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Philips MP60/70/80/90 User's Manual

1. ASYSTOLE No QRS for 4 consecutive seconds in absence of vent fib or chaotic B E signal VENT FIB TACH A fibrillatory wave for 4 consecutive seconds B E V TACH A dominant rhythm of adjacent Vs and a HR gt the V Tach Heart B E Rate Limit SUST V TACH Ventricular tachycardia rhythm for more than 15 seconds E VENT RHYTHM A dominant rhythm of adjacent PVCs and a HR lt the V Tach HR E Limit VENT BIGEMINY A dominant rhythm of N V N V E VENT TRIGEMINY A dominant rhythm of N N V N N V E PACED RHYTHM A dominant rhythm of paced beats B E IRREGULAR HR Consistently irregular rhythm E SINUS BRADY A dominant rhythm of SV beats preceded by P waves B E SINUS RHYTHM SINUS TACHY SV BRADY A dominant rhythm of SV beats not preceded by P waves B E SV RHYTHM SV TACHY UNKNOWN ECG Rhythm cannot be determined B E RHYTHM LEARNING ECG Algorithm is learning the ECG beat morphology B E LEARNING RHYTHM Algorithm is learning the rhythm of the classified beats B E CANNOT ANALYZE ECG signal is predominantly invalid and therefore cannot be B E ECG analyzed Ectopic Status Messages The label B or E indicates basic B or enhanced E arrhythmia capability No message displayed No ectopic activity within the last minute RUN PVCs More than 2 consecutive PVCs within the last minute E PAIR PVCs Pair PVCs within the last minute E PACER NOT CAPT Pause with pace puls
2. tcpCO2 HIGH RR HIGH RESP The respiration rate has exceeded the numeric flashes and high limit high alarm limit is highlighted yellow alarm lamp alarm tone RR LOW RESP The respiration rate has dropped below numeric flashes and low limit the low alarm limit is highlighted yellow alarm lamp alarm tone RUN PVCs HIGH ECG A run of PVCs greater than 2 was numeric flashes yellow alarm Arrhythmia detected lamp short yellow audible alarm lt SpO2 label gt SpO The arterial oxygen saturation has numeric flashes and high limit HIGH exceeded the high alarm limit is highlighted yellow alarm lamp alarm tone lt SpO2 label gt LOW SpO The arterial oxygen saturation has fallen numeric flashes and low limit below the low alarm limit is highlighted yellow alarm lamp alarm tone ST lt n gt HIGH ECG The ST elevation in lead lt n gt is higher numeric flashes and high alarm Arrhythmia than the limit limit is highlighted yellow alarm lamp alarm tone ST lt n gt LOW ECG The ST depression in lead lt n gt is lower numeric flashes and low alarm Arrhythmia than the limit limit is highlighted yellow alarm lamp alarm tone ST MULTI lt n gt lt n gt ECG The ST depression or elevation is numeric flashes yellow alarm Arrhythmia outside of the limit in two or more leads lamp alarm tone lt n gt and lt n gt ST MULTI ECG The ST depression or elevation is o
3. tcpO2 or tcpCO or tcGas tcGas There is a malfunction in the transducer or module Connect EQUIP MALF another transducer If this INOP persists contact your service Numeric is replaced by personnel INOP tone tcpO or tcpCO or tcGas tcGas No transducer is connected to the tcpO tcpCO module NO TRANSDUC Silencing the alarm switches off the measurement Numeric is replaced by INOP tone tcpO or tcpCO or tcGas tcGas The transducer has not yet reached the selected temperature STABILIZING and or skin hyperemization is not yet finished This INOP will Numeric is displayed with a disappear within three minutes tcpO or tcpCO or tcGas tcGas The measurement is switched on but the module is unplugged UNELUCGED The measurement automatically disappears from the display Numeric is replaced by Silencing this INOP switches off the measurement INOP tone lt ATemp gt CHK SOURCES TEMP Not all measurements or values required to perform the Numeric is replaced by Difference calculation are available Check measurement sources lt Atemp gt CHK UNITS TEMP The monitor has detected a conflict in the units used for this Numeric is replaced by Difference calculation Check the unit settings lt Temp label gt DEACTIVATED TEMP A Temp measurement label in the measurement server or INOP tone extension has been deactivated either by connecting a Pressure transducer in the shared Press Temp s
4. Reusable Cuff Kits Infant pediatric small adult adult M1577A Small adult adult large adult thigh M1578A Infant pediatric small adult adult large adult thigh M1579A Adult Pediatric Antimicrobial Coated Reusable cuffs Adult Thigh grey 45 56 5 21 0 cm M4559A M1598B Large Adult X Long burgundy 35 5 46 0 17 0 cm M45584 1 5m or Large Adult burgundy 35 5 46 0 17 0 cm M4557A M1599B 3m Adult X Long navy blue 27 5 36 5 13 5 cm M4556A Adult navy blue 27 5 36 5 13 5 cm M4555A Small Adult royal blue 20 5 28 5 10 6 cm M4554A Pediatric green 13 8 21 5 8 0 cm M4553A Infant orange 9 14 8 5 4 cm M4552A Adult Pediatric Soft Single Patient Single Hose Disposable Cuffs Adult Thigh 45 56 5 cm 20 4 cm M4579A M1598B 1 5m Large Adult X Long 35 5 46 cm 16 4 cm M4578A or Large Adult 35 5 46 cm 16 4 cm M4577A M1599B 3m Adult X Long 27 5 36 5 13 1 cm M4576A Adult 27 5 36 5 cm 13 1 cm M4575A Small Adult 20 5 28 5 cm 10 4 cm M4574A Pediatric 15 0 21 5 cm 8 0 cm M4573A Infant 9 15 cm 5 6 cm M4572A Neonatal Infant Cuffs Disposable non sterile Size 1 3 1 to 5 7 cm 2 2 cm M1866A M1596B 1 5m Size 2 4 3 to 8 0 cm 2 8 cm M1868A o7 5 M1597B 3m Size 3 5 8 to 10 9 cm 3 9 cm M1870A Size 4 7 1 to 13 1 cm 4 7 cm M1872A Invasive Pressure Accessories
5. Ifthe event trigger was user defined instead of an alarm condition the monitor shows for example SpO2 94 lt 96 where the second number is the current event trigger threshold and the first number is the maximum deviation from the set limit Trigger threshold The horizontal lines show the trigger thresholds Gaps in the line indicate that the trigger was inactive for a while possibly because alarms were switched off or because there was an INOP condition in the group measurements Timeline The timeline at the bottom indicates the period currently stored in the event database Event Episode Window 250 To enter the Event Episode window select the pop up key Show Episode Depending on the event group settings the Event Episode window shows either 20 minutes of average trend event information four minutes of high resolution event information or 15 seconds of realtime wave information Event Episode Trigger event values highlighted aa Brady 104 lt 110 Follow on event values Timeline showing episode Pre Post time Active event group The event values to the left of the measurement channels show the trigger threshold set and the maximum amount by which this limit was exceeded In this example Brady 104 lt 110 tells you that 104 was the lowest HR value measured during the event time and that the low HR trigger threshold was set to 110 when the event was triggered If the event was manually triggered
6. the QRS complexes should be at least twice the height of pace pulses large enough to be detected with no re polarization To prevent detection of P waves or baseline noises as QRS complexes the minimum detection level for QRS complexes is set at 0 15 mV according to AAMI EC 13 specifications Adjusting the ECG wave size on the monitor display gain adjustment does not affect the ECG signal which is used for arrhythmia analysis If the ECG signal is too small you may get false alarms for pause or asystole Aberrantly Conducted Beats As P waves are not analyzed it is difficult and sometimes impossible for the monitor to distinguish between an aberrantly conducted supraventricular beat and a ventricular beat If the aberrant beat resembles a ventricular beat it is classified as ventricular You should always select a lead where the aberrantly conducted beats have an R wave that is as narrow as possible to minimize incorrect calls Ventricular beats should look different from these normal beats Instead of trying to select two leads with a narrow R wave it may be easier to just select one lead and use single lead arrhythmia monitoring Extra vigilance is required by the clinician for this type of patient Atrial Fibrillation and Flutter 108 Since P waves are not analyzed it is not possible to discriminate atrial rhythms If there is constant variance in the R R interval the rhythm is classified as Irregular It is extremely
7. These transducers and accessories are designed to have special protection against electric shocks particularly regarding allowable leakage currents and are defibrillator proof 9 If you are using the M3012A Hemodynamic Measurement Server Extension and you want to measure temperature and invasive pressure at the same time we recommend that you use the pressure transducer CPJ840J6 with a round module connector piece and not a transducer with a square connector Pressure transducers with square connectors may make it difficult to connect the adjacent Temperature connector at the same time Reusable pressure transducer 5 UV V mmHg sensitivity CPJ840J6 Sterile disposable pressure domes for CPJ840J6 pack of 50 CPJ84022 Transducer holder for CPJ840J6 pack of 4 CPJ84046 IV pole mount for CPJ840J6 CPJ84447 Single channel disposable sensor kit 20 EU EFTA only M1567A Dual channel disposable sensor kit 20 EU EFTA only M1568A Transducer holder for M1567 8A EU EFTA only M2271A IV pole mount for M1567 8A EU EFTA only M2272C Adapter cable for disposable sensor kit 3 0m for M1567 8A M1634A Pressure transducer kits PiCCO monitoring kit 30cm pressure line includes PV4046 injectate temperature PV8103 sensor housing for M1646A PiCCO monitoring kit 150cm pressure line includes PV4046 injectate temperature PV8115 sensor housing for M1646A PiCCO monitoring kit 150cm pressure line i
8. 2 J4 a Second level D timeout 3 2 period TimeOut 2nd Ifthere is an active Vent Bigeminy alarm a PVCs gt xx min will not be triggered because it is lower on the same chain However a high HR alarm will become active because it is on a different chain Higher priority alarms supersede previous alarms For example if a Vent Trigeminy alarm is active and a Pair PVCs occurs the Pair alarm will be activated 115 Understanding PVC Related Alarms PVC related alarms are detected on the basis of the current ventricular heart rate and the number of consecutive PVCs counted referred to as PVC Runs Changing one alarm limit automatically changes linked alarm limits Example This diagram illustrates the conditions under which PVC alarms would be generated if the Vent Rhythm Run limit is set to 12 the V Tach Run Limit is set to eight and the V Tach HR Limit is set to 100 V Tach Run Limit Lach g 2 WK ZR 3 T V Tach EME A Heart Rate a OE e Limit Z Run PVCs Vent Rhythm mn i gt PVC Run gt 2 but lt 12 PVC Run gt 12 HR lt 100 HR lt 100 1 2 3 4 5 67 8 9 10 e E e Number of Consecutive PVCs PVC Run Run Limit You will see that e if both the V Tach Heart Rate Limit and the V Tach Run Limit are exceeded a red V Tach alarm is generated e if the ventricular heart rate exceeds the V Tach Heart Rate Limit but not the V Tach Run Limit
9. To manually stop a recording select the Recordings SmartKey and then select the pop up key Stop all Recordng M1116B You can also stop a recording by pressing the STOP key on the recorder module only Recording Without a Template To record without a preconfigured template selecting the waves you require 1 Select the Recordings SmartKey 2 Select the pop up key Select Waves and use the pop up keys to choose up to three measurement waves to be printed on the recording If you want fewer than three waves on the recording select the waves you want then select the Continue pop up key 3 Select one of the recording speed pop up keys to set the required recording speed 4 Select the Start pop up key to start the recording Select Waves recordings use default values for any recorder settings not defined runtime is continuous overlapping is set to non overlapping Overview of Recording Types This table details settings for local recordings using either the integrated recorder or the M1116B For details on recordings made on the central recorder see your Information Center Instructions for Use 259 Type of manual automatic manual manual manual manual use the recording triggered by context defined alarm window s pop conditions up keys to start Local or local and central local and central local and central local only local only local only Central Information from the start from the start fr
10. Adult finger clip sensor no yes DS100A Dura Y D YS Y sensor no yes Extension Adapter Cables for Philips and Nellcor Sensors M1941A Extension cable 2 m yes yes For use with Philips reusable sensors and adapter cables M1943A Adapter cable 1 1 m cable yes no Adapter cable for M1943AL _ Adapter cable 3 m cable yes no Philip s Nellcor disposable sensors M1943NL OxiMax adapter cable 3 m cable no yes Adapter cable for Philips disposable Nellcor disposable and reusable sensors OC 3 Adapter Cable for OxiCliq sensors yes yes Available from Nellcor only MASIMO LNOP reusable sensors Require AC 1 adapter cable LNOP DC I Adult Sensor yes no 989803140321 LNOP DC IP Pediatric Sensor yes no 989803140331 LNOP Y I Reusable Multi Site Sensor yes no n a LNOP TC I Tip Clip reusable Sensor yes no 989803140341 MASIMO LNOP disposable sensors Require AC 1 adapter cable LNOP Adt Adult Sensor yes no 989803140231 LNOP Adtx Adult Sensor yes no n a LNOP Pdt Pediatric Adhesive Sensor yes no 989803140261 LNOP Pdtx Pediatric Sensor yes no n a LNOP INF L Neo Infant Adhesive Sensor yes no 989803140311 LNOP NEO L Neo Adhesive Sensor yes no 989803140291 LNOP NEOPT Neo Pre Term Sensitive Skin Adhesive yes no 989803140301 L Sensors Adapter Cable for MASIMO sensors M1020 61101 AC 1 Adapter Cable for Masimo yes
11. Single or Multi lead ST Alarming Be aware that if multi lead ST alarming is switched on only alarms involving more than one ST lead will be announced To choose individual or multi lead ST alarming Inthe Setup ST Analysis menu select ST Alarm Mode and select either Single ST or Multi ST Changing ST Alarm Limits The monitor can detect alarms on each ST lead separately so you can set high and low ST alarm limits individually for each ST lead You can also set separate alarm limits for single lead and multi lead ST monitoring Set the high and low alarm limits based on your assessment of the patient s clinical condition unit protocols physician orders or medication specified limits A good guideline is 1 0 mm or 1 0 mm from the patients s ST or follow your hospital protocol 1 Inthe Setup ST Analysis menu select ST Alarm Mode and select Single ST or Multi ST 2 Select the alarm to be adjusted 3 Select the appropriate setting Viewing ST Maps The monitor can derive a multi axis portrait map from the ST analysis to help you detect changes in ST values It displays two planes obtained from a multilead ECG in a multi axis diagram where each axis represents a lead The ST value at the J point is given The position of the axes within the diagram correspond to the placement of the ECG leads Each ST value is assigned to either a limb lead or to a chest lead Every axis shows the polarity of the lead it represents By joi
12. The MP20 30 including IntelliVue Instrument Telemetry and the MP40 50 with the IntelliVue Instrument Telemetry adapter comply with part 15 of the FCC Rules Operation is subject to the condition that these devices do not cause harmful interference Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service IntelliVue 802 11 Bedside Adapter Option J35 Wireless Network Adapter FCC and Industry Canada Radio Compliance This device complies with Part 15 of the FCC Rules and RSS 210 of Industry Canada Operation is subject to the following two conditions 1 this device may not cause harmful interference and 2 this device must accept any interference received including interference that may cause undesired operation Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment The maximum antenna gain permitted for devices in the 5250 5350 MHz and 5470 5725 MHz bands complies with the e i r p limits as stated in RSS 210 The maximum antenna gain permitted for devices in the 5725 5825 MHz band complies with the e i r p limits specified for point to point operation as stated in RSS 210 The device for the band 5150 5350 MHz is only for indoor usage to reduce potential for harmful interference to co channel mobile
13. To set the horizon trend scale delta 1 Select the horizon trend 2 Select Set Scale Delta and select a value to define the distance between the horizon and the the upper and lower scale limits Be aware that changing the horizon trend scale can change the angle of the trend indicator without the patient s condition having changed If a measurement exceeds the outer limits of the scale the wave will be clipped and you must either reset the horizon or the horizon trend scale to display the values outside the scale limits 232 21 Calculations Calculations are patient data that is not directly measured but calculated by the monitor when you provide it with the appropriate information Your monitor can perform the following hemodynamic oxygenation and ventilation calculations Cardiac Index C I Stroke Volume SV Stroke Index SI Systemic Vascular Resistance SVR Systemic Vascular Resistance Index SVRI Pulmonary Vascular Resistance PVR Pulmonary Vascular Resistance Index PVRI Left Cardiac Work LCW Left Cardiac Work Index LCWI Left Ventricular Stroke Work LVSW Left Ventricular Stroke Work Index LVSWI Right Cardiac Work RCW Right Cardiac Work Index RCWI Right Ventricular Stroke Work RVSW Right Ventricular Stroke Work Index RVSWI Extra Vascular Lung Water Index EVLWI Intrathoracic Blood Volume Index ITBVI Global End Diastolic Volume Index GEDVI Arterial Oxygen Content C
14. enter cardiac output procedure start NBP STAT measurement stop automatic or STAT NBP measurement and measurement series set the NBP repeat time zero invasive pressure transducer 4n ral ha Hardkeys start a delayed recording set wide automatic alarm limits access wedge procedure window review vital signs trend access event surveillance access the calculator gas analyzer exit standby mode unpair equipment start 12 Lead Capture only available if Information Center is connected access EEG CSA display VueLink information access the spirometry data window ROCOO xrEAnags Realtime Record SmartKey to access pop up recording keys set narrow automatic alarm limits access the Loops window review graph trend access calculations access the Drug Calculator suppress zero for all gas measurements access ST Map application access remote applications if Application Server is connected access the EEG montage access timers switch CO pump off A hardkey is a physical key on a monitoring device such as the zero pressure key on the MMS or a setup key on a module Pop Up Keys Pop up keys are task related graphical keys that appear automatically on the monitor screen when required For example the confirm pop up key appears only when you need to confirm a change 19 Using the On Screen Keyboard Use this as you would a conventional keyboard Enter the infor
15. 16 Using the Navigation Point MP20 MP30 MP40 MP50 1 Silence acknowledges all active alarms by Only switching off audible alarm indicators and lamps Exact behavior depends on permanent key configuration 2 Alarms Off Pause Alarms pauses alarm indicators Exact behavior depends on Pause Alarms permanent key configuration 3 Main Screen closes all open menus and windows and return to the main screen 4 Back takes you back one step to the previous menu 5 Navigation Point knob To use the navigation point rotate it left or right With each click the highlight jumps to the neighboring screen element The element under the cursor is highlighted When you reach the screen element you want press the knob to select the element Using a Mouse or Trackball If you are using a mouse or trackball select screen elements by clicking on them press and release the left mouse button While you are moving the mouse a cursor appears and a highlight shows your current position Using Keys The monitor has four different types of keys Permanent Keys A permanent key is a graphical key that remains on the screen all the time to give you fast access to functions Pause Alarms pauses alarm indicators Pause duration depends on monitor configuration If pause duration is infinite this key is labeled Alarms Off Select again to immediately re enable alarm indicators Silence acknowledges all active alarms by
16. 170 injectate volume setting C O 166 INOPs from external devices 283 indicators 41 silencing 44 input defibrillator 345 installation connectors 329 Instructions for Use intended audience 1 integrated module slots MP40 50 60 70 257 IntelliVue family 1 intermittent bundle branch block 109 intermittent mandatory ventilation Resp 133 interruption symbol 328 intravascular dyshemoglobins SpO2 139 intrinsic rhythm 106 invasive pressure 151 in vivo calibration SvO2 206 ISO point ST 120 ITBV ITBVI 162 J J point ST 120 K keyboard connection symbol 328 keys hardkeys 19 permanent keys 17 pop up 19 SmartKeys 18 L label conflict resolution 29 labels resolving conflict 30 language conflicts with device driver 284 latching alarms 51 alarms behavior 52 latching arrhythmia alarms 113 lateral chest expansion neonates monitoring Resp 132 LCW LCWI 162 lead fallback and arrhythmia relearning 112 lead fallback ECG 97 lead labels ECG 97 lead placement activating EASI Standard 96 for Resp measurement 131 leads monitored ECG 96 Leads Off INOP ECG 97 LED battery status 298 levels of arrhythmia analysis 107 levels of event surveillance 241 line frequency interference BIS 220 loops 289 capturing 290 loop size in window 291 loops report 292 source device 291 volume flow 289 low filter EEG 213 low pass filter BIS 220 LVCI 162 M M1116B 257 M
17. 2 Select Printer Status to toggle between the settings Enable and Disable If you set this to Disable no reports will be printed to the named printer If the monitor detects that no printer of a particular type is available the Enable Disable setting will automatically be set to Disable and grayed out Dashed Lines on Reports Ifa section of a wave ona report is drawn with dashed lines this tells you that a setting that affects the appearance of the wave on the screen was changed while the report was printing For example if you change the wave scale while a report is printing the wave scale and wave size are changed immediately on the monitor screen and on the report To indicate that the scale information printed at the beginning of the report no longer matches the currently used scale the wave will be printed using dashed lines starting from the moment the change took place Some examples of settings that cause dashed lines in reports if changed during printing are Filter mode ECG lead placement wave scale measurement unit paced non paced setting and measurement mode Note that as ECG waves are drawn with a fixed gain on reports either 10 mm mV or 20 mm mV changing the ECG wave scale will not cause dashed line reports To avoid dashed lines on reports wait 15 seconds after changing a setting before you trigger a report Unavailable Printer Re routing Reports If you send a report to be printed on a printer that i
18. CCO NOT SUPPORTED C O A catheter for transpulmonary C O measurements has been numeric is replaced by unplugged and replaced with a Right Heart C O catheter or INOP tone the measurement mode has been changed manually Silencing this INOP switches the measurement off CCO CCI OVERRANGE C O The measured CCO or CCI value is not within the specified numeric is replaced by range for CCO CCI measurement INOP tone CCO lt Pressure label gt C O The arterial pressure selected for pulse contour calculation for CCO is available but currently invalid Make sure the pressure transducer is connected and the zero calibration is valid INOP tone CCO PRESS INVALID C O The arterial pressure selected for pulse contour calculation for at Information Center CCO is available but currently invalid Make sure the pressure transducer is connected and the zero calibration is valid CCO PRESS OVERRANG C O The mean value of the arterial pressure values used for pulse numeric is replaced by contour calculation for CCO is below 0 mmHg or above 300 INOP tone mmHg CCO PULSE OVERRANG C O The pulse rate of the pressure used for pulse contour numeric is replaced by calculation for CCO is below 30 bpm or above 240 bpm INOP tone CCO Tb1 NO TRANSD C O No transducer attached to the module or catheter Numeric is replaced by disconnected INOP tone CCO RECALIBRATE C O The m
19. EEG 363 BIS 364 Safety and Performance Tests 365 Electromagnetic Compatibility EMC Specifications 365 Accessories Compliant with EMC Standards 365 Electromagnetic Emissions 365 Avoiding Electromagnetic Interference Resp and BIS 365 Electromagnetic Immunity 366 Recommended Separation Distance 366 Recommended separation distances from portable and mobile RF communication equipment367 Electrosurgery Interference Defibrillation Electrostatic Discharge 368 Fast Transients Bursts 368 Restart time 368 35 Default Settings Appendix 369 Alarm Default Settings 370 ECG Arrhythmia and ST Default Settings 370 Pulse Default Settings 373 Respiration Default Settings 374 SpO Default Settings 374 NBP Default Settings 375 Temperature Default Settings 375 Invasive Pressure Default Settings 376 Cardiac Output Default Settings 377 CO Default Settings 378 Spirometry Default Settings 378 tcGas Default Settings 379 SvO Default Settings 379 EEG Default Settings 380 BIS Default Settings 380 VueLink Default Settings 381 xviii Basic Operation These Instructions for Use are for clinical professionals using the IntelliVue MP20 MP30 M8001A M8002A MP40 50 M8003A M8004A and MP60 70 80 90 M8005A M8007A M8008A M8010A patient monitors Unless otherwise specified the information here is valid for all the above IntelliVue patient monitors The basic operation section gives you an overview of the monitor and its functions It tells you how
20. Examples HP Laserjet 1200 monochrome HP Laserjet 2100 monochrome HP DeskJet 2500 C color Do not use printers that emulate PCL5 Displays must be approved for medical use MP20 30 40 50 60 70 80 90 M1097A option A02 XGA color 15 LCD touchscreen D80 M8031B XGA color 15 LCD touchscreen MP80 MP90 D80 M8033B M8033C SXGA color 17 LCD touchscreen Wireless Network Type Proxim Range LAN2 7920 Technology Frequency Hopping Spread Spectrum FHSS Frequency Band 2 4 GHz ISM Band Weight 300g max IntelliVue Instrument Telemetry Wireless Network USA only MP20 30 40 50 only Internal WMTS Adapter Technology compatible with Philips Cellular Telemetry System MP20 MP30 CTS cellular infrastructure Frequency Band WMTS 1395 1400 MHz and 1427 1432 MHz External WMTS Adapter Technology compatible with Philips Cellular Telemetry System M2638A CTS cellular infrastructure ME40 MT50 Frequency Band WMTS 1395 1400 MHz and 1427 1432 MHz Weight 350g max IntelliVue 802 11 Bedside Adapter Wireless Network Adapter Internal Wireless Adapter Technology IEFE 802 11a b g Option J35 Frequency Band 2 4 GHz and 5 GHz ISM Band 347 Measurement Specifications See the Appendix on Default Settings for a list of the settings the monitor is initially shipped with ECG Arrhythmia ST Complies with IEC 60601 2 25 1993 A1 1999 EN60601 2 25 1995
21. HR Pulse SpO2 6 Resp o ABP QO At Least One En At Least Two E At Least Three i All Four aie The trigger condition for event groups is set in the monitor s Configuration Mode 244 If you use alarm limits as event triggers the event capture is triggered automatically when your patient s values violate set alarm limits or when a specified alarm condition such as apnea occurs No events of this kind are triggered if alarms are switched off Changing alarm limits changes the event trigger definitions The asterisk symbols beside the trigger tell you about the alarm triggers indicates a high priority red alarm indicates a lower priority yellow alarm This category includes short yellow arrhythmia alarms which may be configured to be shown as one star alarms on your monitor Triggers without asterisk symbols are user defined triggers If you set user defined threshold triggers you can define event triggers that are independent of alarm limits You must set a threshold value and a threshold time for the trigger If you set the trigger threshold time to 12 seconds the monitor triggers an event if the threshold is violated for more than 12 seconds If you set On Measurement triggers you can set aperiodic measurements such as NBP or procedures such as Cardiac Output to trigger an event whenever they start If you set user defined deviation triggers you can define event triggers that are independent of
22. NER NER Measurements per group 3 4 3 Triggers per measurement 2 1 Trigger types Simple at least one Combined at least two Simple at least one Annotation no yes no 241 window graphic Event Episode window tabular and tabular Event Review window graphic Average trend Average trend High Resolution Trend High resolution trend Types of event episode Snapshot events Graphic Event Review Summary view graphic and Graphic and tabular Event Review window graphic and tabular Event Episode window Event views Event Episode window 25 events for 24 hours 25 events for 24 hours 25 events for 24 hours 25 events for 8 hours 25 events for 8 hours 50 events for 8 hours 50 events for 8 hours Database capability 50 events for 24 hours 50 events for 24 hours Event Notification no yes no Event Groups The event group e monitors the patient s signals to detect event triggers e defines which waveforms are recorded in the event data In basic event surveillance only one event group can be active at a time with Advanced Event Surveillance all six groups can be active simultaneously Active event groups monitor for event triggers Event groups are defined in Configuration Mode In monitoring mode the groups can be adapted to current conditions for example episode types and threshold levels can be changed Event Episodes When an event occurs information for a
23. SpO and NRCC Perf values Please wait until the search analysis is complete lt SpO label gt SENSOR MALF SpO The SpO sensor or adapter cable is faulty Try another adapter Numeric is replaced by cable and sensor If the INOP persists contact your service INOP tone personnel lt SpO LABEL gt SENSOR OFF SpO The SpO sensor is not properly applied to the patient Apply Numeric is replaced by the sensor following the instructions supplied by the INOP tone manufacturer lt SpO LABEL gt UNKN SENSOR SpO The connected sensor or adapter cable is not supported by the SpO measurement Use only specified sensors and cables SVO numeric is replaced by INOP tone lt SpO LABEL gt UPGRADE SpO The SpO measurement is currently in UPGRADE mode iiss dt ohihie meiek Monitoring is not possible in this mode unavailable Sp vO CHK SOURCES Sp vO Notall measurements or values required to perform the Numeric is replaced by calculation are available Check measurement sources Sp vO CHK UNITS Sp vO The monitor has detected a conflict in the units used for this Numeric is replaced by calculation Check the unit settings SvO CAL FAILED SvO The calibration failed Check the catheter to Optical Module SvO numeric is displayed with connection Manually restart the calibration Try another catheter and Optical Module If the catheter is already in
24. They are Vtach HR Vtach Run PVCs min Vent Rhythm SVT HR SVT Run Asystole Thresh Pause Threshold 1 To adjust alarm limits in the Setup Arrhythmia menu select the alarm to be adjusted 2 Select the appropriate setting from the pop up list Arrhythmia Alarm Timeout Periods Normally an arrhythmia alarm is announced when an alarm condition is detected However there are certain situations that can inhibit the audible and visible indications of the alarm even though the alarm condition was detected These include e if a more serious alarm condition is active in the same chain e ifa timeout period is in effect for a particular alarm e if a timeout period is in effect for a higher alarm in that chain 113 What is a Timeout Period Timeout periods are automatically started when a yellow arrhythmia alarm is detected During this period the same alarm condition will not generate another alarm Alarm conditions further down the same arrhythmia alarm chain will also not generate an alarm but alarms further up the chain will see Arrhythmia Alarm Chaining on page 115 This setting can only be changed in Configuration Mode To view the timeout period configured for your monitor in the Setup Arrhythmia menu see the menu items TimeOut 1st and TimeOut 2nd To reset the timeout period select the Alarms Off or Pause Alarms permanent key and then reselect it Resetting the Timeout Period Switching alarms off an
25. You cannot use this combination of monitor MMS and cable Switch off the monitor and contact your service personnel BAP INOPS PRESS See lt Pressure label gt INOPS under Pressure BATTERIES EMPTY or BATT 1 Batteries The estimated remaining battery powered operating time of BATT 2 EMPTY the indicated battery or batteries is less than 10 minutes INOP tone battery LED flashes Replace the batteries immediately During this INOP alarms cannot be If the condition persists and the monitor is not connected to paused or switched off mains power this INOP is re issued two minutes after you acknowledge it BATTERIES INCOMPAT or BATT Batteries The indicated battery or batteries cannot be used with this 1 BATT 2 INCOMPAT monitor Replace with the correct batteries M4605A INOP tone BATTERIES LOW or BATT 1 Batteries The estimated battery powered operating time remaining is less BATT 2 LOW than 20 minutes INOP tone BATTERIES MALF or BATT 1 Batteries The monitor cannot determine the battery status If this INOP BATT 2 MALFUNCTION persists replace the faulty battery or batteries If the condition INOP tone battery LED flashes persists and the monitor is not ae mses ila this During this INOB alarms cannot be INOP is re issued two minutes after you acknowledge it paused or switched off unless the Place the batteries in a different monitor or in a battery charger monitor is connected to mains power If the same INOP is shown c
26. a yellow Non Sustain VT alarm is generated 116 CETE About ST Monitoring The monitor performs ST segment analysis on normal and atrially paced beats and calculates ST segment elevations and depressions This information can be displayed in the form of ST numerics and snippets on the monitor All available leads can be monitored continuously The ECG waveform does not need to be displayed on the Screen for ST Segment analysis ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients For this reason the recommended and default setting for ST monitoring in neonatal and pediatric modes is ST Analysis Off ST analysis is always performed using a dedicated filter which ensures diagnostic quality If you are monitoring ECG using an ECG filter mode other than Diagnostic the ST segment of the ECG wave may look different from the ST segment of the ST snippet for the same wave For diagnostic evaluation of the ST segment always switch to Diagnostic filter mode or use the ST snippet WARNING Some clinical conditions may make it difficult to achieve reliable ST monitoring for example e ifyou are unable to get a lead that is not noisy e if arrhythmias such as atrial fib flutter are present which may cause an irregular baseline e if the patient is continuously ventricularly paced e if the patient has left bundle branch block You should consider switchi
27. balance air fully hydrated at 35 C P bs 760 mmHg flow rate 2 l min Resolution Numeric 1 0 mmHg 0 1 kPa Wave 0 1 mmHg 0 01 kPa Stability Short term drift 0 8 mmHg over four hours Long term drift Accuracy specification will be maintained over a 120 hour period awRR Range 2 to 150 rpm Accuracy l rpm Warm up Time 2 minutes with CO transducer attached for full accuracy specification Response Time Less than 60 ms with adult or infant reusable or disposable adapter CO Range 0 to 150 mmHg 0 to 20 0 kPa Accuracy after 2 minutes warmup For values between 0 and 40 mmHg 2 0 mmHg 0 29 kPa For values from 41 to 70 mmHg 5 of reading For values from 71 to 100 mmHg 8 of reading For values from 101 to 150 mmHg 10 of reading At respiration rates above 80 rpm all ranges are 12 of actual The specifications are valid for gas mixtures of CO balance N3 dry gas at 760 mmHg within specified operating temperature range Resolution Numeric 1 0 mmHg 0 1 kPa Wave 0 1 mmHg 0 01 kPa Stability Short term drift 0 8 mmHg over four hours Long term drift Accuracy specification will be maintained over a 120 hour period awRR Range 2 to 150 rpm Accuracy l rpm Warm up Time 2 minutes with CO sensor attached for full accuracy specification Sample Flow Rate 50210 ml minute Total System Response Time 3 seconds Operating Temperature 0 to 40 C 32 to 100 F M3014A M
28. each measurement Select each trigger name and select either an alarm trigger or a user defined trigger from the pop up trigger list If you select a user defined trigger set the required threshold level and delay time If a deviation trigger is configured set the deviation and duration 5 Select Confirm to confirm your changes Triggering Events Manually To manually trigger an event select the SmartKey Manual Event and for Advanced Event Surveillance select the group in which the event will be triggered 246 For manually triggered events patient information for the time leading up to the trigger moment is stored using the settings of the assigned event group The Events Database The maximum number of events that can be stored in the event database depends on the database configuration and the level of event surveillance used The event database is set up in the monitor s Configuration Mode Events are stored in the monitor s event database for the configured lifetime either 8 hours or 24 hours Deleted events cannot be retrieved Events are automatically deleted when e their configured lifetime is over e the storage capacity of the database is exceeded storing a further event deletes the oldest event in the memory e a patient is discharged As the event database is cleared when you discharge a patient you should ensure that you have documented any events you require for the patient records before you conf
29. group is activated notification is switched off no symbol group not activated Selecting the Event Summary window calls up the events pop up keys Parts of the Event Summary window can also be embedded in Screens so that they are always visible for example the Total row showing the total number of events with the bars on the timeline or the column showing all the groups with the activation and notification status Event Review Window To enter the Event Review window select the graphic event summary if available or select the events pop up key Show Review When you open the Event Review window it automatically shows the event group with the most recent event To view other event groups select the pop up key Review Group and select the group from the list 249 Event Review ACD OCO BCD 1 1 ABCD 201 D 1 M O Total 4 HR Brady SpOo2 DESAT Resp APNEA Manual Total Event bars Each event bar represents one event The height indicates the event severity Bars that extend over more than one channel represent combi events Manually captured events are marked with a bar above the timeline instead of in the measurement channels Event values Event information for the currently selected event is shown on the left of the review window The trigger measurement is highlighted Ifan alarm triggers the event the monitor shows the alarm conditions that triggered the event
30. i Oct 18 40 Ventil Bpol LOW J3 lt 90 i Oct 18 40 NER p z DESAT 78 lt 80 IELIPS Page 1 last 255 256 24 Recording MP40 MP50 The M1116B plug in recorder records numerics for all active measurements and up to three MP60 MP70 waveforms You can use it for local recording mounted either in the monitor s FMS or in the integrated MP90 module slots MP40 MP50 MP60 MP70 RECORDER o lM Continue LED Flashes if a continuous recording is goa ongoing RUN CONT key Starts a delayed recording or makes the current recording continuous Stops the current recording M1116B Plug in Recorder 257 MP20 MP30 The integrated recorder records numerics for all active measurements and up to three waveforms MP20 MP30 Integrated Recorder Central For central recording from the bedside your monitor must be connected via a network to an Information Center You can use either the M1116B recorder or the standalone M3160A 4 Channel Recorder Recordings made on the M3160A may look slightly different to those described here See the documentation supplied with the Information Center for information on the 4 Channel Recorder Recording Starting and Stopping Recordings The recordings pop up keys let you start and stop recordings Select the Recordings SmartKey to call up the line of pop up keys Scroll right or left to see any pop up keys not displayed The selection of pop up keys available de
31. impedance e g 15 kQ electrode to skin contact above limit green measured value no action necessary e g 3 kQ Electrode connected impedance at or below limit 210 CABS UES Cin a CSS inne oniconig ees About Compressed Spectral Arrays CSA The continuous EEG signal is sampled periodically and this value is stored in a frame Each frame is processed using Fast Fourier Transformation FFT to provide a frequency spectrum displayed as a compressed spectral array CSA The CSA window provides an overview of the patient s EEG values over time It may be configured to look slightly different on your monitor To view the CSA window permanently embedded on a Screen select a Screen configured to display the CSA window To view the CSA window over the current Screen select the EEG CSA SmartKey if configured or select Setup EEG orMain Setup then Show CSA Fp1 T3 Filter 0 5 30 Hz Montage Montage A Fp2 T4 CSA1 Buffer A 2 Sec SEF 90 PPF CSA2 Status line Lead label for example Fp1 T3 Fp2 T4 CSA label CSA1 or CSA2 according to EEG channel Montage label for example Montage A Filter settings for example 1 30 Hz Buffer label and time the buffer and interval between spectral lines on the CSA Current SEF Threshold can only be changed in Configuration Mode Spectral lines The energy at each frequency is computed and displayed as a spectra
32. in the Setup C O menu select Method and then select Right Heart Ice Bath Setup for RH Thermodilution C O Measurements If you are using the flow through method illustrated above the injectate temperature is measured at the time of injection by the temperature probe in the injectate temperature probe housing 168 If you are using the ice bath setup the injectate temperature probe and the injectate are both placed in an ice bath and the probe measures the temperature of the contents of the ice bucket Setting the Computation Constant Check that the correct Computation Constant is entered in the C O procedure window This can be found in the documentation supplied with the catheter and is based on the injectate volume injectate temperature and catheter type To change the value in the C O procedure window select Computation Constant and use the pop up keypad to enter the correct value Performing RH C O Measurements 1 Enter the C O procedure window 2 When you see the message Ready for new measurement select the pop up key Start C O 3 When you hear a ready tone and see the message Inject now inject the solution into the right atrial port of the Swan Ganz catheter The optimal injection rate is 2 5 ml second At the end of the measurement the thermodilution curve cardiac output index values and curve alerts if necessary are displayed and a message will appear Wait before starting new measurement 4
33. is highlighted yellow alarm lamp alarm tone BIS HIGH BIS The Bispectral Index value has exceeded numeric flashes and high limit the high alarm limit is highlighted yellow alarm lamp alarm tone BIS LOW BIS The Bispectral Index value has dropped numeric flashes and low limit below the low alarm limit is highlighted yellow alarm lamp alarm tone 53 exceeded BRADY Pulse Press SpO The heart rate from the Pulse signal has numeric flashes and alarm or fallen below the bradycardia limit xxx limit is highlighted red alarm BRADY xxx lt yyy denotes the lowest measured value yyy lamp alarm tone is the bradycardia limit CCO CCI HIGH CCO Continuous Cardiac Output or CC numeric flashes and high alarm Index is above the high alarm limit limit is highlighted yellow alarm lamp alarm tone CCO CCI LOW CCO Continuous Cardiac Output or CC numeric flashes and low alarm Index is below the low alarm limit limit is highlighted yellow alarm lamp alarm tone CPP HIGH CPP The CPP value has exceeded the high numeric flashes and high limit alarm limit is highlighted yellow alarm lamp alarm tone CPP LOW CPP The CPP value has fallen below the low numeric flashes and low limit alarm limit is highlighted yellow alarm lamp alarm tone DESAT or SpO The SpO value has fallen below the numeric flashes red alarm DESAT xxx lt yyy desaturati
34. or information Check the connection Contact your service personnel NO PPV FROM MeasSrv MMS or The measurement server does not supply a beat to beat arterial at Information Center FMS pressure value Contact your service personnel NO PPV FROM lt Server gt MMS or The measurement server does not supply a beat to beat arterial FMS pressure value Contact your service personnel P P1 P2 P3 P4 INOPS PRESS See lt Pressure label gt INOPS under Pressure PAP INOPS PRESS See lt Pressure label gt INOPS under Pressure PPV BAD lt Pressure Label gt PRESS The arterial pressure source selected for PPV is not providing a SIGNAL pulsatile signal PPV BAD SIGNAL PRESS The arterial pressure source selected for PPV is not providing a at Information Center pulsatile signal PPV CHK SOURCES PRESS The arterial pressure source selected for PPV is unplugged or switched off When this INOP has displayed for 1 minute PPV will be switched off lt Pressure label gt ARTIFACT PRESS A non physiological event is detected for example a flush or Numeric displayed with blood sample A resulting high limit alarm will be suppressed lt Pressure label gt PRESS A Pressure measurement label in the measurement server or DEACTIVATED extension has been deactivated either by connecting a Temp INOP tone transducer in the shared Press Temp socket or by deactivating the label in the Measurement Selection window The measurement automatically disa
35. predefined duration is stored This is the event episode It includes information from a defined period before the trigger called the event pre time The episode time after the event is called the event post time Ifa further event occurs during the event post time it changes a single event to acombined event combi event Event trigger Event pre Event post time time sf Manually triggered event episodes Event Episode document patient information from the time leading up to the event trigger they do not have a post time 242 The episode type defines the level of detail captured in an event episode The higher the data resolution the shorter the period that the monitor can store in its memory High resolution data is suited for neonatal applications where the clinical situation may change very quickly In adult monitoring where the patient s status typically changes more gradually a longer trend may be more informative Average trend 2 minutes 18 minutes 20 minutes five samples per minute 4 minutes 16 minutes 6 minutes 14 minutes 8 minutes 12 minutes 10 minutes 10 minutes 12 minutes 8 minutes 14 minutes 6 minutes 16 minutes 4 minutes 18 minutes 2 minutes HiRes Trnd 1 minute 3 minutes Four minutes four samples per second 2 minutes 2 minutes Neonatal Event Review NER is a type of 3 minutes 1 minute HiRes Trnd Realtime Wave Snapshot 5 seconds 10 seconds 15 se
36. the event value boxes display manua Annotating Events 1 To annotate an event in the Event Episode window select the pop up key Select Annotation 2 Select the required annotation from the pop up list of available annotations for the currently active event group Up to 20 annotations can be configured to let you add commonly used clinical notes to event episodes for documentation purposes To see the complete list of available annotations in the Event Setup menu select Event Annotation Documenting Events You can print a report or make a recording of the events history stored in the database or of individual event episodes Documenting Event Review 1 Inthe Event Review window select the pop up key Print Record This calls up the event documentation pop up keys 251 2 Fora graphic Event Review recording select the Record Graphic pop up key For a tabular Event Review recording select the Record Tabular pop up key To print an Event Report select the Print Review pop up key Documenting an Event Episode 1 Inthe Event Episode window select the pop up key Print Record This calls up the event documentation pop up keys 2 To make an Event Episode recording select the Record pop up key To printan Event Episode select the Print Episode pop up key Event Recordings Event recordings can be sent to a locally connected M1116B recorder module Event Review Recordings Each event revie
37. 1 3m M1629A M1639A 10 Electrode Cable Sets OR Grabber extremities 1 0m 1 6m M1973A M1974A OR Grabber chest 1 0m M1979A M1984A ICU Extremities 1 0m 1 6m M1968A grabber M1971A grabber ICU Chest 1 0m M1976A grabber M1978A grabber 3 Electrode One Piece Cables OR Grabber 1 Im M1970A OR Grabber M1980A ICU Snap 1 Im M1972A ICU Grabber M1981A 5 Electrode One Piece Cables 310 OR Grabber 2 5m M1975A OR Grabber M1985A ICU Snap 2 5m M1977A ICU Grabber M1986A Set Combiners and Organizers Set combiner 3 electrode M1501A 5 electrode M1502A Set organizer Shielded 3 electrode M1503A Shielded 5 electrode M1504A Bedsheet clip M1509A NBP Accessories Y These cuffs and tubings are designed to have special protection against electric shocks particularly regarding allowable leakage currents and are defibrillator proof You can use them during electrosurgery Adult Pediatric Multi Patient Comfort Cuffs and Disposable Cuffs Adult Thigh 42 to 54 cm 20 cm M1879A M1576A Large Adult 34 to 43 cm 16 cm M1878A M1575A Adult 27 to 35 cm 13 cm M1877A M1574A Small Adult 20 5 to28cm 10 5cm M1876A M1573A Pediatric 14 to 21 5cm 8 cm M1875A M1572A Infant 10 to 15 cm 5 5 cm M1874A M1571A M1598B 1 5m or M1599B 3m
38. 81 Data Exchange Between Information Centers 82 Resolving Patient Information Mismatch 82 Manually Resolving Patient Mismatch 82 Patient Mismatch If One Set of Patient Data is Correct 83 Patient Mismatch If Neither Patient Data Set is Correct 83 Patient Mismatch If Both Patient Data Sets Are Correct 84 Automatically Resolving Patient Mismatch 84 Care Groups 84 Understanding the Care Group Overview Bar 85 Viewing the My Care Group Window 86 Viewing the Other Bed Window 87 Other Bed Pop Up Keys 88 Visual Alarm Status Information in the Other Bed Window 88 Care Group Alarms 88 Telemetry Data Overview 89 Unpairing a Telemetry Device 89 Telemetry Data Overview Screen Element 90 Silencing Telemetry Alarms from the Bedside 90 Suspending Telemetry Alarms 90 Using Standby 90 6 ECG Arrhythmia and ST Monitoring 91 Skin Preparation for Electrode Placement 91 Connecting ECG Cables 91 Selecting the Primary and Secondary ECG Leads 92 Checking Paced Status 92 Understanding the ECG Display 93 Monitoring Paced Patients 93 Setting the Paced Status Pace Pulse Rejection 94 Avoiding Pace Pulse Repolarization Tails 94 Changing the Size of the ECG Wave 94 To Change the Size of an Individual ECG Wave 94 To Change the Size of all the ECG Waves 95 Changing the Volume of the QRS Tone 95 Changing the ECG Filter Settings 95 Choosing EASI or Standard Lead Placement 96 About ECG Leads 96 ECG Leads Monitored 96 Changing Lead Sets 96 ECG Lead Fallback 97 E
39. A AAMI ECG lead labels 97 abdominal breathing and Resp electrode placement 132 aberrantly conducted beats 108 AC power input 332 accessories 10 electrode cable sets 310 3 electrode cable sets 309 3 electrode one piece cables 310 5 electrode cable sets 310 5 electrode one piece cables 310 Aspect Medical Systems 322 C O 319 CO2 176 181 188 CO2 mainstream 320 CO2 microstream 321 ECG 309 EEG 322 Hospira Inc 323 NBP adult cuffs 312 comfort cuffs 311 disposable cuffs 311 multi patient comfort cuff kits 311 neonatal infant cuffs disposable 312 reusable cuffs 311 single hose disposable cuffs 312 Nellcor 313 pressure 313 Pulsion 313 recorder paper 324 resp 309 set combiners and organizers 311 SpO2 313 Nellcor adhesive sensors disposable 313 Philips sensors disposable 313 Philips sensors reusable 313 SvO2 323 temperature 318 trunk cables 309 active alarms 41 address Philips 326 addressograph printer configuration setting 272 adjusting ST measurement points 120 adjusting wave scale pressure 154 adjusting wave size CO2 183 192 admit editing information 79 quick admit 78 admitting a patient 77 advanced event surveillance 241 airway adapter CO2 microstream accessory 182 alarm latching 51 52 113 alarm limits changing 48 checking 46 manually adjusting 48 narrow 49 report 273 setting 46 ST 122 switching auto limits on off 49 using automatic limits 49 wide 49 window 47 ala
40. BIS values should be interpreted cautiously in patients with known neurological disorders those taking psychoactive medications and in children below the age of 1 WARNING Conductive Parts The conductive parts of sensors and connectors should not contact other conductive parts including earth High frequency Surgery To reduce the hazard of burns in the high frequency surgical neutral electrode connection the BIS sensor should not be located between the surgical site and the electro surgical unit return electrode Defibrillation The BIS sensor must not be located between defibrillator pads when a defibrillator is used on a patient connected to the patient monitor Securing Cables To minimize the risk of patient strangulation the patient interface cable PIC must be carefully placed and secured CAUTION Revisions The system will only function if all component revisions are compatible Otherwise an incompatibility INOP is displayed If the DSC has an older software revision than the BIS Engine the DSC will automatically be upgraded by the BIS Engine Do not disconnect the DSC from the BIS Engine or disconnect the BIS module from the monitor or switch the monitor power off within the first ten seconds after connection as this will disrupt a possible software upgrade and cause damage to the DSC The BIS Interface board for the MP20 MP30 can only be used with BISx not with the BIS engine If the BIS engine is connected to the
41. C 120 F Altitude range Operating 500 4 600 m 1600 15000 ft Storage 500 13 100 m 1600 43000 ft Temperature range Operating 0 2 55 C G2 130 F Storage 20 60 C 4 140 F Humidity range Operating 95 RH max at 40 C 100 F Storage 85 RH max at 50 C 120 F Altitude range Operating 500 4 600 m 1600 15000 ft Storage 500 13 100 m 1600 43000 ft M4605A Battery Specifications MP20 MP30 Two batteries are required to operate the MP40 MP50 monitors The MP20 MP30 monitors can MP40 MP50_ operate with one battery Only WxDxH 149 mm 5 866 in x89 mm 3 504 in x 19 8 mm 0 78 in Weight 490 g 1 08 lb per battery Performance Specifications Nominal Voltage 10 8 Volt Rated Capacity at discharge C 5 6000 mAh Continuous Discharge Capability 6 5 A Environmental Specifications Temperature Range Discharge 0 to 50 C 32 to 122 F Charge 0 to 45 C 32 to 113 F Storage 20 to 60 C 4 to 140 F Humidity Range 40 to 95 Relative Humidity RH Battery Type Smart Battery 10 8V 6000mAh Lithium Ion Safety complies with UL 1642 UL Recognized and IEC 61960 2 2001 Electromagnetic Compatibility EMC complies with the requirements for FCC Type B computing Device and EN 61000 4 2 and EN 61000 3 Communication Standard complies with the SMBus specificati
42. CCO and CCI Alarms from CCO CCO from ABP Color Green CCO Alarms On CCO High Limit 8 5 l min 3 7 l min 1 3 l min CCO Low Limit 4 0 l min 2 6 l min 0 3 l min CCI Alarms On CCI High Limit 4 3 min m 3 7 l min m 5 2 I min m CCI Low Limit 2 0 I min m 2 6 l min m 1 2 I min m 377 35 Default Settings Appendix CO Default Settings CO Default Settings etCO low 30 25 etCO high 50 60 imCO high 4 CO Alarms on Unit mmHg Scale 40 mmHg 50 ImCO on Off N20 Corr only Off M3015A M3016A Oxygen Corr only 16 M3014A Gas Corr only Off M3014A Humidity Corr BTPS Max Hold Off AwRR On AwRR Alarms On AwRR high limit 30 100 AwRR low limit 8 30 Apnea time 20 secs Color Yellow White Spirometry Default Settings 378 APNEA high limit 20 20 20 MVexp low limit 4 0 2 5 0 4 MVexp high limit 8 0 4 0 0 8 PIP high limit 40 25 20 PEEP low limit 0 0 0 PEEP high limit 25 25 25 RRspir low limit 8 8 30 RRSpir high limit 30 30 60 AWE scale 150 l min 100 l min 20 l min AWV scale 800 ml 200 ml 50 ml AWP scale 40 cmH 0 40 cmH 0 20 cmH O eee ey nnn a tcGas Default Settings tcpO High 80 mmHg tcpO Low 50 mmHg tcpO Alarms On tcpCO High 50 mmHg tcpCO Low 30 mmHg tcpCO Alarms On Site Time 4 0 hours Di
43. Calculator ANY DRUG x Dose 2 mg min v v 480 ml hour Tener ale vaio 100 ma 0 25 mg ml 1 Enter three of these four values dose amount volume and rate of the infusion solution To enter values select the correct unit then select each value field and use the pop up keypad to enter the correct Concentr 1 ml hr 0 004 mg min Weight 150 1b value 2 Ifyou have chosen a weight dependent dose unit you must enter the patient weight now or choose a different unit If available the patient weight from the Patient Demographic window is entered automatically in the Drug Calculator window when the Drug Calculator is accessed To change the patient weight select the Weight key then use the on screen keypad to enter the correct value This will not change the patient weight stored in the patient demographic information 278 3 When you have entered three values the Drug Calculator automatically calculates the unknown fourth value and shows it in the highlighted field Standardized rate and concentration are also calculated Performing Calculations for a Specific Drug 1 Select the arrow beside Drug Calculator xX Any Drug then select the required drug from Patient Category Eidgcaine gt the list of drugs adult mg min This opens the Pedi Rate Enoe Drug Calculator Neo o window for the selected d Volume ml rug a Concentr 8 ml 2 Select the correct patient ms cat
44. Changing CO Alarms 184 Changing the Apnea Alarm Delay 184 Deriving Alarms From awRR 184 Changing awRR Alarm Limits 184 15 Monitoring Airway Flow Volume and Pressure 187 Attaching the Flow Sensor 188 Zero Calibration 190 Automatic Purging 190 Adult Mode 191 Neonatal and Pediatric Modes 191 Manual Purging 191 Gas Compensation 191 Setting up Spirometry 192 Optimizing Scale Settings 192 Spirometry Values Window 192 Alarms and Alarm Limits 192 Changing the Apnea Alarm Delay 192 Automatic Alarm Suppression 193 Choosing Measured AWV Components 193 Setting the Gas Compensation Mode 193 Changing the Type of Balance Gas 193 Changing the Concentration of Inspired O2 and the Inspired Agents 193 Changing the Temperature of the Inspired Gas 194 16 Monitoring tcGas 195 Identifying tcGas Module Components 195 Setting the tcGas Sensor Temperature 196 Using the tcGas Site Timer 196 Setting the tcGas Site Timer 196 Restarting the tcGas SiteTimer 197 Disabling the tcGas Site Timer 197 Setting the tcGas Barometric Pressure 197 Remembraning the tcGas Transducer 197 New Dried Out Transducers 198 Storing tcGas Transducers 198 Calibrating the tcGas Transducer 199 Calibration Failure 200 Troubleshooting tcGas Calibration 200 Applying the tcGas Transducer 201 Selecting the tcGas HeatPowerDisplay Mode 202 Zeroing the tcGas Relative Heat Power 202 Finishing tcGas Monitoring 202 TcGas Corrections 202 Temperature Correction for tcpCO 202 Metaboli
45. EC2 Electrode Cream conductive paste M1937A BIS Accessories Use only Aspect BIS sensors with the BIS module or BIS Interface board MP20 MP30 The sensor is a silver silverchloride electrode array that uses Aspect s patented ZipPrep technology and a proprietary connector The sensor electrodes are for single patient use only Check shelf life before use The patient interface cable Philips Ordering No M1034 61630 Aspect Part No 186 0131 has an estimated lifetime of one year Do not scrap it when disposing of the BIS sensor The sensor cable from the Semi Reusable Sensor is re usable but has a maximum number of uses the electrodes are single patient use only The monitor displays how many uses remain for the sensor cable BIS Sensors To re order sensors outside North America contact your nearest Philips sales office and quote the Philips ordering number In North America contact Aspect Medical Systems BIS and BISx compatible BIS Sensor Quatro formerly Sensor XP 50 M1997A 186 0106 BIS Sensor Plus 50 M4546A 186 0076 BIS Sensor Pediatric 25 M1998A 186 0110 BIS Sensor Pediatric 4 electrode 25 989803143581 186 0200 BIS Semi reusable Sensor not available in 100 M4615A 186 0164 USA Japan BIS Sensor Extend 50 n a 186 0160 Other BIS Accessories Order the following parts from your nearest Philips sales office and quote the Philips ordering number B
46. Hz 85 dB octave Bispectral Index BIS Range 0 100 Signal Quality Index SQI Range 0 100 EMG Range 0 100dB Suppression Ratio SR 0 100 Spectral Edge Frequency SEF 0 5 30 0Hz Total Power TP 0 100 dB Bursts BISx only 0 30 minute Noise lt 0 3HV RMS 2 0uV peak to peak Wave Scale With gridlines on 25 WV 50UV 100uV 250LV With gridlines off 50V 100LV 200LV 5004 V Update Frequency BIS Numeric 2048 ms Bandwidth 0 25 100Hz 3dB High Pass Filters 0 25 Hz 1 Hz 2 Hz 3dB Low Pass Filters 30 Hz 50 Hz 70 Hz 100 Hz 3dB Notch Filters for line frequency 50 Hz 60 Hz Impedance Measurement Range 0 to 999 kQ BIS High Low Alarm 0 100 1 Max 2 seconds Safety and Performance Tests You must observe any national regulations on the qualification of the testing personnel and suitable measuring and testing facilities See the maintenance section for a list of required tests Safety and performance tests and what to do if the instrument does not meet these specifications are described in the Installation and Service guide Electromagnetic Compatibility EMC Specifications Take special precautions regarding electromagnetic compatibility EMC when using medical electrical equipment You must operate your monitoring equipment according to the EMC information provided in this book Portable and mobile radio frequenc
47. Lithium Ion battery chargers approved by Philips 1 Insert the batteries into a monitor connected to mains power The battery LED will light yellow to indicate that charging is in process 2 Charge the battery until it is full the battery LED is green and the battery power gauge is fully shaded Conditioning Batteries CAUTION Do not use a monitor being used to monitor patients to condition batteries The monitor switches off automatically when the batteries are empty You must condition a battery when its battery requires maintenance symbol shows on the Screen Do not interrupt the charge or discharge cycle during conditioning To condition a battery 1 Insert the battery into a monitor connected to mains power 2 Charge the battery until it is completely full Open the Battery Status window and check thatthe Batteries fully chargedorBattery 1 Battery 2 fully charged message is displayed 3 Disconnect the monitor from mains power and let the monitor run until the battery is empty and the monitor switches itself off 4 Reconnect the monitor to mains power and charge the battery until it is full for use or charge to 50 for storage Contact your local Philips representative for information on external battery chargers conditioners Use only Lithium Ion battery chargers approved by Philips Unequally Charged Batteries If two batteries in a monitor are unequally charged the monitor can compensate by causing the fuller
48. MP40 MP50 The IntelliVue MP40 MP50 M8003A M8004A patient monitor has a 12 inch TFT LCD flat panel SVGA display The standard input devices for the MP50 are the Touchscreen and integrated navigation point the MP4O0 is supplied with an integrated navigation point only Up to six waves can be shown on MP40 MP50 Screens 12 ECG traces can be shown on the 12 Lead ECG Screen The MP40 MP50 can be connected to one Multi Measurement Server MMS and any one of the measurement server extensions The IntelliVue family plug in measurement modules can be connected to its four integrated plug in module slots with plug and play convenience the only exception is the SvO module M1021A which cannot be used with the MP40 MP50 The Flexible Module Server M8048A cannot be used with the MP40 MP50 MP40 MP50 Major Parts and Keys MP40 MP50 left side Color coded alarm lamps Alarms off lamp Model indicator ECG out Navigation Point Part number and serial number Mounting quick release lever o N AVA WO NHN e Plug in module slots MP40 MP50 front panel PHILIPS On Standby switch On Standby LED Error LED Battery status LED AC power operation LED read the documentation symbol ND WW KR WOW NHN Mounting quick release lever On Standby LED Green when monitor is switched on Error LED Red if there is a problem with the monitor Battery LED Green yellow and red See the section on Using the Batterie
49. Mode gridlines and the current wave scale values are shown with the EEG wave e IfShow Gridlines is set to Off in Configuration Mode the current wave scale is indicated by a size bar beside the EEG wave 212 Changing Filter Frequencies The low and high pass filters screen out undesirable interference from the raw EEG wave display The current EEG filter frequency settings are shown in the header of the CSA Changing filter settings affects the EEG wave and all the EEG numerics Whenever the filter setting is changed a filter change marker appears next to the spectral lines To change the filter settings 1 Inthe Setup EEG menu select Low Filter or High Filter to call up a list of available frequencies 2 Select the required frequency from this list Changing the Speed of the EEG Wave The EEG measurement has its own speed control and is not affected by the wave speed settings of the other measurements Inthe Setup EEG menu select Wave Speed Choose the required speed from the pop up list This defines the speed at which the wave is drawn across the screen in millimeters per second mm s EEG Reports The content of EEG Reports is always the same and does not need to be configured To print an EEG Report in the Setup EEG menu select Print Report Alternatively you can select the CSA and use the Print Report pop up key to start the report To modify the buffer and trendline settings on the CSA Report in the Rep
50. Module includes an automatic and manual purge feature which provides a flush of room air to keep the sensor tubing free from water condensation and patient secretions This feature is available for the adult pediatric and neonatal modes The purge will begin with the exhalation portion of the ventilator cycle NOTE During the purge cycle the pump will be heard Ifthe purge does not sufficiently clear the flow tubing lines the flow sensor should be replaced e With each purge cycle a zero calibration is automatically performed 190 Adult Mode The system automatically purges the sensor tubing every ten minutes or less depending on system conditions In adult mode the system will purge both sides of the line one at a time during each purge cycle The higher the pressure the more frequent the purging This action anticipates increased moisture migration into the sensor tubing due to the increase in circuit pressure Neonatal and Pediatric Modes The automatic purge cycles used in the neonatal or pediatric mode is fixed at every three minutes regardless of circuit pressure Only one side of the sensor tubing will be purged during each purge cycle Unlike the adult purge mode the neonatal or pediatric purge mode does not use the full force of the internal pump but rather pressurizes an internal reservoir which is used for the purge This minimizes the pressure delivered to the ventilator circuit but does deliver a sufficient pressu
51. New This section lists the most important new features and improvements to the monitor and its user interface introduced with each release Further information is provided in other sections of this book You may not have all of these features depending on the monitor configuration purchased by your hospital What s New in Release D 0 M1014A Spirometry Module The spirometry module produces a real time wave for flow volume and pressure of respiratory gases together with numerics for analysis of ventilatory mechanics It is designed to be used in combination with Philips branded airway flow sensors and combined CO airway flow sensors M3014A Capnography Extension The M3014A Capnography Extension offers an additional measurement method sidestream CO with the M2741A sensor M8016A D80 Intelligent Display The D80 Intelligent Display can be used as a third main display with the MP90 monitor You then have three displays able to be configured individually and to be operated independently IntelliVue 802 11 Bedside Adapter The 802 11 Bedside Adapter is a wireless ethernet adapter which can be built in to the patient monitor option J35 It provides wireless connectivity to standard IEEE 802 11a b g wireless networks Improved Multiple Display Support e Wide and Tall screen layouts are supported which allow screen content to be spread over two screens next to each other wide acreen or one above the other tall screen e A
52. Prolonged delay The selected apnea alarm delay may be prolonged by up to 17 seconds if an apnea occurs during the automatic zero process This applies to the Microstream M3015A measurement only Deriving Alarms From awRR 1 Inthe Setup CO menu select awRR 2 Inthe Setup awRR menu select Alarms 3 Choose On to derive alarms from the airway respiration signal or O to disable them Changing awRR Alarm Limits 1 Inthe Setup CO menu select awRR 2 Select High Limit to set the upper alarm limit Select Low Limit to set the lower alarm limit 3 Select the appropriate setting 185 186 WARNING 15 Monitoring Airway Flow Volume and Pressure The M1014A Spirometry Module is designed to be used in combination with Philips branded airway flow sensors and combined CO airway flow sensors It produces a real time wave for flow volume and pressure of respiratory gases together with numerics for analysis of ventilatory mechanics The measurement provides e Airway flow airway volume and airway pressure waveform e Numerics for respiratory rate tidal volume minute volume PEEP positive end expiratory pressure PIP peak inspiration pressure dynamic compliance airway resistance e Numerics for only visible in Spirometry Values Window no alarming no trending peak inspiratory flow peak expiratory flow negative inspiratory pressure mean airway pressure plat
53. Revision menu select the monitor component for which you need revision information Getting Started Once you understand the basic operation principles you can get ready for monitoring Inspecting the Monitor WARNING If the monitor is mechanically damaged or if it is not working properly do not use it for any monitoring procedure on a patient Contact your service personnel 1 Before you start to make measurements carry out the following checks on the monitor including all connected Measurement Servers modules or measurement server extensions Check for any mechanical damage Check all the external cables plug ins and accessories 2 Plug the power cord into the AC power source If you are using battery power ensure that the battery has sufficient power for monitoring When you use a battery for the first time you must charge it following the instructions given in the section on Charging Batteries 3 Check all the functions of the instrument that you need to monitor the patient and ensure that the instrument is in good working order Switching On Press the on off switch on the monitor for one second The monitor performs a self test and is then ready to use If you see a message such as CO2 Sensor Warmup wait until it disappears before starting monitoring that measurement Connected devices usually take their power from the monitor External devices such as gas monitors and those connected via VueLink have
54. Scale to call up a list of wave scales 2 Select the required scale from this list e When gridlines are switched off you can choose from the available scale values 50 UV 100 UV 200 UV and 500 UV Scaling information is displayed as a vertical bar on the EEG wave together with its height equivalent in LV When gridlines are switched on scales are defined as a range either 25 UV 50 UV 100 LV or 250 UV Scaling information is shown in the form of gridlines Switching BIS Filters On or Off The low and high pass filters screen out undesirable interference from the raw EEG wave display The notch filter removes line frequency interference Filter settings affect the EEG wave and the SEF and TP values but they do not affect the BIS EMG SR and SQI values The filter settings are set in Configuration Mode You can switch all the filters on or off together in Monitoring Mode 1 Inthe Setup BIS menu select Filters 2 Select On Off to toggle between all filters On or Off 220 BIS Safety Information For information on the use of BIS in specific monitoring situations and on pharmacological responses to the anesthetic agents Nitrous Oxide when used as the sole anesthetic agent Ketamine and Etomidate please contact Aspect Medical Systems to request a copy of their publication A Clinician s Guide to the Bispectral Index Considerations for Use Due to limited clinical experience in the following applications
55. Stethoscope Probe 12 French 21093A 180 sec Esophageal Stethoscope Probe French 18 21094A 210 sec Esophageal Stethoscope Probe French 24 21095A 310 sec Foley Catheter Probe 12 French M2255A 180 sec 318 Foley Catheter Probe 16 French 21096A 180 sec Foley Catheter Probe 18 French 21097A 180 sec Adapter cable 1 5m 21082B Adapter cable 3 0m 21082A Cardiac Output C O Accessories See Pressure accessories for PULSION continuous cardiac output accessories Accessories common to both methods Accessories Set of ice buckets 14455A Remote handswitch 15244A PiCCO inline temperature probe for Latex free M1646A warmer injectate Right Heart Thermodilution C O Interface Cables 2 7 meter cable right heart only M1642A 2 4m 2 4 m cable M1643A Right heart catheter for thermodilution from Baxter 831HF75 Baxter CO set only with HP 23001A B contact Baxter for information Injectate Probes 2 4m injectate temp probe reusable 23001A 0 5m injectate temp probe reusable 23001B Ice bath temp probe right heart only 23002A Transpulmonary Thermodilution C O Interface Cables 2 4 m 2 4 m cable M1643A Injectate Probes 2 4m injectate temp probe reusable 23001A 0 5m injectate temp probe reusable 23001B Baxter CO set only with HP 23001A B contact Baxter for information Pressure Transducer Kits PULSION PV 8003 30cm pr
56. The settings you choose in the Setup Vital Signs Report and Graphical Trend Report menus apply for all Vital Signs and Graphic Trend reports printed To set up Vital Signs and Graphic Trend reports 1 Select Main Setup gt Reports gt Vital Signs Rep or Graph Trend Rep 2 Select Trend Group and select the group you want to print on the report The groups available depend on your monitor s trend configuration 3 Select Period and select the period of time for which trend data should be printed on the report If Automatic Period is configured to On all trend data for the current patient will be printed irrespective which trend period is selected 4 Select Interval Vital Signs Reports only and select the resolution of the trend data printed on the report Setting Up Auto Reports Auto Reports print automatically when a specified trigger occurs There are two types of Auto Reports Scheduled Reports which print at predefined intervals and End Case Reports which print when a patient is discharged using the End Case function An Auto Report can be both a Scheduled Report and an End Case report To set up Auto Reports 1 Select Main Setup gt Reports gt Auto Reports and select the Auto Report you want to set up A B C or D 2 Select Report and assign a report type to the Auto Report 3 SelectEnd Case Report and toggle to On if you want the selected report to print automatically when you select End Case to discharge a patie
57. The trend group A11 contains all available measurements you cannot change the order or selection of this group To change the selection of measurements in a trend group either use the Change Group setting in the Segment menu or 1 Select Main Setup gt Trends gt Trend Groups 2 Select the Trend Group you want to change and use the pop up keys to Add Change or Delete the selection of measurements trended To temporarily change the order in which the measurements are displayed in a group 1 Select Main Setup gt Trends gt Trend Groups 2 Select the Trend Group and then the measurement you want to move and use the Sort Up Sort Down pop up keys Trend Interval The trend interval defines the resolution of trend data shown on the Screen High resolution data is especially suited for neonatal applications where the clinical situation may change very quickly In adult monitoring where the patient s status typically changes more gradually a longer trend may be more informative To set the trend resolution in the Vital Signs or Graphical Trends window Select the Select Interval pop up key and then select the required interval from the list Trend Priority The monitor stores trend information for all monitored measurements if configured to do so If your configuration restricts the number of measurements trended you must choose which measurements will be included A priority list is used to select the trended measurement
58. When you see the Ready for new measurement message repeat the procedure until you have completed the measurements you want to perform You can perform a maximum of six measurements before editing If you perform more than six measurements without rejecting any the oldest will automatically be deleted when a seventh curve is stored Editing and Saving RH C O Measurements It is important to identify and reject erroneous measurements called trials as the monitor uses all the measurement trial values you do not reject to calculate the averaged cardiac output 1 Review the trials Irregular trials or trials marked with a should be reviewed carefully Consider the similarity of the values and the shape of the C O curve A normal C O curve has one smooth peak and returns to the temperature baseline level after the peak 2 Reject unsatisfactory trials use the Select Trial pop up key to move between trials then select the Accept Reject pop up key to accept or reject trials If you are using a touch screen you can accept or reject trials directly by tipping on the trial curve Discard conspicuously different values The background of rejected trials is red and the background of accepted trials is green The monitor recalculates the average values after you reject or accept trials If all values are different from each other there may be true hemodynamic instability caused for example by severe cardiac arrhythmia 3 Save aver
59. With the MP60 70 80 you can connect only one FMS With the MP90 M8010A you can connect two FMSs to use up to 10 measurement modules For individual modules the maximum that can be used simultaneously in an FMS is five pressure modules four temperature modules four VueLink modules Connect the FMS to the monitor via the measurement server link cable MSL Use the MSL connector on the left hand side to connect additional measurement servers Use the connector on the right to connect to the monitor 1 Multi Measurement Server 2 Measurement server mount 3 Flexible Module Server 4 Power on LED 5 Interruption indicator Measurement Modules You can use up to eight measurement modules with the Flexible Module Server M8048A two additional modules in the integrated module slots in the MP60 MP70 and up to four in the integrated slots in the MP40 MP50 Available modules are e Invasive blood pressure M1006B e Temperature M1029A e Oxygen saturation of arterial blood SpO7 M1020B e Cardiac output M1012A and Continuous cardiac output with M1012A Option C10 e Transcutaneous gas M1018A e Mixed venous oxygen saturation SvO M1021A MP60 70 80 90 monitor only e Recorder M1116B e VueLink device interface M1032A EEG M1027A e Bispectral Index BIS M1034A e Spirometry M1014A You can plug and unplug modules during monitoring Insert the module until the lever on the module clicks into place Remove
60. a pulmonary artery PA Swan Ganz catheter The injectate bolus mixes with the blood in the right ventricle and the change in blood temperature is measured with a thermistor at the distal end of the catheter in the pulmonary artery Setting up RH C O Measurements Set up the PA line using a PA catheter Attach the injectate temperature probe housing to the PA line Plug the C O interface cable into the C O module or measurement server extension and connect the following devices into the C O interface cable injectate temperature probe remote start switch if used Follow your hospital standards to avoid unintentional extraction of the C O catheter Secure the cable using the mounting clip shipped with each C O interface cable You may also find it helpful to loop the C O interface cable tape the loop and attach it to the undersheet of the patient s bed using a safety pin Plug the thermistor connection cable of the PA catheter into the thermistor connector Connect the injectate temperature probe to the injectate temperature probe housing Check that the correct measurement method is selected M C O Module C O Interface Cable Remote Start Switch Thermistor A Connector TI Injectate Temperature Probe Injectate Temperature Probe Housing PA Catheter Ifa catheter is already connected to the Cardiac Output Interface Cable the monitor automatically recognizes the method used If not
61. alarm indicators and indicator lamps permanently or temporarily if alarm reminder ReAlarm is configured on Selecting Screen Elements Select a screen element to tell the monitor to carry out the actions linked to the element For example select the Patient Identification element to call up the Patient Demographics window or select the HR numeric to call up the Setup ECG menu Select the ECG wave segment to call up the ECG lead menu Note that the space between each line of a menu may be configured to wide or narrow to facilitate your most common method of operation either touch Speedpoint or navigation point or mouse Using the Setup Menu MP20 MP30 MP40 MP50 Only Alarm Messages Alarm Limits Alarm Volume My Care Group Change Screens Profiles Admit Dischrg Paced No Network Bed Information Date Time Using the Touchscreen Select screen elements by pressing them directly on the monitor s screen Disabling Touchscreen Operation For the MP20 MP30 and MP40 MP50 monitors the elements at the top of the Screen are grouped together for ease of navigation Select any item at the top of the Screen to open the Setup menu scroll down the menu to highlight the element you want then press the navigation point to select the element To temporarily disable touchscreen operation of the monitor press and hold the Main a Screen permanent key A padlock will appear o
62. and time event classification and associated detailed view of episode data Episode data configurable except MP20 30 either 4 minutes of high resolution trend or 20 minutes of numerics trend 12 sec resolution or 15 seconds of 4 waves 125 samples sec Snapshot including all current numerics alarms and inops For MP20 30 4 minutes of high resolution trend Capacity max 25 or 50 events for either 8 or 24 hours Alarm signal System delay less than 3 seconds Pause duration 1 2 3 minutes or infinite depending on configuration Extended alarm pause 5 or 10 minutes Review Alarms Information all alarms inops main alarms on off alarm silence and time of occurrence Capacity 100 items Real Time Clock Range from January 1 1997 00 00 to December 31 2080 23 59 Accuracy lt 2 seconds per day typically Hold Time infinite if powered by AC otherwise at least 48 hours typical gt 72 hours Buffered Memory Hold Time if powered by AC infinite without power at least 48 hours typical gt 72 hours Contents Active settings trends patient data realtime reports events review alarms Trends Trend Data Buffered if powered by monitor mains connection via MSL infinite Memory without power applied at least 6 hours Contents trend data patient identification and all active settings Power Specifications Power consumption lt 145 W Line Voltage 100 to 240 V Current 1 6 to 0 7 A Frequency 5
63. battery to discharge faster For this mechanism to work the charge state of the two batteries should not differ by more than 50 302 Battery Safety Information WARNING Use only Philips batteries part number M4605A Use of a different battery may present a risk of fire or explosion Do not open batteries or dispose of them in fire or cause them to short circuit They may ignite explode leak or heat up causing personal injury Dispose of used batteries promptly and in an environmentally responsible manner Do not dispose of the battery in normal waste containers Consult your hospital administrator to find out about local arrangements CAUTION Do not disassemble heat above 100 C 212 F or incinerate the batteries to avoid the risk of fire and burns Keep batteries out of the reach of children and in their original package until you are ready to use them If battery leakage should occur use caution in removing the battery Avoid contact with skin Clean the battery compartment according to the instructions 303 304 32 Maintenance and Troubleshooting WARNING Schedule Failure on the part of the responsible individual hospital or institution employing the use of this equipment to implement a satisfactory maintenance schedule may cause undue equipment failure and possible health hazards Contact If you discover a problem with any of the equipment contact your service personnel Philips or yo
64. by this INOP persists try another transducer INOP tone Possible causes are a measured pressure outside the allowed pressure range or a broken wire to the transducer lt Pressure label gt REDUCE PRESS Increase the scale for the pressure wave SIZE lt Pressure label gt TRANSDUC PRESS Contact your service personnel MALF The transducer is faulty Numeric is replaced by INOP tone lt Pressure label gt PRESS A Pressure measurement label has been deactivated either by UNPLUGGED unplugging a module or by deactivating the label in the Measurement Selection window The measurement automatically disappears from the display To switch the measurement on again either replug the module or reactivate the measurement label in the Measurement Selection window lt Pressure label gt PRESS Perform a zero and check the calibration of the transducer ZERO CHECK CAL Numeric is replaced by RA LEAD OFF ECG The RA electrode has become detached from the patient or the Numeric is replaced by lead set has been changed Reattach the electrode or select New INOP tone Lead Setup inthe Setup ECG menu to confirm the new lead set RAP INOPS PRESS See lt Pressure label gt INOPS under Pressure Rem Alarmdev Malf Monitor There is a problem with the connection to the remote alert INOP tone device Contact your service personnel to check the remote alert device and its connections RESP EQUIP MALF RESP Contact your service pers
65. calculations 237 choosing paper size 270 contents 272 drip table 280 drug calculator 280 ECG 276 end case 269 loops 292 patient trends 228 realtime report 274 re routing 271 scheduled 269 setting up 268 ST map 125 stopping printouts 268 titration table 280 trends 225 re routing reports 271 resampling vitals 234 resolution trends 227 resolving patient mismatch 82 resp accessories 309 Resp alarms apnea alarm delay time 134 Resp detection level and apnea detection 134 Resp detection modes and cardiac overlay 133 changing 132 Resp display 132 Resp monitoring and cardiac overlay 131 Resp safety information 134 Resp wave changing size 133 changing speed 134 respiratory loops source device 291 restarting paused alarms 46 results table C O 163 re triggering events 245 retrolental fibroplasia SpO2 140 review calculations 235 reviewing alarm messages 50 reviewing alarms 50 reviewing alarms window 50 RH method computation constant 169 rhythm status messages arrhythmia monitoring 110 right heart thermodilution method C O 168 right heart thermodilution setup C O 168 rs 232 interface symbol 328 rule of six 278 runtime setting recording runtime 261 RVSW RVSWI 162 S safety maintenance interval 306 monitor 336 safety information batteries 303 BIS 221 C O CCO 173 ECG 105 Resp 134 safety test 365 same patient data merge 84 scale ECG wave 94 Resp wave 133 scales fo
66. change notification is issued The tone type and volume can be configured Automatic alarm notification can be switched off permanently in the monitor s Configuration Mode or at the Information Center To temporarily disable and re enable automatic alarm notification at the bedside monitor for example if you want to carry out a procedure in Monitoring Mode 1 Select the network symbol on the monitor screen to call up the Network menu 2 Select Auto Window to toggle between the settings Enabled and Disabled This setting resets to the default at discharge and when the monitor is switched on Always re enable the Auto Window as soon as possible Telemetry Data Overview You can assign a monitor and a telemetry device to the same patient This is called pairing and is done at the Information Center In paired mode the telemetry data can be displayed as a permanent overview session on the monitor To do this one of the available Screens must have the Telemetry Data Overview screen element embedded If configured this Screen will automatically display when the monitor is paired with a telemetry device at the Information Center Be aware that the data from a paired telemetry device is stored at the Information Center and not in the monitor Unpairing a Telemetry Device To disconnect the patient from the telemetry device and reconnect them to the monitor for example to see realtime waves Po select the Unpair Equipment SmartKey t
67. example LEAD OFF a flat line is displayed After 10 seconds the directly acquired EASI AI AS or ES lead depending on which is available is displayed with the corresponding lead label This causes an arrhythmia relearn 102 EASI Electrode Placement 1 E V on the lower sternum at the level of the fifth intercostal space 2 A LL fon the left midaxillary line at the same level as the E electrode 3 S LA on the upper sternum 4 I RA Jon the right midaxillary line at the same level as the E electrode 5 JN reference electrode can be anywhere usually below the sixth rib on the right hip 103 6 ECG Arrhythmia and ST Monitoring ECG Arrhythmia and ST Alarm Overview _ ECG Arrhythmia and ST Alarm Overview The ECG arrhythmia and ST alarms available depend on which measurements are switched on and the arrhythmia option enabled for your monitor e Cardiotach alarms are available when HR is on and the active alarm source is ECG e Basic arrhythmia alarms are available when Arrhythmia is switched on e Advanced arrhythmia alarms are available when Arrhythmia is switched on and the Advanced Arrhythmia option has been enabled for your monitor e ST alarms are available when ST analysis is switched on and ST leads are selected for analysis Asystole Ventricular Tachycardia Supraventricular Tach ST lt Lead gt High Ventricular Pacer Not Capture Missed Beat S
68. excessive tension to any cable or tubing Replace the sensor if excessive moisture or secretions are observed in the tubing and cannot be removed by a purge cycle Reuse poses a patient hazard Do not disassemble clean disinfect or sterilize the sensor A system leak may significantly affect readings of flow volume pressure and other respiratory mechanics parameters Do not leave the sensor in the patient circuit when not connected to the monitor NOTE Do NOT place the airway adapter between the endotrachial tube and the elbow pediatric adult circuit as this may allow patient secretions to block adapter windows The striped tubing of the flow sensor should always be proximal to the patient Position the airway adapter with the spirometry tubing pointing upwards To prevent rain out and moisture from draining into the airway adapter do NOT place the airway adapter in a gravity dependent position Periodically check the flow sensor and tubing for excessive moisture or secretion build up Perform a purge cycle if droplets are visible within the sensor or tubing Repeat if necessary If purging does not remove the droplets replace the sensor For routine performance of airway care separate the system between the endotrachial tube and the airway adapter neonatal circuit or between the endotracheal tube and elbow pediatric adult circuit Lavage and suctioning of the airway can then be performed without fluids and mu
69. folded or twisted bladder can cause inaccurate measurements The width of the cuff should be in the range from 37 to 47 of the limb circumference The inflatable part of the cuff should be long enough to encircle at least 80 of the limb Apply the cuff to a limb at the same level as the patient s heart If it is not you must use the measurement correction formula to correct the measurement The marking on the cuff must match the artery location Do not wrap the cuff too tightly around the limb It may cause discoloration and ischemia of the extremities Inspect the application site regularly to ensure skin quality and inspect the extremity of the cuffed limb for normal color warmth and sensitivity If the skin quality changes or if the extremity circulation is being affected move the cuff to another site or stop the blood pressure measurements immediately Check more frequently when making automatic or stat measurements Correcting the Measurement if Limb is not at Heart Level To correct the measurement if the limb is not at heart level to the displayed value add 0 75mmHg 0 10kPa for each centimeter higher or deduct 0 75mmHg 0 10kPa for each centimeter lower or add 1 9mmHg 0 25kPa for each inch higher deduct 1 9mmHg 0 25kPa for each inch lower Understanding the NBP Numerics Alarm source Sy Alarm limits Systolic lt 136 85 Measurement Mode j 99 Timestamp erty Timer
70. for information on short yellow arrhythmia alarms latching behavior Testing Alarms Alarm When you switch the monitor on a selftest is started You must check that the alarms lamps light one after the other and that you hear a single tone This indicates that the visible and audible alarm indicators are functioning correctly For further testing of indidual measurement alarms perform the measurement on yourself for example SpO or CO3 or use a simulator Adjust alarm limits and check that appropriate alarm behavior is observed Behavior at On Off When you switch alarms on the settings defined in the currently active Profile are used If the monitor is switched off for longer than one minute and then switched on again or after a loss of power lasting longer than one minute or when a patient is discharged the monitor can be configured to restore either the alarm settings from the monitor s configured default Profile or the most recently used alarm settings After any of these situations you should check that the alarm settings are appropriate for your patient and if necessary select the correct Profile and patient category If power is lost for less than one minute the alarm settings prior to the power loss are restored 4 Patient Alarms and INOPs This chapter lists patient alarms and technical alarms INOPs alphabetically irrespective of their priority INOPs start on page 59 For information on alarms and INOPs f
71. for the correct label The alarm limits you set are stored for that particular label only Changing the label may change the alarm limits You can monitor for alarm conditions in systolic diastolic and mean pressure either singly or in parallel Only one alarm is given at a time in this order of priority mean systolic diastolic Inthe Setup lt Press gt menu select Alarms from and choose the source Sys systolic Dia diastolic Mean mean Sys amp Dia systolic and diastolic in parallel Dia amp Mean diastolic and mean in parallel Sys amp Mean systolic and mean in parallel Sys amp Dia amp Mean all three pressures in parallel Select and set the High Limit and Low Limit for the pressure s you have selected 155 Calibrating Reusable Transducer CPJ840J6 Depending on your monitor s configuration you may be able to perform a calibration in monitoring mode Perform a mercury calibration when you use a new transducer and at regular intervals according to your hospital policy You require e standard sphygmomanometer e sterile 10cc syringe with heparinised solution e 3 way stopcock e approximately 25cm of tubing Making the Pressure Calibration WARNING Never perform the invasive pressure calibration while a patient is being monitored 1 Zero the transducer 2 Connect the syringe and manometer a Attach the tubing to the manometer b Connect the 3 way stopcock to the stopco
72. highlighted yellow alarm lamp alarm tone inN20O HIGH N20 AGM The inspired NO high alarm limit has numeric flashes high limit is been exceeded highlighted yellow alarm lamp alarm tone inO2 HIGH O AGM The inspired O high alarm limit has numeric flashes high limit is been exceeded highlighted yellow alarm lamp alarm tone in02 LOW Oj AGM The inspired O value has fallen below numeric flashes low limit is the low alarm limit highlighted yellow alarm lamp alarm tone inO2 LOW OXYGEN O AGM _ The inspired O value has fallen below numeric flashes low limit is 18 vol highlighted red alarm lamp alarm tone IRREGULAR HR ECG Consistently irregular heart rhythm numeric flashes yellow alarm Arrhythmia lamp short yellow audible alarm MISSED BEAT ECG No beat detected for 1 75 R R interval numeric flashes yellow alarm Arrhythmia or if HR gt 120bpm no beat detected for lamp short yellow audible one second non paced patients only alarm MULTIFORM PVCs ECG Two differently shaped Vs detected numeric flashes yellow alarm Arrhythmia each occurring at least twice within the lamp short yellow audible last 300 beats and at least once within alarm the last 60 beats NBP HIGH NBP The measured NBP value is above the numeric flashes and high limit high alarm limit is highlighted yellow alarm s d or m after the label indicates lamp alarm tone whether the systolic diastolic
73. important for accurate analysis of the rhythm to have p waves with an amplitude of less than 1 5 the height of the R wave or lt 0 15 mV If the p waves are larger than this they may be counted as QRS complexes Understanding the Arrhythmia Display 6 ECG Arrhythmia and ST Monitoring Intermittent Bundle Branch Block Bundle branch and the other fascicular blocks create a challenge for the arrhythmia algorithm If the QRS during the block changes considerably from the learned normal the blocked beat may be incorrectly classified as ventricular causing false PVC alarms You should always select a lead where the bundle branch block beats have an R wave that is as narrow as possible to minimize incorrect calls Ventricular beats should look different from these normal beats Instead of trying to select two leads with a narrow R wave it may be easier to just select one lead and use single lead arrhythmia monitoring Extra vigilance is required by the clinician for this type of patient Understanding the Arrhythmia Display Your monitor screen may look slightly different from the illustration Rhythm status message Beat label P i k 2 E a aac PVC Numeric HR Numeric PVC Paced Rhythm Pair PVCs 2 75 Delayed arrhythmia wave Ectopic status message Viewing Arrhythmia Waves To review arrhythmia beat labels in the Setup Arrhythmia menu select Annotate Arrhy The wave showing the primary ECG lead will be delayed by six second
74. is not affected by the wave speed settings of the other measurements Select the Resp wave to enter the Resp Wave menu then select Change Speed Choose the required speed from the pop up list This defines the speed at which the wave is drawn across the screen in millimeters per second mm s Using Resp Alarms Resp alarms can be switched on and off and the high and low alarm limits can be changed just like other measurement alarms as described in the Alarms chapter Changing the Apnea Alarm Delay The apnea alarm is a high priority red alarm used to detect apneas The apnea alarm delay time defines the time period between the point where the monitor cannot detect any respiration activity and the indication of the apnea alarm 1 Inthe Setup Resp menu select Apnea Time 2 Select the appropriate setting Resp Safety Information WARNING Respiration detection level If you do not set the detection level for the respiration correctly in manual detection mode it may not be possible for the monitor to detect apnea If you set the detection level too low the monitor is more likely to detect cardiac activity and to falsely interpret cardiac activity as respiratory activity in the case of apnea Apnea The respiration measurement does not recognize obstructive and mixed apneas it only indicates an alarm when a pre adjusted time has elapsed since the last detected breath The safety and effectiveness of the respiration measurement
75. is replaced by Difference calculation are available Check measurement sources Aspo CHK UNITS SpO The monitor has detected a conflict in the units used for this Numeric is replaced by Difference calculation Check the unit settings Numeric is replaced by a lt SpO label gt DEACTIVATED SpO You have connected a measurement server that uses a label the INOP tone monitor has already assigned to a different source To activate the new source choose a new label in the Measurement Selection window lt SpO label gt EQUIP MALF SpO The MMS is faulty Unplug and replug the MMS If the INOP Numeric is replaced by persists contact your service personnel INOP tone lt SpO label gt ERRATIC SpO Check the sensor placement Try another adapter cable and Numeric is replaced by sensor If the INOP persists contact your service personnel INOP tone lt SpO label gt EXTD UPDATE SpO The update period of displayed values is extended due to an Label is displayed with a NBP measurement on the same limb or an excessively noisy questionable numeric signal lt SpO2 label gt INTERFERNCE SpO There is too much interference caused by a high level of Numeric is replaced by ambient light and or electrical interference Cover the sensor to INOP tone minimize ambient light If the INOP persists make sure that the sensor cable is not damaged or
76. l min pediatric MVexp 0 4 to 601 min adult Resolution 0 01 l min neonatal pediatric 0 1 l min adult Inspired Volume Range 5 to 100 ml neonatal numeric TVin 30 to 400 ml pediatric 200 to 3000 ml adult Resolution 1 ml neonatal pediatric 10 ml adult Expired Volume Range 5 to 100 ml neonatal numeric TVexp 30 to 400 ml pediatric 200 to 3000 ml adult Resolution 1 ml neonatal pediatric 10 ml adult Lung Compliance Range 0 to 500 ml cmH 0 numeric Resolution 1 ml cmH O Airway Resistance Range 0 to 500 cmH 0O l s neonatal numeric 0 to 250 cmH O l s pediatric 0 to 100 cmH O l s adult Resolution 1 cmH O I s Peak Inspiratory Range 0 to 120 cmH O0 Pressure numeric Resolution 1 cmH 0 PIP Negative Inspiratory Range 20 to 0 cmH 0 Pressure numeric Resolution 1 cmH 0 Mean Airway Pressure Range 20 to 120 cmH 0 Resolution 1 cmH 0 Plateau Pressure Range 0 to 120 cmH 0 numeric Resolution 1 cmH 0 Positive End Range 0 to 99 cmH 0 Exp Oy Pressure U Resolution 1 cmH O numeric PEEP Barometric Pressure Range 400 to 800 mmHg numeric EB Resolution 1 mmHg Peak Inspiratory Flow Range 0 1 to 25 l min neonatal numeric PIF 1 to 100 l min pediatric 2 to 180 l min adult Resolution 0 1 l min neonatal 1 l min pediatric adult Peak Expiratory Flow Range 0 1 to 25 l min neonatal numeric PEF 1 to 100 l min pediatric 2 to 180 l min adult Res
77. label conflict 1 Select the measurement selection key or select Main Setup gt Measurement Selection to display the Measurement Selection window 30 2 Select the device whose label you want to correct 3 Use the measurement selection pop up keys to resolve the conflict Select either Change Label to assign a different label to the conflicting label De activate to disable the conflicting device It retains its label for future use but becomes invisible to the monitor as though it had been unplugged When the device has been deactivated the question marks under the measurement selection key will be replaced by XXX Setup lt Measurement label gt to enter the Setup menu for the measurement and change the conflicting device s label to a different label Modify Driver VueLink only change the VueLink device driver Changing Monitor Settings To change monitor settings such as date and time brightness or QRS tone volume select the Main Setup SmartKey and then select the setting you want to change or select User Interface to enter a submenu where you can change user interface settings Adjusting the Screen Brightness 1 Select the Brightness SmartKey 2 Select the appropriate setting for the screen brightness 10 is the brightest 1 is the least bright Your monitor may be configured with a lower brightness for Standby mode and also for battery powered monitors for transport to conserve battery pow
78. longer present all alarm indicators stop and the alarm is reset Switching off the alarms for the measurement in alarm or switching off the measurement itself also stops alarm indication Acknowledging Disconnect INOPs Acknowledging an INOP that results from a disconnected transducer switches off the associated measurement The only exception is ECG Resp acknowledging a disconnect INOP for ECG leads does not switch off the ECG and Resp measurements Acknowledging a disconnect INOP at the Information Center switches off the audible INOP indicator but does not switch off the measurement Unplugging an MMS or a plug in module automatically switches off its measurements Alarm Reminder ReAlarm If Alarm Reminder is configured on for your monitor you will get an audible reminder of alarm conditions that remain active after you have acknowledged the alarm This reminder may take the form of a repetition of the alarm tone for a limited time or an unlimited repetition of the alarm tone this is the same as a new alarm There is no alarm reminder for INOPs In Configuration Mode you can set the interval between silencing the alarm and sounding the reminder tone to one two or three minutes Pausing or Switching Off Alarms 44 If you want to temporarily prevent alarms from sounding for example while you are moving a patient you can pause alarms Depending on your monitor configuration alarms are paused for one two or three minutes o
79. menu For example to enter the Setup ECG menu select the HR heart rate numeric e via the Setup hardkey on plug in modules press the Setup hardkey on the module front 26 e viathe Main Setup SmartKey if you want to setup a measurement when the measurement is switched off use the Main Setup SmartKey and select Measurements Then select the measurement name from the popup list With this SmartKey you can access any setup menu in the monitor e via the Measurement Selection key This guide always describes the entry method using the setup menu But you can use any method you prefer Switching a Measurement On and Off When a measurement is off its waves and numerics are removed from the monitor s screen The monitor stops data acquisition and alarming for this measurement A measurement automatically switches off if you disconnect its module or measurement server If you disconnect a transducer the monitor replaces the measurement numeric with question marks 1 Enter the measurement s setup menu and select the measurement 2 Select the measurement name to toggle between on and off The screen display indicates the active setting Switching Numerics On and Off For some measurements such as EEG you can choose which numerics to view on the screen Inthe measurement s setup menu select the numeric name to toggle between on and off For example in the Setup EEG menu select the EEG numeric name to toggle between on a
80. message remains visible until the next measurement is started or the Stop A11 SmartKey is selected NBP INTERRUPTED NBP Check the tubing and cuff for leakages or kinks Check that Numeric is replaced by you are using the correct cuff size and placement and that the INOP tone correct patient category is selected Try restarting the measurement If the INOP occurs repeatedly contact your service personnel You can silence this INOP but the INOP message remains visible until the next measurement is started or the Stop A11 SmartKey is selected This INOP arises when the measurement needed longer than the maximum time for inflation deflation or the total measurement NBP MEASURE FAILED NBP Check that you are using the correct cuff size and placement Numeric may be displayed with a and that the correct patient category is selected Try restarting INOP tone the measurement If numerics are displayed the monitor is able to measure mean only and the alarm source is set to S D or S amp D You can silence this INOP but the INOP message remains visible until the next measurement is started or the Stop A11 SmartKey is selected Check the condition and suitability of the patient for NBP monitoring Use another cuff to continue measuring No Central Monit Monitor There is a problem with the communication to the network INOP tone Central monitoring is currently not possible no patient alarms
81. no 451261000771 Sensors 8 pin version 317 The Philips M3001A option A01 Multi Measurement server and the M1020B option A01 SpO2 Module use Masimo certified pulse oximetry for reduced noise and low perfusion performance with Masimo Sensors under the Masimo NR amp LP protocol available from Masimo Sensors for use with the Masimo SET SpO Module and orderable from Philips LNOP Adult Adhesive Sensors box of 20 989803140231 Adult Sensor Sample Pack 4 sensors 989803140241 Neo Sensor Sample Pack 4 sensors 989803140251 Pediatric Adhesive Sensors box of 20 989803140261 LNOP Neonatal Adhesive Sensors box of 20 989803140271 Neo Pre term Sensitive Skin Adhesive Sensors box of 20 989803140281 Neo Adhesive Sensors box of 20 989803140291 Neo Pre term Sensitive Skin Adhesive Sensors box of 20 989803140301 Neo Infant Adhesive Sensors box of 20 989803140311 DC I Adult Reusable Sensor 989803140321 DCIP Pediatric Reusable Sensor 989803140331 LNOP TC I Tip Clip Reusable Sensor 989803140341 Neo Sensitive Replacement Posey Wrap 12 989803140351 Neo Replacement Tapes 100 989803140361 Temperature Accessories Reusable General purpose probe 21075A 90 sec Small flexible vinyl probe Infant Pediatric 21076A 60 sec Attachable surface probe 21078A 60 sec Disposable General purpose probe M1837A 90 sec Skin probe 21091A 60 sec Esophageal
82. patient transfer use model How data is uploaded to the host monitor depends on the configuration mode settings MMS Trend Uploadand MMS Settings Upload If there is a patient conflict and you select Continue Monitor no data will be uploaded from the MMS 81 Data Exchange Between Information Centers You can transfer demographic data and trend data from one IIC to another by selecting Transfer on the patient monitor Trend data is not shared between Information Centers and monitors Resolving Patient Information Mismatch When you connect an MMS to a monitor or a monitor to the network the monitor compares patient category paced status and a unique patient identification number that is internally stored in both the MMS and the monitor The monitor indicates a mismatch if the information is not identical Depending on your monitor s configuration this mismatch may be automatically resolved or you may have to resolve it manually If your monitor is configured to resolve mismatches automatically depending on the configuration either the monitor or the Multi Measurement Server data is automatically retained WARNING USA only When a monitor is connected to an Information Center by the wireless IntelliVue Instrument Telemetry interface the patient data will automatically be merged in the case of a transfer This means there is no patient discharge at the monitor and settings and trend data will be retained You will see a messag
83. point cursor positions the J point relative to the R wave peak It helps you to correctly position the ST point Position the J point at the end of the QRS complex and the beginning of the ST segment The J point cursor is not available if your monitor is configured to let you set the ST point directly To position the ST point relative to the J point select either J 60 or J 80 Select J Point and use the arrow keys to move the J Point and position the ST point at the midpoint of the ST segment To position the ST point directly select ST Point and use the left and right arrow keys to position the ST point at the midpoint of the ST segment 4 Select the Apply Changes pop up key to activate the new ST measurement points and recalculate all ST values The most recent ST Points adjustment time is displayed in the Adjust ST Points window This information is cleared when a patient is discharged or when a new Profile is loaded into the monitor 121 5 To update the ST snippet shown in the Adjust ST Points window select the Update pop up key ST Alarms ST alarms are yellow alarms Each ST lead has its own alarm limit ST alarms are triggered when an ST value exceeds its alarm limit for more than one minute Switching ST alarms off switches off alarms for all ST leads If more than one ST measurement is in alarm the monitor only displays the alarm message of the ST lead which is currently furthest from its set alarm limits
84. positioned too close to power cables lt SpO label gt LOW PERF SpO Accuracy may be compromised due to very low perfusion Label is displayed with a Stimulate circulation at sensor site If INOP persists change questionable numeric the measurement site lt SpO label gt NOISY SIGN SpO Excessive patient movement or electrical interference is causing Numeric is replaced by irregular pulse patterns Try to reduce patient movement or to INOP tone relieve the cable strain on the sensor lt SpO label gt NON PULSAT SpO Check the perfusion at measurement site If necessary Numeric is replaced by stimulate circulation or change measurement site If the INOP INOP tone is due to NBP measurement on the same limb wait until the NBP measurement is finished lt SpO label gt NO SENSOR SpO Make sure the SpO sensor is connected If the INOP persists Numeric is replaced by try another adapter cable and sensor If you silence this INOP INOP tone the measurement will be switched off lt SpO LABEL gt POOR SIGNAL SpO The signal condition of the SpOz measurement is poor and Label is displayed with a measurement accuracy may be compromised questionable numeric lt SpO LABEL gt PULSE SpO The detectable pulsations of the SpO signal are outside the Numeric is replaced by specified pulse rate range INOP tone lt SpO LABEL gt SEARCHING SpO SpO is analyzing the patient signal to derive Pulse
85. recorder choosing 261 cerebral perfusion 157 CFI 162 chaining 115 change screen menu 22 changing ECG lead sets 96 changing EEG wave scale 212 changing EEG wave speed 213 changing Resp detection mode 132 changing Resp wave size 133 changing Resp wave speed 134 changing screen content 22 changing screens 22 changing wave scale EEG 220 channels recorder 261 checking battery charge 301 checking paced status 92 cleaning infection control 293 method 294 monitoring accessories 294 recommended substances 294 recorder printhead 295 CO2 airway adapter 182 alarms apnea delay 184 192 alarms awRR 184 alarms specific 184 awRR alarm limits 184 checking transducer accuracy 179 correction humidity 183 correction N2O 183 corrections 183 192 FilterLine 182 mainstream accessories 176 188 measuring mainstream 176 179 measuring microstream 181 method mainstream 175 method microstream 175 method sidestream 175 microstream accessories 181 microstream extension 181 removing exhaust gases 179 182 transducer calibrating 180 transducer using 180 troubleshooting 183 192 wave scale adjusting 183 192 CO2 mainstream accessories 320 CO2 microstream accessories 321 code recording 262 combi events 248 Compressed Spectral Arrays CSA 211 computation constant RH 169 conditioning batteries 302 configuration drug calculator 278 trends database 229 configuration mode 21 conflict label 29 connecting BIS acces
86. recorder 265 status messages arrhythmia 110 ectopic 111 rhythm 110 sterilizing infection control 293 stopping reports printouts 268 suppression ratio BIS 215 surgical ECG cable 106 suspended alarm 45 suspicious SpO2 reading 139 SV SI 162 SvO2 accessories 323 alarms 204 calibration equipment 203 catheter insertion 205 catheter preparation 204 Hospira accessories 203 in vivo calibration 206 light intensity calibration 205 measurement principle 203 monitoring 204 SVR SVRI 162 switching on monitor 32 symbols 328 battery 298 synchronization marks defibrillator 93 system pulse 127 systolic blood pressure NBP early 146 T tabular trends 224 Tamb 150 task window for ST map 124 Tcereb 150 tcGas 195 sensor temperature 196 transducer calibrating 199 transducer remembraning 197 tcGas site timer 196 technical alarms messages see INOPs 59 temperature 149 accessories 318 alarm settings 149 connecting probe to monitor 149 difference calculating 150 dual Temp measurement 150 extended label set 150 first 150 label 149 making a measurement 149 probe disposable 149 probe selecting 149 second 150 tcGas sensor 196 temperature probe connecting 149 templates creating for recordings 260 testing alarms 52 time setting 31 Tinj Probe Type 165 titration table drug calculator 280 tone configuration alarm 42 tone mod SpO2 141 tone modulation 141 total power TP 207 total power numeric BIS 215 touch tone vo
87. ring lt 2 2KQ 20 ECG Output Marker Input tip lt 2 5kQ 20 Signal delay lt 30ms Marker Input Signal Type 0 to 12V negative edge pulse Reguiremenis Pulse Source lt 7kQ tip Impedance Pulse Fall Time lt 100us Pulse Duration gt 4ms Flexible Nurse Call Connector 20 pin MDR Mini D Ribbon active open and closed contacts Relay 3 5 mm phone jack active closed contact only Contact lt 100 mA lt 24 V DC Isolation 1 5 kV Delay lt Configured Latency 0 5 sec 345 346 Wireless Network Connector 8 pin Mini DIN Device Interface Signals RD TD IEEE 802 3 10Base T PWR GND 12 5 V 20 3 5 W continuous Remote Application Technology Citrix and ICA Independent Computing Architecture Support client Tunneling Control Engine TCE Capabilities a monitor connected to a Philips Application Server can show a Windows application on the monitor display The application can be controlled by the monitor user input devices All displays Sweep Speeds 6 25 12 5 25 and 50 mm s additional EEG sweep speeds 15 mm s 30 mm s with 5 accuracy guaranteed only for integrated displays Integrated SVGA Resolution 800 x 600 Display MP20 30 Refresh frequency 60 Hz Useful screen 211 2 x 158 4 mm Pixel size 0 264 x 0 264 mm Integrated SVGA Resolution 800 x 600 Display MP40 50 Refresh frequency 60 Hz Useful screen 246 x 184 4 mm Pixel size 0 3075 x 0
88. settings 1 Inthe Setup lt Press gt menu select Label 2 Select the appropriate label from the list ABP Arterial blood pressure P Non specific pressure label ART Arterial blood pressure alternative PAP Pulmonary artery pressure Ao Aortic pressure RAP Right atrial pressure CVP Central venous pressure UAP Umbilical arterial pressure ICP Intracranial pressure UVP Umbilical venous pressure LAP Left atrial pressure Extended Pressure Label Set The following additional labels are available if Label Set is set to Full This setting can only be changed in Configuration Mode Note that if your monitor is connected to an Information Center the additional labels in the extended label set may not be correctly displayed See the Configuration Guide for your monitor for more information BAP Brachial arterial pressure FAP Femoral arterial pressure Icl IC2 Alternative intracranial pressures P1 P2 P3 P4 Alternative non specific pressure labels Zeroing the Pressure Transducer To avoid inaccurate pressure readings the monitor requires a valid zero Zero the transducer in accordance with your hospital policy at least once per day You must perform a zero e when you use a new transducer or tubing e every time you reconnect the transducer cable to the monitor Oa f e if you think the monitor s pressure readings are not correct Zeroing ICP or IC1 IC2 Your hospital g
89. specific limits and based instead on deviations from the current values You must set a deviation and a period of time in which the deviation occurs There are three types of deviation available ANY deviation UP deviation where only changes in a positive direction are detected and DOWN deviation where only changes in a negative direction are detected The deviation can be defined either in relative terms as a percentage for example 10 or as an absolute value such as 10 bpm Event Retriggering If a condition that triggered an event persists and the values remain beyond the trigger threshold a new event will not be triggered For a new event to be triggered by the same condition the measured values for at least one of the triggers must cross back into the normal range and then recross the trigger threshold Event Notification Advanced Event Surveillance Only You can be notified when an event is detected For each event group you can define a type of notification depending on the severity of the event conditions The notification can be a status message with a prompt tone or a standard or alarm notification These event alarms are handled exactly like measurement alarms they can be silenced and are also suspended when all alarms are suspended You should only use alarm notification for events which are comparable in severity to standard measurement alarms to avoid potential confusion due to too many alarms Notification in the f
90. switch off automatically for safety reasons if it is not connected to AC power 299 Battery Status X TimeToEmpty 5hrs 10 min Battery Status Window To access the Battery Status window and its associated pop up keys ag C select the battery status 5 10 hrs information on the Screen or select Main Setup gt Battery Capacity Remaining tells you how much power is left in each battery Capacity Full Charge tells you how much power each battery can hold when fully charged Time To Empty tells you approximately how long you can continue to use the monitor with these batteries Note that this time fluctuates depending on the system load the display brightness and how many measurements and recordings you carry out the age of the battery and the remaining capacity of the battery Time To Full is shown in place of Time To Empty if the monitor is connected to mains power and tells you how much time is left until the batteries are charged to 90 When the batteries are charging you can see how much monitoring time the current charging status represents under the battery symbol Viewing Individual Battery Status To view information for individual batteries select the pop up key Battery lorBattery 2 Recording Battery Status To print the information in the Battery Status window on a connected recorder 1 Select the battery status information on the Screen to open the Battery Status window 2 Select the Re
91. switching off audible alarm indicators and Fa f lamps Main Screen close all open menus and windows and return to the main screen Main Setup enter main setup menu 17 SmartKeys 18 A SmartKey is a configurable graphical key located at the bottom of the main screen It gives you fast access to functions The selection of SmartKeys available on your monitor depends on your monitor configuration and on the options purchased o f AT Ee CFR Bjo T gt enter profile menu or revert to default profile show BIS Sensor Q freeze waves miii set alarm limits H 3 change alarm volume change QRS volume enter standby mode suspends patient monitoring All waves and numerics disappear from the display All settings and patient data information are lt a a TE retained review beat labels annotate arrhythmia wave change amplitude size of ECG wave ye start stop manual NBP measurement start auto series a stop current automatic measurement within series start veni puncture inflate cuff to subdiastolic pressure access patient reports change Screen or revert to default screen previous Screen quick admit a patient enter patient identification menu to admit discharge transfer end case to discharge a patient view information for patients in other beds change screen brightness not for independent displays re learn arrhythmia
92. the paper holder The paper feeds from the bottom of the roll and over the top of the recorder door j ST 4 With at least one inch of paper extending beyond the edge of the door swing the recorder door up and push it firmly closed 5 To test if paper is loaded correctly start a recording If no printing appears paper may be loaded backwards Try reloading the paper CAUTION When the recorder is disabled by removal from its slot door open or out of paper any alarm recordings will be sent to the central station recorder if there is one If no recorder is available alarm recordings may be lost during the time the recorder is disabled The messageno alarm recording available will be displayed 264 Recorder Status Messages lt Recording name gt running The named recording is currently running No lt recorder name gt alarm No alarm recording can be made on the selected recorder recording available If available try selecting another recorder If a local recorder was selected the monitor will try to reroute the recording Recordings sent to a central recorder cannot be rerouted Alarm recordings may be lost No alarm recording available The selected recording cannot be made Alarm recordings will be lost Check that the recording has been correctly configured lt Recorder name gt out of paper The named recorder is out of paper lt Recorder name gt door open The door of the specified recorder is op
93. the right of the bandwidth annotation at the Information Center When Mod LeadPlacment is set to Off 12 Lead ECG Reports will be labelled 12 Lead ECG Report and captured 12 lead ECGs will not be annotated at the Information Center WARNING Do not use ECG analysis interpretation statements and measurements for 12 lead ECGs obtained using the modified Mason Likar limb electrode placement This may lead to misdiagnosis since the modified Mason Likar limb electrode placement does not look the same as the conventional 12 lead ECG and may mask inferior infarction due to calculated axis R P and T wave magnitudes shifts and ST slope Do not export 12 lead ECGs obtained using the modified Mason Likar limb electrode placement Captured 12 Lead ECGs using the modified Mason Likar limb electrode placement exported from the Information Center are not annotated with the Mason Likar label Labelling 12 Lead ECG Reports To label 12 lead ECG monitor reports and Captured 12 lead ECGs reports Inthe Setup ECG menu select Mod LeadPlacement to toggle between On and Off When Mod LeadPlacement is set to On 101 12 Lead ECG Reports will be labelled 12 Lead ECG Report Mason Likar Captured 12 lead ECGs will be labelled Mason Likar to the right of the bandwidth annotation at the Information Center When Mod LeadPlacement is set to Off 12 Lead ECG Reports will be labelled 12 Lead ECG Report Captured 12 lead ECGs w
94. to Demonstration or Service Mode Cancelling N print When a patient is discharged all queued print jobs are cancelled N is the jobs due to patient number of print jobs queued discharge Printing failed no A report has been triggered which has not been correctly set up Enter the report configured setup menu for the report type to set up the report Printer lt Printer The chosen device is unavailable Check that the printer is properly name gt unavailable connected and that paper is available The requested report will start job suspended printing when the printer becomes available Job on lt Printer A report cannot be started on the requested printer name gt failed Make sure the printer is plugged in switched on and has paper loaded Try another printer if available If this problem persists call your service personnel Sample Report Printouts Each report header contains the patient s bed label last name and first name the patient ID the date and time and the name of the report The report footer contains the hospital label and page number and the last page contains a note to mark the report end The monitor may be configured to leave a space on the top left or right of the report printout to enable you to stick a patient address label on it This setting is called the Addressograph and it can only be changed in the monitor s Configuration Mode 272 Sample Report Printou
95. to eight of the following numerics Spectral Edge Frequency SEF The SEF is the frequency below which a defined percentage of the Total Power lies The percentage is set in Configuration Mode Mean Dominant Frequency MDF The MDF is the mean value of the frequency which dominates the measured FEG Peak Power Frequency PPF The PPF is the frequency with the highest measured amplitude Total Power TP The TP numeric indicates the power in the measured frequency band Percentage of total power in each frequency band Alpha waves 8 to 13 Hz Beta waves 13 to 30 Hz Theta waves 4 to 8 Hz Delta waves 0 5 to 4 Hz 207 EEG Monitoring Setup 1 Plug the trunk cable into the EEG module in the Flexible Module Server 2 Prepare the patient s skin prior to placing the electrodes Good electrode to skin contact is important for a good EEG signal as the skin is a poor conductor of electricity Shave hair from sites if necessary Wash sites thoroughly with soap and water We do not recommend using ether or pure alcohol because this dries the skin and increases the resistance Use a skin preparation paste to remove skin cells and oil before placing the electrodes 3 Select the desired electrode montage in the Setup EEG menu or in the EEG Impedance Montage window 4 Attach the reference electrode first 5 Place the electrodes on the patients head according to the selected montage Use electrode
96. tone at Information Center Check the monitor display for more detailed alarm information tcpO2 LOW tcGas The tcpO or tcpCOy value has fallen numeric flashes low alarm tcpCO2 LOW below the low alarm limit limit is highlighted yellow alarm lamp alarm tone lt Temperature TEMP The temperature has exceeded the high numeric flashes and high limit label gt HIGH alarm limit is highlighted yellow alarm lamp alarm tone lt Temperature TEMP The temperature has fallen below the numeric flashes and low limit label gt LOW low alarm limit is highlighted yellow alarm lamp alarm tone VENT BIGEMINY ECG A dominant rhythm of N V N V N numeric flashes yellow alarm Arrhythmia supraventricular beat V ventricular lamp short yellow audible beat was detected alarm VENT FIB TACH ECG A fibrillatory waveform for 4 numeric flashes red alarm consecutive seconds was detected lamp alarm tone VENT RHYTHM ECG A dominant rhythm of adjacent Vs gt numeric flashes yellow alarm Arrhythmia vent rhythm limit and ventricular HR lt lamp short yellow audible VTach HR limit was detected alarm VENT TRIGEMINY ECG A dominant rhythm of N N V N N numeric flashes yellow alarm Arrhythmia V N supraventricular beat V lamp short yellow audible ventricular beat was detected alarm VTACH ECG Ventricular tachycardia has been numeric flashes yellow ala
97. values available for display before the next scheduled update are shown in the right hand column with a timestamp in brackets If more than one value is available for an aperiodic trend for a certain trend period all measured values are stored in the database and the value closest to the timestamp is shown in the Vital Signs display marked with an arrow Trends Pop Up Keys When you open the trends window a selection of pop up keys appears to let you navigate through the stored trend data and carry out trends related tasks Select see a pop up list of trend groups and select a group for viewing Group Select see a pop up list of available data resolution settings and select the level of detail shown Interval in the trend view Print print a tabular trends report or make a tabular trend recording of the data in the Record current window The report will use the current trend interval settings Print print a graphic trends report of the data in the current window The report will use the current trend interval settings move the cursor one step to the left or right to navigate through the trends database la gt timeline move the cursor one page to the left or right to navigate through the trends database lad p gt timeline jump to the beginning or the end of the trends database to see the most recent or oldest Cael trend information stored scroll up and down the screen to see measurement trends tha
98. want to see only the mean pressure In the pressure s setup menu select Mean Only Toggle between On to display mean pressure value only and Of to display all pressure values systolic diastolic and mean Changing the Pressure Wave Scale 1 Select the label of the pressure wave whose scale you want to set to enter the Setup menu 2 Inthe Setup lt Press gt menu for example ABP select Scale 154 3 Select a value from the pop up list a positive value sets the top gridline The bottom gridline is set at zero a negative value sets the bottom gridline The middle gridline is set at zero Optimizing the Waveform Inthe Setup lt Press gt menu select Optimum Scale to let the monitor select the best minimum and maximum scales for the current wave Non Physiological Artifact Suppression Some clinical procedures may affect blood pressure for example a flush procedure or a blood sample Your monitor may be configured to suppress these non physiological artifacts for a specified duration Artifact Suppression is configured to 30 60 or 90 seconds During artifact suppression the monitor shows the INOP message lt Pressure label gt ARTIFACT and a question mark is shown beside the pressure numerics Pressure alarms and the Pulse Non Pulsatile INOP are suppressed during the configured period The CPP high alarm is not suppressed Choosing the Pressure Alarm Source WARNING Make sure you set alarm limits
99. window over the currently displayed Screen What s New in Release B 0 IntelliVue MP40 MP50 The MP40 MP50 patient monitor is a new addition to the IntelliVue patient monitor family It uses the same measurement devices as the MP60 MP70 MP90 monitors and shares the same technological platform and user interface but is more compact in size and can be operated by battery M3012A Measurement Server Extension The new Hemodynamic Measurement Server Extension extends measurement capability by adding two additional pressures and Cardiac Output M1020B SpO Module New SpO measurement module M1020B enables dual SpO measurement without the need to use the VueLink module Two options are available Option AO1 for use with Philips reusable and disposable sensors and Nellcor R Cal disposable sensors Option A02 for use with Nellcor OxiMax sensors including the MAX FAST forehead sensor M1020B Option A02 for use with Nellcor OxiMax sensors may not be available in all countries PV Loops compares graphic representations of airway waves to help detect changes in the patient airway condition High resolution waves per Screen the number of high resolution waves that can be shown on a Screen is increased limited only by the Axx Option purchased Alarms symbols New alarm symbols are introduced and short yellow alarms were renamed one star yellow alarms yellow arrhythmia alarms Aperiodic measurements available as
100. with the connection to the nurse relay INOP tone Contact your service personnel Check Screen Res Monitor The Screen you have selected uses a resolution which is not INOP tone supported by the display The monitor will show a generic Screen instead until you select a different Screen Contact your service personnel if you want the Screen deleted from the Profile s to avoid this in future Check Settings Monitor If this INOP appears check the monitor and patient settings INOP tone before you resume monitoring If the settings are unexpected there may be a problem with the monitor software Contact your service personnel Check Speedpoint Monitor Perform a visual and functional check of the SpeedPoint input INOP tone device Contact your service personnel Check Touch Input Monitor Perform a visual and functional check of the touch input device Contact your service personnel Check Waves Monitor The options purchased with this monitor may not support the INOP tone number of waves required to show the selected Screen so some waves or high resolution trends are missing from the Screen Select a different Screen with fewer waves Contact your service personnel if you want the Screen deleted from the Profile s to avoid this in future Chk IndepDsp Cable Monitor The monitor cannot communicate with the D80 Intelligent Display Check the MSL coupling cable The end with the grey connector must be connected to the Intelligent Display C LE
101. 0 1 kPa value exceeds the set 32 to 100 mmHg 2 mmHg limit range 4 2 to 13 kPa 0 2 kPa 105 to 745mmHg 5 mmHg 13 5 to 99 5 kPa 0 5 kPa tcpCO 10 to 195 mmHg 10 to 30 mmHg 1 mmHg 1 0 to 26 kPa 1 0 to 4 0 kPa 0 1 kPa 32 to 100 mmHg 2 mmHg 4 2 to 13 kPa 0 2 kPa 105 to 195 mmHg 5 mmHg 13 5 to 26 kPa 0 5 kPa SvO Range 10 to 100 Accuracy 2 i e 2 units 1 standard deviation over 40 to 100 range Resolution 1 Stability system Drift lt 2 over 24 hours Response Time 10 to 90 5 seconds SvO 10 to 100 1 max 15 4 seconds after value goes beyond the low high alarm limit settings Complies with IEC 60601 2 26 1994 EN60601 2 26 1994 363 BIS 364 Leakage Current lt 10 uA 110V Input Signal Range 1 mVp p Differential Input Impedance gt 15 MQ 10 Hz Max DC Input Offset Voltage 320 mV Input Protection Against defibrillation 5 kV and electrosurgery Common Mode Rejection gt 105 dB 5kQ imbalance and 60 Hz Noise lt 0 4 UVRMS 1 to 30 Hz Electromagnetic Susceptibility lt 10 UVpp 3 V m 26 1000 MHz Electrode Impedance Range 0 to 30 kQ Measurement Accuracy 1 kQ Bandwidth 0 5 Hz to 50 Hz 3 dB Low Filter Cut Off Frequencies 0 5 1 0 2 0 and 5 0 Hz 12 dB octave High Filter Cut Off Frequencies 15 Hz 65 dB octave 30 Hz 75 dB octave 50
102. 0 60 Hz Power Line Voltage 100 240V Frequency 50 60 Hz Power Consumption negligible for Power On LED Current to attached max 3 5 A patient monitor Network Standard IEEE 802 3 10 Base T Connector RJ45 8 pin Isolation 1 5 kV Parallel Printer Port Standard IEEE 1284 I Connector DB 25 Signals Level 1 and Level 2 switchable Isolation 1 5 kV Communication Compatibility for example Centronics Nibble ECP EPP Modes Dual PS 2 Inputs Input Voltage 5V 5 Output Current 250mA comb max to connected PS 2 devices Dual MIB RS232 Standard IEEE 1073 3 2 2000 Connectors RJ45 8 pin Mode Software controllable BCC RxD TxD cross over or DCC RxD TxD straight through Power 5V 5 100mA max Isolation 1 5kV MIB ready RS 232 Interface not available in all geographies Measurement data exported to external systems Numerics alarms and INOPs patient demographics waves up to 7 maximum number depends on the sample rate of the selected waves ECG Output Marker Input 1 4 stereo phone jack with tip ring sleeve General Connector 1 4 phone each with tip ring sleeve Isolation 500 V ECG Output Signal Gain 320 to 3200 ring tip Full Scale on Display 3 2V Gain Error lt 20 Baseline Offset lt 150mV Bandwidth 1 to 80Hz Output Impedance ECG Output
103. 00 m to 4600 m 1600 to 15000 ft Non operating 500 m to 15300 m 1600 to 50000 ft Temperature Range Operating 0 to 35 C 32 to 95 F Non operating 20 to 60 C 4 to 140 F Battery storage 20 to 50 C 4 to 122 F Humidity Range Operating 20 to 85 Relative Humidity RH non condensing Non operating 5 to 85 Relative Humidity RH Altitude Range Operating 500 m to 3000 m 10000 ft Non operating 500 m to 12000 m 40000 ft Temperature Range Operating 0 to 40 C 32 to 100 F Non operating 20 to 60 C 4 to 140 F Humidity Range Operating 20 to 85 Relative Humidity RH non condensing Non operating 5 to 85 Relative Humidity RH Altitude Range Operating 500 m to 3000 m 10000 ft Non operating 500 m to 12000 m 40000 ft Temperature Range Operating 5 to 45 C 41 to 113 F Non operating 10 to 70 C 14 to 158 F Humidity Range Operating 95 Relative Humidity RH max 40 C 104 F non condensing Non operating 95 Relative Humidity RH max 65 C 150 F non condensing Altitude Range Operating up to 3048 m 10000 ft Non operating up to 3048 m 10000 ft Temperature range Operating 0 55 C 32 130 F Storage 20 60 C 4 140 F Humidity range Operating 95 RH max at 40 C 100 F Storage 85 RH max at 50
104. 107 atrial fibrillation and flutter 108 beat labels 109 initiating learning 111 112 intermittent bundle branch block 109 learning during ventricular rhythm 112 levels of analysis 104 107 monitoring non paced patients 108 monitoring paced patients 108 options 107 relearning 111 relearning and lead fallback 112 status messages 110 switching on off 108 understanding the display 109 arrhythmia alarms 41 112 adjusting alarm limits 113 all yellow on off 113 chaining 115 latching 113 multiple 115 pvc related alarms 116 short yellow 105 sinus and SV rhythm ranges 350 352 switching on off 113 timeout periods 113 yellow 113 arrhythmia monitoring and defibrillation 106 arrhythmia options 104 arrhythmia relearning with EASI INOP 102 arterial catheter constant PiCCO 166 arterial pressure source 157 158 arterial pulsation 137 arterial values 195 artifact suppression pressure 155 Aspect Medical Systems Inc 327 atrial fibrillation and flutter 108 audlatching arrhythmia alarms 113 auto alarm limits switching on off 49 using 49 auto detection mode Resp 132 auto ECG wave gain recordings 261 auto window care groups 88 autofilter 95 automatic arrhythmia relearn 112 automatic default setting 26 automatic NBP repeat time 146 autosize ECG wave 94 average trend events 243 awRR alarm limits 184 awRR alarms CO2 184 B backlight maintenance interval 306 balloon inflation wedge measurement 159
105. 139 Understanding SpO Alarms This refers to SpO specific alarms See the Alarms section for general alarm information SpO offers high and low limit alarms and a high priority desat alarm You cannot set the low alarm limit below the desat alarm limit CAUTION Ifyou measure SpO on a limb that has an inflated NBP cuff a non pulsatile SpO INOP can occur If the monitor is configured to suppress this alarm there may be a delay of up to 60 seconds in indicating critical patient status such as sudden pulse loss or hypoxia Alarm Delays There is a delay between a physiological event at the measurement site and the corresponding alarm at the monitor This delay has two components The time between the occurrence of the physiological event and when this event is represented by the displayed numerical values This delay depends on the algorithmic processing and the configured averaging time The longer the averaging time configured the longer the time needed until the numerical values reflect the physiological event The time between the displayed numerical values crossing an alarm limit and the alarm indication on the monitor This delay is the combination of the configured alarm delay time plus the general system delay time see Monitor Performance Specifications on page 342 Adjusting the Alarm Limits In the Setup SpO menu e Select High Limit then choose the upper alarm limit e Select Low Limit then choose the l
106. 15 to 50 the numerics cannot be reliably derived SQI 50 to 100 the numerics are reliable Electromyographic Activity EMG The EMG numeric reflects the electrical power of muscle activity and high frequency artifacts EMG lt 55 dB this is an acceptable EMG EMG lt 30 dB this is an optimal EMG note that the minimum possible EMG is approximately 25 dB Suppression Ratio SR The SR is the percentage of time over the last 63 second period during which the EEG is considered to be in a suppressed state Spectral Edge Frequency SEF The SEF is the frequency below which 95 of the Total Power is measured Total Power TP The TP numeric indicates the power in the frequency band 0 5 to 30 Hz The useful range is 30 100 dB Bursts BISx module used with the Extend Sensor only The Bursts numeric helps you quantify suppression by measuring the number of EEG bursts per minute where an EEG burst is defined as a period of activity followed and preceded by inactivity at least 0 5 second 215 BIS Monitoring Setup There are two BIS solutions available for use with the M1034A BIS module using the DSC and BIS engine or using the BISx Monitoring BIS Using the DSC and BIS Engine r w oe L3 _ Hola 1 Ifyou are monitoring BIS with the DSC and BIS engine a Connect the BIS engine to the BIS module using the BIS Engine Cable b Connect the digital signal converter DSC to the digital signal converter port
107. 30 mmHg 5 mmHg 1 kPa Pulse 25 to 300 bpm Adult 1 bpm steps 25 to 40 bpm 5 bpm steps 40 to 300 bpm Pedi Neo 1 bpm steps 25 to 50 bpm 5 bpm steps 50 to 300 bpm Tachycardia Difference to high limit 0 to 5 bpm steps max 14 50 bpm seconds Clamping at 150 to 300 5 bpm steps bpm Bradycardia Difference to low limit 0 to 5 bpm steps max 14 50 bpm seconds Clamping at 25 to 100 bpm 5 bpm steps Temp Temp Range 1 to 45 C 30 to 113 F Resolution O11 2G G22 Accuracy 0 1 C 0 2 F Average Time Constant Less than 10 seconds Alarms Range 1 to 45 C 30 to 113 F Adjustment 1 to 35 C 30 to 95 F 0 5 C 1 0 F steps 35 to 45 C 95 to 113 F 0 1 C 0 2 F steps 1 to 45 C 30 to 113 F 1 to 35 C 30 to 95 F 0 5 C 1 0 F steps Temp High Low Alarms 35 to 45 C 95 to 113 F 0 1 C 0 2 F steps 355 co The CO measurement in M3014A and M3015A complies with EN ISO 21647 except alarm system alarm system complies with IEC 60601 2 49 2001 CO Range 0 to 988mmHg 0 to 13 kPa or 13 CO whichever is lower Accuracy Up to 5 minutes during warmup 4 mmHg or 12 whichever is greater After 5 minutes warmup 0 to 40 mmHg 0 to 5 3 kPa 2 2 mmHg 0 3 kPa Above 40 mmHg 5 3 kPa 5 5 0 08 mmHg above 40 mmHg of reading These specifications are valid for 21 O and N balance u
108. 3075 mm Integrated XGA Display Resolution 1024 x 768 MP60 70 Refresh frequency 60 Hz Useful screen 304 x 228 mm 12 x 9 in Pixel size 0 297 x 0 297 mm External XGA Display Resolution 1024 x 768 e g M8051B Refresh frequency 60 Hz or 75 Hz Useful screen depends on size of display MP80 MP90 D80 only Pixel size depends on size of display External SXGA Display Resolution 1280 x 1024 pixel e g M8033C Refresh frequency 60 Hz Useful screen depends on size of display Pixel size depends on size of display Video Interface MP20 Specifications must be the same as the integrated display 30 MP40 50 MP60 70 Video Interface SVGA Horizontal Frequency 37 9 kHz MEZ0 ME50 Video Signals 0 7 Vpp 75 Ohm HSYNC VSYNC Signals TTL Connector 15 pin D SUB Video Interface SVGA Horizontal Frequency 37 5 kHz MP40 MP50 Video Signals 0 7 Vpp 75 Ohm HSYNC VSYNC Signals TTL Connector 15 pin D SUB Video Interface MP60 Horizontal Frequency 48 4 kHz or 60 0 kHz or 64 0 kHz NAO eel Video Signals 0 7 Vpp 75 Ohm HSYNC VSYNC Signals TTL SXGA MP80 MP90 D80 only XGA DDC Signals I2C compliant 5V 100 mA max M8010 only Connector 15 pin D SUB Digital Video Video Signals Single Link TMDS MP80 MP90 D80 DDC Signals I2C compliant caly DDC Power 5V 100mA max Connector DVI Printers PCL5 capability required
109. 3160A recorder 258 main screen overview 14 mainstream capnography 12 mainstream CO2 accessories 176 188 measuring 176 179 maintenance cables 305 cords 305 measurements schedule 306 microstreaam CO2 calibration 306 schedule 305 visual inspection 305 major parts and keys MP20 MP30 3 MP40 MP50 4 malfunction symbols battery 298 manual detection mode Resp 133 and apnea alarms 134 manually triggering events 246 manufacture date symbol 328 manufacturer s information 326 map ST 122 marker input connector 345 Mason Likar lead system 100 max hold setting CO2 175 MDF mean dominant frequency 207 mean dominant frequency MDF 207 mean pressure calculation trends 236 measurement adjusting a wave 27 preparation 32 setting up 26 switching on and off 27 wave speed changing 27 measurement modules setting up 32 measurement points ST 120 measurement selection window 31 measurement server ECG connector 91 measurement server extension M3012A 13 M3015A 12 M3016A 12 measurement server link cable 8 vi measurement server link connection symbol 328 measurement servers setting up 32 measurement settings 24 mechanical damage 32 merging patient data 84 methemoglobin SpO2 139 MIB connector 330 331 332 Microstream capnography 12 microstream CO2 181 accessories 181 maintenance calibration 306 measuring 181 minimize 34 mismatch patient data resolving 82 MMS connecting to FMS 10 connecting t
110. 4 wave scale 154 wave size 154 wedge 158 wedge editing 159 zeroing the transducer 152 pressure accessories 313 pressure analog output 160 pressure artifact suppression 155 pressure of NBP cuff 146 pressure transducer calibration 156 zeroing 153 pressure flow loops 289 pressure volume loops 289 previous screen 22 primary lead ECG selecting 92 print job suspended 271 printer disabling 271 settings 270 status messages 272 unavailable 271 printer connection symbol 328 printer connector 332 Vii printing C O measurements 169 calculations reports 237 event reports 251 ST map reports 125 status log 307 trends reports 228 wedge 159 priority list for trends 227 probes disposable temperature 149 profiles 24 default profile 26 patient category 25 swapping 25 swapping setting block 26 prompt messages C O 172 protective earth 332 protective earth symbol 328 pulse alarms 128 system pulse source 127 pulse numerics for SpO2 138 pulse pressure variation 157 Pulsion Medical Systems AG 327 pv loops 289 PVC related alarms 116 PVR PVRI 162 Q QRS tone 129 changing volume 31 QRS tone pitch SpO2 141 QRS volume changing 95 quick admit 78 quick mount release symbol 328 R radiated field immunity Resp 134 rate adaptive pacemakers and ECG monitoring 106 ratemeter drug calculator 279 RCW RCWI 162 realtime recording 259 realtime report 274 realtime reports content 270 reconnecting
111. 522A p M4681A P M4690A A M2526A p M4687A P M2520A e A P M2524A Spirometry Accessories Adult Pediatric Flow Sensor M2785A Neonatal Flow Sensor M2786A Adult Pediatric CO Flow Sensor M2781A Neonatal CO Flow Sensor M2782A Pediatric CO7 Flow Sensor M2783A 321 tcGas Accessories This symbol indicates that the specified transducer but not its membranes is designed to have special protection against electric shocks particularly regarding allowable leakage currents and is defibrillator proof 4 12x tc Accessory Kit O ring remover absorbent paper electrolyte solution 15209 60010 replacement membrane tc Application Kit 4x25 disposable fixation rings 4x20ml contact fluid 15209 60020 Calibration gas 6 gas bottles 15210 60010 Calibration gas 6 gas bottles Europe and Japan only 15210 64010 Replacement tubing 5 tubes M2205A tcpO CO transducer M1918A Calibration unit 15210B Radiometer TCC3 calibration unit available from Radiometer n a EEG Accessories Trunk Cable 2 7m M2268A Trunk Cable 1 0 m M2269A Reusable 80 cm long 5 lead cables with 10mm silver silverchloride leadwired cup M1931A electrodes Adult Reusable 80 cm long 5 lead cables with 6mm silver silverchloride leadwired cup M1932A electrodes Pediatric Neonatal Reusable 80 cm 5 lead cables with clip M1934A Disposable EEG electrodes M1935A
112. A1 1999 IEC 60601 2 27 ENG60601 2 27 1994 IEC 60601 2 51 2003 EN 60601 2 51 2003 and AAMI EC11 EC13 1991 2002 Cardiotach Range Adult pedi 15 to 300 bpm Neo range 15 to 350 bpm Accuracy 1 of range Resolution 1 bpm Sensitivity 2200 pV peak PVC Rate Range 0 to 300 bpm Resolution 1 bpm ST Numeric Range 20 to 20 mm Accuracy 0 5 mm or 15 whichever is greater Resolution 0 1 mm Sinus and SV Rhythm Brady Adult 15 to 60 bpm Ranges Pedi 15 to 80 bpm Neo 15 to 90 bpm Normal Adult 60 to 100 bpm Pedi 80 to 160 bpm Neo 90 to 180 bpm Tachy Adult gt 100 bpm Pedi gt 160 bpm Neo gt 180 bpm Bandwidth Diagnostic Mode Adult 0 05 to 150Hz Neo pedi 0 5 to 150Hz Monitoring Mode Adult 0 5 to 40Hz Neo pedi 0 5 to 55Hz Filter Mode Adult neo pedi 0 5 to 20Hz Differential Input Impedance gt 2MQ RA LL leads Resp gt 5MQ at all other leads at 10Hz including patient cable Common Mode Rejection Ratio Diagnostic mode gt 86 dB with a 51 kQ 47 nF imbalance Filter mode gt 106 dB with a 51 kQ 47 nF imbalance Electrode Offset Potential Tolerance 500mV Auxiliary Current Active electrode lt 100 nA Leads off Detection Reference electrode lt 900 nA Input Signal Range 5 mV 348 HR 15 to 300 bpm Adult 1 bpm steps 15 to 40 bpm maximum delay 10 seconds according 5 bp m steps 40 to 300
113. A4 and letter size paper on a printer connected locally or centrally to your monitor 253 23 Event Surveillance Documenting Events Event Review Reports The event review report documents all the events stored in the event database for a selected group Bob Jones 12345678 Event Surveillance Review 8 Apr 02 13 40 36 5 Stored Events Combi 4 Single 0 Manual 1 Standard HR Pulse bpm 260 TACHY BRADY Pulse HR bpm 17 00 21 00 1 00 5 00 9 00 13 00 HR Pulse Pulse HR LOW B lt 30 LOW 6 lt 30 LOW 8 lt 30 LOW 8 lt 30 Manual PHILIPS General Hospital Page 4 last 254 Documenting Events Event Episode Reports 23 Event Surveillance The event episode report documents the patient information from the currently selected event See the section on event recordings for an explanation of the report elements Bob Jones 12345678 Event Surveillance Episode T Time 8 Apr 02 13 22 P 0 bes se pa acetates Spo2 sis wa DESAT vigorous Stimulation RR 20 pm ce ge ee BR Pulse Pulse HR 12 5 mm sec 5 sec HR 160 bpm Pulse 95 bpm ABP 115 90 104 amEg epoz 51 Pert 4 8 etc
114. AD OFF ECG The C electrode AAMI V electrode has become detached HR Numeric is replaced by for 10 from the patient or the lead set has been changed Reattach the seconds INOP tone electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set CO AUTO ZERO CO The automatic zero calibration is in progress This typically Numeric is replaced by a takes 10 seconds During this time the CO values may not be if the Autozero lasts gt 15 sec INOP updated or they may be replaced by Wait until the zero tone sounds calibration is complete to resume monitoring CO CAL MODE CO Currently no calibration is running Accuracy can be checked CO numeric displays current CO by placing the transducer on the two cells of the calstick and value for accuracy check starting calibration To start monitoring leave Cal Mode CO CAL RUNNING CO Wait until calibration is finished Numeric is replaced by a CO CHANGE SCALE CO The CO wave is clipped Select a more appropriate wave scale to display the whole wave CO2 CHECK ADAPTER CO Check that the sensor is connected to the airway adapter clean the airway adapter if necessary Perform a zero calibration If the INOP persists contact your service personnel Numeric is replaced by a CO CHECK CAL CO The CO value is outside the measurement range Perform an Numeric is replaced by a accur
115. Baseline You can display an ST reference baseline for the current view or for the trended view The baseline is shown in yellow However if the ECG color is yellow the baseline is shown in green Use this baseline to detect ST changes The baseline is derived automatically whenever the monitor relearns arrhythmia and also on user request Select Show Baseline Hide Baseline to toggle between baseline display on and off Updating an ST Map Reference Baseline To update the baseline Inthe Setup ST Analysis menu select ST Baseline gt Update baseline Changing the Scale of the ST Map To change scale Select Size Up or Size Down to alter the size at which monitor displays the map Changing the Trending Interval To determine how frequently the monitor displays a trended sample 1 In Trend view select Select Interval 2 Select the required interval from the menu The interval ranges between 12 seconds to 30 minutes Printing an ST Map Report To print the most recently viewed current or trend window 1 SelectMain Setup gt Reports 2 Select ST Map 3 Press Print 125 126 7 Monitoring Pulse Rate The pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in beats per minute bpm You can display a pulse from any measured SpO signal pleth wave or any arterial pressure ABP ART Ao BAP FAP PAP UAP P see the pressure section for an explanation of the pr
116. CG Lead Placements 97 Standard 3 Lead Placement 98 Standard 5 Lead Placement 98 Chest Electrode Placement 99 10 Lead Placement 100 Conventional 12 Lead ECG 100 Modified 12 Lead ECG 101 Choosing Standard or Modified Electrode Placement 101 Labelling 12 Lead ECG Reports 101 Capture 12 Lead 102 EASI ECG Lead Placement 102 ECG Arrhythmia and ST Alarm Overview 104 Using ECG Alarms 105 Extreme Alarm Limits 105 ECG Alarms Off Disabled 105 HR Alarms When Arrhythmia Analysis is Switched Off 105 HR Alarms When Arrhythmia Analysis is Switched On 105 ECG Safety Information 105 About Arrhythmia Monitoring 107 Arrhythmia Options 107 Where Can I Find More Information 107 Switching Arrhythmia Analysis On and Off 108 Choosing an ECG Lead for Arrhythmia Monitoring 108 Aberrantly Conducted Beats 108 Atrial Fibrillation and Flutter 108 Intermittent Bundle Branch Block 109 Understanding the Arrhythmia Display 109 Viewing Arrhythmia Waves 109 Arrhythmia Beat Labels 109 Arrhythmia Status Messages 110 Rhythm Status Messages 110 Ectopic Status Messages 111 Arrhythmia Relearning 111 Initiating Arrhythmia Relearning Manually 111 Automatic Arrhythmia Relearn 112 Arrhythmia Relearn and Lead Fallback 112 Arrhythmia Alarms 112 Yellow Arrhythmia Alarms 113 Arrhythmia Alarms and Latching 113 Switching Individual Arrhythmia Alarms On and Off 113 Switching All Yellow Arrhythmia Alarms On or Off 113 Adjusting the Arrhythmia Alarm Limits 113 Arrhythmia Alarm Tim
117. G Plug in module Silencing this INOP switches off the INOP tone measurement EEG OVERRANGE or EEG Input signal is too high in one or both channels This is usually EEG lt X gt OVERRANGE caused by interfering signals such as line noise or electrosurgery X denotes the EEG channel FAP INOPS PRESS See lt Pressure label gt INOPS under Pressure FMS UNPLUGGED FMS Make sure that the Flexible Module Server is connected to the INOP tone monitor All FMS measurements are off while the FMS is unplugged FMS UNSUPPORTED FMS The Flexible Module Server is not supported by your monitor INOP tone Contact your service personnel IC1 IC2INOPS PRESS See lt Pressure label gt INOPS under Pressure ICP INOPs PRESS See lt Pressure label gt INOPS under Pressure Indep Dsp Malfunc Display A problem has occurred with the second main display Contact your service personnel Indep Dsp NotSupp Display The monitor does not support a second main display The monitor software is incompatible Contact your service personnel Intell Dsp Malf Display There is a problem with the Intelligent Display Check the INOP tone MSL coupling cable then contact your service personnel Intell Dsp Missing Display The monitor has lost contact with the connected Intelligent Display Contact your service personnel Intell Dsp Unsupp Display The monitor does not support the connected Intelligent Display The monitor software is incompatible Internal Comm Malf Mo
118. HK VueLink The wrong external device has been selected on the VueLink CONF module or the external device has not been correctly setup or INOP tone the wrong cable has been used to connect the device to the VueLink module VueLink INOP abbreviations may differ slightly depending on the device category lt VueLink option gt CHECK VueLink No information was received from the external device The SETUP device may be switched off or disconnected INOP tone VueLink INOP abbreviations may differ slightly depending on the device category VueLnk EQUIP MALF VueLink Malfunction in the VueLink module If this message appears INOP tone repeatedly the module must be replaced Contact your service personnel VueLink INOP abbreviations may differ slightly depending on the device category VueLnk NO CONFIG VueLink The VueLink module has not been configured during INOP tone installation The installation process should be completed by either your biomedical engineering department or the Philips service engineer VueLink INOP abbreviations may differ slightly depending on the device category VueLnk UNPLUGGED VueLink The VueLink module has been unplugged from the rack or the whole rack has been disconnected The measurement automatically disappears from the display Silencing this INOP switches off the measurement VueLink INOP abbreviations may differ slightly depending on the device category 5 Managing Patients Use the Pat
119. Hemo Review pop up key as required The review window lists all the input and output values for each measurement in the calculations group The timeline in the review window lists the times the calculations were performed To review individual calculations select the calculation in the Calculation Review window and then select the Original Calc pop up key Performing Calculations You must check that all input values are appropriate for your patient before performing calculations 1 Select the Calculations SmartKey to open the Calculations window 2 Select the Cale Type field and select the required calculation type for display 3 Check the calculation time in the Cale Time field When you enter the calculation window this field will show either the current time or the time of the most recent available C O measurement depending on your monitor configuration To choose a different calculation time select the Cale Time field This calls up a list showing the timestamps of calculations performed earlier Select a time from this list or select Select Time to enter a time of your choice To enter the current time select the Resample Vitals pop up key If you choose the current time the monitor will resample all the required values that are continuously monitored 4 Enter any values that must be entered or edited manually Select the value field and then use the pop up keypad to enter the required values Select Enter to confirm eac
120. Hg 5 Acetone 0 1 1 mmHg 5 Methane 1 0 1 mmHg 5 Spirometry The following specifications apply for 760 mmHg ambient pressure and patient gas room air at 35 unless otherwise noted Flow Wave AWF Range 25 l min neonatal 100 l min pediatric 180 l min adult Accuracy 3 or 0 125 l min neonatal 0 25 l min pediatric 0 5 l min adult Scales 10 20 40 60 80 100 120 150 l min Scale Default 20 l min neonatal 100 l min pediatric 150 l min adult 359 Volume Wave AWV Range 0 to 100 ml neonatal 0 to 400 ml pediatric 0 to 3000 ml adult Accuracy 5 or 3 ml neonatal 12 ml pediatric 90 ml adult whichever is greater Scales 50 100 200 600 800 1000 2000 3000 ml Scale Default 50 ml neonatal 200 ml pediatric 800 ml adult Pressure Wave AWP Range 20 to 120 cmH O Accuracy 2 or 0 5 cmH20 whichever is greater Scales 10 20 40 60 80 100 120 cmH O Scale Default 20 l min neonatal 40 l min pediatric 40 l min adult Respiration Rate Range 2 to 120 breaths min numeric RRspir Resolution 1 breath min Inspired Minute Range 0 01 to 5 l min neonatal Volume numeric 0 06 to 30 l min pediatric MVin 0 4 to 601 min adult Resolution 0 01 l min neonatal pediatric 0 1 l min adult Expired Minute Range 0 01 to 5 l min neonatal Volume numeric 0 06 to 30
121. ING Injected dyes such as methylene blue or intravascular dyshemoglobin may lead to inaccurate measurements Do not monitor oxygen saturation during infusion of I V fat emulsion or other turbid substances through the distal lumen of the OptiCath catheter These liquids might temporarily modify the blood scattering and absorption characteristics at the catheter tip This interferes with the optical measurement of oxygen saturation After infusion is complete you can again monitor oxygen saturation accurately During injection of the bolus for thermodilution cardiac output measurements the SvO measurement might be disturbed 203 Preparing to Monitor SvO In addition to an SvO module you need a Hospira OptiCath catheter and 50131 Optical Module Use only the Hospira accessories listed in the Accessories section 1 optical module 2 balloon inflation stopcock 3 Hospira fiber optic catheter 4 optical reference 5 enter setup calibration Connect the optical module Hospira 50131 to the SvO module Allow the optical module to warm up before you perform a calibration Although the warm up message disappears from the screen after one minute Hospira recommends letting the optical module warm up for 15 minutes for best accuracy Please refer to the instructions for the optical module To avoid false alarms during the pre insertion calibration and insertion of the catheter into the patient the monitor automatic
122. ION Ensure that the BISx does not come into prolonged contact with your patient s skin as it may generate heat and cause discomfort The BISx may remain connected to a patient during defibrillation as long as the sensor is not located between the defibrillator pads 3 With sensors for single patient use a Attach the patient interface cable PIC to the BISx device b Connect the BIS sensor to the PIC With Semi Re usable Sensors a Attach the sensor cable to the BISx device b Snap the sensor cable onto the electrodes As soon as a valid sensor is detected the impedances of all electrodes are measured automatically and the results are shown in the BIS window The number of uses remaining for the semi re usable sensor is shown in the status line when the BIS window is open 217 Manufacturer s Information BISx the BIS Engine the DSC the Patient Interface Cable and the BIS Sensors are manufactured by Aspect Medical Systems BIS Continuous Impedance Check This checks e the combined impedance of the signal electrodes plus the reference electrode This is done continuously and does not affect the EEG wave As long as the impedances are within the valid range there is no notification of this check or its results e the impedance of the ground electrode This is done every ten minutes and takes approximately 4 seconds It causes an artifact in the EEG wave and the message Ground Check is shown on the monitor screen duri
123. IS M1034A only BIS Engine Cable Short 0 8 m M1034 61610 BIS Engine Cable Long 2 0 m M1034 61620 PIC PLUS Cable M1034 61630 BIS Universal Clamp Mount M1180A C32 BIS FMS Mount Flexible Module Server M1180A C33 BIS Mount for MP40 MP50 M8003 64011 SvO Accessories Contact your local Hospira representative for information on accessories They are not available from Philips Part numbers may vary according to country of purchase Optical Module 50131 Pulmonary artery catheter 50324 05 7 5F 110cm Pulmonary artery catheter 50355 03 5 5F 75cm Pulmonary artery catheter 50328 05 8F 110cm Intravascular catheters 50404 01 4F 40cm Intravascular catheters 50405 01 4F 25cm Intravascular catheters 50407 01 5 5F 40cm 323 Recorder Accessories For M1116B recorder 10 rolls of paper 40477A 80 rolls of paper 40477B For integrated recorder MP20 MP30 10 rolls of paper M4816A 80 rolls of paper M4817A 324 34 Installation and Specifications The specifications in this section apply to the MP20 MP30 MP40 MP50 MP60 MP70 MP80 and MP90 patient monitors unless otherwise stated The monitors are not user installable They must be installed by qualified service personnel Intended Use The monitors are intended to be used for monitoring recording and alarming of multiple physiological parameters of adults pediatrics and neonates in health care fa
124. IntelliVue MP20 30 MP40 50 and MP60 70 80 90 INSTRUCTIONS FOR USE IntelliVue Patient Monitor MP20 30 MP40 50 MP60 70 80 90 Release D 0 with Software Revision D 00 xx Patient Monitoring S PHILIPS Part Number M8000 9001G Printed in Germany 02 06 4512 610 13551 ANAC AAA U DNN NTT PHILIPS Table Of Contents 1 Basic Operation 1 Introducing the IntelliVue Family 1 IntelliVue MP20 MP30 2 MP20 MP30 Major Parts and Keys 3 IntelliVue MP40 MP50 4 MP40 MP50 Major Parts and Keys 4 IntelliVue MP60 MP70 5 MP60 MP70 Major Parts and Keys 6 IntelliVue MP80 MP90 6 MP80 MP90 Major Parts and Keys 7 D80 Intelligent Display 7 Remote Alarm Device Docking Station 8 Related Products 8 Flexible Module Server M8048A 8 Measurement Modules 9 Multi Measurement Server M3001A 10 Measurement Server Extensions 11 M3014A M3015A and M3016A Capnography Extensions 12 M3012A Hemodynamic Measurement Server Extension 13 Operating and Navigating 14 Selecting Screen Elements 15 Using the Setup Menu 15 Using the Touchscreen 15 Disabling Touchscreen Operation 15 Using the SpeedPoint 16 Using the Navigation Point 17 Using a Mouse or Trackball 17 Using Keys 17 Permanent Keys 17 SmartKeys 18 Hardkeys 19 Pop Up Keys 19 Using the On Screen Keyboard 20 Using the On Screen Calculator 20 Operating Modes 21 Standby Mode 21 Understanding Screens 22 Switching to a Different Screen 22 Changing a Screen s Content 22 Using Additional Displa
125. MP20 MP30 aBIS ENGINE INCOMPT INOP will be issued Impedance Checks Impedance checks may influence data acquisition of other electroencephalographic devices 221 222 20 Trends Trends are patient data collected over time and displayed in graphic or tabular form to give you a picture of how your patient s condition is developing Trend information is stored in the trends database for continuously monitored measurements such as ECG as well as for aperiodically measured parameters such as Cardiac Output Viewing Trends Trend information can be viewed embedded as a screen element on specially designed Screens or you can open a trend window over the current Screen To view trends embedded as a screen element select the Screen name in the monitor info line to enter the Change Screen menu then select a Screen designed to show an embedded trend window To open the tabular trends window over the current Screen select the Vitals Trend SmartKey ioe To open the graphic trends window over the current Screen select the Graph Trends SmartKey The trend windows open displaying the most recent data and are updated as new data a is stored A timescale along the bottom of the screen shows you where you are in the trends database The preview column on the right hand side shows the latest available measurement value The preview column is updated every five minutes or whenever an NBP or other aperiodic measurement is c
126. Main Screen key and then turn one click further The highlighting moves to a special jump field at the edge of the Screen 2 Press the knob on the SpeedPoint to confirm the highlighting will automatically move to the other display The content of each Screen can be changed individually as described in the previous section If you are operating two or three displays you can choose Screens for all displays from one location 23 1 Select Profiles in the monitor info line of the first display 2 SelectDisplay 1 Display 2 or Display 3 then select the Screen you want to display on the that display from the list of available Screens When two displays are mounted next to each other or one above the other a special Screen can be assigned which spans across both displays The Screen content for these Tall and Wide Screens can then use the increased area available with two displays These Screens appear in the Screen list with a special Tall Screen or Wide Screen symbol Certain windows for example cardiac output procedure can only be shown on one display at a time If you try to open one of these windows when it is already shown on another display you will see a blank grey window with a cross through it Using the Visitor Screen If a visitor Screen is configured for your monitor you can use it to clear the screen of all waves and numerics but continue to monitor the patient with active alarms and trend storage at the bedside and Info
127. NOP the measurement will be switched off CO OCCLUSION CO The FilterLine or exhaust tube is blocked Check the FilterLine Numeric is replaced by a and exhaust tube then disconnect and reconnect the INOP tone FilterLine If the INOP persists connect a new FilterLine CO OVERRANGE CO The CO value is higher than the measurement range If you Numeric is replaced by suspect a false high value contact your service personnel INOP tone CO PUMP OFF CO The pump has been switched off for fifteen minutes To switch Numeric is replaced by a it on again select Pump On in the Setup CO menu CO PURGING CO The Filterline is being purged to remove an occlusion in the Numeric is replaced by a line or airway adapter If the occlusion is removed the INOP INOP tone will disappear If not the INOP CO2 OCCLUSION is displayed CO2 SENSOR WARMUP CO Wait until the sensor reaches operating temperature and the Numeric is displayed with a INOP disappears Microstream CO INOP tone Mainstream CO no INOP tone C O UNPLUGGED C O Plug in the C O module Silencing this INOP switches off the numeric is replaced by measurement INOP tone CO UPDATE FW CO The software in the Measurement Server Extension does not Numeric is replaced by a match the software in the MMS Contact your service INOP tone personnel CO WAIT CAL2 CO Calibration on the first calstick cell is complete Place the trans
128. OT Diastolic Mean pressure Depending on the NBP numeric size not all elements may be visible Your monitor may be configured to display only the systolic and diastolic values Alarm Sources if you have parallel alarm sources the sources are displayed instead of the alarm limits NBP Timestamp depending on the configured NBP Time setting the time shown beside the NBP numeric can be 145 Meas Time the time of the most recent NBP measurement or Next Meas the time until the next measurement in an E 8 5 1 automatic series displayed with a graphic representation of the remaining time as shown here During measurements the cuff pressure is displayed instead of the units and the repeat time An early systolic value gives you a preliminary indication of the systolic blood pressure during measurement Starting and Stopping Measurements Use the Setup menu SmartKeys or the MMS hardkey to start and stop measurements Start Stop manual measurement Start Stop a Start Stop Start Auto series en me Stop current automatic measurement Stop Automatic Manual or stat Stop All n a Soa measurement AND series ri Start STAT measurement NBP STAT STAT for MMS ey without Pressure Temp measurement Stop current STAT measurement Start Stop a Start Stop and end series en NBP STAT STAT for MMS without Pressure Temp measurement CAUTION Use clinical judgement to decide whether to
129. P NEO L NEOPT L 3 70 to 100 LNOP TC I 3 5 70 to 100 Option A02 Philips Reusable Sensors M1191ANL M1192AN 2 70 to 100 M1193AN M1194AN M1195AN 3 70 to 100 Philips Disposable Sensors with M1943NL M1901B Adult M1902B M1903B M1904B 2 70 to 100 M1901B Neonate 3 NellcorPB Sensors with M1943NL MAX FAST MAX A MAX AL MAX P MAX I MAX N Adult 2 70 100 SC A OxiCliq A P I N Adult 2 5 70 100 MAX N Neonate Dura Y D YS Infant to Adult DS 100A Oxiband OXI A N Adult OXI P I 3 70 100 MAX R OxiCligq N Neonate SC NEO Neonate SC PR Neonate Dura Y D YS with D YSE or D YSPD clip 3 5 70 100 Dura Y D YS Neonate Oxiband OXI A N Neonate 4 70 100 Resolution 1 Accuracy 351 NBP 352 Pulse Range 30 to 300 bpm Accuracy 2 or 1 bpm whichever is greater Resolution 1 bpm Sensors Wavelength range 500 to 1000 nm Emitted Light Energy lt 15mW Information about the wavelength range can be especially useful to clinicians for instance when photodynamic therapy is performed Pulse Oximeter Calibration Range 70 100 SpO Adult 50 to 100 1 steps 0 1 2 3 30 Pedi Neo 30 to 100 4 seconds Desat Adult 50 to Low alarm limit 1 steps Pedi Neo 30 to Low alarm limit Pulse 30 to 300 bpm Adult max 14 seconds 1 bpm steps 30
130. PVCs On Pair PVCs On Off R On T PVCs On Off V Bigeminy On Off V Trigeminy On Off PVCs min On Off Multif PVCs On Off Pacer N Cap On Pacer N Pac On Pause On Off Missed Beat On Off SVT On IrregularHR On Off TimeOut Ist 3 min TimeOut 2nd 10 min Arrhy Off Message Yes SOME ECG IN On Off ST Alarm Mode Single ST Alarms On ST Analysis On Off ST Index On ISO Point 80 ms J Point 48 ms ST Point J 60 ST Label On Off For Alarm Mode Single ST ST Label High 2 0 mm ST Label Low 2 0 mm For Alarm Mode Multi ST ST Label High 1 0 mm ST Label Low 1 0 mm Pulse Default Settings Alarm Source HR Auto Pulse Label On System Pulse SpO2 Auto Alarms Off Enabled Alarm Source Sel Enabled Pulse SpO2 on Pulse Alarms on High Limit 120 bpm 160 bpm 200 bpm Low Limit 50 bpm 75 bpm 100 bpm A Extr Brady 20 bpm Brady Clamp 40 bpm 40 bpm 50 bpm A Extr Tachy 20 bpm Tachy Clamp 200 bpm 220 bpm 240 bpm Pulse alarms use the settings of the currently selected Pulse alarm source 373 Respiration Default Settings High Limit 30 rpm 100 rpm Low Limit 8 rpm 30 rpm Apnea Time 20 sec Alarms On Resp On Off Auto Manual Auto Trigger Mode Resp Speed 6 25mm s Color Yellow White SpO Default Setting
131. PiCCO method 164 Procedure window 163 prompt messages 172 results table 163 right heart thermodilution method 168 saving measurements PiCCO 167 setup for PiCCO method 165 setup for RH method 168 setup menu 164 temperature unit 163 C O warning messages 173 C O CCO safety information 173 Calc Type 233 calculating drug infusions 277 calculating cerebral perfusion 157 calculating oxygen extraction 206 calculating pulse pressure variation 157 calculating temperature difference 150 calculations 233 pop up keys 234 calculations reports 237 calculations review 235 calculator 20 calibrating CO2 transducer 180 tcGas transducer 199 calibrating C O measurements 167 calibration interval NBP 306 NBP 147 pressure 156 pressure transducer 156 SvO2 light intensity 205 SvO2 required equipment 203 SvO2 in vivo 206 SvO2 pre insertion 204 calibration status indicators C O 167 capnography mainstream 12 Microstream 12 capturing loops 290 carbon dioxide see CO2 175 187 cardiac output how the measurement works 161 report 275 cardiac overlay and Resp detection modes 133 when measuring Resp 131 cardiotach alarms 104 care groups alarm notification 88 other bed window 87 pop up window 88 catheter SvO2 insertion 205 catheter constant setting PiCCO 166 catheter preparation SvO2 204 cautions 1 CCO calibration status indicators 167 choosing the correct pressure source 166 how the measurement works 161 PiCCO method 164 central
132. Pop Up Keys 243 Event Triggers 244 Event Retriggering 245 Event Notification 245 Setting Triggers for NER and Basic Event Surveillance 245 Setting Triggers and Notification for Advanced Event Surveillance 246 xii Triggering Events Manually 246 The Events Database 247 Viewing Events 247 Event Counter 247 Counting Combi Events 248 Counting Neonatal Event Review NER Events 248 Event Summary Window 249 Event Review Window 249 Event Episode Window 250 Annotating Events 251 Documenting Events 251 Documenting Event Review 251 Documenting an Event Episode 252 Event Recordings 252 Event Review Recordings 252 Event Episode Recordings 253 Event Reports 253 Event Review Reports 254 Event Episode Reports 255 Event Summary Reports 255 24 Recording 257 Starting and Stopping Recordings 258 Quickstarting Recordings 258 Extending Recordings 259 Stopping Recordings 259 Recording Without a Template 259 Overview of Recording Types 259 All ECG Waves Recordings 260 Creating and Changing Recordings Templates 260 Changing ECG Wave Gain 261 Recording Priorities 262 Sample Recording Strip 262 Recording Strip Code 262 Recorded Waveforms 263 Maintaining Recording Strips 263 Reloading Paper 264 Recorder Status Messages 265 25 Printing Patient Reports 267 Starting Reports Printouts 267 Stopping Reports Printouts 268 Setting Up Reports 268 Setting Up ECG Reports 268 Setting Up Vital Signs and Graphic Trend Reports 269 Setting Up Auto R
133. Report Wedge numerics and reference wave In the Wedge window select the Print Wedge pop up key Calculations Report Hemodynamic Oxygenation or Ventilation Review In the Calculations windows select the Print Record pop up key Drug Calculator Report Titration Table Inthe Titration Table window select the Print Titr Tbl pop up key Drip Table Inthe Drip Table window select the Print Drip Tbl pop up key 267 Alarm Limits Report Graphic and numeric report of all Inthe Alarm Limits window select Print current alarm limits Limits Realtime Reports patient data and numerics and either Select the Realtime Reports SmartKey if including oxy CRG all displayed waves OR all measured configured Reports Neonatal waves OR all measured RT waves Or all Event Review measured HiRes waves OR oxy CRG waves RT waves ECG Primary lead Pleth Resp HiRes waves btbHR HiRes SpO HiRes Resp Loops Report Individual Loops diagram with In the Loops window select Print Loop timestamp currently measured numerics Battery Report Battery serial numbers information on In the Battery Status window select Print the currently measured and potential Status charge status of the battery or batteries Stopping Reports Printouts To stop Reports printing in the Reports menu select Stop Report to stop the current print job Stop All Reports to cancel all queued report
134. Right Heart Thermodilution Method 168 Setting up RH C O Measurements 168 Ice Bath Setup for RH Thermodilution C O Measurements 168 Setting the Computation Constant 169 Performing RH C O Measurements 169 Editing and Saving RH C O Measurements 169 viii Documenting C O Measurements 169 C O Injectate Guidelines 170 Guidelines for Right Heart Thermodilution C O Injectate 170 Guidelines for PiCCO C O Injectate 170 Injectate Volume Patient Weight and ETVI Values PiCCO Only 170 C O CCO Curve Alert Messages 171 C O CCO Prompt Messages 172 C O CCO Warning Messages 173 C O CCO Safety Information 173 14 Monitoring Carbon Dioxide 175 Using the Capnography Extension M3014A 176 Preparing to Measure Mainstream CO 176 Preparing to Measure Sidestream CO 177 Using the Sidestream Sensor Holder 178 Removing Exhaust Gases from the System 179 Using the Mainstream CO Extension M3016A 179 Preparing to Measure Mainstream CO3 179 Checking Transducer Accuracy 179 Calibrating the Transducer 180 Attaching and Removing the CO Transducer 180 Using the Microstream CO Extension M3015A 181 Preparing to Measure Microstream CO 181 Using Microstream Accessories 181 Using the FilterLine and Airway Adapter 182 Removing Exhaust Gases from the System 182 Suppressing Zero Calibration 183 Setting up Mainstream and Sidestream CO 183 Adjusting the CO Wave Scale 183 Setting up CO Corrections 183 Suppressing Sampling not Mainstream CO3 184
135. S 215 EMI filter for ECG 95 end case discharging a patient 79 report printing 79 end case reports setup 269 enhanced arrhythmia option 104 107 entering values calculations 236 equipotential ground connector 332 equipotential grounding symbol 328 event annotation 251 combi events 248 counting oxy CRG NER events 248 event counter 247 event episode 242 event episode recording 253 event episode types 243 event episode window 250 event post time 242 event pre time 242 event retriggering 245 event review recording 252 event review window 249 event summary view 249 event time 242 event triggers 244 event values 251 manual event triggers 246 recording 251 setting up NER 245 event database 247 event episode reports 270 event groups 242 event report 254 event review reports 270 event snapshots 243 event surveillance 241 options 241 events pop up keys 243 EVLW EVLWI 162 exclamation mark symbol 328 exhaust gases removing 179 182 extension cable for SpO2 138 external devices alarms and INOPS 283 connecting to VueLink 281 connecting via VueLink 282 external pacing electrodes and ECG monitoring 106 extreme bradycardia alarm 105 129 extreme rate alarms 105 129 extreme tachycardia alarm 105 129 F fallback ECG 97 FAST Fourier artefact suppression technology 137 filter ECG filter setting 95 filter ECG 95 filter frequencies EEG 213 FilterLine CO2 microstream accessory 182 filters BIS 220
136. ST numeric and the ST numeric stored with the baseline are shown as well as the difference between these two numerics A in front of the difference numeric indicates that the ST measurement points were adjusted since the baseline snippet was stored The Baseline Window opens with the ST pop up keys Update Baseline Record ST Change ST Lead Adjust ST Points ST Map and arrow keys for scrolling through the available leads To view the ST Baseline window select any snippet on the Screen Updating ST Baseline Snippets 6 ECG Arrhythmia and ST Monitoring ST label and ST numeric Baseline Baseline ST numeric and difference since baseline was stored ImV calibration bar A Current snippet ST baseline ST Baseline stored at 14 Feb 03 9 38 Timestamp of most recently stored baseline snippet Updating ST Baseline Snippets ST analysis requires valid samples to measure and store a snippet ST Snippets and ST values are updated every minute If there is artifact in the signal it may take longer for an ST snippet and an ST value to appear The first baseline is stored automatically after ST monitoring is started or when a new patient is admitted To update ST baselines 1 Select an ST snippet to open the ST Baseline window 2 Inthe ST Baseline window select Update Baseline to store all current snippets as baselines This deletes all previously stored baselines Recording ST Segments To record all cur
137. Screen Trends patient trend information for NBP C O C I and Wedge can now be permanently displayed on the Screen in tabular and graphical form 38 PO RESINS TSS EIN What s New in Release A 2 12 Lead ECG recordings 12 Lead ECG waves and numerics can be sent to a connected recorder High Resolution Trend Report high resolution trend report can be sent to a connected printer ST Snippets ST snippets showing a one second wave segment for each measured ST lead can be permanently displayed on the Screen or called up as required EEG Wave Speed new EEG specific wave speeds have been added to the list of wave speeds available Drug Calculator this new feature helps you to calculate drug dosages for your patients On Screen Calculator a mathematics calculator can be used on the Screen Visitor Screen this new Screen is designed to hide sensitive patient information from the Screen Monitoring and alarm generation function as usual Touch selection volume control The volume of the audio prompt given when a screen element is selected is now adjustable VueLink interface the VueLink on screen appearance and controls are improved M3001A Trend upload from the Multi Measurement Server M3001A improved Screen Trends lets you display patient trend information in graphic form permanently on the Screen Alarm Limits Page lets you view and control alarm settings for all measurements in one window New Option for Event Surveillance a new neona
138. T lt Lead gt Low Fibrillation Tachycardia Pacer Not Pacing Pause ne anes Beenie Frequent PVCs PVC gt Trregular HR Extreme Tachycardia _ limit min Ventricular Rhythm High heart rate Run PVCs High Low heart rate Pair PVCs R on T PVCs Ventricular bigeminy Ventricular trigeminy Nonsustained V Tach Multiform PVCs 104 Using ECG Alarms ECG alarms can be switched on and off and the high and low alarm limits changed just like other measurement alarms as described in the Alarms section Special alarm features which apply only to ECG are described here Extreme Alarm Limits The extreme rate alarms Extreme Tachy and Extreme Brady generated by the active alarm source either HR or Pulse are set in Configuration Mode by adding a set value to the high and low alarm limits You need to know what value has been configured for your monitor Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range To see the extreme rate alarms set for your monitor in the Setup ECG menu see the menu items AExtrTachy and AExtrBrady ECG Alarms Off Disabled Be aware that your hospital department may have decided to disable the setting ECG Alarms Off in the monitor s Configuration Mode In this case HR alarms cannot be switched off in Monitoring Mode If you try to switch off the HR alarms you will see the message To activate enter Config
139. The right heart method is available with C O module M1012A standard and option C10 M3012A Hemodynamic Measurement Server Extension options C05 and C10 M3014A Capnography Measurement Server Extension option C05 and C10 e The PiCCO method is available with C O module M1012A option C10 M3012A Hemodynamic Measurement Server Extension option C10 M3014A Capnography Measurement Server Extension option C10 The PiCCO method additionally lets you measure Continuous Cardiac Output CCO by performing pulse contour analysis on the blood pressure waveform 161 Hemodynamic Parameters This table illustrates the hemodynamic parameters available with each method whether they are measured continuously and whether they can be shown on the monitor s resting display or in the HemoCalc Window Blood Temperature Tblood Y Y N Y Y N C O C I Cardiac Output N Y Y N Y Y CCO CCTI Continuous Cardiac Output Y Y Y in the Not available C O field SVR SVRI Systemic Vascular Resistance Nand Y Y Y N N Y SV SI Stroke Volume SV Index Nand Y Y Y N N Y SVV Stroke Volume Variation Y Y N Not available dPmax Left Ventricular Contractility Index Y Y N Not available CFI Cardiac Function Index N Y N Not available ITBV ITBVI Intrathoracic Blood Volume N Y Y Nort available EVLW EVLWI Extravascular Lung Water N Y Y Not available GEDV GEDVI Global End Dia
140. Trends 223 Viewing Trends 223 Viewing Graphic Trends 224 Viewing Vital Signs Trends 224 Trends Pop Up Keys 225 Setting Up Trends 225 Making Segment Settings 226 Expanded View 226 Trend Scales for Segment Measurements 226 Optimum Scale 226 Trend Group 226 No of Segments 226 Trend Groups 227 Trend Interval 227 Trend Priority 227 Trend Parameter Scales 227 Graphical Trend Presentation 228 Documenting Trends 228 Trends Databases 229 Aperiodic Trends Database 229 Trending Multiple Value Measurements 229 Screen Trends 229 Setting the Screen Trend Time 230 Changing the Selection of Screen Trends Displayed 231 Activating the Cursor for Screen Trends 231 Changing the Screen Trend View 231 Tabular View 231 Horizon View 232 Setting the Horizon 232 Setting the Horizon Trend Scale 232 21 Calculations 233 Viewing Calculations 233 Calculations Windows 234 Calculations Pop Up Keys 234 Reviewing Calculations 235 Performing Calculations 235 Entering Values for Calculations 236 Automatic Value Substitution 236 Automatic Unit Conversion 236 Manual Unit Conversion 236 BSA Formula 236 Documenting Calculations 237 22 High Resolution Trend Waves 239 Changing the Hi Res Trend Waves Displayed 239 Hi Res Trend Wave Scales 239 Hi Res Trend Waves and OxyCRG 239 Printing Hi Res Trend Wave Reports 240 Hi Res Trend Wave Recordings 240 23 Event Surveillance 241 Levels of Event Surveillance 241 Event Groups 242 Event Episodes 242 Events
141. Use The monitor is indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients 325 Manufacturer s Information You can write to Philips at this address Philips Medizin Systeme Boeblingen GmbH Hewlett Packard Str 2 71034 Boeblingen Germany Visit our website at www philips com Copyright 2002 2005 Koninklijke Philips Electronics N V All Rights Reserved BIS Manufacturer s Information BISx the BIS engine the DSC the Patient Interface Cable and the BIS Sensor are manufactured by Aspect Medical Systems Aspect Medical Systems Inc 141 Needham St Newton MA 02464 USA 1 617 559 7000 Free call 1 888 BIS_INDEX 1 888 247 4633 Email bis_info aspectms com Web www aspectmedical com Address of the EU Authorized Representative Aspect Medical Systems International B V Rijnzathe 7d2 3454 PV De Meern The Netherlands Phone 31 30 662 9140 Email amsint aspectms com 326 Trademark Acknowledgement PiCCO is a trademark of Pulsion Medical Systems AG Bispectral Index and BIS are trademarks of Aspect Medical Systems Inc and are registered in the USA EU and other countries Oxisensor JI Oxi Cliq and OxiMax are trademarks of Tyco Healthcare Group LP Nellcor Puritan Bennett Division Microstream FilterLine and Smart CapnoLine are trademarks or registered trademarks of Oridion Systems Ltd Citrix an
142. a module 9 recorder 257 4 channel 258 cleaning the print head 295 viii paper accessories 324 recorder module connector 333 recorder status messages 265 recording alarm 259 annotation 262 battery status 300 beat to beat 259 C O measurements 169 central 258 changing recording type 261 channels 261 choosing recorder 261 choosing recording speed 261 context 259 creating templates 260 delayed 259 drug calculations 280 ECG gain 261 extending 259 high resolution 259 local 257 preventing fading ink 263 procedure 259 realtime 259 recording strip 262 recording strip code 262 reloading paper 264 runtime 261 setting the runtime 261 setup menu 260 ST segments 119 starting and stopping 258 types 259 wave overlap 261 wave scale 261 waveforms recorded 263 wedge 159 with the plug in recorder 257 recording delay time 261 recording events 251 reference waves wedge measurement 158 refresh 34 rejecting pace pulses 92 related products power on LED 8 problem LED 8 switching on 8 relearning arrhythmia 111 reloading recorder paper 264 remembraning tcGas transducer 197 reminder alarm 44 remote alarm device alarms remote device 7 remote applications minimize 34 refresh 34 using 33 window size 34 remote SpeedPoint 16 removing a module 9 replacing batteries 301 repolarization tails 94 report cardiac output 275 event review 254 reports alarm limits 273 battery reports 300
143. a module by pressing the lever upwards and pulling the module out Reconnecting a module to the same monitor restores its label and measurement settings such as alarms limits If you connect it to a different monitor the module remembers only its label The connector socket on the front of each module is the same color as the corresponding connector plug on the transducer or patient cable Press the Setup key on the module s front to display the measurement s setup menu on the monitor screen When the setup menu is open a light appears above the key Some modules have a second key On the pressure module for example it initiates a zeroing procedure Example Module Pressure 1 Module name 2 Setup key LED es 3 Setup key to enter setup menu of 1 measurement modules or VueLink gt 2 Press device data window a 4 Connector socket for patient cable 3 e Th 5 transducer 5 Second module specific key for LO example Zero 4 eT Multi Measurement Server M3001A The Multi Measurement Server MMS can simultaneously monitor 3 5 or 10 lead ECG including arrhythmia and ST monitoring respiration SpO 7 NBP and either invasive pressure or temperature Depending on the monitor model you can connect it to the monitor via a cable or mount it either on the left side of the FMS or on the back of the monitor as shown here i MMS mounted on rear of MP40 MP50
144. a thick layer of fat surrounding a limb dampens the oscillations coming from the artery on an edematous extremity Measurement Methods There are three methods of measuring NBP e Manual measurement on demand e Auto continually repeated measurements between one and 120 minute adjustable interval e STAT rapid series of measurements over a five minute period then the monitor returns to the previous mode Use only on supervised patients Reference Method The NBP measurement reference method can be Auscultatory manual cuff or Invasive intra arterial For further information see the Application Note on NBP supplied on the monitor documentation CD ROM In Adult and Pediatric mode to check the current setting selectMain Setup gt Measurements gt NBP and check whether the Reference setting is set to Auscultatory or Invasive This setting can only be changed in Configuration Mode In Neonatal mode to comply with safety standards invasive is always used as the reference method This setting cannot be changed and is not visible in any operating mode Preparing to Measure NBP 1 Connect the cuff to the air tubing 2 Plug the air tubing into the red NBP connector Avoid compression or restriction of pressure tubes Air must pass unrestricted through the tubing Make sure that you are using a Philips approved correct sized cuff and that the bladder inside the cover is not folded or twisted A wrong cuff size and a
145. aO Venous Oxygen Content CvO Arteriovenous Oxygen Content avDO3 Oxygen Availability Index O AVI Oxygen Consumption VO Oxygen Consumption Index VOD Oxygen Extraction Ratio O2ER Alveolar Arterial Oxygen Difference AaDO Percent Arteriovenous Shunt Qs Qt Minute Volume MINVOL Compliance COMP Dead Space Vd Dead Space Tidal Volume Ratio Vd TV Alveolar Ventilation ALVENT The hemodynamic calculations available depend on the Cardiac Output measurement method being used and the regulatory standards that apply for your hospital see the C O chapter for availability details Viewing Calculations Select the Calculations SmartKey to open the Calculations window Select the Cale Type field and select the required calculation type for display 233 Calculations Windows This example calculations window shows the hemodynamic calculations window The ventilation and oxygenation windows are similar Calculations input values C O 8 OOlumin HR 80jbpm ABPs 8 6 mmlg ABPd ABPm 65 mmHg PARANA PAPs 38 fmmHg PAPd 2 6lmmHg 30 lmmHg 22 1 7 Resample Perf Vitals Calc k mHg AN Calculations Pop Up Keys Output values Calculations 75 in 125 Ojlb SV SVR PVR LCW 1 80 m2 100 0 ml 510 80 4 7 LVSW 58 5 RCW 1 74 DS cm5 DS cmS kg m g kg RVSW 21 76 gm Calculations Indexed edioaladen Calculatio
146. abel conflicts e New Previous Next Screen function provides access to the ten most recently modified Screens e Wave speeds can now be set for individual wave channels Trends e Cursor in graphical trend window improves navigation in the trends database e Vital Signs and Graphical Trend screen elements can be embedded on a Screen e New band style format for displaying trends of measurements with multiple numerics e Horizon trend is a new format for screen trends showing the deviation from a stored baseline e Aperiodic measurements now stored with a timestamp in Vital Signs e New symbol representing NBP measurements in Graphical Trends Measurements e ST numerics in the Alarm Limits window can be shown and hidden 37 e ST Point can be set directly by selecting a numeric value e New NBP countdown timer shows the time remaining until the next NBP measurement in a series e Networked monitors can now show Other Bed information embedded on Screen e Additional labels available for Pressure and Temp e Additional options for SpO support for an extended list of accessories e Suppress Zero function for Microstream CO Applications Drug Calculator can now be configured to include a list of commonly used drugs e Cursor in the Loops window improves navigation through the stored loops e Volume flow loops added to the list of respiratory loops types e Loops Report for documentation of stored loops e EEG CSA can now be called up and viewed in a
147. aced by be derived Perform an in vivo calibration If the INOP INOP tone persists try another Optical Module and catheter SvO UNPLUGGED SvO Measurement switched on and SvO module unplugged from SvO numeric is replaced by the rack HSQL bts The measurement automatically disappears from the display Silencing this INOP switches off the measurement SVR SVRI CHK SOURCES SVR SVRI_ Not all measurements or values required to perform the Numeric is replaced by calculation are available Check measurement sources SVR SVRI CHK UNITS SVR SVRI_ The monitor has detected a conflict in the units used for this Numeric is replaced by calculation Check the unit settings SVR SVRI SET CVP USED SVR SVRI_ A CVP value is required for this calculation but is not Numeric is replaced by currently being measured The monitor is using the CVP value preset in the Setup SVR menu T T1 T2 T3 T4 INOPs TEMP See lt Temp label gt INOPs under Temp Tamb INOPs TEMP See lt Temp label gt INOPs under Temp Tart INOPs TEMP See lt Temp label gt INOPs under Temp Tblood NO TRANSDUC C O No transducer attached to the module or catheter Numeric is replaced by disconnected INOP tone Tblood OVERRANGE C O Tblood out of range 17 C 43 C Numeric is replaced by Tcereb INOPS TEMP See lt Temp label gt INOPs under Temp Tcore INOPs TEMP See lt Temp label gt INOPs under Temp tcpO or tcpCO or tcGas tcGas A calib
148. acy check for both calstick cells and if necessary INOP tone recalibrate the transducer C O EQUIP MALF C O There is a problem with the C O hardware Contact your Numeric is replaced by a service personnel INOP tone CO EQUIP MALF CO The Measurement Server Extension is faulty Unplug and Numeric is replaced by replug the Measurement Server with Extension If you are using INOP tone the mainstream method unplug and replug the transducer or try another transducer If the INOP persists contact your service personnel CO FAILED CAL CO Make sure that the Cal cell was changed between CAL1 and Numeric is replaced by CAL2 Repeat the calibration If the INOP reappears try INOP tone another transducer If the INOP persists contact your service personnel CO NO SENSOR CO There is no CO sensor connected If you silence this INOP Numeric is replaced by the CO measurement will be switched off INOP tone CO NO TRANSDUC CO There is no CO transducer connected If you replace the Numeric is replaced by transducer the new transducer must be calibrated If you INOP tone silence this INOP the CO measurement will be switched off CO NO TUBING CO Either the FilterLine is disconnected or an incorrect line is Numeric is replaced by attached Check the connection If necessary connect another INOP tone Microstream Filterline only Microstream accessories can be used If you silence this I
149. ade is completed before resuming monitoring SPIRO CANNOT MEAS Spirometry Measurement is at its limit e g ambient pressure out of range SPIRO PURGE FAILED Spirometry The purge operation could not be completed successfully Check for kinked sensor tubings hard occlusions and make sure that the pump is running and all valves are switching SPIRO UNKN SENSOR Spirometry An unknown sensor ID code was detected Use only the sensors listed in the Accessories chapter SPIRO ALARMS SUPPR Spirometry Alarming is suppressed for the spirometry module SPIRO PURGING Spirometry A purge operation is in progress no data update on the screen Wait until purge is complete SPIRO NO SENSOR Spirometry No sensor detected Make sure the correct sensor is attached to the breathing circuit SPIRO NO BREATH Spirometry No breath was detected for more than 25 seconds Breath derived numerics are not available SPIRO GAS COMPENS Spirometry Gas compensation is set to gas analyzer but not all gases necessary for compensation are measured by a gas monitor Some of the fall back values provided by the user are used Measurement accuracy might be reduced SPIRO PATIENT CAT Spirometry Mismatch of patient size configured in the host monitor and sensor type plugged into the module Check the instructions on selecting the correct sensor in the Spirometry chapter Aspo CHK SOURCES SpO Not all measurements or values required to perform the Numeric
150. age C O values To close a measurement series you must save the average values by selecting the pop up key Save C O This sends the average C O numeric to be displayed on the main screen and stores the averaged values in the trends and calculations databases Documenting C O Measurements You can document C O measurements on the default printer or recorder 1 Inthe C O procedure window select the pop up key Print Record 169 2 From the pop up list choose Print Results to print the contents of the C O procedure window Record Results to record the contents of the C O procedure window Record Trial to send an individual trial curve to the recorder C O Injectate Guidelines The greater the injectate volume and the colder the temperature the more accurate the measurement Reduced injectate volume or higher injectate temperature may reduce the specified accuracy For adult patients to ensure the greatest measurement accuracy use a cold injectate lt 8 C of 10 ml volume if not contra indicated by the patient s condition Your choice of injectate volume should be based on the injectate temperature and the patient s cardiac output Guidelines for Right Heart Thermodilution C O Injectate If you are using the right heart thermodilution method the use of injectate with a temperature less than 8 C lower than the blood temperature may cause incorrect values for the thermodilution Guidelines for PiCCO C O Inj
151. ails the hardware excessive offset may be faulty Replace the adapter cable and try again If it fails replace the transducer and try again If it still fails contact your service personnel unable to zero unstable signal unable to zero Make sure that the transducer is connected and try again If this fails exchange no transducer the adapter cable and try again If this fails exchange the transducer unable to zero Make sure that the transducer is vented to air not to the patient and try again pulsatile pressure unable to zero Try pressing the Zero key again If this fails replace the transducer and adapter timed out cable and contact your service personnel switch lt Press gt on Pressure measurement is switched off To switch it on in the Setup Pressure first menu select the pressure s label Adjusting the Calibration Factor Each time you use a reusable transducer compare the calibration factor written on your transducer with the calibration factor shown on the monitor To ensure accurate measurement they must be the same 1 Inthe Setup lt Press gt menu select Cal Factor If the value here does not match that on the transducer select the corresponding value from the list now in accordance with your hospital s procedure 2 To confirm you want to use the new calibration factor select the Confirm popup Displaying a Mean Pressure Value Only Use this when you
152. ainstream and Sidestream CO Humidity Correction Factor Either BTPS or STPD can be selected as the humidity correction factor for the Mainstream CO readings The formula for the correction calculation is P P Paps STPD BTPS Pine a Puzo 357 Where p partial pressure Pps absolute pressure and Puzo 42 mmHg 35 C and 100 RH CO Range 4 to 150 mmHg 0 5 to 20 0 kPa Accuracy after 20 minutes warmup and calibration For values between 0 and 40 mmHg 2 2 mmHg 0 29 kPa For values between 40 and 76 mmHg 5 5 of reading The specifications are valid for 45 O and N or N30 balance Outside these conditions the accuracy reaches at a minimum the requirements of EN864 ISO9918 Resolution Numeric 1 0 mmHg 0 1 kPa Wave 0 1 mmHg 0 01 kPa Stability 1 0 mmHg over a 7 day period awRR Range 0 to 150 rpm Accuracy 2 rpm Warm up Time 20 minutes with CO transducer attached for full accuracy specification Response Time Less than 125 ms for step from 10 to 90 Mainstream CO Humidity Correction Factor Either BTPS or STPD can be selected as the humidity correction factor for the Mainstream CO readings The formula for the correction calculation is Psrpp Pgrps P abs abs Pi20 Where p partial pressure P absolute pressure and Pyy99 47 mmHg 37 C and 100 RH etCO High 20 to 95
153. air bubbles are visible under the membranes repeat this procedure air bubbles will cause incorrect readings 7 After 24 hours you can calibrate the transducer You must remembrane all new and dried out transducers twice before calibration New Dried Out Transducers Remembrane all new or dried out transducers twice before using After the first remembraning unplug the transducer from the module and leave it for 24 hours with the cap on Remembrane again before calibrating Storing tcGas Transducers If you need to store a sensor for more than 24 hours protect it for up to 28 days by putting two drops of electrolyte solution into the cap Screw the cap on the sensor Remembrane if it dries out or after 28 days 198 Calibrating the tcGas Transducer You can use either a Philips 15210B or a Radiometer TCC3 calibration unit and a gas cylinder whose pressure indicator is above the out of gas zone black on 15210B red on TCC3 To maintain accuracy it is recommended to calibrate the transducer every four hours even if the monitor does not prompt you to do so You MUST calibrate when e you remembrane the transducer e you change the transducer heat setting e you doubt the measurement accuracy e you start a new monitoring period or use a new site e the monitor displays the calibration required INOP message 1 Connect the calibration unit to the inlet on the side of the module s calibration chamber using the recomm
154. airway adapter For non intubated patients Place the nasal cannula onto the patient ie For patients prone to mouth breathing use an oral nasal cannula Trim the oral sampling tip if necessary to fit the patient It should extend down past the teeth and be positioned in the mouth opening Remove the cannula from the a f Y ios patient if the tip needs to be trimmed of O For nasal or oral nasal cannulas with oxygen delivery place the cannula on the patient as shown then attach the oxygen supply tubing to the oxygen delivery system and set the prescribed oxygen flow WARNING Always connect the airway adapter to the sensor before inserting the airway adapter into the breathing circuit In reverse always remove the airway adapter from the breathing circuit before removing the sensor CAUTION Always disconnect the cannula airway adapter or sample line from the sensor when not in use Using the Sidestream Sensor Holder The holder delivered with the sensor can be used to clamp the sensor onto an IV pole or a shelf 178 1 Push the sensor into the holder until it clicks into position 2 Clamp the holder onto an IV pole a shelf or another appropriate location To remove the sensor from the holder release the clip and pull the sensor out of the holder Ss LA clip Removing Exhaust Gases from the System WARNING Anesthetics When using the sidestream CO measureme
155. al Microstream accessories only Refer to the instructions for use provided with the accessory 181 For intubated patient with non humidified ventilation you can use a Microstream FilterLine set For humidified ventilation use a FilterLine H Set For non intubated patients the gas sample is taken through a Nasal FilterLine or a Smart CapnoLine which is a combined oral nasal FilterLine In parallel to the measurement of the CO oxygen O3 may be delivered to the patient to support gas exchange This is done by using an O3 CO FilterLine or a Smart CapnoLine O a combined oral nasal O CO FilterLine Using the FilterLine and Airway Adapter 1 Attach the female Luer connector to the CO inlet connector on the measurement extension b 2 y pushing the socket cover down and screwing the connector into place inlet connector cover outlet connector 2 Check that the FilterLine is not kinked 3 Change the FilterLine if a CO OCCLUSION INOP appears on the monitor or if the readings become extremely erratic Disconnect the FilterLine during suctioning and nebulizing therapies For best results change the FilterLines for non humidified use with orange connectors after 24 hours of continuous use and the FilterLines H for humidified use with yellow connectors after 72 hours of continuous use CO values for non intubated patients using Microstream accessories will alw
156. al extraction of the C O catheter Secure the cable using the mounting clip shipped with each C O ce interface cable You may also find it helpful to loop the C O interface cable tape the loop and attach it to the undersheet of the patient s bed using a safety pin 5 Ifyou are measuring CCO set up the pressure measurement now The CCO measurement requires a minimally dampened invasive pressure setup You must ensure that there are no air bubbles in the pressure line or dome and use only specified accessories 6 Check that the correct measurement method is selected Ifa catheter is already connected to the Cardiac Output Interface Cable the monitor automatically recognizes the method used If not in the Setup C O menu select Method and then select Transpulmonary 7 Check that the Tinj Probe Type setting in the Setup C O menu matches the type of injectate temperature probe used The probe type is usually printed on the plug of the probe To change the probe type in the Setup C O menu select Tinj Probe Type to call up a list of available probes 23001 it is recommended to use this probe with cold injectate M1646 this probe can be used with room temperature injectate or with cold injectate 165 8 Check that the correct arterial catheter constant is selected If the catheter is recognized by the monitor the catheter constant is automatically displayed and cannot be changed manually If it is not recognized
157. ally suspends alarms during the pre insertion calibration for up to three minutes after you remove the catheter tip from the optical reference After light intensity calibration or after three minutes whichever comes first the monitor returns to the alarm state it was in prior to pre insertion calibration Carrying out a Pre insertion Calibration WARNING It is strongly recommended to carry out a pre insertion calibration prior to all insertions If this is not possible you must perform an in vivo calibration after insertion Refer to the instructions for use that accompany the catheter Do not use the catheter if the packaging is damaged If you have to disconnect the monitor from the patient for example when transferring the patient from one location to another you must disconnect at the SvO module The catheter should remain in the optical module otherwise you need to recalibrate 1 Remove outer wrapping from catheter tray to uncover optical connector 2 Place the optical module on the catheter tray in the space provided and open the lid 3 Place the optical connector into the optical module with the label TOP facing upwards and close the lid 4 Inthe Setup SvO2 menu select Start Pre InsCal Ensure that the tip of the catheter is still in the optical reference 5 Insert the catheter when you see the message SvO2 calibration completed catheter ready for insertion If the calibration fails repeat the calib
158. also be viewed on the second display 36 Trends e In graphical trends a segment menu allows direct adjustment of trend scales automatic scale optimization expanded view for an individual segment e In graphical and horizon Screen Trends a cursor is available e In the Vital Signs window the values can be shown with the parameter color Events e Events can be configured to be signaled as alarms advanced event surveillance only e Deviation triggers can be set which trigger an event when measured values change by a defined amount over a set time advanced event surveillance only e Up to six event groups can be active simultaneously advanced event surveillance only Measurements e Pulse Pressure Variation is a new derived measurement calculated from beat to beat arterial pressure values e MAC value calculations Applications e Improved Drug Calculator meeting JCAHO requirements e The ST Map application shows ST changes over time in two multi axis spider diagrams e Freeze and measure waves on the Main Screen What s New in Release B 1 IntelliVue MP20 MP30 The MP20 MP30 patient monitor is a new addition to the IntelliVue patient monitor family It is smaller and lighter than the MP40 MP50 monitors and can be powered by battery It can be used with the measurement server and server extensions and has a built in recorder Basic Operation e New Measurement Selection window makes it easier to resolve measurement l
159. and alarm recordings the list shows all the currently available waves High resolution recordings the list shows all the available high resolution waves In addition to the currently available waves you can choose from several other settings which make an automatic allocation when the recording starts Alarm Par will always record the measurement in alarm in the chosen recorder channel Primary Lead will always record the current primary lead in the chosen recorder channel Secondary Lead will always record the current secondary lead in the chosen recorder channel Agent will always record the currently selected anesthetic agent For high resolution recordings only the Agent setting is available Overlap define whether the recorded waveforms will be printed overlapping or beside each other e Speed choose the recording print speed Delay Time Delayed recordings start documenting on the recorder strip from a pre set time before the recording is started This interval is called the Delay Time and can be set to 10 or 15 seconds This setting can only be changed in Configuration Mode Runtime see how long this type of recording is configured to run This setting can only be changed in Configuration Mode Continuous recordings run indefinitely e Central Config if available select this setting to use the recordings settings set for the centrally connected recorder Changing ECG Wave Gain The ECG Gain setting in t
160. and enable Alarms Off HR Alarms When Arrhythmia Analysis is Switched Off When arrhythmia analysis is switched off only these HR related alarms will be detected e the asystole alarm e the ventricular fibrillation ventricular tachycardia alarm e the extreme tachycardia extreme bradycardia alarms e the high heart rate low heart rate alarms HR Alarms When Arrhythmia Analysis is Switched On WARNING When arrhythmia analysis is on all yellow alarms connected with ECG are short one star This means that the yellow alarm lamp and the tones are active for a configured number of seconds only after which the flashing numeric and the alarm message remain for up to three minutes Alarm reminders are not provided for yellow arrhythmia alarms Red alarms behave as usual ECG Safety Information CAUTION Interference from instruments near the patient and ESU interference can cause problems with the ECG wave See the monitor specifications for more information 105 WARNING Defibrillation and Electrosurgery Do not touch the patient or table or instruments during defibrillation After defibrillation the screen display recovers within 10 seconds if the correct electrodes are used and applied in accordance with the manufacturers instructions According to AAMI specifications the peak of the synchronized defibrillator discharge should be delivered within 60 ms of the peak of the R wave The signal at the ECG output on the IntelliV
161. andatory Ventilation e respiration is weak Try repositioning the electrodes to improve the signal Resp Detection Modes and Cardiac Overlay In Auto Detection Mode If you are monitoring Resp and the ECG is switched off the monitor cannot compare the ECG and Resp rates to detect cardiac overlay The respiration detection level is automatically set higher to prevent the detection of cardiac overlay as respiration In Manual Detection Mode Cardiac overlay can in certain situations trigger the respiration counter This may lead to a false indication of a high respiration rate or an undetected apnea condition If you suspect that cardiac overlay is being registered as breathing activity raise the detection level above the zone of cardiac overlay If the Resp wave is so small that raising the detection level is not possible you may need to optimize the electrode placement as described in the section Lateral Chest Expansion Changing the Size of the Respiration Wave WARNING When monitoring in Manual Detection Mode make sure to check the respiration detection level after you have increased or decreased the size of the respiration wave Inthe Setup Resp menu select Size Up to increase the size of the wave or Size Down to decrease it 133 Changing the Speed of the Respiration Wave Resp waveforms are usually viewed at a slower speed than other waveforms For this reason the Resp measurement has its own speed control and
162. any liquid to enter the monitor case and avoid pouring it on the monitor while cleaning Do not allow water or cleaning solution to enter the connectors of the Multi Measurement Server the measurement server extensions and measurement modules Wipe around not over connector sockets CAUTION To clean the touch enabled display disable the touch operation by switching off the monitor during the cleaning procedure or by selecting and holding the Main Screen key until the padlock symbol appears on it indicating that touch operation is disabled Select and hold again to re enable touch operation Unplug a mouse before cleaning it Switch off the monitor to disable an attached SpeedPoint Device before cleaning the device Recommended cleaning agents are Tensides dishwasher detergents Edisonite Schnellreiniger Alconox Ammonias Dilution of Ammonia lt 3 Window cleaner Alcohol Ethanol 70 Isopropanol 70 Window cleaner Disinfecting CAUTION Solutions Do not mix disinfecting solutions such as bleach and ammonia as hazardous gases may result Hospital policy Disinfect the product as determined by your hospital s policy to avoid long term damage to the product Clean equipment before disinfecting Recommended disinfecting agents are Alcohol based Ethanol 70 Isopropanol g0 Cutasept Hospisept Kodan Tinktur forte Sagrosept Spitacid Sterilium fluid only Ethanol 70 and Isopro
163. art Rate Meter Accuracy and Response to Ventricular bigeminy 80 bpm Irregular Rhythm Slow alternating ventricular bigeminy 60 bpm Rapid alternating ventricular bigeminy 120 bpm Bidirectional systoles 90 bpm Accuracy of Input Signal Reproduction Methods A and D were used to establish overall system error and frequency response Respiration Heart Rate Averaging Method Three different methods are used Normally heart rate is computed by averaging the 12 most recent RR intervals For runs of PVCs up to 8 RR intervals are averaged to compute the HR If each of 3 consecutive RR intervals is greater than 1200 ms that is rate less than 50 bpm then the 4 most recent RR intervals are averaged to compute the HR Response Time of Heart Rate Meter to Change in HR change from 80 to 120 bpm Respiration Rate Range Adult pedi 0 to 120 rpm Neo 0 to 170 rpm Accuracy at 0 to 120 rpm 1 rpm at 120 to 170 rpm 2 rpm Resolution lrpm Bandwidth 0 3 to 2 5Hz 6dB Noise Less than 25mQ rms referred to the input High Adult pedi 10 to 100 rpm under 20 rpm 1 rpm steps max 14 seconds Neo 30 to 150 rpm over 20 rpm 5 rpm steps Low Adult pedi 0 to 95 rpm under 20 rpm 1 rpm steps for limits from 0 to 20 rpm max 4 Neo 0 to 145 rpm over 20 rpm 5 rpm steps seconds for limits above 20 rpm max 14 seconds Apnea Alarm 10 to 40 seconds 5 second steps Unle
164. ased Care Group for a complete unit with up to 64 patients monitored by up to 4 Information Centers Monitors must be assigned to these Care Groups at the Information Center There is a third care group which can be assigned locally at the bedside This is the My Central care group which includes all beds up to 16 from the Information Center your bed is connected to This care group setting is typically used in facilities with only one Information center The selection of beds is automatic and cannot be changed The functions available with Care Groups depend on the Information Center revision your monitors are connected to See your Information Center Instructions for Use for further details Understanding the Care Group Overview Bar The Care Group monitors status is shown in symbol form in the Care Group overview bar Flashing symbols indicate active alarms symbols that are not flashing indicate alarms that have been acknowledged Selecting a bed symbol calls up the Other Patient window for that bed The Care Group overview bar must be configured to display on the monitor Screen If it is not visible on your monitor select a Screen which has been configured to show the bar No data from this bed The alarms are on but there are no currently active alarms at this monitor The highest priority alarm at this monitor is an INOP condition The highest priority alarm at this monitor is a yellow alarm The highest prio
165. atabase server without interrupting the collection of patient trend information 1 Before you disconnect the MMS from the monitor select the patient name in the monitor info line to enter the Patient Demographics window then select the Transfer pop up key If the patient is not admitted or not monitored by an Information Center the Transfer key is inactive grayed out This step preserves the patients demographic data during the transfer 2 Remove the MMS and any connected extensions from the monitor 3 Connect the MMS to the transfer monitor and monitor your patient during the move 4 At the new location connect the MMS to the monitor If the monitor detects a patient conflict the patient selection window will be displayed 5 Select Continue MMS and Confirm your selection This re admits the patient from the transfer list to the new monitor completing the transfer This will upload the patient demographics and if configured the measurement settings and trend data stored in the MMS to the receiving monitor 6 Verify that the settings for patient category and paced mode are correct If you accidentally transfer a patient use Re admit to restore this patient s data to the Information Center If you are not connected to the network select Clear Transfer to leave transfer mode The patient data remains in the monitor Transferring a Patient with an MMS no Central Station Scenario A patient is moved to another moni
166. avoid language conflicts between the VueLink module device driver and the monitor Be aware that if you connect a VueLink module with a different operating language to the monitor the monitor will show e measurement labels in the monitor language e alarm and INOP texts in the VueLink module device driver language 284 28 Using Timers With the Timers function you can set timers to notify you when a specific time period has expired CAUTION Do not use the timers to schedule critical patient related tasks Viewing Timers You can view currently active timers in the Timers window or directly on the Main Screen if a timer has been substituted for a numeric To open the Timers window Select the Timers SmartKey qd or SelectMain Setup gt Timers The maximum number of timers which can be active depends on your monitor model For each timer with a defined run time a progress bar is shown with the run time for that timer Next to the progress bar the elapsed time or the remaining time is shown depending on whether the timer is counting Up or Down On the left the label of the timer and a symbol indicating the type of expiry notification is shown Notification When any timer expires except a No Limit timer the color changes to red and a message appears in the status line on the Main Screen Be aware that if a timer has been configured to display in red the color will not change when the timer expires Additiona
167. ays tend to be lower than for intubated patients If values appear extremely low check whether the patient is breathing through the mouth or whether one nostril is blocked Removing Exhaust Gases from the System WARNING Anesthetics When using the Microstream CO measurement on patients who are receiving or have recently received anesthetics connect the outlet to a scavenging system or to the anesthesia machine ventilator to avoid exposing medical staff to anesthetics Use an exhaust tube to remove the sample gas to a scavenging system Attach it to the Measurement Server Extension at the outlet connector Suppressing Zero Calibration To prevent an automatic zero calibration from being started in the next five minutes inthe Setup CO menu select No Zero for 5 Min or select the Suppress CO2 Zero SmartKey if configured Selecting No Zero for 5 Min or selecting the Suppress CO2 Zero SmartKey again before the timer has timed out resets the timer to five minutes unless an AutoZero became due during the previous suppression Setting up Mainstream and Sidestream CO These tasks are common to all CO measurements except where otherwise noted Adjusting the CO Wave Scale 1 Inthe CO Wave menu or the Setup CO menu select Scale 2 Choose a suitable scale range from the pop up list Setting up CO Corrections Temperature water vapor in the patient s breath barometric pressure and the proportions of O N O and Helium
168. baseline ST map updating 125 ST updating 119 basic arrhythmia option 104 107 basic event surveillance 241 setup 245 battery and display brightness 302 battery compartment location 297 298 battery reports 300 battery status recording 300 ii battery status window 300 charge status 301 conditioning 302 conserving power 302 LED 298 malfunction symbols 298 power gauge 298 recharging 298 replacing 301 safety information 303 symbol 329 battery operation MP20 MP30 297 MP40 MP50 297 beat labels arrhythmia 109 BIS BIS engine software revision 221 cables securing 221 Continuous Impedance Check 218 Cyclic Impedance Check 218 filters 220 Ground Check 218 impedance indicators 219 monitoring 215 monitoring setup 216 numeric 215 numerics on off 220 safety information 221 smoothing rate changing 220 updating software 221 window 219 Bispectral Index monitoring 215 blood pressure See also NBP non invasive or PRESS invasive Brightness SmartKey 31 brightness adjusting 31 BSA formula trends 236 buffer EEG 211 buffer EEG on reports 213 buffer EEG on screen 212 bursts numeric BIS 215 C C I 162 C O 161 accessories 319 calibrating measurements PiCCO 167 curve alert messages 171 documenting measurements 169 editing measurements PiCCO 166 editing measurements RH method 169 flow through method 168 hemocalc window 164 hemodynamic parameters available 162 injectate guidelines 170
169. bel the measurement source as appropriate 150 12 Monitoring Invasive Pressure You can measure pressure using the Multi Measurement Server MMS one of the measurement server extensions or the pressure plug in module Setting up the Pressure Measurement 1 Plug in the pressure cable MMS Module 2 Prepare the flush solution 3 Flush the system to exhaust all air from the tubing Ensure that the transducer and stopcocks are free of air bubbles WARNING If air bubbles appear in the tubing system flush the system with the infusion solution again Air bubbles may lead to a wrong pressure reading 4 Connect the pressure line to the patient catheter 5 Ifyou are using an infusion pressure cuff with the pressure line attach the pressure cuff to the fluid to be infused Inflate it according to your standard hospital procedure then start the infusion 6 Position the transducer so that it is level with the heart approximately at the level of the midaxillary line 151 WARNING If measuring intracranial pressure ICP with a sitting patient level the transducer with the top of the patient s ear Incorrect leveling may give incorrect values Selecting a Pressure for Monitoring Tell the monitor which pressure you want to monitor by selecting its pressure label The label is a unique identifier for each type of pressure When you chose a label the monitor uses that label s stored color wave scale and alarm
170. bial Coated Reusable cuffs 312 Adult Pediatric Soft Single Patient Single Hose Disposable Cuffs 312 Neonatal Infant Cuffs Disposable non sterile 312 Invasive Pressure Accessories 313 SpO Accessories 313 Temperature Accessories 318 Cardiac Output C O Accessories 319 Mainstream CO Accessories for M3014A 320 Sidestream CO Accessories for M3014A 320 Mainstream CO Accessories for M3016A 320 Microstream CO Accessories 321 Spirometry Accessories 321 tcGas Accessories 322 EEG Accessories 322 BIS Accessories 322 BIS Sensors 323 Other BIS Accessories 323 SvO Accessories 323 Recorder Accessories 324 34 Installation and Specifications 325 Intended Use 325 Indication for Use 325 Manufacturer s Information 326 BIS Manufacturer s Information 326 Trademark Acknowledgement 327 Symbols 328 Installation Safety Information 329 Connectors 329 MP20 MP30 330 MP40 MP50 331 MP60 MP70 332 MP80 MP90 334 xvi 802 11 Bedside Adapter Wireless Network Adapter 335 Altitude Setting 336 Monitor Safety Specifications 336 Physical Specifications 337 Environmental Specifications 339 M4605A Battery Specifications 341 Monitor Performance Specifications 342 Measurement Specifications 348 ECG Arrhythmia ST 348 Respiration 350 SpO 350 NBP 352 Invasive Pressure and Pulse 354 Temp 355 CO 356 Interfering Gas and Vapor Effects On CO Measurement Values 359 Spirometry 359 Cardiac Output Continuous Cardiac Output 361 tcGas 362 SvO gt 363
171. body temperature when the measurement is made Small signal more indicator required The peak of the transpulmonary thermodilution curve was below 0 1 C Increase injectate volume and or lower injectate temperature Injectate Temperature too High The difference between the blood and injectate temperatures is too small The calculated value for C O may not be accurate High ETVI use cold injectate or greater inj volume The ETVI value is too high The accuracy of the transpulmonary thermodilution measurement may be reduced Increase injectate volume and or lower injectate temperature following the guidelines given in the section Guidelines for PiCCO C O Injectate on page 170 Disturbed Injection The injection should be performed quickly and with a steady pressure Shaking unsteady pressure or injections that take longer than six seconds may cause this message to appear you should bear this in mind if you are using a large injectate volume gt 10 ml 171 Check Injectate The recorded Tinj signal is uncharacteristic for the M1646 injectate Temperature Probe Type temperature probe The probe may be defective or an incorrect probe type may have been used Unsteady Baseline There is a noisy baseline and thermal baseline drift Multiple Peaks Caused by faulty injection technique Abnormal Decay Time May be caused by low cardiac output Calculated value for C O may not be ac
172. bol is shown beside the measurement label of any measurement whose alarm switched off To open the Alarm Limits window either select any alarm field to open the Alarm FAN ij Messages window then select the Alarm Limits pop up key or select the Alarm Limits SmartKey if configured Alarm Limits ST v4 ST v5 Graphic view of current ST V6 yellow and red alarm limits and currently Spo2 monitored measurement value Off indicates the Pulse Sp02 measurement is switched off NBPs ABPs PAPd Apnea Time Measurement labels with alarms Current alarm limits off symbol where appropriate Select Show ST Limits to expand the list of ST leads and view the currently set alarm limits Selecting Hide ST Limits hides the list again You can use the pop up keys that open with the Alarm Limits window to perform common tasks All Al On All Al Off All Lim Narrow All Lim Wide to set narrow or wide alarm AutoLimits for all measurements Print Limits Record Limits to print a list of all current alarm limit settings on a connected printer or recorder 47 These pop up keys are not available in the window for changing individual alarm limits which you access by selecting the measurement label in the Alarm Limits window Changing Alarm Limits To change individual measurement alarm limits using the measurement s Setup Menu 1 in the measurement s setup menu select the alarm limit you want to change This cal
173. bpm to AAMI EC 13 1992 standard Pedi Neo 1 bpm steps 15 to 50 bpm 5 bpm steps 50 to 300 bpm Extreme Tachy Difference to high limit 0 to 50 bpm 5 bpm steps Clamping at 150 to 300 bpm 5 bpm steps Extreme Brady Difference to low limit 0 to 50 bpm 5 bpm steps Clamping at 15 to 100 bpm 5 bpm steps Run PVCs 2 PVCs Not adjustable by user PVCs Rate 1 to 99 PVCs minute 1 PVC Vent Tach HR 20 to 300 bpm 5 bpm Vent Tach Run 3 to 99 PVCs minute 1 PVC Vent Rhythm Run 2 to 99 PVCs minute 1 PVC SVT HR 120 to 300 bpm 5 bpm SVT Run 3 to 99 SV beats 1 SV beat ST High 19 8 to 20 mm 0 2 mm ST Low 20 to 19 8 mm 0 2 mm Respiration Excitation Waveform Sinusoidal signal 260 WA 39 kHz Noise Suppression RL drive gain 44 dB max max voltage 1 8 Vrms Time to Alarm for Vent Tachycardia Gain 0 5 Range 6 5 to 8 4 seconds Average 7 2 seconds Tachycardia 1mVpp 206 bpm Gain 1 0 Range 6 1 to 6 9 seconds Average 6 5 seconds Gain 2 0 Range 5 9 to 6 7 seconds Average 6 3 seconds Vent Tachycardia Gain 0 5 Range 5 4 to 6 2 seconds Average 5 8 seconds 2 mVpp195bpm Gain 1 0 Range 5 7 to 6 5 seconds Average 6 1 seconds Gain 2 0 Range 5 3 to 6 1 seconds Average 5 7 seconds Tall T Wave Rejection Capability Exceeds ANSI AAMI EC 13 Sect 3 1 2 1 c minimum recommended 1 2 mV T Wave amplitude 349 Heart Rate Range 6 4 to 7 2 seconds Average 6 8 seconds HR change from 80 to 40 bpm Range 5 6 to 6 4 sec Average 6 0 seconds He
174. can be removed To replace battery 2 rotate the battery retainer until the battery can be removed 3 Pull gently on the canvas strap to move the battery towards you then grasp the battery and pull it out fully 4 Slide the new battery into position making sure that the positive and negative poles are facing in the correct direction as outlined on the inside of the battery compartment door 5 Repeat with the second battery if required 6 Center the battery retainer and close the battery compartment door Optimizing Battery Performance The performance of rechargeable batteries may deteriorate over time Maintaining your batteries as recommended here can help to slow down this process 301 Display Brightness Setting IntheMain Setup menu select User Interface gt Brightness gt Optimum This selects a level of brightness suitable for most monitoring locations that uses less battery power than brighter settings Satisfy yourself that this level of brightness is suitable for your monitoring location Note that your monitor may be configured to dim or brighten the display brightness automatically when you disconnect from power to suit the most common transport scenario TransportBrightn setting Charging Batteries Batteries can be charged in monitors used to monitor patients Charging is quicker in unused monitors Contact your local Philips representative for information on external battery chargers Use only
175. cate that the catheter tip is positioned numeric is displayed with against a blood vessel wall or that there is low blood flow INOP tone with display Reposition the catheter and perform a light intensity calibration SvO LOW LIGHT SvO The optical signal levels are too low Check that the catheter is SvO numeric is replaced by or either in the optical reference or inserted into the patient numeric is displayed with Check the catheter to Optical Module connection If INOP INOP tone may sound persists try another catheter and Optical Module SvO NO OPTMOD SvO Connect the Optical Module If the INOP persists try another SvO numeric is replaced by Optical Module Silencing this INOP switches the INOP tone measurement off SvO OPTMOD DEFECT SvO gt The Optical Module memory is faulty and calibration data cannot be stored for transport or during power failure If this feature is needed use another Optical Module SvOz OPTMOD WARMUP SvO gt The Optical Module has not yet reached the operating SvO numeric is displayed with temperature Wait a few minutes until warm up is finished SvO PRE INS CALIB SvO The pre insertion calibration is running This typically takes one minute During this time SvO alarms are switched off Wait until the calibration is complete SvO UNABL TO MEAS SvO The signal is out of the normal range and no SvO value can SvO numeric is repl
176. cement 2 Place the electrodes on the patient according to the lead placement you have chosen 3 Attach the electrode cable to the patient cable 4 Plug the patient cable into the white ECG connector on the measurement server An ECG waveform and numeric appears on the monitor display ECG Connector 91 CAUTION To protect the monitor from damage during defibrillation for accurate ECG information and to protect against noise and other interference use only ECG electrodes and cables specified by Philips Selecting the Primary and Secondary ECG Leads The monitor uses the primary and secondary lead to compute HR and to analyze and detect cardiac arrhythmias They are also available for recordings and for display on the Information Center The secondary lead setting is used only if your monitor is configured for multi lead instead of single lead arrhythmia analysis It determines which additional lead will be used for arrhythmia analysis You should choose a lead as primary or secondary lead that has the following characteristics e the QRS should be either completely above or below the baseline and it should not be biphasic e the QRS should be tall and narrow Omm e the P waves and T waves should be less than 0 2 mV To select a lead as primary or secondary lead Inthe Setup ECG menu select Primary Lead or Secondary Lead then select the appropriate lead You can assign any available lead whether i
177. ch external devices the module is configured The selection LED C shows which device is currently active The device label text may differ slightly from the labels on the external devices See the documentation supplied with the VueLink module for a list of supported devices and accessories and for configuration information 281 Connecting an External Device 1 Insert the module into the FMS or integrated module slot 2 Check that the device selection LED c lights to show that it has correctly identified the external device If not selectMain Setup gt Measurements gt lt VueLink Device Name gt to enter the setup menu for the connected device headed Setup lt VueLink Device Name gt 3 In the device setup menu select Device select the correct device from the list and confirm the selection 4 Connect the external device to the module e and switch it on Once the VueLink device has been correctly connected you can select the VueLink SmartKey and then select the Setup VueLink pop up key to access the Setup VueLink menu for the connected device CAUTION Selecting the wrong device can cause unpredictable system behavior Rectify this by switching off the external device when it is safe to do so and selecting the correct device Changing VueLink Waves and Numerics Displayed To change the waves and numerics from the VueLink module displayed on the Screen 1 SelectMain Setup gt Measurements gt lt VueLin
178. choose from the pop up list of alternatives to input information Ifa conventional Patient Demographics Last Name First Name MRN Patient Cat Adult Paced No Height Weight BSA D Date of Birth Age Gender Notes 1 Notes 2 keyboard or a barcode scanner is connected to the monitor you can use this to enter patient information Last name Enter the patient s last name family name for example Smith 77 First name Enter the patient s first name for example Joseph MRN Enter the patient s medical record number MRN for example 12345678 Patient Cat Choose the patient category either Adult Pediatric or Neonatal Paced Choose Yes or No You must use Yes if your patient has a pacemaker Height Enter the patient s height Weight Enter the patient s weight BSA The monitor calculates the body surface area automatically Date Of Birth Enter the patient s date of birth Enter this in the form dd mm yyyy Age The monitor calculates the patient age automatically Gender Choose Male or Female Notes Enter any extra information about the patient or treatment 5 Select Confirm The patient status changes to admitted Patient Category and Paced Status The patient category setting determines the algorithm the monitor uses to process and calculate some measurements the safety limits that apply for some measurements and the alarm l
179. cilities The devices are to be used by trained health care professionals All the monitors are intended for use in health care facilities the MP20 MP30 MP40 MP50 monitors are additionally intended for use in transport situations within the hospital setting The monitors are only for use on one patient at a time They are not intended for home use Rx only U S Federal Law restricts this device to sale by or on the order of a physician Not a therapeutic device The transcutaneous gas measurement tcGas is restricted to neonatal patients only ST segment monitoring is intended for use with adult patients only and is not clinically validated for use with neonatal and pediatric patients The ECG measurement is intended to be used for diagnostic recording of rhythm and detailed morphology of complex cardiac complexes according to AAMI EC 11 BIS is intended for use under the direct supervision of a licensed health care practitioner or by personnel trained in its proper use It is intended for use on adult and pediatric patients within a hospital or medical facility providing patient care to monitor the state of the brain by data acquisition of EEG signals The BIS may be used as an aid in monitoring the effects of certain anesthetic agents Use of BIS monitoring to help guide anesthetic administration may be associated with the reduction of the incidence of awareness with recall in adults during general anesthesia and sedation Indication for
180. ck that is not connected to the patient catheter when y stop P P you measure a patient c Attach the syringe to one port and the manometer tubing to the other port d Open the port to the manometer tubing to manometer P Syringe with heparinised solution 3 Move the syringe barrel in and raise the mercury to 200mmHg 30kPa 200mmHg is the recommended calibration pressure 4 Inthe Setup Pressure menu select Cal Press 156 5 Select the calibration pressure from the list for example 200 mmHg 6 Select Confirm to recalculate the calibration factor using the applied pressure 7 When the monitor displays lt Press gt calibration done at lt date and time gt remove the manometer tubing syringe and extra stopcock We recommend you replace the transducer dome and tubing with sterile ones 8 Label the transducer with the calibration factor shown in the Cal Factor field in the pressure s setup menu 9 Reconnect the patient and start measuring again Troubleshooting the Pressure Calibration The status line lists the probable cause of an unsuccessful calibration unable to calibrate Contact your service department The pressure hardware is faulty equipment malfunction unable to calibrate Make sure that you have selected the value forCal Press that out of range you are applying to the transducer and repeat the calibration unable to calibrate no Make sure t
181. conds 10 seconds 5 seconds Events Pop Up Keys Depending on the events view you choose a selection of the events pop up keys let you navigate through the stored events and carry out events related tasks Event open the Event Surveillance Setup menu Setup Show open the Event Episode window to review the selected event in Episode detail Show open the Event Review window Review Review choose a different event group for reviewing in the Event Review Group window Advanced Event Surveillance only Show open the Event Summary window Summary Manual start a manually triggered event capture Event move the cursor left or right to the next event to navigate through the la gt events database Placing the cursor over an event highlights it and shows the event values for the selected event 243 jump to the first or last event in the event database Vitals Graphic toggle between a tabular and graphic version of the Event Episode View View window currently viewed Table Graphic toggle between a tabular and graphic version of the Event Review Review Review window currently viewed Delete delete the currently selected event from the database The monitor asks Event you to confirm this deletion You cannot retrieve deleted events Select access the list of available annotations to add a nursing note for the Annot current event episode Advanced Event Surveillance only Pri
182. configuration 2 hours Brightness set to Optimum MMS and measurement server extension connected NBP every 15 minutes Recorder every 15 minutes Charge Time When monitor is off 4 hours When monitor is in use 5 to 12 hours depending on monitor configuration Indicators Alarms Off red crossed out alarm symbol LED Alarms red yellow cyan LED On Standby green LED AC Power green LED Error red LED Battery LED MP20 red yellow green LED 30 40 50 only Sounds Audible feedback for user input Prompt tone QRS tone or SpO modulation tone 4 different alarm sounds Remote tone for alarms on other beds in network Tone for Timer expired Trends Resolution 12 16 24 or 32 numerics 12 sec 1 minute 5 minute resolution Information Multiple choices of number of numerics resolution and duration depending on trend option and application area For example neonatal extended 12 numerics 24 hours 12 secs or 32 numerics 32 hours 1 minute intensive care extended 16 numerics 120 hours 5 minutes anesthesia extended 32 numerics 9 hours 12 seconds High Res Trend Waves Measurements HR SpO Resp tcpO Pulse Perf tcpO CO ABP PAP available CVP ICP CPP BIS CCO AWP Anesthetic Agents Delta SpO inO Resolution Measurement samples are taken at a resolution of four samples per second Update speed waves are drawn at a speed of 3 cm minute 343 344 Events Information trigger condition
183. cord Status pop up key Printing Battery Reports To print the information in the Battery Status window on a connected printer 1 Select the battery status information on the Screen to open the Battery Status window 2 Select the Print Status pop up key Checking Battery Charge To check the charge status of a battery in a monitor see the battery power gauge on the Screen or select Main Setup gt Battery to enter the Battery Status window To check the charge status of a battery that is not connected to a monitor or battery charger press the black dot marked PUSH on the labeled side of the battery The remaining charge is indicated by four LEDs on the electronic fuel gauge directly above the dot Each LED represents 25 of 300 charge If all LEDs are lit the battery is fully charged if only one LED is lit 25 or less charge is left Replacing Batteries MP40 MP50 You can replace batteries without switching off the monitor if you replace them one at a time and if the remaining battery has sufficient power The Battery Missing INOP is suppressed for 30 seconds while you exchange each battery MP20 MP30 When using the monitor with only one battery insert the new battery before removing the previous battery to avoid leaving the monitor without power To replace batteries 1 Press the battery compartment latch to open the battery compartment door 2 To replace battery 1 rotate the battery retainer until the battery
184. cording to the standards that apply for your hospital The electrode placement illustrations in this chapter use the AAMI labels and colors RA I R White Red LA S L Black Yellow ILIE A F Red Green RL N N Green Black Vv E C Brown White Vi Cl Brown Red White Red v2 E2 Brown Yellow White Yellow V3 C3 Brown Green White Green V4 C4 Brown Blue White Brown V5 C5 Brown Orange White Black V6 C6 Brown Violet White Violet 97 Standard 3 Lead Placement Fa RA placement directly below the clavicle and near the right shoulder LA placement directly below the clavicle and near the left shoulder LL placement on the left lower abdomen Standard 5 Lead Placement RA placement directly below the clavicle and near the right shoulder LA placement directly below the clavicle and near the left shoulder RL placement on the right lower abdomen LL placement on the left lower abdomen V placement on the chest the position depends on your required lead selection 98 Chest Electrode Placement For accurate chest electrode placement and measurement it is important to locate the fourth intercostal space 1 Locate the second intercostal space by first palpating the Angle of Lewis the little bony protuberance where the body of the sternum joins the manubrium This rise in the sternum is where the second rib is attached and the space jus
185. cous accumulating on the airway adapter windows Measurement values provided by a ventilator may differ significantly from the values provided by the spirometry module due to different locations of the flow sensor Incorrect entry of gas compensation parameters i e temperature gas composition may reduce the accuracy of the measured values 189 Zero Calibration Abnormal waveform due to leak Normal waveform In general if MVexp or TVexp are significantly smaller than MVin or TVin the tubing should be checked for leaks Zero Calibration The zero calibration maintains the accuracy of the spirometry waves and numerics by regularly compensating for drifts within the measurement section It is performed automatically without user interaction and takes about 2 seconds to complete The automatic zero calibration is normally carried out every ten minutes During warm up or when the ambient pressure changes this interval may be reduced to two minutes During the zero calibration the waveform is flat but the numerics remain on the screen Typically a zero calibration is started at the beginning of a respiration cycle therefore a waveform may begin normally and then immediately become flat for the time of the zero calibration WYT PI 32 520 Pi N H S Ny ped Zero Calibration Automatic Purging A double lumen connecting line tubing connects the flow sensors to the patient monitor The M1014A Spirometry
186. cting AutoSize lets the monitor choose the optimal adjustment factor for all displayed ECG Waves To Change the Size of all the ECG Waves To change the size of all the ECG waves on the screen by a fixed adjustment factor 1 Inthe Setup ECG Lead menu select Adjust Size 2 Select the required adjustment factor from the line of pop up keys Size x0 5 to halve the wave size Size x1 to display the wave without zoom Size x2 to double the wave size Size x4 to multiply the wave size by four Previous Size to return one step to the previous size Auto Size to let the monitor choose the optimal adjustment factor for all the ECG waves Changing the Volume of the QRS Tone The QRS tone is derived from either the HR or Pulse depending on which is currently selected as the alarm source The QRS volume can be set from 0 to 10 0 means off To change the QRS volume in the Setup ECG menu select QRS Volume and then select the appropriate volume from the pop up list Changing the ECG Filter Settings The ECG filter setting defines how ECG waves are smoothed A letter indicating the filter type is shown underneath the lead label on the monitor display Filter settings do not affect ST measurement 12 Lead ECG captures are analyzed in the PIC using the diagnostic filter and displayed on the Information Center using the filter setting from the bedside monitor Any changes you make to the filter setting at the bedside monitor ma
187. ctive grayed out have been disabled in the monitor s Configuration Mode When the alarm volume is set to zero off the alarm volume symbol reflects this If you switch the alarm volume off you will not get any audible indication of alarm conditions Minimum Volume for No Central Monitoring INOP If your monitor is connected to an Information Center and the connection is interrupted the INOP messageNo Central Monit will appear within 30 seconds accompanied by an INOP tone To help ensure that this INOP and any other active alarm is not overlooked the INOP and alarm tones may be configured to have a minimum volume In this case INOP and alarm tones will sound even if the monitor alarm volume is set to zero 43 Acknowledging Alarms To acknowledge all active alarms and INOPs select the Silence permanent key This switches off the audible alarm indicators and alarm lamps Alternatively you can acknowledge alarms by pressing the Silence hardkey on the MMS or on the SpeedPoint The hardkeys follow the behavior configured for the permanent key A check mark beside the alarm message indicates that the alarm has been a Ea acknowledged If the monitor is configured to re alarm a dashed check mark will be shown If the condition that triggered the alarm is still present after the alarm has been acknowledged the alarm message stays on the screen with a check mark symbol beside it If the alarm condition is no
188. ctopic messages detected are listed in Arrhythmia Status Messages on page 110 Where Can I Find More Information See the Application Notes on ST and Arrhythmia supplied on your documentation CD Rom for detailed information on the arrhythmia algorithm and its clinical application 107 Switching Arrhythmia Analysis On and Off 1 Inthe Setup Arrhythmia menu select Arrhythmia to toggle between On and Off 2 Select the Confirm pop up key which appears at the bottom of the screen Be aware that when arrhythmia analysis is switched off the message Arrythmia OFF appears beside the ECG wave if configured to do so only the HR related alarms are detected the asystole alarm the ventricular fibrillation ventricular tachycardia alarm the extreme tachycardia extreme bradycardia alarms the high heart rate low heart rate alarms HR High and HR Low alarms behave like normal yellow alarms no timeout periods are active Choosing an ECG Lead for Arrhythmia Monitoring It is important to select a suitable lead for arrhythmia monitoring Guidelines for non paced patients are QRS should be tall and narrow recommended amplitude gt 0 5 mV R Wave should be above or below the baseline but not bi phasic T wave should be smaller than 1 3 R wave height the P wave should be smaller than 1 5 R wave height For paced patients in addition to the above the pace pulse should be not wider than the normal QRS
189. culations window does not change Substituted values are marked with an asterisk Automatic Unit Conversion The monitor needs consistent units for performing calculations It automatically converts units where necessary before it performs the calculation for example pressures sourced in kPa cmH O or mbar are automatically converted to mmHg or to cmH O for ventilation calculations Manual Unit Conversion If you need to convert units for other purposes you can use the Unit Conversion window Unit Conversion 2 Select Unit Conversion Fahrenheit Celsius 3 Select the field under the unit you know and use the on 104 00 40 00 screen keypad to enter the known value The converted 1 Select Main Setup gt Calculations Inch Centimeter value automatically appears in the adjacent field 7 48 19 00 Pound Kilogram 154 32 70 00 BSA Formula Your monitor provides both the Boyd and Dubois formulas for the calculation of body surface area BSA For calculations the monitor uses the setting defined in the Patient Demographics menu All calculation results that use BSA are indexed to the selected formula 236 To check the current setting select the patient name to enter the Patient Demographics menu BSA B indicates that the Boyd formula is used BSA D indicates that the Dubois formula is used Documenting Calculations To send a Calculations recording to a connected recorder in the Calculation
190. curate Very Long Curve The decay time of the curve is longer than 15 seconds Very Short Curve Decay time of the curve is less than 0 5 seconds If there is a noisy baseline part of the baseline may have been mistaken for a thermodilution curve Calculated value for C O may not be accurate Irregular Curve Any combination of curve alert messages Delayed Injection Injection is given more than 15 seconds after Start C O is selected Calculated value for C O may not be accurate If you have followed all of these guidelines your measurement values should be valid even if you still see a curve alert message Ensure that at least three subsequent measurements within the current series do no differ by more than 15 If the difference exceeds 15 use your clinical judgement to determine the appropriate intervention C 0 CCO Prompt Messages Prompt messages appear in the C O procedure window if a C O measurement trial must be terminated Curve Below Baseline May be caused by thermal baseline drift No C O value measurement terminated calculated Excessive Curve Height The curve exceeds the upper limit This may be caused by an measurement terminated injectate that was too cold No C O value calculated Unstable Baseline The baseline is unstable Wait until the baseline is stable before injection not recommended injecting If this does not occur within a reasonable time injection is possible but the acc
191. d ICA Independent Computing Architecture are registered trademarks of Citrix Systems Inc Masimo Masimo SET and LNOP are federally registered trademarks of the Masimo Corporation Other product and company names mentioned in this book may be trademarks of their respective owners 327 Symbols 328 These symbols appear on the monitor and its associated equipment Refer to accompanying documents Protective earth 4 RS232 connector RS 232 Standby Equipotential grounding M 2002 Identifies year 06 and month of manufacture Connection direction indicator Alternating current Connection direction indicator es On some older measurement Electrical input indicator servers and extensions and modules this symbol may indicate the gas input Q gt Electrical output indicator On some older measurement servers and extensions and modules this symbol may indicate the gas output 79V Connector has special protection against electric shocks and is defibrillator proof Gas input indicator s gt Gas output indicator Quick mount release C FMS Power On ga Serial MIB connector Interruption indicator Indicator Ready for ix operation CY Mouse connection Keyboard aa Printer connection indicator connection indicator indicator Digital video device ar Parallel interface Alarm Nurse call rela
192. d away from its correct location ECG Leads Monitored If you are using these leads are available Resp is measured between electrodes a 3 electrode set I H M RA and LL a 5 electrode set I II III aVR aVL aVF V and MCL RA and LL a 10 electrode set I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 RA and LL an FASI 5 electrode set I II IH aVR aVL aVF V1 V2 V3 V4 V5 V6 Iand A Changing Lead Sets To change the ECG lead set 1 Remove the electrodes and then replace them as required 2 Ifthe new lead set has more leads than the previous the monitor automatically recognizes the new lead placement If the new lead set has fewer leads then you must select New Lead Setup in the Setup ECG menu If you remove electrodes and do not select New Lead Setup the monitor 96 will issue a Lead Off INOP message Select New Lead Setup and the INOP message will disappear ECG Lead Fallback If fallback is configured on and there is a leads off INOP in the primary lead and in the secondary lead if you are using multi lead monitoring for longer than 10 seconds and if another lead is available this available lead automatically becomes the primary lead This is known as lead fallback When the Leads Off condition is corrected the leads are automatically switched back This setting can only be changed in Configuration Mode ECG Lead Placements The labels and colors of the ECG electrodes differ ac
193. d country General Points Keep your monitor modules Multi Measurement Server measurement server extensions Flexible Module Server cables and accessories free of dust and dirt After cleaning and disinfection check the equipment carefully Do not use if you see signs of deterioration or damage If you need to return any equipment to Philips decontaminate it first Observe the following general precautions e Always dilute according to the manufacturet s instructions or use lowest possible concentration e Do not allow liquid to enter the case e Do not immerse any part of the equipment in liquid e Do not pour liquid onto the system e Never use abrasive material such as steel wool or silver polish e Never use bleach WARNING Do not operate any devices when they are wet If you spill liquid on the equipment battery or accessories contact your service personnel or Philips service engineer The general care and cleaning information given here meets the requirements of Aspect Medical Systems for their BIS measurement devices 293 Cleaning Clean with a lint free cloth moistened with warm water 40 C 104 F maximum and soap a diluted non caustic detergent tenside ammonia or alcohol based cleaning agent Do not use strong solvents such as acetone or trichloroethylene Take extra care when cleaning the screen of the monitor because it is more sensitive to rough cleaning methods than the housing Do not permit
194. d display scale dependent on the patient category Hi Res Trend Waves and OxyCRG OxyCRG is a combination of three hi res trend waves btbHR SpO and Resp mainly used in neonatal monitoring 239 22 High Resolution Trend Waves Printing Hi Res Trend Wave Reports Printing Hi Res Trend Wave Reports To print hi res trend waves on reports you can choose to print either e all VisibleWaves prints all waves and hi res trend waves currently displayed All Waves prints realtime waves and hi res trend waves for all currently monitored measurements e HiRes Waves prints hi res trend waves for the currently monitored measurements e OxyCRG Waves prints hi res trend waves for btbHR SpO and Resp For each hi res trend wave six minutes of measurement data will be printed See the section on Reports for more information on setting up reports Hi Res Trend Wave Recordings The selection of waves in hi res trend wave recordings and the printing speed are defined by the pre configured HiResTrd recording template See the section on Recordings for more information To start a hi res trend waves recording 1 select the Realtime Record SmartKey if configured or select Main Setup gt Recordings 2 select the Start HiResTrd pop up key 240 23 Event Surveillance Events are electronic records of episodes in your patient s condition You can trigger them manually or set them to trigger automatically during pre d
195. d then on again cancels all visual and audible indicators and resets the timeout periods Silencing an alarm cancels all visual and audible indicators if the alarm condition is no longer present How are Yellow Arrhythmia Alarms Indicated When a yellow arrhythmia alarm is generated it triggers visual and audible indicators Behavior of Unsilenced Arrhythmia Alarms Yellow arrhythmia alarms are always set to latch visually for three minutes Yellow arrhythmia alarms that have not been silenced behave as explained in this table Single alarm instance Non sustained All settings when alarm condition is for 3 minutes latching V tach initially detected time Continuous alarm condition HR LOW All settings until the alarm condition Same intermittent alarm Pair of PVCs 2 minutes or less stops plus a maximum of condition occurring 3 minutes latching time 3 minutes or more each time the alarm requently more than once condition is detected provided that the timeout period has expired and the per minute alarm message has cleared Behavior of Silenced Arrhythmia Alarms If you silence a yellow arrhythmia alarm and the alarm condition still exists the visual indicators continue until the condition stops You will not get a realarm for the same condition or another condition lower down on the same chain until the alarm condition has stopped and reoccurred and the timeout period has e
196. d yellow alarm tones and the INOP tones e change the alarm sound to suit the different alarm standards valid in different countries Traditional Audible Alarms HP Agilent Philips Carenet e Red alarms A high pitched sound is repeated once a second e Two star yellow alarms A lower pitched sound is repeated every two seconds e One star yellow alarms arrhythmia alarms The audible indicator is the same as for yellow alarms but of shorter duration e INOPs an INOP tone is repeated every two seconds ISO IEC Standard 9703 2 Audible Alarms e Red alarms A high pitched tone is repeated five times followed by a pause e Two star yellow alarms A lower pitched tone is repeated three times followed by a pause e One star yellow alarms arrhythmia alarms The audible indicator is the same as for yellow alarms but of shorter duration e INOPs a lower pitched tone is repeated twice followed by a pause Changing the Alarm Tone Volume The alarm volume symbol at the top right of the monitor screen gives you an ry all indication of the current volume To change the volume select the volume symbol and then select the required volume from the pop up selection Ifyou want to see a numerical indication of the current alarm volume on a scale from zero to 10 select the Alarm Volume SmartKey The volume scale pops up The current setting is indented To change the setting select the required number on the scale Any settings that are ina
197. derstanding the Resp Display 132 Changing Resp Detection Modes 132 Auto Detection Mode 132 vi Manual Detection Mode 133 Resp Detection Modes and Cardiac Overlay 133 Changing the Size of the Respiration Wave 133 Changing the Speed of the Respiration Wave 134 Using Resp Alarms 134 Changing the Apnea Alarm Delay 134 Resp Safety Information 134 9 Monitoring SpO gt 137 SpO Sensors 137 Applying the Sensor 137 Connecting SpO Cables 138 Measuring SpO 138 Assessing a Suspicious SpO Reading 139 Understanding SpO Alarms 140 Alarm Delays 140 Adjusting the Alarm Limits 140 Adjusting the Desat Limit Alarm 140 Pleth Wave 140 Perfusion Pleth Indicator 141 Setting SpO Pleth as Pulse Source 141 Setting Up Tone Modulation 141 Setting the QRS Volume 141 Calculating SpO Difference 141 10 Monitoring NBP 143 Introducing the Oscillometric NBP Measurement 143 Measurement Limitations 144 Measurement Methods 144 Reference Method 144 Preparing to Measure NBP 144 Correcting the Measurement if Limb is not at Heart Level 145 Understanding the NBP Numerics 145 Starting and Stopping Measurements 146 Enabling Automatic Mode and Setting Repetition Time 146 Choosing the NBP Alarm Source 147 Assisting Venous Puncture 147 Calibrating NBP 147 11 Monitoring Temperature 149 Making a Temp Measurement 149 Selecting a Temperature for Monitoring 149 Extended Temperature Label Set 150 Calculating Temp Difference 150 Vii 12 Monitoring Invas
198. ducer on the other calstick cell and start the CAL2 calibration cycle CO ZERO FAILED CO An error occurred during the last zero calibration Check the Numeric is replaced by a airway adapter and clean if necessary Perform another zero INOP tone calibration If the INOP persists contact your service personnel CO ZERO REQUIRED CO Perform zero calibration for the CO sensor If the INOP Numeric is replaced by a persists contact your service personnel INOP tone CO ZERO RUNNING CO Wait until zero calibration is finished CPP CHK SOURCES CPP Not all measurements or values required to perform the Numeric is replaced by a calculation are available Check the measurement sources CPP CHK UNITS CPP The monitor has detected a conflict in the units used for this Numeric is replaced by a calculation Check the unit settings CUFF NOT DEFLATED NBP Remove the cuff from the patient Make sure that the tubing is Numeric is displayed with a not kinked or twisted and that the correct patient category is IMOP Ae selected Try repeating the measurement You can silence the INOP but the INOP message remains During this INOP alarms cannot be visible until the next NBP measurement is started or the Stop paused or switched off A11 SmartKey is selected Adult or pediatric patients The NBP cuff pressure has exceeded 15mmHg 2kPa for more than 3 minutes Neonatal patients The NBP cuff pressure ha
199. ducer reaches operating temperature Wait until this disappears before starting the measurement 180 2 To remove the transducer from the airway adapter open the latch and pull out the airway adapter rere PALE re a Wether MERN WARNING To prevent stress on the endotrachial tube support the transducer and airway adapter To avoid infection use only sterilized airway adapters Using the Microstream CO Extension M3015A The M3015A Microstream CO Extension measures the partial pressure of carbon dioxide in a patient s expired gas using Microstream technology In intubated patients a sample of the respiratory gas is drawn from the patient s breathing circuit through an airway adapter and a gas sampling tube In non intubated patients the gas sample is drawn through a nasal or oral nasal cannula When using the appropriate accessories you can use the Microstream CO measurement with adult pediatric and neonatal patients The M3015A is equipped with an automatic barometric pressure compensation Preparing to Measure Microstream CO Use appropriate accessories for e the patient type adult pediatric or neonatal e the ventilation situation including humidification e the duration short term use up to 24 hours typically OR or long term use typically ICU All accessories are for single patient use only Using Microstream Accessories M3015A can be operated with the speci
200. e Switching off the Resp measurement can prevent this 106 About Arrhythmia Monitoring Arrhythmia analysis provides information on your patient s condition including heart rate PVC rate rhythm and ectopics The monitor uses the user selected primary and secondary ECG leads for single lead or multi lead arrhythmia analysis During arrhythmia analysis the monitor continuously e optimizes ECG signal quality This is important for arrhythmia analysis The monitor continuously filters the ECG signal to remove baseline wander muscle artifact and signal irregularities Also if the Patient Paced status is set to Yes pace pulses are filtered out to avoid processing them as QRS beats e detects beats for example QRS complexes identifying them for further analysis e measures signal features such as R wave height width and timing e creates beat templates and classifies and labels beats to aid in rhythm analysis and alarm detection e examines the ECG signal for ventricular fibrillation asystole and noise Arrhythmia Options Your monitor has either the basic or the enhanced arrhythmia option Both options provide rhythm and ectopic status messages and beat labelling The number of rhythms being classified events being detected and alarms generated differs according to the option The alarms available with the different options are listed in the section ECG Arrhythmia and ST Alarm Overview on page 104 the rhythm and e
201. e paced patient only within the last minute B E PACER NOT PACE Pause without pace pulse paced patient only within the last minute B E PAUSE No beat detected for 1 75 x average R R interval for HR lt 120 or E No beat for 1 second with HR gt 120 non paced patient only or No beat detected for more than the set pause threshold R ON T PVCs R ON T detected within the last minute E MULTIFORM PVCs Multiform PVCs detected within the last minute E FREQUENT SVPBs SVPB count within last minute is greater than 5 E SVPBs 1 5 SVPBs in the last minute with a sinus rhythm and no Vs E SV BEATS SV count within last minute and rhythm status is PACED B E PACED BEATS Paced beat count within last minute and rhythm status is NOT B E PACED Arrhythmia Relearning During a learning phase e Alarm timeout periods are cleared Stored arrhythmia templates are cleared e Asystole Vfib and HR alarms when there are enough beats to compute the HR are active No other alarms are active Initiating Arrhythmia Relearning Manually 1 To initiate relearning manually in the Setup Arrhythmia menu select Relearn Arrhy While the monitor is learning the delayed arrhythmia wave displays the beat label L and the rhythm status message LEARNING ECG Next the monitor determines the dominant rhythm The beats are labeled N and the rhythm status message changes to LEARNING RHYTHM 2 After relearning is complete yo
202. e application site every two to three hours to ensure skin quality and correct optical alignment If the skin quality changes move the sensor to another site Change the application site at least every four hours Using an SpO sensor during MR imaging can cause severe burns Minimize this risk by positioning the cable so that no inductive loops are formed If the sensor does not appear to be operating properly remove it immediately from the patient CAUTION Injected dyes such as methylene blue or intravascular dyshemoglobins such as methemoglobin and carboxyhemoglobin may lead to inaccurate measurements Interference can be caused by e High levels of ambient light Hint cover application site with opaque material e Electromagnetic interference e Excessive patient movement and vibration Assessing a Suspicious SpO Reading Traditionally pulse rate from SpO was compared with heart rate from ECG to confirm the validity of the SpO reading With newer algorithms such as FAST SpOsy this is no longer a valid criteria because the correct calculation of SpO is not directly linked to the correct detection of each pulse When pulse rate is very low or strong arrhythmia is present the SpO gt Pleth pulse rate may differ from the heart rate calculated from ECG but this does not indicate an inaccurate SpO value If you doubt the measured SpOg use the pleth wave and perfusion indicator instead to assess the signal quality
203. e channel on the monitor Screen The wave channel speed is independent of the wave label depicted in the channel if you change the wave the new wave will retain the set channel speed Freezing Waves You can freeze waves on the screen and measure parts of the wave using cursors The waves are frozen with a history of 20 seconds so that you can go back and measure what you have seen Freezing An Individual Wave To freeze a wave 1 Enter the Wave menu for the measurement by selecting the wave on the screen 2 Select Freeze Wave The realtime wave is replaced with the frozen wave Freezing All Waves To freeze all waves on the screen 1 Select the Freeze Waves SmartKey D All realtime waves are replaced with frozen waves Measuring Frozen Waves To measure a frozen wave 1 Select the frozen wave If you are using touch this automatically positions the vertical cursor The cursor can be repositioned by touching the required point on the wave or 2 Using the Speedpoint or another pointing device or touch use the right left arrow keys to move the vertical cursor The vertical cursor moves through the time axis and the current value is displayed next to the cursor 3 Use the up down arrow keys to activate and move the horizontal cursor The horizontal cursor measures the wave value which is displayed above the cursor line 28 Changing The Wave Speed Lowering the wave speed compresses the wave and lets you view a longer time
204. e database configuration In this example we see that the monitor stores the most recent data at the highest resolution older data are stored at a lower resolution 4 hours 12 second resolution means that the monitor stores trend data every 12 seconds for the most recent four hours 48 24 4 hours hours hours now p gt time 4 hours 12 second resolution 24 hours 1 minute resolution 48 hours 5 minute resolution Aperiodic Trends Database Aperiodic trends do not count toward the maximum number of trends allowed by the trend configuration Trend data for aperiodic measurements is stored in a separate database and timestamped with the measurement time Trending Multiple Value Measurements Some measurements generate multiple values for example invasive pressure measurements can provide systolic diastolic and mean values These values are trended as separate measurements Screen Trends Trends configured to display permanently on special monitor Screens are called screen trends The selection and number of measurement waves in the Screen Trend segment depends on your monitor configuration Screen trends are color coded to match the measurement wave and numerics and they can be viewed in graphical tabular or horizon format If you do not see screen trends on the monitor Screen select a different Screen one that is configured to show screen trends Screen trends are only avai
205. e disappear when the DSC update is finished Do not disconnect the DSC during the update No action is needed BIS ELECTR DISC BIS One or more electrodes are not connected to the semi reusable INOP tone sensor cable Check all electrode connections BIS ENGINE DISC BIS BIS engine not connected OR Module Cable defective Make sure that the Module Cable is properly connected If INOP tone INOP persists replace the Module Cable Silencing this INOP switches the measurement off BIS ENGINE INCOMPT BIS BIS engine software is not supported A software upgrade may INOP tone be required Contact your service personnel MP20 30 BIS engine not supported BIS ENGINE MALFUNC BIS Malfunction in the BIS engine hardware Disconnect and INOP tone reconnect the BIS engine If the INOP persists replace BIS engine BIS EQUIP MALF BIS There is a malfunction in the BIS hardware Unplug and replug INOP tone the BIS module If the INOP persists contact your service personnel BIS HIGH IMPEDANCE BIS Impedance of one or more electrode s is above the valid range INOP tone may sound most often caused by bad skin preparation Check the sensor montage and press the electrode pads firmly If this INOP persists replace the sensor s in question using correct skin preparation If INOP persists contact your service personnel BIS IMPEDANCE CHCK BIS The Cyclic Impedance check is running It will stop INOP tone may sound automatically if all impedanc
206. e for the ST point In the Adjust ST Points window you can adjust the ISO and ST point The ST Uses setting can only be changed in Configuration Mode To adjust the ST measurement points 1 Inthe Setup STAnalysis menu select Adjust ST Points to open the Adjust ST Points window Alternatively you can use the Adjust ST Points pop up key in the ST Baseline window 2 Select a suitable ECG lead for ST measurement with a visible J point and a visible P wave Use the up and down arrow keys to scroll through the ST snippets for the other ECG leads 120 About the ST Measurement Points 6 ECG Arrhythmia and ST Monitoring 3 Use the Select Point pop up key to scroll through the points and activate the point you need to adjust then use the left and right arrow keys to move the measurement point Each point is highlighted while active ST label and the ST numeric that would apply using th current points lmV calibration bar Cursors for adjusting ST points Timestamp of _ y most recent ST point adjustment Highlighted ST point Adjust ST Points ST Points adjusted at 04 Apr 03 11 38 ISO Point 80 J Point 48 ST Point J 60 The ISO point cursor positions the isoelectric point relative to the R wave peak The relation is shown beside the ISO point in milliseconds Position the ISO point in the middle of the flattest part of the baseline between the P and Q waves or in front of the P wave The J
207. e on the monitor and the Patient Demographics window will automatically appear so that you can check the data and change it if necessary Manually Resolving Patient Mismatch The patient mismatch is indicated by question marks beside the questionable fields in the Monitor Info Line and in the Patient Demographics window The monitor displays a message such as Different patients in Central and Monitor The Patient Selection window automatically opens so you can decide which patient data to use You do not have to resolve the mismatch immediately however the indicators remain until you do There can be up to three columns of data in the Patient Selection window if the patient is different in the Information Center monitor and MMS After you resolve the mismatch the monitor displays a confirmation window that explains the consequences of your choice telling you where the patient will be continued discontinued Confirm your choice The monitor automatically displays the Patient Demographics window after confirmation Verify that the settings shown are correct for the patient Gender date of birth height weight and nursing notes do not generate a mismatch If these fields are different on different devices the monitor resolves them itself For example it may take date of birth from the Information Center whilst taking gender from the MMS Always check the Patient Demographics after combining patients to ensure that you are satisfied w
208. e or 10 minutes 1 Select one of the alarm fields This calls up the Alarm Messages window 2 Select either the pop up key Pause Al 5 minor the pop up key Pause Al 10 min Each time you select one of these pop up keys the Alarm Pause Time is reset to five or 10 minutes Alarm Limits The alarm limits you set determine the conditions that trigger yellow and red limit alarms For some measurements for example BIS and SpO where the value ranges from 100 to 0 setting the high alarm limit to 100 switches the high alarm off and setting the low alarm limit to 0 switches it off In these cases the alarms off symbol is not displayed WARNING Be aware that the monitors in your care area may each have different alarm settings to suit different patients Always check that the alarm settings are appropriate for your patient before you start monitoring Viewing Individual Alarm Limits HR saa 120 5 You can usually see the alarm limits set for each measurement next to the measurement numeric on the main screen 50 If your monitor is not configured to show the alarm limits next to the numeric Alarm limits you can see them in the appropriate measurement setup menu Select the measurement numeric to enter the menu and check the limits Viewing All Alarm Limits The Alarm Limits overview window lists the currently set alarm limits for all measurements If an Apnea alarm delay time is set this is also shown The Alarms Off sym
209. e site timer depend on your monitor s configuration WARNING Prolonged continuous monitoring may increase the risk of undesirable changes in skin characteristics such as irritation reddening blistering or burns If the site timer is disabled the transducer will heat indefinitely while on a patient Change the site regularly in accordance with medical procedures in your hospital Setting the tcGas Site Timer The site timer helps reduce the risk of skin burn by ensuring that the transducer is used at one site for no longer than a predefined period It reminds you when this period expires 1 Inthe Setup tcGas menu select Site Time 2 Choose the time you want the transducer to remain on the measurement site The optimum time depends on the transducer temperature and your patient s skin sensitivity The site timer starts automatically when you remove the calibrated transducer from the calibration chamber If you return the transducer to the chamber and then remove it again the site time continues to count down the remaining time it does not start a new time period The time remaining before the site timer expires appears in the status line which is visible as long as the Setup tcGas menu is open When the time expires the monitor sounds a tone and a displays a change site INOP The monitor either switches off the transducer heating or continues monitoring depending on its configuration Although you can reuse the transducer for up t
210. e the entire Screen content but only some parts of it you can substitute individual waves numerics high res waves or trends Be aware that these changes cannot be stored permanently in Monitoring Mode To change the selection of elements on a Screen 1 Select the element you want to change 2 From the menu that appears select Change Wave Change Numeric or Change HiResTrend and then select the wave or numeric you want or select the high resolution trend wave you want from the list of available waves If you do not see Change Numeric in the menu this Screen may be configured to always display the numeric beside its wave Changing the wave will automatically change the numeric The changed Screen is shown with an asterisk in the monitor info line Inthe Change Screen menu the changed Screen is shown linked to the original Screen and marked with an asterisk Up to three modified Screens can be accessed via the Change Screen menu 6 Waves A To recall Screens either i Split Screen A select the name of the Screen in the Change Screen menu Loops o Cardiac Output use the previous next arrows at the top of the Vital Signs A Change Screen menu to move back and forth in the Screen history The ten most recently used Screens Vital Signs A including up to three modified Screens can be accessed After a patient discharge the monitor s default Screen is shown Modified Screens are still avai
211. eau pressure numeric I E ratio The measurement also provides pressure volume loops flow volume loops and pressure flow loops Please see the Respiratory Loops chapter for details on loops When using combined CO Flow sensors you can also perform mainstream capnography with intubated adult pediatric and neonatal patients See the Measuring CO chapter for details on the CO measurement and the Accessories chapter for a list of compatible accessories Electrical Shock Hazard Do not open the module Contact with exposed electrical components may cause electrical shock Always turn off and remove power before cleaning the module Refer servicing to qualified service personnel 187 Attaching the Flow Sensor CAUTION Use the M1014A Spirometry Module with Philips approved accessories only Refer to the instructions for use provided with the accessory 1 Select the appropriate flow sensor Make sure that you are using the correct sensor for the respective patient category Otherwise accuracy may be reduced Pediatric Adult Flow Sensor M2785A Color clear For intubated patients with endotracheal tube diameters gt 4 mm Adds is wo approximately 6 5 cc of deadspace Infant Neonatal Flow Sensor M2786A Color violet For intubated patients with endotracheal tube diameters lt 4 mm Adds less than 1 cc of deadspace Ye You can also use combined CO flow sensors Note that the M3014A Capnography Ex
212. ect Print All to print a report of all For each loop the report prints e the currently displayed loop with the loop capture timestamp e up to six realtime numerics provided by the loop source device e SpO etCO PO and PCO numerics from the patient monitor if available Lastname Firstname Bed Label Respiratory Loops Report 10 Jan 13 30 Source Device Loop Captured at 10 Jan 2004 13 10 TV 550 ml MV 7 15 l min awRR 13 rpm in02 100 mmHg etco2 38 mmHg imCO2 0 1 mmHg SpO2 99 Spo2 1 98 Spo2 r 99 AWP mmHg Philips Hospital Name Page number 292 30 Care and Cleaning Use only the Philips approved substances and methods listed in this chapter to clean or disinfect your equipment Warranty does not cover damage caused by using unapproved substances or methods Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection Consult your hospital s Infection Control Officer or Epidemiologist For comprehensive details on cleaning agents and their efficacy refer to Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health Care and Public Safety Workers issued by the U S Department of Health and Human Services Public Health Service Centers for Disease Control Atlanta Georgia February 1989 See also any local policies that apply within your hospital an
213. ectate If you are using the PiCCO method the use of injectate with a temperature less than 12 C lower than the blood temperature may cause incorrect values for the thermodilution and CCO calibration Injectate Volume Patient Weight and ETVI Values PiCCO Only When deciding on an injectate volume and temperature you must consider your patient s weight and extra vascular thermal volume index ETVI High ETVI The dilution of injectate is influenced by extravascular tissue and fluid The accuracy of the PiCCO method may be reduced in patients with high extra vascular thermal volume index ETVI values Use the table below as a guide in selecting the correct injectate temperature As shown in the table if your patient has an ETVI gt 10 you must use cold injectate Weight Use the table below as a guide in choosing an injectate volume appropriate for the patient weight lt 3kg 2 ml 2 ml 3 ml Use cold injectate lt 10 kg 2ml 3 ml 3 ml lt 25 kg 3ml 5ml 5ml lt 50 kg 5ml 10 ml 10 ml lt 100 kg 10 ml 15 ml 15 ml gt 100 kg 15 ml 20 ml 20 ml 170 ee ea SSS oS eens O C 0 CCO Curve Alert Messages After each measurement trial the monitor analyzes the thermodilution curve If the curve appears abnormal a curve alert message appears in the C O procedure window A question mark symbol may appear next to the cardiac output numeric if any of these messages appear The curve alert m
214. ection 145 measurement limitations 144 measurement methods auto 144 measurement methods manual 144 measurement methods stat 144 measurement starting 146 measurement stopping 146 neonatal cuffs disposable 312 numerics 145 oscillometric method 143 pediatric cuffs 312 preparing to measure 144 repeat time 145 repeat time for automatic 146 repetition time setting 146 reusable cuffs 311 single hose disposable cuffs 312 site inspection 145 time of last measurement 145 units 145 venous puncture 147 neonatal event counting 248 neonates Resp electrode placement 132 NER setup 245 network connection indicator 14 network connector wired 332 network connector wireless 332 networked monitoring 33 new features 35 non invasive blood pressure See NBP non paced patients arrhythmia monitoring 108 notch filter BIS 220 numerics explanation of NBP display 145 nurse call 45 nurse call relay connection symbol 328 O on screen calculator 20 operating 14 mouse 17 permanent keys 17 SmartKeys using 18 trackball 17 operating modes 21 configuration 21 demonstration 21 monitoring 21 passcode protection 21 service 21 operating room ECG cable 106 orange ECG cable 106 organizers 311 Oridion Systems Ltd 327 Original Calc pop up key 235 oscillometric NBP measurement method 143 other bed window 87 output ECG 345 overlap in recordings 261 overlapping screen trends 231 oxyCRG 239 event counting 248 OxyCRG event episode
215. edside measurements Refer to the Information Center Instructions for Use for the Suspend Pause alarms behavior of the Information Center and telemetry device Using Standby When you select Standby mode at the monitor the bedside goes into Standby mode Refer to the Information Center Instructions for Use for the Standby behavior of the Information Center and telemetry device 6 ECG Arrhythmia and ST Monitoring The electrocardiogram ECG measures the electrical activity of the heart and displays it on the monitor as a waveform and a numeric This section also tells you about arrhythmia monitoring see page 107 and ST monitoring see page 117 Skin Preparation for Electrode Placement Good electrode to skin contact is important for a good ECG signal as the skin is a poor conductor of electricity 1 Select sites with intact skin without impairment of any kind 2 Clip or shave hair from sites as necessary 3 Wash sites thoroughly with soap and water leaving no soap residue We do not recommend using ether or pure alcohol because this dries the skin and increases the resistance 4 Dry skin thoroughly 5 Gently abrade the skin using ECG skin preparation paper to remove dead skin cells to improve the conductivity of the electrode site Connecting ECG Cables 1 Attach the clips or snaps to the electrodes before placing them If you are not using pre gelled electrodes apply electrode gel to the electrodes before pla
216. efined clinical situations Depending on the level of event surveillance available on your monitor the information stored for each event episode can include e waveforms for up to four measurements of your choice depending on episode type see table on page 243 for more details e numeric vital signs for all the measurements monitored e any alarm conditions active when the event episode was triggered e any annotations connected with the event You can navigate through the event database to view events retrospectively and you can document events on a recording or report marked with the patient name bed label and the data and time Levels of Event Surveillance The appearance of the Events windows and menus and the settings you can select for events depends on the event surveillance option purchased for your monitor basic event surveillance advanced event surveillance or neonatal event review This table lists the differences between the options To determine which level of event surveillance your monitor has select Main Setup gt Event Surveill gt Setup Events and select the trigger group to see the available event groups e if the only event group listed is NER your monitor has the Neonatal Event Review option e if there is one event group and it is not NER your monitor has the Basic Event Surveillance option e if you see six event groups your monitor has the Advanced Event Surveillance option Event groups 1 5
217. egment Measurements To change the trend scales for a measurement in the current segment 1 In the segment menu select the measurement label 2 Select Upper to change the upper limit of the scale or Lower to change the lower limit of the scale Optimum Scale To have the monitor automatically select an optimum scale for viewing based on current values inthe Segment menu select Optimum Scale This scale change is temporary When the graphical trend window is closed the scale reverts back to the setting in Parameter Scales To switch off automatic optimum scaling inthe Segment menu select Optimum Scale again Trend Group To add or remove measurements for this trend group or change the order of the existing measurements 1 Inthe Segment menu select Change Group 2 Use the Add Change Sort Up and Sort Down popup keys to change or re order the group as required No of Segments In an embedded graphical trend window you can select the number of segments to be displayed in the Segment menu 226 1 Inthe Segment menu select No of Segments 2 Select 1 2 or 3 segments Trend Groups The measurements grouped in trend groups define the trends displayed together in the Vital Signs or Graphics Trends windows and printed in trends reports and recordings The sequence of the measurements in the group defines the order in which they are displayed Measurements listed between dotted line separators are displayed overlapping
218. egory for your patient ih alfi Hoes moye If you have a neonatal or Reset Values Weight b pediatric patient the Rule of Six choice may be available Select if required 3 Enter the patient weight if necessary If available the patient weight from the Patient Demographic window is entered automatically in the Drug Calculator window To change the patient weight select the Weight key then use the on screen keypad to enter the correct value This will not change the patient weight stored in the patient demographic information Select the weight unit shown to change between 1b and kg 4 When a specific drug is selected the initial values for Dose Amount and Volume are the configured Start values for this drug The Rate is then calculated If other values are required you can calculate any value by entering the remaining three values as described in Performing Calculations for a Non Specific Drug The column on the right of the Drug Calculator window shows either drug dose or dosage rate whichever is the calculated value The current calculated value is shown on a scale with the recommended range in green If the current calculated value lies outside the recommended range it is shown in red If you have changed values in the Drug Calculator and you want to revert to the configured values select Reset Values key at any time 279 Charting Infusion Progress The Drip Table shows you at a glance how much of the
219. eld IEC 61000 4 8 Voltage dips lt 5 Ur lt 5 Ur Mains power quality should be that short gt 95 dip in Ur for 0 5 gt 95 dip in Ur for 0 5 of a typical commercial and or interruptions cycles cycles hospital environment If the user of and voltage 40 Ur 40 Ux the monitor requires continued variations on 60 dip in Uz for 5 cycles 60 dip in Uz for 5 cycles 0Petation during power mains power supply interruptions it is recommended input lines 70 Ur 70 Ur that the monitor is equipped with IEC 61000 4 30 dip in Ur for 25 cycles 30 dip in Ur for 25 an internal battery or is powered 11 lt 5 Ur cycles from an uninterruptible power gt 95 dip in Ur for 5 sec lt 5 Ur supply gt 95 dip in Ur for 5 sec Power frequency 3 A m 3 A m Power frequency magnetic fields 50 60 Hz should be a t levels characteristic of a typical location in a typical commercial and or hospital environment In this table Uy is the a c mains voltage prior to application of the test level Recommended Separation Distance WARNING The monitor equipped with a wireless network interface intentionally receives RF electromagnetic energy for the purpose of its operation Therefore other equipment may cause interference even if that other equipment complies with CISPR emission requirements In the following table P is the maximum output power rating of the transmitter in watts W according to the t
220. elect the appropriate setting N or N20 Changing the Concentration of Inspired O and the Inspired Agents 1 Inthe Setup Spirometry menu select Gas Compensation 2 Select Inspired 02 to change the concentration of inspired O3 Select Inspired Agent to change the concentration of the inspired agent s 193 3 Select the appropriate setting Changing the Temperature of the Inspired Gas Depending on the type of ventilator environment e g if you are using a Heat Moisture Exchanger you may want to change the temperature setting of the inspired gas 1 Inthe Setup Spirometry menu select Gas Compensation 2 Select Inspired Temp to change the temperature of the inspired gas 3 Select the appropriate temperature setting NOTE Changing the temperature setting unintentionally will result in approximately 3 reduced accuracy per 10 C 18 F temperature setting change 194 16 Monitoring tcGas The tcGas module measures the partial pressure of the oxygen and carbon dioxide that diffuses through the skin thereby providing a measure of these gases in the capillary blood The monitor s settings for altitude and barometric pressure influence the measurement The tcpO tcpCO measurement is valid for an infant patient not under gas anesthesia Anesthetic agents such as halothane can cause incorrect or drifting readings Transcutaneous measurements cannot replace arterial blood gas monitoring However you can use transcutaneou
221. ely empty before trying to remove the valve stem or drill a hole in the cylinder 307 308 33 Accessories You can order parts and accessories from Philips supplies at www medical philips com or consult your local Philips representative for details WARNING Reuse Never reuse disposable transducers sensors accessories and so forth that are intended for single use or single patient use only Reuse may compromise device functionality and system performance and cause a potential hazard Philips approval Use only Philips approved accessories Packaging Do not use a sterilized accessory if its packaging is damaged ECG Resp Accessories 19 Trunk Cables H This symbol indicates that the cables and accessories are designed to have special protection against electric shocks particularly regarding allowable leakage currents and are defibrillator proof 0 9m M1540C M1550C M1560C M1570C n a 2 7m M1500A M1510A M1520A M1530A M1949A 3 Electrode Cable Sets OR 1 0m M1601A M1611A 309 ICU Grabber shielded 1 0m M1603A M1613A ICU snap shielded 1 0m M1605A M1615A ICU Clip non shielded 0 45m M1608A M1618A ICU Clip non shielded 0 7m M1609A M1619A 5 Electrode Cable Sets OR Grabber shielded 1 0m 1 6m M1621A M1631A ICU Grabber shielded 1 0m 1 6m M1623A M1633A ICU Snap shielded 1 0m 1 6m M1625A M1635A ICU Clip non shielded 0 7m
222. en lt Recorder name gt not supported The M1116A recorder is not supported Connect a M1116B plug in recorder 265 266 25 Printing Patient Reports Starting Reports Printouts Most patient reports can be printed by selecting Main Setup gt Reports or the Reports SmartKey and then selecting the report name in the top half of the Reports menu Report names are shown only for reports that have been correctly set up Data from the time of the print request is printed even if the print job is delayed in the printer queue Vital Signs Report Graphic Trends Report depends on selected trend group data resolution and period In the Vital Signs window select Print Record then select Print In the Graphic Trends window select Print Events Reports Event Episode with up to 5 episodes Graphic or tabular Event Review In the Events window select the pop up key Print Record then select the pop up key Print Reviewor Print Episode EEG Report EEG Waves numerics CSAs montage In the Setup EEG menu select Print Report information and impedance values ECG Reports Depends on format selected Select the ECG Report SmartKeys if configured ST Map Report ST data in a transversal and or horizontal In the ST Map window select Print multiaxis diagram Cardiac Output Report Trial curves and numerics In the Cardiac Output window select the pop up key Print Record Wedge
223. ended gas tubing Different tubing will cause inaccurate measurements 2 Plug the transducer cable into the module Swing the calibration chamber cover open and insert the transducer into the chamber Close the cover to secure the transducer Set the transducer temperature at the monitor now 3 On the 15210B calibration unit turn the timer control clockwise as far as you can On the Radiometer calibration unit press the button with the green arrow once 199 4 Press CAL on the module until the light above the key comes on and wait three 20 minutes for the calibration complete message to appear on the monitor Alternatively in the Setup tcGas menu select Start Calibration To save gas on 15210B if the timer control dial is not in the start position when the monitor displays the calibration complete message turn the dial counter clockwise to the start position For TCC3 if the green light is still flashing when INOP tcGas CalRunning disappears press the green arrow button again Calibration Failure If calibration fails the monitor displays tcGas transducer or Cal Unit malf and the CAL FAILED INOP for the measurement Troubleshooting tcGas Calibration Perform each of the following steps in order until calibration is successful 1 Check the calibration unit then recalibrate remembering to turn on the gas supply on the calibration unit If the pressure indicator reading is in the out of gas z
224. ent one The message disappears when Start C O is selected to the catheter used C O CCO Safety Information WARNING Catheter constant Make sure that the arterial catheter constant for the measurement is appropriate Computation Constant Make sure that the computation constant for the measurement is appropriate to the injectate volume injectate temperature and catheter type used IABP Do not perform transpulmonary thermodilution measurements on patients undergoing IABP treatment CCO accuracy Accuracy of the CCO measurement and all the derived values may be influenced by patients with valve diseases or artificial valves C O and MRI Do not use the Cardiac Output Interface Cable in Magnetic Resonance Imaging MRI Applications Aortic graft patients Do not use an arterial catheter in the arteria femoralis when it is contra indicated for example with patients who have an aortic graft 173 CAUTION During the cardiac output measurement procedure the blood temperature alarms are inactive This is indicated by a crossed out alarm symbol next to the temperature numeric Making alarms inactive during this procedure prevents false alarms The alarms are automatically reactivated when you have completed the measurement procedure 14 Monitoring Carbon Dioxide Use the CO measurement to monitor the patient s respiratory status and to control patient ventilation There are two methods for measurin
225. enting Drug Calculations Inthe Drug Calculator window select the pop up key Record DrugCalc to immediately start a recording of the current drug calculation Inthe Titration Table window select the pop up key Print Titr Tbl to printa report of the current Titration Table Inthe Drip Table window select the pop up key Print Drip Tbl to print a report of the current Drip Table 280 27 VueLink Modules A VueLink module transmits information from a connected external device to your monitor Each module can be connected to up to three external devices and supports alarms from the external device Although the external device may transmit more information the number of waves and numerics you can view simultaneously on your monitor s main screen depends on the module type Type A modules support one wave and two numerics type B modules support two waves and six numerics Auxiliary A 1 Ventilator B 2 Gas Analyzer B 2 Anesthesia Machine B 2 Auxiliary Plus B 2 NN WBDW WN standalone measurement module ventilators gas analyzers anesthesia machines external multi measurement devices a module name b device label c selection LED d setup key VueLink mioaza T ENTILATOR E B 7200a ae m SIEMENS 200C D E NEO e external device cable connector f setup indicator LED g module type A or B The device labels b on the module indicate for whi
226. enu the CO measurement in your Measurement Server Extension does not require NjO or Helium correction or the N O correction is setup with N20 Corr see above 183 Agent In the Setup CO2 menu select Agent Corr and select the concentration of the M3014A anesthetic agent between 0 0 and 20 0 If an anesthetic agent is present in the only ventilation gas mixture you must select the appropriate concentration Suppressing Sampling not Mainstream CO To temporarily stop sampling inthe Setup CO menu select Pump 15Min Off or use the CO2 Pump Off SmartKey if available Selecting Pump 15Min Off again before fifteen minutes have passed resets the timer to fifteen minutes To re start the pump inthe Setup CO menu select Pump On Changing CO Alarms This refers to CO specific alarms See the Alarms section for general alarm information 1 Inthe Setup CO menu select etCOz High or imCO High and choose the upper alarm limit 2 Select etCOz Low and choose the lower alarm limit Changing the Apnea Alarm Delay This determines the time limit after which the monitor alarms if the patient stops breathing 1 Inthe Setup CO menu select awRR 2 In Setup awRR menu select Apnea Time 3 Choose the apnea alarm delay time WARNING Safety and effectiveness of the respiration measurement method in the detection of apnea particularly the apnea of prematurity and apnea of infancy has not been established
227. eout Periods 113 What is a Timeout Period 114 Resetting the Timeout Period 114 How are Yellow Arrhythmia Alarms Indicated 114 Behavior of Unsilenced Arrhythmia Alarms 114 Behavior of Silenced Arrhythmia Alarms 114 Arrhythmia Alarm Chaining 115 Understanding PVC Related Alarms 116 About ST Monitoring 117 Switching ST On and Off 117 Selecting ST Leads for Analysis 117 Understanding the ST Display 118 Updating ST Baseline Snippets 119 Recording ST Segments 119 About the ST Measurement Points 120 Adjusting ST Measurement Points 120 ST Alarms 122 Single or Multi lead ST Alarming 122 Changing ST Alarm Limits 122 Viewing ST Maps 122 Current View 122 Trend View 123 Viewing an ST Map 124 Working in the ST Map Task Window 124 Switching Between ST Map Views 124 Displaying an ST Reference Baseline 125 Updating an ST Map Reference Baseline 125 Changing the Scale of the ST Map 125 Changing the Trending Interval 125 Printing an ST Map Report 125 7 Monitoring Pulse Rate 127 Entering the Setup Pulse Menu 127 System Pulse Source 127 Switching Pulse On and Off 128 Using Pulse Alarms 128 Selecting the Active Alarm Source HR or Pulse 128 Alarm Source Selection Disabled 129 Changing HR Pulse Alarm Limits 129 Extreme Alarm Limits 129 QRS Tone 129 8 Monitoring Respiration Rate Resp 131 Lead Placement for Monitoring Resp 131 Optimizing Lead Placement for Resp 131 Cardiac Overlay 131 Lateral Chest Expansion 132 Abdominal Breathing 132 Un
228. eplace the recorder Cleaning the Batteries and Battery Compartment MP20 MP30 Wipe with a lint free cloth moistened with warm water 40 C 104 F maximum and soap Do not use MP40 MP50 _ strong solvents Do not soak the battery Only 295 296 31 IntelliVue MP20 MP30 MP40 MP50 only Using the Batteries MP20 MP30 one OR two Philips M4605A rechargeable Lithium Ion batteries must be inserted into the battery compartment at the rear of the monitor to use the MP20 MP30 monitor with battery power MP40 MP50 two Philips M4605A rechargeable Lithium Ion batteries must be inserted into the battery compartment at the rear of the monitor to use the MP40 MP50 monitor with battery power Battery compartment 297 The MP60 MP70 MP80 MP90 monitors cannot be powered by battery You can switch between battery powered and mains powered AC operation without interrupting monitoring The batteries recharge automatically whenever the monitor is connected to mains power Battery operation may not be available in all geographies Battery Power Indicators The battery LED and battery status information on the Main Screen in combination with INOP messages and prompts help you keep track of the battery power status The indicators always show the remaining capacity in relation to the battery s actual maximum capacity which may lessen as the battery ages You can see the actual capacity in the Battery Status window W
229. eports 269 Setting Up Individual Print Jobs 270 Checking Printer Settings 270 Printing a Test Report 271 Switching Printers On Or Off for Reports 271 Dashed Lines on Reports 271 Unavailable Printer Re routing Reports 271 Printer Status Messages 272 Sample Report Printouts 272 Alarm Limits Report 273 Realtime Report 274 Cardiac Output Report 275 ECG Reports 276 Other Reports 276 26 Using the Drug Calculator 277 Accessing the Drug Calculator 277 Performing Drug Calculations 278 About the Rule of Six 278 Performing Calculations for a Non Specific Drug 278 Performing Calculations for a Specific Drug 279 Charting Infusion Progress 280 Using the Titration Table 280 Documenting Drug Calculations 280 27 VueLink Modules 281 Connecting an External Device 282 Changing VueLink Waves and Numerics Displayed 282 Viewing the VueLink Device Data Window 282 Using VueLink Screens 283 Switching VueLink On and Off 283 Alarms INOPs From External Devices 283 Language Conflict with External Device Drivers 284 28 Using Timers 285 Viewing Timers 285 Notification 285 Timer Types 286 Timer Setup Pop up Keys 286 Setting Up Timers 286 Timer Label 286 Run Time 287 Timer Counting Direction 287 Displaying Timers On The Main Screen 287 Main Screen Timer Pop up Keys 288 Displaying A Clock On The Main Screen 288 xiv 29 Respiratory Loops 289 Viewing Loops 289 Capturing and Deleting Loops 290 Showing Hiding Loops 290 Changing Loops Dis
230. er These settings can only be changed in the monitor s Configuration Mode If you are using an MP80 or MP90 with an external display the Brightness SmartKey does not adjust the brightness of this display See the instructions supplied with the external display for instructions Adjusting Touch Tone Volume The touch tone volume is the tone you hear when you select any field on the monitor screen To adjust the touch tone volume 1 IntheMain Setup menu select User Interface 2 Select TouchToneVolume then select the appropriate setting for the touch tone volume 10 is the loudest and 1 is the quietest Selecting zero switches the touch tone volume off Setting the Date and Time If your monitor is connected to an Information Center the date and time are automatically taken from this Once it is set the internal clock retains the setting even when you switch off the monitor WARNING Changing the date or time will affect the storage of trends and events 1 Select the Date Time screen element from the monitor s info line to enter the Date Time menu 2 Select in turn the Year Month Day Hour in 24 hour format only and Minute as necessary Select the correct values from the pop up list 3 Select Store Date Time to change the date and time Checking Your Monitor Revision 1 SelectMain Setup gt Revision to open the Monitor Revision menu 2 Select the correct device from the device pop up keys 3 FromtheMonitor
231. erence of more than 4 between the stored value and the laboratory value select CalibrationValue to adjust the stored value Selecting Recall PreviousC recalls the previously stored calibration value Complete the calibration by selecting Store In VivoCal even if you did not adjust the calibration value This updates the data stored in the optical module Calculating Oxygen Extraction Oxygen extraction is the difference between the measured SpO and SvO values If you are monitoring SpO and SvO the monitor can calculate this value and display it as a numeric To switch oxygen extraction calculation on or off in the Setup Sp vO2 menu select Sp vO2 and toggle between On and Off If more than one SpO value is available you must choose which value is used in the calculation In the Setup Sp vO2 menu select SpO2 Source and select the required source If one of the calculation sources becomes unavailable the monitor displays the INOP Sp vO2 CHK SOURCES for one minute After this time the calculation automatically switches off If the missing source becomes available again the calculation automatically switches on again 206 18 Monitoring EEG The Electroencephalograph EEG module monitors the patient s cerebral function by measuring the electrical activity of the brain It provides the monitor with two channels of realtime EEG waves EEG trend information in the form of Compressed Spectral Arrays CSA and up
232. ervice Application area I ICU O OR C CCU N NICU Patient category A Adult P Pediatric N Neonatal Recorded Waveforms A selection of up to three waveforms is recorded marked with wave labels and wave scale information Wave scale information can be in the form of a calibration bar like the 1 mV calibration bar for ECG or calibration steps before the waveform starts Maintaining Recording Strips Recording ink sometimes fades when covered with transparent tape Avoid covering any part of a recording that is clinically relevant annotation or waveforms when taping a recording strip to a patient record or other patient documentation 263 Reloading Paper M1116B 1 Use the latch on the right side of the recorder door to pull the door open 2 Remove the empty core 3 Insert a new roll so that it fits snugly into its housing and the paper end is feeding from the top 4 Pull out some paper and fold along the front edge at a 45 angle This makes it easier to feed the paper under the roller as shown 5 Feed the paper through and pull some paper out from the top of the roller 6 Close the recorder door 7 To test if paper is loaded correctly start a recording If no printing appears paper may be loaded backwards Try reloading the paper MP20 MP30 1 Use the latch on the right side of the recorder door to pull the door open 2 Remove the empty core 3 Insert a new roll and secure it in place on
233. es Venipuncture Mode Inflation Inflation Pressure Adult 20 to 120 mmHg 3 to 16 kPa Pediatric 20 to 80 mmHg 3 to 11 kPa Neonatal 20 to 50 mmHg 3 to 7 kPa Automatic deflation Adult pediatric 170 seconds after Neonatal 85 seconds Measurement Validation In adult and pediatric mode the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers ANSI AAMI SP10 1992 in relation to mean error and standard deviation when compared to intra arterial or auscultatory measurements depending on the configuration in a representative patient population For the auscultatory reference the 5th Korotkoff sound was used to determine the diastolic pressure In neonatal mode the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers ANSI AAMI SP 10 1992 and AAMI ANSI SP10A 1996 in relation to mean error and standard deviation when compared to intra arterial measurements in a representative patient population Systolic Adult 30 to 270 mmHg 4 to 36 kPa 10 to 30 mmHg 2 mmHg 0 5 kPa Pedi 30 to 180 mmHg 4 to 24 kPa gt 30 mmHg 5 mmHg 1kPa Neo 30 to 130 mmHg 4 to 17 kPa Diastolic Adult 10 to 245 mmHg 1 5 to 32 kPa Pedi 10 to 150 mmHg 1 5 to 20 kPa Neo 10 to 100 mmHg 1 5 to 13 kPa Mean Adult 20 to 255 mmHg 2 5 to 34 kPa Pedi 20
234. es are within the valid range If any electrodes do not pass the impedance test check the sensor montage and press the electrode pads firmly To manually stop the Cyclic Impedance Check select Cyclic Check Off inthe Setup BIS menu BIS ISOELECTRC EEG BIS No discernible EEG activity is detected for longer than one minute Check the patient Check that the electrodes are properly connected BIS LEAD OFF INOP tone may sound BIS One or more electrodes have no skin contact and therefore impedances cannot be measured Check the sensor montage and press the electrode pads firmly If this INOP persists replace the sensor s in question using correct skin preparation BIS OVERCURRENT INOP tone BIS Unplug and replug the BIS module or f or the MP20 MP30 disconnect and reconnect the BISx from the Interface board If the INOP persists contact your service personnel BIS SENSOR DISCONN INOP tone BIS The sensor is not properly connected to the patient interface cable PIC and or the PIC is not properly connected to the DSC or BISx or the sensor or PIC or DSC or BISx may be faulty Check all the connections Disconnect and reconnect the sensor PIC DSC BISx If the INOP persists replace the sensor If the INOP persists replace PIC If INOP persists contact your service personnel Silencing this INOP switches the measurement off BIS SENSOR INCOMPAT INOP tone BIS Unsuppo
235. es when you leave Demonstration or Service modes or when you discharge a patient This profile is indicated by a diamond Locked Profiles Some profiles are locked so that you cannot change them even in Configuration Mode These are B indicated by this lock symbol y y Understanding Settings Each aspect of how the monitor works and looks is defined by a setting There are a number of different categories of settings including Screen Settings to define the selection and appearance of elements on each individual Screen Measurement settings to define settings unique to each measurement for example high and low alarm limits Monitor settings including settings that affect more than one measurement or Screen and define 8 8 8 general aspects of how the monitor works for example alarm volume reports and recordings and display brightness You must be aware that although many settings can be changed in Monitoring Mode permanent changes to settings can only be done in the monitor s Configuration Mode All settings are reset to the stored defaults e when you discharge a patient e when you load a Profile e when the monitor is switched off for more than one minute if Automat Default is set to Yes Changing Measurement Settings Each measurement has a setup menu in which you can adjust all of its settings You can enter a setup menu e via the measurement numeric select the measurement numeric to enter its setup
236. essages are not error messages and do not necessarily mean that the measured values are invalid Tinj off scale The Tinjectate is out of the range 1 C and 30 C Cool down or heat up the injectate or change the injectate solution and repeat the measurement Noisy Baseline A blood temperature baseline drift that could not be compensated was detected during the C O measurement Possible causes are Interference may be caused by a ventilator Interference may be caused by an infusion pump infusions of significant volume through the central line should be paused at least 30 seconds before the first thermodilution measurement in a series and should not recommence until the measurement series is completed Do not administer injections through the central line during a measurement series Electrical devices in the vicinity can cause interference check for infusion pumps connected to the central catheter cables parallel to the thermodilution cable electrocautery Make sure all devices are properly grounded Wait until measurement results are displayed before moving the patient or catheter Close the stopcock to the injectate syringe after the injection Do not rinse the catheter during measurement to avoid temperature fluctuations Temperature Baseline Drift May occur if patient is recovering from open heart surgery or if patient was cooled down for surgery and is in the process of regaining normal
237. essure labels The displayed pulse numeric is labeled and color coded to match its source wave If the pulse numeric is not displayed see the Setup Pulse menu to check whether it is switched on Entering the Setup Pulse Menu If a pulse numeric is displayed on the screen select it to enter the Setup Pulse Pulse Source menu If no pulse numeric is visible in the Setup SpO menu or an Setup arterial pressure menu select Pulse Pulse Source System Pulse Source The currently active system pulse source is shown in the setup menus of the pulse source measurements The pulse rate chosen as system pulse e is monitored as system pulse and generates alarms when you select pulse as the active alarm source e is sent via the network to the Information Center if available e is trended in the HighRes Trends and stored in the monitor s databases To define which pulse rate is used as system pulse 1 Inthe Setup Pulse menu select System Pulse 2 Select one of the SpO or arterial pressure labels from the pop up list or select Auto If you select Auto the monitor automatically chooses a pulse rate to be used as system pulse It looks through the list from top to bottom and activates the first pulse rate that is switched on and available 127 7 Monitoring Pulse Rate Switching Pulse On and OFF Switching Pulse On and Off To switch a particular pulse numeric on or off enter the Setup Pulse menu via the measurement setup menu or wave
238. essure line PV 8010 100cm pressure line PV 8015 150cm pressure line Pressure Interface Cable for disposable pressure transducer PULSION PMK 206 319 33 Accessories Mainstream CO3 Accessories for M3014A _ Mainstream CO Accessories for M3014A CO Sensor M2501A Adult Pediatric Airway Adapter reusable M2513A Infant Airway Adapter reusable M2516A Adult Airway Adapter single patient use M2533A Infant Airway Adapter single patient use M2536A Sidestream CO Accessories for M3014A CO Sensor M2741A Nasal and Oral Nasal Cannulas CO Nasal Cannula Adult M2744A CO Nasal Cannula Pediatric M2745A CO Nasal Cannula Infant M2746A CO Oz Nasal Cannula Adult M2750A CO Oz Nasal Cannula Pediatric M2751A CO Oral Nasal Cannula Adult M2756A CO Oral Nasal Cannula Pediatric M2757A CO O Oral Nasal Cannula Adult M2760A CO Oz Oral Nasal Cannula Pediatric M2761A Airway Adapters Airway Adapter Set ET gt 4 0 mm M2768A Airway Adapter Set H ET gt 4 0 mm M2772A Airway Adapter Set H ET lt 4 0 mm M2773A Straight Sample Lines Straight Sample Line M2776A Straight Sample Line H M2777A Mainstream CO Accessories for M3016A CO Sensor M1460A Standard Airway Adapter reusable M1465A Small Airway Adapter reusable 14363A 320 Microstream CO Accessorie
239. et to No all active settings are retained if power is restored within 48 hours The Automat Default setting is made in Configuration Mode Networked Monitoring If your monitor is connected to a network a network symbol is displayed in the upper left corner next to the bed label To see details about the Care Group the monitoring equipment and technical information about the network MP20 MP30 MP40 MP50 select the monitor info line to enter the Setup menu then select Bed Information MP60 MP70 MP80 MP90 in the monitor info line select the bed label Be aware that some network based functions may be limited for monitors on wireless networks in comparison to those on wired networks Using Remote Applications If your monitor is connected to a Philips Application Server you can access applications hosted remotely on the Application Server and display and operate them on the bedside monitor screen The Application Server provides portal technology to allow information access through a web browser terminal emulation or served applications The applications available depend on the Application Server configuration see the device documentation for details A Remote Application window can also be embedded in a monitoring Screen To display remote applications on the monitor 33 1 Inthe Main Setup menu select Remote Applics or select the 5 Remote Applications SmartKey 2 Select the required application from the pop up l
240. etry menu Optimizing Scale Settings In the Setup Spirometry menu select Optimize Scales The scale settings for all three spirometry waves AWF AWP AWV will be optimized Spirometry Values Window You can view all spirometry measurement data in the spirometry data window In the Setup Spirometry menu select Show All Values Spirometry Adult Pedi Flow Sensor RRspir 10 rpm MVexp 7 2 1 min PIP 31 cmH 0 I E 1 1 9 MVin 7 3 l min PEEP 4 cmH20 COMP 24 m1 cmH 0 TVexp 720 ml MnAwP 17 cmH20 Raw 4 cmH20 1 s TVin 720 ml Pplat 30 cmH20 PEF 8 l min NgInsP 5 cmH20 PIF 12 l min Figure 1 Example for Spirometry Values Window Alarms and Alarm Limits Alarms can be derived from PEEP PIP MV and RRspir In the Setup Spirometry menu you can set the alarm limits Please refer to the Alarms chapter of this manual for details on alarm settings Changing the Apnea Alarm Delay This determines the time limit after which the monitor alarms if the patient stops breathing 1 Inthe Setup Spirometry menu select RRspir 2 InSetup RRspir menu select Apnea Time 3 Choose the apnea alarm delay time 192 WARNING Safety and effectiveness of the respiration measurement method in the detection of apnea particularly the apnea of prematurity and apnea of infancy has not been established WARNING If an apnea occurs during a zero calibration the time delay between the start of apnea and the activation of the ap
241. f more than one alarm is active the alarm messages are shown in the alarm status area in succession An arrow symbol next to the alarm message informs you that more than one message is active 7 HR HIGH The monitor sounds an audible indicator for the highest priority alarm If more than one alarm condition is active in the same measurement the monitor announces the most severe Your monitor may be configured to increase alarm indicator volume automatically during the time when the alarm is not acknowledged 41 Visual Alarm Indicators Alarm message An alarm message text appears in the alarm status area at the top of the screen indicating the source of the alarm If more than one measurement is in an alarm condition the message changes every two seconds and has an arrow T at the side The background color of the alarm message matches the alarm priority red for red alarms yellow for yellow alarms and light blue for INOPs The asterisk symbols beside the alarm message match the alarm priority for red alarms for yellow alarms for yellow arrhythmia alarms INOPs are displayed without asterisks Depending on how your monitor is configured it may display alarm limit violation messages e in text form for example SpO2 LOW or e in numeric form for example SpO2 94 lt 96 where the first number shows the maximum deviation from the alarm limit and the second number shows the currently set limit F
242. f not calibrate the transducer now 3 Place the transducer on the low cell of the calstick labelled 0 0 mmHg or ZERO The reading on the screen should be zero within 1 mmHg within one minute 17 o 4 Place the transducer on the high cell of the calstick The reading on the screen should be within 1 mmHg of the value on the calstick within one minute 5 Ifboth readings are in range you can leave calibration mode and begin monitoring If either of the readings is out of range calibrate the transducer Calibrating the Transducer 1 Check that the windows on the calstick are clean and clear 2 Place the transducer on one of the calstick cells and select Start Cal 1 3 Enter the calibration value printed on the calstick then press Confirm to start calibration 4 When the message CO2 CAL 1 calibration done start CAL 2 calibration appears put the transducer on the other cell and select Start Cal 2 then press Confirm 5 When you see the message CO2 calibration completed Leave calibration mode calibration is complete 6 Select Cal Mode to switch calibration mode off You cannot monitor in calibration mode Attaching and Removing the CO Transducer Airway Adapter 1 Open the latch and place the transducer onto the airway adapter ea Place the airway adapter in the a patient s breathing circuit between the endotracheal tube and the Y CO Transducer j piece You may see the CO2 SENSOR WARM UP message until the trans
243. f sections are shaded as in this example this indicates that 70 battery power remains If no batteries are detected the battery gauge is grayed out If no data is available from the batteries questions marks are shown in the gauge Monitoring Time Available Below the battery power gauge a time is displayed This is the estimated monitoring time available with the current battery power Note that this time fluctuates depending on the system load the display brightness and how many measurements and recordings you carry out the age of the battery and the remaining capacity of the battery Battery malfunction symbols Ifa problem is detected with a battery these symbols alternate with the symbol indicating the position of the battery affected They may be accompanied by an INOP message or by a battery status message in the monitor information line providing more details Symbols indicating critical situations are colored red Battery status symbols Battery malfunction symbols Battery lis Battery Battery requires Incompatible Battery Battery 2 is present compartments maintenance battery malfunction missing insert are empty Battery 1 Battery 1 battery MP40 50 only battery is battery not red battery Battery 2 has no empty charging as the temperature power left temperature is too high above or below the specified range If both batteries are malfunctioning or incompatible the monitor will
244. field Tblood Thermodilution curve of current trial Ready for new measurement Prompt message field Start Stop Select Accept Save C O amp Print Table Hemo Change Setup c O C O Trial Reject Cal CCO Record Contents Calc Scale C O To change the measurement parameters shown in the results table of the C O procedure window select the Table Contents pop up key and choose from the list of available parameters To view the currently used temperature unit see the grayed out setting Temperature Unit in the Setup C O menu This setting can only be changed in Configuration Mode The Cardiac Output screen element may be configured to display permanently on a specially designed Screen Selecting the screen element opens the cardiac output pop up keys 163 Accessing the Setup C O and Setup CCO Menus C O settings can be changed in the Setup C O menu To access this menu press the C O hard key on the C O module select any of the discontinuous C O numerics for example C O C I on the screen CCO CCI settings can be changed in the Setup CCO menu To access this menu select any of the continuously measured hemodynamic numerics CCO CCI on the screen Entering the HemoCalc Window From the C O procedure window select the pop up key HemoCalc to open the HemoCalc window Measuring C O Using the PiCCO Method The PiCCO method combines tran
245. fixation rings in position to allow them to quickly move the transducer from site to site Always unscrew the transducer from the fixation ring before removing the fixation ring from the skin TcGas Corrections Transcutaneous pCO values tend to be higher than arterial values due to the metabolic processes of the skin and the effect of heating on the blood under the transducer Depending on your monitor s configuration one or both of these corrections may automatically apply Temperature Correction for tcpCO The transducer temperature causes an increase in partial CO pressure Your monitor may be configured to correct this Inthe Setup tcpGas menu look at the menu item CO2 Correction If correction is enabled it is set to On Metabolism Correction for tcpCO CO production in the epidermis increases the CO value Your monitor may be configured to automatically deduct a metabolism factor only applies when CO2 Correction is on Inthe Setup tcGas menu look at the value shown for the menu item MetabolismFactor This is deducted from the CO value 202 MP60 70 80 90 17 Monitoring SvO The SvO module measures the percentage of mixed venous oxygen saturation continuously and invasively using the Hospira Inc formerly Abbott Laboratories OptiCath family of catheters routed monitors via the right side of the heart into the pulmonary artery Can be used only with the MP60 MP70 only MP80 MP90 monitors WARN
246. flexible module server see FMS 8 flushing invasive pressure accessories 151 FMS connecting to monitor 8 modules 8 functional arterial oxygen saturation 137 fusion beat pacemakers and ECG monitoring 106 G gas cylinder empty disposing of 307 gas input symbol 328 gas output symbol 328 GEDV GEDVI 162 getting started 32 global trend time 230 graphic trend report 225 graphic trends 224 graphic trends report 228 gridlines EEG 212 220 Ground Check BIS 218 H hardkeys 19 help INOPS 51 hemodynamic calculations 233 hemodynamic measurement server extension 13 hemodynamic parameters 162 high filter EEG 213 high pass filter BIS 220 high resolution recording 259 high res trend event episodes 243 high res trend waves about 239 OxyCRG 239 high res waves in reports 240 list of available measurements 343 recordings 240 HiResTrnd see high res trend 243 horizon trend trend time 230 HR RR Resp 132 HR alarms when arrhythmia off 105 HR alarms off Config Mode 105 HR and pulse alarm source selection 129 HR from heart rate source 128 humidity correction CO2 183 I IEC ECG lead labels 97 impedance indicators BIS 219 impedance quality indicators 210 IMV Resp 133 independent display connection symbol 328 infection control cleaning 293 disinfecting 293 sterilizing 293 Information Center central recording 258 transferring patients 80 injectate guidelines for C O
247. g 96 digital interface symbol 329 digital video device connection symbol 328 disabling touch operation 15 discharging a patient 79 disconnect INOPs silencing 44 disinfecting infection control 293 recommended substances 294 display arrhythmia 109 ECG 93 NBP 145 Resp 132 ST 118 using a second display 23 display brightness 302 iii display settings 24 disposal gas cylinder 307 parts and accessories 307 documenting events 251 dosemeter drug calculator 279 dPmax 162 drip table drug calculator 280 drug calculator 277 DSC BIS software revision 221 dual SpO2 141 dual Temp measurement 150 dyshemoglobins intravascular SpO2 139 E early systolic blood pressure NBP 146 EASI activating 96 ECG monitoring 102 lead placement 102 EASI ECG lead labels 97 ECG 91 accessories 309 alarms off Config Mode 105 changing lead sets 96 choosing electrode sites 96 conventional 12 lead 100 external pacing electrodes 106 filter settings 95 fusion beat pacemakers 106 intrinsic rhythm 106 modified 12 lead 100 New Lead Setup 96 pacemaker failure 106 rate adaptive pacemakers 106 unfiltered 96 wave size 94 ECG analog sync output 330 332 333 ECG analog output 329 ECG cable for operating room 106 ECG cables connecting 91 ECG connector 91 ECG display 93 ECG electrode colors 97 ECG electrode placement during electrosurgery 106 ECG gain in recordings 261 in reports 268 ECG lead labels 97 ECG lead placemen
248. g and 50 kg Any finger except thumb M1193AN Special Edition SE yes yes Neonatal sensor 1 5m cable for patients between 1kg and 4 kg Hand or foot M1194AN Special Edition SE yes yes No adapter cable Ear sensor 1 5m cable for patients required more than 40 kg M1195AN Special Edition SE yes yes Infant sensor 1 5m cable for patients between 4 kg and 15 kg Any finger except thumb Philips disposable sensors Not available in the USA M1904B Identical to OxiMax MAX A yes yes Option A01 Use M1903B Identical to OxiMax MAX P yes yes adapter cbli M1943A or M1902B Identical to OxiMax MAX I yes yes M1943AL M1901B Identical to OxiMax MAX N yes yes Option A02 Must use adapter cable M1943NL Philips disposable sensors Available worldwide M1131A Adult Pediatric finger sensor 0 45m yes no Use adapter cable cable patient size gt 20 kg M1943A or M1943AL M1132A Infant finger or toe sensor 0 9m cable yes no Use adapter cable patient size 3 10 kg M1943A or M1943AL M1133A Adult Infant Neonatal 0 9m cable yes no Use adapter cable Foot or hand for neonates lt 3 kg M1943A or Big toe or thumb for patients between M1943AL 315 NELLCOR disposable sensors must be ordered from Nellcor OxiMax Adult finger sensor patient size gt 30 yes yes Option A01 Use MAX A kg adapter cable OxiMax OxiMax MAX A with long cable yes ye
249. g carbon dioxide in the patient s airway e Mainstream measurement uses a CO sensor attached to an airway adapter directly inserted into the patient s breathing system This method is available with the M3014A Capnography Extension and the M3016A Mainstream Extension to the M3001A Multi Measurement Server e Sidestream measurement takes a sample of the respiratory gas with a constant sample flow from the patient s airway and analyzes it with a remote CO sensor built into the measurement system Philips offers the sidestream CO measurement in the M3014A Capnography Extension and the Microstream method of sidestream CO measurement in the M3015A Microstream CO Measurement Extension In both cases the measurement principle is infrared transmission where the intensity of infrared light passing the respiratory gas is measured with a photo detector As some of the infrared light is absorbed by the CO molecules the amount of light passing the gas probe depends on the concentration of the measured CO When using a wet ventilator circuit monitor mainstream CO if available in preference to sidestream CO The partial pressure is calculated from the gas concentration by multiplying the concentration value with the ambient pressure The measurement provides e a CO waveform e an end tidal CO etCO value the CO value measured at the end of the expiration phase e an inspired minimum CO imCO the smallest value measured during i
250. g counted as regular QRS complexes which could prevent an asystole alarm from being detected Pace Pulse Repolarization Tails Some unipolar pacemakers display pace pulses with repolarization tails These tails may be counted as QRSs in the event of cardiac arrest or other arrhythmias If you note a visible repolarization tail choose a lead that decreases the size of the repolarization tail Repolarization tail satan aula SAR T Sv note width t __ y E m Changing the Size of the ECG Wave If any of the displayed ECG waves is too small or clipped you can change the size of one or all of the ECG waves on the screen Changing the adjustment factor only changes the visual appearance of the ECG wave on the screen It does not affect the ECG signal analyzed by the monitor Comparing the wave size to the 1 mV calibration bar on the ECG wave segment can help you to get an idea of the true ECG signal strength If you choose a fixed adjustment factor the 1 mV calibration bar will be the same size for all the displayed ECG waves If you choose AutoSize the calibration bar may be a different size for each wave To Change the Size of an Individual ECG Wave 94 1 Select the wave segment you want to change This calls up the lead menu for this segment 2 Inthe lead menu select Size Up to increase wave size or Size Down to decrease the size Sele
251. gel if you are not using pre gelled electrodes Remember to select a site where the signal will not be interfered with by muscle artifacts 6 Connect the electrode connector end to the trunk cable 7 Check the electrode to skin impedance in the EEG Impedance Montage window 8 For good signal quality keep all lead wires together and away from other electric devices and metallic bodies Using the EEG Impedance Montage Window To open the window in the Setup EEG menu select Show Montage or select the EEG Montage SmartKey The window may be configured to look slightly different on your monitor Electrode locations on the patient s head The symbols Wiring and impedance values for the represent the electrode to skin impedance selected montage VA EEG Impedance Montage ImpedanceLimit 5kOhm m EEG 1 F3 P3 EEG 2 F4 P4 208 Choosing an EEG Electrode Montage 1 To activate one of the five pre configured electrode montages select the arrow beside the label in the EEG Impedance Montage window and choose a montage from the list 2 Attach the electrodes as illustrated in the EEG Impedance Montage window The five default electrode montage configurations can be modified and renamed in Configuration Mode Mont A Fpl T3 Fp1 T3 Fp2 T4 Fp2 T4 Mont B O1 T3 O1 T3 02 T4 O2 T4 Mont C F3 C3 F3 C3 F4 C4 F4 C4 Mont D C3 P3 C3 P3 C4 P4 C4 P4 Mont E Fpl T5 Fp1 T5 Fp2 T6 Fp2 T6 The electr
252. ght Green Invasive Pressure Default Settings 376 Alarms from Sys High Limit 160 90 110 120 70 90 90 60 70 180 90 110 Low Limit 90 50 70 70 40 50 55 20 35 70 50 70 Alarms On Scale 150 100 100 Speed 25mm s Mean Only No Filter 12 Hz Mercury Cal Yes Artifact Suppr 60 sec Unit mmHg Color Red Alarms from Mean High Limit 14 6 10 10 2 4 10 2 4 Low Limit 6 4 0 2 4 0 2 4 0 Alarms On Scale 30 Speed 25mm s Mean Only Yes Filter 12 Hz Mercury Cal Yes Artifact Suppr 60 sec Unit mmHg Color Cyan Blue Alarms from Dia Mean High Limit 35 16 20 60 4 26 60 4 26 14 6 10 10 2 4 10 2 4 Low Limit 10 0 0 24 4 12 24 4 12 6 4 0 2 4 0 2 4 0 Alarms On On Scale 30 30 Speed 25mm s 25mm s Mean Only No Yes Filter 12 Hz 12 Hz Mercury Cal Yes Yes Artifact Suppr 60 sec 60 sec Unit mmHg mmHg Color Yellow Magenta Cardiac Output Default Settings Auto Calibration On Thlood High Limit 39 0 C Tblood Low Limit 36 0 C Tblood Alarm On Off On Temperature Unit Ze Color Green Yellow Settings common to
253. gle electrode HIGH exceeds the limit Check the impedance If the impedance is too high reconnect the electrodes according to the EEG monitoring setup guidelines If the INOP persists contact your service personnel EEG lt X gt LEAD OFF lt n gt EEG Reconnect specified electrode X channel n electrode EEG lt X gt LEAD OFF EEG One or more electrodes are not connected Check in the EEG X channel Impedance Montage window on the monitor which at Information Center electrode s are affected and reconnect the electrodes EEG lt X gt LEADS OFF EEG Two or more electrodes are not connected Check in the EEG X channel Impedance Montage window which electrodes are affected and reconnect the electrodes EEG LINE NOISE EEG Excessive line noise has been detected in either channel EEG1 EEG 1 or2 LINE NOISE or EEG2 or in both EEG channels Keep all cables together and away from metallic bodies other cables amp radiated fields EEG MUSCLE NOISE EEG Too much power above 30 Hz has been detected in channel EEG 1 or2 MUSCLE NOISE EEG of EEG2 or both os Check the Electrode to Skin Impedance and reposition the electrode away from possible muscle activity if necessary EEG NO TRANSDUCER EEG The trunk cable is disconnected from the EEG plug in module INOP tone Reconnect the trunk cable Silencing this INOP switches the measurement off EEG UNPLUGGED EE
254. h entered value Manually entered values are marked with an asterisk 235 Entering Values for Calculations The monitor automatically enters any available values for calculations For aperiodically measured values such as C O the monitor will re use the most recent value in the calculation database until a new value becomes available To enter calculations values manually or edit automatically entered values select the value field to open the on screen keyboard and use this to enter the correct value Values edited manually are marked with an asterisk symbol If you enter a value that has more decimal places than allowed for a particular input the value you enter will be rounded off after you select Enter If you enter a value which cannot be stored the message Warning Value out of range will appear Enter a new value In hemodynamic calculations if the systolic and diastolic pressures are manually entered the mean pressure is calculated and marked with an asterisk The formula used to estimate the mean pressure is systolic diastolic x 2 3 Automatic Value Substitution If the monitor cannot find a value required for calculation it automatically tries to find an equivalent source for this value For example if C O is required but unavailable the monitor automatically looks for CCO as a alternative source of C O values or a alternative Pressure label may be used instead of ABP The label of the value in the Cal
255. hat bed Other Units lets you view a list of all the Care Units in your Care Domain Select any Care Unit to view a list of the Information Centers connected to it Select an Information Center to see a list of the monitors connected to it Select any monitor to see the Other Patient window for that bed Alarming Beds lets you view a list of all beds in your care group with an unacknowledged alarm The beds are listed in order of alarm severity Care Groups 5 Managing Patients Viewing the Other Bed Window The Other Bed window lets you view a subset of the waveform and numeric information from another bed on the same network Waves and numeric information from another bed are delayed If configured Other Bed information is displayed in color using the colors defined by the Information Center To open the Other Bed window MP60 MP70 MP80 MP90 select the required bed label or patient name in the Care Group Overview Bar If you are in a Unit Group with many beds the My Care Group window may open for you to select the bed MP20 MP30 MP40 MP50 select any field in the monitor info line to enter the Setup menu then select My CareGroup and select the required bed or Select the Other Patients SmartKey if configured and select the required bed x NO TRANSDUC J 4 110 next Moze My Care Silence gave ehaile Group Bed The Other Bed window may be configured to display embedded in a specially designed Screen To display
256. hat the transducer is connected and try again transducer unable to calibrate Make sure there are no disturbances to the transducer and repeat unstable signal the calibration unable to calibrate No valid zero Zero the transducer perform zero first Calculating Cerebral Perfusion The monitor can calculate the difference between mean arterial pressure and the intracranial pressure The difference is labeled CPP 1 IntheMain Setup menu select Measurements 2 Inthe Setup CPP menu select ABP ART Ao BAP or FAP as the arterial pressure source Calculating Pulse Pressure Variation Note The derived measurement Pulse Pressure Variation is not available in the USA Pulse Pressure Variation PPV is calculated from beat to beat arterial pressure values Pulse pressure is the difference between the systolic and the diastolic pressure values for a single beat The average variation in pulse pressure is calculated over periods of 32 seconds WARNING This monitor can calculate PPV from beat to beat values of any arterial pulsatile pressure The circumstances under which the calculation of a PPV value is clinically meaningful appropriate and reliable must be determined by a physician 157 e The clinical value of the derived PPV information must be determined by a physician According to recent scientific literature the clinical relevance of PPV information is restricted to sedated patients receiving contr
257. he General menu defines how every recorded ECG wave irrespective of template or recording type will appear on the recorder strip This does not affect the displayed ECG wave or printed ECG reports To change the ECG gain setting for recordings 1 Inthe Setup Recording menu select General 2 Select ECG Gain 3 Select the required setting Auto the wave recording will use the same scale as the ECG wave on the monitor screen 5 mm mV 10 mm mv 20 mm mv the wave recording will use a scale of 5 10 or 20 millimeters per millivolt 261 Recording Priorities Manually started recordings have priority over automatically started recordings If an automatically triggered alarm recording is running and a realtime or delayed recording is manually started the alarm recording is stopped and the manually requested recording is started More recent manually started recordings have priority over older manually started recordings Ifa manually started recording is running and another manually started recording is triggered then the older recording is stopped and the more recent manually started recording is started Alarm recordings are prioritized according to alarm priority If an alarm recording triggered by a yellow alarm is running and a new alarm recording is triggered by a red alarm the yellow alarm recording is stopped and the red alarm recording is started Sample Recording Strip The information printed on the recording strip i
258. he same element in different ways For example you might be able to access an item through its on screen setup menu via a hard key or via a SmartKey These Instructions for Use always describe how to access items via an on screen menu You may use whichever way you find most convenient 11 ABP Zero done at 11 Nov 02 7 31 am gt as Start Stop ra 18 17 16 T AB S ea 14 Monitor information line Other screen elements 1 network connection indicator 10 alarm status area shows active alarm messages documented in Information Center Instructions for Use 2 bed label 11 status line shows information messages and prompting you for action 3 patient identification 12 close all open menus and windows and return to main screen 4 patient category 13 enter Main Setup menu 5 paced status 14 scroll right to display more SmartKeys 6 date and time 15 SmartKeys these change according to your monitors configuration 7 access the profiles menu 16 scroll left to display more SmartKeys 8 current screen name enter 17 Pause Alarms pauses alarm indicators Pause duration depends on monitor change screen menu configuration If pause duration is infinite this key is labeled Alarms Off Select again to immediately re enable alarm indicators 9 adjust alarm volume level 18 Silence acknowledges all active alarms by switching off audible
259. hen an ST measurement is in the Change Limits window there are also two pop up keys available labeled ALL ST Narrow All ST Wide With these keys you can set Auto Limits for all ST Leads About Automatic Alarm Limits AutoLimits The monitor can automatically set alarm limits suited to your individual patient using the Automatic Alarm Limits function This tells the monitor to adapt the alarm limits of selected measurements to the measured vital signs within a defined safe limit The monitor calculates safe AutoLimits for each patient based on the measured values from the last 12 seconds The defined safe limits never exceed the non pathological range Limits Narrow sets limits close to the currently measured values for situations where it is critical for you to be informed about small changes in your patient s vital signs Limits Wide sets limits further away from the currently measured values for situations where small changes are not so critical Use the keys in the Change Limits window to apply AutoLimits for individual measurements These keys are not available if AutoLimits have been disabled for the measurement in the monitor s Configuration Mode High alarm limit wide High alarm limit narrow Alarm limits sain Low alarm limit narrow Low alarm limit wide Measurement value Lower limit Upper limit clamps clamps AutoLimits are not available for all measurements The list of measurements for which AutoLim
260. hen both batteries are empty the monitor switches off automatically Battery LED A The battery LED on the front panel of the monitor is indicated by a battery symbol PHILIPS zA T Battery LED Battery LED Colors If the monitor is connected to If the monitor is running on mains power this means battery power this means Green battery power is gt 90 Yellow batteries charging battery power lt 90 Red flashing less than 10 minutes power remaining Red flashes intermittently battery malfunction battery malfunction Red flashes once when on not enough battery power left to standby switch is pressed power monitor MP40 50 If only one battery is inserted during charging the battery LED is yellow during charging and switches only off when the battery is charged Battery Status on the Main Screen Battery status information can be configured to display permanently on all Screens It shows the status of each of the 7 batteries detected and the combined battery power remaining 2 3 i 40 h r with an estimate of the monitoring time this represents S 298 Battery status symbols These symbols tell you the status of the batteries see table below and which battery compartment they are in either 1 or 2 Battery power gauge This shows the remaining battery power in the combined batteries It is divided into sections each representing 20 of the total power If three and a hal
261. heric pressure to compensate for the static and atmospheric pressure exerted on the transducer 3 In the setup menu for the pressure select Zero lt Press gt 4 When you see the message lt Press gt zero done at lt date and time gt on the status line for example ABP zero done at 13 Mar 02 23 35 close the stopcock to atmospheric pressure and open the stopcock to the patient Using the Zero Hardkey Pressing the Zero hardkey for two seconds on the M1006B Pressure module starts a zero for the pressure currently measured with the module Pressing the Zero hardkey for two seconds on the M3001A Multi Measurement Server zeros the pressure being measured by the measurement server and the pressures from any connected measurement extensions Zeroing All Pressures Simultaneously WARNING Before zeroing all pressures make sure that all pressure transducers are vented to atmospheric pressure 15 Qe If you are measuring pressures with more than one measuring device using the Zero SmartKey to initiate the zeroing calls up a list of all active pressures Select the pressure you want to zero or select All Press to zero all pressures simultaneously Troubleshooting the Zero The status line lists the probable cause of an unsuccessful zero unable to zero The hardware is faulty Contact your service personnel equipment malfunction unable to zero Make sure the transducer is vented to air and try again If this f
262. ic movement produce the Resp waveform on the monitor screen The monitor counts the waveform cycles to calculate the respiration rate RR Lead Placement for Monitoring Resp Correct patient skin preparation techniques for electrode placement are important for Resp measurement you will find this information in the chapter on ECG The Resp measurement uses the standard ECG cable sets and lead placements You can use any of the different types of ECG cable sets 3 lead 5 lead or 10 lead using either standard or EASI placement to measure Resp as long as you use ICU ECG cables The Resp signal is always measured between two of the ECG electrodes If you are using standard ECG electrode placement Resp is measured between the RA and LL electrodes If you are using EASI ECG electrode placement Resp is measured between the I and A electrodes Optimizing Lead Placement for Resp If you want to measure Resp and you are already measuring ECG you may need to optimize placement of the two electrodes between which Resp will be measured for some patients Repositioning ECG electrodes from standard positions especially when you are using EASI ECG electrode placement results in changes in the ECG waveform and may influence ST and arrhythmia interpretation Cardiac Overlay Cardiac activity that affects the Resp waveform is called cardiac overlay It happens when the Resp electrodes pick up impedance changes caused by the rhythmic blood f
263. icator must cover at least two small divisions above the midpoint Inthe Setup SvO2 menu select Start Light Cal Calibration is complete after a few seconds If you doubt existing light intensity readings recalibrate 205 Performing In Vivo Calibration Perform an in vivo calibration if you place the catheter in a patient without performing a pre insertion calibration if the catheter was disconnected from the optical module when the catheter has been in the patient for 24 hours if any significant change in light intensity occurs that the monitor cannot correct automatically Setting Up the In Vivo Calibration Check for proper positioning of the catheter in the patient relatively stable oxygen saturation in patient that the SvO light intensity indicator covers at least two divisions above the midpoint Making the In Vivo Calibration 1 2 3 4 wa Be prepared to draw a blood sample from the patient In the Setup SvO2 menu select Start In VivoCal To clear the distal lumen draw off and discard at least 2 ml of blood before taking the sample Draw a blood sample from the distal port of the catheter and flush the line according to standard hospital practice Obtain laboratory analysis of the sample using direct measurements Compare the results with the stored calibration value displayed in the Setup SvO2 menu If the difference is less or equal to 4 you can skip the next step If there is a diff
264. ient Demographics window and its associated pop up keys to admit discharge and transfer ADT patients All patient demographic and ADT information is shared between the patient monitor and the Information Center for example patients admitted to the monitor are automatically admitted to a connected Information Center Admitting a Patient The monitor displays physiological data and stores it in the trends as soon as a patient is connected This lets you monitor a patient who is not yet admitted It is however important to admit patients properly so that you can identify your patient on recordings reports and networked devices During admission you enter data that the monitor needs for safe and accurate operation For example the patient category setting determines the algorithm the monitor uses to process and calculate some measurements the safety limits that apply for some measurements and the alarm limit ranges To admit a patient 1 Select the patient name field or select the Admit Dischrge SmartKey to open the Patient Demographics window 2 Clear any previous patient data by selecting the Dischrge Patient or End Case pop up key and then Confirm If you do not discharge the previous patient you will not be able to distinguish data from the previous and current patients for example in the trend database 3 Select Admit Patient 4 Enter the patient information select each field and use the on screen keyboard or
265. ill have no annotation next to the bandwidth annotation at the Information Center Capture 12 Lead If the monitor is connected to an Information Center via a wired network the Capture 12 Lead SmartKey may be configured to show on the screen Selecting this exports 12 Lead ECG information to the Information Center for analysis For details see the Instructions for Use supplied with the Information Center EASI ECG Lead Placement Using a standard 5 electrode set in EASI lead placement you can monitor up to 12 standard ECG leads simultaneously and continuously at the bedside EASI provides a monitoring method for trending ST segment changes that can provide an early indication of ischemia EASI derived 12 lead ECGs and their measurements are approximations to conventional 12 lead ECGs As the 12 lead ECG derived with EASI is not exactly identical to the 12 lead conventional ECG obtained from an electrocardiograph it should not be used for diagnostic interpretations Respiratory monitoring is also possible with the EASI placement respiration is measured between the I and A electrodes Place the electrodes as accurately as possible to obtain the best quality EASI measurements When FASI lead placement is selected EAST is shown beside the 1mV calibration bar on the ECG wave on the display and EASI is marked on any recorder strips and printouts EASI Monitoring During INOP Conditions If one of the derived EASI leads has an INOP condition for
266. iming relative to the respiratory cycle The monitor displays the PAWP value for up to 48 hours or until you admit a new patient WARNING The pressure receptor in the catheter records pressure changes that occur only in front of the occlusion Even though the catheter tip is in the pulmonary artery the receptor records pressure changes transmitted back through the pulmonary circulation from the left side of the heart While performing the wedge procedure the monitor switches off the pressure alarms for pulmonary artery pressure PAP Due to a slight measurement delay you should not use Microstream sidestream CO as a direct reference for determining the end expiratory point in the pressure curve To start the Wedge procedure 1 Inthe Main Setup menu select Wedge to display the wedge procedures window 2 Prepare and check the pressure line according to your hospital policy If the PAP waveform scale is set to Optimum prior to the wedge procedure it is possible that after wedging the catheter the resulting pressure waveform will fall below the lower scale In this case the wedge waveform will 158 not be displayed or recorded properly To avoid this switch out of optimum scale before performing a wedge procedure 3 Use the Reference Wave 1 and 2 popup keys to select any ECG or respiratory wave as reference waves 4 Select Wave Speed if you want to synchronize all displayed waves to your preferred speed 5 Inflate the ballo
267. imit ranges The paced setting determines whether the monitor shows pacemaker pulses or not When Paced is set to No pace pulses are filtered and therefore do not show in the ECG wave WARNING Patient Category and Paced status will always contain a value regardless of whether the patient is fully admitted or not If you do not specify settings for these fields the monitor uses the default settings from the current profile which might not be correct for your patient Patient category Changing the patient category may change the arrhythmia and NBP alarm limits Always check alarm limits to make sure that they are appropriate for your patient Paced status For paced patients you must set Paced to Yes If it is incorrectly set to No the monitor could mistake a pace pulse for a QRS and fail to alarm during asystole Admitting a Centrally Monitored Patient You can admit a patient at either the bedside or the Information Center When you admit a patient the patient s name appears on the bedside monitor and the Information Center If you do not fill in all patient information required by the Information Center the Information Center may reject the admission Complete all the required fields and try again to admit the patient Quick Admitting a Patient Use Quick Admit only if you do not have the time or information to fully admit a patient Complete the rest of the patient demographic details later If you do not the patient name wil
268. in the C O procedure window select Cathct and use the pop up keypad to enter the correct value The catheter constant is usually written either on the catheter or on the catheter packaging 9 Make sure that the injectate volume setting matches the injectate volume you will use To change the volume in the C O procedure window select InjVol and select the correct injectate volume from the pop up list If there is a problem with the volume or temperature you have chosen the monitor will issue a curve alert message to inform you of this 10 Ifyou are measuring CCO or CCI check that the correct pressure source is selected in the Setup CCO menu The pressure label under CCO from must match the pressure measured with the arterial catheter To change the pressure source select CCO from to call up a list of available pressure labels and select the correct label 11 Ifyou are measuring CCO or CCI verify that the correct alarm source is selected in the menu item Alarms From To change the alarm source select Alarms From and choose either CCO or CCI Performing PiCCO C O Measurements Always wait for the monitor to indicate readiness for the next step before proceeding If you are measuring CCO all measurements should be conducted within 15 minutes Older measurements expire for CCO calibration 1 Enter the C O procedure window 2 When you see the message Ready for new measurement start the measurement by selecting the pop up ke
269. in the mixture all influence CO absorption If values seem inaccurately high or low check that the monitor is using the appropriate corrections Altitude Altitude is set during installation The monitor automatically applies an appropriate M3014A correction only O In the Setup CO2 menu select Oxygen Corr and select a value between 0 and M3014A 100 the default value is 16 only If the O correction is not available in the Setup CO2 menu the CO measurement in your Measurement Server Extension does not require O correction Humidity At installation the monitor is configured to automatically apply either Body Temperature Pressure Saturated BTPS or Standard Temperature Pressure Dry STPD To see which go to the Setup CO2 menu and scroll down to look at HumidtyCorr N O In the Setup CO2 menu select N20 Corr and turn on or off If NO is present in M3016A the ventilation gas mixture you must turn this on instream eau mre If the N20 correction is not available in the Setup CO2 menu the CO and M3015A microstream asurement in your Measurement Server Extension does not require N20 correction or it is setup with Gas Corr see below only Gas In the Setup CO2 menu select Gas Corr and select Helium N20 or turn off If M3014A Helium or NO is present in the ventilation gas mixture you must make the only appropriate selection If the Gas correction is not available in the Setup CO2 m
270. ine was set The horizon view is made up of e a horizon drawn in white as a reference point or baseline to help you visualize changes in your patient s condition The horizon can be set to represent your patient s current condition or a target condition e a graphical trend displaying patient data for the set TrendTime 1 e a trend indicator arrow indicating how the patient trend has developed in the last ten minutes 2 e a deviation bar showing how the currently measured value deviates from the stored baseline 3 The height of the deviation bar is an indication of the extent of the change in your patient s condition relative to the horizon baseline Your monitor may not be configured to show all three elements of the screen trend horizon view Setting the Horizon The horizon is the reference value to which deviations in the measurements are compared 1 To set the baseline select the horizon trend 2 Select Auto A11 to reset the horizon for all horizon screen trends to the currently measured values Auto Horizon to set the horizon for the selected horizon trend to the currently measured value Set Horizon to set the horizon to a specific value from a pop up list Setting the Horizon Trend Scale The horizon trend scale is defined with respect to the horizon If your horizon is set to 100 and you select 20 as the horizon scale delta the upper limit of the horizon scale will be 120 and lower limit 80
271. infusion has ben administered to your patient ene Amount Volume Drip Time and how much time is left Pae 10 00 16 67 0 03 20 O EE A Dose 3 mg min s M 10 To see the Drip Table in 40 00 66 62 0 13 20 300 ml hour 16 the Drug Calculator Sane NERS EENT i 2 Amount 150 mg a 126 window select the Drip oer KOT oar Volume 250 ml 100 00 166 67 0 33 20 Table pop up key 110 00 183 33 0 36 40 Weight aa Ib 120 00 200 00 0 40 00 fthe DripTi ds 24 140 00 238 38 0 46 40 If the DripTime exceeds DripTime 0 50 00 hr min sec 150 00 250 00 0 50 00 hours the DripTime timestamp shows Using the Titration Table Titration Table x Use the Titration Table cose ea e at a glance what dose your Lidocaine Dose 4 mg min patient would receive of a eee Rate 30 ml hour drug at different infusion oa oE fi maen EE 200 meg rates By clicking on the title fp a ien G 1B e Gadi Sei mt row of the table you can In increments of 1 mg min weight sy switch between the Dose Increments and Rate Rate Dose Rate Increments view 3 22 5 13 97 5 o f 4 30 14 105 Values outside of the A yga _ m _ recommended range are E A aT m 9 67 5 _ shown in red T o am a To see the Titration Table inthe Drug Calculator window select the pop up key Titr Table The Titration Table is configured with the service Support Tool Docum
272. irm the discharge Viewing Events To see a summary of all the events in every group in the event database use the Event Summary window e To review all the events in a particular event group use the Event Review window e To review individual event episodes in detail use the Event Episode window To start viewing events either inthe Main Setup menu select Event Surveillance and then select the event view you require from the list or selectthe Event Surveillance SmartKey and then select the event view you require from the list Event Counter i il lI Vertical bars mark 9 00 10 00 11 00 12 00 13 00 14 00 15 00 16 00 events in the Event Summary window The timeline shows Event Counter Event Counter Graphic the position of the stored events in the event database Selecting this view activates a cursor that lets you navigate across the timeline and select individual events for review in the Episode Review window It also calls up the events pop up keys The event counter counts the total number of events in the database If more than one event group was set to trigger events within the event history the event counter also counts the event group totals 247 Counting Combi Events If one or more events occur during the same Episode Time the monitor combines them and displays them as distinct events in one event episode called a combi event The first event is the trigger event and the others are follow
273. is not available the monitor uses a preset static CVP value to calculate the SVR you will see the INOP message SVR SET CVP USED If the BSA is available the monitor uses the CCI to calculate the SVRI SVR SVRI settings can be changed in the Setup SVR SVRI menu To enter the menu select gt Main Setup gt Measurements gt SVR or SVRI To display a SVR SVRI numeric on the Screen select any numeric then select Change Numeric and select SVR or SVRI from the list of available numerics 164 Setting Up the PiCCO C O Measurement C O Module Press Module 1 Set up the arterial line using the arterial catheter transpulmonary catheter and the transducer kit from Pulsion Medical Systems It must be placed in one of the bigger systemic arteries for example the femoral or the axillary artery You must ee use the approved catheters and puncture Transducer A locations Remote Switch 2 Setup the central venous line 3 Connect the injectate temperature probe housing to the venous line Temperature 4 Plug the C O interface cable into the pob Trasts Connection C O module or measurement server ie Cable nyectate extension and connect the following Saige devices to the C O interface cable Thermistor crea Connection Injectate temperature probe Thermistor connector Injectate Temperatur e Probe Housing Remote start switch if used Follow your hospital standards to avoid unintention
274. is sample ABP trend shows the continuously measured values for the systolic diastolic and mean pressures displayed in band form Documenting Trends To print a Vital Signs or Graphical Trends report inthe Vital Signs orGraph Trends window select the pop up key Print to print a report for the trend group currently on the monitor screen Reports include the most recent information in the trends database and extend backwards in time according to the selected trend interval and your monitor s configuration Trends reports can be printed on central or local printers To make a Vital Signs recording inthe Vital Signs window select the Print Record pop up key then select the Record Vitals pop up key Vital Signs recordings print the trend data for the current group and trend period shown in the Vital Signs window 228 Trends Databases Depending on the purchased options and the monitor s configuration the trends databases store information for up to 32 measurements for up to 72 hours The values in the trends database are stored as measured by the monitor they are not averaged values The trend resolution defines how often a value is stored In general if more than one value is available for storage in the trends database the most recent value is used Some values in the trends are marked with arrows This indicates that for this time period more values were available and the most recent one is shown Exampl
275. isible but grayed out so that you can neither select nor change them These are for your information and can be changed only in Configuration Mode e Demonstration Mode Passcode protected this is for demonstration purposes only You must not change into Demonstration Mode during monitoring In Demonstration Mode all stored trend information is deleted from the monitor s memory e Configuration Mode Passcode protected this mode is for personnel trained in configuration tasks These tasks are described in the Configuration Guide During installation the monitor is configured for use in your environment This configuration defines the default settings you work with when you switch on the number of waves you see and so forth e Service Mode Passcode protected this is for trained service personnel boa Confi When the monitor is in Demonstration Mode Configuration Mode or g Service Mode this is indicated by a box with the mode name in the center of the Screen and in the bottom right hand corner Select this field to change to a different mode Standby Mode Standby mode can be used when you want to temporarily interrupt monitoring To enter Standby mode select the Monitor Standby SmartKey or selectMain Setup followed by Monitor Standby The monitor enters Standby mode automatically after the End Case function is used to discharge a patient Standby suspends patient monitoring All waves and numerics disappear f
276. ist of available applications 3 Operate the application with your preferred monitor input device touchscreen SpeedPoint navigation point keyboard or mouse Remote Application Popup Keys Minimize minimize the Remote Application window the session continues running in the background Select the Remote Application symbol to show the window at full size again Keyboard start a keyboard application to show a keyboard on the display This key is not available if the keyboard application is not installed or not supported on the Philips Application Server Refresh update the content of the Remote Application window Close close the Remote Application session The Remote Application window occupies a pre defined area on the monitor Screen The maximum size of the area depends on the resolution of your display If the pre defined area for the Remote Application covers the full monitor Screen on independent second displays only the pop up keys are not displayed In this case a small window appears with two keys one with the Remote Application symbol to display the pop up keys and another to move the small window if it is obstructing viewing If you change the monitor Screen while a Remote Application is running and the pre defined area on the second Screen is smaller the Remote Application cannot be shown at full size You must select a suitable monitor Screen to display the Remote Application again 2 What s
277. ith the check mark symbol The Alarm Messages window pop up keys appear when the window is opened If alarm pause extension is disabled the pause pop up keys are inactive grayed out Selecting the Review Alarms pop up key opens the Review Alarms window Pause Al 10 Min Pause Al 5 Min Review Alarms Alarm Limits Review Alarms Window Review Alarms The Review Alarms window contains a list of up to 100 of the most recent alarms and INOPs with date and time information If configured to do so Apr 16 55 18 Apnea uo Apr 16 55 18 ABPs HIGH 120 gt 95 Apr 16 55 18 Alarms On Apr 16 45 15 SpO2 NON PULSAT Apr 16 44 57 Alarms Off Apr 16 44 46 awRR LOW 14 lt 15 Apr 16 44 39 SpO2 LOW 95 lt 99 Apr 16 44 28 ABPs HIGH each alarm is shown with the alarm limit active when the alarm was triggered and the maximum value measured beyond this limit The Review Alarms window also shows any changes made to the Alarms On Off or Silence status aouwnauw4 uu wu If you select a high or low limit alarm in the list the Graphical Trends window will open to provide further data If you select an alarm resulting from an event alarm notification the Event Episode window for that event will open When you close these windows you will return to the Review Alarms window The information in the Review Alarms window is deleted when a patient is discharged when the mo
278. ith the results Change them if necessary WARNING After resolving a patient mismatch check that the monitor settings especially patient category paced status and alarm limits are correct for the patient Patient Mismatch If One Set of Patient Data is Correct If there is a mismatch between an Information Center and a monitor choose the data set you want to continue using for this patient either Continue Central to continue with the patient demographics from the Information Center discharge the patient in the monitor and use the default monitor profile Continue Monitor to continue with the patient in the monitor and discharge the patient in the Information Center permanently deleting all data in the Information Center If there is a mismatch between a monitor and a measurement server choose the data set you want to continue using for this patient either Continue Monitor to continue with the patient demographics trend data and settings in the monitor This discharges the patient in the measurement server and resets all MMS settings to the defaults currently active for the monitor Continue MMS to upload the data patient demographics trend data if configured and measurement Central Monitor Last name DOE MILLER First name JOHN MRN 1234HG9556 Patient Cat Adult Paced No Continue Continue New Same Central Monitor Patient Patient Monitor MeasServ Last name MILLER ADAMS Firs
279. itors or MP80 MP90 processing unit are used in internal examinations on the Grounding heart or brain ensure that the room incorporates an equipotential grounding system to which the monitor and MP80 MP90 processing unit have separate connections Combining equipment Combinations of medical equipment with non medical equipment must comply with IEC 60601 1 1 Never use a multiple portable socket outlet or extension cord when combining equipment unless the socket outlet is supplied specifically for use with that equipment Fusing The monitors use double pole neutral fusing Connectors The actual placement of boards and configuration of connections for your monitor depends on how your hardware has been configured See the symbols table on page 328 to see which symbols are used to mark the connections WARNING Connect only medical devices to the ECG output connector socket 329 MP20 MP30 MP20 MP30 Left side of monitor MP20 MP30 Rear of monitor 330 MMS and one extension ECG analog output marker input connector 11 Measurement Server Link connector AC power inlet Remote alarm connector Analog video out connector Wired network connector Wireless network connector Battery compartment Equipotential grounding Protective earth Space for optional interface boards e g serial MIB RS232 connectors or optional parallel printer connection Side cover with antenna for IntelliVue Ins
280. its can be used is defined in the monitor s Configuration mode Use the Change Limits window to check AutoLimits before you apply them to ensure that they are appropriate for your individual patient and their clinical condition Once applied AutoLimits are shown on the monitor screen just like manually set alarm limits If the AutoLimits are not appropriate for your patient you must set alarm limits manually The limits remain unchanged until you set them again or change them manually Documenting Alarm Limits The alarm limits pop up keys appear with the Alarm Limits and Change Limits windows Select the Print Limits pop up key to print an overview of all alarm limits on a connected printer Select the Record Limits pop up key to send a recording of the alarm limits to a recorder 49 Reviewing Alarms To review the currently active alarms and INOPs select any of the alarm status areas on the monitor screen The Alarm Messages window pops up All alarms and INOPs are erased from the monitor s alarm history when you discharge a patient or if you change to Demonstration Mode Alarm Messages Window The Alarm Messages window shows all the currently active alarms and INOPs in chronological order beginning at the top with the most recent INOPs are shown on the left hand side and patient alarms are shown on the right hand side Any active red alarms are shown first followed by yellow alarms Acknowledged alarms or INOPs are shown w
281. ive Pressure 151 Setting up the Pressure Measurement 151 Selecting a Pressure for Monitoring 152 Extended Pressure Label Set 152 Zeroing the Pressure Transducer 152 Zeroing ICP or IC1 IC2 153 Determining a Pressure s Most Recent Zero 153 Zeroing a Pressure Measurement 153 Using the Zero Hardkey 153 Zeroing All Pressures Simultaneously 153 Troubleshooting the Zero 154 Adjusting the Calibration Factor 154 Displaying a Mean Pressure Value Only 154 Changing the Pressure Wave Scale 154 Optimizing the Waveform 155 Non Physiological Artifact Suppression 155 Choosing the Pressure Alarm Source 155 Calibrating Reusable Transducer CPJ840J6 156 Making the Pressure Calibration 156 Troubleshooting the Pressure Calibration 157 Calculating Cerebral Perfusion 157 Calculating Pulse Pressure Variation 157 Measuring Pulmonary Artery Wedge Pressure 158 Editing the Wedge 159 Identifying the Pressure Analog Output Connector 160 13 Monitoring Cardiac Output 161 Hemodynamic Parameters 162 Using the C O Procedure Window 163 Accessing the Setup C O and Setup CCO Menus 164 Entering the HemoCalc Window 164 Measuring C O Using the PiCCO Method 164 Measuring Continuous Cardiac Output 164 Measuring Systemic Vascular Resistance 164 Setting Up the PiCCO C O Measurement 165 Performing PiCCO C O Measurements 166 Editing PiCCO C O Measurements 166 Saving and Calibrating PiCCO C O Measurements 167 CCO Calibration Status Indicators 167 Measuring C O Using the
282. j ay left and MP60 MP70 10 1 White ECG Resp connector 2 Blue SpO connector Red NBP connector 4 amp Combined pressure red and temperature 5 brown connector connect either invasive pressure transducer or temperature probe You might have a version of the MMS that does not have this connector 6 NBP Start Stop key edo starts or stops NBP measurements 4 n NBP STAT key starts NBP P STAT series of measurements OR Boe Zero key initiates a zero procedure for the connected pressure transducer when pressed and held for a second 8 3 Silence acknowledges all active AY alarms by switching off audible alarm indicators and lamps 9 MSL cable connector to the monitor Measurement Server Extensions The measurement server extensions connect to the MMS and use the MMS settings and power Trend data and measurement settings from the measurements in the extensions are stored in the measurement server To separate an extension from the MMS press the release lever down and push the server forward 11 WARNING The measurement server extensions can only function when they are connected to a measurement server If the measurement server is removed during monitoring the measurements from both the measurement server and the measurement server extension are lost M3014A M3015A and M3016A Capnography Extensions The M3014A Capnography Extension adds
283. ject trials directly by tipping on the trial curve Discard conspicuously different values The background of rejected trials is red and the background of accepted trials is green The monitor recalculates the average values after you reject or accept trials If all values are different from each other there may be true hemodynamic instability caused for example by severe cardiac arrhythmia Saving and Calibrating PiCCO C O Measurements When you have finished editing the trials you must save the results This closes the measurement series sends the average C O numeric to be displayed on the main screen and stores the averaged values in the trends and calculations databases Before the monitor can calculate CCO you must calibrate the measurement You should also calibrate CCO every eight hours or if the hemodynamic condition of the patient changes consistently in the same direction over 15 minutes or if there are large or sudden changes in the patient s condition The monitor only uses C O measurements from within the last 15 minutes for calibrating CCO To save and calibrate Inthe C O procedure window select the pop up key Save C O amp Cal CCO to use the averaged C O value to calibrate Continuous Cardiac Output CCO Your monitor may be configured to have two separate pop up keys Save C O and Cal CCO instead of the combined Save C O amp Cal CCO WARNING CCO calibration is patient specific When the C O module
284. k Device Name gt to enter the setup menu for the connected device headed Setup lt VueLink Device Name gt 2 Select the item you want to change then select the new item from the pop up list or Select Show Device Data to view the device data window 3 Close the setup menu The monitor takes a few seconds to activate the change Viewing the VueLink Device Data Window To view the VueLink device data window AUxPLUSE either AUXILIARY PLUS 2 Wielink BEND OF leer e select the setup hardkey on the VueLink module or the VueLink SmartKey Ee gente peo for IS Fh a 20 0 Hey and then select the lt Device Name gt ie zo GA pop up key or MS rey WLU g e inthe Setup lt Device Name gt i a le oe a menu select Show Device Data Thtesd 40 5 E Takia 1 5 C Selecting the device data window opens the setup menu for the connected device 282 Using VueLink Screens 27 VueLink Modules Using VueLink Screens Your monitor may be configured to show VueLink device data permanently on the Screens JAUXILIARY PLUS 2 VueLink DEMO Driver Venti Lat ion Mode NORMAL Device Alarms Ignored Select the device data window to display the VueLink pop up keys that let you access the setup menu and carry out VueLink tasks 200 mmHg PSs 150 0 mmHg ty 0 40 Liter 30 mmHg PSd 50 0 mmHg MY 4 00 L min 60 mmHg P5m 100 0 mmHg awRR 185 rpm 170 mmHg UVP 185 0 mmHg PIP 100 cmH 0 5 mmHg UVPd 10 0 mmHg PEEP 43 5 cmH 0 140 mmHg UYP
285. l arrhythmia and ECG HR alarms are switched off e Auto Ifthe Alarm Source is set to Auto the monitor will use the heart rate from the ECG measurement as the alarm source whenever the ECG measurement is switched on and no ECG LEADS OFF INOP is active The monitor will automatically switch to Pulse as the alarm source if a Pulse source is switched on and available and the heart rate becomes unavailable and the ECG LEADS OFF inop is active The monitor then uses the pulse rate from the measurement currently selected as system pulse While Pulse is the alarm source all arrhythmia and ECG HR alarms are switched off If the HR becomes available again the monitor automatically uses this as alarm source 128 WARNING Selecting Pulse as the active alarm source for HR Pulse switches off the arrhythmia alarms listed in the section ECG Arrhythmia and ST Alarm Overview on page 104 and the heart rate alarms This is indicated by the message A11 ECG Alarms Off unless this has been configured off for your monitor and the crossed out alarm symbol beside the ECG heart rate numeric High and low pulse rate and extreme bradycardia and extreme tachycardia alarms from pulse are active Alarm Source Selection Disabled If Alarm Source Selection is disabled you cannot change the alarm source If you try to change the source the monitor displays the message To activate enter Config and enable AlarmSourceSel This setting can onl
286. l line Trendlines EEG values are sampled at configured time intervals and displayed as color coded trendlines Trendlines are available for the three frequency numerics SEF PPE MDF Annotations INOP marker 9 Filter change marker Montage change marker 211 Changing CSA Settings When CSAs are shown embedded on the Main Screen select the CSA to show the pop up keys When the CSA is shown in a window over the current screen the pop up keys are always displayed Buffer choose one of the three pre configured buffers A buffer defines the interval between the spectral lines displayed in the CSA On Off SEF MDF PPE switch the trendline of the specific numeric on or off Changing EEG Settings Be aware that any changes made to EEG settings apply to both EEG channels Switching EEG Numerics On and Off Each EEG numeric can be individually switched on or off in the Setup EEG menu 1 Inthe Setup EEG menu select the numeric label 2 Select On Off to toggle between the settings Changing the Scale of the EEG Waves for Display This only changes the visual appearance of the wave It does not affect the signal analyzed by the monitor or printed in reports or recordings 1 Inthe Setup EEG menu select Wave Scale to call up a list of wave scales 2 Select the required scale from this list Scaling information is displayed with each EEG wave e IfShow Gridlines is set to On in Configuration
287. l noise gray Check sensor to skin contact Press sensor more impedance cannot be measured firmly to skin If necessary clean and dry skin Impedance above limit ea yellow Check sensor to skin contact Press sensor more firmly to skin If necessary clean and dry skin Impedance within valid range v green No action necessary 219 Changing the BIS Smoothing Rate The smoothing rate defines how the monitor averages the BIS value To change the smoothing rate in the Setup BIS menu select BIS Smoothing Rate then choose either 15 seconds this provides increased responsiveness to changes in the patient s state 30 seconds this provides a smoother BIS trend with decreased variability and sensitivity to artifacts Switching BIS and Individual Numerics On and Off To switch the BIS measurement on or off Inthe Setup BIS menu select BIS to toggle between On and Off To switch individual numerics provided by the BIS Module on or off Inthe Setup BIS menu select SQI TP SEF SR EMG or BURSTS to toggle between On and Off Changing the Scale of the EEG Wave Changing the scale only changes the visual appearance of the wave It does not affect the signal analyzed by the monitor or printed in reports or recordings The scale information shown depends on whether gridlines are switched on or off for display This setting can only be changed in Configuration Mode 1 Inthe Setup BIS menu select Change
288. l not be written on reports and on information stored in the database or sent to an Information Center 1 Select the Quick Admit SmartKey 2 Enter the required data MRN or Last Name depending on configuration with the keyboard or a barcode scanner 78 3 Select Enter 4 In the confirmation window select Confirm to discharge the previous patient if confirmation is configured 5 Check that patient category and paced status are correct for the new patient If the monitor is connected to an Information Center and only the MRN is entered the patient name is set to The patient name field on the monitor shows Not Admitted and the patient name space on printed reports is blank To fully admit this patient select Admit Patient again and complete all required fields Editing Patient Information To edit the patient information after a patient has been admitted select the patient name field on the Main Screen to open the Patient Demographics window and make the required changes Discharging a Patient You should always perform a discharge even if your previous patient was not admitted A discharge clears the information in the Patient Demographics window erases all patient data such as trend event and calculation data from the monitor measurement servers and Information Center This ensures that data from a previous patient are not mixed with data from the new patient resets patient category and paced se
289. l notification is also available and can be pre configured to Alarm An INOP alarm indicates the expiry of the timer Sound A single tone indicates the expiry of the timer No Sound No additional notification This additional notification setting is made in the monitor s Configuration Mode and is associated with the timer label The volume of the tone can also be set in Configuration Mode 285 Timer Types There are four types of timer Basic Enhanced Cyclic andNo Limit A Basic timer has a single defined run time and progress is shown in the progress bar An Enhanced timer is like a Basic timer but the progress bar shows progress beyond the end of the run time ACyclic timer is like a Basic timer but restarts automatically when the run time is expired ANo Limit timer has no run time or progress bar and shows the time elapsed since the timer was started The type of timer is set in the monitor s Configuration Mode and is associated with the timer label Timer Setup Pop up Keys When you open the Timers window and select a timer the Set up window opens and a selection of pop up keys appear to let you activate and control the timers Start start the timer Stop stop the timer allowing either restarting after a pause Start key or clearing Clear key Clear clear the timer ending this timer episode Timers return to the timer window showing all active timers Setting Up Timers The additional notification
290. lable in the Change Screen menu If the monitor is switched off and then on again modified Screens are erased from the monitor s memory and cannot be recalled If a modified Screen was the last active Screen when the monitor was switched off it is retained unless Automat Default is configured to Yes Using Additional Displays A second display showing the same Screen as the main display can be connected to any of the monitors for viewing only The MP90 can have two main displays and additionally as a third main display the D80 Intelligent Display connected All main displays can be configured and operated individually using standard input devices For MP90 monitors with multiple displays and multiple input devices the usage and behavior can be configured according to specific requirements at installation for example use for two independent operators or tracking of mouse input across two displays For details refer to the Service Guide When two operators are using two displays the scope of an action depends on the type of operation e Patient monitoring operations such as Silence or Pause alarms take effect for the monitor as a whole the results will be seen on both displays e Display operations such as the Main Screen key and Back hardkey will take effect only on the display being operated If you are operating two displays with one remote SpeedPoint to navigate from one display to another 1 Move the highlight to the
291. lable on specially designed Screens 229 20 Trends Screen Trends Screen Trend information is taken from the Trends database If you do not see a Screen Trend for a particular measurement on the Screen check the trend priority list to ensure that this measurement is being trended Measurement waves Measurement or high res trend Screen trends numerics waves Not Admitted Adult w 10 Apr 15 3 Profiles NeoEvent B Peal Start Stop Sereen i Setting the Screen Trend Time To set the SereenTrend Time for all graphical and horizon screen trends global trend time 1 Select a screen trend then select Setup Trend or select Main Setup gt Trends 2 Select SereenTrend Time and select the required time 30 minutes one two four eight or twelve hours This is now the Global screen trend time and defines the period of trend information shown for all screen trends To set a different ScreenTrend Time for a screen trends or a group of aligned screen trends 1 Select a screen trend 2 Select Change TrendTime 3 Select the required trend time Selecting Globa1 leaves the trend time set to the global screen trend time 230 Changing the Selection of Screen Trends Displayed 1 Select the screen trend 2 Select Change Trend and select the required trend from the list of available trends Select Blank to remove the selected trend from the Screen If you do not see Change Trend in the screen trend menu the trend i
292. lace arm electrodes on the inside of each arm between the wrist and the elbow Place leg electrodes inside of each calf between the knee and the ankle Chest electrodes V1 on the 4th intercostal space at the right sternal border V2 on the 4th intercostal space at the left sternal border V3 midway between the V2 and V4 electrode positions V4 on the 5th intercostal space at the left midclavicular line V5 on the left anterior axillary line horizontal with the V4 electrode position V6 on the left midaxillary line horizontal with the V4 electrode position 100 Modified 12 Lead ECG If your institution uses modified 10 Lead ECG electrode placement the Angle of Lewis Mason Likar Lead System place the four limb electrodes close to the Ee 7 Me shoulders and lower abdomen J The six V electrodes are placed on the chest in the same position as the V1 V6 conventional 12 lead placement Choosing Standard or Modified Electrode Placement If your institution uses modified 10 Lead ECG electrode placement the Mason Likar Lead System you must switch Mod Lead Placment to On in the monitor To do this inthe Setup ECG menu select Mod LeadPlacement to toggle between On and Off WhenMod Lead Placment is set to On 12 Lead ECG Reports will be labelled 12 Lead ECG Report Mason Likar and captured 12 lead ECGs will be labelled Mason Likar to
293. lashes red alarm DISCONNECT mean pressure is continuously less than lamp alarm tone 10mmHg 1 3kPa This alarm occurs only with arterial pressures P ABP ART Ao BAP FAP PAP UAP lt Pressure gt HIGH PRESS The measured pressure value is above numeric flashes high limit is the high alarm limit s d or m after the highlighted yellow alarm label indicates whether the systolic lamp alarm tone diastolic or mean pressure has crossed the limit lt Pressure gt LOW PRESS The measured pressure value is below numeric flashes and low limit the low alarm limit s d or m after the is highlighted yellow alarm label indicates whether the systolic lamp alarm tone diastolic or mean pressure has crossed the limit PULSE HIGH PRESS The pulse rate has exceeded the high numeric flashes and high limit SpO alarm limit is highlighted yellow alarm lamp alarm tone PULSE LOW PRESS The pulse rate has dropped below the numeric flashes and low limit SpO low alarm limit is highlighted yellow alarm lamp alarm tone PVCs min HIGH ECG More premature ventricular numeric flashes yellow alarm Arrhythmia contractions have been detected in a lamp short yellow audible minute than the limit alarm R ON T PVCs ECG For HR lt 100 a PVC with R R interval numeric flashes yellow alarm Arrhythmia lt 1 3 the average interval followed by a lamp short yellow audible alarm
294. lashing numeric The numeric of the measurement in alarm flashes Bright alarm limits If the alarm was triggered by an alarm limit violation the corresponding alarm limit on the monitor screen is shown more brightly Alarm lamp A lamp on the monitor s front panel flashes This has the same color as the alarm priority Nurse call systems Alarm conditions are indicated on any device connected to the nurse call relay if configured to do so Audible Alarm Indicators The audible alarm indicators configured for your monitor depend on which alarm standard applies in your hospital Audible alarm indicator patterns are repeated until you acknowledge the alarm by switching it off or pausing it or until the alarm condition ceases if audible alarm indication is set to non latching WARNING Do not rely exclusively on the audible alarm system for patient monitoring Adjustment of alarm volume to a low level or off during patient monitoring may result in patient danger Remember that the most reliable method of patient monitoring combines close personal surveillance with correct operation of monitoring equipment Alarm Tone Configuration The audible alarm indicators of your monitor are configurable In the monitor s Configuration Mode you can e increase the alarm volume of unacknowledged alarms at regular intervals e change the interval between alarm sounds ISO IEC Standard 9703 2 alarms only e change the base volume of the red an
295. latching setting for your monitor 1 Inthe monitor sMain Setup menu select Alarms 2 SelectAlarm Settings and see the Visual Latching and Audible Latching settings This setting can only be changed in Configuration Mode You should be aware of the settings chosen for your unit There are three possible choices each for visual and audible latching Red Red and Yellow and Off These choices can be combined to give the following settings Visual Latching R amp Y R amp Y R amp Y R R Off Audible latching R amp Y R Off R Off Off R red alarms Y yellow alarms 51 Alarm Latching Behavior Alarm has not been Alarm condition Alarm tone on Alarm lamp on Alarm message Flashing numerics acknowledged still present Alarm condition All audible and visual Alarm tone on Alarm message Flashing no longer present alarm indicators Alarm lamp on numerics automatically stop Alarm message Audible alarm indicators Flashing numerics automatically stop Alarm has been Alarm condition Audible alarm acknowledged Alarm lamp off Alarm message Flashing acknowledged still present numerics Audible alarm reminder if configured Alarm condition Audible and visual alarm indicators automatically stop no longer present All INOPs except DISCONNECT and UNPLUGGED INOPs from measurement servers and modules are non latching See Yellow Arrhythmia Alarms on page 113
296. lay refers to the physical display unit Display Screen and Screen refer to everything you see on monitor s display such as measurements alarms patient data and so forth Introducing the IntelliVue Family The Philips IntelliVue family of patient monitors offers a monitoring solution optimized for the surgical cardiac medical and neonatal care environments Combining patient surveillance and data management it allows multi measurement monitoring by linking separate modules with plug and play convenience Your monitor stores data in trend event and calculation databases You can see tabular trends vital signs and document them on a local or remote printer You can view measurement trend graphs with up to three measurements combined in each graph to help you identify changes in the patient s physiological condition You can view fast changing measurement trends with beat to beat resolution and see up to four high resolution trend segments Event surveillance enhances documentation and review of physiologically significant events by automatically detecting and storing up to 50 user defined clinical events over a 24 hour period There is a choice of monitor configurations as explained below All models can also use computer devices such as a mouse a trackball and a keyboard IntelliVue MP20 MP30 The IntelliVue MP20 MP30 M8001A M8002A patient monitor has a 10 inch TFT LCD flat panel SVGA display The standard input device
297. ld assigned to ST numerics the monitor will display extra numerics in the order in which they appear in the Setup ST Analysis gt Setup ST Leads gt Choices list Any ST leads switched on for analysis that do not fit in the assigned numerics field are shown in succession in place of the last ST numeric ST Index The ST index numeric STindx is the sum of the absolute values for the ST leads V2 V5 aVF Because it is based on absolute values it is always a positive number If you haven t selected one of the leads V2 V5 and aVF for ST analysis the STindx numeric will display a question mark To switch the ST index numeric on or off for display in the Setup ST Analysis menu select ST Index to toggle between On and Off ST Snippets ST snippets show a one second wave segment for each measured ST lead The most recent snippet is drawn in the same color as the ECG wave usually green superimposed over the stored baseline snippet drawn in a different color The comparison shows any deviation in the measurement since the baseline snippet was stored for example as a result of a procedure carried out on the patient The information is updated once per minute If you do not see ST snippets on the Screen select the Screen name in the Monitor Info Line and select a Screen configured to show snippets from the pop up list of available Screens ST Baseline Window The ST Baseline Window shows an ST snippet drawn on a grid The current
298. le Silencing this INOP switches off the measurement BISx DISCONNECTED INOP tone BIS The BISx is not connected to the BIS module or the BIS interface board Silencing this INOP switches the measurement off INVALID numeric is replaced by INOP tone may sound BISx INCOMPATIBLE BIS The BISx software is not compatible with the BIS module or INOP tone with the MP20 MP30 monitor software A software upgrade may be required Contact your service personnel BISx MALFUNCTION BIS The BISx is faulty Disconnect and reconnect it to the module INOP tone or BIS interface board If the INOP persists replace the BISx MP20 MP30 Malfunction on interface board If the INOP persists contact your service personnel CANNOT ANALYZE ECG ECG The arrhythmia algorithm cannot reliably analyze the ECG Arrhythmia data Check the ECG signal quality of the selected primary and secondary leads If necessary improve lead position or reduce patient motion If you have arrhythmia analysis on and you are not getting a reliable HR because the signal is below a minimum amplitude unstable or contains artifact and you have tried to improve the system performance by choosing another lead and changing electrodes you should consider turning arrhythmia analysis off CANNOT ANALYZE ST ST The ST algorithm cannot generate a valid ST value Possible causes are large variations in the measured ST va
299. lly stop a Cyclic Impedance Check select Cyclic Check in the BIS Setup menu to toggle between On and Off or 218 select Stop Cyclic Check in the BIS Impedance Check Window If you stop a Cyclic Impedance Check before the ground electrode has passed a ground electrode impedance check will be started automatically This cannot be switched off BIS Window To open the BIS window in the Setup BIS menu select Show Sensor The window may look slightly different on your monitor The graphic in the BIS Window automatically adapts to show the type of sensor you are using showing three or four electrodes as required Each symbol in the graphic represents an electrode and illustrates the most recently measured impedance status of the electrodes Although BIS may still be measured when the electrode status is red or yellow for best performance all electrodes should be green In addition if the measured electrode to skin impedance of any electrode or electrode combination is above the limit or if disconnected electrodes are detected an INOP will be issued either BIS HIGH IMPEDANCE or BIS LEAD OFF Reference Electrode Ground Electrode Signal Electrode s Cyclic Check 15 May 11 05 3 Start Cyclic Check Time of the most recent cyclic check BIS Impedance Indicators Electrode has no skin contact x red Reconnect electrode or check the sensor to skin contact If necessary clean and dry skin Too much signa
300. low Correct electrode placement can help to reduce cardiac overlay avoid the liver area and the ventricles of the heart in the line between the respiratory electrodes This is particularly important for neonates 131 Lateral Chest Expansion Some patients especially neonates expand their chests laterally In these cases it is best f Da to place the two respiratory electrodes in the 8 right midaxillary and left lateral chest areas at the patient s maximum point of breathing movement to optimize the respiratory wave Abdominal Breathing Some patients with restricted chest movement breathe mainly abdominally In these cases you may need to place the left leg electrode on the left abdomen at the point of maximum abdominal expansion to optimize the respiratory wave Understanding the Resp Display The Resp measurement is displayed on the monitor as a continuous wave and a numeric respiration rate If the detected respiration rate is close to the heart rate this is indicated by the text HR RR next to the respiration wave if you are in manual monitoring mode Your monitor screen may look slightly different from the illustration 1 Ohm calibration bar Manually set Resp detection level Resp numeric and label Resp i RR 22 Changing Resp Detection Modes The Resp detection level can be set either automatically or manually To change the resp detection mode in the Setup Resp menu select Aut
301. ls up a list of available values for the alarm limit 2 Select a value from the list to adjust the alarm limit Alternatively you can use the keys in the measurement Change Limits window which you access by selecting the measurement label in the Alarm Limits window High red alarm view only High yellow alarm field Up down arrow keys for changing high yellow alarm limits Alarms On Off key select to toggle between alarms on or off Preview Alarm AutoLimits for a measurement before applying Select to apply wide AutoLimits Select to apply narrow AutoLimits Up down arrow keys for changing low yellow alarm limits 15 min trend showing alarm Graphic view of alarm limits Low yellow alarm field limits and monitored with currently measured value measurement values MP40 50 60 70 90 only Low red alarm view only To change alarm limits 1 Inthe Change Limits window if you are using touch select the up or down arrow buttons to adjust the high and low alarm limits as required if you are using a SpeedPoint or Navigation Point position the cursor in the high yellow alarm field then press the knob inwards Rotate the knob to the left or right to adjust the limit Press the knob again to set the displayed limit 2 Repeat to set the low yellow alarm limit 48 If you set the yellow alarm limit outside the red alarm limit the monitor will automatically set the red alarm to the yellow alarm limit W
302. lue 0 5 l min 10 0 to 25 0 l min exceeds the set limit range Complies with IEC 60601 2 23 1999 EN60601 2 23 2000 tcpO Range 0 to 750 mmHg 0 to 100 kPa Accuracy 0 5 1 digit Resolution 1 mmHg 0 1 kPa Overall Accuracy 0 to 160 mmHg 5 mmHg incl transducer 0 0 to 21 3 kPa 0 7 kPa gt 160 mmHg 21 3 kPA 3 of reading tcpO Temperature Drift lt 0 1 C tcpO Test Signal 60 mmHg 8 0 kPa tcpO Drift including transducer lt 1 mmHg h 10 O tcpO response time including transducer lt 30s tcpCO Range 5 to 200 mmHg 0 7 to 26 7 kPa Accuracy 1 0 1 digit Resolution 1 mmHg 0 1 kPa Overall Accuracy incl transducer 0 to 76 mmHg 5 mmHg 0 0 to 10 1 kPa 0 7 kPa gt 76 mmHg 10 1 kPa 10 of reading tcpCO Temperature Drift lt 0 1 C tcpCO Test Signal 40 mmHg 5 3 kPa tcpCO Drift including transducer lt 1 mmHg h 5 CO SvO EEG tcpCO response time including transducer lt 50 s Warm up Time lt 3 minutes Site Timer 0 5 1 1 5 2 2 5 3 4 5 6 7 or 8 hours Change Site alarm when site time is expired and configurable automatic heating switch off Transducer Heating Available Temperatures 37 0 C 41 0 to 45 C in steps of 0 5 C tcpO 10 to 745 mmHg 10 to 30 mmHg 1 mmHg 10 seconds after the 1 0 to 99 5 kPa 1 0 to 4 0 kPa
303. lues for consecutive beats or ventricular paced beats Review the ECG signal quality and the ST measurement points If the patient has a ventricular pacemaker ST analysis is not possible CCI NO BSA C O CCI cannot be calculated because the patient s body surface CCI numeric unavailable area is unknown Enter the patient weight and height to INOP tone provide the BSA for CCI calculation CCO BAD PRESS SIGN C O The arterial pressure wave can currently not be used for pulse numeric is replaced by contour calculation for CCO or CCI measurement Possible INOP tone causes are air bubbles in the tubing or a physiological condition for example severe arrhythmia CCO NO lt Pressure label gt C O CCO CCI cannot be calculated Make sure that the pressure numeric is replaced by chosen in the Setup CCO menu under CCO From INOP tone may sound matches the pressure measured with the arterial catheter for CCO measurement A VueLink pressure cannot be used Select another pressure label either ABP Ao ART BAP FAP or UAP CCO NO CALIBRATION C O The CCO measurement is currently not calibrated numeric is replaced by CCO NO PRESS C O CCO CCI cannot be calculated Make sure that the pressure at Information Center chosen in the Setup CCO menu under CCO From matches the pressure measured with the arterial catheter for CCO measurement A VueLink pressure cannot be used Select another pressure label either ABP Ao ART BAP FAP or UAP
304. lume 31 touchscreen 15 disabling 15 TP total power 207 TP numeric BIS on off 220 trackball connector 332 trackball using 17 trademarks 327 transcutaneous gas measurements 195 transducer CO2 accuracy 179 CO2 calibrating 180 pressure zeroing 152 tcGas calibrating 199 tcGas remembraning 197 transferring centrally monitored patients 80 transferring patients with MMS 81 transport brightness setting 302 trend time 230 global 230 trend view ST map 123 trending interval ST map 125 trends automatic unit conversion 236 automatic value substitution 236 database configuration 229 resolution 227 screen trends 229 setting parameter scales 227 setup 225 viewing 223 trends pop up keys 225 trends priority list 227 ST map 124 trigger conditions events 245 triggers for events 244 troubleshooting CO2 183 192 trunk cables accessories 309 Ttymp 150 Tvesic 150 Tyco Healthcare Group LP 327 U unfiltered ECG signal 96 unplugging a module 9 upgrading effect on EEG configuration 214 user interface settings changing 31 V V electrode placement ECG 99 venous puncture 147 ventilation calculations 233 viewing arrhythmia waves 109 viewing trends 223 visible waves report 270 visitor screen 24 vislatching arrhythmia alarms 113 vital signs recording 225 report 225 vital signs report 228 volume Z alarm 43 touch tone volume 31 Zero volume flow loops 289 effect on pressure alarms 153 VueLink zeroi
305. m 150 0 mmHg Pmean 10 0 cmH 0 Tblood 39 9 C etCO 5 50 Weight 150 0 kg Tskin 41 5 C imCO 7 04 Length 35 cm Switching VueLink On and Off To switch VueLink measurements on and off in the Setup VueLink menu select Device Interface to toggle between the settings On and Off Alarms INOPs From External Devices The VueLink module itself generates INOPs but does not generate alarms If the external device s alarms are on the module transmits these to the monitor A message in the VueLink info window tells you either Device Alarms Ignored or Device Alarms Accepted orNo Alarms Available External device alarms status symbols precede some but not all measurement labels the monitor is configured to accept external device alarms but the alarms are switched off at the external device alarms status of this external measurement is unknown Alarms from external devices are e all transmitted to the monitor For all numerics configured in the Setup VueLink menu an alarm condition is announced at the monitor For one or more measurements not configured in the Setup VueLink menu an alarm is announced as a text message for the highest priority alarm Priority is determined at the external device e always non latching on the monitor e announced as a flashing numeric while the alarm condition persists e announced audibly and visibly at the Information Center 283 Language Conflict with External Device Drivers You should
306. m the application site 3 Apply the sensor to the patient The application site should match the sensor size so that the sensor can neither fall off nor apply excessive pressure When using the M1195A Infant Finger Sensor 137 select a finger or toe with a diameter of between 7 and 8 mm 0 27 and 0 31 When applying a M1193A neonatal sensor do not overtighten the strap 4 Check that the light emitter and the photodetector are directly opposite each other All light from the emitter must pass through the patient s tissue WARNING Loose Sensor If a sensor is too loose it might compromise the optical alignment or fall off If it is too tight for example because the application site is too large or becomes too large due to edema excessive pressure may be applied This can result in venous congestion distal from the application site leading to interstitial edema hypoxemia and tissue malnutrition Skin irritations or lacerations may occur as a result of the sensor being attached to one location for too long To avoid skin irritations and lacerations periodically inspect the sensor application site and change the application site at least every four hours Venous Pulsation Do not apply sensor too tightly as this results in venous pulsation which may severely obstruct circulation and lead to inaccurate measurements Ambient Temperature Never apply an SpO sensor at ambient temperatures from above 37 C because this can cause seve
307. mainstream capnography and optionally one pressure plus either a pressure or a temperature Cardiac Output and Continuous Cardiac Output to the MMS The optional M3015A Microstream CO Extension adds microstream capnography and optionally either pressure or temperature to the MMS The optional M3016A Mainstream CO Extension adds mainstream capnography and optionally either pressure or temperature to the MMS M3015A Microstream 1 Pressure connectors red 5 Inlet 2 Temperature connector brown 6 Microstream connector CO 3 Mainstream connector CO optional 7 Gas sample outlet 4 Cardiac Output connector 12 M3012A Hemodynamic Measurement Server Extension The M3012A Hemodynamic Measurement Server Extension HMSE can be connected to the M3001A Multi Measurement Server to provide the following additional measurements Temperature Pressure an additional Pressure or Temperature and C O and CCO measurements Connection to MMS Cardiac Output orange optional red Temperature connectors brown Pressure connectors 13 1 Basic Operation Operating and Navigating Operating and Navigating 14 Everything you need to operate the monitor is contained on its screen Almost every element on the screen is interactive Screen elements include measurement numerics waveforms screen keys information fields alarms fields and menus The configurability of the monitor means that often you can access t
308. mation by selecting one character after another Use the Shift and capital Lock keys to access uppercase letters Use the Back key to delete single characters or use the Clr key to delete entire entries Select Enter to confirm what you have entered and close the on screen keyboard If a conventional keyboard is connected to the monitor you can use this instead of or in combination with the on screen keyboard Using the On Screen Calculator You can use the on screen calculator to perform any of Calculator Ed the standard operations for which you would normally use a handheld calculator To access the on screen calculator select the Calculator SmartKey or selectMain Setup gt Calculations gt Calculator we fae ue e FS ani os FEEL CEL 20 Cic een esc onesion Operating Modes When you switch the monitor on it starts up in monitoring mode To change to a different mode 1 Select the Main Setup menu 2 Select Operating Modes and choose the mode you require Your monitor has four operating modes Some are passcode protected e Monitoring Mode This is the normal every day working mode that you use for monitoring patients You can change elements such as alarm limits patient category and so forth When you discharge the patient these elements return to their default values Changes can be stored permanently only in Configuration Mode You may see items such as some menu options or the altitude setting that are v
309. ments for example measurement on off measurement color alarms limits NBP alarm source NBP repeat time temperature unit F or C pressure unit mmHg or kPa e Monitor Settings Each profile can have a choice of different predefined monitor settings These relate to the monitor as a whole for example display brightness alarms off paused alarm volume QRS tone volume tone modulation prompt tone volume wave speed resp wave speed pulse source Profiles Profile Profile A Patient Category Adult Paced No Measurement B Display Measurement C Measurement D Monitor Settings Monitor A Profiles Menu showing current settings Available choices in measurement menu You can change from one complete profile to another or swap individual settings blocks display screen monitor settings measurement settings to change a subset of a profile Changes you make to any element within the settings blocks are not saved when you discharge the patient unless you save them in Configuration Mode You might find it helpful to think of the three categories in terms of a restaurant menu The Screens are like the first course offering you a choice of starters many different screen configurations from which you can choose the one that best suits your requirements The Monitor Settings category is like the main course offering a choice of different main dishes from which you can pick one The Measurement Settings a
310. menu of the pulse source For example to switch an SpO pulse numeric on or off 1 Enter the Setup Pulse menu by selecting the Pulse numeric or by selecting Pulse in the Setup SpO2 menu 2 Inthe Setup Pulse menu selectPulse Pulse source to toggle between On and Off To switch the system pulse on or off in any Setup Pulse Pulse Source menu check which measurement is currently selected as pulse source Enter the Setup Pulse menu for this pulse source and then switch off the pulse measurement as described Using Pulse Alarms You can change pulse rate alarm limits in the Setup Pulse menu accessed via any Pulse source or in the Setup ECG menu Changing the alarm limits for a specific Pulse numeric changes the alarm limits for all pulse rate alarms and heart rate alarms Pulse alarms are only generated when the active alarm source is set to Pulse and a pulse source is set as system pulse Selecting the Active Alarm Source HR or Pulse In most cases the HR and Pulse numerics are identical In order to avoid simultaneous alarms on HR and Pulse the monitor uses either HR or Pulse as its active alarm source To change the alarm source select Alarm Source in the Setup ECG or Setup Pulse menu then select either e HR if you want the HR to be the alarm source for HR Pulse e Pulse If you select Pulse as the active alarm source the monitor will prompt you to confirm your choice Be aware that if you select Pulse as the alarm source al
311. method in the detection of apnea particularly the apnea of prematurity and apnea of infancy has not been established Interference If operating under conditions according to the EMC Standard EN 60601 1 2 Radiated Immunity 3V m field strengths above 1V m may cause erroneous measurements at various frequencies Therefore it is recommended to avoid the use of electrically radiating equipment in close proximity to the respiration measurement unit Resp Accessories To monitor respiration use only the non OR ECG accessories listed in the Resp section of the accessories chapter You cannot measure respiration if you are using an orange OR ECG cable set This is because of the higher internal impedance of the OR cable set required for use if electro surgery is being performed 134 Rate adaptive pacemakers Implanted pacemakers which can adapt to the Minute Volume may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate Switching off the Resp measurement can prevent this 135 136 9 Monitoring SpO Philips pulse oximetry uses a motion tolerant signal processing algorithm based on Fourier artefact suppression technology FAST It provides four measurements e Oxygen saturation of arterial blood SpO percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin functional arterial o
312. mmHg 2 to 13 kPa 1 mmHg 0 1 kPa M3014A M3016A less than 14 seconds ACOs low 10 to 90 mmHg 1 to 12 kPa M3015A less than18 seconds imCO High 2 to 20 mmHg steps of 1 mmHg 0 1 M3014A M3016A less than 14 seconds 0 3 to 3 0 kPa kPa M3015A less than18 seconds awRR High Adult pedi 10 to 100 rpm under 20 rpm 1 rpm M3014A M3016A less than 14 seconds Neo 30 to 150 rpm steps M3015A less than18 seconds awRR Low Adult pedi 0 to 95 rpm over BUA ED EE M3015A Neo 0 to 145 rpm TRS settings lt 20 rpm less than 8 seconds gt 20 rpm less than 18 seconds M3014A M3016A settings lt 20 rpm less than 4seconds gt 20 rpm less than 14 seconds Apnea delay 10 to 40 seconds 5 second steps set apnea delay time 4 seconds M3014A M3016A or 8 seconds M3015A Interfering Gas and Vapor Effects On CO Measurement Values The specified deviations for M3014A are valid when the appropriate corrections are switched on and set correctly M3014A M3015A Gas Level Additional deviation due to gas interfence measured at Gas or Vapor volume fraction 0 40 mmHg CO Nitrous Oxide 60 1 mmHg 5 Halothane 4 1 mmHg 5 Enflurane 5 1 mmHg 5 Isoflurane 5 1 mmHg 5 Sevoflurane 5 1 mmHg 5 Xenon 80 5 mmHg 5 Helium 50 1 mmHg 5 Metered dose inhaler not specified for use propellants Desflurane 15 3 mmHg 5 Ethanol 0 1 1 mmHg 5 Isopropanol 0 1 1 mm
313. n 42 Traditional Audible Alarms HP Agilent Philips Carenet 43 ISO IEC Standard 9703 2 Audible Alarms 43 Changing the Alarm Tone Volume 43 Minimum Volume for No Central Monitoring INOP 43 Acknowledging Alarms 44 Acknowledging Disconnect INOPs 44 Alarm Reminder ReAlarm 44 Pausing or Switching Off Alarms 44 To Pause All Alarms 45 To Switch All Alarms Off 45 To Switch Individual Measurement Alarms On or Off 45 While Alarms are Paused or Off 45 Restarting Paused Alarms 46 Resetting Arrhythmia Alarm Timeouts 46 Extending the Alarm Pause Time 46 Alarm Limits 46 Viewing Individual Alarm Limits 46 Viewing All Alarm Limits 47 Changing Alarm Limits 48 About Automatic Alarm Limits AutoLimits 49 Documenting Alarm Limits 49 Reviewing Alarms 50 Alarm Messages Window 50 Review Alarms Window 50 Understanding Alarm Messages 51 Latching Alarms 51 Viewing the Alarm Latching Settings 51 Alarm Latching Behavior 52 Testing Alarms 52 Alarm Behavior at On Off 52 4 Patient Alarms and INOPs 53 Patient Alarm Messages 53 Technical Alarm Messages INOPs 59 5 Managing Patients 77 Admitting a Patient 77 Patient Category and Paced Status 78 Admitting a Centrally Monitored Patient 78 Quick Admitting a Patient 78 Editing Patient Information 79 iii Discharging a Patient 79 Transferring Patients 80 Transferring a Centrally Monitored Patient 80 Transferring a Patient with an MMS no Central Station 81 Data Upload from an MMS
314. n additional main display used for a surgeon can be configured not to show alarm information The permanent keys and SmartKeys can also be configured not to display e Input devices can be assigned to an operator independent of physical connector location New SmartKeys For the new spirometry module there is a SmartKey to provide direct access to the spirometry data window For microstream and sidestream CO sampling can now be suppressed directly with the SmartKey CO2 Pump Off 35 2 What sNew2 What s New in Release C 0 What s New in Release C 0 IntelliVue MP80 The MP80 patient monitor is a new addition to the IntelliVue patient monitor family The functionality is similar to that of the MP70 but with the flexibility of component modularity as in the MP90 M3014A Capnography Extension The M3014A Capnography Extension offers a new measurement combination mainstream CO cardiac output invasive pressure and invasive pressure temperature M8045A Docking Station The docking station provides quick mounting and connections for the MP20 MP30 MP40 MP50 in a one step operation By placing the monitor on the docking station and closing the lever you can make the connection to AC power and to a network if present BIS Interface Board This interface board allows use of Bispectral Index monitoring with the MP20 and MP30 Timers Application The new Timers application allows you to set timers to notify you when a specific time peri
315. n measurements by comparing changes in your patient s condition across different hi res trend waves This can aid in the early detection of cardiorespiratory and hemodynamic problems The amount of data you can show on a screen depends on the display size and resolution for example on an eight inch 20 cm wave trace on your monitor screen you can view approximately six minutes of hi res trend wave trace The hi res waves are drawn at a speed of 3 cm minute The availability of hi res trend waves depends on your monitor configuration and on the options purchased for your monitor Changing the Hi Res Trend Waves Displayed To change the selection of hi res trend waves on the Screen select the hi res trend wave and select the required hi res trend wave from the list of available measurements If there are no hi res trend waves on the Screen you must change to a Screen with hi res trend waves Hi Res Trend Wave Scales High resolution trend waves are either compressed realtime waves or fast numeric trends e Hi res trend waves from compressed realtime waves include Resp CO3 ABP PAP CVP ICP AWP anesthetic agents e Hi res trend waves from fast numeric trends include btbHR SpO tcpO3 tcpCOs Pulse Perf CPP BIS CCO inO Delta SpO gt Hi res trend waves from waves use the wave scale as their display scale Changing the wave scale changes the hi res trend wave scale Hi res trend waves from numerics use a pre define
316. n monitor numeric flashes at Information Center Arrhythmia outside of the limit in two or more yellow alarm lamp alarm tone leads Check on the monitor for more details about which leads are affected SvO2 HIGH SvO The SvO value has exceeded the high numeric flashes and high alarm limit limit is highlighted yellow alarm lamp alarm tone SvO2 LOW SvO gt The SvO value has fallen below the low numeric flashes and low alarm limit limit is highlighted yellow alarm lamp alarm tone SVT ECG A run of supraventricular beats greater numeric flashes yellow alarm Arrhythmia than the SVT run limit has been lamp alarm tone detected and the HR has exceeded the SVT HR limit TACHY Pulse Press SPO The heart rate from the Pulse signal has numeric flashes alarm limit is or exceeded the tachycardia limit xxx highlighted red alarm lamp TACHY xxx gt yyy denotes the highest measured value yyy alarm tone is the tachycardia limit Tblood HIGH C O The blood temperature value has numeric flashes high alarm exceeded the high alarm limit limit is highlighted yellow alarm lamp alarm tone Tblood LOW C O The blood temperature value has fallen numeric flashes low alarm below the low alarm limit limit is highlighted yellow alarm lamp alarm tone tcpO2 HIGH tcGas The tcpO or tcpCO value has numeric flashes high alarm exceeded the high alarm limit limit is highlighted yellow alarm lamp alarm
317. n the Main Screen permanent key Press and hold the Main Screen permanent key again to re enable the touchscreen operation 15 Using the SpeedPoint integrated SpeedPoint Gon wee Remote SpeedPoint MP60 MP70 only 7 7 vA all monitors 1 Silence acknowledges all active alarms by switching off audible alarm indicators and lamps Behavior follows the Silence permanent key configuration 2 Alarms Off Pause Alarms pauses alarm indicators Behavior follows the Pause Alarms permanent key configuration Main Screen close all open menus and windows and return to the main screen Back go back one step to the previous menu SpeedPoint knob rotate and tilt to highlight elements Press to select AJJ w amp Function keys on remote SpeedPoint function identical to the first five SmartKeys configured for a screen 7 On standby key Rotate the SpeedPoint knob left or right With each click the highlight jumps to the neighboring screen element Alternatively tilt the knob to move it in the direction of a screen element A cursor moves across the screen following the direction of the knob Any screen element under the cursor is highlighted When you reach the screen element you want press the knob to select the element Using the remote SpeedPoint you can operate the monitor from a distant location such as at the foot of the bed The remote SpeedPoint can be used with all monitors
318. n type Hem gt dynamic jw 15 p 03 11 23 Cc SI SVRI PVRI values 4 44 55 6 918 144 LCWI 2 6 U min m2 mL m2 DSm2 cm5 DSm2 cmS kg m m2 LVSWI 32 5 g m m2 RCWI 0 97 kg m m2 RVSWI 12 09 g m m2 Depending on the calculations group you choose a selection of pop up keys will appear to let you navigate through the stored events and carry out calculations related tasks Resample tell the monitor to override the values in the calculations database and use the most Vitals recent continuously monitored values Resampling sets the calculation time to the current time and displays the corresponding values for the previous second Perform perform the displayed calculation using the currently input values and store the Calc calculation in the calculations database Print print or record the displayed calculation Record On Off toggle between showing the date and time or the units for the calculation input DateTime values On Off toggle between showing the normal ranges or the units for the calculation output Ranges values 234 Cardiac access the C O procedure window Output Hemo open the hemodynamic calculations review window Review Vent open the ventilation calculations review window Review Oxygen open the oxygenation calculations review window Review Reviewing Calculations To enter the calculations review window select the Oxy Review Ventil Review or
319. ncludes PV4046 injectate temperature PV8115CVP sensor housing for M1646A and central venous pressure line PULSION Pressure Interface Cable for disposable pressure transducer PMK 206 SpO Accessories This section lists accessories for use with Philips SpO technology For accessory lists for other SpO7 technologies refer to the instructions for use provided with these devices Some Nellcor sensors contain natural rubber latex which may cause allergic reactions See the Instructions for Use supplied with the sensors for more information M1901B M1902B M1903B and M1904B disposable sensors are not available in USA from Philips Purchase Nellcor sensors and adapter cables directly from Tyco Healthcare Do not use more than one extension cable with any sensors or adapter cables Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in L indicates Long version All listed sensors operate without risk of exceeding 41 C on the skin if ambient temperature is below 37 C The M1020B SpO module with Option A02 may not be available in all countries Some sensors may not be available in all countries Always use the MAX FAST forehead sensor with the foam headband provided by Nellcor Make sure that you use only the accessories that are specified for use with this device otherwise patient injury can result Option A01 is the Philips FAST SpO version Option A02 is
320. ncludes the patient name and MRN bed number date and time of recording recording speed and recording code Active alarm and INOP messages as well as numerics for all currently monitored measurements are also printed Recording strip annotations are printed at the beginning of the recording strip and updated at regular intervals every 15 minutes for recordings made at speeds lower than 6 25 mm s and every 60 seconds for recordings made at speeds greater or equal to 6 25 mm s This sample recording strip shows a typical initial annotation oe Recording speed Measurement numerics a o00in 25 mm sec Tblood 37 0xC 23 Jan 02 10 43 Bed 3 SPO2 95 SV 94 ml Patient M Green Sarah 37549201 Pulse 120 bpm SI 48 ml m2 information PERF 10 0 and medical xx EXTREME BRADY ABP 120 70 91 mmHg record no ABPs HIGH PAP 28 15 21 mmHg PAPd HIGH NBP 120 80 90 mmHg 23 Jan 02 Alarms CCO NO CALIBRATION 10 31 ae SOME ECG ALARMS OFF c o ABP REDUCE SIZE C I cco l min CCI etCO2 40 mmHg imCO2 0 mmHg awRR RR 15 rpm Tnaso 37 0xC Recording Strip Code The recording strip code printed in the first line of the initial annotation has up to seven characters specifying recording type operating mode application area patient category and delay time if applicable 262 Recording type 90 Realtime 8A Delayed OB Alarm 91 Context Procedures Operating mode M Monitoring D Demo C Configuration S S
321. nd off Adjusting a Measurement Wave To quickly adjust wave related measurement settings such as speed or size select the measurement wave itself This displays the measurement Wave menu which has only wave related measurement settings Changing Wave Speeds Lowering the wave speed compresses the wave and lets you view a longer time period Increasing the speed expands the waveform giving you a more detailed view The monitor distinguishes three groups of wave speed settings e RespiratorySpeed for all respiratory waves CO Resp anesthetic agents and O3 EEG Speed for all EEG and BIS waves e Global Speed for all waves not included in the other two groups Changing the Wave Group Speed The wave speed group setting defines the speed of all the waves in the group To change the wave speed of a wave speed group 1 SelectMain Setup gt User Interface 2 SelectGlobal Speed RespiratorySpeed or EEG Speed as required 27 3 Select a value from the list of available speeds Changing Wave Speed for a Channel To change the wave speed of an individual wave channel 1 Enter the Wave menu for a measurement by selecting its wave 2 Select Change Speed 3 To set the speed to the wave group speed select RespiratorySpeed EEG Speed or Global Speed To set an individual channel speed select a numeric value from the list of available speeds This overrides the wave group speed setting and set the speed for the individual wav
322. nd electrosurgery interference can cause problems with the waveform and the CSA Radiated field strengths above 1 V m and patient signals lt 50 pV may cause noise on the EEG waves at various frequencies Therefore it is recommended to avoid the use of electrical radiating equipment in close proximity to the patient monitor The noise does not influence the measurement accuracy Interference from ECG can be eliminated by adjusting the low filter settings 19 Monitoring BIS Bispectral Index monitoring helps to monitor the level of consciousness of a patient under general anesthesia or sedation in the OR and ICU The BIS sensor is placed on the patient s forehead to capture electroencephalographic EEG signals from which several numerics are derived including a single BIS value representing the level of consciousness See the chapter on Specifications for the BIS intended use statement The BIS Module or BIS Interface board for MP20 MP30 provides the monitor with an EEG wave and the following numerics Bispectral Index BIS The BIS numeric reflects the patient s level of consciousness It ranges from 100 fully awake to 0 suppression no electrical brain activity Signal Quality Index SQI The SQI numeric reflects signal quality and provides information about the reliability of the BIS SEF TP SR and Bursts numerics during the last minute It ranges from 0 to 100 SQI lt 15 the numerics cannot be derived SQI
323. nd select SpO from the pop up list Setting Up Tone Modulation If tone modulation is on the QRS tone pitch lowers when the SpO level drops Remember the QRS tone is derived from either heart rate or pulse depending on which is currently selected as the active alarm source Inthe Setup SpO menu select Tone Modulation to toggle between Yes for on and No for off Tone modulation is licensed under US patent US 4 653 498 from Nellcor Puritan Bennett Incorporated a Tyco Healthcare company Setting the QRS Volume Inthe Setup SpO menu select QRS Volume and set the appropriate QRS tone volume Calculating SpO Difference When a second SpO measurement is present either through the SpOz module or through VueLink the monitor displays both SpO values and calculates the difference between them The second value is subtracted from the first 141 From the Main Setup menu select Measurements From the ASpo Setup menu select First SpOp Choose the first measurement source Select Second Sp0 OW Re O N e Choose the second measurement source 142 10 Monitoring NBP This monitor uses the oscillometric method for measuring NBP In adult and pediatric mode the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers ANSI AAMI SP 10 1992 in relation to mean error and standard deviation when compared to intra arterial o
324. nds to the ST values 24 seconds ago and so forth The ST values on the diagrams show the current ST values 123 6 ECG Arrhythmia and ST Monitoring Viewing ST Maps If a lead is turned off its axis is no longer shown This has no impact on the presentation of trended values that were recorded while the lead was still on In the diagram below lead V4 was switched off 20 seconds ago The current ST values and the first trended value reflect this change in the lead setup All other maps are displayed the way in which they were recorded ST Map Trend Limb Leads Chest Leads Interval 12 sec trending interval current ST values In this diagram V4 was either temporarily switched off or in INOP for around 30 seconds No data was recorded Consequently the affected maps are not closed Viewing an ST Map To display an ST map Inthe Setup ST Analysis menu select ST Map Working in the ST Map Task Window You may need to activate the ST map task window to see all the data and to access the pop up keys Select the map view on screen to activate its task window Once you activate it you can perform the tasks detailed here Switching Between ST Map Views To switch between views Select Current View or Trend View to toggle between views If your trend view is empty you need to adjust the priority of this measurement in the trending priority list See Trend Priority on page 227 124 Displaying an ST Reference
325. nea alarm could be up to 10 seconds plus the configured apnea delay time Automatic Alarm Suppression If the automatic alarm suppression is switched on all spirometry alarms are suppressed until breathing activity has been detected This setting must be made in configuration mode Choosing Measured AWV Components 1 Inthe Setup Spirometry menu select AWV 2 Select MV to choose the measured components for Minute Volume inspiratory and or expiratory or off Select TV to choose the measured components for Tidal Volume inspiratory and or expiratory or off NOTE IfMVand TV are set to off there will be no alarming for these parameters Setting the Gas Compensation Mode 1 Inthe Setup Spirometry menu select Gas Compensation 2 Select Mode to choose the Gas Compensation mode select Manual for manually entered gas concentrations or select Gas Analyzer for gas concentrations from the gas analyzer NOTE Gas concentrations from the gas analyzer are only available for Philips gas analyzers not for devices connected via the Vuelink module e If gas concentrations from the gas analyzer are selected but not all data is available the missing data is taken from manually entered values In case of invalid data or no data at all the INOP message SPIRO GAS COMPENS is displayed Changing the Type of Balance Gas 1 Inthe Setup Spirometry menu select Gas Compensation 2 Select Balance Gas to change the type of balance gas 3 S
326. ng alarm messages 283 pressure transducer 152 device driver conflicts 284 language conflicts 284 module 281 module options 281 module setup 282 visible waves and numerics 281 wW warnings 1 wave adjusting 27 changing speed 27 scale CO2 183 192 scale pressure 154 size CO2 183 192 size pressure 154 wave channel speed 28 wave group speed 27 wave scale EEG changing 220 wave size Resp 133 wave size ECG changing 94 wave speed eeg speed wave speed global speed 27 respiratory speed 27 wave speed EEG 213 wave speed Resp 134 wedge balloon inflation 159 editing 159 printing 159 pulmonary artery 158 recording 159 reference waves 158 what s new 35 wide alarms limits 49 wired network connection symbol 328 wireless device connection symbol 328 Y yellow arrhythmia alarms 113 yellow arrhythmia alarms on off 113
327. ng ST monitoring off if these conditions are present This monitor provides ST level change information the clinical significance of the ST level change information should be determined by a physician Switching ST On and Off To switch all ST monitoring on or off in the Setup ST Analysis menu select ST Analysis to toggle between On and Off Selecting ST Leads for Analysis To switch ST monitoring for individual leads on or off in the Setup ST Analysis menu select Setup ST Leads In the pop up window the leads in the left column under Choices are the leads you can choose from and the leads in the right hand column Selected are the leads chosen to be displayed Select the ST leads on the left and use the arrow keys to move the leads from one list to the other then select Done to apply the changes 117 Understanding the ST Display 118 Your monitor screen may be configured to look slightly different from the illustrations Current HR Current heart rate ST Numerics Up to 12 ST numerics plus the ST index can be displayed on the monitor screen They can be configured to show beside the measurement numerics beside the ECG wave or beside the ST snippet alarm limits ST numerics 12 A positive ST value indicates ST segment a i elevation a negative value indicates depression ST aVR 3 0 ST numerics are displayed in the order in which you select ST leads for analysis If there is additional space in the fie
328. ng normal operation the green LED indicates whether Radio is currently on or off the yellow LED remains off 3 Combined power network cable 335 _34 Installation and Specifications Attu de Setting Altitude Setting Altitude affects tcGas and CO measurements The monitor must be configured at installation to the correct altitude Monitor Safety Specifications CE 0366 The monitors together with the Multi Measurement Server M3001A and the Flexible Module Server M8048A all modules and measurement server extensions comply with the Medical Device Directive 93 42 EEC In addition the product complies with IEC 60601 1 1988 A1 1991 A2 1995 EN60601 1 1990 A1 1993 A2 1995 UL 60601 1 2003 UL 2601 1 1994 CAN CSA C22 2 601 1 M90 JIS T 1001 1992 IEC 60601 1 1 2000 EN 60601 1 1 2001 IEC 60601 1 2 2001 EN 60601 1 2 2001 Classification according to IEC 60601 1 Class 1 Type CF Continuous Operation The BIS measurement uses a Type BF applied part The possibility of hazards arising from software errors was minimized in compliance with ISO 14971 2000 EN60601 1 4 1996 A1 1999 and IEC 60601 1 4 1996 A1 1999 This ISM device complies with Canadian ICES 001 Cet appareil ISM est conforme a la norme NMB 001 du Canada CE 185 0145 PH Aspect BISx 185 0111 Aspect BIS Engine and 185 0124 Aspect DSC comply with the requirements of the Council Directive 93 42 EEC of 14 June 1993 Medical Device Directive
329. ng the check If the ground electrode does not pass this check another check is started This continues until the ground electrode passes the check If the Continuous Impedance Check interferes with other measurements it can be switched off To do this 1 Inthe Setup BIS menu select Cont Imp Check 2 Select On Off to toggle between the settings CAUTION Switching the continuous impedance check off will disable automatic notification to the user of impedance value changes which may lead to incorrect BIS values Therefore this should only be done if the check interferes with or disturbs other measurements When a Semi reusable Sensor is in use the continuous impedance check cannot be switched off If it is switched off when the sensor is connected it will automatically be switched on again BIS Cyclic Impedance Check This measures the exact impedance of each individual electrode It causes a disturbed EEG wave and the INOP BIS IMPEDANCE CHCK is shown on the monitor screen during the check Starting a Cyclic Impedance Check The Cyclic Impedance Check is automatically started when a sensor is connected To manually start a Cyclic Impedance Check select Cyclic Check in the BIS Setup menu to toggle between On and Off or select Start Cyclic Check in the BIS window Stopping a Cyclic Impedance Check The Cyclic Impedance Check stops automatically if the impedances of all electrodes are within the valid range To manua
330. ning adjacent ST values the monitor obtains the ST map The contour line and the map shading is shown in the same color as the ECG parameter Current View In current view the monitor displays an ST map that corresponds to the current ST values Three or more leads per plane are necessary to display a map The left of the following diagram shows leads I II HI aVR aVL and aVF on the limb leads On the right the V leads V1 V2 V3 V4 V5 and V6 are on the chest leads 122 Viewing ST Maps 6 ECG Arrhythmia and ST Monitoring alarm status 12 Lead EASI indicator ST index for EASI indicator ST Map Current g EASI Limb leads EJ EASI Chest Leads ST map ST label value and polarity of corresponding lead If an ST lead is switched off its axis is not shown in the map If a lead is in INOP the value is being measured but is invalid or unavailable because for example the corresponding ECG electrode is unplugged the area formed by the remaining ST leads is left open Trend View In trend view you can see up to four trended ST maps and the current ST map simultaneously You can configure the time interval between trended samples The most recent map is shown in the same color as the parameter itself Past values change from white through dark gray In the diagram below the time interval between trends is 12 seconds The first trended sample is white and is 12 seconds old The second trended sample correspo
331. ning pause time in minutes and seconds or alarms off symbol e No alarms are sounded and no alarm messages are shown ALARMS OFF e INOP messages are shown but no INOP tones are sounded The only exceptions are the INOPs Battery Batteries Empty Battery Batteries Malfunction Batt 1 2 Missing andNBP Cuff Overpressure These INOPs are sounded even if alarms are paused or off e The nurse call relay is not active Ifa disconnect INOP is present and alarms are paused or switched off the measurement in question is switched off 45 Restarting Paused Alarms To manually switch on alarm indication again after a pause select the permanent key Pause Alarms orAlarms Off again Alarm indication starts again automatically after the pause period expires If the monitor is configured to stay paused infinitely you must select Alarms Off again to restart alarm indication Resetting Arrhythmia Alarm Timeouts To reset the arrhythmia alarm timeout period select the Alarms Off or Pause Alarms permanent key and then reselect it Extending the Alarm Pause Time If your monitor has extended alarm pause enabled you can extend the alarm pause time Use this to prevent alarms being indicated for example while you are washing a patient or carrying out a procedure Only extend the alarm pause time when you are sure that clinical personnel are available to monitor the patient s condition closely To extend the alarm pause time to fiv
332. nitor There is a problem with I2C Bus communication in the INOP tone monitor Contact your service personnel LA LEAD OFF ECG The LA electrode has become detached from the patient or the Numeric is replaced by for 10 lead set has been changed Reattach the electrode or select New seconds INOP tone Lead Setup inthe Setup ECG menu to confirm the new lead set LAP INOPs PRESS See lt Pressure label gt INOPS under Pressure Numeric is replaced by INOP tone LEADS OFF ECG Check that all of the required ECG leads are attached and that Numeric is replaced by for 10 none of the electrodes have been displaced seconds INOP tone LL LEAD OFF ECG The LL electrode has become detached from the patient or the Numeric is replaced by for 10 lead set has been changed Reattach the electrode or select New seconds INOP tone Lead Setup inthe Setup ECG menu to confirm the new lead set MCC Reversed Monitor The MSL coupling cable is reversed Connect the end with the grey connector to the Intelligent Display MCC Unsupported Monitor An MSL coupling cable has been connected to a device which does not support MSL coupling Measserv Unsupportd Monitor The measurement server is not supported by the monitor Contact your service personnel MMS UNPLUGGED MMS Make sure that the Multi Measurement Server is connected to INOP tone the monitor All MMS measurements are off while the MMS i
333. nitor appropriately before disposing of it in accordance with your country s laws for equipment containing electrical and electronic parts For disposal of parts and accessories such as thermometers where not otherwise specified follow local regulations regarding disposal of hospital waste You can disassemble the monitor MMS FMS and modules as described in the Service Guide There is no metal molded into the plastic case and there are no metal sprays on the plastic All plastic parts with a weight greater than 10g 0 35 ounces are marked with the ISO code for identification The sheet metal card cage uses only one kind of steel The screen has a touch resistor laminate You can recycle the paper Instructions for Use The battery can be easily removed see Replacing Batteries on page 301 and can be returned free of charge to the worldwide recycling program run by the battery manufacturer contact your local supplier Disposing of Empty Calibration Gas Cylinders 1 Empty the cylinder completely by pushing in the pin of the regulator valve or by pulling out the pin of the fill valve using a tire valve stem wrench or a pair of needle nose pliers 2 When the cylinder is empty either remove the valve stem from the fill or regulator hole or drill a hole in the cylinder 3 Write Empty on the cylinder and dispose of it appropriately for scrap metal WARNING Ensure that the cylinder is complet
334. nitor is switched off for longer than one minute and when you leave Demonstration Mode The Review Alarms window pop up keys appear when the window is opened If alarm pause extension is disabled the pause pop up keys are inactive Selecting the Active Alarms pop up key opens the Alarm Messages window Alarm 50 Limits Active Alarms Pause Al 5 Min Pause Al 10 Min Understanding Alarm Messages If you do not immediately understand an INOP or alarm message refer to its help text Inthe Alarm Messages window select the INOP message This calls up a help window with an explanation of the INOP message and where appropriate a suggested solution for the problem Alarm Messages awRR LOW Resp LEADS OFF LL LEAD OFF The lead LL has become detached from the patient or the lead set has been changed Attach the missing electrode or select lt New Lead Setup gt to confirm the new lead set Latching Alarms The alarm latching setting for your monitor defines how the alarm indicators behave when you do not acknowledge them When alarms are set to non latching their indicators end when the alarm condition ends Switching alarm latching on means that visual and or audible alarm indications are still displayed or announced by the monitor after the alarm condition ends The indication lasts until you acknowledge the alarm Viewing the Alarm Latching Settings To see the alarm
335. nspiration e an airway respiration rate awRR the number of breaths per minute calculated from the CO waveform Depending on the Max Hold setting configured for your monitor the etCO numeric shows either the highest CO value measured within the configured time period Max Hold set to 10 sec or 20 sec or the etCO numeric shows breath to breath value Max Hold set to Off Refer to your Gas Module Instructions for Use if you are using a Gas Module to monitor CO 175 WARNING Correlation The etCO readings do not always correlate closely with paCO especially in neonatal patients and patients with pulmonary disease pulmonary embolism or inappropriate ventilation Pharmaceuticals in aerosols Do not measure CO in the presence of pharmaceuticals in aerosols Explosion Hazard Do not use in the presence of flammable anesthetics such as a flammable anesthetic mixture with air oxygen or nitrous oxide Use of the devices in such an environment may present an explosion hazard Failure of operation if the measurement extension or a sensor fails to respond as described do not use it until the situation has been corrected by qualified personnel Low etCO values Leakages in the breathing system or sampling system may cause the displayed etCO values to be significantly too low Always connect all components securely and check for leaks according to standard clinical procedures Displacement of the nasal or combined nasal oral cann
336. nt Toggle End Case Report to Off if the report is a Scheduled Report only 4 Select Scheduled Rep and toggle to On if you want the selected report to print at predefined intervals starting at a predefined time of day The start time you set applies for every following day For example if you set a start time of 07 00 and a repeat time of six hours the first report will print at 07 00 every day the next at 13 00 and so on To set the time of day at which you want the report to print every day select Start Hour and Start Minute and select the required time from the pop up list To set the time interval in minutes between two scheduled reports select Rep Freq Hr and Rep Freq Min and select the time interval from the pop up list If you are setting up an end case report these settings will be inactive grayed out Toggle Scheduled Rep to Off if the report is an End Case Report only 5 Repeat the procedure for all Auto Reports you want to set up All Auto Reports or Scheduled Reports set to On print automatically at the predefined trigger Be aware that the monitor s memory for reports is limited If the memory is full Auto Reports cannot be printed and the information may be lost 269 25 Printing Patient Reports Setting Up Individual Print Jobs Setting Up Individual Print Jobs To adjust the appearance of individual print jobs in the Reports menu 1 SelectMain Setup gt Reports gt Setup Reports to e
337. nt access the printing and recording pop up keys to document events Record Event Triggers You can trigger event capture manually for example if you want to record a patient s condition before a procedure You can also set events to trigger automatically when the patient s values cross a predefined threshold value or when a particular measurement or procedure is carried out for example when an NBP measurement or a Cardiac Output or Wedge procedure is carried out If more than one trigger is available for the measurements in the active event group the trigger condition may be AtLeast1Par AtLeast2Par AtLeast3Par or All14Par If the trigger is AtLeast1Par this is short for at least one measurement parameter the monitor starts an event capture if a trigger occurs in any of this event group s measurements If the trigger is AtLeast 3Par the monitor captures events when three or more trigger thresholds from this event group s measurements are violated With Enhanced Condition you can not only select a minimum number of triggers to trigger an event but define which specific measurement triggers these must be For example AtLeast2Par will cause an event to be captured if a trigger occurs in any two of this event group s measurements with Enhanced Condition you can select that only when triggers are in HR and SpO an event will be captured Enhanced TriggerCondition Single Pair Triple All FRPER FPEEPEEE FFE
338. nt on patients who are receiving or have recently received anesthetics connect the outlet to a scavenging system or to the anesthesia machine ventilator to avoid exposing medical staff to anesthetics Use an exhaust tube to remove the sample gas to a scavenging system Attach it to the sidestream sensor at the outlet connector Using the Mainstream CO Extension M3016A The M3016A Measurement Server Extension measures partial pressure of carbon dioxide in a patient s expired gas using the mainstream method When using the appropriate accessories you can use the mainstream CO measurement with ventilated adults pediatric and neonatal patients WARNING Infra red radiation Do not expose the airway adapter or M1460A transducer to infra red radiation during use This may cause incorrect readings Preparing to Measure Mainstream CO 1 Attach the transducer connector to the CO connector on the measurement extension 2 Wait 20 minutes allowing the transducer to reach its operating temperature and a stable thermal condition 3 Perform an accuracy check and then if necessary calibrate the transducer Checking Transducer Accuracy WARNING Check transducer accuracy at least once a week or if you doubt the CO readings 1 In Setup CO2 menu select Cal Mode to switch on calibration mode 2 Look at the calibration value displayed in the Setup CO2 menu next to Start Cal 1 Is it the same as the value on the calstick I
339. nter the Setup Reports menu 2 Select Report and then select the report you want to set up 3 Select Report Type and then select the reports template you want the report selected in Step 2 to use The selection of templates listed depends on the report type selected Each template includes patient demographic data and each Realtime Report also includes alarm and INOP information In addition the templates include Visible Waves all waves currently visible in the order they appear on the screen All Waves all measured waves RT Waves all currently measured realtime waves according to the monitor s priority list HiRes Waves all measured HiRes waves OxyCRG Waves the OxyCRG Neonatal Event Review waves Vital Signs trend information in tabular form Graph Trend trend information in graphic form ECG3X4 ECG6X2 ECG12X1 ECG4X2 ECG8X1 ECG12X1 2P ECG reports EEG EEG reports Episode a single patient event episode Review an overview of patient events Alarm Limits a list of all currently set alarm limits 4 Select Report Size to set choose the paper size to be used for the report Unspecified to use the default size for the template chosen Universal A4 Letter LrgUniversal A3 or Ledger The list of available sizes depends on the connected printers 5 Select Orientation to set the orientation of the report printout Unspec to use the default size for the template chosen Landscape or Portrait 6 Select Target Device choo
340. o Manual to toggle between the settings Auto Detection Mode In Auto Detection Mode the monitor adjusts the detection level automatically depending on the wave height and the presence of cardiac artifact Note that in Auto Detection Mode e the detection level a dotted line is not displayed on the waveform 132 e the algorithm expects a heart rate and therefore needs at least 3 electrodes attached to the patient If you are monitoring respiration with only two electrodes the detection algorithm becomes less sensitive which may result in reduced breath detection performance Use Auto Detection Mode for situations where e the respiration rate is not close to the heart rate e breathing is spontaneous with or without continuous positive airway pressure CPAP e patients are ventilated except patients with Intermittent Mandatory Ventilation IMV Manual Detection Mode In Manual Detection Mode you must set the Resp detection level Inthe Setup Resp menu select Manual Up or Manual Down Use the dotted detection level line in the Resp waveform to determine when the desired level is reached Once set the detection level will not adapt automatically to different respiration depths It is important to remember that if the depth of breathing changes you may need to change the detection level Use Manual Detection Mode for situations where e the respiration rate and the heart rate are close e patients have Intermittent M
341. o have the Information Center receive the ECG data from the monitor again In this case data from the telemetry device will no longer be monitored at the Information Center Behavior depends on the revision of your Information Center or use the Unpair function at the Information Center In this case you can decide whether the Information Center will continue to monitor data from the telemetry device 89 Telemetry Data Overview Screen Element Bed4 Mayer John Adult 23Feb 17 51 Profiles Telemetry Tele 3 Telemetry Delayed data overview screen element WARNING Waves and numeric information on the telemetry screen element are delayed for several seconds If you need realtime data for example for defibrillation always use the monitor ECG instead of telemetry Silencing Telemetry Alarms from the Bedside When a telemetry device is paired with the monitor an audible status change notification is issued for new telemetry alarms The volume can be configured If configured alarms generated from a paired telemetry device can be silenced at the bedside To silence telemetry alarms from the bedside 1 select the telemetry screen element 2 select the Silence Bed pop up key Depending on your configuration the Silence Bed key may silence both telemetry alarms and bedside alarms Suspending Telemetry Alarms When you select Pause Alarms orAlarms Off at the monitor the alarms are off or paused for the b
342. o monitor 10 patient cable connector 333 using for patient transfer 81 modified 12 lead ECG 100 modified screen history 22 modifying screens 22 module connecting 9 reconnecting 9 removing 9 setup key 9 setup menu 9 tcGas 195 unplugging 9 VueLink 281 VueLink Type A and Type B 281 modules setting up 32 monitor inspecting before use 32 starting monitoring 33 switching on 32 monitor ECG filter setting 95 monitor defaults 369 monitor revision how to find 32 monitor settings 24 changing 31 monitoring preparation 32 monitoring BIS 215 monitoring EEG 207 monitoring mode 21 mouse using 17 mouse connection symbol 328 mouse connector 332 MP20 2 MP20 Junior 2 MP20 MP30 major parts and keys 3 screen menus 15 MP30 2 MP40 4 MP40 MP50 major parts and keys 4 screen menus 15 MP50 4 MR imaging and the SpO2 transducer 139 MSL cable 8 MSL connector 332 MSL additional connector 333 multi lead ST alarming 122 multi measurement server MMS 10 N N20 correction CO2 183 narrow alarm limits 49 navigating 14 mouse 17 permanent keys 17 SmartKeys 18 trackball 17 navigation point 17 NBP adult cuffs 312 alarm source 147 ANSI AAMI SP10 1992 143 automatic mode enabling 146 calibrating 147 calibration interval 306 comfort cuff kits 311 comfort cuffs 311 cuff pressure 146 cuff applying 145 cuff selecting 145 cuff tightness 145 disposable cuffs 311 how the measurement works 143 measurement corr
343. o two hours after the heating is switched off without making a new calibration you are recommended to recalibrate before applying it to a patient After two hours without heat you must recalibrate During the initial few minutes of use the monitor eliminates false alarms by temporarily suppressing tcGas alarms It displays the STABILIZING INOP After you apply the transducer to the skin the instrument reading slowly assumes a steady value The reading stabilizes when the measurement site is warm and local hyperemization is complete This takes 10 to 20 minutes for the tcpO reading and three to seven minutes for tcpCO 196 Restarting the tcGas SiteTimer To restart the site timer without recalibration for example after the site time has elapsed 1 Inthe Setup tcGas menu select Site Time 2 Enter and confirm your desired time Disabling the tcGas Site Timer Depending on your monitor s configuration you might be able to disable the site timer Remember this means that the transducer heats indefinitely while on a patient 1 In Setup tcGas menu select Site Timer and switch this to Disabled 2 Select the Confirm popup key Setting the tcGas Barometric Pressure Altitude and barometric pressure affect tcGas values The monitor derives barometric pressure from its altitude setting If you want to set the true barometric pressure you must do this before starting a calibration changes after calibration do not influence tcGa
344. o2 35 mfg imco2 0 amig wRR 20 rpm RR 20 rpa Trect 39 9 C Thlood c Teore 26 8 C Teo re 13 0 C Pulse LOW ABPs HIGH ars DESAT awRR LOW RR Low Trect HIGH Toore LOW 13 22 NBP 7 7 7 amig NBP P c o Tblood RO TRANSDUC C I VueLnk CHECK SETUP PHILIPS General Hospital Page 1 last Event Summary Reports Advanced Event Surveillance only The event summary report shows a graphical view and a tabular view of all events in the database for all groups rveillance Episode 25 Oct 04 18 41 18 cd i Single 1 Manual 0 Total 1 2 Single 0 Manual 0 Total 0 Single 1 Manual 1 Total 2 7 Single 5 Manual 0 Total 7 I ST Single 0 Manual 0 Total 0 BID 0 0 ABID 0 0 D 3 M 6 Total 3 l aps Single 10 Manual 1 Total 11 22 00 2 00 6 00 10 00 14 00 18 00 Tima Group Parameter 1 Parameter 2 Parameter 3 Parameter 4 5 Oct 17 46 Ventil Repo LOR J8 s90 3 Oct 17 46 Hemo HR Pulse Manual Sp02 Manual ABP Manual CVP Manual 5 Oct 17 54 Ventil 3 Oct 17 54 Standard 3 Oct 17 54 Hemo 5 Oct 17 54 WER 3 Oct 17 56 Ventil 5 Oct 17 58 NER 3 oct 18 00 Ventil 3 Oct 18 37 Standard oet 18 37 Heno i oct 18 37 Ventil 3 Oct 18 37 NER post DESAT J8 lt B0
345. ocket or by deactivating the label in the Measurement Selection window The measurement automatically disappears from the display To switch the measurement on again either reconnect a Temp transducer or reactivate the measurement label in the Measurement Selection window lt Temp label gt EQUIP MALF TEMP Contact your service personnel Numeric is replaced by The temperature hardware is faulty INOP tone lt Temp label gt NO TEMP Make sure the TEMP probe is connected to the MMS or TRANSDUCER module Numeric is replaced by If you silence this INOP the measurement will be switched off INOP tone lt Temp label gt UNPLUGGED TEMP A Temp measurement label has been deactivated either by INOP tone unplugging a module or by deactivating the label in the Measurement Selection window The measurement automatically disappears from the display To switch the measurement on again either replug the module or reactivate the measurement label in the Measurement Selection window lt Temp label gt OVERRANGE TEMP Try changing the application site of the transducer Numeric is replaced by The temperature is less than 1 C or greater than 45 C INOP tone Tesoph INOPS TEMP See lt Temp label gt INOPs under Temp TimeExpired lt timer label gt Monitor The time has expired for the timer indicated in the INOP text INOP tone Clearing the timer clears the INOP Tnaso INOPS TEMP See lt Temp label gt INOPs under Temp T
346. od has expired The timers can have varying characteristics and can be located on the Main screen for easy viewing IntelliVue Instrument Telemetry USA only Wireless network capabilities via the IntelliVue Instrument Telemetry network using a built in interface MP20 MP30 or an external adapter MP40 MP50 Remote Applications Remote applications can now be embedded in a monitoring Screen The display colors for remote applications have been enhanced Basic Operation e Selection and order of SmartKeys can now be configured in the monitor s Configuration mode e Anew SmartKey exits Standby mode at the gas monitor e Direct operation of a second independent display with the MP90 using standard input devices e Networked monitors can now show Telemetry information for the Own Bed in an overview window or embedded in a Screen e Overview bed information can be configured to display in the colors used at the Information Center with Information Center System G or higher e Support for Unit based Care Group model for up to 64 beds with Information Center System G or higher e Battery status information on the main screen now includes estimated monitoring time available during battery charging e Barcode reader support during patient admission e Direct entry to graphical trends when a limit alarm is selected in alarm review and to the event episode window when an event alarm is selected e MP90 screen trends can now
347. ode locations are labeled according to the international 10 20 electrode placement system Changing the Impedance Limit The impedance limit can be set for all electrodes simultaneously in the Setup EEG menu or in the EEG Impedance Montage window using the pop up keys If the limit is exceeded during monitoring an INOP will appear and the graphic impedance indicator will change To change the impedance limit either use the pop up keys that appear with the EEG Impedance Montage window or inthe Setup EEG menu select Impedance Limit to call up a list of selections between 1 and 30 kOhm then select the required limit from this list 209 About Electrode to Skin Impedance Electrode to skin impedance is the main quality indicator for the measured EEG signal During normal EEG monitoring electrode to skin impedance is measured continuously and disconnected electrodes are detected The impedance value for each single independent signal electrode is displayed inthe EEG Impedance Montage window If the measured electrode to skin impedance of one or more electrodes is above the limit an INOP will be issued For impedance measurement at least two electrodes plus the reference electrode must be connected Impedance Indicators Electrode not connected red no value connect electrode gray 60 kQ fixed check electrode to skin Noisy signal connections yellow measured value check limit check Electrode connected
348. olled mechanical ventilation and mainly free from cardiac arrhythmia To select an arterial pressure as PPV source 1 IntheMain Setup menu select Measurements 2 Inthe Setup PPV menu select ABP ART Ao BAP P or FAP as the arterial pressure source CAUTION Older measurement servers cannot supply a beat to beat arterial pressure value In this case the monitor shows aNO PPV FROM lt Server gt INOP At respiration rates below 8 rpm PPV calculation may lead to inaccurate values Measuring Pulmonary Artery Wedge Pressure Pulmonary Artery Wedge Pressure PAWP values used to assess cardiac function are affected by e Fluid status e Myocardial contractility e Valve and pulmonary circulation integrity Obtain the measurement by introducing a balloon tipped pulmonary artery flotation catheter into the pulmonary artery When the catheter is in one of the smaller pulmonary arteries the inflated balloon occludes the artery allowing the monitor to record changes in the intrathoraic pressures that occur throughout the respiration cycle The pulmonary wedge pressure is the left ventricular end diastolic pressure preload The most accurate PAWP values are obtained at the end of the respiration cycle when the intrathoraic pressure is fairly constant Use the ECG waveform to determine the waveform of the wedge pressure You can use the respiration waveform as a reference when assessing the PAWP waveform to ensure constant measurement t
349. olution 0 1 l min neonatal 1 l min pediatric adult Inspiration to Range EOP cee SS Expiration ratio numeric I E Resolution 0 1 Cardiac Output Continuous Cardiac Output C O right heart Range 0 1 to 20 0 l min Accuracy Instrument Specification electrical 3 or 0 1 l min System Specification 5 or 0 2 l min Repeatability Instrument Specification electrical 2 or 0 1 l min System Specification 3 or 0 1 l min C O Range 0 1 to 25 0 l min transpulmonary Accuracy Instrument Specification electrical 4 or 0 15 l min System Specification 5 or 0 2 l min Repeatability Instrument Specification electrical 2 or 0 1 l min System Specification 3 or 0 1 l min EVLW Range 10 to 5000 ml not available in USA Standard Deviation 10 or 1 ml kg 361 tcGas 362 ITBV Range 50 to 6000 ml Accuracy 10 or 30 ml Repeatability 5 or 20 ml CCO Range 0 1 to 25 0 l min Standard Deviation 10 or 0 3 l min Display Update 2 seconds nominal Blood Temperature Range 17 0 to 43 C 62 6 to 109 4 F Injectate Temperature Range 1 to 30 C TBlood 17 to 43 C Steps of 0 5 C 17 to 35 C 10 seconds after the value Steps of 0 1 C 35 to 43 C exceeds the set limit range Steps of 1 F 63 to 95 C Steps of 0 2 F 95 to 109 C CCO 0 1 to 25 0 l min 0 1 l min 0 1 to10 0 l min 10 seconds after the va
350. om the start from the start from the start defined by the recorded trigger minus the trigger minus the trigger trigger in trigger minus context delay time delay time realtime delay time Number of up to 3 up to 3 up to 3 all ECG waves up to 3 high up to 3 waves waves currently resolution trends or specific to monitored and beat to beat the context available waves e g a C O trial curve or a wedge procedure Speed 50 25 12 5 6 25 50 25 12 5 6 25 50 25 12 5 25 mm sec 1 2 2 5 3 6 defined by the 2 5 mm sec 2 5 mm sec 6 25 2 5 mm sec cm min context Runtime 15 20 25 or 30 15 20 25 or 30 15 seconds or 4 seconds per 10 minutes or defined by the seconds seconds continuously wave continuously context Stops automatically automatically automatically if automatically automatically if defined by the limited manually limited manually context if continuous if continuous Delay Time 10 15 seconds 10 15 seconds none none 6 5 4 3 2 1 defined by the minutes context Overlap up to 3 waves up to 3 waves up to 3 waves none up to 3 waves defined by the context All ECG Waves Recordings AnAll ECG Waves recording shows a 4 second recording of each lead with a calibration bar preceding each ECG lead All available leads are recorded sequentially in the standardized lead order The recording is realtime that is the information recorded is not simultaneous Creating and Changing Reco
351. ompleted Graph A question mark beside a value means that the data may not be reliable due perhaps to an INOP condition in the measurement Your monitor screen may look slightly different to the examples shown here 223 20 Trends Viewing Trends Viewing Graphic Trends 9Apr 15 24 15 25 15 26 15 27 15 28 15 29 15 30 F Select ET i Select WAM crocs jiee u a gt gt mf essce sios A cursor spanning all measurements in the trend group helps you to navigate through the trends database and shows you your current position in the database When the cursor is moved across the time line the values measured at the cursor time are shown in the right hand column In graphical trends aperiodic measurement trends are shown as an asterisk NBP has a special symbol To use the trend cursor to navigate in time through the trends database 1 Select the graphical trend or the arrow pop up keys to activate the cursor 2 Use the arrow pop up keys to move the trend cursor backwards and forwards in time or 3 Place the cursor at a specific time by touching the graph Viewing Vital Signs Trends Vital Signs Standard f 2 132 125 69 77 83 86 r az am 1235 ss ES Aperiodic values are shown with a timestamp 224 The currently selected column is highlighted The values can be configured to display in the same colors as the waves and numerics on the realtime display Any
352. on Timers can count up or down showing elapsed time or remaining time No Limit timers automatically count up To change the direction in the Timers window 1 Select the required timer to display the Setup window 2 Select Direction to switch between Up and Down Displaying Timers On The Main Screen If you want to have a timer displayed on the Main Screen you can substitute it for a numeric which is not directly associated with a wave If limited space is available some elements displayed in the Timers window may not be displayed The minimum information displayed is the label and the elapsed or remaining time To display a timer on the Main Screen 1 Select the numeric you want to substitute 2 Select Change Numeric 3 SelectAny Timer 4 Select the timer to be displayed 287 Main Screen Timer Pop up Keys When you select a timer displayed on the Main Screen additional pop up keys become available Setup enter the setup screen for the currently selected timer Label Change select a different timer for display Timer Displaying A Clock On The Main Screen In the same way that you can substitute a timer for a numeric you can also substitute a larger clock display for a numeric To display a clock on the Main Screen 1 Select the numeric you want to substitute 2 Select Change Numeric 3 Select Clock 288 29 Respiratory Loops Using a VueLink module connected to a ventilato
353. on alarm limit xxx denotes lamp alarm tone the lowest measured value and yyy is the desaturation limit et lt Agent label gt AGM The end tidal agent high alarm limit has numeric flashes and high limit HIGH been exceeded is highlighted yellow alarm lamp alarm tone et lt Agent label gt AGM The end tidal agent value has fallen numeric flashes and low alarm LOW below the low alarm limit limit is highlighted yellow alarm lamp alarm tone etCO2 HIGH CO Resp The end tidal CO high alarm limit has numeric flashes and high limit AGM been exceeded is highlighted yellow alarm lamp alarm tone etCO2 LOW CO Resp The end tidal CO value has fallen numeric flashes and low limit AGM below the low alarm limit is highlighted yellow alarm lamp alarm tone etO2 HIGH O AGM The end tidal O high alarm limit has numeric flashes and high limit been exceeded is highlighted yellow alarm lamp alarm tone etO2 LOW O AGM The end tidal O value has fallen below numeric flashes and low limit the low alarm limit is highlighted yellow alarm lamp alarm tone bod kk kkk Event An event has occurred and the event event group name flashes EVENT lt GRP gt surveillance notification is configured to alarm yellow or red alarm lamp and lt GRP gt is the event group alarm tone x k EVENT Event An event has occurred and the event on monitor event group at Information center surveillance notification is config
354. on the front of the BIS Engine Use the attachment clip to secure the digital signal converter near but not above the patient s head c Attach the patient interface cable PIC to the digital signal converter DSC 2 Attach the BIS sensor to the patient following the instructions supplied with the sensor Make sure that the patient s skin is dry Be aware that a wet sensor or a salt bridge may cause erroneous BIS and impedance values A variety of sensors are available for use in the OR and ICU environments see the chapter on accessories for information 3 Connect the BIS sensor to the patient interface cable As soon as a valid sensor is detected the impedances of all electrodes are measured automatically and the results are shown in the BIS window 216 Monitoring BIS using the BISx 1 Ifyou are monitoring BIS using the BISx a Connect the BISx device to the BIS module or BIS Interface board connector MP20 MP30 b Use the clip on the rear of the BISx device to affix it in a position convenient for your patient not above the patient s head 2 Attach the BIS sensor BIS electrodes to the patient following the instructions supplied with the sensor Make sure that the patient s skin is dry Be aware that a wet sensor or a salt bridge may cause erroneous BIS and impedance values A variety of sensors are available for use in the OR and ICU environments see the chapter on accessories for information CAUT
355. on v1 1 Monitor Performance Specifications Power Specifications Power consumption MP60 70 80 90 lt 145 W MP20 30 MP40 50 lt 100 W Line Voltage 100 to 240 V MP60 MP70 MP80 1 6 to0 7A MP90 Current MP20 MP30 MP40 1 8 to 1 0A MP50 Current Frequency 50 60 Hz Battery Specifications Operating Time Basic monitoring configuration 5 hours MP40 MP50 with 2 new fully Brightness set to Optimum MMS connected NBP charged batteries measurement every 15 minutes Extended monitoring configuration 4 hours Brightness set to Optimum MMS and measurement server extension connected NBP every 15 minutes Recorder Pressure Temperature modules connected Charge Time When monitor is off 4 hours When monitor is in use 5 to 12 hours depending on monitor configuration 342 Battery Specifications Operating Time Basic monitoring configuration 5 hours MP20 MP30 with 2 new fully Brightness set to Optimum MMS connected NBP charged batteries measurement every 15 minutes Extended monitoring configuration 4 hours Brightness set to Optimum MMS and measurement server extension connected NBP every 15 minutes Recorder every 15 minutes Operating Time Basic monitoring configuration 2 5 hours with 1 new fully Brightness set to Optimum MMS connected NBP charged battery measurement every 15 minutes Extended monitoring
356. on when the monitor prompts you Ready for balloon inflation The waveform changes from the PAP to the PAWP wave The measurement takes approximately 12 seconds On completion the monitor stores the PAWP waveform display and prompts you to deflate the balloon If the monitor cannot detect a wedging waveform you must use Store Trace to store the wedge and two reference waves manually 6 Deflate the balloon when the monitor prompts you Ready for balloon deflation and verify that the waveform returns to pulmonary artery shape 7 Ifyou need to start a new measurement select Restart Wedge Editing the Wedge 1 Select the Edit Wedge pop up key to see the stored waveforms 2 The monitor displays a cursor in the waveform at the PAWP mean value It also displays any previously stored value and the time it was stored 3 Move the cursors up down right and left to set them on the correct wedge position 4 Select Store Wedge to store the PAWP value 5 Select Print Wedge to print the PAWP waveform and any reference waves or Record Wedge to record them While recording or printing you cannot perform any more Wedge tasks WARNING Prolonged inflation can cause pulmonary hemorrhage infarction or both Inflate the balloon for the minimum time necessary to get an accurate measurement If the pulmonary artery flotation catheter drifts into the wedge position without inflation of the balloon the pulmonary artery pressure waveform assumes a wedged ap
357. one there is insufficient gas in the cylinder Connect the gas tubing firmly to the calibration unit and to the module s calibration chamber 2 If Step 1 fails check whether you need to activate the transducer necessary if the electrolyte has dried out or if you have a new transducer Remembrane the transducer removing the old membranes and cleaning the transducer head thoroughly 3 Calibrate a second time 4 IfStep 2 is unsuccessful calibrate again This calibration may be required to stabilize the electrochemical system in the transducer 5 Only if the above steps are unsuccessful you have activated and remembraned the transducer and calibration has still failed twice replace the transducer 200 Applying the tcGas Transducer 1 Peel protection film from fixation ring Using a finger press the sticky side of the ring on to clean dry skin Press around the outside to ensure a good seal Apply three to five drops of contact fluid in the ring s center Remove transducer from chamber 2 Align the arrow on the transducer with the tab on the ring and fasten by turning turn a quarter turn clockwise Wait 10 20 minutes for readings to stabilize 3 Apply the transducer as soon as possible after you see the calibration complete message If you wait longer than 30 minutes the heat supply to the transducer switches off to prevent the electrolyte from drying out and a new calibration is necessary Optimize the mea
358. onnel The RESP hardware is faulty RESP ERRATIC RESP The monitor has detected too many artifacts in the measured Numeric is replaced by Resp signal Check that the RA and LL electrodes are correctly attached and have not dried out RESP LEADS OFF RESP Not all the required leads for Resp monitoring are attached Numeric is replaced by Make sure that the RA and LL leads are attached INOP tone RL LEAD OFF ECG The RL electrode has become detached from the patient or the Numeric is replaced by for 10 lead set has been changed Reattach the electrode or select New seconds INOP tone Lead Setup inthe Setup ECG menu to confirm the new lead set Settings Malfunc Monitor The monitor cannot use the predefined settings for INOP tone monitoring Contact your service personnel SOME ECG ALARMS OFF Arrhythmia This message appears if configured to do so when the on off settings of the yellow arrhythmia alarms differ from the current Profile Speaker Malfunct Monitor Contact your service personnel to check the speaker and the INOP tone connection to the speaker SPIRO MALFUNCTION Spirometry Module failure detected Contact your service personnel SPIRO INCOMPATIBLE Spirometry Module revision not compatible with the host monitor software revision Contact your service personnel SPIRO UPGRADE Spirometry The module is running a firmware upgrade Wait until upgr
359. ontact your service personnel BATT 1 BATT 2 MISSING Batteries The monitor requires two batteries but can detect only one INOP tone battery Insert the missing battery immediately During this INOP alarms cannot be paused or switched off BIS CABLE INCOMPAT BIS The semi reusable sensor cable connected is unknown or not INOP tone supported by your software revision Replace it with a Philips supported sensor cable BIS CABLE USAGE BIS The semi reusable sensor cable has exceeded the maximum INOP tone number of uses Replace the cable BIS DSC DISCONN BIS DSC is not properly connected OR either DSC or BIS engine INOP tone may be faulty Make sure that the DSC is properly connected to the BIS Engine If INOP persists replace DSC with a known good one of the same type If INOP persists replace BIS engine Silencing this INOP switches the measurement off BIS DSC INCOMPT BIS DSC is not supported by the BIS engine or new DSC INOP tone connected to an old BIS engine A software upgrade may be required Contact your service personnel BIS DSC MALFUNC BIS Electrocautery used during self test OR malfunction in the DSC hardware Make sure not to use electrocautery during the self test procedure Disconnect and reconnect the DSC to the BIS engine If the INOP persists replace the DSC or contact your service personnel BIS DSC UPDATE BIS DSC update currently being carried out This INOP will INOP ton
360. oordinates for any point on a stored loop 1 Select the pop up key Select Loop 2 Select the required loop from the list of available loops 3 Use the arrow pop up keys to move the cursor around the loop The values for both loop axes are shown for every point on the loop Select the X at the top of the loop list to exit the cursor Changing Loops Type To change the loop type in the Loops window select the Loop Type pop up key only available if the source device delivers three waves then select e Press Volume to display Pressure Volume loops e Flow Volume to display Volume Flow loops e Press Flow to display Pressure Flow loops or if the source device only delivers two waves 1 Inthe Loops window select the Setup Device pop up key to enter the Setup lt VueLink Device gt menu 2 Select Wave 1 and select pressure flow or volume waves as required Repeat for Wave 2 Setting Up Source Device The source device for the loops is indicated in the Loops window title Select the Setup Device pop up key to view the settings of the current source device If the source device is changed all reference loops from a previous device are cleared from the reference list when the first loop from the new source device is captured Reconnecting the previous device recalls its reference list 291 Documenting Loops 1 In the Loops window select the pop up key Print Loop 2 From the list of available loops select an individual loop or sel
361. or mean pressure has crossed the limit NBP LOW NBP The measured NBP value is below the numeric flashes and low limit is highlighted yellow alarm lamp alarm tone compensatory pause of 1 25 x average R R interval or two such Vs without compensatory pause occurring within 5 minutes of each other When HR gt 100 1 3 R R interval is too short for detection NON SUSTAIN VT ECG A run of Vs having a ventricular HR gt V numeric flashes yellow alarm Arrhythmia Tach HR limit but lasting for less than lamp short yellow audible the V Tach Run limit has been detected alarm PACER NOT CAPT ECG A missed beat with a pace pulse was numeric flashes yellow alarm Arrhythmia detected lamp short yellow audible paced alarm patients only PACER NT ECG A missed beat without a pace pulse was numeric flashes yellow alarm PACING Arrhythmia detected lamp short yellow audible paced alarm patients only PAIR PVCs ECG A non ventricular contraction followed numeric flashes yellow alarm Arrhythmia by two ventricular contractions lamp short yellow audible followed by a non ventricular alarm contraction has been detected PAUSE ECG No beat detected for a period greater numeric flashes yellow alarm Arrhythmia than the pause threshold lamp short yellow audible alarm lt Pressure gt PRESS The pressure is non pulsatile and the numeric f
362. or measurement server extension is plugged in after the patient has changed make sure that the correct CCO calibration is used When in doubt perform a new CCO calibration first CCO Calibration Status Indicators Each measurement trial is tagged with a calibration status indicator next to its trial number Reflecting the quality of the pressure signal during the thermodilution measurement this tag indicates each trial s validity to be used in a CCO calibration For a trial to be eligible for calibration the pressure signal must be continuously available and undisturbed starting 30 seconds before the first C O measurement of the series Do not zero the pressure measurement change the pressure label or disturb the pressure signal in any other way during this time CAL A pressure signal for CCO was available during the measurement valid for calibration CAL A disturbed pressure signal for CCO was available during the measurement valid for calibration N A _ No adequate pressure signal for CCO was available during the measurement no valid calibration data EXP This trial is more than 15 minutes older than the most recent trial and has expired for CCO calibration no valid calibration data 167 Measuring C O Using the Right Heart Thermodilution Method In the right heart thermodilution method a fluid of known volume and temperature is injected into the right atrium through the proximal port of
363. ording is A4 or letter size so that it fits in a patient file Event Episode Recordings Event episode recordings are divided into four sections 1 The first section shows the patient information and the event group of the episode with the event values for the group measurements The trigger symbol marks the event trigger 2 The second section shows the waveforms recorded during the episode The trigger moment is marked with a triangle and divides the episode into the pre post time Any calibration marks and grid marks on the screen are automatically printed on the recording 1 91MIN Green Sarah 37549201 23 Jan 02 10 43 ICU 3 Standard HR Pulse If there are four measurements in the event group being recorded two waveforms will be recorded in two separate waveforms segments rA 3 4 6 25 5 v 8 51 10 Plet k Na ATN SNI Av Ny WONG NY na aw MY HR 130 a bpm II NAANA NANAMAN LAANA NAANA TANAAN ANANA SPO2 98 RR 80 rpm No an anet semen Resp TACHY HIGH Resp HR 130 bpm HIGH Pulse 130 bpm 3 The third section shows the most important vital signs information including numerics active alarms and any annotations made on the event episode 4 The fourth section shows the numerics for all the currently monitored vital signs and any alarm conditions or INOPs active at the time the event was triggered Event Reports Event reports can be printed on
364. orm of an alarm is not available when the trigger condition is At Least One Param Selecting None switches event notification off Setting the type of notification or switching notification off is done in Configuration Mode Setting Triggers for NER and Basic Event Surveillance 1 Select Main Setup gt Event Surveill gt Setup Events to enter the Event Setup window 245 Event Setup 2 Select the name of the current episode type to set the episode pre post time 3 Set the event trigger for each measurement Select each trigger name and select if available either an alarm trigger or a user defined trigger from the pop up trigger list If you select a user defined trigger set the required threshold level and delay time 4 Set the trigger status to Activated to start event triggering If the status is Deactivated event surveillance is effectively switched off 5 Select Confirm to confirm your changes Setting Triggers and Notification for Advanced Event Surveillance 1 Select the group name to enter the Event Setup lt Group Name gt window 2 Set the trigger status to Activated to have this event group trigger events or Deactivated Event Setup 3 Set the episode type Standard Select the name of a tinct toc the current episode type and select an At least one param episode type from the pop up list The pre post episode time for the selected episode type is displayed 4 Set the trigger for
365. orts menu select CSA On EEG Rep If you do not change these settings the monitor will use the default settings SEF Trendlines On Buffer C Buffer choose one of the three pre configured buffer times Trend SEF MDEF PPF switch the trendline of the specific numeric on or off 213 EEG Safety Information EEG Configuration and Monitor Upgrades The A 2 monitor release software revision A 20 xx introduced a new feature that lets you rename EEG montages It is not possible to clone EEG settings between montages with different names therefore all EEG settings are reset to factory defaults during any upgrade downgrade cloning actions that mix releases software revisions configurations before A 2 A 20 xx with subsequent versions You must check that all EEG settings are correct before resuming monitoring with a monitor that has been upgraded or cloned WARNING Do not touch the patient or table or instruments during defibrillation When connecting electrodes and or patient cables ensure that the EEG leads and connectors do not come into contact with other conductive parts or earth High frequency Surgery To reduce the hazard of burns in the high frequency surgical neutral electrode connection the EEG electrodes should not be located between the surgical site and the electro surgical unit return electrode EEG and Electrical Interference CAUTION Interference from a non grounded instrument near the patient a
366. ost recent CCO or CCI calibration was made over 8 numeric is replaced by hours ago You should recalibrate CCO or CCI with transpulmonary C O measurements at least every 8 hours or when the hemodynamic condition of the patient has changed Charge BATT1 BATT2 now Batteries Battery must be charged Connect the monitor to mains power INOP tone or exchange the battery CHARGER MALFUNCT Batteries There is a problem with the battery charger in the monitor NOP tone barer LED may flash Connect the monitor to mains power and contact your service personnel Check Alarm Lamps Monitor Perform a visual check of the alarm lamp to establish whether INOP tone there is a problem Contact your service personnel to check the internal connections to the alarm lamps CHECK BATT TEMP Battery The temperature of one or both batteries is too high Check INOP tone that ventilation openings are not blocked and monitor is not exposed to heat Check Flex Texts Monitor Check the names of the monitor menus for example the labels INOP tone for screens profiles event or trend group names before you resume monitoring If they are unexpected there may be a problem with the monitor software Contact your service personnel CheckInternVoltage Monitor Potential problem with alarm lamps display or interfaces at Information Center detected Contact your service personnel This INOP will appear on the monitor as Check Monitor Func Check Keyboard Monitor Perform a vi
367. ote 16 SpO2 accessories 313 active alarm source 141 alarms specific to 140 arterial pulsation 137 assessing suspicious reading 139 calculating difference between values 141 connecting the cables 138 disposable sensors 137 dual SpO2 141 extension cable 138 FAST technology 137 Nellcor adhesive sensors disposable 313 perfusion indicator 137 138 141 Philips sensors disposable 313 Philips sensors reusable 313 pleth as alarm source 141 pleth wave 140 pleth waveform 137 pulse numerics 138 QRS tone 141 signal quality 139 site inspection 139 site selection 137 tone modulation 141 SpO2 desat alarm 140 SpO2 limit alarms 140 Sp vO2 206 SQI numeric on off 220 SQI numeric BIS 215 SR numeric BIS 215 on off 220 ST adjusting alarm limits 122 alarms 104 122 baseline updating 119 ensuring diagnostic quality 117 filtering 117 measurement points adjusting adjusting 120 multi lead alarms 122 numerics in ECG wave 93 snippets 118 ST display 118 ST map baseline updating 125 current view 122 report printing printing ST map report 125 scale changing scale ST map 125 task window 124 trend view 123 trending interval changing 125 trending priority 124 ST maps 122 ST point 120 standard 10 lead placement 100 standard 3 lead placement 98 standard 5 lead placement ECG 98 standardized rate 277 standby symbol 328 starting monitoring 33 status line 14 status log printing 307 status messages printer 272
368. ower alarm limit WARNING High oxygen levels may predispose a premature infant to retrolental fibroplasia If this is a consideration do NOT set the high alarm limit to 100 which is equivalent to switching the alarm off Transcutaneous pO monitoring is recommended for premature infants receiving supplemental oxygen Adjusting the Desat Limit Alarm The Desat alarm is a high priority red alarm notifying you of potentially life threatening drops in oxygen saturation 1 Inthe Setup SpO menu select Desat Limit 2 Adjust the limit Pleth Wave The Pleth wave is autoscaled to maximum display size It decreases only when the signal quality becomes marginal It is NOT directly proportional to the pulse volume If you need an indication of change in pulse volume use the perfusion indicator minimum size for reliable SpO value Perfusion Pleth Indicator The perfusion indicator gives a numerical value for the pulsatile portion of the measured signal caused by the pulsating arterial blood flow As pulse oximetry is based on the pulsatile nature of the signal you can also use the perfusion indicator as a quality indicator for the SpO measurement Above 1 is optimal between 0 3 1 is acceptable Below 0 3 is marginal reposition the sensor or find a better site Setting SpO Pleth as Pulse Source 1 Inthe Setup SpO2 menu select Pulse SpO to enter the Setup Pulse menu 2 Inthe Setup Pulse menu select System Pulse a
369. p to 35 C ambient temperature up to 60 rpm in adult mode and 100 rpm in neonatal mode Outside of these conditions the accuracy reaches at a minimum 4 mmHg or 12 of the reading whichever is greater Resolution Numeric 1 0 mmHg 0 1 kPa Wave 0 1 mmHg 0 01 kPa Stability Included in Accuracy specifications awRR Range 0 to 150 rpm Accuracy 0 to 40 rpm 1 rpm 41 to 70 rpm 2 rpm 71 to 100 rpm 3 rpm gt 100 rpm 5 of reading Warm up Time 20 minutes for full accuracy specification Rise Time 190 ms for neonatal mode measured with FilterLine H for neonatal 240 ms for adult mode measured with FilterLine H for adult Sample Flow Rate 50 15 7 5 ml minute Gas Sampling Delay Time Typical 2 3 seconds Maximum 3 seconds Sound Pressure Acoustic noise lt 45 dBA Total System Response Time The total system response time is the sum of the delay time and the rise time Microstream CO Humidity Correction Factor Either BTPS or STPD can be selected as the humidity correction factor for the Microstream CO readings The formula for the correction calculation is Pgrps Psrpp 0 94 CO Range 0 to 150 mmHg 0 to 20 0 kPa Accuracy after 2 minutes warmup For values between 0 and 40 mmHg 2 0 mmHg 0 29 kPa For values from 41 to 70 mmHg 5 of reading For values from 71 to 100 mmHg 8 of reading The specifications are valid for standard gas mixtures
370. panol 70 are tested and qualified Aldehyde based Cidex activated dialdehyde solution Gigasept only Cidex is tested and qualified Cleaning Monitoring Accessories To clean disinfect and sterilize reusable transducers sensors cables leads and so forth refer to the instructions delivered with the accessory 294 Sterilizing Sterilization is not recommended for this monitor related products accessories or supplies unless otherwise indicated in the Instructions for Use that accompany the accessories and supplies Cleaning the Recorder Printhead M1116B only If you run recordings at low speed 1 or 2cm min for extended periods deposits of paper debris may collect on the print head making recordings unevenly fainter in horizontal stripes 1 Remove the recorder 2 Open the recorder door and un thread the paper from behind the rubber roller 3 Tear off or roll up the excess paper into the roll chamber to get it out of your way 4 Thread the cloth cleaning strip instead of paper around the rubber roller until approximately two inches of the strip come out from the top of the roller y 5 Close the recorder door aligning both ends of the strip over the top of the door 6 Holding the top end of the cleaning strip between your thumb and forefinger pull the strip through and out of the recorder 7 Open the door and ensure that the paper cavity is dust free Re thread the paper and r
371. pearance Take appropriate action in accordance with standard procedures to correct the situation If the PAWP mean is greater than the PAP systolic deflate the balloon and report the incident in accordance with hospital policy because the pulmonary artery could be accidently ruptured and the wedge value derived will not reflect the patient s hemodynamic state but will merely reflect the pressure in the catheter or balloon 159 Identifying the Pressure Analog Output Connector analog output module M1006B option C01 only 160 13 Monitoring Cardiac Output The Cardiac Output C O measurement invasively measures cardiac output and other hemodynamic parameters using a technique called thermodilution This can be used to determine the flow rate of a system by introducing a cold solution into the system and measuring the resulting drop in temperature at a downstream site The temperature change is displayed as a curve in the C O procedure window and the monitor calculates the C O value from this curve The C O value is inversely proportional to the area under the curve As cardiac output varies continuously a series of measurements must be carried out to achieve a reliable C O average value Always use the average of multiple thermodilution measurements for therapy decisions The measurements can be carried out using the right heart thermodilution method or the PiCCO method transpulmonary thermodilution e
372. pect the patient cables leads and their strain reliefs for general condition Make sure there are no breaks in the insulation Make sure that the connectors are properly engaged at each end to prevent rotation or other strain 5 Apply the transducer or electrodes to the patient and with the monitor switched on flex the patient cables near each end to make sure that there are no intermittent faults Maintenance Task and Test Schedule The following tasks are for Philips qualified service professionals only All maintenance tasks and performance tests are documented in detail in the service documentation supplied on the monitor documentation CD Ensure that these tasks are carried out as indicated by the monitor s maintenance schedule or as specified by local laws Contact a Philips qualified service provider if your monitor needs a safety or performance test Clean and disinfect equipment to decontaminate it before testing or maintaining it Monitor Tests Safety checks Selected tests on the basis At least once every two years or as needed after any repairs of IEC 60601 1 where the power supply is removed or replaced or if the monitor has been dropped Monitor Maintenance Check ECG synchronization of the At least once every two years or as needed monitor and defibrillator only if hospital protocol requires use of monitor during defibrillation Replace backlight 25 000 30 000 hours about three years of continuo
373. pends on the monitor and recorder model you are using Delayed RT A RT B RT C Select HiRes All ECG Recordng Recordng Recordng Recordng Waves Recordng Waves Vital Alarm ST Setup Stop all Signs Limits Segments Recordng Recordng Quickstarting Recordings To quickstart any type of recording using a preconfigured recordings template Select the Recordings SmartKey and then select the pop up key of the recording type you want to start Alternatively you can Select theMain Setup SmartKey select Recordings then select the recording type 258 To quickstart a delayed recording Select the SmartKey Delayed Record to immediately start a delayed recording M1116B You can also start a delayed recording by pressing the RUN CONT key on the recorder module only Extending Recordings Timed non continuous recordings stop when their runtime is over Continuous recordings continue until stopped manually or by an INOP condition To extend an ongoing recording by its runtime reselect its Start pop up key once To make an ongoing recording continuous reselect its Start pop up key twice within 5 seconds M1116B Youcan also make an ongoing recording continuous by pressing the RUN CONT key on the only recorder module Stopping Recordings Recordings stop automatically when the preset runtime is over when the recorder runs out of paper or when the recorder has an INOP condition
374. perform repeated series of STAT measurements because of the risk of purpura ischemia and neuropathy in the limb with the cuff Enabling Automatic Mode and Setting Repetition Time 1 Inthe Setup NBP menu select Auto Man 2 Toggle between Auto Man if necessary to pick the measurement method 3 If making an automatic measurement select Repeat Time and set the time interval between two measurements 146 CSE ee Se a LO CCIE NEED Choosing the NBP Alarm Source You can monitor for alarm conditions in systolic diastolic and mean pressure either singly or in parallel Only one alarm is given with the priority of mean systolic diastolic In the Setup NBP menu select Alarms from and choose from Sys systolic Dia diastolic Mean mean Sys amp Dia systolic and diastolic in parallel Dia amp Mean diastolic and mean in parallel Sys amp Mean systolic and mean in parallel S amp D amp M all three pressures in parallel Assisting Venous Puncture You can use the NBP cuff to cause sub diastolic pressure The cuff deflates automatically after a set time adult pediatric 170 seconds neonatal 85 seconds if you do not deflate it 1 Inthe NBP Setup menu select VeniPuncture 2 Puncture vein and draw blood sample 3 Reselect VeniPuncture to deflate the cuff During measurement the NBP display shows the inflation pressure of the cuff and the remaining time in venous puncture mode Venous puncture meas
375. period Increasing the speed expands the waveform giving you a more detailed view To change the wave speed 1 Select the frozen wave 2 Select Change Speed 3 Select a speed from the list Updating The Frozen Wave To update the wave that is freeze the current wave 1 Select the frozen wave 2 SelectFreeze Again Releasing Frozen Waves To release frozen waves 1 Select a frozen wave 2 Select Unfreeze Waves All frozen waves are released Using Labels You can measure multiple invasive pressures temperatures and SpO simultaneously The monitor uses labels to distinguish between them The default settings defined in the profile such as measurement color wave scale and alarm settings are stored within each label When you assign a label to a measurement the monitor automatically applies these default settings to the measurement The labels assigned are used throughout the monitor in reports recordings and in trends About Label Sets Your monitor may be configured to use a Restricted or Full label set The Full label set provides extra labels for Pressure and Temp See the sections in this Instructions for Use on Pressure and Temp for more information If you connect a measurement server from a monitor using a Ful 1 label set to an IntelliVue monitor using a Restricted label set or an M3 M4 monitor any additional labels switch to labels available in the target monitor This may cause a label conflict with other monito
376. play Size 291 Using the Loops Cursor 291 Changing Loops Type 291 Setting Up Source Device 291 Documenting Loops 292 30 Care and Cleaning 293 General Points 293 Cleaning 294 Disinfecting 294 Cleaning Monitoring Accessories 294 Sterilizing 295 Cleaning the Recorder Printhead M1116B only 295 Cleaning the Batteries and Battery Compartment 295 31 Using the Batteries 297 Battery Power Indicators 298 Battery LED 298 Battery Status on the Main Screen 298 Battery Status Window 300 Viewing Individual Battery Status 300 Recording Battery Status 300 Printing Battery Reports 300 Checking Battery Charge 300 Replacing Batteries 301 Optimizing Battery Performance 301 Display Brightness Setting 302 Charging Batteries 302 Conditioning Batteries 302 Unequally Charged Batteries 302 Battery Safety Information 303 32 Maintenance and Troubleshooting 305 Inspecting the Equipment and Accessories 305 Inspecting the Cables and Cords 305 Maintenance Task and Test Schedule 306 Troubleshooting 307 Disposing of the Monitor 307 Disposing of Empty Calibration Gas Cylinders 307 33 Accessories 309 ECG Resp Accessories 309 Trunk Cables 309 3 Electrode Cable Sets 309 5 Electrode Cable Sets 310 10 Electrode Cable Sets 310 3 Electrode One Piece Cables 310 5 Electrode One Piece Cables 310 Set Combiners and Organizers 311 NBP Accessories 311 Adult Pediatric Multi Patient Comfort Cuffs and Disposable Cuffs 311 Reusable Cuff Kits 311 Adult Pediatric Antimicro
377. ppears from the display To switch the measurement on again either reconnect a Pressure transducer or reactivate the measurement label in the Measurement Selection window Numeric is replaced by INOP tone lt Pressure label gt EQUIP PRESS Contact your service personnel MALF The pressure hardware is faulty Numeric displayed with INOP tone lt Pressure label gt NO PRESS Make sure that the pressure transducer is connected to the TRANSDUCER measurement server or module server Numeric is replaced by If you silence this INOP the measurement will be switched off INOP tone lt Pressure label gt NOISY PRESS This INOP can only arise when a pressure is selected as the SIGNAL pulse source It occurs when the pulse detector finds a pulse Pulse numeric is replaced by rate above 350bpm This is usually caused by movement INOP tone artifact or electrical interference lt Pressure label gt NON PRESS This INOP can only arise when a pressure is selected as the PULSATILE pulse source It occurs when the pulse rate being measured is Pulse numeric is replaced by less than 25 beats per minute or the amplitude is less than three INOP tone mmHg Check the catheter and connections to the patient lt Pressure label gt PRESS Make sure that the measurement has been properly prepared OVERRANGE and zeroed and that the transducer is level with the heart If Numeric is replaced
378. ppropriate alarm limits for ABP are active Resolving Label Conflicts Each label must be unique that is it can only be assigned once You cannot monitor two pressures labelled ICP at the same time If you need to use two identical pressures you must assign different labels to them for example P and ICP Measurement labels are stored in the measurement device module or measurement server If you try to use two measurement devices that have identical labels this causes a label conflict in the monitor Depending on your configuration the monitor will either e resolve the conflict automatically by assigning a new generic label to the most recently connected conflicting label e g a second FAP label could be changed to ABP measurement selection key with question marks e display the Measurement Selection window automatically indicating a label conflict for you to resolve the conflict e take no action you must enter the Measurement Selection window and resolve the conflict All the currently available measurement devices are depicted in the Measurement Selection window Any measurement labels causing a label conflict are shown in red If a measurement device is connected but currently unavailable for example because it was deactivated due to a label conflict the device is shown grayed out Conflicting measurement Measurement Selection labels are shown in red De activated labels are grayed out To resolve a
379. predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the monitor is used exceeds the applicable RF compliance level above the monitor should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as reorienting or relocating the monitor These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people Recommended separation distances from portable and mobile RF communication equipment The monitor is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled The customer or user of the monitor can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment and the monitor as recommended below according to the maximum output power of the communications equipment 367 0 01 0 1 0 4 0 1 0 4 0 2 0 7 0 1 0 4 1 1 0 4 1 1 0 7 2 2 1 1 3 3 5 1 3 3 5 2 3 7 0 10 3 8 11 1 3 8 11 1 7 3 22 1 100 12 0 35 0 12 0 35 0 23 0 70 0 Electrosurgery Interference Defibrillation Electrostatic Discharge The equipment returns to the previous operating mode within 10 seconds withou
380. printouts Scheduled Rep to toggle to Off and switch off scheduled reports Setting Up Reports ECG Vital Signs Graphic Trends and Auto Reports settings must be defined in Configuration Mode As the content of context linked reports such as Cardiac Output Calculations and Wedge is defined by the content of the procedure window these reports do not need to be set up The content you define in the individual Setup Reports menus will be used in all reports of this type for example if you set a print speed of 50 mm sec in the ECG Reports menu every ECG report will be printed at this speed irrespective of format Setting Up ECG Reports The settings you choose in the ECG Reports menu apply for all ECG reports printed To set up ECG Reports 1 SelectMain Setup gt Reports gt ECG Reports Note the report layout configured for your monitor either Internat or Cabrera This setting is inactive grayed out in Monitoring Mode and can only be changed in Configuration Mode 2 Select ECG Gain and set the required ECG Gain to define how ECG waves will appear on the ECG report printouts 3 Select Speed and select the report print speed 4 Select Annotation and toggle to On if the printed ECG wave should be annotated with beat labels or not See the chapter on ECG for a list of beat labels Pace pulse marks are automatically printed beside the wave for paced patients 268 Setting Up Vital Signs and Graphic Trend Reports
381. r lt 19 lb AB 85 ih and battery without options MP60 MP70 lt 10 kg lt 405 x 360x170 mm_ without handle and speedpoint with speedpoint lt 22 05 Ib BER Wal REO device without options MP70 with touchscreen operation MP80 MP90 D80 lt 10 kg 342 x 108 x 505 mm including AC cable cable cover lt 22 051b 13 47 x 4 25 x 19 88 in 2nd feet M3001A lt 650g 188 x 96 5 x 51 5 mm Multi Measurement Server MMS lt 1 4lb 7 4 x3 8x2in M3012A lt 550 lt 190 x 98 x 40 mm Hemodynamic Measurement Server 1 2 1b lt 7 5x4x1 6in Extension M3014A lt 500g lt 190 x 98 x 40 mm Measurement Server Extension lt 0 99 Ib lt 7 5x4x1 6in Capnography M3015A lt 550 lt 190 x 98 x 40 mm Measurement Server Extension lt 1 21 b lt 7 5x4x1 6in Microstream CO 33 N 225 g 7 9 oz M3016A lt 450 g lt 190 x 98 x 40 mm Measurement Server Extension lt 0 99 lb lt 7 5x4x1 6in Mainstream CO M8048A lt 3500g lt 320x 120x35mm without plug in modules Flexible Module Server FMS lt 7 71b 12 6 x 4 7 x 5 3 in M8045A 2700g 250 x 160 x 270 mm dimensions without lever Docking Station 5 951b 9 8 x 6 3 x 10 6 in M8025A lt 300 g 62 x 125 x 63 mm Remote Alarm Device lt 0 7 lb 2 4x5x2 5 in M8026A lt 400 g 103 x 139 x 63 mm Remote SpeedPoint lt 0 9 Ib 4x5 5x2 5 in M8031A lt 4 9 kg 408 x 333 x 85 mm with mounting bracket XGA Touchscreen LCD Display lt 10 8 lb 16
382. r you can measure and store graphic representations of realtime respiratory loops Respiratory loops can help you recognize changes in your patient s lung function and they can also indicate a fault in the airway tubing for example if the respiratory loop does not close You can measure e Pressure volume loops e Pressure flow loops e Volume flow loops Note that you cannot store loops from different patients and different source devices in the same list as they are patient and device specific This prevents you from inadvertently comparing information from different patients Viewing Loops In the loops display the current loop is drawn in white and up to six stored loops are color coded to match their timestamps The currently used source device is shown in the window title To view respiratory loops permanently on your Screen select the current Screen name to open the Change Screen menu then select a Screen configured to display the loops screen element Select the loops screen element to access the loops pop up keys 289 L Ohmeda 7900 To open the Loops window oops eda and its associated pop up keys selectMain Setup gt Loops or select the Loops SmartKey if configured In the Loops window in addition to the stored loops three realtime airway waves and six available numerics from the 24 Nov 10 39 24 Nov 10 40 source device can be shown Loops Select Size Cap
383. r auscultatory measurements depending on the configuration in a representative patient population For the auscultatory reference the fifth Korotkoff sound was used to determine the diastolic pressure In neonatal mode the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers ANSI AAMI SP10 1992 in relation to mean error and standard deviation when compared to intra arterial measurements in a representative patient population The NBP measurement is suitable for use in the presence of electrosurgery and during the discharge of a cardiac defibrillator according to IEC 601 2 30 EN 60601 2 30 A physician must determine the clinical significance of the NBP information Introducing the Oscillometric NBP Measurement Oscillometric devices measure the amplitude of pressure changes in the occluding cuff as the cuff deflates from above systolic pressure The amplitude suddenly increases as the pulse breaks through the occlusion in the artery As the cuff pressure decreases further the pulsations increase in amplitude reach a maximum which approximates to the mean pressure and then diminish Studies show that especially in critical cases arrhythmia vasoconstriction hypertension shock oscillometric devices are more accurate and consistent than devices using other noninvasive measuring techniques WARNING Patient Category Select the correct pa
384. r infinitely To view the alarm pause setting chosen for your unit 1 SelectMain Setup gt Alarm Settings 2 ChecktheAlarms Off setting This setting can only be changed in Configuration Mode To Pause All Alarms Select the Pause Alarms permanent key If your monitor is configured to iv infinite pause time the permanent key is labelled ALarms Off and selectingit Pause switches alarms off Alarms Or press the Alarms hardkey on the SpeedPoint or Navigation Point The hardkey follows the behavior configured for the permanent key To Switch All Alarms Off You can only switch alarms off permanently if your monitor is configured to allow infinite alarms pause and the permanent key is labelled Alarms Off Select the Alarms Off permanent key NN Or press the Alarms hardkey on the SpeedPoint or Navigation Point The Alarms off hardkey follows the behavior configured for the permanent key Pausing alarms infinitely is the same as switching them off To Switch Individual Measurement Alarms On or Off 1 Select the measurement numeric to enter its setup menu 2 Select Alarms to toggle between On and Off The alarms off symbol is shown beside the measurement numeric While Alarms are Paused or Off e The red Alarms Paused lamp on the monitor front panel is lit e In the alarm field the monitor displays the message PON ALARMS PAUSED 1 28 Alarms Paused orAlarms Off together with i X the alarms paused symbol and the remai
385. r the wrong patient To silence own bed alarms use the Silence permanent key on screen or the Silence hardkey Visual Alarm Status Information in the Other Bed Window e Ifindividual alarms are switched off at the other bed this is indicated by the crossed alarm symbol beside the measurement numeric e Ifalarms are switched off at the other bed the message Alarms Off is shown in the other bed window e In the embedded Other Bed window the crossed speaker symbol in the upper right hand indicates that the volume of the audible alarm status change notification for the other beds in the care group is set to zero at the overview monitor Care Group Alarms Changes in the alarm status of beds in a Care Group are announced visually and audibly at all other beds in the same Care Group The visual and audible indicators used depend on the monitor and Information Center configuration When an alarm is detected at another bed in the Care Group e the alarm status is shown in the Care Group overview bar as an icon e a message informing you about the care group alarm is shown in the monitor status line e if configured the Other Bed window the Alarming Beds window or the My Care Group window may pop up on the Screen if automatic alarm notification is enabled at the bedside monitor and at the Information Center The automatic alarm notification is suppressed when a window menu or pop up keys are active e if configured an audible status
386. r trends waveforms 227 scheduled reports 269 screen adjusting brightness 31 disabling touch operation 15 elements 15 using a second display 23 screen trend trend time 230 screen trends 229 screens changing 22 changing content 22 understanding 22 visitor screen 24 secondary lead ECG selecting 92 SEF spectral edge frequency 207 SEF numeric BIS 215 on off 220 selecting the primary lead ECG 92 selecting the secondary lead ECG 92 selftest alarms 52 sensor disposable SpO2 137 sensor temperature tcGas 196 serial LAN interface 329 serial MIB connector symbol 328 service mode 21 set combiners 311 setting the arterial catheter constant PiCCO 166 setting the computation constant RH 169 setting up trends 225 setting up reports 268 settings about 26 default 369 measurement settings 26 monitor settings 26 screen settings 26 settings blocks 24 setup key module 9 setup menu module 9 setup menu MP20 30 40 50 15 Setup Recording menu 260 short yellow alarms 105 signal quality index numeric BIS 215 signal quality of SpO2 139 sinus and SV rhythm ranges 350 352 site timer tcGas 196 skin preparation ECG 91 EEG 208 SmartKeys 18 smoothing rate BIS 220 snapshots events 243 source device loops 291 specifications 325 arrhythmia 348 spectral edge frequency SEF 207 spectral edge frequency numeric BIS 215 speed recording 261 wave speed changing 27 SpeedPoint 16 SpeedPoint rem
387. ransmitter manufacturer and d is the recommended separation distance in metres m The values given in brackets are for respiration and BIS Portable and mobile RF communications equipment should be used no closer to any part of the monitor including cables than the recommended separation distance calculated from the equation appropriate for the frequency of the transmitter Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range over the frequency range 150 kHz to 80 MHz field strengths should be less than 1 V m for respiration and BIS and 3 V m for all other functions Interference may occur in the vicinity of equipment marked with this symbol e Conducted RF 3 VRMs 3 VRMS Recommended separation distance IEC 61000 4 6 150 kHz to 80 MHz 1 Vgms for respiration and BIS d 1 2 P for respiration and BIS d 3 5 P Radiated RF 3 V m 3 V m Recommended separation distance IEC 61000 4 3 80 MHz to 2 5 GHz 1 V m for respiration 80 MHz to 800 MHz and BIS d 12 P 80 MHz to 800 MHz for respiration and BIS d 35 P 800 MHz to 2 5 GHz d 2 3 P 800 MHz to 2 5 GHz for respiration and BIS d 7 0 P Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be
388. ration before inserting the catheter If it fails a second time replace the optical module Inserting the Catheter 1 Remove the inner cover of the catheter tray 2 Remove the catheter tip from the optical reference Check the catheter s proper operation for example the balloon tip 3 Prepare and insert the catheter in accordance with standard hospital practice The SvO catheter is thin and flexible treat it carefully Avoid kinking bending or grasping the catheter with forceps or a hemostat Damage to the fiber results in low intensity light and sudden decrease in intensity readings Refer to the documentation provided with the fibre optic catheter paying special attention to any precautions warnings or contraindications Secure the optical module directly or in close proximity to the patient to avoid placing excessive tension on the catheter which would result in movement of the catheter tip from the optimal position in the patient Position the optical module to avoid contact with liquids because fluid entering the catheter optical module connection may impair light transmission If you place the catheter in the patient without performing the pre insertion calibration you must perform an in vivo calibration once the catheter is in place Performing a Light Intensity Calibration Perform a light intensity calibration after the catheter is in its proper position When the catheter is positioned properly the light intensity ind
389. ration failed Check the cal unit gas pressure and CAL FAILED tubing connections then restart the cal If the cal has failed Numeric is replaced by more than once remembrane the transducer and restart the INOP tone calibration If this INOP persists contact your service personnel tcpO2 or tcpCO or tcGas tcGas Calibration is required before applying the transducer to the CAL REQUIRD patient Numeric is replaced by Insert a membraned transducer into the cal chamber on the INOP tone module connect the cal unit to the cal chamber open the gas valve and start the calibration If this INOP occurs during a calibration there may be a module or transducer malfunction contact your service personnel tcpO or tcpCO or tcGas tcGas Wait until the tcpO7 tcpCO calibration is finished CAL RUNNING Numeric displays first then numeric is displayed with a tcpO or tcpCO or tcGas tcGas Site Timer due to time out in 15 minutes or less CHECK TIME tcpO or tcpCO or tcGas tcGas Site Timer has timed out Change the application site to avoid CHANGE SITE skin burns To reset the Site Timer either calibrate and change If Heat Switch Off is configured to Yes the measurement site or change the measurement site and reset numeric is replaced by the Site Timer manually by selecting the appropriate site time INOP tone from the Setup TCGas menu
390. rbances induced by RF fields Electromagnetic fields with field strengths above 1 V m and conducted disturbances above 1Vrms may cause erroneous measurements Therefore Philips recommends that you avoid using electrically radiating equipment in the close proximity of these measurements WARNING The monitor should not be used next to or stacked with other equipment If you must stack the monitor you must check that normal operation is possible in the necessary configuration before you start monitoring patients 365 Electromagnetic Immunity The monitor is suitable for use in the specified electromagnetic environment The user must ensure that it is used in the appropriate environment as described below IEC 61000 4 4 Electrostatic 6 kV contact 6 kV contact Floors should be wood concrete or discharge ESD 8kV air 8kV air ceramic tile If floors are covered IEC 61000 4 2 with synthetic material the relative humidity should be at least 30 Electrical fast 2 kV for power supply lines 2 kV for power supply Mains power quality should be that transient burst 1 kV for input output lines lines of a typical commercial and or 1 kV for input output lines hospital environment Surge IEC 61000 4 5 1 kV differential mode 2 kV common mode 1 kV differential mode 2 kV common mode Mains power quality should be that of a typical commercial and or hospital environment magnetic fi
391. rdings Templates 260 To save you defining recording settings each time you start a recording you can create templates for commonly used types of recordings in the Setup Recording menu You can create templates for one delayed recording one alarm recording three realtime recordings and one high resolution recording All ECG Waves recordings do not need to be configured they always use the same format Changing recordings templates changes the settings that will be used each time a recording of this name is triggered 1 Select the Main Setup permanent key to call up the Main Setup menu 2 Select the item Recordings to enter the Setup Recordings menu 3 Select the name of the template you want to create or change Each recording name is linked to a recording type delayed alarm realtime and high res trends Recording names can be changed in the monitor s Configuration Mode 4 Design the template by selecting each menu item and entering the information for the template Recorder choose which recorder the recording will print to Local Central 2 Ch or Central 4 Ch e Channels 1 4 choose which waveform to record in each channel If the wave assigned to a recording channel in a particular template is not available when a recording is triggered the channel is left blank on the recording strip The pop up list of available currently monitored waves differs according to the recording type Realtime delayed
392. re burns after prolonged application Extremities to Avoid Avoid placing the sensor on extremities with an arterial catheter or intravascular venous infusion line Connecting SpO Cables Connect the sensor cable to the color coded socket on the measurement device MMS or module If you are using a disposable sensor plug the sensor into the adapter cable and connect this to the measurement device Connect reusable sensors directly to the measurement device CAUTION Extension cables Do not use more than one extension cable M1941A Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in L indicates long cable version Electrical Interference Position the sensor cable and connector away from power cables to avoid electrical interference Humidity For neonatal patients make sure that all sensor connectors and adapter cable connectors are outside the incubator The humid atmosphere inside can cause inaccurate measurements Measuring SpO 1 Select the correct patient category setting adult pediatric and neonatal as this is used to optimize the calculation of the SpO and pulse numerics 2 During measurement ensure that the application site has a pulsatile flow ideally with a perfusion indicator value above 1 0 138 has not changed in its thickness for example due to edema causing an improper fit of the sensor WARNING Inspect th
393. re like the dessert course From these you build your meal You can choose one from the starters one from the main course then one from the dessert or simply pick one or two courses without having a full meal Depending on your monitor configuration when you switch on or discharge a patient the monitor either continues with the previous profile or resets to the default profile configured for that monitor WARNING If you switch to a different profile the patient category and paced status normally change to the setting specified in the new profile However some profiles may be setup to leave the patient category and paced status unchanged Always check the patient category paced status and all alarms and settings when you change profiles When you leave Demonstration Mode the monitor uses the default profile Swapping a Complete Profile 1 Select Profiles in the monitor info line or select the Profiles SmartKey In the Profiles menu select Profile Chose a profile from the pop up list A O N Confirm your selection 25 Swapping a Settings Block 1 Select Profiles in the monitor info line or select the Profiles SmartKey 2 Inthe Profiles menu select Display or Measmnt Settings or Monitor Settings to call up a list of the settings blocks in each category 3 Choose a settings block from the pop up list 4 Confirm your selection Default Profile Your monitor has a default profile that it us
394. re to purge the sensor tubing Manual Purging Occasionally purging may be required in between the automatic purge cycles The manual purge may be used as often as needed Check the orientation of the flow sensor if repeated manual purge cycles become necessary To manually purge press the Purge button on the module marked by on international versions of the module or select Purge in the Setup Spirometry window to initiate a combined purge and zero cycle Gas Compensation NOTE Temperature and the proportions of individual gases influence the flow measurement If values seem inaccurately high or low check that the monitor is using the appropriate gas compensation Gas compensation can be done using either manually entered gas concentrations or gas concentrations from the gas analyzer If you unintentionally switch the gas compensation to the incorrect setting the accuracy of the measured flow and volume values may be significantly reduced The tables below show examples of incorrect gas compensation settings and the resulting inaccuracies Actual Gas Composition 60 40 Gas Compensation Setting 40 60 15 Table 1 Incorrect Balance Gas Setting NO instead of N gt 191 Actual Gas Composition 55 40 5 Gas Compensation Setting 60 40 0 15 Table 2 Incorrect Agent Percentage Setting Setting up Spirometry The following settings can be accessed through the Setup Spirom
395. reason you should e take care to initiate arrhythmia relearning only during periods of predominantly normal rhythm and when the ECG signal is relatively noise free e be aware that arrhythmia relearning can happen automatically e respond to any INOP messages for example if you are prompted to reconnect electrodes e be aware that a disconnected EASI electrode triggers an arrhythmia relearn on all leads e always ensure that the arrhythmia algorithm is labeling beats correctly Arrhythmia Alarms Arrhythmia alarms can be switched on and off and the settings changed just like other measurement alarms as described in the Alarms section Special alarm features which apply only to arrhythmia are described here The different alarms detected and generated by the monitor depend on the level of arrhythmia analysis that is enabled For a complete list of arrhythmia alarms and INOPs see the Alarms chapter The monitor detects arrhythmia alarm conditions by comparing ECG data to a set of pre defined criteria An alarm can be triggered by a rate exceeding a threshold for example HR gt xx an abnormal rhythm for example Ventricular Bigeminy or an ectopic event for example Pair PVCs 112 Yellow Arrhythmia Alarms Yellow arrhythmia alarms are short yellow alarms specific to arrhythmia related patient conditions Depending on your monitor and Information Center revision they may be shown with one or two stars WARNING When arrhy
396. rect INOPS TEMP See lt Temp label gt INOPs under Temp Tskin INOPS TEMP See lt Temp label gt INOPs under Temp INOP tone Ttymp INOPS TEMP See lt Temp label gt INOPs under Temp Tven INOPS TEMP See lt Temp label gt INOPs under Temp Tvesic INOPS TEMP See lt Temp label gt INOPs under Temp UAP INOPS PRESS See lt Pressure label gt INOPS under Pressure Unsupported LAN Monitor There is a problem with the communication to the network INOP tone and central monitoring is currently not possible Check the connection If the INOP persists switch off the monitor and contact your service personnel User I F Malfunct Monitor Perform a visual and functional check of all the monitor input INOP tone devices Contact your service personnel UVP INOPS PRESS See lt Pressure label gt INOPS under Pressure V LEAD OFF ECG The V electrode IEC C electrode has become detached from Numeric is replaced by for 10 the patient or the lead set has been changed Reattach the seconds INOP tone electrode or select New Lead Setup in the Setup ECG menu to confirm the new lead set lt VueLink option gt CHK VueLink No cable or the wrong cable connected to the VueLink module CABLE or incorrect device selected Silencing this INOP switches the INOP tone measurement off VueLink INOP abbreviations may differ slightly depending on the device category lt VueLink option gt C
397. red measurements Be aware that connecting a monitor using the Ful 1 label set to an Information Center with certain software revisions may affect the availability of measurement information from the additional labels on the Information Center See the Information Center documentation and your monitor s Configuration Guide for information on label set compatibility Changing Measurement Labels e g Pressure To change a measurement label of a measurement with multiple labels invasive pressure temperature or SpO 29 1 Enter the Wave menu of the measurement 2 Select Label 3 Choose a label from the list The monitor automatically applies the scale color etc settings stored in the Profile for the label you select You can change scale settings in Monitoring Mode but color can only be changed in the monitor s Configuration Mode Any labels already being used in the monitor are shown grayed out in the list and cannot be selected Give me an example Let s imagine you used a Press module to monitor your previous patient s CVP Now you want to use the same module to measure ABP with a new patient You ve set up your arterial line When you connect the pressure transducer to the module the pressure shown on the screen still uses the CVP color and wave scale and is labeled CVP To rectify this just change the pressure label to ABP Now the pressure has the correct color the wave is shown in the correct scale and the a
398. rently available ST snippets and baselines in the ST Baseline window select the pop up key Record ST 119 About the ST Measurement Points The ST value for each beat complex is the vertical difference between the ISO point and the ST point as shown in the diagram below The isoelectric ISO point provides the baseline the ST point is at the midpoint of the ST segment The J point is where the QRS complex changes its slope as it is a fixed distance away from the ST point it can be useful to help you position the ST point correctly R wave peak at 0 msec J point for example 48 msec T ae ST value Isoelectric point set to 80 msec ST measurement point for example J 60 msec CAUTION The ST measurement points need to be adjusted when you start monitoring and if the patient s heart rate or ECG morphology changes significantly as this may affect the size of the QT interval and thus the placement of the ST point Artifactual ST segment depression or elevation may occur if the isoelectric point or the ST point is incorrectly set Always ensure that ST measurement points are appropriate for your patient Adjusting ST Measurement Points Depending on your monitor s configuration the ST point can be positioned either e relative to the J point In the Adjust ST Points window the pop up keys ISO Point J Point and ST Point are visible and can be adjusted or e directly by selecting a numeric valu
399. rity alarm at this monitor is a red alarm The alarms at this monitor are suspended The monitor is in standby mode The monitor is in Demonstration mode The current monitor 85 This is a telemetry bed This bed is on a wireless network y This bed is on a wired network This is a paired bed with a bedside monitor and a telemetry transmitter assigned Viewing the My Care Group Window 86 This window shows the alarm status bed name My Care Group and patient name for every bed in the Care Group Beds From bblev4 The window for the Unit group shown here Ws Smith Mary shows first the beds of the Information Center this bed is connected to By selecting the Information Center name you can display a list m Murphy Sarah of all Information Centers associated with the Unit group and select another Information Center to view 7 paker Jane Ma Jones Paul wm Miller John To enter the My Care Group window ja creen Live ery select the Other Patients SmartKey if configured or wu Scott James ua Black Harald intheMain Setup menu select My Care Group Use the My Care Group pop up keys to navigate through the Care Groups My Unit lets you view a list of all the Information Centers in your Care Unit Select an Information Center to see a list of the monitors connected to it Select any monitor to see the Other Patient window for t
400. rm Arrhythmia detected Consecutive PVCs exceed V lamp short yellow audible Tach Run limit and HR exceeds V Tach alarm HR limit VueLink VueLink A yellow or red patient alarm on monitor yellow or red ALARM is present on the VueLink module alarm lamp alarm tone CSC rr essere S Technical Alarm Messages INOPs The measurement labels and abbreviations for pressure temperature SpO anesthetic agent and VueLink INOP messages are explained in the individual chapters ABP INOPS PRESS See lt Pressure label gt INOPS under Pressure ALL ECG ALARMS OFF ECG All ECG alarms have been switched off or the HR alarm Arrhythmia source is not ECG To resume ECG alarm generation switch ECG alarms on or select ECG as the alarms source Ao INOPS PRESS See lt Pressure label gt INOPS under Pressure ART INOPS PRESS See lt Pressure label gt INOPS under Pressure AWF CHANGE SCALE Spirometry Airway flow signal exceeds range of selected scale Adjust scale to display complete wave AWP CHANGE SCALE Spirometry Airway pressure signal exceeds range of selected scale Adjust scale to display complete wave AWV CHANGE SCALE Spirometry Airway volume signal exceeds range of selected scale Adjust scale to display complete wave Bad Serverlink Monitor 1 An MMS with an incompatible software revision is INOP tone connected to the monitor This combination does not allow monitoring OR 2
401. rm recording 259 choosing recorded measurements 261 alarm source selection disabled 129 alarm status area 14 alarms acknowledging 44 active 41 active SpO2 source 141 alphabetical listing 53 apnea delay 184 192 apnea delay time Resp 134 arrhythmia 41 audible indicators 42 awrr limits 184 chaining 115 CO2 specific 184 CO2 apnea delay 184 192 CO2 awRR 184 desat SpO2 140 effect on pressure alarms during zero 153 extending pause time 46 high priority 41 INOP 41 ISO IEC standard 9703 2 43 limit SpO2 352 NBP source 147 patient messages 53 pausing 44 physiological 53 pleth as source 141 red 41 reminder 44 restarting 46 reviewing 50 reviewing messages 50 reviewing window 50 selftest 52 silencing 44 SpO2 high and low limits 140 SpO2 specific 140 ST 122 suspended symbol 45 SvO2 behavior during measurement 204 switching on and off 45 temperature 149 testing 52 tone configuration 42 traditional 43 visual indicators 42 volume changing 43 VueLink and external devices 283 yellow 41 alphabetical listing of alarms 53 alternating current symbol 328 analog interface symbol 329 analog output ECG 329 pressure 160 analog video out connector 332 annotating events 251 annotation recording strip 262 apnea alarm delay CO2 184 192 apnea alarm delay time RESP 134 apnea alarms and Resp detection modes 134 Application Server 33 arrhythmia aberrantly conducted beats 108 analysis how it works
402. rmation Center You can change the name of the visitor Screen in Configuration Mode To activate this Screen select the Screen name in the monitor info line to open the Screen menu then select the name of the visitor Screen configured for your monitor from the list of available Screens Select any element on the Screen to open the Screen menu and select a different Screen to show waves and numerics again Understanding Profiles 24 Profiles are predefined monitor configurations They let you change the configuration of the whole monitor so you can adapt it to different monitoring situations The changes that occur when you change a complete profile are more far reaching than those made when you change a Screen Screens affect only what is shown on the display Profiles affect all monitor and measurement settings The settings that are defined by Profiles are grouped into three categories Each category offers a choice of settings blocks customized for specific monitoring situations These categories are e Display screens Each profile can have a choice of many different predefined screens If you are using a second display each display can have its own individual screen selection When you change the profile the screen selection configured for the new profile becomes active e Measurement Settings Each profile can have a choice of different predefined measurement settings These relate directly to individual measure
403. rmed for non specific drugs You must have a Support Tool to add additional drugs to the Drug Calculator About the Rule of Six If the Rule of Six has been enabled for use with individual drugs in your Drug Calculator you can use the formula in crisis situations to quickly calculate the amount of a drug needed to yield a target dose for continuous infusion for neonatal or pediatric patients the drug amount is given in mg the patient weight in kg The Rule of Six can only be used with the dose unit mcg kg min CAUTION JCAHO recommends disabling the Rule of Six The configuration is not JCAHO compliant if Rule of Six is enabled The Drug Calculator uses the following formula for Rule of Six calculations based on the patient s weight e Fora target dose of 0 1 mcg kg min the Drug Calculator multiplies 0 6 x patient weight to calculate the amount you need to add to the IV solution to equal a total of 100 ml e Fora target dose of 1 0 mcg kg min the Drug Calculator multiplies 6 0 x patient weight to calculate the amount you need to add to the IV solution to equal a total of 100 ml Performing Calculations for a Non Specific Drug If a list of drugs has not been configured for your monitor you can use the Drug Calculator to calculate drug doses for a single generic drug called Any Drug Selecting the arrow beside the drug name in the Drug Calculator window shows that are no other drugs configured Drug
404. rom the display but all settings and patient data information are retained A special Standby screen is displayed If a patient location is entered at the Information Center this will also be displayed on the Standby screen availability depends on Information Center revision To resume monitoring Select anything on the screen or press any key 21 Understanding Screens Your monitor comes with a set of preconfigured Screens optimized for common monitoring scenarios such as OR adult or ICU neonatal A Screen defines the overall selection size and position of waves numerics and SmartKeys on the monitor screen when you switch on You can easily switch between different Screens during monitoring Screens do NOT affect alarm settings patient category and so forth When you switch from a complex to a less complex Screen layout some measurements may not be visible but are still monitored in the background If you switch to a more complex Screen with for example four invasive pressure waves but you have only two pressures connected to the monitor the missing two pressures are either left blank or the available space is filled by another measurement Switching to a Different Screen 1 To switch to a different Screen select the current Screen name in the monitor info line op or select the Change Screen SmartKey 2 Choose the new Screen from the pop up list Changing a Screen s Content 22 If you do not want to chang
405. rom the gas modules refer to your Gas Module Instructions for Use Patient Alarm Messages The measurement labels and abbreviations for pressure temperature SpO and anesthetic agent alarms are explained in the individual chapters Some alarms may be shown at the Information Center in shortened form when transferred through IntelliVue Instrument Telemetry USA only These shortened alarm texts are included in the list and identified with the note at Information Center Note that yellow arrhythmia alarms short yellow alarms may be shown with one or with two stars depending on your monitor configuration and the Information Center revision you are using Refer to your Gas Module Instructions for Use for patient alarms and INOPs from the gas modules APNEA or CO Resp Respiration has stopped for longer than numeric flashes red alarm APNEA xxx sec AGM the preset apnea time xxx denotes the lamp alarm tone Apnea duration XASYSTOLE ECG No QRS detected for a period greater numeric flashes red alarm than the asystole threshold in the lamp alarm tone absence of Vfib or chaotic ECG awRR HIGH CO Resp The airway respiration rate has exceeded numeric flashes and high limit AGM the high alarm limit is highlighted yellow alarm lamp alarm tone awRR LOW CO Resp The airway respiration rate has dropped numeric flashes and low limit AGM below the low alarm limit
406. rted sensor connected or sensor type unknown or not supported by your software revision Replace the sensor using only Philips supported sensors BIS SENSOR MALFUNC INOP tone BIS Malfunction in the sensor hardware most often caused by liquids permeating into the connectors OR patient interface cable PIC or DSC or BISx may be faulty Replace the sensor Manually initiate a Cyclic Impedance Check Make sure all electrodes pass the test Make sure that the both sides of the PIC connector between PIC and sensor are dry If you are not sure that the connector is dry replace the PIC until it has dried If this INOP persists contact your service personnel BIS SENSOR USAGE INOP tone BIS Excessive sensor usage Replace sensor A Cyclic Impedance Check will start automatically BIS SQI lt 15 INOP tone OR BIS SQI lt 50 no INOP tone BIS If the signal quality is below 50 BIS numerics cannot be reliably derived If the signal quality is below 15 no BIS numerics can be derived This may occur as a result of artifacts such as those generated from motion or the presence of electrocautery devices Make sure the sensor is properly attached to the patient Manually initiate a Cyclic Impedance Check Make sure all electrodes pass the test Make sure the patient is completely relaxed even small motions of the facial muscles affect the signal quality BIS UNPLUGGED INOP tone BIS Plug in the BIS modu
407. s Alarms On QRS Volume 1 Tone Modulation Yes Tone Mod Type Enhanced Speed 25mm s Perfusion On Average 10 sec NBP Alarm Suppr On Extd Auto OnOff Disabled Color Cyan Desat Limit 80 80 80 Low Limit 90 90 85 High Limit 100 100 95 Desat delay 20 sec 20 sec 20 sec High Alarm delay 10 sec 10 sec 10 sec Low Alarm delay 10 sec 10 sec 10 sec Parameter Alarms On Off on on on Label SpO SpO SpO Pulse Settings Pulse SpO2 On Off on on on 374 Pulse Alarms On Off on on on Pulse High Limit 120 bpm 160bpm 200 bpm Pulse Low Limit 50 bpm 75 bpm 100 bpm A Extr Brady 20 bpm 20 bpm 20 bpm Brady Clamp 40 bpm 40 bpm 50 bpm A ExtrTachy 20 bpm 20 bpm 20 bpm Tachy Clamp 200 bpm 220 bpm 240 bpm NBP Default Settings Auto Manual Auto Manual Alarms from Sys High Alarm Limit 160 90 110 120 70 90 90 60 70 180 90 110 Low Alarm Limit 90 50 60 70 40 50 40 20 24 70 50 65 Alarms On NBP On Repetition Time 15 min 3 min Unit mmHg Done Tone Off On Start Time Synchronized NotSynchron VP Pressure 60 mmHg 40 mmHg 30 mmHg Reference Auscultatory Invasive Color Red Magenta Temperature Default Settings Low Limit 36 35 High Limit 39 Alarms On Unit oc Range 35 43 30 43 Color Green Li
408. s To see the measurement priority list for trending 1 Inthe Main Setup menu select Trends 2 Select Trend Priority To add measurements to the priority list 1 Select the pop up key Add and choose from the pop up list of available measurements 2 Use the Sort Up and Sort Down pop up keys to change the priority order Trend Parameter Scales Parameter scales define how the trend waveform will appear on the screen and in trend reports Separate scales can be set for adult pediatric and neonatal patient trends To change the trend parameter scales settings either use the Scale setting in the Segment menu or 227 In the Main Setup menu select Trends Select Parameter Scales Select the measurement or parameter you want to change from the list Select the pop up key Change to call up the Scale menu WR O N e In the Scale menu select the parameter label you want to define settings for Select Adult Pedi and Neo and use the pop up keypad to enter new upper and lower scale definitions Graphical Trend Presentation Graphical trends and screen trends for measurements with compound values for example ABP or CO3 can be viewed in line or band form To change the presentation style 1 Select Main Setup gt Trends 2 Select GLobal Style and choose Line to display the trends as a continuous line Band to fill the area between the trend lines for example between the systolic and diastolic pressures with color Th
409. s e FilterLine Set is a combination of a FilterLine with an Airway Adapter e H in the accessory name indicates suitability for humidified ventilation and longer usage due to the active removal of humidity from the sample line e Smart CapnoLine is a combined oral nasal FilterLine e Smart CapnoLine O is a combined oral nasal O7 CO FilterLine e NIV Line is a nasal FilterLine suitable for mask ventilation for example C PAP e Single purpose means CO measurement only dual purpose means CO measurement and O delivery e The accessories are supplied in packs of 25 Is the patient intubated Yes No Does the patient need oxygen Yes No Short term Long term Short term Long term Long term Short term Short term up to 6 hours up to 72 hours J up to 8 hours up to 24 hours up to 24 hours up to 8 hours up to 8 hours Oral Nasal Nasal Nasal Oral Nasal Nasal Key Applications Critical Care OR EMS ED Procedural Critical Care Critical Care Procedural EMS ED Sedation Critical Sleep Lab Long Sleep Lab Sedation Care EMS ED term Pain Critical Care Management EMS ED Philips part numbers A Adult P Pediatric I Infant N Neonate FilterLine Set FilterLine H Set Smart CapnoLine HO f CapnoLine H Smart NIV Line A P M1920A A P M1921A CaPneLine O2 4 M4680A A M46894 Capnoline A 4686A VN M1923A A M2
410. s unplugged MMS UNSUPPORTED MMS The Multi measurement Server is not supported by your INOP tone monitor Contact your service personnel MSL Power High Monitor The power consumption of the devices connected to the Measurement Server Link MSL cable is too high If this situation continues the MSL will be switched off Contact your service personnel MSL Power Off Monitor The power consumption of the devices connected to the INOP tone Measurement Server Link MSL cable was too high for too long and the MSL has been switched off Contact your service personnel MSL Power Overload Monitor The power consumption of the devices connected to the INOP tone Measurement Server Link MSL cable is much too high or there has been a short circuit The MSL has been switched off Contact your service personnel NBP CUFF OVERPRESS NBP The NBP cuff pressure exceeds the overpressure safety limits Numeric displayed with INOP Remove the cuff from the patient Make sure that the tubing is tone not kinked or twisted and that the correct patient category is During this INOP alarms cannot be selected Try restarting the measurement paused or switched off You can silence this INOP but the INOP message remains visible until the next measurement is started or the Stop A11 SmartKey is selected NBP EQUIP MALF NBP Remove the cuff from the patient The NBP hardware is faulty Contact your service personnel You can silence this INOP but the INOP
411. s 243 oxygen extraction 206 oxygenation calculations 233 P pace pulse rejection ECG about 92 switching on off 94 paced patients arrhythmia monitoring 108 repolarization tails 94 safety information 106 setting status 106 paced status checking 92 pacemaker failure 106 paper reloading recorder 264 paper size for reports 270 parallel interface symbol 328 parallel printer connection symbol 328 parameter scales trends 227 passcode protection 21 patient admit 77 category NBP 143 discharge 79 end case 79 patient alarm messages 53 patient demographics window 77 patient mismatch 82 patient reports contents 272 patient trends viewing 223 paused alarms 44 extending time 46 restarting 46 PAWP 158 peak power frequency PPF 207 performance specifications pressure 348 354 performance test 365 performing calculations 235 perfusion indicator 137 138 141 pfloops 289 Philips contact information 326 physiological alarms 41 PIC cable BIS securing 221 PiCCO method C O 164 CCO 164 setup 165 pleth alarm source 141 pleth wave 140 pleth waveform 137 plug in recorder 257 pop up keys 19 events 243 power disconnecting from mains power disconnecting from 33 power on symbol 328 PPF peak power frequency 207 PPV 157 preparing skin for ECG 91 pressure alarms during zero 153 arterial source 157 158 calibration pressure 156 cerebral perfusion calculating 157 performance specifications 348 35
412. s Miter MAX AL M1943AL OxiMax Pediatric foot hand sensor patient _ yes yes Option Atas Mist MAX P size 10 50 kg use adapter cable 5 M1943NL OxiMax Infant foot hand sensor patient size yes yes MAX I 3 20 kg OxiMax Adult finger or neonatal foot hand _ yes yes MAX N sensor patient size gt 40 kg or lt 3 kg MAX FAST Forehead sensor no yes Must use OxiMax Adult nasal sensor no yes M1943NL adapter MAX R cable OxiMax SC Adult softcare sensor no yes A OxiMax SC Neonatal softcare sensor no yes NEO OxiMax SC Preterm infant softcare sensor no yes PR Oxisensor II Adult sensor patient size gt 30kg yes no Must use M1943A D 25 or M1943 AL Oxisensor II Pediatric sensor patient size 10 50 kg yes no adapter cable D 20 Oxisensor II Infant sensor patient size 3 20 kg yes no 1 20 Oxisensor II Neonatal sensor patient size lt 3 kg or yes no N 25 gt 40 ke OxiCliq A See OxiMax MAX A yes yes Option A01 Use OxiCliqP See OxiMax MAX P yes yes adapter able M1943A or OxiCliq I See OxiMax MAX I yes yes M1943AL together OxiCliq N See OxiMax MAX N yes yes with OC3 adapter cable Option A02 Must use adapter cables M1943NL and OC3 adapter cable 316 Oxiband Adult neonatal sensor no yes Must use OXI A N M1943NL adapter Oxiband Pediatric infant sensor no yes cable OXI P I Durasensor
413. s aligned to display with the measurement wave Changing the wave automatically changes the trend To display two or more screen trends overlapping 1 Select the screen trend to open the screen trend menu 2 Select Change Trend gt Add Trend and select a screen trend from the pop up list Activating the Cursor for Screen Trends To activate the cursor for Screen Trends 1 Select the screen trend 2 Select Activate Cursor You can now use the arrow keys to move the cursor across the time line The values measured at the cursor time are shown next to the cursor To de activate the cursor Select Main Screen Changing the Screen Trend View To switch between tabular graphic and horizon views select the screen trend then select Change View and select the required view Tabular View 120 80 95 i 120 80 95 Aperiodic measurements such as 120 80 95 120 80 95 NBP C O C I and Wedge can be 120 80 95 i 120 80 95 viewed as a screen trend in tabular i 120 80 95 120 80 95 form The measured values and their 120 80 95 120 80 95 timestamps are shown with the measurement label The trend time for tabular screen trends depends on the space available on the Screen Up to 30 measurements or 12 hours information can be shown Horizon View The horizon view presents trend information superimposed over a defined baseline This helps you visualize changes in your patient s condition since the basel
414. s and shown on a grey background Beat labels will be annotated above the ECG wave and Delayed will be written beside it To return to the normal ECG primary lead display select Annotate Arrhy again Arrhythmia Beat Labels Arrhythmia beat labels tell you how the monitor is classifying beats N Normal v Ventricular Ectopic S Supra ventricular Premature P Paced Pacer spike L Learning patient s ECG A Artifact noisy episode Insufficient information to classify beats I Inoperative condition e g LEADS OFF M Pause or missed beat 109 Arrhythmia Status Messages The monitor displays two types of status messages e Rhythm Status Messages to indicate the patient s rhythm e Ectopic Status Messages to indicate the presence of ectopic beats These status messages are shown on the right hand side of the primary ECG wave They are updated every second with the exception of the Sinus and Supraventricular SV rhythm messages The Sinus and SV rhythm messages are updated based on the current heart rate taking into account the patient category adult pediatric or neonatal For the message to change from one rhythm status to another the HR must be in the new range for five beats If you have basic arrhythmia capability you will get only messages for the alarms provided with this level Rhythm Status Messages 110 The label B or E indicates basic B or enhanced E arrhythmia capability
415. s exceeded 5mmHg 0 7kPa for more than 90 seconds CVP INOPS PRESS See lt Pressure label gt INOPS under Pressure ECG EQUIP MALF ECG Contact your service personnel Numeric is displayed with a The ECG hardware is faulty INOP tone lt ECG LEAD gt LEAD OFF ECG Nort all the required leads for ECG monitoring are connected Numeric is displayed with a Check the ECG connections and make sure that the electrode INOP tone indicated by lt ECG lead gt RA LA LL RL V or C electrodes is attached In EASI mode all 5 electrodes must be connected ECG EL NOISY lt ECG LEAD gt ECG The ECG signal from the named ECG electrodes RA LA LL RL V or C is noisy Check the ECG connections and make sure that the electrode indicated is attached ECG NOISY SIGN ECG The ECG signal is too noisy Check that the electrodes are INOP tone properly placed and have not dried out Remove any possible sources of signal noise such as power cords from the area around the cable and the patient The ECG signal may be saturated or overloaded EcgOut EQUIP MALF ECG Check that the ECG out cable is securely connected Contact INOP tone your service personnel EEG EQUIP MALFUNC EEG The EEG hardware is faulty Contact your service personnel INOP tone EEG IMPEDANCE HIGH or EEG The signal electrode in one or both channels exceeds the user EEG1 and or EEG2 IMPED selected impedance limit or the impedance of a sin
416. s for details AC Power LED Green while the monitor is connected to AC power mains IntelliVue MP60 MP70 The IntelliVue MP60 MP70 M8005A M8007A patient monitors integrate the display unit with a 15 color LCD display and the data processing unit into one Up to eight waves can be shown on the screens as well as the 12 Lead ECG Screen The MP60 uses the SpeedPoint as its primary input device while the MP70 uses touch screen operation but may have an optional SpeedPoint The monitors can be connected to the Multi Measurement Server MMS and any one of the measurement server extensions and to the Flexible Module Server M8048A The IntelliVue family plug in measurement modules can be connected to its FMS module slots with plug and play convenience The MP60 MP70 has two integrated slots for plug in modules You can combine one each of the following modules in these slots Pressure Temperature C O SpO and VueLink Two of the same type of module cannot be used You can also use the two slot recorder module in the integrated slots MP60 MP70 Major Parts and Keys Color coded alarm lamps Alarms Off lamp Display Model indicator SpeedPoint optional for MP70 Part number and serial number Mounting quick release lever AC power LED Error LED Power on standby switch Power on LED Do ON WB WN HR WO NHN e oO IntelliVue MP80 MP90 Note The MP80 monitor M80084A is not available in the USA The In
417. s for the MP30 are the Touchscreen and integrated navigation point the MP20 is supplied with an integrated navigation point only Up to six waves can be shown on MP20 MP30 Screens USA up to four waves 12 ECG traces can be shown on the 12 Lead ECG Screen The MP20 MP30 can be connected to one Multi Measurement Server MMS and any one of the i measurement server extensions There is an optional built in recorder The Flexible Module Server E M8048A and all plug in modules cannot be used with the MP20 MP30 With an optional Interface j board Bispectral Index BIS monitoring is possible MP20 unior and MP20L are options of MP20 M8001A and are not referred to separately in these Instructions for Use MP20 MP30 Major Parts and Keys MP20 MP30 left side MP20 MP30 front panel N AUA UNa ND WW MAA UNa Color coded alarm lamps Alarms off lamp Model indicator ECG out Navigation Point Part number and serial number Mounting quick release lever On Standby switch On Standby LED Error LED Battery status LED AC power operation LED read the documentation symbol Mounting quick release lever On Standby LED Green when monitor is switched on Error LED Red if there is a problem with the monitor Battery LED Green yellow and red See the section on Using the Batteries for details AC Power LED Green while the monitor is connected to AC power mains IntelliVue
418. s monitoring to reduce the frequency of arterial sampling The values at tissue level will not be the same as those measured arterially because the measurement is transcutaneous They correlate with track closely the arterial values For example a drop in transcutaneous values usually indicates a corresponding drop in arterial values Transcutaneous values will not always correlate with blood samples taken from the capillary blood of the heel heelsticks or astrups Identifying tcGas Module Components 1 press to enter Setup tcGas menu tcGas ORI M1018A 2 press to start calibration Dm CAL Lo a 3 calibration chamber 1 4 transducer connector M 195 Setting the tcGas Sensor Temperature 1 Inthe Setup tcGas menu select Transducer Temp 2 Choose a temperature value appropriate for your patient s age weight and physical condition in accordance with your hospital policy Usually a higher transducer temperature gives a better correlation and a quicker response time However higher temperatures also increase the risk of skin burns Most physicians prefer a temperature between 42 C 107 F and 44 C 111 F and a site time of four hours or less Usually the higher the transducer temperature the less the site time should be Whenever you change the temperature setting the monitor forces you to make a new calibration Using the tcGas Site Timer Availability and behavior of th
419. s not available for example because it has run out of paper this print job is suspended and stored in the monitor s memory If the target device of this print job was set to Unspecified the monitor will periodically try to resend the print job to the first printer listed in the Setup Printers menu under Printer that is set to Enabled and that has paper of the correct size To allow the report to print you must either solve the problem with the target printer or re route the print job to another printer with paper of the correct size To re rout a print job Enable the new target printer by selecting it in the Setup Printers menu and toggling to Enabled As the monitor tries to send the report to the printers in the order they are listed you must make sure that all the printers above the new target printer are disabled If the target device of the print job was set to a specific printer re routing is not possible 271 Printer Status Messages Print job could not The printer queue is full and the monitor cannot accept another report be queued request Wait until some more reports have been printed then try again OR A report has been triggered that uses a paper size unavailable with the target printer Try another printer if available or change the paper size of the print request Cancelling all Stop All Reports has been selected in the Report menu OR print jobs The Operating Mode has been changed from Monitoring Mode
420. s values The monitor remembers this pressure setting until you enter a new one 1 Inthe Setup tcGas menu select AMbientPress 2 Enter the current barometric pressure reading indicated by your barometer 3 Select the Confirm popup key Remembraning the tcGas Transducer CAUTION The tcGas transducer is thin and flexible You must treat it with care Avoid kinking bending or pulling the cable Remembrane the transducer if the electrolyte in your transducer has dried out or e if the transducer is new e if you are using the transducer with a new patient e if the membranes are damaged scratched or wrinkled e after five days of continued use or 28 days of storage 197 1 Unscrew the protection cap from the transducer and hook the O ring remover under both O rings to remove them 2 Remove both of the clear plastic membranes using your fingers 3 Clean the transducer head including the groove and rim with absorbent paper to remove all old electrolyte old electrolyte causes incorrect values and apply approximately two drops of electrolyte solution to the transducer head 4 Press the transducer head downwards into an unused membrane replacer until the replacer retracts as far as it can and you hear a click Discard used replacer 5 Remove any surplus electrolyte solution on the outside of the membranes with a soft tissue 6 Make sure that the new membranes are secured by two O rings on the transducer If any
421. s window select the Print Record pop up key then select the Record Calc pop up key Calculations recordings print the patient demographic information and the content of the current Calculations window on the recorder strip To print a report for the calculation group currently on the monitor screen select the pop up key Print Calc To print the Calculations Review window select the pop up key Print in the Calculations Review window All the calculations in the current group will be printed in the report Calculation Reports can be printed on central or local printers This example report shows the oxygen calculation group Ventilation and hemodynamic calculation reports are similar Patient information ee Calculation group Oxygen Calculations gt Calculation Time Ape 02 22 34 Three columns of 25 eee a a m m M PIO 0 85 imat cvo NE was ayn calculations input and eee Se ln BREE aoe ans output values with Sol wae ins ce le Bass o T e X p svoa 53 iim s aapo2 OMIS ieas muy times units and m esoun wa joyo WES gt s gt ranges where Meight 185 22 28 Weight 85 0 13 34 ay ssa 2 09 appropriate i PP P S PHILIPS E General Hospital Page 1 last 237 238 22 High Resolution Trend Waves High resolution hi res trend waves provide information for fast changing parameters at a glance They can help you to recognize trend patterns and to find interrelationships betwee
422. sable Timer Not Allowed Heat Switch Off i e after Site Timer No elapsed Transducer Temp 43 0 C CO Correction Severinghaus On Metabolism Factor 8 mmHg TcGas Unit mmHg Temperature Unit ne tcpO Color Blue tcpCO Color Green SvO Default Settings Low Limit 60 High Limit 80 Alarms On Light Intensity On Color Yellow 379 35 Default Settings Appendix EEG Default Settings EEG Default Settings TP SEF On MDE PPE Delta Theta Off Alpha Beta SEF Threshold 90 Numeric Average 8 sec Wave Scale 100uV or 50uV if Show Gridlines is configured to Yes Show Gridlines No Low Filter 0 5 Hz High Filter 30 Hz Impedance Limit 5 kOhm Smoothing CSA On Color Yellow BIS Default Settings SQI On EMG On SR On SEF Off TP Off Bursts On Off Scale 100uV or 50uV if Show Gridlines is configured to Yes Show Gridlines No Filters On Low Filter 2 Hz High Filter 70 Hz Notch Filter On High Alarm Limit 70 Low Alarm Limit 20 Alarms On Smoothing Rate 30 sec 15 sec Color Yellow Magenta D ee o acme OP tener APRenas VueLink Default Settings Device Alarms Ignored Color Green 381 382 10 lead placement ECG 100 12 lead placement ECG 100 3 lead placement ECG 98 4 channel recorder 258 5 lead placement ECG 98
423. satellite systems 336 The OEM radio device used in this product is in compliance with the essential requirements and other relevant provisions of Directive 1999 5 EC This product is intended to be connected to the Publicly Available Interfaces PAI and used throughout the EEA CAUTION High power radars are allocated as primary users meaning they have priority of 5250 5350 MHz and 5650 5850 MHz and these radars could cause interference and or damage to LE LAN devices IntelliVue 802 11 Bedside Adapter CE compliances This device is compliant to Council Directive 73 23 EEC Low voltage directive amp 89 336 EEC EMC directive amp 1999 5 EC Radio Equipment and Telecommunications Terminal Equipment Directive The radio component contained in this device is compliant to Council Directive 1999 5 O EC Radio Equipment and Telecommunications Terminal Equipment Directive WARNING To minimize the risk of causing severe burns during MR imaging ensure that transducers sensors and cables are positioned so that no inductive loops are formed If the measurement does not appear to be operating properly remove all transducers sensors and cables immediately from the patient Physical Specifications MP20 MP30 lt 6kg lt 345 x 275 x 230 mm _ including M3001A recorder lt 13 lb 13 6x11x9in and battery without options MP40 MP50 lt 8 6 kg lt 365 x 330x217 mm including M3001A recorde
424. se which printer the print job will be sent to Unspec to use the default printer or the printer name defined at the Information Center or in the monitor s Configuration Mode for example Local 1 Some settings may be inactive grayed out in this menu for reports that can only be started in a special window Checking Printer Settings The printer settings for your monitor are defined in Configuration Mode The printer settings Paper Size Resolution Color Support and Duplex Option for the active printer are visible but inactive grayed out in the Setup Printers menu Printer names for locally connected printers can be defined in Configuration Mode You can see whether a specified printer is centrally or locally connected in the Setup Printers menu under Port Local lt name gt indicates locally connected printers Remote lt name gt indicates centrally connected printers To enter the Setup Printers menu in the Reports menu select Setup Printers 270 Printing a Test Report 25 Printing Patient Reports Printing a Test Report A test report can be printed in Configuration mode refer to the Service Guide for details Switching Printers On Or Off for Reports You can enable or disable printer status to switch individual printers on or off for report printouts 1 Inthe Setup Printers menu select Printer and then select the name of the device you want to switch on or off for Reports printing from the pop up list
425. serted perform an in vivo calibration SvO CAL MODE SvO Pre insertion calibration is complete but the catheter tip is still SvO numeric is replaced by inside the optical reference The catheter is now ready for insertion SvO2 CAL REQUIRED SvO There is no valid calibration data in the Optical Module SvO numeric is replaced by Perform either a pre insertion or an in vivo calibration INOP tone may sound SvO2 CONFIGURATION SvO The Optical Module has been configured to SaO Mode Use SvO numeric is replaced by Change to Sv02 inthe Setup SvO2 menu to INOP tone reconfigure to SvO Mode SvO2 CONNCT OPTMOD SvO The Optical Module was disconnected during data storage SvO numeric is replaced by Reconnect the Optical Module for at least 20 seconds INOP tone SvO EQUIP MALF SvO The SvO Module or Optical Module is faulty Unplug and SvO numeric is replaced by replug the Optical Module and SvO module Exchange the INOP tone modules If the INOP persists contact your service personnel SvO IN VIVO CALIB SvO The in vivo calibration is not yet complete Lab values must be SvO numeric is replaced by stored to the Optical Module to complete the calibration Either continue with the next steps of the current calibration or recall the previous calibration SvO LIGHT INTENS SvO The intensity changed considerably since the last light intensity SvO numeric is replaced by or calibration This may indi
426. setting is made in the monitor s Configuration Mode and is associated with the timer label The timer type display color of the timer and whether a window automatically pops up on expiry are also settings made in Configuration Mode for each timer label The remaining timer settings can be made in Monitoring Mode If you change settings when a timer is running it will not be stopped The timer will continue to count but the new settings will be applied To display the Setup window for a timer inthe Timers window select the required timer or selecta timer on the Main Screen then select Setup Timers Timer Label You can select from a variety of specific labels for example Tourniquet Infusion Documentation or from four non specific labels Timer A B C D When you assign a label to a timer the monitor automatically applies the associated configuration settings to this timer but the timer continues counting and is not reset To select a label in the Timers window 1 Select the required timer to display the Setup window 2 Select Label 3 Select a specific or non specific label from the list 286 Displaying Timers On The Main Screen 28 Using Timers Run Time The run time can be set between 1 minute and 96 hours No Limit timers have no run time To set the run time in the Timers window 1 Select the required timer to display the Setup window 2 Select Run Time 3 Select a run time from the list Timer Counting Directi
427. sk of missing cardiac arrest may be reduced by monitoring these patients with low heart rate limit at or slightly above the basic demand pacemaker rate A low heart rate alarm alerts you when the patient s heart rate drops to a level where pacing is needed Proper detection and classification of the paced rhythm can then be determined Filtered ECG signal from external instruments Instruments such as defibrillators or telemetry units produce a filtered ECG signal When this signal is used as an input to the bedside monitor it is filtered again If this twice filtered signal is passed to the arrhythmia algorithm it may cause the algorithm to fail to detect pace pulses pacemaker non capture or asystole thus compromising paced patient monitoring performance External pacing electrodes When a pacemaker with external pacing electrodes is being used on a patient arrhythmia monitoring is severely compromised due to the high energy level in the pacer pulse This may result in the arrhythmia algorithm s failure to detect pacemaker noncapture or asystole Fusion beat pacemakers Pacemakers that create fusion beats pace pulse on top of the QRS complex cannot be detected by the monitor s QRS detector Rate adaptive pacemakers Implanted pacemakers which can adapt to the Minute Volume may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rat
428. sm Correction for tcpCO 202 17 Monitoring SvO gt 203 Preparing to Monitor SvO 204 Carrying out a Pre insertion Calibration 204 Inserting the Catheter 205 Performing a Light Intensity Calibration 205 Performing In Vivo Calibration 206 Setting Up the In Vivo Calibration 206 Making the In Vivo Calibration 206 Calculating Oxygen Extraction 206 18 Monitoring EEG 207 EEG Monitoring Setup 208 Using the EEG Impedance Montage Window 208 Choosing an EEG Electrode Montage 209 Changing the Impedance Limit 209 About Electrode to Skin Impedance 210 Impedance Indicators 210 About Compressed Spectral Arrays CSA 211 Changing CSA Settings 212 Changing EEG Settings 212 Switching EEG Numerics On and Off 212 Changing the Scale of the EEG Waves for Display 212 Changing Filter Frequencies 213 Changing the Speed of the EEG Wave 213 EEG Reports 213 EEG Safety Information 214 EEG and Flectrical Interference 214 19 Monitoring BIS 215 BIS Monitoring Setup 216 Monitoring BIS Using the DSC and BIS Engine 216 Monitoring BIS using the BISx 217 Manufacturer s Information 218 BIS Continuous Impedance Check 218 BIS Cyclic Impedance Check 218 Starting a Cyclic Impedance Check 218 Stopping a Cyclic Impedance Check 218 BIS Window 219 BIS Impedance Indicators 219 Changing the BIS Smoothing Rate 220 Switching BIS and Individual Numerics On and Off 220 Changing the Scale of the EEG Wave 220 Switching BIS Filters On or Off 220 BIS Safety Information 221 20
429. sories 216 connecting temperature probe 149 connection direction indicator symbol 328 connection direction symbol 328 connector AC power input 332 additional MSL 333 analog video out 332 ECG analog sync output 330 332 333 equipotential ground 332 marker input 345 MMS patient cable 333 mouse 332 MSL 332 printer 332 protective earth 332 recorder module 333 trackball 332 wired network 332 wireless network 332 connectors 329 serial MIB 330 331 332 continuous cardiac output 161 Continuous Impedance Check BIS 218 conventional 12 lead ECG 100 correcting the NBP measurement 145 counting events 247 CPAP RESP 133 CSA Compressed Spectral Arrays 211 cuff pressure NBP 146 selection NBP 145 current view ST map 122 curve alert messages C O 171 Cyclic Impedance Check BIS 218 D damage mechanical 32 database events 247 database configuration trends 229 date setting 31 default profile 26 default settings 369 defibrillation and arrhythmia monitoring 106 and ECG monitoring 106 and monitoring BIS 221 during EEG monitoring 214 synchronization marks 93 defibrillator input 345 defibrillator proof symbol 328 defibrillator synch maintenance interval 306 delay time recording 261 delayed recording 259 deleting events 247 demonstration mode 21 desat alarm SpO2 140 detection modes Resp 132 device driver language conflict with monitor 284 diagnostic ECG filter settin
430. spulmonary thermodilution and pulse contour analysis on the blood pressure waveform A fluid with a known volume and temperature is injected into the right atrium through a CVP catheter The injectate bolus mixes with the blood in the heart and the change in blood temperature is measured with a thermistor at the distal end of an arterial catheter placed in one of the bigger systemic arteries for example the femoral or the axillary artery The PiCCO Method requires a pressure measurement made using either the M1006B Pressure module or a M3001A MMS or a measurement server extension M3015A M3014A or M3012A A VueLink pressure may not be used You will also need a conventional central venous CVP line and an arterial catheter from Pulsion Medical Systems You must use the approved catheters and puncture locations Measuring Continuous Cardiac Output Every time C O is measured with the PiCCO method the monitor uses this C O value and the result of the pulse contour analysis to calculate a patient specific calibration factor The monitor uses this value to compute CCO and the other continuous hemodynamic parameters CCO values are calculated on a beat to beat basis and then averaged over a 12 second time frame The calculated values are displayed as numerics on the monitor screen Measuring Systemic Vascular Resistance The monitor uses CCO an arterial pressure and CVP to calculate a continuous SVR value Ifa continuously measured CVP value
431. ss otherwise specified this information is valid for SpO measured using the M3001A measurement server and the M1020B measurement module Complies with EN ISO 9919 2005 except alarm system alarm system complies with IEC 60601 2 49 2001 Measurement Validation The SpO accuracy has been validated in human studies against arterial blood sample reference measured with a CO oximeter Pulse oximeter measurements are statistically distributed only about two thirds of the measurements can be expected to fall within the specified accuracy compared to CO oximeter measurements Display Update Period Typical 2 seconds Maximum 30 seconds Max with NBP INOP suppression on 60 seconds SpO Range 0 to 100 The specified accuracy Option A01 Philips Reusable Sensors is the root mean Accuracy M1191A M1191AL M1192A M1192AN 2 70 to 100 square RMS M1193A M1194A M1195A 3 70 to 100 difference between the M1191T M1192T M1193T Adult 3 70 to 100 measured values and M1193T Neonate 4 70 to 100 the reference values Philips Disposable Sensors with M1943A L M1132A M1133A adult infant 2 M1901B M1902B M1903B M1904B M1131A M1133A neonate 3 70 to 100 NellcorPB Sensors with M1943A L MAX A MAX AL MAX P MAX I MAX N D 25 D 20 I 20 N 25 OxiClig A P I N 3 70 to 100 Masimo Sensors with AC 1 LNOP Adt Adtx Pdt Pdtx INF L DC I DC IP Y I 2 70 to 100 LNO
432. stolic Volume N y Y Not available PVR PVRI Pulmonary Vascular Resistance Not available N N Y LCW LCWI Left Cardiac Work N N Y N N Y RCW RCWI Right Cardiac Work Not available N N Y RVSW RVSWI Right Ventricular Stroke Work Not available N N Y currently not available in the U S A or in clinical environments under FDA control 162 Using the C O Procedure Window The C O procedure window displays up to six trials measurement curves with the trial number and the C O value under the thermodilution curve When you open the window a line of pop up keys automatically appears to let you carry out C O related tasks This example shows the procedure window for the transpulmonary PiCCO Method The window may be configured to look slightly different on your monitor To open the C O procedure window Select Cardiac Output in the Setup C O or Setup CCO menu or Select the Cardiac Output SmartKey on the Screen if configured or Press the START hardkey on the front of the C O plug in module if available or Press a remote start switch if you are using one Trial curves Results table of current trial Trial curve scale Averaged values Cardiac Output Transpulmonary A f 5 Average Unit cros T m CFI ae 1 min m ITBVI ml m ETVI Setup Tinj information InjVol d cathct InjVol C I 4 40 105 182 Tblood 37 0 persed Current tri number PP Se IQ wl Bsa 1 93 numeric Curve alert message
433. sual and functional check of the keyboard Contact INOP tone your service personnel Check Main Board 2 Monitor There is a problem with the second main board in the monitor INOP tone Contact your service personnel Check MCC Monitor The monitor cannot communicate with the D80 Intelligent Display Check the MSL coupling cable The end with the grey connector must be connected to the Intelligent Display Check Monitor Func Monitor Potential problem with alarm lamps display or interfaces INOP tone detected Contact your service personnel This INOP may appear on the Information Center as CheckInternVoltage Check Monitor Temp Monitor The temperature inside the monitor is too high Check that the monitor ventilation is not obstructed If the situation continues contact your service personnel Numeric is replaced by a INOP tone Check Mouse Device Monitor Perform a visual and functional check of the mouse input INOP tone device Contact your service personnel Check MSL Voltage Monitor There is a problem with the voltage of the Measurement Server INOR tone Measuremt Link MSL Contact your service personnel Server Check Network Conf Monitor The monitor is receiving network topology information from INOP tone more than one source e g the Database Server and an Application Server Contact your service personnel Check Nurse Relay Monitor There is a problem
434. surement by selecting a site with high capillary density and blood flow thin epidermis and no cardiovascular disorders Most physicians use the abdomen chest and back WARNING You must either remove the transducer before defibrillating or remembrane and calibrate the transducer after defibrillating CAUTION To avoid transducer damage remove it from the patient during high frequency surgical procedures 201 Selecting the tcGas HeatPowerDisplay Mode The heat power display gives an indication of the skin s perfusion below the transducer and of the transducer s contact with the skin If the transducer loses contact the heat power value drops significantly When perfusion is poor you need less heat power to maintain the transducer temperature Inthe Setup tcGas menu select HeatPowerDisplay to toggle between Relative and Absolute Choose Relative when the skin temperature is stable the STABILIZING INOP disappears This indicates subsequent changes in the relative heat power and therefore changes in perfusion or transducer contact since the last zeroing Zeroing the tcGas Relative Heat Power When you start a calibration the HeatPowerDisplay is set to Absolute When you switch to Relative it automatically zeros Zero again if you change application site Finishing tcGas Monitoring Replace the transducer in the calibration chamber When changing the application site after a measuring period some users leave the
435. t iv choosing EASI Standard 96 ECG leads monitored 96 ECG output 345 ECG report 276 lead layout 268 ECG safety information 105 ECG wave autosize 94 calibration bar 94 ectopic status messages arrhythmia monitoring 111 editing C O measurements PiCCO method 166 editing C O measurements RH method C O saving measurements RH method 169 EEG accessories 322 monitor configuration and upgrade 214 EEG monitoring 207 buffer time 211 changing filter frequencies 213 changing wave scale 212 changing wave speed 213 choosing electrode montages 209 CSAs 211 electrical interference 214 electrode to skin impedance 210 gridlines 212 impedance quality indicators 210 Impedance Montage Window 208 international 10 20 electrode placement system 209 safety information 214 setting report buffer time 213 setting screen buffer time 212 setup 208 skin preparation 208 switching numerics on and off 212 EEG wave changing scale 220 electrical input symbol 328 electrical interference during EEG monitoring 214 electrical output symbol 328 electrode montage EEG 209 electrode placement ECG 91 conventional 12 lead 100 modified 12 lead 100 electrode placement Resp 131 with abdominal breathing 132 with lateral chest expansion 132 electrode to skin impedance BIS 219 electrode to skin impedance EEG 210 electromyographic activity numeric BIS 215 electrosurgery and ECG 106 EMC interference Resp 134 EMG numeric BI
436. t below this is the second intercostal space 2 Palpate and count down the chest until you locate the fourth intercostal space V1 placement on the fourth intercostal space at the right sternal border V2 placement on the fourth intercostal space at the left sternal border V3 placement midway between the V2 and V4 electrode positions V4 placement on the fifth intercostal space at the left midclavicular line V5 placement on the left anterior axillary line horizontal with the V4 electrode position V6 placement on the left midaxillary line horizontal with the V4 electrode position V3R to V6R placement on the right side of the chest in positions corresponding to those on the left VE placement over the xiphoid process V7 placement on posterior chest at the left posterior axillary line in the fifth intercostal space V7R placement on posterior chest at the right posterior axillary line in the fifth intercostal space 99 10 Lead Placement When monitoring 12 leads of ECG using a 10 Electrode Lead Placement it is important to correctly place electrodes and to label all 12 lead ECG reports with the correct lead placement Conventional 12 Lead ECG In conventional 12 Lead ECG using 10 electrodes an electrode is placed on the right arm left arm right leg and left leg Six V electrodes are placed on the chest The right leg electrode is the reference electrode Limb electrodes P
437. t do not fit in the current view Vital open the current trend view in tabular form The displayed time period and resolution Signs stay the same Graph open the current trend view in graphic form The displayed time period and resolution Trends stay the same Setting Up Trends Trends are set up in Configuration Mode You can make temporary changes to trends settings such as trend groups priorities or scales in Monitoring Mode The general settings for all Trends are under Main Setup gt Trends Settings for a single segment in graphical trends or for the corresponding trend group can be made more easily in that segment menu 225 Making Segment Settings The Graphical Trends window is divided into measurement segments each of which has its own settings To enter the segment menu select the left hand column of the segment where the measurement label is displayed Expanded View To expand the segment to fill the Graphical Trends window inthe Segment menu select Expand to have that segment enlarged to fill the window In the expanded view you can also highlight a measurement to make it more easily visible for example when multiple ST trends are in one segment To highlight a measurement inthe Segment menu select Highlight repeatedly until the highlight is on the required measurement To return the segment to its original size inthe Segment menu select Expand again Trend Scales for S
438. t is currently displayed or not Checking Paced Status It is important to set the paced status correctly when you start monitoring ECG To change the paced status in the Setup ECG menu select Paced then select Yes or No WARNING Pace pulse rejection must be switched on for paced patients by setting Paced to Yes Switching pace pulse rejection off for paced patients may result in pace pulses being counted as regular QRS complexes which could prevent an asystole alarm from being detected When changing profiles and at admission discharge always check that paced status is correct for the patient Some pace pulses can be difficult to reject When this happens the pulses are counted as a QRS complex and could result in an incorrect HR and failure to detect cardiac arrest or some arrhythmias Keep pacemaker patients under close observation Understanding the ECG Display Your display may be configured to look slightly different 1 mV calibration bar Pace pulse marks Defibrillator synchronization marks Lead Pacer spikes label of the Y displayed wave N ECG Filter label FASI lead placement label Current heart rate alarm limits Current heart rate ECG numeric This is derived from the monitored ECG Pace pulse markers These are shown if the Paced status has been set to Yes and the patient has a paced signal Defibrillator synchronization marks If an HP Agilent Philips defibrillator is connected the synchroniza
439. t loss of any stored data Measurement accuracy may be temporarily decreased while performing electro surgery or defibrillation This does not affect patient or equipment safety Do not expose the equipment to x ray or strong magnetic fields MRI Fast Transients Bursts The equipment will return to the previous operating mode within 10 seconds without loss of any stored data M1032 within 30 seconds If any user interaction is required the monitor indicates with a technical alarm INOP Restart time After power interruption an ECG wave will be shown on the display after 30 seconds maximum 368 35 Default Settings Appendix This appendix documents the most important default settings of your monitor as it is delivered from the factory For a comprehensive list and explanation of default settings see the Configuration Guide supplied with your monitor The monitor s default settings can be permanently changed in Configuration Mode Settings are only entered once per table row if they are the same for all patient categories 369 Alarm Default Settings Alarm Volume 5 Alarms Off 3 min Pause Al 5min Enabled Pause Al 10min Enabled Auto Alarms Off Off Alarm Off Reminder Off Visual Latching Red amp Yell Red Only Audible Latching Red amp Yell Off Alarm Reminder On Reminder Time 3 min Alarm Sounds Traditional Red Alarm Inter
440. t loss of data information can be shared between measurement servers patient monitors and Information Centers patient demographic information is shared between connected measurement servers patient monitors and Information Centers measurement settings and calibration data can be uploaded from an MMS to a patient monitor if configured trend information can be uploaded from an MMS to a patient monitor if configured Different sets of patient and measurement related data are stored in the monitor and the Multi Measurement Server Understanding this will help you to understand what happens to patient data when you transfer patients measurements alarm limits measurement on off etc Patient demographics name Yes yes DOB MRN Monitor settings alarm pause yes no time alarm volume Measurement settings for all _ yes yes for all MMS and extensions measurements Trend data yes for all MMS and extensions measurements up to a maximum of 16 or 32 depending on your database configuration most recent 8 hours of information for all MMS and extensions measurements Calculation data HemoCalc__ yes no data Events data yes no If the monitor is not battery powered you cannot monitor during transport Transferring a Centrally Monitored Patient Scenario A centrally monitored patient is moved to another monitoring location on the same Information Center d
441. t name PETER MRN Patient Cat Neo Paced Yes Continue Continue New Same Monitor MMS Patient Patient settings if configured stored in the MMS to the monitor This clears all data in the monitor resets the monitor to the default Profile and discharges the patient in the monitor Patient Mismatch If Neither Patient Data Set is Correct A patient mismatch where neither set of patient data is correct might occur if you connect a new MMS to a monitor in order to prepare for a new patient before you actually start measuring SelectNew Patient if you are sure that none of the information is correct This discharges all patients erases all data in both the monitor and MMS resets all settings to the default Profile and lets you admit a new patient 83 Patient Mismatch If Both Patient Data Sets Are Correct A patient mismatch where both sets of patient data are correct might occur if you admit a new patient at the monitor or Information Center before the patient arrives at your unit and then connect the MMS that was used during the patient transport to the monitor Select Same Patient ifthe patient information is different but you are sure it is the same patient This merges the demographics and updates them in the Information Center monitor and MMS according to this table Be aware that your monitor may be configured to merge trend data from the MMS and the monitor and to upload measurement settings from the MMS
442. t of monitor ECG analog output marker input connector 333 MP80 MP90 MP80 MP90 rear of processing unit MP80 does not have the top row of connectors 2 3 4 5 6 7 8 9 10 1 11 21 20 19 18 17 16 15 14 13 12 1 Serial MIB RS232 connectors type RJ45 12 ECG analog output marker input 2 Serial MIB RS232 connectors type RJ45 13 Wired network connector 3 Independent display remote alarm device connector 14 Wireless network connector 4 Keyboard connector 15 Primary measurement server link 5 Independent display remote SpeedPoint connector 16 Parallel printer connector 6 Independent display mouse trackball connector 17 Additional measurement server link 7 Independent display keyboard connector 18 Remote SpeedPoint connector 8 Independent display analog video out connector 19 Mouse trackball connector 9 Primary display analog video out connector 20 Remote alarm connector 10 Independent display digital video out connector 21 Flexible nurse call interface 11 Primary display digital video out connector 334 MP80 MP90 front of processing unit 1 2 3 4 5 6 7 8 1 AC Power LED 5 Power supply 2 Error LED 6 AC power input 3 Power on LED 7 Protective earth screw hole 4 Power on switch 8 Equipotential grounding point 802 11 Bedside Adapter Wireless Network Adapter 802 11 Bedside Adapter can be used with all monitors Antenna 2 LEDs green and yellow LEDs light up during startup while selftests are performed Duri
443. tal event review option C04 is introduced Second display To simultaneously show two different Screens a second display can be connected to the MP90 The second display is for viewing only 39 40 Alarms The alarm information here applies to all measurements Measurement specific alarm information is discussed in the sections on individual measurements The monitor has three alarm levels red yellow and INOP Red and yellow alarms are patient alarms A red alarm indicates a high priority patient alarm such as a potentially life threatening situation for example asystole A yellow alarm indicates a lower priority patient alarm for example a respiration alarm limit violation Yellow arrhythmia alarms are specific to arrhythmia related patient conditions for example ventricular bigeminy INOPs are technical alarms they indicate that the monitor cannot measure or detect alarm conditions reliably Ifan INOP interrupts monitoring and alarm detection for example LEADS OFF the monitor places a question mark in place of the measurement numeric and an audible indicator tone will be sounded INOPs without this audible indicator indicate that there may a problem with the reliability of the data but that monitoring is not interrupted Alarms are indicated after the alarm delay time This is made up of the system delay time plus the trigger delay time for the individual measurement See the specifications section for details I
444. telliVue MP80 MP90 M8008A M8010A patient monitors have the display and the processing unit as separate components They offer both touchscreen and the Remote SpeedPoint as standard input devices The MP80 can display up to 8 waves simultaneously and the MP90 up to 12 Waves The monitors can be connected to the Multi Measurement Server MMS and any one of the measurement server extensions and to the Flexible Module Server M8048A The IntelliVue family plug in measurement modules can be connected to its FMS module slots The MP90 can be connected to two Flexible Module Servers FMS The MP90 has the capability for two displays and can have a third main display with the D80 Intelligent Display MP80 MP90 Major Parts and Keys AC Power LED Power on Switch Error LED Display Unit Processing Unit D80 Intelligent Display The D80 Intelligent Display can be used as a third main display with the MP90 monitor You then have three displays able to be configured individually and to be operated independently Remote Alarm Device The Remote Alarm Device provides audio and visual indicators of alarms in addition to those shown on the display 1 Two color coded alarm lamps right hand lamp flashes red or yellow for patient alarms left hand lamp flashes light blue for INOPs 2 Alarms off lamp when illuminated it indicates that all alarms are deactivated 3 Speaker for alarm tones QRS tones and so forth Monitor po
445. tension is required to measure CO3 Pediatric Adult Combined CO Flow Sensor M2781A Color clear For intubated patients with endotracheal tube diameters gt 5 5 mm Adds 8 cc of deadspace Pediatric Combined CO Flow Sensor M2783A Color green For intubated patients with endotracheal tube diameters of 3 5 6 mm Adds less than 4 cc of deadspace Infant Neonatal Combined CO Flow Sensor M2782A Color violet For intubated patients with endotracheal tube diameters of 2 5 4 mm Adds less than 1 cc of deadspace 2 Ifyou are using a combined CO Flow sensor connect it to the CO sensor head first The airway adapter clicks into place when seated correctly 3 Click the connector into place in the flow sensor receptacle on the monitor before connecting to the breathing circuit 4 Install the flow sensor or the combined CO Flow sensor at the proximal end of the breathing circuit between the elbow and the ventilator Y piece Make sure that the spirometry sensor is in a horizontal position with its tubing pointing upwards The correct position is also indicated by an arrow on some of the sensors Graphic shows combined CO Flow Sensors 188 Pediatric adult sensor Pediatric sensor Infant Neonatal sensor WARNING To prevent stress on the endotrachial tube support the sensor and airway adapter Position sensor cables and tubing carefully to avoid entanglement or potential strangulation Do not apply
446. the embedded Other Bed i Bed Label Patient Name screen element in the VTACH Change Screen menu select a Screen designed to show the Other Bed information permanently Note that a Screen with an embedded Other Bed screen element cannot be displayed on the D80 Intelligent Display 87 Note that changing the Screen may automatically change the bed shown in the other bed window If you switch to a different Screen you should check if the correct other bed is displayed Other Bed Pop Up Keys Select the Other Patients SmartKey or the Other Bed window or embedded screen element to access the associated pop up keys Next Wave lets you view waveforms not currently shown in the other bed window More Vitals lets you view more numerics not currently shown in the other bed window Next Bed lets you view waveforms and numerics from the next available bed in the Care Group My Care Group lets you call up the Care Group window to select another bed Alarming Beds lets you view a list of all beds in your care group with an unacknowledged alarm The beds are listed in order of alarm severity Silence Bed lets you silence active alarms at the other bed Whether you see this key depends on the revision and configuration of the Information Center your monitors are connected to WARNING The Silence Bed pop up key in the Other Bed window silences alarms at a remote bed Be aware that accidental use of this key could silence alarms fo
447. the Nellcor OxiMax compatible version Philips reusable sensors M1191A Adult sensor 2m cable for patients yes no No adapter cable over 50 kg Any finger except thumb required M1191AL M1191A with longer cable 3 m yes no M1192A Small adult pediatric sensor 1 5m __ yes no cable for patients between 15 kg and 50 kg Any finger except thumb M1193A Neonatal sensor 1 5m cable for yes no patients between 1kg and 4 kg Hand or foot M1194A Ear sensor 1 5m cable for patients yes no more than 40 kg M1195A Infant sensor 1 5m cable for patients yes no between 4kg and 15 kg Any finger except thumb M1191T Adult sensor 0 45m cable for yes no Requires M1943 patients over 50 kg Any finger except 1 m or M1943AL thumb 3 m adapter cable M1192T Small adult pediatric sensor 0 45m yes no cable for patients between 15 kg and 50 kg Any finger except thumb M1193T Neonatal sensor 0 9m cable for yes no patients between 1kg and 4 kg Hand or foot 314 10kg and 20kg Any finger except thumb for patients gt 40kg MI1191ANL Special Edition SE yes yes No adapter cable Adult sensor 3m cable for patients required over 50 kg Any finger except thumb M1192AN Special Edition SE yes yes Small adult pediatric sensor 1 5m cable for patients between 15 k
448. their own power switches CAUTION When using an MP90 monitor with a D80 Intelligent Display always switch power on directly at the MP90 or at a remote SpeedPoint or remote alarm device directly connected to the MP90 Setting up the Measurement Servers and Modules 1 Decide which measurements you want to make 2 Connect the required modules Measurement Servers or measurement server extensions 3 Check that you have the correct patient cables and transducers plugged in The connectors are color coded to the patient cables and transducers for easy identification Starting Monitoring After you switch on the monitor 1 Admit your patient to the monitor 2 Check that the profile alarm limits alarm and QRS volumes patient category and paced status and so forth are appropriate for your patient Change them if necessary 3 Refer to the appropriate measurement section for details of how to perform the measurements you require Disconnecting from Power The On Standby switch does not disconnect the monitor from the ac power source To disconnect unplug the power cable Monitoring After a Power Failure If the monitor is without power for less than one minute monitoring will resume with all active settings unchanged If the monitor is without power for more than one minute the behavior depends on your configuration If Automat Default is set to Yes the default profile will be loaded when power is restored IfAutomat Default is s
449. thmia analysis is on all yellow alarms connected with ECG are short one star This means that the yellow alarm lamp and the tones are active for a configured number of seconds only after which the blinking numeric and the alarm message remain for up to three minutes Red alarms behave as usual Arrhythmia Alarms and Latching When using arrhythmia analysis Visual Latching and Audible Latching should be on for red alarms or at least Visual Latching should be on Because of the transient nature of arrhythmia alarms many arrhythmia conditions may go unnoticed if alarm latching is off This setting can only be changed in Configuration Mode Switching Individual Arrhythmia Alarms On and Off Some arrhythmia alarms can be individually switched on or off They are Pacer not capture Pacer not pace Non Sustain VT Vent Rhythm Run PVCs Pair PVCs R on T PVCs V Bigeminy V Trigeminy MultifiPVCs Pause SVT Irregular HR Missed Beat PVCs min To switch individual alarms on or off in the Setup Arrhythmia menu select the alarm from the list to toggle between On and Of The monitor displays the INOP message SOME ECG ALRMS OFE Switching All Yellow Arrhythmia Alarms On or Off All yellow arrhythmia alarms can be switched on and off together To do this Inthe Setup Arrhythmia menu select A11 Yellow Off or All Yellow On Adjusting the Arrhythmia Alarm Limits Some arrhythmia alarms have limits which can be individually adjusted
450. tient category setting for your patient Do not apply the higher adult inflation overpressure limits and measurement duration to neonatal patients Intravenous infusion Do not use the NBP cuff on a limb with an intravenous infusion or arterial catheter in place This could cause tissue damage around the catheter when the infusion is slowed or blocked during cuff inflation Skin Damage Do not measure NBP on patients with sickle cell disease or any condition where skin damage has occurred or is expected Unattended measurement Use clinical judgement to decide whether to perform frequent unattended blood pressure measurements on patients with severe blood clotting disorders because of the risk of hematoma in the limb fitted with the cuff 143 CAUTION Ifyou spill liquid onto the equipment or accessories particularly if there is a chance that it can get inside the tubing or the MMS contact your service personnel Measurement Limitations Measurements are impossible with heart rate extremes of less than 40 bpm or greater than 300 bpm or if the patient is on a heart lung machine The measurement may be inaccurate or impossible e if a regular arterial pressure pulse is hard to detect e with cardiac arrhythmias e with excessive and continuous patient movement such as shivering or convulsions e with rapid blood pressure changes e with severe shock or hypothermia that reduces blood flow to the peripheries e with obesity where
451. ting its temperature label The label is a unique identifier for each type of temperature When you choose a label the monitor uses that label s stored color and alarm settings 1 Inthe Setup lt Temp gt menu select Label 2 Select the appropriate label from the list 149 Temp non specific temperature label Trect rectal temperature Tart arterial temperature Tskin skin temperature Tcore core temperature Tven venous temperature Tesoph esophageal temperature Tnaso nasopharyngeal temperature Extended Temperature Label Set The following additional labels are available if Label Set is set to Full This setting can only be changed in Configuration Mode Note that if your monitor is connected to an Information Center the additional labels in the extended label set may not be correctly displayed See the Configuration Guide for your monitor for more information Tile As Iia A Non specific temperature labels Tamb ambient temperature Tcereb cerebral temperature Ttymp tympanic temperature Tvesic vesical temperature Calculating Temp Difference The monitor can calculate and display the difference between two temperature values by subtracting the second value from the first The difference is labeled ATemp 1 Inthe Setup Main menu select Measurements In the Setup ATemp menu select First Temp 2 3 Label the measurement source as appropriate 4 Select Second Temp 5 La
452. tion marks vertical lines on the ECG wave are shown on the ECG wave ST numerics in ECG wave ST numerics can be configured to show underneath the ECG wave on the bottom left Monitoring Paced Patients An ECG optimized for monitoring a paced patient should look like this PITT en eT Normal Beats _ ja HATLI int ATA AIN _ Pace Pulses Beats RTE THEY DONOR SOR TTE Peete EAT You should choose a lead as primary or secondary lead that has these characteristics e the normal QRS should be either completely above or below the baseline and it should not be biphasic For paced patients the QRS complexes should be at least twice the height of pace pulses e the QRS should be tall and narrow e the P waves and the T waves should be less than 0 2 mV 93 Setting the Paced Status Pace Pulse Rejection Avoiding Inthe Setup ECG menu select Paced to toggle between Yes and No Paced en You can also change the paced status in the Patient Demographics window BV When Paced is set to Yes Pace Pulse Rejection is switched on This means that pacemaker pulses are not counted as extra QRS complexes Non Paced OK the paced symbol is displayed on the main screen pace pulse marks are shown on the ECG wave as a small dash When Paced is set to No pacer spikes are not shown in the ECG wave Be aware that switching pace pulse rejection off for paced patients may result in pace pulses bein
453. to perform tasks that are common to all measurements such as entering data switching a measurement on and off setting up and adjusting wave speeds working with profiles The alarms section gives an overview of alarms The remaining sections tell you how to perform individual measurements and how to care for and maintain the equipment Familiarize yourself with all instructions including warnings and cautions before starting to monitor patients Read and keep the Instructions for Use that come with any accessories as these contain important information about care and cleaning that is not repeated here This guide describes all features and options Your monitor may not have all of them they are not all available in all geographies Your monitor is highly configurable What you see on the screen how the menus appear and so forth depends on the way it has been tailored for your hospital and may not be exactly as shown here In this guide e A warning alerts you to a potential serious outcome adverse event or safety hazard Failure to observe a warning may result in death or serious injury to the user or patient e A caution alerts you to where special care is necessary for the safe and effective use of the product Failure to observe a caution may result in minor or moderate personal injury or damage to the product or other property and possibly in a remote risk of more serious injury e Monitor refers to the entire patient monitor Disp
454. to 160 mmHg 2 5 to 21 kPa Neo 20 to 120 mmHg 2 5 to 16 kPa 353 Adult gt 300 mmHg 40 kPa gt 2 sec not user adjustable Pedi gt 300 mmHg 40 kPa gt 2 sec Neo gt 150 mmHg 20 kPa gt 2 sec Invasive Pressure and Pulse Complies with IEC 60601 2 34 2000 EN60601 2 34 2000 Measurement Range 40 to 360 mmHg Pulse Rate Range 25 to 350 bpm Accuracy 1 Full Range Resolution 1 bpm Input Sensitivity Sensitivity 5pV V mmHg 37 5pV V kPa Adjustment range 10 Transducer Load Impedance 200 to 2000 Q resistive Output Impedance lt 3000 Q resistive Frequency Response dc to 12 5 Hz or 40 Hz Zero Adjustment Range 200 mmHg 26 kPa Accuracy 1 mmHg 0 1 kPa Drift Less than 0 1mmHg C 0 013 kPa C Gain Accuracy Accuracy 1 Drift Less than 0 05 C Non linearity Error of lt 0 4 FS CAL 200 mmHg and Hysteresis Overall Accuracy including 4 of reading or 4 mmHg 0 5 kPa whichever is greater transducer Analog Output Range 0 4 V to 3 6 V available only with Level 1 V 100 mmHg M1006B C01 Accuracy 3 full scale CAL 200 mmHg Offset 30 mV Resolution 8 Bit 5 V range Signal delay 20 ms Volume displacement of CPJ840J6 0 1 mm 100 mmHg 354 Pressure 40 to 360 mmHg 40 to 30 mmHg max 12 5 0 to 48 kPa 2 mmHg 0 5 kPa seconds gt
455. to 40 bpm 5 bpm steps 40 to 300 bpm Pedi Neo 1 bpm steps 30 to 50 bpm 5 bpm steps 50 to 300 bpm Tachycardia Difference to high limit 0 to 50 bpm 5 bpm steps max 14 seconds Clamping at 150 to 300 bpm 5 bpm steps Bradycardia Difference to low limit 0 to 50 bpm 5 bpm steps max 14 seconds Clamping at 30 to 100 bpm 5 bpm steps Complies with IEC 60601 2 30 1999 EN60601 2 30 2000 Measurement Ranges Systolic Adult 30 to 270 mmHg 4 to 36 kPa Pedi 30 to 180 mmHg 4 to 24 kPa Neo 30 to 130 mmHg 4 to 17 kPa Diastolic Adult 10 to 245 mmHg 1 5 to 32 kPa Pedi 10 to 150 mmHg 1 5 to 20 kPa Neo 10 to 100 mmHg 1 5 to 13 kPa Mean Adult 20 to 255 mmHg 2 5 to 34 kPa Pedi 20 to 160 mmHg 2 5 to 21 kPa Neo 20 to 120 mmHg 2 5 to 16 kPa Accuracy Max Std Deviation 8 mmHg 1 1 kPa Max Mean Error 5 mmHg 0 7 kPa Heart Rate Range 40 to 300 bpm Measurement Time Typical at HR gt 60bpm Auto manual 30 seconds adult 25 seconds neonatal Stat 20 seconds Maximum time 180 seconds adult pediatric 90 seconds neonates Cuff Inflation Time Typical for normal adult cuff Less than 10 seconds Typical for neonatal cuff Less than 2 seconds Initial Cuff Inflation Pressure Adult 165 15 mmHg Pedi 130 15 mmHg Neo 100 15 mmHg Auto Mode Repetition Times 1 2 2 5 3 5 10 15 20 30 45 60 or 120 minutes STAT Mode Cycle Time 5 minut
456. to the monitor Patient name the monitor if the patient was admitted there For centrally admitted MRN patients this information is taken from the Information Center Screen Notes Patient Category the Multi Measurement Server if connected otherwise the data is Date of Birth taken from the monitor Height Weight Gender Paced Status Paced status is always set to Yes where there is a conflict in patient information Trend data if there is newer trend data stored in the MMS it is uploaded to the monitor Automatically Resolving Patient Mismatch Your monitor can be configured to automatically resolve mismatches in one of two ways e continue using the patient in the MMS and delete the old data in the monitor This is suitable for transport monitors e continue with the patient in the monitor and delete the data in the MMS Care Groups If your monitor is connected to an Information Center you can group bedside monitors into Care Groups This lets you e view information on the monitor screen from another bed in the same or in a different Care Group e be notified of yellow or red alarm conditions at the other beds in the Care Group e see the alarm status of all the beds in the Care Group on each monitor screen There are two main types of Care Groups e standard care group Bed based Care Group up to 12 patients monitored by up to 4 Information Centers e unit group Unit b
457. toring location using a transport monitor and re admitted at the new monitor 1 Disconnect the MMS from the original monitor and silence the resulting MMS UNPLUGGED INOP If you are sure that the patient will not be returning to this monitor you should perform a discharge or end case This prevents data from the next patient accidentally being mixed up with your current patient s data 2 Connect the MMS to the transport monitor and move the patient 3 At the new monitoring location remove the MMS from the transport monitor and connect it to the new monitor 4 If prompted re admit the patient to the new monitor in the Patient Selection window select Continue MMS to retain the data in the MMS This will upload the patient demographics and if configured the measurement settings and trend data stored in the MMS to the monitor Verify that the settings for patient category and paced mode are correct Data Upload from an MMS The Multi Measurement Server stores eight hours of patient trend data at one minute resolution It also stores patient demographic information and the measurement settings and calibration data for the measurements carried out by the MMS and any connected extensions This data can be uploaded to an IntelliVue patient monitor if your monitor is configured to do so and if at least five minutes of trend information is stored in the MMS Your monitor s data upload settings are defined in Configuration Mode to suit your
458. trument Telemetry Wireless Network USA only MP40 MP50 MP40 MP50 Rear of monitor 10 11 12 13 14 Space for optional interface boards e g serial MIB RS232 connectors or optional parallel printer connection Equipotential grounding Protective earth AC power inlet Wireless network connector for use with wireless LAN or Instrument Telemetry adapter Remote alarm connector Analog video out connector Wired network connector Battery compartment Measurement Server Link connector IntelliVue Instrument Telemetry adapter USA only Monitor connector to 5 above 12V DC Power Inlet to 5 above Antenna connector 331 MP40 MP50 Left side of monitor MP60 MP70 Right side of monitor MP60 70 332 So AN HAWN KR YW WN 10 MMS and one extension 2 Plug in module slots 3 ECG analog output marker input connector Serial MIB RS232 connectors optional type RJ45 Parallel printer connector Keyboard connector Mouse trackball connector Main measurement server link MSL Wired network connector Wireless network connector Analog video out connector Equipotential ground connector AC power input Protective earth screw hole Left side of monitor MP60 70 MMS patient cable connectors Slot for integrated recorder module or measurement module Additional measurement server link MSL cable alternative or additional to MSL on righ
459. ts Alarm Limits Report Measurement labels with alarms off symbol where alarms are switched off 25 Printing Patient Reports Patient Name Alarm Limits 123456789 P1 o W pulse re ea 2 pulaa CRP Sv02 etcoz imctoz awkE Apnea indz ER Apnea BIs plo 50 rsg 30 7 r m50 Tine 20 gec 100 ie 30 al Time 20 sec r70 Apr 03 12 39 44 wii amp PHILIPS Page 1 ast Graphic view of current alarm limits in relation to currently monitored measurement value 273 Realtime Report Built Jones Roh ARMET RIM PIE a ae a e a Apr 03 13 51 25 Patient pa Patient Cet Adut Date O Birth 4 Fee 155 Weigh P Ib Paced He Age 0 roaa BJA F ae demographic a Gander Male Height in information m gt 482 APNEA ST IIE 0 1 me awER 17 m Ad IGE St avr 4 am etoj Lt amp time stamp ctga LOW ST aL 0 1 om inva ta we PyCS min HIGH 3r ayr 0 1 mi ER a1 DT IEO N TRANGDCE 3 7 OC om P v i Check Settings 40 MOT 11 0 mm TH ro Active Alarms Mo Centra Momit 3003 WR 4 SEI 3 EZ Ema TEACT TTATETI Pilsa 92 Tpm SEF 7a EZ PAF RENCE STIR Parf 33 Toor 47 3 70 and INOPs Fh TRROSCHECE Pat HF ata 3 amp ABP BGsTS 94 wale ingzy J followed b
460. tside the specified temperature and humidity ranges When the monitor and related products have differing environmental specifications the effective range for the combined products is that range which is common to the specifications for all products Temperature Range Operating 0 to 35 C 32 to 95 F Non operating 20 to 60 C 4 to 140 F Battery storage 20 to 50 C 4 to 122 F Monitor MP60 MP70 in conjunction with IntelliVue 802 11 Bedside Adapter option J35 Temperature Range Operating 0 to 30 C 32 to 86 F Temperature Range Operating 0 to 40 C 32 to 104 F Operating when charging battery or when equipped with Telemetry IntelliVue Instrument 0 to 35 C 32 to 95 F Non operating 20 to 60 C 4 to 140 F Battery storage 20 to 50 C 4 to 122 F Humidity Range Operating 20 to 85 Relative Humidity RH non condensing Non operating 5 to 85 Relative Humidity RH Altitude Range Operating 500 m to 3000 m 10000 ft Non operating 500 m to 12000 m 40000 ft 340 Temperature Range Operating 0 to 45 C 32 to 113 F Non operating 40 to 70 C 40 to 158 F Humidity Range Operating 95 Relative Humidity RH max 40 C 104 F M3015A only non condensing Non operating 90 Relative Humidity RH max 65 C 150 F Altitude Range Operating 5
461. ttings to the settings defined in the default Profile resets all monitor and measurement settings as well as the active Screen to the settings defined in the default Profile discharges the patient from the Information Center When a patient is discharged from the monitor or from an Information Center all patient data is deleted Make sure that you have printed out any required reports before discharging Check that a functioning local or central printer is available before you use End Case To discharge a patient 1 Select the patient name field to display the Patient Demographics window and associated pop up keys 2 Select the pop up key for either End Case to print any configured end case reports or vital signs recording discharge the patient and clear the patient database then enter standby mode Ifan End Case SmartKey is configured for your monitor you can also select this instead and then confirm To see which end case reports are set up for your monitor select Main Setup gt Reports gt Auto Reports For each auto report ifEnd Case Report is set to On this report will be printed when you select End Case See the section on AutoReports for information on setting up end case reports Dischrge Patient to discharge the patient without printing any reports 79 Transferring Patients WARNING To save you from having to enter the same patient data multiple times and enable patient transfer withou
462. ture Select Print Loop Setup Loop Loop Loop Type Device Capturing and Deleting Loops Up to six loops of each kind can be stored for reference To capture the current Loop and display it in the Loops window select the Capture Loop pop up key The monitor will prompt you to save the loop for reference either in addition to or in place of previously stored loops Status messages at the bottom of the window provide information on the loop capture process To delete Loops from the reference list Select the Select Loop pop up key to view the list of stored loops and delete the loops from the list Showing Hiding Loops Colored rectangles beside the loops timestamps and color coded with the loops tell you whether each loop is currently displayed or not A filled in rectangle marks loops currently shown in the Loops window Arectangle outline marks loops not currently shown a Selecting the timestamp of the currently displayed loop hides it and shows the next in the list selecting the timestamp of a currently hidden loop displays it 290 Changing Loops Display Size To change the loops display size in the Loops window select the pop up key Select Size then select e Size x 0 5 to display loops at half the usual size e Size x 1 to display loops at the usual size e Size x 2 to display loops at twice the usual size This does not affect the size of loops printed in reports Using the Loops Cursor To view the c
463. u should check the delayed arrhythmia wave to ensure that the algorithm is labeling the beats correctly 3 If beats are still not classified correctly check that the ECG is optimized for arrhythmia monitoring You may need to select a different lead or change the electrodes or electrode positions if there is excessive noise unstable voltage low amplitude or large P or T waves 111 Automatic Arrhythmia Relearn Arrhythmia relearning is initiated automatically whenever e ECG monitoring is switched on e The ECG Lead or Lead Label is changed manually or when fallback occurs e AlLeads Off INOP condition that has been active for gt 60 seconds ends If you are monitoring multi lead arrhythmia and there is a change in one lead only relearning happens only in the affected lead During this learning phase the system will continue monitoring using the other lead Therefore the delayed arrhythmia wave is not labeled L and there is no LEARNING ECG rhythm status message In addition alarm timeout periods are maintained stored arrhythmia templates are maintained for the operative lead and all alarms switched on are active Arrhythmia Relearn and Lead Fallback Lead fallback triggers an automatic arrhythmia relearn WARNING If arrhythmia learning takes place during ventricular rhythm the ectopics may be incorrectly learned as the normal QRS complex This may result in missed detection of subsequent events of V Tach and V Fib For this
464. ue patient monitors is delayed by a maximum of 30 ms Your biomedical engineer should verify that your ECG Defibrillator combination does not exceed the recommended maximum delay of 60 ms When using electrosurgical ES equipment never place ECG electrodes near to the grounding plate of the ES device as this can cause a lot of interference on the ECG signal General When you are connecting the electrodes or the patient cable make sure that the connectors never come into contact with other conductive parts or with earth In particular make sure that all of the ECG electrodes are attached to the patient to prevent them from contacting conductive parts or earth During surgery Use the appropriate orange electrode ECG safety cable for measuring ECG in the operating room These cables have extra circuitry to protect the patient from burns during cautery and they decrease electrical interference These cables cannot be used for measuring respiration Pacemaker failure During complete heart block or pacemaker failure to pace capture tall P waves greater than 1 5 of the average R wave height may be erroneously counted by the monitor resulting in missed detection of cardiac arrest Patients exhibiting intrinsic rhythm When monitoring paced patients who exhibit only intrinsic rhythm the monitor may erroneously count pace pulses as QRS complexes when the algorithm first encounters them resulting in missed detection of cardiac arrest The ri
465. uent and drug ml Concentration ratio of the amount of drug to the solution amount units per ml volume Standardized 1ml volume of the mixture to be delivered to ml hr Rate the patient per hour Be aware that your hospital may use either Ug or mcg as an abbreviation for microgram These abbreviations are equivalent WARNING Before you administer any drug always check that the correct calculation units and patient category are selected Consult your pharmacy if you have questions Decisions on the choice and dosage of drugs administered to patients must always be made by the physician in charge The Drug Calculator performs calculations based on the values input during use it does not check the plausibility of the calculations performed Accessing the Drug Calculator To access the Drug Calculator selectMain Setup gt Calculations gt q Drug Calculator or select the Drug Calculator SmartKey if configured 277 Performing Drug Calculations Using the service Support Tool a list of drugs can be configured for the monitor containing pre defined dosage recommendations and unit settings Selecting the arrow beside the drug name in the Drug Calculator window opens a list of configured drugs Contact your pharmacist if you have any questions about the drugs in the list IfAny Drug is the only entry in the list of drugs no drugs have been preconfigured for your monitor Drug calculations can be perfo
466. uidelines may require you to zero the ICP transducer less frequently than other transducers due to the need for aseptic conditions When you zero an ICP transducer the zero values are automatically stored and you will not be prompted to repeat the zero procedure If you want to simultaneously zero all pressures except ICP disconnect the ICP transducer from the measurement server or module while zeroing Reconnecting the transducer recalls the stored values WARNING If you select the label ICP or IC1 IC2 the measurement device uses the most recently stored zero Therefore make sure you zeroed the transducer correctly in accordance with the transducer manufacturer s instructions and your hospital policy When you use a transducer that you cannot rezero after placement ensure that you keep the measuring device with the patient so that you are certain you have the correct zero data for this patient Determining a Pressure s Most Recent Zero The monitor displays the most recent zero on the status line If this has timed out after you have play y performed a zero redisplay the information in the status line by entering the pressure s setup menu Zeroing a Pressure Measurement WARNING Invasive pressure alarms and pulse alarms if derived from invasive pressure are temporarily suppressed until 30 seconds after the transducer finishes zeroing 1 Turn off the stopcock to the patient 2 Vent the transducer to atmosp
467. ulas can cause lower than actual etCO readings Even with combined nasal oral cannulas the etCO readings may be slightly lower than actual in patients breathing through the mouth only Using the Capnography Extension M3014A The M3014A Capnography Extension measures partial pressure of carbon dioxide in a patient s expired gas using the mainstream method or the sidestream method The mainstream CO measurement can be used with appropriate accessories with intubated adult pediatric and neonatal patients The sidestream CO measurement can be used with appropriate accessories with intubated and nonintubated adult pediatric and infant patients With intubated patients a sample of the respiratory gas is drawn from the patient s breathing circuit through an airway adapter and a gas sampling tube With non intubated patients the gas sample is drawn through a nasal or oral nasal cannula WARNING Altitude Setting The monitor is not equipped with automatic barometric pressure compensation Before the CO measurement is used for the first time the altitude must be set to the correct value An incorrect altitude setting will result in incorrect CO readings The CO readings will typically deviate 5 for every 1000m difference Electrical Shock Hazard Do not open the measurement extension Contact with exposed electrical components may cause electrical shock Always turn off and remove power before cleaning the sensor or measurement ser
468. up events For example if an apnea event is followed 40 seconds later by a brady event the brady event is not counted as a single event but as part of the apnea event Counting Neonatal Event Review NER Events For neonatal events NER formerly OxyCRG apnea events A bradycardia events B and combinations of these events are counted and classified by the event counter in the Event Summary If they are associated with a Desaturation D this is also marked Manual events M are counted separately In the example below A D 2 1 indicates that two apnea events occurred and one of them was associated with a desaturation 16 Stored Events A D 2 1 B D 7 1 AB D 1 1 D 6 M 0 248 Viewing Events 23 Event Surveillance Event Summary Window Advanced Event Surveillance only The Event Summary window shows the number of stored events in each event group and the total number of events in the database Vertical bars mark events on a timeline showing the position of the stored events in the event database The symbol next to the group name indicates the activation and notification status meaning Standard group activated Neuro notification set to Hena alarm A Ventil group activated notification set to Anrhy st alarm NER group activated Total IE tel notification set to i00 19 00 23 00 alarm group activated notification set to screen prompt
469. ur authorized supplier Inspecting the Equipment and Accessories You should perform a visual inspection before every use and in accordance with your hospital s policy With the monitor switched off 1 Examine unit exteriors for cleanliness and general physical condition Make sure that the housings are not cracked or broken that everything is present that there are no spilled liquids and that there are no signs of abuse If the MMS and Server Extensions are mounted on the monitor make sure that they are locked into place and do not slide out without releasing the locking mechanism Inspect all accessories cables transducers sensors and so forth If any show signs of damage do not use Switch the monitor on and make sure the backlight is bright enough Check that screen is at its full brightness If the brightness is not adequate contact your service personnel or your supplier Inspecting the Cables and Cords 1 Examine all system cables the power plug and cord for damage Make sure that the prongs of the plug do not move in the casing If damaged replace it with an appropriate Philips power cord Inspect the Measurement Server Link cable and ensure that it makes good connection with the MMS and the FMS Make sure that there are no breaks in the insulation If the MMS is not mounted directly on the monitor inspect the cable connecting it to the monitor Make sure the connectors are properly engaged 305 4 Ins
470. uracy of the measured values may be reduced Excessive baseline drift No measurement is possible Measured values are incorrect don t inject now 172 See eso O C 0 CCO Warning Messages Warning messages contain important information about the C O measurement Next measurement erases older curve Six curves are stored this is the maximum possible If another measurement is stored the oldest thermodilution curve will be erased Previous C O Setup Data replaced A C O module or measurement server extension has been plugged in with different C O setup data from the previous data The new C O setup data is read from the new C O device and replaces the current data The message disappears when the Start C O pop up key is pressed Verify the C O Setup Data A new transpulmonary thermodilution catheter has been connected to the C O Interface Cable Check arterial pressure CCO cal currently not possible Poor or invalid pressure signal for example if pressure was not zeroed Verify the Computation Constant A new catheter has been plugged in or the computation constant has been changed and Start C O has not been selected Previous Comp Constant replaced A new C O module or measurement server extension with a different computation constant from the current one has been connected The new computation constant is read from the new C O device and replaces the curr
471. ured to alarm name flashes yellow or red Check on the monitor for more details alarm lamp and alarm tone on event group EXTREME BRADY ECG The bradycardia limit has been numeric flashes and alarm exceeded limit is highlighted red alarm lamp alarm tone EXTREME TACHY ECG The tachycardia limit has been numeric flashes and alarm limit is highlighted red alarm lamp alarm tone low alarm limit s d or m after the label indicates whether the systolic diastolic or mean pressure has crossed the limit HR HIGH ECG The heart rate high alarm limit has been numeric flashes and high limit exceeded is highlighted yellow alarm lamp alarm tone The sound switches off after 5 seconds if Arrhythmia is On HR LOW ECG The heart rate has fallen below the low numeric flashes and low limit alarm limit is highlighted yellow alarm lamp alarm tone The sound switches off after 5 seconds if Arrhythmia is On imCO2 HIGH CO Resp The inspired minimum CO high alarm numeric flashes and high limit AGM limit has been exceeded is highlighted yellow alarm lamp alarm tone in lt Agent label gt AGM The inspired agent high alarm limit has numeric flashes high limit is HIGH been exceeded highlighted yellow alarm lamp alarm tone in lt Agent label gt AGM The inspired agent value has fallen numeric flashes low limit is LOW below the AGT low alarm limit
472. urement mode Cuff pressure sK Time left in venous nN puncture mode Calibrating NBP NBP is not user calibrated Cuff pressure transducers must be verified and calibrated if necessary at least once every two years by a qualified service professional See the Service Guide for details 147 148 11 Monitoring Temperature You can measure temperature using the Multi Measurement Server MMS one of the measurement server extensions or the temperature plug in module Temp measurement automatically switches on when you connect a probe You can switch the measurement off manually Making a Temp Measurement 1 Select the correct type and size of probe for your patient 2 Ifyou are using a disposable probe connect the probe to the temperature cable 3 Plug the probe or temperature cable into the temperature connector socket Temp connector socket 4 Apply the probe to the patient You are advised to use a protective rubber cover on rectal probes 5 Select an appropriate temperature label 6 Check that the alarm settings on or off high and low limits are appropriate for this patient and this type of temperature measurement WARNING Make sure you set alarm limits for the correct label The alarm limits you set are stored for that particular label only Changing the label may change the alarm limits Selecting a Temperature for Monitoring Tell the monitor which temperature you want to monitor by selec
473. us usage integrated displays only or as needed Measurement Server and Module Tests Performance assurance for all At least once every two years or if you suspect the measurement measurements not listed below values are incorrect Measurement Server and Module Maintenance NBP calibration At least once every two years or as specified by local laws Microstream CO calibration and At least once a year or after 4000 operating hours performance test Mainstream and sidestream CO At least once a year or if you suspect the measurement values are calibration check M3014A incorrect Battery Maintenance Battery See the section on Maintaining Batteries 306 Troubleshooting If you suspect a problem with an individual measurement read the Instructions for Use and doublecheck that you have set up the measurement correctly If you suspect an intermittent system wide problem call your service personnel You may be asked for information from the status log To view the status log 1 IntheMain Setup menu select Revision 2 Select a pop up key according to the status log you want to consult for example to check the status log for the MMS select the M3001A pop up key 3 View the status log by selecting the Stat Log pop up key Disposing of the Monitor WARNING To avoid contaminating or infecting personnel the environment or other equipment make sure you disinfect and decontaminate the mo
474. val 10 sec Yel Al Interval 20 sec Alarm Low 4 2 Red Alarm Volume AlarmVol 2 Yell Alarm Volume AlarmVol 0 Inop Volume AlarmVol 0 Auto Increase Vol 2 Steps Increase Vol Delay 20 sec Keep Blinking No Relay 1 Sensitiv R amp Y amp I Relay 2 Sensitiv Red amp Yell Relay 3 Sensitiv Red Inop Relay Latency 5 sec Yel Relay Latency 2 sec Alarm Text Standard No Centr Mon Min Vol 4 ECG Arrhythmia and ST Default Settings High Limit 120 bpm 160bpm 200 bpm Low Limit 50 bpm 75 bpm 100 bpm Alarms On Alarm Source HR Auto ECG On QRS Volume 1 Primary Lead II Secondary Lead Vv Analysis Mode Multi lead Lead Placement Standard Mod Lead Placment Off Filter Monitor Filter Speed 25mm s Auto Filter Off Default ECG Size xl Color Green Asystole Thresh 4 0 sec 3 0 sec A ExtrTachy 20 bpm Tachy Clamp 200 bpm 220 bpm 240 bpm A ExtrBrady 20 bpm Brady Clamp 40 bpm 50 bpm 40 bpm 60 bpm 80 bpm ALL ECG IN On Fallback On Alarms Off Enabled Alarm Source Sel Enabled 371 372 Arrhythmia On Off Off Pause Threshold 2 0 sec 1 5 sec VTach HR 100 120 150 VTach Run 5 Vent Rhythm 14 SVT HR 180 200 210 SVT Run 5 PVCs min 10 5 5 Non Sustain On Vent Rhythm On Run
475. ver Do not use a damaged sensor or one with exposed electrical contacts Refer servicing to qualified service personnel CAUTION Use the M3014A measurement extension with Philips approved accessories only Refer to the instructions for use provided with the accessory Preparing to Measure Mainstream CO You must perform a zero as described in this procedure each time you use a new airway adapter 1 Attach the sensor connector to the CO connector on the measurement extension 2 Wait 2 minutes allowing the sensor to reach its operating temperature and a stable thermal condition 176 3 Choose the appropriate airway adapter and connect it to the sensor head The airway adapter clicks into place when seated correctly 4 To zero the sensor expose the sensor to room air and keep it away from all sources of CO including the ventilator the patient s breath and your own in the setup menu for the CO select Start Zero Cal When you see the message Zero done at lt date and time gt on the status line the zero calibration is finished and you can begin monitoring Ma WARNING To prevent stress on the endotrachial tube support the sensor and airway adapter 5 Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y section Position sensor cables and tubing carefully to avoid entanglement or potential strangulation Do not apply excessive tension to an
476. w Patient Event k Recording information total per recording strip strip Event types and medical event 7 code r rd no row begins with a j 4 get aroye summary of the 90MIN Green Sarah 37549201 events stored in 23 Jan 02 10 43 ICU 37 the event r database Standar Single Manual Total f3 z Event d Combi 2 1 Recording strip group 0 annotation Is lained in th Neuro Single Manual Total 2 exp aine in the Combi 0 2 Recording 0 chapter _ Hemo Single Manual Total 2 tae Combi 0 2 database 0 In graphic event review recordings events are represented by bars and each event group is printed on a separate Standa L channel rd The timeline reflects the period stored in the database either 24 hours divided into 4 hour sections or 8 hours divided 09 0 11 0 15 0 1 into one hour sections 252 In tabular event review recordings the events stored in the event database are shown in chronological order with a number and time stamp Time Group Parameter 1 Parameter Parmeter 3 2 1 23 Jan 02 Neuro Resp BIS LOW sl 07 56 51 lt 60 2 23 Jan 02 Stand HR Pulse ST II SpO02 07 59 ard TACHY 201 gt 180 3 BIS ABP 23 Jan 02 Neuro Resp HIGH The measurements in the event group are shown in the next columns marked Parameter 1 Parameter 2 along with the event values measured at the time of the event For each event the trigger values are shown This section of the rec
477. wer on standby switch Press to switch monitor on remotely Press and hold for one second to turn monitor off lll 4 5 m Sf eriies i Power on LED green when monitor is on Docking Station MP20 30 The docking station provides quick mounting and connections in a one step operation By placing the 40 50 only monitor on the docking station and closing the lever you can make the connection to power and to a wired network if present WARNING If the docking station is in a tilted position you must hold the monitor in place while closing the locking lever When using the monitor for transport directly after use on the docking station insert the batteries before placing the monitor on the docking station Data Connector Power Connector Open Position Power On wv 8 g Locked Position Related Products Related products extend the measurement capabilities of your monitor None of the related devices have their own power on standby switches They take their power from the monitor and switch on automatically when you turn on the monitor A green power on LED indicates when they are drawing power from the monitor A permanently illuminated or flashing red LED indicates a problem with the unit that requires the attention of qualified service personnel Flexible Module Server M8048A MP60 70 80 The flexible module server FMS lets you use up to eight plug in physiological measurement modules 90 only
478. width the patient s paced status the ECG gain and the print speed are printed at the bottom of the wave area Pace pulse marks are automatically printed beside the wave for paced patients Beat labels can be set to print on the rhythm stripe The 12X1 2P format prints the report over two pages 12 Lead ECG 3X4 landscape A4 letter A3 ledger 6X2 landscape A4 letter A3 ledger 12X1 portrait A4 and letter only 12X1 landscape A4 letter A3 ledger 12X1 2P landscape AG letter 2 pages Multi lead ECG 2X4 landscape A4 letter A3 ledger 8X1 portrait A4 and letter only 8X1 landscape A4 letter A3 ledger Other Reports See the sections on Trends and Calculations and the chapter on Event Surveillance for other example reports 276 26 Using the Drug Calculator Drug mixtures for intravenous IV drug infusions combine information on drug dose rate amount volume concentration and standardized rate The Drug Calculator helps you to manage infusions by calculating one of these values at a time Dose total quantity of drug to be delivered to the amount units per time or per kg patient over time time if the drug is weight dependent Rate volume of the mixture to be delivered to the ml hour patient over time Amount amount of drug to be added to diluent to ng mcg mg g mUnit Unit where make up a mixture g stands for gram Volume quantity of mixture of dil
479. width which is 0 05 to 150 Hz for the Adult and 0 5 to 150 Hz for the Pedi and Neo patient category The term diagnostic relates only to the ECG bandwidth requirements for diagnostic electrocardiographic devices as outlined in the ANSI AAMI standard EC11 1991 Choosing EASI or Standard Lead Placement If EASI monitoring is available on your monitor you must enable either standard lead placement or EAST lead placement Inthe Setup ECG menu select Lead Placement and then Standard or EASI EAST is shown beside the 1mV calibration bar on the ECG wave on the display and EASI is marked on any recorder strips and printouts See the section on EASI ECG Lead Placement for electrode placement diagrams About ECG Leads To make it possible to compare measured ECG signals the electrodes or lead sets are placed in standardized positions forming so called leads To obtain ECG signals optimized for use in diagnosis and patient management in different care environments different lead sets in varying lead placements can be used You can use either standard lead placements or EASI lead placements with this monitor When placing electrodes choose a flat non muscular site where the signal will not be interfered with by either movement or bones Correct lead placement is always important for accurate diagnosis Especially in the precordial leads which are close to the heart QRS morphology can be greatly altered if an electrode is move
480. x 13 1 x 3 4 in M1006B 190 g 6 7 0z 36 x 99 6 x 97 5 mm avave Pres Module Option C01 1 4 x 3 9 x 3 8 in M1029A Temperature Module 215 g 7 6 0z 36 x 99 6 x 97 5 mm 1 4 x 3 9 x 3 8 in Thermal Array Recorder Module M1012A 225 g 7 9 02 36 x 99 6 x 97 5 mm Cardiac Output Module 1 4 x 3 9 x 3 8 in M1014A 250 g 8 8 0z 36 x 99 6 x 97 5 mm Spirometry Module 1 4 x 3 9 x 3 8 in3 M1018A 350 g 11 3 0z 72 5 x 99 6 x 97 5 mm Transcutaneous Gas Module 2 9 x 3 9 x 3 8 in M1020B lt 250 36 x 99 6 x 97 5 mm SpO Module 0 55 Ib 1 4x 3 9 x 3 8 in M1021A 460 g 72 5 x 99 6 x 97 5 mm Mixed Venous Oxygen Saturation 13 04 oz 2 9 x 3 9 x 3 8 in Module M1027A 210 g 7 4 0z 36 x 99 6 x 97 5 mm Electroencephalograph Module 14x 3 9 x 3 8 in M1034A 215g 36 x 99 6 x 97 5 mm without cables BIS Interface Module 7 6 oz 1 4 x 3 9 x 3 8 in BISx 450 gr 102 x 38 mm with PIC Plus Cable 1 22 m 4 1lb iso ft and cable to BIS module DSC Digital Signal Converter 130 g 4 6 oz 66 x25 x 107 mm with PIC Plus Cable 1 22 m 4 without 2 6x 1 0 x 4 25 in f cabling BIS Engine 170 g 6 0 oz 43 x93 x95 mm 1 7 x 3 7 x 3 8 in M1032A 240 g 8 4 0z 36x 99 6 x 97 5 mm Vuelink Module 1 4 x 3 9 x 3 8 in M1116B 507 5 g 73 x 99 6 x 97 mm 17 9 oz 2 9 x 3 6 x 3 9 in Environmental Specifications The monitor may not meet the performance specifications given here if stored or used ou
481. xpired If you silence a yellow arrhythmia alarm and the alarm condition has stopped the visual indicators are immediately cleared Silencing an alarm does not reset its time out period so you will not get a realarm for the same condition or lower on the chain until the time out expires 114 Arrhythmia Alarm Chaining When arrhythmia analysis is switched on multiple alarm conditions may be present Announcing all of the detected alarm conditions would be confusing and might hide a more serious condition For this reason arrhythmia alarms are prioritized in three alarm chains PVC Alarms Beat Detection Alarms and Rate Alarms Only the highest priority alarm condition in each chain is announced Lower priority alarms in the same chain will not be announced while an alarm is active or during the configured timeout period If alarm conditions of equal severity from different chains are detected the alarm condition that occurred most recently is announced The exception is Irregular HR which only occurs if no other alarms are occurring See ECG Arrhythmia and ST Alarm Overview on page 104 for information on which alarms are included in the different arrhythmia options See Arrhythmia Alarm Timeout Periods on page 113 for an explanation of how alarm timeouts work Red Arrhythmia Alarms Yellow Arrhythmia Alarms mB a ne a 2 First level E timeout period TimeOut 1st eB
482. xygen saturation e Pleth waveform visual indication of patient s pulse e Pulse rate derived from pleth wave detected pulsations per minute e Perfusion indicator numerical value for the pulsatile portion of the measured signal caused by arterial pulsation The monitors are also compatible with SpO technologies from other manufacturers Please refer to the instructions for use provided with these devices for further information SpO Sensors Depending on the purchased SpO option different sensors and adapter cables can be used The sensors for the different options are color coded to match the connectors See the section on Accessories for a compatibility table Familiarize yourself with the instructions for use supplied with your sensor before using it In particular check that the sensor being used is appropriate for your patient category and application site CAUTION Do not use OxiCliq disposable sensors in a high humidity environment such as in neonatal incubators or in the presence of fluids which may contaminate sensor and electrical connections causing unreliable or intermittent measurements Do not use disposable sensors on patients who have allergic reactions to the adhesive Always use the MAX FAST forehead sensor with the foam headband provided by Nellcor Applying the Sensor 1 Follow the SpO sensor s instructions for use adhering to all warnings and cautions 2 Remove colored nail polish fro
483. y HF 17 bpm 7D 25 10 l mm EBAR myc EF Juin Tua mmHg ingr vital signs mr 3 0 an Sook umd whe Lz Sea YU om impu 15 mhe i TT j fi Li ni on fd i whoa a aA Poaki ai r Poe ha La i j r joa da Measurement f Eisen 0 5 9 Ha deg Tanoa JEMO LIM ace waves section including HiRes waves Raap Sbn SoM 0g mary coir al Spill 5ni behan bpa aa Se eee cee Secs pts Seah 9 p be ASAE AT ETS PRT BT EE E N A Pee ae i Ju aLy ap eee ey nee ees a naeimmngea Roe eens oe ee aN a ae ue ee ea eaciemesaimenices PHILIPS i CenaralHesptd OO Pa 274 Cardiac Output Report Patient information Fr O 6 28 ifn enra n Trem em 0 O Apt 02 iciae gt Iais gt oo Iinj Numbered trial curves 0 8 ape oa 20 27 O 6 35 3 mis ope 02 10 98 Es jaina Cr Trial information in tabular form ajir ea loa a Apr os 107 93 eat eas Ps Page 1 aso 275 ECG Reports Patient information Numeric __ _ _ block Wave area 5 PHILIPS General Hosptal Page 1 last Below the header on ECG Reports the numeric block shows the current HR PVC and ST values The wave area shows the printed waves for all available ECG leads A 1 mV calibration bar is printed at the beginning of each wave With the 3X4 6X2 and 2X4 formats a rhythm stripe prints a longer section of the ECG wave from the primary ECG lead for ECG rhythm evaluation The ECG signal band
484. y RF communications equipment can affect medical electrical equipment Accessories Compliant with EMC Standards All accessories listed in the accessories section comply in combination with the IntelliVue patient monitors with the requirements of IEC 60601 1 2 2001 WARNING Using accessories other than those specified may result in increased electromagnetic emission or decreased electromagnetic immunity of the monitoring equipment Electromagnetic Emissions The monitor is suitable for use in the electromagnetic environment specified in the table below You must ensure that it is used in such an environment Radio Frequency RF emissions Group 1 The monitor uses RF energy only for its internal function Therefore its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment RF emissions CISPR 11 Class A The monitor is suitable for use in all establishments other Pata DSR GNU Lc onal n a than domestic and those directly connected to the public low voltage power supply network that supplies buildings used for domestic purposes Voltage fluctuations IEC 61000 3 3 n a Avoiding Electromagnetic Interference Resp and BIS The respiration Resp and BIS measurements are very sensitive measurements that measure very small signals Technological limitations don t allow higher immunity levels than 1V m for radiated RF electromagnetic fields and 1 Vrms for conducted distu
485. y DVI Video video de indicator for connection indicator connection indicator connection to parallel for connection to printer independent display 12V MSL Measurement 12 Volt DC LAN LAN connection server link ENN connection for indicator for connection connection to wireless connection to a wired indicator device network Remote Device Philips remote device SpeedPoint or Alarm Device connection indicator Analog interface indicator for connection to any analog video display Analog Digital interface indicator for connection to any digital video display Digital Antenna connector Battery symbol 12 Volt DC LAN connection LAN SER indicator for connection to serial interface c Non ionizing Cii Data input output l2V 12 Volt DC A radiation symbol symbol socket Locked position Unlocked position Always use separate collection for waste electrical and electronic equipment WEEE Installation Safety Information WARNING If multiple instruments are connected to a patient the sum of the leakage currents may exceed the limits given in IEC EN60601 1 Consult your service personnel Grounding The monitors or the MP80 MP90 processing unit must be grounded during operation If a three wire receptacle is not available consult the hospital electrician Never use a three wire to two wire adapter Equipotential If the mon
486. y Start C O or pressing the Start hardkey on the C O module or pressing the remote start switch 3 When you hear the ready tone and see the message Stable baseline inject now inject the solution into the CVP catheter At the end of the measurement the thermodilution curve cardiac output index values ITBV and EVLW values and any curve alerts are displayed and a message will appear Wait before starting new measurement 4 When you see the Ready for new measurement message repeat the procedure until you have completed the measurements you want to perform You can perform a maximum of 6 measurements before editing If you perform more than 6 measurements without rejecting any the oldest will automatically be deleted when a 7th curve is stored Editing PiCCO C O Measurements It is important to identify and reject erroneous trials as the monitor uses all the measurement trial values you do not reject to calculate the averaged cardiac output 1 Review the trials Irregular trials or trials marked with a should be reviewed carefully Consider the similarity of the values and the shape of the C O curve A normal C O curve has one smooth peak and returns to the temperature baseline level after the peak 2 Reject unsatisfactory trials use the Select Trial pop up key to move between trials then select the Accept Reject pop up key to accept or reject trials If you are using a touch screen 166 you can accept or re
487. y be changed in Configuration Mode Changing HR Pulse Alarm Limits As Pulse and HR share the same high and low alarm limits if you change the alarm limit in the Setup Pulse menu the high or low alarm limits for HR in the Setup ECG menu change automatically and vice versa The only exceptions are caused by a low limit clamp for each measurement the lowest value for Pulse when derived from SpO is 30 bpm for HR 15 bpm and for Pressure 25 bpm Extreme Alarm Limits The extreme rate alarms Extreme Tachy and Extreme Brady generated by the active alarm source either HR or Pulse are set in Configuration Mode by adding a set value to the high and low alarm limits You need to know what value has been configured for your monitor Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range To see the values added to the high and low limit alarms to create the extreme rate alarms for your monitor in the Setup ECG menu see the menu items AExtrTachy and AExt rBrady QRS Tone The active alarm source is also used as a source for the QRS tone You can change the tone volume in the Setup SpO2 and Setup ECG menus and the QRS tone modulation in the Setup SpO2 menu 129 130 8 Monitoring Respiration Rate Resp For the respiratory measurement Resp the monitor measures the thoracic impedance between two ECG electrodes on the patient s chest Changes in the impedance due to thorac
488. y cable Replace the airway adapter if excessive moisture or secretions are observed in the tubing or if the CO waveform changes unexpectedly without a change in patient status To avoid infection use only sterilized disinfected or disposable airway adapters Inspect the airway adapters prior to use Do not use if airway adapter appears to have been damaged or broken Observe airway adapter color coding for patient population Preparing to Measure Sidestream CO 1 Plug the sensor cable into the monitor s CO input connector Allow the sensor two minutes warm up time 2 Connect the cannula airway adapter or sample line as appropriate to the sensor It will click into place when seated correctly 3 To zero the sensor 177 expose the sensor to room air and keep it away from all sources of CO including the ventilator the patient s breath and your own Inthe setup menu for the COs select Start Zero Cal When you see the message Zero done at lt date and time gt on the status line the zero calibration is finished and you can begin monitoring 4 For intubated patients requiring an airway adapter Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y section For intubated patients with an integrated airway adapter in the breathing circuit Connect the male luer connector on the straight sample line to the J ae female port on the
489. y take up to a minute to be reflected at a connected Information Center For this reason you should wait one minute between changing the filter setting and sending a 12 lead capture to an Information Center To change the filter setting in the Setup ECG menu select Filter and then select the appropriate setting Monitor Use under normal measurement conditions Filter The filter reduces interference to the signal It should be used if the signal is distorted by high frequency or low frequency interference High frequency interference usually results in large amplitude spikes making the ECG signal look irregular Low frequency interference usually leads to a wandering or rough baseline In the operating room the Filter reduces artifacts and interference from electrosurgical units Under normal measurement conditions selecting Filter may suppress the QRS complexes too much and thus interfere with the clinical evaluation of the ECG displayed on the monitor This does not affect the ECG analysis performed by the monitor If AutoFilter is set to On in Configuration Mode the filter setting will automatically be set to Filter if electromagnetic interference is detected 95 Diag Diagnostic Use when diagnostic quality is required The unfiltered ECG wave is displayed so that changes such as R wave notching or discrete elevation or depression of the ST segments are visible The setting Diag selects the highest available ECG band
490. ys 23 Using the Visitor Screen 24 Understanding Profiles 24 Swapping a Complete Profile 25 Swapping a Settings Block 26 Default Profile 26 Locked Profiles 26 Understanding Settings 26 Changing Measurement Settings 26 Switching a Measurement On and Off 27 Switching Numerics On and Off 27 Adjusting a Measurement Wave 27 Changing Wave Speeds 27 Changing the Wave Group Speed 27 Changing Wave Speed for a Channel 28 Freezing Waves 28 Freezing An Individual Wave 28 Freezing All Waves 28 Measuring Frozen Waves 28 Changing The Wave Speed 29 Updating The Frozen Wave 29 Releasing Frozen Waves 29 Using Labels 29 About Label Sets 29 Changing Measurement Labels e g Pressure 29 Resolving Label Conflicts 30 Changing Monitor Settings 31 Adjusting the Screen Brightness 31 Adjusting Touch Tone Volume 31 Setting the Date and Time 31 Checking Your Monitor Revision 32 Getting Started 32 Inspecting the Monitor 32 Switching On 32 Setting up the Measurement Servers and Modules 32 Starting Monitoring 33 Disconnecting from Power 33 Monitoring After a Power Failure 33 Networked Monitoring 33 Using Remote Applications 33 Remote Application Popup Keys 34 2 What s New 35 What s New in Release D 0 35 What s New in Release C 0 36 What s New in Release B 1 37 What s New in Release B 0 38 What s New in Release A 2 39 3 Alarms 41 Visual Alarm Indicators 42 Audible Alarm Indicators 42 Alarm Tone Configuratio

Philips MP60/70/80/90 User's Manual

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