B40/B20 Patient Monitor User’s Reference ManualUser's Reference Manual Related to software license VSP-C Monitoring functions Conformity according to the Council Directive 93/42/EEC

GE Healthcare

B40/B20 Patient Monitor

User’s Reference Manual

B40/B20 Patient MonitorEnglish2081504-001 E (Paper)© 2015 General Electric Company.All Rights Reserved.


User's Reference Manual

Related to software license VSP-C

Monitoring functions

Conformity according to the Council Directive 93/42/EEC concerning Medical Devices amended by 2007/47/EC.

All specifications are subject to change without notice.

Document no. 2081504-001 E

October 22, 2015

Copyright © 2015 General Electric Company. All rights reserved.

GE Medical Systems Information Technologies, Inc.8200 West Tower AvenueMilwaukee, WI USAZip: 53223Tel: 1 414 355 5000 (outside US)800 558 5102 (US only)Fax: 1 414 355 3790www.gehealthcare.com

GE Healthcare3F Building 1, GE Technology Park

1 Huatuo RoadShanghai PRC 201203Tel: +86 21 3877 7888

Fax: +86 21 3877 7451

0459

http://www.gehealthcare.com

Classifications

In accordance with IEC 60601-1− Class I and internally powered equipment - the type of protection against electric shock.

− Type BF or CF equipment. The degree of protection against electric shock is indicated by a symbol on each parameter module.

− Equipment is not suitable for use in the presence of a flammable anesthetic mixture with air or with oxygen or nitrous oxide.

− Continuous operation according to the mode of operation.

− Portable Monitor

In accordance with IEC 60529− IP21 - degree of protection against harmful ingress of water.

In accordance with EU Medical Device Directive− IIb.

In accordance with CISPR 11: − Group 1 Class A;

• Group 1 contains all ISM (Industrial, scientific and medical) equipment in which there is intentionally generated and/or used conductively coupled radio-frequency energy which is necessary for the internal functioning of the equipment itself.

• Class A equipment is equipment suitable for use in all establishments other than domestic and those directly connected to a low-voltage power supply network which supplies buildings used for domestic purposes.

TrademarksListed below are GE Medical Systems Information Technologies and GE Healthcare Finland Oy trademarks used in this document. All other product and company names contained herein are the property of their respective owners.

Datex, Ohmeda, DINAMAP, Trim Knob, Unity Network, CARESCAPE, EK-Pro, TruSignal, Entropy, GE Healthcare, GE Medical system, General Electric Company.

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Table of Contents

1 IntroductionAbout this device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1

Indications for use: B40 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1Indications for use: B20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1Responsibility of the manufacturer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2Product availability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2Intended audience. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2Printed copies of this manual. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2Training requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2CE marking information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2Product Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

About this manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4Illustrations and names . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4Conventions used in this manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4Related documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5

Safety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-6Safety message signal words. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-6Warnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-6Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7ESD precautionary procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8Disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8

2 System descriptionSafety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1

Warnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1

Principles of functions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1System introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2

Frame front view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3Frame back view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4Acquisition modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5E-miniC module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5E-sCO, E-sCAiO module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6N-CAiO module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6Entropy module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7How to identify the Hemo connectors’ configuration . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7

Keyboard. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9


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Network. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-10Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11Technical specification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-15

General Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-15Parameters specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-18

3 InstallationSafety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1


Unpacking instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1Choosing location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2Mounting the monitor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2Connection to power. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2Check configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3Connection to Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3

Pre-installation requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3To connect the network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4

Install the network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4Inserting and removing the E module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5

To insert module: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5To remove module: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5

Visual indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5Installation checkout. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6

Recommended tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6Visual inspection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7Functional inspection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7

4 Monitoring basicUsing menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1Starting and ending. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4

Warnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4Preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4Starting monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4Admitting a patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5Loading previous data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6During monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6Automatic saving of patient data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6Discharging the patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7Ending monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7

Using modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7Demo Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8

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5 AlarmsOverview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1Safety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2Alarm indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3

NOTES: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3Alarm conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3Alarm categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3Alarm priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4

Alarm priority escalation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4Alarm light . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5Alarm activation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5Alarm tones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5Checking alarm function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5Alarms Setup menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6Adjusting alarm limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8

Adjusting limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8Choosing automatic limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8Returning to default limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8

Alarm off/on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9Audio off: silencing audible alarms permanently . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10

Choosing silence selections: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10Audio on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11

Audio paused or Alarm reset: silencing audible alarms temporarily. . . . . . . . . . . . . . . . . . 5-11Other adjustable features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-13

Displaying limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-13Enabling or disabling alarm audio ON/OFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-14Latching alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-15Enabling or disabling breakthrough alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-16Changing minimum alarm volume. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-17Changing reminder volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-18Changing the tone pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-19Enabling or disabling the alarm remote control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-20

6 Monitor setupWarnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1Passwords . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1Setting time and date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2Viewing battery status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2Changing monitor installation settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3

Changing basic units. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3Changing alarm options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4Changing printer settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5Changing the monitor settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

Setting time zone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6Changing the user modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7

Saving changes in user modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7


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Changing the startup mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8Renaming a mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8Loading modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8Select the user mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8

Changing the Normal Screen layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-9Modifying waveform fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10Modifying digit fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-11Modifying split screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-12Modifying the minitrend length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-12

Other adjustable screen features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-13Changing sweep speeds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-13Displaying pulse rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-13Changing parameter colors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-13

Changing the recorder and printer settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-14Recorder settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-14Printer settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-15

Configuring trends and snapshot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-16Changing default trend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-16Configuring trend pages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-16Configuring snapshots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-17Setting trend length and scales. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-17

Using Network. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-18Demo Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-18

7 TrendsSafety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

Caution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

Trended parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1Most common tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

Minitrend view. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3Minitrend length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4Removing minitrend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

Graphical trend view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-5Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-6Graphical trend pages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7

Changing trend length and resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7Moving on graphical trend pages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8Recording and printing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8Factory default parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8

Numerical trend view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-9Numerical trend pages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-10

Moving between numerical trend pages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-10Recording and printing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-10Factory default parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-11

Snapshots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-12Snapshot view. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-12

v

To create a snapshot manually: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13To create automatic snapshots: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13Viewing and printing snapshots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13

OCRG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-14View OCRG snapshot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-14View realtime OCRG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-14Setup OCRG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-14

Erasing trend data and snapshot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-15Showing alarm history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-15

8 Print and recordOverview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1Recording . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1

Direct function keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1Recording waveforms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2

Sample of waveform recording . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3Selecting waveforms for recording . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3Changing the paper speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4Controlling the recording time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5Selecting the recording delay time. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5Recording on alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6

Recording trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-7Recording numerical trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-7Tabular trend format. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8Selecting graphical trends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8

Inserting recorder paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-9Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10

Printing settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10Printing currently displayed screen contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10Printing all the information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10Changing the printer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10

Other adjustable features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10

9 Cleaning and careSafety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1


Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2Preventive maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2

Daily and between the patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2Regular checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3Every two months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4Every six months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4Every 12 months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4Power interruption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4


vi

Recycling the monitor battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5Changing fuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5

Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5Permitted detergents and disinfectants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5Other accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-8

10 TroubleshootingOverview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1Power interruption. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1

Battery indicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3

Advanced ECG troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-9Advanced arrhythmia troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-10Advanced impedance respiration troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . 10-11Advanced SpO2 troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-11Advanced NIBP troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-13Advanced InvBP troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-14Advanced temperature troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-14Advanced airway gas troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-15Advanced entropy troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-15

Other situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-16

11 ECGSafety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1

Warnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-2Displaying ECG and heart rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-3

Preparing the patient and placing the electrodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4Preparing the patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4Placing the electrodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4

Patient connection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4Lead measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-5

Color and letter coding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-5Setup ECG waveform view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-6Selecting a lead. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-6

Viewing a cascaded ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-6Adjusting the ECG size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-7ECG Setup menu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-7Setting heart rate alarm limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-9Setting PVC alarm limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-10ECG printout type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-11Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-11

vii

Pacemaker detection 12Safety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-12

Warnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-12NOTES: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-12

Monitoring pacemaker patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-13Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-13

Arrhythmia detection 14Safety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-14Warnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-14NOTES: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-14

About the arrhythmia detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-15Starting relearning manually . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-15Adjusting arrhythmia alarm settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-16

Detecting arrhythmia alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-16Description of the arrhythmia algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-17

Test results of arrhythmia algorithm testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-17

ST detection 18Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-18

NOTES: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-18Display of ST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-18

Monitoring the ST segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-19Setting the ST measurement points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-20Setting ST alarm limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-21Description of the ST segment measurement algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-22

12 Impedance respirationSafety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-1


Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-2Respiration detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-2Respiration rate source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-3

Displaying impedance respiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-3Patient connections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-4Activating measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5Improving waveform readability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-6Correcting the respiration number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7Turning off the measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8

13 Pulse oximetrySafety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-1

Warnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-1


viii

Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-2Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-3

Display of pulse oximetry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-4Patient connections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-4

Connecting the patient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-5Pulse oximetry menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-6Data update and averaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-7

Nellcor OxiMax data averaging and updating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-7Masimo SET data averaging and updating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-7

During monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-8Waveform quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-8Removing the sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-8

Measurement limitations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-9Interference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-9SpO2 functional testers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-10

GE Trusignal technology clinical studies on neonatal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-10Bland-Altman graphical plot analysis on blood test results. . . . . . . . . . . . . . . . . . . . . . . . . 13-10Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-15

14 Non-invasive blood pressureSafety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-1


Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-2Direct function keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-3Displaying non-invasive blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-3

Patient connections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-4Selecting a cuff and a cuff hose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-5Connecting the cuff hose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-5

NIBP Setup menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-6Starting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-7

During measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-7Autocycling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-8

Setting cycle time. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-8Setting custom mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-9Starting and stopping autocycling: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-9

Starting and stopping a single manual measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-10Starting and stopping a continuous measurement (STAT) . . . . . . . . . . . . . . . . . . . . . . . . . . 14-10Principles of SuperSTAT Noninvasive Blood Pressure Determination . . . . . . . . . . . . . . . . 14-11

Systolic Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-12Automatic NIBP double check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-13NIBP measurement limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-13Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-13

15 Invasive blood pressure

ix

Safety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-1Warnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-1

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-1Direct function keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-2Display of invasive blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-3

Patient connections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-4Zeroing invasive blood pressure transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-5Starting with accurate values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-5Invasive Pressures menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-6

IBPx Setup menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-6Determining pressure values visually . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-7

Labeling channels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-7Cerebral perfusion pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-8Adjusting alarm sources and limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-9Smart InvBP and flushing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-10Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-10

16 TemperatureSafety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-1

Warning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-1Caution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-1

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-1Displaying temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-2

Patient connections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-2Temp Setup menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-3Changing temperature label . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-3Combining different temperatures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-4Testing temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-4Changing temperature units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-4Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16-4

17 Airway gasSafety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-1


Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-3Display of gases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-4

Airway gases measurement setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-5E-miniC module to patient connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-5CARESCAPE Respiratory Modules and Airway Gas Option to patient connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-6Patient connections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-7Alternative airway gases patient connections with gas modules . . . . . . . . . . . . . . 17-7

Airway Gas setup menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-9CO2 setup menu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-9


x

O2 setup menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-10Agent/N2O Setup menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-10To select the MAC type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-11To enable the MACage calculation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-11

Setting alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-11Scavenging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-12

Scavenging through the ventilator reservoir. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-12Scavenging through the anesthesia gas scavenging system . . . . . . . . . . . . . . . . . 17-12Connecting directly to the scavenging system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-12

Calibrating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-13Calibration setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-13Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-14

Basics of airway gases measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-16Airway gases measurement description, CARESCAPE respiratory modules and Airway Gas Option . . . . . . . . . . . . . . . . . . . . 17-16Airway gases measurement description, E-miniC . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-16Sidestream gas sampling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-16Automatic agent identification with E-sCAiO, N-CAiO modules . . . . . . . . . . . . . . . 17-17Minimum alveolar concentration (MAC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-17ET balance gas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-19Basics of CO2 measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-19Oxygen measurement interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-21

Airway gases practicalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-21Ventilation management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-21Prevention of the breathing system contamination . . . . . . . . . . . . . . . . . . . . . . . . . . 17-21How to prevent effects of humidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-22Oxygen delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-22Level of anesthesia: E-sCAiO, N-CAiO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-22Airway gases calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-23Unit conversions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-23

Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17-24

18 EntropySafety precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-1

Warnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-1Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-1Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-1

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-2Entropy measurement description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-3Entropy parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-3How to interpret the Entropy values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-3Burst suppression ratio (BSR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-4Entropy range guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-4Entropy in typical general anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-4Displaying EEG waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5Entropy module keys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5Entropy practicalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-5

xi

Preparing the patient and placing the electrodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-6Preparing the patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-6Equipment module to connect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-6

Entropy Setup menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-7Starting sensor check manually . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-8Setting RE and SE alarm limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-8Entropy measurement limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-10Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18-10

Abbreviations 1


xii

1 Introduction

Introduction

1-1

1 Introduction

About this device

Indications for use: B40

This device is a portable multi-parameter unit to be used for monitoring and recording of, and to generate alarms for, multiple physiological parameters of adult, pediatric, and neonatal patients in a hospital environment and during intra-hospital transport.

The device is intended for use under the direct supervision of a licensed health care practitioner.

The device is not intended for use during MRI.

The device can be a stand-alone monitor or interfaced to other devices via a network.

The device monitors and displays : ECG (including ST segment, arrhythmia detection), invasive blood pressure, heart/pulse rate, oscillometric non-invasive blood pressure (systolic, diastolic and mean arterial pressure), functional oxygen saturation (SpO2) and pulse rate via continuous monitoring( including monitoring during conditions of clinical patient motion or low perfusion), temperature with a reusable or disposable electronic thermometer for continual monitoring Esophageal/Nasopharyngeal/Tympanic/Rectal/Bladder/Axillary/Skin/Airway/Room/Myocardial/Core/Surface temperature, impedance respiration, respiration rate, airway gases (CO2, O2, N2O, anesthetic agents, anesthetic agent identification and respiratory rate), and Entropy.

Indications for use: B20

This device is a portable multi-parameter unit to be used for monitoring and recording of, and to generate alarms for, multiple physiological parameters of adult, pediatric, and neonatal patients in a hospital environment and during intra-hospital transport.

The device is intended for use under the direct supervision of a licensed health care practitioner.

The device is not intended for use during MRI.

The device can be a stand-alone monitor or interfaced to other devices via a network.

The device monitors and displays oscillometric non-invasive blood pressure (systolic, diastolic and mean arterial pressure), invasive blood pressure, end-tidal carbon dioxide, heart/pulse rate, respiration rate, ECG (including arrhythmia and ST segment analysis), temperature with a reusable or disposable electronic thermometer for continual monitoring Esophageal/Nasopharyngeal/Tympanic/Rectal/Bladder/Axillary/Skin/Airway/Room/Myocardial/Core/Surface temperature, and functional oxygen saturation (SpO2) and pulse rate via continuous monitoring, including monitoring during conditions of clinical patient motion or low perfusion, and Entropy.

Service

If the product malfunctions or if assistance, service, or spare parts are required, contact GE service for technical support or contact your local representative. It is helpful for you to duplicate the problem, check and confirm the operation of all accessories to ensure that they are not the cause of the problem.


1-2

Responsibility of the manufacturer

GE Medical Systems Information Technologies, Inc. is responsible for the effects on safety, reliability and performance of the equipment only if:

• Assembly operations, extensions, readjustments, modifications, or repairs are carried out by persons authorized by GE.

• The electrical installation of the relevant room complies with the requirements of the appropriate regulations.

• The equipment is used in accordance with the instructions for use.

• The equipment is installed, maintained and serviced in accordance with the instructions provided in the related technical manuals.

Product availability

Some of the products mentioned in this manual may not be available in all countries. Please, consult your local representative for the availability.

Intended audience

This manual is intended for clinical professionals. Clinical professionals are expected to have a working knowledge of medical procedures, practices, and terminology, as required for monitoring critically ill patients.

Printed copies of this manual

A paper copy of this manual will be provided upon request. Contact your local GE representative and request the part number on the first page of the manual.

Training requirements

No product-specific training is required for the use of this monitor.

CE marking information

CE complianceThe monior bears CE Mark CE-0459 indicating its conformity with the provisions of the Council Directive 93/42/EEC concerning medical devices amended by 2007/47/EC and fulfills the essential requirements of Annex I of this directive. The country of manufacture can be found on the equipment labeling.

Product Compliance

• This equipment is suitable for connection to public mains as defined in CISPR 11.

• This Monitor conforms to general safety standard for medical devices to IEC 60601-1.

• This Monitor conforms to EMC safety standard to IEC 60601-1-2.

• This Monitor conforms to usability safety standard for medical devices to IEC 60601-1-6.

• The application of usability engineering to medical device conforms to IEC 62366.

• The software life cycle processes conforms to IEC 62304.

• The application of risk management analysis to medical device conforms to ISO 14971.

• The SpO2 Parameter conforms to ISO 80601-2-61.

Introduction

1-3

• The SpO2 Parameter controlled desaturation study conforms to ISO 14155:2011.

• The TEMP parameter conforms to ISO 80601-2-56.

• The gas parameter conforms to ISO 80601-2-55.

• This Monitor conforms to particular safety standard for multifunction patient monitoring equipment to IEC 60601-2-49.

• The invasive blood pressure parameter conforms to the IEC 60601-2-34.

• The ECG parameter conforms to IEC 60601-2-27, with exception of Sub-clause 201.12.1.101.15.

• The NIBP parameter conforms to IEC 80601-2-30, EN 1060-3, ANSI/AAMI/ISO 81060-2.

• The Entropy parameter conforms to IEC 60601-2-26.

• The alarm systems of the Monitor conform to IEC 60601-1-8.

ExceptionThe ECG parameter conforms to IEC 60601-2-27, with exception of Sub-clause 201.12.1.101.15 QRS detection.

WARNING WARNING: In clinical conditions, it is reasonable toassume that spurious signals of this type are either random in occurrence, or related to pacemaker activity. The arrhythmia analysis algorithm is designed to factor the randomness of spikes into its rejection logic, and this randomness is not exercised in the above referenced testing. The algorithm does correctly reject pace signals as prescribed by IEC 60601-2-27.


1-4

About this manualThis User’s Reference Manual describes the functions offered by the B40 and B20 patient monitor running the software license VSP-C. As the monitor setup may vary, some menus, displays and functions described may not be available in the monitor you are using.

This manual is an integral part of the product and describes its intended use. Keep it always close to the equipment. Observance of the manual is a prerequisite for proper product performance and correct operation and ensures patient and operator safety.

NOTE: Before using your monitor, please read the “User’s Guide” or this manual thoroughly. This User’s Reference Manual gives you more specific information about the clinical and technical aspects. Pay special attention to WARNING and CAUTION statements.

The new user of the monitor should begin with sections "Safety precautions" "System description" and "Monitoring basic." These sections describe the system and the basic operation of the monitor.

The measurement sections describe the measurement technique, setup and how to adjust displays and menus for patient monitoring and special views.

Section "Monitor setup" gives instructions about setting up the system and making changes in the default settings. Section "Cleaning and care" describes cleaning and daily maintenance procedures.

Illustrations and names

All illustrations in this manual are only examples, and may not necessarily reflect your system settings or data displayed in your system. If a particular selection is not available in your system, the selection is shown grayed in the menu.

All names used in examples and illustrations are fictitious.

Conventions used in this manual

To help you find and interpret information easily, the manual uses consistent text formats:

Hard keys Names of the hard keys on the Command board are written in the following way: Others.

Menu items Software terms that identify window parts or menu items are written in bold italic: Monitor Setup

Menu access Menu access is described from top to bottom. For example, the selection of the Monitor Setup hard key, the Screen Setup menu item and the Waveform Fields menu item would be shown as Monitor Setup - Screen Setup - Waveform Fields.

Messages Messages (alarm messages, informative messages) displayed on the screen are written inside single quotes: ‘Please wait.’

References When referring to different sections in this manual or to other manuals, manual names and section names are enclosed in double quotes: See section "Cleaning and care." Please refer to "Technical Reference Manual: Installation."

The following symbols are also used to distinguish procedures:

Press the menu key described. ECG

Introduction

1-5

Monitor naming conventionsIn this manual, the B40 Patient Monitor and B20 Patient Monitor are referred to as “the monitor” when a function or a feature applies to both. For describing monitor-specific issues, the monitors are referred to as B40 and B20 respectively.

Acquistion module naming conventionsIn this manual, the following naming conventions are used to refer to different modules and module categories:

• Single-width airway module: E-miniC

• CARESCAPE respiratory modules: E-sCO, E-sCAiO

• Airway Gas Option: N-CAiO

• E-modules: All modules with the prefix E-, In parameter chapters, E-modules refers to those modules that measure the parameter(s) in question.

Related documentation

− Installation, technical solutions and servicing: B40/B20 Technical Reference Manual

− Options and selections of the software: B40/B20 Default Configuration Worksheet

− Compatible supplies and accessories: B40/B20 Supplies and Accessories

− Other devices closely related to the monitor:

• iCentral and iCentral Client User's Reference Manual

• CIC Pro Clinical Information Center Operator's Manual

• CARESCAPE Central Station User’s Manual

Turn the Trim Knob.

Push the Trim Knob.


1-6

Safety precautionsThe following list contains all the general warnings and cautions you should know before starting to use the system. Warnings and cautions specific to parts of the system can be found in the relevant section.

Safety message signal words

Safety message signal words designate the severity of a potential hazard.

DANGER: Indicates a hazardous situation that, if not avoided, will result in death or serious injury. No danger messages apply to this system.

WARNING: Indicates a hazardous situation that, if not avoided, could result in death or serious injury.

CAUTION: Indicates a hazardous situation that, if not avoided, could result in minor or moderate injury.

NOTE: Indicates a hazardous situation not related to personal injury that, if not avoided, could result in property damage.

Warnings

The following warning safety messages apply to this monitoring system.

• Read all the safety information before using the monitor for the first time.

• Equipment is intended for clinical professionals.

• For continued safe use of this equipment, it is necessary that the listed instructions are followed. However, instructions listed in this manual in no way supersede established medical practices concerning patient care.

• Single-use devices and accessories are not designed to be reused. Reuse may cause a risk of contamination, affect the measurement accuracy and/or system performance, and cause a malfunction as a result of the product being physically damaged due to cleaning, disinfection, re-sterilization and/or reuse.

• There are hazards associated with the reuse of single-use sample tubing and adapters

• Inspect the sensor for signs of physical damage. Discard a damaged sensor immediately. Never repair a damaged sensor; never use a sensor repaired by others.

• Do not sterilize or immerse the sensor or cable in liquid. Do not spray or soak the connectors.

• Do not route cables in a way that presents tripping hazard

• Route all cables away from patient’s throat to avoid possible strangulation.

• Do not touch the patient, table, instruments, modules or the monitor during defibrillation.

• To avoid the risk of electric shock, this equipment must only be connected to a supply mains with protective earth.

• Always check that power cord and plug are intact and undamaged.

• Use only approved accessories, including mounts, and defibrillator-proof cables and invasive pressure transducers. For a list of approved accessories, see the supplies and accessories list delivered with the monitor. Other cables, transducers and accessories may cause a safety hazard, damage the equipment or system, result in increased emissions or decreased immunity of the equipment or system or interfere with the measurement.

Introduction

1-7

• DISCONNECTION FROM MAINS - When disconnecting the system from the power line, remove the plug from the wall outlet first. Then you may disconnect the power cord from the device. If you do not observe this sequence, there is a risk of coming into contact with line voltage by inserting metal objects, such as the pins of leadwires, into the sockets of the power cord by mistake.

• If liquid has accidentally entered the system or its parts, disconnect the power cord from the power supply and have the equipment serviced by authorized service personnel.

• If service message appears, discontinue use as soon as possible and have the device repaired.

• PROTECTED LEADWIRES - Only use protected leadwires and patient cables with this monitor

• When applying devices intracardially, never contact electrically conductive parts connected to the heart (pressure transducers, metal tube connections and stopcocks, guide wires, etc.).

• Do not use the monitor in high electromagnetic fields (for example, during MRI).

• Do not tilt the monitor to avoid liquid entering.

• Do not touch the electrical connector located within the extension rack housing.

• Never store the monitor with the batteries inside. Storing the monitor with the batteries inside may result in damage to the monitor.

• NETWORK INTEGRITY — The monitor resides on the CARESCAPE, S/5 and/or HL7 network. It is possible that inadvertent or malicious network activity could adversely affect patient monitoring. The integrity of the network is the responsibility of the hospital.

• Don't modify this device without authorization of manufacturer. If this device is modified, appropriate inspection and testing must be conducted to ensure continued safe use of equipment.

Cautions

The following caution safety messages apply to this monitoring system.

• U.S. Federal law restricts this device to sale by or on the order of a physician.

• SUPERVISED USE - This equipment is intended for use under the direct supervision of a licensed health care practitioner.

• Dispose of equipment in compliance with instructions and regulations

• Reset the monitor if loss of monitoring data occurs.

• Leave space for circulation of air to prevent the monitor from overheating.

• Before connecting power, check voltage and frequency ratings of equipment.

• System time changes will result in time differences between stored and realtime data.

Notes

The following notice safety messages apply to this monitoring system.

• NOTICE - The warranty does not cover damages resulting from the use of accessories and consumables from other manufacturers.

• If the device has been transported or stored outside operating temperature allow it to stabilize back to operating temperature range before applying power.


1-8

• Medical electrical equipment needs special precautions regarding electromagnetic compatibility, EMC, and needs to be installed and put into service according to the EMC information provided in the "Technical Reference Manual" by qualified personnel.

• Portable and mobile RF communications equipment can affect the medical electrical equipment.

• The equipment is suitable for use in the presence of electrosurgery. Please notice the possible limitations in the parameter sections and in "Technical specification" on page 2-15.

• Service and repairs are allowed for authorized service personnel only.

ESD precautionary procedures

• To avoid electrostatic charges to build up, it is recommended to store, maintain and use the equipment at a relative humidity of 30% or greater. Floors should be covered by ESD dissipative carpets or similar. Non-synthetic clothing should be used when working with the component.

• To prevent applying a possible electrostatic discharge to the ESD sensitive parts of the equipment, one should touch the metallic frame of the component or a large metal object located close to the equipment. When working with the equipment and specifically when the ESD sensitive parts of the equipment may be touched, a grounded wrist strap intended for use with ESD sensitive equipment should be worn. Refer documentation provided with the wrist straps for details of proper use.

ESD precautionary procedure training• It is recommended that all potential users receive an explanation of the ESD warning

symbol and training in ESD precautionary procedures.

• The minimum content of an ESD precautionary procedure training should include an introduction to the physics of electrostatic charge, the voltage levels that can occur in normal practice and the damage that can be done to electronic components if they are touched by an operator who is electrostatically charged. Further, an explanation should be given of methods to prevent build-up of electrostatic charge and how and why to discharge one’s body to earth or to the frame of the equipment or bond oneself by means of a wrist strap to the equipment or the earth prior to making a connection.

Disposal

• At the end of lifetime, the product and its accessories must be disposed of in compliance with the guidelines regulating the disposal of such products. If you have questions concerning disposal of the product, please contact your local GE representatives.

2 System description

System description

2-1

2 System description

Safety precautions

Warnings

• All system devices must be connected to the same power supply circuit

• EXCESSIVE LEAKAGE CURRENT - Do not use a multiple socket outlet or extension cord.

• INTERFACING OTHER EQUIPMENT - Devices may only be interconnected with each other or to parts of the system when it has been determined by qualified biomedical personnel that there is no danger to the patient, the operator, or the environment as a result. In those instances where there is any element of doubt concerning the safety of the connected devices, the user must contact the manufacturers concerned (or other informed experts) for proper use. In all cases, safe and proper operation should be verified with the applicable manufacturer’s instructions for use, and system standards IEC 60601-1 must be complied with.

• Verify compatibility of all system components prior to installation.

• Do not use multiple modules with identical measurements in the same monitor.

• The parameter modules are not able to withstand unpacked drops from a height of 1 m without damaging the module latches. If the device is dropped, please service the device before taking it back into use.

• The medical electrical equipment or medical electrical system may be interfered with by other equipment, even if that other equipment complies with CISPR EMISSION requirements.

• EXPLOSION OR FIRE-Using non-recommended batteries could result in injury/burns to the patients or users. Only use batteries recommended or manufactured by GE.

• EXPLOSION HAZARD - not suitable for use in the presence of a flammable anaesthetic mixture with air or with oxygen or nitrous oxide.

• EXPLOSION HAZARD - Do not incinerate the battery or store at high temperatures.

• Do not disassemble, open, or shred the battery; do not short circuit the battery pack; charge only with internal charger.

Cautions

• Do not dismantle the battery.

Principles of functionsThe monitor is a semi-modular multi parameter patient monitor. The monitor is designed for nurses and other healthcare providers who care for patients in critical care, perioperative care, emergency care, general care and intra-hospital transportation environments.

The modular design makes the system flexible and easy to upgrade.


2-2

System introductionNOTE: Your system may not include all these components. Consult your local representative for the available components.

Figure 2-1 Patient monitor components

1. Monitor frame

2. E modules: The compatible acquisition modules

3. Extension rack

4. Software: VSP-C

1, 42

3

System description

2-3

Frame front view

Figure 2-2 B40 front B20 front

(1) Transportation handle

(2) Alarm light

(3) The Trim knob

(4) Command board keys

(5) Battery compartment

(6) Guide rail for GCX mounting

(7) Mains power and battery LEDs

(8) On/Off key

(9) Hemo connectors

(10) E module

(11) Recorder

10

456

8 7

9

11

2

1

3


2-4

Frame back view

Figure 2-3 B40 back B20 back

Figure 2-4 I/O and connectors

(1) Receptacle for power cord

(2) Serial port

(3) Defibrillator connector

(4) Nurse call connector

(5) Network connector

(6) Equipotential connector

(7) Multi I/O connector

NOTE: The Multi I/O with ports 2,3,4 are optional parts for customer.

1

73

6 5

4

2

System description

2-5

Acquisition modules

B40 acquisition modules:

• E-miniC

• E-sCO, E-sCAiO

• N-CAiO

• E-Entropy

B20 acquisition modules:

• E-miniC

• E-Entropy

E-miniC module

Figure 2-5 E-miniC

(1) Water trap

(2) Sample gas inlet

(3) Gas outlet

12

3


2-6

E-sCO, E-sCAiO module

1. D-fend Pro water trap

2. Gas sample, sampling line connector on the water trap

3. Water trap container

4. Gas exhaust, connector for the gas exhaust line (sampling gas out)

N-CAiO module

1. D-fend Pro water trap

2. Gas sample, sampling line connector on the water trap

3. Water trap container

4. Gas exhaust, connector for the gas exhaust line (sampling gas out)

12

3

4

12

3

4

System description

2-7

Entropy module

1. Module keys

2. Entropy connector

How to identify the Hemo connectors’ configuration

The monitor provides different configurations for Hemo measurement.

The user can identify Hemo connectors’ configuration from connectors and label.

Hemo connectors’ type Basic feature Optional feature Identifier

ECG NIBP SpO2 IBP Temperature

(a) Hemo with GE SpO2 X X GE SpO2 X X SpO2, IBP, T

(b) Hemo with Masimo SpO2 X X Masimo SpO2 X X Masimo SpO2, IBP, T

(c) Hemo with Nellcor SpO2 X X Nellcor SpO2 X X Nellcor SpO2, IBP, T

(d) Hemo with GE SpO2, without IBP

X X GE SpO2 X SpO2, T

(e) Hemo with Masimo SpO2, without IBP

X X Masimo SpO2 X Masimo SpO2, T

(f) Hemo with Nellcor SpO2, without IBP

X X Nellcor SpO2 X Nellcor SpO2, T

(g) Hemo with GE SpO2, without IBP and Temp

X X GE SpO2 SpO2

1

2


2-8

KeyboardYou can control monitoring through the keys on the Command Board. For more information, see section "Monitoring basic."

Figure 2-6 Keyboard

(1) ON/OFF key

(2a) Battery status LED (light-emitting diode), refer to "Battery indicators" on page 10-2 for details

(2b) AC power status LED

(3) Admit or discharge a patient; for selecting user modes

(4) Monitor settings

(5) Print and record different trends and waveforms

(6) Activate parameter specific menus.

(7) Zero invasive pressure channelsNOTE: Functional only when IBP option is available.

(8) Start or stop the NIBP auto cycling

(9) Reset active alarms

(10) Audio pause active alarms

(11) Return to normal screen view

(12) Start or stop local recordingNOTE: Functional only when recorder option is available.

(13) Start or stop the NIBP manual determination.

(14) Take up to 10 snapshots

(15) Activate the Alarms Setup menu

(16) View trends and alarm events

16

3 4 98751 62a

15 13 12 11

Admit/Discharge

MonitorSetup

Print/Record

ECG NIBP Airway Gas

NIBP Auto On/Off

RecorderStart/Stop

Pt.Data & Trends

AlarmsSetup

SpO2 IBP Others NIBP Start/Cancel

IBP Zero All

Take Snapshot

142b

10

Alarm Reset

System description

2-9

BatteriesThe monitor can be run either on mains power or batteries. Battery operation is initiated when the power cord is disconnected or when the mains power is lost during monitoring.

The monitor has two lithium-ion batteries at most, located in the battery compartment. They can be charged separately, and screen symbols and monitor frame LEDs indicate their charging level and possible failure, see "Battery indicators" . You can also check the battery status through Monitor Setup - Battery Setup. The internal battery capacity is up to 4.5 hours with fully charged batteries.

NOTE: When the monitor is battery powered, the green battery LED is on. When the monitor is mains powered, the green mains LED is on. When the monitor is battery charging, the orange battery LED is on.

If you wish to have the battery status visible at all times, select it in one of the digit fields: Monitor Setup - Screen Setup - Digit Fields - Battery. You can now see how much time is left for each battery separately both in numbers and as symbols, and the total remaining time in numbers.

NetworkThe monitor has been verified to be able to work in CARESCAPETM Network and S/5 network environments. Other network infrastructures are not supported.

The monitor has EMR connectivity. There are three ways to acquire trended vital sign data from patient monitor: HL7 directly from monitor, HL7 from the CARESCAPE Gateway, or connecting to the serial port of each monitor. The monitor HL7 (Health Level Seven) message match with IHE PCD-01 OBR/OBX format.

MonitorSetup


2-10

• In CARESCAPE network, the monitor can:

− communicate with GE CARESCAPE Central Station V1

− communicate with GE CARESCAPE pro CIC version 4.0.8, 4.1.1 and 5.1.0

− compatible with Aware Gateway Server V1.6

− compatible with CARESCAPE Gateway Server V1.

− compatible with Mobile Care Server V6.0

− compatible with S/5 Collect V4.0

The monitor can talk to at most 4 CIC Central stations, 1 Aware Gateway Server or 1 CARESCAPE Gateway Server, 1 Mobile Care Server and 1000 other devices simultaneously in one CARESCAPE network. The monitor can’t be set as the Time Master in CARESCAPE network.

• In S/5 network, the monitor can:

− communication with iCentral version 5.1.1 and 5.1.2.

− compatible with S/5 Collect V4.0

− compatible with Mobile Care Server later than V5.2

The monitor does not support Patient Data Server; The monitor’s realtime patient data can’t be viewed on other monitors (e.g. Dash 3000/4000/5000, Solar 8000, B850, B650).

The monitor’s information transfer to central station as following:

• All available parameters: 3/5 lead ECG, NIBP, IBP, SpO2, Resp, Temp, Gas, Entropy

• Real-time multi-parameter waveforms

• Graphical/numerical trends

• Real-time Alarm, including Arrhythmia alarms: ASYSTOLE, VFIB, VTACH, Brady, Tachy

• Patient admit/discharge and patient name update

• Alarm settings for multiple parameters

Also in CARESCAPE network, the monitor support to set up parameters and waveforms on CIC remotely.

NOTE: The NIBP trends data, in 2 minutes before the monitor is disconnected from network, is probably can’t transmit to the Aware Gateway Server or CARESCAPE Gateway Server.

NOTES:

• The Entropy parameter is not supported by CIC.

• The monitor with different care area settings will behave differently in iCentral. The care area settings can setup to “OR” or “Non OR” in DRI service menu. Please consult the authorized service personnel.Non OR:

− Show 72 hours trend data, but without Anesthesia Gas trend data

− Don’t show Entropy alarm limit

OR:

− Show 24 hours trend data

System description

2-11

Symbols

On the rear panel this symbol indicates the following warnings and cautions:

- Electric shock hazard. Do not open the cover or the back. Refer servicing to qualified personnel.

- For continued protection against fire hazard, replace the fuse only with one of the same type and rating.

- Disconnect from the power supply before servicing.

- Do not touch the monitor during defibrillation.

- Do not use without manufacturer approved mounting.

On the hemo module this symbol indicates the following warning:

- Protection against cardiac defibrillator discharge is due in part to the accessories for pulse oximetry (SpO2), temperature (T) and invasive pressure (P) measurement.

Follow instructions about operation.

Refer to instruction manual/booklet about operation.

Electrostatic sensitive device. Connections should not be made to this device unless ESD precautionary procedures are followed.

Type BF (IEC 60601-1) protection against electric shock. Isolated (floating) applied part suitable for intentional external and internal application to the patient, excluding direct cardiac application.

Type BF (IEC 60601-1) defibrillator-proof protection against electric shock. Isolated (floating) applied part suitable for intentional external and internal application to the patient, excluding direct cardiac application.

Type CF (IEC 60601-1) protection against electric shock. Isolated (floating) applied part suitable for intentional external and internal application to the patient, including direct cardiac application.

Type CF (IEC 60601-1) defibrillator-proof protection against electric shock. Isolated (floating) applied part suitable for intentional external and internal application to the patient including direct cardiac application.

In the front panel: battery

Equipotentiality. Monitor can be connected to potential equalization conductor.

Alternating current

Audio pause.


2-12

Home. Return to the Normal Screen view.

ON/OFF.

Fuse. Replace the fuse only with one of the same type and rating.

Gas inlet.

Gas outlet.

IP21

Degree of ingress protection.

Degree of protection against harmful ingress of water:

Components not marked with and IPX n code are rated as Ordinary (no protection against fluid ingress). All other IPXn rated components have the degree of protection per the ‘n’ rating.

SN,S/N Serial number

Date of manufacture. This symbol indicates the date of manufacture of this device. The four digits identify the year.

Manufacturer: This symbol indicates the name and the address of the manufacturer.

European authorized representative.

European Union Declaration of Conformity.

Rx Only U.S.Prescriptive Device. USA only. For use by or on the order of a Physician, or persons licensed by state law.

Fragile. Handle with care.

Keep dry. Protect from rain.

This way up.

Storage temperature

Humidity limitations.

System description

2-13

Atmospheric pressure limitations.

Recycled materials or may be recycled.

This symbol indicates that the waste of electrical and electronic equipment must not be disposed as unsorted municipal waste and must be collected separately. Please, contact an authorized representative of the manufacturer for information concerning the decommissioning of your equipment.

The separate collection symbol is affixed to a battery, or its packaging, to advise you that the battery must be recycled or disposed of in accordance with local or country laws. To minimize potential effects on the environment and human health, it is important that all marked batteries that you remove from the product are properly recycled or disposed. For information on how the battery may be safely removed from the device, please consult the service manual or equipment instructions. Information on the potential effects on the environment and human health of the substances used in batteries is available at this url: http://www.gehealthcare.com/euen/weee-recycling/index.html

Battery operation and remaining capacity. The height of the green bar indicates the charging level.

Battery (A) charging (white bar)

Battery (A) failure

No battery backup

Battery (A) missing

Submenu. Selecting a menu item with this symbol opens a new menu.

The monitor is connected to Network.

A blinking heart next to the heart rate or pulse rate value indicates the beats detected.

A lung next to the respiration rate value indicates that respiration rate is calculated from the impedance respiration measurement.

Alarm off indicator - Displays in the digit field and in the Alarms Setup menu when physiological alarms for this parameter are turned off.


2-14

Audio alarms off indicator - Displays in the upper left corner of the alarm area when physiological audible alarms are turned off.

Audio alarms paused indicator - Indicates all audio alarms are paused and the amount of time remaining for the alarm pause period displays as a countdown timer. Displays in the upper left corner of the screen.

Underwriters Laboratories product certification mark. Medical Equipment with respect to electrical shock, fire and mechanical hazards only in accordance with ANSI/AAMI ES60601-1:2005/(R)2012 and A1:2012, C1:2009/(R)2012 and A2:2010/(R)2012; CSA CAN/CSA-C22.2 NO. 60601-1:14; IEC 60601-2-26; IEC 60601-2-27; IEC 80601-2-30; IEC 60601-2-34; IEC 60601-2-49; ISO 80601-2-55; ISO80601-2-56; ISO80601-2-61

C US3ZG9

System description

2-15

Technical specificationWARNING Operation of the monitor outside the specified values may cause inaccurate

results.

NOTE: Information in this section can be especially useful to clinicians.

General Specifications

Size

B40 and B20 Monitor

Without extension module 312±5 mm (H) * 312±5 mm (W) * 158±5 mm (D)

With extension module 312±5 mm (H) * 352±5 mm (W) * 178±5 mm (D)

Weight

B40 with extension module <=7 kg

B20 with extension module <=6 kg

Monitor environment

Operating temperature Normal operation: +5 to +40°C (41 to 104°F)

Charging batteries: +5 to +35°C (41 to 95°F)

Storage and transport

temperature

-20 to +60°C (-4 to 140°F)

Operating humidity 20 to 90% noncondensing

Storage and transport humidity

10 to 90% noncondensing

Operating atmospheric pressure

70 to 106 kPa (525 to 795 mmHg)

Storage and transport atmospheric pressure

70 to 106 kPa (525 to 795 mmHg)

E-miniC module environment

Operating temperature 10 to 40°C (50 to 104°F)

Non-operating temperature

-25 to 70°C (-13 to 158°F)


Non-operating humidity 10 to 95% noncondensing

Operating altitude 666 to 1060 mbar

E-sCAiO, E-sCO, N-CAiO modules environment



-25 to 60°C (-13 to 140°F)




2-16

Operating altitude 660 to 1060 mbar

E-Entropy module environment



-20 to 60°C (-4 to 140°F)



Electrical

AC input voltage 100 to 240 V ±10%

AC input frequency 50/60 Hz

AC input power ≤ 150 VA

Power supply Internal battery or AC power

Power cord type cord connector IEC/EN 60320-1/C13

For USA, difference type of plugs should be used for connection to the alternate voltage 13 A 125 V or 6 A 250 V.

Fuse 250 V, 2.5 Ah

Battery Exchangeable lithium-ion, 2 pcs max.

Battery life 300 cycles minimum to 50% capacity

Battery information model SM 201-6; 11.1 V, 3.52 Ah

Charging time 2 hours to 90% per battery pack

Operation time Up to 4.5 hours

Recorder

Power comsumption Standby: ≤ 1.2 W

Printing: ≤ 10 W

Recorder type Thermal array

Resolution Vertical 8 dots/mm (200 dots/inch) in non-waveform mode

Horizontal 24 dots/mm (600 dots/inch) mimimum in waveform mode

Paper width 50 mm, printing width 48 mm

Waveforms Selectable 1, 2, or 3 waveforms

Print speed 1, 6.25, 12.5, 25 mm/s

System description

2-17

Defibrillator synchronization connectorNOTE: In the defibrillator synchronization connector, Pin 1,2,3,4,7 are grounding.

Synchronization pulse (Pin 5)

Pulse width: 10 ms ±20% positive pulse

Delay: < 35 ms (R-wave peak to leading edge of pulse)

Amplitude: CMOS compatible

3.5 V min. at 1 mA sourcing

0.5 V max. at 5 mA sinking

Output impedance: 200 Ω


2-18

Parameters specifications

ECG specifications

Leads available 3-lead configuration: I, II, III

5-lead configuration: I, II, III, aVR, aVL, aVF and VA

QRS detection range 0.5 to 5mV

QRS detection width (Q to S)

40 to 120 ms

Defibrillation protection 5000 V, 360 J

Recovery time <5 s

Input impedance Common mode > 10 MΩ @ 50/60 Hz

Differential > 2.5 MΩ from 0.67 to 40 Hz

Common mode rejection 90 dB minimum at 50 Hz

Tall T wave rejection >1.4 mV

ECG leads off detection Active patient electrode: <30 nA

Reference electrode: <300 nA

Filter modes

50/60 Hz

Monitoring filter 0.5 to 40 Hz

ST filter 0.05 to 40 Hz

Dagnostic filter 0.05 to 150 Hz

Heart rate

Measurement range 30 to 300 bpm

Measurement accuracy ±5 % or ±5 bpm, whichever is greater

resolution 1 bpm

Heart rate response time (IEC 60601-2-27 201.7.9.2.9.101 b) 5))

Step increase from 80 to 120 bpm

average 6.9 s (6.5 to 7.5 s)

Step decrease from 80 to 40 bpm

average 8.2 s, (7.6 to 10.0 s)

The heart rate calculation operates with irregular rhythms of IEC 60601-2-27 201.7.9.2.9.101 b) 4), the heart rate after a 20 second stabilization period is:

Figure 3a 80 bpm

Figure 3b 59 bpm

Figure 3c 122 bpm

Figure 3d 117 bpm

Heart rate averaging computation (IEC 60601-2-27 201.7.9.2.9.101 b) 3)): Average of 10 second median values

The average time and time range ( ) to alarm (VFib or VTachy) for tachycardia waveform are as follows (IEC 60601-2-27 201.7.9.2.9.101 b) 6))

System description

2-19

NOTE: Pacemaker detector may not operate correctly during the use of high-frequency (HF) surgical equipment. The disturbances of HF surgical equipment typically cause false positive pacer detection.

Direct cardiac application:The display area reserved for the ECG measurement in the monitoring system screen may not be adequate for displaying the complete ECG amplitude when measuring ECG direct from the surface of the heart. Clipping of the signal can be reduced by adjusting the size of the signal on the screen (for example, from the default 1.0 to 0.2) in the ECG menu.

Impedance respiration specifications

Figure 4a halved ampli-tude:

9.9 s (8.4 to 11.5 s)

Figure 4a

normal amplitude:

7.1 s (5.8 to 8.2 s)

Figure 4a

doubled amplitude:

4.4 s (4.2 to 4.6 s)

Figure 4b halved ampli-tude:

7.0 s (6.1 to 7.5 s)

Figure 4b

normal amplitude:

5.8 s (4.5 to 7.4 s)

Figure 4b

doubled amplitude:

6.1 s (5.1 to 7.0 s)

ST

ST numeric range -9 to 9 mm (-0.9 to 0.9 mV)

ST numeric accuracy ±0.2 mm or ±10%, whichever is greater (within the range of -8 to 8 mm)

ST numeric resolution 0.1 mm

Pacemaker detection

Input voltage range 2 to 700 mV

Input pulse width 0.5 to 2 ms

Input overshoot Specified for both Method A and Method B required in IEC 60601-2-27 201.12.1.101.13

Pacer pulse rejection of fast ECG signals

2.0 V/s (according to the test defined in IEC 60601-2-27 201.12.1.101.12)

Measurement range 4 to 120 resp/min

Measurement accuracy ±5% or ±5 resp/min, whichever is greater

Nomalized respiration sensing current

<= 5.0 µA

Impedance respiration carrier frequency

31.25 kHz


2-20

GE TruSignal SpO2 specifications

Measurement and display range

1 to 100%

Calibrated against functional oxygen saturation.

Measurement accuracy

Adult/Pediatric

(100 to 70%):

without motion: ±2 digits (±3 digits with ear sensor)

with motion: ±3 digits

low perfusion: ±3 digits

Neonatal

(100 to 70%):

without motion: ±3 digitswith motion: ±3 digits

Adult/Pediatric/Neonatal (69 to 1%):

unspecified

Display resolution 1 digit (1% of SpO2)

Display averaging Normal 12s, Fast 3s

Wavelength of SpO2 probe LEDs:

Infrared LED 940 nm

RedLED 660 nm

Maximum energy of SpO2 probe LEDs:

Infrared LED 42 µJ/pulse

Red LED 62 µJ/pulse

NOTE: This information may be useful to clinicians, such as those performing photodynamic therapy.

Pulse rate


30 to 250 bpm

Display resolution 1 bpm


Without motion: ±2 bpm (Adult/Pediatric/Neonatal)

With motion: ±3 bpm (Adult/Pediatric/Neonatal)

Low Perfusion: ±5 bpm (Adult/Pediatric)

System description

2-21

Table 1: Accuracy for sensors (Arms) *

* Because SpO2 measurements are statistically distributed, only about 2/3 of the measurements can be expected to fall within ±1 Arms of the value measured by a CO-oximeterTest methods used to establish SpO2 accuracy: GE TruSignal SpO2 measurement have been validated for no motion and motion accuracy in a controlled hypoxia studies with healthy non-smoking adult volunteers over the specified SpO2 rage. SpO2 readings were compared to SaO2 values of drawn blood samples measured by CO-oximetry. Subjects comprised both adult men and women and spanned a range of skin pigmentation.

** GE TruSignal technology have been validated for low perfusion SpO2 accuracy over the specified range in a bench top testing against BioTek Index 2 patient simulator with 0.3% signal amplitude.

Table 2: The table below shows Arms values measured using GE SpO2 sensors with GE CARESCAPETM V100 in a clinical study.*

* The sensors were clinically tested for accuracy with the following sensors: OXY-E (equivalent to TS-E-D, TS-E2-GE, TS-E4-GE), OXY-SE (equivalent to TS-SE-3), OXY-F (equivalent to TS-F-D, TS-F2-GE, TS-F4-GE, TS-SA-D, TS-SA4-GE), OXY-W (equivalent to TS-W-D), OXY-AP (equivalent to TS-AP-10, TS-AP-25), OXY-AF (equivalent to TS-AF-10, TS-AF-25).The sensors were clinically tested for neonatal accuracy with the following sensors: OXY-SE (equivalent to TS-SE-3), OXY-AF (equivalent to TS-AF-10, TS-AF-25).

GE SpO2 Sensor Non motion (70-100%)

Motion (70-100%)

Low perfusion (70-100%)**

Neonatal

(70-100%)

TS-E-D, TS-E2-GE, TS-E4-GE ±3 digits unspecified unspecified unspecified

TS-SE-3 ±2 digits unspecified unspecified ±3 digits

TS-F-D, TS-F2-GE, TS-F4-GE, TS-SA-D, TS-SA4-GE

±2 digits unspecified ±3 digits unspecified

TS-W-D ±2 digits unspecified unspecified unspecified

TS-AP-10, TS-AP-25 ±2 digits ±3 digits unspecified unspecified

TS-AF-10, TS-AF-25 ±2 digits ±3 digits unspecified ±3 digits

GE SpO2 Sensor 70 - 80% 80 - 90% 90 - 100%

OXY-E 2.3 digits 1.4 digits 1.3 digits

OXY-SE 2.5 digits 2.0 digits 1.1 digits

OXY-F 1.3 digits 1.0 digits 1.1 digits

OXY-W 2.9 digits 1.8 digits 1.0 digits

OXY-AP 2.0 digits 1.9 digits 1.7 digits

OXY-AF 2.5 digits 1.4 digits 0.9 digits


2-22

Nellcor SpO2 specifications

Masimo SpO2 specifications

Measurement range 1 to 100%

Display range 0 to 100%


Measurement accuracy Adult 100 to 70% ±2 digits

Neo 100 to 70% ±3 digits

Low perfusion 100 to 70% ±2 digits

Display resolution 1% of SpO2

Display averaging 2 to 7 seconds

Pulse rate


20 to 250 bpm


Measurement accuracy ±3 digits

Sensor Light Source

Wavelength Infrared: 900 nmRed: 660 nm

Total optical output power of the sensor LEDs

less than 15 mW

* This information may be useful to clinicians, such as those performing photodynamic therapy.

Measurement range 1 to 100%

Display range 0 to 100%



Without motion Adult/Pediatric 100 to 70% ±2 digits

Neonate 100 to 70% ±3 digits

With motion Adult/Ped/Neo 100 to 70% ±3 digits

Low perfusion 100 to 70% ±2 digits

0~69% unspecified

Display resolution 1% of SpO2

Display averaging 2 to 16 seconds

Pulse rate


25 to 240 bpm


Measurement accuracy Without motion ±3 bpm

With motion ±5 bpm

System description

2-23

NIBP

Sensor Light Source

Wavelength Infrared: 905 nm (nominal)

Red: 660 nm (nominal)

Power Dissipation Infrared: 22.5 mW (max)

Red: 27.5 mW (max)

* This information may be useful to clinicians, such as those performing photodynamic therapy.

Measurement technique Oscillometric with step deflation

Supported modes Manual, automatic and stat

Measurement time Adult/Pediatric inflate duration time less than 120 s

Neonate cycle time less than 85 s

Measurement ranges

Systolic Adult/Pediatric: 30 to 290 mmHg

Neonate: 30 to 140 mmHg

MAP Adult/Pediatric: 20 to 260 mmHg


Diastolic Adult/Pediatric: 10 to 220 mmHg


Accuracy According to AAMI SP10-2002 4.4.5.2 B, accuracy of NIBP parameter was validated against the intra-arterial method 1.

Default initial inflation pressure

Adult/Pediatric: 135 ± 15 mmHg

Neonate: 100 ± 15 mmHg

Over pressure allowed by independent safety controller

Adult/Pediatric: 300 ± 6 to 330 mmHg

Neonate: 150 ± 3 to 165 mmHg

1. Blood pressure measurements determined with this device are equivalent to those obtained by an intra-arterial blood pressure measurement device, within the limits prescribed by the American National Standard, Manual, electronic, or automated sphygmomanometers


2-24

Invasive blood pressure

Temperature

Measurement range -40 to 320 mmHg (-5.3 to 42.7 kPa)

Measurement accuracy ±5% or ±2 mmHg, whichever is greater

Frequency response 4 to 22 Hz

Transducer sensitivity 5 µV/V/mmHg

Pulse rate

Range 30 to 250 bpm

Accuracy ±5% or ±5 bpm, whichever is greater


Zero adjustment range ± 150 mmHg

Measurement units ° Fahrenheit (F)

° Celsius (C)

Measurement range 10 to 45°C (50 to 113°F)

Measurement accuracy ± 0.1°C without temperature sensor

Display resolution ± 0.1°C at 25 to 45 °C with reusable probes

Probe types supported Use only GE Healthcare recommend temperature YSI probes.

Temperature self-check At start-up and then every 10 minutes

Probe type time response

Reusable skin temperature probe:

3 s

Reusable adult central temperature probe:

6 s

Reusable pediatric central temperature probe:

4 s

Disposable skin temperature probe:

3 to 6 s

Disposable central temperature probe, 12F:

5 to 8 s

Disposable central temperature probe, 9F:

5 to 8 s

System description

2-25

Airway gases

Accuracy specifications apply in normal conditions after a 30 min warm-up period:

Ambient temperature 18 to 28°C, within ±5°C of calibration

Ambient pressure 660 to 1060 hPa, ±67 hPa of calibration

Ambient humidity 20 to 80%, within ±20% RH of calibration

Sampling rate

E-miniC module

E-sCO, E-sCAiO, N-CAiO module

• 150 ±25 ml/min (sampling line 2 to 3 m, normal conditions)

• 120 ±20 ml/min

Warm-up time

E-miniC module


• 1 minute for operation, 30 minutes for full specification

• 1 minute for operation with CO2, O2 and N2O, 5 minutes for operation of anesthetic agents, 20 minutes for full specification

Respiration rate

Measurement range

E-miniC module


• 4 to 80 breaths/min

• 4 to 100 breaths/min


E-miniC module


• 4 to 20 breaths/min: ±1 breaths/min20 to 80 breaths/min: ±5%

• 4 to 20 breaths/min: ±1 breaths/min20 to 100 breaths/min: ±5%

Resolution 1 breaths/min

CO2

CO2 measurement range

E-miniC module


• 0 to 20 vol%

• 0 to 15 vol%


2-26

CO2 measurement accuracy

E-miniC module


• 0 to 15 vol%: ± (0.2 vol% + 2% of reading)

• 15 to 20 vol%:± (0.7 vol% + 2% of reading)

NOTE: Valid for respiration rate < 40 breaths/min at I:E ratio of 1:1. (Relative error is typically 10% for respiration rate 80 breaths/min at I:E ratio of 1:1.) The accuracy is specified in simulated ventilation. With higher respiration rates and with varying ventilation methods the specifications may not be met.

• ± (0.2 vol% + 2% of reading)

CO2 display resolution 0.1%, 0.1kpa or 1 mmHg

CO2 total system response time

E-miniC module


• < 2.4 seconds with a 3m sampling line

• < 3.3 seconds with a 2 or 3m sampling line

CO2 rise time

E-miniC module


• < 300 ms with nominal flow

• < 260 ms with 120 ml/min sampling rate and 2 or 3m sample line

CO2 drift < 0.1 vol%

O2

O2 measurement range 0 to 100 vol%

O2 measurement accuracy ± (1 vol% + 2% of reading)

O2 display resolution 1% for values under -10% and over 10%0.1 for values between -9.9…9.9%

O2 total system response time < 3.3 seconds with a 2 or 3m sampling line

O2 rise time < 260 ms

O2 drift < 0.3 vol%

N2O

N2O measurement range 0 to 100 vol%

N2O measurement accuracy 0 to 85 vol%: ± (2 vol% + 2% of reading)85 to 100 vol%: ± (2 vol% + 8 % of reading)

N2O display resolution 1%

N2O total system response time < 3.4 seconds with a 2 or 3m sampling line

N2O rise time < 320 ms with 120 ml/min sampling rate and 2 or 3m sample line

N2O drift < 0.3 vol%

Anesthetic agents

System description

2-27

Anesthetic agents specified measurement range

Hal, Enf, Iso: 0 to 6 vol%Sev: 0 to 8 vol%Des: 0 to 20 vol%

Anesthetic agents measurement accuracy

± (0.15 vol% + 5% of reading)

Anesthetic agents display resolution

0.01% for values between 0…1%0.1% for values equal or above 1%

Anesthetic agents total system response time

< 3.5 seconds with a 2 or 3m sampling line (< 3.8 for Hal)

Anesthetic agents rise time Hal, Enf, Iso, Des: < 420 ms with a 3 m sampling lineHal: < 800 ms with a 3 m sampling lineHal, Enf, Iso, Des: < 700 ms with a 6 m sampling lineHal: < 1800 ms with a 6 m sampling line

Hal drift < 0.1 vol%

Enf drift < 0.1 vol%

Iso drift < 0.1 vol%

Sev drift < 0.1 vol%

Des drift < 0.3 vol%

The E-sCAiO, N-CAiO modules automatically identify the anesthetic agent present in the sampled gas and measure the concentration of the identified agent.

Identification threshold 0.15 vol%

Identification time < 20 s

The E-sCAiO module automatically identifies mixtures of two anesthetic agents present in the sampled gas and measures the concentrations of the two identified agents.

Identification threshold for the second agent at 1 MAC of the first agent:

0.2 vol% +10% of the concentration of the first agent

Effects of interfering gases and vapors

E-miniC module

Non-disturbing gases of which effect on CO2 (5 vol%) readings < 0.2 vol%:

- Ethanol C2H5OH (<0.3%)

- Acetone (<0.1% )

- Methane CH4 (<0.2%)

- Nitrogen N2 (0-100%)

- Water vapor (0-100%)

- Trichloromonofluoromethane (<1%)

- Dichlorotetrafluoroethane (<1%)

- Dichlorofluromethane (<1%)


2-28

NOTE: E-miniC measurement is intended for patients weighing over 5 kg (11 lb).

Disturbing gas and its effect • Halotane (4%): increases CO2 (5 vol%) < 0.3 vol%

• Isoflurane (5%): increases CO2 (5 vol%) < 0.4 vol%

• Enflurane (5%): increases CO2 (5 vol%) < 0.4 vol%

• Desflurane (24%): increases CO2 (5 vol%) < 1.2 vol%

• Sevoflurane (6%): increases CO2 (5 vol%) < 0.4 vol%

• N2O (40%): increases CO2 (5 vol%) < 0.4 vol%

• Helium (50%): decreases CO2 (5 vol%) < 0.3 vol%

• If O2 compensation is not activated: O2 (40-95%) decreases < 0.3 vol%

• If O2 compensation is activated: O2 (40-95%) error < 0.15 vol%

• If N2O compensation is not activated: N2O (40-80%) increases < 0.8 vol%

• If N2O compensation is activated: N2O (40-80%) error < 0.3 vol%


Non-disturbing gases: - Ethanol C2H5OH (< 0.036%)

- Acetone (< 0.2%)

- Methane CH4 (< 0.3%)

- Isopropanol (< 0.48%)

- Nitrogen N2

- Carton Monoxide CO (< 100 ppm)

- Nitrous Oxide NO (< 200 ppm)

- Freon R134A (< 1%) (for CO2, O2 and N2O)

- Water vapor

Effects of a non-disturbing gas to the measured gas concentrations

• CO2 < 0.2 vol%

• N2O < 2 vol%

• O2 < 2 vol%

• Anesthetic agents < 0.15 vol%

Gas cross effects • Helium (50 vol%): Decreases CO2 (5 vol%) readings < 0.5 vol% Decreases O2 (50 vol%) readings < 2 vol%

• Xenon (80 vol%): Decreases CO2 (5 vol%) readings < 0.5 vol%Decreases O2 (14 vol%) readings <1.5 vol%

System description

2-29

Entropy

Display range

• Response Entropy (RE)

• State Entropy (SE)

• Burst Supression Ratio (BSR)

• 0 to 100

• 0 to 91

• 0 to 100%

Display accuracy ±1 or ±1%

Amplifier input impedance

1 MΩ @ 50 Hz

Defibrillation protection 3000 V, 130 J

Amplifier frequency range 0.5 to 118 Hz


2-30

3 Installation

Installation

3-1

3 Installation

Safety precautions

Warnings

• After transferring or reinstalling the monitor, always check that it is properly connected and all parts are securely attached. Pay special attention to this in case of stacked mounting.

• Do not use without manufacturer approved mounting.

• Do not install equipment above the patient.

• The parameter modules are not able to withstand unpacked drops from a height of 1 m without damaging the module latches. If the device is dropped, please service the device before taking it back into use.

• Ensure modules are oriented with release latch downward to ensure retention.

• Do not touch the back of frame enclosure in normal use.

• Be careful not to drop modules while detaching.

Cautions

• The monitor display is fragile. Ensure that it is not placed near a heat source or exposed to mechanical shocks, pressure, moisture or direct sunlight.

• Do not drop battery or subject to mechanical shock.

• Use only the recommended batteries.

• Malfunction may cause gases to vent.

• SAFETY GROUND PRECAUTION - Remove power cord from the mains source by grasping the plug. DO NOT pull on the cable.

Unpacking instructions1. Confirm that the packing box is undamaged. If the box is damaged, contact the shipper.

2. Open the top of the box and carefully unpack all components.

3. Confirm that all components are undamaged. If any of the components is damaged, contact the shipper.

4. Confirm that all components are included. If any of the components is missing, contact your GE Healthcare distributor.


3-2

Choosing locationEnvironmental requirements• Install the patient monitor to a location that meets the specified environmental

requirements of operating temperature, humidity and atmospheric pressure.

• Set up the device in a location which affords sufficient ventilation. The ventilation openings of the device must not be obstructed.

EMI & RFI interference:• The patient monitor should be isolated from sources of strong electromagnetic and radio

frequency interference.

Mounting the monitorMounting of monitor to the Wall Mount, Rollstand, Wall Mount with standard arm or Counter Top Mount is described in a separate instruction sheet delivered with each mount.

Refer to the “Supplier and accessories” to identify the compatible mounting hardware.

Connection to powerTesting the battery chargeBefore installing a battery to the patient monitor, verify the battery’s state of charge. Press the green TEST button on the battery. The number of charge level indicator LEDs that illuminate indicates the approximate charge remaining in the battery.

− Four LEDs illuminated: 75% – 100% of full-charge capacity.

− Three LEDs illuminated: 50% – 74.9% of full-charge capacity.

− Two LEDs illuminated: 25% – 49.9% of full-charge capacity.

− One LED illuminated: 10% – 24.9% of full-charge capacity.

− One LED flashing: < 10% of full-charge capacity remaining.

Installing the batteries

1. Open the lid of the battery compartment by the side of the monitor. Move the latch up or down.

2. Put in the new battery. Make sure that the charging indicator is facing to the back side of the monitor, then push the battery in all the way, move the latch to the middle and close the lid. Power on the monitor, check the monitor indicators, see above.

Installation

3-3

Connecting to mainsConnect the power cord to the mains power inlet at the back of the monitor and to the wall socket.

NOTE: Before taking the monitor into use for the first time, the batteries should be fully charged. Keep the monitor connected to the mains until the Battery charging symbol disappears (may take up to 5 hours if the batteries are fully discharged).

WARNING The power cord may only be connected to a three-wire, grounded, hospital grade receptacle

Check configurationCheck the monitor’s configuration and record in B. Installation and checkout form, B40/B20. The later set up and check out shall according to monitor’s configuration.

1. Turn on the monitor, enter to the service menu: Monitor Setup > Install/Service (16-4-34) > Service (26-23-8)

2. Enter to license control menu: SW Management > License

3. Check and record the product license.

4. If the configuration is difference with your order, contact GE Healthcare distributor.

Connection to NetworkWARNING Do not use with iCentral software V5.0.3 and earlier.

WARNING Do not use Mobile Care Server software V5.2 and earlier.

CAUTION Install HL7 network interfaces as specified, and only by qualified personnel.

NOTE: Not all the features mentioned following is available you monitor, according to your monitor’s configuration to set up.

Pre-installation requirements

Ensure that the applicable network infrastructure is in place prior to the installation of the patient monitor.

Acquire the network configuration information from the hospital IT or the related project documentation and installation files.

MC Network• The MC Network infrastructure shall be installed according to the "CARESCAPE Network

Configuration Guide".

• The installation site of the patient monitor shall have a wall jack and a network patch cable for the MC Network.

S/5 Network• The S/5 Network shall be installed according to the "S/5 Network Installation Guide". Refer

to the "iCentral and iCentral Client Service Manual" for iCentral installation instructions.

• The installation site of the patient monitor shall have a wall jack and a network patch cable for the S/5 Network.


3-4

HL7 network• The HL7 Network shall be installed according to the "B40/B20 Patient Monitor HL7

reference manual"

To connect the network

MC and S/5 networkUse the CAT-5 network cable to connect the monitor to the network.

1. Make sure that the power is switched off.

2. Connect the one RJ-45 connector to network port at the back of the monitor.

3. Connect the other RJ-45 connector to the corresponding port on the wallbox.

4. Turn on the monitor, confirm that the network symbol and 'Network made' message are displayed in the upper part of the screen.

Install the networkNOTE: To install network, please ask the GE service personnel to support.

Installation

3-5

Inserting and removing the E module

To use the E module, your monitor need pre-configure the extension rack from manufacture.

To insert module:

1. Align the module with the insertion guides

2. Push the module into the monitor frame until it clicks and stops.

3. Pull the module outwards to insure the module is firmly seated.

To remove module:

1. Pressing the release latch, on the bottom of the module.

2. Grasp the module firmly and pull out of the Frame. Make sure not to drop it when it comes out.

Visual indicatorsFunction Specification Explanation

External power supply Green LED Indicates when monitor is powered from mains

Battery operation Green LED Indicates when monitor is powered from internal batteries

Battery condition Orange LED Indicates when monitor is charging batteries (solid) or battery failure (flashing).

Alarm Light Highly visible Red/Yellow/Cyan light

Indicates when alarm is detected.


3-6

Installation checkoutIt is recommended to be performed after monitor installation. Skip the tests that are not applicable for the installed monitor.

These instructions include a “B. Installation and checkout form, B40/B20” to be filled in when performing the procedures.

Recommended tools

NOTE: Use only properly maintained, calibrated and traceable measurement equipment for the specified calibrations and adjustments to ensure accuracy.

NOTE: A functional tester cannot be used to assess the accuracy of pulse oximeter for monitor.

Table 3-1 Recommended accessories and tools

NOTE: For details on recommended accessories see “Supplies and Accessories“ catalog.

Visual inspection

Perform the following visual inspection to the installed monitoring system:

• Carefully inspect the patient monitor if any damage.

• Verify that the patient monitor is properly mounted with specified mounting solutions.

• Verify that the cables between the patient monitor and the connected peripheral devices are intact and properly connected to the right connectors.

Accessories

A rigid cylinder or pipe

NIBP cuff

Adult NIBP cuff hose with cuff ID

Infant NIBP cuff hose with cuff ID

Tubing parts to connect a manometer and a pump to the NIPB cuff and hose.

Dual invasive pressure adapter cable

ECG accessories, IEC or AHA

- Multi-link 3-lead integrated cable and leadwire

- Multi-link 5-leadwire set

- Multi-link 3/5-lead ECG trunk cable

SpO2 finger probe

SpO2 Interconnect Cable

Temperature dual cable

Gas sampling line 3m/10 ft

Entropy cable

Tool

A multiparameter patient simulator with IBP, Temp adpter cables

Installation

3-7

• Verify that the modules are properly connected and locked in place.

• Verify that the battery lid is properly locked.

The cleaning precautions, cleaning requirements, cleaning procedures, and recommended cleaning solutions for the monitor are described in the "9. Cleaning and care". For details about cleaning, disinfecting and sterilizing the accessories, see the instructions for use in the accessory package.

Functional inspection

Start-up1. Turn on the patient monitor.

Verify that the monitor starts up normally:

• The red, yellow and cyan alarm lights are lit in sequence.

• The speaker gives an audible beep.

• Check that the GE logo screen is displayed, followed by the notes screen and the normal monitoring screen appears.

• Check and there are no error messages on the screen.

NOTE: Refer to section "Condition the battery" to see the procedure for battery conditioning if you receive a a Condition Battery X message.

NOTE: Before taking the patient monitor into use for the first time, the battery should be fully charged. Keep the monitor connected to the mains until the battery is fully charged.

Display

1. Verify that all text is readable and all images are clear.

2. Verify that the brightness is good. Adjust if necessary.

Time and date1. Check that the clock on the screen shows correct time. Adjust the time and date, if

necessary. Monitor Setup < Time and Date

NOTE: The monitor can’t be set as the TIME MASTER in network. You should adjust the time and date from the central station.

Parameters measurementsConnect the accessories (no need connect simulator/patient), check the following phenomenon will appeared.

• ECG: After connecting ECG cable, ‘leads off’ will display in the Waveform Field

• NIBP: After connecting NIBP hose to module, ‘Adult/Pediatric’ or ‘Neonatal’ will display in NIBP Digital Field for several seconds


3-8

• SpO2: After connecting SpO2 cable and sensor, SpO2 sensor will be lit.

• Temperature: After connecting Temp cable and sensor, ‘Performing temp test:’ will display in Temp Digital Field for several seconds.

• IBP: After connecting IBP cable and transducer, ‘InvBP’s not Zeroed’ will display in Message Field.

• Gas: After installing the gas module, ‘Calibrating gas sensor’ will display in CO2 waveform field for about 1 minutes.

• Entropy: After installing the E-Entropy module and cable, 'No sensor' message will display in Entropy digital field.

Recorder1. Press the Recorder Start/Stop key and check that the module starts recording the

selected waveforms. Press the Recorder Start/Stop key again to stop recording.

2. Check that the quality of the recordings is acceptable.

MC or S/5 Network connection

NOTE: Pre-configure the network when install the monitor.

1. Check that the CAT-5 cable connector is clean and intact, then connect it to the Network connector on the backside of the monitor.

Check that the monitor connects to the network, i.e. the network symbol appears on the upper right-hand corner of the screen.

Conclusion• Power off the monitor

• Perform final cleaning

• Fill in all necessary documents

4 Monitoring basic

Monitoring basic

4-1

4 Monitoring basic

Using menusA menu is a list of functions or commands displayed on the monitor screen.

To display a menu, press one of the Command Board keys.

Figure 4-1 Example of a menu

(1) Menu header

(2) List of menu selections

(3) Indicates the present selection

(4) Adjustment window with other options

(5) Short instructions

(6) Entry indicator to submenus


4-2

Select items in the menus with the Trim Knob. For example, to change what is displayed in the ECG display:

Select the desired function by pressing the menu key.

ECG

Turn the Trim Knob to move the highlight down in the menu to the desired selection.

Monitoring basic

4-3

Press the Normal Screen key to return to normal monitoring display.

Submenus are indicated by a symbol . They function just like the main menus and contain less frequently used functions.

Push the Trim Knob to enter an adjustment window or a submenu

Turn the Trim Knob to choose the desired option or selection in the window.

Push the Trim Knob to confirm the selection.


4-4

Starting and ending

Warnings

• Always make sure that appropriate mode is chosen and necessary alarm limits are active according to the patient’s clinical condition.

• Connect only one patient to the monitor at a time.

Preparations

1. Check that the monitor, accessories and monitor parts are clean and intact.

2. Plug in the desired measurement module.

3. Turn on the monitor from the ON/OFF key. The monitor performs a self-test to ensure correct functioning.

4. If necessary, change the user mode:

− Press the Admit/Discharge key and select Select Mode.

NOTE: Press the ON/OFF key for more than 1 second, the monitor will turn on after the red, yellow and cyan alarm lights lit in sequence, the speaker gives an audible beep and the GE logo screen display, followed by the notes screen.

The mode defines what is displayed on screen and in the trends. Note that changing the mode also changes settings such as alarm limits.

The monitor automatically reconfigures the display when modules are inserted. Reconfiguration of the display may take up to 5 seconds.

Starting monitoring

1. Prepare the patient connections according to the setup picture in the measurement section. Use only approved supplies and accessories, see the “Supplies and Accessories” catalog. The alarms and parameter settings become active.

2. Enter or load patient data by pressing the Admit/Discharge key, according to the instructions given later in this chapter.

3. Check that you have the desired waveforms and digits in the fields. If necessary, adjust the selections:

− Press the Monitor Setup key.

− Select Screen Setup.

− Select Waveform Fields or Digit Fields.

4. Zero invasive blood pressure lines.

5. Check the alarm limits.

− Press the Alarms Setup key.

The alarms are operative and the parameter default settings are active when the patient is connected to the monitor.

6. Start the measurement according to the instructions in the measurement section.

Monitoring basic

4-5

Admitting a patient

Monitoring of a new patient is started by admitting the patient. After the patient has been admitted, you can start monitoring and trend gathering. To admit the patient:

1. Press the Admit/Discharge key and select Admit Patient

2. Choose the Patient Type (The option A/P means Adult/Pediatric, the option NEO means Neonatal).

3. Enter the patient data. Select letters and numbers by turning and pushing the Trim Knob (max. 14 characters or numbers for each name and ID).

NOTE: Always observe the monitor and the patient carefully during start-up periods and when inserting module.

NOTE: The patient admission happens through Admit Patient selection or automatically when the monitor receives a patient's vital signs.

Enter demographics1. Press the Admit/Discharge key.

2. Select Admit Patient - Demographics.

3. Enter patient data: Height is adjustable from 15 to 250 cm (5 in to 8 ft 2 in), Weight is adjustable from 1 to 250 kg (2 to 555 lb).

The body surface area, BSA, is calculated automatically by using du Bois formula. The body surface area is used in calculating index values of some parameters.

Admit/Discharge


4-6

Loading previous data

If the patient has already been admitted on the same monitor and this monitor has been restarted, the Contin. Previous will be appeared.

Contin. PreviousSelect this to load the most recent patient trends from the monitor memory when less than 15 minutes has elapsed from the turn-off.

NOTE: This selection is available if the patient is already admitted on this monitor.

During monitoring

• If you need to avoid audible alarms, press the Silence Alarms key.• Empty the water trap container of the gas module whenever it is more than half full.

Automatic saving of patient data

The monitor continuously and automatically collects and saves patient data such as trends. Saving is activated once the patient is admitted or the monitor receives vital data.

− In the monitor memory the most recent patient data up to 72 hours if the network is not in use.

− In the network the most recent patient data up to 2 to 90 days depending on the configuration.

All the data can be printed through network and saved to the network for monitor memory.

Admit/Discharge

Monitoring basic

4-7

Discharging the patient

When you end monitoring, discharge the patient. The monitor erases screen layout, trend data and alarm and parameter settings that were active during monitoring, and returns to the starting mode and its settings.

1. Press the Admit/Discharge key.

2. Select Discharge - Yes..

Ending monitoring

1. Print necessary data.

− Press the Print/Record key, and setup what you want to print or record.

− Print or record the necessary data.

2. Wait until the printing is finished. Then clear patient data and return settings, including alarm limits, to their defaults by discharging the patient:

− Press the Admit/Discharge key.

− Select Discharge and Yes.

3. Turn off the monitor from the ON/OFF key if the monitor will not be used.

4. Clean the monitor according to the instructions, see section "Cleaning and care."

Using modesThe monitor has seven user modes. These user modes are predefined combinations of settings. They determine, for example, what is displayed on the screen and in trends and what the alarm limits are. In other words, by choosing a specific mode you get suitable settings on the screen without having to choose all features one by one.

Modes can be hospital specific. The monitor starts in start-up modes, which is one of the user modes chosen during configuration. The default modes are STEP-DOWN, ED, PACU, CCU, OR, PEDIATRIC and NEONATAL. Please refer to the “Default Configuration Worksheet“ delivered with the monitor for more information.

For more information about the installation settings and using modes, see section "Monitor setup."


4-8

Demo ModeThe Demo Mode is designed for training and demo of operation before use. Under Demo Mode, the monitor displays the main vital signs values and waveforms. No need accessories, central station or any other peripheral equipment connect to the monitor while in Demo Mode.

NOTE: All the values and waveforms the Monitor displays are fictional.

NOTE: The Demo Mode is only designed for the use of training and demo of operation. It is not intended for clinical use or patient monitoring and diagnosis.

The Demo Mode menu is under service menu of the monitor, it’s need password to enter. Please consult the qualified service personnel to open and close the Demo Mode.

5 Alarms

Alarms

5-1

5 Alarms

OverviewWhen an alarm for the monitored parameter becomes active:

Figure 5-1 View of alarms

(1) Alarm messages appear in the message field in the order of priority.

(2) The measurement value flashes. The color (red, yellow) indicates the alarm category (high priority, medium priority). If the alarm is a low priority, the measurement value is not flashing.

(3) In some cases a message in the digit or waveform field gives more detailed information using the color of the parameter.

An audible alarm is also triggered If enabled, also the alarm light flashes red (high priority), yellow (medium priority), cyan (low priority) according to alarm levels. Refer to “Default Configuration Worksheet“ for more information about priorities and escalating.

1 2

3


5-2

Safety precautionsWarnings• Verify alarm processing is active and no arrhythmia occurred during power interruption.

• Latched alarms are not retained through monitor reset if alarm condition is been removed.

• Do not rely on secondary alarm system for receipt of alarm signal.

• Observe patient frequently while alarms or audio are paused or off.

• No alarm sound during Audio Pause.

• The audible alarm signal can be paused by central station.

• ALARMS - 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 a hazard to the patient. Remember that the most reliable method of patient monitoring combines close personal surveillance with correct operation of monitoring equipment. After connecting the monitor to the central station and/or nurse-call system, verify the function of the alarm system. The functions of the alarm system for monitoring of the patient must be verified at regular intervals.

• Make sure alarms are active and set according to patient condition.

• Only the latest and highest priority alarm is sent to CARESCAPE Network.

• ACCURACY - If the accuracy of any value displayed on the monitor, central station, or printed on a graph strip is questionable, determine the patient’s vital signs by alternative means. Verify that all equipment is working correctly.

• A potential hazard can exist if different alarm presets are used for the same or similar equipment in any single area.

• The same or similar equipment used in any single area with different alarm presets, may present a hazard.

• Audible alarm automatically can be sounded when monitor starting up.

• Always make sure that the audio alarm volume level is adequate in your care environment.

Alarms

5-3

Alarm indications• When the monitor is turned on, you will hear a beep: this tells you that the alarm audio

signal is working. Also the alarm light are lit up in red, yellow and cyan. You can also check the functioning of the audio signal through Alarms Setup - Alarm Volume.

• If alarms are turned off or a power interruption occurs when there is no battery backup, for up to 15 minutes, check the alarm status before you start monitoring again.

• If the monitor is connected to the network, the alarms can be heard and seen on the Central as well. Please, consult the "iCentral User's Reference Manual: Alarms" or “CIC Pro Clinical Information Center Operator's Manual“ for details.

• If the monitor is connected to the network, the alarms can also be silenced using the Central if this feature has been enabled in Central configuration.

NOTES:

• If the monitor is connected to the network, it also sends alarms to the central station.

• If the monitor is connected to the nurse call, the high and medium priority alarms will triggered the nurse call system.

• If the alarms disabled in monitor, the alarm limits in central station are automatically set beyond the maximum/minimum alarm limit values of bedside monitor.

• When have the "memory error" message, the monitor will automatically return to default settings, include the alarm preset.

• When monitor starting up, alarm will beep and light to do self-testing automatically.

Alarm conditions• Physiological alarm conditions are triggered by a patient measurement exceeding the

parameter limits, or by an arrhythmia condition.

• Technical alarm conditions are triggered by an electrical, mechanical, or other failure of the equipment, or by failure of a sensor or component. Technical alarm conditions may also be caused when an algorithm cannot classify or interpret the available data. The visual manifestation of a technical alarm is active as long as the reason for that alarm exists.

For more information about alarm conditions and alarm condition delay, see the “Default Configuration Worksheet” for more details.

Alarm categoriesThe alarms are classified into four categories according to the priority: HIGH PRIORITY/RED ALARM, MEDIUM PRIORITY/YELLOW ALARM, LOW PRIORITY/CYAN ALARM, MESSAGE/WHITE.

The priority of an alarm depends primarily on the cause and the duration (generally minimum 20 seconds) of the alarm condition, the priority increasing with the duration and according to the physiological significance. Thus, for example, brady advances rapidly to high priority, whereas apnea is allowed a slightly longer duration.


5-4

Table 5-1 Alarm categories

For more information about audible tone pattern see the “Default Configuration Worksheet”.

Alarm priorityThe alarm priority levels are determined automatically.

For more information about alarm priority levels, see the “Default Configuration Worksheet”.

Two or more alarms of equal priority are ranked according to the generate time. The latest alarm displays on the left.

Alarm priority escalation

An escalating alarm starts at a designated priority level (low or medium) and will escalate to the next higher priority level of alarm (after a set number of seconds) if the alarm condition has not been resolved. It is important to note that these escalate up to the next level but will not reset until the condition has been resolved.

NOTE: Alarm priority escalation affects the currently ongoing alarm condition, not any future alarms of the same type. Any new alarms will alarm at their designated priority level, not at the escalated level.

For more information about alarm priority escalation, see the “Default Configuration Worksheet”.

Signal Priority level

High Medium Low Informational

Alarms in Message Field

Solid red background Yellow boundary, blue-gray background

Cyan boundary, blue-gray background

Blue-gray background field

Alarm reset in Message Field

Solid red background with audio pause symbol

Yellow boundary, blue-gray background, with audio pause symbol

Cyan boundary, blue-gray background, with audio pause symbol

No

Physiological data values in Digit Field

Flashing red, physiological alarms only

Flashing yellow, physiological alarms only

No No

Alarm light Flashing red Flashing yellow Solid Cyan No

Alarm tone ISO pattern

10 beeps every 5 seconds

3 beeps every 19 seconds

1 beep every 30 seconds

No

Alarm tone ISO2 pattern

10 beeps every 5 seconds (rising tone)

3 beeps every 19.5 seconds (rising tone)


No

Alarm tone IEC pattern




No

Alarm tone Gerenal pattern

Continuous beep Double beep every 5 seconds


No

Alarms

5-5

Alarm lightIn addition to the audible, the monitor has an alarm light, located in the top of the monitor. The alarm light flashes red, yellow and cyan according to the currently active highest priority alarm. The brightness of the light is fixed.

Alarm activationPhysiological alarms have individual activation criteria as shown in the table. Alarm annunciation does not depend on case activity.

Alarm tonesThe monitor has four options for alarm tones and patterns: ISO, ISO2, General and IEC.

Checking alarm function1. Set a parameter alarm limit outside of the current measured patient values. For example,

connect the SpO2 sensor and adjust the SpO2 high limit under the measured SpO2 values.

2. Confirm that the following alarm notification events occur:

• The audible alarm sounds the correct tone.

• The alarm light illuminates.

• The SpO2 numeric value flashes in the digit field with the correct color.

• An alarm printout (if enabled).

3. Audio pause the alarms and confirm that the alarms are paused and that the left side of the alarm indicator light is a correct color.

4. Return the parameter alarm limit to the original value.

Parameter Physiological alarm activation criteria

ECG Active measurement for 30 seconds.

Impedance respiration

Active measurement for 30 seconds.

Apnea After 3 breath within 1 minutes.

SpO2 After successful pulse search.

NIBP Manual, Auto or Stat mode started.

IBP Active measurement for 30 seconds.

Temperature As soon as measurement readings are available.

Gases After 1st breath detection.

Entropy Measurement readings within the preset alarm limits for 30 seconds.


5-6

Alarms Setup menuYou can view and adjust patient alarm limits in the Alarms Setup menu.

(1) List of selections

(2) Exit from the alarm limit adjustment area back to Alarms Setup menu

(3) Parameter box with high and low limit values and a 10-minute trend showing the current status

Adjust Limits Adjusts individual measurement alarm limits. You can also access the adjustment menu through each parameter menu.

NOTE: If the monitor is connected to the network, the alarm limits can also be changed using the Central if this feature has been enabled in its configuration.

Auto Limits Auto limits are calculated from the displayed patient reading at the time when auto limits are selected.

Default Limits Sets the alarms to the default alarm limits.

NOTE: For detail information about default limits, see "Default Configuration Worksheet." The default limits can be changed and saved to modes, see "Changing the user modes" page 6-7.

Cancel ChangesReturns all the limits to the ones set before entering the Alarms Setup menu if you have not exited the menu yet.

Arrh. Alarms Set arrhythmia alarm whether to create snapshot, and enter to Alarms Setup menu.

Alarm Volume Adjusts the volume of the audio alarms. The default minimum alarm volume is 5. You can adjust minimum alarm volume through password, see "Changing alarm options" page 6-4.

Alarms Setup

CVP SpO2 CO2

15 100 8.0

ET

0 3.090

ALARM LIMITS AND 10 MIN TRENDS:

Mean

Adjust Limits

Auto Limits

Default Limits

Adiuo ON/OFF

Alarm Light 100%

Alarm Volume 5

Remove Menu

Cancel Changes

Arrh. Alarms

Normal Screen

Push Trim Knobto adjust alarmlimits manually.

HR STLat.

NIBPSys

ARTSys

40 -2.0 80 80

180 180160 2.0

60

4

RespRate

38.0

34.0TempT1

Exit

AlarmsSetup

13

2

Alarms

5-7

NOTE: Audible alarms cannot be totally silenced with the Alarm Volume function.

Alarm Light This is a grey option menu. The brightness of the alarm light is fixed, can’t be adjusted.

Audio ON/OFF Opens a menu to select Silence Apnea, Silence ECG, Silence Apn & ECG or Silence All.

NOTE: The silencing selections, except the Activate Alarms, are available only if alarm silencing has been enabled by selecting Monitor Setup - Install/Service (password) - Installation - Alarm Options - Show Audio ON/OFF - Yes. By default, it is disabled.

Activate Alarms = Activates silenced alarms. This selection is always available for activating alarms that have been permanently silenced using the Central.

Silence Apn =Turns off audible alarms for apnea, respiration rate, EtCO2 and FiCO2 limit alarms, except the related technical alarms.

Silence ECG = Turns off audible alarms for all HR source (ECG, Art and Pleth) limit and arrhythmia alarms, except the related technical alarms.

Silence Apn & ECG = Turns off audible alarms for apnea, respiration rate, EtCO2, FiCO2, all HR source limit and arrhythmia alarms, except the related technical alarms.

Silence ALL = Turns off all audible alarms (both of physiological and technical), except specifically defined as breakthrough alarms.

Remove Menu Clears the menu selections from the display so that only 10 minute trends and limits are displayed (push the Trim Knob to return the selections on the screen).


5-8

Adjusting alarm limits

Adjusting limits

1. Press the Alarms Setup key.

2. Select Adjust Limits.

3. Turn the Trim knob to selest the specific alarm to be configured.

4. Choose the highlight measurement. If the desired measurement is not displayed in the window, select Next Page.

5. Push the Trim Knob to open an adjustment window.

6. Turn the Trim Knob to change the limits and accept them by pushing it. Move between selections by turning the Trim Knob.

7. To return to the Alarms Setup menu to select more measurements, push the Trim Knob until the cursor is in the adjustment menu, then select Previous Menu or Alarms Setup.

8. Press the Normal Screen key to return to normal monitoring view.

You can enter the alarm limit adjustment window also through the measurement menus. When you are in an XX parameter menu, select XX Alarm or enter XX Setup and then select XX Alarm.

NOTES:

• In NIBP measurement, the alarm limits change automatically according to the cuff hose type used.

• If the monitor is connected to the network, the alarm limits can also be adjusted using the Central if this feature has been enabled in its configuration. If alarm limits are adjusted using the Central, the message 'Alarm settings changed from Central' is displayed in the bedside monitor.

Choosing automatic limits

To activate automatic patient-specific alarm limits enabling close patient control, select Auto Limits in the Alarms Setup menu. Limits are then calculated from the displayed patient reading at the point of time when auto limits are selected.

Returning to default limits

Select Default Limits to set the alarms to the default alarm limits. The factory default alarm limits are listed in the "Default Configuration Worksheet."

Alarms

5-9

Alarm off/on1. Press the Alarms Setup key.


3. Select the measurement. If the desired measurement is not displayed, select Next Page.

4. Push the Trim Knob. An adjustment window is displayed.

5. In the adjustment window, turn the Trim Knob to change the selection OFF or ON.

Or:

1. Select X Alarm in parameter’s menu and push the Trim Knob to change the selection OFF or ON.

If you select the OFF option, the symbol appears in the digit field.

AlarmsSetup CVP

ADJUST ALARM LIMITS:

Adjust Limits

Sys Alarm

Dia Alarm

Mean Alarm

Alarms Setup

Previous Menu

ON CVP Sys

320

40

10

-40mmHg

Push Trim Knobto turn alarmON/ OFF.

ON

ON320

20

5

-40mmHg

320

30

5

-40mmHg

CVP Dia

CVPMean


5-10

Audio off: silencing audible alarms permanentlyWhen audible alarms are turned off:

• All audible alarms are turned off except for specific alarms configured to break through the audio off setting.

• The audio off bell icon displays in the upper left corner of the display screen.

• The visual alarm signals still display.

NOTES:

• The silencing selections, except the Activate Alarms, are available only if alarm silencing has been enabled by selecting Monitor Setup - Install/Service (password) - Installation - Alarm Options - Show Audio ON/OFF - Yes. By default, it is disabled.

• If the monitor is connected to the network, the bedside alarms can also be silenced using the Central if this feature has been enabled in its configuration.

Choosing silence selections:


2. Select Audio ON/OFF menu.

− Silence Apn =Turns off audible alarms for apnea, respiration rate, EtCO2 and FiCO2 limit alarms, except the related technical alarms.

− Silence ECG = Turns off audible alarms for all HR source (ECG, Art and Pleth) limit and arrhythmia alarms, except the related technical alarms.

− Silence Apn & ECG = Turns off audible alarms for apnea, respiration rate, EtCO2, FiCO2, all HR source limit and arrhythmia alarms, except the related technical alarms.

− Silence ALL = Turns off all audible alarms (both of physiological and technical), except specifically defined as breakthrough alarms.

If an active alarm is silenced, the monitor gives a reminder beep every two minutes. You can adjust the volume of the reminder beep through Monitor Setup - Install/Service - Installation - Alarm Options - Reminder Volume (a password is required for this operation).

AlarmsSetup

Alarms

5-11

Audio on


2. Select Audio ON/OFF menu.

3. Select Activate Alarms to turn on audible alarms.

Audio paused or Alarm reset: silencing audible alarms temporarily

NOTES:

• When monitor’s remote control is set to active and the related feature has been enabled in the Central configuration. The bedside alarms can be audio paused by iCentral, the message 'Alarms silence from Central' is displayed on the bedside monitor display. The bedside alarms can be reset by CIC, the message 'Alarms Reset from Central' is displayed on the bedside monitor display.

• If the monitor is connected to the network and the network connection is lost, the audio paused alarms are reactivated and the volume level is automatically set to 7.

* Alarms are listed as follow:

− Physiology alarms:

Action Result Indicator

Press audio pause key once

• Start a 2 minute audio pause period for all alarms except the critical breakthrough alarms (for example, V Tach). See the “Default configuration worksheet” for details about breakthrough alarm

• Cease all latched alarms (including message and light).

• Alarm light: Yes

• Alarm message: Yes and has the audio pause countdown icon

• Alarm audio: No, except breakthrough alarms

Press audio pause key second time during audio paused period

• Cease the audio pause state.

• Remove alarms listed below*.


• Alarm message: Yes

• Alarm audio: Yes

Press alarm reset key

• Pause all active audio alarms for 2 minutes.

• Does not silence any new alarms.

• Cease all latched alarms (including message and light).

• Cease the audio pause state.


• Alarm message: Yes, with audio pause symbol in the message block

• Alarm audio: No


5-12

• NIBP Dia high

• NIBP Sys high

• NIBP Mean high

• NIBP Dia low

• NIBP Sys low

• NIBP Mean low

− Technical alarms:

• Leads off

• Entropy cable off

• Entropy sensor off

• Entropy sensor check failed

• No Entropy sensor

• No SpO2 probe

• SpO2 probe off

• Check SpO2 probe

• No SpO2 pulse

• No Px transducer

• NIBP cuff loose

• NIBP cuff occlusion

• Check NIBP

• Weak pulsation

• Long measurement time

• NIBP manual

• NIBP cuff overpressure

• NIBP call service error

• Gas measurements removed

• Recorder module removed

• Entropy measurement removed

• Alarm volume changed

• Zero ICP separately

• Recorder system error

• Recorder cover open

• Recorder input voltage high

• Recorder input voltage low

• Recorder out of paper

• Recorder thermal array overheat

• No battery backup

Alarms

5-13

Other adjustable featuresNOTE: This section describes the rest of the adjustable features regarding the alarms. You can adjust each feature if you know the required password for entering the Install/Service menu. If you wish to adjust the settings, we recommend that you contact the person responsible for the entire configuration.

Displaying limits

You may select the alarm limits to be displayed next to the numerical parameter value.

1. Press the Monitor Setup key.

2. Select Install/Service and enter the password (16-4-34).

3. Select Installation - Alarm Options.

4. Select Show Limits and YES or NO.

The alarm limits become visible when patient monitoring begins and the monitor receives patient data. The default setting will be YES.

MonitorSetup


5-14

Enabling or disabling alarm audio ON/OFF

With this selection, you can determine whether the audible alarms can be turned off or not.


2. Select Install/Service and enter the password.


4. Select Show Audio ON/OFF and YES to enable alarm audio off or NO to disable it.

The default setting will be NO.

MonitorSetup

Alarms

5-15

Latching alarms

If the Latching Alarms selection is active, the alarm messages stay on the screen even if the initial alarm condition goes away. This enables unattended monitoring. You will also hear a reminder beep every 10 seconds.

To clear the message field of the no longer active alarm messages and to clear the beep:

• Press the audio pause key once, or

• Press Alarm Reset key once.

To select latching alarms:




4. Select Latching Alarms - Yes.

The default setting will be Yes.

MonitorSetup


5-16

Enabling or disabling breakthrough alarms

The breakthrough alarms feature allows some alarms to “break through” (interrupt) an All Alarms Audio Off or a 2 minute alarm audio pause condition.

See the “Default configuration worksheet” delivered with the monitor for details of which alarms and conditions are enable for breakthrough feature.

With this selection, you can determine whether the breakthrough alarms turn off or not.



3. Select Installation - Breakthrough Alarm.

− Off: close breakthrough alarms feature

− Pedi: turn on breakthrough feature for new fatal alarms, including Brady

− Adult: turn on breakthrough feature for new fatal alarms, excluding Brady

In PEDIATRIC and NEONATAL modes, the default value is Pedi; In other modes, the default value is Adult.

MonitorSetup

Alarms

5-17

Changing minimum alarm volume




4. Select Min Alarm Volume and adjust the minimum alarm volume with the Trim Knob.

The default setting will be 5.

MonitorSetup


5-18

Changing reminder volume




4. Select Reminder Volume and adjust the alarm reminder volume with the Trim Knob.

The default setting will be 5.

MonitorSetup

Alarms

5-19

Changing the tone pattern

The monitor has four choices of alarming tone patterns: ISO, ISO2, General and IEC.

To change the tone pattern:




4. Select Alarm Tones and ISO, ISO2, IEC or General.

MonitorSetup


5-20

Enabling or disabling the alarm remote control

The bedside monitor’s alarm can be remote controlled by central station: adjust alarm settings, alarm reset by CIC, alarm audio pause and silence all by iCentral.

To enable the alarm remote control:




4. Select Remote Control to Active.

The default setting will be Inactive.

MonitorSetup

Alarms

5-21

NurseCall

With this selection, you can determine whether the NurseCall can be turned open according to NruseCall system electrical level in the hospital.




4. Select NurseCall - NO.

The default setting will be NO.

NOTE: For NO selection, high electrical level is exported from Nurse call connector when there is medium or high priority alarm.

NOTE: For NC selection, low electrical level is exported from Nurse call connector when there is medium or high priority alarm.

MonitorSetup


5-22

6 Monitor setup

Monitor setup

6-1

6 Monitor setup

Warnings• Operator should check the preset in use before use on each patient.

• A hazard can exist when using differing presets on like devices in a common area. For instance, two beside monitors used in an ICU with different presets may present a hazard.

OverviewThe monitor has numerous setup options for screen, parameters, alarms, etc. The monitor provide 7 preconfigured user modes. The monitor starts in one of the user modes. You can change to another user mode, see "Select the user mode" page 6-8.

The changes you make in the user mode settings are valid only temporarily until you discharge the patient or change a mode, or until more than 15 minutes has elapsed from the turn-off the monitor. The changes need to be saved in the mode to become permanent.

Before starting to use the monitor, check the monitor’s settings and what is configured in the different user modes, and make necessary changes. You need passwords for making the changes, see "Passwords" below.

NOTE: You can find the factory settings of each mode in the "Default Configuration Worksheet" delivered with each monitor.

NOTE: If you wish to make permanent changes, we recommend you to contact the person responsible for the configuration, who is familiar with the configuration architecture. When new settings are saved, they should be marked in the "Default Configuration Worksheet".

Passwords− The password for entering the Install/Service menu is 16, 4, 34.

− The password for entering the Save Modes menu is 13, 20, 31.

The access is:

Monitor Setup - Install/Service (Enter password) - Save modes (Enter password)

Turn and hit the Trim Knob to enter the password.


6-2

Setting time and dateThe time is shown in the upper right corner of the screen. Turning off the monitor does not affect the clock.

1. Press Monitor Setup and select Time and date.

2. Turn and push the Trim Knob to set the time and date:

− Hours, minutes and seconds.

− Day, month and year.

NOTE: If the monitor is connected to the Central, the monitor follows the Central’s time settings and the Time and date menu is not available.

NOTE: You cannot change the monitor's time settings after the patient has been admitted.

Viewing battery statusThrough this menu you can check the battery status:


2. Select Battery Setup. Battery information is now available.

MonitorSetup

Monitor setup

6-3

Changing monitor installation settingsEnter to following menu to setup settings:

Monitor Setup - Install/Service (Enter password) - Installation

Changing basic units

You can change basic units for height, weight and blood pressure. The changes are permanent. To change the units:

1. Press the Monitor Setup key, select Install/Service and enter the password.

2. Select Installation - Units.

3. Set the units for height, weight and blood pressure.

NOTE: You can change temperature units through Others - Temp Setup and CO2 units through Airway Gas - CO2 Setup.

MonitorSetup

Installation

Units

Alarm Options

Printer

Previous Menu

Set unit of height, weight andblood pressure.

Install / Service

Monitor Settings

MonitorSetup


6-4

Changing alarm options



• Show limits: YES(default) is show alarm limits in digit fields.

• Show Audio ON/OFF: YES is enable alarm silence options in the Audio ON/OFF menu in Alarms Setup. NO is the default.

• Latching Alarms: YES to keep alarm messages on screen until Audio pause key or Alarm Reset key pressed. NO is the default.

• Breakthrough Alarm: Select Off to close breakthrough alarms feature, select Pedi to turn on breakthrough feature for new fatal alarms, select Adult to turn on breakthrough feature for new fatal alarms, excluding Brady.

• Min Alarm Volume: Adjust minimum volume of audible alarm tone.

• Reminder Volume: Adjust the volume of the audible alarm reminder tone.

• Alarm Tones: Choose the IEC, ISO, ISO2 (default) or General for alarm tone pattern.

• Remote Control: Select active to enable alarm remote control by central station. Inactive is the default.

• NurseCall: Select NO, high electrical level is exported from Nurse call connector when there is medium or high priority alarm. Select NC low electrical level is exported from Nurse call connector when there is medium or high priority alarm.

NOTE: The Show Audio ON/OFF setting should be changed only by the system administrator.

Other alarm settings (alarm limits, and alarm volume) can be changed in the Alarms Setup menu. To make the changes permanent, save them in user modes, see section "Saving changes in user modes"

MonitorSetup

Monitor setup

6-5

Changing printer settings


2. Select Installation - Printer.

• Snapshot Printout: Select 12.5 or 25 mm/s

• Printer Connection: Select Net1…Net16 or None (default).

• Paper Size: Select A4 (default) or Letter.

NOTE: Network printer only.

Other printer settings can be changed in the Record & Print menu. To make the changes permanent, save them in user modes.

Changing the monitor settings



3. Select Installation - Monitor Settings - Parameter Settings

• CO2 Numbers: Set humidity compensation type Dry (default), Wet.

• MAC Type (B40 only): Set MAC type MAC or MACage

Printer

Snapshot Printout

Previous Menu

Select snapshot printoutsweep speed for waveforms:12.5 mm/s or 25 mm/s.

Paper Size

Printer Connection

A4

None

12.5 mm/s

MonitorSetup


6-6

Setting time zoneTime Zone menu is enable only when monitor is not connected to network and discharge paitent/haven’t admitted patient.

1. Press Monitor Setup key.


3. Select Time Zone

• Daylight Saving: to turn on, turn off or set auto adjust daylight saving time (DST).

• DST Offset Hour: to set the hours offset for daylight saving.

• DST Offset Minute: to set the minutes offset for daylight saving.

• DST Begins: to set daylight saving begin time.

• DST Ends: to set daylight saving end time.

• Time Sync: to set time sync options, Unity is time sync to Unity Network, NTP is time sync to NTP Server.

• NTP Config: to set NTP Server configuration.- GMT Offset Hours: to set offset hours from GMT (Greenwich Mean Time).- GMT Offset Minutes: to set offset minutes from GMT.- Primary Server IP: to set primary NTP Server IP address.- Secondary Serv IP: to set secondary NTP Server IP address.

NOTES:

− DST Offset Hour and DST Offset Minute menu are enable only when the Daylight Saving is set to ON or AUTO.

− DST Begins and DST Ends menu are enable only when the Daylight Saving is set to AUTO.

− Time Sync menu is shown only when monitor configuration is Unity+HL7.

− NTP Config menu is shown only when monitor configuration is Unity+HL7 or HL7. NTP Config menu is enable only when Time Sync is set to NTP.

MonitorSetup

Monitor setup

6-7

Changing the user modesYou can change the settings in each user mode to suit your specific needs. User modes are predefined combinations of settings that include both general and measurement specific settings. A user mode defines, for example, what is displayed on the screen and in the trends. General settings can be changed in the Monitor Setup menu, other settings in the parameter setup menus.

To change the general settings that can be saved in user modes:

Changing the Normal Screen layout on page 6-9

Changing sweep speeds on page 6-13

Changing parameter colors on page 6-13

To change the trends and snapshot settings

Configuring trends and snapshot on page 6-16

To change the alarm limits and volume

Adjusting alarm limits on page 5-8

Alarms Setup menu on page 5-6

To change the parameter settings

Press a parameter key and go to the setup menu.

To change the recorder and printer settings

Changing the recorder and printer settings on page 6-14

Saving changes in user modes

The modifications are valid only temporarily unless you accept them by saving them in the modes:



3. Select Save Modes and enter the password.

4. Select the mode from the list and select Save.

Temporary modifications are valid until you discharge the patient or change a mode or until more than 15 minutes has elapsed from the turn-off of the monitor.

MonitorSetup


6-8

Changing the startup mode

The monitor always starts in startup mode. The startup mode is one of the user modes, and it is chosen during configuration. To change the startup mode permanently.

1. Select Monitor Setup - Install/Service - Save Modes. Enter the password.

2. Select Startup Mode - 1, 2, 3, 4, 5, 6 or 7.

Renaming a mode


2. Select the mode, select Name and give a new name.

Loading modes


2. Select Load Modes and one of the following:

• From Network: Loads all modes from network and saves them in monitor's permanent memory.

• To Network: Copies all modes from monitor's permanent memory to network. This selection is available only if saving modes to network is enabled in Central

NOTE: Make a discharge before loading modes.

Select the user mode

To change the current mode to another:

1. Press Admit/Discharge and select Select Mode.

2. Select one of the following modes:

When you want to select NEONATAL mode. You should:

− Press the Admit/Discharge and select Patient Type to NEO

The mode will automatically change to NEONATAL.

STEP-DOWN Mode for intermediate care

ED Mode for emergency care

PACU Mode for post-anesthesia care

CCU Mode for ECG and ST care

OR Mode for operation room monitoring

PEDIATRIC Mode for pediatric ICU monitoring

NEONATAL Mode for neonatal monitoring

Monitor setup

6-9

The selected mode is marked with a circle. You can return to the previous mode by selecting Return to X.

During monitoring, you can make additional changes to the mode settings and, to make the changes permanent, save them through the Save Modes menu.

Changing the Normal Screen layout At startup, the screen is arranged according to the startup mode definitions. Not all the parameters are used and displayed. There is not enough space reserved for all of them. You can decide which waveforms and numerical information are displayed, and where on the screen they are arranged. You can do this for the duration of monitoring or save the changes in the user mode.

To make the changes permanent, save them in the user mode through Monitor Setup - Install/Service - Save Modes.

Figure 6-1 Display fields

Admit/Discharge


6-10

Modifying waveform fields

Up to six waveforms can be displayed on the central of the monitor at a time, with the related numerical filed on the right. The fields are numbered from up to down.

Figure 6-2 Waveform field

To setup the waveform fields:


2. Select Screen Setup - Waveform Fields and select the parameters.

If you hope display invasive pressures in the same waveform field with individual scales to increase waveform size.

3. Select Combine Pressures - YES.

When waveforms are configured to be displayed, they appear and disappear automatically when module is connected or disconnected. The invasive pressure waveforms are displayed only when the transducer is connected to the module.

Waveforms are always evenly spread to fill the entire waveform area. Whenever there are less than 6 waveforms configured on the screen, the remaining waveforms are enlarged.

Changing the waveform to another also changes the numerical field to the right of the waveform.

When you use 5-lead ECG measurement, up to three different ECG leads can be displayed simultaneously in different fields.

MonitorSetup

Waveform Fields

Lower Field 1

Previous Menu

Change waveform in field 2.Select OFF to clear field.

Screen Setup

Resp OFF

Pleth

Resp

ECG1

Pleth

CO2

IBP1

IBP2

OFF

Lower Field 2

Lower Field 4

Lower Field 3

Lower Field 5

Lower Field 6

IBP2

IBP1

Combine Pressures NO

ECG2

CO2

Monitor setup

6-11

Modifying digit fields

Patient data may be displayed in up to four digit fields, located in the lower part of the screen. The fields are numbered from left to right.

Figure 6-3 Digit field

You may change the contents of each field, or turn them off individually. Before modifying the digit fields remember to check that the desired parameter module is plugged in.

1. Press the Monitor Setup key

2. Select Screen Setup - Digit Fields and select the paramters.

If a digit field is turned OFF, the remaining digit fields are enlarged to fill the space.

NOTE: Choosing the same parameter in the waveform and digit field makes the previously chosen field disappear.

MonitorSetup

Dight Fields

Lower Field 1

Previous Menu

Change contents of lower digitfield 1. Select OFF to clearfield.

Screen Setup

NIBP

T1+T2

CO2

Lower Field 2

Lower Field 4

Lower Field 3

CO2

AA

O2

Gases

MAC

Balance

Resp

- More -

- More -

Entropy

- More -

Temp

Resp

T1+T2

T1

T2

Battery

OFF

Entropy


6-12

Modifying split screen

You can split Normal Screen so that one part continuously displays trend data.

To select a split screen view:


2. Select Screen Setup.

3. Select Split Screen and choose from the options: Trend or None.

Figure 6-4 Split screen view

Modifying the minitrend length

You can choose to view minitrend data from the last 5-minute or 30-minute period next to the parameter’s waveform field. The 5-minute minitrend is updated every 10 seconds, and the 30-minute minitrend once every minute.

To modify the minitrend length:



3. Select Minitrend Length and choose 5 min or 30 min.

MonitorSetup

Monitor setup

6-13

Other adjustable screen features

Changing sweep speeds

You can change the speed of the waveforms on the screen. The selections are Fast (6.25 mm/s) and Slow (0.625 mm/s). For hemodynamic parameters, the selections are 12.5, 25 and 50 mm/s. Slow waveforms have a sweep speed one tenth of normal, for a full screen sweep. Slow waveforms show amplitude changes better than fast waveforms.


2. Select Sweep Speeds, select the parameter and adjust the value.

Displaying pulse rate

Combined heart rate and pulse rate can be displayed next to the ECG waveform. The current HR source is displayed with bigger font and the heart rate symbol flashes next to it.

1. Press the ECG key.

2. Select ECG Setup.

3. Select Display with HR and PR, PVC or None.

Changing parameter colors

You can select the color of each parameter to be yellow, white, green, red, blue, orange and violet. To change the color:



3. Select Colors.

4. Select the desired parameter and the color.


6-14

Changing the recorder and printer settings

Recorder settings

1. Press Print/Record.2. Select Record Waveforms.

• Select Waveform 1 and select a parameter or select OFF. Then select Waveform 2 and Waveform 3 and their parameters. You can record up to three waveforms simultaneously. If you wish to record only one waveform, select the other waveform fields OFF.

• Select Start on Alarms - Yes to start automatic strip chart recording when the following alarms reach the red alarm level (NO is the default):

− with VSP software license: bradycardia, tachycardia, asystole, Art high/low, V Fib, V Tach

• Select Delay and OFF or 12 s. If the recording delay is OFF, the recording starts when an event occurs and continues for 30 seconds or until manually stopped, or until the recorder runs out of paper. If the delay is 12 seconds (default), the recording starts when an event occurs and the 12 seconds prior to the event are recorded from the recorder memory. The recording continues for 18 seconds if the length has been set to 30 seconds or until the recorder runs out of paper.

• Select Paper Speed and 1, 6.25, 12.5, or 25 mm/s (default).

• Select Length and choose 30 s (default) or Cont.

Print/Record

Monitor setup

6-15

3. Select Record Trends.

• Select Trend Resolution and every 1 min, 5 min, 10 min (default) or 30 min. This setting is for numerical trends.

• Select Num Trend Type and Num. (default) or Tab. as the format of the numerical trend recorded.

• Select Graphic. Trend 1 and select the parameter and then do the same for Graphic Trend 2. These settings define the graphical trends recorded in upper field and lower field. You can record graphical trends of two parameters.

Printer settings

1. Press the Print/Record.2. Select Print Graphical

3. Select Page 1 (default), 2, 3, 4, the ones you want to print.

4. Select Hours/Page for how many hours will be printed on one page: .1, 2 (default), 4, 6, 8, 10, 12, 24, 36, 48 or 72 hours on one page.

5. Select End Time, printing starts from selected end time

6. Select Trend Length and select hours to be printed: 1, 2, 4, 6, 8 (default), 10, 12, 24, 36, 48 or 72 hours.

Print/Record

Record Trends

Record Numerical

Num. Trend Type

Graphic Trend 2

Previous Menu

5 min

Num

NIBP

HR

IBP1

IBP1

Change graphical trendrecorded in upper field.

Record & Print

Trend Resolution

Record Graphical

Graphic Trend 1

SpO2

HR

ST

IBP2

Pleth

-More-

CO2

Print Graphical

Print Graphs

Page 2

Hours/Page

End Time

Trend Length

Previous Menu

√

8 h

2 h

8:59

Print selected graphical trendpages to laser printer.

Record & Print

Page 1

Page 3

Page 4

Printer Connection None

Print/Record


6-16

Configuring trends and snapshot

Changing default trend

You can select graphical or numerical trends to be displayed by default:



3. Select Trends & Snapshot - Default Trend

Configuring trend pages

You can change the parameters on the trend fields:



3. Select Trends & Snapshot - Graphical Trends.

4. Select the trend page that you want to change.

5. Select graphical parameters for each field.

The field numbers start from the top of the screen. Select one parameter for each field on the trend page, or turn the field OFF. When all the fields are OFF, the page is displayed with empty fields. The time scale and page number appear at the bottom of the page.

Field 1-5 can be displayed on screen and Field 6 can be printed.

If several similar fields are selected on top of each other, they form one higher field. Equal fields cannot be defined separate to each other.

NOTE: You cannot make changes in numerical trend page configuration.

Trends & Snapshot

Default Trend

Previous Menu

Graph

Change default trend type:graphical or numerical.

Install/Service

Graphical Trends

Snapshot

MonitorSetup

Monitor setup

6-17

Configuring snapshots

You can change the snapshot settings:



3. Select Trends & Snapshot - Snapshot

• Field 1 – Field 6: Select to display waveform, graphical trend or numerical trend. Field 1-5 can be displayed on screen and Field 6 can be printed.

• Create on Alarms: Select YES (default) to create automatic snapshots for Tachy, Brady, Art high, Art low alarms.

NOTE: If you need arrhymia alarms to trigger snapshot, please set up in ECG arrhymia alarms menu, see "Adjusting arrhythmia alarm settings" page 11-16.

• Automatic Print:

− ALL to print all the snapshots immediately after creation.

− ALARMS to print snapshots created on alarms and arrhymia alarms if create snapshot selected YES.

− NO to print only on request. NOTE: Network laser printer only.

Setting trend length and scales

Press Pt. Data & Trends.

• Select Trends - Graphical - Time Scale and select 20min, 1h, 2h (default), 4h, 6h, 8h, 10h, 12h, 24h, 36h, 48h or 72h.

• Select Trends - Graphical - Trend Scales and adjust the scales. You can change the scale for HR, ST, PVC, CPP, SpO2 and temperature trends.


6-18

Using NetworkUse the CAT-5 network cable to connect the monitor to the network.

1. Make sure that the power is switched off.

2. Connect one RJ-45 connector to the network port at the back of the monitor.

3. Connect the other RJ-45 connector to the corresponding port on the wallbox.

4. Switch on the power. Confirm that the network symbol and 'Network: XXX' message are displayed in the upper part of the screen.

NOTE: If any problems or need advanced configuration, please ask the GE service personnel to support.

Demo ModeThe Demo Mode is designed for training and demo of operation before use. Under Demo Mode, the monitor displays the main vital signs values and waveforms. No need accessories, central station or any other peripheral equipment connect to the monitor while in Demo Mode.

NOTE: All the values and waveforms the Monitor displays are fictional.

NOTE: The Demo Mode is only designed for the use of training and demo of operation. It is not intended for clinical use or patient monitoring and diagnosis.

The Demo Mode menu is under service menu of the monitor, it’s need password to enter. Please consult the qualified service personnel or refer to the Technical Reference Manual to open and close the Demo Mode.

7 Trends

Trends and OCRG

7-1

7 Trends and OCRG

Safety precautions

Caution

• Snapshot waveforms are in some cases drawn from compressed data that may not allow perfect reconstruction. Verify diagnostic waveform measurements with the waveform data from realtime graph strips.

OverviewThe monitor displays two types of trend data: graphical and numerical. The monitor collects graphical and numerical trend data automatically from trended variables.

The graphical trend time scale varies from 20 minutes to 72 hours. With the 20 minute trend length, the displayed time period is 30 minutes and the resolution 10 seconds. With trend lengths from one to 72 hours, the displayed time period is 72 hours and the resolution is one minute.

You can view the trends through Pt.Data & Trends - Trends, or you can select graphical minitrends to be displayed continuously next to the waveform fields (Monitor Setup – Screen Setup – Split Screen).

Trended parameters

− Electrocardiography (HR, ST, PVC)

− Invasive pressures (IBP1, IBP2, CPP)

− Non-invasive blood pressure

− Oxygen saturation (SpO2)

− Gases (CO2, O2, N2O, AA, Resp, Balance)

− Impedance respiration (Resp)

− Temperatures (T1, T2)

− Entropy

Trend data is stored in the memory for 15 minutes after turn off the monitor.


7-2

Most common tasks

Displaying trends and activating the Trends menu

• Press the Pt.Data & Trends key and select Trends.The most recently displayed trend (graphical or numerical) is displayed together with the Trends menu.

Scrolling time with trend cursor 1. Turn the Trim Knob to move the Cursor to the time you want.

2. Numeric measurement values of that time are displayed in the graphical trend next to the cursor.

3. Push the Trim Knob to return to the menu.

Scrolling pages to see more parameters

• Select Scroll Pages and turn the Trim Knob to move from one page to the other.

Changing the time scale 1. Select Time Scale.2. Select the trend time (20 min or 1, 2, 4, 6, 8, 10, 12, 24,

36, 48, 72 hours).

Selecting numerical, graphical trends or a snapshot to the screen

• Select Graphical, Numerical or Snapshot.

Changing trend scales • Select Trend Scales.

Viewing OCRG snaphsot in Neonatal mode

• When patient mode is Neonatal. Press the Pt.Data & Trends key and select OCRG Snapshots.

Viewing realtime OCRG in Neonatal mode

• When patient mode is Neonatal. Press the Pt.Data & Trends key and select OCRG Realtime.

Printing trends • To print the currently viewed trend data, select Graphical or Numerical and then Print Page.

• To print all the graphical trend data, press the Print/Record key and select Print Graphical – select page - Print Graphs.

Recording trends • To record numerical trends, press the Print/Record key and select Record Trends - Record Numerical.

• To record graphical trends, press the Print/Record key and select Record Trends - Record Graphical.

Erasing trend history 1. Press the Admit/Discharge key.2. Select Discharge - Yes.

Selecting minitrend as split screen option

1. Press the Monitor Setup key.2. Select Screen Setup and Split Screen – Trend.

Trends and OCRG

7-3

Minitrend view

Figure 7-1 Minitrend view

You can split the Normal Screen page so that one fourth of the screen, on the left hand side, continuously shows graphical minitrends beside waveforms. Note that the split screen option is available only when the Normal Screen page shows waveforms.


7-4

To select a split screen view:



3. Select Split Screen and Trend.

Minitrend length

You can choose to view trend data from the last five minutes or the last 30 minute period. The five minute minitrend is updated every 10 seconds, the 30 minute minitrend is updated once every minute.

To modify the split screen trend view:



3. Select Minitrend Length and choose 5 min or 30 min.

Removing minitrend

To remove the minitrend from the screen:



3. Select Split Screen and None.

MonitorSetup

Trends and OCRG

7-5

Graphical trend view

Figure 7-2 Graphical trend page

(1) Trends menu

(2) Measurement trend field

(3) Real time ECG

(4) Numeric value of a measurement at the trend cursor point

(5) Trend page number

(6) Snapshot point

(7) Time and marker field

7

1 2 3 4

56


7-6

Symbols

Trend bar, parameter scale to the left.The gap shows the blood pressure mean value.

NIBP trend bar

Dotted vertical line across the trend field indicates change, such as ST relearning or zeroing of an invasive blood pressure channel/changing a label.

___________

A blue, white or red line above the marker field indicates the following things:

Blue line indicates the amount of data on the screen: the left end of the line shows the starting point of the trend data gathering. The right end of the line shows the last moment the data has been gathered.

White line indicates which proportion of the data you see on the screen. If the line is on the left, there is more data to see after the current view. If the line is on the right, there is more data to see before the current view. If the line is in the middle, there is more trend data to see towards the beginning and the end of the case.

Red line indicates the availability of trend data with 10 second resolution (available for the last 30 minutes only).

Trends and OCRG

7-7

Graphical trend pagesGraphical trends contain:

− Four pages

− Six fields on each page

Five fields are usually visible. The lowest (sixth) field is replaced by digit fields on the screen. All six fields are printed.

Scale, label, unit and color of the parameter follow the real time waveform setting for each parameter. For HR, ST, PVC, CPP, SpO2 and temperature you can select the scale through Pt.Data & Trends - Trends - Trend Scales.

Changing trend length and resolution

1. Press the Pt.Data & Trends key.

2. Select Trends - Time Scale.

3. Select the trend length.

Table 7-1 Trend length and resolution

Trend length on the screen

Resolution Trended time period

20 minutes 10 seconds last 30 minutes

1 hour 1 minute last 24 hours

2 hours 1 minute last 24 hours

4 hours 2 minutes last 24 hours










7-8

Moving on graphical trend pages

To see more parameters on other pages:

• Select Scroll Pages in the Trends menu.

Numeric measurement values for trended parameters are displayed next to the cursor. The cursor indicates the time when these values have been measured. To change the cursor location:

1. In the Trends menu, select Cursor.

2. to move the cursor.

3. to return to the menu.

To scroll the time, move the cursor past the right or left border of the trend.

Recording and printing

Recording1. Press the Print/Record key.


3. Select Record Graphical.

The recording time of a trend corresponds to the time scale of the graphical trends. You can choose the time scale (20 minutes to 72 hours) in the trends menu.

To select the parameters for graphical trend recording:

1. Press the Print/Record key.


3. Select Graphic Trend 1 and choose the parameter in the opened adjustment menu.

4. Select Graphic Trend 2 and choose the parameter in the opened adjustment menu.

PrintingYou can print all the graphical trends gathered:


2. Select Print Graphical.

3. Select the page and Print Graphs.

Factory default parameters

The default graphical trend setup varies according to mode types. For details refer to “Default Configuration Worksheet”. To change these settings, see section "Monitor setup."

Trends and OCRG

7-9

Numerical trend view

Figure 7-3 Numerical trend page

(1) Trend menu

(2) Page name and number

(3) Real time ECG

(4) Real time digit fields, if the Normal Screen shows waveforms

1 2 3 4


7-10

Numerical trend pagesNumerical trends contain:

− four pages of maximum 72 hours trend information

− real-time ECG on top of each page

Resolution is five minutes.

Moving between numerical trend pages

• Use the Trim Knob to scroll the trend in vertical direction.

When the highlight reaches the top or the bottom of the view, next five minutes of information appear.

Recording and printing

Recording Parameters for recording are chosen during configuration. To change the parameters, see section "Monitor setup."



3. Select Record Numerical.

Printing 1. Press the Pt.Data & Trends key and select Trends.

2. To print all the numerical trend data, select Numerical - Print Page.

Trends and OCRG

7-11

Factory default parameters

You cannot change the contents of numerical trend fields. The parameter units follow the real time waveform settings of each parameter.

Page 1: Vital parameters

Mark Time HR SpO2 NIBP sys/dia

NIBPmean

Artsys/dia

Artmean

CVPmean

CO2ET

Page 2: Hemodynamics

Mark Time IBP1Art

IBP2CVP

C.O. REF PCWP

Page 3: Gases

Mark Time CO2ET/FI

O2ET/FI

N2OET/FI

HALET/FI

BalETI

MAC RR

Page 4: Temperatures and saturations

Mark Time T1 T2 Tblood SpO2 SvO2

Page 5: Adequacy of Anesthesia

Mark Time RE SE BSR


7-12

SnapshotsA snapshot is a frozen frame of preconfigured waveforms or trends saved in the monitor memory. A snapshot can contain waveforms, numerical trends and graphical trends. You can take up to 10 snapshots. It is automatically numbered. When graphical trend view, snapshots mark “s” in mark field; when numerical trends view, the number appears in the column 'Mark'.

For configuration, see "Configuring snapshots" in section "Setting up the monitor before use".

Snapshot view

A snapshot includes 15 seconds of a waveform, and/or a graphical trend from the time period that corresponds to the graphical trends’ timescale, and/or numerical trends.

(1) Trends menu

(2) Real time ECG

(3) Waveform snapshot

(4) Time of the snapshot. If created on alarm, the cause of the alarm is displayed.

(5) Real time digit fields, if the Normal Screen shows waveforms

(6) Page number

(7) Cursor

(8) Graphical trend snapshot

(9) Time and marker field

5

1 2 43

9 8 7 6

Trends and OCRG

7-13

To create a snapshot manually:

• Press the Take Snapshot key.

To create automatic snapshots:

The monitor can automatically take snapshots on Brady, Tachy and Art sys/dia/mean high/low alarms if automatic snapshot creation is enabled. For enable this function, see "Configuring snapshots" in section "Setting up the monitor before use".

Viewing and printing snapshots

To view snapshots:1. Press the Pt.Data & Trends key.

2. Select Trends - Snapshot - Next Snapshot.

Turn the Trim knob to move to the cursor in the time and marker field. When the cursor hits the saving time of a snapshot (marked with an “S” in the time axis), the snapshots that were saved at that time appear.

In the waveform field, you can see the time the snapshot was created. Five fields can be displayed on the snapshot page, and six fields can be printed.

In the trend field, the graphical trend view or the numerical trends view are displayed according to the snapshot’s configuration.

To print snapshots:1. Press the Pt.Data & Trends key.

2. Select Trends - Snapshot.

3. Select Print Page.

NOTE: Network laser printer only.

NOTE: If the graphical trend time scale is 20 minutes, the displayed time period is 30 minutes. So after 30 minutes of snapshot creating, the trends for that time will disappeared.


7-14

OCRGThe monitor support 8 minutes OCRG (oxycardiorespirogram) function in the NEONATAL mode. The OCRG subsystem provides services to view and review specific high resolution trends, high resolution beatto- beat HR, high resolution beat-to-beat SpO2 and compressed respiration waveform - simultaneously in the same view. Two types of views are provided: OCRG Snapshot view and OCRG Realtime view.

View OCRG snapshot

The OCRG snapshot is created when OCRG event is triggered. Refer to "Setup OCRG" for OCRG event setup. The monitor can store up to 70 OCRG snapshots. OCRG snapshot includes the trend data 6 minutes before and 2 minutes after the OCRG event. If multiple OCRG events are triggered within 2 minutes, they will be detected as one OCRG event. During this time, only the first OCRG event will trigger OCRG Snapshot creation.

To display the OCRG snapshot record.1. In NEONATAL mode, Press the Pt.Data & Trends key.

2. Select OCRG Snapshots.

You can select Scroll Snapshots and scroll left and right with the Trim Knob to see OCRG snapshots earlier. The trigger time and condition also showed on the left menu area.

You can select Remove Menu to hide the left side menu. Press the Trim Knob to show the menu.

View realtime OCRG

To display the realtime OCRG.1. In NEONATAL mode, Press the Pt.Data & Trends key.

2. Select OCRG Realtime.

You can select Remove Menu to hide the left side menu. Press the Trim Knob to show the menu.

Setup OCRG

The OCRG event is that any one of HR, SpO2, Apnea is out of OCRG triggering limits range. You can setup these limits.

Adjust OCRG alarm limits1. In NEONATAL mode, Press the Pt.Data & Trends key.

2. Select OCRG Setup.


Adjust short apnea time1. In NEONATAL mode, Press the Pt.Data & Trends key.

2. Select OCRG Setup.

3. Select Short Apnea.

NOTE: The default short apnea time is 20 seconds.

Trends and OCRG

7-15

Erasing trend data and snapshotTrends are erased when you discharge the patient.

1. Press the Admit/Discharge key.

2. Select Discharge.

3. In the opened window, select Yes to erase the trends and to discharge the patient.

Showing alarm history• Press the Pt. Data & Trends key and select Alarm History. This displays a list of the

last 20 alarms that have reached the yellow, red and cyan alarm level. The time and type of occurrence are displayed next to the alarm list items.

Admit/Discharge


7-16

8 Print and record

Print and record

8-1

8 Print and record

OverviewYou can manage recording and printing via the Print/Record menu. For recordings, you need a extension rack with recorder, and for printouts you need connect to network and a laser printer (PCL5 compatible, min. 2 MB memory). The monitor is connected to a laser printer via network.

Recording The recorder:

− Near real-time recording of up to three user-selectable waveforms simultaneously

− Selectable paper speed

− Prints up to 72 hours of graphical and numerical trends

− Numerical printout with annotation when one or two waveforms are printed

− Numerical trend resolution selectable

− Configurable to create a 30-second recording automatically on alarm

NOTE: Recording on thermal paper may be destroyed when exposed to light, heat, alcohol, and so on. Take a photocopy for your archives.

Direct function keys

There is a key for starting and stopping recorder on the Command Board:

For starting or stopping recording waveforms to local.NOTE: Functional with the recorder only.

Recorder

RecorderStart/Stop


8-2

Recording waveformsYou can record three waveforms to a local recorder as you set up.

To start the recording, do one of the following:

• Press the Recorder Start/Stop key, orPress the Print/Record key and select Record Waveforms - Record to Local.

To stop the recording:

• Press the Recorder Start/Stop key, orPress the Print/Record key and select Record Waveforms - Stop Waveforms.

You can also use the network recorder by selecting Record to Net. The network recorder uses the settings of the central station.

Print/Record

Print and record

8-3

Sample of waveform recording

(1) Recorder speed

(2) Scale

(3) Selected waveform

(4) Date

(5) Time

NOTE: Waveform scaling follows the displayed parameter scaling, when applicable.

Selecting waveforms for recording

You can select which waveforms and how many of them you want to record.


2. Select Record Waveforms.

3. Select Waveform 1 and a parameter for it, or select OFF.

4. Select Waveform 2 and 3 and their parameters.

You can record simultaneously up to three waveforms. The following menu figure shows which parameters have recordable waveforms.

Print/Record

Record WaveformsRecord to Net

Waveform 1

Start on Alarms

Delay

Paper Speed

Previous Menu

ECG1

OFF

25 mm/s

OFF

ON

12 s

Change waveform recordedin upper field.Select OFF to clear field.

Record & Print

Record to Local

Waveform 2

Waveform 3

Length 30 s

ECG1

ECG2

ECG3

IBP1

IBP2

Pleth

CO2

Resp

OFF


8-4

Changing the paper speed

To see the waveforms more clearly or more generally, you can change the paper speed. The recorder speed can be 1, 6.25, 12.5, or 25 mm/second.



3. Select Paper Speed.

Print/Record

Print and record

8-5

Controlling the recording time

You can adjust the recording time to be 30 seconds or continuous, which means that the recording continues until the recorder runs out of paper.



3. Select Length and choose 30 s or Cont.

The default setting for the recording time is 30 seconds.

NOTE: When recording is activated by alarms, the recording time is always 30 seconds.

Selecting the recording delay time

If the recording delay time is set to OFF, the recording starts when an event occurs and continues for 30 seconds or until it is manually stopped, or until the recorder runs out of paper. If the delay time is set to 12 seconds (default), the recording starts when an event occurs and the 12 seconds prior to the event are recorded from the recorder memory. The recording continues for 18 seconds if the length has been set to 30 seconds or until the recorder runs out of paper.

To change the delay:



3. Select Delay and OFF or 12 s.

The recording can be started manually, or automatically when certain alarms occur. The automatic alarm recording is explained in the following.

NOTE: When recording is activated by alarms, the delay is always 12 seconds.

Print/Record


8-6

Recording on alarms

An automatic strip chart recording is activated when the following alarms reach the red level: Asystole, Tachy, Brady, Art Sys/Dia/Mean high, Art Sys/Dia/Mean low, V Fib, and V Tach. When recording is activated by alarms, the recording time is always 30 seconds and the delay always 12 seconds.



3. Select Start on Alarms and Yes.

The following alarms start recording:

All alarm recordings are marked with the alarm source.

Alarm Recorded parameters

AsystoleTachy/BradyArt Sys/Dia/Mean High/LowV FibV Tach

ECG1 + Art waveforms, 25 mm/sECG1 + Art waveforms, 25 mm/sECG1 + Art waveforms, 25 mm/sECG1 + Art waveforms, 25 mm/sECG1 + Art waveforms, 25 mm/s

Print/Record

Print and record

8-7

Recording trendsTo record trends:


2. Select Record Trends – Record Numerical or Record Graphical.

3. Stop recording by selecting Stop Numerical or Stop Graphical.

You can record numerical, graphical or tabular trends.

Recording numerical trends

Since the contents of the numerical trends are preconfigured, you cannot choose the parameters or change their order.

The following parameters are printed in the numerical trend record:

Figure 8-1 Numerical trend printout

For pressures, either Sys/Dia or Mean are recorded depending on the digit format selected in the pressure setups.

Parameter Printed values and units

HR and SpO2 /min and %

NIBP Sys/Dia mmHg

IBP1 ‘Art’ Sys/Dia or mean mmHg

IBP2 ‘CVP’ Sys/Dia or mean mmHg

T1/T2 Celsius or Fahrenheit

CO2 ET/FI %, kPa or mmHg

O2 ET/FI %, kPa or mmHg

AA ET/FI %, kPa or mmHg

Resp Rate /min


8-8

Selecting the format for the recorded numerical trendsYou can select the format for the recorded numerical trend to be either Num. (vertical) or Tab. (horizontal):

1. Press the Print/Record key and select Record Trends.

2. Select Num Trend Type and Num. or Tab.

Changing resolutionTo select the resolution of a numerical or tabular trend record:

1. Press the Print/Record key and select Record Trends.

2. Select Trend Resolution. Choices are: every 1 minute, 5 minutes, 10 minutes, 30 minutes.

Tabular trend format

Table 8-1 Tabular trend printout

Selecting graphical trends

You can record graphical trends of two parameters.

To select the parameters for the graphical trends:



3. Select Graphic Trend 1 or Graphic Trend 2.

The following figure shows which parameters have graphic trends that you can record.

Parameter Printed values and units

HR

SpO2

NIBP or Art

CO2

bpm

%

sys/dia mmHg

Et%, mmHg or kPa

Print/Record

Record Trends

Record Numerical

Num. Trend Type

Graphic Trend 2

Previous Menu

5 min

Num

NIBP

HR

IBP1

IBP1

Change graphical trendrecorded in upper field.

Record & Print

Trend Resolution

Record Graphical

Graphic Trend 1

SpO2

HR

ST

IBP2

Pleth

-More-

CO2

Pleth

O2

CO2

N2O

HAL

Entropy

Resp

T1+T2

-More-

Print and record

8-9

Inserting recorder paperTo load paper in the reocrder:

1. Open the recorder door by pressing the door latch.

2. Remove the paper core.

3. Place a new paper roll between the tabs of the paper holder. The paper should unroll from underneath the paper roll.

4. Begin to close the door while still holding onto and pulling about 6 to 8 cm of paper; then close the door completely. You should hear a snap as the door latch is engaged.

5. Attempt to print out a annotated strip by pressing the Recorder Start/Stop key, to make sure you load paper in the correct direction.

Figure 8-2 Inserting recorder paper


8-10

PrintingThe monitor support the laser printer in S/5 network. The user can directly print the patient data from the laser printer when the monitor and printer are correctly configured on iCentral Server.

The monitor don’t support the laser printer in CARESCAPE Unity network. The user can print the patient data from the CIC central station only.

You can print to a laser printer:− Graphical or numerical trends− SnapshotsYou can print several pages or trend data through the Print/Record menu.

NOTE: Before you start printing, check that the printer is operational.

Printing settings

For printing setup details, please go to Chapter “6 Monitor Setup”, see Printer settings" page 6-15.

Printing currently displayed screen contents

To print a trend view

1. Press the Pt.Data & Trends key.

2. Select Trends - Graphical/Numerical.

3. Select the desired trend page with Scroll Pages.

4. Select Print Page.

Printing all the information

To print several pages of graphical trend data:


2. Select Print Graphical.

Changing the printer

If you need to change the printer connection:


2. Select Printer Connection.

3. Select the printer from the list.

The default printer is set during configuration, see section "Monitor setup."

Other adjustable featuresTo adjust the ECG printout type, default printer connection or default paper size, please, see section "Monitor setup."

9 Cleaning and care

Cleaning and care

9-1

9 Cleaning and care

Safety precautions

Warnings

• Disconnect equipment from power line before cleaning

• If liquid has accidentally entered the system or its parts, disconnect the power cord from the power supply and have the equipment serviced by authorized service personnel.

• Regular preventive maintenance should be carried out annually.

• Do not use unspecified cleaners, materials or chemicals as they may damage device surfaces, labels, or cause equipment failures.

• Do not pour or spray any liquid directly on cables or leadwires or permit fluid to seep into connections or openings.

• Never use conductive solutions, solutions that contain wax, or wax compounds to clean devices, cables or leadwires.

• Do not immerse any part of the device in liquids or allow liquid to enter the interior.

• The decision to sterilize must be made per your institution’s requirements with an awareness of the effect on the integrity of the cable or leadwire.

• Clean the surface of the probe before and after each patient use.

• CABLE/SENSOR AFTER CARE

− Do not immerse sensors or patient cables in water, solvents or cleaning solutions.

− Do not reuse sensors intended for single patient use.

− Do not sterilize sensors or patient cables by irradiation, steam, or ethylene oxide.

− Clean the surface of the probe before and after each patient use.

− Allow sensor and cable to dry completely after cleaning. Moisture and dirt on the connector can affect the measurement accuracy.

− If a probe is damaged in any way, discontinue use immediately.

− Inaccurate SpO2 data can result if a sensor is past its useful life.

− A damaged sensor or a sensor soaked in liquid may cause burns during electrosurgery.

• Since calibration gas contains anesthetic agents, always ensure sufficient ventilation of the room during calibration.

• Inaccurate readings due to:

− use of unapproved accessories

− reuse of single-use accessories

− affect on pressure strong scavenging suction

• The user may only perform maintenance procedures specifically described in this manual.

• On the gas module indicates that airway gases should be calibrated every six months in normal use and every two months in continuous use.


9-2

• Do not autoclave any part of the system with steam or sterilize with ethylene oxide.

• Do not disinfect or open the water trap cartridge. Do not touch the water trap membrane. The hydrophobic membrane is damaged if any cleaning is attempted other than rinsing with water.

Cautions

• PACKAGING DISPOSAL - Dispose of packaging material, observing applicable waste control regulations.

• Do not use or store equipment outside the specified temperature, humidity, or altitude ranges.

• DISPOSAL - At the end of its service life, the product described in this manual, as well as its accessories, must be disposed of in compliance with the guidelines regulating the disposal of each product. If you have any questions concerning disposal of a product, please contact GE or its representatives.

OverviewFor safe and reliable function and operation of the monitor, regular care has to be carried out according to the instructions in this manual and to the maintenance procedures described in the "Technical Reference Manual”.

If the monitor does not function as it should and troubleshooting cannot solve the problem, contact your service or sales representative. Do not perform any other cleaning or maintenance procedures than those described in the monitor manuals.

NOTE: Refer to the accessory package for detailed cleaning instructions.

NOTE: For information regarding materials used in accessories, see the instructions for use for the specific accessory.

Preventive maintenance

Daily and between the patients

• Wipe the monitor and module surfaces.

• Wipe the ECG trunk cable and leadwires, NIBP cuff and cables and SpO2 sensors. Avoid excessive use of liquids.

• Change or sterilize all airway and invasive patient accessories.

• Clean, disinfect or sterilize reusable temperature probes.

• Empty the D-fend water trap whenever half full.

• Check that all accessories, cables and monitor parts are clean and intact.

• Clean the device as described in the “Cleaning” part of this section.

• When you start monitoring, check that the module is firmly in place, the accessories are intact and properly connected, and that you have selected desired parameters to be displayed in digit and waveform fields.

• Check/note the following points regarding different parameters.

Cleaning and care

9-3

Regular checks

If the monitor does not work as described, see section "Troubleshooting." first.

When you start monitoring, check that:• The module is firmly in place.

• Accessories are intact and properly connected.

• You have selected desired parameters to be displayed in the digit and waveform fields.

ECG and impedance respiration• After connecting ECG cable, check that the message 'Leads off' display in waveform field .

NIBP• After connecting NIBP hose, check that the message ‘Adult/Pediatric’ or ‘Neonatal’ will

display in NIBP digital field for several seconds.

Pulse oximetry• After connecting SpO2 cable and sensor, check that the red light is lit in the sensor .

Temperature• After connecting Temp cable and sensor, check that the message ‘Performing temp test:’

will display in Temperature digital field for several seconds.

IBP• After connecting IBP cable and transducer, check that the message ‘InvBP’s not Zeroed’

will display in message field.

Airway gas• Make sure the acquisition module is connected to the monitor.

• After installing the module, ‘Calibrating gas sensor’ will display in gas waveform field for about 1 minutes.

Entropy• Make sure the acquisition module is connected to the monitor.

• Connect the Entropy sensor cable to the module, and check that the “No sensor” message apprears.

Functioning of the alarms• Check that the red, yellow and cyan alarm lights are lit and the speaker gives an audible

beep momentarily when the monitor starts up.

Safety checks for softwareThe GE Healthcare software design controls include performance of a risk analysis using methods consistent with ISO 14971 Medical devices - Application of risk management to medical devices.

The monitor software employs watchdog timers, self-monitoring activities (memory, communication and sensor checks and so on), and power-on self-diagnostics (for example, memory checksums).


9-4

Every two months

• Change the water trap when the ‘Replace D-Fend’ message displays on the screen.

• Perform gas calibration in continuous use, see “Calibrating” in Gas chapter for detail procedures.

Every six months

Gas calibrationPerform gas calibration for airway gas monitoring according to the instructions in the relevant section. If gas measurement is in extensive use, calibration is recommended every two months. See “Calibrating” in Gas chapter for detail procedures

NOTE: Do not wash or disinfect calibration gas sampling lines.

Condition the batteryBattery conditioning is needed if the ‘Condition Battery X’ message is displayed.

Condition the battery by fully discharging and recharging the battery twice according to the following procedure:

NOTE: The patient monitor must be in a discharged state during battery conditioning. Disconnect any acquisition modules from the patient monitor if connected.

1. Turn on the patient monitor. Disconnect the power cord from the wall outlet. Leave the patient monitor on until the battery is fully discharged and the patient monitor turns off automatically.

NOTE: Ignore the ‘Battery Low’ and ‘Battery Empty’ messages when discharging the battery.

2. Reconnect the power cord to the wall outlet and turn on the patient monitor. Leave the patient monitor on until the battery is fully recharged and the orange battery charging indicator LED turns off.

3. Repeat the steps 1 and 2 once.

The battery is now conditioned and ready for use. However if the ‘Condition Battery X’ message is still shown on the screen, replace the battery or contact your service.

Every 12 months

Planned maintenance checkThe annual check according to detailed instructions of the "Technical Reference Manual" requires trained service personnel and appropriate testing tools and equipment.

Calibration check of temperature, NIBP and invasive blood pressuresCalibration check of temperature, NIBP and invasive blood pressures should be performed at least once a year by qualified service personnel as a part of the Maintenance, see "Technical Reference Manual”.

Power interruption

NOTE: Always use the monitor with batteries inserted. Otherwise all trend data and temporary settings are lost if the power cable is detached from the mains.

If the monitor is turned off, patient data and the latest user-made settings remain in the monitor memory for 15 minutes even if the mains power is interrupted. If not, contact service personnel. After 15 minutes, patient data is lost and the monitor returns to the user default settings.

Cleaning and care

9-5

Recycling the monitor battery

When the battery no longer holds a charge, it should be replaced. Remove the old battery and follow your local recycling guidelines.

Changing fuses

1. Remove the power cord if used.

2. Remove the fuse holder by pulling the holder out with screwdriver.

3. If a fuse is blown, replace it with a fuse of the correct type and rating.

NOTE: Only a qualified medical personnel allow to operate.

CleaningThe appropriate cleaning procedure depends on where and how the part or accessory is used and on the patient's condition.

Permitted detergents and disinfectants

− Tap water

− Distilled water

− Ethyl alcohol 99.5%

− Ethyl alcohol 95 to 96%

− Ethyl alcohol 90% + methyl alcohol 10%

− Ethyl alcohol 80%

− Isopropyl alcohol 60%

− Phenol 2%

− Purified benzine

− Chloramine 5%

− Glutaraldehyde 2%

Monitor casing• Wipe with mild hospital detergent solution. Make sure not to leave any liquid spills on any

metal part.

• Let dry completely before connecting to power source.

• Check ventilation holes and clean if necessary.

Modules• Wipe the front panel as any monitor casing.

• Do not wash or immerse module in any liquid.

The internal sampling system of the airway module does no cleaning nor sterilization. The water trap functions as a bacteria filter and there is no reverse flow back to the patient. If the measuring chamber is suspected to be contaminated (for example, gas zero error), the airway module should be serviced by authorized service personnel.

Display• Wipe all splashes immediately with a dry cloth.

• Wipe the LCD display after use with a cloth moisturized with mild detergent solution.


9-6

ECG cables • Wipe the cables with mild detergent solution.

• Avoid excessive use of liquids.

• Disinfect when necessary.

• Allow the product to dry completely after cleaning.

Pulse oximetry sensorsThe GE Healthcare pulse oximetry sensors are latex-free. Take possible patient allergies into account also when selecting the cleaning agent.

1. Detach the sensor from the patient and the monitor.

2. Wipe the sensor with mild detergent solution. Allow it to dry completely before use.

Temperature probes• Clean with mild detergent solution and rinse with water.

• Disinfect or sterilize when necessary.

NIBP cuff hose• The cables and hose can be wiped with mild detergent solution.

• Disinfect when necessary.

NIBP cuffThe NIBP cuffs listed in the “Supplies and Accessories” catalog are latex-free. Take possible patient allergies into account also when selecting the cleaning agent.

• Clean only when necessary. Wash the cuff in mild detergent solution. Do NOT use alcohol.

Invasive blood pressure cables• Wipe the cables with sterile alcohol-based detergent. After cleaning rinse surfaces by

wiping them with a cloth damped with sterile water. Dry with a dry cloth.

Airway adapter• Replace the single use adapter after each patient.

Sampling line• Do not reuse the sampling line. Reusing a cleaned sampling line may affect measurement

results.

NOTE: Do not wash or disinfect calibration gas sampling lines.

Water trapWARNING Do not disinfect or open the water trap cartridge. Do not touch the water

trap membrane. The hydrophobic membrane is damaged if any cleaning is attempted other than rinsing with water.The water trap is based on a hydrophobic membrane, which prevents water and secretions from entering the measuring chamber. Condensed water and saliva are collected into a washable container.

• Empty the water trap container as soon as it is more than half full. With a sample gas temperature of 37°C, a room temperature of 23°C, and sample gas relative humidity of 100 %RH, the water trap should be emptied every 24 hours (applies when the sample gas

Cleaning and care

9-7

flow is within 120 ± 20 ml/min for E-sCO, E-sCAiO and N-CAiO modules, 150 ± 25 ml/min for E-miniC). Follow local hospital’s regulations to dispose the accumulated fluids.

• In anesthesia: Replace the water trap every two months or when the text 'Replace D-Fend' appears.

• In critical care: Replace the water trap every 24 hours, for each new patient, or when the text 'Replace D-Fend' appears.

• When taking a new water trap into use, mark the date on the appropriate label on the water trap cartridge.

• The water trap cartridge is disposable. Do not wash or reuse the cartridge.

To lengthen the lifetime of the monitor and minimize downtime:

• After washing or disinfecting the water trap container, make sure there is no alcohol nor detergent left when used again. Traces of alcohol or other organic cleaning solutions may affect measurement.

• Do not force air or oxygen through the water trap.

• Do not allow smoke and dust to enter the water trap.

• While administering nebulized medication, disconnect the gas sampling line from the patient circuit for 30 minutes.

If the message ‘Sample line blocked’ alarm occurs:

• Replace the sampling line.

• Empty the water trap container. It may be full.

Figure 9-1 Emptying the water trap container

To remove the water trap, push the trigger above the water trap. The water trap is spring-loaded. The message ‘Check D-fend’ is displayed.

• Detach the container from the water trap cartridge by pulling it carefully downward.

• Empty and clean the container.

• Attach the container tightly back into the cartridge.

• Push the whole unit into its housing on the front panel until the latch is set.

• Press the Normal Screen key to restart monitoring. Check that the message ‘Check D-fend’ disappears.


9-8

Other accessories

See the accessory package for instructions for how to clean and check them. Do not reuse single-use disposable accessories.

10 Troubleshooting

Troubleshooting

10-1

10 Troubleshooting

OverviewThe troubleshooting section consists of two parts which together should help you resolve the most common monitoring problems. The parts are "Checklist" and "Messages".

ChecklistCheck the following things before monitoring to ensure that you have remembered to make all essential preparations, and if any problems occur during monitoring. Parameter-specific checklists can be found in the respective parameter sections.

Check that:

• The monitor and its module do not have any visual defects such as cracks or loose parts.

• The batteries are inserted and charged.

• The power cord is connected to an electrical wall outlet and to the monitor.

• The module are pushed properly into the frame and the monitor recognizes the module (parameter is displayed on the screen and menu selections are active).

• Patient connection cables are attached to the module connectors.

• Trends of the previous patient are erased.

• Alarm limits are suitable for the patient.

• The desired measurements have been selected for screen through Monitor Setup – Screen Setup - Waveform Fields or Digit Fields.

• Disposable accessories are not reused.

• Sensors are not expired.

Power interruptionIf the monitor is turned off, trend data and the latest user-made settings remain in the monitor memory for 15 minutes even if the power (mains) is interrupted. After 15 minutes, trend data is lost and the monitor returns to the user default settings (start-up mode).


10-2

Battery indicators

The messages, screen symbols and front panel LED indicators tell the user about the status of the batteries. For LED indicators, consult the table below and for messages, see section “Troubleshooting.”

Table 10-1 Battery indicators

Screen symbol Explanation Front panel battery LED indicators

Monitor is battery powered. Batteries are fully charged; the size of the green bar indicates the charging level.

Orange dark

Green lit

Monitor is battery powered. Battery A is empty, battery B charge is ok.

Orange dark

Green lit

Monitor is battery powered. Battery A failure, battery B is full.

Orange flashing

Green lit

NOTE: If both batteries fail, the green battery LED is dark.

Monitor is mains powered. Battery A is being charged (white bar), battery B is already charged.

Orange lit

Green dark

No battery is in the monitor.

Orange dark

Green dark

Troubleshooting

10-3

MessagesTable 10-2 Messages

Message Explanation What to do

Agent Mixture Mixture of halogenated agents is detected.

• Check the ventilator and agent vaporizer settings.

Alarm setup changed from Central

Alarm limits or arrhythmia alarm priorities have been changed using the Central.

• Check the alarm limits and the arrhythmia alarm priorities; see "Alarms" and "Troubleshooting".

Alarms silenced from Central Alarms have been silenced using the Central.

• If required, turn on the alarms through Alarms Setup – Audio ON/OFF – Activate Alarms.

Alarm volume changed The network connection is lost, and the local alarm volume is increased

• Readjust volume if desired.

Apnea/No breath No breath detected for a period. • Check the patient status.

• Check the ventilator and breathing circuit.

Arrhythmia paused Arrhythmia paused in ECG. • Check the patient status.

• Check the electrodes.

Art disconnect/ABP disconnect/UAC disconnect

IBP line disconnect. • Check the Art/ABP/UAC line.

• Check the patient status.

Asystole No QRS detected in ECG. • Check the patient status.

• Check the electrodes.

Battery A temperature high,

Battery B temperature high

Battery temperature too high. • Replace the battery.

• If the problem persists, contact authorized service personnel.

Battery empty, Battery low About 20 minutes of battery operation time left.

• Replace the battery or connect the monitor to power outlet.

Brady HR is equal to or below the lower alarm limit.


Call service: UMBC error UMBC error • Contact authorized service personnel.

Check D-fend The water trap is not attached. • Check that the water trap is properly attached to the module. If the problem persists, contact authorized service personnel.

Check OCRG New OCRG snapshot is created • Check OCRG if desired.


10-4

Check NIBP NIBP measurement affected by low blood pressure and pulsation, or a change in patient's condition.


• Check the measurement setup.

• Check the cuff.

Check sample gas out Sample gas outlet is blocked. • Remove blockage from the sample gas outlet.

Check SpO2 probe SpO2: There is no detectable SpO2 signal, the sensor is faulty or it is detached from the patient.

• Check the sensor and connections.

Condition Battery A, Condition Battery B

The batteries need condition • Condition the battery according to the instructions of the external charger.

Creating OCRG snapshot In neonatal mode, new OCRG is creating.

• Check OCRG if desired.

Default settings returned Monitor return to Factory settings. • Check your power and reset the settings.

DEMO MODE The demo mode is active • Contact authorized service personnel to quit the demo mode if desired.

ECG module error The Hemo module has a communication error.

• Contact authorized service personnel.

End of 20 min trend data There is more trend data available but not with this resolution.

• Change the time resolution in graphic trends to be more than 20 minutes (e.g., 1 hour, 2 hours).

• Scroll the trends to see past data.

Entropy cable off The Entropy sensor cable is not connected to the Entropy module.

• Connect the Entropy cable to the Entropy module.

Entropy sensor off The Entropy sensor is connected to the cable but not attached to the patient.

• Check the sensor is properly attached to the patent.

Entropy sensor check failed The sensor has not passed the impedance check.

• Check sensor placement and attachment.

• Press each electrode in the sensor.

• Replace the sensor.

Frame temperature high The temperature is too high inside the frame

• Make sure the sufficient ventilation.


• Turn off the monitor, waiting for cool down.

Freq PVCs Physiological alarm. • Check the patient status.


Troubleshooting

10-5

Incompatible SpO2 Probe The SpO2 sensor is not compatible. • Replace the sensor. See the “Supplies and accessories” manual


InvBP’s not zeroed One or both InvBP channels have not been zeroed.

• Zero the channel indicated or zero both channels.

Leads off ECG cable is disconnected. • Check the ECG cable and connections.

License invalid License is invalid when monitor is startup.


Loading from network Loading mode from network. • Waiting until loading finished

Loading failed Load mode from network has been interrupted.

• Check device or network cable connections.

• Load again without interruption, if still failed, contact authorized service personnel.

Long measurement time NIBP measurement time too long. • NIBP: reduce patient’s motion.

Low gas sample flow Sample flow is less than 80% of the module’s nominal flow value. This can happen if nebulized medications are given without disconnecting the sample line.

• Check the sample line.


Mark X A snapshot is created. • Check the snapshot if desired.

Memory ERROR Memory issue • Contact authorized service personnel.

Mode data reset Error when loading settings from the flash file.z


Module power supply overload

Parameters may not be working properly due to a technical fault in the monitor.


Multiple agents present Identify more than one anesthetic agents when use N-CAiO module.

• Check if the anesthetic agents are more than one.


Network: xxx Network is connected. • Network is connected.

Network down: xxx Network cable is not connected.

The Central is shut down.• Check the network cable and

central station, try to re-establish the connection


Network recording... Network recorder has been started. • Wait unitl the recording is finished.



10-6

NIBP call service error NIBP error • Contact authorized service personnel.

NIBP manual Autocycling mode is interrupted because of an air leak or loose cuff.

• Check the NIBP setup and restart autocycling.

NIBP cuff loose Cuff is not attached to the patient or it is too loose. The hose is not connected to the module.

• Check cuff and hose.

NIBP cuff occlusion Tubes or hose are kinked. • Check tubes and hose.

NIBP cuff overpressure Cuff is squeezed during measurement and pressure safety limits are exceeded.

• Check cuff, hose and tubes.

• Restart measurement.

No battery backup The monitor has the battery option but there is no battery inserted.

• Insert a battery.

No Entropy sensor The sensor is not connected to the cable.

• Check connection between Entropy sensor and cable.

No xx transducer Transducer or channel x cable disconnected.

• Connect the transducer or the cable.

No SpO2 probe There is no SpO2 probe. • Check connection between the SpO2 sensor and module.

No SpO2 pulse Pulse signal is poor. • Try other measurement sites.

No printer selected There is no printer selected on the monitor.

• Select a printer, see section "Print and record." chapter.

Patient discharged The patient has just been discharged. • For more information, see section "Starting and ending." chapter.

Patient admitted The current patient has just been admitted.

• For more information, see section "Starting and ending." chapter.

P1 over range

P2 over range

Measured pressure is out of alarm limit’s max value


P1 under range

P2 under range

Measured pressure is out of alarm limit’s min value


Printer error Printer is not working properly. • Check that the network printer is operational.

Printing... Printing network printer has started. • Please wait until the printing is finished.

Printing ready Monitor has completed sending printing data to the printer.

• Please wait until the printing is finished.

Recorder: out of paper The recorder is out of paper. • Add paper.

Recorder: cover open The recorder cover is open. • Close the recorder cover.


Troubleshooting

10-7

Recorder: input voltage high,

Recorder: input voltage low

There are problems with the recorder input voltage.


Recorder: thermal array overheat

There are problems with the recorder temperature.


Recorder module removed There is no recorder module. • Reconnect the recorder module if you need a recorder.

Recorder: system error 29 It’s a data transfer delay between frame and recorder, the current recording will stop also.

• Press the Recorder Start/Stop key again.

Recorder: system error X The local recorder is not working. • Reset the local recorder by turning its power off and on again. If this does not help, contact authorized service personnel.

Replace Battery AReplace Battery B

There is hardly any charge left in one of the batteries. Also check the symbol on screen.

• Replace the battery as soon as possible.

Replace D-fend Water trap is partially blocked. This decreases air flow.

• Replace the water trap.

Restart needed The monitor should be restarted • Restart the monitor

Saving to Network Saving trend and information to network

• Waiting and not interrupt.

Sample line blocked The sampling line inside or outside the monitor is blocked, or the water trap is occluded.

• Change the sampling line and water trap.

Select inflation limits You are using a hose without an automatic identification. When you try to start the measurement, the monitor goes automatically to the selection NIBP Setup - Inflation Limits.

• Select appropriate inflation limits. NOTE: Auto option is not available for these hoses.

Snapshot created A snapshot has been created. • No action required.

Snapshot memory full. Oldest snapshot erased

The oldest snapshot lost. • No action required.

SpO2 probe off The finger or ear lobe may be too thin or sensor halves are not aligned.

• Check connection between sensor and patient.

• Replace the sensor.

SpO2 faulty probe The sensor has failed. • Replace the sensor.

SpO2 module error The module communication error. • Contact authorized service personnel.

Tachy HR is equal to or above the higher

alarm limit.• Check the patient status.



10-8

Temp sensor error Frame temperature sensor error. • Contact authorized service personnel.

T1 temperature error

T2 temperature error

Hardware failure or unsuccessful calibration.

• Check the probe whether is set to 400.


V Fib Physiological alarm. • Check the patient status.

V Tach Physiological alarm. • Check the patient status.

Weak pulsation Weak or unstable oscillation signal due to improper cuff position or attachment, weak or abnormal blood circulation, slow heart rate associated with artifacts, moving or disturbed patient during measurement, small air leak.


• Check the NIBP cuff position and attachments.

• Check that the cuff is not damaged.

• Repeat the measurement and check the patient status.

Zero ICP separately The ICP channel must be zeroed separately from all other invasive pressures.

• In IBP menu to zero ICP labelled channel separately.

xxx high/low Physiological alarm. • Check the patient status.

• Adjust the alarm limits.

xxx measurement removed Acquisition module has been removed. • Check and connect the module if you want to restart the measurement.



Troubleshooting

10-9

Advanced ECG troubleshooting

Symptom Possible cause and solution

ECG signal is noisy or no QRS is detected

• Ensure that the patient is not shivering. Incorrect ECG filter.

• Check the filter through ECG - ECG Setup - Filter.Poor electrode quality or wrong positioning.

• Check the electrodes and cables and their placement. See section"ECG" for details.

• Change the lead.

• Remove the ECG cable from the connector and reinsert it.

Why is the monitor alarming for asystole, bradycardia, pause, or inaccurate heart rate when a visible QRS waveform is present?

The monitor may not be detecting sufficient QRS amplitude.

1. Check the ECG signal acquired from the patient.2. View all ECG leads to assess the amplitude of the QRS complexes. To

ensure correct HR readings, a 0.5 mV QRS amplitude is recommended for a normal ECG signal. If the QRS amplitude drops below 0.5 mV or an abnormal QRS width occurs (more than 120 ms), QRS detection may be reduced, leading to false Asystole alarms.

3. Relearn arrhythmia. It is important to relearn the patient’s ECG pattern any time the electrode configuration is adjusted.


10-10

Advanced arrhythmia troubleshooting

Why is the monitor calling V Tach when the patient is not in V Tach?

The monitoring system may be detecting a wider QRS complex or artifact in some of the analyzed ECG waveforms. In addition, the V leads may be exhibiting polarity changes, which may occasionally cause an inaccurate call.

1. Check the ECG signal acquired from the patient.

- Reprep the patient’s skin, replace electrodes, and adjust the electrode placement.

- It may be beneficial to move V lead electrodes (chest lead) to alternate precordial electrode placements to improve detection.

2. Relearn arrhythmia. It is important to relearn the patient’s ECG pattern any time the electrode configuration is adjusted.

How can pacemaker detection be improved?

Possible problems include:

• Heart rate double counting.

• Inaccurate alarms for low heart rate or asystole.

• Pacemaker spikes not recognized by the software.

• False PVC detections and arrhythmia alarms.

Possible solutions include:

• Relearn arrhythmia.

• Try an alternate electrode placement.

Why is the monitor double-counting the heart rate, alarming for a low heart rate, or not detecting pacemaker spikes?

The monitor is not detecting pacemaker activity. Causes may include:

• The pacemaker signal is too weak for the monitor to detect.

• The ECG signal is too weak for the monitor to detect.

• The monitor is detecting atrial pacemaker artifact or non-QRS features as beats.

If the monitor is alarming for low heart rate or asystole, assess the QRS amplitude.

1. View all ECG leads to assess the amplitude of the QRS complexes. To ensure correct HR readings, a 0.5 mV QRS amplitude is recommended for a normal ECG signal. If the QRS amplitude drops below 0.5 mV or an abnormal QRS width occurs (more than 120 ms), QRS detection may be reduced, leading to false Asystole alarms.

2. If necessary, reprep the skin and reposition the electrodes.3. Relearn ECG.


Extra arrhythmia alarms The morphology of the ECG signal has changed.

• Start relearning manually through the ECG menu.

Extra Ventricular Fibrillations are detected

Patient’s medical condition.


Low amplitude signal in some ECG leads.

• Leads I and II: Select the one with the largest amplitude to ECG1.

• After selecting the leads, start relearning manually.

Troubleshooting

10-11

Advanced impedance respiration troubleshooting

Advanced SpO2 troubleshooting


Respiration measurement fails

• Check the electrode quality and positioning.

• Adjust the detection limits. During ventilator-supported breathing, the respiration calculation may count only ventilator-produced inspirations and expirations.

• Other electrical devices may interfere with the measurement.

Why does the waveform have a combination of shallow and deep breaths, but the monitor is not detecting the shallow breaths?

If the detection sensitivity threshold is set too high, shallow breaths will not be detected.

• Decrease the detection limit percentage until the markers correctly identify each inspiration and expiration or set to Auto

NOTE: Respiration detection is not dependent on the size of the waveform. Size is for visual purposes only.

Why is the monitor detecting cardiac artifact as breaths?

The breath detection threshold is too low

• Increase the detection sensitivity percentage until the markers correctly identify each inspiration and expiration.


SpO2 signal is poor • Check the sensor and sensor positioning.

• Change the averaging time from slow to normal.

• Note that skin pigment causes differences.

• Make sure that the patient is not shivering.

Why does the pulse oximeter sometimes read differently than a blood gas analyzer?

Blood gas analyzers calculate the O2 saturation based on normal values for pH, PaCO2, Hb, temperature, etc. (i.e., a normal oxyhemoglobin dissociation curve). Depending on the patient’s physiologic and metabolic status, this curve and all values may be shifted away from “normal.” Thus the oximeter, which measures O2 saturation, may not agree with the blood gas.

What effect can ambient light have on pulse oximetry monitoring?

Light sources such as surgical lamps, bilirubin lamps, fluorescent lights, infrared heating lamps, and sunlight can cause poor waveform quality and inaccurate readings. Error messages are possible. Shielding the sensor with opaque tape, the posey wrap, or other dark or opaque material can increase oximetry accuracy, verified by good waveform and signal strength.


10-12

What does electrosurgical interference look like and how can it be minimized?

Electrosurgical interference is most obvious on the displayed waveform. It is a very spiky, erratic looking waveform caused by the electrosurgical unit’s overwhelming interference. It can result in grossly inaccurate pulse oximeter results.

Electrosurgical interference can be minimized by:

• Making sure the pulse oximeter sensor is as far away from the return pad and operating site as possible.

• Making sure the sensor is not between the return pad and operating site.

• Keeping the power cord and sensor cable away from the power cord of the electrosurgical unit.

• Plugging the electrosurgery unit into a separate set of outlets from the monitor.

What does motion artifact look like, what problems can it cause, and how can it be corrected?

For modules using Nellcor OxiMax technology, the main problem motion artifact can cause is erroneous SpO2 readings.

Motion artifact occurs with excessive motion of the sensor, the cable leading to the sensor, or the cable/sensor junction. In other words, anything that causes any of these things to move, like the patient moving his hands, or the cable lying across the ventilator tubing and being moved with every cycle, can cause motion artifact. A non-arterial, often erratic looking waveform and a pulse rate that does not coincide with the heart rate on the ECG will result.

Motion artifact can be reduced, if not eliminated, by selecting a “quieter” site on the patient. An ear sensor if the hands do not remain still, an adhesive sensor on the toe, or an adhesive sensor on the little finger for an adult or on the sole of the foot in a newborn can help greatly.

Cable movement can be reduced by applying the sensor with the cable leading toward the patient, then taping the cable to the side of the hand or foot. The cable and sensor can also be stabilized with a stress loop near the sensor. Tape the stress loop to the patient (excluding children). In the case of the butterfly sensor, the tape was designed to secure the cable to the finger.

It has been noted that letting the patient view the SpO2 waveform enables the patient to assist in reducing motion artifact.

Why isn’t the parameter window displayed on the monitor after connecting the SpO2 interface cable and sensor?

Hardware failure or an unrecognized or defective sensor.

• Make sure the accessories are compatible with the module.

• Make sure the sensor is attached to the interface cable and the cable is connected to the module.

• Change the sensor.

• Change the cable.

If the problem persists, contact your institution’s biomedical department for service.

Troubleshooting

10-13

Advanced NIBP troubleshooting


NIBP measurement does not work or values seem unstable

• Check that cuff tubings are not bent, stretched, compressed or loose.

• Prevent motion artifacts.

• Use cuffs of correct size.

Why does the mean value display while the associated systolic and diastolic values display as - - -?

The following conditions may cause the mean value to display in the NIBP parameter window while the associated systolic and diastolic values display as - - -.

• Very low systolic and diastolic amplitude fluctuations (e.g., patient in shock).

• Very small difference between the mean and systolic pressure or the mean and diastolic pressure.

• Loss of system integrity (e.g., loose connections or worn parts).

Assess the patient and perform a visual inspection of the equipment to ensure system integrity.

Why is the monitor re-inflating the cuff automatically?

The cuff target pressure must be higher than the patient’s systolic pressure to obtain an accurate systolic and diastolic measurement. If a systolic blood pressure cannot be found, the monitor searches for a systolic reading by re-inflating the cuff at a higher pressure. This systolic search may occur once per NIBP determination cycle. During a systolic search, the maximum cuff inflation pressure will not exceed the normal pressure range of the cuff.

The monitor may be taking a control measurement. If the measured NIBP value exceeds the alarm limits, a single low priority alarm sounds and a new measurement is automatically taken. If the new value (the control measurement) also exceeds the alarm limits the alarm priority escalates to medium. In Manual mode and STAT mode there are at least four seconds between the first measurement and the Control measurement for Adult and Child cuffs, eight seconds for Infant cuffs. In Auto mode there are at least 30 seconds between the first measurement and the control measurement.

If Weak pulsation is detected, the module repeats the measurement up to three times. Assess the patient and perform a visual inspection of the equipment to ensure system integrity.

If cuff occlusion is detected during inflation the module might repeat the measurement. Perform a visual inspection of the equipment to ensure system integrity.


10-14

Advanced InvBP troubleshooting

Advanced temperature troubleshooting


InvBP readings seem unstable

• Make sure there are no air bubbles in the transducer system. Flush and zero.

• Place the transducer on the patient’s mid-heart level and zero.

Why are displayed pressure values different than expected?

• Check the patient. Values could be valid, the patient could be lying on the tubing, or the tubing could be kinked.

• Check tubing for bubbles.

• Remove excess tubing.

• Check phlebostatic axis placement of transducer.

• Rezero pressure.

• Is patient on IABP? If so, verify that the monitor’s IABP program is turned on. If necessary, turn it on.

Why are the arterial, non-invasive (oscillometric), and auscultated blood pressure readings indicating different values?

The three measurement methods use different technologies. Auscultation and oscillometric are both indirect methods of measuring blood pressure. In auscultation, changes in arterial sounds during cuff deflation are related to systolic and diastolic pressure. With oscillometric measurement, changes in measured pressure oscillations during cuff deflation are related to systolic, mean and diastolic pressures. Changes in the vascular tone of the arterial system can cause these two indirect methods to differ from one another and from direct arterial pressure measurements.

Invasive arterial blood pressure is a direct method of measuring blood pressure. Differences between direct and indirect blood pressure measurements are expected. These differences occur because direct methods measure pressure and indirect methods measure flow. In addition, differences occur because the measurement location is not the same (e.g., brachial artery for NIBP vs. radial artery for invasive arterial pressure monitoring).

Why is the monitor alarming arterial disconnect?

• Check the patient immediately in the event the catheter has been dislodged.

• If the arterial disconnect alarm is turned on and the mean pressure falls below 25 mmHg, the monitor alarms. When zeroing the pressure line, the clinician has 14 seconds to complete the process. After that time the disconnect alarm is activated.

• If zeroing, close the stopcock. Once the monitor detects the return of waveform and numeric data, the alarm will reset.


Temperature measurement fails

• Check that you are using a correct probe.

• Try another probe.

Troubleshooting

10-15

Advanced airway gas troubleshooting

Advanced entropy troubleshooting


Airway gas values are too low

• Check the sampling line and connectors for leakage.

Why can we see dips in the capnogram during expiration?

The dips seen in the capnogram during expiration are related to the sidestream gas sampling, the continuous gas flow to the Y-piece, and patient’s cardiac contractions, which cause intra-thoracic pressure changes and therefore flow variations.

Why can we see variations in the oxygram during inspiration?

Changes in the fresh gas flow reate and oxygen concentrations affect the shape of the oxygram during inspiration. Rule out any potential clinical complications such as hypoventilation, hyperventilation, circuit hypoxia, disconnection.

Why is the EtCO2 value considerably lower than the CO2 partial pressure determined by blood gas analysis?

The major clinical reasons are dead-space ventilation, ventilation/perfusion mismatch, a drop in cardiac output, alveolar shunts, and incomplete emptying of the alveoli.

Also check the following technical issues: integrity of the breathing circuit; blood-gas analysis corrected to a lower temperature in case of hypothermia.

NOTE: If you are using N2O and the E-miniC, make sure that the N2O compensation has been selected in the monitor menu.


What does a sudden drop in values mean?

A sudden drop in values can be caused by the following:

• Bolus administration of intravenous anesthetics

• Increase in inhalation anesthesia level

• Administration of other medication affecting EEG/FEMG

What does an unexpected increase in values indicate?

An unexpected increase in values can be caused by the following:

• Change in infusion pump settings for intravenous anesthetics

• Change in vaporizer settings, or fresh-gas flow rate

• Volume loading with infused fluids

• Fault in the operation of anesthetic delivery systems

• Impedance check


10-16

Other situationsThe following table lists some other situations that may occur during monitoring and possible explanations.

Table 10-1 Other operation problems


Printing is not possible

• Printer selection is None; change it through Print/Record - Printer connection.

• Printer is not connected to the network. Check printer cable.

The measured values are not displayed

• Check that you have selected the desired parameter to a waveform or digit field.

The monitor does not start

• Check that the power cord is properly connected.

• Check that all cables are properly connected.

• Check the fuses and replace them if necessary.

You cannot perform a measurement or a function

• Check that the measurement module is properly installed.

• Check that all cables are properly connected.

• Remove the module and reinstall it.

Battery operation time is markedly shortened

• Condition the batteries according to the instructions in this manual.

11 ECG

ECG

11-1

11 ECG

Safety precautions

Warnings

• Make sure that the leadwire set clips or snaps do not touch any electrically conductive material including earth.

• Whenever patient defibrillation is a possibility, use non-polarizing (silver/silver chloride construction) electrodes for ECG monitoring

• Single-use devices and accessories are not designed to be reused. Reuse may cause a risk of contamination and affect the measurement accuracy.

• Proper placement of defibrillator paddles in relation to the electrodes is required to ensure successful defibrillation.

• To ensure proper defibrillator protection, use only defibrillator proof transducers and cables.

• Set the pacemaker rate responsive mode off or turn off the impedance respiration measurement on the monitor.

• Do not use equipment for positioning (floating) temporary pacemaker leadwires, performing pericardiocentesis, or other internal applications.

• HEART RATE ALARM INTERFERENCE - Poor cable positioning or improper electrode preparation may cause line isolation monitor transients to resemble actual cardiac waveforms and thus inhibit heart rate alarms. To minimize this problem, follow proper electrode placement and cable positioning guidelines provided with this product.

• Do not use the electrodes of dissimilar metals.

Cautions

• When using the electrosurgery unit, ensure proper contact of the ESU return electrode to the patient to avoid possible burns at monitor measurement sites. Also ensure that the ESU return electrode is near the operating area.

• Patient's skin may become irritated after long contact with electrode gel or adhesive

• The impedance respiration measurement may cause rate changes in Minute Ventilation Rate Responsive Pacemakers.


11-2

OverviewThe electrocardiography, ECG, reflects the electrical activity generated by the heart muscle. ECG monitoring is used for a heart rate measurement, for arrhythmia analysis and for detecting pacemaker function and myocardial ischemia.

In Normal Screen, when measuring 5-lead ECG, you can simultaneously monitor the waveforms of up to three different ECG leads. In 3-lead ECG, the monitor displays one ECG lead.

When monitoring the ECG, the monitor simultaneously analyzes ST segment changes.

.

Figure 11-1 Electrocardiographic (ECG) measurement connector

ECG andimpedancerespirationconnector

ECG

11-3

Displaying ECG and heart rate

Figure 11-2 Display of ECG and HR

(1) ECG1 is displayed first

(2) ECG2 is displayed below ECG1

(3) ECG3 is displayed below ECG2

(4) Selected lead label

(5) ECG gain bar (1 mV reference)

(6) Heart rate (HR) label

(7) Heart rate/pulse rate source (ECG/Art/ABP/Pleth)

(8) HR/PR value

(9) Heart beat detector is flashing with every detected heart beat

(10) ST values are always displayed next to ECG2

(11) Fourth ST value, showing the largest absolute ST value

(12) Selected ST leads

(13) ST label

(14) Message field for parameter messages

NOTE: The input circuits are protected against the effects of electrosurgery and defibrillation. However, the ECG waveform on the monitor screen may be disturbed during electrosurgery.


11-4

Preparing the patient and placing the electrodes

Preparing the patient

• Prepare the skin properly to ensure optimal signal quality.

• Shave any hair from the electrode site. Gently rub the skin surface to increase capillary blood flow and remove dead skin cells and oil.

• Clean the skin using a mild soap and water solution.

• Dry the skin completely before applying the electrodes.

• Pre-gelled electrodes are recommended. Check that the electrodes are moist and have not dried out during storage.

Placing the electrodes

NOTES:

• Pre-gelled ECG electrodes are recommended. Check the expiration date.

• Make sure the electrode gel is moist.

• Make sure the electrodes have good skin contact.

• Replace all electrodes at least every 24 to 48 hours.

• Use the Multi-Link electrosurgical unit (ESU) ECG patient cable when using the monitor in the presence of an electrosurgical unit. This cable, with a built-in ESU filter, helps reduce electrosurgical noise detected on the ECG signal.

• Whenever a cable, electrode or V-lead is changed, the monitor automatically relearns.

When placing the electrodes, avoid bones close to the skin, obvious layers of fat and major muscles.

Patient connectionNOTE: Keep the ECG cable, lead set and connectors dry. Avoid excessive use of liquids when cleaning the cables and connectors.

Figure 11-3 ECG setup

LL

RL

RA

I

II

III

LA

RL

RA

LA

2

LEAD I

LEA

DII I

LEADII

L/ LAR/RA

F/LL

1

3

R=RED (IEC)RA=WHITE (AAMI)

L=YELLOW (IEC)LA=BLACK (AAMI)



C=WHITE (IEC)V=BROWN (AAMI)

F=GREEN (IEC)LL=RED (AAMI)


N=BLACK (IEC)RL=GREEN (AAMI)

ECG

11-5

(1) ECG connector

(2) ECG trunk cable, or 3-lead ECG cable with integrated leadwires

(3) 3 or 5 leadwire set

NOTE: For a comprehensive list of accessories, see the “Supplies and Accessories“ catalog.

Lead measurementThe following table lists the electrodes needed to measure different ECG leads:

Color and letter coding

For a 3-leadwire electrode placement, the R/RA, L/LA, and F/LL electrodes should be used.

Lead Electrodes needed

I R/RA, L/LA + F/LL or N/RL

II R/RA, F/LL + L/LA or N/RL

III LL/LA, F/LL + R/RA or N/RL

aVR N/RL, R/RA, L/LA, F/LL

aVL N/RL, R/RA, L/LA, F/LL

aVF N/RL, R/RA, L/LA, F/LL

V5 N/RL, R/RA, L/LA, F/LL, C5

IEC AAMI/AHA Electrode placement

R (red) RA (white) Just below the right clavicle.

L (yellow) LA (black) Just below the left clavicle.

C (white) V (brown) For the 5-lead placement, place the precordial electrode according to the physician's preference.

N (black) RL (green) Lower right edge of the rib cage.

F (green) LL (red) Lower left edge of the rib cage.


11-6

Setup ECG waveform view• To change the number of ECG waveforms in Normal Screen:

Monitor Setup - Screen Setup - Waveform Fields

Choose the ECG waveforms to display.

• To change the waveform sweep speed:

Monitor Setup - Sweep Speeds - Hemodynamics

Choose the waveform sweep speed.

Selecting a leadThe following lead selections are possible:

− with 3 leadwire set: I, II or III

− with 5 leadwire set: I, II, III, aVL, aVF, aVR or V

− For channels ECG2 and ECG3, also a cascaded lead selection (Casc.) is available.

To select the ECG1 lead:

• Press the ECG key and select ECG1 Lead.

You can select all leads (ECG1, ECG2 and ECG3) in the ECG menu.

Viewing a cascaded ECG

With a 3 leadwire set, ECG2 and ECG3 leads are automatically shown as cascaded. The same ECG will be displayed in each waveform field. Thus more QRS complexes are displayed at the same time.

With a 5 leadwire set either a cascaded ECG or different leads can be displayed. Select the leads in the ECG menu.

• To cascade a lead, press ECG and select ECG2/ECG3 Lead - Casc.

The label of the lead is displayed in the ECG field.

ECG

ECG

11-7

Adjusting the ECG sizeIncreasing or decreasing the ECG gain affects the size of the 1 mV bar at the left end of the ECG waveform and the size of the ECG waveform accordingly.

ECG Setup menuFor advanced ECG setup, please go the sub menu: ECG - ECG Setup

You can adjust the following settings:

Beat Sound Volume

Adjusts the pulse/heart beat sound volume (0 to 10). When the monitor has detected a QRS complex or a pleth or pressure pulse, a beep tone is produced. You can raise, lower or turn off the volume.

Adjusting beat sound volume affects also the beat sound volume of the HR source (ECG, Art or Pleth).

ECG

ECGECG Setup

Beat Sound Volume

HR Source

Display with HR

Filter

Pacemaker

Grid

5 - lead cable

3

AUTO

None

Monit

Hide

OFF

Adjust volume of pulse / heartbeat sound.

ECG

V lead V5

5 elect

Previous menu

QRS width Normal

!


11-8

When Pleth is monitored, the monitor provides a variable pulse beep, so that the tone of the pulse beep rises with increasing oxygen saturation and falls with decreasing saturation. This affects also the ECG tone.

HR Source Selects the heart rate source (AUTO, ECG, ART, ABP, UAC or Pleth). The selected heart rate source is displayed above the numerical display of the heart rate. The color of the heart rate source indicator is the same as that of the source parameter.

The AUTO selection priorities for heart rate calculation are: ECG, pressure (UAC, ART or ABP), plethysmographic pulse waveform. The first heart rate source available is selected.

The following circumstances may warrant the use of an alternate pulse rate source:

• Excessive artifact due to an electrical interference from equipment (e.g., electrosurgical device).

• Excessive patient movement causing significant artifact (e.g., seizure activity).

• Inability to use standard lead placement (e.g., burns).

Display with HR Select PR, PVC or None to display combined heart rate and pulse rate or heart rate and PVC rate next to the ECG waveform. The current HR source is displayed with bigger font and the heart rate symbol flashes next to the reading.

Filter Filters the ECG signal high frequency noise and slow respiratory artifacts.

Monit (monitor) filter effectively filters the artifacts caused by, for example, the electrosurgery unit and respiration.

STfilt (ST filter) permits more accurate information of the ST segment. It filters the high frequency artifacts caused by the electrosurgery unit but catches the slow changes in the ST segment. The ST filter is more susceptible to baseline wander than the monitor filter.

Diagn (diagnostic) filter is used if more accurate information of the waveform is needed (for example, of the P wave or AV block). The diagnostic filter is more susceptible to both high frequencies and baseline wander than the monitor filter.

Pacemaker Selects how to display the pacing spike of cardiac pacemaker.

QRS width Selects the QRS complex widths for ECG rhythms.

Normal option is suitable for adult/pediatric, between 70 to 120 ms.

Narrow option is suitable for neonatal, between 40 to 120 ms.

Grid Selects the ECG gridlines to be displayed or not. If you select ON, you can view the ECG waveforms over gridlines.

5-lead cable Selects five or three electrodes.

V Lead Selects the label for V lead according to the placement of the 5th electrode (see Placing the electrodes on page 11-4).

NOTE: Selectable with the 5 lead trunk cable only.

ECG

11-9

Setting heart rate alarm limitsTo set the heart rate alarm limits:


2. Select ECG Alarms.


You can also adjust the limits through Alarms Setup - Adjust Limits. For detailed instructions, see section "Alarms."

ECG ECG ADJUST ALARM LIMITS:

Adjust Limits

HR Alarm

PVC Alarm

ST AlarmsArrh. Alarms

Alarms Setup

Previous Menu

ON

OFF HR

250

160

40

30/ min



11-10

Setting PVC alarm limitsTo set the PVC alarm limits:



3. Select PVC Alarm - ON.



ECGECG ADJUST ALARM LIMITS:

Adjust Limits

PVC Alarm

ST Alarms

Arrh. Alarms

Alarms Setup

Previous Menu

ONHR

250

160

40

30/ min


PVC

100

20

0/ min

ECG

11-11

ECG printout typeSee "Changing printer settings" on page 6-5.

NOTE: To adjust this feature, you need a password. If you wish to adjust the settings of the features, we recommend that you contact the person responsible for the entire configuration.

ChecklistCheck that:

• Electrode gel is moist.

• Electrodes have good skin contact.

• Electrodes are positioned correctly.

• Correct leadwire set is selected.

• The trunk cable is connected properly.

• Leadwire set is properly connected to the trunk cable.

• Correct leadwire type is selected in the ECG Setup menu.

• Pacemaker selection in the ECG Setup menu is Show when a pacemaker is used.

• ECG is selected for screen through Monitor Setup - Screen Setup.


11-12

Pacemaker detection

Safety precautions

Warnings

• Do not diagnostically interpret pacemaker spike size and shape.

• A pacemaker pulse can be counted as a QRS during asystole in either pace mode. Keep pacemaker patients under close observation.

• The shape of QRS complex may be changed so much because of the pacemaker that QRS detection may be affected.

• The monitoring of pacemaker patients can only occur with the pace program activated.

• PACEMAKER PATIENTS - Rate meters may continue to count the pacemaker rate during occurrences of cardiac arrest or some arrhythmias. Do not rely entirely upon rate meter alarms. Keep pacemaker patients under close surveillance. See "ECG specifications" for the pacemaker pulse rejection capability of this instrument.

• FALSE CALLS — False low heart rate indicators or false Asystole calls may result with certain pacemakers because of pacemaker artifact such as electrical overshoot of the pacemaker overlapping the true QRS complexes.

NOTES:

• Pacemaker detection is always on.

• The shape of QRS complex may be changed because of the pacemaker so much that QRS detection may be affected.

• If the patient has an atrial pacer, ST calculations can be performed if the pacer does not coincide with the ISO point’s adjustment range.

• Pacemaker detector may not operate correctly during the use of high-frequency (HF) surgical equipment. The disturbances of HF surgical equipment typically cause false positive pacer detection.

ECG

11-13

Monitoring pacemaker patientsThe monitor can detect and reject pacemaker. To display the pacing spike of cardiac pacemaker:

1. Press ECG key.

2. Select ECG Setup - Pacemaker, choose following opitions:

• Hide = The pacing spike is filtered away from ECG data.

• Show = The pacing spike is filtered away from ECG data but the spike is displayed as a constant height marker.

• Sensit = This selection uses a more sensitive pacemaker detection. Pacing spike is displayed on ECG.

NOTE: In Neonatal mode, pacemaker spike is always hide.

ChecklistRefer to ECG’s Checklist on page 11-11.


11-14

Arrhythmia detection

Safety precautions

Warnings

• LOSS OR DETERIORATION OF ARRHYTHMIA DETECTION -Automated arrhythmia analysis programs may incorrectly identify the presence or absence of an arrhythmia. A physician must therefore interpret the arrhythmia information in conjunction with other clinical findings. Please take special note of the following ECG waveform conditions:

− Noisy waveforms. Noisy portions of ECG waveforms are typically excluded from analysis. The exclusions are necessary to reduce the occurrence of inaccurate beat interpretations and/or rhythm alarms. If the excluded noisy portions of the ECG waveform contain true arrhythmia events, those events may remain undetected by the system.

− Beat amplitude and duration. Accurate detection and interpretation of beats becomes increasingly difficult as the amplitude and/or duration of those beats approach the design limits of the analysis program. Thus, as beats become extremely wide or narrow, or especially as beats become small, arrhythmia interpretation performance may degrade.

− Other morphology considerations. Automated arrhythmia detection algorithms are designed fundamentally to detect significant changes in QRS morphology. If an arrhythmia event is present and does not exhibit a significant change from the patientís predominant morphology, it is possible for those events remain undetected by the system.

• SUSPENDED ANALYSIS - Certain conditions suspend arrhythmia analysis. When suspended, arrhythmia conditions are not detected and alarms associated with arrhythmias do not occur.The messages which alert you to the conditions causing suspended arrhythmia analysis are: 'Arrhythmia Paused', ‘Leads off’ and ‘Patient discharged’.

• Always monitor ECG for arrhythmia detection purposes. HR calculated from pulsatile SpO2 waveform may differ significantly from ECG HR measured values. Users should be aware that the “SpO2 probe off” and “No SpO2 pulse” technical alarms escalate no higher than a Medium priority.

• Artifact and arrhythmia paused alarm - The artifact and arrhythmia paused alarm indicates that the system is no longer monitoring ECG and there may be no Tachy or Brady alarms.

NOTES:

• Since the arrhythmia detection algorithm sensitivity and specificity is less than 100%, sometimes there may be some false arrhythmias detected and also some true arrhythmia events may not be detected. This is especially true when the signal is noisy.

• If QRS amplitude is low, the monitor might not be able to calculate HR and false Asystole may occur.

• During the learning phase of the algorithm, arrhythmia detection may not be available. As a result, the patient condition should be closely monitored during the learning phase and

ECG

11-15

for several minutes after the learning phase to allow the algorithm to reach optimal detection performance.

About the arrhythmia detectionWhen an ECG signal is detected at the start of monitoring, the arrhythmia detection algorithm begins acquiring and analyzing QRS complexes in the leads used for arrhythmia detection. This phase is known as learning. Once learning is complete, the dominant QRS complex is stored as a reference template. Reference template is used as a normal morphology of that patient and it is compared with incoming beats to identify possible arrhythmias.

The EK-Pro arrhythmia detection algorithm is used. EK-Pro simultaneously analyzes leads I, II, III, and V. Once learning is complete, the dominant QRS complex becomes the template.

The algorithm uses continuous correlation, incremental template updating and contextual analysis. Continuous correlation attempts to find the best match between each incoming complex and the set of stored (learned) templates. If no match is found with the existing template, a new template is stored for the identified new QRS shape. Incremental template updating allows information from each beat, that correlates over time, to be reflected in the associated template. Contextual analysis uses information from neighboring QRS complexes along with existing template measurements to make the best possible decision regarding the beat’s origin (e.g., early, wide).

NOTE: With the 3 leadwire trunk cable, the algorithm uses the only one available lead ECG1 Lead, which is I, II or III, depending on the selected user lead.

Starting relearning manuallyWhen the patient’s ECG pattern changes considerably, the monitor should start relearning a new ECG pattern. The pattern changes, for example, when changing the patient’s position. To start relearning manually:


2. Select Relearn.

ECG


11-16

Adjusting arrhythmia alarm settingsIn the adjustment menu, the priority for all alarms are always red (high priority). You can turn and push the Trim Knob to set arrhythmia alarm to create snapshot.

1. Press ECG.

2. Select ECG Alarms - Arrh. Alarms.

3. Select YES (default) or NO with the Trim Knob for each alarm.

Detecting arrhythmia alarms

NOTE: Arrhythmia alarms are just for reference, but not for diagnose. A physician must analyze the arrhythmia information in conjunction with other clinical findings.

NOTE: Asystole alarm will sound when HR reaches zero.

Alarm Criteria

Asystole • HR is decreased to zero, the V Fib alarm is not displayed and a beat detection has not occurred in the last two seconds.

Bradycardia • HR below the HR alarm limit

Tachycardia • HR over the HR alarm limit

Ventricular fibrillation • Occurs when the ECG waveform indicates a chaotic ventricular rhythm.

Ventricular tachycardia • Six or more consecutive PVCs with a successive beats over 100 bpm

ECG

ECG

11-17

Description of the arrhythmia algorithmWhen an ECG signal is detected at the start of monitoring, the arrhythmia detection algorithm begins acquiring and analyzing QRS complexes in the leads used for arrhythmia detection. This phase is known as learning. Once learning is complete, the dominant QRS complex is stored as a reference template. Reference template is used as a normal morphology of that patient and it is compared with incoming beats to identify possible arrhythmias.

The algorithm uses continuous correlation, incremental template updating and contextual analysis. Continuous correlation attempts to find the best match between each incoming complex and the set of stored (learned) templates. Incremental template updating allows information from each beat, that correlates over time, to be reflected in the associated template. Contextual analysis uses information from neighboring QRS complexes along with existing template measurements to make the best possible decision regarding the beat’s origin (e.g., early, wide).

NOTE: A physician must analyze the arrhythmia information in conjunction with other clinical findings.

Test results of arrhythmia algorithm testing

The algorithm testing has been performed per EC57 by using the following databases:

− AHA (The American Heart Association Database for Evaluation of Ventricular Arrhythmia Detectors)

− MIT-BIH (The Massachusetts Institute of Technology- Beth Israel Hospital Arrhythmia Database)

QRS numeric accuracy • QRS sensitivity: >97.5%

• QRS positive predictivity: >97.5%

VEB numeric accuracy • VEB sensitivity: >90%

• VEB positive predictivity: >90%

VF numeric accuracy • VF episode sensitivity: >95%

• VF episode positive predictivity: >95%


11-18

ST detection

OverviewThe ST value, analyzed by the monitor, shows the difference of electrical activity between ISO and ST points.

Myocardial ischemia appears in the ECG as an ST segment deviation from the isoelectric line (ISO point). The ST segment generally rises above the PQ isoelectric line in the presence of transmural ischemia and is pressed below the isoelectric line in the subendocardial ischemia. The ST measurements are displayed as a numeric value: a negative (-) number indicates ST depression; a positive number indicates ST elevation.

NOTES:

• ST segment changes may also be affected by such factors as drugs or metabolic and conduction disturbances.

• Since ST is often calculated with a fixed delay from the J point, changes in heart rate may affect ST.

• The significance of the ST segment changes needs to be determined by a physician.

• The ST algorithm has been tested for accuracy of the ST segment data. ST segment deviations are not displayed for patients with ventricular pacemakers or if the rhythm is considered as from ventricular origin.

Display of ST

Figure 11-4 ST number field

(1) Message field

(2) ST values of ECG1, ECG2, and ECG3

(3) Fourth ST value showing the largest absolute ST value

(4) Lead label

NOTE: ST segment deviations are not displayed if the patient has a ventricular pacemaker in use.

ECG

11-19

Monitoring the ST segmentThe monitor analyzes ST for all measured leads and gives ST trends separately for each lead. Numerical ST data is shown to the right of the second real-time ECG waveform field.

You can also select numerical ST data to the lower digit field. Press the Monitor Setup key and select Screen Setup - Digit Fields. Select ST data to the field you prefer.

The ST analysis starts automatically after the leads have been connected and the QRS detection has started. During a learning period of 32 accepted beats the median ST values are displayed. Also, when the cable or the V lead is changed, or when an electrode is removed, or relearning is started manually, the monitor starts to learn the ST segment.

During the learning period, the algorithm uses the isoelectric reference and the J+reference points to calculate the ST values. The algorithm automatically searches for the J and ISO points. These settings can be adjusted for the current patient.

NOTE: If the patient has an atrial pacemaker, ST calculations can be performed if the pacer spike does not coincide with the ISO point’s adjustment range.


11-20

Setting the ST measurement pointsAutomatic setting of the J, ST and ISO pointsThe ST algorithm automatically searches for the J and ISO points. The distance between the ST and J point is set according to the heart rate:

− If the heart rate is less than 120 bpm, the ST point is set at J+80 ms.

− If the heart rate is more than or equal to 120 bpm, the ST point is set at J+60 ms.

Setting the J, ST and ISO points manuallyYou can also set the J, ST and ISO points manually. If any of these points is manually set, the other two are set at their current values.

Select Adjust ST and Set ISO point, Set J point or ST point.

• Setting the J point manually

The J point is the point on the ECG trace where the S wave transitions to the ST segment.

Adjust the J point by turning the Trim Knob and confirm by pushing the Trim Knob. If the J point setting is changed, the original point is shown as a dashed line. When you adjust the J point, also the ST point is set according to the selected ST point setting (J+20, J+40, J+60 or J+80).

The manually set J point remains until the monitor is turned off or reset. After a turn-off or reset, the J point is set automatically.

• Setting the ST point manually

ST segment is the component of the ECG trace between the end of the QRS complex and the T wave.

Manual ST point adjustment sets the distance between ST and J points in ms. Selection values are J+20, J+40, J+60, J+80.

The manually set ST point remains until the monitor is turned off or reset. After a turn-off or reset, the ST point is set automatically according to the heart rate.

• Setting the ISO point manually

The ISO point is on the isoelectric line. Adjust the ISO point by turning the Trim Knob and confirm by pushing the Trim Knob. If the ISO point setting is changed, the original point is shown as a dashed line.

The manually set ISO point remains until the monitor is turned off or reset. After a turn-off or reset, the ISO point is set automatically.

ECG

11-21

Setting ST alarm limitsTo set the ST alarm limits:



3. Select ST Alarms.


You can also adjust the limits through Alarms Setup - Adjust Limits.

ECG

High

low

ST ADJUST ALARM LIMITS:

Adjust Limits

Lat. Alarm

Inf. Alarm

Ant. Alarms

Alarms Setup

Previous Menu

ON

OFFSTLat.

6.0

2.0

-2.0

-6.0mm


OFF

I

avl

v5


11-22

Description of the ST segment measurement algorithmThe ST segment begins at the point where the QRS ends (J point). Diagnostic criteria of ST segment changes are measured at 60 ms after the J point. For monitoring purposes it is important to keep the measurement point fixed during monitoring to notice the ST changes on the respective trends.

The sophisticated algorithms of monitor search the J and isoelectric (ISO) points. The system learns the ECG and stores the reference QRST complex. The algorithm sets the ISO and J points. Due to the large variation with QRST complexes the user has possibility to adjust the ST measurement points manually. The QRS analysis classifies each beat by using several criteria and rejects distorted complexes from the ST calculation.

NOTE: The ST algorithm has been tested for accuracy of the ST segment data. The significance of the ST segment changes needs to be determined by a physician.

12 Impedance respiration


12-1

12 Impedance respiration

Safety precautions

Warnings

• Make sure that the leadwire set clips or snaps do not touch any electrically conductive material including earth.

• The monitor may not detect all episodes of inadequate breathing, nor does it distinguish between central, obstructive and mixed apnea events.

• ELECTRODE CONFIGURATION - Impedance respiration monitoring is not reliable when ECG electrodes are placed on the limbs.

• This device is not an apnea monitor system intended to alarm primarily upon the cessation of breathing. In central apnea it indicates an alarm after a pre-determined time since the last breath detection. Do not attempt to use it for detecting obstructive or mixed apneas, since respiration movements and impedance variations may continue in these cases.

• The impedance respiration measurement is inherently very sensitive as it measures very small physiologic signals (changes of impedance of the patient's chest area). Conducted RF current above 1 Vrms may cause erroneous measurements at various frequencies, for example interference with the signal/waveform leads to respiration rate readings inconsistent with the patient's true respiration rate. If you notice this, use another form of respiration monitoring, for instance the E-miniC module.

• Electrical interference - Electrical devices, such as electrosurgery units and infrared heaters, that emit electromagnetic disturbance may cause artifacts or disable the respiration measurement completely.

• Movement artifacts - Changing position, moving the head, moving the arms or shivering may result in movement artifacts. Also the heart may cause noticeable movement and sometimes this may interfere with the respiration measurement.

• Intermittent mechanical ventilation - During spontaneous breathing the ventilator may at times support the patient’s ventilation with an extra inspiration. If these ventilator inspirations are substantially larger than the spontaneous breaths, the respiration calculation may mistakenly count only the inspirations and expirations produced by the ventilator.

• The impedance respiration measurement may cause rate changes in Minute Ventilation Rate Responsive Pacemakers. Set the pacemaker rate responsive mode off or turn off the impedance respiration measurement on the monitor.

• APNEA alarm - If you deactivate the Apnea alarm, keep the patient under close surveillance.

Cautions

• When using the electrosurgery unit, ensure proper contact of the ESU return electrode to the patient to avoid burns at measurement sites. Also ensure that the ESU return electrode is near the operating area.


12-2

OverviewImpedance respiration is measured across the thorax. When the patient is breathing or is ventilated, the volume of air changes in the lungs, resulting in impedance changes between the electrodes Respiration rate is calculated from these impedance changes, and a respiration waveform is displayed on the monitor screen.

Figure 12-1 Impedance respiration measurement connector

Respiration detectionThe respiration rate is the sum of the respirations that have exceeded the detection limit.

When starting respiration monitoring, the system “learns” the patient’s respiration pattern. The respiration rate is calculated from impedance changes and a respiration waveform is displayed. Respiration detection is not dependent on the size of the waveform. Size is for visual purposes only.

The dotted lines present the zero line and the detection limit. The signal strength produced by a respiration should thus exceed this minimum limit to be included in the respiration rate calculation. Peaks within the grids are not calculated.

If the detection mode is AUTO, the grid lines present the minimum limits. The limits in use may be larger. The RR value could include fewer respirations than indicated by the gridline.

NOTES:

• Electrical devices, such as electrosurgery units and infrared heaters, that emit electromagnetic disturbance may cause artifact or disable the respiration measurement completely.

ECG andimpedancerespirationconnector

%


12-3

Respiration rate sourceRespiration rate is calculated automatically when ECG or CO2 is measured unless the respiration measurement is turned off. When CO2 is measured, the respiration rate is automatically calculated from CO2.

Respiration rate calculation switches back to impedance respiration if you press the Silence Alarms key during an Apnea alarm.

The respiration rate source is displayed above the respiration numeric value.

Figure 12-2 Respiration rate source indication for impedance and CO2

The impedance respiration waveform is displayed next to the RR value also when the RR value is calculated from CO2.

To manually select impedance respiration as respiration rate source:

1. Select respiration in a waveform or a digit field.

2. Press the Others key.

3. Select Resp Setup.

4. Select Resp Rate Source and select AUTO, CO2 or Imped.

Displaying impedance respiration

Figure 12-3 Impedance respiration waveform and numeric respiration rate value.

Others Others

Resp Setup

Normal Screen

Set size , Resp rate source andalarm. Enable or disable Respmeasurement.

Temp Setup

Entropy


12-4

Patient connectionsThe setup is the same as for the ECG measurement. For more information, see section “ECG.”

Figure 12-4 Impedance respiration setup

(1) ECG connector

(2) Multi-link 5 lead standard cable

(3) Multi-link leadwire set (3 or 5 leads)

ECG electrodes (pre-gelled electrodes are recommended). Check the expiration date.

NOTES:

• Impedance respiration measurement with neonates is not available in specific regions, including USA, Argentina, Guam, Puerto Rico, Saint Croix, Saint Thomas and Canada.

• Do not place electrodes on obvious layers of fat, or major muscles.

• Make sure the electrode gel is moist.

• Make sure electrodes have good skin contact.

• For a comprehensive list of accessories, see the "Supplies and Accessories" catalog.

LL

RL

RA

I

II

III

LA

RL

RA

LA

2

LEAD I

LEA

DII I

LEADII

L/ LAR/RA

F/LL

1

3





C=WHITE (IEC)V=BROWN (AAMI)



N=BLACK (IEC)RL=GREEN (AAMI)


12-5

Activating measurement1. Select respiration in a waveform or a digit field, otherwise the respiration information is

not included in the trends and the alarms are not operative.

Monitor Setup - Screen Setup - Waveform Fields or Digit Fields, Or

Others - Resp Setup - Screen Setup - Waveform Fields or Digit Fields

Refer to "Changing the Normal Screen layout" on page 6-9 for details.

2. Check that the measurement is on:

• Press the Others key.

• Select Resp Setup.

• Select Measurement and ON.

Others Others

Resp Setup

Normal Screen

Set size , Resp rate source andalarm. Enable or disable Respmeasurement.

Temp Setup

Entropy


12-6

Improving waveform readabilityTo improve readability, increase the waveform size.



3. Select Size and adjust the waveform size.

The bar on the left side of the waveform always indicates a 1 Ω reference.

Others


12-7

Correcting the respiration numberNormally, we recommend the use of the AUTO detection limit. However, in some specific cases you may wish to adjust the limits manually.

− When the respirations are weak, you can manually adjust the detection limits (measurement sensitivity) closer to each other to ensure that all respirations are included in the RR value. In this case, the dotted line represents the absolute detection limits.

− When there are lots of artifacts, the grids can be adjusted further apart to separate smaller artifacts from larger, true respiration peaks. The small peaks fall within the grids and are not calculated, while the bigger peaks cross the grids and are calculated as true respirations.

To ensure the correct respiration number, adjust the limits closer to each other:

1. Press Others.

2. Select Resp Setup - Detection Limit and adjust the limit.

The percentage is the ratio to the 1 Ω reference bar which is 100%.

Others


12-8

Turning off the measurement If the impedance respiration measurement signal interferes with other measurements, such as ECG, you can turn it off.



3. Select Measurement OFF.





• Correct leadwire set is selected.

• The trunk cable is connected properly.

• Leadwire set is properly connected to the trunk cable.

• Correct leadwire type is selected in the ECG Setup menu.

• ECG + Resp are selected for screen through Monitor Setup - Screen Setup.

Others

13 Pulse oximetry

Pulse oximetry

13-1

13 Pulse oximetry

Safety precautions

Warnings

• Allow sensor and cable to dry completely after cleaning. Moisture and dirt on the connector can affect the measurement accuracy.

• To prevent erroneous readings, do not use physically damaged sensors, cables or modules. Discard a damaged sensor or cable immediately. Never repair a damaged sensor or cable; never use a sensor or cable repaired by others. A damaged sensor or a sensor soaked in liquid may cause burns during electrosurgery.

• Inaccurate SpO2 data can result if a sensor is past its useful life. Therefore, re-evaluate the measurement periodically by performing additional assessment of the patient and equipment, including consideration of use of alternate monitoring methods such as direct measurement of arterial oxyhemoglobin saturation (SaO2).

• Conditions that may cause inaccurate readings and impact alarms include interfering substances, excessive ambient light, electrical interference, ventricular septal defects (VSD), excessive motion, low perfusion, low signal strength, incorrect sensor placement, poor sensor fit, and/or movement of the sensor on the patient.

• Physiological characteristics of the patient can affect the SpO2 signal and readings.

• NEONATAL - The display of inaccurate pulse oximetry (SpO2) values has been linked to the presence of poor signal strength or artifact due to patient motion during signal analysis. This condition is most likely to be encountered when the monitor is used on neonates or infants. These same conditions in adults do not impact the SpO2 values to the same extent.We recommend the application of the following criteria when using the pulse oximetry function on neonates and infants:

− The peripheral pulse rate (PPR) as determined by the SpO2 function must be within 10% of the heart rate, and

− The SpO2 signal strength should be adequate. This is indicated by the display of two or three asterisks or the absence of a Low Signal Quality message.

Procedures or devices previously applied in your facility for SpO2 monitoring should be used in the event the SpO2 value from the monitor cannot be validated by the above criteria.

• If the accuracy of any measurement does not seem reasonable, first check the patient’s vital signs, then check for conditions that may cause inaccurate SpO2 readings. If the problem is still not resolved, check the SpO2 module or sensor for proper functioning.

• Oximetry performance may be impaired when patient perfusion is low or signal attenuation is high.

• The operator is responsible for checking the compatibility of the pulse oximetry monitor, sensor, and patient cable prior to use. Incompatible components can result in degraded performance and/or device malfunction.

• SpO2 readings may be inaccurate for a short time after defibrillation.


13-2

• Change the sensor site immediately if there is evidence of blistering, skin erosion, or ischemic skin necrosis (such as skin discoloration or reddening). Otherwise, change the site every four hours.

• A pulse oximeter should not be used as an apnea monitor.

• A pulse oximeter should be considered an early warning device. As a trend toward patient deoxygenation is indicated, blood samples should be analyzed by a laboratory CO-oximeter to completely understand the patient's condition. Check that the pulse oximetry waveform is physiological in shape to ensure waveform quality and minimize noise spikes caused by motion conditions. (Not applicable when monitoring SpO2 with Masimo SET technology).

• Interfering substances can affect the SpO2 reading.

• Improper sensor placement can affect the SpO2 signal and readings.

• Do not allow tape to block the probe light detector.

• During electrosurgery the SpO2 measurement results may be incorrect.

• Using the Maximum sensitivity setting delays the “Probe Off” Patient detection alarm.

• If you deactivate the “SpO2 Probe Off” alarm, keep the patient under close surveillance.

Cautions

• Prolonged monitoring or incorrect sensor application can cause skin irritation or impaired circulation. Recommend checking probe site every four hours (more frequently for poor perfusion or neonate). Refer to instructions supplied with sensor.

Pulse oximetry

13-3

OverviewOxygen saturation SpO2 is the percentage of saturated hemoglobin compared to total hemoglobin measured by a two wavelength pulse oximeter (also called functional or In Vivo oxygen saturation.

The SpO2 value is measured by light absorption technique: Red and infrared light is emitted from the emitter side of the sensor. The light is partly absorbed when it passes through the monitored tissue. The amount of transmitted light is detected in the detector side of the sensor. When the pulsative part of the light signal is examined, the amount of light absorbed by arterial hemoglobin is discovered and the saturation level can be calculated.

The plethysmographic pulse wave is derived from variations of the intensity of the transmitted light and reflects the blood pulsation at the measuring site. Thus the amplitude of the waveform reflects the perfusion.

The monitor have three options for SpO2 configuration: GE, Masimo and Nellcor. The set up will be preconfigured by the manufacturer according to your choice. Depending on the different SpO2 configuration, not all SpO2 measurements and settings are available to view or change. And also have different performance, please refer to "Technical specification" for more details.

For Masimo SpO2, possession or purchase of this device does not convey any express or implied license to use the device with unauthorized sensors or cables which would, alone, or in combination with this device, fall within the scope of one or more of the patents relating to this device.

Masimo SpO2 is covered under one or more of the following U.S.A. patents: 5,758,644, 6,011,986, 6,699,194, 7,215,986, 7,254,433, 7,530,955 and other applicable patentslisted at: www.masimo.com/patents.htm

Figure 13-1 Pulse oximetry measurement connector

Pulseoximetryconnector


13-4

Display of pulse oximetry

Figure 13-2 Display of SpO2 value and pleth waveform

(1) Scale of plethysmogram

(2) Label

(3) Oxygen saturation (SpO2) value

(4) Pulse oximetry message field

Patient connections

Figure 13-3 Pulse oximetry setup

(1) Compatible SpO2 measurement capability

(2) Interconnect cable

(3) Reusable sensors

(4) Disposable sensors

21

3

4

2

31

2

4

Pulse oximetry

13-5

NOTES:

• GE sensors are latex-free.

• Use dry and clean sensors only.

• Do not use damaged sensors.

• Check that you are not re-using a disposable sensor or other disposable accessories.

• For a comprehensive list of accessories, see the "Supplies and Accessories" catalog delivered with the monitor.

• For each SpO2 accessory, refer to the instructions for use in the accessory package for patient weight limits.

Connecting the patient

NOTE: Use dry and clean sensors only.

1. Connect the sensor to the blue connector in the module.

2. Clean the application site: Remove nail polish, artificial fingernails, earrings etc., clip long fingernails.

3. Position the sensor correctly. For proper sensor positioning, see the “Instructions for use” accompanying each sensor.

4. Attach the sensor to the patient.

5. Attach the sensor cable to the wrist or bed clothes to prevent the cable and sensor from moving.

The message ‘Pulse Search’ is display in the message field. After the pulse search is completed. the plethysmographic pulse waveform and the SpO2 reading are displayed on the screen.


13-6

Pulse oximetry menu

Pleth Scale Changing size of plethysmograph by changing scale. The scale indicator number is displayed on the left side of the waveform.

− GE TruSignal SpO2 configuration: The selection is 2, 5, 10, 20, 50, Auto.

If the pleth scale selection is Auto, the scale of the plethysmographic waveform display is automatically set during ‘Pulse Search’. The scale is then kept constant throughout the case to enable easy detection of changes in the patient's perfusion.

With automatic AUTO scaling mode, the scale changes automatically if the amplitude of the pleth waveform either exceeds the current scale or falls below the maximum value of the next lower scale by 10% for 30 seconds or more. When the scale changes, the message ‘Scale changed’ is displayed.

− Nellcor and Masimo SpO2 configuration: The selection is 1X, 2X, 4X, 8X.

SpO2 Response (GE SpO2 configuration only)

Selecting the SpO2 averaging time. The selections are Normal: 12 seconds (default setting), Fast: 3 seconds.

Averaging (Masimo SpO2 configuration only)

Adjusting the averaging time. It can be 2, 4, 8, 10, 12, 14, 16s.

SpO2Pulse Oximetry

Pleth Scale

HR Source

SpO2 Alarm

Normal

AUTO

Change size of plethysmographby changing scale. Select AUTOto auto-scale waveform.

Beat Sound Volume 3

20

SpO2 Response

Normal Screen

Screen Setup

GE SpO2 Masimo SpO2

Nellcor SpO2

Pulse Oximetry

HR Source

SpO2 Alarm

AUTO

Adjust volume ofpulse/heart beat sound.

Beat Sound Volume 3

Normal Screen

Screen Setup

Pleth Scale 1X

Pulse Oximetry

Averaging

HR Source

SpO2 Alarm

Maximum

AUTO

Change SpO2 averaging time:2~16s.

Beat Sound Volume 3

8s

Sensitivity

Normal Screen

Screen Setup

Pleth Scale 1X

Pulse oximetry

13-7

Sensitivity (Masimo SpO2 configuration only)

Adjusting the Masimo SpO2 sensor sensitivity level.

− Use the Normal sensitivity setting for normal patient monitoring purposes.

− Use the Maximum sensitivity setting for improved poor perfusion performance and for faster tracking of rapid SpO2 saturation changes.

Beat Sound Volume

Adjusting the SpO2 beat volume also affects the beat volume of ECG.

When SpO2 is monitored, the monitor provides a variable pulse beep so that the tone of the pulse beep rises with increasing oxygen saturation and falls as saturation decreases. You can select the volume from 1 (soft) to 10 (loud). With selection 0 there is no audible sound.

HR Source Selects the heart rate source. If the ECG signal is affected by too much noise for a reliable heart rate calculation, heart rate can also be calculated from invasive pressure (Art/ABP/UAC) or plethysmographic pulse waveform Pleth. The selected heart rate source is displayed above the numerical display of the heart rate. The color of the heart rate is the same as that of the source parameter.

The AUTO selection priorities for heart rate calculation are: ECG (the lead with highest R-wave), pressure (Art/ABP/UAC) and plethysmographic pulse waveform.

SpO2 Alarm Alarms can be adjusted in this menu or in the Alarms Setup menu which opens by pressing the Alarms Setup key.

Alarm Delay (Masimo SpO2 configuration only)

Adjusting alarm delay time in SpO2 Alarm menu. Medium priority ‘SpO2 Low’ alarm appears

according to the selection.

Adjusting the delay time. It can be 0s, 5s, 10s, 15s.

Data update and averaging

Nellcor OxiMax data averaging and updating

The Nellcor OxiMax algorithm automatically extends the amount of data required for measuring SpO2 and pulse rate depending on the measurement conditions. During normal measurement conditions in the normal response mode, the averaging time is 6 to 7 seconds.

During difficult measurement conditions, which can be caused by low perfusion, motion, ambient light, electrocautery, other interference, or a combination of these factors, the OxiMax algorithm automatically extends the dynamic averaging time required beyond 7 seconds.

If the resulting dynamic averaging time exceeds 20 seconds, the pulse search condition will be set, while SpO2 and pulse rate values continue to be updated every second.

As the measurement conditions become even more difficult, the amount of data required continues to expand. If dynamic averaging time reaches 40 seconds, the pulse timeout condition will be set and the module will report a zero saturation indicating a loss-of-pulse condition.

Masimo SET data averaging and updating

For Masimo SET technology, when using the default averaging time of 8 seconds, there is a maximum data-averaging signal processing time of 10 seconds from real time plus an additional delay of 2 seconds to update the displayed waveform. Audible alarms are delayed until an alarm limit violation occurs for at least 5 seconds.


13-8

During monitoringPatient condition or prolonged use may require changing the sensor site periodically. Check skin integrity, circulatory status and correct alignment and change sensor site at least every four hours.

For patients with poor peripheral blood circulation or sensitive skin, change the site at intervals of 30 minutes to one hour. To confirm the circulatory status, observe the size of the plethysmographic waveform with a fixed pleth scale. Take special care of this when monitoring small children.

If possible, do not attach the SpO2 sensor on a limb that is used for NMT measurement or for administrating cold infusions.

NIBP measurement and arterial blood pressure measurement

To avoid erroneous readings, do not use a blood pressure cuff or arterial blood pressure measurement device on the same limb as the sensor.

Plethysmographic pulse wave

To get an optimal pulse wave use smaller scale indicators when using measuring sites with poor perfusion. A small pulse wave may be a sign of impaired circulation that may require increased attention.

Higher scale indicators together with a well defined pulse wave indicate strong circulation and a relaxed patient.

NOTE: Always check the patient and the sensor site if the accuracy of the SpO2 values is questionable.

Waveform quality

NOTE: For all technologies except Masimo SET.

Under normal conditions, the SpO2 waveform corresponds to (but is not proportional to) the arterial pressure waveform. The typical SpO2 waveform can help the user find a sensor location with the fewest noise spikes.

If noise (artifact) is seen on the waveform because of poor sensor placement, the photodetector may not be flush with the tissue. Check that the sensor is secured and the tissue sample is not too thick. Pulse rate is determined from the SpO2 waveform, which can be disrupted by hemodynamic pressure disturbances. Motion at the sensor site is indicated by noise spikes in the normal waveform.

The stability of the displayed SpO2 values can also be used as an indication of signal validity.

Removing the sensor

• Open the sensor. Do not pull the sensor from its cable.

Pulse oximetry

13-9

Measurement limitations• The monitors are designed to minimize the interference of electrosurgery. Under some

circumstances electrosurgery may cause noise on the screen. Therefore, be careful in interpreting the results, especially the plethysmographic pulse waveform, during electrosurgery.

• The saturation values may be somewhat higher for smokers. Special care should be taken with patients who have burns or carbon monoxide (CO) intoxication. When carbon monoxide intoxication is suspected, always confirm the pulse oximetry reading with a blood sample measurement.

• Intravascular dyes may cause erroneous readings. For example, methylene blue, indigo carmine, indocyanine green or any substances that contain dyes, interfere with the SpO2 measurement.

• Vasoconstrictive drugs, such as phenylephrine hydrochloride and dopamine, may affect the accuracy of the measurement.

• The pulse oximeter cannot distinguish between oxyhemoglobin and dyshemoglobins.

• Poor perfusion may affect the accuracy of measurement, especially when using an ear sensor.

• To avoid erroneous readings, do not use a blood pressure cuff or arterial blood pressure measurement device, or NMT sensor in the same limb as the SpO2 sensor.

• For Masimo SpO2, loss of pulse signal can occur when:

− Sensor is too tight

− The patient has hypotension, severe vasoconstriction, severe anemia or hypothermia.

− There is arterial occlusion proximal to the sensor.

Interference

These types of interference can influence the function of SpO2:

• Incorrect sensor application, e.g., sensor placement on an extremity with a blood pressure cuff, arterial catheter, or intravascular line, sensor applied too tightly.

• Intravascular dyes, such as idocyanine or methylene blue.

• Externally applied coloring agents with opaque materials in high ambient light conditions, e.g., conditions created from one or more of the following sources:

− Surgical lights, especially xenon light sources

− Bilirubin lamps

− Fluorescent lights

− Infrared heating lamps

− Direct sunlight

• Excessive patient activity

• Venous pulsation

• Dysfunctional hemoglobin

• Poor (low) peripheral perfusion

• Arterial occlusion proximal to the sensor

• Loss of pulse (cardiac arrest)


13-10

• Electromagnetic interference (EMI)

• Ventilator-induced pressure changes

SpO2 functional testers

Some models of commercially available bench-top functional testers and patient simulators can be used to verify proper functionality of pulse oximeter sensors, cables and monitors. While such devices may be useful for verifying that the pulse oximetry system is functional, they are incapable of providing the data required to properly evaluate the accuracy of the system’s SpO2 measurements.

Many functional testers and patient simulators have been designed to interface with the pulse oximeter’s expected calibration curves, and may be suitable for use with the pulse oximeter monitor and sensors. Not all devices, however, are adapted for use with all digital calibration systems. While this will not affect use of the simulator for verifying system functionality, displayed SpO2 measurement values may differ from the setting of the device. For a properly functioning monitor, this difference will be reproducible over time and from monitor to monitor within the performance specifications of the test device.

GE Trusignal technology clinical studies on neonatalGE Oxy-AF and GE Oxy-SE sensors have been validated for neonatal accuracy. The subject demographics included 28 neonates and 1 infant (15 females and 14 males). The subjects ranged in age from newborn to 37 days old. The weights ranged from 560 to 3060 g. The skin tones included in the study were light to dark. For neonatal study, the Arms of the collected convenience samples are 2.7, Oxy-AF sensor in the SaO2 range of 87-100% collected 52 data points, Oxy-SE sensor in the SaO2 range of 81-100% collected 53 data points.

Bland-Altman graphical plot analysis on blood test resultsLinear regression graphical plot of TruSignal V2 SpO2 Test DataBland-Altman graphs with a linear regression fit and the upper 95% and lower 95% limits of agreement (Mean ± 1.96 * standard deviation) are given below.

For each graph, the subjects are differentiated with different color and style. Figure 1 to Figure 8 represent different sensors under test.

Pulse oximetry

13-11

Figure 13-4 Bland-Altman plot of TruSignal V2 with Oxy-F sensor. Population mean bias: 0.0, upper 95% limit of agreement: 2.2, lower 95% limit of agreement: -2.2, between subject variance: 10.2, Within-subject variance: 0.9.

Figure 13-5 Bland-Altman plot of TruSignal V2 with Oxy-W sensor. Population mean bias: 1.1, upper 95% limit of agreement: 4.5, lower 95% limit of agreement: -2.3, between subject variance: 41.5, within-subject variance: 1.5.


13-12

Figure 13-6 Bland-Altman plot of TruSignal V2 with Oxy-SE sensor. Population mean bias: 1.3, upper 95% limit of agreement: 4.2, lower 95% limit of agreement: -1.7, between subject variance: 29.2, within-subject variance: 1.2.

Figure 13-7 Bland-Altman plot of TruSignal V2 with Oxy-AP sensor. Population mean bias: 1.3. Upper 95% limit of agreement: 4.0, lower 95% limit of agreement:-1.4. Between subject variance: 11.4, within-subject variance: 1.3.

Pulse oximetry

13-13

Figure 13-8 Bland-Altman plot of TruSignal V2 with Oxy-AF sensor. Population mean bias: 0.9, upper 95% limit of agreement: 3.8, lower 95% limit of agreement: -2.0, between subject variance: 10.7, within-subject variance: 1.7.

Figure 13-9 Bland-Altman plot of TruSignal V2 with Oxy-E sensor. Population mean bias: 0.8, upper 95% limit of agreement: 3.9, lower 95% limit of agreement: -2.3, between subject variance: 20.8, within-subject variance: 1.7.


13-14

Figure 13-10 Bland-Altman plot of TruSignal V2 with Oxy-AP sensor, motion conditions. Population mean bias: 0.8. Upper 95% limit of agreement: 5.0, lower 95% limit of agreement:-3.4. Between subject variance: 22.6, within-subject variance: 3.6.

Figure 13-11 Bland-Altman plot of TruSignal V2 with Oxy-AF sensor, motion conditions. Population mean bias: 0.6. Upper 95% limit of agreement: 3.5, lower 95% limit of agreement:-2.3. Between subject variance: 10.5, within-subject variance: 1.7.

Pulse oximetry

13-15

Checklist Check that

• Only one module with pulse oximetry measurement is inserted.

• Correct SpO2 sensor is selected for each patient size.

• The sensor is completely dry after cleaning.

• Sensor or interconnect cable is plugged to the blue connector in the module.

• Sensor is properly connected to the interconnection cable if used.

• Sensor is positioned correctly to the patient.

• SpO2 is selected for screen through Monitor Setup - Screen Setup.


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14 Non-invasive blood pressure

Non-invasive blood pressure

14-1

14 Non-invasive blood pressure

Safety precautions

Warnings

• The NIBP parameter will not measure blood pressure effectively on patients who are experiencing seizures or tremors.

• Arrhythmias will increase the time required by the NIBP parameter to determine a blood pressure and may extend the time beyond the capabilities of the parameter.

• Do not apply external pressure against the cuff while monitoring. Doing so may cause inaccurate blood pressure values.

• Do not place the cuff on a limb being used for A-V fistulas, intravenous infusion or on any area where circulation is compromised or has the potential to be compromised.

• Accuracy of NIBP measurement depends on using a cuff of the proper size. It is essential to measure the circumference of the limb and choose the proper size cuff.

• The cuff size selected in the NIBP menu and the cuff size used must be correct to obtain reliable NIBP data and to prevent overpressure in neonatal or pediatric use.

• For SuperSTATTM NIBP Only - It takes one to three minutes for the NIBP parameter to identify an irregular rhythm after ECG is connected. For patients with irregular rhythms, simultaneous monitoring of ECG will enhance NIBP performance. Wait three minutes after ECG has been connected and ECG heart rate is present on the monitor screen before performing an NIBP determination.

• NIBP READINGS MAY TIME OUT WHEN USING IABP — An IABP balloon pump creates non-physiological arterial waveforms. These waveforms create an oscillometric signal that may not be interpreted by the NIBP algorithm, causing NIBP to time out. The patient blood pressure can be monitored from the balloon pump device.

• GE Healthcare monitors are designed for use with dual-hose cuffs and tubing. The use of single-hose cuffs with dual hose tubing can result in unreliable and inaccurate NIBP data.

• If a patient’s beat-to-beat pulse amplitude varies significantly (e.g., because of pulsus alternans, atrial fibrillation, or the use of a rapid-cycling artificial ventilator), blood pressure and pulse rate readings can be erratic, and an alternate measuring method should be used for confirmation.

• If Luer lock connectors are used in the construction of tubing, there is a possibility that they might be inadvertently connectd to intravascular fluid systems, allowing air to be pumped in to a blood vessel.

Cautions

• Devices that exert pressure on tissue have been associated with purpura, skin avulsion, compartmental syndrome, ischemia, and/or neuropathy. To minimize these potential problems, especially when monitoring at frequent intervals or over extended periods of time, make sure the cuff is applied appropriately and examine the cuff site and the limb distal to the cuff regularly for signs of impeded blood flow.


14-2

• Periodically check patient limb circulation distal to the cuff. Check frequently when using Auto NIBP in one and two minute intervals. The one and two minute intervals are not recommended for extended periods of time.

• The monitor sets the inflation pressure automatically according to the previous measurement. Reset the case or discharge the patient to reset the inflation limits before measuring NIBP on a new patient.

OverviewThe non-invasive blood pressure (NIBP) measurement uses the oscillometric measuring principle. The cuff is inflated with a pressure slightly higher than the presumed systolic pressure, then slowly deflated at a speed based on the patient’s heart rate, collecting data from the oscillations produced by the pulsating artery. Based on this data, the unit calculates values for systolic, mean and diastolic pressures.

Blood pressure measurements determined with this device are equivalent to those obtained by an intra-arterial blood pressure measurement device. Multiple intra-arterial sites were used.

You can set the NIBP module into an automatic cycling mode to make measurements at desired time intervals. You can also measure NIBP continuously for five minutes in STAT mode or take separate single measurements.

NOTE: Intervals below 10 minutes and STAT measurements are not recommended for extended periods of time.

NOTE: This equipment is suitable for use in the presence of electrosurgery.

Figure 14-1 Non-invasive blood pressure measurement connector

NIBP connector


14-3


There are two keys for starting NIBP on the Command Board:

Displaying non-invasive blood pressure

NIBP can be displayed in the digit field:

Figure 14-2 NIBP digit field display

(1) Systolic and diastolic pressure value of non-invasive blood pressure

(2) Label

(3) Mean pressure value of NIBP

(4) Time since the last autocycle measurement

(5) NIBP autocycle time indicator

NOTE: When 60 minutes has passed from the latest NIBP measurement, the NIBP numeric value digits turn gray. When 245 minutes has passed from the latest NIBP measurement, the gray numeric value digits are replaced by a dashed line.

Starts and stops autocycling measurements.

Starts a single measurement, and cancels any measurement.

NIBPAuto ON/OFF

NIBPStart/Cancel


14-4

Patient connections

Figure 14-3 NIBP setup

(1) NIBP connector in monitor

(2) Cuff hose

(3) Cuff of correct size

Place the arrow (4) over the brachial artery. Check that the index line (5) falls within the range markings on the cuff, and wrap the cuff around the upper arm.

Always choose the appropriate blood pressure measurement site. In adult and child patients, the upper arm is preferred for convenience and because normative values are generally based on this site. When factors prohibit use of the upper arm, the clinician must plan patient care accordingly, taking into account the patient’s cardiovascular status and the effect of an alternative site on blood pressure values, proper cuff size, and comfort.

Always measure patient’s limb and select appropriately sized cuff according to size marked on cuff or cuff packaging. When cuff sizes overlap for a specified circumference, choose the larger size cuff.

If patient is standing, sitting, or inclined, ensure that cuffed limb is supported to maintain the cuff at level of patient’s heart. If the cuff is not at heart level, the difference in the measured pressure values due to hydrostatic effect must be considered.

NOTE: For a comprehensive list of accessories, see the “Supplies and Accessories” catalog. The listed NIBP cuffs are latex-free.

2

1

4 53


14-5

Selecting a cuff and a cuff hose

Two different cuff hoses with different cuff connections are available:

− BLACK hose for adults and pediatric (corresponding inflation limits A/P including cuff identification.

− LIGHT BLUE hose for neotatal (corresponding inflation limit NEO without cuff identification.

To set up the inflation limits:

1. Press the NIBP key and select NIBP Setup - Inflation Limits.

2. Select the limit according to the hose with the Trim Knob.

NOTE: The monitor automatically identifies the setting of the inflation limits. When using hoses without identification, the monitor goes to this selection automatically when you try to start the NIBP measurement. You must set the inflation limits manually. With these hoses, AUTO option is not available.

NOTES:

− You cannot select A/P inflation limits when using an infant cuff.

− The NIBP system incorporates a safety circuit to prevent overpressure or prolonged inflation of the cuff.

− The alarm limits change automatically according to the cuff hose type used.

To determine the correct cuff size, check that the index line on the outer edge of the cuff falls between the range lines. If not, use a larger or smaller cuff.

Connecting the cuff hose

1. Connect the cuff hose to the NIBP cuff by placing the opposite connectors in contact and locking them together.

2. Plug the NIBP cuff hose to the module.


14-6

NIBP Setup menu

Ready Prompt Ready prompt gives an audible tone when the NIBP measurement is ready. Adjust the volume of the beep tone from 1 (soft) to 10 (loud), or to 0 (OFF.)

Inflation Limits When this selection is ‘Auto’, the monitor automatically identifies the cuff hose and selects the right inflation pressure and alarm limits for different cuff size. This selection allows you to override the automatic safety limit feature for the hose/cuff being used.

The selections are: Auto, A/P and NEO. The selection AUTO is not available when using hoses without identification.

NOTE: You cannot select adult limits with an infant cuff hose.

NOTE: When using very large adult cuffs, use ‘Adult’ limits to prevent ‘Cuff loose’ message from displaying.

Previous Menu Returns to the NIBP menu level.

NIBPNIBP Setup

Ready Prompt

Inflation Limits

Previous Menu

5

AUTO

Adjust volume of soundindicating completion ofNIBP measurement.

NIBP


14-7

StartingNote that the measurement unit may be mmHg or kPa. The unit is selected during configuration through Monitor Setup - Install/Service - Installation - Units.

You can start the NIBP measurement using either the direct function keys, or from the NIBP menu by pressing the NIBP key.

In the beginning of the measurement, sys and dia labels are replaced by the inflation limit indication (Adult/Pediatric, Neonatal) for five seconds. The cuff pressure is displayed in the mean pressure value field.

If motion artifacts are detected, the monitor automatically holds deflation until the motion stops (maximum of 30 seconds). If the artifacts prevent proper measurement, a new measurement starts automatically.

When the measurement is ready, you can hear a short beep and see the result numbers flashing.

During measurement

• Observe the cuffed limb frequently. Measurement may impair blood circulation. Intervals below 10 minutes and STAT measurements are not recommended for extended periods of time.

• Make sure that the tubes are not bent, pressed or stretched. Measurement may be impaired.

• Blood pressure values may be affected by a change in the patient's position.

• The presence of some arrhythmias during NIBP measurement may increase the time required for the measurement.

NIBP


14-8

AutocyclingThe NIBP Auto On/Off key sets automatic NIBP measurement at selected intervals on and off. To automatically measure NIBP at set time intervals, you must first set the cycle time before setting the automatic measurements.

You also can configure a custom auto mode to meet the need of your clinical situation.

Autocycling is synchronized to real time, for example, if the first measurement was at 12:02, the next measurement is at 12:05 and again at 12:10 (5 min. interval.)

Setting cycle time

The possible intervals for autocycling are 1, 2, 3, 4, 5, 10, 15, 20, 30, 60, 90, 120 minutes, and the custom option. To set the cycle time:

• Press the NIBP key on the Command Board and select Cycle Time.

• Select the alternative with the Trim Knob.

NOTE: When you select the custom option, the NIBP measurements will follow custom mode. You need configure or verify the custom mode’s set up before start the automatic measurements.

NIBP


14-9

Setting custom mode

You can set up to 4 separate steps for auto NIBP determinations by setting the time interval and how many times this interval is repeated.

To set the custom mode:

• Press the NIBP key.

• Select Custom Setup.

• Set up time interval and repeat times for every series.The cycle time can be set to 1 to 120 min or OFF.The repeat option can be set to 1 to 25 times or OFF or cont.

Starting and stopping autocycling:

To start the autocycling, do one of the following:

• Press the NIBP Auto On/Off key, orpress the NIBP key and select Start Cycling.

The bar at the bottom of the NIBP field shows the time remaining to the next measurement.

To stop autocycling:

• Press the NIBP Auto On/Off orpress the NIBP key on the Command Board and select Stop Cycling.

NIBP


14-10

Starting and stopping a single manual measurement To start the measurement, do one of the following:

• Press the NIBP Start/Cancel key, orpress the NIBP key and select Start Manual.

To stop any NIBP measurement, do one of the following:

• Press the NIBP Start/Cancel key, orpress the NIBP key and select Cancel.

Starting and stopping a continuous measurement (STAT)The STAT mode initiates continuous measurement for five minutes. A new NIBP measurement starts immediately after the previous one.

After five minutes the monitor automatically returns to the previously selected cycling interval or to manual mode.

To start the measurement, do the following:

• press the NIBP key and select Start STAT.

To stop the measurement, do one of the following:

• Press the NIBP Start/Cancel key, orpress the NIBP key and select Stop STAT.

NOTE: For the NIBP trends, the displayed and printed value is an average if there has been more than one NIBP measured in one minute. Except the Time Scale is 20’ in Graphical mode.

NOTE: Stat NIBP measurement is deactivated in neonatal mode.


14-11

Principles of SuperSTAT Noninvasive Blood Pressure Determination

The oscillometric method of determining NIBP is accomplished by a sensitive transducer which measures cuff pressure and pressure oscillations within the cuff. For the first determination taken on a patient, the algorithm stores the pattern of the patient's oscillation size as a function of the pressure steps. For subsequent manual (determined as such when the previous determination is less than 16 minutes old), auto or stat determinations taken of the same patient,

as few as four pressure steps may be necessary to complete the determination process. When employing fewer pressure steps, the system uses the stored information from the previous blood pressure determination to decide the best pressure steps to take. The algorithm measures the consistency of pulse size to tell if the oscillations taken at a step are good and if more steps are needed.

The first determination settles at an initial target pressure of 135 mmHg (adult mode) and 100 mmHg (neonate mode), depending on initial target pressure preset. To allow for rapid settling of cuff pressure, the monitor will momentarily inflate to a higher pressure then immediately deflate to the target pressure. After inflating the cuff, the NIBP parameter begins to deflate. The oscillations versus cuff pressure are measured to determine the mean pressure and calculate the systolic and diastolic pressures.

During an NIBP determination, the parameter deflates the cuff one step each time it detects two pulsations of relatively equal amplitude. The time between deflation steps depends on the frequency of these matched pulses (pulse rate of the patient). However, if the monitor is unable to find any pulse within several seconds, it will deflate to the next step. The process of finding two matched pulses at each step provides artifact rejection due to patient movement and greatly enhances the accuracy of the monitor. In stat mode, some steps may require only one pulse.

Figure 14-4 Full NIBP Determination Sequence for Adult

At each step the microprocessor stores cuff pressure, the matched pulse amplitude, and the time between successive pulses. The stepped deflation and matched pulse detection continues until diastolic pressure is determined or total cuff pressure falls below 8 mmHg. The parameter then deflates the cuff (to zero detected pressure), analyzes the stored data, and updates the screen.


14-12

The operating cycle is composed of four parts: inflation time, deflation time, evaluation time, and wait time. Wait time, which varies from mode to mode, is affected by the cycle time (auto mode) or operator intervention (manual mode). The figure shows the basic operating cycle for an NIBP determination.

Figure 14-5 NIBP - Auto Mode

Systolic Search

If systolic pressure is not found, the NIBP parameter can search at cuff pressures higher than the initial target pressure. The parameter will inflate the cuff above the initial target pressure to get better data in the systolic region. The maximum pressure allowed in systolic search is limited by the normal range for cuff pressures.

In any operating mode, if a patient's systolic pressure exceeds the inflation pressure, the parameter will begin normal deflation sequence, detect the absence of a systolic value, stop deflation, reinflate to a higher (than initial) inflation pressure (290 mmHg maximum in adult mode; 145 mmHg in neonatal mode), and resume the normal deflation sequence.

If it has been 16 minutes or less since the last determination and the current blood pressure is similar to the previous reading, the monitor will try to make an accelerated determination of blood pressure. During irregular rhythms, only pulses from the current determination are used in calculating the blood pressure values. In order to ensure adequate artifact rejection capability and optimal SuperSTAT NIBP performance, several criteria used to match and qualify the oscillometric pulses at each pressure step are relaxed while supplementing the criteria with additional information from ECG.

NOTE: (Adult/Pediatric only) When ECG is monitored, SuperSTAT NIBP is able to determine blood pressure in the presence of irregular heart rhythms. At the beginning of a SuperSTAT NIBP determination, the coefficient of variation from the previous 120 ECG R-R intervals is used to determine if an irregular rhythm is present.

Accuracy of the NIBP parameter was validated against the intra-arterial method. Do not use the auscultatory method to verify the accuracy of the NIBP parameter. Auscultatory method (using cuff and stethoscope) calculates the mean pressure value from audible sounds at systolic and diastolic, but the NIBP parameter method detects all three values.


14-13

Automatic NIBP double checkIf the NIBP value exceeds the alarm limits, a low level alarm will be given and the auto measurement takes place, if the alarm situation persists, the alarm will be raise to yellow level.

NIBP measurement limitations• A patient's vital signs may vary dramatically during the use of cardiovascular agents such

as those that raise or lower blood pressure or those that increase or decrease heart rate.

• The NIBP feature not validated for pregnant, including pre-eclamptic patients use.

• Although automated NIBP is generally safe and accurate, it has some limitations. It may be difficult to obtain reliable readings under the following circumstances:

− Shock accompanied by low blood pressure and pulse.

− Variations in blood pressure and pulse rate.

− In patients with anatomic abnormalities, such as calcified (hardened) arteries or subclavian compression.

− Compression of the cuff caused by shivering, seizures, arm movement, or bumping against the cuff.

• Proper sizing and position of the cuff are essential to obtaining reliable readings:

− Too large a cuff is better than too small a cuff, which may yield falsely high readings.

− The cuff should also fit properly over the brachial artery (or whatever artery is being used) so that the cuff is sufficiently sensitive to vibrations in the artery.


• The hose is correct: grey NIBP hose for adults and pediatric and light blue for neonatal.

• The O-ring on the hose connector is intact.

• The connector is firmly pushed inside the cuff tube.

• The NIBP hose is properly connected to the module and will not detach if pulled.

• The NIBP cuff is correct for the patient size.

• There are no holes or cracks in the cuff bladder or cuff tube.

• The symbol indicating the center of the bladder is over the artery.

• All residual air is squeezed out of the cuff before wrapping it around the arm.

• The cuff is not loose.

• The cuff is at heart level.

• The cuff tubes or NIBP tube are not kinked or squeezed together.

• Non-invasive blood pressure is selected to be displayed through Monitor Setup - Screen Setup.


14-14



15-1


Safety precautions

Warnings

• All invasive procedures involve risks to the patient. Use aseptic technique. Follow catheter manufacturer's instructions.

• Make sure that no part of the patient connections touches any electrically conductive material including earth.

• Mechanical shock to the invasive blood pressure transducer may cause severe shifts in zero balance and calibration, and cause erroneous readings.

• When initializing the IBP parameter, Invasive blood pressure alarm activation criteria may result in inactive limit alarms.


OverviewYou can measure and monitor two invasive blood pressures at the same time using a dual invasive blood pressure cable. To measure invasive blood pressure you need the IBP configuration in monitor.

To measure invasive blood pressure, a catheter is inserted into an artery or vein. The invasive blood pressure setup, consisting of connecting tubing, a pressure transducer, and a fluid source to maintain pressure (all connected together by stopcocks) is attached to the catheter. The transducer is placed at the same level with the heart, and is electrically zeroed. The transducer is a piezo-resistive device that converts the pressure signal to a voltage. The monitor interprets the voltage signal so that pressure data and pressure waveforms can be displayed.

The measured invasive blood pressure parameters are systolic, diastolic, and mean. Pulse rate can be monitored with any arterial site. CPP is a calculated value that requires a valid ICP value and a valid arterial site value. 2 channel pressures can be monitored.

During the invasive blood pressure measurement, the transducer converts pressure variations into electrical signals. The electrical signals are amplified and displayed as numeric pressure values and waveforms.


15-2

Figure 15-1 Invasive pressure measurement connector


There is a key for zeroing IBP on the Command Board:

NOTE: Selecting Zero ALL does not zero ICP. Zero it separately.

Zeros all pressure transducers.

Invasive pressures connector

IBPZero All


15-3

Display of invasive blood pressure

Figure 15-2 InvBP display

(1) Invasive blood pressure waveforms with zero and reference lines

(2) Selected pressure label

(3) Selected pressure scale

(4) Field for messages and alarm limit settings

(5) Systolic, diastolic and mean pressure values of invasive blood pressures

You can have a combined display of all those waveforms that are selected on the screen. This combined display uses the whole waveform field area and the same zero line for all waveforms.

To select:

1. Press the Monitor Setup key and select Screen Setup.

2. Select Waveform Fields.

3. To combine all waveforms in one field, select Combine Pressures and Yes.

NOTES:

• A pressure channel is activated when a pressure transducer is connected to the monitor.

• A pressure channel is deactivated when a pressure transducer is disconnected to the monitor.

2 3 4 5

1


15-4

Patient connections1. Connect the pressure transducer to the transducer adapter cable. Connect the cable to

the red connector in the module, or to the dual invasive blood pressure adapter cable.

NOTE: Invasive pressures need to be zeroed after reconnecting the pressure transducer or cable, and whenever the patient’s position is changed. The transducer is always leveled to the mid right atrium.

2. Prepare the transducer kit according to the manufacturer’s instructions. Mount the kit with the transducer zeroing port at mid-heart level.

3. Ensure that there is no air in the line. Refer to transducer manufacturer’s instructions on how to remove trapped air from the transducer.

4. Connect the patient catheter to the pressure line.

5. Open the dome stopcock to room air.

6. Zero the transducer. See "Starting with accurate values" on page 15-5.

7. Open the dome stopcock to pressure catheter and check the quality of the waveform.

Figure 15-3 Invasive blood pressure setup

(1) Compatible InvBP measurement capability

(2) Heparinized fluid bag with pressure infusor

(3) Flushing set

(4) Disposable catheter

(5) Transducer

(6) Adapter cable for the InvBP transducer

(7) Adapter cable for dual InvBP measurement

NOTE: Patient connections made according to the picture above using approved accessories are defibrillator-proof.

3

5

4

7

2

6

1


15-5

Zeroing invasive blood pressure transducersPrior to monitoring, zero transducers at the patient’s phlebostatic axis. Zeroing the pressure transducers is very important for accurate pressure measurements. To avoid inaccurate measurements, you must zero the pressure transducers:

• Before measuring invasive blood pressures.

• Before initiating treatment changes reliant upon pressures data.

• When using a new transducer or tubing.

• After reconnecting the transducer cable to the acquisition device.

• Whenever the patient’s position is changed.

• Whenever the pressure reading is questionable.

Starting with accurate valuesPressure transducers generally produce a small signal even when no pressure is applied to them. It is necessary to zero the monitor with the transducer to establish an accurate electrical zero point.

Also, the position of the transducer effects the accuracy of the measurement. An error of 10 mmHg of static pressure is introduced for every 13.6 cm (5.4 inches) difference in height between the mid-heart and the transducer.

To zero the transducer, open the transducer to air and do one of the following:

• Press the IBP Zero All key. This starts zeroing immediately.

Or:

• Press the IBP key on the Command Board and select Zero Pressures.

During the zeroing process, the message ‘Zeroing’ is displayed. After the transducer is zeroed, the message ‘Zeroed’ is displayed in the digit field. After each channel is zeroed, the time of zeroing is displayed in the menu.

NOTES:

• Selecting Zero ALL does not zero ICP. Zero it separately.

• Check zero level after power interruptions.

IBP


15-6

• Invasive pressures need to be zeroed after reconnecting the pressure transducer or cable, and whenever the patient’s position is changed. If all channels have not been zeroed, the message ‘InvBP not zeroed’ appears. However, the alarms advance to yellow and red levels regardless of zeroing.

Invasive Pressures menu

Zero Pressures Opens a menu to zero both pressures or one of them.

Ventilation Mode Respiration causes artifacts in invasive pressures. At the end of expiration the artifact is at its smallest. Select Spont for spontaneous respiration and Contr for controlled ventilation.

IBPx Setup menu

Label Start-up labels are Art and CVP. Other labels are IBP1, IBP2, PA, RAP, RVP, LAP, ICP, ABP, UAC and UVC. Assigning the appropriate label automatically changes other pressure settings accordingly.

Scale Scales are assigned by the monitor when the channel is labeled. Scales can also be individually adjusted between 10 and 300 mmHg in steps of 10.

Digit Format With the numeric display format you can choose either the Systolic/Diastolic numbers (S/D) or the Mean pressure value (Mean) in large size to the screen. You can also choose all values (S/D/M) to the screen. If the label is ICP, also the CPP selection is available (see also page 15-8).

Response Use the Trim Knob to change the invasive blood pressure averaging time. The available values are Normal and B-TO-B (beat-to-beat). With selection Normal, normal averaging is used. Depending on the label, the values are updated approximately every five seconds. With selection B-TO-B, no averaging is used and the values of the last detected pulse are displayed. These values can change up to three times per second. This feature is useful when it is necessary to detect fast pressure changes. NOTE: This setting affects only the displayed values, not the averaging of invasive pressure trends.

Filter FrequencyMeasured signal is filtered to remove noise and artifacts. Use the Trim Knob to adjust the filter between 4 and 22 Hz.

HR Source If the ECG signal is affected by too much noise for a reliable heart rate calculation, heart rate can be calculated mechanically from the pressure (Art) or plethysmographic pulse waveform. The selected heart rate source is displayed above the numerical display of the heart rate. The color of the heart rate is the same as that of the source parameter. Auto selection prioritizes

IBP


15-7

the heart rate calculation in a specified order: ECG (the lead with highest R-wave), pressure (Art), and plethysmographic pulse waveform.

IBPX Alarm Alarms can be adjusted in this menu or in the Alarms Setup menu which opens by pressing the Alarms Setup key.

Determining pressure values visually

By moving the horizontal cursor across the pressure waveform, you can get accurate pressure values at selected points. This may be useful, for example, if the patient's breathing pattern is irregular. The cursor is not available for pressures shown with a combined scale.

1. Press the IBP key.

2. Select Px Setup - Px Cursor.

3. Move the cursor up or down by turning the Trim Knob. Every time the cursor is moved, the time (hours and minutes) and pressure values are displayed on the screen. This way, you can keep track of the changes made.

4. You can remove the cursor by selecting Remove cursor. Note that if the cursor is not removed, it remains visible in the Normal Screen.

Labeling channelsThe label of the pressure channel sets its display scale, color, filter, alarm source and alarm limits. The label descriptions are preconfigured.

To change the label:

1. Press the IBP key.

2. Select IBP1 Setup.

3. Select Label.

IBP


15-8

The labels are the following:

IBP1, IBP2 Standard labels

Art Arterial pressure

CVP Central venous pressure

PA Pulmonary arterial pressure

RAP Right atrial pressure

RVP Right ventricular pressure

LAP Left atrial pressure

ICP First intracranial pressure

ABP Arterial blood pressure

UAC Umbilical artery catheters

UVC umbilical venous catheters

Both Art and ABP labels are available for situations when two arterial lines are desired but you want to use different settings or alarm labels.

Table 15-1 Invasive blood pressure labels and descriptions

Cerebral perfusion pressureCerebral Perfusion pressure CPP is calculated by subtracting ICP mean pressure from Art mean pressure.

CPP mean is displayed next to the ICP value.

NOTE: Set the Label of the channel to ICP, and the Digit Format to CPP.

LABEL P1, Art, ABP

P2, CVP RAP, LAP

ICP PA RVP UAC UVC

Scale mmHg/kPa 200/30 20/4 20/4 20/4 60/8 60/8 100/14 10/2

Color Red Blue White White Yellow White Red White

Alarm source Sys Mean Off Off Off Off Sys, Dia, Mean

Mean

Digit format S/D Mean Mean CPP S/D S/D S/D Mean

Filter (Hz) 22 9 9 9 9 9 14 14

Response normal normal normal normal normal normal normal normal


15-9

Adjusting alarm sources and limitsYou can adjust or turn off pressure alarm limits in the Alarms Setup/Adjust Limits menu. Enter the menu by pressing the Alarms Setup key.

For each pressure channel you can choose as a source Sys (Systolic), Dia (Diastolic), Mean or Off. Note that you can choose one or both sources to be active at a time.

For more information about alarms and adjusting, see section "Alarms."

AlarmsSetup

IBP1 ADJUST ALARM LIMITS:

Adjust Limits

Sys Alarm

Dia Alarm

Mean AlarmAlarms Setup

Previous Menu

ON

OFFIBP1Sys

320

180

80

-40mmHg

Push Trim Knobto turn alarmON/ OFF.

OFF

High

Low

Alarms Setup

CVP SpO2 CO2

15 100 8.0

ET

0 3.090

ALARM LIMITS AND 10 MIN TRENDS:

Mean

Adjust Limits

Auto Limits

Default Limits

Adiuo ON/OFF

Alarm Light 100%

Alarm Volume 5

Remove Menu

Cancel ChangesArrh. Alarms

Normal Screen


HR STLat.

NIBPSys

ARTSys

40 -2.0 80 80

180 180160 2.0

60

4RespRate

38.0

34.0TempT1

Exit


15-10

Smart InvBP and flushingFlushing is performed to keep the lines open. It prevents blood from clotting and occluding the lines and measurements. Infusion that is used for flushing goes through the dome into the patient’s artery.

Two types of flushing are used simultaneously: flushing with continuous infusion and manual flushing. Flushing with continuous infusion uses a higher pressure than the patient’s blood pressure and contains Heparin to prevent blood from clotting. Manual flushing is always used after having taken a blood sample, and every now and then to ensure that the lines remain open.

The monitor detects the pressure used for infusion to flush the invasive blood pressure line. There is a 40 second time-out for performing the flushing. The digits change to dashes, ---/--- , and there are no alarms. After 40 seconds, or when flushing is completed and patient’s pulse detected, the pressure digits are displayed and alarms become active. If pressure values are outside the alarm limits, an alarm is given.

The monitor functions the same way when blood samples are taken.


• Invasive blood pressure transducer cable is plugged to the adapter cable, and this is connected to the red connector in the module.

• Pressure transducer is connected to the cable.

• Patient catheter is connected to the pressure line.

• There is no air in the transducer dome or catheter line and transducer is at mid heart level.

• Pressure transducer is zeroed.

• Invasive blood pressure is selected for screen through Monitor Setup - Screen Setup.

16 Temperature

Temperature

16-1

16 Temperature

Safety precautions

Warning

• Temperature measurement response time is affected by use of esophogeal stethoscope with certain temperature sensors.

Caution


OverviewYou can simultaneously measure and monitor temperature of two sites with TEMP configuration. Temperature monitoring provides numerics only. No waveform is generated or displayed.

Thermally sensitive resistors (thermistors) are used to monitor temperature. As temperature changes, electrical resistance changes. Thermistors measure this resistance change and use it to calculate the temperature. The signal from the probe is processed by the monitor and is displayed as measured numerics.

As a measuring probe use only GE Healthcare temperature probes or defibrillator-proof YSI 400 series probes. You can measure, for example, esophageal, nasopharyngeal, rectal, and skin temperature.

NOTE: Monitoring of perioperative body temperature is recommended when inducing hypothermia or if unexpected temperature changes occur.

Figure 16-1 Temperature measurement connector

Temperature connector


16-2

Displaying temperature

Figure 16-2 T1+T2 digit display

(1) Labels

(2) Temperature measurement value

(3) Calculated T2-T1 difference

The other options are individual T1 and T2 readings in a digit field.

Patient connections

Figure 16-3 Temperature measurement setup

(1) Compatible temperature measurement capability

(2) Adapter cable for temperature probes

(3) Reusable temperature probe

(4) Adapter cable for disposable temperature probe

(5) Disposable temperature probe

To connect the patient:

1. Attach the temperature probe to the patient.

2. Connect the adapter cable to the module connector.

NOTES:

• Use only GE approved temperature accessories. For a comprehensive list of accessories, see the "Supplies and Accessories" catalog.

• A temperature channel is activated when the monitor detects a temperature transducer interface cable.

1

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1

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1

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2

Temperature

16-3

• A temperature channel is deactivated when a temperature interface cable is detached from the monitor.

Temp Setup menu

T1, 2 Label Allows you to label each temperature measurement site.

Unit Allows you to select the units to be either degrees Celsius or degrees Fahrenheit.

Allows you to adjust temperature alarm limits for two measurement sites, measured by T1 or T2. You can choose one or both sources to be active at a time.

Temp Alarm Alarms can be adjusted in this menu or in the Alarms Setup menu which opens by pressing the Alarms Setup key.

Previous Menu Returns to the previous menu level.

Changing temperature label1. Press the Others key.

2. Temp Setup - T1 Label or T2 Label.

3. Select the label with the Trim Knob. Labels are T1 and T2, or:

Eso (Esophageal temperature)

Naso (Nasopharyngeal temperature)

Tymp (Tympanic temperature)

Rect (Rectal temperature)

Blad (Bladder temperature)

Axil (Axillary temperature)

Skin (Skin temperature)

AirW (Airway temperature)

Room (Room temperature)

Myo (Myocardial temperature)

Core (Core temperature)

Surf (Surface temperature)

Others


16-4

Combining different temperaturesThe monitor displays the difference between different temperatures if they are displayed in the same digit field. differences (T2-T1,) are displayed in the temperature digit field if you choose them in the same digit field. For example, to display T1+T2:

1. Press the Monitor Setup key and select Screen Setup.

2. Select Digit Fields.

3. Select T1+T2 to one of the lower fields.

Testing temperature The temperature measurement functioning is automatically tested periodically. During the test, the message ‘Performing temp test’ is displayed. If the test fails, the monitor displays the message ‘Temperature error’.

Changing temperature unitsYou can select the temperature unit to be either degrees Centigrade or degrees Fahrenheit:


2. Temp Setup - Unit.

3. Select the unit (°C or °F) with the Trim Knob.


• Temperature adapter cable is properly inserted into the connector in the module, and the probe is inserted into the adapter cable.

• Temperature probe is positioned correctly.

• Temperature is selected for screen through Monitor Setup - Screen Setup.

17 Airway gas

Airway gas

17-1

17 Airway gas

Safety precautions

Warnings

• Always check the airway adapter for a tight connection and proper operation before attaching it to the patient.

• Remove the airway gas sampling line from the patient’s airway while nebulized medications are being delivered.

• Keep the monitor horizontal when the gas module is used. Tilting the monitor may cause erroneous results in the gas module's readings and damage the module.

• Leak in breathing circuit (water trap and sampling line) may cause inaccurate readings.

• Blocked gas exhaust may cause inaccurate readings.

• EtCO2 values may differ from blood gas readings.

• Be sure gas or CO2 measurement is off before removing water trap.

• Never connect any tubing to reference gas inlet connector. The inlet must be open at all times.

• Strong scavenging suction may change the operating pressure of the module and cause inaccurate readings or excessive sample gas flow.

• Do not use gas or CO2 sidestream sampling modules on patients who may be adversely affected by the specified withdrawal rates (e.g. a neonate with low tidal volume).

• To avoid the spread of infectious disease, do not allow the exhaust to discharge in the direction of the patient or user.

• Handle the water trap and its contents as you would any body fluid. Infectious hazard may be present.

• E-miniC measurement is intended for patients weighing over 5 kg (11 lb).

• Since sample gas may contain anesthetic agents, make sure that it is not released in the room. Connect the exhaust to a scavenging system to prevent exposure to anesthetic agents.

• Always ensure the correct size and fit of accessories according to patient type and application, especially when monitoring pediatric and neonatal patients. The size and fit of accessories may impact the measured gas concentration values at low tidal volumes. It is recommended to have the gas sampling port close to the proximal end of the endotracheal tube. Excessive dead space in the circuit, including the accessories, may cause re-breathing of gases. Very low accessory dead space between the breathing circuit Y-piece and the gas sampling site may impact the measured gas concentration due to dilution of the sampled exhaled gas with fresh gas from the ventilator. To confirm accurate correlation with measured gases and blood, check arterial blood gas values to confirm a suitable setup is used.

• When monitoring neonatal or other patients that have high respiration rate or low tidal volume these modules shall be used within the limits of respiration rates and tidal volumes to ensure specified measurement accuracy.


17-2

• When using the CARESCAPE respiratory modules and Airway Gas Option module with volume controlled ventilation at low tidal volumes, the specified gas withdrawal rate may significantly reduce the amount of gas delivered to the patient.

• CARESCAPE respiratory modules and Airway Gas Option: Make sure to compensate for the possible reduction of tidal volume caused by the 120 ml/min gas sample flow.

• E-miniC module: Do not use this module on patients that cannot tolerate the removal of 150 ml/min from their total minute ventilation.

• A failure in zeroing or calibrating airway gases may cause inaccurate readings.

• E-miniC module: O2, N2O and anesthetic agent gases may interfere with EtCO2 readings.

• EQUIPMENT FAILURE OR INACCURATE READINGS — Planned maintenance should be carried out annually according to the instructions given in the technical manual. Failure to implement the recommended maintenance schedule may cause equipment failure or inaccurate readings.

• PATIENT CROSS-INFECTION — Returning the sampled gas to the patient circuit causes a risk of patient cross-infection.

• PATIENT CROSS-INFECTION — Always use a bacterial breathing system filter proximal to the patient when returning the sampled gas to the patient circuit. If a bacterial breathing system filter is not used, a failure in the D-Fend Pro water trap may cause a risk of patient crossinfection.

• PATIENT CROSS-INFECTION — If the sampled gas is returned to the patient circuit, ensure the protective function of the D-Fend Pro water trap by replacing it at least once a week, or immediately in case of a defective or missing bacterial breathing system filter. Otherwise, there is a risk of patient cross-infection.

• When use Airway Gas Option module (N-CAiO) for anesthetic agent measurement, make sure the agent is no more than one.

Cautions

• Do not apply pressurized air or gas to any outlet or tubing connected to the monitor, pressure may destroy sensitive elements.

• Patient-specific MAC is affected by several factors such as patient age and body temperature.

Airway gas

17-3

OverviewThe E-miniC, CARESCAPE Respiratory Module (E-sCO and E-sCAiO modules) and Airway Gas Option (N-CAiO module) provide airway measurements. Letters in these module name stand for:

C=CO2 and N2O, O=patient O2, A=anesthetic agents and i=agent identification

The following table shows the airway gases for each acquisition module. The “X” indicates that the module measures the listed parameter.

NOTE: The CARESCAPE Respiratory Module module and Airway Gas Option automatically compensate for N2O in realtime. The E-miniC requires manual selection from the monitor menu to compensate for N2O.

NOTE: When monitoring neonatal or other patients that have high respiration rate or low tidal volume, The CARESCAPE Respiratory Module and Airway Gas Option shall be used within the limits of respiration rates and tidal volumes to ensure specified measurement accuracy.

NOTE: The monitor also is compatible with the E-sCOV and E-sCAiOV modules, but the patient spirometry function can’t be used.

Figure 17-1 Module for gas measurement

Module Parameters/measurements Additional measurements

CO2 N2O O2 Anesthetic agents

Agent ID MAC MACage Balance Gas

Respiration rate

E-miniC X X

E-sCO X X X X

E-sCAiO X X X X X X X X X

N-CAiO X X X X X X X

Modulefor gas measurement


17-4

Display of gases

Figure 17-2 CO2 waveform display

(1) 30 minute trend for CO2 (selected in the Monitor Setup menu)

(2) Gas waveforms

(3) Message field for gases

(4) Gas label

(5) Digit field for ET and FI gas values

(6) Respiration rate

(7) Scale

NOTE: When the measured CO2 and O2 value is outside the specified measurement range, the numeric value is gray.

Figure 17-3 Lower digit field for gases

Airway gas

17-5

Figure 17-4 Anesthetic Agents waveform display

(1) 30 minute trend for Anesthetic Agent

(2) Primary agent gas waveform

(3) Message field for gases

(4) Primary agent gas label

(5) Digit field for ET and FI gas values

(6) MAC

(7) Scale

NOTE: When the measured anesthetic agent value is outside the specified measurement range, the numeric value is gray.

Airway gases measurement setup

E-miniC module to patient connection

(1) E-miniC module

(2) Gas sampling line

(3) Airway adapter with sampling line connector

(4) Sampling line connector on the water trap


17-6

CARESCAPE Respiratory Modules and Airway Gas Option to patient connection

(1) E-sCO, E-sCAiO or N-CAiO module

(2) Gas sample, gas sampling line connector on the water trap

(3) Gas sampling line

(4) Gas sampling line connector on the airway adapter; place the connector upwards

(5) Airway adapter with sampling line connector

(6) Heat and moisture exchanger with filter (HMEF) (optional)

Take the gas sample as close to the patient’s airway as possible, as shown in the illustrations, and connect the sampling line to the patient’s airway adapter.

Position the adapter’s sampling port upwards to prevent any condensed water from entering the sampling line.

NOTES:• Make sure that you are using a water trap that is compatible with the module:

− CARESCAPE respiratory modules and Airway Gas Option: D-fend Pro or D-fend Pro+

− E-miniC: Mini D-fend

• Empty the water trap container as soon as it is half full.

• Place the airway adapter between the HME and Y-piece.

• Place the airway adapter with all sampling ports upwards.

• Always check the tightness of all connections.

• For a comprehensive list of accessories, see the "Supplies and Accessories" catalog.

• Make sure that the gas sampling line is properly connected to the water trap and the water trap is properly connected to the airway gas module. Gas leaks in these connections may dilute the gas sample from the patient circuit, thus resulting in erroneous gas readings. During normal operation, all sampled gas flows out of the sample gas outlet. Room air is used as reference gas for the oxygen measurement and it is mixed with the sampled gas. The sampled gas is diluted by room air so that the fraction of room air in the exhaust gas is about 20%.

• Calibrate the airway gas module every six months in normal use and every two months in continuous use.

Airway gas

17-7

Patient connections

1. Make sure that the water trap container is empty and properly attached.

2. Connect the gas sampling line to the sampling line connector on the water trap.

3. If CARESCAPE Respiratory Module or Airway Gas Option is used with N2O or volatile agents, connect the sample gas outlet to gas scavenging.

4. Turn on the monitor. The monitor performs a self-check. Make sure the related gas measurement is ON. Automatic agent identification is activated in those modules that have this feature.

5. Wait until the message ‘Calibrating gas sensor’ disappears before connecting the sampling line to the airway adapter or the airway adapter to the ventilator circuit.

6. Position the adapter with the sampling port upwards. This prevents any condensed water from entering the sampling line.

7. Check that the airway adapter connections are tight and that the adapter is operating properly.

8. If E-miniC is used with O2 and/or N2O contents higher than 40%, make sure that FiO2 Level and N2O Level are set.

NOTE: Check that the sample line is connected to the water trap before connecting the module to the monitor or turning on the monitor.

NOTE: To minimize the amount of dust drawn into the gas sampling system, always keep the water trap connected to the module. When gas measurement is not in use, you can disconnect the module from the monitor to eliminate the operating sound of the gas pump.

Alternative airway gases patient connections with gas modules

Tracheostomy

(1) Tracheostomy tube with 15 mm connector

(2) Heat and Moisture Exchanger (HME)

(3) Airway adapter

(4) Sample line

1

24

3


17-8

Mask ventilation

(1) Mask

(2) Bacterial filter

(3) Airway adapter

(4) Sample line

Infant ventilation

(1) Endotracheal tube

(2) Pediatric airway adapter

(3) Fresh gas inlet

(4) Sample line

2

1

3

4

2

3

1

4

Airway gas

17-9

Airway Gas setup menu

CO2 setup menu

Scale Allows you to select the following scales:

FiO2 Level (Only for E-miniC)

Selects the FiO2 level. The FiO2 level is used in gas compensations of the CO2 measurement to increase the measurement accuracy. Make sure the level is set if the FiO2 level is higher than 40%.

N2O Level (Only for E-miniC)

Selects the N2O level. The presence of N2O causes the CO2 value to appear higher than the actual value. Use this option to compensate for the presence of N2O.

Unit Selects the CO2 display unit: %, kPa or mmHg.

Resp Rate SourceYou can select the rate to be calculated from the ECG leads (impedance measurement) or the CO2 measurement. If you select AUTO, the rate is automatically calculated from the measured CO2. If impedance measurement is present and the source is AUTO, the respiration rate calculation switches back to impedance respiration if you press the Silence Alarms key during an Apnea alarm.

CO2 Alarm Opens the CO2 alarm adjustment menu to change the CO2 alarm limits.

Resp Rate Alarm

Opens the Resp Rate alarm adjustment menu to change the respiration rate alarm limits.

Previous Menu Returns to the previous menu.

scale options for % scale options for kPa scale options for mmHg

0-6%0-10%0-15%0-20%

0 - 6 kPa0 - 10 kPa0 - 15 kPa0 - 20 kPa

0 - 50 mmHg0 - 80 mmHg0 - 100 mmHg0 - 160 mmHg

AirwayGas


17-10

O2 setup menu

NOTE: B40 only.

Scale Allows you to select the O2 waveform scales. The scale selesctions for O2 waveform are: DIFF6, DIFF10, DIFF15, DIFF30,10-60% and 100%.

Measuremnet Set O2 measurement and alarm on or off.

O2 Alarm Opens the O2 alarm adjustment menu to change the O2 alarm limits.


Agent/N2O Setup menu

NOTE: B40 only.

AirwayGas

AirwayGas

Airway gas

17-11

Scale Allows you to select the AA waveform scales. The scale selesctions for AA waveform are: 1.2, 2.5, 5, 10 and 20.

Agent Measuremnet

Set Anesthetic Agent measurement and alarm on or off.

N2O Measuremnet

Set N2O measurement and alarm on or off.

Agent Alarm Opens the Anesthetic Agent alarm adjustment menu to change the AA alarm limits.


NOTE: If the agent value is out of measurment range, “---” will show on screen, means invalid.

To select the MAC type

NOTE: B40 only.



3. Select Installation - Monitor Settings - Parameter Settings.

4. Select MAC Type.

To enable the MACage calculation:

NOTE: B40 only.

− Give the patient’s age in menu Admit/Discharge - Admit Patient - Demographics.

− Attach a temperature sensor.

MACage is calculated if it is enabled in the settings and the patient’s age is given on the monitor. If no age is given, the monitor shows normal MAC even if MACage has been selected.

NOTE: The MAC value displayed by the monitor is that of exhaled air, and it does not always correspond to the amount of anesthetic in the patient’s organs.

NOTE: If oxygen or CO2 status is invalid or agent identification fails, the monitor displays the balance gas value as invalid.

Setting alarmsTo select alarm sources, go to the

CO2 Setup - CO2 Alarm, Resp Rate Alarm

O2 Setup (B40 only) - O2 Alarm

Agent/N2O Setup (B40 only) - Agent Alarm

The selections are FI or ET as the high and low alarm limit.


17-12

ScavengingWhen N2O and volatile anesthetics are used, prevent operating room pollution by connecting the sample gas outlet (gas exhaust) of the module to the scavenging system. Follow local hospital’s regulations

Scavenging through the ventilator reservoir

Connect an exhaust line to the sample gas outlet (gas exhaust) on the module's front panel. Attach the other end of the line to the ventilator reservoir. Make sure that the reservoir tube diameter is at least 2 to 3 times larger than the exhaust line.

Scavenging through the anesthesia gas scavenging system

Anesthesia machines are equipped with an anesthesia gas scavenging system (AGSS), and in some machines you can connect the sample gas outlet directly to it. See the anesthesia machine's user documentation to find out where and how the sample gas can be connected.

Connecting directly to the scavenging system

1. Connect the exhaust line to the module's sample gas outlet.

2. Connect the exhaust line only to an open scavenging system where gas is removed at room pressure.

NOTE: Do not connect the module directly to a strong vacuum scavenging system.

NOTE: If the E-miniC is used, do not return sample gas to the patient circuit.

Airway gas

17-13

CalibratingPerform calibration every six months in normal use, once every two months in continuous use, and whenever there are indications of errors in the gas readings to ensure that the measurement accuracy remains within specifications.

Calibration setup

Required tools• P/N: 755534-HEL Calibration Gas Regulator

• P/N: M1006864, Calibration Gas Regulator, US only

• 3 m / 10 ft anesthesia gas sampling line

• For E-sCO, E-sCAiO, N-CAiO module:

− P/N: 755583-HEL Calibration gas, CO2, O2, N2O, DESF, package of 1 can (with E-sCAiO or N-CAiO module)

− P/N: 755581-HEL QUICK CAL calibration gas, CO2, O2, N2O, package of 4 cans (with E-sCO module)

− P/N: 755571-HEL, Calibration Gas, 5% CO2, 54.5% O2, 36.0% N2O, 2.0% DESFLURANE, BAL N2 (with E-sCAiO or N-CAiO module) US only

− P/N: 755587, Calibration Gas, CO2, O2, Balance, 4 cans/pkg (with E-sCO module) US only

NOTE: Use only the specified GE Healthcare calibration gas for the gas calibration to ensure measurement accuracy. Do not use any other calibration gases. Check the calibration gas container's labelling to ensure that the calibration gas has not expired.

NOTE: Ensure that the gas regulator is functioning properly before gas calibration. Refer to the gas regulator's "Instructions for Use" letter for the annual maintenance instructions.

Connections1. Ensure that the module is connected to the monitor.

2. Ensure that you have a new D-fend or D-fend Pro water trap in use.

3. Connect the gas regulator to the calibration gas container.

Figure 17-5 Attaching regulator to calibration can

4. Connect a new gas sampling line to the sampling line connector in the water trap.

5. Connect the other end of the gas sampling line to the regulator on the gas container. Leave the regulator overflow port open to room air.


17-14

Figure 17-6 Connecting sampling line to the gas valve and feeding gas

Procedure

NOTE: Gas calibration is not available during the first 5 minutes after the module is connected. For maximum accuracy, let the monitor to warm up for 30 minutes before starting calibration.

NOTE: Gas calibration is not available during a 'Sample line blocked', 'Check D-Fend' and 'Check sample gas out’ alarm condition. Resolve the alarm condition before starting calibration.

1. Turn on the power, enter to gas calibration menu: Airway Gas - Gas Calibration

2. The monitor will start automatic zeroing of the gas sensors. Wait until the message 'Zeroing' is replaced by a message 'Zero Ok' for all measured gases.

3. Open the regulator after a message 'Feed gas' is shown. The measured gas concentrations are shown in real-time in the gas calibration menu. Continue feeding the calibration gas until the message ‘Adjust’ is displayed, then close the regulator.

4. Check that the displayed gas values match the values on the calibration gas container.

NOTE: If an error occurs during calibration or if no gas is fed, the highlight goes automatically over the item Recalibrate and the text ‘Calibr. error’ is displayed after each gas. Push the Trim Knob to perform a new calibration.

If adjustments are required:

• Turn the Trim Knob to highlight the first gas to be adjusted and then push the Trim Knob.

• Turn the Trim Knob until the displayed value matches the desired value in the gas bottle and push it again.

Repeat these two steps for each gas.

Airway gas

17-15

If the message ‘Zero error’ is displayed, press the Normal Screen key and repeat the calibration procedure. If the problem persists, contact authorized service personnel.

The monitor performs autozeroing after start up. The autozeroing intervals are: 4 min, 15 min, 30 min and 60 minutes after start-up, thereafter every 60 minutes.

NOTE: If you are using separate gas cylinders, calibrate each gas separately.

The time of the last calibration is shown at the bottom of the menu page.


17-16

Basics of airway gases measurement

Airway gases measurement description, CARESCAPE respiratory modules and Airway Gas Option

With CARESCAPE Respiratory Modules and Airway Gas Option, you can measure and monitor gases being delivered to the patient and exhaled by the patient through the breathing circuit. The modules consist of an infrared sensor for measuring CO2 and N2O, and paramagnetic O2 sensor. The E-sCAiO, N-CAiO modules also include anesthetic agents measurement.

The gas sampling system samples the measured air to the module, and removes water and impurities from it. The pump of the gas sampling system draws gas at a fixed rate through the sampling line into the gas measuring units. The side flow creates a slight sub-atmospheric pressure within the water trap, which causes fluid removed by the hydrophobic filter to collect in the bottle. After the measurement, gas is exhausted through the sample gas out connector.

Airway gases measurement description, E-miniC

The E-miniC is designed for critical care environment to measure and monitor the expired and inspired CO2 concentration (EtCO2, FiCO2) as well as the respiration rate (RR) up to 80 breaths per minute. E-miniC has a sample flow of 150 ml/min.

Respiration rate from the CO2 parameter is counted from the frequency of end-tidal (peak) CO2 measurements per minute. A sufficient respiration is defined as a difference of at least 1% (at least 7 mmHg) between the measured inspired fraction and end-tidal CO2.

Total sample size volume during one respiratory cycle depends on the respiration rate. The following table shows different sample size volumes with a 150 ml/min sample flow and I:E ratio of 1:2.

Sidestream gas sampling

The gas modules use a sidestream gas sampling method. It means that a sample of patient’s respired gases from the sampling site is transported through a sampling line to the module for analysis.

A sidestream gas analyzer takes a constant sample from the patient airway adapter at the following sample rates:

• CARESCAPE respiratory modules: 120 ml/min

• E-miniC: 150 ml/min

Total sample size volume during one respiratory cycle depends on the respiration rate.

Respiration rate 10 20 30 40

Duration of inspiration 2.0 seconds 1.0 seconds 0.7 seconds 0.5 seconds

Duration of expiration 4.0 seconds 2.0 seconds 1.3 seconds 1.0 seconds

Volume sampled during inspiration

5 ml 2.5 ml 1.67 ml 1.25 ml

Volume sampled during inspiration

10 ml 5 ml 3.33 ml 2.5 ml

Total volume sampled 15 ml 7.5 ml 5 ml 3.75 ml

Airway gas

17-17

Automatic agent identification with E-sCAiO, N-CAiO modules

The modules with agent identification option will automatically identify and select Isoflurane, Desflurane, Sevoflurane, Enflurane and Halothane. The E-sCAiO module is able to identify two agents simultaneously and displaying them as primary and secondary agents. The N-CAiO module is able to identify and display one agent. The inspiratory and expiratory concentrations of the agent are displayed in a numeric parameter window. Minimum concentration for the identification is 0.15 vol%. The agent selection remains active even if the concentration decreases below 0.15 vol%. Automatic agent identification is operational after the normal warm up of the module (approximately five minutes).

• If rapid agent concentration changes are required, fresh gas flow must be increased.

• Anesthetic agent concentration in the circuit is affected by patient uptake, breathing system volume and the fresh gas flow. It quantifies the speed of washin and wash-out anesthetic agents.

Minimum alveolar concentration (MAC)

MAC and MACageThe minimum alveolar concentration (MAC) concept is based on the assumption that in a steady state, the alveolar partial pressure of a gas is equal to the partial pressure in the effector organ of the central nervous system. MAC values are used to estimate the level of anesthesia caused by volatile anesthetics.

The MAC value can be displayed in digit field: 1 MAC is the alveolar concentration (end-tidal) of the agent at which 50% of patients do not respond to a noxious or surgical stimulus. The value is calculated from the actual measured anesthetic agent and N2O values with empirical formulas based on statistical studies with anesthetized patients.

The monitor can display two different MAC values, MAC or MACage, based on different formulas. The use of MAC or MACage is selected during installation and configuration.

The MAC values correspond to those of healthy adults of about 40 years old, and cannot be applied to children or elderly patients. Age and some other individual factors influencing the effect of volatile agents are not taken into account.

The other calculation method, MACage, takes the patient's age into account. The calculation uses 0 if age is less than 0, and 100 if age is more than 100. In addition, MACage calculations include the atmospheric pressure and the patient’s (highest measured) temperature values. If no patient temperature is measured, 37°C is used instead. For volatile agents this calculation method means about 6.7% decrease of MAC value with each increasing decade of life.

MACage is calculated if it is enabled in the care unit settings and the patient’s age is given on the monitor. If no age is given, MAC is calculated despite the care unit setting.

References used for MAC and MACage valuesThe alveolar concentrations of traditional (MAC) and age dependent (MACage) values are based on the following references:

• References for anesthetic agent MAC values:

− Mapleson W.W.: Effect of age on MAC in humans: a meta-analysis. Br. J. of Anaesthesia 1996; 76: 179-185

− Rampil I.J.; Zwass M.; Lockhart S.; Eger E.I. II; Johnson B.H.; Yasuda N.; Weiskopf R.B.: MAC of I653 in surgical patients, Anesthesiology. Tram-Rac71 (3A):A269, September 1989

− Scheller M.S., Partridge B.L., Saidman L.J.: MAC of sevoflurane in humans and the New Zealand white rabbit. Anesthesiology 1987; 67: A373


17-18

− ISO21647:2004 + C1:2005, Medical electrical equipment - Particular requirements for the basic safety and essential performance of respiratory gas monitors.

• References for MACage calculations:

− Eger, E.I. II.: Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake. Anesth. Analg. 2001; 93:947-953

− Rampil I.J.; Zwass M.; Lockhart S.; Eger E.I. II; Johnson B.H.; Yasuda N.; Weiskopf R.B.: MAC of I653 in surgical patients, Anesthesiology. 71 (3A):A269, September 1989

MAC values of different anesthetics in oxygenNormal values (40-year-old patient) and compensated values (65-year-old and 3-year-old patients):

The following illustration shows the Agent% corresponding to 1 MAC as function of age:

MAC values of different anesthetics in 65% N2ONormal values (40-year-old patient) and compensated values (65-year-old and 3-year-old patients).

HAL ENF ISO SEV DES N2O

1 MAC 0.75% 1.70% 1.15% 2.05% 6.00% 100%

1 MAC (65 yrs) 0.63% 1.43% 0.97% 1.73% 5.05% 82%

1 MAC (3 yrs) 0.97% 2.2% 1.5% 2.65% 7.80% N/A

HAL ENF ISO SEV DES

1 MAC 0.27% 0.61% 0.41% 0.73% 2.09%

1 MAC (65 yrs) 0.14% 0.31% 0.21% 0.37% 1.1%

1 MAC (3 yrs) 0.51% 1.15% 0.78% 1.40% 4.1%

Agent%

Age (years)

Desflurane

Sevoflurane

Enflurane

Isoflurane

Halothane

Airway gas

17-19

ET balance gas

You can obtain a calculated value for balance gas, EtBal. End-tidal balance gas is the percentage of gas concentration not measured by the gas sensors. It is displayed in digit field with the MAC value.

An increased balance gas value may indicate the amount of nitrogen flushed out from the patient into the circuit. The increase may be due to an accumulation of nitrogen during low flow anesthesia.

The monitor calculates end-tidal balance gas when all gases (CO2, O2, AA, N2O) measurements are active. If more than one of gases measurements off or the status are invalid, the monitor displays the balance gas value as invalid.

Basics of CO2 measurement

Normal CO2 waveformThe CO2 waveform is referred to as capnogram and it reflects the different stages in breathing. The capnogram of a healthy patient under controlled ventilation has a normal shape. Changes in the CO2 waveform may indicate compromised patient respiratory and/or circulatory function or improper mechanical ventilator functionality.

The origin of the CO2 waveformThe following illustration shows a normal capnogram. In this illustration, the letters indicate the following:

• A: The gas first exhaled is from the anatomical and apparatus dead-space. It contains no CO2 because it has not been in the alveoli and no gas exchange has taken place.

• B: Briefly, the exhaled gas is a mixture of gas from the anatomical dead-space and gas from the alveoli.

• C: A plateau is reached when the gas exhaled is entirely from the alveoli. The end-tidal CO2 (EtCO2) concentration is measured at the end of this plateau.

• D: When the next inspiration starts the capnogram rapidly falls towards the baseline. The minimum level of CO2 measured during the inspiratory phase is called the inspired CO2 concentration (normally 0.0%).

• E: With a scale, the height of the capnogram tells you the end-tidal CO2 concentration. The monitor automatically calculates and display the EtCO2 in numbers. EtCO2 approximates the alveolar CO2 concentration because it is measured when the patient exhales virtually pure alveolar gas.


17-20

Dips in capnogramThe dips seen in the capnogram during expiration are related to the sidestream gas sampling, the continuous gas flow to the Y-piece, and patient’s cardiac contractions, which cause intra-thoracic pressure changes and therefore flow variations.

The alterations in expired CO2 waveform are cardiogenic movements of exhaled and circuit gas at the sidestream gas sampling site. When the respiratory gas flow drops below the gas sampling rate, a variable mixture of CO2 free fresh gas and exhaled CO2 rich gas is sampled. This causes variations in sampled CO2 concentrations.

In the illustration below, CO2 waveform is the one on top, and flow is the lower waveform.

1. Expiration

2. Cardiogenic oscillations

Cardiogenic oscillations appear when:

• A continuous fresh gas flow is fed into the patient Y-piece.

• Sidestream gas sampling is done at the Y-piece.

• The patient is ventilated with a long expiration time or low respiration times, and when there is a long zero flow at end-expiration for some other reason.

Oscillations can be eliminated by adding a spacer with a 5 ml dead space between the Y-piece and the airway adapter. Increased dead space creates a buffer volume between the Y-piece and the sampling point, preventing the inspiratory and expiratory air from mixing during gas sampling. Misinterpretation of EtCO2 information can be avoided through identifying cardiogenic oscillation and understanding the reasons for it.

EtCO2 value % EtCO2 value mmHg Indicates

4.5 to 5.5% 34 to 41 mmHg normocapnia

< 4% < 30 mmHg hypocapnia

> 6% > 45 mmHg hypercapnia

Airway gas

17-21

Oxygen measurement interpretation

The CARESCAPE respiratory modules and Airway Gas Option oxygen measurement provides:

• Inspired oxygen level, the actual inspired oxygen concentration

• End-tidal oxygen level, the expired oxygen concentration

• Inspiratory-expiratory oxygen difference reflects patient’s consumed oxygen volume-percentage from the administered gas mix

• Oxygram, a diagnostic tool both in real time and as a trend

The patient oxygen provides breath-by-breath information about the breathing circuit,alveolar ventilation and some vital indicators of adequate oxygenation.

Oxygram is a mirror image of a capnogram in a steady state in normal patient. It is a graphic presentation of changes in O2 concentrations in the airway gas. The oxygram reflects the oxygen uptake from the alveoli. To avoid patient administered hypoxic gas mixes the inspired fraction of oxygen (FiO2) should never be lower that 21%.

Airway gases practicalities

Ventilation management

Normoventilation (adequate alveolar ventilation of a patient) can be maintained by monitoring the end-tidal carbon dioxide and oxygen concentrations, and adequacy of ventilation can be maintained by monitoring airway pressures, volumes and spirometry loops. Alveolar minute ventilation is usually adjusted to achieve normocapnia, where EtCO2 is in the range of 4.5% to 5.5% (34 mmHg to 41 mmHg). This is called normoventilation as it is the normal situation in healthy people.

A low EtCO2 concentration (EtCO2 < 4% / 30 mmHg) indicates hyperventilation.

NOTE: A low EtCO2 value in itself is dependent from the ventilation volume vs. circulation status (lung perfusion). This means that in case of low blood pressure (e.g. shock) or shunting low EtCO2 values may be observed while using a “normal” TV/MV.

Increased EtCO2 concentration (EtCO2 > 6.0% / 45 mmHg) indicates hypoventilation or ineffective alveolar ventilation, which will lead to hypercapnia and respiratory acidosis. Increased inspiratory CO2 (FiCO2) concentrations may also be caused by:

• Exhausted CO2 absorber.

• Malfunction of the breathing system valves.

• Rebreathing when a rebreathing system without a CO2 absorber is used with inadequate fresh gas flows.

NOTE: During some surgical procedures, e.g. laparoscopy, CO2 may be used to inflate the abdomen which may result in rise of PaCO2 due to the absorption of CO2 into the blood via the vascular wound bed. This may lead to an increase in the EtCO2.

Prevention of the breathing system contamination

You can use a microbial filter between the endotracheal tube and the airway adapter. Change the filter for every patient. Change the patient circuit at intervals given in the circuit manufacturer’s documentation, and according to your hospital protocols.


17-22

How to prevent effects of humidity

In anesthesia, the lower the fresh gas flow, the more rebreathed gas recirculates through the CO2 absorber and the more humidity and heat is produced through the chemical CO2 absorption process.

• If a moisture exchanger is used, place it between the endotracheal or intubation tube and the airway adapter. In intensive care, the moisture exchanger must be replaced at least every 24 hours.

• Place all airway adapter ports upwards with a 20° to 45° tilt to prevent condensed water from entering the sensor interior and the tubings.

• The airway adapter should be emptied of clearly visible water droplets, or replaced with a dry and clean adapter.

• If active humidification is used, extra water collectors may be placed between the ventilator’s inspiratory and expiratory breathing tubings. They are also useful for condensed water collection during long-lasting anesthesia.

Oxygen delivery

Oxygen uptake and consumptionOxygen consumption is the difference between the amount of oxygen delivered to the tissues by the arterial circulation and the amount of oxygen returned to the heart by the venous system. The formula for oxygen consumption is a simple restatement of the Fick equation, which identifies all of the pertinent variables of oxygen supply and demand. VO2 = CO x Hb x 13.8 x (SaO2 - SvO2). Dependent from the patient’s circulation status the mechanical ventilator settings for, amongst others, FiO2 in the delivered gas mix (min. > 25%) should guarantee a sufficient PAO2 and PaO2. Patients with fever may consume oxygen at considerably higher rates.

Oxygen supply to the breathing system must meet the metabolic need of the patient.

To prevent hypoxemia and to ensure safe and sufficient oxygen supply, the alveolar oxygen concentration (EtO2) should be at the level of 25% minimum.

Nitrogen eliminationDuring the maintenance of minimal low flow anesthesia, a small amount of nitrogen may accumulate in the circuit. It may be detected as decreased concentration of other gases, and eliminated by temporarily increasing the fresh gas flow.

Flow reductionReduction of fresh gas flow may increase rebreathing in case of a CO2 absorber malfunction or during the use of open anesthesia gas delivery systems.

The lower the fresh gas flow, the higher the oxygen concentration required in the fresh gas.

Level of anesthesia: E-sCAiO, N-CAiO

Anesthetic agent uptakeFresh gas flow reduction decreases the total amount of anesthetic agent fed into the breathing system if agent concentration is maintained constant.

The lower the fresh gas flow rate, the longer the time required to reach the effect of a change in the fresh gas settings.

Airway gas

17-23

Airway gases calculations

• MAC=

where AA1=primary agent, AA2=secondary agent, x(AA) is Hal=0.75%, Enf=1.7%, Iso=1.15%, Sev=2.05%, Des=6.0% and N2O=100%.

• MACage (volatile agent) = (0.05T-0.85) A (1.32 x 10-0.00303age)where T=temperature, A=MAC

• MACage (N2O) =

• Balance gas (EtBal) = 100-EtCO2-EtO2-EtN2O-EtAA(pri)-EtAA(sec)

where EtAA(pri) and EtAA(sec) are the primary and secondary end tidal values for the measured anesthetic agent.

Unit conversions

NOTE: 47 mmHg is the partial pressure of the saturated water vapor at 37°C.

The following lists the relationship between gas concentration and its partial pressure:

Reading in mmHg (dry gas) =

(ambient pressure in mmHg) x (gas concentration in%) 100

Reading in mmHg (water vapor saturated gas) =

(ambient pressure in mmHg - 47 mmHg) x gas concentration in% 100

Reading in kPa (dry gas) =

(ambient pressure in mmHg) x (gas concentration in%) 750

Reading in kPa (water vapor saturated gas) =

((ambient pressure in mmHg - 47mmHg) x (gas concentration in%) 750

NOTE: 47 mmHg is the partial pressure of the saturated water vapor at 37°C.

atmN2O

1.14 1.378 10 0.00347age–×( )----------------------------------------------------------------


17-24


• Water trap is locked into the module.

• Water trap container is empty.

• A new sampling line is used after each patient.

• Sampling line is connected to the water trap.

• Monitor is turned on and self-check is performed with the sampling line attached.

• Sampling line is connected to the airway adapter.

• The humidification and/or bacteria filter are in correct place.

• Breathing circuit or accessories have no residuals of alcohol based disinfectants.

• Desired gas parameter is selected for screen through Monitor Setup - Screen Setup.

18 Entropy

Entropy

18-1

18 Entropy

Safety precautions

Warnings

• Make sure that the electrodes, sensor and connectors do not touch any electrically conductive material, including earth.

• DEFIBRILLATOR PRECAUTIONS - Patient signal inputs labeled with the CF and BF symbols with paddles are protected against damage resulting from defibrillation voltages. To ensure proper defibrillator protection, use only the recommended cables and leadwires. Do not reuse the single-use entropy electrodes.

• DEFIBRILLATOR PRECAUTIONS - Proper placement of defibrillator pads in relation to the electrodes is required to ensure successful defibrillation.

• In case of spill, take device out of service and have it checked.

Cautions

• When using the electrosurgery unit, ensure proper contact of the ESU return electrode to the patient to avoid burns at monitor measurement sites. Also ensure that the ESU return electrode is near the operating area.

• Strong 30-40 Hz magnetic fields may cause erroneous Entropy measurement. Do not use devices with such a field close to the module or sensor.

• The Entropy measurement is always to be used only as an adjunct to other physiological parameters. Clinicians are advised to use their knowledge and experience when making clinical judgements. Entropy values are not to be used as sole indicators of the patient status.

• Check the sensor expiration date on the sensor package. Do not use expired sensors. Do not use a sensor for more than 24 hours.

Note

• Automatic sensor check may need to be disabled if the 70 Hz impedance check signal interferes with other equipment, such as EEG module with evoked potentials measurement.

• The device is not compatible with M-ENTROPY module.


18-2

OverviewEntropy is a non-invasive parameter suitable for adults and pediatric patient population older than two years of age.

Entropy may be used as an aid in monitoring the effects of certain anesthetic agents on the patient’s central nervous system (CNS) during general anesthesia. Displaying and using clinical information from Response Entropy (RE) and State Entropy (SE) may allow the clinician to tailor the anesthetic according to the individual needs of a patient.

The use of Entropy parameters may help the clinician to improve drug management. It may also enable a faster recovery from anesthesia and a more predictable wake-up and extubation.

Prior to using Entropy as an adjunct to guide anesthesia care, it is recommended to review important situations and limitations that can influence the Entropy number. GE recommends that clinicians review the following practice advisory that includes a section on brain function monitoring: The American Society of Anesthesiologists, Practice Advisory for Intraoperative Awareness and Brain Function Monitoring (Anesthesiology 2006; 104: 847-64). Clinicians are also recommended to maintain current knowledge of government regulatory, practice or research information on brain function monitoring and related topics.

Entropy is for monitoring the state of CNS by data acquisition of electroencephalograph (EEG) and frontal electromyograph (FEMG) signals. The spectral entropies, Response Entropy (RE) and State Entropy (SE), are processed EEG and FEMG variables. The Entropy measurement is to be used as an adjunct to other physiological parameters.

Response Entropy (RE) and State Entropy (SE) may be used as an aid in monitoring the effects of certain anesthetic agents, which may help the user titrate anesthetic drugs according to the individual needs of patients. Furthermore, the use of Entropy parameters may be associated with a reduction of anesthetic use and faster emergence from anesthesia.

The Entropy module and accessories are indicated for use by qualified medical personnel only.

Figure 18-1 Entropy measurement connector

Entropyconnector

Entropy

18-3

Entropy measurement description

EEG signals reflect the underlying state of brain activity. As a person falls asleep or is anesthetized, the brain function (activity) starts to decrease and becomes more orderly and regular. EEG changes from irregular to more regular patterns when anesthesia deepens. Similarly, frontal EMG quiets down as the deeper parts of the brain are increasingly saturated with anesthetics.

Entropy measurement is based on processing of raw EEG and FEMG signals by using the Entropy algorithm, a GE application of Spectral Entropy. Entropy measures irregularity of EEG and FEMG. The GE Entropy measurement devices are responsible for EEG and FEMG signal acquisition, amplification, filtering and digitization and electrode impedance measurement.

Entropy parameters

RE is a fast reacting parameter, which measures EEG and FEMG in the frequency range 0.8 Hz to 47 Hz. Its reaction time is two seconds. It may give an indication of the patient’s reaction to external stimuli, such as intubation and skin incision, if neuromuscular blocking agents are not used.

SE is a more stable and robust parameter, which measures EEG in the frequency range of 0.8 Hz to 32 Hz. Its reaction time is 15 seconds. SE may be used to assess the effect of certain anesthetic drugs on the brain.

How to interpret the Entropy values

High values of Entropy indicate high irregularity of the signal, signifying that the patient is awake. A more regular signal produces low Entropy values, which can be associated with low probability of consciousness. A decrease in Entropy may enable the physician to observe the moment when the patient loses responsiveness. During an operation, both Entropies stabilize.

During general anesthesia with adequate anesthesia and hypnosis the RE and SE values will be within a narrow range or equal. The numbers will also merge during profound neuromuscular paralysis with neuromuscular blocking agents since the patient’s facial muscles are unable to react. RE is typically higher during periods prior to induction and before wake-up. If the numbers diverge (RE exceeds SE) during general anesthesia, it indicates that the facial muscles are activated. This may happen due to noxious stimuli. SE value may remain within a constant range if the level of hypnosis is adequate. A quick rise in RE may give an early warning of impending wake-up.

Patients emerging from general anesthesia will demonstrate a rise in both the RE and SE values.


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Burst suppression ratio (BSR)

BSR is defined as the percentage of time of suppressed (isoelectric, flatline) EEG periods during the last minute of observation. Emergence of burst suppression pattern may indicate very deep anesthesia, hypothermia or ischemia.

Typically, during general anesthesia, in the absence of requirements for profound levels of anesthesia, BSR is 0%. Higher levels of burst suppression indicate very deep hypnosis/unconsciousness level. Burst suppression generally emerges with Entropy values below 40, but may not appear even with very low Entropy values.

Entropy range guidelines

NOTE: Individual patients may show different values. These are only guidelines.

Entropy in typical general anesthesia

(1) Awake: RE > SE

(2) Induction: RE = SE

(3) Intubation response: RE increases rapidly

(4) Maintenance: RE = SE

(5) Wake-up: RE increases prior to SE

RE SE Description

100 90 Awake

60-40 60-40 Low probability of recall, clinically adequate level for most surgical operations

<40 <40 Deep anesthesia

0 0 Suppressed EEG

Entropy

18-5

Displaying EEG waveform

Figure 18-2 Display of EEG waveform

(1) EEG waveform is displayed

(2) EEG waveform label

(3) EEG waveform scale

(4) Entropy label

(5) Response Entropy (RE) label

(6) Response Entropy (RE) value

(7) State Entropy (SE) label

(8) State Entropy (SE) value

(9) Burst suppression ratio (BSR) label

(10) Burst suppression ratio (BSR) value

(11) Burst suppression ratio (BSR) unit

Entropy module keys

There are two keys on the module

Entropy practicalities

• It is very important to ensure good contact between the sensor electrodes and skin. With careful skin preparation, correct sensor placement and use of correct cable, the skull and sinuses between the electrodes and the brain interfere minimally with the signal acquisition. See the sensor instructions for use for more detailed information.

• A high quality EEG signal is the prerequisite for successful Entropy calculation. Displaying the raw EEG within the Entropy waveform area may help the user to confirm the signal quality. Raw EEG on the screen may also enable the clinician to view the EEG for recognizable and clinically relevant patterns of EEG activity.

• Do not use other sensors than Entropy sensors by GE.

• Entropy is not a parameter for monitoring neuromuscular blockade. Though RE may give an indication of the patient’s reaction to external stimuli, such as intubation and skin incision, the level of neuromuscular blockade should be assessed with NMT, which is an

Entropy Opens or closes the Entropy menu on the screen

Check sensor

Starts the manual sensor check


18-6

active assessment of the effects of neuromuscular blockade agents on the neuromuscular junction.

• Neuromuscular blocking agents administered in surgically appropriate doses are not known to affect the EEG, but are known to have an effect on the EMG. RE values may drop in response to NMBA administration, due to paralysis of facial muscles.

• The Entropy sensors and cable are designed to be defibrillation-proof.

Preparing the patient and placing the electrodes

Preparing the patient

• Connect the Entropy sensor cable to the module.

• Clean the application site according to the sensor’s instructions for use and let it dry before attaching the sensor..

• Place the Entropy sensor on the patient's forehead; see sensor package for instructions

• Connect the sensor to the Entropy sensor cable.

• Observe the results of the automatic sensor check in the parameter window.

• The measurement starts automatically after the sensor has passed the check.

Equipment module to connect

(1) Module with Entropy measurement capability

(2) GE Entropy sensor cable

(3) GE Entropy sensor, or

(4) Entropy sensor

NOTES:

• Entropy sensors are latex- and PVC-free, disposable and for single-patient use only.

• Make sure that the sensor connectors of the sensor cable are not in contact with fluids.

• Always ensure that the sensor is properly attached to the patient and connected to the cable.

• In NEONATAL mode, the entropy function will be disabled and the related menu is gray.

Entropy

18-7

Entropy Setup menuTo enter the Entropy setup menu:

Entr.EEG Scale

Adjusts the setting of Entropy EEG waveform scale. The scale selesctions for Entropy EEG waveform are: 25 µV, 50 µV, 100 µV, 250 µV, 400 µV and 500 µV.

Trend Length Adjusts the length of trend shown in the horizontal dight field.

Display Format Adjust the display format in the horizontal dight field. The selections are:

RE Only RE diaplays in the horizontal dight field.

SE Only SE diaplays in the horizontal dight field.

RE+SE RE and RE display in the horizontal dight field.

All Both RE, SE and BSR diplay in the horizontal dight field.

Check Sensor Start the impedance check of the sensor.

Bypass Check Start Entropy measurement without completing the impedance check.

Automatic Check Select ON to start Automatic sensor check every 10 minutes.

Entropy Alarms Alarms can be adjusted in this menu or in the Alarms Setup menu which opens by pressing the Alarms Setup key.

Others


18-8

Starting sensor check manuallyWhen the patient’s EEG pattern, RE and SE value change considerably, the monitor should start Entropy sensor checking manually.

1. Press the Other key.

2. Select Entropy

3. Select Check Sensor.

Setting RE and SE alarm limitsTo set the RE alarm limits:

1. Press the Other key.

2. Select Entropy.

3. Select Entropy Alarms.


Others

Entropy

18-9


NOTE:

• The default values for RE and SE alarm are off. Please set the alarm on by selecting RE Alarms. in Entropy menu.

• Set the SE alarm in the same way.

Others

Others


18-10

Entropy measurement limitations• Entropy measurement is not indicated for pediatric patients younger than two years old.

• Entropy is not validated with patients undergoing sedation.

• Unusual or excessive electrical interference is a potential cause for artifact. During extended periods of electrocautery there may not be any good EEG epochs, and Entropy values will not be displayed.

• ECG, frequent eye movements, coughing, muscle rigidity and patient movement cause artifact and may interfere with the measurement. Epileptic episodes may also cause interference.

• Entropy readings may be inconsistent when monitoring patients with neurological disorders, traumas or their sequelae.

• Entropy readings may be inconsistent when using benzodiazepines, nitrous oxide or ketamine as anesthetics.

• Psychoactive medication or very high opiate doses may suppress EEG and cause inconsistent Entropy readings.

• Cooling the patient may suppress their EEG and cause inconsistent Entropy readings.





Abbreviations

A-1

Abbreviations

/min beats per minute, breaths per minute

°C Celsius degree

°F Fahrenheit degree

µg microgram

A arm (describing location)

A alveolar

a arterial

a/AO2 arterio-alveolar PO2 ratio

AaDO2 alveolo-arterial oxygen difference

AA anesthetic agent

AAMI Association for the Advancement of Medical Instrumentation

ABG arterial blood gases

ABP arterial pressure

ADU Anesthesia Delivery Unit

AEP auditory evoked potential

AirW airway temperature

Alpha, Al alpha frequency band

AM Anesthesia Monitor

Amp amplitude

Ant anterior

APN apnea

Arrh. arrhythmia

Art arterial pressure

ASY asystole

ATMP atmospheric pressure

ATPD atmospheric/ambient temperature and pressure, dry gas

ATPS ambient temperature and pressure, saturated gas

AV atrioventricular

aVF left foot augmented lead

avg average

aVL left arm augmented lead

aVR right arm augmented lead

aw airway

Axil axillatory temperature

BAEP brainstem auditory evoked potential

Bal balance gas

bar 1 atmosphere

Beta, Be beta frequency band

Bigem. bigeminy

Abbreviations

A-2

BIS bispectral index

Blad bladder temperature

Blood blood temperature (C.O. measurement)

Body body temperature

BP blood pressure

Brady bradycardia

BSA body surface area

BSR burst suppression ratio

B-to-B beat-to-beat

BTPS body temperature and pressure, saturated gas

c calculated/derived value

C chest

C(a-v)O2 arteriovenous oxygen content difference

C.C.O. continuous cardiac output

CFI cardiac function index

C.I. cardiac index

C.O. cardiac output

cal. calibration

Calc calculated/derived value

Calcs calculations

CAM Compact Anesthesia Monitor

CaO2 arterial oxygen content

Casc. cascaded (ECG)

cc cubic centimeter

CCCM Compact Critical Care Monitor

CCM Critical Care Monitor

CcO2 capillary oxygen content

CCU cardiac (coronary) care unit

CEL Celsius degree

CFI cardiac function index

CISPR International Special Committee on Radio Interference

cmH2O centimeter of water

CMRR common mode rejection ratio

CO carbon monoxide

CO2 carbon dioxide

COHb carboxyhemoglobin

Compl compliance

Cont. continuous

Contrl controlled ventilation

Core core temperature

Count count of responses

CPB cardiopulmonary bypass

CPP cerebral perfusion pressure

Abbreviations

A-3

CSA compressed spectral array

CT computer tomography

CvO2 (mixed) venous oxygen content

CVP central venous pressure

d day

dB decibel

DBS double burst stimulation (NMT)

DEL delete

Delta, De delta frequency band

depr. depression

Des desflurane

Dia diastolic pressure

Diagn diagnostic (ECG filter)

DIFF difference

DIS S/5 Device Interfacing Solution

DO2 oxygen delivery

DO2I oxygen delivery index

DSC digital signal converter

dyn dynamic

e estimated

ECG electrocardiogram

ECG1 first ECG waveform (top)

ECG1/r real-time ECG

ECG2 second ECG waveform

ECG3 third ECG waveform

ED emergency department

EDV end-diastolic volume

EDVI end-diastolic volume index

EE energy expenditure (kcal/24h)

EEG electroencephalogram

EEG1 first EEG waveform

EEG2 second EEG waveform

EEG3 third EEG waveform

EEG4 fourth EEG waveform

EEMG evoked electromyogram

EEtot total energy expenditure

elect electrode

elev. elevation

EMC electromagnetic compatibility

EMG electromyogram

Enf enflurane

Entr entropy

Abbreviations

A-4

EP evoked potential

ESD electrostatic discharge

Eso esophageal temperature

ESV end-systolic volume

ESVI end-systolic volume index

ET, Et end-tidal concentration

EtAA end-tidal anesthetic agent

EtBal end-tidal balance gas

EtCO2 end-tidal carbon dioxide

EtN2O end-tidal nitrous oxide

EtO2 end-tidal oxygen

ET-tube, ETT endotracheal tube

EVLW extravascular lung water

EVLWI extravascular lung water index

Exp expiratory

F foot (describing location)

FAH Fahrenheit degree

FEMG frontal electromyogram

FFT fast Fourier transform

FI, Fi fraction of inspired gas

FiAA fraction of inspired anesthetic agent

Fib fibrillation

FiBal fraction of inspired balance gas

FiCO2 fraction of inspired carbon dioxide

FiN2 fraction of inspired N2

FiN2O fraction of inspired nitrous oxide

FiO2 fraction of inspired oxygen

Flow airway gas flow

Freq. frequent

ft foot, feet

FVloop flow volume loop

G Gauss

g gram

GEDI global enddiastolic volume index

GEDV global enddiastolic volume

GEF global ejection fraction

Graph. graphical

h hour

H hand (describing location)

Hal halothane

Hb hemoglobin

Abbreviations

A-5

Hbtot total hemoglobin

HCO3- bicarbonate

Hemo hemodynamic

Hemo Calcs hemodynamic calculations

HHb reduced hemoglobin

HME heat and moisture exchanger

HMEF heat and moisture exchanger with filter

hPa hectopascal

HR heart rate

HRdiff heart rate difference

ht height

HW hardware

Hz hertz

IEC International Electrotechnical Comission

I:E inspiratory-expiratory ratio

IABP intra-aortic balloon pump

IC inspiratory capacity

ICP intracranial pressure

ICU intensive care unit

ID identification

Imped. impedance; impedance respiration

in inch

Inf inferior

Infl. inflation (limit)

Insp inspiratory

Inv. invasive

Inv. BP invasive blood pressure

Irreg. irregular

Iso isoflurane

ISO International Standards Organisation

ISM Industrial, Scientific and Medical

ITBV intrathoracic blood volume

IVR idioventricular rhythm

J joule

K kelvin

kcal kilocalorie

kJ kilojoule

kPa kilopascal

L leg (describing location)

L left (describing location)

L, l liter

l/min liters/minute

Abbreviations

A-6

Lab laboratory

LAN local area network

LAP left atrial pressure

Lat lateral

lb pound

LCD liquid crystal display

LCW left cardiac work

LED light emitting diode

LVEDP left ventricular end diastolic pressure

LVEDV left ventricular end diastolic volume

LVSW left ventricular stroke work

LVSWI left ventricular stroke work index

MAC minimum alveolar concentration

Max maximum

mbar millibar

mcg microgram

Mean mean blood pressure

mEq milliequivalent

MetHb methemoglobin

MF median frequency

mg milligram

min minute

Min minimum

ml milliliter

MLAEP middle-latency auditory evoked potential

mmHg millimeters of mercury

mol mole

Monit monitoring (ECG filter)

MRI magnetic resonance imaging

Mult. multiple

Multif. PVCs multifocal PVCs

MV minute volume

MVexp expired minute volume (l/min)

MVexp(BTPS) expired minute volume in BTPS conditions

MVexp(STPD) expired minute volume in STPD conditions

MVinsp inspired minute volume (l/min)

MVspont spontaneous minute volume

Myo myocardiac temperature

N neutral

N2 nitrogen

N2O nitrous oxide

Na sodium

Abbreviations

A-7

Naso nasopharyngeal temperature

neo neonate

Net network

NIBP non-invasive blood pressure

Ni-Cd nickel-cadmium

Ni-MH nickel-metal hydride

NMT neuromuscular transmission

NO nitric oxide

NTPD normal temperature and pressure, dry gas

Num. numerical

O2 oxygen

O2ER oxygen extraction ratio

O2Hb oxygenated hemoglobin

OR operation room

Oxy oxygenation

Oxy Calcs oxygenation calculations

P partial pressure

P pressure

P(BTPS) pressure in BTPS conditions

P(g-a)CO2 difference between gastrointestinal carbon dioxide and arterial blood carbon dioxide concentration

P(g-ET)CO2 difference between gastrointestinal carbon dioxide and end tidal carbon dioxide concentration

P(STPD) pressure in STPD conditions

P1, P2 invasive pressure channel identification on module

PA pulmonary artery

Pa Pascal (unit of pressure)

Paced paced beats

PaCO2 partial pressure of carbon dioxide in the arteries

PAO2 partial pressure of oxygen in the alveoli

PaO2 partial pressure of oxygen in the arteries

PAOP pulmonary artery occlusion pressure

PA pulmonary arterial pressure

Paw airway pressure

Pbaro barometric pressure

PCWP pulmonary capillary wedge pressure

PE polyethylene

pedi pediatric

PEEP positive end-expiratory pressure

PEEPe extrinsic positive end expiratory pressure

PEEPe+i total positive end expiratory pressure (ICU)

PEEPe+PEEPi total positive end expiratory pressure (ICU)

Abbreviations

A-8

PEEPi intrinsic positive end expiratory pressure

PEEPtot total positive end expiratory pressure (anesthesia)

PgCO2 gastrointestinal carbon dioxide concentration

pH pH

pHa arterial pH

pHi intramucosal pH

pHv (mixed) venous pH

PIC patient interface cable

Pleth plethysmographic pulse waveform

PM pacemaker

PM non-capt. pacemaker non-capturing

PM non-funct. pacemaker non-functioning

Pmax maximum pressure

Pmean mean pressure

Pmin minimum pressure

Ppeak peak pressure

Pplat plateau (pause) pressure

PR pulse rate

Prev. previous

psi pounds per square per inch

pt patient

PTC post tetanic count (NMT)

pts patients

PVC polyvinylchloride

PVC premature ventricular contraction

PVloop pressure volume loop

PvO2 partial pressure of oxygen in (mixed) venous blood

PVR pulmonary vascular resistance

PVRI pulmonary vascular resistance index

Px standard pressure label, x being 1, 2, 3, 4, 5, or 6

QRS QRS complex

Qs/Qt venous admixture

R right (describing location)

RAP right atrial pressure

Raw airway resistance

RCW right cardiac work

RCWI right cardiac work index

RE Response Entropy

Rect rectal temperature

REF right ventricular ejection fraction

ref. reference

Resp respiration rate (total) (set)

Abbreviations

A-9

Resp Rate respiration rate (total) (measured)

RF radio frequency

RMS average (root mean square) power

Room room temperature

RQ respiratory quotient

RR respiration rate (total) (measured)

rtm rhythm

RV residual volume

RVEDV right ventricular end-diastolic volume

RVESV right ventricular end-systolic volume

RVP right ventricular pressure

RVSW right ventricular stroke work

RVSWI right ventricular stroke work index

s second

SA sinoatrial

SaO2 arterial oxygen saturation

S.A.R. specific absorption rate

SD standard deviation

SE State Entropy

SEF spectral edge frequency

SEMG spontaneous electromyogram

Sev sevoflurane

SI stroke index

Skin skin temperature

SN, S/N serial number

Spiro patient spirometry

SpO2 oxygen saturation

Spont spontaneous breathing

SQI signal quality index

SR suppression ratio

SR sinus rhythm

SSEP somatosensory evoked potentials

ST single twitch (NMT)

ST ST segment of electrocardiograph

stat static

STAT continuous NIBP cuff inflation for five minutes

STBY standby

Stfilt ST filter (ECG)

STPD standard temperature and pressure, dry gas

Surf surface temperature

SV stroke volume

SVC supraventricular contraction

SVI stroke volume index

Abbreviations

A-10

SvO2 (mixed) venous oxygen saturation

SVR systemic vascular resistance

SVRI systemic vascular resistance index

SW software

SVV stroke volume variation

Sys systolic pressure

t time (min)

T temperature

T tesla

T(BTPS) temperature in BTPS conditions

T1% first stimulus as % of the reference value (NMT)

T1, T2 temperature channel identification on module

Tab. tabular

Tachy tachycardia

Tbl, Tblood blood temperature

Tcorr temperature correction

Temp temperature

Theta, Th theta frequency band

Tinj injectate temperature

TOF train of four (NMT)

TOF% ratio of the 4th to the 1st response (NMT)

Trigem. trigeminy

TV tidal volume

TVexp expired tidal volume (ml)

TVinsp inspired tidal volume (ml)

Tx temperature label, x being 1, 2, 3, or 4 or one of the other label choices

Tymp tympanic temperature

v venous

V ventricular

V volume

V/Q ventilation/perfusion ratio

V0.5 volume expired during the first 0.5 seconds

V1.0 volume expired during the first second

VA alveolar ventilation

VC vital capacity

VCO2 carbon dioxide production

Vd dead space

Vd/Vt dead space ventilation

Vent Calcs ventilation calculations

VFib ventricular fibrillation

VO2 oxygen consumption

VO2Calc calculated oxygen consumption*

Abbreviations

A-11

VO2CalcI calculated oxygen consumption index*

VO2I oxygen consumption index

Vol volume

V Run ventricular run

V Tachy ventricular tachycardia

WLAN wireless local area network

wt weight

X extreme

yr year

yrs years

* with Fick equation

Abbreviations

A-12

Installation and checkout form, B40/B20

B-1

APPENDIX B: Installation and checkout form, B40/B20

OK = Test OK N.A. = Test not applicable Fail = Test failed

Customer

Service

Service engineer Date

Monitor license

MAC Address: License key:

Modules

Gas module: Entropy module:

Visual Inspection Expected result Observed result OK N.A. Fail

. Visual inspection

Functional Inspection Expected result Observed result OK N.A. Fail

. Start-up

. Display

. Time and date

. Parameters measurements

. Recorder

. MC or S/5 Network connection

. Conclusion

Notes

Signature


B-2

GE Medical SystemsInformation Technologies, Inc.8200 West Tower AvenueMilwaukee, WI 53223 USATel:+ 1 414 355 5000 1 800 558 5120 (US only)Fax:+ 1 414 355 3790

GE Medical SystemsInformation Technologies GmbHMunzingerstrasse 579111 FreiburgGermanyTel: + 49 761 45 43 - 0Fax: + 49 761 45 43 - 233

Asian HeadquartersGE Medical SystemsInformation Technologies Asia1 Huatuo RoadZhangjiang Hi-tech Park PudongShanghai, P.R. China, 201203Tel: + 86 21 3877 7888Fax: + 86 21 3877 7451

GE Medical Systems Information Technologies, a General Electric Company, going to market as GE Healthcarewww.gehealthcare.com

0459

Documents

B40/B20 Patient Monitor User’s Reference ManualUser's Reference Manual Related to software license VSP-C Monitoring functions Conformity according to the Council Directive 93/42/EEC