TRANSMITTER ZM-940PA 0614-009881
Model: ZM-940PA Manual code no.: 0614-009881 Reader Comment Card We welcome your comments about this manual. Your comments and suggestions help us improve our manuals. Please circle the number for each of the following statements corresponding to your evaluation and add comments in the space provided. Fax or send your completed comment card to: Fax: +81 (3) 5996-8100 International Div., Sales Promotion Section, Nihon Kohden Corp.
Contents GENERAL HANDLING PRECAUTIONS .................................................................... i WARRANTY POLICY ............................................................................................... iii Equipment Authorization Requirement ................................................................... iii EMC RELATED CAUTION ....................................................................................... iv Conventions Used in this Manual and Instrument .....................
SELECTABLE INTERVALS .............................................................................. INITIAL INTERVAL ............................................................................................ INITIAL CUFF PRESS ...................................................................................... NIBP MODE AFTER STAT ................................................................................ START/FINISH SOUND ...........................................................................
Monitoring SpO2 during NIBP Measurement ................................................... ECG and Respiration Monitoring .......................................................................... Electrode Detachment ..................................................................................... SpO2 Monitoring ..................................................................................................... SpO2 and PR Display Order ...............................................................
Respiration Measurement ............................................................................... SpO2 Measurement .......................................................................................... NIBP Measurement .......................................................................................... Pulse Rate ........................................................................................................ Transmitter ................................................................
GENERAL HANDLING PRECAUTIONS This device is intended for use only by qualified medical personnel. Use only Nihon Kohden approved products with this device. Use of non-approved products or in a non-approved manner may affect the performance specifications of the device. This includes, but is not limited to, batteries, recording paper, pens, extension cables, electrode leads, input boxes and AC power. Please read these precautions thoroughly before attempting to operate the instrument. 1.
(3) Clean the instrument together with all accessories for their next use. 6. The instrument must receive expert, professional attention for maintenance and repairs. When the instrument is not functioning properly, it should be clearly marked to avoid operation while it is out of order. 7. The instrument must not be altered or modified in any way. 8. Maintenance and Inspection: (1) The instrument and parts must undergo regular maintenance inspection at least every 6 months.
WARRANTY POLICY Nihon Kohden Corporation (NKC) shall warrant its products against all defects in materials and workmanship for one year from the date of delivery. However, consumable materials such as recording paper, ink, stylus and battery are excluded from the warranty.
EMC RELATED CAUTION This equipment and/or system complies with IEC 60601-2 International Standard for electromagnetic compatibility for medical electrical equipment and/or system. However, an electromagnetic environment that exceeds the limits or levels stipulated in IEC 60601-1-2, can cause harmful interference to the equipment and/or system or cause the equipment and/or system to fail to perform its intended function or degrade its intended performance.
6. Use with other equipment When the equipment and/or system is adjacent to or stacked with other equipment, the equipment and/or system may affect the other equipment. Before use, check that the equipment and/or system operates normally with the other equipment. 7. Use of unspecified accessory, transducer and/or cable When an unspecified accessory, transducer and/or cable is connected to this equipment and/or system, it may cause increased electromagnetic emission or decreased electromagnetic immunity.
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Conventions Used in this Manual and Instrument Warnings, Cautions and Notes Warnings, cautions and notes are used in this manual to alert or signal the reader to specific information. WARNING A warning alerts the user to the possible injury or death associated with the use or misuse of the instrument.
Explanations of the Symbols in this Manual and Instrument The following symbols found in this manual/instrument bear the respective descriptions as given.
Introduction The ZM-940PA transmitter transmits ECG, respiration, SpO2, NIBP and pulse waveform from a patient to a Nihon Kohden monitor for continuous monitoring. The transmitter can change channels when connected to the QI-901PK channel writer. The front LCD displays SpO2%, NIBP, pulse rate, pulse waveform amplitude, electrode condition mark, battery condition and NIBP measuring mode and interval. Read the operator’s manual for the receiving monitor together with this manual before operation.
Panel Description Front Panel LCD: Displays measuring data, settings and other information. NIBP START/STOP key: Starts/stops NIBP measurement in selected mode. NIBP INTERVAL key: Selects NIBP measurement mode. Refer to the WARNING below. (This symbol is attached to the rear of the battery case cover.) Battery case: Contains three 1.5 V AA batteries. WARNING Close the battery case cover during operation.
Rear Panel Lock plate: Fastens the transmitter to an NIBP cuff. Refer to the WARNING below. WARNING This transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop using it and contact your Nihon Kohden distributor. If a wet transmitter is used, the patient or anyone in contact with the transmitter may receive an electric shock or patient leakage current over the allowed amount may flow.
Top Panel Refer to the WARNING on the next page. Refer to the WARNING on the next page. Refer to the symbol page. NIBP socket: Connects the cuff hose. Refer to the symbol page. ECG/impedance RESP socket: Connects the electrode lead for measuring ECG and/or respiration by the impedance method. Bottom Panel Channel number label: Indicates the channel number of the transmitter. Attach the channel number label to the panel of the monitor. Refer to the symbol page. SpO2 socket: Connects the SpO2 probe.
WARNING • Before performing defibrillation, check that the electrode leads and SpO2 probe attached to the patient are properly connected to the transmitter. Touching the metal parts of disconnected leads and probes causes serious electrical shock or injury by discharged energy. • When performing defibrillation, all persons must keep clear of the bed and must not touch the patient, any equipment connected to the patient or the metal parts of leads and probes connected to the patient.
LCD 3 1 2 6 LOCK KEYS 10 11 9 No. 1 2 3 4 5 Name NIBP SYS NIBP DIA NIBP MEAN 4 Check electrode mark 5 Battery replacement mark 6 Message display area 8 7 Description Displays NIBP systolic value. Displays NIBP diastolic value. Displays NIBP mean value. “CUFF” is displayed with the cuff inflation pressure during measurement. Appears when an electrode or electrode lead becomes detached during ECG measurement. Appears when the batteries are weak.
No. Name 7 NIBP measurement mode 8 NIBP interval bar graph 9 Pulse level bar graph 10 %SpO2 11 PR Operator's Manual ZM-940PA Description Displays NIBP measurement mode. When set to auto mode, the measurement interval is displayed. In auto NIBP measurement, the remaining time from the last measurement to the next measurement is displayed as a bar graph. Displays pulse level in 7 steps. Displays SpO2 data. Displays pulse rate when NIBP or SpO2 is measured.
Notes on Parameter Settings When monitoring NIBP and SpO2, the following setting must be set as indicated in the table to properly transmit the monitoring data to the receiving monitor. Otherwise, SpO2 cannot be monitored properly during NIBP measurement. Some receiving monitors require the software to be upgraded. For details, contact your Nihon Kohden distributor.
Important Safety Information General WARNING • Never use this transmitter in the presence of any flammable anesthetic gas or high concentration oxygen atmosphere. Failure to follow this warning may cause explosion or fire. • Never use this transmitter in a high-pressure oxygen medical care tank. Failure to follow this warning may cause explosion or fire. • Do not take this transmitter into the MRI test room. This transmitter is not designed to be used during MRI tests.
Preparation Installing (Replacing) Batteries WARNING and CAUTION for Battery Handling WARNING • Do not dispose of the battery in fire because it may explode. • Do not use a disassembled or damaged battery. The contents of the battery are harmful and the battery may catch fire. • If the contents of the battery contact the skin or clothes, immediately wash it thoroughly with water. • Never short-circuit the + and – terminals. The battery may overheat and catch fire.
NOTE When using rechargeable NiMH batteries, shallow charging/discharging shortens battery capacity. For details, refer to the battery operator’s manual. Installing (Replacing) Batteries CAUTION Battery replacement must be performed by medical staff. When replacing batteries of the transmitter currently used for a patient, disconnect electrode leads from the transmitter before replacing batteries or do not touch the patient during replacement.
3. Close the cover. NOTE Remove the batteries before disposing of the transmitter. Situations Requiring Battery Replacement Replace the batteries when any of the following occurs. • The transmitter LCD displays the “ ” or “ ”mark. • The transmitter generates a constant alarm (continuous “peep” sound). • The transmitter LCD does not display anything when the power is turned on. • The monitor displays the battery replacement message on the screen.
Turning the Transmitter On/Off Peep Turning On the Power When the batteries are installed correctly, the power is turned on. A one second “peep” sounds and the startup screen appears. (There is no “peep” sound when there is no battery power.) NOTE Replace the batteries when the LCD displays the “ ” or “ ”mark. Turning Off the Power To turn off the power, remove batteries.
Check Items After Power On After turning on the power, check the following. Power On • The transmitter generates about a one second “peep” sound and the startup screen appears. • The transmitter does not generate a continuous “peep” sound. • The transmitter does not give excessive heat. • The transmitter LCD displays a “ ” mark. • The transmitter does not interfere with the operation of other medical instruments in use.
Changing the Transmitter Channel The channel of the transmitter can be changed. The optional QI-901PK Channel Writer is required. WARNING The following action must be taken to properly receive the transmitter signal of the correct patient on the receiving instrument. Otherwise, there may be signal loss or signals may mix causing a serious accident, such as monitoring a different patient.
Changing Parameter Setup Settings The initial settings on the PARAMETER SETUP screen must be changed before monitoring. Changing these settings during monitoring interrupts monitoring. Parameter Setup Setting List The factory default settings are underlined. Setting Item SELECTABLE INTERVALS Description Select the NIBP measurement modes for the mode selection. INITIAL INTERVAL Select the initial NIBP measurement mode at power on. INITIAL CUFF PRESS Select the NIBP cuff inflation pressure.
Displaying the PARAMETER SETUP Screen 1. Remove one battery. 2. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery. The SETUP screen appears. 3. Press the NIBP START/STOP key to enter the PARAMETER SETUP screen. When the cursor is moved to “EXIT” by pressing the NIBP INTERVAL key and the NIBP START/STOP key is pressed, the startup screen appears, then the monitoring screen appears. 4. To select or change a setting, press the NIBP START/STOP key.
Changing Settings SELECTABLE INTERVALS During monitoring, when the NIBP INTERVAL key is pressed, the measurement mode changes according to the modes selected in this item. MANUAL mode is already selected for the mode selection. 1. Press the NIBP INTERVAL key to move the cursor to the desired mode. 2. Press the NIBP START/STOP key to select or unselect the mode. Selectable modes are: STAT, 5, 10, 15, 30, 60, 120 and 240 min. INITIAL INTERVAL Select the initial NIBP measurement mode at power on. 1.
NIBP MODE AFTER STAT Select the NIBP measurement mode after completing the STAT measurement. 1. Press the NIBP INTERVAL key to move the cursor to “NIBP MODE AFTER STAT”. 2. Press the NIBP START/STOP key to select the mode. The selected mode is automatically selected for “SELECTABLE INTERVALS” as well. START/FINISH SOUND Turn on or off the sound for NIBP measurement start and finish. Start sound End sound 1. Press the NIBP INTERVAL key to move the cursor to “START/FINISH SOUND”. 2.
INHIBIT SpO2 DURING NIBP Set whether or not to monitor SpO2 during NIBP measurement. When the SpO2 probe is attached to the same limb as the NIBP cuff and this setting is set to OFF, the pulse may become unstable and SpO2 or PR alarm may occur. It is recommended to set this setting to ON so that SpO2 is not measured during NIBP measurement. When the SpO2 probe is attached to the other limb from the NIBP cuff, this setting can be set to OFF.
LEADS OFF DISPLAY Select the mode for displaying electrode off. This setting is only available when ECG is monitored with 6 electrodes. 1. Press the NIBP INTERVAL key to move the cursor to “LEADS OFF DISPLAY”. 2. Press the NIBP START/STOP key to select “CHAR” or “IMAGE”. When set to IMAGE When set to CHAR ECG ELECTRODE Select the electrode lead type. This setting is only available when “CHAR” is selected for LEADS OFF DISPLAY. 1. Press the NIBP INTERVAL key to move the cursor to “ECG ELECTRODE”. 2.
Changing System Setup Settings NOTE Changing System Setup settings must be done only by a qualified personnel. System Setup Setting List The factory default settings are underlined. Setting Item CHANNEL PRESSURE UNIT LANGUAGE BRIGHTNESS SYSTEM INITIALIZE Description Displays the transmitter channel. Select the units for NIBP. Select the language for screen display. Select the LCD brightness. Initializes all settings to the factory default settings.
5. To select or change a setting, press the NIBP START/STOP key. To move the cursor, press the NIBP INTERVAL key. Selects or changes setting Moves cursor When the cursor is moved to “RETURN” by pressing the NIBP INTERVAL key and the NIBP START/STOP key is pressed, the SETUP screen appears. Changing Settings CHANNEL The channel of this transmitter is displayed. Channel of this transmitter PRESSURE UNIT Select the unit for NIBP. Operator's Manual ZM-940PA 1.
LANGUAGE Select the language for screen display. 1. Press the NIBP INTERVAL key to move the cursor to “LANGUAGE”. 2. Press the NIBP START/STOP key to select the language. 1. Press the NIBP INTERVAL key to move the cursor to “BRIGHTNESS”. 2. Press the NIBP START/STOP key to select the LCD brightness from 1 to 4. 1 2 3 4 Light .............................. Dark BRIGHTNESS Select the LCD brightness.
Attaching NIBP Cuff, Electrodes and SpO2 Probe to the Patient The transmitter can be attached to an arm of the patient or placed on the bedside. The required length of the electrode leads and SpO2 probe cable depends on how the transmitter is to be attached to the patient. NOTE Monitoring SpO2 during NIBP Measurement When the SpO2 probe is attached to the same limb as the NIBP cuff, the blood flow decreases during NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitored properly.
Attaching the NIBP Cuff Selecting the NIBP Cuff Select the NIBP cuff appropriate for the patient. NOTE NIBP cannot be measured on neonates using this transmitter. Reusable Cuffs When attaching the transmitter to the patient arm, a special NIBP cuff is required. An optional YN-990P extension hose (1.5 m) is available to extend the length between the NIBP socket on the transmitter and NIBP cuff (e.g. when not attaching the transmitter to the patient arm and placing the transmitter on a bedside).
Disposable Cuffs CAUTION The disposable cuffs are not sterilized. If necessary, sterilize the disposable cuffs using glutaraldehyde solution by following the instructions for the glutaraldehyde. When not attaching the transmitter to the patient arm, the following disposable cuffs can be used. To use these cuffs, an optional YN-990P extension hose (1.5 m) is required.
Reference for selecting a cuff The AHA (American Heart Association) recommends that the cuff width be 40% of the circumference of the upper arm. Refer to the following graph and select the cuff which suits the patient’s arm. NOTE • If a range of arm circumference appropriate for the cuff is prescribed, use a cuff within that range. • To obtain accurate measured values, select a wide cuff which can be attached to the upper arm.
Connecting the NIBP Cuff to the Transmitter When Using YP-943P/944P NIBP Cuff To attach the YP-943P/944P NIBP cuff to the transmitter, the lock plate is required. YP-943P/944P NIBP cuff Front cover Air hose D ring Belt Belt for the strap Lock plate pocket Front cover open Lock plate Top tab For attaching the NIBP cuff to the transmitter NOTE Do not roll up or put weight on the cuff with the lock plate attached to it. Otherwise, the lock plate may break.
1. Remove the lock plate from the transmitter. 2. Insert the lock plate into the lock plate pocket on the NIBP cuff. 3. Attach the transmitter to the lock plate by inserting the tabs on the lock plate into the slots on the transmitter. 4. Cover the transmitter with the front cover of the NIBP cuff. 5. Connect the air hose to the NIBP socket on the transmitter. Turn the cuff connector joint until it clicks.
When Using YP-960T series or YP-910P series NIBP Cuff To use these NIBP cuffs, an optional YN-990P extension hose (1.5 m) is required. NOTE Connect the joints properly. If there is an air leak, NIBP cannot be measured properly. 1. Connect the NIBP cuff to the extension hose. 2. Connect the other end of the extension hose to the NIBP socket on the transmitter. Turn the joint clockwise until it clicks. To disconnect the cuff from the transmitter, turn the hose joint counterclockwise.
• NIBP and SpO2 can be measured on the same limb, but the SpO2 monitoring may not be accurate during NIBP measurement. Be careful when reading the SpO2 values.* • Do not reuse disposable cuffs. * Monitoring SpO2 during NIBP Measurement When the SpO2 probe is attached to the same limb as the NIBP cuff, the blood flow decreases during NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitored properly.
Using the YP-943P/944P NIBP Cuff 1. Attach the NIBP cuff to the transmitter. Refer to the “Connecting the NIBP Cuff to the Transmitter” section. 2. Insert the end of the cuff into the belt and then through the D ring as shown at left. 3. Fold back the cuff at the D ring and fasten it using the velcro tape. Belt D ring End of cuff Make sure that the cuff is not attached on a joint. NOTE The cuff must not wrap around the elbow.
Attaching the Strap to the Transmitter NOTE • Use the strap to prevent the transmitter from falling. • Do not attach the clip to hard objects such as thick cloth or zipper. It will break the clip. Attach a strap provided with the transmitter to the NIBP cuff and patient clothes. To open the clip, firmly pull out the tab in direction of the arrow. To adjust the strap length, push down the tab on the adjuster and slide. Belt for the strap on the NIBP cuff 1. 34 Adjust the length of the strap. 2.
Using the YP-960T series Reusable Cuffs or YP-910P series Disposable Cuffs ARTERY 1. Put the cuff on the upper arm so that the mark of “ARTERY ” aligns with the artery of the patient. 2. Wrap the cuff so that “INDEX RANGE ”. within the “ ” comes If “Index ” is not within the “ ”, change the cuff size. RANGE RANGE Attaching Electrodes Selecting Electrode Lead CAUTION Use only Nihon Kohden specified electrode leads.
Connecting the Electrode Lead to the Transmitter Connect the electrode lead to the ECG/RESP socket on the transmitter. When the transmitter is attached on an arm CAUTION Hold the connector of the electrode lead when connecting/disconnecting the electrode lead. If you disconnect the electrode lead by pulling the lead, it damages the electrode lead. Selecting the Electrode Position Follow the physician’s instructions for electrode placement when available.
Six Electrodes The 6-electrode method with lead II and lead V5 is effective for monitoring myocardial ischemia. You can improve monitoring accuracy considerably by adding lead V4 to this combination. Va and Vb can be at any position of the standard 12 leads V1 to V6, but V4 and V5 are most appropriate for myocardial ischemic monitoring.
Lead Position Standard limb leads Lead I RA Lead II LA Lead III RA LL N (RL) Monopolar limb leads aVR lead N (RL) aVL lead aVF lead RA LA RA LA N (RL) N (RL) LA LL LL LL LA LL LL N (RL) RA RA LA N (RL) Monopolar chest leads V1 to V6 leads to RA LA LL N (RL) 38 Operator's Manual ZM-940PA
Three Electrodes • Lead MII, which is similar to standard lead II, used when ECG measurement has priority Electrode Position Left infraclavicular fossa Right infraclavicular fossa Below lowest rib on the left anterior axillary line • Lead MI, which is similar to standard lead I Change F/LL and L/LA of the lead MII. Symbol AHA IEC LA L RA R LL F Lead Color AHA IEC Black Yellow White Red Red Green • Lead MIII, which is similar to standard lead III. Change R/RA and L/LA of the lead MII.
Attaching Electrodes to the Patient and Connecting the Electrode Leads to Disposable Electrodes Prepare the Patient Skin Shave off excessive body hair. To reduce skin impedance, clean the electrode site with cream or with a cotton pad moistened with alcohol. Thoroughly dry the skin with a clean cotton pad. NOTE • For a patient with frequent body movement, rub the sites with Skinpure skin preparation gel. However, do not use Skinpure skin preparation gel on sensitive skin.
Electrode Position for Respiration Monitoring Place the R/RA and F/LL electrodes so that the lungs are between the electrodes. NOTE The optimum electrode positions for ECG measurement of a patient are not always optimum for respiration measurement of the patient. Select positions suitable for both ECG and respiration measurements, or positions which have priority for one measurement. Electrode Position Examples NOTE The following examples are when monitoring with 3 electrodes.
Position 3 In this position, the respiration waveform is optimum, but the ECG lead is unusual. R or RA Right midaxillary at the horizontal level of V4 F or LL Fifth intercostal space on the left midaxillary line, V6 Position 4 In this position, the respiration measurement is influenced by the impedance variation of the abdomen, so the cardiac pulse wave included in the respiration wave is reduced.
Attaching the SpO2 Probe Selecting the SpO2 Probe Select an appropriate probe for the patient. CAUTION • Use Nihon Kohden specified SpO2 probe to assure maximum performance from your instrument. • Do not use damaged or disassembled probe. It causes incorrect measurement and may hurt the patient. Reusable Probes When using a TL-201T finger probe, choose the appropriate cable length for attachment. Probe Cable Length Patient Attachment site Finger probe TL-201T Adult or children Finger 20 kg or more 0.
Disposable Probes CAUTION • Use the disposable probe only for one patient. Never reuse the disposable probe for another patient because it causes cross infection. • Disposable probes are not sterilized.
Model TL-271T Patient Adult 30 kg or more TL-272T Child 10 to 50 kg TL-273T Neonate 3 kg or less Attachment site Finger or toe Instep Adult 40 kg or more TL-274T Operator's Manual ZM-940PA Infant 3 to 20 kg Finger or toe 45
Connecting the SpO2 Probe to the Transmitter Connect the probe to the SpO2 socket on the transmitter. When the transmitter is attached on an arm CAUTION Hold the connector when connecting/disconnecting the probe. If you disconnect the SpO2 probe by pulling the cable, it damages the cable. Attaching the Probe to the Patient Attach the probe to the patient by referring to the probe’s manual. Make sure that the light emitter and photo detector of the probe face each other at the attachment site.
• Check the circulation condition by observing the skin color of the measuring site and the pulse waveform. Change the measuring site every 8 hours for disposable probes and every 4 hours for reusable probes. The skin temperature may increase at the attached site by 2 or 3°C (4 or 5°F) and cause a burn or pressure necrosis. When using the probe on the following patients, take extreme care and change the measurement site more frequently according to symptoms and degree.
Locking the Keys on the Transmitter To prevent the patient from pressing the keys on the transmitter during monitoring, you can lock the NIBP START/STOP and NIBP INTERVAL keys. 1. Press the NIBP INTERVAL key for about 3 seconds. 2. A “pip, pip” sounds and the “LOCK KEYS” message is displayed on the LCD. Pip, pip LOCK KEYS When the NIBP START/STOP key or NIBP INTERVAL key is pressed while the keys are locked, the “PRESS INT. KEY 3S TO UNLOCK” message appears. To unlock the keys: 1.
Monitoring When preparation is done, monitoring starts. NIBP Oscillometric Method NIBP is measured from the change in amplitude pattern of pulsatile oscillation in cuff pressure as the cuff pressure is reduced from above systolic to below diastolic pressure. The occlusiveoscillometry method uses this to determine the systolic, diastolic and mean arterial pressure. NIBP Monitoring Selecting the Initial Cuff Inflation Pressure The initial cuff inflation pressure can be changed on the PARAMETER SETUP screen.
AFTER STAT” setting on the PARAMETER SETUP screen. The default setting is Manual mode. Refer to the “Changing Parameter Setup Settings” section. The STAT measurement completes within 15 minutes. When more than 12 minutes elapse from the start of measurement, there will be no more measurement performed and the measurement mode changes to the mode selected for “NIBP MODE AFTER STAT” on the PARAMETER SETUP screen.
NOTE • When measuring patients who are conscious, help the patient to relax. Measurement may not be accurate if the patient’s arm is tense or if the patient talks. • The data for measurement on a leg tends to be higher than measurement on the arm. When making diagnosis based on the NIBP values, measure NIBP on an upper arm. • Do not apply pressure to the cuff or air hose. NIBP may not be measured correctly because of noise or NIBP measurement may stop due to the NIBP safety circuit.
The cuff is inflated and the inflation pressure is displayed on the screen. Inflation pressure In manual mode: Measurement is performed once. In STAT mode: Measurement is performed repeatedly for 15 minutes. In auto mode: The first measurement is performed when the NIBP START/STOP key is pressed. The second measurement is performed when the current time in the transmitter reaches the selected time interval. To stop measurement during measurement, press the NIBP START/STOP key again.
Data Display After NIBP Measurement When the time set at “OLD NIBP DATA” on the PARAMETER SETUP screen elapses after the last measurement, the NIBP data is dimmed or hidden. Whether to dim or hide the old data can also be selected at “OLD NIBP DATA”. Refer to the “Changing Parameter Setup Settings” section.
the pacemaker by referring to the pacemaker’s manual. For more details, contact your pacemaker distributor or Nihon Kohden distributor. * Minute ventilation is sensed in rate-adaptive pacemakers by a technology known as bioelectric impedance measurement (BIM). Many medical devices in addition to pacemakers use this technology.
Electrode Detachment In the following conditions, the check electrode indication is displayed on the LCD of the transmitter and the “CHECK ELECTRODE” message is displayed on the monitor. • Electrode is detached from skin. • Electrode lead is disconnected from the electrode. • Polarization voltage between the electrode and skin is excessively high. In these cases, check the cause and if necessary, replace electrodes with new ones.
SpO2 Monitoring When monitoring starts, SpO2 and pulse waveform are sent to the monitor and SpO2, pulse rate and pulse level bar graph are displayed on the transmitter LCD. WARNING • Measurement may be incorrect in the following cases. • When the patient’s carboxyhemoglobin or methemoglobin increases abnormally. • When dye is injected in the blood. • When using an electrical surgery unit. • During CPR. • When there is body movement. • When there is vibration.
• Do not pull or bend the probe cable, and do not run over the probe cable with caster feet. Do not immerse the probe cable in detergents or water. Failure to follow these cautions may cause cable discontinuity, short circuit, skin burn on the patient and incorrect measurement data. Replace any broken probe with a new one. • When the probe is attached on an appropriate site with sufficient circulation and the error message confirming the probe attachment repeatedly appears, the probe may be deteriorated.
NOTE • When continuous SpO2 monitoring is necessary, attach the probe to the limb to which the NIBP cuff is not attached and set “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen to OFF. • When the probe is attached to the same limb as the NIBP cuff, set the sync source to a parameter other than SpO2 on the receiving monitor. • When monitoring SpO2 during STAT NIBP measurement, attach the probe to the limb to which the NIBP cuff is not attached.
Display and Message List Battery Indication Indication Cause Countermeasure Fully charged battery Batteries are low. Batteries are low. NIBP cannot be measured. No indication Replace batteries. Dead batteries ECG/Respiration Indication Cause Electrode lead is disconnected from the electrode. Electrode lead is disconnected from the transmitter. Electrode lead discontinuity. Electrode is not firmly attached to the skin. Polarization voltage is abnormally high.
SpO2 Message During NIBP measurement Detecting body movement SpO2 CHECK PROBE SpO2 CHECK PROBE SITE SpO2 DETECTING PULSE SpO2 LIGHT INTERFERENCE SpO2 PROBE FAILURE Cause SpO2 monitoring is paused for NIBP measurement. Considerable body movement. The probe is not attached to the patient properly. The probe is not attached to the patient properly. The probe is not attached at the appropriate site. Probe is expired. Searching for the correct pulse wave.
NIBP Message NIBP AIR LEAK Cause The cuff and extension hose are not properly connected. The cuff hose (or extension hose) is not properly connected to the NIBP socket. The cuff or extension hose is damaged. Countermeasure Connect them properly. Replace with a new one. The patient’s pulse wave is small. Measure by palpation or auscultation. The cuff is not wrapped on the patient properly. Wrap the cuff on the patient properly. NIBP CUFF OCCLUSION Transmitter malfunction.
Troubleshooting If the problem still remains after checking the following, contact your Nihon Kohden distributor. Transmitter Problem Nothing is displayed on the LCD after turning the power on. LCD is difficult to see (too dark or too light). Cause Batteries are not installed correctly. The battery polarity is wrong. Batteries are completely discharged. LCD brightness is not appropriate. Nothing is displayed on the monitor after turning the transmitter power on.
ECG/Respiration Problem The heart rate is unstable. Cause Pacing detection setting on the monitor is not correct. The “CHECK ELECTRODE” message appears on the receiving monitor. Electrode lead is disconnected from the electrode. Electrode lead discontinuity ECG baseline is thick. (Hum is overlapping) Respiration waveform measurement is unstable. Electrode is not firmly attached to the skin. Polarization voltage is abnormally high. The gel on the electrode is dried out.
NIBP Problem Cuff inflation pressure is less than 10 mmHg. The cuff does not inflate when the NIBP START/STOP key is pressed. Abnormal measurement results are displayed. Cause The cuff hose is not connected to the NIBP socket properly. The cuff is not wrapped around the arm or is wrapped too loosely. The cuff hose is not connected to the NIBP socket.
Problem Cannot measure NIBP. Blood congestion occurs. Thrombus occurs. NIBP data on the screen is --- or dark. Three loud pip sounds indicting NIBP measurement cannot be started. Cause Vibration on the cuff. The cuff hose or extension hose is bent or squeezed. The cuff has worn out. Measuring over a long period of time at short intervals. Measuring on a patient with known bleeding disorders or coagulation. The time set for “OLD NIBP DATA” on the PARAMETER SETUP screen elapsed from the last measurement.
Maintenance To use the instrument in safe and optimum condition, perform maintenance check once every six months. CAUTION Do not disassemble the transmitter when performing maintenance and inspection. Do not repair the transmitter. When there is any problem with the transmitter after maintenance and inspection, contact your Nihon Kohden distributor. A maintenance check sheet is provided at the end of this section. Make a copy of this check sheet before performing maintenance check. 1.
2. Remove one battery. 3. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery. The SETUP screen appears. 4. Press the NIBP INTERVAL key to move the cursor to “SYSTEM SETUP”. 5. Press the NIBP START/STOP key to enter the SYSTEM SETUP screen. The channel of this transmitter is displayed. 6. Check that the channel displayed on the LCD matches the label on the transmitter.
3. LCD Display Check that there are no dots missing on the LCD. 1. Remove one battery. 2. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery. The SETUP screen appears. 3. Press the NIBP INTERVAL key twice to move the cursor to “MANUAL CHECK”. 68 4. Press the NIBP START/STOP key to enter the MANUAL CHECK screen. 5. Check that the cursor is on “LCD TEST” and press the NIBP START/ STOP key.
6. Every time the NIBP INTERVAL key is pressed, the screen changes as below. Check that there are no dots missing. When the NIBP START/STOP key is pressed, the screen returns to the MANUAL CHECK screen. 4. Key Operation NIBP START/STOP Key 1. Attach the NIBP cuff to your upper arm. 2. Press the NIBP START/STOP key. Check that the cuff inflates and deflates properly. 3. Press the NIBP START/STOP key again. During inflation, press the NIBP START/STOP key to check that the cuff deflates properly.
5. NIBP Cuff for Attaching Transmitter to Patient Arm The NIBP cuff is a consumable. Check the following and when necessary, replace it with a new one. Appearance • There are no dirty parts. • There are no broken stitches on the cuff. • The label on the cuff is readable. • The velcro tape on the cuff is not removed and there are no broken stitches. • The lock plate is not damaged and functions properly. Inflation bag • The inflation bag is not torn or damaged. • There is no water inside the inflation bag.
Maintenance Check Sheet Hospital/Organization: Service Personnel: Instrument Name: Transmitter Instrument Model: ZM-940PA Instrument Serial Number: Hardware Revision Number: Software Revision Number: 1. External Check OK No 2. Transmitter Channel OK No 3. LCD Display OK No 4. Key Operation OK No 5. NIBP Cuff for Attaching Transmitter to Patient Arm OK No Overall Judgement OK Can be used but needs maintenance Maintenance required. Cannot be used.
Repair Parts Availability Policy Nihon Kohden Corporation (NKC) shall stock repair parts (parts necessary to maintain the performance of the instrument) for a period of 8 years from the date of delivery. In that period NKC or its authorized agents will repair the instrument. This period may be shorter than 8 years if the board or part necessary for the faulty section is not available.
Lifetime and Disposal Disposing of Used Batteries Battery Lifetime Replace the batteries when the battery replacement indication appears on the transmitter. When using rechargeable batteries, recharge them. Type NiMH secondary Alkaline primary Lifetime (Measuring parameters) ECG, SpO2, NIBP ECG, SpO2 ECG only 2 days 2 days 2.5 days 1 day 2.
Cleaning, Disinfection and Sterilization Transmitter and Electrode Leads CAUTION • This transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop cleaning/disinfecting/sterilizing it and contact your Nihon Kohden distributor. The transmitter needs to be checked for safety and function before use. • Before cleaning or disinfecting the transmitter, remove the batteries from the transmitter. • The transmitter cannot be sterilized.
SpO2 Probe Refer to the probe manual. YP-943P/944P NIBP Cuffs CAUTION • • • • Do not autoclave. Use only glutaraldehyde solution. Never allow liquid to get inside the rubber cuff. Do not sterilize or disinfect the cuff with ultraviolet light or ozone. Cleaning To clean the cuff, remove the lock plate and carefully pull out the inflation bag from the cloth cover. Cloth cover: Wash with neutral detergent and water. Thoroughly dry it. When washing in a washing machine, put it in a net.
Specifications Measuring Parameters Measuring waveforms: Measuring numeric data: Transmitting Data Waveform data: Numeric data: Status information: ECG, Respiration in impedance method, pulse SpO2, NIBP, pulse rate ECG, respiration, pulse wave SpO2 and NIBP Battery replacement, channel ID, type of transmitter, check electrodes, abnormal polarization voltage, pacing data, SpO2 status Displayed Data SpO2, NIBP, pulse rate, pulse wave bar graph, check electrode, battery replacement, NIBP measurement mode an
NIBP Measurement Displayed items: Cuff pressure display range: Measurement modes: Systolic, diastolic, mean 0 to 300 mmHg Manual, STAT, auto at 5, 10, 15, 30, 60, 120 or 240 minute interval Pulse Rate 30 to 200 beats/minute ±8 beats/min (NIBP) Measuring range: 30 to 250 beats/min ±3% ±1 beat/min (SpO2) Transmitter FCC regulation: Field strength limits: Undesired emission: Antenna: Transmission channel: Transmission frequency range: Channel spacing: Type of emission: Occupied bandwidth: Effective radiate
Environment Operating environment Operating temperature: 5 to 40°C, 41 to 104°F When using NIBP cuff, 10 to 40°C, 50 to 104°F Operating humidity: 30 to 85% (non-condensing) Operating atmospheric pressure: 70 to 106 kPa Storage environment Storage temperature: −20 to 65°C, −4 to 149°F Storage humidity: 10 to 95% Storage atmospheric pressure: 70 to 106 kPa Safety Standards Safety standard: CAN/CSA-C22.2 No. 601-1 M90:1990 CAN/CSA-C22.2 No. 601-1. 1S1-94:1994 CAN/CSA-C22.2 No. 601-1. 1B-90:R2002 CAN/CSA-C22.
Electromagnetic Compatibility IEC 60601-1-2 (2001) Emissions: CISPR11 Group1,Class B Electromagnetic Emissions This Model ZM-940PA is intended for use in the electromagnetic environment specified below. The customer or the user of the ZM-940PA should assure that it is used in such an environment.
Electromagnetic Immunity This Model ZM-940PA is intended for use in the electromagnetic environment specified below. The customer or the user of the ZM-940PA should assure that it is used in such an environment.
Immunity test IEC 60601 test level Compliance level Electromagnetic environment guidance Portable and mobile RF communications equipment should be used no closer to any part of the ZM-940PA, including cables, than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter. Recommended separation distance Conducted RF IEC 61000-4-6 3 Vrms 3 Vrms d = 1.2√P Radiated RF IEC 61000-4-3 3 V/m 80 MHz to 2.5 GHz 3 V/m 80 MHz to 2.5 GHz d = 1.
Recommended Separation Distances between Portable and Mobile RF Communications Equipment The ZM-940PA is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the ZM-940PA can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the ZM-940PA as recommended below, according to the maximum output power of the communications.
Standard Accessories 1 2 No. 1 2 Name NIBP cuff for adult, standard Strap Model YP-943P --- Q’ty 1 1 Supply Code No. S938B Y236 The following parts are available for replacement. 3 4 Lock plate is a standard accessory of the YP-943P/944P NIBP cuff. No. 3 4 Name Battery case cover Lock plate Operator's Manual ZM-940PA Model Q’ty 1 1 Supply Code No.
Options CAUTION Use only Nihon Kohden electrodes, electrode leads, SpO2 probes and NIBP cuffs to assure maximum performance from your instrument. Transmitter Channel writer, QI-901PK ECG/RESP Name Electrode lead Application 3 electrodes,clip type, lead length 80 cm 3 electrodes, snap type, lead length 80 cm 6 electrodes,clip type, lead length 80 cm 6 electrodes,snap type, lead length 80 cm Model Q’ty Supply Code No.
SpO2 Name Finger probe (reusable) Multi-site probe (reusable) SpO2 probe (for adult, disposable) SpO2 probe (for child, disposable) SpO2 probe (for neonate, disposable) Multi-site Y probe (for low birth weight infant/child/ neonate, disposable) SpO2 probe (for adult, disposable) SpO2 probe (for child, disposable) SpO2 probe (for neonate/adult, disposable) SpO2 probe (for child/infant, disposable) SpO2 probe(for adult/neonate, disposable) SpO2 probe (for child/infant, disposable) COTTONY tape Foam tape for
Transmission Frequencies USA BAND CHANNEL SPACING C USA BAND CHANNEL SPACING C USA BAND CHANNEL SPACING C Transmission Transmission Transmission 25 kHz step 25 kHz step 25 kHz step frequency frequency frequency Channel No. Channel No. Channel No. (MHz) (MHz) (MHz) 608.0250 608.0500 608.0750 608.1000 608.1250 608.1500 608.1750 608.2000 608.2250 608.2500 608.2750 608.3000 608.3250 608.3500 608.3750 608.4000 608.4250 608.4500 608.4750 608.5000 608.5250 608.5500 608.5750 608.6000 608.6250 608.6500 608.
USA BAND CHANNEL SPACING C USA BAND CHANNEL SPACING C USA BAND CHANNEL SPACING C Transmission Transmission Transmission 25 kHz step 25 kHz step 25 kHz step frequency frequency frequency Channel No. Channel No. Channel No. (MHz) (MHz) (MHz) 610.2750 610.3000 610.3250 610.3500 610.3750 610.4000 610.4250 610.4500 610.4750 610.5000 610.5250 610.5500 610.5750 610.6000 610.6250 610.6500 610.6750 610.7000 610.7250 610.7500 610.7750 610.8000 610.8250 610.8500 610.8750 610.9000 610.9250 610.9500 610.9750 611.
USA BAND CHANNEL SPACING C USA BAND CHANNEL SPACING C USA BAND CHANNEL SPACING C Transmission Transmission Transmission 25 kHz step 25 kHz step 25 kHz step frequency frequency frequency Channel No. Channel No. Channel No. (MHz) (MHz) (MHz) 612.7500 612.7750 612.8000 612.8250 612.8500 612.8750 612.9000 612.9250 612.9500 612.9750 613.0000 613.0250 613.0500 613.0750 613.1000 613.1250 613.1500 88 9380 9382 9384 9386 9388 9390 9392 9394 9396 9398 9400 9402 9404 9406 9408 9410 9412 613.1750 613.2000 613.
