Philips Medical Systems North America 4852 IntelliVue Access Point User Manual M4841 91001

Philips Medical Systems North America Co. IntelliVue Access Point M4841 91001

Users Manual

Instructions for UseIntelliVue TRx/TRx+ Transceivers for the ITS4840A/ITS4850A IntelliVue Telemetry SystemPart Number: M4841-9001JPrinted in the U.S.A. December 2006First Edition Notice (ITS4840A)This system complies with part 15 of the FCC Rules. Operation is subject to the condition that this device does not cause harmful interference.Operation of this equipment in the United States requires the prior coordination with a frequency coordinator designated by the Federal Communications Commission (FCC) for the Wireless Medical Telemetry Service (WMTS).Notice (ITS4850A)This system complies with part 15 of the FCC Rules, ETSI, RS-210, and other international radio standards that govern operation in the ISM band. Operation is not subject to WMTS rules.
Printing HistoryiiNotice Document number: M4841-9001J, First EditionPrinted in the USA.© Copyright 2004, 2005, 2006 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.Equipment specifications are subject to alteration without notice. All changes will be in compliance with regulations governing manufacture of medical equipment.OxiCliq® and OxiMax® are registered trademarks of Nellcor Incorporated.Duracell® is a registered trademark of Duracell International Incorporated.Manufacturer Philips Medical Systems3000 Minuteman RoadAndover, MA 01810-1099(978) 687-1501Printing HistoryNew 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. The printing date changes when a new edition is printed. (Minor corrections and updates which are incorporated at reprint do not cause the date to change.)
About this Book iiiThe document part number changes when extensive technical changes are incorporated.First Edition...............................................................................December 2006IntelliVue TRx4841A Transceivers are compatible with:IntelliVue Telemetry System, Revision A.00IntelliVue Information Center, Software Revisions F.00, G.00, H.00 and J.00M2636C TeleMon Companion Monitor, Revision A.00, B.00 and C.00IntelliVue MP5 Patient Monitor, Revision E.00IntelliVue TRx4851A Transceivers are compatible with:IntelliVue Telemetry System, Revision B.00IntelliVue Information Center, Software Revision J.00M2636C TeleMon Companion Monitor, Revision C.00IntelliVue MP5 Patient Monitor, Revision E.00About this BookThis book contains operating instructions for use of the IntelliVue TRx and TRx+ Transceivers as used with the IntelliVue Telemetry System with Smart-Hopping 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. Additional resources for Philips products used in conjunction with the IntelliVue TRx and TRx+ Transceivers include:• IntelliVue Information Center Instructions for Use• IntelliVue Information Center Online Help• M2636C TeleMon Companion Monitor Instructions for Use• IntelliVue Telemetry System Training Program
About this Bookiv• IntelliVue MP5 Patient Monitor Instructions for UseFor preventive maintenance, repair, and test methods for verification of device performance, refer to the IntelliVue Telemetry System Service Kit.
About this Book vDocument ConventionsThe following document conventions are used throughout this manual to identify specific safety and operational information.WarningsWarningWarningWarnings are information you must know to avoid injuring patients and personnel. CautionsCautionCautions are information you must know to avoid damaging your equipment and software.NotesNote—Notes contain additional information on use of the IntelliVue Telemetry System.ProceduresProcedures are indicated in the following table:Step Action123
About this Bookvi
ContentsContents-11. Introducing IntelliVue Telemetry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1 The IntelliVue Transceiver. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2Transceiver Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2Transceiver Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2IntelliVue Telemetry System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4Bi-directional Capability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4Smart-hopping Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5Spectrum Sharing (USA Only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-6IntelliVue Clinical Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8Transceiver Use with Other Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-92. Product Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1 General Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5ECG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6For Paced Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8ST/AR Arrhythmia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8For Paced Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-10ST/AR ST Segment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-14Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-163. Transceiver Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1Transceiver Controls - Front . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2Buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3Power On/Off. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5Ports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6Transceiver Controls - Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8Safety Symbols & Other Marks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8Audible Tones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10Clinical Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11
Contents-2Adjustable Sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-12Service Sounds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-134. Basic Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1Transceiver Safety Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2Turning the Transceiver On/Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2Turning On. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2Turning the Transceiver Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3Standby Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4Briefing the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6Pouch Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7Securing the Pouch. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7Showering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-9Testing Transceiver Functionality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-10Self Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-10Status Check. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-11Battery Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-12Battery Safety Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-12Inserting/Removing Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-13Checking the Battery Power Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-155. Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1Alarm Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2Testing Alarm Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2Suspending/Pausing Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2Unsuspending& Resuming Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3Physiologic Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4Technical Alarms (INOPs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-96. ECG Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1ECG Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2For Paced Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3Measuring ECG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4ECG Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4ECG Leads Monitored . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5 Positioning ECG Electrodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-9Locating the Fourth Intercostal Space . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-123-Wire Placement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-135-Wire Placement (Standard Mode) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-145-Wire Placement (EASI Mode) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-16
Contents-36-Wire Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-18Connecting the ECG Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-22Cable Disconnection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-24Verifying Electrode Connections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-25Monitoring during Leads Off. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-26ECG Fallback . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-26Extended Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-27Relearning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-27Using EASI Leads to Troubleshoot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-27Optimizing ECG Measurement Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-28Dropouts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-29Muscle and Movement Artifact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-317. ST/AR Arrhythmia & ST Segment Monitoring. . . . . . . . . . . . . . . . . . . . . . . 7-1ST/AR Arrhythmia Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2For Paced Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3ST/AR Arrhythmia Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4ST/AR ST Segment Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7The Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7Algorithm Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8Displayed ST Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-9EASI ST Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-9ST Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-9ST Alarm Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-118. SpO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1SpO2 Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2SpO2 Information for the User . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3Pulse Oximetry Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4Pulse Tone Indication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5Selecting a SpO2 Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6 Applying the Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10Sensor Application Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10Site Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10Sensor Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11Connecting the SpO2 Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-14Measuring SpO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-15Spot Check Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-15Continuous Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-16
Contents-4When Connected to TeleMon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-17When Connected to the MP5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-18Turning SpO2 Monitoring Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-18SpO2 Enable/Disable at Information Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-19SpO2 Auto ON at Information Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-19Understanding SpO2 Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-20Optimizing SpO2 Measurement Performance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-209. Telemetry Functions at the Information Center & TeleMon . . . . . . . . . . . . 9-1Telemetry Functions at the Information Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2Telemetry Controls in the Patient Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2Locating the Transceiver (Find Device) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3Viewing Device Location History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4Patient-Configurable Settings in Telemetry Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4Unit-Configurable Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-8RF Auto Shutoff. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-16Transceiver Operation when Connected to TeleMon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1610. Pairing with IntelliVue Patient Monitors . . . . . . . . . . . . . . . . . . . . . . . . . 10-1Pairing with a Direct Connection to the MP5 Patient Monitor . . . . . . . . . . . . . . . . . . . . . . . . . 10-2Pairing at the Information Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3 Alarm Behavior with Telemetry Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3Paired Device Synchronized Alarm Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-611. Maintenance, Cleaning & Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . 11-1Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-2Basic Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-2Testing Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-2Label Assignment for Replacement Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-2Cleaning and Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4Cleaning the Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-5EO Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-6Alternate Cleaning and Disinfection Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-11Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-12Basic Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-12Information Signals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1312. Safety Standards & Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-1Regulatory Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-2Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-2
Contents-5Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-2Rx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-2Patient Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-2Safety Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-3Essential Performance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-3System Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-4FCC Compliance (USA only). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-4AC Power Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5Software Hazard Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5Electromagnetic Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5Reducing Electromagnetic Interference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7Restrictions for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7Battery Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8Radio Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-9TRx4841A &TRx4851A Transceiver. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-9WMTS Channel Frequencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-10Physical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-11ECG-only Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-11ECG/SpO2 Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-12Environmental Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-13TRx4841A & TRx4851A Transceiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-13 Measurement Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-14ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-14SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-16SpO2 Sensor Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-18A. Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1Accessory Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2Transceiver Accessories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2Pouches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2Protective Covers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3ECG Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3Electrodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3Leadsets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3Alignment Guides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4Skin Prep Paper. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5SpO2 Accessories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5Reusable Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5Disposable Sensors - Single Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-7
Contents-6Adapter Cables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-7Monitor Interface Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-8Wristband . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-8B. Sales and Support Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1
Introducing IntelliVue Telemetry 1-1Introduction1Introducing IntelliVue TelemetryThis chapter introduces the IntelliVue TRx and TRx+ Transceivers, the patient-worn 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8• Transceiver Use with Other Equipment . . . . . . . . . . . . . . . . . . . . . . . . 1-9
The IntelliVue Transceiver1-2 Introducing IntelliVue Telemetry The IntelliVue TransceiverThe 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. Transceiver Features• EASI/Standard and Standard only (No EASI) selectable in one device.• 6-lead with two V-leads for diagnosing multiple cardiac abnormalities, including wide-QRS complex tachycardias and acute myocardial ischemia/infarction.• Small, lightweight ECG-only device.• Audio feedback for out-of-range and lost device.• Battery gauge on device and at Information Center.• Powered by 2 AA batteries.• Alarm suspend and resume from standby at device and Information Center.•SpO2 Spot Check measurement without using any controls.• Easy for clinicians to use and comfortable for patients to wear.• Protective covers preventing debris from accessing unused ports.• Pouch with clear front that closes securely.• Simultaneous operation in network with M2601B Transmitter.Transceiver ModelsThe transceiver is available in two models for each radio frequency spectrum in which they operate (TRx4841A - 1.4 GHz; TRx4851A - 2.4 GHz): • TRx - ECG Only•TRx+ - ECG and SpO2
The IntelliVue Transceiver Introducing IntelliVue Telemetry 1-3. EASI, 3 5M2601BEASI, 3 5,6IntelliVue TRx+M4841AIntelliVue TRx+M4841A EASI FCCID: XXXXXXXX EASIIEAS 234455661 backfrontIntelliVue TRx Transceiver - ECG Only EASI, 3 5,6IntelliVue TRx+M4841A EASI FCCID: XXXXXXXX EASIIEAS 234455661front IntelliVue TRx+ Transceiver - ECG/SpO2back
IntelliVue Telemetry System1-4 Introducing IntelliVue Telemetry IntelliVue Telemetry SystemThe 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. The system connects a number of individual devices to form a complete method of transporting patient data to a central repository for subsequent distribution to clinical staff. Full patient mobility is available within the areas defined by the wireless coverage of the multiple Access Points. Bi-directional CapabilityTelemetry transmits the patient’s measurements using radio waves. The signals obtained from the patient travel from the transceiver to an access point in the ceiling or wall and then to the Information Center. Bi-directional capability enables you to remotely control certain transceiver functions from the Information Center. Physiological data is transported from the transceiver, and a reverse data channel enables data to be transported to the transceiver. Bi-directional operations include the following:• Change SpO2 measurement mode, or turn SpO2 measurement off.• Enable or disable display of the pleth wave.• Adjust the transceiver volume, or turn it off.• Find Device feature for locating a lost transceiver within the coverage area.• Suppress SpO2 technical alarms (INOPS) during NBP measurement.• Return from Standby mode after a patient is away from the unit and not being monitored by the IntelliVue Telemetry System.• Configurable Alarm Pause/Suspend time initiated at the transceiver as well as the Information Center.• Transceiver location information displayed at the Information Center.• Transceiver out of area notification at the Information Center.
IntelliVue Telemetry System Introducing IntelliVue Telemetry 1-5Smart-hopping TechnologySmart-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.Bi-directional Signal Flow in the IntelliVue Telemetry System
IntelliVue Telemetry System1-6 Introducing IntelliVue Telemetry 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. In cases of excessive intermittent wireless interference, such as machinery operation or construction activity, you should identify patterns of interference. This information may assist your service provider in helping you resolve a problem with interference. Normal Operation
IntelliVue Telemetry System Introducing IntelliVue Telemetry 1-7Excessive Interference’Hop’ to New Frequency/Time Slot
IntelliVue Clinical Network1-8 Introducing IntelliVue Telemetry Spectrum SharingThe 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. Although WMTS is managed by a frequency coordination process, this coordination and licensing does not grant the user an exclusive right to the spectrum on which their system operates, and is subject to the terms and conditions of the FCC license. Other WMTS and non-medical FCC licensees, as well as government agencies, may be legally authorized to use this licensed spectrum. The ITS4850A IntelliVue Telemetry System operates in the 2.4 GHz ISM band, with up to six RF channels using a similar Smart-hopping technology as described on page 1-5. The system also scans the selected six RF channels to determine whether the spectrum is sufficiently clear. If the system is too congested, a system level alert is provided.IntelliVue Clinical NetworkThe IntelliVue Clinical Network (ICN) is the communication infrastructure necessary to tie together all the patient monitoring systems within an organization. This includes getting information to and from the IntelliVue Information Center(s). Patients can be monitored within the defined coverage areas. When a patient goes out of range, an auditory out-of-range indicator sounds at the transceiver, and a "No Signal" technical alarm at the Information Center notifies the clinical staff.The Network can include both wired and wireless devices. An installation typically includes the following components:• IntelliVue Clinical Network infrastructure.• TRx4841A/TRx4851A Transceivers, bi-directional patient-worn devices.• ITS4842A/ITS4852A Access Points (AP), placed within the areas with defined coverage. APs are centers for bidirectional communication
Transceiver Use with Other Equipment Introducing IntelliVue Telemetry 1-9between 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.• M8105A MP5 IntelliVue Patient Monitor (optional) for bedside display of patient data being sourced from the transceiver.Transceiver Use with Other EquipmentIntelliVueInformationCenterThe transceiver’s bi-directional capability enables remote control from the Information Center for alarm, setup, and general monitoring functions. In addition, the system supports Telemetry Overview, the pairing of a telemetry bed with an IntelliVue Patient Monitor (Release B.10 or higher) for bedside ECG viewing of a single patient. Telemetry Overview provides the telemetry-monitored waveforms, numerics, and alarms in an integrated form both on the bedside monitor and at the IntelliVue Information Center. See “Chapter 10. Pairing with IntelliVue Patient Monitors” for operating and configuration information.TeleMon The transceiver can employ the full functionality of the M2636C TeleMon Companion Monitor, including NBP measurement and local display of alarms. Connection is made through an interface cable at the TeleMon/Service port on the transceiver. Please refer to “Transceiver Operation when Connected to TeleMon” on page 9-16 for an operational summary, and the M2636C TeleMon Instructions for Use for general operating instructions.
Transceiver Use with Other Equipment1-10 Introducing IntelliVue Telemetry PatientBedsideMonitorsRemote 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 a bi-directional radio interface. 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 the M8105 MP5 Patient Monitor. The connection is made through a monitor interface cable inserted in the Telemon/Service Port and connected to the MP5. Please refer to the MP5 Instructions for Use for additional information.M2601BTransmitters If your hospital uses TRx and/or TRx+ Transceivers and M2601B Transmitters, you can distinguish between them by:• Name on the front of the device (TRx or M2601B)• Label color (light gray for transceivers, dark gray for transmitters)
Product Safety 2-1Introduction2Product SafetyThis 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 sections:• General Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2• Battery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5• ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6• ST/AR Arrhythmia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8• ST/AR ST Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11•SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11• Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-14• Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-16
General Safety2-2 Product Safety General SafetyWarningWarningThe IntelliVue Telemetry System should not be used for primary monitoring in applications where the momentary loss of the ECG is unacceptable. WarningWarningFor 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.WarningWarningDo not touch the patient, or table, or instruments, during defibrillation.The battery door must be closed during defibrillation. These steps protect the clinician from high defibrillator voltage.WarningWarningThis device is not to be used in the vicinity of electrosurgical units because such use may interrupt or interfere with the transmission of signals from the transceiver.WarningWarningThis equipment is not suitable for use in the presence of a flammable anesthetic mixture with air, or with oxygen or nitrous oxide
General Safety Product Safety 2-3WarningWarningDo not use patient cables with detachable lead wires that have exposed male pins. Electrocution could result if these pins are plugged into AC power.WarningWarningThe 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.WarningWarningThe product should not be used next to or stacked with other equipment. If you must stack the product, you must check that normal operation is possible in the necessary configuration before the product is used on patients.WarningWarningDo not use the transceiver for patient monitoring if it fails the Power On Self Test.WarningWarningWhen the patient is showering, signal quality and leads off detection may be compromised due to significant patient movement. Appropriate clinical precautions must be taken.
General Safety2-4 Product Safety WarningWarningIf the Alarms Suspend indicator on the transceiver remains illuminated after the button combination to unsuspend alarms is pressed, a transceiver malfunction may have occurred. (Alarms resume automatically after the configured alarm suspend duration, or you can resume them manually at the Information Center.) The transceiver should be replaced, and the malfunctioning unit should be sent to your service provider.WarningWarningIf the remote Silence key in the Overview window is enabled for IntelliVue monitors connected to the Information Center, remote silencing for these beds may be enabled in other clinical unitsWarningWarningPlace the transceiver in a pouch or over clothing, or both, during patient use. The transceiver should not touch the patient’s skin during use.WarningWarningTo avoid the risk of strangulation, do not tie a pouch solely around the patient’s neck.WarningWarningPatients should be instructed not to open the battery compartment while the transceiver is in use.WarningWarningFailure on the part of the responsible individual hospital or institution employing the use of this equipment to implement satisfactory maintenance as needed may cause undue equipment failure and possible health hazards.
Battery Product Safety 2-5BatteryWarningWarningThe battery door must be closed during defibrillation.WarningWarningUse Duracell Alkaline 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.WarningWarningCertain failure conditions, such as short circuits, can cause a battery to overheat during use. High temperatures can cause burns to the patient and/or user. If the transceiver becomes hot to the touch, place it aside until it cools. Then remove the batteries and discard them. Have the transceiver operation checked by your service provider to identify the cause of overheating.WarningWarningIf you receive a BATTERY LOW alarm, the batteries must be promptly replaced. A “Battery Low” condition that is not corrected will result in a transceiver shutdown and cessation of monitoring.
ECG2-6 Product Safety WarningWarningBatteries 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.ECGWarningWarningAlways confirm Information Center observations with clinical observation of the patient before administering interventions.WarningWarningNon-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.WarningWarningDo not mix and match electrodes of different types. In particular, do not use electrodes of dissimilar metals. This helps ensure optimal signal quality.
ECG Product Safety 2-7WarningWarningEvery 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. This will ensure a match between the monitored lead and the label, and prevent any possible confusion.WarningWarningEASI derived 12-lead ECGs and their measurements are approximations to conventional 12-lead ECGs. As the 12-lead ECG derived with EASI is not exactly identical to the 12-lead conventional ECG obtained from an electrocardiograph, it should not be used for diagnostic interpretations.EASI lead placement is supported for adult patients onlyWarningWarningWhen switching between EASI and standard monitoring, there is a loss of data for 30 seconds.
ST/AR Arrhythmia2-8 Product Safety For Paced PatientsWarningWarningThe 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. In order to minimize the possibility of interference, position electrodes, electrode wires, and the transceiver as far away from the pacemaker as possible. Consult the pacemaker manufacturer for information on the RF susceptibility of their products and the use of their products with the IntelliVue Telemetry System. See the IntelliVue Information Center Instructions for Use for additional information on monitoring paced patients.ST/AR ArrhythmiaWarningWarningDuring complete heart block or pacemaker failure (to pace or capture), tall P-waves (greater than 1/5 of the average R-wave height) can be erroneously counted by the arrhythmia algorithm, resulting in missed detection of cardiac arrest.
ST/AR Arrhythmia Product Safety 2-9WarningWarningLearningIf you initiate learning during ventricular rhythm, the ectopics can be incorrectly learned as the normal QRS complex. This can result in missed detection of subsequent events of V-Tach and V-Fib.WarningWarningRelearningArrhythmia 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. This can result in missed detection of subsequent events of V-Tach and V-Fib. For this reason, you should:1. Respond promptly to any technical alarm.2. Ensure that the arrhythmia algorithm is labeling beats correctly.When using EASI ECG monitoring, Relearn happens automatically when there is a LEADS OFF technical alarm. If learning takes place during ventricular rhythm, the ectopics can be incorrectly learned as the normal QRS complex. This can result in missed detection of subsequent events of V-Tach and V-Fib. Be sure to check the beat labels and initiate a relearn to correct.1. Respond to the technical alarm [for example, reconnect the electrode(s)].2. Ensure that the arrhythmia algorithm is labeling beats correctly.
ST/AR Arrhythmia2-10 Product Safety For Paced PatientsWarningWarningSome pace pulses can be difficult to reject. When this happens, the pulses are counted as a QRS complex, and could result in an incorrect HR and failure to detect cardiac arrest or some arrhythmias. Keep pacemaker patients under close observation.WarningWarningDuring complete heart block or pacemaker failure (to pace or capture), tall P-waves (greater than 1/5 of the average R-wave height) can be erroneously counted by the arrhythmia algorithm, resulting in missed detection of cardiac arrest.WarningWarningFor 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. Proper detection and classification of the paced rhythm can then be determined.WarningWarningWhen an external pacemaker is being used on a patient, arrhythmia monitoring is severely compromised due to the high energy level in the pacer pulse. This can result in the arrhythmia algorithm’s failure to detect pacemaker non-capture or asystole.
ST/AR ST Segment Product Safety 2-11WarningWarningIt is possible that pacemaker pulses will not be detected when the ECG analog output of a defibrillator is plugged into a bedside monitor. This can result in the arrhythmia algorithm’s failure to detect pacemaker non-capture or asystole.ST/AR ST SegmentWarningWarningThis device provides ST level change information; the clinical significance of the ST level change information should be determined by a physician.SpO2WarningWarningAlways confirm Information Center observations with clinical observation of the patient before administering interventions.WarningWarningUsing 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.
SpO22-12 Product Safety WarningWarningDo not use disposable sensors on patients who exhibit allergic reactions to the adhesive.WarningWarningProlonged, continuous SpO2 monitoring can increase the risk of changes in skin characteristics, such as irritation, reddening, blistering or pressure necrosis, particularly on patients with impaired perfusion and varying or 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 can be required due to an individual patient's condition.WarningWarningInjected dyes such as methylene blue or intravascular dyshemoglobins such as methemoglobin and carboxyhemoglobin can lead to inaccurate (over-estimated) measurements.WarningWarningInterference 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.
SpO2 Product Safety 2-13WarningWarningFailure 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. This can result in venous congestion distal from the application site, leading to interstitial edema, hypoxia and tissue malnutrition. Skin irritations or ulcerations can occur as a result of the sensor being attached to one location for too long. To avoid skin irritations and ulcerations, inspect the sensor application site every 2-3 hours, and change the application site at least every 4 hours or according to clinical practice guidelines.Venous Pulsation: Do not apply sensor too tightly as this results in venous pulsation and can severely obstruct circulation and lead to inaccurate measurements.Ambient Temperature: Never apply an SpO2 sensor at ambient temperatures above 37 oC (99 oF) because this can cause severe burns after prolonged application.Extremities to Avoid: Avoid sites distal to BP cuff or intra-arterial line.WarningWarningWhen the specified Nellcor® sensors are used, the application must be consistent with the sensor manufacturer's own guidelines.WarningWarningIf you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile 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.
Cleaning2-14 Product Safety WarningWarningRemoval of the SpO2 sensor during Continuous SpO2 monitoring results in a "No Sensor" technical alarm. Silencing this technical alarm turns the SpO2 measurement off. There is no technical alarm for a “No Sensor” condition in Spot Check mode.WarningWarningThis 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).CleaningWarningWarningEO 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.Vent sterilizer gas outdoors or to a suitable, evacuated container for reprocessing, depending upon state, provincial, or country environmental regulations. Do not vent sterilant indoors.Vent aerator exhaust only to the outdoors.* See “References” on page 11-9.
Cleaning Product Safety 2-15WarningWarningComply 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 11-9. WarningWarningTo 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 11-9
Accessories2-16 Product Safety AccessoriesWarningWarningUse 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 productWarningWarningReuse: Never reuse disposable sensors, accessories and so forth that are intended for single use, or single patient use only.Packaging: Do not use a sterilized accessory if the packaging is damaged.WarningWarningAlignment guides may present a choking hazard. Handle with appropriate care.WarningWarningThe SpO2 and Telemon/Service Port protective covers may present a choking hazard. Handle with appropriate care.
Transceiver Controls 3-1Introduction3Transceiver ControlsThis 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4•Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4•Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5•Ports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6• Transceiver Controls - Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7•Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8•Safety Symbols & Other Marks . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8• Audible Tones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10•Clinical Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11•Adjustable Sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-12•Service Sounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-13Note—For the purpose of the following diagrams, the transceiver model shown is the TRx4841A with SpO2.
Transceiver Controls - Front3-2 Transceiver Controls Transceiver Controls - FrontIntelliVue TRx+ Transceiver - Front ViewI 3I 2I 1I 4B1B2O1L3P1P2P3L1L2The labeled items in the diagram include: • Buttons (B1-B2)• Power On/Off (O1)• Indicators (I1-I4)• Labels (L1-L3)• Ports (P1-P3)TRx4851A
Transceiver Controls - Front Transceiver Controls 3-3ButtonsB1B2EASI, 3 5,6IntelliVue TRx+M4841ACallout Button DefinitionB1 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.• When pressed simultaneously with the Check button, turns Alarm Suspend/Pause on/off (not when connected to TeleMon or IntelliVue MP5 Patient Monitor). See “Suspending/Pausing Alarms” on page 5-2. B2 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 3-10.• When pressed simultaneously with the Telemetry button, turns Alarm Suspend/Pause on/off (if configured and not when connected to TeleMon or IntelliVue MP5 Patient Monitor). See “Suspending/Pausing Alarms” on page 5-2.• Silences the Find Device tone. See “Locating the Transceiver (Find Device)” on page 9-3.
Transceiver Controls - Front3-4 Transceiver Controls Power On/OffIndicatorsO1EASI, 3 5,6IntelliVue TRx+M4841ACallout Battery Door to Access DefinitionO1 Power On/Off Power On/OffInsertion of batteries turns transceiver power on; removal of batteries turns power off. See “Turning the Transceiver On/Off” on page 4-2.EASI, 3 5,6IntelliVue TRx+M4841AI 3I 4I 2I 1Callout Indicator DefinitionI 1Lead 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. Green indicator only on indicates all leads are off.• Momentarily illuminates three alternate lights, indicating the transceiver has no Equipment Label assigned. Accompanied by “Unlabeled Device” tone. See “Label Assignment for Replacement Transceiver” on page 11-2.
Transceiver Controls - Front Transceiver Controls 3-5LabelsI 2EASI Indicator• Illuminates momentarily upon insertion of leadset in EASI position.• Illuminates when Check button is pressed if EASI is in use.I 3Alarms Suspend/Pause Indicator Illuminates during alarm pause period initiated at transceiver, Information Center, or TeleMon.I 4Battery GaugeIlluminates 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 4-16.Callout Indicator DefinitionEASIEASI, 3 5,6IntelliVue TRx+M4841AL1L2L3Callout Label DefinitionL1 Leadset Insertion GuideAssists in aligning the ECG cable for different leadsets. See “Connecting the ECG Cable” on page 6-22.Note—If your unit uses only one monitoring configuration, the transceiver may have special alignment guides that allow only one leadset insertion position.Warning—Alignment guides may present a choking hazard. Handle with appropriate care.EASI, 3 IntelliVue TRx5,6TRx4841A
Transceiver Controls - Front3-6 Transceiver Controls PortsL2 Device Identification LabelIdentifies the device to the IntelliVue Clinical Network.L3 Unit Identification LabelUses one of seven color-coded labels for visual identification of a clinical unit.Callout Label DefinitionEASI, 3 5,6IntelliVue TRx+M4841AP1 P2P3Callout DefinitionP1 ECG Leadset PortConnection for 3-, 5-, or 6-wire leadset.P2 SpO2 Sensor Port (IntelliVue TRx+ only)Connection for SpO2 sensor. See Note.P3 TeleMon/Service PortConnection for cable to the TeleMon Companion Monitor, MP5 IntelliVue Patient Monitor, or to the Service Tool. See Note.Note—The SpO2 and TeleMon/Service Ports can be covered with protective covers when not in use. These are listed in “Appendix A. Accessories”.Warning—The SpO2 and Telemon/Service Port protective covers may present a choking hazard. Handle with appropriate care.
Transceiver Controls - Back Transceiver Controls 3-7Transceiver Controls - BackS8-S13 not shown(inside battery compartment) IntelliVue TRx+ Transceiver - Back ViewEASI S2S3S4S7S6S1L1The labeled items in the diagram include: • Labels (L1-L2)• Safety symbols and other marks (S1-S13) L2EASI S5
Transceiver Controls - Back3-8 Transceiver Controls LabelsSafety Symbols & Other Marks EASI EASIIEAS123456L1L2Callout DefinitionL1 Electrode Placement Diagram for EASI See “5-Wire Placement (EASI Mode)” on page 6-16.L2 Electrode Placement Diagram for Standard ECGSee “5-Wire Placement (Standard Mode)” on page 6-14.EASI EASIIEAS123456S1-13Callout Label DefinitionS1 FCC ID: PQCXXXXXIC: 3549B-XXXXFederal Communications Commission (FCC) IDCanadian IDS2 Non-Ionizing RadiationInterference to electronic equipment may occur in the vicinity of devices marked with this symbol.S3 DisposalDispose of in accordance with the local country’s requirements.S4 Follow operating instructions.i
Transceiver Controls - Back Transceiver Controls 3-9S5 Prescription DeviceS6 Canadian and American standards complianceComplies with applicable Canadian and American standards.S7 Defibrillation ProofPatient connections are protected against defibrillation (DEFIBRILLATION-PROOF) and are a TYPE CF APPLIED PART.Labels on Inside of Battery CompartmentS8 Catalog NumberUse to identify the equipment during a call to the Philips Response Center.S9 Serial NumberUse to identify the equipment during a call to the Philips Response Center.S10 MAC Address of deviceCallout Label DefinitionRxREFSNMAC
Audible Tones3-10 Transceiver Controls Audible TonesThe transceiver produces six different auditory information signals to inform you of measurement and transceiver conditions during normal use. Most are generated automatically.S11 Date of manufactureS12 Battery PolarityS13 Attention! See Instructions for Use.Callout Label Definition
Audible Tones Transceiver Controls 3-11Clinical UseAuditory Information Signal Sound How UsedSound 1 beep • Indicates successful Self-Test at power on.• Indicates successful SpO2 Spot Check measurement when measurement is initiated at the transceiver.• If the Check button is pressed, confirms that the transceiver is in contact with the Information Center (e.g., when transceiver is brought back into range). Sound 2 low-pitch toneIndicates pulse detected during Spot Check SpO2 measurement.Note—The pulse tone can be muted from the Information Center. See “Patient Configurable Settings in Telemetry Setup” on page 9-4.Sound 3 alternating pitch repeated toneContinuous tone to help you locate a missing transceiver. Initiated by clicking Find Device in the Telemetry Setup window. Tone continues until Check button is pressed and held for 6 seconds, batteries are removed, or batteries completely discharge.Sound 4 beep beep • 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.
Audible Tones3-12 Transceiver Controls Adjustable SoundsSome transceiver sounds can be set to 5 different volume levels (see “Patient Configurable Settings in Telemetry Setup” on page 9-4). The adjustable sounds include SpO2 Spot Check measurement complete/fail, Check/Standby functions, and pulse detection tone. The Spot Check and pulse detection tones can be turned off (muted) on a per patient basis in the Telemetry Setup window.Sound 5 beep beep every 5 secondsIndicates transceiver is out of range or not associated with a sector. Sound stops when contact is re-established with the Information Center, or it can be silenced by pressing the Check button for six seconds.Sound 6 beep beep every 2 secondsIndicates that the leadset is not inserted correctly.Auditory Information Signal Sound How UsedAuditory Signal (sound) Function How UsedSound 1 (beep)Spot Check Announces a successful SpO2 Spot Check measurement.Sound 1 (beep)No MuteCheck ButtonConfirms contact with the Information Center.Sound 2 (low pitch tone)Pulse Detection ToneIndicates pulse during SpO2 Spot Check measurement.
Audible Tones Transceiver Controls 3-13Service SoundsTwo additional sounds that you may hear occur during the labelling of transceiver devices within the IntelliVue Clinical Network. The volume of these sounds is not adjustable, and cannot be turned off. See “Label Assignment for Replacement Transceiver” on page 11-2.Service Sound Descriptionbeep beep repeated every 3 seconds, and all visual indicators flashingUnlabeled Device. Equipment Label needs to be assigned at Information Center. No monitoring.Fast beep beep and alternate Leads Off indicators flashingUnacknowledged Labeled Device.Equipment label has been assigned at Information Center; press the Check button to complete label assignment. No monitoring.
Audible Tones3-14 Transceiver Controls
Basic Operation 4-1Introduction4Basic OperationThis 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-10• Battery Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-12
Transceiver Safety Information4-2 Basic Operation Transceiver Safety InformationWarningWarningThe 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.WarningWarningPlace the transceiver in a pouch or over clothing, or both, during patient use. The transceiver should not touch the patient’s skin during use.Turning the Transceiver On/OffWarningWarningArrhythmia relearning is initiated whenever the transceiver is powered down for one minute or longer. Be sure to check your patient’s arrhythmia annotation for accuracy whenever relearn has occurred.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.
Turning the Transceiver On/Off Basic Operation 4-3c. cessation of sounds, indicating a successful association with the Information Center.d. If you hear any other sound sequence, either the device has failed the automatic Self-Test (in which case you should use a replacement device), or the device cannot establish contact with the Information Center (check that a sector has been assigned to the device, and that the device is within the coverage area).Turning the Transceiver OffTurn off the transceiver by removing the batteries. A "No Signal" technical alarm will be in effect at the Information Center until the device is reactivated or until Standby is initiated.The configuration data set by the service provider prior to transceiver use is retained after battery removal. RF AutoShutoffWhen 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. The technical alarm, "No Signal", followed by the "Transmitter Off" INOP will be displayed at the Information Center. Remove the batteries to conserve battery charge. However, if there is no ECG signal for 10 minutes but the SpO2 cable is inserted, the transceiver does not stop broadcasting the signal. Sounds at Successful Start-up Transceiver connected with Information CenterTransceiver performs self-testOne beep Test passedInsert batteries Two beepsevery 5 sec-ondsBeeping stopsTransceiver searches for Information Center
Turning the Transceiver On/Off4-4 Basic Operation To restart monitoring, insert batteries (if needed), attach leads to the patient, insert the SpO2 sensor cable in the SpO2 sensor port and press the Check button to verify association with the Information Center.This feature must be enabled by your service provider.Standby ModeStandby mode is used to temporarily suspend monitoring at the Information Center, for example, when a patient goes out of access point range or is discharged.Standby does not power down the transceiver, so if the standby period is prolonged, you should remove the batteries. InitiatingStandbyStep Action1 Do not remove the leads until after the patient is in Standby. This will avoid an "ECG Leads Off" technical alarm, as well as reminders, if configured.2 In the Patient Window, select the Standby button.3 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.
Turning the Transceiver On/Off Basic Operation 4-5ResumingMonitoring4 Select the appropriate location, then select Suspend Monitoring. The message “Telemetry Standby” and location, if selected, are displayed in the sector.Note—If the transceiver is paired with an IntelliVue Patient Monitor, monitoring will be suspended at both the transceiver and the IntelliVue Patient Monitor as well as at the Information Center. The messages "Monitor Standby" and "Telemetry Standby" will be displayed in the patient sector. If paired directly with an IntelliVue MP5 Patient Monitor, the message "Monitor Standby" only will be displayed.Step ActionStep Action1 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. Press the Check button to verify the resumption of monitoring. You should hear a single beep.If a new patient is connected:•Press the Check button, or select the Resume Monitoring in the appropriate patient sector.Important—When an EASI patient comes out of Standby, the lead settings are reset to the default EASI leads.
Briefing the Patient4-6 Basic Operation Briefing the PatientWarningWarningPatients should be instructed not to open the battery compartment while the transceiver is in use.If the Telemetry button has been configured to generate a Nurse Call, recording at the Information Center, or both, instruct the patient to use the button when needed.If desired, you can turn off patient use of the button at the Information Center. See “Patient Configurable Settings in Telemetry Setup” on page 9-4.
Briefing the Patient Basic Operation 4-7Pouch 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.Securing the PouchStep Action1 Insert the transceiver into the pouch with lead wires and SpO2 sensor cable, if used, exiting from the top opening of the pouch. Pinch the velcro enclosures together to close the pouch around the cables.Important—Do not coil the cables inside the pouch. They are part of the wireless system, and need to be freely exposed.
Briefing the Patient4-8 Basic Operation 2 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.WarningWarningTo avoid the risk of strangulation, do not tie a pouch solely around the patient’s neck.Step ActionPlace Tie a under thearm.Place Tie b around theneck. Tie a and b together around the neck.Tie c and d together aroundthe torso.cdba
Briefing the Patient Basic Operation 4-93 Check that the patient is comfortable wearing the pouch with transceiver.Step Action
Briefing the Patient4-10 Basic Operation ShoweringWarningWarningWhen 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.Drying theTransceiverafterShoweringAfter showering, perform the following steps to continue monitoring:1. Pat dry the leadset connections at the electrodes.2. Wipe the lead wires with care.3. If wet, dry the outside of the transceiver with a non-lint producing cloth.4. If wet, wipe dry the inside of the battery compartment. Dry the batteries.5. If wet, disconnect the ECG leadset and shake out any water. Dry the connector pin area with a cotton swab.Note—The transceiver should not be used for monitoring if the battery compartment is wet. Remove the batteries and wipe the compartment dry before continued monitoring use.AccidentalWettingIf the transceiver is accidentally immersed in liquid for up to 5 minutes, no damage to the device and no electrical safety issues for the patient will result. Remove the device, dry it off, and follow the procedure for cleaning/sterilization under “Cleaning and Sterilization” on page 11-4 as needed.
Testing Transceiver Functionality Basic Operation 4-11Testing Transceiver FunctionalityThere 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 TestWarningWarningDo not use the transceiver for patient monitoring if it fails the Power On Self Test.CautionDo not insert a leadset during a self-test. The leadset can be inserted before or after the self-test. A self test of the transceiver functions is automatically performed each time that the transceiver is turned on (that is, when batteries are inserted). This test should be performed before ECG leads and/or an SpO2 sensor is attached. In Case ofFailureIf any portion of the self test fails, the transceiver will attempt to report the failure to the monitoring system. In case of failure, use another transceiver, and contact your service provider.Self Test StatusAuditory Signal Visual IndicatorsPassed beep All indicators illuminate for 3 seconds.Failed beep beep One or more indicators do not light up.
Testing Transceiver Functionality4-12 Basic Operation Status CheckYou can check the status of the transceiver indicators at any time.Initiating aStatus CheckStep Action1Press the Check button.The following indicators should illuminate for as long as the Check button is depressed.• Battery gauge• Type of leadset• EASI (if in use)2 If one or more of the expected indicators do not light up, check the following:• Power and position of batteries (see “Checking the Battery Power Level” on page 4-15).• Leadset insertion. Make sure the leadset is correctly inserted in the transceiver and the colored line at the base of the cable is not visible (see “Connecting the ECG Cable” on page 6-22).• Lead positions and connections (see “Verifying Electrode Connections” on page 6-25).If there is still a problem, contact your service provider for assistance.
Battery Information Basic Operation 4-13Battery InformationBattery Safety Information WarningWarningThe battery door must be closed during defibrillation.WarningWarningUse 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.WarningWarningCertain failure conditions, such as short circuits, can cause a battery to overheat during use. High temperatures can cause burns to the patient and/or user. If the transceiver becomes hot to the touch, place it aside until it cools. Then remove the batteries and discard them. Have the transceiver operation checked by your service provider to identify the cause of overheating.WarningWarningIf you receive a BATTERY LOW alarm, the batteries must be promptly replaced. A “Battery Low” condition that is not corrected will result in a transceiver shutdown and cessation of monitoring.
Battery Information4-14 Basic Operation WarningWarningBatteries 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.Inserting/Removing Batteries WarningWarningArrhythmia relearning is initiated whenever the transceiver is powered down for one minute or longer. Be sure to check your patient’s arrhythmia annotation for accuracy whenever relearn has occurred.CautionRemove the batteries before storing a transceiver for an extended period of time.The battery compartment is located at the bottom of the transceiver behind a swinging door. It accommodates a pair of AA 1.5V Alkaline batteries. Only this type of disposable battery should be used.Important—Do not use rechargeable batteries. Use of this type of battery will adversely affect:• Battery gauge performance• Battery low warnings• Battery life performance
Battery Information Basic Operation 4-15Inserting theBatteriesInsert batteries into the transceiver using the following procedure.Step Action1 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.4 Listen for the start-up sounds. (See “Turning On” on page 4-2).Watch for the indicators on the front of the transceiver to illuminate briefly.5 Connect the patient cables to the transceiver.++
Battery Information4-16 Basic Operation Removing theBatteriesTo 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.Batteries should be removed when the transceiver is not in use or is being stored.Important—DO NOT “STORE” BATTERIES BY LEAVING THEM IN THE INCORRECT POLARITY POSITION IN THE TRANSCEIVER. Be careful not to short circuit the batteries. Batteries can get hot when shorted. Short circuits are caused when a piece of metal touches both the positive and negative terminals simultaneously. More than a momentary short circuit will generally reduce the battery life. In case of a short circuit, discard both batteries in a pair, or just the shorted one if the batteries are new.Disposal ofBatteriesWhen disposing of batteries, follow local laws for proper disposal. Dispose of batteries in approved containers. If local regulations require you to recycle batteries, recycle batteries in accordance with those regulations.Checking the Battery Power LevelWhen 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.To check the power level:Step Action1Press the Check button to determine the level (see Battery Levels following).
Battery Information Basic Operation 4-17Battery Levels2If no indicators flash: 1. Check that the batteries are inserted properly.2. Replace both batteries. 3. If there are still no indicators on the battery gauge, contact your service provider.If the indicators illuminate but do not behave as described above, the transceiver has malfunctioned. Contact your service provider.Battery GaugeApproximate Battery Life* RemainingApproximate Operating Time* RemainingFunctionality 4 green indicators > 75% > 34.7 hours Normal operation3 green indicators > 50% > 23.1 hours Normal operation2 green indicators > 25% > 11.6 hours Normal operation1 green indicator 25% to Battery Low level> 15 minutes Normal operation1 red indicator Battery Low level to Replace Battery level< 15 minutes Normal operation (see note)no indicator Replace Battery level(Check batteries for correct polarity)none Transceiver shutdown/RF shutoffStep Action
Battery Information4-18 Basic Operation 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.You can optimize battery life by:• Removing the batteries when the transceiver is not in use. Keep them paired for future use.• Disconnecting the SpO2 adapter cable, if used. When the SpO2 sensor is disconnected, the SpO2 functionality is automatically powered down, but if an adapter cable is still connected, it will continue to drain power from the SpO2 electronics.* Battery life times are based on use of Duracell MN 1500 batteries in a TRx transceiver. Times for TRx+ are somewhat lower. Life times when other battery brands are used may be different.Note—For the TRx+ transceiver, SpO2 functionality is disabled when the red light (Battery Low) is lit. Battery GaugeApproximate Battery Life* RemainingApproximate Operating Time* RemainingFunctionality
Alarms 5-1Introduction5AlarmsThis 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4• Technical Alarms (INOPs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9
Alarm Indicators5-2 Alarms Alarm IndicatorsA 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. Pairing with IntelliVue Patient Monitors”.Testing Alarm IndicatorsThe visual alarm information signal on the transceiver is the Alarms Suspend icon. During self test, the Alarm Suspend indicator illuminates briefly, and a single tone indicates association with the Information Center. These positive test results indicate that the Alarm Suspend icon on the transceiver is functioning correctly (see “Self Test” on page 4-11).Suspending/Pausing AlarmsWarningWarningIf the Alarms Suspend indicator on the transceiver remains illuminated after the button combination to unsuspend alarms is pressed, a transceiver malfunction may have occurred. (Alarms resume automatically after the configured suspend duration time, or you can resume them manually at the Information Center.) The transceiver should be replaced, and the malfunctioning unit should be sent to your service provider.All alarms for a patient can be suspended/paused from the Information Center, from the TeleMon Companion Monitor, or, depending on transceiver configuration, from the transceiver itself. The Alarm Suspend/Pause duration is configurable with a default of two minutes. Alarms automatically resume after the configured suspend duration time, or can be reactivated manually earlier.
Suspending/Pausing Alarms Alarms 5-3If the transceiver is connected to TeleMon or the MP5 IntelliVue Patient Monitor, alarms can be suspended only from TeleMon, 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 and the Information Center. Patient monitoring (display of patient waveforms and numerics) continues for the duration of Alarm Suspend/Pause.Unsuspending& Resuming AlarmsAlarms will be resumed automatically after the configured suspend duration time. You can cancel alarm suspend manually before the configured suspend Step Action1Press the Telemetry and Check buttons simultaneously to activate Alarm Suspend/Pause. While alarms are suspended:• The transceiver illuminates the Alarms Suspend icon. • The message "Alarms Suspended" (or "Alarms Paused") is displayed in the Patient Sector at the Information Center.Note—For paired bedsides in Telemetry Overview, the message is "Tele Alarms Suspend".2 For instructions on how to suspend/pause alarms from the Information Center, see the IntelliVue Information Center Instructions for Use and the Information Center Online Help.For instructions on how to suspend/pause alarms from TeleMon or the MP5, see their respective Instructions for Use.
Physiologic Alarms5-4 Alarms duration time has expired from the transceiver (see following directions) or from the Information Center.Physiologic AlarmsPhysiologic alarms indicate a life-threatening situation or a less urgent situation such as heart rate beyond limits. There are no physiologic alarm signals generated by the transceiver. All physiologic alarms are generated at the IntelliVue Information Center, and all alarm signals must be acknowledged at the Information Center.Arrhythmia alarm chaining and other aspects of alarm behavior, such as alarm levels, setting alarm limits, customizing arrhythmia alarm settings on a per patient basis, switching individual measurement alarms on/off, and reviewing alarm messages, are described in IntelliVue Information Center Instructions for Use. There are two levels of arrhythmia analysis available at the Information Center: Basic and Enhanced. Enhanced analysis includes Basic alarms. Step Action1Press the Telemetry and Check buttons simultaneously until the indicator turns off.• The Alarm Suspend icon is turned off.• The message "Alarms Suspended" (or "Alarms Paused") is removed from the Information Center display.2 Alternately, you can unsuspend alarms at the Information Center. See IntelliVue Information Center Instructions for Use or Online Help for directions.For instructions on how to resume alarms from TeleMon, see the TeleMon Instructions for Use.
Physiologic Alarms Alarms 5-5NBP alarms are listed in the TeleMon Instructions for Use and the Information Center Online Help.In the following table, Red (***) alarms are listed alphabetically, followed by the Yellow (**) alarms, and the Yellow (*) arrhythmia alarms.Physiologic (Patient) Alarms Alarm Text Priority Condition Source***ASYSTOLE Red Asystole. No QRS for 4 consecutive secondsST/AR Basic & Enhanced Arrhythmia*** BRADY yyy < xxx Red Extreme Bradycardia. Heart Rate (yyy) less than Extreme Brady limit (xxx)ST/AR Enhanced Arrhythmia*** DESAT Red Very Low SpO2 Saturation. SpO2 value below Desaturation limitNote—Desat limit is set 10 points below low limit.SpO2*** TACHY yyy > xxx Red Extreme Tachycardia. Heart Rate (yyy) greater than Extreme Tachy limitST/AR Basic & Enhanced Arrhythmia*** V-FIB/TACH Red Ventricular Fibrillation. Fibrillatory wave (sinusoidal wave between 2-10 Hz) for 4 consecutive secondsST/AR Basic & Enhanced Arrhythmia*** V-TACH Red Ventricular Tachycardia. Consecutive PVCs greater than or equal to V-Tach Run limit and Heart Rate greater than V-Tach limit (xxx)ST/AR Basic & Enhanced Arrhythmia
Physiologic Alarms5-6 Alarms ** MULTI ST Lx, Ly Yellow Two ST leads (Lx and Ly) exceed alarm limit elevation or depression for > 60 seconds (EASI mode or when selected).ST/AR ST** NURSE CALL Yellow The Telemetry button on the transceiver has been pressed (and the system is configured to alarm and the Telemetry button is on.Also initiated if the installation includes a paging system and the Information Center is configured for paging upon receipt of Nurse Call signal.Note—For IntelliVue Information Centers Release J and later, Nurse Call is a yellow, one star (*) alarm.Clinician-initiated at transceiver or by paging subsystem** 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. ST/AR* HR yyy > xxx Yellow Heart Rate (yyy) greater than the upper Heart rate limit (xxx).ST/AR Basic & Enhanced Arrhythmia* HR yyy < xxx Yellow Heart Rate (yyy) lower than the lower Heart Rate limit (xxx).ST/AR Basic & Enhanced ArrhythmiaPhysiologic (Patient) Alarms Alarm Text Priority Condition Source
Physiologic Alarms Alarms 5-7* IRREGULAR HR Yellow Consistently irregular rhythm (irregular R-R intervals).ST/AR Enhanced Arrhythmia* MISSED BEAT Yellow No beat detected for 1.75 x average R-R interval for Heart Rate greater than 120, or no beat for 1 second with Heart Rate greater than 120 (non-paced patient only).ST/AR Enhanced Arrhythmia* MULTIFORM PVCs Yellow The occurrence of two differently shaped Vs, each occurring at least twice within the last 300 beats as well as each occurring at least once within the last 60 beats.ST/AR Enhanced Arrhythmia* 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).ST/AR Basic & Enhanced Arrhythmia* PAIR PVCs Yellow Two consecutive PVCs between non-PVCs. ST/AR Enhanced Arrhythmia* PAUSE Yellow No QRS detected for x seconds. Choices of >1.5 to 2.5 seconds.ST/AR Enhanced ArrhythmiaPhysiologic (Patient) Alarms Alarm Text Priority Condition Source
Physiologic Alarms5-8 Alarms * PVCs >xxx/MIN Yellow PVCs within one minute exceed by the PVCs/min limit (xxx).ST/AR Basic & Enhanced Arrhythmia* 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.)ST/AR Enhanced Arrhythmia* RUN PVCs Yellow Run of PVCs greater than or equal to 2. ST/AR Enhanced Arrhythmia* SVT Yellow Run of SVPBs greater than or equal to SVT Run limit and with SVT Heart Rate greater than the SVT Heart Rate limit.ST/AR Enhanced Arrhythmia* VENT BIGEMINY Yellow A dominant rhythm of N, V, N, V (where N= supraventricular beat, V=ventricular beat).ST/AR Enhanced Arrhythmia* VENT RHYTHM Yellow A dominant rhythm of adjacent Vs greater than Vent Rhythm limit and ventricular Heart Rate less than V-Tach limit.ST/AR Enhanced Arrhythmia* VENT TRIGEMINY Yellow A dominant rhythm of N, N, V, N, N, V (where N=supraventricular beat, V=ventricular beat).ST/AR Enhanced ArrhythmiaPhysiologic (Patient) Alarms Alarm Text Priority Condition Source
Technical Alarms (INOPs) Alarms 5-9Technical Alarms (INOPs)Technical Alarms, or INOPs (inoperative conditions), are sourced at the transceiver, the ST/AR algorithm running at the Information Center, or TeleMon Companion Monitor. They identify inoperative conditions (that is conditions where the system is not operating properly and therefore cannot measure or detect alarm conditions reliably). There are four levels of Technical Alarms:•Severe - Monitoring and alarms disabled. Audible tone at the Information Center. Must be acknowledged by a clinician.•Hard - Monitoring and alarms are disabled. Audible tone at the Information Center. If the hard INOP is "latched", the sound will be silenced, but the message will remain on the display until resolution of the offending condition.•Soft - Monitoring and alarms remain active. No audible tones are generated.•Red/Yellow - Replace Battery and ECG Leads Off INOPs may be configured to display as either Red or Yellow Technical Alarms.In the following table, technical alarms are listed alphabetically.Technical Alarms (Inoperative Conditions)Alarm Text Priority Condition What to doBATTERY LOWBATTERY LOW TSoft Battery power is low. There is less than 15 minutes of monitoring time remaining. Replace batteries promptly to avoid transceiver shutdown and cessation of monitoring.CANNOT ANALYZE ECGHard Arrhythmia algorithm cannot reliably analyze the ECG data on any monitored leads.Assess the lead selections, initiate relearn, and validate analyzed rhythm. Check other INOPs for possible source of problem.
Technical Alarms (INOPs)5-10 Alarms CANNOT ANALYZE ST Soft ST algorithm cannot reliably generate any valid ST values on any monitored lead.Review the ECG signal quality and correct if necessary. Reposition the ISO and J points.ECG EQUIP MALF Hard Failure of the ECG equipment or failure to calibrate ECG.• Remove leadset. Remove and re-insert batteries. Let Self-Test complete before reinserting leadset.• Replace the transceiver.• Contact Service.ECG LEADS OFFNote—This INOP may also be configured to display as a Red or Yellow Technical Alarm.Hard Multiple leads are off. Reattach ECG leads to patient.<electrode> LEAD OFF Hard Single lead is off.Note—If primary lead is MCL, lead will be identified as V/C in INOP text.Reattach ECG lead to patient.INVALID LEADSET Hard • Wrong leadset.• Leadset inserted incorrectly.• Bad lead selection switches in the transceiver.• Check for appropriate leadset.• Check for correct insertion.• Contact Service.NO ARRHYTHMIA Soft All basic ST/AR ECG alarms have been turned off.Turn arrhythmia alarms on.Technical Alarms (Inoperative Conditions)Alarm Text Priority Condition What to do
Technical Alarms (INOPs) Alarms 5-11NO SIGNAL Hard • Patient is out of range, or• No batteries in transceiver, or• Transceiver has failed, or• Connection to Database Server has failed.• Make sure that the transceiver is in range and has good batteries. • Replace the transceiver if Power On Self Test fails.• Put bed in Standby.• Contact Service.REPLACE BATTERYREPLACE BATTERY TNote—This INOP may also be configured to display as a Red or Yellow Technical Alarm.Hard, LatchedDead battery. No monitoring is occurring.Replace batteries. SOME ECG ALRMS OFF Soft Some yellow arrhythmia alarms have been turned off for this patient. For information only.SpO2T EQUIP MALF Hard Malfunction in the SpO2 equipmentCall Service.SpO2T ERRATIC Hard Erratic SpO2 measurements, often due to a faulty sensor or invalid SpO2 measurements, or incorrect transducer positionRepeat measurement, reposition sensor on patient, or finally, replace sensor.Technical Alarms (Inoperative Conditions)Alarm Text Priority Condition What to do
Technical Alarms (INOPs)5-12 Alarms SpO2T EXTD UPDATENumeric is replaced by a -?-.Soft The update period of displayed values is extended due to an NBP measurement on the same limb or an excessively noisy signal. If NBP is not active, check the sensor placement. Reposition the sensor on patient, or replace sensor.SpO2T INTERFERENCE Hard Level of ambient light or level of electrical interference are so high that the SpO2 sensor cannot measure SpO2 and pulse rate.Reduce ambient light to sensor or electrical noise sources.SpO2T LOW PERFUSION Soft Accuracy may be reduced due to low perfusion. Data displayed with ?.Increase perfusion. Change sensor site. Avoid site distal to BP cuff or intra-arterial line. Warm the site.SpO2T NO SENSORNote—Silencing this technical alarm turns off the SpO2 measurement.Hard No sensor attached to SpO2 deviceAttach SpO2 sensor.SpO2T NOISY SIGNAL Hard Excessive patient movements or electrical interference are causing irregular pulse patternsReduce movement or electrical noise sources.SpO2T NON-PULSATILENote—When paired directly with an IntelliVue MP5 Patient Monitor, the INOP will display as SpO2T SENSOR OFF.Hard Pulse is too weak or not detectableCheck connection to patient. Change sensor site. Avoid site distal to BP cuff or intra-arterial line.Technical Alarms (Inoperative Conditions)Alarm Text Priority Condition What to do
Technical Alarms (INOPs) Alarms 5-13SpO2T SENSOR MALF Hard Malfunction of the SpO2 sensor/adapter cableReplace sensor.TELEMETRY STANDBY Soft Information Center standby mode timer is active, or patient was not returned to telemetry coverage area. There is no data from bed.Cancelled when patient is removed from Standby.TRANSMITTER MALF Hard Transceiver malfunction Replace and notify service provider.TRANSMITTER OFF Hard RF Auto Shutoff after 10 minutes of all leads of and no SpO2 sensor connected.• Reattach ECG leads to patient.• Reattach SpO2 sensor.• Press the Check button.TELE WEAK SIGNAL Soft • Patient is at outer range of the radio coverage area.• Telemetry pack is receiving a weak signal with high data loss from the AP.• Condition exists for multiple devices in a specific area• Return patient to the coverage area. • If patient is in close proximity to AP, replace telemetry pack. Contact service. • The AP covering the specific area is suspect. Contact service.Technical Alarms (Inoperative Conditions)Alarm Text Priority Condition What to do
Technical Alarms (INOPs)5-14 Alarms
ECG Monitoring 6-1Introduction6ECG MonitoringThis chapter covers the specifics of ECG measurement. It includes the following sections:• ECG Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2• Measuring ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4• Positioning ECG Electrodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-9• Connecting the ECG Cable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-22• Verifying Electrode Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-25• Monitoring during Leads Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-27• Optimizing ECG Measurement Performance. . . . . . . . . . . . . . . . . . . 6-29
ECG Safety Information6-2 ECG Monitoring ECG Safety InformationWarningWarningAlways confirm Information Center observations with clinical observation of the patient before administering interventions.WarningWarningEvery 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. This will ensure a match between the monitored lead and the label, and prevent any possible confusion.WarningWarningWhen switching from EASI to standard monitoring, there is a loss of data for 30 seconds. WarningWarningEASI derived 12-lead ECGs and their measurements are approximations to conventional 12-lead ECGs. As the 12-lead ECG derived with EASI is not exactly identical to the 12-lead conventional ECG obtained from an electrocardiograph, it should not be used for diagnostic interpretations.EASI lead placement is supported for adult patients only
ECG Safety Information ECG Monitoring 6-3For Paced PatientsWarningWarningThe 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. In order to minimize the possibility of interference, position electrodes, electrode wires, and the transceiver as far away from the pacemaker as possible. Consult the pacemaker manufacturer for information on the RF susceptibility of their products and the use of their products with the IntelliVue Telemetry System. See the IntelliVue Information Center Instructions for Use for additional information on monitoring paced patients.CautionDuring defibrillation, monitoring may be temporarily interrupted or distorted. It may take several seconds for the ECG trace to reappear on the screen. After defibrillation, the device will continue to monitor as before; the device settings will not be affected.
Measuring ECG6-4 ECG Monitoring Measuring ECGThe 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. Both standard lead and EASI lead placements can be used with the transceiver.ECG ConfigurationThe IntelliVue Transceiver supports 3-, 5-, and 6-wire leadsets. The 5-wire leadset can be used for either standard or EASI electrode configurations. The transceiver leadset configuration choices are as follows:• Leadset Mode = ALL (default)This configuration allows you to switch the leadset type and position during use. The transceiver will automatically reconfigure itself accordingly.• Leadset Mode = EASI ONLYIn this configuration only the use of the 5-wire leadset in the EASI position is allowed.• Leadset Mode = NO EASIIn this configuration the use of 3- and 6-wire leadsets is allowed along with the use of the 5-wire leadset in the standard position only. • Leadset Mode = 3 WIRE ONLYIn this configuration, only the use of the 3-wire leadset is allowed.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
Measuring ECG ECG Monitoring 6-5transceiver 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. An INVALID LEADSET INOP is generated at the Information Center.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 MonitoredDepending on the leadset connected to the transceiver, a different set of viewable leads are available at the Information Center. The transceiver can source up to four raw ECG waves. If you are using ...these leads can be selected at the Information Center3-wire I, II, IIISourced (raw) waves are received as:• Channel 1 = I, II, or IIIDefault is II.5-wire (Standard mode) I, II, III, aVR, aVL, aVF, MCL and VSourced (raw) waves are received as:• Channel 1 = II• Channel 2 = III• Channel 3 = MCLDefaults are II, V, III.
Measuring ECG6-6 ECG Monitoring 5-wire (EASI mode) I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6In 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.Note—Arrhythmia monitoring is performed only on the primary and secondary leads selected at the Information Center, although you can view and perform ST analysis on all 12 EASI derived leads.If you are using ...these leads can be selected at the Information Center
Measuring ECG ECG Monitoring 6-76-wire(Vb is not supported on TeleMon and is only supported on MP5 Patient Monitors with 12-Lead option)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 = VbDefaults 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). Lead assignment is available at the Information Center. When unassigned, the chest leads use the defaults.Note—The lead label assigned to Vb cannot be selected for Va even though Vb does not appear to be used.Note—When display of the pleth wave is enabled at the Information Center, the second chest lead (Vb) is not available for monitoring. If you are using ...these leads can be selected at the Information Center
Measuring ECG6-8 ECG Monitoring ReconstructedLeadsReconstruction 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.ECG LeadClinical Calculationsin terms of electrodes3-Wire5-Wire Standard 6-WireII ILA-RAII (default)II (default)II (default)LL-RAIII III (default)III (default)LL-LA-MCL V-LA, where V=C-aVR aVR RA-(LA+LL)/2-aVL aVL LA-(RA+LL)/2-aVF aVF LL-(LA+RA)/2-V (default)V-(RA+LA+LL)/3, where V=CVa Va-(RA+LA+LL)/3, where Va=V2 (default) positionVb Vb-(RA+LA+LL)/3, where Vb =V5 (default) position
Positioning ECG Electrodes ECG Monitoring 6-9 Positioning ECG ElectrodesWarningWarningDo not mix and match electrodes of different types. In particular, do not use electrodes of dissimilar metals. This helps ensure optimal signal quality.WarningWarningNon-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.CautionTo protect the transceiver from damage during defibrillation, to ensure accurate ECG information, and to provide protection against signal noise and other interference, use only ECG electrodes and cables specified by Philips.Correct lead placement is always important for accurate diagnosis. Especially in the precordial leads, which are close the heart, QRS morphology can be greatly altered if an electrode is moved away from its correct location. Each electrode is color-coded. Use the diagrams for 5-lead standard and EASI placement on the back of the transceiver and in this section for guidance. Additional lead placement information is available in the Online Help at the IntelliVue Information Center.When placing electrodes on the patient, choose a flat, non-muscular site where the signal will not be impacted by either movement or bones.Philips recommends that electrodes be changed every 24 hours.
Positioning ECG Electrodes6-10 ECG Monitoring The labels and colors of the ECG electrodes differ according to the standards that apply for your hospital. The electrode placement references and illustrations in this chapter use the AAMI labels and colors. See the table below for additional label and color information.In addition to correct positioning of the electrodes, optimal skin preparation prior to electrode placement will help ensure a clear signal for diagnosis.Electrode Labels Electrode ColorsAAMI EASI IEC AAMI IECRA I R White RedLA S L Black YellowLL A F Red GreenRL N N Green BlackV/Va E C/Ca Brown WhiteVb Cb Brown/White White/RedV2 C2 Brown/Yellow White/YellowV3 C3 Brown/Green White/GreenV4 C4 Brown/Blue White/BrownV5 C5 Brown/Orange White/BlackV6 C6 Brown/Violet White/Violet
Positioning ECG Electrodes ECG Monitoring 6-11Step Action1 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.• Wash site with soap and water, leaving no soap residue. Note--Philips does not recommend using ether or pure alcohol, because they dry the skin and increase the resistance.• Dry thoroughly.• Use ECG skin preparation paper (abrasive) to remove dead skin cells and to improve the conductivity of the electrode site.2 Check electrodes for moist gel, and attach to the clips. If you are not using pre-gelled electrodes, apply electrode gel to the electrodes before placement.Note—Gel must be moist to provide a good signal.3 Place the electrodes on the patient according to the lead placement you have chosen (see the electrode placement diagrams following). Place the edge down, then “roll down” the rest of the pad. Press firmly around the adhesive edge toward the center.
Positioning ECG Electrodes6-12 ECG Monitoring Locating the Fourth Intercostal SpaceFor 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). This rise in the sternum is where the second rib is attached, and the space just below this is the second intercostal space.2. Palpate and count down the chest until you locate the fourth intercostal space.Angle of Lewis
Positioning ECG Electrodes ECG Monitoring 6-133-Wire PlacementLead PlacementRA directly below the clavicle and near the right shoulderLA directly below the clavicle and near the left shoulderLL on the left lower abdomenRA LALL
Positioning ECG Electrodes6-14 ECG Monitoring 5-Wire Placement (Standard Mode)Lead PlacementRA directly below the clavicle and near the right shoulderLA directly below the clavicle and near the left shoulderLL on the left lower abdomenRL on the right lower abdomenV 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.V2V3V4 V5 V6V1RA LARL LL
Positioning ECG Electrodes ECG Monitoring 6-15V1 on the fourth intercostal space at the right sternal borderV2 on the fourth intercostal space at the left sternal borderV3 midway between the V2 and V4 electrode positionsV4 on the fifth intercostal space at the left midclavicular lineV5 on the left anterior axillary line, horizontal with the V4 electrode positionV6 on the left midaxillary line, horizontal with the V4 electrode positionLead Placement
Positioning ECG Electrodes6-16 ECG Monitoring 5-Wire Placement (EASI Mode)LeadCorresponds to Standard LeadPlacementE V on the lower sternum at the level of the fifth intercostal spaceA LL on the left midaxillary line at the same level as the E electrodeS LA on the upper sternumI RA on the right midaxillary line at the same level as the E electrodeESAI
Positioning ECG Electrodes ECG Monitoring 6-17N Reference can be anywhere, usually below the sixth rib on the right hipNote—Make sure that the S and E electrodes line up vertically on the sternum, and that the I, E and A electrodes align horizontally.LeadCorresponds to Standard LeadPlacement
Positioning ECG Electrodes6-18 ECG Monitoring 6-Wire Placement6-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. If your unit uses other precordial leads for Va and Vb, they may be assigned in Unit Settings as defaults for your whole unit, or you may need to assign the new positions on a per-patient basis in the Patient Window at the Information Center (see “Telemetry Controls in the Patient Window” on page 9-2).Lead PlacementRA directly below the clavicle and near the right shoulderV2V3V4 V5 V6V1RA LARL LL
Positioning ECG Electrodes ECG Monitoring 6-19LA directly below the clavicle and near the left shoulderRL on the right lower abdomenLL on the left lower abdomenVa 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. For other positions, relabel the lead at the Information Center.Lead Placement
Positioning ECG Electrodes6-20 ECG Monitoring Lead PlacementV1 on the fourth intercostal space at the right sternal borderV2 on the fourth intercostal space at the left sternal borderV3 midway between the V2 and V4 electrode positionsV4 on the fifth intercostal space at the left midclavicular lineV5 on the left anterior axillary line, horizontal with the V4 electrode positionV6 on the left anterior axillary line, horizontal with the V4 electrode position
Positioning ECG Electrodes ECG Monitoring 6-21V7 on the left posterior axillary line, straight line from V6V8 on the left midscapular line, straight line from V7V9 on the left paraspinal line, straight line from V8V3R midway between the V1 and V4R electrode positionsV4R on the fifth intercostal space at the right midclavicular lineV5R on the right anterior axillary line, straight line from V4R
Connecting the ECG Cable6-22 ECG Monitoring Connecting the ECG CableCautionDo 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.Step Action1 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.23-wireMatch the arrow on the cablewith the left arrow (labeledEASI, 3) on the Leadset In-sertion Guide.Note—Leadset is keyed for only one insertion position.EASI, 3 5.6IntelliVue TRxM4841Acoloredline
Connecting the ECG Cable ECG Monitoring 6-2335-wire Standard5-wire EASINote—If you are using a 5-wire leadset in both Standard and EASI modes, insert the alignment guide into the open lead port with the wide lip facing the leads. Then, press down firmly so that the guide is securely under the leadset and the colored line is not visible.Step ActionMatch the arrow on the cablewith the right arrow (labeled 5,6) on the Leadset InsertionGuide.EASI, 3 5.6IntelliVue TRxM4841Ali necoloredlineMatch the arrow on the cablewith the left arrow (labeledEASI, 3) on the Leadset In-sertion Guide.EASI, 3 5.6IntelliVue TRxM4841Acoloredline
Connecting the ECG Cable6-24 ECG Monitoring Cable DisconnectionWhen disconnecting the leadset from the transceiver, grasp the leadset block firmly and pull free. Do not pull on the lead wires.4 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. • When using 5-lead standard, the EASI indicator does not illuminate.When using EASI, the EASI indicator illuminates momentarily.56-wire6 For 6-lead, select the lead label(s) at the Patient Window.Step ActionEASI, 3 5.6IntelliVue TRxM4841AMatch the arrow on the cablewith the right arrow (labeled5,6) on the Leadset InsertionGuide.coloredline
Verifying Electrode Connections ECG Monitoring 6-25Verifying Electrode ConnectionsThe 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.To verify electrode connections, use the following procedure:Step Action1 Press and hold the Check button for 2 seconds
Verifying Electrode Connections6-26 ECG Monitoring 2Expected Response:• 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.• If 6-wire cable is attached: Red, White, Black, Green, Solid Brown and Brown/White indicators illuminate, then all turn off.• If all leads are off, the green indicator will be lit.3Unexpected Response:Any other response indicates a problem with the transceiver or lead set. • Check the leadset connection. The colored line should not be visible; otherwise the wrong leadset type may be detected. • If the INOP, INVALID LEADSET, and the corresponding audible tone occur, the leadset inserted does not match the transceiver’s configuration . Insert the correct leadset per the configuration. • Use a new leadset.If the problem is not corrected, contact your service provider.Step Action
Monitoring during Leads Off ECG Monitoring 6-27During 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. After 10 minutes of this leads off condition, without the SpO2 sensor connected, the transceiver will enter an RF Auto Shutoff state (if enabled). To correct the condition, re-attach the lead to the electrode.Monitoring during Leads OffECG Fallback and Extended monitoring states are supported for the transceiver when the primary and/or secondary leads are in a "Leads Off" INOP condition. Both of these states are entered into after 10 seconds of "Leads Off" in an attempt to maintain monitoring and arrhythmia analysis.ECG FallbackECG Fallback occurs when the primary lead is in "Leads Off" for 10 seconds and a secondary lead is available.MultileadAnalysisIf there is a "Leads Off" technical alarm in the primary lead for > 10 seconds, the active secondary lead becomes the primary lead. The arrhythmia algorithm switches the leads on the display, but relearn does not occur. When the "Leads Off" condition is corrected, the leads are switched back to their original state.Single LeadAnalysisFor single lead analysis, if there are two leads available, the secondary lead is made the primary lead until the "Leads Off" condition is corrected. The arrhythmia algorithm performs a relearn using the available lead.
Monitoring during Leads Off6-28 ECG Monitoring Fallback forEASIIf 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).Extended MonitoringExtended monitoring occurs when both the primary and secondary leads are in "Leads Off" for 10 seconds and another lead is available. It becomes the primary lead and the arrhythmia algorithm performs a relearn. Extended Monitoring applies if:• Telemetry is configured for Extended Monitoring ON by your Service Provider.• The lead set provides more than two leads (e.g., when using a 5-or 6-wire leadset ).Relearning Whenever there is a "Leads Off" condition, the arrhythmia algorithm performs a Relearn, using the available leads.WarningWarningSince Relearn happens automatically, if learning takes place during ventricular rhythm, the ectopics can be incorrectly learned as the normal QRS complex. This can result in missed detection of subsequent events of V-Tach and V-Fib. For this reason, you should:1. Respond promptly to any technical alarm.2. Ensure that the arrhythmia algorithm is labeling beats correctly.Using EASI Leads to TroubleshootIf there is artifact in the ECG waves or a "Cannot Analyze ECG" technical alarm condition is in effect, you can use the three EASI leads to troubleshoot at the Information Center:1. Click 12-Lead ECG on the Patient Window, then on 3 EASI Leads.
Optimizing ECG Measurement Performance ECG Monitoring 6-292. The three directly acquired EASI leads will be displayed so that you can determine which electrodes are causing the problem and need to be replaced.Optimizing ECG Measurement PerformanceWarningWarningTelemetry 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. If occasional loss of ECG monitoring is not acceptable for certain patients, they should be connected to a hardwired bedside monitor.Smart Hopping technology alleviates most of the problems associated with legacy telemetry technologies. Reception problems are less frequent, because Smart Hopping avoids interference and moves to a different access point if the signal strength is too low. The level of radio frequency activity is always fluctuating in the environment. If the level becomes high enough to significantly interfere with transceiver operation, the system responds by moving to another “cleaner” area where there is less activity.The effect of interference on the IntelliVue Telemetry System ranges from a momentary loss of ECG to complete inoperability, and can be caused by many sources. The strength, frequency, and proximity of the source of interference to the transceiver or the access point are factors that determine the degree of severity. In cases where the source of interference can be identified, corrective action can be taken. For example, removing or moving away from the source of interference will increase the equipment's dependability.
Optimizing ECG Measurement Performance6-30 ECG Monitoring 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. Patient-related sources with noise on the waveform caused by clinical considerations such as poor skin prep, dry electrodes, and poor electrode adhesion, as well as by patient motion and muscle artifact.Even in complex situations where problems overlap, most of the time you’ll be able to greatly enhance performance by taking corrective action.MonitoringConsiderations• Patient should be restricted to the designated coverage area. Monitoring performance will degrade if patients go outside the radius of coverage of the receiving wireless network.• A patient location strategy is critical to a telemetry system. If a life-threatening event occurs, the clinician must be able to locate the patient quickly. The importance of this increases as the coverage area increases.• Frequency management is the responsibility of the hospital. Philips Medical System has no control over the RF environment in the hospital. If interference exists at the operating frequencies of the telemetry equipment, telemetry performance will be affected. Careful selection of frequencies for all wireless devices used within a facility (transceivers, other wireless medical devices, etc.) is important to prevent interference between them.Dropouts Because the IntelliVue Telemetry System is a wireless system, under certain frequency conditions dropouts can occur. Dropouts result from a weak signal or RF interference, and appear on the waveform when the signal "drops" to the bottom of the channel for a minimum of 200 ms. If dropouts are frequent enough to affect the heart rate count, the "Cannot Analyze ECG" or "Cannot Analyze ST" technical alarm occurs. If there are enough dropouts to cause
Optimizing ECG Measurement Performance ECG Monitoring 6-31disassociation/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. Signal Strength The IntelliVue Telemetry System is custom designed for your site, so reliable signal reception is only possible where there are receiving access points. When the signal is too low, the following technical alarms can occur:• "Cannot analyze ECG"• "Cannot analyze ST• " Tele Weak signal"•"No signal"Corrective Action1. Check the location of the patient. If the patient is out of range, return the patient to the specified coverage area.2. If the patient is intentionally out of the coverage area, put telemetry in Standby Mode. See “Standby Mode” on page 4-4.3. If the patient is in the coverage area and is stationary, try moving the transceiver about 15 cm (6 inches).4. Check for INOP and information signals at the Information Center.5. Check for interference activity in other sectors at the Information Center to see if the problem is occurring with other transceivers.6. If the problem is persistent, call service.RadioFrequencyInterferenceRadio frequency (RF) interference is caused by monitoring devices from other manufacturers that intrude into the transmitted electrical signal. You are probably familiar with electrical interference in our homes and cars when it causes signal loss or static with cell phones. This same type of interference can occur with the transmitted telemetry signal even though the IntelliVue Problem Cause RemedyDropouts Low signal strengthRF interferenceSee “Signal Strength” below.See “Radio Frequency Interference” below.
Optimizing ECG Measurement Performance6-32 ECG Monitoring Telemetry System is designed to resist these 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. When detected, a "Wireless Monitoring Loss - Call Service" alert is issued at the Information Center.Corrective Action1. To improve performance, the source of the interference must be identified and eliminated. Try moving or removing other wireless devices transmitting in the Wireless Medical Telemetry Service (WMTS - USA only). Such devices can be identified by the presence of an antenna and/or the following symbol::Important—The IntelliVue Telemetry System emits radio frequencies that can affect the operation of other devices. Contact the manufacturer of other equipment for possible susceptibility to these frequencies.Muscle and Movement ArtifactMuscle and movement artifact, respiratory variation, as well as poor electrode contact, inadequate skin preparation, and other patient-related factors can also affect interference with the ECG signal. Good clinical practice can have a significant effect on the quality of ECG monitoring.Corrective ActionUse the following table to help you troubleshoot the most common sources of physiologically-caused ECG noise.
Optimizing ECG Measurement Performance ECG Monitoring 6-33Problem Cause Remedy60-Cycle (AC) Interference Poor electrode placement.Possible non-grounded instrument near patient.Re-apply electrodes, using good skin preparation (see “Positioning ECG Electrodes” on page 6-9).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.Make sure patient is comfortable.Check that electrodes are applied on flat non-muscular areas of the torso; apply fresh electrodes if necessary, using good skin preparation (see “Positioning ECG Electrodes” on page 6-9).Irregular Baseline Poor electrical contact.Respiratory interference.Faulty electrodes.Dry electrodes.Re-apply electrodes, using good skin preparation (see “Positioning ECG Electrodes” on page 6-9).Move electrodes away from areas with greatest movement during respiration.
Optimizing ECG Measurement Performance6-34 ECG Monitoring Baseline Wander Movement of patient.Improperly applied electrodes.Respiratory interference.Make sure patient is comfortable.Re-apply electrodes, using good skin preparation (see “Positioning ECG Electrodes” on page 6-9). Check that patient cable is not pulling electrodes.Move electrodes away from areas with greatest movement during respiration.Poor Electrode Contact Loose electrodes.Defective cables.Leadset not firmly connected.Change electrodes, using good skin preparation (see “Positioning ECG Electrodes” on page 6-9). Replace cables.Problem Cause Remedy
ST/AR Arrhythmia & ST Segment Monitoring 7-1Introduction7ST/AR Arrhythmia & ST SegmentMonitoringThis 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 Arrhythmia Algorithm7-2 ST/AR Arrhythmia & ST Segment MonitoringST/AR Arrhythmia AlgorithmSafety InformationWarningWarningDuring complete heart block or pacemaker failure (to pace or capture), tall P-waves (greater than 1/5 of the average R-wave height) can be erroneously counted by the arrhythmia algorithm, resulting in missed detection of cardiac arrest.WarningWarningLearningIf you initiate learning during ventricular rhythm, the ectopics can be incorrectly learned as the normal QRS complex. This can result in missed detection of subsequent events of V-Tach and V-Fib.
ST/AR Arrhythmia AlgorithmST/AR Arrhythmia & ST Segment Monitoring 7-3WarningWarningRelearningArrhythmia 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. This can result in missed detection of subsequent events of V-Tach and V-Fib. For this reason, you should:1. Respond promptly to any technical alarm.2. Ensure that the arrhythmia algorithm is labeling beats correctly.When using EASI ECG monitoring, Relearn happens automatically when there is a LEADS OFF technical alarm. If learning takes place during ventricular rhythm, the ectopics can be incorrectly learned as the normal QRS complex. This can result in missed detection of subsequent events of V-Tach and V-Fib. Be sure to check the beat labels and initiate a relearn to correct.1. Respond to the technical alarm [for example, reconnect the electrode(s)].2. Ensure that the arrhythmia algorithm is labeling beats correctly. For Paced PatientsWarningWarningSome pace pulses can be difficult to reject. When this happens, the pulses are counted as a QRS complex, and could result in an incorrect HR and failure to detect cardiac arrest or some arrhythmias. Keep pacemaker patients under close observation.
ST/AR Arrhythmia Algorithm7-4 ST/AR Arrhythmia & ST Segment MonitoringWarningWarningDuring complete heart block or pacemaker failure (to pace or capture), tall P-waves (greater than 1/5 of the average R-wave height) can be erroneously counted by the arrhythmia algorithm, resulting in missed detection of cardiac arrest.WarningWarningFor 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. Proper detection and classification of the paced rhythm can then be determined.WarningWarningWhen an external pacemaker is being used on a patient, arrhythmia monitoring is severely compromised due to the high energy level in the pacer pulse. This can result in the arrhythmia algorithm’s failure to detect pacemaker non-capture or asystole.WarningWarningIt is possible that pacemaker pulses will not be detected when the ECG analog output of a defibrillator is plugged into a bedside monitor. This can result in the arrhythmia algorithm’s failure to detect pacemaker non-capture or asystole.ST/AR Arrhythmia AnalysisFor information on arrhythmia detection, refer to the following documentation:•ST/AR Algorithm - Arrhythmia Monitoring Application Note, #452298193051•IntelliVue Information Center Instructions for Use and Online Help
ST/AR Arrhythmia AlgorithmST/AR Arrhythmia & ST Segment Monitoring 7-5The intended use of the ST/AR basic arrhythmia analysis algorithm is to monitor the patient’s ECG for heart rate and ventricular arrhythmias and to produce events/alarms simultaneously for one or more ECG leads. The arrhythmia algorithm is effective when monitoring both paced and non-paced patients in a clinical environment.IntelliVue Telemetry does not have a dedicated cardiotach. Instead, the arrhythmia cardiotach at the Information Center is used. Therefore, the ST/AR Arrhythmia algorithm is always on for all IntelliVue Telemetry patients, and cannot be turned off.ST/AR provides Heart Rate and PVC Rate numerics and alarm detection for the conditions listed in the following table. There are two detection levels: Basic and Enhanced. Enhanced includes the Basic alarms.Basic & Enhanced Arrhythmia DetectionBasic Arrhythmia Detection Enhanced Arrhythmia DetectionAsystole Non-Sustain VTV-Fib/Tach Vent RhythmV-Tach Run PVCsBrady yyy < xxx Pair PVCsTachy yyy > xxx PauseHR yyy > xxx Missed BeatHR yyy < xxx SVTPVCs > xxx/min R-on-T PVCsPacer Not Capturing Vent BigeminyPacer Not Pacing Vent TrigeminyMultiform PVCsIrregular HR
ST/AR Arrhythmia Algorithm7-6 ST/AR Arrhythmia & ST Segment MonitoringBeat 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.When monitoring is initiated, when the Wave 1 lead is changed, or if Relearn is selected, a question mark (?) is displayed next to HR and the annotation “L” appears on the annotated wave until the HR is calculated and the rhythm is learned. Annotation Beat Classification Display ColorAArtifact BlueIInoperative RedLLearning RedMMissed Beat RedNNormal BluePPaced BlueSSupraventricular Premature BlueVVentricular Premature Red?Questionable Red|Pacer Mark Blue
ST/AR ST Segment AlgorithmST/AR Arrhythmia & ST Segment Monitoring 7-7ST/AR ST Segment AlgorithmWarningWarningThis device provides ST level change information; the clinical significance of the ST level change information needs to be determined by a physician.The ST/AR ST algorithm at the Information Center monitors ST segment elevation or depression for each available telemetry ECG lead and produces events/alarms simultaneously. ST values update with every measurement period and enunciate, depending upon the severity of the change, events and alarms as they are detected.The ST/AR ST algorithm is approved for use only with non-paced and atrially-paced adult telemetry-monitored patients. With EASI monitoring, ST analysis is performed on up to 12 leads, and an additional value of ST index is calculated and displayed (see “EASI ST Analysis” on page 7-9). Assessment of EASI-derived 12-lead ST measurement is recommended for adult patients that meet the following parameters:• Ages: 33-82 years• Heights: 147 to 185 cm (58 to 73 in)• Weights: 53 to 118 kg (117 to 261 lbs)• Height to Weight Ratios: 1.41 to 2.99 cm/kg (0.25 to 0.54 in/lb)All ST analysis and ST alarms for telemetry patients are performed by the Information Center.For additional information on ST monitoring, refer to the following documentation:•ST/AR Algorithm - ST Segment Monitoring Application Note, #452298192851•Information Center Online Instructions for Use and Online HelpThe MeasurementThe ST measurement for each beat complex is the vertical difference between two measurement points. The isoelectric point provides the baseline for the
ST/AR ST Segment Algorithm7-8 ST/AR Arrhythmia & ST Segment Monitoringmeasurement and the ST point provides the other measurement point. It is positioned with reference to the J-point.Algorithm ProcessingST analysis analyzes ECG signals to classify the heart beats. Only beats classified as normal or Supraventricular (atrially paced) are used to calculate ST elevations and depressions.The ST/AR ST algorithm processing includes special ST filtering, beat selection and statistical analysis, calculation of ST segment elevations and depressions, and lead reconstruction and wave generation. When ST analysis is being performed on two leads, the averaged derived and reconstructed ST waves and associated ST segment values are given for up to six leads, depending on the type of patient cable:• 3-wire: one lead• 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 leadsNote—No ST analysis is done on a patient if an electrode falls off.R-WAVE PEAK AT 0 MSECJ POINTISO ELECTRIC POINT DEFAULT = -80 MSECMEASUREMENT POINT DEFAULT = J+60 MSECDIFFERENCE = ST VALUEPQSSTT
ST/AR ST Segment AlgorithmST/AR Arrhythmia & ST Segment Monitoring 7-9Displayed ST DataST data displays as values in the Patient Sector and Patient Window. A positive value indicates ST segment elevation; a negative value indicates ST segment depression. You can view ST data in ST Review, Trend Review, and Event Review windows.EASI ST AnalysisThe Information Center generated ST values presented in the patient sector and Patient Window for EASI derived leads is STindx (ST Index). STindx is a summation of three ST segment measurements, using the leads that can indicate ST segment changes in the different locations of the heart:• anterior lead V2• lateral lead V5• inferior lead aVFST OperationTurning STMonitoring On/OffThe ST Setup Window allows you to turn ST monitoring on or off for all available ECG leads. To turn ST monitoring on at the Information Center, perform the following steps:You would turn ST monitoring off if:• 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.Step Action1From the Patient Window, click the All Controls button.2From the All Controls Window, click the ST Setup button.3From the ST Setup Window, click ST On.
ST/AR ST Segment Algorithm7-10 ST/AR Arrhythmia & ST Segment MonitoringAdjusting STMeasurementPointsThe 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. • The J-point cursor positions the J-point in relation to the R-wave peak. The purpose of the J-point is to correctly position the ST measurement point.• The ST measurement cursor positions the ST point a fixed distance from the J point.Note—The ST measurement points may need to be re-adjusted if the patient's heart rate or ECG morphology changes significantly.Perform the following steps at the Information Center to adjust the ST measurement points:Step Action1Access the ST Setup window by clicking on the All Controls button in the Patient Window, then clicking on the ST Setup button.2If you need to adjust the ISO (isoelectric) point, place the cursor over the ISO button to access the adjustment arrows. Then use the arrows to position the bar in the middle of the flattest part of the baseline (between the P and Q waves or in front of the P wave).TRPISO point QS
ST/AR ST Segment AlgorithmST/AR Arrhythmia & ST Segment Monitoring 7-11EstablishingST ReferenceBeats(Baseline)After adjusting the measurement points, you can establish baseline reference beats for all available leads in the ST Review window at the IntelliVue Information Center. Reference beats enable you to compare waveform changes, for example from admission, or prior to or after treatment. The reference continues to be saved beyond the 24 hour review window, but you can update it to any beat within the last 24 hours. Please refer to the IntelliVue Information Center Instructions for Use or Online Help for directions.ST Alarm SettingsAll 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.3Adjust the J point, if necessary, by placing the cursor over the J-point 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.4Adjust 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.Step ActionTRPSQJ pointTRPSQST point
ST/AR ST Segment Algorithm7-12 ST/AR Arrhythmia & ST Segment Monitoring• Physician orders or medication specified limits.You can make the following adjustments to ST alarm limits to accommodate the clinical condition of individual patients:• Turn all alarms off/on.• Adjust the alarm limits:– to specific high and low limits– to Smart Limits (see the IntelliVue Information Center Instructions for Use for information on Smart Limits)– back to unit default settings.You adjust the ST alarm limits in the ST Alarms Window. Each ST parameter has its own alarm limit. The alarm is triggered when the ST value exceeds its alarm limit for more than 1 minute. The alarm will be a yellow alarm. When more than one ST parameter is in alarm, only one alarm message displays. For multilead alarms when using an EASI transceiver, an alarm is generated if two or more ST leads exceed the alarm limits. The default setting is +/-1.0. The alarm message indicates the two leads that are in greatest violation of the limits, for example, “**MULTI ST AVR, V6”. If another lead becomes deviant, the message changes but it is considered the same alarm (no new alarm sounds and it is not listed as a new event). See “Physiologic Alarms” on page 5-4 for a list of all ST alarms.See IntelliVue Information Center Instructions for Use for specifics on alarm management and behavior.Adjusting STAlarmsMake adjustments to ST alarms on the ST Alarms window at the Information Center. Step Action1From the Patient Window, select the All Controls button.
ST/AR ST Segment AlgorithmST/AR Arrhythmia & ST Segment Monitoring 7-132 From the All Controls window, select the ST Alarms button under Alarm Management and Setup.3In 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.Smart Limits—Click on this button to set high and low limits around your patient's current ST value. The difference above and below the patient's ST value are pre-set for your unit. Note—Smart Limits can be configured to automatically be activated when the patient is connected. See the IntelliVue Information Center Instructions for Use for additional information on using smart limits.Specified limits—Use these to set the high and low alarm limits based on your assessment of the patient's clinical condition, unit protocols, or physician orders or medication specified limits. A good guideline is + 1.0 mm or - 1.0 mm from the patient's ST, or follow your unit protocol.Step Action
ST/AR ST Segment Algorithm7-14 ST/AR Arrhythmia & ST Segment Monitoring
SpO2 Monitoring 8-1Introduction8 SpO2 MonitoringThis chapter provides an introduction to the SpO2 measurement and its application. It includes the following sections:•SpO2 Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2• Pulse Oximetry Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4• Selecting a SpO2 Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6• Applying the Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10• Connecting the SpO2 Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-14•Measuring SpO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-15• Understanding SpO2 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-20• Optimizing SpO2 Measurement Performance . . . . . . . . . . . . . . . . . . 8-20
SpO2 Safety Information8-2 SpO2 Monitoring SpO2 Safety InformationWarningWarningAlways confirm Information Center observations with clinical observation of the patient before administering interventions.WarningWarningUsing 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.WarningWarningProlonged, continuous monitoring can increase the risk of changes in skin characteristics, such as irritation, reddening, blistering or pressure necrosis, particularly on patients with impaired perfusion and varying or 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 can be required due to an individual patient's condition.WarningWarningInjected dyes such as methylene blue or intravascular dyshemoglobins such as methemoglobin and carboxyhemoglobin can lead to inaccurate (over-estimated) measurements.
SpO2 Safety Information SpO2 Monitoring 8-3WarningWarningInterference 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.WarningWarningThis 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 Information for the UserThe pulse oximeter is calibrated to indicate functional oxygen saturation (fractional oxyhemoglobin), and displayed results can range from 0 to 100%.A 10 second averaging filter is used in the calculation of the result. Displayed results are typically updated every second, but the update period can be automatically delayed by up to 30 seconds in the presence of noise.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. There is no alarm function for pulse rate.The pleth wave is auto-scaled to maximum display size. It decreases only when the signal quality becomes marginal. Pleth wave size is NOT directly proportional to the pulse volume.
Pulse Oximetry Measurement8-4 SpO2 Monitoring Pulse Oximetry MeasurementThe 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. SpO2 can be measured continuously, where a value is sent to the Information Center every second, or as a single, individual measurement (Spot Check). The Spot Check measurement will be removed from the Information Center display after 1 hour. If 1-minute or 5-minute sampling rate is selected at TeleMon, the transceiver will provide Continuous SpO2 measurement after disconnection (see “Transceiver Operation when Connected to TeleMon” on page 9-16).The SpO2 parameter measures the arterial oxygen saturation, that is, the percentage of oxygenated hemoglobin in relation to the total hemoglobin.If, for example, a total of 97% of the hemoglobin molecules in the red blood cells of the arterial blood combine with oxygen, then the blood has an oxygen saturation of 97%. The SpO2 numeric that appears on the monitor will read 97%. The SpO2 numeric indicates the percentage of hemoglobin molecules which have combined with oxygen molecules to form oxyhemoglobin.• The oxygen saturation is measured using the pulse oximetry method. This is a noninvasive method of measuring the arterial hemoglobin oxygen saturation. It measures how much light, sent from light sources on one side of the sensor, travels through patient tissue (such as a finger or an ear), to a receiver on the other side of the sensor.• 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
Pulse Oximetry Measurement SpO2 Monitoring 8-5during a pulsation. Correct placement of the sensor is essential for accurate measurements (see “Applying the Sensor” on page 8-10).Note—Because pulse oximeter equipment measurements are statistically distributed, only about two-thirds of pulse oximeter equipment measurements can be expected to fall with ± Arms of the value measured by a CO-oximeter.Pulse Tone IndicationDuring Spot Check measurement initiated at the transceiver, the pulse signal is detected and communicated to you via an auditory signal at the transceiver. The indicator is a single low-pitched tone for each pulse detected; it ceases when a measurement is complete. The tone is controlled by the Volume and Mute controls at the Information Center. Since it is possible to have a strong pulse but fail an SpO2 measurement, you should listen for the successful completion of a measurement (single beep), or a double beep if the measurement fails. The pulse indicator is for information only, and should not be used as an indication for treatment. The indicator is not functional in Continuous measurement mode, and no tones, for pulse indication or successful/failed measurement, are generated when Spot Check is initiated remotely from the Information Center.Clinical Note: If the transceiver is in Spot Check mode, and the sensor light is illuminated but you do not hear a low-pitch sound synchronized with the pulse, readjust the sensor, or move the sensor to another site to provide better detection. (Adjustable sounds must be on.)
Selecting a SpO2 Sensor8-6 SpO2 Monitoring Selecting a SpO2 SensorWarningWarningUse 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 productWarningWarningReuse: Never reuse disposable sensors, accessories and so forth that are intended for single use, or single patient use only.Packaging: Do not use a sterilized accessory if the packaging is damaged.WarningWarningDo not use disposable sensors on patients who exhibit allergic reactions to the adhesive.WarningWarningWhen the specified Nellcor® sensors are used, the application must be consistent with the sensor manufacturer's own guidelines.
Selecting a SpO2 Sensor SpO2 Monitoring 8-7Philips 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.CautionDo 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 Sensor8-8 SpO2 Monitoring The following table and chart will help you in selecting the correct sensor type. .Sensor Type When to UseReusable 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. See the Directions for Use supplied by Nellcor® Incorporated for instructions on preparation and application of reusable sensors.Disposable Use disposable sensors only once and then discard. However, you can relocate them to a different patient-site if the first location does not give the desired results. Do not reuse disposable sensors on different patients.See the Directions for Use supplied by Nellcor® Incorporated for instructions on preparation and application of disposable sensors.
Selecting a SpO2 Sensor SpO2 Monitoring 8-9To 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.Selecting an SpO2 SensorPreferred sensor typesAlternative sensor types Disposable sensorM1192A M1191A M1194APhilips M1901B N-25 NM1903B D-20 PM1904B D-25 A11088664433Pedi AdultPatientWeight( kg )5040302015PediAdult AdultPediAdultPatientWeight( lb )PediPediPediAdultOxisensorOxiMaxM1196AReusable sensor
Applying the Sensor8-10 SpO2 Monitoring Applying the SensorSensor Application Safety InformationWarningWarningFailure 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. This can result in venous congestion distal from the application site, leading to interstitial edema, hypoxia and tissue malnutrition. Skin irritations or ulcerations can occur as a result of the sensor being attached to one location for too long. To avoid skin irritations and ulcerations, inspect the sensor application site every 2-3 hours, and change the application site at least every 4 hours or according to clinical practice guidelines.Venous Pulsation: Do not apply sensor too tightly as this results in venous pulsation, which can severely obstruct circulation and lead to inaccurate measurements.Ambient Temperature: Never apply an SpO2 sensor at ambient temperatures above 37 oC (99 oF) because this can cause severe burns after prolonged application.Extremities to Avoid: Avoid sites distal to BP cuff, intra-arterial line, or intravascular venous infusion line.Site Selection• Avoid sites with impaired perfusion, skin discoloration, excessive motion or nail polish.
Applying the Sensor SpO2 Monitoring 8-11• 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). These result in venous pulsations and inaccurate measurement, and may severely obstruct circulation.Sensor ApplicationA minimum pulsatile flow must be present at the application site of your patient to obtain measurements. Select an appropriate sensor and apply the sensor properly to avoid incorrect measurements. Applying a small amount of pressure at the application site can improve the measurement. Use one of the preferred application sites for your sensor. Selecting the most suitable sensor and application site will help you to ensure that:• The light emitter and the photo detector are directly opposite each other and that all the light from the emitter passes through the patient's tissues,• The application site is of the correct thickness for light to pass through. If the application site is too thick or too thin, an SpO2 NON-PULSATILE technical alarm will occur. You should then select another site as appropriate.Positioning of the Light Emitter and Photo DetectorInspect 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.Light EmitterPhoto Detector
Applying the Sensor8-12 SpO2 Monitoring Follow the sensor’s instructions for use, adhering to all warnings and cautions.To apply the sensor, use the following directions.Adult Fingersensor(M1191A)Push the sensor over the fingertip in such a way that the fingertip touches but does not protrude from the end of the sensor. The fingertip must be uppermost and the cable must lie on the back of the hand. This ensures that the light source cover the base of the fingertip giving the best measurement results. The cable can be held in place by the accompanying wristband.Step Action1 Select the site and appropriate sensor (see “Selecting a SpO2 Sensor” on page 8-6).2 Apply the sensor to the appropriate part of the patient’s body. Note—The application site should match the sensor size so that the sensor can neither fall off nor apply excessive pressure.3 Check that the light emitter and the photo detector are directly opposite each other. All light from the emitter must pass through the patient’s tissue.
Applying the Sensor SpO2 Monitoring 8-13Small Adult/PediatricFinger 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.The clip sensor can be used as an alternative if the adult finger sensor does not provide satisfactory results. The preferred application site is the ear lobe, although other application sites with higher perfusion (such as the nostril) can be used. Due to the physiologically lower perfusion in the ear lobe, you should be aware of the reduced accuracy of the measurement and more frequent technical alarms.
Connecting the SpO2 Cable8-14 SpO2 Monitoring Connecting the SpO2 CableCautionExtension cables: The use of extension cables presents a tripping hazard. Use appropriate care when they are in use.Electrical Interference: Position the sensor cable and connector away from power cables, to avoid electrical interference.Step Action1 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).3 Make other adjustments in the Telemetry Setup Window (see “Patient Configurable Settings in Telemetry Setup” on page 9-4).
Measuring SpO2 SpO2 Monitoring 8-15Measuring SpO2WarningWarningRemoval 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.WarningWarningIf you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile 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.SpO2 measurements can be made manually on an as-needed basis in Spot Check mode, or continuously in Continuous mode, depending on the transceiver configuration. While operating in Continuous mode, you can also measure pulse, and display the pleth wave at the Information Center. The SpO2 parameter is turned on by inserting/removing the sensor cable into the transceiver, or by control from the Information Center. SpO2 monitoring consumes considerable electrical energy. The battery power must be at least 25% full in order to make SpO2 measurements.Setting the mode at Spot Check or Continuous is done at the Information Center (see “Patient Configurable Settings in Telemetry Setup” on page 9-4) or at TeleMon.Spot Check MeasurementWhen 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 STAT SpO2 icon (see “Patient Configurable Settings in Telemetry Setup” on page 9-4).
Measuring SpO28-16 SpO2 Monitoring Note—Spot Check measurements cannot be made when the transceiver is connected to TeleMon or the IntelliVue MP5 Patient Monitor, because only Continuous measurement is available with these devices. Continuous MeasurementWhen the transceiver is configured for Continuous SpO2 measurement ((see “Patient Configurable Settings in Telemetry Setup” on page 9-4), use the following directions to initiate Continuous SpO2 monitoring. Step Action1 Attach the sensor to the patient.2 Connect the SpO2 cable to IntelliVue TRx+, and check that:•The SpO2 sensor light turns on.• A low-pitch tone detecting each pulse is audible (unless sounds are muted).3 After approximately 30 seconds, if the measurement was successful, you’ll hear a single beep from the transceiver. The value, with the measurement time, will be displayed at the Information Center. The sensor light will extinguish. If the measurement was unsuccessful, you’ll hear a double beep. Remove the sensor cable and reinsert it to retake the measurement.Note—The SpO2 value and time stamp remain on the Information Center for 1 hour or until another measurement is taken, with one exception: If the batteries are removed from the transceiver, the Spot Check measurement will be erased from the display; however, the SpO2 measurements will be available in Trend Review.4To repeat a Spot Check measurement at the bedside, disconnect then reconnect the SpO2 cable to the transceiver.Step Action1 Insert the SpO2 cable into the IntelliVue TRx+, and check that the sensor light turns on.2 Attach the sensor to the patient.
Measuring SpO2 SpO2 Monitoring 8-17DisplayingPulse RateWhen operating in Continuous mode, you can view the Pulse rate at the Information Center. See “Patient Configurable Settings in Telemetry Setup” on page 9-4.Note—If Pulse rate is turned on, the Patient Sector and Patient Window of the Information Center display the parameter label with “T” (for example, "PulseT") to indicate that the measurement was made via telemetry.DisplayingPleth WaveThe transceiver can be configured to transmit the Pleth wave for display at the Information Center. See “Patient Configurable Settings in Telemetry Setup” on page 9-4.When Connected to TeleMonWhen the transceiver is connected to TeleMon:• The SpO2 measurement mode is always Continuous. 3 After approximately 15 seconds, the value, with the measurement time, is displayed at the Information Center.Note—There are no sounds associated with continuous SpO2 measurement.4 To discontinue SpO2 monitoring, uncheck the Enable SpO2 box at the Information Center. Note— If the sensor is removed without discontinuing SpO2 monitoring in the Telemetry Setup Window at the Information Center, an SpO2T NO SENSOR technical alarm will result. Silencing this technical alarm will turn the SpO2 measurement off.Step Action
Measuring SpO28-18 SpO2 Monitoring • You can change the mode. Changes to the mode take effect when the transceiver is disconnected from TeleMon. The following settings will be used:When Connected to the MP5When the transceiver is sourcing the display of patient data on an MP5 bedside monitor:• The SpO2 measurement mode is always Continuous.Turning SpO2 Monitoring OffTo turn SpO2 monitoring off, disconnect the sensor cable from the transceiver. SpO2 enters a power-down mode after the cable is disconnected from the transceiver, thereby conserving battery life. It is important to disconnect the sensor from the transceiver in order to conserve battery life. Unplugging the sensor from an adapter cable that is connected to the transceiver does NOT provide SpO2 power-down mode. SpO2 should also be turned off at the Information Center. If the transceiver is configured for Continuous SpO2 measurement and the sensor is removed without turning SpO2 off, a SpO2T NO SENSOR technical alarm will result. Silencing this technical alarm will turn the SpO2 measurement off.Mode Set at TeleMon Mode when Transceiver is DisconnectedContinuous Continuous5-minute Continuous1-minute ContinuousManual Spot Check
Measuring SpO2 SpO2 Monitoring 8-19SpO2 Enable/Disable at Information CenterYou can enable/disable SpO2 monitoring at the Information Center. See “Patient Configurable Settings in Telemetry Setup” on page 9-4.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.When SpO2 monitoring is disabled, setting the sample rate to Spot Check or Off at the Information Center or at TeleMon will help you conserve the transceiver’s battery life. See “Patient Configurable Settings in Telemetry Setup” on page 9-4.SpO2 Auto ON at Information CenterThe SpO2 parameter is automatically enabled at the IntelliVue Information Center if a manual SpO2 measurement is initiated at the transceiver while in Spot Check mode or if the SpO2 sensor is inserted into the transceiver while the transceiver is in Continuous SpO2 mode.When a patient is discharged and the transceiver is in Continuous mode, the SpO2 parameter is disabled. To reactivate the SpO2 parameter Auto ON feature from the transceiver, remember to do one of the following when a patient is discharged:– remove the SpO2 cable from the transceiver, wait 15 seconds, then reinsert the cableor– if using TeleMon, reset the transceiver to Manual mode.Note—The SpO2 parameter Auto ON feature only needs to be reactivated when the transceiver is in Continuous mode at discharge.Note— SpO2 can always be enabled/disabled at the IntelliVue Information Center.
Understanding SpO2 Alarms8-20 SpO2 Monitoring Understanding SpO2 AlarmsPhysiologic 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.The delay between the physiologic alarm condition and alarm annunciation at the Information Center is <16 seconds. This means that the Information Center will generate an alarm if the averaged numeric value on the display exists beyond the alarm limit for more than a maximum of 16 seconds.Setting the high SpO2 alarm limit to 100% is equivalent to switching off the high alarm. Therefore the upper alarm limit for oxygen saturation must be carefully selected in accordance with accepted clinical practices.The default setting for SpO2 yellow alarms is latched. That is, when an SpO2 limit is exceeded, you will need to acknowledge it at the Information Center. The sound will be silenced but the message will remain on the display until the condition is resolved.See Chapter 5, “Alarms” for a list of the SpO2 alarms.Optimizing SpO2 Measurement PerformanceRefer to this section on problem situations if you have difficulty getting a signal or obtaining accurate measurements.DistortionAmbient light, motion, perfusion or incorrect sensor placement can affect the accuracy of the derived measurements.
Optimizing SpO2 Measurement Performance SpO2 Monitoring 8-21Arterial Blood FlowThe measurement depends on the pulsatile nature of blood flow in the arteries and arterioles; with the following conditions arterial blood flow can be reduced to a level at which accurate measurements cannot be made:•shock• hypothermia • use of vasoconstrictive drugs • anemiaWavelength AbsorptionThe measurement also depends on the absorption of particular light wavelengths by the oxyhemoglobin and reduced hemoglobin. If other substances are present which absorb the same wavelengths, they will cause a falsely high, or falsely low SpO2 value to be measured. For example:• carboxyhemoglobin • methemoglobin • methylene blue • indocyanine green*• indiocarmine**These chemicals are used in dye dilution cardiac output calculations.Ambient LightVery high levels of ambient light can also affect the measurement; an "SpO2 Interference" message will appear on the display. The measurement quality can be improved by covering the sensor with suitable opaque material.Care and CleaningFor care and cleaning instructions, see the instructions accompanying the sensors.Sensor WearNormal 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. Moreover, Philips Medical Systems’ warranty agreement shall not apply to defects arising from improper use.To get the best results from your SpO2 reusable sensor:
Optimizing SpO2 Measurement Performance8-22 SpO2 Monitoring • Always handle the sensor and cable with care. The soft finger sleeve houses a sensitive electronic device that can be damaged by harsh treatment. Always protect the cable from sharp-edged objects.• Use the wristband that is supplied with your M1191A sensor. By keeping the cable between the finger sensor and the wristband fairly loose, you will maintain good monitoring conditions.
Telemetry Functions at the Information Center & TeleMon 9-1Introduction9Telemetry Functions at theInformation Center & TeleMonThis chapter describes the telemetry functions at the Information Center and IntelliVue Patient Monitor, 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 . . . . . . . . . . . . . . . . . . 9-2•Locating the Transceiver (Find Device). . . . . . . . . . . . . . . . . . . . . 9-3•Patient Configurable Settings in Telemetry Setup . . . . . . . . . . . . . 9-4•Unit-Configurable Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-8• Transceiver Operation when Connected to TeleMon . . . . . . . . . . . . . 9-16
Telemetry Functions at the Information Center9-2 Telemetry Functions at the Information Center & TeleMon Telemetry Functions at the Information Center1Telemetry Controls in the Patient WindowThe 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.To View ECG or SpO2Alarm LimitsMove the cursor over the HR or SpO2 label to display the current high and low alarm limits.To Change ECG or SpO2 Alarm LimitsMove the cursor over the High or Low numeric to display up/down arrow controls for adjusting the limit. After adjusting the limit, move the cursor away from the area to dismiss the limit controls.To Change ECG Waveform SizeMove the cursor over the ECG waveform to display the ECG Waveform Size control. Select the desired size from the list.To Select LeadMove the cursor over the ECG waveform to display the Lead Selection control. Select the desired lead from the list.Important—Do not set the primary and secondary channels to the same lead.To Change Va and Vb Default Lead Settings (6-lead only)Move the cursor over the ECG waveform to display the Lead Selection popup. Select the label from the label list. For Va or Vb, select Va or Vb, then select the lead to be assigned. Assignment of the same V lead to both Va and Vb is not allowed.Important—Do not set the primary and secondary channels to the same lead.1. For information on ST functions performed at the Information Center, see “ST/AR ST Segment Algorithm” on page 7-7.
Telemetry Functions at the Information Center Telemetry Functions at the Information Center & TeleMon 9-3To Initiate a Spot Check MeasurementMove 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 StandbySee instructions under “Standby Mode” on page 4-4.Locating the Transceiver (Find Device)The Find Device feature enables you to generate an alternating pitch repeated tone at the transceiver to assist in locating a missing device. This function is initiated in the Telemetry Setup Window. Find Device requires that the transceiver has good working batteries and is within the coverage area. The device will not return from out-of-range until association with the Information Center is re-established.To locate atransceiverStep Action1 From the Patient Window, select Telemetry Setup.2 Select Find Device to generate a repeated tone at the transceiver.
Telemetry Functions at the Information Center9-4 Telemetry Functions at the Information Center & TeleMon To silence thesoundViewing 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. If the location of the transceiver changes, the Patient Window is updated within 5 seconds of the location change.Viewing Device Location History (optional)You can view the location history for a particular transceiver in the Device Location History field in the Telemetry Setup window. The field displays the five most recent Device Location descriptions in ascending order and updates every time there is a change in location for the device. The total timespan of the log is 60 minutes. Note—If there is a change in location while viewing the Telemetry Setup window, you must re-enter Telemetry Setup to see the change, as it does not update automatically.Patient Configurable Settings in Telemetry SetupThe 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.Step Action1 Press and hold the Check button for 6 seconds to turn off the sound. ORRemove the batteries.
Telemetry Functions at the Information Center Telemetry Functions at the Information Center & TeleMon 9-5 Patient-Configurable Settings in Telemetry SetupControl Function Setting Choices Factory DefaultTelemetry ButtonDetermine the Information Center response when Telemetry Button is pressed.Nurse Call - generate nurse call alarmRecord - generate a recording stripNurse Call and Record - generate nurse call alarm and recording stripNoneNurse CallTelemetry Device: VolumeSet the volume level for all adjustable sounds on the transceiver.Note—This control is grayed out if disabled in Unit Settings.1 (low), 2, 3, 4, 5 (high) 3Telemetry Device: MuteEnable/disable Spot Check and pulse detection tones on the transceiver.Note—This control is grayed out if disabled in Unit Settings.enable (mute)disable enableFixed Pacer AmplitudeSets the appearance of the pacer spikes to a fixed size as they appear in the patient window. enabledisabledisable
Telemetry Functions at the Information Center9-6 Telemetry Functions at the Information Center & TeleMon SpO2 EnabledEnable/disable the SpO2 measurement at the Information Center or Telemon.enabledisableenableSpO2 Mode Determine the transceiver SpO2 behavior.Note—Pulse Rate and Pleth Wave are not available in Spot Check.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 the Spot Check SpO2 icon in the Patient Window. No pulse or successful/failed measurement tones are generated when measurement is initiated at Information Center.Continuous - Sends an SpO2 parameter value to the Information Center every second. If selected, Pulse Rate and Pleth Wave may also be sent.Spot CheckPatient-Configurable Settings in Telemetry SetupControl Function Setting Choices Factory Default
Telemetry Functions at the Information Center Telemetry Functions at the Information Center & TeleMon 9-7Suppress SpO2 INOPs with NBPEnable/disable the SpO2 algorithm to suppress sending technical alarms from the transceiver during an NBP measurement for 60 seconds.WarningWarningIf you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile 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.enabledisableenablePleth Wave Enable/disable the transmission of the Pleth wave (and its subsequent display) to the Information Center. For Continuous SpO2 mode only.Note—When enabled, the Pleth wave replaces the Vb wave in the Patient Window during 6-lead monitoring.enabledisabledisable (Pleth is not displayed.)Pulse Enable/disable display of the Pulse rate at the Information Center. For Continuous SpO2 mode only.enabledisabledisable (Pulse rate is not displayed.)Patient-Configurable Settings in Telemetry SetupControl Function Setting Choices Factory Default
Telemetry Functions at the Information Center9-8 Telemetry Functions at the Information Center & TeleMon Unit-Configurable SettingsUnit Settings provide access to clinical configuration items that affect all patients on an Information Center. Changes in unit settings take effect upon discharge, except for Standby duration and SpO2 mode, which take effect immediately.Access to unit settings requires a password, and the displays are in English. Telemetry specific settings are accessed through All Controls -> Unit Settings -> Telemetry Setup. The setting for telemetry non-arrhythmia yellow alarms is located in All Controls -> Unit Settings -> Alarms Unit Settings. For all other information on unit settings, see IntelliVue Information Center Instructions for Use. SpO2 Alarm Turn SpO2 alarms on/off at the Information Center.enable (on)disable (off)enableUnit Settings Change current settings back to last saved clinical unit settings.(none)Patient-Configurable Settings in Telemetry SetupControl Function Setting Choices Factory DefaultUnit Settings - Telemetry SetupControl Function Settings Factory DefaultPatient Type Set patient type used for SpO2 and NBP alarm limits.AdultPediatricAdult
Telemetry Functions at the Information Center Telemetry Functions at the Information Center & TeleMon 9-9Telemetry ButtonDetermine the Information Center response when Telemetry Button is pressed.Nurse Call - generate nurse call alarmRecord - generate a recording stripBoth - generate nurse call alarm and recording stripNoneNurse CallTelemetry Device: VolumeSet the volume level for all adjustable sounds on the transceiver.1 (low) to 5 (high) 3Telemetry Device: MuteEnable/disable all adjustable sounds on the transceiver.enable (unchecked) = sounddisable (checked) = mutemuteStandby DurationSets the standby duration on the device.Infinite10 minutes20 minutes30 minutes1 hour2 hours3 hours4 hoursInfiniteEnable Remote SuspendEnable/disable alarm pause/suspend at the transceiver.enabledisabledisableUnit Settings - Telemetry SetupControl Function Settings Factory Default
Telemetry Functions at the Information Center9-10 Telemetry Functions at the Information Center & TeleMon Suspend DurationSets the alarm suspend duration time for each assigned device on the Information Center.1, 2, or 3 minutes 2 minutesBattery Gauge on Information CenterDisplay/disable a battery gauge for each assigned device on the Information Center.Note—Set to disable if rechargeable batteries are being used.enabledisableenable (battery gauge is displayed)RF Auto ShutoffEnable/disable RF operation during an extended situation of all leads off for more than 10 minutes and the SpO2 sensor is not connected.enabledisableenable Fixed Pacer AmplitudeSets the appearance of the pacer spikes to a fixed size as they appear in the patient window. enabledisabledisableEnable AutopairEnable/disable the autopairing of the transceiver and MP5 Patient Monitor at the Information Center.enabledisableenableSpO2 EnabledEnable/disable the SpO2 measurement at the Information Center or Telemon.enabledisableenableUnit Settings - Telemetry SetupControl Function Settings Factory Default
Telemetry Functions at the Information Center Telemetry Functions at the Information Center & TeleMon 9-11SpO2 Mode Determine the transceiver SpO2 behavior.Note—Pulse Rate and Pleth Wave are not available in Spot Check.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.Continuous - Sends an SpO2 parameter value to the Information Center every second. If selected, Pulse Rate and Pleth Wave may also be sent.Spot CheckUnit Settings - Telemetry SetupControl Function Settings Factory Default
Telemetry Functions at the Information Center9-12 Telemetry Functions at the Information Center & TeleMon Suppress SpO2 Inops with NBPEnable/disable the SpO2 algorithm to detect NBP running and suppress sending technical alarms from the transceiver for 60 seconds.WarningWarningIf you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile 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.enabledisableenablePleth Wave Enable/disable the transmission of the Pleth wave and its subsequent display to the Information Center. For Continuous mode only.enabledisableNote—When enabled, during 6-lead monitoring, the Pleth wave will replace the Vb wave in the Patient Window.disable (Pleth wave is not displayed.)Pulse Enable/disable the transmission of the Pulse rate and its subsequent display to the Information Center. For Continuous mode only. enabledisabledisable (Pulse rate is not displayed.)Unit Settings - Telemetry SetupControl Function Settings Factory Default
Telemetry Functions at the Information Center Telemetry Functions at the Information Center & TeleMon 9-13SpO2 Alarm Turn SpO2 alarms on/off at the Information Center.enable (on)disable (off)enableSpO2 Limits HighIncrement/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 LowIncrement/decrement SpO2 low alarm limit by 1 (in %). Limit maximum is 99. Limit minimum is 50 (adult) or 30 (pediatric). High and low limit must be at least 1% apart.90 (adult, pediatric)3-wire Set the unit default lead. I, II, III II5-wire, ECG1 Set the unit default lead. I, II, III, MCL, AVR, AVL, AVF, VII5-wire, ECG2 Set the unit default lead. I, II, III, MCL, AVR, AVL, AVF, VV5-wire, ECG3 Set the unit default lead. I, II, III, MCL, AVR, AVL, AVF, VIII5-wire EASI, ECG1Set the unit default lead. I, II, III, AVR, AVL, AVF, V1, V2, V3, V4, V5, V6II5-wire EASI, ECG2Set the unit default lead. I, II, III, AVR, AVL, AVF, V1, V2, V3, V4, V5, V6V2Unit Settings - Telemetry SetupControl Function Settings Factory Default
Telemetry Functions at the Information Center9-14 Telemetry Functions at the Information Center & TeleMon 5-wire EASI, ECG3Set the unit default lead. I, II, III, AVR, AVL, AVF, V1, V2, V3, V4, V5, V6III5-wire EASI, ECG4Set the unit default lead. I, II, III, AVR, AVL, AVF, V1, V2, V3, V4, V5, V6V56-wire, ECG1 Set the unit default lead. I, II, III, MCL, AVR, AVL, AVF, V1, V2, V3, V4, V5, V6, V7, V8, V9, V3R, V4R, V5RII6-wire, ECG2 Set the unit default lead. I, II, III, MCL, AVR, AVL, AVF, V1, V2, V3, V4, V5, V6, V7, V8, V9, V3R, V4R, V5RV2; V lead choice is determined by Va and Vb settings6-wire, ECG3 Set the unit default lead. I, II, III, MCL, AVR, AVL, AVF, V1, V2, V3, V4, V5, V6, V7, V8, V9, V3R, V4R, V5RIII6-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, V5RV5; V lead choice is determined by Va and Vb settingsUnit Settings - Telemetry SetupControl Function Settings Factory Default
Telemetry Functions at the Information Center Telemetry Functions at the Information Center & TeleMon 9-15RF Auto ShutoffWhen 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. The technical alarm, "No Signal", followed by the "Transmitter Off" INOP will be displayed at the Information Center. Remove the batteries to conserve battery charge. However, if there is no ECG signal for 10 minutes but the SpO2 cable is inserted, the transceiver does not stop broadcasting the signal. This feature can be disabled in Unit Settings.Unit Settings - AlarmsControl Function Settings Factory DefaultNon-arrhythmia Yellow AlarmsSet latched/non-latched status for SpO2, ST, and other non-arrhythmia yellow alarms.LatchedNon-latchedLatchedLeads Off Adjust the severity level of this technical alarm (INOP).LowMediumHighLowReplace BatteryAdjust the severity level of this technical alarm (INOP).LowMediumHighLow
Transceiver Operation when Connected to TeleMon9-16 Telemetry Functions at the Information Center & TeleMon Transceiver Operation when Connected to TeleMonWhen 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. The alarm suspend indicator on the transceiver will accurately reflect the current state of alarm pause.ECG Operation• Vb, the second V-lead in 6-wire lead-set, is not supported.• After a change in leadset, the TeleMon returns to the default ECG settings, and arrhythmia relearn occurs automatically. Be sure to check the monitoring leads after you switch leadsets.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:• If the sensor is disconnected from the transceiver during SpO2 monitoring at TeleMon, a No Sensor technical alarm will be displayed at the Information Center. NO VISUAL OR AUDITORY INDICATORS FOR THE NO SENSOR ALARM WILL BE ACTIVE AT TELEMON.Mode Selected at TeleMon Mode at Disconnected TransceiverContinuous Continuous5-min. Continuous1-min. ContinuousManual Spot Check
Transceiver Operation when Connected to TeleMon Telemetry Functions at the Information Center & TeleMon 9-17Battery• The transceiver battery status is not available. When the Check button is pressed, the battery gauge on the transceiver and at the Information Center indicates full power, regardless of actual battery strength. Defibrillation• In the event of patient defibrillation, it may take several seconds for the ECG trace to reappear on the screen.Telemetry Overview• If NBP is being monitored, NBP values will be displayed at the Overview window.
Transceiver Operation when Connected to TeleMon9-18 Telemetry Functions at the Information Center & TeleMon
Pairing with IntelliVue Patient Monitors 10-1Introduction10 Pairing with IntelliVue PatientMonitorsYou 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. There are two ways to transmit measurement data to the monitor: either by directly connecting the transceiver to the monitor using an interface cable (IntelliVue MP5 Patient Monitor only), or by pairing the transceiver with the monitor at the Information Center. This chapter describes how to pair the devices using a direct connection and how the devices operate in paired mode. It includes the sections listed below. For additional information on monitor operation, consult the MP5 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.• Pairing with a Direct Connection to the MP5 Patient Monitor. . . . . . 10-2• Pairing at the Information Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3• Alarm Behavior with Telemetry Overview . . . . . . . . . . . . . . . . . . . . 10-3• Paired Device Synchronized Alarm Settings . . . . . . . . . . . . . . . . . . . 10-7Note—Pairing of transceivers and IntelliVue Patient Monitors is not available with IntelliVue Patient Monitors connected to the M3140 Information Center or with IntelliVue Patient Monitors operating via a 1.4/2.4 GHz wireless connection.
Pairing with a Direct Connection to the MP5 Patient Monitor10-2 Pairing with IntelliVue Patient Monitors Pairing with a Direct Connection to the MP5 Patient MonitorWhen 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 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.To connect the transceiver to the monitor, perform the following steps:WarningWarningWhen the transceiver is directly connected to the monitor, arrhythmia relearning is initiated, and again when the transceiver is disconnected from the monitor. Controls on the Transceiver, (e.g. Telemetry button to generate a Nurse Call alarm) will be inactive when directly connected to the monitor. 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.Step Action1 Remove the protective cover from the transceiver’s service port.2 Insert the interface cable into the service port.3 Attach the interface cable to the monitor using the port labeled with the icon.
Pairing at the Information Center Pairing with IntelliVue Patient Monitors 10-3Pairing at the Information CenterYou can pair an IntelliVue Patient Monitor (Release B.1 or higher) 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.See your IntelliVue Information Center Instructions for Use or IntelliVue Patient Monitor Instructions for Use for information on how to pair/unpair devices. Alarm Behavior with Telemetry OverviewBoth the IntelliVue Telemetry System and the IntelliVue Patient Monitor source alarms. The following tables summarize alarm behavior when a telemetry device is paired with an IntelliVue bedside monitor (wirelessly or directly connected to the MP5 using the Telemon/Service Port). For detailed information, see the IntelliVue Patient Monitor Instructions for Use and the IntelliVue Information Center Instructions for Use.
Alarm Behavior with Telemetry Overview10-4 Pairing with IntelliVue Patient Monitors AlarmSuspend/PauseWhen alarms are suspended/paused, the messages and types of alarms affected depend on where the suspend/pause was initiated.Alarm Silence When an active alarm is silenced, the types of alarms that are silenced depend on the alarm source and where the silence was initiated.If alarms aresuspended/ paused from....these alarms are suspended/pausedand this message appearsInformation Centerboth bedside and telemetry measurementsInformation Center: ALARMS SUSPENDED or ALARMS PAUSEDBedside: ALARMS OFF in Overview window and ALARMS OFF or ALARMS PAUSED on the monitor (depending on configuration)IntelliVue Patient Monitorbedside measurements onlyInformation Center: BED ALARMS SUSPENDED or BED ALARMS PAUSED (depending on configuration)Bedside: ALARMS OFF or ALARMS PAUSED
Alarm Behavior with Telemetry Overview Pairing with IntelliVue Patient Monitors 10-5WarningWarningIf the remote Silence key in the Overview window is enabled for IntelliVue monitors connected to the Information Center, remote silencing for these beds may be enabled in other clinical units.Alarm SourceWhere SilencedEffect at Paired BedsideEffect at Information CenterBedside alarm Bedside Silence buttonAlarm is silencedBedside alarm is silenced. There is no effect on telemetry alarms (if Global Silence is not enabled at the Information Center)Telemetry alarmBedside No effect on telemetry alarmsNo effect on telemetry alarmsBedside and/or telemetry alarmTelemetry Data Window at bedside (if configured)Bedside and/or telemetry alarm is silencedBedside and/or telemetry alarm is silenced (if Silence Overview Alarms is enabled at the Information Center)
Alarm Behavior with Telemetry Overview10-6 Pairing with IntelliVue Patient Monitors Note—If the transceiver is connected to TeleMon, silencing an active alarm at TeleMon silences the alarm at TeleMon only. It has no effect on the alarms at the Information Center.Alarm/INOPsat theInformationCenterThe alarms and INOPs that are displayed, recorded, and stored at the Information Center depend on the type of alarm.Bedside and/or telemetry alarmInformation CenterBedside and/or telemetry alarm is silencedBedside and/or telemetry alarm is silencedBedside and/or telemetry alarmBedside Silence buttonBedside and/or telemetry alarm is silencedBedside and/or telemetry alarm is silenced (if Global Silence is enabled at the Information Center)Alarm SourceWhere SilencedEffect at Paired BedsideEffect at Information CenterType of Alarm/INOP Effect at Information CenterAll ECG alarms and INOPs based on ECG sourceDisplayed, recorded (if configured), and stored Bedside non-ECG alarms and non-ECG INOPsDisplayed, recorded (if configured), and stored
Paired Device Synchronized Alarm Settings Pairing with IntelliVue Patient Monitors 10-7Paired Device Synchronized Alarm SettingsIf 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. In general, the following settings will be synchronized: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 devices at the Information Center or the monitor.Heart Rate HR/Pulse Alarm On/Off, Heart Rate High/Low LimitECG Primary Lead, Secondary Lead, Va Lead, Vb Lead Arrhythmia Analysis Mode, Asystole Threshold, Pause Threshold, VTach HR, VTach Run, PVCs/min, Vent. Rhythm, SVT HR, SVT Run, PVCs/min On/Off, Pacer not Capture On/Off, Pacer not Pace On/Off, Non-sustain On/Off, Vent. Rhythm On/Off, Run PVCs On/Off, Pair PVCs On/Off, Missed Beat On/Off, Pause On/Off, R-on-T On/Off, Vent. Bigeminy On/Off, Vent. Trigeminy On/Off, Multiform PVCs On/Off, Irregular HR On/Off, SVT On/Off ST ST Analysis On/Off, ST Alarm On/Off, ISO point, J point, ST point, ST Priority List, Single ST Alarm Limit, Multi ST Alarm Limit SpO2TSpO2 Alarms On/Off, SpO2 Alarm LimitsNBP Alarm Suppression On/Off, Pulse (SpO2) On/Off
Paired Device Synchronized Alarm Settings10-8 Pairing with IntelliVue Patient Monitors
Maintenance, Cleaning & Troubleshooting 11-1Introduction11 Maintenance, Cleaning &TroubleshootingAll 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-2• Cleaning and Sterilization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4• Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-12
Maintenance11-2 Maintenance, Cleaning & Troubleshooting MaintenanceBasic MonitoringBefore 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. Contact the service provider.WarningWarningFailure on the part of the responsible individual hospital or institution employing the use of this equipment to implement satisfactory maintenance as needed may cause undue equipment failure and possible health hazards.Testing AlarmsVisual and auditory alarms appear at the Information Center. One method of verifying visual and auditory alarms at the Information Center is to connect the transceiver to an ECG or ECG/SpO2 simulator. By varying the ECG rate and SpO2 value, alarms can be generated and confirmed for proper operation.Label Assignment for Replacement TransceiverDuring installation, an electronic equipment label is assigned to each transceiver in a clinical unit so that the device can be identified during operation within the wireless system. If a transceiver is lost, the Assign Label function at the Information Center enables you to unassign the label from a lost transceiver, and re-assign its label to a replacement transceiver. Labels are limited to those available in an individual clinical unit. The Label Assignment function requires a password for access, and its controls are available in English only.
Maintenance Maintenance, Cleaning & Troubleshooting 11-3Re-assigningan EquipmentLabelThe 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 Action1 At the Information Center, clear the sector that the original Equipment Label was assigned to. (Patient Window -> Sector Setup -> Clear Sector -> OK).Note— Ensure that no patient is being monitored by the original (lost) device before clearing the sector.2 Select All Controls, then Label Assignment.3 Enter password. Note—The remaining screens will be in English only.4Insert batteries into the replacement device, and remove the leadset, if present. All transceiver indicators should flash, and you should hear a double tone repeated every 3 seconds, indicating that the transceiver has no Equipment Label.5 Select Refresh.6 Select the MAC address of the replacement device from the “New Devices” list.Note—The transceiver MAC address is located inside the battery compartment.7 Select the Equipment Label that was assigned to the unit’s previous device from “Equipment Labels” list.
Cleaning and Sterilization11-4 Maintenance, Cleaning & Troubleshooting Cleaning and SterilizationThe procedures in this section keep the transceiver clean and provide protection against infectious agents and bloodborne pathogens. Both the outside of the transceiver and the inside of the battery compartment must be kept free of dirt, dust, and debris. The procedures in this section cover the following activities:•Cleaning: removing surface contaminants from the device.•EO Sterilization: using EO gas treatment to decontaminate cleaned equipment.Important—After exposure, the transceiver must be cleaned or cleaned and EO sterilized as per the instructions contained herein.8 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. The transceiver goes through the normal startup sequence and starts monitoring. Verify the signal in the appropriate Patient Sector.Step Action
Cleaning and Sterilization Maintenance, Cleaning & Troubleshooting 11-5Cleaning the TransceiverCautionUse 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. The use of Sterrad® and Virex® is not supported. CautionWhen cleaning the TeleMon/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. A forceful water stream may be used after soaking for 5 minutes to flush the port if necessary.Perform the following steps to clean the transceiver of visible surface contamination.Step Action1 Remove the batteries and any cables or accessories.2 Soak the transceiver in 70% isopropyl alcohol or 10% sodium hypochlorite (prepared within 24 hours) for 5 minutes.3 Wipe the transceiver clean by using a cloth dampened modestly with one of the following approved cleaning agents:• 70% isopropyl alcohol• 10% sodium hypochlorite (prepared within 24 hours)4 If any visible residue remains in the TeleMon/Service Port, flush the port with a forceful stream of water.5 Rinse or wipe the transceiver with distilled water.6 Allow to air-dry, or dry with a non-lint producing cloth.
Cleaning and Sterilization11-6 Maintenance, Cleaning & Troubleshooting EO Sterilization The transceiver can be subjected to EO sterilization four times per year for 2 years.Equipment must first be cleaned (see “Cleaning the Transceiver” on page 11-5) before this procedure is performed.Note—If there is concern over cross-contamination due to leadsets or sensors, new leadsets or sensors should be used.Equipment andMaterialsWarningWarningEO 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.Vent sterilizer gas outdoors or to a suitable, evacuated container for reprocessing, depending upon state, provincial, or country environmental regulations. Do not vent sterilant indoors.Vent aerator exhaust only to the outdoors.* See “References” on page 11-9.
Cleaning and Sterilization Maintenance, Cleaning & Troubleshooting 11-7Use the following equipment and material to process the transceiver:1. Ethylene Oxide gas (Allied Signal Oxyfume-2002™ or equivalent).2. Gas sterilizer manufactured by American Sterilizer Company or other appropriate manufacturer.EOSterilizationThe following generic procedure can be used to supplement the sterilizer manufacturer’s instructions, although the processing times, temperatures, and EO concentrations must be equivalent to those given in this procedure in order to achieve a sterility level of 10E-6. Step Action1Remove any obvious contamination from the equipment to be processed using approved cleaners.2Individually package each transceiver in standard central supply room (CSR) wrapping material secured with EO color-change indi-cator tape.3Apply -26 inHg +/- 1 (-12.77 psig +/- .49) vacuum to the empty sterilizer chamber two times, to remove any residual EO or mois-ture. Vent the vacuum pump to the outdoors to avoid toxic hazards to personnel.4Insert the equipment to be processed into the gas sterilizer.5Heat the chamber and its contents to 54.4 +/- 2.8oC (130 +/- 5oF).6Apply -26 inHg +/- 1 (-12.77 psig +/- .49) vacuum to the sterilizer chamber.7Humidify the chamber at 50% +/- 10% relative humidity for 20 to 30 minutes.8Taking a minimum of five minutes, slowly introduce EO sterilant until the sterilizer unit pressure gauge reaches 11 +/- 1 psig.Note—At this pressure, the concentration of sterilant in the chamber will be 600 +/- 50 mg/liter, regardless of the chamber size.
Cleaning and Sterilization11-8 Maintenance, Cleaning & Troubleshooting 9Process the equipment to be processed as follows:Pressure: 11 +/- 1 psig (established in the preceding step).Time: 2-3 hoursTemperature: 54.4 +/- 2.8oC (130 +/- 5oF)10 Extract the gas mixture from the sterilizer as follows:WarningWarningComply 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 environ-mental regulations. (If the mixture is captured, it can be sepa-rated commercially and the component gases re-used.)* See “References” on page 11-9.a. Pump the gas mixture out of the chamber until you ob-tain a vacuum of -26 inHg +/- 1 (-12.77 psig +/-.49), re-turning the mixture to a suitable evacuated container.b. Return the sterilizer chamber to ambient pressure by in-troducing air that has been bacterially filtered.11 Air-wash the chamber and material as follows:a. Apply -26 inHg +/- 1 (-12.77 psig +/- .49) vacuum to the chamber and processed material again, to remove residu-al EO. The vacuum pump must be vented to the out-doors.b. Return the sterilized chamber to ambient pressure by in-troducing air that has been bacterially filtered.12 Continue with the “Aeration Procedure” (following).Step Action
Cleaning and Sterilization Maintenance, Cleaning & Troubleshooting 11-9AerationProcedureWarningWarningTo 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 11-9. Aerate the processed equipment by performing the following steps:1 These values will produce EO and Ethylene Chlorohydrin residual levels in the transceiver and patient cable plastic that meet ISO 10993-7 in conjunction with AAMI Technical Information Report 19, that the FDA currently endorses. References OSHA: Standard for acceptable levels of personnel exposure to Ethylene Oxide Gas: 1 ppm on an eight-hour time-weighted average basis.Reference: U.S.A. Federal Regulations 49 FR 25734/29 CFR Part 1910.1047, June 22, 1984; final approval 50 FR 9800/2- CFR Part 1910.1047, March 12, 1985.Step Action1To dissipate residual EO, aerate the processed equipment with air that has been bacterially filtered, using a mechanical aerator or combination sterilizer/aerator as follows:1Time: 8-9 hoursTemperature: 54.4 +/- 2.8oC (130 +/- 5oF)Ventilation Frequency: At least 30 air exchanges per hour.2 Continue with the “Test Procedure” (following).
Cleaning and Sterilization11-10 Maintenance, Cleaning & Troubleshooting Test ProcedureCautionYou 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.Note—This test assumes that the telemetry system and Information Center are fully installed, and that you have performed the procedure to learn the transceiver identity code. Test the transceiver by performing the following steps. If the test indications do not appear, refer to your service provider.Step Action1Perform a mechanical inspection of the transceiver (connectors, battery door opening and closing, Telemetry and Check buttons). 2At the Information Center, select the telemetry bedside you are testing.
Cleaning and Sterilization Maintenance, Cleaning & Troubleshooting 11-11Alternate Cleaning and Disinfection MethodsThe transceiver may be cleaned and disinfected using Metrex Cavi-Wipes, Cavi-Wipes XL, CaviCide, or PDI Sani-Cloth® HB pre-moistened towelettes. Follow the instructions supplied by the manufacturers of these products.3Test the transceiver:a. Put fresh batteries in the transceiver (without a leadset attached) and close the battery doorResult: 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 avail-able, attach the ECG leads to the simulator and the SpO2 sensor to yourself. At TeleMon, set the SpO2 sample rate to Continuous.Result: An ECG trace and SpO2 information should be visible on the Information Center display. All transceiv-er lights should be off.c. Disconnect the Right Arm lead for standard ECG or the “I” electrode for EASI. Result: The RA LED or the “I” lead LED should turn on, and a Leads Off INOP should appear on the display at the Information Center.d. Reconnect the electrode.4a. Connect the transceiver to TeleMon and observe the ECG waveform and SpO2 numerics on the TeleMon dis-play. Result: The ECG waveform and SpO2 numerics should be displayed on the TeleMon screen.Step Action
Troubleshooting11-12 Maintenance, Cleaning & Troubleshooting TroubleshootingBasic TroubleshootingImportant—If changes are made to the Group Settings (how telemetry devices, such as Access Points and Controllers, are grouped in order to provide coverage for patients throughout the hospital), there will be a break in monitoring of all transceivers within the Group(s) being modified. Monitoring will resume when the new Group Settings are in place. Clinical settings will be unaffected by the reconfiguration.Information SignalsIf there is a connection failure within the IntelliVue Clinical Network, an information signal will be generated. This information signal will be displayed For problems with... see... • ECG measurement “Optimizing ECG Measurement Performance” on page 6-29.“Using EASI Leads to Troubleshoot” on page 6-28.“Technical Alarms (INOPs)” on page 5-9.•SpO2 measurement “Optimizing SpO2 Measurement Performance” on page 8-20.“Technical Alarms (INOPs)” on page 5-9.• 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. See “Telemetry Button” on page 9-5 for directions on how to turn it on.• Electromagnetic Interference“Reducing Electromagnetic Interference” on page 12-7.
Troubleshooting Maintenance, Cleaning & Troubleshooting 11-13in 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. The condition causing the failure will be described in the Wireless Status Log, which is available in Service Mode.Information SignalsInformation Signal Description What to DoWireless monitoring loss - Contact ServiceNote—This information signal appears on ALL Information Centers connected to a common Database Server.Problem with wireless network infrastructure device(s).Contact Service. Note—Details about the communication disruption are available in the Wireless Status Log.Router failureCall ServiceNote—This information signal appears on ALL Information Centers connected to a common Database Server.A router used in the wireless network has failed.Contact Service.
Troubleshooting11-14 Maintenance, Cleaning & Troubleshooting
Safety Standards & Specifications 12-1Introduction12Safety Standards & SpecificationsThis 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-9• Physical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-12• Environmental Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-14• Measurement Specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-15
Regulatory Information12-2 Safety Standards & Specifications Regulatory InformationIntended 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 UseIndicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of patients. Intended for monitoring, recording and alarming of multiple physiological parameters of adult and pediatric patients in transport and hospital environments.Rx Federal Law restricts this device to sale by or on the order of a physician.Patient PopulationThis device is not for use with infant or neonatal patients.Use of the transceiver is restricted to one patient at a time.The components/accessories which come into contact with the patient’s skin are in compliance with the relevant requirements of EN ISO 10993-1 for Biocompatibility. The transceiver is not designed for direct contact with the patient’s skin. The accompanying pouch is the appropriate means for holding the transceiver.
Regulatory Information Safety Standards & Specifications 12-3Safety StandardsThe 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. deviations)• IEC 60601-1-1:2000 System Safety• IEC 60601-1-2:2001 Electromagnetic Compliance• IEC 60601-1-4:1996 Safety for Programmable Electrical Medical Systems• ISO 10993-1:2003 Biocompatibility (for lead wires and pouch)• ISO 9919:2005 Pulse Oximeters• EN 865:1997 Particular Requirements for Pulse Oximeters• AAMI EC 13:2002 Performance Standard, Cardiac MonitorsEssential PerformanceThe IntelliVue Telemetry System provides Essential Performance (EP) under normal operating conditions (includes EMC exposure) only as a complete Medical Electrical System, consisting of the TRx4841A or TRx4851A Transceivers, the IntelliVue Telemetry Network Infrastructure, the M3150 Information Center, the M2636C TeleMon Companion Monitor (optional), and the M8105A IntelliVue MP5 Patient Monitor (optional). The IntelliVue Telemetry System achieves its Essential Performance exclusively through alarm generation at the M3150 Information Center.The IntelliVue Telemetry System protects the patient from unacceptable immediate clinical risk by generating specific Physiological Alarms when appropriate. If the System cannot generate Physiological Alarms, then relevant Severe or Hard Technical Alarms (Inoperative Conditions) are created.
Regulatory Information12-4 Safety Standards & Specifications System ClassificationThe TRx4841A and TRx4851A Transceivers are FDA Class II devices. They have the following characteristics.FCC Compliance (USA only)Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service.The transceiver and the IntelliVue Telemetry System are subject to radio frequency interference. In the event of suspected radio frequency interference with your device, contact your service provider. This device complies with Parts 15 and 95H of the Federal Communications Commission (FCC) Rules. Operation is subject to the condition that this device does not cause harmful interference.Pursuant to Part 15.21 of the FCC Rules, any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference, and void your authority to operate this equipment.Characteristic DefinitionInternally Powered EquipmentThe TRx4841Aand TRx4851A transceivers are internally powered devices.Continuous Operation All equipment is Ordinary Equipment, IPX0, and provides continuous operationType CF Defibrillation ProofThe TRx4841A and TRx4851A transceivers are Type CF Defibrillation Proof relative to ECG and SpO2 patient applied parts.Water Resistance IPX0, Non-ProtectedWhen placed inside a Philips-specified carrying pouch with the flap closed and snaps secured, the combination of the transceiver and pouch will withstand showering for up to 10 minutes.
Electromagnetic Compatibility Safety Standards & Specifications 12-5AC Power SourceThe system is not intended for connection to the public mains as defined in CISPR11.Software Hazard PreventionPotential hazards arising from errors in the software program have been identified. Mitigations applied to reduce the associated risk of such hazards are included as part of the Risk Management, Clinical Evaluation, and Verification and Validation phases of the product’s development.Electromagnetic CompatibilityMedical electrical equipment can either generate or receive electromagnetic interference. This product has been evaluated for electromagnetic compatibility (EMC) with the appropriate accessories according to IEC 60601-1-2:2001, the international standard for EMC for medical electrical equipment. This IEC standard has been adopted in the European Union as the European Norm, EN 60601-1-2:2001. Radio frequency (RF) interference from nearby transmitting devices can degrade performance of the product. Electromagnetic compatibility with surrounding devices should be assessed prior to using the product.Fixed, portable, and mobile radio frequency communications equipment can also affect the performance of medical equipment. See your service provider for assistance with the minimum recommended separation distance between RF communications equipment and the product.The cables, sensors/transducers, and other accessories for which compliance is claimed are listed in the Service and User documentation accompanying the product.
Electromagnetic Compatibility12-6 Safety Standards & Specifications WarningWarningThe 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.WarningWarningThe product should not be used next to or stacked with other equipment. If you must stack the product, you must check that normal operation is possible in the necessary configuration before the product is used on patients.
Electromagnetic Compatibility Safety Standards & Specifications 12-7Reducing Electromagnetic InterferenceThe 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. If interference is encountered, as demonstrated by artifact on the ECG or dramatic variations in physiological parameter measurement values, attempt to locate the source. Assess the following:• Is the interference due to misplaced or poorly applied electrodes or sensors? If so, re-apply electrodes and sensors correctly according to directions in Chapter 6. ECG Monitoring. • Is the interference intermittent or constant?• Does the interference occur only in certain locations?• Does the interference occur only when in close proximity to certain medical electrical equipment?Once the source is located, attempt to attenuate the interference by distancing the transceiver from the source as much as possible. If assistance is needed, contact your local service representative.Restrictions for UseArtifact on ECG and other physiological waveforms caused by electromagnetic interference should be evaluated by a physician or physician authorized personnel to determine if it will negatively impact patient diagnosis or treatment.
Battery Specifications12-8 Safety Standards & Specifications Battery SpecificationsBattery TypeBattery Life Note—The battery life specifications listed below are based on Duracell MN 1500 batteries. Battery life for other brands may differ.TransceiverCurrent Equipment SpecificationBattery Type 2 fresh AA disposable alkaline batteriesOperating Mode Battery LifeECG Only 50 hours ECG/SpO2 Continuous 18 hoursECG/SpO2 Spot Check between 18 hours and 50 hours, depending on usage rateOperating Mode Nominal CurrentECG Only 51.3 mA @ 2.4V ECG/SpO2 Continuous 116 mA @ 2.4V
Radio Specifications Safety Standards & Specifications 12-9Radio SpecificationsTRx4841A Parameter SpecificationFrequency Ranges Bands: 1395-1400 MHz and 1427-1432 MHzChannel Spacing: 1.6 MHzRF Output Power 8 dBm +2/-3 dB (3.2 mW to 10 mW), into antenna load @ nominal battery voltageTransceiver Frequency Accuracy during normal operation+/- 15 KHz relative to channel frequency, includes temperature compensation and aging effectsModulation Type FSK with Root Raised Cosine filtering (1M60Q7D)Out of Band Spurious Emission Levels:• <= 1394 MHz, >= 1401 MHz• <= 1428 MHz, >= 1433 MHz<-41 dBm in 1 MHz bandwidth for FCC limitOccupied bandwidth as defined by power in 99% BW< +/- 800 KHz
Radio Specifications12-10 Safety Standards & Specifications TRx4851AParameter SpecificationFrequency Range ISM Band: 2400 - 2483.5 MHzChannel Spacing: 1.728 MHzRF Output Power FCC: 17 dBm +/- 1 dB (40 mW to 63 mW, nominal 50 mW), into antenna load @ nominal battery voltageETSI: 12 dBm +/- 1 dB (13 mW to 20 mW, nominal 16 mW), into antenna load @ nominal battery voltageARIB: 13.5 dBm +/- 1 dB (18 mW to 28 mW, nominal 22 mW), into antenna load @ nominal battery voltageTransceiver Frequency Accuracy during normal operation<+ 60 /- 100 KHz relative to channel frequency, includes temperature compensation and aging effectsModulation Type GFSK, Gaussian Frequency Shift keying (1M40Q7D)Modulation Bandwidth Typically 1.4 MHz (20 dB Bandwidth)Out of Band Spurious Emission LevelsMeets ETSI, RS210, FCC, ARIB standards
Radio Specifications Safety Standards & Specifications 12-11WMTS Channel Frequencies 1395 to 1400MHz BandParameter SpecificationLower band edge 1395 MHzChannel 1 1395.8977 MHz Channel 2 1397.4970 MHzChannel 3 1399.0963 MHzUpper band edge 1400 MHzChannel spacing 1.6 MHz
Physical Specifications12-12 Safety Standards & Specifications 1427 to 1432MHz BandPhysical SpecificationsECG-only TransceiverParameter SpecificationLower band edge 1427 MHzChannel 4 1427.8979 MHzChannel 4a (*) 1430.2410 MHzChannel 5 (**) 1429.4972 MHzChannel 6 (**) 1431.0965 MHzUpper band edge 1432 MHz* Available in special geographic area only.** Not available in special geographic areas. Parameter SpecificationHeight 140 mm (5.6 in)Width 75 mm (3 in)Depth 28.5 mm (1.14 in)
Physical Specifications Safety Standards & Specifications 12-13ECG/SpO2 Transceiver Weight• without batteries or leadset• with batteries only• with batteries and 3-wire leadset• <165 g (5.8 oz.)• <210 g (7.4 oz)• <284 g (10 oz.)Volume 215 cm3Parameter SpecificationParameter SpecificationHeight 140 mm (5.6 in)Width 88 mm (3.52 in)Depth 37 mm (1.48 in)Weight• without batteries or leadset• with batteries only• with batteries and 5-wire leadset• <205 g (7.2 oz.)• <255 g (9.0 oz)• <324 g (11.5 oz.)Volume 300 cm3
Environmental Specifications12-14 Safety Standards & Specifications Environmental SpecificationsParameter SpecificationTemperature• Operating•Storage• 0 t 37 oC (32 to 99o F)•-40o C to 60o C (-40 to 140o F) without batteriesHumidity• Operating•Storage•< 95% RH at 37o C (99o F) non-condensing•< 90% RH at 60o C (140o F) without batteriesAltitude• Operating & Non-operating0 to 3,048 m (10,000 ft)
Measurement Specifications Safety Standards & Specifications 12-15 Measurement SpecificationsECGParameter SpecificationECG channel transmitted Leads• 3 electrodes• 5 electrodes• 5 electrodes, EASI• 6 electrodes• Channel #1 = I, II, or III• Channel #1 = IIChannel #2 = IIIChannel #3 = MCL• Channel #1 = Va-iChannel #2 = Va-sChannel #3 = Ve-s• Channel #1= IIChannel #2 = IIIChannel #3 = VaChannel #4 = VbResolution 5 μVECG Input Differential, defibrillator protected against 360 joules discharge into a 100 ohm loadInput Impedance > 5 megohms (@ 10 HzInput Dynamic Range +/- 9 mVDC Offset Range +/- 320 mVCMRR > 90 dB @ 50, 60 HzBandwidth +/- 3 dB 0.05 to 40 Hz
Measurement Specifications12-16 Safety Standards & Specifications Gain Accuracy +/- 5% at 25 oC (77 oF)Noise Referred to ECG InputAAMI: 30 μVLead Wires 3, 5 or 6-wire leadset. 5-lead compatible with IntelliVue Patient Monitor, AAMI/IEC color codesTime to baseline from DefibrillatorAAMI: 5 s max (until ECG wave is on display but not yet centered, monitoring bandwidth)Pacer Rejection Performance (Pace pulses with no tails). Positive pacers1Amplitude Width+2 to +700 mV 0.1, 0.2, 0.5 and 1.0 ms+2 to +500 mV 1.5 ms+2 to +400 mV 2 msNegative pacers1Amplitude Width-2 to -700 mV 0.1, 0.2, 0.5 and 1.0 ms-2 to -500 mV 1.5 ms-2 to -400 mV 2 ms1 Philips does not claim, verify, or validate support for all available pacemakers.EMC Performance Limits, radiated immunityMeets Essential Performance, but may observe some waveform disturbance over 181 to 202 MHz @ >1.8 V/m and 203 to 213 MHz @ > 1.0 V/mParameter Specification
Measurement Specifications Safety Standards & Specifications 12-17SpO2 Parameter SpecificationSpO2 Measurement Range (Calibration and Display)0 to 100%SpO2 Accuracy See table following.SpO2 Resolution 1%SpO2 Numerics - Averaging10 secondsNote—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. The effect of SpO2 pulse oximetry on data averaging is internally controllable by the transmitter, with no user controls.SpO2 & Pulse Numerics - Update RateTransmitted once per second.Pleth Wave- Sampling Rate125 spsTechnical Alarms (INOPs)Triggered if the sensor is disconnected, if a pulse is not detected, if the signal is noisy, if light interference is detected, if the sensor is defective, if the measurement is erratic, or if the module is malfunctioning
Measurement Specifications12-18 Safety Standards & Specifications Wavelength Range 500 to 1000 nmNote—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 bpmAccuracy: +/- 2%Resolution: 1 bpmDisplay of SpO2 numericsSpO2 values are displayed as xxx % SpO2T to meet ISO/EN standard EN 865.Maximum Optical Output Power< 15 mWParameter Specification
Measurement Specifications Safety Standards & Specifications 12-19SpO2 Sensor Accuracy.Type DescriptionModel NumberAccuracy% Arms (70-100% Range)Philips Reusable SensorsAdult Finger M1191A 2.0Adult Finger M1191AL 2.0Adult Finger M1191ANL 2.0Adult Finger* M1191T 3.0Adult Finger M1196A 3.0Adult Finger M1196T 3.0Pediatric Finger M1192A 2.0Pediatric Finger* M1192T 3.0Pediatric Finger M1192AN 2.0Adult/Pediatric Ear M1194A 3.0Adult/Pediatric Ear M1194AN 3.0* Requires M1943A or M1943AL adapter cable.
Measurement Specifications12-20 Safety Standards & Specifications Type DescriptionModel NumberAccuracy% Arms (70-100% Range)Philips Disposable SensorsAdult Finger M1901B 3.0Pediatric Finger M1903B 3.0Adult Finger M1904B 3.0
Measurement Specifications Safety Standards & Specifications 12-21Nellcor Disposable Sensors (not available from Philips)OxiCliq A, Adult N/A 3.0OxiCliq N, Adult >40 kg (88 lb)N/A 3.0OxiCliq P, Pediatric N/A 3.0OxiMax MAX-A, Adult >30 kg (66 lb)N/A 3.0OxiMax MAX-AL, Adult >30 kg (>66 lb)N/A 3.0OxiMax MAX-N, Adult >40 kg (>88 lb)N/A 3.0OxiMax MAX-P, Pediatric 10-50 kg (22-110 lb)N/A 3.0Oxisensor II D-20, Pediatric 10-50 kg (22-110 lb)N/A 3.0Oxisensor II D-25, Adult >30 kg (>66 lb)N/A 3.0Oxisensor II N-25, Adult >40 kg (>88 lb)N/A 3.0Type DescriptionModel NumberAccuracy% Arms (70-100% Range)
Measurement Specifications12-22 Safety Standards & Specifications
Accessories A-1IntroductionAAccessoriesThis 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 SafetyA-2 Accessories Accessory SafetyWarningWarningUse 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 productWarningWarningReuse: Never reuse disposable sensors, accessories and so forth that are intended for single use, or single patient use only.Packaging: Do not use a sterilized accessory if the packaging is damaged.Transceiver AccessoriesPouchesOrder Number Description989803137821 Telemetry Pouch, box of 5989803137831 Telemetry Pouch, box of 50989803140371 Telemetry Pouch, case of 200
ECG Accessories Accessories A-3A Sales and SupportProtective CoversMonitor Interface CableECG AccessoriesElectrodesOrder Number Description 989803140431 Protective Cover for TeleMon/Service Port (ECG-only Transceiver), package of 10989803140451 Protective Cover for TeleMon/Service Port (ECG/SpO2Transceiver), package of 10989803140441 Protective Cover for SpO2 Port (ECG/SpO2 Transceiver), package of 10Order Number DescriptionM1688A Monitor Interface Cable for use with IntelliVue MP5 Patient MonitorOrder Number DescriptionM2202A 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)
ECG AccessoriesA-4 Accessories LeadsetsOrder Number Description989803133831 AAMI 3-wire Leadset, Snap, 79 cm (30 ”)989803133841 AAMI 3-wire Leadset, Grabber ,79 cm (30 ”)989803133871 AAMI 5-wire Leadset, Snap, 79 cm (30 ”)989803133881 AAMI 5-wire Leadset, Grabber, 79 cm (30 ”)989803137241 AAMI 5-wire Color Leadset, Snap, 79 cm (30 ”)989803137251 AAMI 5-wire Color Leadset, Grabber, 79 cm (30 ”)989803133911 AAMI 6-wire Leadset, Snap, 79 cm (30 ”)989803133921 AAMI 6-wire Leadset, Grabber, 79 cm (30 ”)989803137281 AAMI 6-wire Color Leadset, Snap, 79 cm (30 ”)989803137291 AAMI 6-wire Color Leadset, Grabber, 79 cm (30 ”)989803133851 IEC 3-wire Leadset, Snap, 79 cm (30”)989803133861 IEC 3-wire Leadset, Grabber, 79 cm (30”)989803133891 IEC 5-wire Leadset, Snap, 79 cm (30”)989803133901 IEC 5-wire Leadset, Grabber, 79 cm (30”)989803137261 IEC 5-wire Color Leadset, Snap, 79 cm (30”)989803137271 IEC 5-wire Color Leadset, Grabber, 79 cm (30”)989803133931 IEC 6-wire Leadset, Snap, 79 cm (30”)989803133941 IEC 6-wire Leadset, Grabber, 79 cm989803137301 IEC 6-wire Color Leadset, Snap, 79 cm989803137311 IEC 5-wire Color Leadset, Grabber, 79 cm
SpO2 Accessories Accessories A-5A Sales and SupportAlignment GuidesSkin Prep PaperSpO2 AccessoriesReusable SensorsOrder Number Description989803140401 Single ECG Alignment Guide, package of 10989803140411 Single ECG Alignment Guide, tethered, package of 10989803140421 Double ECG Alignment Guide, package of 10Order Number Description989803134771 Skin Preparation Sheets, 10 preps/sheet, package of 10 sheetsOrder Number DescriptionM1191A Philips Adult Finger Sensor, 2 m (6.6 feet)M1191AL Philips Adult Finger Sensor, 3 m (9.8 feet)M1191ANL 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)M1192AN Philips Pediatric Finger Sensor, 1.5 m (4.9 feet)
SpO2 AccessoriesA-6 Accessories M1192T Philips Pediatric Finger Sensor, 0.45 m (1.5 feet)M1194A Philips Adult & Pediatric Ear Sensor, 1.5 m (4.9 feet)M1194AN Philips Adult & Pediatric Ear Sensor, 1.5 m (4.9 feet)M1196A Philips Adult Finger Clip Sensor (8-pin), 3 m (9.8 feet)M1196T Philips Adult Finger Clip Sensor (9-pin), 0.90 m (2.9 feet)Order Number Description
SpO2 Accessories Accessories A-7A Sales and SupportDisposable Sensors - Single UseNote—OxiCliq, OxiMax and Oxisensor II sensors are not available from Philips in the USA or Canada. In those countries, contact Nellcor Incorporated directly.Adapter CablesNote—Adapter cables are not available from Philips in Canada or Japan. In those countries, contact Nellcor Incorporated directly.Order Number DescriptionM1901B Philips Adult >40 kg (>88 lb)M1903B Philips Pediatric 10-50 kg (22-110 lb)M1904B Philips Adult >30 kg (>66 lb)N/A from Philips *Nellcor Adhesive OxiCliq A, AdultN/A from Philips *Nellcor Adhesive OxiCliq N, Adult >40kg (>88 lb)N/A from Philips *Nellcor Adhesive OxiCliq P, PediatricN/A from Philips *Nellcor OxiMax MAX-A, Adult >30 kg (>66 lb)N/A from Philips *Nellcor OxiMax MAX-AL, Adult >30 kg (>66 lb)N/A from Philips *Nellcor OxiMax MAX-N, Adult >40 kg (>88 kg)N/A from Philips *Nellcor OxiMax MAX-P, Pediatric 10-50 kg (22-110 lb)N/A from Philips *Nellcor Oxisensor II D-20, Pediatric 10-50 kg (22-110 lb)N/A from Philips *Nellcor Oxisensor II D-25, Adult >30 kg (>66 lb)N/A from Philips *Nellcor Oxisensor II N-25, Adult >40 kg (>88 lb)* Uses reusable OC-3 Sensor Cable.Order Number DescriptionM1943A Adapter cable for Nellcor SpO2 sensor, 2 m (6.6 ft)M1943AL Adapter cable for Nellcor SpO2 sensor, 3 m (9.8 ft)
SpO2 AccessoriesA-8 Accessories WristbandOrder Number DescriptionM1627A Wristband, package of 10
Sales and Support Offices B-1IntroductionBSales and Support OfficesPlease 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 webwww.medical.philips.comVia emailmedical@philips.comBy fax+31 40 27 64 887By postal servicePhilips Medical SystemsGlobal Information CenterP.O. Box 11685602 BD EindhovenThe NetherlandsAsiaTel: +852 2821 5888Europe, Middle East, AfricaTel: +31 40 27 63005Latin AmericaTel: +55 11 2125 0764North AmericaTel: +1 800 229 6417
B-2 Sales and Support Offices
Index-1IndexAalarmsbehavior with paired bedsides, 10-3indicators, 5-2physiologic, 5-5SpO2, 8-20technical, 5-9testing indicators, 5-2testing, 11-2audible tonesdefinitions, 3-10start-up, 4-3turn off, 9-9auditory information signalssee audible tones, 3-10Bbatteryinserting, removing, 4-13life, 4-16, 12-8safety, 2-5, 4-12storing, 4-15type, 4-13Cconfigurationgroup settings, 11-12label assignment, 11-2Telemetry Setup, 9-4unit settings, 9-8controlsbuttons, 3-3indicators, 3-4labels,back, 3-8labels,front, 3-5on/off, 4-2other marks, 3-8ports, 3-6Ddropouts (ECG), 6-29Eelectrodesplacement, 6-9skin prep, 6-11electromagnetic interference, 12-5extended monitoring, 6-27Ffallback 6-26Find Device, 9-3Ggroup settings 11-12IInformation Centertransceiver use with, 1-9information signals, 11-13INOPs, see technical alarms, 5-9intended useST/AR, 7-4transceiver, 12-2interference, 6-28, 12-7Llabel assignment, 11-2lead placement, 6-13Nnoiseeliminating, 6-31Nurse Call 5-6on/off 9-5Oon/off, 4-2ordering informationECG supplies, A-3SpO2 supplies, A-5
Index-2 transceiver supplies, A-2Ppaired bedsidesalarm behavior 10-3patient window, 9-2pause alarms, 5-2pleth wave display on/off, 9-7, 9-12pouch, 4-7pulse rate display on/off, 9-7, 9-12pulse tone on/off, 3-12, 9-5RRF auto shutoff 9-10, 9-16RF interference, 6-30Ssafetybattery, 2-5, 4-12ECG, 2-6general, 2-2paced, 2-11, 7-4SpO2 sensor, 8-10SpO2, 2-11, 8-2ST/AR, 2-8, 7-2symbols, 3-8transceiver, 4-2self-testalarm indicators, 5-2sensorsapplying, 8-10optimizing use, 8-20selecting, 8-8service log, 11-13shower, transceiver use in, 4-9signal strength, 6-30silence alarms, 10-4skin prep, 6-11smart hopping 1-5soundssee audible tones, 3-10SpO2audible tones, 8-16, 8-17auto on/off, 8-19Continuous, 8-16measurement, 8-4mode selection, 9-6, 9-11NBP inop suppression, 9-7, 9-12optimizing sensors, 8-20Spot Check, 8-15turning measurement on/off, 8-18turning SpO2 parameter on/off, 8-19ST 7-11adjusting measurement points, 7-10alarm adjustments, 7-12smart limits, 7-13turning on/off, 7-9ST/ARarrhythmia analysis, 7-4intended use, 7-4ST analysis, 7-7standby mode, 4-4suspend alarms, 5-2symbols, 3-6system messagessee information signals, 11-13Ttelemetry overview, 10-3Telemetry Setup, 9-4TeleMonNBP measurement with, 1-9SpO2 measurement modes, 8-17transceiver use with, 1-9, 9-16testingalarm indicators, 5-2alarms, 4-10self test, 4-10status check, 4-11transceivercontrols, 3-2models, 1-2
Index-3troubleshooting 6-31TRx (ECG-only)see transceiver models, 1-2TRx+ (ECG + SpO2)see transceiver models, 1-2Uunit settings, 9-8Vvolume, 9-5
Index-4

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