Transmitter ZM-940PA/ZM-941PA If you have any comments or suggestions on this manual, please contact us at: www.nihonkohden.
Copyright Notice The entire contents of this manual are copyrighted by Nihon Kohden. All rights are reserved. No part of this document may be reproduced, stored, or transmitted in any form or by any means (electronic, mechanical, photocopied, recorded, or otherwise) without the prior written permission of Nihon Kohden.
Contents GENERAL HANDLING PRECAUTIONS...........................................................................i WARRANTY POLICY...................................................................................................... iii Equipment Authorization Requirement............................................................................ iii EMC RELATED CAUTION...............................................................................................
Changing Parameter Setup Settings....................................................................................26 Parameter Setup Setting List..........................................................................................26 Displaying the PARAMETER SETUP Screen.................................................................27 Changing Settings..........................................................................................................28 SELECTABLE INTERVALS....................
Measuring NIBP.........................................................................................................61 Monitoring SpO2 during NIBP Measurement..............................................................64 ECG and Respiration Monitoring....................................................................................64 Electrode Detachment................................................................................................66 SpO2 Monitoring...................................
SpO2 Measurement....................................................................................................87 NIBP Measurement....................................................................................................88 Pulse Rate..................................................................................................................88 Transmitter..................................................................................................................88 Power Requirements.
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.
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/ZM-941PA 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. The difference between the ZM-940PA and ZM-941PA is the transmission frequency range. ZM-940PA: 608.
• NIBP cannot be measured on a neonate. (ECG, respiration and SpO2 can be monitored on a neonate.) • Do not diagnose a patient based on only part of the monitoring data on the transmitter or only on the data acquired by the transmitter. Overall judgement must be performed by a physician who understands the features, limitations and characteristics of the transmitter by reading this operator’s manual thoroughly and by reading the biomedical signals acquired by other instruments.
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 (R6) batteries. WARNING Close the battery case cover during operation.
Rear Panel Lock plate: Fastens the transmitter to an NIBP cuff. Refer to the symbol page. 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 representative. If a wet transmitter is used, the patient or operator may receive an electrical shock or injury.
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.
WARNING WARNING Before defibrillation, all persons must keep clear of the bed and must not touch the patient or any equipment or cord connected to the patient. Failure to follow this warning may cause electrical shock or injury. The following actions 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.
LCD 1 2 4 5 6 3 LOCK KEYS 11 10 9 No. 1 2 3 Name 8 7 Description NIBP SYS NIBP DIA NIBP MAP Displays NIBP systolic value. Displays NIBP diastolic value. Displays NIBP mean value. “CUFF” is displayed with the cuff inflation pressure during measurement. 4 Check electrode mark Appears when an electrode or electrode lead becomes detached during ECG measurement. 5 Battery replacement mark Appears when the batteries are weak. For details, refer to the “Battery Condition Indication” section.
1 2 4 5 6 3 LOCK KEYS 11 10 9 No. Name 7 NIBP measurement mode 8 NIBP interval bar graph 9 Pulse level bar graph 10 %SpO2 11 PR 8 7 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 representative.
Important Safety Information General 10 WARNING WARNING Never use the 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 the transmitter in a hyperbaric oxygen chamber. Failure to follow this warning may cause explosion or fire. WARNING WARNING When performing MRI test, remove all electrodes from the patient which are connected to this transmitter.
WARNING WARNING Close the battery case cover during operation. If the transmitter is used with the battery case cover open, anyone who touches the opened battery case may receive an electrical shock when defibrillation is performed. Touching the opened battery case may cause electrostatic discharge and intermittently interfere with the waveform or data. This transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop using it and contact your Nihon Kohden representative.
CAUTION Turn off the power of mobile phones, small wireless devices and other devices which produce strong electromagnetic interference around a patient (except for devices allowed by the hospital administrator). Radio waves from devices such as mobile phones or small wireless devices may be mistaken as pulse waves and the displayed data may be incorrect.
CAUTION CAUTION Battery replacement must be performed by the operator. 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. The battery charger must be used outside the patient environment. CAUTION Refer to the battery and battery charger manuals for details on handling the batteries.
For Patients Using Implantable Pacemaker WARNING Interaction Between Minute Ventilation Rate-Adaptive Pacemakers and Cardiac Monitoring and Diagnostic Equipment* The bioelectric impedance measurement sensor of a minute ventilation rate-adaptive implantable pacemaker may be affected by transmitter which is connected to the same patient. If this occurs, the pacemaker may pace at its maximum rate and the transmitter may give incorrect data to the monitor.
CAUTION CAUTION Do not wrap the cuff on an arm or thigh which is used for injection. NIBP measurement on an arm or thigh which is used for injection may cause reflux of blood and stop injection. Do not wrap the cuff too tight. It may cause poor blood circulation and congestion. If the cuff is wrapped too loosely, the NIBP value may increase. CAUTION Do not attach the cuff to the site where there is injury or inflammation.
SpO2 Monitoring WARNING WARNING SpO2 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 electrosurgical unit. • During CPR. • When measuring at a site with venous pulse. • When there is body movement. • When the pulse wave is small (insufficient peripheral circulation). When not monitoring SpO2, disconnect the SpO2 cable from the transmitter.
CAUTION CAUTION NIBP and SpO2 can be measured on the same limb, but the SpO2 monitoring might not be accurate during NIBP measurement. Be careful when reading the SpO2 values.* While a patient is on medication which causes vasodilation, the pulse waveform may change and in rare cases the SpO2 value might not be displayed.
CAUTION Do not pull or bend the probe cable, and do not put caster feet on the probe cable. Do not immerse the probe cable in chemical solutions or water. Failure to follow these instructions may cause cable discontinuity, short circuit, skin burn on the patient and incorrect measurement data. Replace any broken probe with a new one. CAUTION When a message indicates a faulty probe, stop monitoring and replace the probe with a new one. CAUTION Neonatal skin is delicate.
Maintenance CAUTION Before cleaning or disinfection, remove the batteries from the transmitter. Failure to follow this instruction may result in electrical shock or transmitter malfunction. CAUTION The transmitter cannot be sterilized. Sterilizing the transmitter may damage it. Operator’s Manual ZM-940PA/941PA CAUTION This transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop cleaning or disinfecting it and contact your Nihon Kohden representative.
Preparation Installing (Replacing) Batteries WARNING and CAUTION for Battery Handling WARNING WARNING • Keep the batteries away from fire. They may explode. • Keep the batteries away from patients. • Never short-circuit the + and – terminals on the battery. It may cause overheating and fire. • Do not damage, disassemble, drop or give impact to the battery.
Battery Lifetime Use three AA (R6) type alkaline dry cell batteries. NiMH rechargeable batteries can also be used. ZM-940PA Type NiMH secondary Alkaline primary Lifetime (Measuring parameters) ECG, SpO2, NIBP ECG, SpO2 ECG only 2 days 2.5 days 3 days 1 day 2.5 days 3 days ZM-941PA Type NiMH secondary Alkaline primary Lifetime (Measuring parameters) ECG, SpO2, NIBP ECG, SpO2 ECG only 1.5 days 2 days 2.5 days 1 day 2 days 2.
CAUTION • Replace all batteries at the same time. • Do not use different types of batteries together. NOTE Insert the batteries with the correct polarity (+ and –). Procedure 1. Remove the battery case cover. 2. Insert three new or fully charged batteries into the battery case observing the correct polarity. 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.
Battery Condition Indication The battery condition is indicated as follows. Indication Condition Receiving Monitor Batteries are full. There is no indication on the monitor. Fully charged battery Batteries are low. Replace batteries. Batteries are low. NIBP cannot be measured. Replace batteries. Message requiring battery replacement is displayed. No signal can be transmitted to the monitor. There is no indication on the monitor.
• The transmitter is completely dry. • The electrode lead, SpO2 probe and NIBP cuff are not broken. • There are no damaged or dirty parts on the disposable SpO2 probe, disposable electrodes or disposable NIBP cuff. Batteries • The battery polarity is correct. • The battery case spring is firmly fixed and the battery is not loose. • The battery case cover is firmly closed. Channel Setting • The transmitter channel corresponds to those of the receiving monitor.
Changing the Transmitter Channel The channel of the transmitter can be changed. The optional QI-901PK Channel Writer is required. WARNING The following actions 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. • Assign a channel administrator in the hospital and only he or she should manage channel assignment.
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 Settings STAT, 5, 10, 15, 30, 60, 120, 240 MAN., 5 min, 10 min, 15 Select the initial NIBP measurement INITIAL INTERVAL min, 30 min, 60 min, 120 mode at power on.
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.
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 CHAR When set to IMAGE 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. 1. Press the NIBP INTERVAL key to move the cursor to “PRESSURE UNIT”. 2.
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. BRIGHTNESS Select the LCD brightness. 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 SYSTEM INITIALIZE Do the following procedure to initialize the settings to the factory default settings. 1.
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 Disposable cuffs are not sterilized. If necessary, sterilize the cuff using glutaraldehyde solution. 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 when the lock plate is attached to it.
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. 2 5. Connect the air hose to the NIBP socket on the transmitter. Turn the cuff connector joint until it clicks.
