User’s Reference Manual HP Dravidian Telemetry System r HEWLETT PACKARD HP Part No. M2600-30039 Printed in U.S.A.
Notice Responsibility of the manufacturer HEWLETT-PACKARD MAKES NO WARRANTY OF ANY KIND WITH REGARD TO THIS MATERIAL, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANT ABILITY AND FITNESS FOR A PARTICULAR PURPOSE. Hewlett-Packard shall not be liable for errors contained herein or for incidental or consequential damages in connection with the furnishing, performance, or use of this material. This document contains proprietary information, which is protected by copyright.
intended Use The HP Dravidian Telemetry System (M2600A) is a comprehensive ambulatory system solution for the intermediate care unit. The foundation of the solution is a transmitter that can capture and transmit ECG signals and SpO; values which are then processed and displayed on the HP Omnivore Component Central Monitor. The central monitor generates alarms and recordings, thus notifying clinicians of changes in patients’ conditions.
System Safety The HP Dravidian Telemetry System (except the HP Standards Dravidian Wave Viewer) complies with the following international safety requirements for medical electrical equipment: =m UL2601-1 = CSA 22.2 601.1 w IEC 601-1 = IEC 606-1-1 wm TAMI Voluntary Performance Standards for Cardiac Monitors: Sections 3.2.6.2, 3.2.6.3, 3.2.7, 3.2.8.3, 3.2.8.4, 3.2.8.7, 3.2.9.2, 3.2.9.3, and 3.1.4.1 The system is protected against the effects of defibrillation and neurosurgery.
Warnings Warning 9 Warning 9 The following warnings apply to the HP Dravidian Telemetry System. General System = DO NOT TOUCH THE PATIENT, BED, OR INSTRUMENT DURING DEFIBRILLATION. um A possible explosive hazard exists if the system is used in the presence of flammable anesthetics. = Do not use a 3-wire to 2-wire adapter with this instrument. = Removal of the secondary grounding wire from the rear of the product voids the IEC approval.
um The Exercise bandwidth should not be used on ECG-CH 1 for paced patients. The pace pulse may be sufficiently distorted and be inadvertently detected as & QRS complex which could lead to missed detection of cardiac arrest. us The Exercise bandwidth should not be used when arrhythmia monitoring is turned on. = Do not touch the patient, bed or instrument during defibrillation. = Pacemakers can be susceptible to radio frequency (RF) interference which may temporarily impair their performance.
Warning 9 heart rate during cardiac arrest or some arrhythmia. Keep pacemaker patients under close observation. m Failure on the part of the responsible individual hospital or institution employing the use of this equipment to implement a satisfactory maintenance schedule may cause undue equipment failure and possible health hazards. m If you are cleaning the transmitter or receiver mainframe with a flammable liquid, prevent fire by providing adequate ventilation, and avoid smoking.
Warning 9 m Performance may be compromised by excessive motion. This can lead to inaccurate Spoor readings. m Avoid placing the Spy transducer on any extremity with an arterial catheter, or intramuscular venous infusion line. = Do not use disposable transducers on patients who exhibit allergic reactions to the adhesive. For Specific SpO, Transducers = When the specified NELLCOR® transducers are used, the application must be consistent with the manufacturer’s own guidelines.
Cautions nine immature skin morphology. Specific attention must be given to sensor site inspection for changes in skin quality, proper optical path alignment and attachment. Check the application site at regular intervals and change the site if any compromise in skin quality should occur. More frequent checking may be required due to an individual patient's condition. m Setting the high SpO, alarm limit to 100% is equivalent to switching off the high alarm limit.
= CAUTION REMOVAL OR INSERTION OF RECEIVER MODULES WITH POWER ON MAY CAUSE DAMAGE TO INSTRUMENT HP M1407A Power Supply The following caution can be found on the HP M1407A Power Supply.
Contents A Aa 1. Introducing the HP Dravidian Telemetry System System Introduction Transmitter ECG Signal Processing Integrated SpO, Processing Transmitter Button Batteries Automatic Shutoff Ted Sets Leads Off Lights Transmitter Durability Receiver Module Receiver Mainframe Turning the Receiver Mainframe On or off 1-8 Receiver Mainframe Malfunction Light 1-9 Channel Frequencies Retaining Telemetry Settings Antenna System... ECG Monitoring Optimizing Your System's Performance .
Contents-2 Heart Rate Limit Adjustment Monitoring Paced Patients Optimizing Pace Pulse Detection with the HP Dravidian Transmitter . . . Preparing the Patient Preparing the Patient for Telemetry Monitoring Applying the Electrodes Selecting Lead The HP Dravidian Transmitter Dravidian Transmitter, 3-Wire Lead Set/Standard Electrode Placement Dravidian Transmitter, 3-Wire Lead Set/Standard Electrode Placement Dravidian Transmitter, 5 Wire Lead Set/Standard Electrode Placement The HP M1400A/B Transmitter . .
3. 5. Spot, Monitoring Introduction to SpO; Monitoring Measurement Limitations SpO, Transducers Transducers and Accessories Transducer Selection Transducer Application Application of the HP Reusable Adult Finger Transducer (M1191A) . . Application of the HP Reusable Small Adult/Pediatric Finger Transducer (M1192A) Application of the HP Reusable Ear Clip Transducer (M1194A) . . .
Contents-4 6.
A. Specifications and Ordering Information System Classification Transportation & Storage Specifications . Power Specifications M2601A Dravidian Transmitter . HP M1400A/B Transmitters M2604A/M1401A Receiver Mainframe M2603A Receiver Module Analog Output Option (J01) M1402A Receiver Module . Antenna System Specifications M1408A Active Antenna Combiner M1406A Line Amplifier HP M1407A Multiple Unit Power Supply . « «ooh oo.
Introducing the HP Dravidian Telemetry System This chapter describes the individual parts of the HP Dravidian Telemetry System, including transmitters, receiver modules, receiver mainframe, and antenna system. The wave viewer is described in Chapter 4. System Introduction The HP Dravidian Telemetry System provides remote monitoring of ECG (and optional ST segment) and integrated Spot.
i x sis TT —— Transmitter Note $ ECG Signal Processing Note 9 The following transmitters can be used with thé HP Dravidian Telemetry System: wu HP Dravidian Transmitter (Spongecake; or ECG only) =» HP M1400A/B Transmitter (ECG only) See Chapter 1 in the User’s Guide for illustrations of the transmitters, information about the transmitter button, and directions for removing and inserting the battery and connecting and disconnecting the ECG lead set and SpO, sensor.
Warning 9 Integrated SpO, Processing Transmitter Button Batteries Warning Gg 1-4 Introduction Pacemakers can be susceptible to radio frequency (RF) interference from devices such as telemetry transmitters. See “Monitoring Paced Patients” in Chapter 2 for additional information. Algorithm processing for integrated Occurs in the HP Dravidian transmitter. Measurements can be made on a continuous basis, periodically at l-minute or S-minute intervals, or manually on demand.
Note 5 Automatic Shutoff Battery Life Expectancy Battery Typo BOG Only (BOG & Spl BUG L85p0y Continuous | Intermittent Lilith: ais Howrah 18 Hou TEL Dave Alkaline! $day 8 hos 18 Ours day 1 Tested with DURACELL battery If you have a transmitter with SpO, that is not in use, HP recommends setting the SpO, measurement mode to manual at the wave viewer to conserve battery power.
Lead Sets Leads Off Lights Transmitter Durability 1-6 Introduction The HP Dravidian transmitter uses M259X series and 5-lead cables. When a combiner shield is added to headsets from bedside monitors, such as the HP Omnivore CMS, bedside lead sets can also be used with the HP Dravidian transmitter. Use of the combiner shield provides for optimal telemetry performance. The M1400A/B transmitter uses M14XX series 3-, 4-, or 5-lead cables.
0 — Receiver Module The HP receiver modules are housed in the receiver mainframe. Each receiver module is dedicated to a specific transmitter by an internal identity code. This prevents another patient’s waveform from being erroneously transmitted and displayed. The receiver acquires the ECG and SpO; signals from the transmitter and sends them to the receiver mainframe.
Receiver Mainframe Turning the Receiver Mainframe On or Off 1-8 Introduction The HP M2604A Receiver Mainframe houses up to eight receiver modules. For each receiver, the receiver mainframe calculates the heart rate, and sends the waveform, alarms, inoperative messages (SYNOPSIS, and status messages over the HP Dravidian monitoring network (SDN) to the central monitor for display and recording.
Receiver Mainframe Malfunction Light Channel Frequencies Retaining Telemetry Settings A red light on the front panel of the mainframe illuminates when either the mainframe or one of the receivers has malfunctioned. Depending on the problem, you may see the message, NO DATA FROM BED, in single or multiple patient sectors. Contact service. When the mainframe is first turned on, the red light flashes. If no problems are detected, the flashing stops and the light turns off.
ECG Monitoring This chapter provides information on how to obtain the best ECG signal for effective telemetry monitoring. GET et Topics include: = Optimizing Your System's Performance wm How to Get the Best Signal m Lead Selection m Electrode Placement m Characteristics of 2 Good ECG Signal Optimizing Your While telemetry monitoring offers many advantages, it System’s can be a challenge.
Warning 9 Understanding the Telemetry Signal Antenna System Frequent Signal Strength and RF IN OPS 2-2 ECG Monitoring equipment removing the source of interference will increase the system’s dependability. Telemetry should not be used for primary monitoring in applications where the momentary loss of the ECG is unacceptable. In this section, we’ll investigate some of the problems affecting ECG signal clarity and when possible, show yor how you can greatly enhance performance.
Warning G If frequent dropouts are occurring, there are some steps you can take to improve performance. Signal Strength The antenna system is custom designed for your unit, so reliable signal reception is only possible where there are receiving antennas. When the signal is too low, the following IN OPS occur: =m TEL CANNOT ANALYZE =u WEAK SIGNAL = NO SIGNAL To correct, first check the location of the patient. If not in the coverage area, do one of the following.
Radio Frequency Interference when the patient returns. However, if you do turn the telemetry off, you must remember to turn it back on when the patient returns to your unit. If the patient is in the coverage area and is stationary, try the following. m Move the location of the transmitter or patient about six inches. Radio frequency (RF) interference is caused by anything that intrudes into the transmitted electrical signal, such as paging transmitters and walkies-talkies.
More About Bandwidths Warning G 2-6 ECG Monitoring The telemetry system contains between two and five bandwidths, depending on the type of transmitter used. Each is appropriate for specific applications. You can select a different bandwidth for each monitored lead. ECG-CH 1, the tachycardia lead, should always be monitored in a bandwidth with sufficient noise suppression, such as monitoring. A selected bandwidth allows a specific range of electrical frequencies of the ECG signal‘to be displayed.
Warning 9 For the M1400A /B Transmitter Choices are: w Monitor: Exercise: Diagnostic: 0.05 100 Hz = Paced : 0.5 100 Hz m ST: 0.05 40 Hz Monitor Exercise This bandwidth is the most commonly used. It has greater noise suppression than Diagnostic but less than Exercise. It is the bandwidth of choice for most monitoring including arrhythmia monitoring. Assigning arrhythmia monitoring automatically changes the bandwidth to Monitor, unless the bandwidth selection is ST.
Note 9 Heart Rate Limit Adjustment 2-8 ECG Monitoring Diagnostic This bandwidth allows the widest range of electrical frequencies to be shown. Sometimes certain frequencies can be present as noise on the waveform since the Diagnostic bandwidth has the least noise suppression. The Diagnostic bandwidth is usually only selected when diagnostic measurements are done, or the clinician needs to closely examine the ECG complexes momentarily.
Monitoring Paced Patients Warning 9 Warning 9 recommends setting the high heart rate limit no more than 10 to 20 beats above the patient’s heart rate. You inst select the paced mode when monitoring patient’s with pacemakers. The purpose of the paced mode is to detect a pace pulse correctly, and not count it as a QRS. If using the M1400A/B transmitter, when the paced mode is designated, the paced bandwidth is automatically selected. If desired, you can manually select another bandwidth.
2-10 ECG Monitoring Consult the pacemaker manufacturer for information on the RF susceptibility of their products and the use of their products with the telemetry transmitters. In order to minimize the possibility of interference, position electrodes, electrode wires, and transmitter as far away trim the pacemaker as possible. Monitoring Paced Patients with Arrhythmia If your paced patient is arrhythmia monitored, all heart rate processing is done with arrhythmia software.
To optimize pace pulse detection: = Use a 5-wire headset if possible. This also enables a wider set of leads from which to select. = Select leads so that: a R-wave is monophonic and between 1 and 2 mv. o R-waves are taller than pace pulses. o Pace pulses have no visible depolarization tails (see next section) u If you are using a 3-wire headset, either change to a §-wire cable or reposition the electrodes to find a suitable lead. Remember to set the lead label accordingly.
2-12 ECG Monitoring 2. In the rare situation where you cannot reduce the size, the JAG (diagnostic) bandwidth should be used (M1400A/B transmitter only).
Preparing the Patient Note 9 Monitoring patients who are ambulating and exercising _ can be a challenge to the monitor and the clinical staff. Certain applications are very helpful in preventing noise caused from improper skin preparation and electrode placement. Preparing the Patient for Telemetry Monitoring The skin is a poor conductor of electricity, therefore preparation of the skin is important to ensure good electrode contact and a clear ECG signal. 1. Shave hair from electrode sites. 2.
Selecting a Lead Note $ The HP Dravidian Transmitter 2-14 ECG Monitoring The system supports two types of transmitters, each with several lead cables. How your telemetry system operates is dependent on the type of transmitter and the type of cable used. If you are not receiving a good ECG waveform and the electrodes are securely placed, you should try changing the lead in which you are monitoring.
Warning 9 and then change the label at central to correspond to the placement. Label Choices: I, II, ITI, MCL i you are using a 3-wire placement, Hewlett-Packard recommends you do not use Change Label except to select the correct labels which reflects the physical placement of the electrodes. This will ensure that the monitored lead and the label match, and prevent any possible confusion.
The HP M1400A/B Transmitter Warning 9 Warning 9 2-16 ECG Monitoring The HP M1400A/B transmitter supports 3-, 4-, and 5-wire lead sets. M1400A/B Transmitter and 4-Wire Lead Set The 4-wire lead set enables monitoring of two leads, ECG-CH 1 and ECG-CH 2. If the electrodes are in standard position, the user can change the monitored lead at the central monitor without moving the electrodes on the patient.
Warning 9 Note ¥ M1400A/B Transmitter and 5-Wire Lead Set If you are using a 5-wire lead set, the default leads are displayed and the operation of the leftmost soft key depends on whether your system is configured for lead swap OFF or lead swap ON. Lead Swap OFF The default settings for the 5-wire lead set, when you place electrodes in the standard position, are Leads II and MCL.
Lead Placement for Telemetry Monitoring Note To ensure patient safety, all leads must be attached to the patient. Electrode labels and colors are given for U.S norms. International colors are shown in brackets.
um White(RA) electrode place directly below the clavicle and near the right shoulder. u Black(LA) electrode place directly below the clavicle and near the left shoulder. » Red(LL) electrode place in left lower abdomen.
Marriott Configuration: enables monitoring of MCL. This lead configuration is not available for 3-wire lead sets with Lead Select ON (HP Dravidian transmitters only). If you choose to monitor MCL; with a 3-wire lead set, this is the electrode placement that is required. m White(RA) electrode place directly below the clavicle and near the left shoulder. ® Red(LL) electrode place on the 4th intercourse space at the right eternal border. » Black(LA) electrode place in left lower abdomen.
4-Wire Lead Set (M1400A/B transmitter only) Standard Placement: enables monitoring of up to two leads of ECG, and lead selection of Leads I, II, III and aVL, aVR and aVF. BLACK [YELLOW] GREEN ~~ BLACK] re i RED TT ren m Whitebait) electrode place directly below the clavicle and near the right shoulder. u Black(LA) electrode place directly below the clavicle and near the left shoulder. = Green(REF) electrode place in right lower abdomen. m Red(LL) electrode place in left lower abdomen.
5-Wire Patient Lead Set enables monitoring of Leads II and MCL, or McLean. The telemetry system produces bipolar leads only (for example, MCLEAN, not Vy). Note $ HP M1400A/B transmitters: Standard Placement HP Dravidian Transmitter: Standard Placement enables monitoring of limb and precolonial leads. Angle of BLACK YELLOW] BROWN GITE] GREEN =. {BLACK] re m White(RA) electrode place directly below the clavicle and near the right shoulder. 2.
Note 9 s Black(LA) electrode place directly below the clavicle and near the left shoulder. ma Green(REF) electrode place in right lower abdomen. = Red(LL) electrode place in left lower abdomen. ® Brown(V) electrode place on the chest as illustrated: For MCL, on the 4th intercourse space at the right eternal border. For McLean, V6 on the left maxillary line, horizontal with V4 electrode. For accurate V lead electrode placement and monitoring it is important to locate the 4th intercourse space.
A — Characteristics of a Good ECG Signal Note $ 2-24 ECG Monitoring The QRS is: » completely above or below the baseline. = 2-3 times the size of the P and T wave. » {ree from artifact and baseline wander. If you are not receiving a good ECG waveform and the electrodes are securely placed, you should try changing the lead in which you are monitoring.
Characteristics of a Good ECG for Arrhythmia Monitoring The QRS is: wm tall and narrow, and topics are wider and differently shaped. m free from artifact and baseline wander. = the same size as other Hdqrs (stable amplitude). w larger than the P wave, T wave and pace pulses. w large enough to fill at least 1/2 the sector without clipping.
Tips for ECG Do Telemetry =» Take time to properly prepare the patient’s skin before Monitoring applying electrodes (see “Patient Preparation” in this chapter). w Position the electrodes following the diagram on the transmitter. wm Check the waveform at wave viewer to verify correct electrode positioning. m Support the transmitter and if needed, tape the lead wires to the chest to prevent traction on the electrodes. m Use appropriate bandwidths.
SpO, Monitoring Introduction to This chapter provides an introduction to the SpO, O, Monitoring measurement and its application. The information under Sp 2 9 “Optimizing Your System’s Performance” in Chapter 2 also applies when monitoring SOs. Topics include: m What does Spy Measure? = Measurement Limitations w Spot; Transducers Selection and Application What does SpO, The SpO; parameter measures the arterial oxygen Measure? saturation.
through patient tissue (such as a finger or an ear), to a receiver on the other side. The amount of light getting 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 pulsate. This measurement principle is used to derive the $pO, measurement.
Note $ Measurement Limitations The Spot alarm delay built into the system is ten seconds. That means that the monitor generates an alarm if the averaged numeric value on the display stays beyond the alarm limit for more than 10 seconds. Refer to this section on problem situations if you have difficulty getting a signal or obtaining accurate measurements. 1. Distortion, such as ambient light, motion, perfusion or incorrect sensor placement may affect the accuracy of the derived measurements. 2.
* These chemicals are used in dye dilution cardiac output calculations. 4. Very high levels of ambient light can also affect the measurement; an Sp0, INTERFERENCE. message will appear on the display. The measurement quality can be improved by covering the transducer with suitable non see-through material. Sp0, Transducers Transducers and Disposable Accessories Transducers Reusable Transducers 3-4 SpO, Monitoring These should be used once only and then discarded.
Description NELLCOR® Label HP Part No. Qiy. HP Reusable Transducers Adult finger Milligram 1 Pediatric/Small Adult finger MISSOURI 1 Adult/Pediatric ear clip M11944 1 Disposable Transducers Adult digit Sensor 1M Lion Amigo Pediatric finger /ioe Dispenser HIM Don Malignant 9g Accessories Adapter cable for disposable transducers M1943A 1 Wristbands for MIAMI transducer M1627A 10 SENSOR 1I™ js a trademark of NELLCOR® Incorporated. Disposable transducers are not available as HP parts in the USA or Canada.
Transducer Selection 3-6 Spot, Monitoring Use the following chart as a guideline to select the most appropriate transducer for your patient. (Note: In the following chart, N-25 and 1-20 transducers cannot be used with the HP Dravidian Telemetry System.) Find the patient's weight on the vertical axis, and draw 2 horizontal line across the chart. Each shaded area that the line passes through represents a transducer which can be used on this patient.
i Transducer A minimum pulsate flow must be present at the Application application site of your patient to obtain measurements. Select an appropriate transducer and apply the transducer properly to avoid incorrect measurements. Use one of the preferred application sites for your transducer.
Warning 9 3-8 Spot, Monitoring Inspect the application site every 2 to 3 hours to ensure skin integrity and correct optical alignment. If skin integrity changes, move the transducer to another site. w Failure to apply the transducer properly may cause incorrect measurement of Spot. » Specific attention must be given to sensor site inspection for changes in skin quality, proper optical path alignment and attachment.
Warning 9 Application of the HP Reusable Adult Finger Transducer {(M1191A) Push the transducer over the fingertip in such a way that the fingertip touches but does not protrude from the end of the transducer. The fingernail must be uppermost and the cable must lie on the back of the hand. This ensures that the light sources cover the base of the fingernail giving the best measurement results. The cable can be held in place by the accompanying wristband.
Warning g 3-10 SpO, Monitoring Application of the HP Reusable Small Adult/Pediatric Finger Transducer (M1192A) Push the transducer over the fingertip in such a way tha the fingertip touches but does not protrude from the enc of the transducer. Small Adult/Pediatric Finger Transducer Failure to apply the transducer properly may reduce the accuracy of the Spy measurement.
Warning @ Application of the HP Reusable Ear Clip Transducer (M11944) 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. Ear Clip Transducer The lip transducer can be used as an alternative if the adult finger transducer does not provide satisfactory results.
Warning 9 Optimizing Transducer Performance 3-12 pop Monitoring Preparation and Application of Disposable Transducers See the Directions for Use supplied by NELLCOR® Incorporated for instructions on preparation and application of disposable transducers. When the specified NELLCOR® transducers are used, the application must be consistent with the manufacturer’s own guidelines. To get the best results from your Spot reusable transducer: » Always handle the transducer and cable with care.