Arrhythmia Directory Directory of Keys E C G ECG MENU ALARM LIMITS SIZE LEAD CONTROL SETUP ECG - RELEARN CLEAR MEMORY RELEARN PRINT REVIEW ECG - PRINT SAVE MEMORY ARR CLASSES ECG REVIEW ST ARRHYTHMIA REVIEW REVIEW REPORT REVIEW ST SEGMENTS RUN 1 CPL 0 ALL LEADS PRINT ALL CANCEL PRINT REAL TIME ST TREND TREND TIMEBASE 15 MIN/30 MIN TREND DISPLAY ON OFF REVIEW DOM SUSPEND PROCESSING DISPLAY FORMAT ABN 3 TACH PAUSE 8 PACED 8 ARRHYTHMIA REVIEW LEAD VI II ALARM YES NO CLEAR MERGE
Arrhythmia Contents Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Setting Up Arrhythmia Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Setting and Adjusting Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Reviewing Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Display Detail. . . . . . . . . . . . . .
Ultraview Care Network Setting Up Arrhythmia Monitoring To set up arrhythmia monitoring: 1 2 3 4 5 6 Set up system and patient for standard ECG monitoring. Touch ECG. Touch SETUP. Touch CONFIG. Ensure ADULT is selected. Select ARR ON. With the Multiview I or II option, the ARR ON/OFF key (located in the Config menu under Setup) can be used to selectively enable or disable arrhythmia detection functions.
Arrhythmia Detecting Abnormal Beats The system compares each incoming beat with the dominant class. It examines morphology and the intervals between both the previous and following beats to determine whether the beat does or does not match the dominant. If the system determines the beat is abnormal, it compares the new beat with each of the abnormal shapes categorized since the learn sequence was completed.
Ultraview Care Network Selecting CLEAR MEMORY clears all arrhythmia and ST segment data and resets the Abnormals per Minute, Abnormals in a Row, and ST segment alarms. Upon completion of the learn sequence, ECG alarms are enabled and rate alarms limits are reset. Selecting SAVE MEMORY saves all previously-acquired arrhythmia and ST segment data. Once the learn sequence is completed, ECG alarms are enabled and rate alarms are reset. The Abnormals per Minute and Abnormals in a Row alarms remain unchanged.
Arrhythmia The factory default setting for the Abnormals per Minute limit is OFF. ! • If the alarm limit for high rate, low rate, ABN/MIN, or ABN IN ROW is displayed in reverse video, this is an indication that alarm tone, alarm recording, and alarm watch have been disabled for the indicated alarm. Table 1 describes the arrhythmias detected with the Multiview I or II options (with arrhythmia detection enabled).
Ultraview Care Network Reviewing Arrhythmias To review arrhythmias: 1 2 3 4 Touch ECG. Touch REVIEW. Select an arrhythmia class type for review. Select NEXT CLASS or PRIOR CLASS keys to progress through the review. ! • Arrhythmia Review and Edit functions are only available in modules with the Multiview II option in the ADULT mode, and with both arrhythmia detection and review enabled.
Arrhythmia Display Detail The system stores and displays arrhythmia review data in two categories: non-template forming classes and template-forming classes. The non-template forming class displays a waveform that is 6.25-seconds long and is representative of the most recent occurrence. The template-forming class displays two waveforms. The waveform on the left is 1.25-seconds long; the arrhythmia that originated the class is centered. The waveform on the right is 4.
Ultraview Care Network Controlling Arrhythmia Alarms To control arrhythmia alarms: 1 2 3 4 5 Touch ECG. Touch REVIEW. Touch ARRHYTHMIA REVIEW. Select CPL, ABN or TACH. Select ALARM YES or NO. To clear a class or the most recent event in a class: 1 2 3 4 5 6 Touch ECG. Touch REVIEW. Touch ARRHYTHMIA REVIEW. Select an arrhythmia class. Touch CLEAR. Select ENTIRE CLASS or LAST EVENT. Touch ALARM YES or NO to enable or disable alarms for couplets, single abnormals, or tachycardia.
Arrhythmia You can merge a maximum of two classes into a third class. The following constraints apply to merging classes: • • • • Two single templates can be merged into a class with one template. One class of two (previously merged) templates can be merged with one additional template. If a class has been merged once, then (M1) follows the class number, for example, ABNORMAL 12 (M1). If a class has been merged twice, then (M2) follows the class number, for example, ABNORMAL 12 (M2).
Ultraview Care Network Plotting Arrhythmia Trend Graphs To plot a trend graph: When you plot trend graphs the display area consists of: 1 2 3 • 4 5 Touch ECG. Touch REVIEW. Touch ARRHYTHMIA REVIEW. Select an arrhythmia class for review. Select CLASS TREND or GROUP TREND. ABNORMAL 1 • a 1.5-second segment of the selected class waveform on the left (individual class trends only). a trend graph of the selected class, or group of classes, on the right. Refer to Figure 9-2: Abnormal class trend.
Arrhythmia Excluding Classes from Trends To exclude a class in a group trend: 1 2 3 4 5 6 Touch ECG. Touch REVIEW. Touch ARRHYTHMIA REVIEW. Select an arrhythmia class. Touch CLASS TREND. Select INCLUDE NO. Use this function to exclude specific classes from the group trend for that class as well as from the dominant trend graph (only valid with CPL and ABN classes). This function defaults to YES indicating that all classes will be included.
Ultraview Care Network Arrhythmia Problem Solving Refer to ECG on page 8-3 for additional monitoring tips. False Alarms Careful attention to good monitoring techniques, especially during setup, will reduce false alarms. When false alarms occur, check the following: • • • • Multiple classes with atrial fibrillation or flutter waveforms.
Arrhythmia Previous Abnormal Classes Missing in Arrhythmia Review If you find that previously classified abnormal beats are no longer stored for review, one of the following conditions have occurred: • • • The class has been cleared. Memory was cleared using the RELEARN key or data was purged during the Admit/Discharge function. A module error recovery reset occurred. Classes Full The total number of abnormal and couplet classes that can be stored is 12.
Arrhythmia Troubleshooting Guide Clinical Situation Abnormal beat not detected Possible Cause ■ ■ ■ ■ False Alarms Some beats not recognized as morphologically different from the learned dominant beat. System has not seen 5 abnormals or 3 couplets of like morphology to generate a class. Arrhythmia detection is not enabled. ■ ■ ■ ■ ■ ■ Make the necessary adjustments to restore good signal. Check all leads to determine a better monitoring lead or select another lead. Remove the cause of the noise.
ST Analysis Directory Directory of Keys E C G ECG MENU ALARM LIMITS SETUP SIZE LEAD CONTROL SUSPEND PROCESSING DISPLAY FORMAT RELEARN PRINT REVIEW ECG REVIEW ST REVIEW ARRHYTHMIA REVIEW REPORT REVIEW REAL TIME ST TREND TREND DISPLAY ON OFF ST REVIEW - ST SEGMENT LEVELS at HR:MIN DAY-MONTH-YEAR TIME SAVE ST PRIOR NEXT CLEAR TREND SET SET YES NO SAVE SET TREND TIMEBASE 15 MIN/30 MIN PRINT TREND OF ST SEGMENT LEVEL ST SCALE TIMEBASE 6 HOURS PRINT Do you wish to clear the displayed ST data
ST Analysis Contents Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Setting Up ST Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Adjusting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ultraview Care Network Display Detail The current ST segment level is displayed for all leads to the right of the ECG parameter key in the split view and the full view modes. Question marks (???) are displayed when the current ST segment level is not available, or as OFF when the lead is not connected. E C G I AVR II AVL III AVF V1 V4 V2 V5 V3 V6 II A=0 70 MON A/M 10 ROW 4 120 40 I 0.16 AVR 0.16 II 0.00 AVL 0.24 III 1.44 AVR 0.16 V1 -1.44 V4 0.16 V2 2.88 V5 0.
ST Analysis E C G 5.00 30 MIN 0.00 70 ST = X.XX V2 Figure 10-3: Real-time ST trend display ECG lead designator Abnormals per minute counter Current heart rate ST segment levels (updates at 30-second intervals) ST segment level (single lead); asterisk indicates ST alarms are enabled Real-time ST trend Amplitude scale in millivolts Time scale - either 15- or 30-minutes Setting Up ST Monitoring To set up ST monitoring: 1 2 3 4 5 Set up system and patient for standard ECG monitoring.
Ultraview Care Network The SINGLE ST alarm allows you to monitor for localized changes that may only be detectable in a single lead. An ST alarm for a SINGLE LEAD will activate if the ST level for any one lead exceeds the SINGLE ST alarm limit, with respect to its current reference level. The factory default setting for the single lead ST alarm limit is 1.00 mm. The MULTI ST alarm allows you to monitor for global changes that may be detectable in multiple leads.
ST Analysis As a second example, assume the SINGLE ST alarm is set at 1.00 mm. The initial ST amplitude for a particular lead is +0.60 mm. Based on the initial reference level of 0.00 mm, an alarm would activate if the ST level exceeds +1.00 mm. Therefore, no alarm occurs. Instantaneously, the ST level increases to +1.20 mm. SINGLE ST alarm occurs and the new reference level for the lead is set to +1.20 mm.
Ultraview Care Network Reviewing ST Data To review ST data: 1 2 3 Touch ECG. Touch REVIEW. Touch ST REVIEW. Use the ST Review menu to display and review ST segment data. A snapshot of ST segments for all available leads is displayed. The time and date of the ST snapshot is displayed on the menu prompt line. Touch the PRIOR SET or NEXT SET key to display ST data at other time points. Figure 10-5 is an example of a ST segment snapshot. Nine ST snapshots can be stored for display.
ST Analysis Viewing ST Trends To view ST trends: 1 2 3 4 5 Touch ECG. Touch REVIEW. Touch ST REVIEW. Touch ST TREND. Touch the trend plot near the desired data point. Then use arrow keys to adjust the cursor position. Trends showing deviations in ST segment level are displayed for each lead monitored in the past 24-hours. Touching the trend graph or one of the arrow keys in the menu produces a cursor on the baseline of the trend plot.
Ultraview Care Network Printing ST Data To print all ST segment data: Printouts of ST segment data are annotated with the following: 1 2 3 • • • Touch ECG. Touch PRINT. Touch ST SEGMENTS. To print selected ST segments: 1 2 3 4 Touch ECG. Touch REVIEW. Touch ST REVIEW. Touch PRINT. To print the current trend data: 1 2 3 4 5 Touch ECG. Touch REVIEW. Touch ST REVIEW. Touch ST TREND. Touch PRINT.
ST Analysis Troubleshooting Guide Clinical Situation No access to ST analysis functions ST = ?? is displayed Possible Cause ■ ■ ■ The system must learn the ST segment level before it can provide access to ST analysis functions. Infrequent occurrence of dominant beats. ECG amplitude may be insufficient to detect QRS complexes. Solution ■ ■ ■ Wait until the system analyzes sufficient QRS complexes to calculate the ST segment level (approximately one minute).
12-Lead Diagnostics Directory Directory of Keys E C G ECG MENU ALARM LIMITS SETUP SIZE LEAD CONTROL DISPLAY FORMAT SUSPEND PROCESSING RELEARN PRINT REVIEW ECG - REVIEW ST REVIEW ECG - REPORT REVIEW STAT REPORT REPORT SETUP AUTO REPORT XX MIN ARRHYTHMIA REVIEW REPORT REVIEW REAL TIME ST TREND HR:MN DAY-MONTH-YEAR MORE TEXT CLEAR SAVE DIR PRINT SEND ECG* *This box will only display if the Module Configuration Manager Send ECG Report setting is set to manual AUTO PRINT ON OFF Do you wis
12-Lead Diagnostics Contents Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Initiating a 12-Lead Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ultraview Care Network Display Detail The 12-lead report display shows 2.5-seconds of waveform data per lead. Presentation of the leads may be in a standard format (refer to Figure 11-1) or the Cabrera format. When analysis is complete, measurements and diagnostic statements are displayed above the waveform data (requires option D). Vent.
12-Lead Diagnostics Automatic Scheduling of 12-Lead Reports To schedule 12-lead ECG reports: 1 2 3 4 5 6 Touch ECG. Touch REVIEW. Touch REPORT REVIEW. Touch REPORT SETUP. Select AUTO REPORT of 30-minutes, 1-hour, 2-hours, 4-hours, 8-hours, or 24-hours. Touch AUTO PRINT ON or OFF. 12-lead reports can be acquired automatically by selecting an interval time using the AUTO REPORT key. User-selectable intervals include 30-minutes or 1-, 2-, 4-, 8-, or 24-hours. Selecting OFF will disable this feature.
Ultraview Care Network Report Directory Display To view directory of 12-lead ECG reports: Touching the DIR key will display a directory of 12-lead reports. The time and date of each report is shown with the summary diagnosis. 1 2 3 4 Use the arrow keys to select the report of interest, then touch the DISPLAY key to display the selected diagnostic report. Touch ECG. Touch REVIEW. Touch REPORT REVIEW. Touch DIR. Reports that have been saved will be marked as YES in column three.
Respiration Directory Directory of Keys - ECG E C G ECG MENU ALARM LIMITS SIZE LEAD CONTROL SETUP DISPLAY FORMAT SUSPEND PROCESSING RELEARN PRINT REVIEW ECG - DISPLAY FORMAT FULL VIEW ON OFF SPLIT VIEW ON OFF 2 LEAD ON OFF CASCADE ON OFF RESP ON OFF VARITREND ON OFF NEXT VIEW ECG - SETUP SWEEP SPEED QRS TONE MONITOR EXTENDED PACED YES NO CONFIG RATE SOURCE RESTORE SETTINGS TRANSFER DATA ECG - CONFIG ADULT INFANT ARR ON OFF R E S P V A R I Refer to Refer to Respiration Varitrend 3
Respiration Directory Directory of Keys - Respiration R E S P RESP MENU ALARM LIMITS SIZE SWEEP SPEED RESP TONE WAVEFORM ON OFF LEAD SELECT SHALLOW NORMAL CVA FILTER ON OFF RESP - LEAD SELECT RL - LA RESP - TONE TONE ON OFF RA - LA VOLUME RA - LL RL - LL VOLUME RESP - SWEEP SPEED 25 mm/sec 12.5 mm/sec 6.25 mm/sec 1.
Respiration Directory Directory of Keys - Varitrend 3 V A R I VARITREND MENU 1.5 MIN RESP RATE 3.
Respiration Contents Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Setting Up Respiration Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Selecting Adult or Infant Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Setting and Adjusting Alarms. . . . . .
Ultraview Care Network Setting Up Respiration Monitoring To set up respiration monitoring: 1 2 3 4 5 6 7 Attach the patient ECG leads. Plug the ECG cable into the module’s ECG input. Touch ECG. Touch DISPLAY FORMAT. Select RESP ON. Touch RESP. Select additional keys as necessary. Refer to the Directory of Keys - Respiration on page 12-2 for a flow diagram of respiration keys and menus.
Respiration Selecting Adult or Infant Mode To specify the patient type: 1 2 3 4 Touch ECG. Touch SETUP. Touch CONFIG. Select ADULT or INFANT. The respiration function provides both adult and infant operational modes to optimize monitoring accuracy. When you select adult or infant, RESP alarm limits and breath detection sensitivity are adjusted based upon your selection. CAUTION: • When the system is in the infant mode, respiration alarm activation can be delayed for up to 3-minutes.
Ultraview Care Network Turning Respiratory Waveform On/Off To turn the respiration waveform display ON or OFF: You may choose to turn the respiration waveform OFF and display only the respiration numeric values. 1 2 The factory default setting for respiration waveform is ON. Touch RESP. Select WAVEFORM ON/OFF. Adjusting Waveform Size To adjust respiratory waveform size: 1 2 3 Touch RESP. Touch SIZE. Adjust waveform size using SIZE ↑ or SIZE ↓.
Respiration RA LA RA LL LA LL Maximum Impedance Change: Alternate Method: Position RA and LA electrodes at the nipple level, midaxillary line. Position RA and LA electrodes at the 2nd intercostal space, midclavicular line. Position LL below the diaphragm, preferably below the umbilicus. Position LL below the diaphragm, preferably below the umbilicus. Figure 12-2: Infant electrode placement Adjusting Respiration Sensitivity To adjust respiration monitoring sensitivity: 1 2 Touch RESP.
Ultraview Care Network The Spacelabs Medical CVA detection filter provides a method of discriminating between true respiratory effort and cardiac activity. The filter checks for coincidence between the respiratory and the heart rate. If the rates are the same, the digital display for respiratory rate changes to CVA, a CVA message appears in the waveform zone, and an apnea alarm is triggered if the apnea alarm has been enabled. This minimizes the possibility of apneic episodes being undetected due to CVA.
Respiration Setting the Time Scale To set the horizontal time scale: 1 2 Touch VARI. Select 1.5 MIN or 3.0 MIN. You can set the time scale for the horizontal axis at either 1.5- or 3.0-minutes. Selecting Respiratory Display Type To select the type of respiratory display: 1 2 Touch VARI. Select RESP RATE or RESP WAVE. The lower graph displays the trend for either the respiration rate or the compressed respiration waveform. • • RESP RATE displays the current respiration rate trend.
Ultraview Care Network Defining Events To access Event Trend: 1 2 Touch VARI. Touch EVENT TREND. To define an event: 1 2 3 4 5 6 Touch VARI. Touch EVENT TREND. Touch DEFINE EVENT. Select event(s) to define. Use arrow keys to adjust. Touch ENTER. The Event Trend feature of Varitrend 3 enables you to store events that represent a change in a patient’s condition based on multiple variables. You can define criteria for up to five different events.
Respiration Printing Varitrend 3 Graphs To print a Varitrend 3 graph: 1 2 Touch VARI. Touch PRINT. You may produce a recording of the currently displayed Varitrend 3 graph. Refer to Printing on page 4-1 for a complete overview of printer functions.
Respiration Troubleshooting Guide Clinical Situation Inaccurate respiratory rate or 0 displayed. Question marks displayed instead of rate Possible Cause ■ ■ ■ ■ No respiration waveform. LOSS OF SIGNAL message is displayed No respiration waveform is displayed 12-14 ■ ■ Respiration too shallow for normal detection. ECG electrode contact or placement poor. Incorrect lead selection for respiration. CVA artifact. ECG electrodes or patient cable not attached.
NIBP Directory Directory of Keys N I B P ADULT NIBP - MENU ALARM LIMITS TIME INTRVL AUTO ON OFF REVIEW CHANGE CONFIG. NIBP - CHANGE CONFIGURATION DISPLAY PR ON OFF TIME INTERVAL for automatic readings = q xx yyy << << ← → >> ADULT NEONATAL >> PRINT ADULT NIBP - ALARM LIMITS ALARMS ON OFF ! HI= 150 • LO= 100 SYS DIA MEAN Based on features purchased, more or fewer keys may appear here than on your menu screens.
NIBP Contents Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Setting Up NIBP Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Setting and Adjusting Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Selecting Adult or Neonatal Mode . . . . . . . .
Ultraview Care Network Setting Up NIBP Monitoring To set up NIBP monitoring: 1 2 3 4 Attach the cuff tube to the appropriate module front panel connector. Attach the cuff to the patient. Touch NIBP. Touch additional screen keys as needed. Proper cuff selection and application is essential in ensuring the accuracy of NIBP readings. To select the proper cuff, first measure the circumference of the limb at its midpoint.
NIBP Patient Factors Affecting Readings Excess patient movement, speech, or muscle contractions (as a result of severe pain or shivering) can interfere with automated NIBP readings. Ensure that the patient is quiet and not moving during NIBP readings just as you would during manual readings. Avoid applying external pressure to the cuff during readings. Institute measures to minimize shivering and alleviate pain.
Ultraview Care Network Display Detail Figure 13-1 and Figure 13-2 illustrate typical NIBP displays. You can view NIBP readings from any Ultraview Care Network bedside or central monitor on a network. The NIBP display on a split-screen central monitor appears in a format slightly different from that of a bedside or full-screen central monitor.
NIBP Bedside monitors show an NIBP table displaying a chronological listing of NIBP readings. The oldest data is at the top of the left column. Each reading contains the time of the measurement and the pressure values for systolic, diastolic, and mean. As new measurements are taken, the oldest data moves off the screen. ! • If you remove one NIBP module and insert another without purging data (via ADMIT/DISCHARGE), the NIBP table may display data for two patients.
Ultraview Care Network Selecting Adult or Neonatal Mode To select the patient type: 1 2 3 Touch NIBP. Touch CHANGE CONFIG. Select ADULT or NEONATAL. In modules that offer both adult and neonatal modes, you can determine the current mode by observing which key is highlighted or by reading the menu prompt in the NIBP menu. The factory default setting is adult. The following events occur with each change of mode: • • • • The monitor erases current NIBP readings from the display but retains them in memory.
NIBP Setting Automatic Measurements To determine automatic measurement intervals: 1 2 3 4 Touch NIBP. Select AUTO ON. Touch TIME INTRVL. Use arrow keys to adjust interval. The NIBP module always powers ON with automatic measurements set to OFF. The current time interval for automatic measurements is displayed on the message line above the arrow keys. The factory default setting for automatic time interval is 15-minutes.
Ultraview Care Network Recording Measurements To print the NIBP measurements currently displayed: 1 2 3 You can choose to print out either the complete NIBP display or only the numeric values of the last reading. Touch NIBP. Touch REVIEW. Touch PRINT. To print the most recent measurement (no table): 1 2 Touch RECORD (monitor key). Touch NIBP. Reviewing Measurements To review NIBP measurements: 1 2 Touch NIBP. Touch REVIEW.
NIBP Status Messages At the beginning of a blood pressure measurement: • The mean value of the previous reading disappears. • The message READING IN PROGRESS replaces the diastolic value. • A bleed step replaces the previously displayed systolic pressure. If the system fails to complete an initial measurement reading, the message SECOND READING REQUIRED will be displayed along with a description of the cause of the failure.
NIBP Troubleshooting Guide Clinical Situation No NIBP screen key is displayed No NIBP readings can be obtained Possible Cause ■ Module not inserted correctly. ■ ■ Incorrect or inoperative cuff in use. ■ ■ ■ ■ ■ ■ Intermittent or complete failure to operate Solution ■ Cuff tubing is attached to an adult outlet, but monitor is configured in the neonatal mode (or vice versa). Tubing is kinked.
Clinical Situation Variable readings occur Possible Cause ■ ■ No NIBP readings or questionable values in the presence of shock ■ Some arrhythmias may cause beat-to-beat pressure and NIBP readings. Larger than normal influence of respiratory phases on blood pressure (inspiratory fall in blood pressure; expiratory rise). Peripheral vascular changes experienced during shock may reduce the reliability of blood pressure readings obtained with any indirect method.
SpO2 Directory Directory of Keys S P O 2 SPO2 MENU ALARM LIMITS IABP SETUP YES NO PULSE RATE ON OFF SUSPEND PROCESSING SPO2 - SUSPEND PROCESSING YES NO SPO2 - SETUP WAVEFORM SIZE ON AVERAGING TONE SPO2 - DATA AVERAGING TIME XXs SPO2 - WAVEFORM SIZE SIZE OFF SIZE SPO2 - TONE TONE ON OFF VOLUME VOLUME SPO2 - ALARM LIMITS ALARMS ON HI = 100 OFF LO = 85 ALM DELAY 15s MSG ALARM DELAY 30s MSG ALARM KEY is displayed only when its value is other than 20 seconds.
SpO2 Contents Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Setting Up SpO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Dual SpO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Ensuring Accurate Monitoring . . . . . . .
Ultraview Care Network ! • Pulse oximetry may interfere with magnetic resonance imaging (MRI) procedures. Refer to your hospital’s protocols for specific instructions. • You can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Setting User-Defined Default Values on page 7-7 for further information.
SpO2 Dual SpO2 Monitoring Some modules support real-time monitoring of dual SpO2 sites. To employ this option, insert a second Spacelabs Medical SpO2 module into an available slot in the monitor. The new parameter will be displayed below the first SpO2 channel. Affix a label to the monitor’s bezel to indicate the sensor site location (for example, right hand, left foot) for each SpO2 parameter displayed on the monitor.
Ultraview Care Network Ensuring Accurate Monitoring While each sensor requires site specific application procedures, the following general points aid in ensuring oximetry monitoring success. • Choose a site that provides proper alignment of the LEDs and receiving photodetector. • Reduce light interference when monitoring a neonate under bright light by using a diaper or other light block over the sensor.
SpO2 Additional Information for Telemetry Products To set or adjust SpO2 alarms (telemetry): 1 2 3 4 5 6 Touch ECG. Touch ALARM LIMITS. Touch SPO2 ALARM LIMITS. Select SPO2 ALARMS ON. Select HI=, LO=, ALM DELAY, and MSG ALARM DELAY. Use arrow keys to adjust. When SpO2 alarms are enabled, a bell symbol is displayed between the SPO2 label and the SpO2 measured saturation value.
Ultraview Care Network Adjusting Tone Volume To adjust tone volume (non-telemetry): 1 2 3 4 5 Touch SPO2. Touch SETUP. Touch TONE. Touch TONE ON. Use arrow keys to adjust. Use this function to turn the pulse tone ON or OFF. The pitch varies according to the SpO2 value. The higher the oxygen saturation, the higher the pitch. The default setting for the pulse tone is OFF. ! • This feature is not supported in telemetry products.
SpO2 Restoring User-Defined Settings To restore user-defined settings: Configurations with ECG 1 2 3 4 With the Restore Settings feature, you can restore the user-configurable settings to the defaults previously stored as user settings. User-configurable settings are listed in Setting User-Defined Default Values on page 7-7. Touch ECG. Touch SETUP. Touch RESTORE SETTINGS. Touch YES. ! • RESTORE SETTINGS changes the user-configurable settings for all parameters in the module.
Ultraview Care Network Error Messages WARNING: • Error messages indicate a problem or condition which may affect accurate monitoring values. Do not ignore these messages. Correct any fault before continuing. When error messages are displayed, the saturation value and pulse rate immediately change to ??? and an alarm may occur if your module is configured to do so. If it occurs, this alarm does not begin until after the message alarm delay time has elapsed.
SpO2 ADAPTER DISCONNECTED — CHECK CONNECTION AT MODULE • The module does not detect an adapter cable connected to the front panel. Check proper adapter cable connection. • If the message persists and the adapter cable is secure, replace the adapter cable. • The channel will drop and the alarm will stop after approximately 10-seconds. • On remote view, there may be no audible alarm on the remote monitor before the channel drops.
Ultraview Care Network NOISY SIGNAL • Sensor signal disturbed by motion or other interference. Eliminate sensor movement. Message disappears when the value is obtained. • Sensor placement adjacent to power cords or other electrically noisy devices. Move the noisy device or move the sensor to another site. • If the message persists, replace the sensor.
SpO2 Troubleshooting Guide Clinical Situation No SpO2 parameter key is displayed Possible Cause ■ ■ ■ ■ ■ SpO2 value displays ??? Adapter cable not connected to module properly. Sensor not connected to adapter cable. SpO2 is not enabled at the 90343 transmitter. SpO2 is not enabled at the 90478 receiver. ■ Remove and reinsert the module. ■ Correctly connect the adapter cable. ■ Correctly connect the sensor. ■ ■ ■ Sensor not connected to patient. ■ ■ Excessive patient motion.
Clinical Situation Factors which cause significant variances in sensor accuracy Possible Cause ■ ■ Presence of intravascular dyes (indocyamine green, methylene blue) depending on their concentration in the blood stream. ■ ■ ■ High ambient light level. ■ ■ Electrosurgical interference. ■ ■ No SpO2 alarms are displayed Presence of dysfunctional hemoglobins (COHb, MetHb). Solution ■ Patient is significantly anemic (Hb less than 5g/dl) or patient has received large amounts of IV solutions.
Fetal Monitoring Directory Directory of Keys F E T A L FETAL MAIN MENU F-ALERT RESET SETUP RECORDER ON OFF PAPER FEED AUDIO X XX% FETAL ECG F ALERT LIMITS PRINT PERIOD MARK UA REF FETAL SETUP MENU TWIN SHIFT TOCO SENS RESTORE SETTINGS HIDDEN KEY FETAL - FETAL ECG MENU SIZE X mm/sec SIZE WAVEFORM ON OFF ECG PLOT ON OFF ECG HR EDIT ON OFF FETAL - TOCO SENS MENU MEDIUM LOW HIGH FETAL - TWIN SHIFT MENU AUTO MANUAL NO SHIFT FETAL - F-ALERT LIMITS MENU F-ALERT ON OFF ! • HI= XXX LO=
Fetal Monitoring Contents Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Fetal Display Detail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Starting Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Ultrasound Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Uterine Activity. . . . .
Ultraview Care Network For a twin pregnancy, the display appears as follows: ♥ FHR1 (ECG) UA (EXT) FHR1 (US) UC (EXT) 136 144 32 67 ♥ 쐉 쐅 FHR2 (US) 125 F E T A L TIME and DATE PATIENT’S NAME ROOM 1003 PATIENT’S NAME RM 1003 ALERT ON PAPER OUT 쐈 씈 Figure 15-2: Twin display 15-4 Heart beat indicator (flashes once per detected beat) 쐅 쐈 쐉 씈 UA channel label Channel 1 heart rate (beats per minute) FHR channel label Source of heart rate signal (US = ultrasound,
Fetal Monitoring Starting Operation Power ON To prepare the monitor for operation: 1. Plug the appropriate end of the power supply cord into the monitor’s right side panel receptacle labeled J1. 2. Secure the connector with the screw that is provided. 3. Plug the other end of the power cord into a properly grounded three-wire outlet marked Hospital Grade or Hospital Only. 4. Press the main power switch ON. The monitor will perform a self-test.
Ultraview Care Network Under standalone or BirthNet connections, when the monitor is in fetal heart rate alert status, the clinician will have to first touch the F-ALERT RESET to reset the alert, and again, to confirm the patient’s name. Loading Chart Paper To advance and calibrate the fetal recorder paper: To load chart paper: 1 1. Press the Recorder Release button and slide the drawer out to reveal the paper bin. 2.
Fetal Monitoring Ultrasound Monitoring Channel 1 The ultrasound transducer sends sound waves into the uterine cavity and detects echoes returning from objects in the path. The monitor uses auto-correlation to analyze these echoes from moving objects, specifically the fetal heart. The rhythm of the motion is used to compute the fetal heart rate. To produce a reliable recording, the transducer must be positioned properly to send sound waves directly at the fetal heart.
Ultraview Care Network Channel 2 To set the twin FHR shift: 1 2 3 Touch the SETUP key on the main fetal menu. Touch the TWIN SHIFT key. Select MANUAL, AUTO, or NO SHIFT mode. The monitor is equipped with a second FHR connector to provide simultaneous monitoring of twins. Both fetuses can be monitored using ultrasound transducers. Ultrasound transducer preparation and application for the second fetus is the same as for a single fetus. Volume controls for both channels are located on screen.
Fetal Monitoring Uterine Activity The toco transducer detects uterine activity by sensing changes in tension on the abdomen. Although absolute uterine pressure cannot be measured by this method, the toco transducer does provide a reliable indication of the timing and approximate duration of contractions. ! • Do not use any kind of gel on the toco transducer. Toco Transducer Preparation and Application To initialize uterine activity: 1 2 Touch the UA REF key. Touch YES to confirm.
Ultraview Care Network ECG Monitoring In addition to ultrasound, channel 1 is designed to monitor fetal heart rate using an invasive spiral electrode to obtain the fetal ECG and derive the heart rate. The ECG (internal) mode is generally considered the most accurate and reliable method to obtain a fetal heart rate.
Fetal Monitoring Intrauterine Pressure Monitoring Actual intrauterine pressure, including contraction frequency, duration, intensity, and uterine tone (pressure between contractions), is measured using an intrauterine catheter and pressure transducer. Application techniques for internal pressure catheters are considered to be beyond the scope of this manual. Consult the manufacturer’s instructions included with the package for proper application techniques.
Ultraview Care Network 12. Press Yes to confirm the initialization. The UA display should read 0 (zero). Release the cap on the pressure relief valve or replace the dead-end stopper to reseal the dome. ! • Check to see that all of the air bubbles have been removed. • If there are still air bubbles in the dome, repeat the process. 13. Turn the handle of the stopcock toward the syringe to begin recording uterine activity. ! • Between contractions, the UA channel should not return to zero.
Fetal Monitoring Main Menu When the FETAL key is touched, the menu will appear at the bottom of the screen. This menu will remain on screen during the monitoring session, unless the operator accesses another menu screen. To return the to Main menu, touch the FETAL key. Fetal Heart Rate Alerts To turn F-Alert ON or OFF: 1 2 3 Touch the SETUP key on the main fetal menu. Touch the F-ALERT limits key. Select F-ALERT ON or OFF. To set fetal alert limits: 1 2 3 4 5 Touch the SETUP key on the main fetal menu.
Ultraview Care Network Bradycardia Alert Type 1 The heart rate is divided into eight groups of 20-seconds each. Group H represents the current 20-seconds. An alert will activate if Groups G and H are below 90 bpm. Figure 15-3: Type 1 bradycardia alert CAUTION: • Any time the alert activates, the heart rate must return to normal before the Alert can be reactivated. Reset the alert by pressing the F-ALERT RESET key on the screen.
Fetal Monitoring Type 2 An alert will activate if: • • • • • Group H is less than Group F; and Group G is less than Group E; and Group F is less than Group D; and Group E is less than Group C; and Group H is below Group C by more than 30 bpm. Figure 15-4: Type 2 bradycardia alert Type 3 An alert will activate if the average of Groups G and H is lower than the average of Groups A, B, C, and D by more than 40 bpm.
Ultraview Care Network Tachycardia Alert The monitor analyzes the fetal heart rate for tachycardia using the following algorithms. The heart rate is divided into eight groups of 20-seconds each. Type 1 An alert will activate if: • • Group C is less than 180 bpm, and Groups F, G, and H are each greater than or equal to 190 bpm. Figure 15-6: Type 1 tachycardia alert ! • The most recent Heart Rate Group is H; Heart Rate Group A must not be zero.
Fetal Monitoring Recorder Operations The monitor is automatically programmed to print predetermined data items on the fetal strip chart. The following two strips identify the data items and illustrate how twin FHRs print on the strip. The recorder will also print values from maternal monitoring parameters. When installed with the BirthNet Obstetrical Data Management System, designated data items entered in BirthNet will also print on the strip.
Ultraview Care Network Figure 15-9: Twin fetal heart rates on same scale, then shifted to separate scales These messages print according to the following schedule: Table 1: Print Time Intervals DATA ITEM TIME INTERVALS Time and Date Recorder Speed Every 5-minutes HR Mode 5-, 20-, 35-, and 50-minutes after the hour Uterine contraction mode 5-, 20-, 35-, and 50-minutes after the hour Monitor ID # 10-, 25-, 40-, and 55-minutes after the hour Twin Shift (when selected) Every 10-minute
Fetal Monitoring Printing Heart Rates Over 240 bpm (ECG only) To set the time interval for SpO2 and MHR parameters to print on the fetal strip: 1 2 3 Touch the SETUP key on the main fetal menu. Touch PRINT PERIOD. Select numeric value equal to the number of minutes to set the time interval for SpO2 and MHR parameters to print on the fetal strip. When a spiral electrode is in use and the heart rate exceeds 240 bpm, the numeric value (up to 300) is displayed on the screen.
Ultraview Care Network Figure 15-10: ECG rhythm strip Figure 15-11: ECG rhythm strip Variability Trend Plots When operating in ECG mode, a trend of fetal heart rate variability is automatically calculated and plotted. This X-Y graph, printed every 10-minutes, is computed by combining long-term and short-term heart rate variability. One point is plotted for each 128 heart beats. The X-axis corresponds to time, and the Y-axis corresponds to the value of variability for each measurement.
Fetal Monitoring Figure 15-12: Above-average variability plot Figure 15-13: Average variability plot 15-21
Ultraview Care Network Figure 15-14: Below-average variability plot ! • The Variability Trend Graph is only generated in direct ECG mode from FHR channel 1. • Variability data is not meant to indicate the status or well being of the fetus. • Variability data is a mathematical expression of the variability of the fetal heart rate displayed in a convenient way. Paper Out Memory If the recorder runs out of chart paper, the screen flashes PAPER OUT in the dedicated status area on the screen.
Fetal Monitoring Module Configuration Manager The Module Configuration Manager feature provides the capability to define and store all user-configurable options for the fetal parameter. Once configured, these settings control its operation whenever the monitor is powered ON. Display Detail The User Settings screens list all user-configurable options. From these screens you can change and store the options in your monitor.
Ultraview Care Network Setting User-Defined Default Values Use the User Settings screens to change and store settings. If the setting for the selected parameter cannot be changed, the message THIS SETTING CANNOT BE CHANGED will be displayed. The ability to access the Module Configuration Manager screens can either be visible to all users or remain hidden. The factory default setting is INVISIBLE. Adjust the SYSTEM SETUP key to the VISIBLE setting to enable user access to this function.
Fetal Monitoring Parameter Configurations To review or change settings: 1 2 3 4 5 6 Touch FETAL. Touch SETUP. Touch the hidden key 3 times. Touch DEFAULT STORAGE. Touch USER SETTINGS. Use CURSOR↑ and CURSOR↓ to scroll through the parameter description list. 7 Use ↑ and ↓ to change the settings. 8 Touch NEXT PAGE to continue to next screen of parameters. 9 Touch STORE to save the new settings. 10 Touch YES when the Yes/No message is displayed.
Ultraview Care Network Table 3: Fetal Alert Attributes Y/N N User Settings Factory Defaults N Alarm Watch Available User Settings N User Settings Factory Defaults Medium Available User Settings Medium Alarm Recording User Settings Factory Defaults Fetal Heart Rate Alert Tone Type Available User Settings Alarm Type Telemetry Option Each fetal monitor can be equipped with a fetal telemetry system to provide continuous monitoring of an ambulatory patient.
Fetal Monitoring ! • When the transmitter is powered ON, it should emit a short tone to indicate that the battery is good. If the battery is low, the transmitter emits a steady tone until depleted. Replace the battery if the transmitter is emitting a steady tone or is depleted. • If the patient exceeds the receiving range, the signal may be weak or may drop out. The patient should return to within range of the fetal monitor.
Ultraview Care Network c d b a Figure 15-16: Wireless transducer Mermaid system 3. Twist the battery pack clockwise slightly to lock it into the Toco transducer. Repeat the procedure for the Mermaid ultrasound transducer. 4. Pin the transmit badge (c) to the patient’s clothing (preferably at shoulder level) with the clasp or use the necklace provided. Clothing or blankets must not cover the badge. 5. Attach either of the blue connectors (d) on the transmit badge to the Mermaid Toco transducer.
Fetal Monitoring Recharging Batteries 1. The battery packs are enclosed in the top half of the Mermaid ultrasound and Toco transducers (Figure 15-17). To remove the packs (a) from the transducer elements, twist the pack counterclockwise. There will be a noticeable movement. Simply pull the battery pack to disengage. ! • Thoroughly dry the battery pack before inserting it into the charger.
Ultraview Care Network 15-30 4. The amber light (g) on the recharger unit indicates that the battery pack is being charged. A green light (h) indicates that charging is complete. It may take up to one hour to reach a full charge. The battery packs may be left on the charger when the transducers are not in use. 5. Each battery pack has three green lights (i) to indicate the remaining charge. The lights automatically power ON whenever the battery pack is attached to the transducer or is being charged.
Temperature Directory Directory of Keys One Temperature T E M P keys may not be displayed keys may not be displayed TEMP MENU RESTORE SETTINGS ALARM LIMITS NO YES TEMP - ALARM LIMITS ALARMS HI= OFF ON OFF LO= OFF Two Temperatures (same module) T E M P keys may not be displayed keys may not be displayed TEMP MENU RESTORE SETTINGS ALARM LIMITS YES TEMP - ALARM LIMITS ALARMS HI= OFF ON OFF LO= OFF NO TEMP 1 TEMP 2 DELTA TEMP Alternate key display ALARMS ON OFF ! • HI= OFF LO= OFF TE
Temperature Contents Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setting Up Temperature Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Setting or Adjusting Temperature Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . Recording Temperatures . . . . . . . . . . . . . . . . . . .
Ultraview Care Network Display Detail Temperature readings appear on the monitor screen as soon as you plug a temperature probe into the module. T E M P 38.0 T1 oC 38.5 37.5 T E M P DT 2.9 T1 T1 ON T2 ON o C DT OFF 35.1 38.
Temperature Setting or Adjusting Temperature Alarm Limits To set or adjust alarm limits 1 2 3 4 5 6 Touch TEMP. Touch ALARM LIMITS. Select TEMP 1, TEMP 2, TEMP 3, TEMP 4, or DELTA TEMP. Select ALARMS ON. Select HI= or LO=. Use arrow keys to adjust limit. High and low alarm limits can be set for T1 (T3), T2 (T4), and the temperature difference (DT) between two temperatures. The factory default settings for high and low temperature alarms are 37.5°C and 36.5°C.
Temperature Troubleshooting Guide Clinical Situation Possible Cause Solution Intermittent or no operation ■ Module error. ■ Call a qualified service person. Temperature not displayed ■ Module not inserted correctly. ■ Reinsert the module. ■ Probe not connected to module. ■ Reconnect the probe.
Digital Telemetry Directory Directory of Keys MONITOR SETUP SCREEN FORMAT RECORDER CONFIG. MONITOR CONFIG. ADMIT/ DISCHARGE TONES MONITOR SETUP PRIVILEGED ACCESS.
Digital Telemetry Contents General Telemetry Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Multiparameter Telemetry Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Transmitters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ultraview Care Network ! • Spacelabs Medical’s telemetry equipment complies with Part 15 and Part 95 of the FCC Rules and with RSS-210 of Industry Canada and with requirements of other national spectrum management authorities. Repeated here are operational cautions for biomedical telemetry from the FCC Rules (47CFR15.
Digital Telemetry Multiparameter Telemetry Overview 90217 ABP Monitor The 90343 digital telemetry multiparameter transmitter sends NIBP data acquired by the 90217 ambulatory blood pressure (ABP) monitor to the 90478 digital telemetry receiver. The 90478 displays the patient’s episodic NIBP data and trigger alarms based on thresholds set at the patient monitor. Refer to Setting Up NIBP Monitoring on page 17-17 for information on configuring and using ABP monitors with multiparameter telemetry.
Ultraview Care Network Intended Use As an option, on adult patients, additional abnormal cardiac rhythms, such as ventricular runs, tachycardia, and ST segment deviations can be detected. The Ultraview Digital Telemetry System also provides a means for the episodic monitoring of NIBP signals to detect abnormal events such as high and low blood pressure.
Digital Telemetry WARNING: • Medical telemetry spectrum allocations may be assigned to frequencies already allotted to other priority users. This means that telemetry operations may be exposed to radio frequency interference that may disrupt or impede telemetry patient monitoring during the life of this equipment. You are urged to regularly consult with applicable local and federal regulatory agencies (e.g., FCC, FDA, etc.
Ultraview Care Network Selecting Options for the 90341 Lead Display There are two operational modes available with the 90341 dual-lead transmitter: (1) the standard mode which offers a choice of one V lead (V1-6), plus lead II, or (2) the limb lead mode which offers choices of the leads I, II, III, AVR, AVL, or AVF. The standard mode is available if the chest lead is applied. The limb lead mode is available when there is not a chest lead applied.
Digital Telemetry Transmitter Batteries A 9-volt alkaline battery is recommended for standard use in the digital telemetry transmitter. A 9-volt lithium battery may also be used for applications requiring more extended battery service life. Always observe the battery position and polarity as illustrated at the bottom of the battery compartment. After battery installation, close and latch the compartment cover. The transmitter begins transmitting as soon as the battery is in place.
Ultraview Care Network Cleaning The transmitter does not require any preventive maintenance other than cleaning but should be cleaned after each use. To clean the transmitter, use only the following agents. • • • • • Mild soap and water solution U.S.
Digital Telemetry mains indicator light on the front panel of the housing must be illuminated. Operating the system without AC mains power is limited to 10-minutes of battery backup time. Diversity Antenna System NOTE: The UCW bedside connects to the remote module housing, and the UCW central connects to the digital telemetry module housing. E C G ETHERNET HUB VI ST=0.
Ultraview Care Network Display Detail Signal detection is indicated on your monitor when an ECG signal appears next to the ECG parameter key in the zone assigned to receive the transmitted telemetry channel. The transmitter’s channel number is always identified above the waveform, to the left of the ECG key. 씍 씉 씊 * CHAN 2241 II E C G MON PACED ST=0.
Digital Telemetry Abnormals per minute alarm limit * ST segment level for first lead** (the asterisk indicates ST alarms are enabled) 쐅 Abnormals in a row alarm limit * 쐈 ECG rate alarm limits.
Ultraview Care Network Assigning a Telemetry Channel To initiate telemetry ECG monitoring: 1 2 3 4 5 6 7 Select a transmitter. Note its channel number. Attach lead wires to transmitter. Attach lead wires to electrodes. Apply electrodes to patient. Install a transmitter battery. Close the transmitter case. To set up the central for ECG (if bed name not remembered): 1 2 Your central monitor can only display a telemetry channel after that channel has been assigned a specific bed name.
Digital Telemetry Entering Patient Information Refer to Admit/Discharge on page 3-3 for information on this subject. Setting or Adjusting Alarm Limits To set or adjust multiparameter telemetry alarms: 1 Touch ECG. 2 Touch ALARM LIMITS. 3a Touch ECG ALARM LIMITS -OR4a Touch NIBP ALARM LIMITS -OR5a Touch SPO2 ALARM LIMITS. 6a For ECG and NIBP — Touch HI = or LO = key. 6b For SpO2 — Touch HI=, LO=, ALM DELAY, or MSG ALARM DELAY (if present). 7 Use the arrow keys to adjust.
Ultraview Care Network Discharging a Patient To discharge a patient: 1 2 3 4 5 Remove battery. Disconnect the transmitter from the patient. Touch YES to confirm signal loss permanent. Touch YES to discharge. Touch YES to purge data. The process of discharging a patient begins by removing the battery from the transmitter. The monitor responds to this as described Acknowledging Signal Loss on page 17-15.
Digital Telemetry SIGNAL INTERFERENCE The signal interference message indicates, via the displayed triangle squelch waveform, that an interfering signal has been detected. A signal can no longer be detected because of interference from a stronger signal source lasting more than 0.5-seconds. A low priority alarm tone sounds whenever this message is displayed in the waveform zone. IS SIGNAL LOSS PERMANENT? The permanent signal loss message indicates that no RF signal is being detected.
Ultraview Care Network Patient Factors Affecting Readings Excess patient movement, speech, or muscle contractions as a result of severe pain or shivering can interfere with automated NIBP readings. Ensure that the patient is quiet and not moving during NIBP readings just as you would manual readings. The patient must avoid applying external pressure to the cuff during readings. Institute measures to minimize shivering and alleviate pain.
Digital Telemetry Table 1: Cuff Size by Limb Circumference 4. Cuff Size Limb Circumference Pediatric 13 to 20 cm Small adult 17 to 26 cm Average adult 24 to 32 cm Large adult 32 to 42 cm Extra-large adult 38 to 50 cm Position the cuff so that the center of the inflatable bladder is directly over the brachial artery. The center of the bladder location is marked on the outside of the cuff.
Ultraview Care Network alternative #1 alternative #2 Figure 17-4: Common cuff hose positions 7. Connect the hose to the monitor. 8. To verify proper monitor operation, take one or more blood pressure readings. Push the START/STOP key to begin a measurement. 9. The 90343 transmitter must be configured for use with the 90217 ABP monitor by opening the battery compartment door, removing the battery, and setting DIP switches 5 ON and 8 OFF. Refer to Figure 17-2 on page 17-12. 10.
Digital Telemetry 11. Interconnect the adapter cable between the communications port on the ABP monitor and the NIBP port on the 90343 as shown in Figure 17-5. SpO2 adapter cable NIBP cuff SpO2 sensor NIBP adapter cable 90217 & 90343 mount in pouches to patient’s belt. Figure 17-5: Transmitter ECG, SpO2, and ABP monitor connections Figure 17-2 and Figure 17-3 illustrate typical NIBP displays. You can view NIBP readings from any Ultraview bedside or central monitor on a network.
Ultraview Care Network Setting or Adjusting Alarm Limits To set or adjust NIBP alarms: 1 2 3 4 5 6 7 Touch ECG. Touch ALARM LIMITS. Touch NIBP ALARM LIMITS. Select NIBP ALM ON. Select SYS, DIA, or MEAN. Select HI= or LO=. Use arrow keys to adjust. To display the current reading: 1 2 3 Touch ECG. Touch CHANNEL FORMAT. Select NIBP ON. Refer to NIBP on page 13-3.
Digital Telemetry NIBP READING FAILURE (xx) Displayed when the ABP monitor was unable to make a reading. The code (xx) defines the cause of failure. NIBP AIR LEAK Displayed when an air leak has been detected in the pneumatic system, preventing a reading from being taken. NIBP LOOSE OR NO CUFF Displayed when the cuff was able to be inflated in a manner indicating that it was not attached to the patient correctly.
NIBP Troubleshooting Guide Clinical Situation No NIBP displays Possible Cause ■ ■ ■ ■ No NIBP readings can be obtained 90343 Low battery indicator constantly illuminated. Enable NIBP function by setting transmitter DIP switch 5 ON and setting DIP switch 8 OFF. ■ Re initialize 90217 ABP using 90121. ■ Call qualified service person. ■ Replace with cuff known to be operative. ■ Tubing is kinked. ■ Locate kink and straighten tubing. ■ Some arrhythmias (e.g.
Clinical Situation 90217 ABP Display is incorrect Possible Cause ■ Data not retained. ■ ■ Low or no power. ■ ■ No NIBP alarms are displayed Solution ■ ■ May be one of the following: timeout, no reading due to air leak in the system, improper cuff size, cuff size not properly attached to the 90217 ABP. ECG “Leads Off” condition exists. Higher priority alarm condition is present.
Pressure Directory Directory of Keys The pressure label you select will appear here PRESSURE MAIN MENU ALARM SIZE SETUP LIMITS SELECT LABEL SCALES ZERO PRESSURE SCALES Menu SCALES FREEZE SCALE 0-180 ON OFF ON OFF This key becomes SAVE PCWP with PA SAVE SYS SAVE DIA CURSOR = 95 SAVE MEAN ZERO PRESSURE Label Select Menu ART PA CVP PRESSURE Setup Menu SWEEP SPEED FILTER 25 mm/sec.
Pressure Contents Directory of Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Setting Up Pressure Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Zeroing the Pressure Transducer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Display Detail. . . . . . . . . . . . . . . . . .
Ultraview Care Network Systolic, diastolic, and mean pressure values are displayed for arterial, pulmonary artery, umbilical artery, umbilical vein and generic pressures. Only the mean value is displayed for other pressure types. Refer to the Display Detail on page 18-5 for a sample arterial pressure and intracranial pressure display on the bedside monitor.
Pressure Display Detail A pressure display appears once you select a pressure label and zero the transducer. Figure 18-1 shows an example of the display for ART and ICP. The system identifies the specific pressure type in the parameter key and menu title (PA, CVP, LAP, etc.).
Ultraview Care Network Setting and Adjusting Alarms To set or adjust alarm limits: 1 2 3 4 5 Touch the desired pressure parameter key. Touch ALARM LIMITS. Select desired alarm. Select ALARM ON. Use arrow keys to adjust a limit value. Pressure alarm limits can be defined for systolic, diastolic, and mean values for ART, PA, UA, UV, and PRS. Alarm limits can only be set for the mean value for all other pressures.
Pressure Adjusting Sweep Speed To select a pressure waveform sweep speed: 1 2 3 4 Touch the desired pressure parameter key. Touch SETUP. Touch SWEEP SPEED. Select a sweep speed. The sweep speed determines the rate at which the pressure waveform moves across the screen. Sweep speed selections are: 50, 25, 12.5, 6.25 mm/second, or the same sweep speed as ECG.
Ultraview Care Network Storing Values for Trending To store values in memory: 1 2 3 Touch the desired pressure parameter key. Touch SCALES. Use arrow keys to position cursor. You can store values into memory for pressure trend displays for use in clinical calculations. For ART, PRS, UA and UV 4 Select SAVE SYS, SAVE DIA or SAVE MEAN. For CVP, RAP, LAP or ICP 5 Touch SAVE MEAN. For PA 6 Touch SAVE PCWP. Recording Waveforms To print pressure waveforms: 1 2 Touch RECORD.
Pressure Selecting a Filter Frequency To adjust the filter frequency: 1 2 3 4 Touch the desired pressure parameter key. Touch SETUP. Touch FILTER. Touch the arrow keys to choose the desired setting. When noise and other interference appears on the pressure waveform, you can adjust the filter frequency to minimize its effect. A higher filter frequency shows greater detail, but can also produce more artifact.
Ultraview Care Network Factory Default Pressure Alarm Settings Arterial (ART), Generic Pressure (PRS), Umbilical Artery and Vein (UA and UV), Cerebral Perfusion (CPP-mean only) Systolic * Diastolic Mean mmHg High Low -50 to 79 +30 -05 mmHg High Low -50 to 69 +30 -05 mmHg High Low -50 to 69 +30 -05 80 to 109 +30 -10 70 to 79 +30 -10 70 to 79 +20 -10 110 to 119 +30 -15 80 to 99 +30 -15 80 to 89 +20 -15 120 to 129 +25 -20 100 to 109 +30 -20 90 to 99 +15 -15 130
Invasive Pressure Troubleshooting Guide Clinical Situation Possible Cause Solution Intermittent or no operation ■ Module error. ■ Call a qualified service person. No pressure key appears ■ Module not inserted correctly. ■ Reinsert the module. ■ Transducer not connected. ■ Reconnect the transducer. ■ Respiration artifact too high. ■ Select ART REJ ON. ■ Reconnect cable. ■ Reconnect cable.
