PATIENTNET OPERATOR’S MANUAL Software Version 1.
Note: Due to continuing product innovation, specifications in this manual are subject to change without notice. Copyright ©2001 GE Medical Systems Information Technologies. All rights reserved. 15222 Del Amo Avenue, Tustin, California 92780 Limited Software License and Equipment Use The PatientNet Suite of Products is covered under U.S. Patent numbers 5,944,659 and 5,748,103 and one or more pending patent applications.
TECHNICAL SUPPORT INFORMATION TECHNICAL SUPPORT INFORMATION PatientNet Operator’s Manual Technical/Service/Clinical Support Our support professionals are ready to help you with operations and clinical application questions, parts replacement requests, supplies, technical and clinical training, or product service emergencies. We are available 24 hours a day, 7 days a week. Telephone 714.546.0147 800.955.2424 Continental United States Fax 714.571.
TECHNICAL SUPPORT INFORMATION Additional Resources Additional literature is available as shown below. To obtain copies, contact your sales representative. part number PatientNet Administrator’s Guide, software v1.03 PatientNet Service Manual, software v1.01 and above Central Station Quick Reference Card, v1.0X Series IRVS Quick Reference Card, v1.0X Series RVS Quick Reference Card, v1.
TABLE OF CONTENTS Technical Support Information......................................................................................................... 3 PatientNet“ Operator’s Manual .................................................................................................... 3 List of Figures ................................................................................................................................... ix List of Tables..........................................................
Printing Patient Information........................................................................................................ 77 Discharging a Patient From the System ...................................................................................... 78 Patient Settings ............................................................................................................................... 81 Setting Device Types ..............................................................................
Tagging Events as Report Candidates ...................................................................................... Archiving Events ...................................................................................................................... ST History................................................................................................................................. Printing History Events..........................................................................................
Commonly Asked Questions..................................................................................................... 226 Error Messages.......................................................................................................................... 228 Glossary of Terms......................................................................................................................... 231 Optional Features and Equipment...................................................................
LIST OF FIGURES LIST OF FIGURES Fig. 1. Help Screen ..............................................................................................................................25 Fig. 2. Help Index Screen ....................................................................................................................25 Fig. 3. Using the On-line Help Function .............................................................................................26 Fig. 4. Basic Configuration .....................
LIST OF FIGURES Fig. 35. Device popup ......................................................................................................................... 82 Fig. 36. Digital Parameter Popup - Bedside Device ........................................................................... 85 Fig. 37. Assign Transceiver Screen .................................................................................................... 86 Fig. 38. Label Set Definition popup ............................................
LIST OF FIGURES Fig. 70. Page Indicator ......................................................................................................................149 Fig. 71. Full Disclosure Options Popup ............................................................................................149 Fig. 72. Wave popup .........................................................................................................................150 Fig. 73. Skip To Popup ..............................................
LIST OF FIGURES Fig. 105. Example 9 - No Asystole Alarm Called ............................................................................ 216 Fig. 106. Example 10 - No V-TACH Alarm Called ......................................................................... 216 Fig. 107. Example 11 - Tall P and T-Waves .................................................................................... 217 Fig. 108. Example 12 - Small R-Wave Voltage ....................................................................
LIST OF TABLES LIST OF TABLES Table 1. Default and Optional Palette Colors ....................................................................................41 Table 2. Waveform Trace colors ........................................................................................................42 Table 3. Electrode Positions and Colors ............................................................................................47 Table 4. 1.05 Arrhythmia Beat Classification Labels ........................
LIST OF TABLES Table 35. DT-7000/7001 Environmental Specifications ................................................................. 251 Table 36. DT-7000/7001 Device Specifications ............................................................................. 251 Table 37. Uninterruptible Power System ......................................................................................... 252 xiv PatientNet Operator’s Manual, v1.
INTRODUCTION INTRODUCTION The PatientNetSystem is intended to collect and analyze patient data from ECG ambulatory transceivers, leading manufacturers’ bedside monitors, and ventilators anywhere in a healthcare facility and distribute the data to locations throughout the facility. With OpenNet technology, a hospital can connect bedside monitors from other vendors to the network. This allows standardization of display and distribution of patient information and may allow the use of existing equipment.
INTRODUCTION About This Manual This manual presents the information and instructions you need to operate the PatientNet System. After you have been trained on the system, use it as a reference guide. This manual does not provide advice on interpreting patient data.
INTRODUCTION Clinical Calculations Heart Rate Accuracy Ambulatory Patients The heart rate accuracy of the Central Station for ambulatory patients meets the performance required for adult patients as specified in the Standard for Cardiac Monitors, Heart Rate Meters and Alarms ANSI/AAMI EC-13 1992 (3.2.7). The heart rate is based on a tracked six-beat average.
INTRODUCTION Clinical Use and Responsibility CAUTION: United States Federal law restricts this device to sale by, or on the order of, a physician or properly licensed practitioner. The PatientNet System provides the technology to monitor cardiac rhythms, vital signs, and equipment alarms for patients with various levels of acuity in multiple patient care settings. The monitoring system does not replace physicians, caregivers or system operators.
INTRODUCTION Warnings, Cautions, and Notes Before operating the PatientNet System, read and follow all warnings and cautions provided in this section and throughout the manual. The warnings and cautions in this section are general to the PatientNet System. Warnings and cautions that refer to specific functions of the system appear in appropriate sections of the manual. Warnings 1. PatientNet is designed to monitor patients; it is not an ECG diagnostic device.
INTRODUCTION Equipment Safety Warnings 1. Do not operate this system in the presence of flammable anesthetics. Such an environment presents the risk of explosion. 2. Do not obstruct air-holes on the unit. Improper ventilation and air flow may cause the unit to overheat, resulting in automatic shut down. 3. Do not alter the configurations of the Central Station, PatientNet Viewers (also known as the IRVS and RVS), associated antenna, and network components as installed by our service technicians.
INTRODUCTION Notes • Consignment Central Stations are provided for the sole purpose of temporarily backing up the Central Station and PatientNet Viewers (IRVS and RVS). Consignment units do not have a software license; they use the license of the unit that they temporarily replace. • The clock/time mechanism on the Central Station is accurate to +/- 1 minute per month. If greater accuracy is desired, then you will need to update the clock periodically.
INTRODUCTION Definitions of International Symbols The following table defines the international symbols that appear on the PatientNet Wireless NetworkTM Symbol 22 Name Definition Attention Consult accompanying documents Hazardous Voltage Caution: Dangerous Voltages. Do not remove cover or back. Refer servicing to qualified service personnel. Off Power is disconnected from main source On Power is connected to main source Button System on/off PatientNet Operator’s Manual, v1.
INTRODUCTION Earth Ground Functional. The device is electrically grounded. Defib Protection This is a type BF equipment with Defibrillator protection UL Mark Underwriters Laboratory classification mark UL Mark Listed Underwriters Laboratory classification mark, indicating that the equipment is listed by UL. Fragile: Handle with Care Storage / Transportation Packaging Keep Dry Storage / Transportation Packaging LISTED PatientNet Operator’s Manual, v1.
INTRODUCTION 24 Temperature Limitation Storage / Transportation Packaging Humidity Limitation Storage / Transportation Packaging IPX7 IPX7 This device can be immersed in 1m of water for 30min. IPX1 IPX1 FCCID: FCC Identification Number This device is protected against vertically falling water drops. Unique Idenentification number that signifies the equipment is certified by the FCC. PatientNet Operator’s Manual, v1.
INTRODUCTION Software Help Software Help is available to provide additional instructional support. To use the Software Help: 1. Press Help on the Main screen to display the Help screen (fig. 1). Fig. 1. Help Screen 2. Click on a help topic or click on Index/Key Words to display the Index screen (fig. 2). Fig. 2. Help Index Screen PatientNet Operator’s Manual, v1.04, 10001001-00X, Draft All information contained herein is subject to the rights and restrictions on the title page.
INTRODUCTION 3. Select a topic and press the Show button to display the help information. Use the Pg Up and Pg Dn buttons to move through the topic choices. 4. Click the Topics button again to return to the Help Topics Screen. Select the Help and How to Use It topic (fig. 3) to view details on using the On-line Help function. Fig. 3. Using the On-line Help Function 5. Click the Exit button to close the help system and return to the previous screen. 26 PatientNet Operator’s Manual, v1.
INTRODUCTION Cleaning PatientNet System Components CAUTION: Do not gas sterilize or AUTOCLAVE any part of the monitoring system or transceivers. CAUTION: Do not allow liquid to come in contact with any display monitor of the Central Station, PatientNet Viewers (also known as IRVS and RVS), power cord, controls or switches. Doing so may damage and compromise the electrical safety of the equipment. CAUTION: To avoid possible electric shock, the equipment must be turned off before cleaning.
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THE PATIENTNET SYSTEM THE PATIENTNET SYSTEM About this Section This section presents the following information or tasks: • descriptions of the PatientNet System components (page 29) • using the Main and Split screen elements (page 34) • adjusting system volume (page 40) • adjusting waveform and display colors (page 41) The PatientNet System is an open, real-time network that allows caregivers to access vital patient information from anywhere in the hospital enterprise.
THE PATIENTNET SYSTEM WMTS Remote Transceivers Wireless Medical Telemetry Services (WMTS) Remote Transceivers provide the link between the patient and the Central Station through the new 608 - 614 MHz Medical Telemetry frequency band. They have the ability to send and receive data via the Access Point for data control command transfer and seamless roaming from Access Point to Access Point.
THE PATIENTNET SYSTEM stand-alone paging systems to alert caregivers of patient alarm conditions. Alphanumeric (nurse unit, room number, alarm condition, and extension) text messages are sent and displayed on compatible alphanumeric pagers. Multi-mouse Multi-mouse allows a single mouse to control multiple system screens. Up to six Central Stations and one Interactive-PatientNet Viewer in a pod configuration may be connected to a single mouse.
THE PATIENTNET SYSTEM System Configuration Basic Configuration A basic configuration (fig. 4) consists of the Central Station, which monitors, displays and prints data for up to eight patients. The Central Station may be connected to a laser printer and/or to the hospital’s paging system. Central Stations can then be linked together to form a Pod (See figure 5 on page 33). Patient 1 Patient 5 Patient 2 Patient 6 Patient 3 Patient 4 Patient 8 Patient 7 Central Station Hospital Paging System Fig. 4.
THE PATIENTNET SYSTEM Pod Configuration A pod configuration (fig. 5) consists of two to six connected Central Stations. An optional Interactive-PatientNet Viewer can also be added to a pod. With this configuration, one system operator can monitor up to 48 patients (eight patients per Central Station) at a time. Multiple pods can be connected to the same network.
THE PATIENTNET SYSTEM PatientNet Screen Elements Main Screen The Main screen of the Central Station, the screen normally used for monitoring, displays eight patient channels. Each channel is dedicated to one patient and displays that patient’s real-time waveforms, monitoring data, patient demographics, and digital data. Patient Channel Main Menu Buttons Patient Information Block Record Buttons Waveform Areas Fig. 6. Central Station Main screen 34 PatientNet Operator’s Manual, v1.
THE PATIENTNET SYSTEM Split Screen application screen The “split screen” format of the Main screen shows the eight channels but with a narrow window for waveforms; this makes room at the bottom of the screen for other applications. It is on the application screens that operations are performed. Fig. 7. Split screen You can enter an application screen by either selecting a button from the main menu, or by selecting buttons within the currently open application.
THE PATIENTNET SYSTEM Patient Channel Tile Patient channels display the patient’s name and other identifying information, current monitored parameters and data, alarms and waveforms. See “Admit, Discharge, and Patient Demographic Information” on page 73 for more information.
THE PATIENTNET SYSTEM • waveform label or ALARM, or one of the following: • • • • • TRACE OFF LEARNING Smart Alarm location ALARM OFF silence indicator (crossed-out bell) in place of the Rhythm Indicator when an alarm is silenced Note: Ventilator patient blocks are green, making them easily distinguishable from non-ventilator blocks. Patient Channels that are admitted via the Remote Admit feature are green until acknowledged by the Operator.
THE PATIENTNET SYSTEM System Settings You can optimize the visibility and sound level of PatientNet by making the color and sound adjustments described in this section. Note: The settings you make here apply to all channels on the monitor. Choose settings that are easiest to see and hear in your particular environment. All of the settings in this section are made on the Passcode screen. Display the Passcode screen by pressing System on the Main screen. Fig. 9.
THE PATIENTNET SYSTEM Cancel Laser Button Pressing the Cancel Laser button cancels the currently printing laser output. Even though you press the Cancel Laser button, data may still be in the print queue. The printer will continue to print the data was in the queue prior to pressing the Cancel Laser button. OpenNet Button Note: The OpenNet Button is only available on the Central Station. Pressing the OpenNet button displays the OpenNet Transceiver Status screen on monitors that are OpenNet LAN enabled.
THE PATIENTNET SYSTEM Sound Volume Adjustment You can adjust the sound volume for Touch/Mouse clicks, Medical Alarms, and Technical Alarms. To adjust the sound volume: 1. Press Volume on the Passcode screen to display the System Volume Setup screen. Note: The Volume button is enabled and disabled by your System Administrator. If this button is disabled, check with your System Administrator for details. 2.
THE PATIENTNET SYSTEM Screen and Waveform Colors You can adjust the screen and waveform colors to your preference on the System and Waveform Colors Setup screen. Press Colors on the Passcode screen to bring up the System and Waveform Colors Setup screen shown in fig. 11. Fig. 11. System and Waveform Colors Setup screen Screen Display Colors Press Palette to scroll through the choices for display background colors. Table 1.
THE PATIENTNET SYSTEM Waveform Trace Color Choose waveform colors for bedside monitored patients using the Bedside Waveform Setup buttons and for ambulatory patients using the ECG button under Ambulatory Waveform Setup. Press these buttons to cycle through the color choices shown below. Table 2.
SKIN PREPARATION AND LEAD PLACEMENT SKIN PREPARATION AND LEAD PLACEMENT Patient Preparation for Monitoring The single most important factor for accurate computerized arrhythmia monitoring is the quality of the ECG signal. Electrode application is the critical step. Prepare the patient’s skin to provide for good adherence of the electrode. This may seem time-consuming, but if done meticulously in the beginning to decrease skin impedance in the skin/electrode interface, much effort will be saved later.
SKIN PREPARATION AND LEAD PLACEMENT For stable electrode contact: 1. 2. 3. 4. 5. 6. Clean and dry skin Remove excess hair Buff the skin briskly Attach snap to electrode before applying Place close to bone or over soft tissue Secure wires and transceiver Preventing or Minimizing Motion Artifact Understanding and practicing the following seven concepts will greatly reduce the effect of motion artifact. The electrical contact to the skin must be stable.
SKIN PREPARATION AND LEAD PLACEMENT Note: Make sure that the expiration date on the electrodes has not passed. A dry electrode will not conduct. The transceiver must be carried securely on the patient. If the transceiver is allowed to dangle or jostle as the patient moves, then the weight of the device will tug on the electrodes, causing degradation of the signal.
SKIN PREPARATION AND LEAD PLACEMENT Electrode Placement on Ambulatory Patients WARNING: ECG lead wires must be dressed and secured to the patient to prevent the possibility of them encircling the patient’s neck and causing strangulation. CAUTION: The type of electrode used with this device may affect the system overload recovery time, especially recovery time after the application of defibrillator pulses, since some electrodes may be subject to large offset potentials due to polarization.
SKIN PREPARATION AND LEAD PLACEMENT Fig. 14. 5-Wire Lead Set Placement The following table describes the electrode positions and corresponding colors. Table 3.
SKIN PREPARATION AND LEAD PLACEMENT Alternative Placement of Electrodes Surgical Patients Place the Brown electrode in the area of the V5 chest lead. Fig. 15. Surgical Patients Lead Placement Patients Using Transcutaneous Electrical Nerve Stimulators (TENS) TENS signals may saturate the signal and can interfere with, or result in gross distortion, of the ECG waveform. This may result in false asystole or low heart rate alarms. It also affects the displayed ECG waveform.
SKIN PREPARATION AND LEAD PLACEMENT Patients with a Pacemaker Note: Do not place an electrode near the implant. Move the relevant electrode at least four inches, either lower on the chest or near the scapula. The chest lead may also have to be moved. Note: Initiate the learning process when the patient is in their dominant rhythm. Fig. 16. Pacemaker Patients Lead Placement The transceiver detects pacemaker pulses on Leads I and II.
SKIN PREPARATION AND LEAD PLACEMENT Right Arm Implant: Reposition the RA Electrode The impedance vector runs from the right pectoral region to the bottom of the heart. Begin to work with Lead II. This will accomplish two things: 1. The electrode is repositioned farther from the pacemaker; typically three to four inches to the right (towards the center of the chest). 2. Lead II is made less parallel to the impedance vector, reducing the likelihood of false pacer detect triggers.
ARRHYTHMIA ANALYSIS ARRHYTHMIA ANALYSIS PatientNet performs arrhythmia analysis on ambulatory and bedside monitored patients. Arrhythmia processing is not performed when the device type is a NPB 7200 series ventilator. WARNING: This device does not detect all arrhythmias.
ARRHYTHMIA ANALYSIS V-TACH, V-RUN, and V-RHYTHM Configurations V-TACH The V-TACH arrhythmia alarm can now be configured. The number of consecutive PVCs can be set equal to, and between, 3 and 8. The Heart Rate can be set equal to, and between, 100 and 120 BPM. A V-TACH alarm is triggered when the consecutive PVC count is reached AND the heart rate is greater than or equal to the set Heart Rate Value.
ARRHYTHMIA ANALYSIS Bedside Arrhythmia Source Some bedside monitors can perform arrhythmia processing and generate their own arrhythmia alarm calls. You can elect to have the system use such bedside monitors for arrhythmia processing and the Central Station’s arrhythmia processing will be turned off for that particular channel. To do so, set the patient’s alarm source to bedside and set arrhythmia/ST to ON on the Alarm Source popup described on page 116.
ARRHYTHMIA ANALYSIS Computerized Arrhythmia Monitoring Computerized arrhythmia monitoring was never intended to replace the human interface as the mathematical brain of the computer does not think like ours. It does one thing better than us however, and that is to provide continuous surveillance of all monitored patients simultaneously without fatigue or distractions.
ARRHYTHMIA ANALYSIS Step 2 - Data Transmission The Central Station processes the incoming data and uses digital processing to remove any artifact from outside sources of RF (Radio Frequency) interference. The digital data stream received by the Central Station includes the waveform data with encoded pacer flags. The pacer flags are used to indicate where the front end device (ambulatory transceiver or bedside monitor) detected a pacemaker spike.
ARRHYTHMIA ANALYSIS Step 4 - Template Creation Learning the Reference Beat The learn “mode” may be initiated by any one of many possible triggers. See “Learn and Relearn Considerations” on page 70. The purpose of the learning period is to identify or learn the patient’s dominant beat which is accomplished by identifying the dominant morphology or the most frequently occurring morphology during the learn period. At the beginning of every learn, all previously stored template information is cleared.
ARRHYTHMIA ANALYSIS Similar to the process used by clinicians to evaluate ECG, the algorithm determines if the patient has previously had that type of beat, if it is occurring more frequently, or if the shape (morphology) has changed. The technical name for this process is template matching. Feature Extraction Another aspect of arrhythmia analysis is feature extraction. Similar to template matching, feature extraction compares beats based on a series of characteristics.
ARRHYTHMIA ANALYSIS Beat Labels Beat classification labels define the beat. If the features match the reference, then the new beat is classified as NORMAL, or dominant. If they do not match, then the beat is classified as aberrant normal or ventricular. If an abnormal beat is seen repeatedly then it is sent on for further analysis. Beat classifications must precede rhythm classification. The following annotations are seen in full disclosure: Table 4 1.
ARRHYTHMIA ANALYSIS Table 5 1.05 Arrhythmia Analysis Alarm Label Rhythm Description MUSCLE Muscle Muscle Artifact ASYSTOLE Asystole No QRS Detected for 3.0 Sec CHKSIGNAL Check Signal Intermittent no signal detected NO SIGNAL No Signal No QRS Detected for 9.0 Sec V-FIB Ventricular Fibrillation Rapid disorganized Ventricular Impulses, no QRS’s V-TACH Ventricular Tachycardia Configurable. The number of consecutive PVCs can be set equal to, and between, 3 and 8.
ARRHYTHMIA ANALYSIS System Performance This section includes laser output examples of the majority of the arrhythmia calls detected by the PatientNet System. Regular; Dominant Rhythm; Beat Annotations - N Fig. 18. Regular; Dominant Rhythm 60 PatientNet Operator’s Manual, v1.04, 10001001-00X, Draft All information contained herein is subject to the rights and restrictions on the title page.
ARRHYTHMIA ANALYSIS Low HR; Heart Rate less than Low Rate Limit; Beat Annotations - N Fig. 19. Low HR; Heart Rate less than Low Rate Limit PatientNet Operator’s Manual, v1.04, 10001001-00X, Draft All information contained herein is subject to the rights and restrictions on the title page.
ARRHYTHMIA ANALYSIS High HR; Heart Rate greater than High Rate Limit; Beat Annotations - N Fig. 20. High HR; Heart Rate greater than High Rate Limit 62 PatientNet Operator’s Manual, v1.04, 10001001-00X, Draft All information contained herein is subject to the rights and restrictions on the title page.
ARRHYTHMIA ANALYSIS High PVC; PVC rate greater than the number of PVCs/minute limit; Beat Annotations - V Fig. 21. High PVC; PVC rate greater than the number of PVCs/minute limit PatientNet Operator’s Manual, v1.04, 10001001-00X, Draft All information contained herein is subject to the rights and restrictions on the title page.
ARRHYTHMIA ANALYSIS Ventricular Couplet; Beat Annotations - Two Consecutive Vs Fig. 22. Ventricular Couplet Ventricular Bigeminy; Beat Annotations - N-V-N-V-N Sequence Fig. 23. Ventricular Bigeminy 64 PatientNet Operator’s Manual, v1.04, 10001001-00X, Draft All information contained herein is subject to the rights and restrictions on the title page.
ARRHYTHMIA ANALYSIS Ventricular Trigeminy; Beat Annotations - N-N-V-N-N-V Sequence Fig. 24. Ventricular Trigeminy PatientNet Operator’s Manual, v1.04, 10001001-00X, Draft All information contained herein is subject to the rights and restrictions on the title page.
ARRHYTHMIA ANALYSIS Ventricular Rhythm; HR less than the configured V-TACH value; Beat Annotations - 3 or more consecutive Vs Fig. 25. Ventricular Rhythm 66 PatientNet Operator’s Manual, v1.04, 10001001-00X, Draft All information contained herein is subject to the rights and restrictions on the title page.
ARRHYTHMIA ANALYSIS Ventricular Tachycardia; HR greater than or equal to the configured V-TACH value; Beat Annotations - 3 or more consecutive Vs Fig. 26. Ventricular Tachycardia PatientNet Operator’s Manual, v1.04, 10001001-00X, Draft All information contained herein is subject to the rights and restrictions on the title page.
ARRHYTHMIA ANALYSIS Ventricular Fibrillation; no QRSs; Beat Annotations - rapid disorganized ventricular impulses Fig. 27. Ventricular Fibrillation; no QRSs 68 PatientNet Operator’s Manual, v1.04, 10001001-00X, Draft All information contained herein is subject to the rights and restrictions on the title page.
ARRHYTHMIA ANALYSIS Paced Rhythm; Beat Annotations - N or Q Fig. 28. Paced Rhythm Lead Off Fig. 29. Lead Off PatientNet Operator’s Manual, v1.04, 10001001-00X, Draft All information contained herein is subject to the rights and restrictions on the title page.
ARRHYTHMIA ANALYSIS Learn and Relearn Considerations Immediately upon placing the patient on the system, the arrhythmia analysis software begins a LEARN. During this time, the software is comparing all incoming beats to a reference in order to form a template for that patient’s normal QRS complex. During the learn mode, only the alarms for ASYSTOLE and V-FIB are activated. HIGH HR and LOW HR will be generated if the alarms are ON.
ARRHYTHMIA ANALYSIS WARNING: Do not initiate a relearn during an episode of arrhythmia, including ST events, unless it is indicated as stated above. The arrhythmia analysis software may learn an abnormal beat as the patient’s Normal if the abnormal beat is the dominant, or most frequently occurring beat, during the learn. If a relearn is accidentally initiated during an episode of arrhythmia, then initiate another manual relearn as soon as it is appropriate to do so.
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