Admit/View a Patient: Discharge Instructions Clearing a Patient Window To clear discharged patient information from the window and bring up the Admit button, use the right-click menu. 1. Use the RIGHT mouse button to click anywhere inside a discharged bed window. The right-click menu appears. 387A 2. Slide the mouse over the Select Care Unit, then Bed Number text, without pressing either mouse button. The text highlights, and a list of units on the network pops up. 3.
Admit/View a Patient: Move Telemetry Patients Move Telemetry Patients This option allows you to move a telemetry patient to a new bed within the same care unit or to move Combo patients in and out of combo mode. The Move feature is located on the Admit tab sheet on the CIC Pro. To move a patient within the same care unit, follow this procedure: 1. At the CIC Pro, select the bed window of the patient you wish to move. 2. Click on the Admit tab to bring the tab sheet to the front. 3.
Admit/View a Patient: Viewing a Patient Viewing a Patient When you wish to see detailed information about a patient’s status, you can use the View Patient tab in the single patient viewer. 1. Click in the bed window of the patient you wish to view. The display rearranges to accommodate the single patient viewer at the bottom. 2. Click on the View Patient tab to bring it to the front.
Admit/View a Patient: Viewing a Patient Relearn Clicking on the Relearn button initiates a relearn of the patient’s ECG rhythm. The relearn takes only a few seconds. The patient’s heart rate reading will appear as Xs momentarily, and then be replaced by numerics once the relearn is complete. Use the relearn function whenever there has been a significant change in the patient’s normal rhythm.
Admit/View a Patient: Viewing Another Patient Viewing Another Patient NOTE When viewing a patient from another unit, you cannot make any changes to the patient’s information or settings. Viewing in the Single Patient Viewer To display the single patient viewer of a patient on the network who is not currently displayed on your CIC Pro, follow the steps below. 1. Click on the View Other button in the Main Menu at the bottom of the CIC Pro display. 2. The View Other Patient window appears.
Admit/View a Patient: Viewing Another Patient Viewing in the Multiple Patient Viewer When in the multiple patient viewer, you can replace the data in any unlocked bed window with the data from another patient on the network who is not currently displayed on your CIC Pro. NOTE The data for the patient who was originally displayed in the bed window you select will not be visible on your CIC Pro once you use that patient’s bed window to view another patient.
Admit/View a Patient: Viewing Another Patient 3. Without pressing either mouse button, slide the mouse pointer to the unit name you wish to select a bed from. The unit name highlights, and a list of beds on that unit pops up. 338A 4. Without pressing either mouse button, slide the mouse pointer to the bed you wish to view. The bed name becomes highlighted. NOTE A check mark next to a bed name means that the bed is already being viewed at this CIC Pro. 5.
Admit/View a Patient: Viewing Patients Through Alarm Condition Indicators Viewing Patients Through Alarm Condition Indicators You can open the single patient viewer for any patient in your care unit who is experiencing an alarm condition. When a patient experiences an alarm condition, a red button appears at the bottom of the CIC Pro display. The button contains the unit name and bed number, as well as the cause of alarm.
Admit/View a Patient: Viewing Patients Through Alarm Condition Indicators 7-18 ApexPro Telemetry System 2001989-134 Revision D
8 Revision D Alarm Control ApexPro Telemetry System 2001989-134 8-1
For your notes 8-2 ApexPro Telemetry System 2001989-134 Revision D
Alarm Control: Alarm Structure Alarm Structure The alarm structure of the CIC Pro is divided into two classifications: Patient status alarms System status alarms Within each classification there are levels that correlate to the severity of the condition that is causing the alarm. The levels and how the CIC Pro responds to each are described below. Patient Status Alarms Patient status alarms are triggered by a patient condition that exceeds parameter limits, or by an arrhythmia condition.
Alarm Control: Alarm Structure Colored Window Borders Crisis and Warning alarms are indicated with a large border around the individual patient’s bed window in the multiple patient viewer. This border flashes on and off several times when the alarm occurs before staying on. The color of the border indicates the severity of the alarm — red for a Crisis alarm and yellow for a Warning alarm. When the alarm is silenced, the colored border reverts to the black background.
Alarm Control: Alarm Control Tab Alarm Control Tab Parameter and arrhythmia alarm levels are, from most critical to least critical, Crisis, Warning, Advisory, and Message. Each alarm level elicits a specific response from the CIC Pro. The four alarm levels are configurable. This means that an alarm can be moved from one category to another if the default is not satisfactory to your situation. This is done in the Alarm Control tab sheet for the patient whose alarm settings you wish to adjust.
Alarm Control: Alarm Control Tab Parameter Limits 1. To change the individual patient’s settings for Parameter Limits and Alarm Levels, click in the Low or High field for the parameter you wish to change. NOTE The alarm limits for some parameters cannot be changed. To indicate that they cannot be changed, the text in the Low and High fields for these parameters always appears dimmed. Once you click in the field, it is framed by a rectangle, and up and down arrow buttons appear in the field.
Alarm Control: Alarm Control Tab Parameter Alarm Levels 1. Click in the Level field for the parameter whose alarm level is to be changed. A down arrow button appears in the field. 2. Click on the down arrow button. A popup list of alarm level selections appears. 331A NOTE Alarms are always sorted from top 3. Click on the desired alarm level to select it. to bottom in highest to lowest 4. If you are finished making changes in the Alarm Control tab sheet, priority.
Alarm Control: Alarm Control Tab Arrhythmia Alarm Levels 1. To change the Arrhythmia Alarm Levels, click in the Level field of the arrhythmia alarm you wish to change. A down arrow button appears in the field. NOTE The Arrhythmia Alarm Levels for ASYSTOLE and VFIB/VTAC cannot be changed. Therefore, the text in the Level field for these alarms always appears dimmed.
Alarm Control: Alarm Control Tab Alarms On/Off To turn a telemetry patient’s alarms on or off, click on the appropriate radio button or on the text itself in the Alarms On/Off section of the Alarm Control tab. ON and OFF buttons 334B Selecting Off turns all alarms off until you turn them back on by selecting On. NOTE Refer to the Alarm Pause Breakthrough section in this chapter for important information about turning alarms off.
Alarm Control: Alarm Control Tab Alarm Off Reason Selecting from a list of reasons, you can define why alarms have been turned off. This text is displayed in addition to the ALARMS OFF message in the patient’s window at the CIC Pro. The following are the options for alarms off reasons. Alarms Off Reason On Off X-ray Shower Surgery Physical therapy Cardiac rehab GI Lab Occupational therapy Off unit Cath Lab Text Displayed At CIC Pro (no text) ALARMS OFF XRAY SHOWER SURGERY P.T. CAR REHAB GI LAB O.T.
Alarm Control: Alarm Control Tab The alarms off reason appears in the event trend for graphic trends. If the patient is in LEADS FAIL or NO TELEM and an alarms off reason is selected, the reason is displayed in the waveform window. NOTE 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 or bedside monitor.
Alarm Control: Alarm Control Tab 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. All data on the tab sheet will clear, and after a moment the preset unit defaults will appear. In addition, clicking on the Recall Unit Defaults button also restores the default graph locations and settings on the patient’s ECG tab sheet.
Alarm Control: Alarm Control Tab 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, Printing, in this manual.
Alarm Control: Alarm Pause Breakthrough Alarm Pause Breakthrough The alarm pause breakthrough feature allows any crisis level alarm to “break through” (interrupt) an alarm pause and sound at the CIC Pro. In other words, when this feature is turned on in the Telemetry Unit Defaults tab sheet, Crisis level alarms will sound at the CIC Pro, even if an alarm pause is in effect. NOTE The Alarm Pause Breakthrough feature defaults to Always On.
Alarm Control: Alarm Pause Breakthrough 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 ApexPro transmitter, press both transmitter buttons simultaneously twice.
Alarm Control: Unit Default Settings for Alarms Unit Default Settings for Alarms Telemetry Alarm Control Defaults You can set Telemetry Unit Defaults for parameter limits and alarm levels, as well as for arrhythmia alarm levels. These defaults are in effect for all telemetry patients admitted to your unit, unless they are modified in an individual patient’s Alarm Control tab sheet (for more information, see the Alarm Control Tab section in this chapter).
Alarm Control: Unit Default Settings for Alarms 3. Use the keyboard to enter the service password, then click the Apply button. The Current Permission entry changes from User to Service. 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 operating system software, or disruption of the entire Unity network. 4.
Alarm Control: Unit Default Settings for Alarms Parameter Limits 5. 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. 329A 6. 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. 7.
Alarm Control: Unit Default Settings for 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.
Alarm Control: Unit Default Settings for Alarms Arrhythmia Alarm Levels To make a change in the telemetry unit default alarm level for arrhythmia alarms, 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 the Telemetry Alarm Control Defaults tab, the arrhythmia alarm levels for which unit defaults can be set appears on the right side of the window: 333C 2.
Alarm Control: Unit Default Settings for Alarms System Alarm Levels WARNING ADJUSTING SYSTEM ALARM LEVELS — The LEADS FAIL alarm indicates that one or more electrodes are not connected to the patient and, as a result, there is loss of all waveforms and arrhythmia analysis. The ARR SUSPEND alarm indicates that arrhythmia conditions are not being detected and therefore alarms associated with arrhythmias will not occur.
Alarm Control: Unit Default Settings for Alarms For your notes 8-22 ApexPro Telemetry System 2001989-134 Revision D
9 Revision D Printing ApexPro Telemetry System 2001989-134 9-1
For your notes 9-2 ApexPro Telemetry System 2001989-134 Revision D
Printing: Initiating a Manual Graph Initiating a Manual Graph If you click on a patient’s ECG parameter window, a continuous graph is initiated for the patient. Clicking on the ECG parameter window again will stop the graph. The PRN 50 digital writer and the Direct Digital Writers (DDW) print patient data (generally referred to as a graph or graph strip). Data can also be printed on a laser printer. The waveforms graphed and graph speed are controlled in the individual patient’s Graph Setup tab sheet.
Printing: Initiating a Manual Graph Transmitter Initiated Graphs (Manual Graphs) When the Graph button on the ApexPro transmitter is pressed, a 20second graph strip is printed at a speed of 25 millimeters per second. When an IMPACT.wf paging system (version II or later) is also available in the same care unit, pressing the Graph button enables the View on Demand feature (also called the Apex Graph Button Push feature). The IMPACT.
Printing: Initiating a Manual Graph Graph Messages One of the following messages is displayed on the CIC Pro screen during graphing: GRAPH ALARM—An alarm graph was initiated and is running. GRAPH MANUAL—A manual graph was requested and is running. GRAPH TTX—The Graph button on the transmitter was pressed and a 20-second graph strip is running. PRINTING—A non-real time graph is currently being printed.
Printing: Graph All Patients Graph All Patients Clicking on the Print button at the bottom of the CIC Pro display sends a Graph All Patients request to all beds displayed on the CIC Pro, initiating a 10-second graph for each admitted telemetry patient. When this option is selected for telemetry patients, graph requests always print at a speed of 25 millimeters per second. NOTE This Graph All Patients function is only available when the single patient viewer is closed.
Printing: Graph All Patients Initiating a Graph All Patients Request To initiate a Graph All Patients request, follow these steps. 1. Click on the Print button at the bottom of the CIC Pro display. The Graph All Patients window opens. 378A 2. Click on Limits or Waveforms. Selecting Limits graphs all patient limits. Selecting Waveforms graphs all patient waveforms. 3. Click on the OK button to complete the Graph All Patients request.
Printing: Graph Location Settings Graph Location Settings Graphs print at the graph locations specified in the patient’s Graph Setup tab sheet. Upon admission of a patient, these locations are set from the unit defaults, but they can be modified if desired.
Printing: Stopping a Graph Stopping a Graph To stop a graph request that has been sent to an external writer, press its Graph Stop control key. This stops any graph already in process. If this key is pressed when no graph is in process, it advances the paper in the writer. A manual graph may also be stopped by clicking on the patient's ECG parameter window.
Printing: Graph Paper Out Indicator Graph Paper Out Indicator When there is no graph paper in the writer (or the door is open), the message Graph Paper Out/Door Open is displayed at the top of the screen. When printing to a laser printer, a similar status message is displayed if the printer is unable to print. NOTE Because the CIC Pro can communicate with many laser printers, specific status messages are not documented in this manual.
Printing: Graph Setup Tab Sheet Graph Setup Tab Sheet The Graph Setup tab sheet allows you to define the waveforms to be graphed, change the graph location and speed, and turn the telemetry transmitter graph on and off. NOTE Changes made in the Graph Setup tab sheet affect only the patient currently being viewed.
Printing: Graph Setup Tab Sheet Graph Waveforms Controls The Graph Waveforms controls allow you designate which waveforms should print in which positions on a patient’s graph printout. ECG 1 Control 1. Click in the ECG 1 field. A down arrow button is displayed next to the waveform currently in the ECG 1 position. 2. Click on the down arrow to display a list of available ECG waveforms. 3. Click on the desired ECG waveform. The ECG 1 menu closes, with the selected ECG waveform name remaining visible.
Printing: Graph Setup Tab Sheet Graph Location Controls The Graph Location controls allow you to set the print destinations for manual, alarm, and print window graphs. Manual Graph Location To designate where manual graph requests will print, follow these steps. 1. Click in the Manual field. A down arrow icon is displayed next to the printer currently designated for printing manual graphs. 2. Click on the down arrow to display a list of available printers. 3. Click on the desired printer.
Printing: Graph Setup Tab Sheet Enable Transmitter Graph The Enable Transmitter Graph option allows you to turn off/on the transmitter graph function for telemetry patients. When this option is enabled, a telemetry patient can initiate a graph by pressing the Graph button on the ApexPro transmitter. When this option is disabled, no graph can be initiated. To enable or disable this option, follow this procedure: 1.
Printing: Graph Setup Tab Sheet Graph Speed Controls The graph Speed controls allow you to adjust the speed at which a graph prints (mm/s). Simply click on the desired speed.
Printing: Laser Printer Laser Printer A laser printer can be connected to the back of the CIC Pro. (Refer to the service manual for more information on printer connections.) The CIC Pro must be formatted for a laser printer upon installation in order for a laser printer to function with it. Refer to the service manual for the CIC Pro for more information. Printing to a laser printer for a telemetry patient may be configured on an individual basis or set up as a unit default.
10 Revision D Patient Data ApexPro Telemetry System 2001989-134 10-1
For your notes 10-2 ApexPro Telemetry System 2001989-134 Revision D
Patient Data: Introduction Introduction For the purposes of this manual, patient data consists of the information presented within these tab sheets: Alarm Histories Graphic Trends Vital Signs Full Disclosure Once a patient is admitted to the CIC Pro, a history of the patient’s vital signs is continually collected. The most recent 24 hours of data can be viewed in a tabular format (vital signs) or in a graphic format (graphic trends).
Patient Data: Alarm Histories Alarm Histories A patient’s arrhythmia events are stored in Alarm Histories, and can be reviewed, printed, and deleted at the CIC Pro. To access a patient’s Alarm Histories tab sheet, follow the instructions below. 1. Click in the bed window of the patient whose Alarm Histories you wish to view. The CIC Pro display rearranges to accommodate the single patient viewer at the bottom of the display. 2.
Patient Data: Alarm Histories Event Directory An event directory appears on the left side of the Alarm Histories tab. This directory is a list of all arrhythmia events that have occurred for this particular patient. A maximum of 100 events is stored for each patient (36 events in the Combo monitoring mode). Following are the numbers for each type of event that can be stored.
Patient Data: Alarm Histories Alarm Histories Buttons There are nine buttons that perform various functions in the Alarm Histories tab. They are described below. Data Source This option allows the user to select the specific data source from which historical patient data can be retrieved (option not shown on figure). Refer to “Data Source” on page 10-16 for additional information.
Patient Data: Alarm Histories View Older Event Click on the View Older Event button to view the next older event waveforms, if any. If there are no events older than the highlighted event, this button is dimmed and does not function. Delete Event Click on the Delete Event button to delete the event that is currently highlighted in the event directory. This cannot be undone.
Patient Data: Graphic Trends Graphic Trends To view a patient’s graphic trends, follow these steps. 1. Click on the desired patient’s bed window in the multiple patient viewer. The single patient viewer for that patient opens. 2. Click on the Graphic Trends tab in the single patient viewer. The Graphic Trends tab sheet moves to the front.
Patient Data: Graphic Trends Cursor One-minute median values can be accessed through the use of a cursor at the CIC Pro. Time and Date Corresponding to Cursor Position Numeric Values at the Cursor 384C Cursor Revision D Arrow Keys Move Cursor The default cursor location is at the current time when entering the Graphic Trends tab sheet. You can move the cursor to any median value and review the actual numeric data. The cursor is not printed with the graphic trend data.
Patient Data: Graphic Trends Time Resolution Menu In the Graphic Trends tab sheet, you can define the amount of trend data (resolution) to display in the trend window. This is done with the popup menu located to the right of the time and date. 1. Click on the down arrow to display the time options. 385A 2. Click on the desired time resolution. The time resolution menu closes, with the selected resolution remaining visible.
Patient Data: Graphic Trends Scan Older Click on the Scan Older button to initiate a scan of older trend data. When clicked, the scan begins and older trend data scrolls across the display. While the scan is in progress, you can select Scan Newer to reverse the scanning direction. This button changes to STOP when a scan is in process. Click on the STOP button to stop a scan in process. When the oldest event is displayed, the scan automatically stops, and the label on this button will be dimmed.
Patient Data: Graphic Trends Scalable Trends Key The Scalable Trends keys allow you to adjust the graphic trend plots. Selecting this key will scale the trend up or down in preset increments. For example, the preset scales for HR are: 431A 50–150 0–100 100–200 0–250 PDS Icon The PDS (Patient Data Server) icon indicates that information has been archived to the PDS server and is available to be viewed on the Graphic Trends tab sheet.
Patient Data: Vital Signs Vital Signs To view a patient’s vital signs, follow these steps. 1. Click in the desired patient’s bed window in the multiple patient viewer. The single patient viewer for that patient opens. 2. Click on the Vital Signs tab in the single patient viewer. The Vital Signs tab sheet moves to the front. The Vital Signs tab sheet displays periodic and episodic trend data in tabular, or spreadsheet, form.
Patient Data: Vital Signs Sort Mode The Sort Mode popup menu provides options for sorting the way vital signs data is viewed. If the telemetry patient is being monitored for NBP, the sort options are All Data and NBP. If the patient is not being monitored for NBP, the only option available is All Data. All other sort options appear dimmed. 360A Increment In the Vital Signs tab sheet, you can define the amount of data (resolution) to display in the Vital Signs window.
Patient Data: Vital Signs Scroll Bars If all of the Vital Signs data does not fit into the available display space, use the scroll bars to navigate among columns and rows of data. For more information on using scroll bars, refer to the CIC Pro Clinical Information Center Operator’s Manual. Printing Vital Signs Displayed trends can be printed using the same time scale as the display. To print a set of vital signs, click on the Print button at the bottom of the CIC Pro display.
Patient Data: Data Source Data Source The Data Source option allows the user to select the specific data source from which historical patient data (Alarm Histories, Graphic Trends, and Vital Signs) can be retrieved. The Data Source option is only available when PDS is Enabled (refer to “Telemetry Unit Defaults” on page 6-7). The Data Source option is labeled Data Source and exists on the left side of the screen, between the Multi-patient viewer and the Single view window.
Patient Data: Time Focus Time Focus The CIC Pro has a feature called time focus. When you are viewing one of the four types of patient data (alarm histories, vital signs, graphic trends, or full disclosure), time focus allows you to view the other three types of patient data that were recorded at that same time.
Patient Data: Full Disclosure Full Disclosure NOTE This section provides a brief overview of the Full Disclosure function. Refer to the CIC Pro Clinical Information Center Operator’s Manual for detailed information. The full disclosure feature must be enabled in the Full Disclosure Defaults tab sheet. Refer to the CIC Pro Clinical Information Center Operator’s Manual for details on enabling this feature. When full disclosure is enabled, follow these steps to view a patient’s Full Disclosure window. 1.
Patient Data: Full Disclosure Full Disclosure Options Speed The Speed popup list allows you to set the waveform compression for the full disclosure waveform display. Caliper Select the Caliper button to perform caliper measurements on the ECG waveform. When selected, the Caliper window opens displaying default ECG waveform and Calipers which allow you to measure time intervals for the following waveform measurements: PR, QRS, QT, R-R, and ST.
Patient Data: Full Disclosure Scan Newer Clicking on the Scan Newer button initiates a scan of newer full disclosure data. When the button is clicked, the scan begins and newer data scrolls across the display. This button changes to STOP when a scan is in process. Click on the STOP button to stop a scan in process. When the newest data is displayed, the scan automatically stops and the label on this button will be dimmed.
11 Revision D ECG Monitoring ApexPro Telemetry System 2001989-134 11-1
For your notes 11-2 ApexPro Telemetry System 2001989-134 Revision D
ECG Monitoring: Introduction Introduction This chapter describes how a telemetry patient’s ECG monitoring information is displayed at the clinical information center. Data Synchronization Information displayed on the ECG tab sheet is synchronized with the source (ApexPro transmitter) every two seconds. If differences are detected, the display is refreshed with new information.
ECG Monitoring: Patient Preparation Patient Preparation The quality of ECG information received and displayed is a direct result of the quality of the electrical signal at the electrode. Skin Preparation Proper skin preparation is necessary for good signal quality at the electrode. Choose flat, non-muscular areas to place electrodes, then follow the established prep protocol for your unit. Following is a suggested guideline for skin preparation: 1. Shave hair from skin at chosen sites. 2.
ECG Monitoring: Patient Preparation 5-Leadwire (Einthoven + V Lead) and 6-Leadwire Electrode Placement Following are the standard 5- and 6-leadwire electrode configurations for AHA and IEC: LA RA L C V1 RL V6 V2 V3 V4 V5 LL C1 368B AHA Configuration N C6 C2 C3 C4 C5 F 372B IEC Configuration Right arm and left arm electrodes should be placed just below the right and left clavicle.
ECG Monitoring: Patient Preparation 3-Leadwire Electrode Placement When a 5-leadwire electrode configuration is not desirable, a 3-leadwire cable can be used. RA LA LL L R 370A 3-Leadwire AHA Configuration 373A F 3-Leadwire IEC Configuration NOTE Electrode configuration will vary depending on the type of leadwire set you are using. Right arm and left arm electrodes should be placed just below the right and left clavicle.
ECG Monitoring: Patient Preparation Modified Chest Lead (MCL) Electrode Placement Following is the modified chest lead (MCL) electrode configuration with the associated location: LA RA L V1 R LL F 371A RL C1 AHA Configuration MCL Electrode Placement N 375A IEC Configuration MCL Electrode Placement Right arm electrode should be placed in the fourth intercostal space to the right of the sternum. Left arm electrode should be placed just below the left clavicle.
ECG Monitoring: Patient Preparation Electrode Placement for Pacemaker Patients Electrodes need to be repositioned to modify detection of the electrical signals generated by the pacemaker.
ECG Monitoring: Patient Preparation Maintaining Quality ECG Signal Regardless of patient type, electrodes should be replaced at least every 48 hours to maintain quality signals during long-term monitoring. Over the course of 48 hours, the electrode gel will start to dry out and the adhesive will age. This may irritate the patient’s skin. Stabilize the electrode and leadwire with a leadwire stress loop near the electrode. Tape the stress loop to the patient.
ECG Monitoring: Special Considerations for 6-Lead Monitoring Special Considerations for 6-Lead Monitoring V FAIL Message CAUTION The clinical information center does not detect 6-lead monitoring until a signal from the sixth lead is received at the clinical information center. Therefore, if the sixth lead on the ApexPro transmitter has failed before the telemetry patient is admitted to the clinical information center, the clinical information center will NOT generate a V FAIL message for the sixth lead.
ECG Monitoring: ECG Monitoring ECG Monitoring ECG in the Multiple Patient Viewer For telemetry patients, up to four leads of ECG can be displayed in the bed window of the multiple patient viewer. Also displayed are the patient’s heart rate, current PVC per minute value, ST analysis, and a “P” if pace detection is turned on. Below is an example of a telemetry patient’s bed window in the multiple patient viewer.
ECG Monitoring: ECG Monitoring ECG in the Single Patient Viewer View Patient Tab Sheet For telemetry patients, up to eight leads of ECG can be seen in the View Patient tab sheet. It is also possible to sample ten seconds of ECG data for storage in Alarm Histories, and to initiate a relearn of the patient’s rhythm. The patient’s heart rate, current PVC per minute value, ST information, and “P” for pace detection (if turned on) are also displayed. To access the View Patient tab sheet, follow the steps below.
ECG Monitoring: ECG Monitoring Full Disclosure Tab Sheet When you purchase the appropriate Full Disclosure licenses, you can acquire either 24-hours or 72-hours of Full Disclosure data per bed license. If full disclosure is turned on, data can be viewed in the Full Disclosure tab sheet. To access the Full Disclosure tab sheet, follow the steps below. 1. Click in the desired patient’s bed window in the multiple patient viewer. The display rearranges to accommodate the single patient viewer for that patient.
ECG Monitoring: ECG Monitoring ECG Artifact The clinical information center has two levels for artifact alarms. Level 1 artifact displays the ARTIFACT message, but continues to display a heart rate. The ARTIFACT message does not flash or generate an audible alarm. The ARTIFACT message will be relocated to the lead fail area of the display. If the patient is in a lead fail, the lead fail message has priority over the ARTIFACT message on the display.
ECG Monitoring: ECG Tab Sheet ECG Tab Sheet The ECG tab sheet allows you to view and modify settings specific to the viewed patient’s ECG display. Settings may be viewed for any patient. However, you can only modify settings for patients who are admitted to a bed in your care unit. Accessing the ECG Tab Sheet To access a patient’s ECG tab sheet in the single patient viewer, follow this procedure: 1. Click in the desired patient’s bed window in the multiple patient viewer.
ECG Monitoring: ECG Tab Sheet Display Lead This option allows you to change the lead currently displayed as the primary lead. Use the mouse to click on your Display Lead selection. Relearn Clicking on the Relearn button initiates a relearn of the patient’s ECG rhythm. The relearn takes only a few seconds. The patient’s heart rate reading is momentarily replaced by Xs. Numerics return once the relearn is complete.
ECG Monitoring: ECG Tab Sheet Detect Pace Safety Considerations Be aware of the following when monitoring a patient with a pacemaker. WARNINGS FALSE CALLS—False low heart rate indicators or false asystole calls may result with certain pacemakers because of electrical overshoot. MONITORING PACEMAKER PATIENTS—Monitoring of pacemaker patients can only occur with the pace program activated. PACEMAKER SPIKE—An artificial pacemaker spike is displayed in place of the actual pacemaker spike.
ECG Monitoring: ECG Tab Sheet CAUTION FDA POSTMARKET SAFETY ALERT—The United States FDA Center for Devices and Radiological Health issued a safety bulletin October 14, 1998. This bulletin states “that minute ventilation rate-adaptive implantable pacemakers can occasionally interact with certain cardiac monitoring and diagnostic equipment, causing the pacemakers to pace at their maximum programmed rate.
ECG Monitoring: ECG Tab Sheet Monitoring Pacemaker Patients The Detect Pace option enables/disables the pacemaker detection program. It must be used whenever the monitored patient has a pacemaker. Pace detection choices are Pace 1 and Pace 2. You can also choose to turn pace detection Off. Use the mouse to click on a Detect Pace selection. NOTE The Off option turns pacemaker detection off. It does NOT perform pacemaker detection.
ECG Monitoring: ECG Tab Sheet For successful monitoring of pacemaker patients follow these suggestions: Use recommended electrode placement. Brady, Pause, and Low Heart Rate are additional alarms available for use when monitoring pacemaker patients. Problems you may experience are: heart rate double counting; inaccurate alarms for low heart rate or asystole; pacemaker spikes not recognized by the software.
ECG Monitoring: ECG Tab Sheet Pace Help Clicking on the Pace Help button opens a window that shows common problems and solutions in regard to pacemaker detection. This window is shown below.
ECG Monitoring: ECG Tab Sheet Lead Analysis The Lead Analysis control signals the ApexPro transmitter to process the ECG in Single Lead or Multi-Lead mode. Use the mouse to click on your selection. Multi-lead analysis is the default setting for adults.
ECG Monitoring: ECG Tab Sheet Single Lead ECG Telemetry Data NOTE When acquiring Single Lead ECG data using a 5-leadwire or 6leadwire cable, it is NOT necessary to connect the V leads or the right leg lead to the transmitter or to the patient. The following constraints apply when using Single Lead ECG telemetry data. Function change the displayed lead Single Lead Constraints The factory default display lead is lead II. Contact your local service representative to change the default displayed lead.
ECG Monitoring: ECG Tab Sheet Arrhythmia NOTE Full arrhythmia processing is suspended when the level 1 “ARTIFACT” message is displayed. Lethal arrhythmia is still active but its accuracy may be hindered by the artifact. WARNINGS SUSPENDED ANALYSIS—Certain conditions suspend arrhythmia analysis. When suspended, arrhythmia conditions are not detected and alarms associated with arrhythmias do not occur.
ECG Monitoring: ECG Tab Sheet No Arrhythmia Detection with Patient Monitors at 7015 Software Level If an ApexPro telemetry system patient is admitted to a patient monitor at the 7015 software level (ECG source is telemetry, not the monitor), the following scenario may occur when monitoring in Combo or Rover/Combo monitoring modes: Since the 7015 software level does not support arrhythmia processing, arrhythmia detection for the telemetry patient is reduced from full arrhythmia detection to no arrhythmia
ECG Monitoring: ECG Tab Sheet Full Arrhythmia Conditions Below is an alphabetical list of the arrhythmia messages that are displayed when full arrhythmia is selected and the condition occurs. Definitions of each condition are included. The CIC Pro’s response to each condition is determined by the alarm level to which the arrhythmia has been assigned.
ECG Monitoring: ECG Tab Sheet PAUSE Occurs when a 3-second interval without a QRS complex is detected. PVC Isolated premature ventricular complexes occur when a premature ventricular beat is detected and has non-ventricular beats before and after. R ON T Occurs when a ventricular complex is detected within the repolarization period of a non-ventricular beat. TACHY Tachycardia is four R-to-R intervals at a heart rate greater than the set HIGH heart rate limit.
ECG Monitoring: ECG Tab Sheet V TACH Adult—Ventricular tachycardia occurs when a run of six or more ventricular beats is detected with an average heart rate greater than or equal to 100 beats per minute. 0-2 years—Occurs when a run of six or more ventricular beats is detected with an average heart rate greater than or equal to 160 beats per minute. 3-10 years—Occurs when a run of six or more ventricular beats is detected with an average heart rate greater than or equal to 140 beats per minute.
ECG Monitoring: ECG Tab Sheet Lethal Arrhythmia Conditions When Lethal arrhythmia is selected, the following conditions (as defined for Full arrhythmia) are detected: ASYSTOLE VFIB/VTAC V TACH (defaults to the Crisis level, but can be moved to a different level) BRADY (if the patient age range selected is 0-2 years or 3-10 years) PVC Limit When on, the PVC Limit control displays a PVC counter in the ECG parameter window. When off, the PVC counter is not displayed.
ECG Monitoring: ECG Tab Sheet AFIB Identification Atrial fibrillation (AFIB) is characterized by random, chaotic, lowamplitude deflections of the supraventricular component of the ECG waveform, resulting in irregular timing of QRS complexes and an absence of uniform P waves preceding the QRS complex. The AFIB algorithm feature identifies atrial fibrillation arrhythmias for the ApexPro transmitter.
ECG Monitoring: ST Analysis ST Analysis The patient’s most dominant, normal beat is used for ST measurement. This beat is identified by the arrhythmia analysis program. Turn ST on to display the numerics calculated for ST at the clinical information center. GE Medical Systems Information Technologies identifies the ST segment of the QRS complex as beginning at the J point and ending 60 milliseconds following the J point.
ECG Monitoring: ST Analysis ST Deviation Alarm When any individual ST value is beyond the limit, an ST deviation alarm occurs. It is considered a parameter alarm, and the default alarm level is warning. This can be modified in the parameter alarm level setup. 11-32 When the ST program is turned on, or a relearn is done with ST on, the ST deviation values are set for all leads of ST. The current ST value is determined in all eight leads.
ECG Monitoring: Arrhythmia Troubleshooting Arrhythmia Troubleshooting Problem: Inaccurate heart rate and/or false asystole Solution: Check ECG signal from patient: 1. Check/adjust lead placement. 2. Check/perform skin preparation. 3. Check/replace electrodes. Check amplitude of ECG waveform: 1. Click on the patient’s ECG tab. 2. Click on all ECG leads in the Display section and check for 0.5 mV amplitude at normal (1X) size. (At least 0.5 mV amplitude is required for QRS detection.
ECG Monitoring: Arrhythmia Troubleshooting Problem: False ventricular calls Solution: Check ECG signal from patient: (V leads may exhibit polarity changes which may occasionally cause an inaccurate call.) 1. Check/adjust lead placement. 2. Check/perform skin preparation. 3. Check/replace electrodes. (If V lead is a problem, move the V lead to another V position.) 4. Relearn ECG: a. Click on the patient’s ECG tab. b. Click on the Relearn button. IF PROBLEM CONTINUES: 1. Remove the V lead(s). 2.
ECG Monitoring: Pacemaker Troubleshooting Pacemaker Troubleshooting There are two general things that occur when the pace mode is activated for pacemaker patients: 1. Beats that would otherwise be classified as ventricular are instead classified as V-paced if a ventricular pacemaker event is detected. 2. Residual pacemaker energy that might otherwise appear in the ECG is removed, and a “pacemaker enhancement spike” (shown in an offset color from the ECG waveform) is artificially placed in the ECG.
ECG Monitoring: Pacemaker Troubleshooting Problem: Inaccurate pacemaker detection Solution: Use pacemaker processing: 1. Click on the patient’s ECG tab. 2. In the Detect Pace section, select either Pace 1 or Pace 2. Notes: In general, BE AWARE that a pacemaker pulse could be falsely counted as a QRS during asystole. Pace 1 mode analyzes the presence of a pacer spike, assesses the waveform for residual pacemaker energy, and determines the presence of an R wave following the pacer spike.
ECG Monitoring: ST Troubleshooting ST Troubleshooting Problem: ST numerics changed to Solution: An ST value changes to Xs when the patient’s dominant Xs morphology has not been detected 16 times in the last 30 seconds. The program waits one minute and then automatically relearns. ST numerics will be displayed after the relearn. IF PROBLEM CONTINUES: 1. Check for morphology change. 2. Check for noise on ECG. 3. Relearn: a. Click on the patient’s ECG tab. b. Click on the Relearn button.
ECG Monitoring: ST Troubleshooting For your notes 11-38 ApexPro Telemetry System 2001989-134 Revision D
12 Revision D SpO2 Monitoring ApexPro Telemetry System 2001989-134 12-1
For your notes 12-2 ApexPro Telemetry System 2001989-134 Revision D
SpO2 Monitoring: Introduction Introduction NOTE SpO2 and SPO2 are used interchangeably throughout this manual to refer to pulse oximetry. The ApexPro transmitter supports the Apex Oximeter and the Xpod Oximeter. Unless specified, “oximeter” refers to both units.
SpO2 Monitoring: Introduction SpO2 Probe Safety Be sure to read all literature accompanying probes for specific safety information. Be aware of the following safety precautions when using SpO2 probes. WARNINGS DATA VALIDITY—Do not expose probe detector to strong ambient light while monitoring a patient. A poor signal may result. DATA VALIDITY—Do not allow tape to block the probe light detector. PATIENT SAFETY—Prolonged monitoring may require changing the probe site periodically.
SpO2 Monitoring: Infants and Pulse Oximetry Infants and Pulse Oximetry WARNING 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 equipment is used on infants. These same conditions in adults do not impact the SPO2 values to the same extent. When using pulse oximetry on infants, ALWAYS observe the following precautions.
SpO2 Monitoring: Signal and Data Validity Signal and Data Validity It is extremely important to determine that the probe is attached to the patient correctly and the data is verifiable. To make this determination, the signal strength indicators on the Apex Oximeter and the CIC Pro are of assistance. Signal Strength Indicator A signal strength (perfusion) indicator is displayed on the Apex Oximeter display and at the CIC Pro in the appropriate patient window.
SpO2 Monitoring: Signal and Data Validity Error Messages If the probe is not correctly attached to the patient and data is not verifiable, one of the following error messages may appear in the patient’s bed window at the CIC Pro: SPO2 PROBE OFF SPO2 PROBE If either of the above messages appears, check the position of the probe or replace the probe. If the problem persists, call GE Medical Systems Information Technologies Service or contact your sales/service representative.
SpO2 Monitoring: SPO2 Monitoring SPO2 Monitoring SPO2 in the Multiple Patient Viewer In the multiple patient viewer, the bed window for a telemetry patient being monitored for SpO2 displays the current SPO2 value; one, two, or three asterisks indicating signal strength; and, if turned on, the derived pulse rate for the patient. Below is an example of a telemetry patient’s bed window in the multiple patient viewer.
SpO2 Monitoring: SPO2 Monitoring SPO2 in the Single Patient Viewer In the single patient viewer, SpO2 data appears in the View Patient tab sheet in the same format and location as it does in the multiple patient viewer. To access the View Patient tab sheet, follow the steps below. 1. Click in the desired patient’s bed window in the multiple patient viewer. The display rearranges to accommodate the single patient viewer for that patient. 2.
SpO2 Monitoring: SPO2 Tab Sheet SPO2 Tab Sheet The SpO2/Respiration tab sheet allows you to view and modify settings specific to the viewed patient’s SpO2 display. Settings may be viewed for any patient. However, you can only modify settings for patients who are admitted to a bed in your unit. NOTE The SPO2 tab is labeled SpO2/Respiration because respiration monitoring settings are available on this tab sheet for bedside monitored patients only.
SpO2 Monitoring: SPO2 Tab Sheet Rate A pulse rate is derived from the SPO2 signal and is displayed in the parameter window. You can turn this displayed rate off and on. Simply click On to turn rate on, or Off to turn rate off. Size Because no waveform is displayed when SpO2 is monitored via telemetry, the Size option does not function for telemetry patients. Size and its selections appear dimmed when monitoring telemetry patients.
SpO2 Monitoring: Troubleshooting Troubleshooting SpO2 Messages Below is a list of system status alarm messages that may be displayed in the patient’s bed window during monitoring. SpO2 messages appear in abbreviated form in graph headers. If you are unable to resume SpO2 monitoring, contact your sales/service representative. NOTE The Xpod Oximeter can display the same SpO2 system status messages as the Apex Oximeter, except for the CHANGE BATTERY message.
SpO2 Monitoring: Troubleshooting NO DATA The oximeter is still connected, but no valid data is being transmitted to the receiver. Check that the patient is within antenna range. If the problem persists, contact GE Medical Systems Information Technologies Service. SPO2 PROBE OFF The probe is off the patient. Check the probe. The saturation value is X The oximeter is still connected, but no valid data is being received at the receiver.
SpO2 Monitoring: Troubleshooting For your notes 12-14 ApexPro Telemetry System 2001989-134 Revision D
13 Revision D NBP Monitoring ApexPro Telemetry System 2001989-134 13-1
For your notes 13-2 ApexPro Telemetry System 2001989-134 Revision D
NBP Monitoring: Introduction Introduction NOTE The Accutracker DX noninvasive blood pressure monitor is available in the United States only. This model, available from GE Medical Systems Information Technologies, has been modified by SunTech Medical Instruments to operate with the ApexPro telemetry system. NBP monitoring via telemetry is done with an Accutracker DX noninvasive blood pressure monitor connected to the ApexPro transmitter.
NBP Monitoring: Safety Considerations Safety Considerations Keep the following warnings and cautions in mind when using the Accutracker DX noninvasive blood pressure monitor. WARNINGS The Accutracker DX noninvasive blood pressure monitor is designed for use with adult patients only. Do not use on neonates or on patients known to be susceptible to bruising. Do NOT attach the blood pressure cuff to a limb being used for IV infusions as the cuff inflation can block the infusion, causing harm to the patient.
NBP Monitoring: Programming the Blood Pressure Monitor Programming the Blood Pressure Monitor The blood pressure measurement interval, the maximum and minimum inflation pressures, dynamic or fixed inflate, and the deflate rate can all be adjusted on the Accutracker DX blood pressure monitor. Follow the instructions below to set these options.
NBP Monitoring: Programming the Blood Pressure Monitor The patient’s blood pressure is displayed for one minute on the blood pressure monitor and for two hours on the CIC Pro. The blood pressure reading is updated each time a measurement is successfully completed. Measurements are taken at the selected interval until the blood pressure monitor is turned off, or until the monitor determines that the batteries are too weak for additional measurements.
NBP Monitoring: Programming the Blood Pressure Monitor 5. When the minimum pressure has been set, press the NEXT button to select DYNAMIC INFLATE or FIXED INFLATE. Press the YES + button to turn dynamic inflate on, or press the NO – button for fixed inflate. When dynamic inflate is turned on, the blood pressure cuff inflation pressure automatically ranges 30 mmHg above the most recent systolic reading. Fixed inflate always inflates the blood pressure cuff to the set maximum inflation pressure.
NBP Monitoring: Programming the Blood Pressure Monitor Setting Limits It is possible to set the maximum and minimum values, as well as the change (delta) limit, at which the blood pressure monitor will reject a systolic, diastolic, or pulse pressure reading and attempt a new measurement. Contact technical support (refer to “How to Reach Us” at the beginning of this manual) for more information about setting these limits.
NBP Monitoring: Patient Preparation Patient Preparation Blood pressure cuff selection and application are important. Inappropriate selection or improper application of the cuff will result in erroneous measurements. Most people use their non-dominant arm for acquiring ambulatory noninvasive blood pressure readings. Follow these steps to prepare the patient for NBP monitoring: 1. Place the K-sound microphone in the microphone pad (or blood pressure cuff).
NBP Monitoring: Patient Preparation When attached, the blood pressure cuff and hoses should be positioned like those in the following illustration.
NBP Monitoring: Patient Preparation Microphone Placement A microphone is used to “hear” the Korotkoff sounds (K-sounds) that the blood pressure monitor uses to determine the systolic and diastolic pressure readings. The microphone can be placed in a microphone pad and adhered to the patient’s arm under the blood pressure cuff, or alternatively, it can be placed directly into the microphone pocket inside the blood pressure cuff. Placement in the Microphone Pad Using a microphone pad is recommended.
NBP Monitoring: Patient Preparation Placement in the Blood Pressure Cuff As already stated, using the microphone pad is recommended, especially in the case of ambulatory patients or patients with weak K-sounds. However, as an alternative, the microphone can also be placed directly in the blood pressure cuff. Follow the directions below. NOTE Blood pressure readings taken with the microphone in the blood pressure cuff may not be as accurate as readings obtained when using the microphone pad. 1.
NBP Monitoring: NBP Monitoring NBP Monitoring NBP in the Multiple Patient Viewer In the multiple patient viewer, the bed window for a telemetry patient being monitored for NBP displays an NBP label, along with the systolic and diastolic values from the most recent measurement. NOTE The mean blood pressure value is not measured or calculated when monitoring blood pressure via telemetry.
NBP Monitoring: NBP Monitoring NBP Limits You can adjust alarm limits for NBP in the Alarm Control tab sheet for each patient. For more information on how to set the alarm limits, refer to Chapter 8, Alarm Control, in this manual. NOTE The mean pressure limits can be changed, but there will be no effect on alarms for telemetry patients because the mean pressure is not measured or calculated for telemetry patients.
NBP Monitoring: Pressures Tab Sheet Pressures Tab Sheet The Pressures tab sheet allows you to view and modify settings specific to the viewed telemetry patient’s NBP display. Settings may be viewed for any patient. However, you can only modify settings for patients who are admitted to a bed in your unit. NOTE The NBP tab is labeled Pressures because other invasive pressures settings are available on this tab sheet for bedside monitored patients only.
NBP Monitoring: Pressures Tab Sheet Auto The interval for automatic NBP measurements is controlled at the blood pressure monitor, not at the CIC Pro. Because the control is in the blood pressure monitor, the Auto option is inactive for telemetry patients and appears dimmed. Cuff Size The Cuff Size option is inactive for telemetry patients and appears dimmed. Clear Message If you want to remove the displayed NBP values, use the mouse to click on the Clear Message button. The values are replaced with Xs.
NBP Monitoring: Troubleshooting Troubleshooting Problem: Erroneous NBP measurement Solution: 1. Check for proper cuff size: Too small a cuff can give an erroneously high value. Too large a cuff can give an erroneously low value. 2. Check for residual air left in the cuff from a previous measurement. This could indicate a hardware problem that may require service. 3. Make sure the cuff is not too tight or too loose. 4.
NBP Monitoring: Troubleshooting LEAK The NBP cuff is loose or there is an air leak in the cuff or tubing. Check that the cuff is on snugly. Check the connection between the cuff and the tubing. Check the connection between the tubing and the blood pressure monitor. Try another measurement. If the problem persists, contact your local sales/service representative. LOW INFLATION PRESS This message appears when K-sounds are detected immediately upon inflation.
A Revision D Message Glossary ApexPro Telemetry System 2001989-134 A-1
For your notes A-2 ApexPro Telemetry System 2001989-134 Revision D
Message Glossary: Message Glossary Message Glossary Alarm Messages The following messages appear in the patient’s bed window at the Clinical Information Center. ALARM PAUSE All alarms for this patient have been turned off for five minutes. This is initiated from the transmitter. Refer to ALL ALARMS OFF. ALL ALARMS OFF All alarms for this patient have been turned off. No graph strips run, arrhythmia events are not stored, and no audible tones sound if an alarm condition should occur.
Message Glossary: Message Glossary NO TELEM The NO TELEM alarm occurs in two situations: NOTE Refer to the Suspended Analysis warning in the Arrhythmia section of Chapter 11, ECG Monitoring. 1. The patient moves out of range. NOTE Patient must be within antenna range to receive a CHANGE BATTERY message. 2. Transmitter batteries are extremely low or dead. A-4 Transmitter is out of range. A repeating, low-pitched foghorn tone sounds after sensing NO TELEM for 30 seconds.
Message Glossary: Message Glossary OFF NETWORK In the Combo mode, telemetry patient data is provided from the bedside monitor to the Clinical Information Center. If the bedside monitor is removed from the network or becomes otherwise unavailable, the OFF NETWORK alarm is generated. The Clinical Information Center will then display patient data directly from the telemetry bed along with this message in that Clinical Information Center bed window.
Message Glossary: Message Glossary Transmitter-Related Messages The following messages appear in the patient’s bed window on the Clinical Information Center display. CHANGE BATTERY This message flashes when the batteries are low. There is approximately 1 hour of use left after this message appears. If the batteries are extremely low or completely dead, a NO TELEM message flashes, and an audible alarm sounds. LEADS FAIL All leads have failed. If set to Warning or Advisory level, a system alarm is heard.
Message Glossary: Message Glossary Patient Status Messages Patient status messages are also displayed in the lower left corner of the Clinical Information Center screen. They are not, however, preceded by the receiver system name or Ethernet address. Revision D “Unit/Bed” IS UNMONITORED A telemetry patient is admitted but is not displayed (and therefore is unmonitored) on any Clinical Information Center.
Message Glossary: Message Glossary For your notes A-8 ApexPro Telemetry System 2001989-134 Revision D
B Revision D Supplies ApexPro Telemetry System 2001989-134 B-1
For your notes B-2 ApexPro Telemetry System 2001989-134 Revision D
Supplies: Contact Information Contact Information To ensure patient safety, use only supplies manufactured or recommended by GE Medical Systems Information Technologies. Your local sales representative can provide current supplies lists, or you can contact GE Medical Systems Information Technologies Supplies. (Refer to “How to Reach Us” at the front of this manual.
Supplies: Contact Information For your notes B-4 ApexPro Telemetry System 2001989-134 Revision D
C Revision D Abbreviations and Symbols ApexPro Telemetry System 2001989-134 C-1
For your notes C-2 ApexPro Telemetry System 2001989-134 Revision D
Abbreviations and Symbols: Abbreviations and Symbols Abbreviations and Symbols Abbreviations and symbols which you may encounter while reading this manual or using the Clinical Information Center are listed below with their meanings. Abbreviations A ABG AHA APIC arterial blood gas American Heart Association Association for Professionals in Infection Control and Epidemiology, Inc.
Abbreviations and Symbols: Abbreviations and Symbols CE CH CIC CISPR cm COMM CPP CRT CSA CV CVP Conformité Européene channelized clinical information center International Special Committee on Radio Interference centimeter communication cerebral perfusion pressure cathode ray tube Canadian Standards Association central venous central venous pressure D DDW DIA direct digital writer diastolic E ECG EEC EN EMC electrocardiograph European Economic Community European Norm (European standard) electromagnetic
Abbreviations and Symbols: Abbreviations and Symbols H HRS Hz hours hertz I IABP ICU IEC in ISO intra-aortic balloon pump intensive care unit International Electrotechnical Commission inch International Organization for Standardization L LA left arm M MAX MB MCL Mhz mmHg mm/S MSDS maximum megabyte modified chest lead megahertz millimeters of mercury millimeters per second Material Data Safety Specifications N NBP noninvasive blood pressure O OEM OR Revision D original equipment manufacturer ope
Abbreviations and Symbols: Abbreviations and Symbols P PA PC PDS PPM Pulm Calc PVC pulmonary artery personal computer Patient Data Server parts per million pulmonary calculations premature ventricular contraction Q QRS interval of ventricular depolarization R RA RAM RESP right arm random access memory respiration S SP SpO2 ST STD VGA SYS C-6 special arterial oxygen saturation interval of ventricular repolarization standard graphics array systolic ApexPro Telemetry System 2001989-134 Revision D
Abbreviations and Symbols: Abbreviations and Symbols T T1 T2 Temp, TMP TTX temperature site 1 temperature site 2 temperature transmitter U UA UAC UL UV umbilical artery umbilical artery catheter Underwriters’ Laboratories umbilical venous V V-Fib, V-FIB VAC VENT ventricular fibrillation voltage alternating current ventilator " ° ± – % inches degrees plus or minus minus percent Symbols Revision D ApexPro Telemetry System 2001989-134 C-7
Abbreviations and Symbols: Abbreviations and Symbols For your notes C-8 ApexPro Telemetry System 2001989-134 Revision D
D ApexPro FH Transceiver (Not for sale outside of the United States) Revision D ApexPro Telemetry System 2001989-134 D-1
For your notes D-2 ApexPro Telemetry System 2001989-134 Revision D
ApexPro FH Transceiver: The Basics The Basics About the ApexPro FH Transceiver The Wireless Medical Telemetry Services (WMTS) ambulatory transceiver provides the link between the patient and the CIC Pro (or other display) through the 608 - 614 MHz Medical Telemetry frequency band. The ambulatory transceiver communicates data to the CIC Pro through the Access Point transceiver. In addition, the ambulatory transceiver is capable of receiving control commands for self-use or connection transfer.
ApexPro FH Transceiver: The Basics Programming Transceivers Before a transceiver can be used with the ApexPro FH Telemetry System, it must first be programmed with a Network Key and TTX ID to match the corresponding CIC Pro. Each ApexPro FH transceiver TTX ID number must be entered at the corresponding CIC Pro. To enter the TTX ID on the CIC Pro, refer to the CIC Pro Clinical Information Center Operator’s Manual.
ApexPro FH Transceiver: Safety Safety Warnings, Cautions, and Notes Before operating the ApexPro FH transceiver, read and follow all warnings and cautions presented in this section. Warnings WARNING Do not use the output of the ApexPro FH transceiver as a synchronization source for cardiac defibrillation. Delays in presentation of the R-Wave exist. Do not monitor pacer patients with a 3-wire leadset when reliable pacer detection is required.
ApexPro FH Transceiver: Safety WARNINGS Our transceivers have been validated to comply with the requirements of IEC 60601-1-2. To prevent electromagnetic interference, please ensure that any other equipment used within the vicinity of the patient meets the applicable requirements. As with all medical telemetry systems, a single point failure in the infrastructure could result in loss of monitoring. Therefore, it is vital that the patient displays be monitored by qualified personnel at all times.
ApexPro FH Transceiver: Safety Notes The ApexPro FH transceiver has been tested and found to comply with the limits for a digital device, pursuant to Part 95H of the FCC Rules. These limits are designed to provide reasonable protection against harmful interference. This equipment generates, uses, and radiates radio frequency energy, and, if not installed and used in accordance with the instructions contained in this manual, may cause harmful interference to other devices.
ApexPro FH Transceiver: Equipment Overview Equipment Overview ApexPro FH Transceiver Operating Instructions The ApexPro FH transceiver is a battery-operated ambulatory transceiver worn by the patient and used with a 3, 5, or 6-wire leadset that is connected to electrodes on the patient. Push Button Function and Use See “ApexPro FH transceiver Controls and LED Indicators” on page D-11 for an image of the ApexPro FH transceiver controls and LED indicators.
ApexPro FH Transceiver: Equipment Overview Attendant Present/Procedure Alarm Silence (PAS) Unlock Button The Attendant Present/PAS Unlock Buttons consists of two buttons that are located on either side of the transceiver. (See “ApexPro FH transceiver Controls and LED Indicators” on page D-11). The Attendant Present push buttons have three functions. Each function is initiated based on how long the buttons are pressed.
ApexPro FH Transceiver: Equipment Overview Procedure Alarm Silence (PAS) Button Depressing the PAS button, while the PAS Status Indicator LED is flashing, informs the clinicians at the CIC Pro location that the attending nurse will be performing a procedure to the patient that may cause inadvertent false alarms at the CIC Pro (i.e. changing lead wires, electrodes, etc.) Once the PAS button is pressed, the following events occur at the CIC Pro. 1.
ApexPro FH Transceiver: Equipment Overview *External Serial Device (I/O) Cable ECG Leadset and connector cover ECG Leadset Connector *External Serial Device (I/O) Connector Attendant Present / Procedure Alarm Silence Unlock buttons Battery Low, RF, and I/O Connector Link Status Indicators Remote Record button Event Marker button Procedure Alarm Silence button Electrode Status Indicators Procedure Alarm Silence Status Indicator Battery Compartment ApexPro FH transceiver Controls and LED Indicators
ApexPro FH Transceiver: Equipment Overview LED Indicators Function Upon Power-On, all LED indicators are illuminated for a brief period. After the specified time period, only those LEDs displaying positive (or negative) transceiver functions, as described in each section below, remain illuminated. Procedure Alarm Silence Status Indicator The Procedure Alarm Silence Status Indicator is illuminated when the PAS function is active.
ApexPro FH Transceiver: Equipment Overview RF link (RF) The RF link indicator is illuminated while there is RF communication between the ApexPro FH transceiver and the CIC Pro. The LED flashes if there is communication between the ApexPro FH transceiver and the Access point, but not the CIC Pro. Electrode Status Indicators (RA, LA, RL, LL, Va, Vb) Each ECG electrode wire is named, color coded (Table 2), and represented by an LED indicator.
ApexPro FH Transceiver: Connections Connections Connecting the ApexPro FH Transceiver to Accessory Devices WARNING Our transceivers have been validated to comply with the requirements of IEC 60601-1-2. To prevent electromagnetic interference, please ensure that any other equipment used within the vicinity of the patient meets the applicable requirements The ApexPro FH transceiver can be connected to external, accessory devices, and will transmit data from those devices to the Central Station.
ApexPro FH Transceiver: Connections Apex Oximeter To attach the ApexPro FH transceiver to the Apex Oximeter: 1. Plug the ApexPro FH Accessory Cable host connector into the ApexPro FH transceiver I/O port, and the other end into the Apex Oximeter I/O port. 2. Plug the Nonin SPO2 Sensor cable connector into the Apex Oximeter accessory port.
ApexPro FH Transceiver: Connections Nonin XPod Assembly To attach the ApexPro FH transceiver to the Nonin XPod Assembly: 1. Plug the Nonin XPod Accessory Cable host connector into the ApexPro FH transceiver I/O port. 2. Plug the Nonin SPO2 Sensor cable connector into the Nonin XPod assembly accessory port.
ApexPro FH Transceiver: Connections Dinamap Pro To attach the ApexPro FH transceiver to the Dinamap Pro: 1. Plug the ApexPro FH Accessory Cable host connector into the ApexPro FH transceiver I/O port, and the other end into the DinaLink device. 2. Plug the DinaLink cable connector into the Data Interface Device Connector on the back of the Dinamap Pro device, and the other end into the DinaLink device.
ApexPro FH Transceiver: Maintenance Maintenance General Cleaning/Disinfecting This section provides cleaning and maintenance instructions for ApexPro FH transceivers. Read and follow all precautions when cleaning transceivers. WARNING No claims are made concerning the sterility of the ApexPro FH transceiver. CAUTION Do not sterilize any part of the transceivers.
ApexPro FH Transceiver: Maintenance Cleaning the Chassis CAUTION Prior to cleaning the battery compartment and transceiver chassis, remove the battery from the unit. The following applies to cleaning the ApexPro FH transceiver.
ApexPro FH Transceiver: Maintenance Cleaning the Battery Compartment CAUTIONS The battery compartment is not waterproof. Make certain fluids do not enter the electronics through the air holes in the batter compartment floor. Cleaning the battery compartment in a manner other than that specified below may cause the unit to malfunction and void the warranty Under normal operation, the battery compartment should not require cleaning.
ApexPro FH Transceiver: Maintenance Cleaning the ECG Leadsets The transceiver ECG Leadsets are manufactured by Affinity Medical. Contact your technical support representative for additional leadsets. WARNINGS 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. Do not use leadsets which exhibit signs of wear or damage such as cracking or degradation of the connectors or cable insulation.
ApexPro FH Transceiver: Maintenance General Cleaning 1. Wipe the leadset with a solution of soap and water. 2. Use a cloth moistened with distilled water to rinse away the cleaning solution. 3. Dry thoroughly with a lint-free cloth. Disinfecting Refer to the disinfecting instructions provided by the manufacturer. Cleaning the Accessory Cables General Cleaning 1. Wipe the accessory cable with a solution of soap and water. 2. Use a cloth moistened with distilled water to rinse away the cleaning solution.
ApexPro FH Transceiver: Maintenance Storage and Usage Transceiver Storage Store the transceiver with the leadset attached and hanging freely. If that is not possible, then wrap the leadset loosely around the transceiver. Wrapping the leadset tightly around the transceiver can damage the wires. NOTE The ApexPro FH transceiver contains no user-serviceable parts. Thus, maintenance service is not needed.
ApexPro FH Transceiver: Maintenance Installing and Removing a Battery NOTE Battery service life can be substantially improved by using nine-volt lithium batteries. CAUTION Do not attempt to insert the 9V battery into the battery compartment in the opposite direction of that which is specified. Incorrect battery insertion may result in additional stress on the door hinge and battery contacts. This may result in hinge breakage, poor battery contact, and a decrease in transceiver performance.
ApexPro FH Transceiver: Maintenance WARNINGS When installing or replacing the battery, visually inspect the battery compartment and ensure that there are no foreign objects inside. A conductive object making contact with the battery contacts could cause the battery and battery compartment to overheat, resulting in burns to the patient and to the attendant removing the battery.
ApexPro FH Transceiver: Compliance Compliance Compliance Statement Table 3.
ApexPro FH Transceiver: Compliance UL Classification ApexPro FH WITH RESPECT TO ELECTRIC SHOCK, FIRE, AND MECHANICAL HAZARDS ONLY IN ACCORDANCE WITH UL2601-1/CAN/CSA C22.2 NO. 601.1 4P41 The ApexPro FH transceiver is classified in accordance with UL 2601-1, Type CF with Defibrillator Proof (5000V per AAMI EC-13-1992), and IPX7 (according to IEC 60529-1989). The ApexPro FH transceiver has been designed to withstand the effects of EMI and meets the EMC requirements of IEC 60601-1-2 (April 1993).
ApexPro FH Transceiver: Compliance The ApexPro FH transceiver is intended for use in the electromagnetic environment specified in the table below. The customer or user of the device should ensure that is used in such an environment Table 5. Electromagnetic Immunity for all equipment and systems.
ApexPro FH Transceiver: Compliance The ApexPro FH transceiver is intended for use in the electromagnetic environment specified in the table below. The customer or user of the device should ensure that is used in such an environment. Table 6. Electromagnetic Immunity for all non-life-supporting equipment and systems Immunity Test IEC 60601 Test Level Compliance Level 3 Vrms 0.
ApexPro FH Transceiver: Compliance The ApexPro FH transceiver is intended for use in the electromagnetic environment in which RF disturbances are controlled. The customer or user of the device can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the device, as recommended below, according to the maximum power of the communications equipment. Table 7.
ApexPro FH Transceiver: Compliance FCC Compliance in the 608-614 MHz bands 1. The marketing and operation of intentional radiators, under the provisions of the FCC rules, is restricted to biomedical telemetry devices that are employed on health care facilities premises. a.
ApexPro FH Transceiver: Compliance Receiver Sensitivity (dBm) Emission Designator GFSK 0.7 -87 300KFXD 608 614 Part 95H ETAP Z10020-005 BQI02DR-10100 16 GFSK 0.7 -87 300KFXD 608 614 Part 95H BQI01DT-4500 3.5 GFSK 0.7 -87 230KFXD 608 614 Part 95H ApexPro FH APRO-FH-USENG-AHA-4 Note Receiver Predetection Bandwidth (MHz) 16 Upper Freq Modulation BQI01DR-10000 Lower Freq. Max EPR (dBm) Z10020-001 Part Number DR-10000 Model Number FCC ID 4.
Index
Index For your notes Index-2 ApexPro Telemetry System 2001989-134 Revision D
Index A Abbreviations and symbols C-1 Accutracker DX noninvasive blood pressure monitor 314, 13-3 Battery installation 4-10 Buttons and switches 3-15 Connections 4-12 Setup 13-5 Admit HL7 admit data 7-6 Admitting 7-5–7-7 Alarm condition indicators 7-17 Alarm control 8-5–8-13 Alarm defaults 8-16 Alarm help 8-12 Alarm history Deleting events 10-7 Print directory 10-6 Scanning events 10-6 Viewing events 10-6 Alarm off reason 8-10 Alarm pause breakthrough 8-14 Alarm volume 6-16 Apex Oximeter 4-7 Apex Oximeter c
Index N NBP monitoring In the multiple patient viewer 13-13 In the single patient viewer 13-13 Patient preparation 13-9 Microphone placement 13-11 Pacemaker patients 11-8 Pediatric patients 11-6 Equipment inspection 5-4 F False asystole 11-33 False ventricular calls 11-34 FCC compliance CE-7, 2-15 RF exposure 2-14 Full arrhythmia 11-25 G Graph all patients 9-6 Graph button IMPACT.
Index Telemetry unit defaults Changing 6-8 Viewing 6-7 Transmitter graph 9-14 Troubleshooting NBP 13-17 Pacemaker 11-35 SpO2 messages 12-12 ST 11-37 U Underwriters Laboratories, Inc 2-13 Unit defaults worksheet 1-10 User mode 6-3 V Ventricular arrhythmia 11-24 View on demand 3-8, 9-4 Viewing a patient 7-12 Viewing another patient 7-14 In the multiple patient viewer 7-15 In the single patient viewer 7-14 Vital signs Printing 10-15 W Warnings 2-4 Revision D ApexPro Telemetry System 2001989-134 Index-5
Index For your notes Index-6 ApexPro Telemetry System 2001989-134 Revision D
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