System setup Option Graph Setup Function NOTE When changing the Graph Setup options for admitted patients, the changes do not take effect until the patients are discharged. NOTE Temporary changes may be made for a specific patient via the single patient viewer > Monitor Setup > Graph Setup. Default Locations for this CIC Set the print location for Manual, Alarm and Print Window.
System setup Option Event Marker Graph Function Turn on or off Event Marker Graph printing. Off is the default. This option allows you to select whether a graph will be printed when a patient’s event is marked using the event marker button on the transmitter. NOTE This feature is not applicable to all transmitters. Display Lead Set the primary ECG lead for display in the patient’s waveform window. Choices are: I, II, III, V, aVR, aVL and aVF. Lead II is the default.
System setup Option Detect Pace Function Enable or disable pacer detection. Choices are: Pace 1, Pace 2, and Off. Off is the default. NOTE Selecting Off turns pacemaker detection off. It does not perform pacemaker detection. Pace 1 or Pace 2 must be used with pacemaker patients. See Monitoring pacemaker patients on page 7-13. NOTE Temporary changes may be made for a specific patient via the single patient viewer > Monitor Setup > ECG. PDS Enable or disable use of the Patient Data Server (PDS).
System setup Patient age WARNING INCORRECT ALGORITHMS, ARRHYTHMIA PROCESSING AND CALCULATIONS BASED ON PATIENT AGE — After manually updating or automatically retrieving patient demographic information from a network database, always confirm that the entered patient’s date of birth matches the patient’s actual date of birth. Otherwise the appropriate age-related algorithms, arrhythmia detection, and calculations will not be applied.
System setup Telemetry Unit Defaults Tab Sheet Setting 3-10 years 11-13 years Age Chosen In The Admit Tab Sheet When Patient Admitted Resulting Limits Unit Default Alarm Level (Brady) Resulting Alarm Level Adult 50, 150 Message Advisory 0-2 years 90, 200 Message Crisis 3-10 years 60, 180 Message Message 11-13 years 50, 150 Message Advisory Adult 50, 150 Message Advisory 0-2 years 90, 200 Message Crisis 3-10 years 60, 180 Message Crisis 11-13 years 50, 150 Message Messag
System setup af t To view the telemetry unit default settings, click CIC Setup > Telemetry Alarm Control Defaults. Parameter Limits and Alarm Levels Low High Level HR bpm 50 150 Warning ST-I mm -2.0 2.0 Warning ST-II mm -2.0 2.0 Warning ST-III mm -2.0 2.0 Warning ST-V mm -2.0 2.0 Warning ST-V2 mm -2.0 2.0 Warning ST-V3 mm -2.0 2.0 Warning ST-V4 mm -2.0 2.0 Warning ST-V5 mm -2.0 2.0 Warning ST-V6 mm -2.0 2.0 Warning ST-aVR mm -2.0 2.
System setup Parameter Limits and Alarm Levels Low High Level RR breaths/min 5 30 Warning RR-APNEA seconds 30 Warning PVC #/min 6 Advisory Levels ASYSTOLE1 Crisis VFIB/VTAC Crisis V TACH Crisis VT > 2 Crisis V BRADY Crisis ACC VENT Advisory PAUSE Advisory TACHY Advisory BRADY Advisory af t Arrhythmia Alarm Levels Message COUPLET Message BIGEMINY Message TRIGEMINY Message PVC Message IRREGULAR Message ATRIAL FIB Message Dr R ON T 1 The default alarm lev
System setup Full disclosure defaults This option sets the full disclosure settings. In user mode, only the full disclosure Report and Strip settings can be configured. You must be in the Service mode to set the other full disclosure settings at the CIC Pro center. Dr af t To view the full disclosure default settings, click CIC Setup > Full Disclosure Defaults. Option 503A Function Report Duration Designate how much data is included in the report.
System setup Option Duration Function Designate how much data is included in the strip. The maximum strip duration is 60 minutes. To set the strip duration, place the cursor on the scroll bar below the Strip Duration display field. Move the scroll bar to the left for shorter duration or to the right for longer duration. Hole Location Provide space for binding printed reports. Choices are: none, top, bottom, left, and right.
System setup NOTE Telemetry beds are distinguished from monitoring beds by an asterisk appended to the end of the bed number. Dr af t To view the Current Telemetry Listings, click CIC Setup > Current Telemetry Listings. Option Admitted Telemetry Patients 2001989-301A- draft 1 364B Function Provide a view-only overview of the admitted telemetry patients. NOTE Each row contains information for one telemetry patient.
System setup Control settings (temporary) Control settings allow you to make temporary adjustments to some of the system and clinical application settings of the CIC Pro center. Control settings are temporary, meaning they apply to a selected patient and are erased when the patient is discharged. For detailed control setting information, including displayed waveform, Alarm Control, parameter control and print settings, refer to the CIC Pro Clinical Information Center Operator’s Manual.
Alarms Dr af t 5 2001989-301A- draft 1 ApexPro™ 5-1
Alarms Alarm notification WARNING ALARM ACTIVATION—No alarms sound or display on the CIC Pro center until a monitored patient is admitted to the CIC Pro center. The CIC Pro center will not alarm if an unadmitted patient enters an alarm condition. You must admit the patient to activate the alarms, automatic alarm printing, and the Events directory. WARNING OUT-OF-UNIT ALARMS—No audible alarms sound on the CIC Pro center for any viewed out-of-unit patient beds.
Alarms Alarm categories The CIC Pro center categorizes alarms into patient status or system status alarms. NOTE The system will enunciate the system Warning and system Advisory fog horn for Leads Fail, as it takes priority over any active patient status Warning, Advisory and Message alarms. NOTE Crisis alarms are never superseded. NOTE When in Combo mode, alarm priority may be affected by the monitoring mode, i.e., USER DEFINED or TELE DEFINED.
Alarms 3 For telemetry patients only, the factory default for this setting is Always on. To change this setting, see the Telemetry Unit Defaults in the CIC Pro Clinical Information Center Bedrock Hardware Platform Service Manual. A graph prints automatically when a patient experiences a Crisis or Warning alarm. Arrhythmia alarm graphs run until the end of the alarm event or manually stopped by the user.
Alarms The bedside monitors automatically stores a 10-second strip for all Advisory, Warning, or Crisis arrhythmia events. The CIC Pro center can retrieve and display the 10-second strip stored at the bedside monitor. When configured for it, your CIC Pro center automatically prints patient alarm graphs. See Printing patient alarm graphs on page 5-17.
Alarms ALARM PAUSE displays in the patient’s waveform window on the CIC Pro center screen. After five minutes, the LED on the transmitter will no longer flash and alarms will be reactivated. Reactivating alarms at the transmitter To reactivate the alarms before the five minute time period has elapsed, press both transmitter buttons simultaneously again.
Alarms If you wish to continue pausing alarms after an Alarm Pause Breakthrough occurs, you must re-initiate the alarm pause: 1. To re-initiate an alarms off with reason condition, select the alarms off reason in the telemetry patient’s Alarm Control tab sheet. 2. To re-initiate an alarm pause from the transmitter, press both transmitter buttons simultaneously twice.
Alarms NOTE The following conditions apply when you silence alarms at the CIC Pro center: The alarms remain silent for one minute unless a new patient alarm condition occurs. ApexPro telemetry beds: If a patient alarm condition of any severity level occurs, the alarm silence condition is cancelled and the alarm will break through.
Alarms NOTE The following guidelines apply to changing Alarm Control settings at the CIC Pro center: The changes you make to the settings apply to the selected patient only and are adopted by the patient’s monitor. Some control settings for non-GE acquisition devices that are interfaced via the Unity Network Interface Device or the OCTANET interface device are not adjustable. It may be necessary to use the scroll bar at the right side of the window to view the appropriate alarm.
Alarms You may change any of the undimmed setting options. When an option appears dimmed, you cannot change it. Adjusting the parameter limit values WARNING ALARM CONTROL SETTINGS—If you adjust parameter limits or alarm levels at the CIC Pro center, these setting changes are also implemented by the bedside monitor. You must notify the bedside caregiver that you changed the parameter limit or alarm levels of that bedside monitor. 1.
Alarms WARNING Alarms do not sound, alarm histories are not stored, and alarm graphs do not print during an alarms off with reason condition. NOTE The patient must be in antenna range for the alarm pause state to cease. After the patient has returned to antenna range and/or alarms have been turned back on, verify that the patient’s waveforms are displayed at the CIC Pro center or bedside monitor NOTE Refer to Alarm pause breakthrough on page 5-6 for important alarm pause information.
Alarms Alarms Off Reason Text Displayed At CIC Pro center Text Printed On Graph Cardiac rehab CAR REHAB CARDIAC REHAB GI Lab GI LAB GI LAB Occupational therapy O.T. OCCUPATIONAL THERAPY Off unit OFF UNIT OFF UNT Cath Lab CATH LAB CARDIAC CATH LAB 1 OFF appears dimmed and is not selectable when the following service-level default is set: CIC Setup > CIC Defaults > Allow Alarms OFF on this CIC > No.
Alarms 318B Use the keyboard to enter the service password, then click the Apply button. The Current Permission entry changes from User to Service. t 3. Dr af CAUTION The service mode is intended for use only by qualified personnel with training and experience in its use. The consequences of misuse include loss of patient data, corruption of the CIC Pro center operating system software, or disruption of the entire Unity network. 4.
Alarms t af Parameter limits 319D To change the unit defaults for Parameter Limits and Alarm Levels, use the mouse to click in the Low or High field for the parameter you wish to edit. The field is framed by a rectangle, and up and down arrow buttons appear in the field. Dr 1. 2. 329A To increase or decrease the limit by 5, click on the up or down arrow button. To increase or decrease the limit in increments other than 5, use the keyboard to enter a new limit value. 3.
Alarms Parameter alarm levels To make a change in the telemetry unit default alarm level for a parameter, first access the Telemetry Alarm Control Defaults tab as described in the Telemetry Alarm Control Defaults section in this chapter. Then follow the procedure below. 1. In Telemetry Alarm Control Defaults tab, use the mouse to click in the Level field of the parameter for which the alarm level is to be changed. A down arrow button appears in the field. 2. Click on the down arrow button.
Alarms 3. Click on the down arrow button. A popup list of alarm level selections appears. 4. Click on your choice to select it. 5. Once you have set the desired level, click the Apply button for the changes to take effect. If you are finished making changes to the Telemetry Alarm Control Defaults tab sheet, click the OK button.
Alarms 5. Once you have set the desired level, click the Apply button for the changes to take effect. If you are finished making changes to the Telemetry Alarm Control Defaults tab sheet, click the OK button. Recalling unit defaults To recall the preset telemetry patient unit defaults for all options in the Alarm Control tab, simply click on the Recall Unit Defaults button on the bottom right side of the Alarm Control tab sheet.
Alarms Printing alarm settings A telemetry patient’s Alarm Control tab sheet can be printed, showing all current alarm settings and limits. Click on the Print button in the main menu to start a printout of the Alarm Control tab sheet. The Alarm Control tab sheet prints at the Print Window location. For more information about setting the Print Window location, refer to Chapter 9 in this manual. NOTE The Alarm Control tab sheet must be the front tab of the single patient viewer in order to print it.
Managing patients Dr af t 6 2001989-301A- draft 1 ApexPro™ 6-1
Managing patients Introduction Prior to admitting a telemetry patient to the CIC Pro center, several steps need to be performed: 1. Transmitter setup on page 3-2. 2. Skin preparation on page 6-2. 3. Electrode placement on page 6-2. You can manage in-unit patients from the CIC Pro center or from a networked monitor. When managing in-unit patients from the CIC Pro center, you can complete the following tasks: Admit patients. Change patient demographic information. Adjust parameter settings.
Managing patients The following chart shows the label used to identify each leadwire. Included also is its associated color code per AHA (American Heart Association) and IEC (International Electrotechnical Commission) standards.
Managing patients NOTE The V1 lead is recommended for arrhythmia detection, and the V5 lead is recommended for ST depression monitoring.1 NOTE For telemetry monitoring, any two precordial electrodes may be placed according to the clinician or physician’s preference.
Managing patients LA RA LL 3-leadwire AHA Electrode Placement L R F 3-leadwire IEC Electrode Placement 370A, 373A Right arm and left arm electrodes should be placed just below the right and left clavicle. Left leg electrode should be placed on a non-muscular surface on the lower edge of the rib cage. When using the standard 3-leadwire configuration, the following operating conditions occur: t Lead Analysis automatically switches to Single-Lead analysis.
Managing patients Lead II Lead I Neonatal AHA Electrode Placement Lead II Lead I Neonatal IEC Electrode Placement 883B, 884B Verify status After the transmitter leadwires have been properly attached to the patient's electrodes, verify lead quality, electrode status and transmitter function. For more information, refer to Maintaining quality ECG signal on page 6-6. For more information, refer to Transmitters on page 2-2.
Managing patients can be carried securely is inserted into pouches or placed into a patient’s gown pocket. Special considerations for 6-leadwire monitoring V FAIL message CAUTION The CIC Pro center does not detect 6-leadwire monitoring until a signal from the sixth lead is received at the CIC Pro center. Therefore, if the sixth lead on the transmitter has failed before the telemetry patient is admitted to the CIC Pro center, the CIC Pro center will not generate a V FAIL message for the sixth lead.
Managing patients Terminology Term Definition Locked and unlocked beds The CIC Pro center can be configured with the bed names in either locked or unlocked mode. When locked, the bed names are permanently assigned to specific windows. For information about locked and unlocked beds, refer to the CIC Pro Clinical Information Center Bedrock Hardware Platform Service Manual. NOTE It is possible to admit a patient to a window with a bed name that is locked to NONE.
Managing patients Term Definition Bedside monitoring WARNING INCORRECT ALGORITHMS, ARRHYTHMIA PROCESSING AND CALCULATIONS BASED ON PATIENT AGE — After manually updating or automatically retrieving patient demographic information from a network database, always confirm that the entered patient’s date of birth matches the patient’s actual date of birth. Otherwise the appropriate age-related algorithms, arrhythmia detection, and calculations will not be applied.
Managing patients The source of the ECG data You can admit patients to the CIC Pro center when the source of their ECG data comes from either a monitor or a transmitter. The source of the ECG data determines the monitoring mode the CIC Pro center uses. The monitoring mode is configured during installation. The CIC Pro center supports one of the following monitoring modes: Monitoring Modes Mode Description Standard Rover The patient is not connected to a transmitter.
Managing patients 4. Connect the monitor to an appropriate power outlet. 5. Turn on the monitor. 6. Wait 30 seconds, then verify the monitor displays the correct Unit Name and Bed Name. If the Unit Name and Bed Name do not appear, refer to To manually enter the patient demographic information on page 6-14. 7. Admit the patient to the monitor following the monitor’s operator instructions.
Managing patients a. When you see an empty patient window displaying an Admit button, go to step 2. b. If you do not see an empty patient window displaying an Admit button, click Auto Display in the menu bar.
Managing patients To bypass the manual entry of the patient demographic information, you can search for and retrieve the information from a networked database. WARNING INCORRECT ALGORITHMS, ARRHYTHMIA PROCESSING, AND CALCULATIONS BASED ON PATIENT AGE—After manually updating or automatically retrieving patient demographic information from a network database, always confirm that the entered patient's date of birth matches the patient's actual date of birth.
Managing patients NOTE If the message, Server off network is displayed, the Hospital Information System (HIS) is either not available or not present. 3. Review the displayed list of patients and demographic information to find the demographic information that matches the patient you are admitting. 4. When the demographic information from the list does not match your patient, click Clear. You must now manually enter the patient demographic information.
Managing patients WARNING INCORRECT ALGORITHMS, ARRHYTHMIA PROCESSING, AND CALCULATIONS BASED ON PATIENT AGE—After manually updating or automatically retrieving patient demographic information from a network database, always confirm that the entered patient's date of birth matches the patient's actual date of birth. Otherwise the appropriate age-related algorithms, arrhythmia detection, and calculations will not be applied.
Managing patients If the message Would you like to start Full Disclosure? is displayed, the full disclosure data collection method is set to Manual. To complete the admit process, you must select Yes or No. 3. If an Admit Information Mismatch window displays while you are trying to establish the Combo monitoring mode, the CIC Pro center has detected a mismatch of patient data between the hardwired bed and the telemetry bed.
Managing patients WARNING INCORRECT ALGORITHMS, ARRHYTHMIA PROCESSING, AND CALCULATIONS BASED ON PATIENT AGE—After manually updating or automatically retrieving patient demographic information from a network database, always confirm that the entered patient's date of birth matches the patient's actual date of birth. Otherwise the appropriate age-related algorithms, arrhythmia detection, and calculations will not be applied. 4. Click Save.
Managing patients Move a patient to telemetry monitoring To discharge a patient from the bedside monitor, but remain on telemetry monitoring, complete the following procedure: 1. From the multi-patient viewer, click on the patient you want to move. The single patient viewer displays. 2. From the single patient viewer, click Admit to display the Admit window. 3. Click on the down arrow next to Bed to display a list of available telemetry beds. 4. Choose the bed you want to move the patient to.
Managing patients Discharging an admitted patient Discharging a patient at the CIC Pro center completes the following tasks: Discharges a telemetry patient from CIC Pro center. Discharges a hard-wired patient from both the CIC Pro center and from the monitor. Deletes the discharged patient’s locally stored patient data from the CIC Pro center. Complete the following procedure to discharge an admitted patient from the CIC Pro center: Disconnect all patient cables. 2.
Managing patients The alarm pause feature (if available on your transmitter) is honored at the monitor. You should not turn off the monitor until you have discharged the patient from the monitor. Second V lead data is not sent to the monitor from the transmitter. If you wish to see telemetry second V lead data, you must view the telemetry patient. When switching ECG monitoring from the monitor to telemetry: Arrhythmia alarm histories from the monitor are merged in the telemetry system.
Managing patients When the monitor alarms are paused and the ECG parameter is turned off, the following network devices will not display an ALARM PAUSE text message for that monitor. CIC Pro center using software version 3.0 or earlier. Centralscope central station using any version of software. ECG setting source Selecting ECG setting source When the monitor is in Combo mode, you can select whether the monitor uses its own ECG settings or the telemetry ECG settings.
Managing patients The following tables indicate the source (monitor or telemetry) of ECG settings when entering Combo mode.
Viewing real-time patient data Dr af t 7 2001989-301A- draft 1 ApexPro™ 7-1
