IntelliVue TRx/TRx+ Transceivers for the ITS4840A/ITS4850A IntelliVue Telemetry System Notice (ITS4842A, TRx4841A) These devices comply with part 15 of the FCC Rules. Operation is subject to the following two conditions: (1) these devices may not cause harmful interference, and (2) these devices must accept any interference received, including interference that may cause undesired operation.
Notice Document number: 453564087761, First Edition Printed in the USA. © Copyright 2008 Koninklijke Philips Electronics N.V. All Rights Reserved. Reproduction in whole or in part is prohibited without the prior written consent of the copyright holder. Philips Medical Systems Nederland B.V. reserves the right to make changes in specifications and/or to discontinue any product at any time without notice or obligation and will not be liable for any consequences resulting from the use of this publication.
Printing History Printing History New editions of this document will incorporate all material updated since the previous edition. Update packages can be issued between editions and contain replacement and additional pages to be merged by a revision date at the bottom of the page. Note that pages which are rearranged due to changes on a previous page are not considered revised. The documentation printing date and part number indicate its current edition.
About this Book About this Book This book contains operating instructions for use of the IntelliVue TRx and TRx+ Transceivers as used with the IntelliVue Telemetry System with SmartHopping Technology. It also includes operational information for the telemetry functions of the IntelliVue Information Center. The intended audience is the clinician who uses and/or teaches others to use this equipment in a healthcare environment.
About this Book Document Conventions The following document conventions are used throughout this manual to identify specific safety and operational information. Warnings Warning Warnings are information you must know to avoid injuring patients and personnel. Cautions Caution Cautions are information you must know to avoid damaging your equipment and software. Notes Note—Notes contain additional information on use of the IntelliVue Telemetry System.
About this Book vi
Contents 1. Introducing IntelliVue Telemetry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1 The IntelliVue Transceiver. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Transceiver Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Transceiver Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pouch Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7 Securing the Pouch. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7 Showering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-10 Testing Transceiver Functionality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. ST/AR Arrhythmia Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1 ST/AR Arrhythmia Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2 Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2 Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Turning SpO2 Monitoring Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SpO2 Enable/Disable at Information Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SpO2 Auto ON at Information Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Understanding SpO2 Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Label Assignment for Replacement Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-2 Cleaning and Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4 Cleaning the Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-5 EO Sterilization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A. Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1 Accessory Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Transceiver Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pouches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
This chapter introduces the IntelliVue TRx and TRx+ Transceivers, the patientworn device of the IntelliVue Telemetry System with Smart-Hopping Technology. It includes the following sections: • • • • The IntelliVue Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2 IntelliVue Telemetry System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4 IntelliVue Clinical Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The IntelliVue Transceiver The IntelliVue Transceiver The IntelliVue Transceiver is a patient-worn device for monitoring ECG and SpO2 on adult and pediatric patients within the IntelliVue Telemetry System. The transceiver combines traditional transmitter features with communication to and from the IntelliVue Information Center.
The IntelliVue Transceiver .
IntelliVue Telemetry System IntelliVue Telemetry System The IntelliVue Telemetry System with Smart-Hopping Technology uses cellular architecture to provide two-way communication between transceivers and the IntelliVue Information Center. Smart-hopping technology dodges interference and seeks out the strongest available signal to achieve seamless connections wherever patients roam on the clinical network.
IntelliVue Telemetry System Bi-directional Signal Flow in the IntelliVue Telemetry System Smarthopping Technology Smart-hoppingTM technology provides dynamic management of the RF spectrum used by each transceiver. This technology allows a virtually unlimited number of transceivers to operate simultaneously within the IntelliVue Telemetry System by creating a frequency-agile system that changes frequency without user involvement or awareness whenever interference occurs.
IntelliVue Telemetry System Smart-hopping enables the signal to avoid wireless interference. When baseline noise is low (see illustrations following), telemetry signals reside in their frequency/time slot locations. If excessive interference occurs, degrading the signal, the telemetry signal then “hops” over the interference to a location that provides optimal signal-to-noise performance.
IntelliVue Telemetry System 1395 1400 FR EQ UE NC IES TS LO S E TIM 1427 1432 Excessive Interference 1395 1400 FR EQ UE NC I ES T IM 1427 L ES OT S 1432 ’Hop’ to New Frequency/Time Slot Introducing IntelliVue Telemetry 1-7
IntelliVue Clinical Network Spectrum Sharing The ITS4840A IntelliVue Telemetry System operates in the Wireless Medical Telemetry Service bands (WMTS - USA only). WMTS uses radio frequency spectrum which was allocated by the FCC for medical telemetry applications, with a reduced potential for harmful interference.
Transceiver Use with Other Equipment • ITS4842A/ITS4852A/ITS4853A Access Points (AP), placed within the areas with defined coverage. APs are centers for bidirectional communication between the transceivers and the Information Center. • M3150B IntelliVue Information Center for centralized monitoring. • M3154A IntelliVue Database Server (optional) for centralized data management. • M2636C TeleMon Companion Monitor (optional) for local alarms, NBP measurement, and bedside display of patient data.
Transceiver Use with Other Equipment Patient Bedside Monitors Remote control of monitoring parameters such as NBP, SpO2, Alarm Suspend, and Relearn, as well as limited overview of waves and data are supported through Patient Bedside Monitors equipped with IntelliVue Instrument Telemetry. Please refer to the Instructions for Use for the specific Patient Monitor for operating information. Patient Data can be sourced directly from the transceiver to MP5/MP5T, MP2 or X2 Patient Monitors.
This chapter consolidates the safety warnings that apply to use of the IntelliVue Transceivers in a IntelliVue Clinical Network. These warnings are repeated throughout the book in context where relevant. The chapter includes the following section: • General Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
General Safety General Safety Warning The IntelliVue Telemetry System should not be used for primary monitoring in applications where the momentary loss of the ECG is unacceptable. Warning For continued safe use of this equipment, it is necessary that the listed instructions are followed. Instructions in this manual in no way supersede established medical procedures. Warning Do not touch the patient, or table, or instruments, during defibrillation. The battery door must be closed during defibrillation.
General Safety Warning Do not use patient cables with detachable lead wires that have exposed male pins. Electrocution could result if these pins are plugged into AC power. Warning The system is not completely immune from radio interference although it is designed to minimize interference through smart hopping. Sources of interference that may be a problem include failing fluorescent lights and construction equipment. See “Electromagnetic Compatibility” on page 12-5.
General Safety Warning Place the transceiver in a pouch or over clothing, or both, during patient use. The transceiver should not touch the patient’s skin during use. Warning To avoid the risk of strangulation, do not tie a pouch solely around the patient’s neck. Warning Patients should be instructed not to open the battery compartment while the transceiver is in use.
General Safety Warning Short-range radio connections are subject to interruption due to interference from other radio sources in the vicinity, including microwaves, bluetooth devices, and DECT phones. Outside the frequency band and 5% above and below, i.e. the exclusion band according to IEC 60601-1-2, the short-range radio connection is immune up to 3V/m in the frequency range from 80MHz to 2.0 GHz and up to 1V/m in the frequency range from 2.0 to 2.3 GHz.
General Safety 2-6 Product Safety
This chapter describes the clinical controls of the transceiver. These controls include buttons, visual and auditory indicators, ports, and safety labelling located on the front and back of the device. The chapter includes the following sections: • • • Transceiver Controls - Front. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2 •Buttons. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3 •Power On/Off . . . . . . . . . . . . . . . . . . . .
Transceiver Controls - Front Transceiver Controls - Front P1 L1 P2 TRx4851A I1 I2 B1 I3 I4 B2 L2 L3 P3 O1 The labeled items in the diagram include: • • • • • Buttons (B1-B2) Power On/Off (O1) Indicators (I1-I4) Labels (L1-L3) Ports (P1-P3) IntelliVue TRx+ Transceiver - Front View 3-2 Transceiver Controls
Transceiver Controls - Front Buttons IntelliVue TRx+ M4841A EASI, 3 5,6 Callout B1 B2 B1 Button Definition Telemetry Button • Depending on configuration, directs the Information Center to generate a Nurse Call alarm, remote recording, both Nurse Call alarm and recording, or none. See “Telemetry Functions at the Information Center” on page 9-2. Note—Delayed recordings generated by the Telemetry button are stored in Alarm Review at the Information Center.
Transceiver Controls - Front Callout Button B2 Definition Check Button • Initiates a Status Check of the transceiver. See “Status Check” on page 4-12. • Resumes monitoring after Standby. See “Standby Mode” on page 4-4 • Indicates association with the Information Center (single beep). See “Audible Tones” on page 3-12. • When pressed simultaneously with the Telemetry button, turns Alarm Suspend/ Pause on/off (if configured and not when connected to TeleMon or networked IntelliVue MP5 Patient Monitor).
Transceiver Controls - Front Indicators IntelliVue TRx+ I1 I2 I3 I4 M4841A EASI, 3 5,6 Callout Indicator Definition I1 Lead Indicator • Illuminates momentarily during leadset insertion to indicate attached leads. • Illuminates when Check button is pressed to indicate attached leads. • During a Leads Off condition, illuminates to indicate the lead(s) that need to be reapplied. Reference lead indicator only on indicates all leads are off.
Transceiver Controls - Front Callout Indicator I4 Definition Battery Gauge Illuminates when the Check button is pressed, indicating the amount of power remaining in the batteries. Note—Valid only for recommended battery type. See “Checking the Battery Power Level” on page 4-17. Labels L1 IntelliVue TRx+ M4841A EASI, 3 5,6 Callout Label Definition L1 L2 L3 IntelliVue TRx TRx4841A EASI, 3 5,6 Leadset Insertion Guide Assists in aligning the ECG cable for different leadsets.
Transceiver Controls - Front Ports P2 P1 IntelliVue TRx+ M4841A EASI, 3 5,6 Callout Definition P1 ECG Leadset Port Connection for 3-, 5-, or 6-wire leadset. P2 SpO2 Sensor Port (IntelliVue TRx+ only) Connection for SpO2 sensor. See Note. P3 Monitor/Service Port Connection for the Short-Range Radio Adapter, the cable to the TeleMon Companion Monitor and MP5 IntelliVue Patient Monitor, or to the Service Tool. See Note.
Transceiver Controls - Back Transceiver Controls - Back S8-S14 not shown (inside battery compartment) EASI EASI L1 L2 S1 S2 S7 S3 S5 S4 S6 The labeled items in the diagram include: • Labels (L1-L2) • Safety symbols and other marks (S1-S14) IntelliVue TRx+ Transceiver - Back View 3-8 Transceiver Controls S8
Transceiver Controls - Back Labels L1 Callout EASI EASI L2 Definition S A I E 12 6 345 Safety Symbols & Other Marks L1 Electrode Placement Diagram for EASI See “5-Wire Placement (EASI Mode)” on page 6-16. L2 Electrode Placement Diagram for Standard ECG See “5-Wire Placement (Standard Mode)” on page 6-14.
Transceiver Controls - Back Callout Label Definition S5 Follow operating instructions. i S6 Prescription Device Rx S7 Canadian and American standards compliance Complies with applicable Canadian and American standards. S8 Defibrillation Proof Patient connections are protected against defibrillation (DEFIBRILLATIONPROOF) and are a TYPE CF APPLIED PART. Labels on Inside of Battery Compartment S9 REF Catalog Number Use to identify the equipment during a call to the Philips Response Center.
Transceiver Controls - Back Callout Label Definition S11 MAC Address of device MAC S12 Date of manufacture S13 Battery Polarity S14 Attention! See Instructions for Use.
Audible Tones Audible Tones The transceiver produces seven different auditory information signals to inform you of measurement and transceiver conditions during normal use. Most are generated automatically. Clinical Use Auditory Information Signal 3-12 Sound Sound 1 beep Sound 2 low-pitch tone Sound 3 alternating pitch repeated tone Transceiver Controls How Used • Indicates successful Self-Test at power on.
Audible Tones Auditory Information Signal Sound 4 Sound 5 Adjustable Sounds Sound beep beep How Used • • Indicates failed Self-Test at power on. Indicates failed SpO2 Spot Check measurement when measurement is initiated at the transceiver. • If it sounds when the Check button is pressed, it indicates that the transceiver is not in contact with the Information Center. beep beep Indicates transceiver is out of range or not every 5 seconds associated with a sector.
Audible Tones and pulse detection tone. The sounds can be turned off (muted) on a per patient basis in the Telemetry Setup window. Auditory Signal (sound) Service Sounds Function Sound 1 (beep) Spot Check Announces a successful SpO2 Spot Check measurement. Sound 1 (beep) Check Button Confirms contact with the Information Center. Sound 2 (low pitch tone) Pulse Detection Tone Indicates pulse during SpO2 Spot Check measurement.
This chapter describes the basic operation of the transceiver. It includes the following sections: • • • • • Transceiver Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2 Turning the Transceiver On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2 Briefing the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6 Testing Transceiver Functionality . . . . . . . . . . . . . . . . . . . . . . . . . . .
Transceiver Safety Information Transceiver Safety Information Warning The system is not completely immune from radio interference although it is designed to minimize interference through smart hopping. Sources of interference that may be a problem include failing fluorescent lights and construction equipment. See “Electromagnetic Compatibility” on page 12-5. Warning Place the transceiver in a pouch or over clothing, or both, during patient use.
Turning the Transceiver On/Off Turning On The transceiver is powered by two AA alkaline batteries. To turn the transceiver on, insert both batteries. When batteries are inserted: 1. All indicators illuminate briefly. 2. A sequence of sounds indicates the instrument is ready for use. a. a single beep, indicating that the self test was passed. b. a series of double beeps, indicating the transceiver is attempting to establish contact with the Information Center. c.
Turning the Transceiver On/Off The configuration data set by the service provider prior to transceiver use is retained after battery removal. RF Auto Shutoff When RF Auto Shutoff is enabled (default), the transceiver stops broadcasting a radio signal in order to prevent interference with other transceivers in use. This condition occurs if there is no ECG signal for 10 minutes and the SpO2 sensor cable is not inserted in the SpO2 sensor port.
Turning the Transceiver On/Off Step 3 Action Select the duration of the standby period (depending on your system’s configuration: Infinite, 4 Hours, 3 Hours, 2 Hours, 1 Hour, 30 Minutes, 20 Minutes, or 10 Minutes). Note—If the patient will be discharged, select “Infinite” as the standby duration. 4 Select the appropriate location, then select Suspend Monitoring. The message “Telemetry Standby” and location, if selected, are displayed in the sector.
Briefing the Patient Resuming Monitoring Step 1 Action If the standby period has not expired: • Press the Check button to re-establish contact with the Information Center. The single beep at the transceiver verifies that monitoring has resumed. • If you hear a double beep, click Resume Monitoring at the Information Center. If there’s still no association, contact the service provider. If the standby period has expired: • Monitoring resumes automatically if the patient is in the coverage area.
Briefing the Patient If desired, you can turn off patient use of the button at the Information Center. See “Patient Configurable Settings in Telemetry Setup” on page 9-6. Pouch Use The transceiver is not intended for direct contact with the patient’s skin. During normal use, the transceiver should be worn over clothing, in a pocket or, preferably, in a pouch. The carrying pouch with clear front is an appropriate means for holding the transceiver. See Appendix A, “Accessories” for ordering information.
Briefing the Patient Step 2 Action Turn the pouch so that the opening is facing downward. This protects the transceiver from fluid and debris. Secure the pouch on the patient with the upper ties around the patient’s head and arm and the lower ties around the patient’s torso. Warning To avoid the risk of strangulation, do not tie a pouch solely around the patient’s neck. Place Tie arm. a under the a b Place Tie b around the neck. Tie a and b together around the neck.
Briefing the Patient Step 3 Action Check that the patient is comfortable wearing the pouch with transceiver.
Briefing the Patient Showering Warning When the patient is showering, signal quality and leads off detection may be compromised due to significant movement. Appropriate clinical precautions must be taken. The transceiver can be used to monitor a patient in the shower, but only when placed inside a Philips carrying pouch and secured on the patient as described above. The combination of the transceiver and pouch will withstand showering for up to 10 minutes.
Testing Transceiver Functionality Testing Transceiver Functionality There are two tests of IntelliVue Transceiver functionality: • • Self Test - performed automatically each time the transceiver is turned on. Status Check - initiated manually by the clinician. Self Test Warning Do not use the transceiver for patient monitoring if it fails the Power On Self Test. Caution Do not insert a leadset during a self-test. The leadset can be inserted after the self-test.
Testing Transceiver Functionality Status Check You can check the status of the transceiver indicators at any time. Initiating a Status Check Step 1 Action Press the Check button. The following indicators should illuminate for as long as the Check button is depressed.
Battery Information Battery Information Battery Safety Information Warning The battery door must be closed during defibrillation. Warning Use Duracell Alkalaine batteries, size AA, MN 1500, 1.5V, to ensure specified performance. Outdated, mismatched, or poor-quality batteries can give unacceptable performance (e.g., insufficient Battery-Low warning time). The use of fresh high-quality alkaline batteries is strongly recommended.
Battery Information Warning Batteries should be removed from the transceiver at the end of the battery’s useful life to prevent leakage. If battery leakage should occur, use caution in removing the battery. The leaked substance may cause eye or skin irritation. Avoid contact with skin. Clean the battery compartment according to instructions in “Chapter 11. Maintenance, Cleaning & Troubleshooting”. Wash hands.
Battery Information Inserting the Batteries Insert batteries into the transceiver using the following procedure. Step Action 1 Open the battery compartment by swinging the compartment door 90o counterclockwise into an open hinged position. 2 Insert two AA 1.5V Alkaline batteries, matching the polarity with the +/- indications inside the compartment. + + Note— Both batteries are inserted with the + polarity in the same direction. 3 Close the battery compartment door.
Battery Information Removing the Batteries To remove the batteries, open the battery compartment door and push from the opening at the back of the compartment to pop the batteries out. Transceiver settings (ECG leadset type, SpO2 mode, volume, etc.) are retained indefinitely when the batteries are removed. If you remove good batteries to turn off the transceiver, keep them together as a set for later re-use so that both batteries will have the same level of power remaining.
Battery Information Checking the Battery Power Level When the Check button is pressed, the battery gauge on the transceiver indicates the battery power level. It is reliable only when specified batteries (i.e., AA 1.5V Alkaline) are used. The battery gauge is also displayed in the Patient Sector at the Information Center (if configured) to enable you to closely monitor battery status, for example, after a change of shift.
Battery Information Battery Levels Battery Gauge Approximate Battery Life* Remaining Approximate Operating Time* Remaining Functionality 4 green indicators > 75% > 34.7 hours Normal operation 3 green indicators > 50% > 23.1 hours Normal operation 2 green indicators > 25% > 11.
Battery Information Battery Life Battery life is dependent upon: • • • Condition of the batteries. Parameters being monitored - ECG only, ECG and Spot Check SpO2, or ECG and Continuous SpO2. Use of the Short Range Radio Adapter (SRRA). The transceiver’s batteries power the SRRA, and under normal operating conditions, battery life may be reduced by up to 25%. See “Battery Specifications” on page 12-8 You can optimize battery life by: • • Removing the batteries when the transceiver is not in use.
Battery Information 4-20 Basic Operation
This chapter lists Physiologic (Patient) Alarms and Technical (Inoperative Condition) Alarms. It also describes how to pause/suspend alarms temporarily. It includes the following sections: • • • • Alarm Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2 Suspending/Pausing Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2 Physiologic Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Alarm Indicators Alarm Indicators A description of visual and auditory information signals for patient and technical alarms on the Information Center is located in the IntelliVue Information Center Instructions for Use and the Information Center Online Help.The Information Center documentation also includes the default alarm settings and physiological alarm limit ranges. Alarm behavior specific to the use of the transceiver paired with an IntelliVue Patient Monitor is described in “Chapter 10.
Suspending/Pausing Alarms If the transceiver is connected to TeleMon or the MP5 IntelliVue Patient Monitor, alarms can be suspended only from TeleMon or the IntelliVue Patient Monitor, and not from the Information Center. The Alarms Suspend icon on the transceiver is lit (see “Transceiver Controls - Front” on page 3-2), and an "Alarms Suspended" message appears at TeleMon, the patient monitor and the Information Center.
Physiologic Alarms Unsuspending & Resuming Alarms Alarms will be resumed automatically after the configured suspend duration time. You can cancel alarm suspend manually before the configured suspend duration time has expired from the transceiver (see following directions) or from the Information Center. Step 1 Action Press the Telemetry and Check buttons simultaneously until the indicator turns off. • • 2 The Alarm Suspend icon is turned off.
Physiologic Alarms Warning Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm volume to a low level during patient monitoring may result in patient danger. Remember that the most reliable method of patient monitoring combines close personal surveillance with correct operation of monitoring equipment.
Physiologic Alarms Physiologic (Patient) Alarms Alarm Text Priority Condition Source *** DESAT Red Very Low SpO2 Saturation. SpO2 value below Desaturation limit SpO2 Note—Desat limit is set 10 points below low limit. *** TACHY yyy > xxx Red Extreme Tachycardia. Heart Rate (yyy) greater than Extreme Tachy limit ST/AR Basic & Enhanced Arrhythmia *** V-FIB/TACH Red Ventricular Fibrillation.
Physiologic Alarms Physiologic (Patient) Alarms Alarm Text Priority Condition Source ** SpO2T yyy > xxx Yellow High SpO2. SpO2 value (yyy) greater than high SpO2 limit (xxx). SpO2 ** SpO2T yyy < xxxx Yellow Low SpO2. SpO2 value (yyy) less than low SpO2 limit (xxx). SpO2 ** ST lead > xxx Yellow STlead is greater than the Elevation limit. ST/AR ** ST lead < xxx Yellow STlead is less than the Depression limit.
Physiologic Alarms Physiologic (Patient) Alarms Alarm Text Priority Condition Source * NON-SUSTAIN VT Yellow A run of Vs having a ventricular Heart Rate greater than V-Tach limit but lasting for less than the V-Tach Run limit. ST/AR Enhanced Arrhythmia * PACER NOT CAPT Yellow No QRS for 1.75 x the average R-R interval with Pace Pulse (paced patient only). ST/AR Basic & Enhanced Arrhythmia * PACER NOT PACE Yellow No QRS and Pace Pulse for 1.75 x the average R-R interval (paced patient only).
Physiologic Alarms Physiologic (Patient) Alarms Alarm Text Priority Condition Source * R-ON-T PVCs Yellow For Heart Rate less than 100, a PVC with R-R interval less than 1/3 the average interval followed by a compensatory pause of 1.25 x average R-R interval, or 2 such Vs without a compensatory pause occurring within 5 minutes of each other. (When Heart Rate is greater than 100, 1/3 R-R interval is too short for detection.
Technical Alarms (INOPs) Technical Alarms (INOPs) Technical Alarms, or INOPs (inoperative conditions), are sourced at the transceiver, the ST/AR algorithm running at the Information Center, the TeleMon Companion Monitor, or the IntelliVue Patient Monitor. They identify inoperative conditions (that is conditions where the system is not operating properly and therefore cannot measure or detect alarm conditions reliably).
Technical Alarms (INOPs) In the following table, technical alarms are listed alphabetically. Technical Alarms (Inoperative Conditions) Alarm Text Priority Condition What to do BATTERY LOW BATTERY LOW T Soft When operating wirelessly, the patient monitor is no longer providing power to the transceiver, and battery capacity is diminished. There is less than 15 minutes of monitoring time remaining. Replace batteries promptly to avoid transceiver shutdown and cessation of monitoring.
Technical Alarms (INOPs) Technical Alarms (Inoperative Conditions) Alarm Text Priority Condition What to do CENTRAL: TELE ONLY Hard System connectivity via the transceiver is limited (no alarms, only local numerics) when in companion mode and host monitor does not have system connectivity. Only the transceiver’s measurements and alarms can be displayed at the Information Center. If the disconnection of the host monitor is not intentional, re-connect the monitor to the network.
Technical Alarms (INOPs) Technical Alarms (Inoperative Conditions) Alarm Text Priority CHECK PAIRING Yellow Technical Alarm Source - Telemetry CHECK SpO2T Settings What to do • There is a problem with device pairing. • • When the transceiver is wirelessly paired with an X2 patient monitor (no label) docked with a larger networked MP series monitor, and the network connection is lost. • Hard Synchronization of SpO2T settings between the monitor and the Information Center has failed.
Technical Alarms (INOPs) Technical Alarms (Inoperative Conditions) Alarm Text Priority ECG LEADS OFF Note—This INOP may also be configured to display as a Red or Yellow Technical Alarm. Red or Yellow or Hard Technical Alarm Condition What to do • Multiple leads are off. • Re-attach ECG leads to patient. • The short-range radio connection between the transceiver and the MP5, MP2, or X2 Patient Monitor has failed. • Identify and remove the interference source.
Technical Alarms (INOPs) Technical Alarms (Inoperative Conditions) Alarm Text Priority Condition MORE BED ALARMS Source - Patient Monitor Red or Yellow or Hard Technical Alarm The monitor is associated with a transceiver and is sending data to the Information Center via the transceiver. There are currently more alarms at the bedside than can be transmitted to the Information Center. NO ARRHYTHMIA Soft All basic ST/AR ECG alarms have been turned off. Turn arrhythmia alarms on.
Technical Alarms (INOPs) Technical Alarms (Inoperative Conditions) Alarm Text Priority NO SIGNAL Hard Source - Information Center Condition • • • • OUT OF AREA Source - Information Center Hard REPLACE BATTERY REPLACE BATTERY T Note—This INOP may also be configured to display as a Red or Yellow Technical Alarm.
Technical Alarms (INOPs) Technical Alarms (Inoperative Conditions) Alarm Text Priority Condition What to do SpO2T EQUIP MALF Hard Malfunction in the SpO2 equipment Contact Service. Hard Erratic SpO2 measurements, often due to a faulty sensor or invalid SpO2 measurements, or incorrect transducer position Repeat measurement, reposition sensor on patient, or finally, replace sensor.
Technical Alarms (INOPs) Technical Alarms (Inoperative Conditions) Alarm Text Priority Condition What to do SpO2T NOISY SIGNAL Hard Excessive patient movements or electrical interference are causing irregular pulse patterns Reduce movement or electrical noise sources. Hard Pulse is too weak or not detectable Check connection to patient. Change sensor site. Avoid site distal to BP cuff or intraarterial line. Hard Malfunction of the SpO2 sensor/adapter cable Replace sensor.
Technical Alarms (INOPs) Technical Alarms (Inoperative Conditions) Alarm Text Priority TELE DISCONNECTED Red, Yellow or Hard Technical Alarm Condition What to do The interface cable is not connected. Short-range radio connection between the transceiver and the patient monitor has been lost. There are too many short-range radios operating in the same vicinity (maximum of 4 per radio channel). If the disconnection is not intentional: • Re-connect the interface cable.
Technical Alarms (INOPs) Technical Alarms (Inoperative Conditions) Alarm Text Priority Condition What to do TELE UNSUPPORTED Hard The transceiver is not supported for direct connection to the monitor. Contact Service. Make sure the transceiver is the correct revision. Source - Patient Monitor TELE WEAK SIGNAL Soft • Source - Telemetry • • TRANSMITTER MALF Patient is at outer range of the radio coverage area. Telemetry pack is receiving a weak signal with high data loss from the AP.
This chapter covers the specifics of ECG measurement. It includes the following sections: • • • • • • • ECG Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2 Measuring ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4 Positioning ECG Electrodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10 Connecting the ECG Cable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ECG Safety Information ECG Safety Information Warning Always confirm Information Center observations with clinical observation of the patient before administering interventions. Warning Every lead must be secured to an electrode on the patient. Conductive parts of electrodes must not contact earth or other conductive parts. Philips recommends that you change the lead label only to reflect the physical placement of electrodes.
ECG Safety Information For Paced Patients Warning The output power of the transceiver and other sources of radio frequency energy, when used in the proximity of a pacemaker, can be sufficient to interfere with pacemaker performance. Due to the shielding effects of the body, internal pacemakers are somewhat less vulnerable than external pacemakers. However, caution should be exercised when monitoring any paced patient.
Measuring ECG Measuring ECG The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the Information Center as a waveform and a numeric. In order to compare measured ECG signals, the electrodes (or leadsets) are placed in standardized positions, forming so-called “leads”. To obtain ECG signals optimized for use in diagnosis and patient management in different care environments, different leadsets in varying lead placements are used.
Measuring ECG The transceiver detects the inserted leadset type and automatically determines the ECG measurement and transmitted leads. The Leadset Insertion Guide on the device will assist you in ensuring the correct measurement during transceiver usage. If the transceiver senses the insertion of a leadset not matching the current configuration, the transceiver will source the ECG per the leadset detected and issue and auditory signal to indicate the condition.
Measuring ECG There is no cardiotach within the transceiver; cardiotach analysis resides in the arrhythmia algorithm at the Information Center. Therefore, arrhythmia analysis is always turned on for telemetry patients. Arrhythmia analysis is either Basic or Enhanced, depending on the product configuration. ECG Leads Monitored Depending on the leadset connected to the transceiver, a different set of viewable leads are available at the Information Center.
Measuring ECG If you are using ... 5-wire (EASI mode) these leads can be selected at the Information Center I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 In EASI mode, the sourced (raw) waves are received as: • Channel 1 = Vector 1 (A-I) • Channel 2 = Vector 2 (A-S) • Channel 3 = Vector 3 (E-S) Defaults are II, V2, III, V5.
Measuring ECG If you are using ... 6-wire (Vb is not supported on TeleMon.) these leads can be selected at the Information Center I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6, V7, V8, V9, V3R, V4R, V5R. Sourced (raw) waves are received as: • Channel 1 = II • Channel 2 = III • Channel 3 = Va • Channel 4 = Vb Defaults are II, Va = V2, III,Vb = V5. The two chest leads, Va and Vb, can be placed on the patient in any of the V lead positions (V1 through V9, V3R, V4R, V5R).
Measuring ECG Reconstructed Leads Reconstruction of leads from the sourced wave is defined by the calculations in the following table. EASI reconstructed leads are a linear combination of all three raw EASI leads.
Positioning ECG Electrodes Positioning ECG Electrodes Warning Do not mix and match electrodes of different types. In particular, do not use electrodes of dissimilar metals. This helps ensure optimal signal quality. Warning Non-manufacturer supplied accessories and supplies can corrupt the performance of the equipment. Use only AAMI EC-12 compliant electrodes with this device. Use of electrodes that are non-compliant may provide erroneous results.
Positioning ECG Electrodes In addition to correct positioning of the electrodes, optimal skin preparation prior to electrode placement will help ensure a clear signal for diagnosis. Step Action 1 Prepare the patient’s skin. Good electrode-to-skin contact is important for a good ECG signal, as the skin is a poor conductor of electricity. • Select sites with intact skin, without impairment of any kind. • Clip or shave hair from the site as necessary.
Positioning ECG Electrodes Locating the Fourth Intercostal Space Angle of Lewis For accurate chest electrode placement and measurement, it is important to locate the fourth intercostal space. This can be done using the Angle of Lewis. 1. Locate the second intercostal space by first palpating the Angle of Lewis (the bony protuberance where the body of the sternum joins the manubrium).
Positioning ECG Electrodes 3-Wire Placement RA LA LL Lead Placement RA directly below the clavicle and near the right shoulder LA directly below the clavicle and near the left shoulder LL on the left lower abdomen ECG Monitoring 6-13
Positioning ECG Electrodes 5-Wire Placement (Standard Mode) RA LA V1 V2 V3 V4 V5 V6 RL 6-14 ECG Monitoring LL Lead Placement RA directly below the clavicle and near the right shoulder LA directly below the clavicle and near the left shoulder LL on the left lower abdomen RL on the right lower abdomen V on the chest, the position depends on your required lead selection. The typical position is V1, although this may vary according based on your hospital’s protocol.
Positioning ECG Electrodes Lead Placement V1 on the fourth intercostal space at the right sternal border V2 on the fourth intercostal space at the left sternal border V3 midway between the V2 and V4 electrode positions V4 on the fifth intercostal space at the left midclavicular line V5 on the left anterior axillary line, horizontal with the V4 electrode position V6 on the left midaxillary line, horizontal with the V4 electrode position ECG Monitoring 6-15
Positioning ECG Electrodes 5-Wire Placement (EASI Mode) S I A E Lead Corresponds to Standard Lead E V on the lower sternum at the level of the fifth intercostal space A LL on the left midaxillary line at the same level as the E electrode S LA on the upper sternum I RA on the right midaxillary line at the same level as the E electrode N Reference can be anywhere, usually below the sixth rib on the right hip Placement Note—Make sure that the S and E electrodes line up vertically on the
Positioning ECG Electrodes 6-Wire Placement 6-lead placement uses the same four limb leads as 5-lead standard placement, and two precordial leads - referred to at the Information Center as Va and Vb. The default position of Va - the brown lead - is at the V2 position. The default position for Vb - the brown/white lead - is at the V5 position. The lead placement for the Va and Vb lead labels must be appropriate.
Positioning ECG Electrodes 6-18 ECG Monitoring Lead Placement LA directly below the clavicle and near the left shoulder RL on the right lower abdomen LL on the left lower abdomen Va on the chest, the position depends on your required lead selection (see below). The default position is V2. For other positions, relabel the lead at the Information Center. Vb on the chest, the position depends on your required lead selection (see below). The default position is V5.
Positioning ECG Electrodes Lead Placement V1 on the fourth intercostal space at the right sternal border V2 on the fourth intercostal space at the left sternal border V3 midway between the V2 and V4 electrode positions V4 on the fifth intercostal space at the left midclavicular line V5 on the left anterior axillary line, horizontal with the V4 electrode position V6 on the left anterior axillary line, horizontal with the V4 electrode position ECG Monitoring 6-19
Positioning ECG Electrodes 6-20 ECG Monitoring V7 on the left posterior axillary line, straight line from V6 V8 on the left midscapular line, straight line from V7 V9 on the left paraspinal line, straight line from V8 V3R midway between the V1 and V4R electrode positions V4R on the fifth intercostal space at the right midclavicular line V5R on the right anterior axillary line, straight line from V4R
Connecting the ECG Cable Connecting the ECG Cable Caution Do not insert a leadset in the transceiver during a self-test. The leadset should be inserted either before the transceiver is powered up, or after the device has established connection with the Information Center. Note—When using 3- or 5-wire leadsets, alignment guides should be used to prevent the build up of debris in open lead ports.
Connecting the ECG Cable Step 1 Action Match the arrow on the ECG cable with the arrow on the Lead Insertion Guide according to the lead type you have chosen, and insert the ECG cable into the transceiver. Important—Make sure that the cable is pushed completely into the transceiver, otherwise the device may not detect the proper leadset type. When correctly inserted, the colored line at the base of the cable is not visible.
Connecting the ECG Cable Step Action 5-wire Standard 3 Match the arrow on the cable with the right arrow (labeled 5, 6) on the Leadset Insertion Guide. colored line line IntelliVue TRx M4841A EASI, 3 5.6 5-wire EASI Match the arrow on the cable with the left arrow (labeled EASI, 3) on the Leadset Insertion Guide. colored line IntelliVue TRx M4841A EASI, 3 5.
Connecting the ECG Cable Step Action 6-wire Match the arrow on the cable with the right arrow (labeled 5,6) on the Leadset Insertion Guide. colored line IntelliVue TRx M4841A EASI, 3 5.6 4 For 6-lead, select the lead label(s) at the Patient Window. 5 Check that the correct Electrode Indicators are lit for the leadset you are using, and that the EASI indicator light is illuminated appropriately. See “Verifying Electrode Connections” on page 6-25.
Verifying Electrode Connections Verifying Electrode Connections The electrode indicators enable you to verify that the leads are available for the desired monitoring. Pressing and holding the Check button enables you to view the leadset status. During routine use of the transceiver for monitoring, all lead indicators are off.
Verifying Electrode Connections Step 2 Action Expected Response: • • • • • 3 If 3-wire cable is attached: Red, White and Black indicators illuminate, then all turn off. If 5-wire cable in Standard mode is attached: Red, White, Black, Green & Brown indicators illuminate, then all turn off. If 5-wire cable in EASI mode is attached: Red, White, Black, Green & Brown indicators illuminate, then all turn off. The EASI indicator also illuminates briefly.
Monitoring during Leads Off During routine monitoring, the electrode indicators also notify you if one or more leads are not functioning. When a "Leads Off" condition occurs, the transceiver automatically illuminates the indicator corresponding to the missing lead. Note—Should the lead in the reference lead placement position (standard mode - RL; EASI mode - green) become disconnected, the ECG signal is lost entirely.
Monitoring during Leads Off Fallback for EASI Relearning If one of the derived EASI leads is in a technical alarm condition, a flat line is displayed. After 10 seconds, the directly acquired EASI AI, AS, or ES lead, depending on which is available, is displayed with the label “ECG”. Arrhythmia relearn is performed with transition to or from EASI Fallback monitoring using the available lead(s).
Optimizing ECG Measurement Performance Optimizing ECG Measurement Performance Warning Telemetry should not be used for primary monitoring in applications where the momentary loss of the ECG is unacceptable. No matter how good a wireless network design is, a telemetry system will always experience occasional loss of radio communications, resulting in ECG waveform dropouts. A telemetry system will never be as reliable as a hardwired bedside monitor that transmits its signal through a wire.
Optimizing ECG Measurement Performance Clinicians will tend to see more motion related artifact on the ECG of ambulatory patients than on patients that are restricted to a bed. Proper skin preparation and electrode application are very important in reducing this problem. Problems with the ECG signal stem from two main sources: 1. Frequency-related sources resulting in dropouts from signal disturbances and loss of signal. 2.
Optimizing ECG Measurement Performance disassociation/reassociation with the Information Center, events in the Clinical Review application can reflect loss of data for up to 1 minute in the worst case. Problem Cause Dropouts Signal Strength Remedy Low signal strength See “Signal Strength” below. RF interference See “Radio Frequency Interference” below.
Optimizing ECG Measurement Performance effects and Smart-hopping enables the system to avoid most instances of interference. The 2.4 GHz ISM band used by the ITS4850A IntelliVue Telemetry System is used by many different radio technologies, (e.g. microwave ovens, wireless phones, Bluetooth devices). Therefore, there is increased potential for interference. The system has the ability to detect whether the spectrum is too congested.
Optimizing ECG Measurement Performance Problem Cause Remedy 60-Cycle (AC) Interference Poor electrode placement. Re-apply electrodes, using good skin preparation (see “Positioning ECG Possible non-grounded Electrodes” on page 6-10). instrument near patient. Disconnect electrical appliances near patient (one at a time) by pulling wall plugs, to determine faulty grounding. Have engineering check grounding. Muscle Artifact Tense, uncomfortable patient. Poor electrode placement. Tremors. Diaphoresis.
Optimizing ECG Measurement Performance Problem Baseline Wander Cause Remedy Movement of patient. Make sure patient is comfortable. Improperly applied electrodes. Re-apply electrodes, using good skin preparation (see “Positioning ECG Electrodes” on page 6-10). Check that patient cable is not pulling electrodes. Respiratory interference. Move electrodes away from areas with greatest movement during respiration. Poor Electrode Contact Loose electrodes. Defective cables. Leadset not firmly connected.
This chapter describes the ST/AR algorithms used for telemetry at the IntelliVue Information Center. It includes the following sections: • • • ST/AR Arrhythmia Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2 ST/AR ST Segment Algorithm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7 ST/AR QT Interval Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ST/AR Arrhythmia Algorithm ST/AR Arrhythmia Algorithm Indications for Use The ST/AR Arrhythmia Algorithm is indicated for use in instances where the clinician decides to monitor cardiac arrhythmias of adult and pediatric patients and/or the ST segment of adult patients to gain information for treatment, monitor the adequacy of treatment, or to exclude causes of symptoms.
ST/AR Arrhythmia Algorithm Warning Relearning Arrhythmia relearning is initiated whenever the transceiver is powered down for one minute or longer or whenever it is directly connected/ disconnected to an IntelliVue MP5 Patient Monitor. Be sure to check your patient’s arrhythmia annotation for accuracy whenever relearn has occurred. Since Relearn happens automatically, if learning takes place during ventricular rhythm, the ectopics can be incorrectly learned as the normal QRS complex.
ST/AR Arrhythmia Algorithm Warning For paced patients who exhibit only intrinsic rhythm, the monitor can erroneously count pace pulses as QRS complexes when the algorithm first encounters them, resulting in missed detection of cardiac arrest. The risk of missing cardiac arrest can be reduced by monitoring these patients with the low heart rate limit at or slightly above the basic/demand pacemaker rate. A low heart rate alarm alarms you when the patient begins pacing.
ST/AR Arrhythmia Algorithm ST/AR Arrhythmia Analysis For information on arrhythmia detection, refer to the following documentation: • • ST/AR Algorithm - Arrhythmia Monitoring Application Note, #453564115631. IntelliVue Information Center Instructions for Use and Online Help IntelliVue Telemetry does not have a dedicated cardiotach. Instead, the arrhythmia cardiotach at the Information Center is used.
ST/AR Arrhythmia Algorithm Beat classification determined by the ST/AR algorithm is shown on the primary delayed wave in the Arrhythmia Analysis window at the Information Center. To access this window, select Arrhythmia Analysis from the Patient Window. The annotation requires clinical validation of the analyzed heart rhythm. If the analysis is inaccurate, perform a relearn of the rhythm.
ST/AR ST Segment Algorithm ST/AR ST Segment Algorithm Intended Use The intended use of the ST/AR ST Analysis algorithm is to monitor an adult patient’s ECG for ST segment elevation or depression and produce events/ alarms for all possible ECG leads. The ST Analysis algorithm is capable of monitoring paced and non-paced adult patients. Note—The ST Analysis algorithm does not analyze ventricularly paced or ventricular ectopic beats.
ST/AR ST Segment Algorithm • • The Measurement ST/AR Algorithm - ST Segment Monitoring Application Note, #452298192851 IntelliVue Information Center Instructions for Use and Online Help The ST measurement for each beat complex is the vertical difference between two measurement points. The isoelectric point provides the baseline for the measurement and the ST point provides the other measurement point. It is positioned with reference to the J-point.
ST/AR ST Segment Algorithm • • • • 5-wire: up to two leads if monitoring a chest and a limb lead 5-wire: up to six leads if monitoring two limb leads 5-wire: up to 12 leads if monitoring using EASI 6-wire: up to 8 leads if monitoring two limb leads and two chest leads Note—No ST analysis is done on a patient if an electrode falls off. Displayed ST Data ST data displays as values in the Patient Sector and Patient Window.
ST/AR ST Segment Algorithm • • • • Adjusting ST Measurement Points You are unable to get any lead that is not noisy. Arrhythmias such as atrial fib/flutter cause irregular baseline. The patient is continuously ventricularly paced. The patient has left bundle branch block. The ST Setup Window enables you to adjust the ST measurement points to ensure accurate data. There are three measurement cursors: • The ISO measurement cursor positions the isoelectric point in relation to the R-wave peak.
ST/AR ST Segment Algorithm Step 3 Action Adjust the J point, if necessary, by placing the cursor over the Jpoint button to access the adjustment arrows. Then use the arrows to position the bar at the end of the QRS complex and the beginning of the ST segment. R T P Q 4 S J point Adjust the ST point, if necessary, by using the J point as an “anchor” and placing the bar at the midpoint of the ST segment. Choices are J+0, J+20, J+40, J+60, or J+80.
ST/AR ST Segment Algorithm ST Alarm Settings All IntelliVue Information Center alarm settings (limits and on/off status) have unit default settings. The IntelliVue Information Center however, lets you set the high and low ST alarm limits for individual patients based on: • • • Your assessment of the patient's clinical condition. Unit protocols. Physician orders or medication specified limits.
ST/AR ST Segment Algorithm Adjusting ST Alarms Make adjustments to ST alarms on the ST Alarms window at the Information Center. Step Action 1 From the Patient Window, select the All Controls button. 2 From the All Controls window, select the ST Alarms button under Alarm Management and Setup. 3 In the ST Alarms window, adjust alarms as needed. Choices for setting the ST alarm limits are: Unit Settings—Click on this button if want to have the specific limits that are pre-set for your unit.
ST/AR QT Interval Algorithm ST/AR QT Interval Algorithm Intended Use The intended use of the ST/AR QT/QTc analysis is for use by the physician in the risk assessment process indicated for pediatric and adult patients with and without symptoms of arrhythmia. QT measurement is intended to be used by qualified health professionals in hospital or clinical environments.
ST/AR QT Interval Algorithm What is QT Interval Monitoring Of special concern for QT monitoring is the administration of QT prolonging drugs to patients identified with risk factors for Torsade de Pointe. Females, older patients and patients with bradycardia, impaired left ventricular function (ischemia, left ventricular hypertrophy), hypokalemia and hypomagnesemia are in this increased risk category. QT interval monitoring can assist in the detection of prolonged QT interval syndrome.
ST/AR QT Interval Algorithm QT Definitions 7-16 Measurement Definition QT QT interval in milliseconds. The QT interval is the time between the beginning of the Q wave and the end of the Twave. QTc QTc represents the heart rate corrected QT interval. By default, the Information Center uses the Bazett correction formula to correct the QT interval for heart rate. Your system, however, may be set up to use the Fridericia correction formula.
ST/AR QT Interval Algorithm QT Alarms Alarm Definition **QTc High The QTc high limit alarm is a long yellow alarm that occurs when there are two consecutive 5 minute QTc values above the set alarm limit. **dQTc High The dQTc alarm is a long yellow alarm that occurs when the difference between the current value and the baseline value exceeds the set limit for two consecutive 5 minute dQTc values. The dQTc alarm has a lower priority than the QTc High alarm.
How the QT Analysis Algorithm Works How the QT Analysis Algorithm Works The Information Center measures the QT values once every minute during startup. Subsequently, the Information Center updates the QT values every five minutes. Normal or atrial paced beats and beats with a similar morphology are averaged to form a representative waveform for further processing.
How the QT Analysis Algorithm Works Adjustment Description Turn QT Analysis On/Off Turn QT analysis on by clicking in the QT Analysis On check box. QT analysis is on when a checkmark displays in the check box. When the QT measurement is on, a QT status message is displayed in the QT Setup window, along with the current values for QT, QTc, dQTc and QT-HR. The lead labels indicating the leads used to calculate the baseline and current values also appear.
How the QT Analysis Algorithm Works Adjustment Description Select the QT Lead The QT Lead field allows you to select which leads to analyze when calculating the QT parameters. To select the desired lead by clicking on the QT Lead drop down arrow then highlighting the lead from the list that displays. Choose: • All if you want a global QT measurement based on all available leads. For standard placement leads I, II, III, V and V1 through V6 are used.
How the QT Analysis Algorithm Works Adjustment Description Set the QT Baseline To quantify changes in the QTc value you can set a QTc baseline. Select the Set QT Baseline button to replace the baseline QTc value with the current QTc value. If a baseline has not been set the Information Center sets the baseline to the first valid value after measuring QT for five minutes. Setting a new baseline discards the previous baseline.
How the QT Analysis Algorithm Works Adjustment Description Turning QT Alarm On/Off There are two QT long yellow alarms (**); QTc High and dQTc High. The QTc High alarm occurs when two consecutive 5 minute QTc values are above the set alarm limit. The dQTc alarm occurs when the difference between the current value and the baseline value exceeds the set limit for two consecutive 5 minute dQTc values.
How the QT Analysis Algorithm Works Limitations for QT Monitoring Some conditions may make it difficult to achieve reliable QT monitoring. When this occurs the CANNOT ANALYZE QT INOP message displays at the Information Center, along with a QT STATUS message. Some conditions that may make reliable QT monitoring difficult include: • T-Wave Detection Limitations. Flat T-wave, atrial Fibrillation or atrial Flutter and prominent U-waves can make QT monitoring difficult.
How the QT Analysis Algorithm Works 7-24 ST/AR Arrhythmia Monitoring
This chapter provides an introduction to the SpO2 measurement and its application. It includes the following sections: • • • • • • • • SpO2 Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2 Pulse Oximetry Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5 Selecting a SpO2 Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-7 Applying the Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SpO2 Safety Information SpO2 Safety Information Warning Always confirm Information Center observations with clinical observation of the patient before administering interventions. Warning Using a sensor during MR imaging can cause severe burns. To minimize this risk, ensure that the cable is positioned so that no inductive loops are formed. If the sensor does not appear to be operating properly, remove it immediately from the patient.
SpO2 Safety Information Warning Interference leading to inaccurate measurements can be caused by: - High levels of ambient light (Hint: cover application site with opaque material) - Electromagnetic interference - Excessive patient movement and vibration. Warning This equipment is not suitable for use in the presence of a flammable anesthetic mixture or oxygen concentrations greater than 25% (or partial pressures greater than 27,5 kPa /206.27 mmHg).
SpO2 Safety Information Physiological SpO2 alarm signals will be generated at the Information Center. The SpO2 low limit can be set between 50 and 99% inclusive, in 1% increments. The SpO2 high alarm limit can be set between 51 and 100% inclusive, in 1% increments. The maximum delay between the physiological alarm condition and alarm signal generation at the central station is 10 seconds. Pulse rate is also derived from the pulsatile SpO2 measurement, and displayed results can range from 30 to 300 bpm.
Pulse Oximetry Measurement Pulse Oximetry Measurement The ECG-SpO2 TRx+ Transceiver supports an SpO2 sensor connection using Fourier Artifact Suppression Technology (FAST). The FAST algorithm overcomes many of the issues associated with traditional pulse oximetry such as sensitivity to patient movement and intense ambient light. The algorithm offers improved motion artifact rejection as well as performance improvements for patients with low perfusion.
Pulse Oximetry Measurement • The amount of light passing through depends on many factors, most of which are constant, such as tissue or venous blood. However one of the factors, the blood flow in the arterioles, varies with time - because it is pulsatile. This measurement principle is used to derive the SpO2 measurement. The numeric that is displayed at the Information Center is the oxygen saturation of the arterial blood - the measurement of light absorption during a pulsation.
Selecting a SpO2 Sensor Selecting a SpO2 Sensor Warning Use only Philips-approved accessories. Use of product accessories (ECG leadsets, SpO2 sensors, etc.) other than those specified in this manual may: - lead to patient injury - result in increased electromagnetic emissions or decreased immunity of the product Warning Reuse: Never reuse disposable sensors, accessories and so forth that are intended for single use, or single patient use only.
Selecting a SpO2 Sensor Philips reusable sensors in adult, pediatric and infant models can be used, as well as Philips and Nellcor® disposable sensors. If you are using Nellcor® sensors, see the Directions for Use supplied with these sensors. Caution Do not use OxiCliq disposable sensors in a high humidity environment, or in the presence of fluids. These can contaminate sensor and electrical connections, and thereby cause unreliable or intermittent measurements.
Selecting a SpO2 Sensor The following table and chart will help you in selecting the correct sensor type. Sensor Type When to Use Reusable You can use reusable sensors on different patients after cleaning and disinfecting them. For care and cleaning instructions, see the instructions accompanying the sensors. Reusable sensors should be changed to another site every 2-3 hours or in accordance with your clinical practice guidelines.
Selecting a SpO2 Sensor To use the chart: Find the patient’s weight on the vertical axes. On the horizontal axis at this weight, the shaded areas indicate that the sensor is a “best choice” for the patient. Unshaded areas indicate a “good choice.” For example, the best reusable sensor for a 50 kg patient is the M1191A, applied to the finger or toe. Alternatively, you could use M1194A applied to the ear. For a complete listing of available sensors, see “SpO2 Accessories” on page A-6.
Applying the Sensor Applying the Sensor Sensor Application Safety Information Warning Failure to apply a sensor properly can reduce the accuracy of the SpO2 measurement. Loose/Tight sensor: If a sensor is too loose, it can compromise the optical alignment or fall off. If it is too tight, for example because the application site is too large or becomes too large due to edema, excessive pressure can be applied.
Applying the Sensor Site Selection Sensor Application • Avoid sites with impaired perfusion, skin discoloration, excessive motion or nail polish. • Avoid placing the sensor in an environment with bright lights (if necessary, cover the sensor with opaque material). • Avoid use of excessive pressure at the application site (e.g., sensor applied too tightly, excessive adhesive tape to secure the sensor, clothing or restraints that are too tight).
Applying the Sensor Inspect the application site every 2 to 3 hours or according to clinical practice guidelines to ensure skin integrity and correct optical alignment. If skin integrity changes, move the sensor to another site. Follow the sensor’s instructions for use, adhering to all warnings and cautions. To apply the sensor, use the following directions. Step Action 1 Select the site and appropriate sensor (see “Selecting a SpO2 Sensor” on page 8-7).
Applying the Sensor Small Adult/ Pediatric Finger sensor (M1192A) Push the sensor over the fingertip in such a way that the fingertip touches but does not protrude from the end of the sensor. Ear Clip sensor (M1194A) Clip the probe onto the fleshy part of the ear lobe as shown in the diagram below. The plastic fixing mechanism helps to minimize artifact generated by patient motion. Do not position the probe on cartilage or where it presses against the head.
Connecting the SpO2 Cable Connecting the SpO2 Cable Step Action 1 Connect the sensor cable to IntelliVue TRx+. • Connect reusable sensors directly into the transceiver. • Connect disposable sensors into the adapter cable, then connect the adapter cable to the transceiver. Remove the protective backing. 2 Adjust SpO2 alarms in the Patient Window (see “Telemetry Controls in the Patient Window” on page 9-2).
Measuring SpO2 Measuring SpO2 Warning Removal of the SpO2 sensor during Continuous SpO2 monitoring results in a "No Sensor" technical alarm. There is no technical alarm for a “No Sensor” condition in Spot Check mode. Warning If you measure SpO2 on a limb that has an inflated NBP cuff, a nonpulsatile SpO2 technical alarm can occur. If the monitor is configured to suppress this alarm, there can be a delay of up to 60 seconds in indicating critical patient status, such as sudden pulse loss or hypoxia.
Measuring SpO2 Spot Check Measurement When the transceiver is configured for Spot Check measurement, use the following instructions to take an individual, manual SpO2 reading from the transceiver. Note—You can also initiate a Spot Check measurement in the Patient Window at the Information Center by selecting the Spot Check SpO2 icon (see “Patient Configurable Settings in Telemetry Setup” on page 9-6).
Measuring SpO2 Continuous Measurement When the transceiver is configured for Continuous SpO2 measurement (see “Patient Configurable Settings in Telemetry Setup” on page 9-6), use the following directions to initiate Continuous SpO2 monitoring. Step Action 1 Insert the SpO2 cable into the IntelliVue TRx+, and check that the sensor light turns on. 2 Attach the sensor to the patient. 3 After approximately 15 seconds, the value, with the measurement time, is displayed at the Information Center.
Measuring SpO2 When Connected to TeleMon When the transceiver is connected to TeleMon: • • The SpO2 measurement mode is always Continuous. You can change the mode. Changes to the mode take effect when the transceiver is disconnected from TeleMon.
Measuring SpO2 SpO2 Enable/ Disable at Information Center SpO2 Auto ON at Information Center You can enable/disable SpO2 monitoring at the Information Center. See “Patient Configurable Settings in Telemetry Setup” on page 9-6. When SpO2 is enabled, the Patient Sector and Patient Window of the Information Center display a “T” next to the SpO2 numeric (for example, “SpO2T 90%”) to indicate that the measurement was made via telemetry.
Understanding SpO2 Alarms Understanding SpO2 Alarms Physiologic SpO2 alarms are generated and displayed at the Information Center. SpO2 offers high and low limit alarms, and a high priority (red level) oxygen desaturation alarm. The SpO2 low limit can be set between 50 and 99% inclusive, in 1% increments. The desaturation limit is set automatically at 10 below the Low Limit. The SpO2 high alarm limit can be set between 51 and 100% inclusive, in 1% increments.
Optimizing SpO2 Measurement Performance Optimizing SpO2 Measurement Performance Refer to this section on problem situations if you have difficulty getting a signal or obtaining accurate measurements. Distortion Ambient light, motion, perfusion or incorrect sensor placement can affect the accuracy of the derived measurements.
Optimizing SpO2 Measurement Performance Care and Cleaning For care and cleaning instructions, see the instructions accompanying the sensors. Sensor Wear Normal wear and tear associated with patient movement and regular sensor cleaning typically mean that the sensor will have a limited lifetime. However, provided you handle the sensor and its cable with care, you can expect useful service from it for up to two years. Harsh treatment will drastically reduce the lifetime of the sensor.
Optimizing SpO2 Measurement Performance 8-24 SpO2 Monitoring
This chapter describes the telemetry functions at the Information Center, as well as the differences in transceiver operation when connected to TeleMon. It includes the sections listed below. For additional information, consult the IntelliVue Information Center Instructions for Use and TeleMon Instructions for Use. • • Telemetry Functions at the Information Center . . . . . . . . . . . . . . . . . . 9-2 •Telemetry Controls in the Patient Window . . . . . . . . . . . . . . . . . .
Telemetry Functions at the Information Center Telemetry Functions at the Information Center1 Telemetry Controls in the Patient Window The Patient Window at the Information Center (accessed from the Patient Window control in the Patient Sector) includes controls for a number of telemetry operations. For detailed instructions on these operations, see the IntelliVue Information Center Instructions for Use or the Online Help.
Telemetry Functions at the Information Center To Initiate a Spot Check Measurement Move the cursor over the SpO2 label. Then click on the Spot Check icon. . Note—There is no audio feedback at the transceiver (pulse tone or successful/ failed measurement) when Spot Check is initiated at the Information Center. To Initiate Standby See instructions under “Standby Mode” on page 4-4.
Telemetry Functions at the Information Center To silence the sound Step 1 Action Press and hold the Check button to turn off the sound. OR Remove the batteries. Viewing Device Location in the Patient Window (optional) You can see the location of a transceiver in the Patient Window. The Device Location information is identified in the Patient Window by a compass icon followed by the location name configured by your hospital for your system.
Telemetry Functions at the Information Center Using the Device Location Client (optional) The Device Location Client application is an optional software application that allows you to display and locate devices visually, using Floor Plans associated with your hospital’s layout. Device location history is also available. The application is accessible using a separate PC’s web browser. For additional installation information, see the IntelliVue Device Location Installation Guide.
Telemetry Functions at the Information Center Patient Configurable Settings in Telemetry Setup The Telemetry Setup window enables you to configure the transceiver for patient-specific settings. All patient-specific settings will be reset to the unit defaults upon patient discharge. To access the window, from the Patient Window click Telemetry Setup. The following settings can be adjusted in this window.
Telemetry Functions at the Information Center Patient-Configurable Settings in Telemetry Setup Control Function Setting Choices Factory Default SpO2 Enabled Enable/disable the SpO2 measurement at the Information Center or Telemon. enable enable SpO2 Mode Determine the transceiver SpO2 behavior. Spot Check - Provides manual measurements so the clinician can check as needed.
Telemetry Functions at the Information Center Patient-Configurable Settings in Telemetry Setup Control Function Setting Choices Factory Default Suppress SpO2 INOPs with NBP Enable/disable the SpO2 algorithm to suppress sending technical alarms from the transceiver during an NBP measurement for 60 seconds. enable enable disable Warning If you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile SpO2 technical alarm can occur.
Telemetry Functions at the Information Center Patient-Configurable Settings in Telemetry Setup Control Function Setting Choices Factory Default SpO2 Alarm Turn SpO2 alarms on/off at the Information Center. enable (on) enable Change current settings back to last saved clinical unit settings. (none) Unit Settings UnitConfigurable Settings disable (off) Unit Settings provide access to clinical configuration items that affect all patients on an Information Center.
Telemetry Functions at the Information Center Unit Settings - Telemetry Setup Control Function Settings Telemetry Button Determine the Information Center response when Telemetry Button is pressed. Nurse Call - generate nurse call alarm Factory Default Nurse Call Record - generate a recording strip Both - generate nurse call alarm and recording strip None Telemetry Device: Volume Set the volume level for all adjustable sounds on the transceiver.
Telemetry Functions at the Information Center Unit Settings - Telemetry Setup Control Function Settings Factory Default Suspend Duration Sets the alarm suspend duration time for each assigned device on the Information Center. 1, 2, or 3 minutes 2 minutes Battery Gauge on Information Center Display/disable a battery gauge for each assigned device on the Information Center.
Telemetry Functions at the Information Center Unit Settings - Telemetry Setup Control Function Settings SpO2 Mode Determine the transceiver SpO2 behavior. Spot Check - Provides manual measurements so the clinician can check as needed. Measurement initiated by plugging the SpO2 cable into the transceiver or by selecting Spot Check SpO2 icon in the Patient Window. No pulse or successful/failed measurement tones are generated when measurement is initiated at Information Center.
Telemetry Functions at the Information Center Unit Settings - Telemetry Setup Control Function Settings Factory Default Suppress SpO2 Inops with NBP Enable/disable the SpO2 algorithm to detect NBP running and suppress sending technical alarms from the transceiver for 60 seconds. enable enable disable Warning If you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile SpO2 technical alarm can occur.
Telemetry Functions at the Information Center Unit Settings - Telemetry Setup Control Function Settings Factory Default SpO2 Alarm Turn SpO2 alarms on/off at the Information Center. enable (on) enable SpO2 Limits High Increment/decrement SpO2 high alarm limit by 1 (in %). Limit maximum is 100. Limit minimum is 51 (adult) or 31 (pediatric). High and low limit must be at least 1% apart. 100 (adult, pediatric) SpO2 Limits Low Increment/decrement SpO2 low alarm limit by 1 (in %).
Telemetry Functions at the Information Center Unit Settings - Default Leads Factory Default Control Function Settings 5-wire, ECG3 Set the unit default lead. I, II, III, MCL, AVR, AVL, AVF, V III 5-wire EASI, ECG1 Set the unit default lead. I, II, III, AVR, AVL, AVF, V1, V2, V3, V4, V5, V6 II 5-wire EASI, ECG2 Set the unit default lead. I, II, III, AVR, AVL, AVF, V1, V2, V3, V4, V5, V6 V2 5-wire EASI, ECG3 Set the unit default lead.
Telemetry Functions at the Information Center Unit Settings - Default Leads Control Function Settings 6-wire, ECG4 Set the unit default lead. I, II, III, MCL, AVR, AVL, AVF, V1, V2, V3, V4, V5, V6, V7, V8, V9, V3R, V4R, V5R Factory Default V5; V lead choice is determined by Va and Vb settings Unit Settings - NBP Setup Control Function Settings Factory Default Patient Type Set patient type used for NBP alarm limits. Adult Adult Set NBP alarm notification.
Telemetry Functions at the Information Center Unit Settings - NBP Setup Control Function Settings Systolic Low Increment/decrement NBP low alarm limit by 1. Limit Maximum is 155 Limit Minimum is 28 (Adult) Factory Default 90 Adult 70 Pediatric Limit Maximum is 255 Limit Minimum is 28 (Ped.) Diastolic High Increment/decrement NBP high alarm limit by 1. Limit Maximum is 260 Limit Minimum is 90 (Adult) 90 Adult 70 Pediatric Limit Maximum is 260 Limit Minimum is 45 (Ped.
Telemetry Functions at the Information Center Unit Settings - Alarms Control Function Settings Factory Default Nonarrhythmia Yellow Alarms Set latched/non-latched status for SpO2, ST, and other nonarrhythmia yellow alarms. Latched Latched Leads Off Adjust the severity level of this technical alarm (INOP). Cyan Non-latched Cyan Yellow Red Replace Battery Adjust the severity level of this technical alarm (INOP).
Transceiver Operation when Connected to TeleMon Transceiver Operation when Connected to TeleMon When connected to TeleMon, the following differences in transceiver operation will be in effect. Important—The transceiver must have good batteries installed before being connected to TeleMon. Alarms • Alarm Suspend/Pause and Standby can be initiated only from TeleMon, not from the transceiver or the Information Center.
Transceiver Operation when Connected to TeleMon SpO2 Operation • SpO2 is always in continuous mode. • Changes in SpO2 mode do not take effect until after the transceiver is disconnected from TeleMon. Mode settings are defined in the following table: Mode Selected at TeleMon • Mode at Disconnected Transceiver Continuous Continuous 5-min. Continuous 1-min.
You can display measurement data from IntelliVue TRx and TRx+ Transceivers on IntelliVue Patient Monitors. The transceiver and the monitor must be assigned to the same patient; this is called "pairing". Once paired, the ECG source is automatically detected at the Information Center. Should you subsequently switch the ECG source between the two devices, the change is also automatically detected at the Information Center.
This chapter describes how to pair the devices using a direct connection and a wireless, short-range radio connection, and how the devices operate in paired mode (networked and non-networked). It includes the sections listed below. For additional information on monitor operation, consult the IntelliVue Patient Monitor Instructions for Use. For additional information on pairing other IntelliVue Patient Monitors at the Information Center, consult the IntelliVue Information Center Instructions for Use.
Device Revision Pairing Functionality The level of pairing functionality available is dependent on the software revision of the devices in use. Refer to the following table to identify available functionality. Functionality Transceiver Rev. Patient Monitor Rev. Information Center Rev. Basic Pairing A.00 B.1 F.00 Pairing via Direct B.00 Connection E.00 J.00 Enhanced Pairing B.01 via Direct Connection F.00 K.00 Pairing via Short- C.00 Range Radio Connection G.00 L.
Networked Devices Networked Devices Basic Pairing Pairing at the Information Center You can pair an IntelliVue Patient Monitor with the transceiver at the Information Center. The telemetry data automatically displays as a permanent overview session in the Telemetry Data Window on the IntelliVue Patient Monitor. At the Information Center, the telemetry data and any patient monitor data (e.g. NBP) are integrated in the patient sector.
Networked Devices Pairing via Direct Connection to the MP5 When the transceiver, assigned to a patient sector at the Information Center, uses an interface cable to connect to an MP5 Patient Monitor, the Information Center automatically pairs (if configured to do so) the two devices. Pairing using this method provides up to 4 ECG waves at the MP5, along with SpO2 measurements and a pleth wave. Lead selection and alarm limits may be changed either at the Information Center or the MP5 Patient Monitor.
Networked Devices Important—When transceivers and MP5 Patient Monitors are paired directly via an interface cable, your ECG source must be connected before connecting or disconnecting the interface cable to maintain synchronized alarm settings. The interface cable must be disconnected prior to unpairing the devices at the Information Center or the monitor.
Networked Devices If your transceiver is not already equipped with the Short-Range Radio Adapter (SRRA), follow the instructions and figures below to install the adapter. Step Action 1 Remove the protective cover from the transceiver’s monitor/service port. 2 Position the rubber cover over the top of the SRRA. Attach the connected strap around the transceiver above the Leadset Insertion Guide. 3 Insert the SRRA connector in the monitor/service port.
Networked Devices To pair the transceiver to the monitor: 1. Press the Check Button on the transceiver. The measurement selection key on the monitor will change to show the "assign telemetry" icon . 2. Select the assign telemetry icon. 3. In the Assign Telemetry Device menu, select the correct equipment label for the device. When connected, the icon appears at the Information Center. The transceiver is assigned to the monitor.
Networked Devices Note—The Unpair SmartKeys and pop-up keys appear only on the monitor which is directly involved in pairing. Stopping ShortRange Radio Communication Alarm Behavior (Networked) To stop communication via the short-range radio connection and turn the transceiver’s radio back on while maintaining device pairing, use the Stop SRR button in the Telemetry Device Window. Both the IntelliVue Telemetry System and the IntelliVue Patient Monitor source alarms.
Networked Devices Where Initiated Effect at Bedside Effect at Information Center Silence Bedside Silences bedside alarms. Silences telemetry alarms if Enable Global Silence for Paired Beds is on at the Information Center. Silences bedside alarms. Silences telemetry alarms if Enable Global Silence for Paired Beds is on at the Information Center. Bedside from Telemetry Data Window Silences bedside and telemetry alarms. Silence Overview Alarms at Bedside must be enabled at the Information Center.
Networked Devices Where Initiated Effect at Bedside Effect at Information Center Suspend/Pause Bedside Suspends/Pauses bedside alarms. Bed Alarms Suspend/Bed Alarms Paused INOP displayed. Information Center Suspends/Pauses bedside and telemetry alarms. Suspends/Pauses bedside and telemetry alarms. Alarms Suspend/ Alarms Paused INOP displayed. All Arrh Alrms OFF displayed. Note—Suspends bedside alarms for the minimum of the transceiver configuration and the bedside configuration.
Networked Devices Warning If the remote Silence key in the Overview window is enabled for IntelliVue monitors connected to the Information Center, remote silencing for these beds will be enabled in other clinical units. Alarm/INOPs at the Information Center 10-12 The alarms and INOPs that are displayed, recorded, and stored at the Information Center depend on the type of alarm.
Networked Devices Alarm Behavior (Networked with Cable or Short-Range Radio Connection) Where Initiated The following table summarizes alarm behavior when a transceiver is paired with an IntelliVue MP5, MP2, or X2 bedside monitor with a direct cable or short-range radio connection. Warning As long as the ECG is being measured with the transceiver, there will be no ECG signal available at the ECG analog output or ECG Sync Pulse output.
Networked Devices Where Initiated Effect at Bedside Effect at Information Center Suspend/Pause Bedside Suspends/Pauses bedside and telemetry alarms. Alarms Suspend/Alarms Paused INOP displayed. Information Center Suspends/Pauses bedside and telemetry alarms. Alarms Suspend/Alarms Paused INOP displayed. Standby Bedside Bedside and telemetry put into standby. Monitor Standby and Arrhythmia Off INOPs displayed. Standby location displayed. Information Center Bedside and telemetry put into standby.
Networked Devices Paired Device Synchronized Alarm Settings (Networked) If the patient’s ECG is initially being measured with a patient monitor, and then the patient is connected to the transceiver for monitoring, the Information Center will use the patient monitor settings for the transceiver. When the initial ECG source is the transceiver, and then the patient is connected to the monitor, the Information Center uses its Telemetry Setup settings.
Networked Devices Important—When transceivers and MP5 Patient Monitors are paired directly via an interface cable or short-range radio connection, your ECG source must be connected before connecting or disconnecting the interface cable to maintain synchronized alarm settings. The interface cable must be disconnected prior to unpairing devices at the Information Center or the monitor.
Non-networked Devices Non-networked Devices Using the monitor interface cable, you can directly connect the TRx /TRx+ Transceivers to an MP5/MP5T monitor that does not have a network connection in order to transmit additional measurement data to the IntelliVue Information Center using the transceiver’s radio. You can also connect the monitor (MP5/ MP5T, MP2 and X2) and transceiver if both are equipped with short-range radio capability.
Non-networked Devices Pairing via Direct Connection to the MP5/ MP5T Pairing via ShortRange Radio Connection 10-18 To connect the transceiver to the monitor, perform the following steps: Step Action 1 Remove the protective cover from the transceiver’s monitor/service port. 2 Insert the interface cable into the monitor/service port. 3 Attach the interface cable to the monitor using the port labeled with the icon.
Non-networked Devices Step Action 1 Remove the protective cover from the transceiver’s monitor/service port. 2 Position the rubber cover over the top of the SRRA. Attach the connected strap around the transceiver above the Leadset Insertion Guide. 3 Insert the SRRA connector in the monitor/service port. Note—The rubber cover/strap can be easily removed, e.g. for cleaning purposes, by dipping that end of the adapter in isopropyl alcohol and pushing up from the base of the cover.
Non-networked Devices To pair the transceiver to the monitor: 1. Press the Check Button on the transceiver. The measurement selection key on the monitor will change to show the "assign telemetry" icon . 2. Select the assign telemetry icon. 3. In the Assign Telemetry Device menu, select the correct equipment label for the device. When connected, the icon appears at the Information Center. The transceiver is assigned to the monitor.
Non-networked Devices Alarm Suspend/Pause and Standby can be initiated only from patient monitor, not from the transceiver or the Information Center. The alarm suspend indicator on the transceiver will accurately reflect the current state of alarm pause. Silencing an active alarm at the patient monitor has no effect on the alarms at the Information Center. For detailed information, see the IntelliVue Patient Monitor Instructions for Use and the IntelliVue Information Center Instructions for Use.
Non-networked Devices Short-Range Radio Monitoring Considerations When monitoring using the short-range radio connection, interference may cause transition between the short-range radio and the telemetry radio. To minimize this occurrence, consider the following: • • • Monitoring performance will degrade if the patient moves outside the typical coverage area of 15 ft. Limit the number of short-range radio devices in the area (maximum of 3 per radio channel).
Non-networked Devices ShortRange Radio Error Conditions The following table describes error conditions that may occur when the transceiver is paired with the monitor (MP5, MP2 and X2 IntelliVue Patient Monitors only) via short-range radio capability. Condition Description Action Short-range radio connection TELE DISCONNECTED INOP between the transceiver and displayed at the monitor and the Information Center. NO SIGNAL INOP displayed at the Information Center.
Non-networked Devices 10-24 Condition Description Action REPLACE BATTERY T INOP displayed at the monitor and the Information Center. When operating wirelessly, the patient monitor is no longer providing power to the transceiver, and battery capacity is now depleted. There is no monitoring occurring at either the monitor or the Information Center. Insert new AA batteries in the transceiver. Absence of successful association sound/visual indicator.
All installation tasks are performed by Service personnel and are described in detail in the service documentation accompanying the system. This chapter provides procedures for maintaining the equipment after installation including assigning labels for replacement transceivers, keeping the transceiver clean, and troubleshooting common problems. It includes the following sections: • • • Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Maintenance Maintenance Basic Monitoring Before beginning monitoring on a patient: • • • • Check for any mechanical damage. Check all the external leads, plug-ins and accessories. Check all the functions of the instrument which are needed to monitor the patient. Ensure that the instrument is in good, working order. Do not use the IntelliVue transceiver for any monitoring procedure on a patient if you identify features which demonstrate impaired functioning of the instrument.
Maintenance Re-assigning an Equipment Label The following instructions enable you to reassign an equipment label from a lost device to a replacement transceiver. Note—If the leadset is attached during this procedure, the label assignment will fail. Step 1 Action At the Information Center, clear the sector that the original Equipment Label was assigned to. (Patient Window -> Sector Setup -> Clear Sector -> OK).
Cleaning and Sterilization Step 8 Action Select Assign Label to initiate programming of the Equipment Label into the replacement telemetry device - AND within 10 seconds, press the Check button on the telemetry device. Note—If 10 seconds pass without a button push, then repeat starting with step 5. When the label assignment is complete, the assignment will be verified in the “Status” field. 9 Go back into Sector Setup, and select the Bed Label and Equipment Label, followed by OK.
Cleaning and Sterilization Cleaning the Transceiver Caution Use of abrasive cleaning materials, or disinfectants or cleaning agents not listed herein, on any part or component of the IntelliVue TRx or TRx+ transceiver may damage the components. See the list of unsupported cleaners in the table below. Caution When cleaning the Monitor/Service port, do not use any stiff, rigid instruments, tools, or other devices to clean debris in the port, as such actions will damage the connector pins.
Cleaning and Sterilization Cleaner Active Ingredient Cidex* Gluteraldehyde (2.4%) WipesPlus Disinfecting Wipes Phenylphenol (0.28%), Benzyl-p-chlorophenol (0.03%) TechSpray General Purpose Cleaner Isopropyl Alcohol *To prevent damage, avoid the use of antibacterial soap and water and Cidex inside the battery compartment. Note—The cleaners listed above are also suitable for the optional Short- Range Radio Adapter (SRRA).
Cleaning and Sterilization Caution The use of unsupported cleaners will result in the degradation and eventual cracking of the transceiver’s plastic casing. Perform the following steps to clean the transceiver of visible surface contamination. Step Action 1 Remove the batteries and any cables or accessories. 2 Wipe the transceiver clean by using a cloth dampened modestly with one of the approved cleaning agents listed in the table above.
Cleaning and Sterilization Equipment and Materials Warning EO is highly explosive, toxic, and a potential occupational carcinogenic and reproductive hazard. Handle it with extreme care, following U.S. Occupational Safety and Health Administration (OSHA) standards for EO (29 CFR 1910.1047)*. Personnel exposure and/or room air must be monitored per OSHA standards.
Cleaning and Sterilization Step Action 3 Apply -26 inHg +/- 1 (-12.77 psig +/- .49) vacuum to the empty sterilizer chamber two times, to remove any residual EO or moisture. Vent the vacuum pump to the outdoors to avoid toxic hazards to personnel. 4 Insert the equipment to be processed into the gas sterilizer. 5 Heat the chamber and its contents to 54.4 +/- 2.8oC (130 +/- 5oF). 6 Apply -26 inHg +/- 1 (-12.77 psig +/- .49) vacuum to the sterilizer chamber.
Cleaning and Sterilization Step 10 Action Extract the gas mixture from the sterilizer as follows: Warning Comply with OSHA standards*. Do not vent sterilizer gas to the room, but vent only outdoors or to a suitable, evacuated container, depending upon state, provincial, or country environmental regulations. (If the mixture is captured, it can be separated commercially and the component gases re-used.) * See “References” on page 11-11. a.
Cleaning and Sterilization Aeration Procedure Warning To avoid chemical burns and toxic effects, the equipment must be aerated after sterilization, as described. The aerator must have bacterial filters and outdoor venting.* See “References” on page 11-11.
Cleaning and Sterilization Test Procedure Caution You must perform this test each time you put a transceiver through the EO sterilization process. This test allows you to verify that patient information for both ECG and SpO2 (if you are monitoring pulse oximetry) appear at the Information Center and at the bedside. You can use this procedure with a Patient Simulator.
Cleaning and Sterilization Step 3 Action Test the transceiver: a. Put fresh batteries in the transceiver (without a leadset attached) and close the battery door Result: All six lead lights should flash, and one light should remain on. b. Attach a leadset to the ECG port, and attach an SpO2 sensor to the SpO2 port. If an ECG simulator is available, attach the ECG leads to the simulator and the SpO2 sensor to yourself. At TeleMon, set the SpO2 sample rate to Continuous.
Troubleshooting Troubleshooting Basic Troubleshooting For problems with... • ECG measurement see... “Optimizing ECG Measurement Performance” on page 6-29. “Using EASI Leads to Troubleshoot” on page 628. “Technical Alarms (INOPs)” on page 5-10. • SpO2 measurement “Optimizing SpO2 Measurement Performance” on page 8-22. “Technical Alarms (INOPs)” on page 5-10. • Batteries “Battery Information” on page 4-13. “Self Test” on page 4-11. • Nurse call Nurse Call may have been turned off for the patient.
Troubleshooting Information Signals If there is a connection failure within the IntelliVue Clinical Network, an information signal will be generated. This information signal will be displayed in the system message area on the Information Center where the affected wireless patient monitoring device(s) (transceiver, access point, access point controller, sync unit, or router) is assigned, as well as on all other Information Centers connected to a common Database Server.
Troubleshooting 11-16 Maintenance, Cleaning & Troubleshooting
This chapter describes the regulatory standards that the product complies with, along with product and measurement specifications. It includes the following sections: • • • • • • • Regulatory Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-2 Electromagnetic Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5 Battery Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8 Radio Specifications . . . . . . .
Regulatory Information Regulatory Information Intended Use The device is intended to provide ambulatory and bedside monitoring of ECG and SpO2 parameters of adult and pediatric patients in professional healthcare facilities. It is intended to be used by trained healthcare personnel. It is not intended for home use. Indications for Use Indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients.
Regulatory Information Safety Standards The device complies with the following safety requirements for medical electrical equipment: • • • • • • • • IEC 601-1:1988 + A1:1991 + A2:1995 General Requirements for Safety (with worldwide deviations, including U.S.
Regulatory Information System Classification The TRx4841A and TRx4851A Transceivers are FDA Class II devices. They have the following characteristics. Characteristic Definition Internally Powered Equipment The TRx4841Aand TRx4851A transceivers are internally powered devices.
Electromagnetic Compatibility harmful radio frequency interference, and void your authority to operate this equipment. Industrie Canada Compliance (Canada) This Class A digital apparatus complies with Canadian ICES-003. AC Power Source The system is not intended for connection to the public mains as defined in CISPR11. Software Hazard Prevention Potential hazards arising from errors in the software program have been identified.
Electromagnetic Compatibility The cables, sensors/transducers, and other accessories for which compliance is claimed are listed in the Service and User documentation accompanying the product. Warning The use of accessories, transducers and cables other than those specified in the product service and user documentation can result in increased electromagnetic emissions or decreased immunity of the product.
Electromagnetic Compatibility Reducing Electromagnetic Interference The transceiver and associated accessories can be susceptible to interference from other RF energy sources and continuous, repetitive, power line bursts. Examples of other sources of RF interference are other medical electrical devices, cellular products, information technology equipment, and radio/ television transmission.
Battery Specifications Battery Specifications Battery Type Equipment Battery Type Battery Life Specification 2 fresh AA disposable alkaline batteries Note—The battery life specifications listed below are based on Duracell MN 1500 batteries. Battery life for other brands may differ.
Radio Specifications Transceiver Current Operating Mode Nominal Current ECG Only 51.3 mA @ 2.4V (TRx4841A) 42.0 mA @ 2.6V (TRx4851A) ECG/SpO2 Continuous 116 mA @ 2.4V (TRx4841A) 100 mA @ 2.6V (TRx4851A) Radio Specifications TRx4841A Parameter Frequency Ranges Specification Bands: 1395-1400 MHz and 1427-1432 MHz Channel Spacing: 1.6 MHz RF Output Power 8 dBm +2/-3 dB (3.
Radio Specifications Parameter Specification Out of Band Spurious Emission Levels: • <= 1394 MHz, >= 1401 MHz • <= 1428 MHz, >= 1433 MHz <-41 dBm in 1 MHz bandwidth for FCC limit Occupied bandwidth as defined by power in 99% BW < +/- 800 KHz TRx4851A Parameter Frequency Range Specification ISM Band: 2400 - 2483.5 MHz Channel Spacing: 1.
Radio Specifications Parameter Specification Modulation Type GFSK, Gaussian Frequency Shift keying (1M40Q7D) Modulation Bandwidth Typically 1.
Radio Specifications SRRA Parameter 12-12 Specification Frequency Ranges ISM Band: 2400-2483.5MHz Radio Channel assignment 16 Radio Channel assigned, Fc= 2405 +5*(k11)MHz, k=11,12,…,26 Frequency Control Configured via the bedside monitor. RF Output Power - 1.5 to -4.5 dBm +0/-3dB (0.7 mW to 0.3 mW), into Antenna load.
Physical Specifications Physical Specifications ECG-only Transceiver Parameter Specification Height 140 mm (5.6 in) Width 75 mm (3 in) Depth 28.5 mm (1.14 in) Weight • without batteries or leadset • with batteries only • with batteries and 3wire leadset • <165 g (5.8 oz) • • <210 g (7.4 oz) <284 g (10 oz) 215 cm3 Volume ECG/SpO2 Transceiver Parameter Specification Height 140 mm (5.6 in) Width 88 mm (3.52 in) Depth 37 mm (1.
Physical Specifications Parameter Weight • without batteries or leadset • with batteries only • with batteries and 5wire leadset Specification • <205 g (7.2 oz) • • <255 g (9.0 oz) <324 g (11.5 oz) 300 cm3 Volume SRRA Parameter 12-14 Specification Height 88 mm (3.5 in) Width 25 mm (1 in) Depth 13 mm (.
Environmental Specifications Environmental Specifications Parameter Specification Temperature • Operating • Storage • 0 t 37 oC (32 to 99o F) • -40o C to 60o C (-40 to 140o F) without batteries Humidity • Operating • Storage • < 95% RH at 37o C (99o F) non-condensing • < 90% RH at 60o C (140o F) without batteries Altitude • Operating & Non-operating 0 to 3,048 m (10,000 ft) Safety Standards & Specifications 12-15
Measurement Specifications Measurement Specifications ECG Parameter ECG channel transmitted Leads • 3 electrodes • 5 electrodes 12-16 Specification • • • 5 electrodes, EASI • • 6 electrodes • Channel #1 = I, II, or III Channel #1 = II Channel #2 = III Channel #3 = MCL Channel #1 = Va-i Channel #2 = Va-s Channel #3 = Ve-s Channel #1= II Channel #2 = III Channel #3 = Va Channel #4 = Vb Resolution 5 μV ECG Input Differential, defibrillator protected against 360 joules discharge into a 100 ohm lo
Measurement Specifications Parameter Specification Gain Accuracy +/- 5% at 25 oC (77 oF) Noise Referred to ECG Input (Peak-to-Peak) AAMI: 30 μV (as per AAMI EC 13) Lead Wires 3, 5 or 6-wire leadset compatible with IntelliVue Patient Monitor, AAMI/IEC color codes Time to baseline from Defibrillator AAMI: 5 s max (until ECG wave is on display but not yet centered, monitoring bandwidth) Pacer Rejection Performance (Pace pulses with no tails).
Measurement Specifications SpO2 Parameter Specification SpO2 Measurement Range (Calibration and Display) 0 to 100% SpO2 Accuracy See table following. SpO2 Resolution 1% SpO2 Numerics Averaging 10 seconds Note—The update rate for the SpO2 pulse oximetry value and pulse rate is typically 1 second. This can be extended to a max. 60 s when NIBP is measured on the same limb, with a corresponding INOP message after a max. of 30 s, indicating that the displayed values are not current values.
Measurement Specifications Parameter Wavelength Range Specification 500 to 1000 nm Note—Information about wavelength range can be especially useful to clinicians (e.g., clinicians performing photodynamic therapy). Pulse Rate Measurement (available only with Continuous SpO2) Range: 30 to 300 bpm Accuracy: +/- 2% Resolution: 1 bpm Display of SpO2 numerics SpO2 values are displayed as xxx % SpO2T to meet ISO/EN standard EN 865.
Measurement Specifications SpO2 Sensor Accuracy . Type Philips Reusable Sensors Description Model Number Adult Finger M1191A 2.0 Adult Finger M1191AL 2.0 Adult Finger M1191ANL 2.0 Adult Finger* M1191T 3.0 Adult Finger M1196A 3.0 Adult Finger M1196T 3.0 Pediatric Finger M1192A 2.0 Pediatric Finger* M1192T 3.0 Pediatric Finger M1192AN 2.0 Adult/Pediatric Ear M1194A 3.0 Adult/Pediatric Ear M1194AN 3.0 * Requires M1943A or M1943AL adapter cable.
Measurement Specifications Type Philips Disposable Sensors Model Number Description Accuracy% Arms (70-100% Range) Adult Finger M1901B 2.0 Adult Finger M1902B 2.0 Pediatric Finger M1903B 2.0 Adult Finger M1904B 2.0 Adult/Pediatric Finger M1131A 3.
Measurement Specifications Model Number Accuracy% Arms (70-100% Range) OxiCliq A, Adult N/A 3.0 OxiCliq N, Adult >40 kg (88 lb) N/A 3.0 OxiCliq P, Pediatric N/A 3.0 OxiMax MAX-A, Adult >30 kg (66 lb) N/A 3.0 OxiMax MAX-AL, Adult >30 kg (>66 lb) N/A 3.0 OxiMax MAX-N, Adult >40 kg (>88 lb) N/A 3.0 OxiMax MAX-P, Pediatric 10-50 kg (22110 lb) N/A 3.0 Oxisensor II D-20, Pediatric 10-50 kg (22110 lb) N/A 3.0 Oxisensor II D-25, Adult >30 kg (>66 lb) N/A 3.
This appendix lists the accessories for use with the Transceiver. Accessories are subject to change. Some accessories are not supplied by Philips. To order accessories, visit the Philips Medical Supplies website located at the following web address: http://shop.medical.philips.com, or contact your local Philips representative. Accessory Safety Warning Use only Philips-approved accessories. Use of product accessories (ECG leadsets, SpO2 sensors, etc.
Transceiver Accessories Transceiver Accessories Pouches Order Number Description 989803137821 Telemetry Pouch, box of 5 989803137831 Telemetry Pouch, box of 50 989803140371 Telemetry Pouch, case of 200 Order Number Description 989803140431 Protective Cover for Monitor/Service port (ECG-only Transceiver), package of 10 989803140451 Protective Cover for Monitor/Service port (ECG/ SpO2Transceiver), package of 10 989803140441 Protective Cover for SpO2 port (ECG/SpO2 Transceiver), package of 10
ECG Accessories Order Number Description 989803158241 Short-Range Radio Adapter 989803160381 Short Range Radio Adapter Strap (1 package of 10) ECG Accessories Electrodes Order Number Description M2202A Radio Translucent Foam Electrodes, 60 packages of 5 (300 per box) 40489E Paper Tape Electrodes, 10 packages of 30 (300 per box) 40493D Foam Electrodes, 60 packages of 5 (300 per box) 40493E Foam Electrodes, 10 packages of 30 (300 per box) Skin Prep Paper Order Number Description 98980313477
ECG Accessories Leadsets Order Number A-4 Accessories Description 989803151991 AAMI 3-wire Leadset, Snap, 79 cm (30 ”) 989803151971 AAMI 3-wire Leadset, Grabber ,79 cm (30 ”) 989803152071 AAMI 5-wire Color Leadset, Snap, 79 cm (30 ”) 989803152051 AAMI 5-wire Color Leadset, Grabber, 79 cm (30 ”) 989803152151 AAMI 6-wire Color Leadset, Snap, 79 cm (30 ”) 989803152131 AAMI 6-wire Color Leadset, Grabber, 79 cm (30 ”) 989803152001 IEC 3-wire Leadset, Snap, 79 cm (30”) 989803151981 IEC 3-wire
ECG Accessories Order Number Description 989803140401 Single ECG Alignment Guide, package of 10 989803140411 Single ECG Alignment Guide, tethered, package of 10 989803140421 Double ECG Alignment Guide, package of 10 Order Number Description 989803153031 3-wire Leadset Detachable Shield, package of 10 989803153041 5-wire Leadset Detachable Shield, package of 10 989803153051 6-wire Leadset Detachable Shield, package of 10 A Sales and Support Alignment Guides Detachable Shields Accessories
SpO2 Accessories SpO2 Accessories Reusable Sensors Order Number A-6 Accessories Description M1191A Philips Adult Finger Sensor, 2m (6.6 feet) M1191AL Philips Adult Finger Sensor, 3m (9.8 feet) M1191B Philips Adult Finger Sensor, 2 m (6.6 feet) M1191BL Philips Adult Finger Sensor, 3 m (9.8 feet) M1191T Philips Adult Finger Sensor, 0.45 m (1.5 feet) M1192A Philips Pediatric Finger Sensor, 1.5 m (4.9 feet) M1192T Philips Pediatric Finger Sensor, 0.45 m (1.
SpO2 Accessories Note—OxiCliq, OxiMax and Oxisensor II sensors are not available from Philips in the USA or Canada. In those countries, contact Nellcor Incorporated directly.
SpO2 Accessories Order Number Description 989803148231 ***Masimo LNCS Adtx Adult >30 kg (>66 lb) 989803148241 ***Masimo LNCS Pdtx Pediatric 10-50 kg (22-110 lb) N/A from Philips ***Masimo LNCS Neo-3 Adult >40 kg (>88 lb) * Uses Philips M1943A or Nellcor OC-3 Adapter Cable **Uses Philips M1020-61100 Adapter Cable ***Uses Philips 989803148221 Adapter Cable A-8 Accessories
SpO2 Accessories Note—Adapter cables are not available from Philips in Canada or Japan. In A Sales and Support Adapter Cables those countries, contact Nellcor Incorporated directly. Order Number Description M1943A Adapter cable for Nellcor SpO2 sensor, 2 m (6.6 ft) M1943AL Adapter cable for Nellcor SpO2 sensor, 3 m (9.
SpO2 Accessories A-10 Accessories
Please call your local Philips Medical Systems sales office listed in your telephone directory or a Philips Medical Systems regional office listed below for the location of your nearest sales office. On the web www.medical.philips.com Via email medical@philips.com By fax +31 40 27 64 887 By postal service Philips Medical Systems Global Information Center P.O.
B-2 Sales and Support Offices
Index A ports, alarms indicators, 5-2 more bed alarms, 10-21 physiologic, 5-5 SpO2, 8-21 technical, 5-11 testing indicators, 5-2 testing, 11-2 turning off, 4-3 audible tones definitions, 3-12 start-up, 4-3 auditory information signals see audible tones, 3-12 B battery inserting, removing, life, 4-18, 12-8 safety, 4-13 storing, 4-16 type, 4-14 buttons 3-3 4-14 C configuration group settings, 11-14 label assignment, 11-2 Telemetry Setup, 9-6 unit settings, 9-9 controls buttons, 3-3 indicators, 3-5 labels
N noise eliminating, 6-32 Nurse Call 5-6 on/off, 9-6 O on/off, 4-2 operation, 4-3 ordering information ECG supplies, A-3 SpO2 supplies, A-6 transceiver supplies, A-2 P pairing at Information Center, 10-4 pairing with MP5, 10-4 patient window, 9-2 pause alarms, 5-2 pleth wave display on/off, 9-8, 9-13 pouch, 4-7 pulse rate display on/off, 9-8, 9-13 pulse tone on/off, 3-14, 9-6 Q QT, 7-14 R RF auto shutoff 9-18 RF auto shutoff, 9-11 RF interference, 6-31 S safety battery, 4-13 general, 2-2 paced, 7-3 Sp
alarm adjustments, 7-13 smart limits, 7-13 turning on/off, 7-9 ST/AR arrhythmia analysis, 7-5 intended use, 7-5 ST analysis, 7-7 ST/AR QT analysis, 7-14 ST/AR QT interval algorithm, 7-14 standby mode, 4-4 suspend alarms, 5-2 symbols, 3-7 system messages see information signals, 11-15 T Telemetry Setup, 9-6 TeleMon NBP measurement with, 1-9 SpO2 measurement modes, 8-19, transceiver use with, 1-9, 9-19 testing alarm indicators, 5-2 alarms, 5-2 status check, 4-12 transceiver controls, 3-2 models, 1-2 troubles
Index-4
