ultrasound External Method Ultrasound External Method Methodology An ultrasound transducer placed on the maternal abdomen is used to direct an ultrasonic beam toward the fetal heart the transducer detects Doppler shifted frequency changes in echoes created by moving cardiac structures An autocorrelation process is used to determine the time interval between successive cardiac cycles The fetal heart rate is displayed in BPM and is continuously plotted on the strip chart paper Refer to Table 5 1 The heartbeat indicator flashes for each detected heartbeat US US2 Setup Screen Select the US or US2 softkey to access the US US2 Setup screen Figure 5 1 The title of the screen US vs US2 is dependent on the mode selected when the screen is activated FECG US TOCO ON or 10 MIN US SETUP OFF t HR OFFSET OFF HIGH LOW VOLUME 5 140 200 OFF OFF 60 140 0 1 1 2 2 3
172. n labor The absence of an alert does not indicate fetal or maternal well being The alert message and priority level are only a means to direct the staff s attention to the patient since more than one parameter may be contributing to the alert condition Visual assessment of the strip chart combined with knowledge of patient history and risk factors are necessary to manage the situation appropriately The alert system will not detect every possible abnormality and cannot detect abnormalities that have not been clinically recognized and described in the literature Frequent assessment of the fetal monitor tracing is necessary to ensure recognition of unusual undefined or suspicious patterns The care provider should only make the diagnosis of abnormal fetal heart rate patterns by personal assessment of the fetal monitor tracing from the bedside fetal monitor not the alert message The monitor requires data of a consistently good quality to recognize abnormalities Artifact will limit its ability to recognize abnormalities Increased variability long and frequent accelerations baseline changes half counting or double counting and poor or absent uterine activity are examples of factors which may limit detection capabilities 120 Series Maternal Fetal Monitor Revision C 2015589 001 Spectra Alerts Using the Spectra Alert Option Using the Spectra Alert Option Enabling Disabling Spectra Alerts Methodology CAUTION C
173. nal Only Mode Recorder Off If the recorder is running in maternal only mode the waveform does not interrupt the printing of data and prints at a high speed mode of 12 cm min When finished the recorder returns to the maternal only mode If the recorder is off the waveform print using a high speed mode of 12 cm min after which the recorder turns off again NOTE You cannot switch between different types of waveforms without cancelling any printing that is in progress NOTE The monitor must collect six seconds of new data following completion of a print function before it can print again Stopping a Print Command The following actions interrupt waveform printing m change in recorder mode pressing the Test button opening the recorder door running out of paper or turning off the monitor CAUTION DATA STORAGE Stored data for the maternal Vital Signs Screen is immediately lost when the monitor is turned off This ensures that stored data for one patient is not inadvertently transferred to a new patient Refer to Chapter 13 Maternal Vital Signs History for more information 15 6 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maintenance All equipment no matter how reliable needs to be maintained on a regular basis This section describes general care and cleaning instructions for the 120 Series Monitor and its accessories CAUTION Unplug the monitor from the AC power s
174. nce m Check the fetus for other signs of distress m f possible keep the patient still m Check whether the sensor is positioned properly and reposition it if necessary m Access FSpO Setup screen and select FAST mode m Check for interference from other hospital devices Do not use the 120 Series Monitor in the presence of an ESU FSpO readings greater than 8596 m The sensor may be facing the uterine wall and may be reading maternal saturation m The sensor may be affected by maternal pulsations m Confirm that the sensor is positioned properly against the fetus m Ensure that the displayed F SpO2 is fetal and not maternal Patient module cannot be connected m Invalid fetal patient module m Damaged fetal patient module m Use only a Corometrics Fetal Patient Module m Check for bent connector pins Replace with another Corometrics Fetal Patient Module Pulse Search icon K is displayed Pulse Amplitude appears to indicate pulses but there is no FSpO reading displayed m Fetal distress m The signal quality is below the acceptable threshold requirement necessary to post data on the display m Excessive maternal or fetal patient motion may be interfering with signal quality m The sensor may be improperly positioned m The fetus s perfusion may be too low for the monitor to detect an acceptable pulse m f Searchingindicator continues to display after evaluations
175. ndard Revision C 120 Series Maternal Fetal Monitor 1 5 2015589 001 Safety Monitor Contraindications Warnings and P recautions WARNINGS LINE ISOLATION MONITOR TRANSIENTS Line isolation monitor transients may resemble actual cardiac waveforms and thus cause incorrect heart rate determinations and alarm activation or inhibition MRI USE Do not use the electrodes during MRI scanning conducted current could potentially cause burns PATIENT CABLES AND LEADWIRES Do not use patient cables and electrode leads that permit direct connection to electrical sources Use only safety cables and leadwires Use of non safety patient cables and lead wires creates risk of inappropriate electrical connection which may cause patient shock or death PACEMAKER PATIENTS Rate meters may continue to count the pacemaker rate during occurrences of cardiac arrest or some arrhythmias Do not rely entirely upon rate meter alarms Keep pacemaker patients under close surveillance Refer to Chapter 17 Troubleshooting for disclosure of the pacemaker pulse rejection capability of the 120 Series Monitor SIMULTANEOUS DEVICES Do not simultaneously connect more than one device that uses electrodes to detect ECG and or respiration to the same patient Use of more than one device in this manner may cause improper operation of one or more of the devices STRANGULATION Make sure all patient cables leadwires and tubing are positi
176. neaneaneaneaneaues 9 9 Blood Pressure Methodology ssssssssssse eeteeees 9 9 Hydrostatic Effect arit Pt o ed a ic 9 9 Manual Mode sgiir e ea Sar t eer toes f over ev CE LORS 9 9 A tomatic Mode zs coegi e EORR Cer tea teat ane 9 10 Taking a Manual Reading Between Auto Determinations 9 10 Venous Return in Auto Mode isses 9 10 Adjusting the Interval Time Between Automatic Determinations 9 11 NBP Interval Button Shortcut isses 9 11 Terminating a Determination in Progress cc ccc ee cence eee e eens 9 12 Smart BP Feature 555r oic aaa ie a Vc Ya C CE I RR ae 9 13 Enabling Disabling Smart BP ence ea eeas 9 13 Methodology 54 55 5 bete Sete rre PE Qe Eti sels ira Pee iare 9 13 Maternal Pulse Oximetry Monitoring 10 1 TheOLy i emer aa e Fa rel Qo Vaca Rp OEC c Ro a CE 10 2 NGICOR 50h Duden castitate ees ead E E Heat Se Rost 10 2 Masimo c t a tae et t dba e eR ve hee het uota E ER Be hk 10 2 MSp02 Technology t qu E Ee Goa p Reg Fender adit 10 2 MSpOz Setup Screen ccccccceccuceucecceceuceueeuaeuaneaeuanuaraas 10 3 Response Time Nellcor Module Only sss 10 3 Sensitivity Masimo Module Only isse 10 4 Averaging Time Masimo Module Only i sss 10 4 P rintilnterdal 5a Son aa oh t Rente da D ec ead nash lt hd TR ier 10 4 9002 TACO xe dr ake Lee oe oe e ode c et ete aie e 10 4 Adam LIMIE toes cesa Perret t rr ro Oc the t e eren ont etre 10 4 Audio
177. nt light m Damaged sensor m Check patient The patient may be experiencing shock hypotension severe vasoconstriction severe anemia hypothermia arterial occlusion proximal to the sensor or cardiac arrest Ensure that the intermediate cable is firmly attached to the monitor and to the sensor assembly m Ensure sensor is nottoo tight Move sensor to another location m Restrict patient limb movement R estrain limb if necessary m Cover sensor with opaque material m Replace sensor MHR P Pulse source is blank when MS p0 is selected Nellcor only SLOW mode selected Select NORMAL or FAST mode on MSp0 setup screen REPAIR message shown in MS pO area of display System error or self test failure Contact Biomedical Engineering Department 17 12 120 Series Maternal Fetal Monitor 2015589 001 Revision C Technical Specifications This section contains a detailed list of the technical specifications for the 120 Series Monitor This chapter lists specifications for the following General MOHIOR 242 sien eget eee dea Sela MAS ER aes 18 2 Operating MOSS coro sre e eR CURRERE PERERERRCUESEXS 18 3 Stip Chart Recorder ios ione eb DUREE doh oY CS Shh 18 8 Revision C 120 Series Maternal Fetal Monitor 2015589 001 Technical Specifications General Monitor General Monitor Table 18 1 General Monitor Technical Specifications Category Technical Sp
178. o mode is selected with a time interval of two minutes A determination begins at 12 00 00 Due to excessive patient movement the determination ends at 12 01 35 This leaves only 25 seconds until the next automatic reading scheduled at 12 02 00 The 12 02 00 determination is cancelled and the following reading will resume at 12 04 00 The 120 Series Monitor is factory set with the optional 1 minute interval time disabled For information on enabling the 1 minute interval refer to the 120 Series Monitor Service Manual 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Non Invasive Blood Pressure Monitoring NBP Monitoring The optional one minute interval is an exception When one minute is selected if a determination ends with less than 30 seconds until the next one the reading will be reset to start in 30 seconds Example 2 The auto mode is selected with a time interval of one minute An automatic determination begins at 11 59 00 with the next reading therefore scheduled for 12 00 00 The 11 59 00 determination ends at 11 59 35 This leaves only 25 seconds until the next scheduled automatic reading Instead of being cancelled the next reading is reset to start in 30 seconds at 12 00 05 Adjusting the Interval Time Between Automatic Determinations You can adjust the interval time in between determinations by going back into the maternal NBP Setup screen Regardless of whether you are increasing or decreasin
179. on C 2015589 001 Maternal Heart Pulse Rate Monitoring MHR P Source MHR P Source The MHR P can be determined by the MECG MSpO2 and NBP sections of the monitor However the data from only one parameter is referred to as the MHR P source m displayed in the MHR P area m used to evaluate an MHR P alarm condition and m used to generate the MHR P trace on the strip chart paper The source is selected via the MHR P Setup screen may be manually selected or automatically selected by the monitor according to the following priority order MECG MSpO2 NBP IMPORTANT BLOOD PRESSURE AS AN MHR P SOURCE Although it is unusual to prioritize NBP as the MHR P source when MECG and MSpO are available it can be done In this case an MHR P alarm occurs only if the pulse rate value derived from the NBP cuff violates an MHR P alarm limit The MHR P values derived from the MECG and MSpO sections of the monitor are ignored MSpO AS AN MHR P SOURCE If MSpO is selected as the MHR P source an MHR P alarm only occurs if the pulse rate value derived from the MSpO sensor violates an MHR P alarm limit The MHR P values derived from the MECG and NBP sections of the monitor are ignored The heart rate tone varies in pitch to reflect changes in the maternal oxygen saturation reading The pitch rises as the saturation values increase the pitch lowers as the saturation values decrease The pulse rate trend is a grey lin
180. oned away from the patient s head to minimize the risk of accidental strangulation WATER BIRTHS Do not use the monitor to directly monitor patients during water births in whirlpool or submersion water baths during showers or in any other situation where the mother is immersed in water Doing so may result in electrical shock hazard 120 Series Maternal Fetal Monitor Revision C 2015589 001 Safety Monitor Contraindications Warnings and P recautions Cautions CAUTIONS ANNUAL SERVICING For continued safety and performance of the monitor it is recommended that the calibration accuracy and electrical safety of the monitor be verified on an annual basis by a GE Medical Systems Information Technologies Service Representative DAILY TESTING It is essential that the monitor and accessories be inspected every day It is recommended practice to initiate the monitor s self test feature at the beginning of each monitoring session follow the instructions in Chapter 4 Setup Procedures ENVIRONMENT The performance of the monitor has not been tested in certain areas such as x ray and imaging suites The monitor is not recommended for use in these environments PERFORMANCE Report all problems experienced with the monitor If the monitor is not working properly contact your Service Representative for service The monitor should not be used if it is not working properly Revision C 120 Series M
181. onitor 2015589 001 Troubleshooting FECG Troubleshooting FECG Troubleshooting Table 17 3 FECG Troubleshooting Problem Probable Cause Possible Solution Internal FECG erratic or not recording properly m Transducer not properly connected to monitor m Attachment pad or legplate not securely attached to patient m Electrode wire not secure in legplate post m Paste is dried or incorrect paste is being used m Electrode not properly attached m No FECG signal m Defective electrode m Defective attachment pad m Service required m Ensure transducer is securely attached to the monitor m Secure attachment pad or legplate to patient m Inspect legplate connection m Check ECG paste re apply if necessary m Replace electrode m Auscultate FHR m Replace electrode m Replace attachment pad m Call Biomedical Engineering Department Rate in FHR area ofthe display and the FHR trend on the strip chart paper do not correlate Monitor is set for 30 BP M cm vertical scale and 20 BP M cm vertical scale strip chart recorder paper is being used or vice versa Call Biomedical Engineering Department 17 4 120 Series Maternal Fetal Monitor 2015589 001 Revision C Troubleshooting Fetal Pulse Oximetry Troubleshooting Fetal Pulse Oximetry Troubleshooting Table 17 4 Fetal Pulse Oximetry Troubleshooting Problem Probable Cause Possib
182. onitor all zeroing information is lost If you re connect the patient to the monitor you must re zero regardless of whether you connect to the same monitor or a different monitor m If the mother s position has changed so that the height of the maternal xiphoid has changed in relation to the position of the strain gauge the baseline may have been altered If this is the case adjust the height of the strain gauge and re Zero m Ifthe message CHECK IUP flashes in the UA display area there is insufficient compensation to provide 100 mmHg above the reference level Re zeroing should correct the problem m Ifa negative value is displayed pressure less than 0 mmHg the baseline should be re zeroed When a negative value occurs for more than 20 seconds the message BASELINE PRESSURE OFFSCALE is on the bottom grid on the strip chart paper 7 4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Heart P ulse Rate Monitoring NOTE MECG is available on a Model The maternal pulse rate can be determined by the built in MSpO and NBP modules 129 only MSpO and NPP are available ofthe monitor The maternal heart rate can be measured via MECG on Models 128 and 129 This chapter describes the following MARP SOURCE 25 5 cc sees Sauer aeter Sur ba Ex eines 8 2 MHR P Setup S6reen iieceibseniekeeb Ee REG PES A dees 8 3 Maternal ECG Monitoring 2 0 6 cise ee RR HERR 8 6 120 Series Maternal Fetal Monitor 8 1 Revisi
183. onnections are OK use a new sensor m Replace with another Corometrics Fetal Patient Module m Replace with valid Nellcor OxiFirst F etal Oxygen Sensor Series FS 14 COMM message shown in FSpO area of display m Communication error between the built in F5p02 module and the remainder of the monitor circuitry m Contact Biomedical Engineering Department FHR slows during or immediately after Sensor placement m Changes in intracranial pressure due to examination could cause a reflex bradycardia stimulus m Stop the exam Do not proceed with sensor placement Wait for the FHR to return to the previous range Dashes shown in FS p02 display area m Monitor unable to make a determination due to insufficient signal m improperly applied sensor m Excessive fetal movement m Excessive maternal movement m Maternal uterine contraction m Damaged sensor m SLOW mode selected m Check centimeter mark on stylet chamber relative to the introitus The sensor may have ascended or descended independent of fetal head descent m Ensure thatthe fetal patient module cable is firmly attached to the monitor and to the sensor assembly m Move sensor to another location m Waitfor movementto stop m Restrict patient movement m Waitfor contraction to end m Replace sensor m Access FSpO Setup screen and select FAST mode REPAIR message shown in FS pO display area m System error
184. ons Maternal NBP Connector Connect a pneumatic hose and blood pressure cuff assembly to this black twin lumen receptacle Maternal S pO Connector Connect a 120 Series MS pO intermediate cable to this royal blue receptacle Use only Nellcor Maternal Oxygen Saturation Sensors if Nellcor technology is installed in your monitor or Masimo Sensors if Masimo technology is installed in your monitor FECG or FECG MECG Connector Connect an FECG cable legplate or MECG cable plug to this green receptacle For Models 126 or 128 the connector is labeled FECG For a Model 129 the connector is labeled FECG MECG Cables with rectangular plugs connect directly to the FECG MECG receptacle Cables with round plugs require an FECG MECG adapter cat no REF 1442AA0 Use this adapter for dual ECG monitoring as well The adapter branches into two cables each with a round receptacle at the end one branch is labeled MECG the other branch is labeled FECG UA Connector Connect a tocotransducer IUPC or strain gauge transducer plug to this white receptacle Contact your Sales Representative for information about compatibility US2 Connector Connect the secondary ultrasound transducer plug to this light gray receptacle US Connector Connect the primary ultrasound transducer plug to this light gray receptacle Fetal SpO Connector Connecta 120 Series Fetal Patient Module cable to this light blue receptacle Us
185. oring Operator s Manual for additional information FSpO Contraindications FSpO Warnings CONTRAINDICATION PATIENT CONDITIONS Use of the FSpO feature is contraindicated in patients with any of the following conditions Documented or suspected placenta previa Ominous FHR pattern requiring immediate intervention Need for immediate delivery unrelated to FHR pattern such as active uterine bleeding WARNINGS INDICATIONS FOR USE The 120 F Series System continuously monitors intrapartum fetal oxygen saturation FSpO and is indicated as an adjunct to fetal heart rate FHR monitoring in the presence of a non reassuring heart rate pattern It should only be used after maternal membranes have ruptured on a singleton fetus in vertex presentation with a gestational age greater than or equal to 36 weeks ELECTROSURGICAL EQUIPMENT Do not use the FSpO feature while using an Electrosurgical Unit ESU Remove the fetal oxygen sensor from the mother and fetus before using an ESU An improperly grounded ESU can cause surface skin burns on the fetus if both the monitor and an ESU are used together 6 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Fetal Pulse Oximetry Monitoring FSpO Indications Contraindications Warnings and Precautions FSpO Precautions Clinical Use Precautions WARNINGS EXPLOSION HAZARD Do not use the monitor in the presence of flammable
186. orm chosen for display is independent of any of the numerics shown on the display For example MSpO can be chosen as the maternal pulse rate source numerics while the MECG waveform is selected for display in the waveform area CAUTION WAVEFORM INTERPRETATION Waveforms generated by the 120 Series Monitor are not intended for true diagnostic interpretation Selecting the Waveform Waveform Speed ECG Size MECG Lead Select NOTE The MECG lead can also be changed from the MHR P Setup screen MECG Pacer Label Use the Waveform Softkey on the normal operating screen to select FECG MECG FSpO MSpO or OFF Refer to Figure 15 1 All waveforms are displayed at a rate o 25mm sec This speed is not adjustable The speed is displayed at the top right of the waveform The size is printed in the upper right above the waveform This label is also a softkey which can be used to change the setting Select from the following 0 25X 4 mV cm 0 5X 2 0 mV cm 1X 1 0 mV cm 2X 0 5 mV cm 4X 0 25 mV cm or AUTO The selected lead is displayed in the upper right above the waveform This label is also a softkey which can be used to change the setting Select from the following I II or III When the MECG pacer option is enabled on the letter P is displayed prior to the waveform speed See Figure 8 3 on page 8 5 15 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Waveforms Waveform Ar
187. orrect access code the Install Options screen displays Figure 4 12 Revision C 120 Series Maternal Fetal Monitor 4 15 2015589 001 Setup Procedures Accessing the Install Options Screen INSTALL OPTIONS DEFAULT SETTINGS FACTORY LINE FREQUENCY 60 HZ ECG ARTIFACT ELIMINATION OFF SCALING 30 240 LANGUAGE ENGLISH NBP 1 MIN INTERVAL OFF HR OFFSET 10 MIN DEFAULT TOCO REFERENCE 10 FM REMOTE MARK ON COROLAN ADDRESS CHECKING OFF HBC OFF SMART BP OFF VS PRINT INTERVAL REAL TIME RECORDER FONT SIZE SMALL FETAL ALERT ALARM OFF ALERT SUSPEND OFF PRINTALL LOG COMM EXIT Figure 4 12 Install Options Screen 5 Refer to the 120 Series Monitor Service Manual for more information about the Install Options screen 4 16 120 Series Maternal Fetal Monitor Revision C 2015589 001 Setup Procedures Preparing the Monitor for Patient Use Preparing the Monitor for Patient Use The following procedures should be performed before use on each patient 1 3 4 7 8 9 Ensure an adequate supply of paper is in the recorder The recorder will automatically stop when paper runs out If the recorder requires paper refer to Loading Strip Chart Recorder Paper on page 4 2 Set the chart speed to the desired setting 1 2 or 3 cm min Refer to General Setup Screen on page 4 9 Ensure the Power switch is in the on position Connect the appropriate transducers for monitoring Read the
188. ory CO Oximeter Close correlation requires simultaneous blood sampling and pulse oximeter measurements from the same arterial supply Blood samples exposed to air during the sampling process may not accurately reflect true arterial values Fractional measurements may not have been converted to functional measurements before the comparison was made The 120 F Series Monitor as well as other two wavelength oximeters measures functional saturation Multi wavelength oximeters measure fractional saturation Fractional measurements must be converted to functional measurements for comparison Oxygen saturation values greater than 85 could indicate that the values are maternal in origin m Refer to the equation in Principles of Operation on page 6 6 for this conversion m Check sensor placementto ensure that it is properly positioned on the fetus Revision C 120 Series Maternal Fetal Monitor 2015589 001 Troubleshooting Fetal Pulse Oximetry Troubleshooting Table 17 4 Fetal Pulse Oximetry Troubleshooting Continued Problem Probable Cause Possible Solution FSpO2 values change rapidly Pulse Amplitude indicator is erratic m Fetal distress m Excessive maternal or fetal patient motion may be making it impossible for the monitor to find a pulse pattern m improperly applied sensor m SLOW mode selected m A nearby electrosurgical unit ESU may be interfering with performa
189. ource and detach all accessories from the monitor Do not immerse accessories in any liquid Do not use abrasive cloth or cleaners on monitor or accessories This chapter describes the following Clean E e oer entere nt tace e ev A Re deed Maternal SpOx Calibration isis se Re ERR RR 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maintenance Cleaning Cleaning The following cleaning instructions are provided If an accessory is not listed consult the manufacturer s instructions Monitor Exterior 1 Wipe any fluids from the surface of the monitor 2 Dampenacloth or paper towel with isopropyl alcohol and gently rub soiled area until clean Electroluminescent Panel 1 Dampen a soft cloth with water The cloth should be free of grit or other particles that may cause abrasion CAUTION CLEANING AGENTS Do not use isopropyl alcohol 2 Rub lightly in a circular motion 16 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maintenance Cleaning Tocotransducer Ultrasound Transducer and MECG Cables CAUTIONS ABRASION Do not use abrasive cloth sharp objects or abrasive cleaners ALCOHOL Do not use Alcohol in cleaning solutions DISCONNECTION Detach the transducers cables legplate from the monitor IMMERSION Do not immerse transducers or cables or hold under running water NOTE Only Nautilus tocotransducers are immersible 1 Dampen a
190. panel Revision C 120 Series Maternal Fetal Monitor 6 13 2015589 001 Fetal Pulse Oximetry Monitoring FS pO Methodology FSpO Methodology The fetal oxygen saturation is indicated by up to three digits representing the percentage of oxygen saturation The pulse amplitude indicator is a vertical bar that qualitatively indicates the pulse amplitude When enabled the FSpO gt trend print in the bottom grid as a beaded trace annotated by 99FSpO Values are printed on the annotation area preceded by an outlined diamond which marks the time of the reading An adequate FSpO2 signal is indicated by a continuous trace on the paper NOTE Refer to MSpO gt Trend Scale on page 12 8 for information about possible changes in the MSpO trend scale at the commencement of FS pO trending 6 14 120 Series Maternal Fetal Monitor Revision C 2015589 001 Fetal Pulse Oximetry Monitoring FS pO Waveform FSpO Waveform When FSpO monitoring is employed the FSpO pulsatile plethysmograph waveform can be displayed and printed by selecting the F p02 waveform softkey Refer to Chapter 15 Waveforms Revision C 120 Series Maternal Fetal Monitor 6 15 2015589 001 Fetal Pulse Oximetry Monitoring FSpO Monitoring Basic Operation FSpO Monitoring Basic Operation NOTE Readings provided by an external FSpO monitor are denoted by a filled diamond marker Plug the fetal oxygen senso
191. patient discomfort during labor Enabling Disabling Smart BP The Smart BP feature is enabled disabled via the Install Options service screen Refer to the 120 Series Monitor Service Manual for more information Methodology NOTE Blood pressure readings The Smart BP feature is available for both TOCO and IUP monitoring when cannot be postponed indefinitely The a the automatic blood pressure mode is selected and Smart BP feature ensures that a BP reading is completed even in the presence of frequent uterine m the interval time is set to 5 minutes or greater Uterine activity trends are continuously analyzed to recognize patterns of uterine contractions Be Bas e contractions Once the onset of a contraction is identified m An active blood pressure reading automatically stops and the cuff deflates it will be re started following the contraction A scheduled reading is delayed until after the contraction Revision C 120 Series Maternal Fetal Monitor 9 13 2015589 001 Maternal Non Invasive Blood Pressure Monitoring Smart BP Feature For your notes 9 14 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Pulse Oximetry Monitoring NOTE MSpO monitoring is available The 120 Series Monitor measures the maternal oxygen saturation MSpO and with Models 128 and 129 pulse rate using the principles of spectrophotometry and plethysmography This chapter describes the methods of monitoring e
192. ption ccccccccccceeeeeeeceevaeeaeeaneeaeereaneags 3 18 Communication Option 2 2 ves ete eee aper ad ee HO 3 20 Corlan Option e uh strom t MR ea OETA RA eae 3 21 Setup Procedures eeeen nn n n n nnns Al Loading Strip Chart Recorder Paper enn n n n n nnn 4 2 Powe 22 595 itti anette a arte afhea e am A MEA a ca fade a arene 4 6 Self Test Routine ripiene rnea a a a a nena na 4 7 Setup Screens ira o aa ere Dare bx wee aer a P EAT E A A 4 8 Using the Trim Knob Control 4 8 General Setup Sereen cist wegiaegs ke en esr ARTE V3 e pov 4 8 TINE score erento c p e ELA o e i los 4 9 Dale s inent on nEn E EEE OTENE eEthrbiertenu eh rn 4 9 Song Playet 1e aa td bp DU MO te Pan 4 10 Song Player Volume viene aeter ore xo te Notae e C Rd 4 10 Sp0 Scalg s crc a eu etta a eL Els 4 10 Papers Deed 1 stad eso eee ee ht eio bee PE Dame 4 10 Paper Chile nator carat e Rn qon ette RU Rno E irre bbc a 4 10 Recorder Light ico reme egere maet m PUn 4 10 Paper Chime Volume cc ccc cece cect nn 4 10 MS pO2 Print Internal ac t i ttt ei trea 4 11 FSpOPriritInterVal e rrr e nt Ra er eh 5 4 11 ESpO TICE 5 eee IE qe ep d po gp n oe oss 4 11 Customizing the Power On Settings essen 4 12 Factory Defaults s nega eckauts REDOTR Three Ae e RD n 4 12 Current Last Used Settings 0 ccc ccc eee c cece eaten eee eeteaeeas 4 12 Hospital Defile recueie terr veto p elei def See Eb Rein do 4 12 Accessing the Install
193. r Conditions For your notes 12 26 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Vital Signs History This section describes the maternal vital signs history feature of the 120 Series Monitor The monitor collects up to eight hours of continuous maternal vital signs data available for review and printing at any time This chapter includes the following Revision C 120 Series Maternal Fetal Monitor 2015589 001 Maternal Vital Signs History What is the Maternal Vital Signs History Screen What is the Maternal Vital Signs History Screen NOTE The monitor stores blood pressure and maternal pulse oximetry events from the monitor s built in modules The monitor does not store data provided by external devices This feature displays prints maternal vital signs data in a spreadsheet format called Vital Signs History An example of the maternal Vital Signs Screen is shown in Figure 13 1 A printout example is shown in Figure 13 2 CAUTION DATA STORAGE Stored data for history is immediately lost when the monitor is turned off This ensures that stored data for one patient is not inadvertently transferred to a new patient It should be noted that the maternal Vital Signs History feature is most beneficial when a patient is being continuously monitored If a patient is being monitored intermittently all history data is erased each time the monitor is turned off If a significant
194. r Versus Electronic Strip Charts As described earlier the monitor s maternal only mode acts as a paper saver turning the strip chart recorder on and off as needed However the QS System overrides the maternal only mode by storing the entire patient record In other words the electronic strip chart is retained as if the monitor s recorder were left on continuously with all data lines printing in the annotation area this may result in many blank pages in between maternal vital signs data Messages If the QS System is connected via RS 232 cabling messages print as described in Paper Versus Electronic Strip Charts If the QS System is connected via Corolan cabling and uses Software Version 4 0 3 0 or earlier maternal only mode messages will not print on the electronic strip chart of the QS System Contact your Service Representative for clarification on whether your QS System is wired via RS 232 or Corolan cabling Contact your Sales Representative about availability of QS System software upgrades Fetal Heart Rate Alarms The QS System is designed to alarm when there is no fetal heart rate signal so it is recommended that you unplug the ultrasound and or FECG transducers from the monitor when not in use to eliminate false alarms i In addition the FHR modes will list INOP Revision C 120 Series Maternal Fetal Monitor 12 23 2015589 001 Recorder Modes Changing Recorder Modes Changing Recorder Modes Use the Reco
195. r and applied to the patient 17 2 120 Series Maternal Fetal Monitor 2015589 001 Revision C Troubleshooting Ultrasound Troubleshooting Ultrasound Troubleshooting Table 17 2 Ultrasound Troubleshooting Problem Probable Cause Possible Solution Ultrasound not functioning properly m Transducer not properly connected to monitor m Transducer placement m Too little gel applied to transducer m Defective transducer m Active fetus or mother Fetal arrhythmia or hiccups Extreme maternal obesity m No signal m Service required m Ensure that transducer is securely attached to monitor m Wait before moving transducer FHR often returns Reposition transducer m Apply more gel m Replace transducer m Use alternate technique m Auscultate FHR m Call Biomedical Engineering Department Static noise on ultrasound m Active fetus m Environmental noise m Maternal movement m Defective transducer m Reposition transducer m Keep sheets and gown off transducer Do not hold transducer with hand m Use alternate monitoring mode m Replace transducer Rate on FHR area of display and FHR trend on strip chart paper do not correlate Monitor is set for 30 BP M cm vertical scale and 20 BP M cm vertical scale strip chart recorder paper is being used or vice versa Call Biomedical Engineering Department Revision C 120 Series Maternal Fetal M
196. r into the sensor connector on the fetal patient module The Sensor Disconnected icon E should disappear and the Sensor Lifted icon 4 should display Place the sensor as described in the Maternal Fetal Monitoring Operator s Manual After the sensor is appropriately positioned the Sensor Lifted icon 4 goes away and the Pulse Search icon e appears The Pulse Amplitude indicator lights up with each pulse with the number of bars lit depending upon pulse strength The Signal Quality indicator lights up to display the quality of the signal used to calculate the FSpO value The fetal oxygen saturation is indicated by three digits indicating the percentage of oxygen saturation Values are printed on the strip chart preceded by an outlined diamond which marks the time of the reading The FSpO trend is printed on the bottom grid of the strip chart paper 6 16 120 Series Maternal Fetal Monitor Revision C 2015589 001 Uterine Activity Monitoring This section provides a brief overview of the uterine activity monitoring methods available on a 120 Series Monitor Refer to the Maternal Fetal Monitoring Operator s Manual for patient application information This chapter describes the following monitoring methods Tocotransducer External Method 000 cee ee eee 7 2 Internal Method IUPQ 22 02 4058 Aciaidecditenceade RRE RR 7 4 Revision C 120 Series Maternal Fetal Monitor 2015589 001
197. rd pushbutton to select between on maternal only mode and off refer to Table 12 4 and Table 12 5 Turn the recorder on for continuous trending set the recorder to maternal only mode when you are interested in the maternal vital signs but not the MHR P trend CAUTION DATA STORAGE Stored maternal vital signs history data is erased when you turn the monitor off Therefore for intermittent monitoring it is recommended that you leave the monitor on but turn the recorder off Refer to Chapter 13 Maternal Vital Signs History for more information Table 12 4 Changing Recorder Modes From To Pushbutton Off On Briefly press once or press and hold three seconds Off Maternal Only Briefly press twice On Maternal Only Briefly press once On off Press and hold three seconds Maternal Only On Briefly press once Maternal Only Off Press and hold three seconds a P audio tones are provided for confirmation thatthe recorder has been turned off Table 12 5 Recorder Mode Audiovisual Indicator Status Recorder Mode Record Indicator Audio Indicator On continuously illuminated Maternal Only lights three shortflashes every Off 5 seconds Off Off 12 24 120 Series Maternal Fetal Monitor Revision C 2015589 001 Recorder Modes P aper Low Paper Out and Paper Load Error Conditions Paper Low Paper Out and Paper Load Error Conditions A 120 Series Mon
198. ress the Remote Event Marker button whenever she feels fetal movement Ask her to hold down the button for the duration of the perceived fetal movement The annotation Tor 1 With a horizontal bar prints on the strip chart for as long as the button is held down Refer to Figure C2 The annotation resulting from the Remote Event Marker can be configured as one of the following m f commonly used to record a general event or 1 commonly used as an indication that the mother has perceived fetal movement This is the factory default setting C4 120 Series Maternal Fetal Monitor Revision C 2015589 001 Fetal Movement Detection Using Fetal Movement Detection While Monitoring LL 9 00US MSpO P FMD TOCO Figure C 2 Simulated Fetal Movement Detection Trace Revision C 120 Series Maternal Fetal Monitor 2015589 001 C 5 For your notes C 6 120 Series Maternal Fetal Monitor Revision C 2015589 001 Spectra Alerts Each monitor in the 120 Series can be upgraded to include Spectra Alerts Contact your Sales Representative for more information This feature analyzes heart rate and uterine activity data to detect certain abnormal trends and alert the clinician A Nurse Call Light Interface is also provided as part of the Spectra Alerts upgrade This chapter provides the following information Important Safety Information 000020008 D 2 Using the Spectra Alert Option
199. ring can continue during the monitoring of twins even when one twin is monitored using FECG Refer to Chapter 8 Maternal Heart Pulse Rate Monitoring for more information The dual fetal heart rate monitoring modes are summarized as follows m dual external US US2 or m internal external FECG US or FECG US2 The 120 Series offers two advanced features to aid in monitoring twins W heartbeat coincidence m fetal heart rate offset Table 5 1 FHR Display and Trend Summary DISPLAY MODE TREND ANNOTATION ACTIVE CONNECTORS FHR1 FHR2 FHR1 FHR2 US US US US2 US2 US FECG FECG FECB v US US2 US US2 US US2 FECG US FECG US FECG US FECG US2 FECG US2 FECG US2 wv FECG US US2 FECG US2 FECG v US2 wv Heartbeat Coincidence All 120 Series Monitors have a feature called heartbeat coincidence When this feature is enabled the monitor alerts you when there is the possibility that you may be monitoring a duplicate signal Refer to Chapter 14 Heartbeat Coincidence for more information Fetal Heart Rate Offset When monitoring dual fetal heart rates overlapping traces may be difficult to interpret All 120 Series Monitors provide a 20 BPM shift for the secondary FHR trend to alleviate this problem whether using dual ultrasound or ultrasound and FECG MECG monitoring is available on a Models129 only 5 6 120 Series Maternal Fetal
200. rms This chapter provides a summary of alarms for all modalities in the 120 Series This chapter describes the following ttoduetlot eL na EUER ERGO 11 2 Alami Setup autc a SO pede pu REC ee erts 11 3 Fetal Heart Rate Alarms 0 cece cee eee eens 11 7 Maternal Alarms ccc ace eie eee eae E RR ep EE 11 9 Revision C 120 Series Maternal Fetal Monitor 2015589 001 Alarms Introduction Introduction NOTE The audio portion of an alarm A 120 Series Monitor provides patient alarms alarm limit threshold violations for takes priority to override the song player m FHR1 if activated FHR2 m NBP systolic diastolic and mean arterial pressures m MHR P for the selected source m MSpO2 In addition the monitor provides signal quality alarms 120 Series Maternal Fetal Monitor Revision C 2015589 001 Alarms Alarm Setup Alarm Setup Master Alarm Setup Screen Audio Alarms Re Alarm Alarm Limits Volume Figure 11 1 shows an example Master Alarm Setup screen Although each of the fields on this screen can be accessed under the individual parameter setup screens this screen provides an overall summary of the maternal alarm setup information TOCO 165v 172 30 MASTER ALARM SETUP AJDIO ALARMS NBP ON MHR P ON MSPO2 ON RE ALARM 120 SEC MAP ALARM HIGH LOW SYSTOLIC 160 90 DIASTOLIC 90 50 140 50 MHRIP 120 50 MSPO2 100 95 VOLUME 5
201. rnal Vital Signs History Printing automatically stops if m you open the recorder door m strip chart paper runs out m you press the Test button m you change the recorder mode CAUTION Do not turn monitor off during printing or your data will be lost VITAL SIGNS H stoRY DATE 24 MAR 24 MAR 24 MAR 24 MAR 24 MAR TIME 22 49 P2 50 22 51 22 52 i it NBP sys 129 MAP 85 PR 56 MSpO2 O2 99 97 98 96 97 PR 75 70 71 86 66 MHR 65 69 72 70 71 Figure 13 2 Vital Signs History Print Example Revision C 120 Series Maternal Fetal Monitor 13 5 2015589 001 For your notes 13 6 120 Series Maternal Fetal Monitor Revision C 2015589 001 Heartbeat Coincidence The heartbeat coincidence feature alerts you when there is the possibility that you may be monitoring a duplicate signal This chapter describes the following Heartbeat Coincidence Theoty i c eme em emen 14 2 Using the Heartbeat Coincidence Feature 14 3 Revision C 120 Series Maternal Fetal Monitor 2015589 001 Heartbeat Coincidence Heartbeat Coincidence Theory Heartbeat Coincidence Theory NOTE The maternal heart rate derived The heartbeat coincidence feature alerts you when there is the possibility that you from blood pressure readings is not used may be monitoring a duplicate signal Heartbeat coincidence is indicated when any two heartbeats have a consistent phase relationship for equ
202. rometrics fetal patient module cable must be plugged into the FSp02 connector in order to activate the FSp02 mode softkey US 165 172 30 Y FSPO2 SETUP ett ill RESPONSE TIME SLOW FSPO2 PRINT INTERVAL 5 MIN o 02 TRACE ON 47 J o Figure 6 2 FSpO Setup Screen This field sets the response time or averaging mode the time the monitor takes to respond to changes in fetal oxygen saturation m Slow The FSpO display responds to step changes in the fetal saturation with approximately 120 accepted pulses or in about 50 seconds at 150 BPM m Fast The FSpO display responds to step changes in the fetal saturation with approximately 30 accepted pulses or in about 11 seconds at 150 BPM The factory default setting is SLOW When signal quality is poor the response time becomes longer regardless of the mode selected This setting determines the time interval for printing the FSpO values on the strip chart paper Revision C 120 Series Maternal Fetal Monitor 6 9 2015589 001 Fetal Pulse Oximetry Monitoring FSpO Setup Screen 960 Trace This setting enables or disables the printing of the FSpO trend on the bottom grid of the strip chart paper m On The FSpO trend is printed as a beaded trace on the bottom or right grid annotated by FSp02 s m Off The FSpO trend is not printed FSpO2 51
203. rovides an audible and visual indication of that alert When an alert condition is detected the system categorizes the alert into one of three levels with level three being the most severe Refer to Table D 1 Limits are not user selectable Revision C 120 Series Maternal Fetal Monitor D 3 2015589 001 Spectra Alerts Using the Spectra Alert Option 9 00 US TOCO 3 CM MIN Figure D 1 Spectra Alert Enabled Annotation Table D 1 Possible Alert Conditions Level One Alert Level Two Alert Level Three Alert x m decreased variability m flat variability m bradycardia 100 119 BPM m tachycardia 161 180 BPM m mild moderate variable decelerations m mild moderate sporadic decelerations m mild variable decelerations with decreased variability ormild tachycardia ormild bradycardia m tachycardia 161 180 BP M with decreased variability m undefined decelerations m mild bradycardia andidecreased variability m prolonged deceleration gt 120 BPM m increased variability m uterine hypertonus m tetanic uterine contraction gt 60 sec m signal quality m tachycardia 2180 BP M m bradycardia 90 99 BPM m late decelerations m severe variable or sporadic decelerations m tachycardia with flat variability m mild sporadic decelerations with decreased variability m moderate variable decelerations with tachycardia orbradycardia or decreased variability m m
204. rt Recorder aerisire nener nennen nnns 18 8 Supplies amp Accessories soooeroors 19 1 General Add Ons Ordering Information nnn nnn 19 2 Paper Supplies Ordering Information en nn nn nnn 19 3 Ultrasound Ordering Information cccccceeeseeaeeaeeaeeeneaneags 19 4 FECG Ordering Information sse 19 5 FSpO Information iie ce seke raa coe we a Ci a d ceo aca 19 6 Tocotransducer Ordering Information 0ccccceeecuceeeueeeueeaeuaes 19 7 IUPC Ordering Information ssennn nennen 19 8 MECG Ordering Information cccccccccceuaeeaeeaeeaeeeneeneanegs 19 9 NBP Ordering Information snennn mmm 19 10 MSpO2 Ordering Information ssssnnn nennen 19 11 Peripheral Device Ordering Information nn nnn 19 12 Factory Defaults 2252s sacas e aras And Table of Defaulls 5e vk rose aper ace ne va doa o e a RT ER A 2 Alarms Summary 1 x san xh erra B 1 Table of Alaims 5 9 v c e oce Oe nce e hee OR C D OG B 2 Fetal Movement Detection o s CH Introduction cererea a A meme C2 Availability 1 2 4 4 9 a r etes e e Leal a dd nore qe A C 2 Methodology s dde RR Free ru Perd recur tes C 2 Using Fetal Movement Detection While Monitoring sens C 3 Enabling Disabling Fetal Movement Detection 0 cece cece eens C 3 Display IndiCatoE once reo o ete ce os tdt poni e RAD ER e eq eine C 3 Strip Chart Annotation 22s stop am t tert tatg
205. rt paper grid BASELINE PRESSURE OFFSCALE during IUP C monitoring when the pressure falls below 0 mmHg for more than 20 seconds Maternal NBP vital signs data prints for each manual and automatic Maternal NBP vital signs data For example Ste vata m identifies the 120 Series as the source NBP 103 71 M 83 P 72 m identifies an external device as the source or n The diamond prints on the bottom two lines of the bottom grid of the strip chart paper and marks the time of the reading The vital signs data prints in one of the top three lines of the annotation area as soon as a printing line is available The printed pulse rate value is derived from the blood pressure module and is independent of the MHR P source selected on the MHR P Setup screen NBP 103 71 M 83 P 72 0j Indicates a BP determination was cancelled or delayed due to the occurrence of NBP D a uterine contraction MS pO vital signs data is printed at selected intervals according to the MSpO Setup screen built in module or the General Setup screen external device In addition for the built in module only vital signs data is printed when a 95MSpO alarm occurs however only one alarm related print occurs within a 5 minute MS pO vital signs data For example period m identifies the 120 Series as the source MSpO2 97 P 66 m 4 identifies an external device as the source or The diamond prints on the bottom two lines of the
206. ry and m notes from a Model 2116B Clinical Notes Data Entry System When the recorder is in the maternal only mode the yellow Record indicator flickers approximately every five seconds See Table 12 4 and Table 12 5 for more information Information printed using the maternal only mode prints sideways across the page Figure 12 9 provides an example of a maternal only mode printout 12 46 Q MSPO 97 12 45 9 NBP 113 64 MSPO2 98 12 41 v 12 36 Q MSPO2 97 12 31 Q MSPO2 99 12 30 Q NBP 115 62 18 FEB 96 12 28 Figure 12 9 Maternal Only Mode Printout 120 Series Maternal Fetal Monitor 2015589 001 Revision C Recorder Modes Maternal Only Mode The following provides a summary of the printed information A blank line is printed after each message to improve readability m Each message can be a maximum of 40 characters in length m The time precedes each message m An outlined diamond marker Q indicates the data is provided by one of the monitor s built in modules m A filled diamond marker 9 indicates the data is provided by an external device interfaced to the monitor m The date is printed when the maternal only mode is first activated when the date time is changed and at midnight Functionality with a QS System Users of a Quantitative Sentinel QS System Software Version 4 0 3 0 or earlier should be aware of the following three items when using the monitor s maternal only mode Pape
207. s Battery requires service Call GE Service to report Softkeys A softkey is an area on the screen that can be selected with the Trim Knob control When the softkey is activated by pressing the Trim Knob control it may cycle through available settings or it may display a setup screen Mode Title Softkeys Most of the mode titles in the display are also softkeys which give access to corresponding setup screens US US2 FECG NBP MECG PULSE FSPO and MSPO Waveform Softkeys The waveform title is a softkey used to select the waveform for display or to disable the area The ECG scale and MECG lead labels are softkeys used to configure the waveform currently displayed Dedicated Softkey Area Softkeys are located at the bottom of each screen as shown in Figure 3 11 and Figure 3 12 Although there are many possible softkeys which may appear in this area a maximum of five are shown at a time Revision C 120 Series Maternal Fetal Monitor 3 15 2015589 001 Controls Indicators and Connectors Front Panel Displays US2 TOCO 165 172 v 30 m f NBP Qo fA MECG A MPO 130 85 899 97 MAP 107 03 15 25 mm s 1 P B C _ BES 09 21 41 ECG FROZEN 09 22 06 PRINT FREEZE ALARMS SETUP VSHX H F D G Figure 3 11 Display Summary Table 3 11 Display Summary Name Description Selects US US2 FECG NBP MHR P or SpO A Mode Title Softkeys Setup screens B ECG Scale So
208. s a sample Trend screen with dual FHR monitoring in progress and a level one decelerations alert FECG 30 210 Alert level and message The Trend screen displays the most recent 10 minutes of FHR and uterine activity data For dual heart rate monitoring the same trend screen displays regardless of which FHR setup screen FECG or US US2 you use to access the Trend screen The current time Figure D 8 Trend Screen Example 120 Series Maternal Fetal Monitor Revision C 2015589 001 Spectra Alerts Uterine Contraction Frequency Uterine Contraction Frequency The Spectra Alerts option includes a uterine contraction UC frequency display When enabled the UA screen m provides the setup field for the UA display W provides a uterine contraction audio indicator and m provides a UC frequency histogram which graphs the contractions per ten minutes over the most recent 100 minutes Enabling Disabling UC Frequency Display A UA Setup screen is automatically activated when the Spectra Alerts option is installed and enabled To enable disable the UC Frequency display option 1 Access the UA setup screen by selecting the UA mode title TOCO or IUP 2 Setthe UA Display field to the desired setting UA or UA UCF Refer to Figure D 10 UC Frequency in UA Display Area When enabled ON the UC frequency per ten minutes displays in the UA Display area the UA value displays in a smaller size in order
209. s have been made Rotate the Trim Knob control until the bar cursor highlights the EXIT softkey on the bottom of the screen This returns the monitor to normal operation IMPORTANT EFFECTIVITY AII changes take effect immediately after a selection is enacted in step six 6 4 8 120 Series Maternal Fetal Monitor Revision C 2015589 001 Setup Procedures Setup Screens General Setup Screen OFF HAPPY BIRTHDAY BRAHMS LULLABY ROCK A BYE BABY ALL AUTO 0 100 1 CM MIN 2 CM MIN 3 CM MIN OFF LOW OUT OUT ONLY Figure 4 9 shows a sample General Setup screen ON OFF Time Date GENERAL SETUP 0 TIME 12 01 00 DATE 01 JUN 2003 L PLAY SONG OFF 3 4 VOLUME 5 4 2 SPO2 SCALE 0 100 s 3 RECORDER SETUP e 4 PAPER SPEED 3 CM MIN LIGHT ON 7 5 PAPER CHIME OUT ONLY ON 8 6 VOLUME 5 OFF joj 8 9 EXTERNAL MONITOR SETUPS MSPO2 PRINT INTERVAL 5 MIN FSPO2 PRINT INTERVAL 5 MIN OFF FSPO2 TRACE OFF 2 MIN 5 MIN SERVICE 10 MIN 15 MIN 30 MIN 60 MIN Figure 4 9 General Setup Screen Itis very important to set the monitor s clock prior to initial operation and during daylight saving time changes A long lasting battery maintains the set time even when the monitor is unplugged from AC power The time is represented by a 24 hour clock in hours
210. s in relation to the electrodes is required to minimize harm to the patient ELECTRICAL SHOCK To reduce the risk of electrical shock do not remove monitor cover Refer servicing to qualified personnel ELECTROMAGNETIC INTERFERENCE Be aware that strong electromagnetic fields may interfere with monitor operation Interference prevents the clear reception of signals by the monitor If the hospital is close to a strong transmitter such as TV AM or FM radio police or fire stations a HAM radio operator an airport or cellular phone their signals could be picked up as signals by the monitor If you feel interference is affecting the monitor contact your Service Representative to check the monitor in your environment Refer to page 1 8 for additional information 120 Series Maternal Fetal Monitor Revision C 2015589 001 Safety Monitor Contraindications Warnings and P recautions WARNINGS ELECTROSURGERY The monitor is not designed for use with high frequency surgical devices In addition measurements may be affected in the presence of strong electromagnetic sources such as electrosurgery equipment EXPLOSION HAZARD Do not use this equipment in the presence of flammable anesthetics or inside an oxygen tent GROUNDING Do not defeat the three wire grounding feature of the power cord by means of adaptors plug modifications or other methods A dangerous shock hazard to both patient and operator may result
211. s of one of the following applicable standards Underwriters Laboratories UL 2601 1 Canadian Standards Associations CSA 22 2 No 125 or International Electrotechnical Commission EN60601 1 The communication option is an additional circuit board that can be installed in the 120 Series Monitor Contact your Service Representative for upgrade information The following four connectors are part of the optional communications package J101 J102 J103 and J104 3 20 120 Series Maternal Fetal Monitor Revision C 2015589 001 Controls Indicators and Connectors Rear Panel Description Corolan Option J108 is installed as part of a Corolan Option Contact your Service Representative for upgrade information Revision C 120 Series Maternal Fetal Monitor 3 21 2015589 001 For your notes 3 22 120 Series Maternal Fetal Monitor Revision C 2015589 001 Setup Procedures This section lists all available setup options in the monitor and provides step by step instructions for making selections Loading Strip Chart Recorder Paper 02 000 4 2 POWE C ssec euer Eee dae bel oret A RPG e ere te er die 4 6 Self Test ROUNE eeror pcs pado ced rcu S REOR E RUE Ree 4 6 DEDUD OCTCENS o C L4 Laco dont eee vena ipa eta 4 8 Customizing the Power On Settings 4 12 Accessing the Install Options Screen 4 0 4 14 Preparing the Monitor for Patient Use
212. scription Table 3 13 120 Series Rear Panel Standard and Optional Features Name Description Receptacle for the Corometrics Remote Event Marker When activated one ofthe following marks prints on the strip chart paper m The event marker is commonly used to record an event f m The fetal movement marker default setting is commonly used as an indication that the mother has perceived fetal movement T Refer to the 120 Series Monitor Service Manual for more information Remote Event Marker Connector A binding post terminal is directly connected to the Equipotentalitug chassis for use as an equipotentiality connection This switch is intended for qualified service personnel to select a voltage range for the AC Communication Option input E eee m 120 Accepts an AC input in the range of 100 120 VAC m 240 Accepts an AC input in the range of 220 240 VAC AC line power cord receptacle R efer to the rear Power Entry Module panel markings to verify line voltage and line frequency requirements CAUTION NON DESTRUCTIVE VOLTAGE The maximum non destructive voltage that may be applied to the rear panel connectors is 0 volts Do not attempt to connect cables to these connectors without contacting your Biomedical Engineering Department or GE Medical Systems Information Technologies Service Representative This is to ensure the connectors comply with leakage current requirement
213. section are representative of all possible features Your monitor screens may vary All functions are performed easily using the front panel Trim Knob control Setup screens for FECG US US2 Maternal NBP MHR P and MSpO are detailed in Chapters 5 11 Using the Trim Knob Control General instructions for using the Trim Knob control follow NOTE While any setup screen is 1 displayed the primary labor parameters remain displayed To display a parameter setup screen rotate the Trim Knob control until the bar cursor highlights the title of the parameter FECG US US2 NBP MECG PULSE FSpO or MSp0 To access the Master Alarm Setup screen or the General Setup screen rotate the Trim Knob control until the bar cursor highlights the ALARMS softkey or the SETUP softkey respectively on the bottom of the screen Press the Trim Knob control once to display the selected setup screen While the screen is displayed rotate the Trim Knob control until the desired field is highlighted Press the Trim Knob control again to activate the selected field The cursor flashes to indicate the field is active Rotate the Trim Knob control in either direction to cycle through the available choices for the field Continuous rotation will wrap around through the choices When the desired selection is made for the field press the Trim Knob control once to confirm the selection Repeat steps three 3 through six 6 until all desired setting
214. t Alarm isses 11 7 Resolved Patient Alarm ccc cece eee ne 11 7 FHR Signal Quality Alarms 2 recte eR RR Rer ERR nas ees 11 7 Active Signal Quality Alarm 0 0 ccc cece cece e 11 7 Resolved Signal Quality Alarm ccc cect eee ete eect aes 11 7 Silencing a FHR Audio Alarm cece cece c e 11 8 Maternal Alarms ccccccceceeceeeeeeeeeeeeeeeeeaneaneaeeaeeaneanegs 11 9 Maternal Patient Alarms isses mne 11 9 Active Patient Alarm 0 0 ccc cece eect eect mnn 11 9 Resolved Patient Alarm cc ccc eect c tect e nne 11 9 Signal Quality AlarMS 0 isses 11 10 Active Signal Quality Alarm 0 0 ccc ccc c eect eee eee teens 11 10 Resolved Signal Quality Alarm sss 11 10 Silencing a Maternal Audio Alarm 11 10 12 13 Recorder Modes en n n n n n n n nn 12 1 Strip ChartPaper is i sies ka sa e c oe gea Y c C a oia 12 2 Off Mode irrg enema 12 5 ON Mode wicccccccceuececccccucucueeecucusueueueueerauguaueueueugas 12 6 TENIS siren o re et is cin acne wet vorn Naan d de ad Mme ee t eh 12 6 MUItIDIEST eNOS ess soc oret voces codon OR E ER ae ue ORA 12 6 AMS pO Trend Scale een tx REDE ON EE EA 12 8 Annotations cesis tme eim ub ovecpere tenui dinate pease 12 10 Standard Annotations 12 10 Fetal Pulse Oximetry Annotation 0 ccc cee eee eee eueeaeees 12 11 Blood Pressure Annotations 12 12 Maternal Pulse Oximetry Annotations 12 13 Annotations from a Central Information Syst
215. t pushbutton or open the recorder 2 Refer Table 4 1 and ensure the test results are produced as expected At the Gane successful completion of the self test routine the monitor is ready for use Table 4 1 Monitor Self Test Routines Test Routine Description Display Test All display pixels illuminate for one second and then all extinguish for one second Afterwards a vertical line moves across the screen from left to right followed by a horizontal line moving from top to bottom Then the display remains black Lamp Test The yellow Record indicator illuminates Recorder Test The message TEST ARE ALL DOTS PRINTED prints followed by two vertical lines which should appear continuous Discontinuous lines may be an indication of damaged printhead elements if gaps occur in the same place on both lines Counting Test After the Recorder Test the display returns to the main screen The software generates a 120 BP M 9 rate in the FHR 1 area a 180 BPM rate in the FHR2 area and both mode titles display TEST The monitor adds 50 mmHg to the present pressure level and displays this value in the UA display Uterine Activity m area the mode title displays TEST Revision C 120 Series Maternal Fetal Monitor 4 7 2015589 001 Setup Procedures Setup Screens Setup Screens The 120 Series Monitor provides a variety of options that are selected using the setup screens shown on the display The illustrations in this
216. ternal Fetal Monitor 4 13 2015589 001 Setup Procedures Accessing the Install Options Screen Accessing the Install Options Screen To customize the Power On settings and to set other monitor options 1 Select the SETUP softkey from the main operating screen to display the General Setup screen Figure 4 10 GENERAL SETUP TIME 12 01 00 DATE 01 JUN 2003 PLAY SONG OFF VOLUME 5 SPO2 SCALE 0 100 RECORDER SETUP PAPER SPEED 3 CM MIN LIGHT ON PAPER CHIME OUT ONLY VOLUME 5 EXTERNAL MONITOR SETUPS MSPO2 PRINT INTERVAL 5 MIN FSPO2 PRINT INTERVAL 5 MIN FSPO2 TRACE OFF SERVICE MSN Figure 4 10 General Setup Screen 2 Selectthe SERVICE softkey from the General Setup screen to display the Service Lock screen Figure 4 11 The access code is displayed as 0 0 0 0 4 14 120 Series Maternal Fetal Monitor Revision C 2015589 001 Setup Procedures Accessing the Install Options Screen NOTE The correct date and time must 3 be set on the General Setup screen or you will not gain access to the service SERVICE LOCK ENTER ACCESS CODE 0000 CPU V3 52 DSP 03 07 Figure 4 11 Service Lock Screen Use the Trim Knob control to set the access code to the current month and date You can enter the date followed by the month or the month followed by the date For example February 21 can be entered as 02210r 2102 screens 4 As soon as you enter the c
217. ternal exams or while making adjustments to internal sensors transducers without having to watch the monitor An anesthetized mother can use the indicator as a push signal if she is unable to feel contractions To enable disable the UC Chime 1 Access the UA setup screen by selecting the UA mode title TOCO or IUP 2 Setthe UC Chime field to the desired setting ON or OFF Refer to Figure D 10 D 14 120 Series Maternal Fetal Monitor Revision C 2015589 001 Spectra Alerts Nurse Call Interface Nurse Call Interface NOTE If the Spectra Alerts are The Spectra Alerts option includes a Nurse Call Interface rear panel connector as suspended see page D 6 the Nurse shown in Figure D 11 This connector attaches to a standard Nurse Call System The Call output is inhibited during the connector s maximum output is 50 Vdc at 100 mA the maximum on resistance is suspension time 0 5 Q When connected to a Nurse Call System the monitor will activate the system each time a Spectra Alert is issued This interface simulates pressing the button on a bedside Nurse Call System allowing nurses to respond to patient needs quickly and efficiently Refer to the 120 Series Monitor Service Manual for more information J103 CONNECT TO J102 CONNECT TO DATA ENTRY SYSTEMS ONLY CENTRAL SYSTEMS ONLY RC J101 CONNECT TO Nurse Call TELEMETRY RECEIVERS ONLY J104 Interface Figure D 11 120 Series Rear Panel Communications Connectors Revision
218. tes source as indicated by the MECG mode title softkey trather than PULSE m The MECG waveform is displayed at 25 mm sec at a size of 2X with lead II selected m Heartbeat coincidence is enabled as indicated by the HBC acronym in the primary labor parameters area m All alarms are enabled as indicated by Lh 165 1720 A NBP fA MECG fA MSpO 87 98 25mm s I 2X MECG 15 52 58 PRINT FREEZE ALARMS SETUP VSHX Figure 3 2 Model 129 Display Example 3 6 120 Series Maternal Fetal Monitor Revision C 2015589 001 Controls Indicators and Connectors Front Panel Displays The Model 126 has a unique feature which automatically centers the primary fetal parameters in the display when no waveform is active See Figure 3 3 15 50 27 ALARMS SETUP Figure 3 3 Model 126 Display Revision C 120 Series Maternal Fetal Monitor 3 7 2015589 001 Controls Indicators and Connectors Front Panel Displays Primary Labor Parameters The primary labor parameters section displays FHR1 FHR2 and UA data FHR Display The FHR1 and FHR 2 areas are summarized by Figure 3 4 and Table 3 3 EET Figure 3 4 FHR Display Table 3 3 FHR Display Name Description A FHR Value Up to three digits indicate the fetal heart rate in beats per minute FHR Alarm Setting Indicator This symbol provides information about the FHR audio alarm andthe FHR high low alarm limit settings See
219. the last reading the continuous display of the old NBP reading may cause confusion Mode NOTE As soon as the auto mode is This field alternates between the manual and automatic monitoring modes for selected on the setup screen the maternal blood pressure For auto mode this field also sets the interval time in countdown timer begins to decrement minutes between automatic blood pressure determinations This interval time is The first automatic determination measured from beginning to beginning of determinations The monitor is factory begins after expiration of one complete set with the optional 1 minute interval time disabled For information on enabling interval time period the 1 minute interval refer to the 120 Series Monitor Service Manual Values are removed from the NBP area of the display only values are still retained in memory for display and printing of the maternal Vital Signs History screen Revision C 120 Series Maternal Fetal Monitor 9 7 2015589 001 Maternal Non Invasive Blood Pressure Monitoring NBP Setup Screen NBP Done Volume Alarm Limits Audio Alarm Alarm Volume This field sets the volume of the sound emitted at the completion of each blood pressure determination As you adjust the volume a sample tone sounds These fields adjust the high and low alarm limits for maternal systolic diastolic and mean arterial pressures as well as for MHR P in increments of 5 mmHg or 5 BPM The
220. the light absorbance signal are caused by oscillations in the arterial blood volume This assumes that the blood flow in the region of the sensor passes entirely through the capillary bed rather than through any arterio venous shunts Models 128 and 129 are available with a choice between two MSp02 modules depending on your site needs m Nellcor technology or m Masimo technology If your monitor has a Masimo module installed a Masimo SET label Figure 10 1 Masimo Set Label on page 10 2 appears next to the lower right hand side of the display If no label is present a Nellcor module is installed in your monitor OMasino5 Figure 10 1 Masimo Set Label 10 2 120 Series Maternal Fetal Monitor Revision C 2015589 001 Maternal Pulse Oximetry Monitoring MS pO Setup Screen MSpO Setup Screen Select the MSPO softkey to access the MSpO Setup screen Figure 10 2 TOCO 165v 172v 30 MSpO2 SETUP RESPONSE TIME NORMAL A MSpO2 PRINT INTERVAL 5 MIN o O2 TRACE OFF 97 Yo ALARM HIGH MSpO2 100 MHR P 120 AUDIO ALARMS ON VOLUME 5 Figure 10 2 Nellcor MSpO Setup Screen NOTE A Masimo MSpO Setup Screen differs slightly from the Nellcor Setup Screen The Response Time field is missing and in its place is a Sensitivity field followed by an Averaging Time field Response Time Nellcor Module Only Choose a response time modes in order to compensate for different levels o
221. the pack is laying flat in the recorder Figure 4 5 Inserting the Paper 6 Close the strip chart recorder door Figure 4 6 Closing the Recorder Door Refer to Chapter 12 Recorder Modes for information about paper loading errors Revision C 120 Series Maternal Fetal Monitor 4 5 2015589 001 Setup Procedures Power Power 1 Ensure the Power switch is in the off O position Figure 4 7 Turning the Monitor On Off 2 Connect the detachable line cord to the rear panel power connector plug the other end into a hospital grade grounded wall outlet of appropriate voltage If you are unsure about the voltage contact your hospital Biomedical Engineering Department or Service Representative Figure 4 8 Attaching the Power Cord 3 Move the front panel Power switch to the on I position The green indicator light next to the Paper Advance pushbutton illuminates and a series of tones are heard indicating that the monitor has been turned on 4 6 120 Series Maternal Fetal Monitor Revision C 2015589 001 Setup Procedures Self Test Routine Self Test Routine The 120 Series Monitor contains a self test routine which checks the calibration and internal circuitry of the monitor Initiate the self test routine at the beginning of each monitoring session to print the results on the patient s strip chart NOTE To disable the routine press Press and hold the Test button for one second the Tes
222. this directive The device is manufactured in India and or the United States of America the CE mark is applied under the authority of Notified Body GMED 0459 The country of manufacture and appropriate Notified Body can be found on the equipment labeling The product complies with the requirements of standard EN 60601 1 2 Electromagnetic Compatibility Medical Electrical Equipment and standard EN 60601 1 General Requirements for Safety Components of the Certified Systems The IEC electromagnetic compatibility EN standards require individual equipment components and accessories to be configured as a system for evaluation For systems that include a number of different equipments that perform a number of functions one of each type of equipment shall be included in the evaluation The equipment listed below is representative of all possible combinations For individual equipment certification refer to the appropriate declarations of conformity Component Description 120 Series Maternal Fetal Monitor Model 146 Fetal Acoustic Stimulator Intrauterine Pressure Transducer FECG Cable Legplate Ultrasound Transducers x2 Blood Pressure Hose and Cuff MSpO Interconnect Cable and Sensor FSpO Interconnect Cable and Sensor MECG Cable FECG MECG Adapter Cable Remote Event Marker RS 232C Interconnect Cables x3 COROLAN Interconnect Cable Central Nurses Station Interconnect Cable Model 2116B Interconnect Cable Ex
223. uracy with Nellcor Puritan Bennett D 25 Sensor Pulse Rate Accuracy Wavelengths Red Infrared Response Time Alarms audible and visual Audio Visual Limits Technical Spectrophotometry and plethysmography Nellcor Puritan Bennett D 25 or D 25L recommended 0 100 30 250 BPM SpO2 1 standard deviation 70 100 2 digits 50 69 3 digits 0 49 unspecified 3 BPM 660 nm nominal 920 nm nominal User selectable slow normal and fast averaging modes Alternating 1 5 second chimes 773 Hz and 523 Hz Flashing SpO2 numeric or message User selectable high and low S pO User selectable high and low pulse rate Sensor errors connection errors insufficient signal excessive motion communication problem internal calibration error or self test failure 1 counted in the specification The accuracy of a given oxygen range is valid for only 68 of the data points taken and the remaining 32 of the data points are not 18 6 120 Series Maternal Fetal Monitor 2015589 001 Revision C Technical Specifications Operating Modes Table 18 2 Operating Mode Specifications Continued Maternal Pulse Oximetry Mode Masimo Range Saturation 96S p02 1 100 Pulse Rate bpm 25 240 Perfusion 0 02 20 Accuracy Saturation 96S p0 During no motion conditions Adults P ediatrics 70 100 2 digits 0 69 unspecified Neonates 70 100 3 digits 0 69 unspeci
224. ures of the Model 128 plus the following m Built in independent MECG monitoring is provided with selection of lead I II or III m Twins and maternal monitoring can be accomplished simultaneously using dual ultrasound and MECQG or by using ultrasound FECG and MECG m The MECG waveform can be optionally displayed and can be frozen on the screen for review In addition a six second snapshot can be printed on the strip chart paper m The large display area provides for fetal parameters maternal parameters and maternal waveforms all at once Upgrading Your Monitor The 120 Series family of monitors provides one solution for high risk and low risk labors and deliveries The 120 Series of monitors lets you start with a basic monitor and add the extended and or more advanced features later as your clinical needs increase and your budget allows Blood pressure is not automatically activated Manual blood pressure readings must be started via a front panel pushbutton Automatic readings must be initiated via a setup screen Revision C 120 Series Maternal Fetal Monitor 2 5 2015589 001 Introduction Series Overview Upgrading to the Next Level Upgrade kits are available for in hospital installation from one model to the next Contact your Service Representative for more information Adding Fetal Movement Detection and Spectra Alerts Each monitor in the series can be upgraded to include Spectra Alerts and fetal movement
225. usable Belt for Button Style Transducer Elastic Style 10 carton 4425EA0 Semi Reusable Belt for Loop Style Transducer Velcro Style 4425F AO 2 pack 50 packs carton Single P atient Use Belt for Loop Style Transducer Foam Style with Velcro Closure 8024AA0 Revision C 120 Series Maternal Fetal Monitor 2015589 001 Supplies amp Accessories IUPC Ordering Information IUPC Ordering Information Table 19 7 IUPC Supplies and Accessories Item Catalog Number REF Saflex IUP C with Amnio Infusion Sampling Capabilities 10 carton 2076BAO0 Saflex Intermediate Cable 1336AA0 19 8 120 Series Maternal Fetal Monitor Revision C 2015589 001 Supplies amp Accessories MECG Ordering Information MECG Ordering Information Table 19 8 MECG Supplies and Accessories Item Catalog Number REF FECG MECG Adapter Cable 1442AA0 MECG Cable for use with detachable leadwires requires 1442AA0 USA AHA 1554AA0 MECG Cable for use with detachable leadwires requires 1442AA0 Intl IEC 1554BA0 MECG Cable for use with detachable leadwires USA AHA 1553AA0 MECG Cable for use with detachable leadwires Intl IEC 1553BA0 Multi Link Snap Leadwires Set of 3 Grouped Detachable 31 inches 411203 001 Multi Link Snap Leadwires Set of 5 Individually Detachable 31 inches 411200 001 Multi Link Grabber Leadwires Set of 3 Grouped Detachable 31 inches 412682 001 Multi Link Grabber Leadwires Set of 5 Individually
226. y which in turn is based on spectrophotometry and plethysmography The system includes an electro optical sensor and a microprocessor based monitor Oxyhemoglobin and deoxyhemoglobin have different light absorption characteristics in the red and infrared wavelength spectrums Less red light is absorbed by oxyhemoglobin than by deoxyhemoglobin Relatively more infrared light is absorbed by oxyhemoglobin than by deoxyhemoglobin Arterial blood in a well oxygenated fetus will typically contain a higher concentration of oxyhemoglobin than deoxyhemoglobin A 120 F Series Monitor uses these differences in the absorption of red and infrared light by oxy and deoxy hemoglobin to determine fetal oxygen saturation by measuring the change in light levels caused by pulsating arterial blood in the tissue 6 6 120 Series Maternal Fetal Monitor Revision C 2015589 001 Fetal Pulse Oximetry Monitoring Theory The fetal oxygen sensor has two low voltage light emitting diodes LEDs One of these LEDs emits red light nominal 735 nm wavelength and the other emits infrared light nominal 890 nm wavelength When the sensor has been properly positioned on the fetal temple or cheek light from each of these LEDs is alternately sent through the fetal skin into the underlying tissues at the sensor site The amount of light absorbed by the tissue or blood underlying the fetal sensor is determined from the amount of light that scatters back to the tissue surface an
227. yed before being automatically erased starting from the time the reading is displayed In the presence of an NBP alarm the display timer begins to decrement only after the Alarm Silence pushbutton is pressed Refer to Display Timer on page 9 7 for further information ANBP 11 41 130 85 Figure 11 2 Display Timer Clock 11 6 120 Series Maternal Fetal Monitor Revision C 2015589 001 Alarms Fetal Heart Rate Alarms Fetal Heart Rate Alarms FHR Patient Alarms NOTE The re alarm time does not A fetal heart rate patient alarm occurs when any fetal heart rate falls outside of the apply to FHR alarms only MECG and pre defined alarm limits greater than the high limit setting or less than the low MSpO alarms FHR values are not limit setting configurable The FHR alarm function can be completely disabled from the Install Options service screen In order for this change to take effect you must turn the monitor off then back on again Refer to the 120 Series Monitor Service Manual for more information Active Patient Alarm A patient alarm is indicated both visually and audibly The visual indication is provided by flashing the affected FHR numeric The audio alarm is alternating high low tones Resolved Patient Alarm Resolved FHR alarms function differently than other alarms with a 120 Series Monitor m Resolved Unsilenced FHR Patient Alarm You must acknowledge a FHR patient alarm even if the condition

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