Spacelabs Healthcare 76A90341-WMTS 90341-05 User Manual 3 of 3

Spacelabs Healthcare, Inc. 90341-05 3 of 3

Contents

User Manual 3 of 3

19-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.Cardiac Output DirectoryDirectory of KeysCARDIACOUTPUTHEIGHT/WEIGHT CALCS0.5 5 0HEIGHT =170 CMWEIGHT =70 KGCLEAR CANCEL STORE CALCS PRINTAVERAGEALLYES NOYES NOYES NOENTERENTERSTARTCO#1 BAD CURVE5.8Inject when readyEnter computational constantBSA = ?.? Must enter patient height and weight for calculationsInject when ready (if auto) Touch START then INJECT (if manual)Press YES toPress YES to confirmPress YES to confirmCC =.550COCO - MENUconfirm STORECLEARAVERAGE ALLSTOPCURVECO#2 CO#3CO#4TB XX.XoCTI X.XoC5.85.8data by pressingthe key corresponding tothe day/timedesiredCOCO/CISelect a row of DAY/TIME CO CI SV SV SVR PVR LVSW RVSW HR MAP CVP MPA PCWP26/02:25p 5.1 2.9 70.8 40.4 1629 235 54.9 10.4 72 110 6 25 1027/09:30p 4.9 2.8 65.3 37.8 1712 211 51.4 9.2 75 112 7 25 1228/10:15p 4.5 2.5 56.2 32.1 1917 213 44.5 7.8 80 115 7 25 1329/07:30a 4.0 2.2 47.0 26.8 2237 219 38.2 6.5 85 120 8 26 1530/08:30a 4.0 2.2 47.0 26.8 2237 219 38.2 6.5 85 120 8 26 15HEIGHT/WEIGHTVITALSIGNSSCROLLUPSCROLLDOWN PRINTMAP = xxx mmHgCVP =xx mmHgMPA =xx mmHgPCWP =xx mmHg ENTERVR INDEXON OFFSW INDEXON OFFCALCULATIONSVITAL SIGNS - Adjust vital signs, then touch ENTERHR = xxxAUTOMANUAL
Contents19-3 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setup Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Entering the Computational Constant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Entering Patient Height/Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Measuring Cardiac Output. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Averaging Cardiac Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Clearing Cardiac Output Curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Storing Cardiac Output Curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Stopping Curve Drawing and Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Selecting Index Normalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Displaying Cardiac Index and Cardiac Output Values. . . . . . . . . . . . . . . . . . . . 8Displaying Calculations Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Editing Vital Sign Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10View Additional Table Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Recording Cardiac Output Curves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Error Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Cables and Probes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Cardiac Output Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Cardiac OutputOverviewCardiac output (CO) monitoring enables you to evaluate the patient’s fluid status and the pumping ability of the heart, as well as calculate and display various hemodynamic values.Cardiac output is calculated by the thermodilution technique using a variation of the Stewart-Hamilton formula. Thermodilution involves injecting a cooled fluid (injectate) through a flow-through housing into an intravascular catheter. The catheter delivers the injectate directly to the right atrium and monitors the temperature downstream from the delivery site at the pulmonary artery.Cardiac output is determined by measuring the change in blood temperature downstream from the delivery site with respect to time. The change in temperature is inversely proportional to the flow of blood through the right heart. If the flow is large, the volume of blood that the injectate mixes with is large as well, so the monitor detects a small change in temperature. When a smaller flow of blood is diluted by the same volume of injectate, the change in temperature is larger. The injectate has a larger influence on the temperature as measured in the pulmonary artery.The system displays cardiac output by plotting a curve for each injection. The vertical axis of the curve represents temperature and the horizontal axis represents time.Spacelabs Medical’s cardiac output monitoring automatically captures vital sign values at the moment each CO curve is completed. This data is used to produce hemodynamic calculations.
Ultraview Care Network19-4Setup ProcedureThe setup procedure that follows assumes that the pulmonary artery catheter has been placed. Follow your standard hospital procedure to properly place the pulmonary artery catheter in the patient.Figure 19-1 illustrates the components used for CO monitoring. When using a reference solution injectate temperature probe, it should be inserted into the cardiac output cable in place of the in-line injectate temperature probe.When you connect the thermistor connector port of the catheter to the cardiac output cable, the system monitors patient blood temperature (TB) and displays the value on the screen. When you connect the injectate temperature probe, the system detects the temperature of the injectate (TI) and displays it on the screen, but does not trend the data. The system displays a message instructing you to connect the probe or catheter, or to enter the computational constant (CC).If you connect the cardiac output cable only to the catheter or only to the injectate probe, you can enter or adjust the computational constant but you cannot monitor cardiac output.Figure 19-1: Cardiac output monitoring setupTo set up the system for monitoring cardiac output:1Insert the cardiac output cable into the module.2Attach the thermodilution catheter to the cardiac output cable.3Connect either an in-line injectate temperature probe or a reference solution injectate probe to the cardiac output cable.Cardiac outputcableInjectateThermodilu-tion catheterIn-lineinjectate temperature probeThermistorconnectorConnect to module
Cardiac Output19-5 Display DetailThe CO key is displayed once you connect the CO cable to the module. To display the CO main menu, touch the CO key and curves will appear as the system detects the flow for each injection. The message INJECT WHEN READY is displayed when the system is ready to plot a new output curve.Figure 19-2 illustrates the cardiac output display when curves are being acquired, on a bedside monitor.Figure 19-2: Cardiac output displayCardiac output curveCardiac output (liters/minute)Curve ID number key (used to select a curve)Blood temperatureInjectate temperatureCardiac output (average)Time and date of averagingStop curve key (only displayed during curve drawing)Cardiac index value쐅Cardiac index value (average)CO#1 CO#2 CO#35.8 5.86.0TB 36.5 oCTI5.80.2 oC01:07 P01/09STOPCURVECO#15.8COCI 3.7CI = 3.7쐅
Ultraview Care Network19-6Entering the Computational ConstantTo generate calculations, you must first enter the computational constant (CC) and verify that the system is correctly configured. Refer to your thermodilution catheter package insert for current constants.The temperature of the injectate changes due to contact with the catheter wall and the surrounding blood. To account for this interaction, the system includes a correction factor in the equation. The correction factor (K or CT) is a function of catheter and flow-through housing dimension, internal volume, and injectate temperature and differs among catheter models and manufacturers.Once you enter a value for the computational constant, the value is displayed on the CC= key and remains in system memory. Until you enter the computational constant, the message CC REQUIRED is displayed, and ENTER COMPUTATIONAL CONSTANT is displayed on the message line after the CC= key is selected. Entering Patient Height/WeightTo perform indexed hemodynamic calculations, you must enter the patient’s height and weight before you generate CO curves. CO uses the patient’s height and weight entered during the admit function.The valid range for height is 10 to 85 in (25 to 215 cm). The valid range for weight is 2 to 400 pounds (1 to 180 kg). After you enter both height and weight values, the system automatically calculates and displays the patient’s body surface area (BSA). Measuring Cardiac OutputTo maintain the accuracy of the readings, you must allow the catheter to warm up between injections. When in AUTO mode, wait until the INJECT WHEN READY message appears between injections. When in MANUAL mode, wait until the TOUCH START THEN INJECT message appears. Five curves can be displayed at one time. Some curves may automatically be classified as “bad,” in which case they are then labeled BAD CURVE and are automatically excluded from averaging. CO curves are numbered consecutively from 1 to 99. A 15-minute timer begins after acquisition of the first good curve. After 15-minutes, the AUTO/MANUAL and START keys become invalid (dotted), and the messages MUST SELECT CURVES, AVERAGE, STORE, or CLEAR CO appear. Cardiac output injections are disabled until you perform one of these actions. Injections may resume as soon as the INJECT WHEN READY or TOUCH START, THEN INJECT message appears.!• To obtain all hemodynamic calculations remember to enter height and weight, and to store a PCWP prior to initiating measurement of CO. To enter the computational constant:1Touch CO.2Touch CC =. 3Touch the appropriate keys (tenths, hundredths, and then thousandths) and use arrow keys to adjust. 4Touch ENTER. To enter patient height and weight:1Touch CO.2Touch HEIGHT/WEIGHT.3Select HEIGHT = and/or WEIGHT =.4Use arrow keys to adjust. 5Touch ENTER.To obtain CO measurements:1Touch CO.2Touch CARDIAC OUTPUT.3Select AUTO or MANUAL.4a Wait for the INJECT WHEN READY or the TOUCH START THEN INJECT message to display.-OR-4b If in manual mode, touch START.5Inject the prepared injectate into the proximal lumen of the thermodilution catheter.
Cardiac Output19-7 Averaging Cardiac OutputThis function computes the average using the data from up to five, good, displayed curves. Curves labeled as “bad” are not included in the average.You can perform cardiac output averaging as soon as the system has measured and displayed at least two acceptable curves. When the cardiac output averaging is complete:• The CO zone displays the curves used in the average, the averaged cardiac output, and cardiac index values. • The time and date of the last curve displays.Clearing Cardiac Output CurvesOccasionally you may want to delete a curve prior to averaging or storing. All curves, or only selected curves, can be cleared. If a “bad” curve is displayed when you select to average, store, or clear another displayed curve, the “bad” curve is also cleared.When you clear an individual CO curve or all CO curves, the INJECT WHEN READY message is displayed in the first available curve position, so the curves displayed on the screen may not appear in numerical order.Storing Cardiac Output CurvesThis feature enables you to store all of the acceptable, displayed curves at once or individually. The system stores the vital signs and cardiac output value it acquired at the end of curve acquisition, along with the time it displayed each curve. The curves clear from the screen as they are stored. The system does not store “bad” curves. After you store the acceptable curves, the system clears all curves from the screen.Stopping Curve Drawing and AcquisitionThis feature enables you to stop the curve drawing and data acquisition of a cardiac output curve in progress. The STOP CURVE key only appears during curve drawing. Touching this key will invalidate all curve data for that injection. Once the blood temperature is again stable, the INJECT WHEN READY message will appear if in AUTO mode. The TOUCH START THEN INJECT message will appear if in MANUAL mode.To average all cardiac output curves: 1Touch CO. 2Touch CARDIAC OUTPUT.3Touch AVERAGE ALL.4Touch YES.To clear or store all curves:1Touch CO.2Touch CARDIAC OUTPUT.3Select CLEAR or STORE.4Touch YES.To clear or store selected curves:1Touch CO.2Touch CARDIAC OUTPUT.3Touch the CO# keys adjacent to the curves (up to 5) that you wish to clear or store.4Select CLEAR or STORE.5Touch YES.To stop a curve in progress:1Touch STOP CURVE.
Ultraview Care Network19-8Selecting Index NormalizationTo individualize the values to the patient, the system calculates them with the BSA. Cardiac Index (CI) and Stroke Volume Index (SVI) are automatically displayed.You can display either the Systemic Vascular Resistance (SVR) and the Pulmonary Vascular Resistance (PVR) or their indexed values (SVRI and PVRI), but not both simultaneously. Similarly, you can display the Left Ventricular Stroke Work (LVSW) and the Right Ventricular Stroke Work (RVSW) or their indexed values (LVSWI and RVSWI), but not both simultaneously.Displaying Cardiac Index and Cardiac Output ValuesThe cardiac output or both cardiac output/index values can be displayed with the curves. If the CO portion of the CO|CO/CI key is highlighted, only the cardiac output value will be displayed. To activate the display for the cardiac output and cardiac index values, touch the CO|CO/CI key to highlight the CO/CI segment. If the cardiac index value is available, then it is displayed when the CO parameter is inactive.To select indexing:1Touch CO.2Touch CARDIAC OUTPUT.3Touch CALCS.4Select VR INDEX ON or SW INDEX ON.To display both cardiac output and cardiac index values: 1Touch CO|CO/CI.
Cardiac Output19-9 Displaying Calculations TableYou can view hemodynamic calculations after storing or averaging data. The table includes only those calculations that have been stored or averaged.Table 1 shows an example of the hemodynamic calculations table displayed when you touch the CALCS key. Each horizontal row is one complete set of data. Each new value appears at the bottom of the table. The system defaults to VR INDEX OFF and SW INDEX OFF. The system automatically calculates and enters CO and CI values in the table. Values in the columns SV, SVI, SVR, PVR, LVSW, and RVSW are automatically calculated from the vital sign values entered in the columns HR, MAP, CVP, MPA, and PCWP.The values under the columns HR, MAP, CVP, MPA, and PCWP are parameter values obtained from other channels in the bedside monitor at the time a CO value is calculated or those values you have entered manually. To enter values in these columns refer to Editing Vital Sign Values on page 19-10.If you do not enter height and weight values prior to generating CO curves, the monitor displays any value that uses BSA (e.g. CI, SVI, LVSWI and RVSWI) as ?.?. If a calculated value is out of the displayable range, the monitor displays the value as ++++. If any of the vital signs in the hemodynamics table are negative, the system uses the value 0 (zero) in the calculations.The equations used for the hemodynamics table are defined in the table to the left. Table 1: Sample CalculationsDAY/TIME CO CI SV SVI SVR PVR LVSW RVSW HR MAP CVP MPA PCWP26/02:25p 5.1 2.9 70.8 40.4 1629 235 54.9 10.4 72 110 6 25 1027/09:30p 4.9 2.8 65.3 37.8 1712 211 51.4 9.2 75 112 7 25 1228/10:15p 4.5 2.5 56.2 32.1 1917 213 44.5 7.8 80 115 7 25 1329/07:30a 4.0 2.2 47.0 26.8 2237 219 38.2 6.5 85 120 8 26 1530/08:30a 4.0 2.2 47.0 26.8 2237 219 38.2 6.5 85 120 8 26 15!• The vital sign values shown in Table 1 are typical if your monitor's UNITS OF MEASURE key is set to mmHg. Consult your system administrator if your display is different from that shown here.To display the calculations table: 1Touch CO.2Touch CALCS.Hemodynamic EquationsBSA = Ht 0.725 x Wt 0.425 x 0.007184CI = CO/BSASV = (CO/HR) x 1000SVI = SV/BSASVR = 79.9 x [(MAP-CVP)/CO]SVRI= 79.9 x [(MAP-CVP)/CI]= 79.9 x [(MAP-CVP)]/[CO/BSA]= 79.9 x [(MAP-CVP)]/[CO x 1/BSA]= 79.9 x [(MAP-CVP)/CO] x BSA= SVR x BSAPVR = 79.9 x [(MPA-PCWP)/CO]PVRI= 79.9 x [(MPA-PCWP)/CI]= 79.9 x [(MPA-PCWP)]/[CO/BSA]= 79.9 x [(MPA-PCWP)]/[CO x 1/BSA]= 79.9 x [(MPA-PCWP)/CO] x BSA= PVR x BSA
Ultraview Care Network19-10Editing Vital Sign ValuesSelect a row of data in the hemodynamic calculations table to turn the vital signs keys ON.Default values are supplied if you touch the VITAL SIGNS key and no prior value is available. When you edit a value, the system recalculates the hemodynamic calculation values using the new vital sign value.A CVP value is used in calculations if it is available. If only a RAP value is available, then the RAP value is used in place of CVP. If neither CVP nor RAP pressure is available, the system cannot automatically calculate SVR, SVRI, RVSW, or RVSWI. A CVP or RAP value can be manually entered using this edit process.A PCWP value is used in calculations if the last stored PCWP value is less than 15-minutes old. If no such PCWP value is present, an LAP value is substituted. If neither PCWP nor LAP values are available, the system cannot automatically calculate PVR, PVRI, LVSW, nor LVSWI and the monitor displays the message NO PCWP VALUE AVAILABLE WITHIN THE LAST 15-MINUTES. You can add a PCWP value manually using this edit process.View Additional Table DataFive sets of values display at any one time. Additional sets of values can be displayed by scrolling through the data.Thirty sets of values are saved in the monitor’s hemodynamic calculations table so you can remove and re-insert the module without losing hemodynamic values. You can erase these values by discharging a patient or by powering the monitor OFF.Table 2: Hemodynamic and Vital Signs ValuesLabel Name Units Default ValueValid RangeHR Heart Rate beats/min 70 0 - 300MAP Mean Arterial Pressure mmHg kPa8010.70 - 3000.0 - 40.0CVP Central Venous Pressure mmHgkPa101.30 - 990.0 - 13.2MPA Mean Pulmonary Artery PressuremmHgkPa152.00 - 990.0 - 13.2PCWP Pulmonary Capillary Wedge PressuremmHgkPa101.30 - 990.0 - 13.2!• To ensure that a RAP/CVP value can be registered, immediately reopen the stopcock to the patient after you inject the bolus so that flow is reinstated.To edit vital sign values:1Touch CO.2Touch CARDIAC OUTPUT.3Touch CALCS.4Touch DAY/TIME in the row you wish to select.5Touch VITAL SIGNS.6Select the vital sign you wish to edit.7Use arrow keys to edit the displayed value.8Press ENTER.To view additional sets of data:1Touch CO.2Touch CALCS.3Touch SCROLL UP to scroll the data up one row, touch SCROLL DOWN to scroll the data down one row.
Cardiac Output19-11 Recording Cardiac Output CurvesIf a bedside or system printer is installed, you can record all curves in the CO display area. You can also record the calculations table when it is displayed on the screen.Error MessagesCatheter FaultThere is a problem with the thermodilution catheter. Connect or replace the catheter.TB Out Of RangeThe blood temperature (TB) is unacceptable. The temperature must be between 27° and 43°C.Probe FaultThere is a problem with the probe. Connect or replace the probe.TI Too WarmThe injectate temperature (TI) is greater than 25.5°C. Cool down injectate.Bad CurveThere are a number of different possible causes: unsteady baseline, irregular curve from shunts or poor injection, delayed curve, catheter or probe fault during curve recording. Delete the bad curves as necessary to perform additional cardiac output determination.Injectate Temperature ErrorThe temperature difference between the injectate and body is less than 8°C. Cool the injectate down.To record thermodilution curves:1Touch CO.2Touch CARDIAC OUTPUT.3Touch PRINT.
Ultraview Care Network19-12Cables and ProbesRefer to Spacelabs Medical Supplies Products catalog for part numbers and specifications for cables, probes, and injectate systems.Computation Constants/Catheter CompatibilityNominal resistance @ 37°C 14,004 Ω + 15%Refer to the instructions provided with your catheter for the computation constants for your specific catheter, setup injectate temperature, and injectate volume. Contact your local thermodilution catheter sales representative for further information.Refer to Calculations on page 25-5 for hemodynamic and vital sign value tables.!• Cardiac output function is compatible with the Baxter Edwards Critical-Care REF™ and REF-Ox™ catheters for cardiac output measurement, but cannot perform the REF function.WARNING:• For 3 cc injectate volumes, the 0° - 5°C injectate temperature is required for consistent results.
19-13 Cardiac Output Troubleshooting GuideClinical Situation Possible Cause SolutionInvalid pressure reading ■Stopcock of the CVP or RAP line may not have been turned OFF quickly enough after injection was made. ■Turn the stopcock off immediately after making the injection to provide the module with the correct pressure value at the time it obtains the curve.Erroneous CO values using room temperature injectate■Injectate too warm. ■Injectate temperature is above 25.5° C. ■Injection rate too slow. ■Administer bolus smoothly at a rate of < 10 cc/4-seconds. Unable to obtain indexed values for calcs■Did not enter height and/or weight prior to averaging curves.■Enter the height/weight and reinject the curves.■If the Calcs option is installed, enter the height/weight in hemocalcs to obtain index values without reinjecting curves.Value of calcs variable displays as +++■Measured value is out of range. ■Check computation constant (CC) values for validity.Spontaneous CO curves drawn while in AUTO mode■Infusion of IV drips or medications through proximal port.■Turn off the IV solutions temporarily.■Mechanically ventilated patient causing shifts in PA temperature.■Use the Manual mode. ■Cardiac arrhythmias causing blood flow variance.■Use the Manual mode and time the injection during stable ECG rhythm.Substantial variance in CO values/irregular curves■Varied temperature in bolus.■Injection delivered at varying points in the respiratory cycle.■Standardize the temperature of bolus.■Use the Manual mode and time the injection at end expiration, if desired.■Movement. ■Standardize the patient position during procedure.■Physiological problems. ■Any of the following conditions can affect accurate readings: ventricular arrhythmias, low stroke volume, and/or valve insufficiency.■Injectate rate too slow. ■Administer the bolus smoothly at a consistent rate.No curve drawn after bolus injected■Insufficient time has elapsed between injections to allow blood temperature stabilization.■Wait 60- to 90-seconds between injections.
20-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.SvO2Directory of KeysSVO2 MENU11:55 av DO2 = 4.61 Ca = 19.80 Cv = 15.20 ml/dl O2AV = 990 VO2 = 250 ml/minSVO2ALARMLIMITSTIMEBASE2 HOURSINTENSITYDISPLAY CALIBRATE STOREREAD PRINT SCALES CALCSSTORE READYES NO YES NOSVO2TRENDCALCRESULTSPRE-INSERTIONINVIVOLIGHTINTENSITYYES NO YES NO YES NOENTERENTER1HOUR2HOUR4HOUR8HOUR16HOURALARMSON OFFHI =80LO =80LIGHT INTON OFFPaO2 = PvO2 = CO = SaO2 = SvO2 = Hgb =
Contents20-3 SvO2OverviewMeasurements of venous oxygen saturation (SvO2) provide a status indicator of the oxygen transport system in the critically ill patient.Low or rapidly decreasing saturation values indicate an imbalance between oxygen consumption and oxygen delivery. Normal values reflect a balance of the oxygen transport system or the patient’s ability to successfully compensate for alterations in oxygen supply or demand. Continuous SvO2 monitoring can reduce the frequency of additional invasive measurements and enhance the timeliness of intervention in the critically ill patient.This system utilizes three-wavelength reflectance spectrophotometry to sense the amount of light absorbed by the blood. The use of three wavelengths compensates for changes in light reflectance from red blood cell surfaces, blood vessel walls, and for variations in hematocrit values. Digital filtering reduces vessel-wall artifacts.Data acquisition begins when an Abbott Opticath catheter is positioned at a site within the pulmonary artery. The catheter connects to an Abbott Oximetrix optical module which contains three LEDs emitting red and infrared wavelengths of light. The catheter returns reflected light through a second optical fiber to the optical module. Here the light is converted to an electrical signal which the SvO2 module recognizes and displays as a saturated venous oximetry value (percent SvO2).Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up SvO2 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Preparing the Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Performing Pre-insertion (in vitro) Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . 6Inserting the Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Performing Light Intensity Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Performing In Vivo Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Displaying Intensity Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Setting Alarm Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Setting the Light Intensity Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Adjusting Trend Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Obtaining Oximetry Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Printing Oximetry Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Storing or Reading Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Correcting Out-of-Range Light Intensity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Correcting Insufficient Light Intensity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Correcting Calibration Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Correcting Optical Module Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Correcting SvO2 Display Error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Ensuring Catheter Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13SvO2 Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Ultraview Care Network20-4Setting Up SvO2MonitoringIn addition to the Spacelabs Medical module, venous oximetry monitoring requires an Abbott Oximetrix 3 optical module with connecting cable and an Abbott Opticath catheter. You must correctly connect all necessary cables, prepare the catheter and patient for this invasive procedure, and calibrate the catheter to begin monitoring.The system provides two calibration methods. The patient’s current status determines the proper calibration method. You can calibrate the catheter:• while in its sterile package, or• after it has been placed within the pulmonary artery, and you can verify adequate light intensity during monitoring.Refer to Preparing the Catheter on page 20-5 and Performing Pre-insertion (in vitro) Calibration on page 20-6 for more details.Display DetailFigure 20-1 provides a trend of oximetry values and the current light intensity value.Figure 20-1: Typical venous oximetry displayCurrent time base — 1HRVenous oximetry trend graphEvent marks — I (in vivo calibration initiated), C (in vivo calibration complete)Light intensity display marks (vertical lines) superimposed over trend graphLight intensity bar graph (light meter)Real time intensity signal level (two vertical lines)CAUTION:• The Spacelabs Medical SvO2module will not correctly operate with any other catheter for SvO2monitoring.To set up SvO2 monitoring:1Place the catheter’s optical connector into the optical module on the connecting cable.2Insert the connecting cable into the SvO2module.
SvO220-5 Markers for normal intensity levels (two horizontal lines)SvO2 parameter keyCurrent venous oximetry value — 76%쐅Status or error message area쐈Current alarm limits — high 80, low 60Preparing the CatheterEach Abbott Opticath catheter is packaged in a sterile, disposable tray which includes a disposable optical reference. Inspect the catheter tray carefully. If you suspect damage to the tray DO NOT USE THE CATHETER.Perform the catheter setup according to the instructions included with the catheter. Setup instructions are included here as a convenience.1. Peel back the outer wrap. Do not break the seal of the inner wrap.2. Peel back the lift tab to uncover the optical connector at the end of the tray.3. Pull the optical connector slightly away from the tray. Place the optical module in the recess at the open end of the catheter tray.4. Open the end of the optical module by pulling straight out in the direction of the arrow (refer to Figure 20-2). The monitor will display an INSUFFICIENT LIGHT message.Figure 20-2: Placing the optical module into the catheter tray
Ultraview Care Network20-65. Place the optical connector into the optical module with the word TOP facing up. Close the module (refer to Figure 20-3).Figure 20-3: Placing the optical connector into the optical module6. With the inner wrap still in place, press down on the black optical reference at the point labeled PUSH. Listen for a click.The catheter is now ready for pre-insertion calibration. After you complete the calibration, prepare the patient for catheter insertion.Performing Pre-insertion (in vitro) CalibrationThis calibration procedure tales up to 72-seconds. When calibration is successful, the message PRE-INS CAL COMPLETE displays and the event mark P displays on the oximetry trend.If the catheter fails calibration, verify the following:• A secure cable connection exists between the optical and SvO2 modules.• The catheter tip is inserted properly within the optical connector.• You have pressed the optical reference with enough force to hear the click, indicating a secure connection.• You tested the catheter by replacing it with a known good catheter to ensure proper catheter function.Repeated calibration failure with a known good catheter may indicate a defective optical module. Replace the optical module if necessary.To initiate pre-insertion calibration:1Touch SVO2.2Touch CALIBRATE.3Touch PRE-INSERTION.4Touch YES.
SvO220-7 Inserting the CatheterFollow standard hospital procedure to prepare the patient for catheter insertion.1. Using sterile procedures, peel back the remaining inner wrap from the catheter tray. Pull the retainer (white tab) to release the catheter.2. Grasp the catheter at approximately the 5 cm mark and gently pull it straight out from the optical reference.3. Prepare the catheter and insert it into the patient according to hospital procedure. Oxygen saturation readings will immediately display on the bedside monitor.4. When the catheter is positioned properly, verify the light intensity signal is within the correct operating range (i.e., the bars on the graph extend at least two vertical dots within the high and low range markers).5. Perform a light intensity calibration.6. Begin continuous mixed venous oxygen saturation monitoring.Performing Light Intensity CalibrationThis procedure adjusts the optical module’s light intensity reference level to match the light intensity returned through the catheter from the patient’s blood. The SvO2module stores this value and signals an alarm if the detected light differs significantly from the stored light levels.Perform a light intensity calibration only when the catheter is in the proper position in the patient.CAUTION:• The optical fibers can be damaged if you do not draw the catheter out carefully.!• Do not begin a light intensity calibration if the signal is out of range. If this occurs, refer to Correcting Out-of-Range Light Intensity on page 20-11.To initiate light intensity calibration:1Touch SVO2.2Touch CALIBRATE.3Touch LIGHT INTENSITY.4Touch YES.
Ultraview Care Network20-8Performing In Vivo CalibrationIn vivo calibration compares a drawn (measured) blood gas value with the value displaying on the monitor. The catheter manufacturer recommends that the oxygenation value be checked periodically. Several conditions may necessitate in vivo calibration.• Catheter was placed without pre-insertion calibration.• Catheter has been in place for an extended period of time.• Decaying light intensity values indicate possible damage to the fiber optics (in this case, the catheter manufacturer recommends checking the oxygenation value every 12-hours).• You believe the saturation reading is incorrect.Perform an in vivo calibration only when the patient’s oxygen saturation is relatively stable and the intensity signal is within normal limits. When calibration begins, the optical module stores the preceding 5-seconds of oxygen saturation data.Displaying Intensity DataYou can display a history of light intensity values superimposed over the saturation trend graph. This combined display can be valuable for troubleshooting because the quality of light passing the catheter tip directly affects the accuracy of the saturation value. Successful monitoring ensures light intensity values remain within the limits of the bar graph display.Real time maximum and minimum intensity values display as vertical bars to each side of a vertical row of dots. This display updates every 6-seconds. Horizontal lines represent the recommended operating limits for light intensity.Removing display of the intensity data does not affect storage of the data in monitor memory, and the current intensity continues to display in the intensity bar.Setting Alarm LimitsThe current limits for venous oximetry display to the right of the parameter key. You can set high or low saturation limits.The alarm default is OFF. When you turn alarms ON:• they default to a high of 80% and low of 60%.• the exceeded limit key flashes.• the limit value is displayed in the message area of the screen.!• Use only measured oxyhemoglobin saturation values from a co-oximeter. Do not use values calculated from a laboratory blood gas analyzer. Oxyhemoglobin values calculated on the basis of PO2, pH, and temperature have been shown to be inaccurate.To initiate in vivo calibration:1Touch SVO2.2Touch CALIBRATE.3Touch IN VIVO.4Touch YES.5Draw blood from the distal lumen when the message DRAW BLOOD is displayed and send to lab for analysis.6Use arrow keys to adjust value if displayed value differs from lab value by more than four saturation units.To display a history of light intensity values:1Touch SVO2.2Touch INTENSITY DISPLAY.To set or adjust alarm limits:1Touch SVO2.2Touch ALARM LIMITS.3Select ALARMS ON.4Select HI= or LO=.5Use arrow keys to adjust.
SvO220-9 Setting the Light Intensity AlarmIf the light intensity alarm is turned ON, a second-level alarm will sound in the event of an intensity alert.Adjusting Trend DisplayThe most recent minute of mixed venous oxygen saturation data is displayed as a point on the right side of the trend graph. As the module acquires new data, the older data points move left to create a record of data.Select TimebaseThe SvO2module stores the most recent 16-hours of saturation trend data. You can view this data graphically in 1-, 2-, 4-, 8-, or 16-hour time bases. Data is displayed in 1-minute increments on 1- to 4-hour graphs, in 2-minute increments on the 8-hour graph, and in4-minute increments on the 16-hour graph.Select ScaleYou can select one of three sizes for the trend graph:•30% to 70%•40% to 80%• 50% to 90% (default)Event MarksThe system automatically displays event marks along the top of the trend graph to note the point when any of the following events occur:P — pre-insertion calibration initiatedI — in vivo calibration initiatedC — in vivo calibration completeL — light intensity calibration completeF — calibration failureR — light intensity range errorTo set the light intensity alarm:1Touch SVO2.2Touch ALARM LIMITS.3Select LIGHT IN - ON or OFF.To select a timebase:1Touch SVO2.2Touch TIMEBASE x HOURS.3Select hours.To change trend graph size:1Touch SVO2.2Touch SCALES.3Use arrows to adjust.
Ultraview Care Network20-10Obtaining Oximetry CalculationsYou can use the calculations feature to obtain specific values for the oximetry measurements listed below.Arterial oxygen content — CaCaO2 = (1.34 x Hgb x SaO2/100) + (0.0031 x PaO2)Venous oxygen content — CvCvO2 = (1.34 x Hgb x SvO2/100) + (0.0031 x PvO2)Arterial-venous oxygen content differenceavDO2 = CaO2 - CvO2Oxygen availability or oxygen deliveryO2AV = CaO2 x CO x 10Oxygen consumptionVO2 = avDO2 x CO x 10Values for cardiac output (CO), pulse oximetry (SpO2), and venous oxygen saturation (SvO2) are automatically displayed when data is available in the Ultraview Care Network system. You must manually enter laboratory values for PaO2, PvO2, and hemoglobin (Hgb) to obtain calculations.Printing Oximetry DataYou can print venous oximetry data in two formats: the current trend or the results of the most recent set of oxygenation calculations. Refer to Printing on page 4-5 for more details on system and bedside printers.Storing or Reading DataThe last 15-minutes of data gathered by the SvO2module may be stored in the optical module’s memory before disconnection. That data can be read back into the SvO2 module. The stored data includes the year, month, hour, and minute of collection.!• If an SaO2value is available, it may be used in place of the SpO2value.To obtain oxygenation calculations:1Touch SVO2.2Touch CALCS.3Select a manually entered value(s) for PaO2, PvO2, Hgb.4Use arrow keys to adjust.5Touch ENTER.To print saturation data:1Touch SVO2.2Touch PRINT.3Select SvO2TREND or CALC RESULTS.To read or store data in the optical module:1Touch SVO2.2Touch STORE READ.3Select STORE or READ.4Touch YES.
SvO220-11 Correcting Out-of-Range Light IntensityEach time you perform a light intensity calibration, the oximetry module stores the intensity value and signals an alarm or error message if the current light level differs significantly from the stored level. Light intensity error messages serve as a reference to determine if the light at the catheter tip is adequate for accurate monitoring. Do not ignore these messages.The module alerts you to this condition when:• an INTENSITY ALERT or SVO2 DATA OUT OF RANGE message is displayed; or• a second level alarm begins.When the monitor displays the SVO2 DATA OUT OF RANGE or INTENSITY ALERT message, select the intensity display feature to view a history of light intensity values. Refer to Figure 20-4 to identify the type of abnormal intensity. Refer to the following list of possible causes and solutions.• High — check the position of the catheter as the tip may lie against the vessel wall. Reposition the catheter according to your hospital protocol.• Low, dampened, or erratic — check the blood flow past the catheter as a clot may have formed over the catheter tip.Figure 20-4: Abnormal intensitiesTake the following actions:• If a Spacelabs Medical invasive pressure module is being used, examine the pulmonary artery (PA) pressure waveform for spontaneous wedge indicating the catheter tip may lie against the vessel wall. If this occurs, reposition the catheter.• If a Spacelabs Medical invasive pressure module is being used for pulmonary artery pressure monitoring, examine the pressure waveform for dampening, indicating clotting over the tip of the catheter. If this occurs, follow hospital procedure to flush the distal lumen. Reposition the catheter if necessary.• Abnormal resistance when you push the catheter through the distal lumen indicates damage to catheter fiber optics. Reposition the catheter and replace if necessary.• If connections between the catheter optical connector and the optical module appear loose, tighten the connections.• If the catheter contains obvious kinks, the optical fibers may be damaged. Replace the catheter.
Ultraview Care Network20-12Correcting Insufficient Light IntensityThe message INSUFFICIENT LIGHT displays when an unusually small amount of light is being received during monitoring or during pre-insertion calibration.Take the following actions:• If this message displays while the catheter is exposed to room light during pre-insertion calibration, take no action. It disappears when the catheter is placed in the patient.• If this message displays during pre-insertion calibration while the catheter is connected to the optical module, verify proper connection to the module.• Check that the tip is fully inserted into the optical reference and firmly press PUSH on the optical reference until you hear a click. Do not use the catheter if the tip is pulled out of the optical reference when you receive the catheter tray.• Disconnect the optical module from the catheter, close the optical module lid, and place the optical module in an area out of direct light. If the message disappears, replace the catheter. If the message remains, contact your system administrator.• Examine the catheter for kinking. If optical fibers are damaged, replace the catheter.Correcting Calibration ErrorsThe message CALIBRATION REJECTED displays when pre-insertion or in vivo calibration is not successful.Take the following action as indicated:• Check for secure catheter connection to the optical module. Reconnect the catheter if necessary.• Check the status message on the monitor screen to verify sufficient, stable light intensity. If the INSUFFICIENT LIGHT message displays, refer to the previous section which describes steps to correct this condition.• Allow the optical module to warm up for one more minute, then retry.The message NOT CALIBRATED displays and an alert sounds (if alarms are ON) if you begin monitoring before you calibrate the system. The message disappears after you complete a successful calibration.Correcting Optical Module ErrorsThe SvO2module performs constant memory checks to ensure data is not lost or changed erroneously. When the OPTICAL MODULE MEMORY ERROR message displays, replace the optical module with a known good unit.Expect the NO OPTICAL MODULE message whenever you disconnect the optical module from the SvO2module because this suspends SvO2monitoring.If this message appears when the optical module is not disconnected, replace the module or contact a qualified service person.
SvO220-13 Correcting SvO2 Display ErrorIf the oxygen saturation value is out of the display range, the display changes from a percentage to ???.Take the following action as indicated:• Verify proper function of the optical module; no error messages display. Replace with a known good module if necessary.• Display light intensity history to verify proper catheter function (refer to Correcting Insufficient Light Intensity on page 20-12).• Perform in vivo calibration.Ensuring Catheter FunctionThe catheter fiber optics are sensitive to damage. Avoid kinking, excessive manipulation, or grasping with forceps or a hemostat. Damage to the fiber optics reduces transmission of light to and from the blood which significantly compromises oxygen saturation accuracy.Damage is indicated by one or more of the following:• Low intensity display.• Intensity error message displays.• Intensity alarms begin if alarms are ON.• Oxygen saturating values are inaccurate.
20-14SvO2 Troubleshooting GuideClinical Situation Possible Cause SolutionINTENSITY ALERT or SVO2 DATA OUT OF RANGE message is displayed■Faulty catheter position within vessel. ■Check for spontaneous wedge or balloon inflation; if present reposition the catheter.■Clot over catheter tip. ■Flush distal lumen.■Loose connections between catheter optical connector and optical module.■Tighten the connections.■Kinked or damaged fiber optics in catheter.■Replace the catheter.INSUFFICIENT LIGHT message is displayed■Catheter exposed to room light during pre-insertion calibration.■No action required; status message only.■Catheter is kinked. ■Check the catheter.■Faulty connection between catheter and optical module.■Fully insert the tip into the optical reference.CALIBRATION REJECTED message is displayed■Faulty connection between catheter and optical module.■Reconnect.■Optical module not warmed up. ■Wait one minute and retry.??? is displayed in place of SvO2 value■Value out of range. ■If optical module error message also is displayed, replace optical module.■Poor light intensity. ■Display light intensity history to verify.■Pre-insertion calibration insufficient. ■Perform in vivo calibration.!• Catheters should be handled according to your hospital’s protocol.
21-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.Capnography DirectoryDirectory of KeysGAS - CAL MENU - O2 CALLIMITSALARM FREEZEON OFFSETUP CAL VIEWALARMS PRINTROOM O2SPAN 100% O2 SPANZEROTONESIZE SWEEPSPEEDPERCENTmmHg (kPa)LARGE TXTSMALL TXTRESP TONEON OFFVOLUMEVOLUME25mm/sec12.5mm/sec6.25mm/sec3.12mm/sec1.56mm/secWAVEFORMON OFF0-80 0-60 0-40 APNEA RR ETCO2 O2 MINCO2APNEAON OFFAPNEA =OFFAPNEARRAPNEARRHI =OFFLO =OFFRRON OFFGASGAS - ALARM LIMITS MENU - APNEAGAS - ALARM LIMITS MENU - RRGAS - ALARM LIMITS MENUGAS - MAIN MENUGAS - SETUP MENUGAS - SETUP MENU - RESP TONEGAS - SETUP MENU - SWEEP SPEEDGAS - SETUP MENU - SIZECOMPGAS - COMPN2OON OFFO2AUTO MANO2ON OFFGAS - CAL MENUO2CALCO2CHECKGAS - CAL MENU - CO2 CHECKCO2 = XX.XNEXTREADINGBarPres = XXXADAPTERCALCANCELSTARTRESP mmHg mmHg mmHgRESTORESETTINGSYES NOGAS - CAL MENU - ADAPTER CALCAPNOO2 ONLY0-5.3 kPa0-10.7 kPa 0-8.0 kPaHIDDENKEY
Contents21-3 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Patient Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Setting Alarm Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Adjusting the Waveform Size. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Turning the Waveform Display On/Off. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Selecting a Unit of Measure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Selecting a Sweep Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Respiration Tone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Selecting a Text Format. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Freezing the Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Recording Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Calibrating the Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Selecting Gas Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Restoring Default Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Capnography Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14CapnographyOverviewThe 90516 Ultraview Capnograph module is a mainstream gas analyzer, designed to measure the concentration of carbon dioxide in a gas mixture to aid in determining the patient’s ventilatory, circulatory, and metabolic status. The capnograph module has a small, lightweight sensor that continuously measures the end-tidal and minimum CO2 levels in the patient’s airway. Respiration can be monitored via airway and endotracheal or tracheostomy tubes. Both adults and neonates can be monitored with this type of capnograph (using separate adult and neonatal airway adapters).The sensor head contains a small infrared transducer that accurately measures the CO2 in the airway. The sensor is connected to the airway by an airway adapter. These adapters may either be disposable or reusable and are available in adult and neonatal sizes.The capnograph automatically compensates for the ambient barometric pressure to ensure accurate readings. A connector is included to allow measurement of O2in the airway using a fuel cell type O2 sensor. A full calibration menu is provided to easily calibrate and use the O2 sensor. A separate adapter is used for O2monitoring.
Ultraview Care Network21-4CAUTION:• Although the 90516 capnograph module detects and reports apnea conditions, it is not intended to be a primary diagnostic apnea monitor and/or apnea recording device.• Use only Spacelabs Medical sensors with this monitor. Other sensors may plug in, but will not operate.• Use only Spacelabs Medical airway adapters with Spacelabs Medical sensors. The monitor may not function if other airway adapters are used, and sensor damage may result.• If the patient’s airway is configured with a closed suctioning system, make sure the airway adapter is placed close to the suctioning system (on the ventilator side). This will help ensure that the sampling adapter is not impaired during and after suctioning.• U.S. Federal law restricts this device to sale by or on the order of a physician.!• If your module is equipped with the Module Configuration Manager feature, you can define your own default settings for such characteristics as alarm limits and display configuration. Refer to Module Configuration Manager on page 7-5 for further details.
Capnography21-5 Patient ConnectionRespiration can be monitored via an endotracheal or tracheostomy tube.Mainstream capnography is a highly accurate method of measuring respiratory gas values. There are several variations of closed circuit tracheal suction systems that can be used with Spacelabs Medical capnography units. Spacelabs Medical recommends the Ballard style tracheal suction system.Closed Circuit Tracheal Suction SystemsClosed circuit tracheal suction systems (such as those provided by Ballard) extend the life of the endotracheal tube and associated tubing by allowing the endotracheal tube to be periodically suctioned without detaching it from the ventilator circuit. Spacelabs Medical recommends use of Ballard Model #221 elbow closed tracheal suction systems, or similar systems, with Spacelabs Medical capnography units. Such a system allows the Spacelabs Medical airway adapter to be placed outside the tube through which fluids are being suctioned, reducing the chance of occluding the airway.Spacelabs Medical does not recommend use of traditional setups that require the airway adapter to be in line with the endotracheal tube. However, if you prefer a traditional setup such as the Ballard Model 2205 style, using the Ballard Model 112 adapter moves the airway adapter away from the suction catheter.Figure 21-1 shows examples of setups using the Ballard Model #221 and Model 2205 style (with Model 112 adapter). Similar closed systems, such as the Concord Portex (not shown), must be placed in the ventilator circuit in the same positions as shown in Figure 21-1.Figure 21-1: Ballard setupsTo start capnography monitoring:1Plug the module into the monitor.2Plug the sensor connector into the monitor.3Perform sensor calibration, if necessary.4Prepare the patient according to hospital procedures.5Select appropriate airway adapter (neonate or adult).6Verify that windows are clean and dry.7Place sensor head over the airway adapter and perform an adapter calibration, if necessary.8Remove the airway adapter from the sensor head.9Insert the airway adapter into the ventilator circuit and Ballard style tracheal suction system (if present) as shown in Figure 21-1.10 Attach the sensor head to airway adapter.11 Ensure that the sensor head is always positioned above the ventilator circuit so that moisture will not enter the adapter.suction catheterBallard Adapter #112ventilator circuitmainstream airway endotracheal tubeBallard closed tracheal suction systemendotracheal tubeventilator circuitsuction catheterwith adapter (Model 2205/Adapter #112)Ballard elbow closed tracheal suction system (Model 221)oradapter adapter mainstream airway sensor headsensor head
Ultraview Care Network21-6When you first power on the module, the GAS parameter key is displayed adjacent to a flat waveform.Display DetailWhen you connect the capnography device to a monitor, the waveform area is displayed in one of four formats, the large and small text formats in normal or view alarms modes. Instructions for choosing a format are detailed later in this manual.The full screen, large text format is the default display for bedside monitors. The full screen, small text format in VIEW ALARMS is the only display format for the full screen remote view monitors. The split screen central format is available only for central monitors operating in split screen mode. Refer to Figure 21-2 through Figure 21-6.Figure 21-2: Bedside screen in small text (waveform ON)Figure 21-3: Bedside screen in large text (waveform OFF)!• Capnography is not analyzed during unit warm-up.• The typical initial warm-up period is 2- to 5-minutes (5-minutes is the maximum warm-up time). This time varies based upon the temperature of the sensor.• The capnograph is protected against the effects of a cardiac defibrillation discharge and is safe to use on patients with a cardiac pacemaker or other electrical stimulation.• The airway adapter may require regular cleaning or replacement if the capnograph is used on patients that emit excessive mucous.쐄쐃쐇쐋쐏ETCO2= 30 mmHgMINCO2= 0 mmHgO2= 20%RR= 6 BPM쐂GAS쐄쐃쐇쐋쐏쐂O2 COMP ONN2O COMP ON 6RRBPMMINCO2mmHg0GAS30 ETCO2mmHgO2%20
Capnography21-7 Figure 21-4: Bedside screen in large text during View Alarms (waveform OFF)Figure 21-5: Full remote view (waveform OFF)Figure 21-6: Split screen쐃GAS key쐇End tidal carbon dioxide data 쐋Oxygen data쐏Alarms ON bell (refer to Table 1)쐄Minimum inspired carbon dioxide data쐂Respiratory rate쐄쐃 쐇쐋쐏쐂O2 COMP ONN2O COMP ONETCO2O24508015APNEA 303015RRMINCO230 ETCO2mmHgO2%20GAS쐄쐃쐇쐋쐏쐂O2 COMP ONN2O COMP ON ETCO2O24508015APNEA 303015RRMINCO2ETCO2= 40 mmHgMINCO2= 2 mmHgO2= 18%RR= 12 BPMGAS쐏쐃쐇쐋쐄ETCO2= 3.2MINCO2= 0.5O2= 21RR= 23Numeric keyETCO2= 40 mmHgAPNEA= 30 sO2= 18%RR= 12 BPMMINCO2= 32 mmHgGAS
Ultraview Care Network21-8Setting Alarm LimitsYou can set high and low alarm limits for respiratory rate (RR), EtCO2, O2,minimum CO2 (high limit only), and the apnea alarm delay time. When alarm limits for EtCO2 and RR are initially enabled, the limit values depend upon the patient’s current readings for those parameters (these limit values are learned). Alarm limits for all other monitored parameters, when enabled; always have the same fixed values.You can modify limits for any of the monitored parameters. Factory-set default values appear for alarm limits when you initially power up the unit. Factory default settings and ranges for alarm limits are shown on the table below. Refer to Alarmson page 2-3 for additional information on alarms.Table 1: Alarm Status and DisplayAlarm Status Bell DisplayAt least one alarm ON PresentAt least one alarm ON and violated FlashingAll alarms OFF Replaced with GAS ALM OFF in reverse videoAt least one alarm ON; alarms temporarily suspended by monitorReplaced with GAS ALM SUSP in reverse video (flashes if any alarm is violated)!• The VIEW ALARMS format with small text selected is the default display for all full screen remote. In this format, all text is cleared from the waveform zone and the labels and alarm limits of respiratory rate, EtCO2, O2, minimum CO2, and apnea are displayed. The VIEW ALARMS screen is the only format that displays the alarm limits.To set gas alarm limits:1Touch GAS.2Touch ALARM LIMITS.3Select the parameter for which you wish to set alarm limits.4Touch ON for the parameter selected in step 3.5Select the HI=, LO=, or APNEA= alarm.6Use the arrow keys to set the high and/or low alarm limits or the apnea alarm delay time.7Touch PREVIOUS MENU to select another parameter for setting alarm limits.8Repeat steps 3 through 7 until all limits are set.
Capnography21-9 * The current barometric pressure measurement affects the maximum high and low alarm limits for EtCO2 when measured in %.** Learned Alarm LimitsThe respiration rate alarm limits default as shown below: Condition LimitRR < 12 LO = 1 BPMRR > 12 LO = RR* 0.5 (truncated to the next lower resolution)RR < 20 HI = 30 BPMRR > 20 HI = RR* 1.5 (rounded to the next higher resolution)The EtCO2 high alarm limit defaults to the displayed value + 15% and is rounded to the next higher resolution, when needed. The EtCO2 low alarm limit defaults to the displayed value – 15% and is truncated to the next lower resolution, when needed.Table 2: Alarm Limit RangesMonitored Parameter UnitsLow Alarm High Alarm ResolutionMinimum Default Maximum Minimum Default MaximumEtCO2%0.0** 9.9 *0.1 ** 10.0 *0.1EtCO2 mmHg 0 ** 75 1 ** 76 1EtCO2kPa 0.0 ** 9.9 0.1 ** 10.0 0.1RR BPM 1 ** 145 15 ** 150 1 for 1 — 305 when > 30APNEA sec - - - 20 30 45 5MINCO2% - - - 0.1 1.0 9.9 0.1MINCO2mmHg - - - 1 8 76 1MINCO2kPa - - - 0.1 1.0 9.9 0.1O2% 15 18 95 20 100 100 1 for 1 — 305 when > 30!• If the current EtCO2 reading is 0 when the alarms are first turned ON, special EtCO2 limits are defined. If mmHg is selected, the high and low limits are set to 0 and 1, respectively. If % or kPa is selected, the high and low limits are set to 0.0 and 0.1, respectively.
Ultraview Care Network21-10Adjusting the Waveform SizeThe capnography waveform can appear on your monitor in three scale sizes: 0 to 40 mmHg (0 to 5.3 kPa), 0 to 60 mmHg (0 to 8.0 kPa), or 0 to 80 mmHg (0 to 10.7 kPa).Turning the Waveform Display On/OffYou can turn the capnography waveform ON or OFF.Selecting a Unit of MeasureYou can monitor capnography values as a percentage or with the monitor’s selected units of measurement for pressures (mmHg or kPa).Selecting a Sweep SpeedYou can view capnography waveforms at any of the following sweep speeds: 25, 12.5, 6.25, 3.12, or 1.56 mm/second. Respiration ToneYou can turn the respiration cycle tone ON or OFF, and adjust the volume of the respiration cycle tone that sounds at the peak of the respiration cycle. To adjust the waveform scale size:1Touch GAS.2Touch SETUP.3Touch SIZE.4Select the desired scale.To turn the waveform display ON or OFF:1Touch GAS.2Touch SETUP.3Touch SIZE.4Select WAVEFORM ON or OFF.To select a measurement unit:1Touch GAS.2Touch SETUP.3Select PERCENT or mmHg (kPa).To select a sweep speed:1Touch GAS.2Touch SETUP.3Touch SWEEP SPEED.4Select desired sweep speed.To turn tone OFF:1Touch GAS.2Touch SETUP.3Touch RESP TONE.4Select RESP TONE OFF.To adjust the tone volume:1Touch GAS.2Touch SETUP.3Touch RESP TONE.4Select RESP TONE ON.5Use arrow keys to adjust the volume.
Capnography21-11 Selecting a Text FormatYou can change display formats for capnography by switching between large and small text (refer to Display Detail on page 21-6).Freezing the WaveformYou can freeze the waveform display at any time. The waveform stays frozen until you press the FREEZE ON/OFF key again or until you press the NORMAL SCREEN key. Recording WaveformsYou can print Capnography waveforms and values. Refer to Printing on page 4-7 for additional information.Calibrating the SensorsCalibrating O2A ZERO calibration establishes baseline values for the oxygen channel. You are prompted to perform a ZERO calibration if it is required. A room O2 span calibration calibrates the oxygen sensor using room air. A 100% O2 span calibration sets the level for oxygen so that the display reads 100% when pure oxygen is input to the unit. For improved accuracy, a 100% O2span calibration should be performed whenever the patient is receiving more than 60% O2.!• To minimize patient disruptions, perform O2 zero and span procedures before the O2 adapter is placed in the ventilator circuit.!• Authorized service personnel also use the 100% O2 span calibration to calibrate the oxygen sensor’s response to 100% O2.To switch text formats:1Touch GAS.2Touch SETUP.3Select LARGE TXT or SMALL TXT.To freeze the gas waveform:1Touch GAS.2Select FREEZE ON.To print gas waveforms:1Touch RECORD.2Touch flashing GAS parameter. key.To calibrate O2 using room air1Touch GAS.2Touch CAL.3Touch O2CAL.4Disconnect O2 cell and touch ZERO.5Reconnect O2 cell.6Ensure that O2 cell is in room air7Wait for the O2 reading to stabilize.8Touch ROOM O2 SPAN.To calibrate O2by performing a 100% O2 span1Touch GAS.2Touch CAL.3Touch O2 CAL.4Flow 100% O2 through the O2airway adapter and wait for O2readings to stabilize.5Touch 100% O2 SPAN.
Ultraview Care Network21-12Calibrating the Airway AdapterAdapter calibration compensates for the optical differences between the adult and neonatal airway adapters. Adapter calibration needs to be performed each time you switch from an adult airway adapter to a neonatal airway adapter.Calibrating the CO2 SensorThe CO2 sensor does not require calibration at each power up. Calibration is only necessary the first time the sensor is connected, or when a CAL REQUIRED message is displayed.Once calibrated, the sensor can be unplugged and reconnected without being recalibrated. However, a sensor calibration is required whenever the CO2 sensor is changed. !• During calibration, keep the sensor and airway adapter away from all sources of CO2 (including the patient’s and your own exhaled breath, and ventilator exhaust valves).!• To maintain optimum performance of the sensor and capnograph, you should perform a calibration verification of the sensor at least once a week.To calibrate the airway adapter:1Touch GAS.2Touch CAL.3Select appropriate airway adapter (neonate or adult).4Place sensor head over the airway adapter.5Place the sensor and adapter away from all sources of CO2.6Touch ADAPTER CAL.7Touch START.To calibrate the CO2 sensor:1Remove the airway adapter from the sensor head (if present).2Place the sensor on the zero cell.3When the message ZERO CAL COMPLETE appears, remove the sensor from the zero cell and place it on the reference cell.4When the message CALIBRATION VERIFIED appears, remove the sensor from the reference cell (An airway adapter calibration may be required).5Sensor is ready for use.To verify the sensor calibration:1Remove the airway adapter from the sensor head (if present).2Place the sensor on the reference cell.3When the message CALIBRATION VERIFIED appears, remove the sensor from the reference cell (An airway adapter calibration may be required).4Sensor is ready for use.
Capnography21-13 Selecting Gas CompensationThe measurement of CO2 by infrared analysis is affected by the presence of oxygen and nitrous oxide. The module must be set up with the appropriate compensations turned on in order to obtain accurate end-tidal CO2 readings when increased levels of O2 (greater than 60%), or N2O (greater than 50%) are present in the airway. Restoring Default SettingsWith the Module Configuration Manager feature, you can restore all default settings. User-configurable options are listed in Setting User-Defined Default Values on page 7-7.!• High concentrations of O2 will cause a lower than expected CO2reading. • High N2O level will cause a higher than expected CO2 reading.To select gas compensation:1Touch GAS.2Touch COMP.3Select N2O ON, if N2O is greater than 50%.4Touch O2 AUTO to automatically select COMP, if O2cell is present.5Select O2 MAN, if no O2 cell is present.6Select O2 ON, if O2 is greater than 60%.To restore default settings:1Touch GAS.2Touch SETUP.3Touch RESTORE SETTINGS.4Select YES.
21-14Capnography Troubleshooting GuideThe capnography module displays error messages in the gas waveform zone. Many of these messages also trigger an alarm. If the menu line is available, the monitor displays messages there as well. The table below provides the text, meaning and suggested response to these messages.Problem or Message Probable Cause(s) Suggested Response Alarm SoundsSERVICE REQUIRED - Send for repair■Incompatible or faulty sensor.■Barometric pressure reading error.■Module self-test failure.■Return to factory for repair or use compatible sensor.■YesSENSOR OVER TEMPERATURE■Sensor is exposed to extreme heat.■Remove the excessive heat source from the sensor. If problem persists, return to factory for repairs.■YesWARMING UP ■Module or sensor was just plugged in.■Allow 2- to 5-minutes to warm up.■NoPLACE ADAPTER IN RM AIR■The adapter calibration menu is accessed.■Either place the sensor head and the airway adapter in room air and start an airway adapter calibration, or leave the adapter calibration menu.■NoADAPTER CAL IN PROGRESS■An airway adapter calibration sequence is in progress.■Wait until adapter calibration is completed and message goes away.■NoADAPTER CAL ERROR -Perform adapter calibration■An error was found during the airway adapter calibration.■Place the sensor head and the airway adapter in room air and away from any source of CO2 and perform an airway adapter calibration. If the problem persists, return to factory for repairs.■YesNOT CALIBRATED -Place adapter in room air■An airway adapter calibration was started, but either the sensor was not ready, or the sensor was on the zero or reference cell, or some CO2 or a breath has been detected in the last 20-seconds.■Place the sensor head and the airway adapter in room air and away from any source of CO2 and perform an airway adapter calibration. If problem persists, return to factory for repairs.■Yes
21-15 ADAPTER ERROR -Check airway adapter■Airway adapter was removed from the sensor head.■Snap airway adapter back into the sensor head.■Yes■Optical blockage on airway adapter windows.■Clean or replace the airway adapter.■Yes■Adapter calibration was not performed.■Perform an airway adapter calibration.■YesCO2 CAL IN PROGRESS ■A zero calibration of the CO2sensor is in progress.■Wait for the message ZERO CAL COMPLETE to appear.■NoZERO CAL COMPLETE -Place sensor on REF cell■A zero calibration of the CO2sensor was completed successfully.■Remove the sensor head from the zero cell and place it over the reference cell.■NoCO2 ZERO CAL ERROR -Perform zero calibration■An error was found during the sensor zero calibration■Perform a zero and a reference calibration. If the problem persists, return sensor to factory for repairs.■YesSENSOR ERROR -CO2 zero cal required■A drift of the source current is detected since the last time that the sensor was either plugged in or zeroed.■Perform a zero and a reference calibration. If the problem persists, return sensor to factory for repairs.■YesCHECKING CALIBRATION ■A span or reference calibration of the CO2 sensor is in progress.■Wait for the CALIBRATION VERIFIED message to appear.■NoCALIBRATION VERIFIED -Remove sensor from cell■A reference calibration of the CO2 sensor was completed successfully.■Remove the sensor head from the reference cell and place it over the airway adapter.■No!• The unit does not analyze patient data while the monitor displays the above messages.Problem or Message Probable Cause(s) Suggested Response Alarm Sounds
21-16Problem or Message Probable Cause(s) Suggested Response AlarmSoundsLow or high CO2 values are observed■An airway adapter and/or sensor calibration is needed.■Perform a zero and a reference calibration, make sure an appropriate airway adapter is selected, and perform an airway adapter calibration. If problem persists, return to factory for repairs.■NoADAPTER CALIBRATION ABORTED■The airway adapter calibration was aborted by the user.■Wait for the message to go away.■NoO2 ZERO COMPLETE ■The zero calibration of the O2sensor was completed successfully.■Wait for the message to go away.■NoO2 ZERO REJECTED Zero value too high■O2 cell was connected during zero.■Disconnect O2 cell and repeat the O2 zero.■No21% O2 SPAN COMPLETE■The span calibration of the O2sensor in room air was completed successfully.■Wait for the message to go away.■NoO2 SPAN REJECTED -Span value out of range■O2 cell was not functioning during the room O2 span.■Replace O2 cell perform room O2 span. If problem persists, return to factory for repairs.■No■O2 cell was not in room air. ■Place the O2 sensor in room air and away from any source of higher level oxygen and perform room O2 span. If problem persists, return to factory for repairs.■No100% O2 SPAN COMPLETE■The span calibration of the O2sensor using 100% oxygen was completed successfully.■Wait for the message to go away.■No100% O2 SPAN FAILED -O2 cell bad or 100% O2 not present■O2 cell is wearing out. ■Replace O2 cell and perform 100% O2 span. If problem persists, return to factory for repairs.■No■100% oxygen was not present in the O2 sensor airway adapter.■Make sure 100% O2 is present in the O2 sensor airway adapter and perform 100% O2span. If problem persists, return to factory for repairs.■No
21-17 O2 SPAN REQUIRED -Perform a ROOM O2 SPAN■O2 cell requires new span when initially plugged in.■Place the sensor in room air and away from any source of oxygen and perform room O2span. If problem persists, return to factory for repairs.■No■A drift in the O2 cell output voltage level was detected.■Place the sensor in room air and away from any source of oxygen and perform room O2span. If problem persists, return to factory for repairs.■NoProblem or Message Probable Cause(s) Suggested Response AlarmSounds
22-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.Multigas DirectoryDirectory of KeysGAS - CAL MENULIMITSALARM FREEZEON OFFSETUP CAL VIEWALARMS PRINTCHECK O2SENSORBAR. PRESS.SIZE SWEEPSPEEDLARGE TEXTSMALL TEXT25mm/sec12.5mm/sec6.25mm/sec3.12mm/sec1.56mm/secWAVEFORMON OFF 0-80 mmHg 0-60 mmHg 0-40 mmHgAPNEA RR ETCO2 I CO2 FiO2 I N2O I AGNTAPNEAON OFFHI =OFFAPNEARRAPNEARRHI =OFFLO =OFFRRON OFFGASGAS - ALARM LIMITS MENU - APNEAGAS - ALARM LIMITS MENU - RRGAS - ALARM LIMITS MENUGAS - MAIN MENUGAS - SETUP MENUGAS - SETUP MENU - SWEEP SPEEDGAS - SETUP MENU - SIZE0-5.0 kPaSUSPENDSAMPLINGPUMPSPEED50ml/min100ml/min150ml/min75ml/min125ml/min175ml/min200ml/min XXX mmHgE N2OGAS - SETUP MENU - PUMP SPEED PERCENTmmHg (kPa)E AGNTAGENTSELECTHAL ENF ISO SEVGAS - SELECT AGENT MENU - AGENT TYPE DETECTED: XXXDESIDAUTO0-10.0 kPaFeO20-7.5 kPa100% O2SPANSERVICECAL MODESee yourSystem Administratorfor access to this key
Contents22-3 MultigasOverviewThe Spacelabs Medical Multigas Analyzer simultaneously monitors gas concentrations and alerts clinical personnel when the concentration of anesthetic agents, oxygen, carbon dioxide, or nitrous oxide falls outside of defined limits. The anesthetic agent being administered is automatically identified.The analyzer is for use primarily in the operating room, but can be used with any Ultraview monitor.Although the analyzer sounds an alarm when the duration between monitored breaths exceeds user-defined limits, it is not intended to be a primary diagnostic apnea monitor and/or recording device.Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Warnings and Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Analyzer Controls and Indicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Multigas Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Patient Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Replacing the Water Trap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Replacing the Gas Analyzer Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Setting Alarm Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Waveform Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Selecting a Text Format. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Selecting a Unit of Measure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Selecting an Agent ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Selecting Stand By Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Selecting a Pump Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Initiating a Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Suspending Sampling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Multigas Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Ultraview Care Network22-4Warnings and CautionsWarningsThe life or health of a patient, clinical staff member, multigas analyzer operator, or other persons may be endangered if the items in this Warnings section are not followed.WARNING:• Always test the sampling line adapter for a tight connection and proper operation before attaching to a patient.• To protect the patient’s safety, do not silence, suspend, or disable audible alarms without providing continuous, direct observation of the patient.• Connect the sample gas outlet on the monitor’s rear panel to the scavenging system to prevent pollution of the room air.• Always turn the power off and unplug the analyzer before cleaning to protect against electrical shock.• To avoid explosion hazards, flammable anesthetic agents such as ether and cyclopropane must not be used in the analyzer. • Only halothane (HAL), enflurane (ENF), isoflurane (ISO), sevoflurane (SEV), and desflurane (DES) are suitable for use with the analyzer. If any other halogenated anesthetic agent is present, it will be misidentified and/or will interfere with the reported anesthetic agent concentrations.• The use of antistatic or electrically conductive breathing tubes when using high-frequency electrosurgery equipment may increase the risk of burns and is, therefore, not recommended in any application of this anesthetic monitor.• The analyzer is not intended for use in an MRI environment.
Multigas22-5 CautionsEquipment may be damaged or cease to function properly if the items in this Cautions section are not followed. CAUTION:• When administering anesthetic agents, incorrect agent identification may occur when a mixture of two or more anesthetic agents occurs in the sample circuit.• Always verify your vaporizer setting when administering anesthetic agents.• Use only original Spacelabs Medical sampling lines and accessories; other sampling lines may cause inaccurate readings and malfunctions.• The diameter of the scavenging system line must be two to three times larger than the sample line tubing to avoid changes in the operating pressure of the monitor, and consequential inaccurate readings or internal damage.• Route the scavenger hose so that it does not kink during operation of the monitor. A kinked or partially kinked scavenger hose can impair performance of the monitor.• If the patient’s airway is configured with a closed suctioning system, the airway adapter must be placed near the suctioning system (on the ventilator side). This helps to ensure that the sampling adapter is not impaired during and after suctioning.• Do not use cellular phones or other wireless communications equipment near the analyzer.!• Check the disposable water trap regularly during monitoring. Replace the water trap when full.• Between patients, replace the sampling line and check the disposable water trap. Replace the water trap when full.• The Spacelabs Medical sampling lines are for single-patient use only. Cleaning deteriorates the properties of the sampling line, resulting in slower response time and more frequent occlusions• Before you administer nebulized drugs to a patient that is connected to the multigas analyzer, you must disconnect the sample line from the patient or stop the pump by using the SUSPEND SAMPLING key.• To facilitate disconnecting and reconnecting the sample line, use a T-connector in the patient airway circuit and keep the sampling suspended, until all nebulized drugs have cleared from the patient’s airway.
Ultraview Care Network22-6Analyzer Controls and IndicatorsFigure 22-1: Analyzer front panel controls and indicatorsFigure 22-2: Analyzer rear panel controls and indicatorsPOWER ONOCCLUSIONWATER TRAP FULLSTAND BYGas analyzer filter Water trapStand by switchSample lineaccess doorProduct Orientation UpSDLC connectorFuse blockPower switchScavenger portAC power input receptacle Fan grill!!SDLC J2J3J4MAINSUSE SPECIFIED FUSES50/60 Hz1A/100-240V~T1.0A/250VPbCAUTION
Multigas22-7 Multigas SetupBefore you put the unit into service, it must be unpacked and the exterior inspected for visible damage. A biomedical technician or an authorized Spacelabs Medical customer service representative should inspect the interior and exterior of the analyzer for signs of visible damage. Instructions for these procedures are in the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx).Figure 22-3: Monitor connectionCAUTION:• The diameter of the scavenging system line must be two to three times larger than the sample-out tubing to avoid changes in the operating pressure of the monitor, and consequential inaccurate readings or internal damage.• Route the scavenger hose so that it does not kink during operation of the monitor. A kinked or partially kinked scavenger hose can impair performance of the monitor.To connect the multigas analyzer: 1Verify that the power cord is connected as required by local standards.2Assemble the cables necessary for the desired configuration. (Refer to 90518Multigas Analyzer Service Manual,P/N 070-0643-xx.)3Connect the T-cable assembly between the multigas analyzer and the monitor.4Connect the SDLC terminator to the T-cable.5Connect the hospital scavenging system to the scavenger port.Multigas AnalyzerSDLC terminatorSDLCconnector .........T cableincluded with the analyzerMonitorScavengerport
Ultraview Care Network22-8Patient ConnectionRespiration can be monitored via a nasal cannula, an oxygen mask, or an airway and endotracheal or tracheostomy tube. There are several variations of closed circuit tracheal suction systems that can be used with Spacelabs Medical multigas units.Figure 22-4: Example of sidestream multigas setup for an adultThe sample line must be connected to the disposable water trap and patient circuit. Connect the line to the water trap prior to the insertion of the water trap onto the analyzer to protect the sample port.CAUTION:• If the multigas analyzer is powered on before the patient monitor, communication might not be initiated. Make sure the patient monitor is powered on first.• Use only original Spacelabs Medical sampling lines and accessories. Other sampling lines may cause inaccurate readings and malfunctions. The analyzer must use a sample line that is fabricated from a special material. Use of other sample lines results in erroneous readings. This sample line is color-coded as blue and is available from Spacelabs Medical.• If you use the multigas analyzer with setups that do not include the Spacelabs Medical approved gas analyzer filters, and service inspection determines that patient fluids have contaminated the unit, your warranty will be nullified.!• Use the filtered gas sampling tee when you operate the analyzer on patients that emit excessive mucous. This prevents patient fluids from clogging the sample line.To start multigas monitoring when the unit is OFF:1Plug the device power cord into an AC power outlet and assure that the unit is connected to a monitor.2If not present, insert the gas analyzer filter above the water trap and close the lid.3If not present, insert the water trap with the patient connector on the right side.4Check to make certain the Stand By switch is OFF (in the “out” position). 5Turn power to patient monitor ON.6Turn power to gas analyzer ON (ON/OFF switch on back of unit).7Prepare the patient according to hospital procedures.8Allow the analyzer to warm up for a minimum of 2-minutes. Full accuracy is achieved after 30-minutes.9Connect one end of the gas sample line to the gas sampling tee or breathing circuit and connect the other end to the water trap luer connection.10 Check for a good seal at the top of the water trap.11 During the use of anesthetic agents, ensure that the scavenge line connects to the scavenger port on the multigas analyzer's rear panel.ventilator circuitendotracheal tubegas samplingteeelbow
Multigas22-9 Prior to connecting to the patient airway, verify that there are no leaks in the sample line, water trap, and gas analyzer filter by sealing the end of the sample line with your thumb. After approximately 15-seconds, the Occlusion LED lights and an occlusion message appears on the monitor. If this does not occur within 30-seconds, check for an air leak by removing and carefully reinstalling the water trap, the gas analyzer filter, and/or the sample line. Repeat the test.Closed Circuit Tracheal Suction SystemsClosed circuit tracheal suction systems (such as those provided by Ballard) extend the life of the endotracheal tube and associated tubing by allowing the endotracheal tube to be periodically suctioned without detaching it from the ventilator circuit. Spacelabs Medical recommends use of Ballard Model #221 elbow closed tracheal suction systems, or similar systems, with Spacelabs Medical capnography units. Such a system allows the Spacelabs Medical airway adapter to be placed outside the tube through which fluids are being suctioned, reducing the chance of occluding the airway.Spacelabs Medical does not recommend use of traditional setups that require the airway adapter to be in line with the endotracheal tube. However, if you prefer a traditional setup such as the Ballard Model 2205 style, using the Ballard Model 112 adapter moves the airway adapter away from the suction catheter.Figure 22-5 shows examples of setups using the Ballard Model #221 and Model 2205 style (with Model 112 adapter). Similar closed systems, such as the Concord Portex (not shown), must be placed in the ventilator circuit in the same positions as shown in Figure 22-5.Figure 22-5: Ballard setupsWARNING:• Always test the sampling line adapter for a tight connection and proper operation before attaching to a patient.suction catheterBallard Adapter #112ventilator circuitmainstream airway endotracheal tubeBallard closed tracheal suction systemendotracheal tubeventilator circuitsuction catheterwith adapter (Model 2205/Adapter #112)Ballard elbow closed tracheal suction system (Model 221)oradapter adapter mainstream airway sensor headsensor head
Ultraview Care Network22-10OperationCO2, N2O, and anesthetic agents are measured by drawing a sample gas stream into the measuring chamber. The absorption of different infrared light wavelengths is measured here. These measurements are compared to a zero concentration light level to calculate the different gas concentrations. Oxygen concentration is measured using the micro-fuel cell sensing technology. During the sensing process, the oxygen molecules in the sampled gas diffuse through the sensing membrane and become reduced at the sensing electrode, creating a current signal. The current signal is proportional to the oxygen partial pressure in the sampled gas. The fast response of the oxygen measurement is achieved by combining a unique design of the pneumatic sampling system, fast sensing membrane, and state-of-the-art signal processing electronics. Because this method of measurement has a fast response time, inspired and expired values of O2 can be reported. This method of O2measurement requires periodic replacement of the sensor. The user must perform routine calibration checks to determine when replacement is needed. Refer to Initiating a Calibration on page 22-19 for further details.The analyzer uses a side-stream sampling technique to acquire respiratory gases from an endotracheal tube, nasal cannula, or mask. A constant-flow vacuum system maintains the flow rate through the sample line.The analyzer is equipped with an external water trap to prevent humidity, water drops, and patient secretions from contaminating the unit or affecting the accuracy of the gas measurements. The water trap collects water drops that condense in the sample line. A “Water Trap Full” indicator warns you that the water trap should be replaced. The analyzer is also equipped with a filter as a second line of defense in case the water trap overflows or nebulized drugs are accidently drawn into the sample line. After the gas sample passes through the water trap and filter, it passes through a Nafion tube that is inside the analyzer. This helps to equalize the humidity of the gas sample so that it is close to the humidity of ambient air.WARNING:• If any halogenated anesthetic agent other than halothane, enflurane, isoflurane, sevoflurane, or desflurane is present, it will be misidentified and/or will interfere with the reported anesthetic agent concentrations.CAUTION:• When administering anesthetic agents, incorrect agent identification may occur when a mixture of two or more anesthetic agents occurs in the sample circuit.• Always verify your anesthetic vaporizer setting when administering anesthetic agents.
Multigas22-11 The analyzer automatically compensates for the ambient barometric pressure to ensure accurate readings. Both CO2 values may appear in partial pressure (in mmHg or kPa) or in percent.Powering ON the UnitBefore powering the multigas analyzer ON, make sure it is attached to a patient monitor and the Stand By switch on the gas analyzer is OFF (in the “out” position). Press POWER ON/OFF located on the rear panel of the analyzer. The patient monitor must be powered on prior to powering on the analyzer.When you first power ON a properly installed multigas device, the green power-on LED lights within 5-seconds. Within 30-seconds the patient monitor displays the vertical GAS parameter key adjacent to a flat waveform.If this does not occur, verify that the POWER ON/OFF button is pressed and appears green, and that the front panel STAND BY button is not pressed. The analyzer must be connected to an AC power outlet. Verify that the appropriate SDLC cable and terminator are connected from the unit to the monitor (refer to the 90518 Multigas Analyzer Service Manual, P/N 070-0643-xx). If the monitor or the module housing has a SDLC switch, check that the switch is in correct position (refer to the operations manual for the monitor or module housing). If the GAS parameter key does not display on the monitor, turn the power to the analyzer OFF, then turn the power to the monitor OFF. Power ON the monitor again, and then power on the analyzer again.CAUTION:• The analyzer cannot be operated without a water trap and a gas analyzer filter installed.• Replace the water trap and gas analyzer filter as needed. Verify the water trap is not broken as a result of connecting the sample line fitting too tightly or by tugging on the sample line. To verify, place a finger over the end of the sample line and wait for the alarm. Check the sample line connection on the water trap for damage. A broken water trap results in low values due to room air entrainment. If a span calibration is performed with a broken water trap, patient values will be unusually high. Refer to Initiating a Calibration on page 22-19 and Replacing the Gas Analyzer Filter on page 22-12 for details.!• Check the disposable water trap regularly during monitoring. Replace the water trap when full.• Between patients, replace the sampling line and check the disposable water trap. Replace the water trap when full.% Gas = PARTIAL PRESSURE GAS x 100%BAROMETRIC PRESSURE!• Respiration rate and alarm limit accuracies are not specified above 100 breaths per minute.
Ultraview Care Network22-12No multigas analyzer data appears during the warm-up period following power-on. Data first appears during the stabilization period.Upon initiation of power, all factory-default settings will be re-established. Any modifications made to the default settings (alarm limits, text display, etc.) prior to cessation of power will be lost.Replacing the Water TrapThe water trap must be disposed of when full. To remove the water trap, grasp the water trap firmly and pull it down from underneath, then lower it from the assembly.To install a new water trap, grasp it from the bottom and insert it up and into the assembly.Replacing the Gas Analyzer FilterThe gas analyzer filter must be disposed of when occluded. To remove the gas analyzer filter, lift the filter door, grasp the filter tab, lift up, and remove.To install the filter, open the filter door, hold the filter by the tab (with the gasket down) and place it into the recess. Close the door after insertion.Display DetailWhen you connect the multigas device to a monitor, the waveform area is displayed in one of four formats, the large and small text formats in normal or VIEW ALARMS modes. Instructions for choosing a format are detailed later in this manual.The full screen, large text format is the default display for bedside monitors. The full screen, small text format in VIEW ALARMS is the only display format for the full screen remote view monitors. The split screen central format is available only for central monitors operating in split screen mode. (Refer to Figure 22-10).!• The analyzer is protected against the effects of a cardiac defibrillation discharge, and it is safe to use on patients with a cardiac pacemaker or other electrical stimulation.CAUTION:• The warm-up period is less than 2-minutes with full accuracy after 30-minutes. You may use it prior to full warm up but be aware of possible inaccuracies in gas analysis.WARNING:• The used water trap and gas analyzer filter may contain hazardous fluids and should be disposed of in accordance with hospital procedures.
Multigas22-13 Figure 22-6: Full screen, large textFigure 22-7: Full screen, small textFigure 22-8: Full screen, large text, with VIEW ALARMSFigure 22-9: Full screen, small text, with VIEW ALARMSI N2O 6 2.51.721170.520%I AGNTE AGNT%FeO2%FiO2%I CO2%쐃RRbpm GAS 5E N2O%%5.2 ETCO2%쐅쐈GASETCO2=5.2%RR=20BPMFiO2=21%I N2O=6%I AGNT=2.5%GASETCO2 7.52.52.0I CO2APNEARRI N2O FiO2FeO2 30301015 40202515I AGNTE AGNT4.50.03.00.05E N2O 1500.5 I CO2%5.2 ETCO2%쐈GASETCO2=5.2%RR=20BPMFiO2=21%I N2O=6%I AGNT=2.5%ETCO2 7.52.52.0I CO2APNEARRI N2O FiO2FeO2 30301015 40202515I AGNTE AGNT4.50.03.00.05E N2O 150
Ultraview Care Network22-14Figure 22-10: Split screen, central with numeric key display Agent Parameter Label ViewWhen in AUTO ID mode, the inspired and expired agent labels are displayed in normal video, and in the MANUAL mode, the labels are displayed in reverse video.In MANUAL mode, full-screen large text view, the mixed condition is reported by displaying MIX under the parameter label area next to the units of measure. In the full-screen small text view, the parameter labels alternate between the mix label and agent type label. In AUTO ID mode, the agent labels are replaced by “I MIX” and “E MIX”.No Breath Mode ViewNormal mode of operation is in effect as long as breathing is detected. Twenty seconds after the last breath is detected, the analyzer switches to “no breath mode” automatically and the EtCO2, Resp rate, expired agent, FeO2, and expired N2O numeric values are shown as ???. The momentary data is displayed in place of the inspired numeric values.Inspired nitrous oxide data Fractional expired O2Inspired agent Expired agentFractional inspired O2쐅Expired nitrous oxide dataRespiration rate in breaths/minute 쐈Inspired carbon dioxide dataAlarms ON bell (refer to Table 1 on page 22-15) 쐉Apnea alarm setting (the delay value)End tidal carbon dioxide data 씈Bed ID and patient name (remote displays only)Gas screen keyGASBED1 DANIELS, RI CO2=0.5%RR=20BPMFiO2= 21%I AGNT=2.5%I N2O=6% ETCO2=5.2% APNEA=30sFeO2=17% E AGNT=1.7% E N2O=5%RR=20BPMFiO2= 21%I N2O=6% ETCO2=5.2% Numeric key display쐈쐉씈쐅
Multigas22-15 Setting Alarm LimitsYou may set alarm limits for the following:• Apnea (delay is measured in seconds) - high limit• RR (respiratory rate) - high and low limits•EtCO2- high and low limits•I CO2- high limit•FiO2 - high and low limits•FeO2 - high and low limits• Inspired and Expired N2O - high and low limits• Inspired and Expired Agent - high and low limitsWhen alarm limits for EtCO2 and RR are initially enabled, the limit values depend upon the patient’s current readings for those parameters (these limit values are learned). Alarm limits for all other monitored parameters, when enabled, always have the same fixed values.Factory-set default values appear for alarm limits when you initially power up the multigas unit. You may modify limits for any of the monitored parameters. These modifications will remain in check until the unit is turned off or placed on Standby. Default settings and ranges for alarm limits are shown in Table 2 on page 22-16. Refer to Alarms on page 2-3 for additional information on alarms.The VIEW ALARMS display format is the default for all full screen remote and central monitors. In this format, all text is cleared from the waveform zone and ten sets of parameter labels and their alarm limits are displayed. This is the only mode that displays all alarm limits. Table 1: Alarm Status and DisplayAlarm Status Bell DisplayAt least one alarm ON PresentAt least one alarm ON and violated FlashingAll alarms OFF Replaced with GAS ALM OFF in reverse videoAt least one alarm ON; alarms temporarily suspended by monitorReplaced with GAS ALM SUSP in reverse video (flashes if any alarm is violated)To set gas alarm limits:1Touch GAS.2Touch ALARM LIMITS.3Select the parameter for which you wish to set alarm limits.4Touch ON for the parameter selected in step 3.5Use the arrow keys to set the high and low alarm limit or the apnea alarm delay time.6Touch PREVIOUS MENU to select another parameter for setting alarm limits.7Repeat steps 3 through 6 until all limits are set.
Ultraview Care Network22-16* The current barometric pressure measurement affects the maximum high and low alarm limits for EtCO2 when measured in %.** Learned Alarm LimitsThe respiration rate alarm limits default as shown below: Condition LimitRR < 12 LO = 1 BPMRR > 12 LO = RR x 0.5 (truncated to the next lower resolution)RR < 20 HI = 30 BPMRR > 20 HI = RR x 1.5 (rounded to the next higher resolution)The EtCO2 high alarm limit defaults to the displayed value + 15% and is rounded to the next higher resolution, when needed. The EtCO2 low alarm limit defaults to the displayed value – 15% and is truncated to the next lower resolution, when needed.Table 2: Alarm Limit RangesMonitored Parameter UnitsLow Alarm High Alarm ResolutionMinimum Default Maximum Minimum Default MaximumEtCO2 %0.0 ** 9.9 *0.1 ** 10.0 *0.1EtCO2 mmHg 0 ** 79 1 ** 80 1EtCO2 kPa 0.0 ** 9.9 0.1 ** 10.0 0.1I N2O%0075580805E N2O%0075580805RR BPM 0 ** 170 15 ** 175 1 for 1 - 305 when > 30APNEA sec - - - 20 30 45 5I CO2% - - - 0.1 1.0 9.9 0.1I CO2 mmHg - - - 1 8 80 1I CO2 kPa - - - 0.1 1.0 9.9 0.1O2 Inspired (FiO2)- 18 18 95 20 100 100 5 when > 30Otherwise 1O2 Expired (FeO2)- 15 18 95 20 100 100 5 when > 30Otherwise 1Inspired AgentHAL, ISO, ENF, DES, SEV% 0.0 0.0 19.9 0.1 3.0 20 0.1Expired AgentHAL, ISO, ENF, DES, SEV% 0.0 0.0 19.9 0.1 3.0 20 0.1!• If the current EtCO2 reading is 0 when the alarms are first turned on, special EtCO2 limits are defined. If mmHg is selected, the high and low limits are set to 0 and 1, respectively. If % or kPa is selected, the high and low limits are set to 0.0 and 0.1, respectively.
Multigas22-17 Waveform DisplayAdjusting Waveform SizeThe CO2 waveform can appear on your monitor in any of three scale sizes: 0 to 80 mmHg, 0 to 60 mmHg or 0 to 40 mmHg (0 to 10.0 kPa, 0 to 7.5 kPa, or 0 to 5.0 kPa).Turning the Waveform Display OffTo reduce display clutter, the multigas waveform can be turned off while leaving the numerics visible. When the waveform is off, the size adjustment, sweep speed, and freeze keys are disabled.Selecting a Sweep SpeedYou can view this waveform at any of the following sweep speeds: 25, 12.5, 6.25, 3.12, or 1.56 mm/second.Freezing the WaveformYou can freeze the gas waveform display at any time. The waveform stays frozen until you press the FREEZE ON/OFF key again or until you press the NORMAL SCREEN key. When the waveform is frozen, the SIZE key in the SETUP menu is disabled.Selecting a Text FormatYou can change display formats for multigas by switching between large and small text (refer to Display Detail on page 22-12).Small text allows clear visualization of the waveform. However, It is recommended that large text be used for routine monitoring.Selecting a Unit of MeasureYou can monitor CO2 values as a percentage (%), as millimeters of mercury (mmHg) or kilo Pascal (kPa). If you want to use % as the measurement, press the PERCENT/mmHg (kPa) key until PERCENT is highlighted. If you want to measure in mmHg (kPa), press the PERCENT/mmHg (kPa) key until mmHg (kPa) is highlighted. To adjust the waveform scale size:1Touch GAS.2Touch SETUP.3Touch SIZE.4Select the desired scale size.To turn the waveform display OFF:1Touch GAS.2Touch SETUP.3Touch SIZE.4Select WAVEFORM OFF.To select a sweep speed:1Touch GAS.2Touch SETUP.3Touch SWEEP SPEED.4Select desired sweep speed.To freeze the gas waveform:1Touch GAS.2Select FREEZE ON.To switch text formats:1Touch GAS.2Touch SETUP. 3Select LARGE TEXT or SMALL TEXT.To select a measurement unit:1Touch GAS.2Touch SETUP.3Select PERCENT or mmHg (kPa).
Ultraview Care Network22-18Selecting an Agent IDYou can manually choose an agent type by touching the SELECT AGENT key in the main menu which opens the agent selection sub-menu. The prompt line above the sub-menu identifies the detected agent: DES, SEV, ISO, HAL, ENF. MIX is displayed if more than one agent is detected, and NONE if the agent type is not identified.Touching the AUTO ID key sets the analyzer to automatically use the agent type detected. The five agent keys are the manual agent selection keys. Selecting one of the agent keys forces the analyzer to use and report the concentration levels based upon coefficient factors of the manually selected agent.Agent ID Conflict DetectionIn AUTO ID mode, if nonzero concentration levels are reported for more than 2-minutes and the agent type is not detected, a conflict is declared and the AUTO ID key flashes. In manual mode, when an agent type other than the selected agent type is detected, a conflict is declared and the key with the detected agent type flashes. When a conflict is declared, the agent parameter areas flash on all screens also.The conflict is confirmed and the flashing of the keys and agent parameter areas stops when either a selection is made in the Select Agent menu (a key is touched) or the Select Agent menu is exited.Conflict detection is restarted if:• the agent concentration level goes to zero for more than 2-minutes.• an agent type is selected that is not the type currently selected and not the first agent type in conflict.WARNING:• In the event an agent is selected manually, but not administered, the analyzer will detect the difference and begin flashing the agent parameter label area and the detected agent’s key. This is to alert the clinician to possible errors.CAUTION:• If you see AGNT or MIX next to the numeric values on the display, wait until HAL, ISO, ENF, SEV, or DES only appear on the screen to indicate that the multigas analyzer recognizes the agent you are using. The displayed values are based on the coefficient factors of the last detected or selected agent type. If the last detected or selected agent is different than the agent you are using, you may receive inaccurate values. Confirm the agent type before you continue with patient treatment.To select Auto Agent ID:1Touch GAS.2Touch SELECT AGENT.3Touch AUTO ID.To select Agent ID manually:1Touch GAS.2Touch SELECT AGENT.3Select HAL, ENF, ISO, SEV, DES.
Multigas22-19 Selecting Stand By ModeStand By mode should be used for short durations only (for example, case turnover). The Stand By feature keeps the unit warmed up.The Stand By mode is not to be used in place of the power on/off. If the unit is in Stand By mode and loses power (for example, if the unit is unplugged during moving), when power is re-initiated, the analyzer may not display on the patient monitor. It is best to use Stand By mode under supervision.Press the front panel STAND BY button to initiate the Stand By mode. The pumps stop drawing sampled gases, the analyzer display disappears from the monitor screen, and the STAND BY light illuminates. Press STAND BY again to return the analyzer to its normal operating mode when multigas monitoring is needed again. Selecting a Pump SpeedYou may select any of the following volumes of sampled gases that are drawn for use in measuring gas values: 50, 75, 100, 125, 150, 175, or 200 ml/min, or you may suspend sampling (pumps off). The unit defaults to 175 ml/min whenever it is turned on.Initiating a CalibrationDaily O2 Sensor TestThe oxygen channel may drift slightly over time; therefore, an O2 sensor test should be performed daily. This test uses room air to check for aging of the oxygen sensor and may be performed at any time (except during the first 4-minutes of operation). This check does not require special equipment or additional gases.If drift or aging of the sensor is detected, the 100% O2 SPAN REQUIRED message will be displayed and a 100% O2 span must then be performed to calibrate the O2 sensor for high concentration levels (>60%) of oxygen.Further action is needed if an O2 SPAN FAILURE message or an O2 SPAN REQUIRED message displays on the screen. However, the gas analyzer is still functioning and all Agent, CO2, and N2O values remain accurate. The unit can be used until the required calibrations can be performed. To remove the message from the screen, simply touch the GAS key and then the NORMAL SCREEN key of the monitor.CAUTION:• If the unit is taken out of Stand By and the analyzer display does not appear on the patient monitor, turn the unit off and then power on correctly.WARNING:• The gas analyzer calibrations must be performed by qualified personnel.• The calibration should occur when the unit is not actively monitoring a patient.To start multigas monitoring from Stand By mode:1Press STAND BY to deactivate the Stand By mode (switch is “out”).2If the disposable water trap and filter are not present, install them now.3When multigas monitoring is no longer needed, press STAND BY (switch is “in”) or turn unit OFF (on back of unit). Do not disconnect power to the analyzer or the monitor.To select a pump speed:1Touch GAS.2Touch SETUP.3Touch PUMP SPEED.4Select desired pump speed.To check O2 sensor:1Turn unit on and allow warm up to occur (4-minutes).2Touch GAS.3Touch CAL.4Touch CHECK O2 SENSOR.5At completion of successful test, normal monitoring will resume.
Ultraview Care Network22-20100% O2 Span CalibrationThe 100% O2 Span is used to calibrate the response of the oxygen sensor to 100% O2. This function sets the level for oxygen so the monitor displays 100% when pure oxygen is input to the unit. The 100% O2 Span calibration should be performed monthly or whenever the FiO2 value is not between 98% and 100% when sampling pure (100%) oxygen. The 100% O2 calibration must be done correctly. A source of pure O2 with adequate flow is required to perform this calibration. Some institutions rely on their biomedical engineering department to perform this calibration. When the 100% O2calibration is completed successfully, the monitor displays a normal screen with measured values of all gases.Further action is needed if an O2 SPAN FAILURE message or an O2 CELL REPLACEMENT REQUIRED message displays on the screen. However, the gas analyzer is still functioning and all Agent, CO2, and N2O values remain accurate. The unit can continue to be used until the required action can be performed. To remove the message from the screen, simply touch the GAS key and then the NORMAL SCREEN key of the monitor.O2 Cell ReplacementTo change an O2 cell, plan on the analyzer to be out of operation for approximately 2-hours. Therefore, if the day begins with a CHECK O2 SENSOR calibration and it is found that additional calibration or O2 sensor replacement is required, you can simply schedule that within your department (when the biomedical engineers are available). You may continue to use the analyzer until there is time to re-calibrate the unit or change the sensor.Autozero CalibrationTo guarantee accurate readings, the zero reference of the multigas analyzer is automatically calibrated on a regular basis. Autozero calibrations last less than 1.5-seconds and are performed without notice to the user.The interval between autozero calibrations depends upon the amount of time the unit operates (either in normal or stand by mode). After the unit has been ON for at least 30-minutes, and has become thermally stable, autozero occurs in normal mode at approximately 10-minute intervals.CAUTION:• If the message ??? appears in the numerics of FiO2andFeO2 at any time you are monitoring a patient, you must perform a check O2 sensor test.CAUTION:• Performing a 100% O2 span calibration without using the proper concentration and flow of oxygen will result in span calibration failure.To span calibrate O2 sensor with 100% O2:1Allow unit to stabilize for 30-minutes.2Touch GAS.3Touch CAL.4Disconnect the sample line from patient.5Connect the sample line to the sampling port of an airway T-adapter.6Connect the airway T-adapter to a source of 100% oxygen supply.7Adjust the oxygen supply to flow through the T-adapter at a rate of approximately 500 ml/min.8Wait for O2 value to stabilize.9Touch 100% O2 SPAN.10 Select YES.11 At completion of successful test, normal monitoring will resume.
Multigas22-21 Pump CalibrationThis function is used by service personnel to adjust the pump flow rate. Refer to the 90518 Multigas Analyzer Service Manual P/N 070-0643-xx for details.Gas Span CalibrationA gas span calibration is recommended whenever gas values appear to be too low or too high. Always perform a leak test first to verify that the suspected values are not the result of a leak (poor connection, cracked water trap, etc.).The gas calibration (SPAN) procedure is used to recalibrate the gas channels for CO2, N2O, and anesthetic agents. This procedure should be done every 30-90 days. Equipment required for this calibration includes a gas mixture for the calibration, calibration adapter kit, gas pressure regulator, and flow meter. This equipment can be purchased from Spacelabs Medical Supplies Products.Refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details on calibrating the analyzer.WARNING:• Performing a gas span calibration without the calibrated gas mixture connected adversely affects the accuracy of the analyzer.• Gas span calibrations must be performed by trained personnel only.!• The waveform display and the numeric values may disappear during calibration.
Ultraview Care Network22-22Suspending SamplingSampling may be suspended by touching the SUSPEND SAMPLING key under the following conditions:• When suctioning a patient• Use (by the patient) is temporarily discontinued• Nebulized drugs are being usedThis stops the sampling pump and keeps the system free of debris. Touch the RESUME SAMPLING key to resume sampling.When sampling is suspended, the CAL key is disabled.Refer to Patient Connection on page 22-8 for examples of recommended suction system setups.CAUTION:• The sampling must be resumed for proper monitoring of respiratory gases.To suspend sampling:1Touch GAS.2Touch SUSPEND SAMPLING.3Touch RESUME SAMPLING when finished.
22-23 Multigas Troubleshooting GuideThe analyzer displays error messages in the gas waveform zone. Many of these messages also trigger an alarm. If the prompt line is available, the monitor displays messages there as well. Clinical Situation Possible Cause Solution Alarm SoundsFILTER DOOR OPEN - Close filter access door■The gas analyzer filter door is ajar.■Close the door by pressing it downward.■YesOCCLUSION -Check T-adapter, sample line■The sample line is blocked. ■Check the sample line for blockage or crimps, and replace as necessary. ■Yes■The gas analyzer filter is plugged. ■Replace the gas analyzer filter cartridge.■YesSPAN IN PROGRESS ■One of the span calibration procedures is in progress.■Wait until span calibration is completed and message goes away.■NoWARMING UP ■The unit is self testing or warming up. ■Wait until warm up completes before operating.■NoWATER TRAP ABSENT - Install water trap■There is no water trap installed in the holder.■Install a water trap. ■YesWATER TRAP FULL -Replace or empty■The water trap is full. ■Replace the water trap. ■Yes!• The unit does not analyze sampled gases while the monitor displays any of the above messages.
22-24Clinical Situation Possible Cause Solution Alarm Sounds100% O2 SPAN FAILED - Check 100% O2 gas supply, Check for leaks■Sampled gas supply does not have 100% O2 present when compared to room air O2.■Verify the O2 supply. Allow the analyzer to warm up for at least 30-minutes before attempting a 100% O2 span.■Yes■Air leak in external sample circuit. ■Check water trap, gas analyzer filter, and sample lines for air leaks. Replace all leaking components.■Yes■Air leak in internal sample circuit. ■Perform a unit leak test. Service may be required.■Yes■External/internal pressures may be out of operating range or measurement of the pressures has failed.■Check that the cell pressure in SERVICE CAL MODE is between 525-825 mmHg. If the cell pressure is greater than the barometric pressure, external sample circuit is over pressured, adjust circuit.■Yes■O2 cell linearity error. ■Contact your Biomed or your Spacelabs Medical service representative.■Yes■O2 concentration may be more than 23% or less than 19% in vicinity of the analyzer.■Check the room air around the analyzer for high O2concentrations. Successful completion of O2 span is not possible under this condition.■Yes■Repeat 100% O2 SPAN (refer to To span calibrate O2 sensor with 100% O2 on page 22-20). Contact a qualified service person if the span fails again after the above checks.100% O2 SPAN FAILED - O2 cell replacement required■O2 cell output is below acceptable levels, O2 values are disabled.■Contact your Biomed or your Spacelabs Medical service representative.■Yes100% O2 SPAN REQUIRED■Initial 100% O2 CAL required. ■Perform 100% O2 Span. ■Yes■CHECK O2 SENSOR determined need for 100% O2 Span to restore specified O2 accuracy.■Perform 100% O2 Span. ■YesO2 CELL REPLACEMENTREQUIRED■Previous O2 span determined that O2 cell has aged to the point of needing replacement.■Contact your Biomed or your Spacelabs Medical service representative.■Yes
22-25 O2 INSTALLATION FAILED - O2 install cal requires new O2 cell■Install cal detected an O2 cell output above or below the allowable threshold for a new O2 cell.■Contact your Biomed or your Spacelabs Medical service representative.■YesO2 SPAN FAILED - Check exhaust port■Scavenger port is blocked. ■Remove scavenger port blockage and repeat the SPAN. If the SPAN fails again, contact a qualified service person.■Yes■O2 sensor assembly output is very negative.■After checking exhaust port, if RAW = 0 in SERVICE CAL MODE, service is required. Replacement of the O2 sensor electronics assembly is indicated.■YesCAL GAS SPAN FAILED - Check span gas supply■The unit could not calibrate the gas channel.■Repeat the span. Contact a qualified service person if the span fails again.■Yes!• The unit does not analyze sampled gases while the monitor displays any of the above messages.• For the above messages, you can touch the GAS key and then the NORMAL SCREEN key to remove the message from the waveform zone and stop the alarm tone. However, the message will continue to display on the monitor’s prompt line. Whenever a span failure occurs, the previous calibration factors are not lost. The analyzer continues to function and report the gas values, but the full accuracy of the values are not guaranteed.Clinical Situation Possible Cause Solution Alarm Sounds
22-26Clinical Situation Possible Cause Solution AlarmSoundsHIGH VALUES OBSERVED■A span calibration was performed while there was a leak in the sample circuit.■Check connections and check for a broken water trap. Perform leak test. Verify the anesthesia delivery devices and vaporizer calibrations. Refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details.■Assure vaporizer accuracy.■NoLOW VALUES OBSERVED ■A leak exists at the sample line connection, a water trap is broken at the luer connection, or a gas analyzer filter is leaking.■Check connections and check for a broken water trap. Perform leak test. Verify the anesthesia delivery devices and vaporizer calibrations. Refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details.■No■Assure vaporizer accuracy. ■NoMinimum waveform deflection and very low or zero numeric values when breathing normally through a new or unused sample line■Clogged or missing gas analyzer filter.■Replace or install gas analyzer filter underneath the door above the water trap.■No■A large leak in the sample circuit.■Check connections and perform a leak test. Refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details.■NoMIX NOTE: This message appears in agent numerics area.■Agent mixture detected.■The analyzer is not designed to simultaneously measure multiple anesthetic agents. Inaccurate numeric concentration values may be displayed when two or more agents are mixed.■No■The displayed value of the mixed condition is based on the combined value of agents using the coefficient factors of the last detected or selected agent type.■No
22-27 ■When the analyzer detects an agent mixture:• In Auto ID Mode — The mixed condition is reported by displaying I MIX and E MIX as the agent labels on all screens.• In Manual ID Mode — In large text screen, the mixed condition is reported by displaying the word MIX under the parameter label area next to the units of measure. In the small text screen or the split screen central, the parameter labels will alternate between the mix labels in normal video and the selected agent-type labels in reverse video.■The display zones will continue with the above displays, until the mix of the agents has flushed from the patient and delivery system and a single agent identity has been detected.■Depending on the agents used, the residue in the patient, and the breathing or delivery system, mixed conditions can last for more than an hour.■If the message persists, contact a qualified service person.Zeros or ??? are displayed for one or more of the inspired gases (I N2O, I AGNT, FiO2, or I CO2)■No gas is being administered.■Administer gas. ■No■Sample line is not connected.■Check sample line connections, the water trap, and the filter above the water trap.■No■A leak in the system. ■Perform a leak test; refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for more details. ■No■Failure in one of the internal electronics parts.■Cycle the power to the analyzer. If the problems persist, contact a qualified service person.■NoClinical Situation Possible Cause Solution AlarmSounds
23-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.BIS DirectoryDirectory of KeysBIS - MAIN MENUALARMLIMITS SETUP TESTELECT PRINT STARTALARM LIMITS MENUHI=XXBIS SETUP MENUTIME SCALES MENU1HRYES NOEXITELECTBISCAUTIONON OFFALARMSON OFFPLOT SCALES MENU0-100 40-100 20-80SIZE MENU0-60PROCEDCLEAR DATA?LO=YYDISPLAYFORMATTIMESCALES SIZE SWEEPSPEEDPLOTSCALESADVSETUPDISPLAY FORMAT MENU13AUTOZONE ZONE ZONE2HR4HR8HR12HR24HRSWEEP SPEED MENU15 mm/sec 30 mm/sec 50 mm/secADVANCED SETUP MENULOWFREQRESTORESETTINGSHIGHFREQLINEFREQSAVESETTINGSLOW FREQ MENU0.25 HZ 1.0 HZ 2.0 HZHIGH FREQ MENU30 HZ 50 HZ 70 HZ NONELINE FREQ MENU50 HZ 60 HZ
Contents23-3 BISOverviewThe Spacelabs Medical 90482 Bispectral Index® (BIS®) Analysis module acquires and processes real-time EEG data into a BIS number between 0 and 100. The EEG data is also displayed as:•BIS• Spectral Edge Frequency (SEF)• Median Power (MF)• EMGL (EMG energy in the 70–110 Hz band)• Signal Quality Index (SQI)• Suppression Ratio (SR)The BIS module may be used in any of the Spacelabs Medical monitors listed in Table 1, with or without other Spacelabs Medical modules.The BIS module uses disposable BIS sensors from Aspect Medical, Inc., a Digital Signal Converter (DSC), and a patient interface cable.Table 1: BIS CompatibilityModel DescriptionMinimum Version of Software Required For Compatibility90363 Ultraview 1500 1.01.1090364 Ultraview 1600 1.03.0890369 Ultraview 1050 1.01.1090367 Ultraview 1030 1.01.1290385/6 UCW/RDI 1.04.3390387 Ultraview 1700 1.05.56Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Patient Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Initialization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Normal Bedside Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Remote View Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Split Screen Display Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Numeric Key Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12BIS Main Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Status Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Care and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Ultraview Care Network23-4Figure 23-1: Module, DSC, PIC, and sensorCAUTION:• Place the sensors as far away from the electrosurgery site as possible because considerable high frequency current may flow into the electrodes. This can cause patient burns, especially if a defect is present in the neutral cable of the electrosurgical unit. Placing electrodes too close to the electrosurgery site can also cause a noisy EEG trace. • Do not allow conductive parts of sensors or connectors, including the neutral electrode, to contact other conductive parts, including the ground. • Detach all connectors and cables by grasping the connectors and pulling them straight out. Do not detach connectors and cables by pulling on the cables themselves.BIS moduledigital signal converter (DSC)patient interface cable (PIC)BIS sensor
BIS23-5 Digital Signal ConverterThe digital signal converter (DSC) receives the EEG input from the patient and converts it to digital information that is processed by the module.Figure 23-2: Digital signal converterThe DSC plugs into the front of the module as shown in Figure 23-1.Patient Interface CableThe patient interface cable (PIC) is attached to the three-foot cable on the DSC and connects to the BIS sensor as shown in Figure 23-1.To attach the PIC to the BIS sensor:1. Remove the BIS sensor from its packaging. 2. Locate the small, raised arrows on both the light-blue end of the PIC connector and the BIS sensor connector.Plug the BIS sensor into the PIC so that the arrows are on the same side and point toward each other. You may attach the BIS sensor to the PIC cable either before or after the sensor is placed on the patient.!•The PIC is not a disposable cable. Do not dispose of it when you dispose of the attached BIS Sensor.• A cable tie is provided with the PIC to secure it to the DSC cable to prevent accidental disposal of the PIC.top view side view bottom viewend view
Ultraview Care Network23-6To replace a faulty or damaged PIC:1. Remove and discard the unusable cable. 2. Locate the end with a yellow dot on the PIC connector. 3. Engage the PIC connector and the DSC cable connector with the yellow dots oriented the same way, ensuring that they are fully seated. Patient PreparationTo prepare the patient for monitoring:1. Make sure the skin surface is clean and dry.2. Position BIS sensor circle #1 and BIS sensor circle #2 high on the center of the patient’s forehead approximately 1.5 inches above the bridge of the nose. 3. Apply BIS sensor circle #3 on either temple between the corner of the patient’s eye and the hairline.4. Insert the tab into the patient interface cable until it is fully engaged (if you prefer, you may do this step before applying the sensor to the patient).5. Using your finger, trace around the adhesive areas of the sensor, including the space between circles #1 and #2 to assure good adhesion and to prevent any bridging between the sensor elements. 6. Press each circle firmly and hold for 5-seconds to assure adequate prepping and to maximize sensor performance.InitializationBefore processing data, the BIS sensor must be applied to the patient.When the sensor is applied and the PIC and DSC are connected to the module, you are ready to begin BIS monitoring. 1. Touch BIS. 2. Touch START PROCED (refer to START/STOP PROCED Key on page 23-16). 3. Touch YES at the Clear Data? prompt, and the module will automatically perform an impedance test. CAUTION:• The BIS sensor will only work if it is placed on the patient’s forehead. Accordingly, it should not be used with any surgical procedure that precludes such placement.CAUTION:• Do not expose the BIS sensor to surgical skin preparation solutions. This may result in harm to the patient’s skin.
BIS23-7 If the test passes, an Impedance Test Passed message displays (Figure 23-3).Figure 23-3: Impedance Test Passed messageIf the test fails, an Impedance Test Failed message displays (Figure 23-4).Figure 23-4: Impedance Test Failed message!• You do not need to test electrode placement because this is done automatically when you touch START PROCED.Impedance Test PassedImpedance Test FailedImpedance Test PassedImpedance Test PassedImpedance Test Failed
Ultraview Care Network23-8Impedance ValuesIf the impedance value is too high, it could indicate that the BIS sensor is no longer making good contact and needs to be examined. Usually artifacts will signal this fact.After touching the TEST ELECT key, additional feedback is given to the user by flashing the impedance value when the value exceeds the threshold. (Refer to Impedance Montage on page 23-11 and TEST ELECT Key on page 23-15.) The Pass/Fail thresholds for the terminals are:• Ground < 100 Kohms• Center < 7.5 Kohms• Left/Right < 7.5 KohmsNormal Bedside Display FormatMonitor SoftwareThe full bedside view requires three waveform zones. The example in Figure 23-5displays the BIS plot and EMGL trends.Figure 23-5: BIS bedside display (3 zones)Analog WaveformA single waveform is displayed in a box that is 300 pixels wide by 60 pixels high. With this display, roughly 8-seconds of waveform data can be displayed at a sweep speed of 15 mm/sec, 4-seconds at 30 mm/sec, and 2.4-seconds at 50 mm/sec.!• In normal use, the typical impedance value for the ground is less than or equal to 6 Kohms, while the values for the center and left/right terminals are between 0.5 and 1.5 Kohms.• The user cannot control the impedance thresholds.
BIS23-9 Numeric ZoneThe numeric zone is to the right of the plot and the moving waveform on the monitor and is usually updated every 2-seconds. Some items, such as sweep speed, are only updated when the selection is changed.Display Fonts:• The BIS value is displayed in a large font.• The units of measure are displayed in a small font.• The remaining text is displayed in a small font.Figure 23-6: Plot area numericsAlarm DisplayWhen the alarms are turned ON, the high and low alarm limit values are displayed. When the alarms are turned OFF, BIS ALM OFF is displayed. When the alarms are temporarily suspended, BIS ALM SUSP is displayed.The alarm display consists of a block of reverse video text containing either BIS ALM OFF or BIS ALM SUSP. They are mutually exclusive, and only one will be displayed in the numeric area.• Turn the alarms OFF by touching ALARM OFF on the Alarm Limits menu.• Temporarily suspend the alarms by pressing the ALARM SUSPEND button on the monitor.Alarm SuspendPress the ALARM SUSPEND button on the monitor to temporarily turn off the audible alarm for 3-minutes. The text BIS ALM SUSP replaces the alarm limits. The BIS number continues to flash if the limit is exceeded.When the temporary time has elapsed, the display returns to normal behavior. If the audible alarm is enabled, the alarm tone will sound again, and the limit number will flash.In the split screen display, the bell symbol displays in reverse video when the alarms are enabled but suspended. During an alarm violation, the bell symbol flashes in reverse video.SR=0%SQI=100%EMGL=20dBSEF=30HzMF=30HzBISBIS valueSuppression Ratio valueSignal Quality Index valueAlarm limitsEMGL valueSpectral Edge Frequency valueMedian Power Frequency value6045
Ultraview Care Network23-10Top Line AnnotationThe top of the plot area contains two labels: • Primary trend label (BIS) • Secondary trend label (EMGL)Figure 23-7: BIS primary and secondary trendsWaveform AnnotationWaveform annotations are placed to the right of the moving EEG waveform (refer to Figure 23-8).Figure 23-8: Waveform zone annotationsThe analog scale size can be set at ±2, ±5, ±10, ±20, ±50, ±100, or ±200 µV. The analog scale limits are displayed with ± and µV in the label.+ 50µVL/R - CTR15 mm/s-50µVwaveform upper size scaleBIS sensor labelssweep speedwaveform lower size scale
BIS23-11 Impedance MontageIf, during BIS monitoring, you wish to test impedance without losing your trended data, you can perform an impedance test. An impedance test is automatically checked (or tested) every 10-minutes.The impedance montage is a temporary display that appears when the BIS sensor is connected to a patient and you touch the TEST ELECT key (refer to TEST ELECT Key on page 23-15). The montage displays on the right side of the screen to the right of the second wave zone area from the top. Figure 23-9: Impedance test displayRemote View Display FormatThe “Remote View” software option on Ultraview monitors allows you to view the BIS parameter from a remote monitor. This display shows the BIS plot in a single display zone format. No analog waveforms are available in this mode.Figure 23-10: Remote displayRemote monitors permit one display zone to be used to display remote channels from other monitors, regardless of the type and the number of zones that are in use at the bedside monitor. When viewing the BIS from another monitor, the lower part of the BIS trend will not be visible due to the patient’s name being there. !• All processing is suspended until you stop the impedance test by touching EXIT ELECT.
Ultraview Care Network23-12In the one zone or remote view mode, all numeric text must be compacted into one display zone height. In the remote view only, the BIS plot can have variable scaling and only the BIS value can be plotted. The scaling options for remote view are shown in Table 2.Split Screen Display FormatThe split screen display is shown in Figure 23-11.Figure 23-11: Split screen displayNumeric Key FormatThe numeric parameter key is labeled with the combined Bispectral Index value. You can display the BIS parameter as an icon on the bottom of the monitor screen. This allows other parameters to be displayed in the waveform zone. The full BIS display is restored whenever this icon is touched.Table 2: BIS Variable ScalingParameter Scaling Value for the LabelsBIS0-100 0, 50, 10040-100 40, 70, 10020-80 20, 50, 800-60 0, 30, 60!• A split screen display is available only on central monitors.2125/R=9.9 20%0%Imp L/R = 0.5KBIS=50 Bispectral Index value
BIS23-13 BIS Main MenuThe Main menu is the initial menu that displays when you touch the BIS key.Refer to the following sections for descriptions of each key:•ALARM LIMITS Key on page 23-13•SETUP Key on page 23-14•TEST ELECT Key on page 23-15•PRINT Key on page 23-16•START/STOP PROCED Key on page 23-16ALARM LIMITS KeyTouch ALARM LIMITS on the Main menu to display the Alarm Limits menu.This menu turns the BIS alarms ON or OFF, sets the upper and lower BIS alarm limits, and turns the Caution alarm ON or OFF.Setting Alarm LimitsTo raise or lower each alarm limit setting, first touch the HI or LO key, then touch the up or down arrow key. Each touch of an arrow key raises or lowers the alarm limit by five units. There are separate values for the low limit and the high limit.Caution AlarmTouch CAUTION ON to enable the caution alarm.When the caution alarm is enabled, you will be warned when the BIS value is within five units of either alarm limit.When the BIS value is within the caution zone, the BIS number flashes. !• In the remote view, only the ALARM LIMITS, SETUP, and PRINT keys are active. All other keys are disabled.!• The alarm limits appear on the HI and LO keys as they are changed.!• No tone is emitted for the caution alarm.
Ultraview Care Network23-14SETUP KeyThis menu enables you to set the display parameters to be used during the procedure. Refer to the following sections for descriptions of each key:•DISPLAY FORMAT Key on page 23-14•PLOT SCALES Key on page 23-15•TIME SCALES Key on page 23-15•SIZE Key on page 23-15•SWEEP SPEED Key on page 23-15•ADVANCED SETUP Key on page 23-15DISPLAY FORMAT KeyFrom this menu, you can set the type of display you want to use. • Touch 1 ZONE to display the single waveform zone format (Figure 23-12).• Touch 3 ZONE to display the full bedside view format (Figure 23-13).• Touching AUTO ZONE displays either format as follows:- 3-zone format if the BIS parameter key is touched.- 1-zone format if the BIS parameter key is not touched.Figure 23-12: One-zone displayFigure 23-13: Three-zone display
BIS23-15 PLOT SCALES KeySelect the vertical display scale range options for the graphical BIS trend display in the one-zone or remote view format only. The selections are: 0–100, 40–100, 20–80, or 0–60.TIME SCALES KeyThis menu is used to select the time base for the BIS and EMGL trend plots to indicate the total number of hours represented by the x-axis of the BIS plot display. Available time base options are 1-, 2-, 4-, 8-, 12-, and 24-hours.SIZE KeyFrom this menu, you can modify the amplitude scale of the analog waveforms. The available amplitude scales (full scale) can be set at ±2, ±5, ±10, ±20, ±50, ±100, and ±200 µV. Touching the ↑ or ↓ key changes the scale to the next value up or down. The default setting is ±50.SWEEP SPEED KeyThis menu allows you to modify the sweep speed of the analog waveform(s). The selections are 15, 30, or 50 mm/sec.ADVANCED SETUP KeyThis menu allows you to control a variety of functions. (On a remote display, only the BIS SCALES key is available.)LOW FREQ — Touch LOW FREQ on the Advanced Setup menu to set the lowest frequency that is displayed and processed. The options are 0.25 Hz, 1.0 Hz, and 2.0 Hz.HIGH FREQ — Touch HIGH FREQ on the Advanced Setup menu to set the highest frequency that is displayed and processed. The options are 30 Hz, 50 Hz, and 70 Hz. Selecting NONE disables any high frequency filtering.LINE FREQ —Touch LINE FREQ on the Advanced Setup menu to select either a 50 Hz or 60 Hz line frequency. SAVE SETTINGS — Touch SAVE SETTINGS to store the current selections in memory for later recall. RESTORE SETTINGS — Touch RESTORE SETTINGS to recall the stored settings from memory and reset all the current settings. The display may change with this operation. TEST ELECT KeyTouch TEST ELECT to initiate a continuous impedance check of all electrodes (refer to Impedance Montage on page 23-11). Touching this key displays the Impedance Montage, and the key label changes to EXIT ELECT. When you touch EXIT ELECT, the Impedance Montage display disappears and the key label changes to TEST ELECT again.
Ultraview Care Network23-16PRINT KeyTouch PRINT to print a bitmap display of the BIS and EMGL trends. The analog waveform is not printed using this key. Press the RECORD button on the monitor and touch the BIS parameter key to print the analog waveform.START/STOP PROCED KeyTouch START PROCED to denote the beginning of a procedure to be recorded. If prior data has been stored for the patient, you have the option of retaining archived data or clearing it. • Touch NO to append the new data to the existing data. • Touch YES to erase the trend memory and clear the trend display.When you touch START PROCED, its function and label change to STOP PROCED.When you touch STOP PROCED, the label changes to START PROCED again.Status MessagesStatus messages are displayed in the waveform zone when in 3-zone format.Processing may be suspended when any of these messages are displayed. The numeric data may be displayed as question marks. The EEG waveform may have artifacts.The status message will continue to display until all faults are corrected.Table 3: Status MessagesMessage User ActionImpedance Test In Progress The impedance test is in progress; this should normally last 10- to 15-seconds.Re-prep Ground Electrode The impedance test has failed; check to see that all the electrodes are connected properly. The module will not collect data until the test passes.DSC Test in Progress The system is performing a hardware self test of the DSC cable.DSC Not ConnectedCheck that the PIC cable is connected to the DSC and at the front of the module. If connected, and the DSC doesn’t work, the DSC or module may require service.DSC Shut Down - Restart ModuleToo many fatal errors (overcurrent, voltage regulation) have occurred with this DSC, and the module has stopped communicating. Remove the module and reinsert it. If this problem persists, the DSC and/or module may require service.Illegal DSC ID: DSC Turned OffAn unrecognized DSC has been connected to the module. Connect correct DSC. If error persists, the DSC and/or the module may require service. Illegal PIC ID An unrecognized Patient Interface Cable has been connected to the DSC. The PIC may be defective. Replace the PIC.Check the SensorThe BIS sensor has an impedance which is too high. Check the cable connections and correct as necessary. If the message persists, check the impedance of the sensor and replace the sensor as necessary.PIC Not Connected The Patient Interface Cable may be disconnected from the DSC. Check the cable connections. The PIC may be defective. Replace the PIC.
BIS23-17 Last Impedance Test Not CompletedAt least one BIS element failed during the last impedance test and the test was ended by pressing the STOP PROCED key. Repress the element that failed. Re-test the impedance. This message will also appear if the test was ended prematurely by pressing STOP PROCED.Poor Signal QualityThe Signal Quality Index is poor and the numeric display blinks. Check BIS Sensor. This may occur as a result of artifacts such as those generated from motion or the presence of electrocautery devices.Bad Signal QualityThe Signal Quality Index is unacceptable, therefore, the Primary Trend variable cannot be calculated. Check BIS Sensor. This may occur as a result of artifacts such as those generated from motion or the presence of electrocautery devices.Iso-electric EEG Detected No discernible EEG activity is detected for several minutes, SR = 100. Check the patient. Check the BIS Sensor for proper connection.Check BIS Sensor (GND Element)The ground element on the patient has an impedance that is too high. Check the Sensor and cable connections, and correct as necessary. If the message persists, check the impedances of the BIS Sensor. Re-prep the patient’s scalp if necessary. Hardware Error, Service Required Major problems in the DSC, BIS engine or module. Requires servicing.Table 3: Status Messages (continued)Message User Action
Ultraview Care Network23-18DefinitionsBIS — Bispectral Index Analysis. A mathematical calculation derived from the frequency, power, and phase throughout the entire frequency range of the EEG. The Index is a number between 0 and 100.DSC — The Digital Signal Converter. The DSC contains the input connector, amplifiers, and digitizer for the 90482 one channel EEG. The DSC is configured for referential montage monitoring.EEG — Electroencephalogram. Real-time electrical activity of the brain. The EEG waveform can be further separated (digitized) into elements. The signal can be processed in time, frequency, and Fourier analysis.EMG — Electromyogram. Electrical activity of the muscles. Processed as the absolute power in the frequency (Hz) range. This product calculates EMGL, which is over a fixed 70 to 110 Hz frequency range. EMGL — EMG Low. Refer to EMG.Epoch — The time during which the bispectral index is calculated. MF — Median Power Frequency measured in Hz. The frequency at which 50% of the total power lies equally on either side. The frequency range is between 0.5 and 30 Hz. Montage — A pattern of linking electrodes together over the scalp to generate a display of EEG channels in a particular way. Montages can be bipolar or referential.PIC — The Patient Interface Cable. Used by the BIS module. This cable is configured to tell the DSC and module to automatically use a single channel montage for the BIS Sensor. The BIS Sensor is normally placed on the left or right side of the forehead.SEF — Spectral Edge Frequency. The frequency (measured in Hz) at which 95% of the total EEG power lies below it and 5% lies above it. Frequency range is between 0.5 and 30 Hz.SQI — Signal Quality Index. The percentage of good epochs in the last 60-seconds that are used to calculate the Bispectal Index and spectral variables. Not affected by the suppression ratio. Percentage values range between 1 and 100.SR — Suppression Ratio. The percentage of time in the last 60-seconds in which the EEG signal is considered suppressed. Percentage values range from 0.0 to 100.
BIS23-19 Care and MaintenanceBIS Module and Host Monitor CleaningTo clean monitor screens and covers, modules, processors, and printers use a cloth or swab that has been slightly dampened in a solution of warm water and a mild detergent. Avoid solvents that may damage the product cases. Follow your hospital protocol.Digital Signal Converter CleaningClean all visible blood, liquids, and soil as soon as possible from the Digital Signal Converter (DSC), cabling, and connectors. Use a lint-free, absorbent towel that has been moistened (damp, but not dripping) with a solution of mild detergent and lukewarm, clean water. Using light pressure, thoroughly clean all surfaces. Dilute and handle detergents and disinfectants according to their instructions. Dispose of the towels properly. Before cleaning, wipe thoroughly. Apply an approved disinfectant for the DSC with a germicidal, disposable wipe, such as the SANI-CLOTH. Active ingredients in the approved wipe are: n-Alkyl dimethyl benzyl ammonium choride (0.1%), and n-Alkyl dimethyl ethylbenzyl ammonium chloride (0.1%). Be sure the disinfectant is not dripping from the wipe. Using light pressure, wipe the surface of the DSC, its cabling, and connectors as indicated by manufacturer’s instructions. Dispose of the wipes properly. BIS Sensor DisposalThe BIS Sensor is a patient-connected, single-use sensor that must be disposed of after each use. Dispose of the sensor per your applicable hospital practice.CAUTION:• Using cleaning agents other than those listed may cause degradation to the product’s plastic enclosure and labels. Refer to Cleaning and Sterilization on page 32-1 for questions or concerns regarding cleaning.CAUTION:• When cleaning the connectors (or other small features of the DSC), do not let dirt, moisture, or lint get trapped in the cracks or cavities of the receptacle or pin ends.• Do not autoclave any of the components of the BIS monitoring system. Autoclaving will seriously damage the components.
24-1!• Based on features purchased and setup configuration, more or fewer keys may appear here than on your menu screens.EEGDirectory of KeysDISPLAYFORMAT SETUP MARKEVENT PRINT STARTPROCSTOPPROCEEGDISPLAYFORMAT SETUP MARKEVENT PRINTEEG - MAIN MENU (SETUP # X)EEG MAIN MENU (SETUP # X)DSA &ANALOGDSA &TRENDTREND &ANALOGTWOTRENDSEEG - DISPLAY FORMAT DSA ANALOG TRENDEEG SETUPSTORESNAPSHOTRECALLSNAPSHOTLIVEDATAERASESNAPSHOT*EEG - ARCHIVESTORE SNAPSHOT - SNAPSHOT = 1 (11 Snapshots Available)STOREReview DSA/TRENDSYES NOYES NOYES NORETAIN ARCHIVEDEEG DATAERASE ARCHIVEDEEG DATAEEG- STOP PROCEEG - PRINT DSA/TRENDSEEG - MARK EVENT ‘a’ARCHIVEARCHIVEDSA ANALOG TREND FREEZEON OFFEEG - DISPLAY FORMAT MAG 1 MAG 2 FBR 1 FBR 2 SEF PPF EMGMPFFREEZEON OFFMAG 1 MAG 2 FBR 1 FBR 2 SEF PPF EMGMPFDSA ANALOG TRENDEEG - SETUPRECALLSETUPINITIALSETUPDSA ANALOG TRENDINITIAL SETUP MENURECALLSETUPSTORESETUPSYSTEMPARAMSContinued on next page (System Params)refer to DSA, ANALOG and Trend on page 24-3EEG - START PROCPRINTREVIEW REVIEWRECALLSETUPINITIALSETUPTREND DISPLAY SELECTION Upper = MAG1 Lower = SEFTREND DISPLAY SELECTIONProcessing OffProcessing On*not displayed at remote monitors(DualFormat OFF)(DualFormat On)These keys are functionalonly when Processing refer to DSA, ANALOG and Trend on page 24-3is in the “OFF” mode *DUAL FORMATOFFONDUAL FORMATON OFFsee DSA, ANALOG and Trend on page 3
EEG!• Based on features purchased and setup configuration, more or fewer keys may appear here than on your menu screens.24-2Directory of Keys - Processing OffDSA ANALOG TRENDINITIAL SETUP MENURECALLSETUPSTORESETUPSYSTEMPARAMSMONTAGESYSTEM PARAMSFILTERS SELECTLABELDISPLAYFORMAT0.5Hz1.0Hz5.0Hz20Hz32Hz50Hz70HzLOW CUTOFF HIGH CUTOFFFILTERS -EEG1 EEG2 EEG3 EEG4SELECT LABELDUAL FORMATOFFON DSA ANALOG TRENDEEG - DISPLAY FORMAT (Dual Format OFF)DSA &TRENDDSA &ANALOGTREND &ANALOGTWOTRENDSEEG - DISPLAY FORMAT (Dual Format ON)MONTAGET3 C3 Cz C4 T4Fp1FpzFp2F7F3 Fz F4F8P3 Pz P4T5O1 Oz O2T6A1M1A2M2Left FRONTAL Right2 CH4 CH+ CH1 -—+ CH2 -—+ CH3 -—+ CH4 -—CLEARCHANNELEMGCONTINUOUSIMPEDANCELINE FREQ50HZ 60HZRETAIN ARCHIVEDEEG DATAERASE ARCHIVEDEEG DATAThese keys appear onlywhen data is stored inthe module.The Select Label key is displayed only when more than one EEG moduleis in use.DUAL FORMATON OFFON OFFSYSTEM PARAMETERSrefer to page 24-3
24-3!• Based on features purchased and setup configuration, more or fewer keys may appear here than on your menu screens.EEGDirectory of KeysSIZE SIZE 50mm/sec30mm/sec15mm/secANALOG - SIZE = (+/-) 50 uV SWEEP SPEEDDSA ANALOG TRENDINITIAL SETUP MENUSYSTEMPARA MSTREND - BAND FREQUENCY (Hz) = 0.0 - 3.5DELTA(∆)THETA(θ)ALPHA(α)BETA1(β1)BETA2(β2)SELECTTRENDSMAG 1 MAG 2 FBR 1 FBR 2 SEF PPF MPFSELECT TRENDSSET TRENDPARAMETERSMAG 1 MAG 2 FBR 1 FBR 2 SEF PPF MPF TIMEBASETREND SETUP (only trends selected in the SELECT TRENDS menu will display in this menu)5Min10Min20MIn40MinTIME BASESIZE SIZE DELTA(∆)THETA(θ)ALPHA(α)BETA1 BETA2(β2)SIZE SIZE DELTA(∆)THETA(θ)ALPHA(α)BETA1(β1)BETA2(β2)SEF/PPF/MPF - SIZE =30Hz BAND ∆ - β2MAG 1/ MAG 2 - SIZE =100uV BAND ∆ - β2SIZE SIZE DELTA(∆)THETA(θ)ALPHA(α)BETA1(β1)BETA2(β2)FBR1/FBR2- SIZE= 100% BAND ∆/∆ - β2NUMERATORDENOMINATOREMGEMGFREQ FREQHI FREQ =200LO FREQ =10SIZE SIZEEMG - SIZE = 200uVRECALLSETUPSTORESETUPSIZE TIMEBASEFREQUENCYRANGEDSATRENDSIZE SIZEDSA - SIZE = 100 uV25Min10Min20Min40MinDSA - TIME BASE10Hz15Hz20Hz30HzDSA - FREQUENCY RANGESEF PPF MPF TRENDOFFDSA - DSA TRENDDSA SETUPCONTINUOUSIMPEDANCEThis key appearsonly when Processingmode turned “ON” DSA ANALOG TRENDEEG - SETUP(refer to TREND SETUP below)(β1)
Contents24-5 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Setting Up the EEG Module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Configuring the EEG Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Initial Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Storing a Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Recalling a Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12EEG Displays. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13EMG Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Archiving EEG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Marking Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Storing DSA/Trend Snapshots. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Recalling DSA/Trend Snapshots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Erasing Snapshots. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Printing EEG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Patient Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Remote Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28EEGOverviewThe Spacelabs Medical Electroencephalograph (EEG) module is a two or four channel processed EEG monitor, used to acquire, process, and display brain electrical activity. The module also includes one channel of EMG (electromyogram) for measuring and displaying muscle electrical activity.The EEG can be displayed as an analog waveform or as processed EEG. The analog EEG is displayed as a moving waveform similar to ECG. The analog signal is converted to the frequency domain using the Fast Fourier Transform (FFT) algorithm, and displayed as a spectral plot (density spectral array) or as trended parameters.EEG data is displayed in a left/right hemisphere orientation for both the analog and processed data. The data appearing on the left part of the display indicates left hemisphere EEG, while the right part of the display shows right hemisphere EEG. This right and left orientation of the display remains consistent throughout the various display types. Display formats include analog EEG, density spectral array (DSA), and various EEG trends.EEG can be viewed in single or dual format. The single format displays one type of EEG at a time. If you wish to see two EEG formats at one time, choose dual format display. With dual format display, you can see both DSA and analog, trend and analog, DSA and trend, or two trends.A snapshot of DSA and trends can be stored and recalled. EEG data can also be marked with an event label to facilitate recall for later examination.
Ultraview Care Network24-6The EEG is commonly divided into four frequency bands. From lowest to highest, they are: Delta (less than 4 Hz), Theta (4 to 8 Hz), Alpha (8 to 13 Hz), and Beta (13 Hz and higher). Delta waves emanate from the central region of the brain, and occur most frequently if a patient is an infant or a sleeping adult. Theta waves, also from the central region, occur in children and lightly sleeping adults. Alpha waves originate primarily from the occipital region of the brain, and occur in adults that are relaxed or drowsy. Finally, Beta waves emanate from the parietal and frontal regions of the brain, and indicate that the patient is alert and awake. Normal EEG patterns are influenced by cerebral blood flow, medications, and anesthetic levels.The beta band can be divided into two bands. The low beta band is labeled beta1 and usually represents signals between about 13 Hz and 20 Hz. The high beta band is labeled beta2 and usually represents signals between about 20 Hz and 30 Hz. It is clinically useful to separate the beta band for trending purposes, especially when looking at high frequency activity.Setting Up the EEG ModuleUp to six setup configurations can be saved and recalled as needed. To recall a particular EEG display setup requires only that you touch one of the six recall setup keys.After determining what your EEG monitoring needs are, Spacelabs Medical recommends that you pre-configure the EEG module and store your configuration setup. Module configurations should be set up and stored prior to connecting a patient for monitoring. In this way, you can simply select a pre-configured setup after you connect the patient. Also, some of the configuration menus are not available after EEG processing has started. Therefore, it is recommended that you pre-configure the module, defining the trend parameters, frequency ranges, and other variables (such as those outlined in the bulleted list below), before processing starts. This way, you will not have to stop processing to change some parameters.The following sections describe:• How to change the module’s EEG monitoring parameters and store them • The EEG displays• How to prepare the patient for monitoring• How to connect the patient to the module• Bedside and central monitorsCAUTION:• The Spacelabs Medical model 90481 EEG module should only be used by someone with a knowledge of and/or background in EEG monitoring.
EEG24-7 Configuring the EEG ModuleThere are several different ways to configure the EEG module. You can monitor EEG in either two or four channel mode. You may also elect to monitor EMG. The EEG module also allows you to choose several formats for the EEG display, from analog waveforms to trend displays. Since the EEG module can store up to six setups, you will want to determine which setups best suit your needs, and store them in the module. You can then recall any of these configurations simply by recalling a setup you have pre-configured. Some of the factors to consider when configuring a setup are:• Electrode placement; what lead placement locations are best for your application?• Filters; what should the low cutoff, high cutoff and line frequency settings be?• Display format; what type of data display is best?• Size; what size best shows the data you have chosen?• Time base; which time base best reflects the information you need?• Frequency range; what range do you wish to monitor?• Trends; do you want to trend an EEG parameter?• Sweep speed; what speed should an analog display use?• EEG band frequencies; what frequency ranges do you want to apply to the delta, theta, alpha and beta bands?• Trends; what size do you want your trends to be? What frequency bands should the trends reflect? Initial SetupTouching the INITIAL SETUP key will display the Initial Setup menu. The Initial Setup menu has four general categories of parameters: • System Parameters •DSA•Analog•Trends!• When the module is first inserted into the module housing, processing is stopped. To access the Initial Setup menus after the EEG module is processing information, first turn the processing off.• The following instructions on accessing the initial setup menus assumes that processing is off. The quickstart steps addressing initial setup procedures also assume that processing is off. To access the initial setup menus: (processing must be off)1Touch EEG.2Touch SETUP.3Touch INITIAL SETUP.
Ultraview Care Network24-8System ParametersThe system parameters sub-menu accesses the montage display, where electrode lead placement is entered and EMG is enabled, the filters sub-menu, used to set the high and low cutoff and line frequency filters, the display format menu, used to choose the data format and the EEG label selecting sub-menu. To enter electrode lead placement: (processing must be off)1Touch EEG.2Touch SETUP.3Touch INITIAL SETUP.4Touch SYSTEM PARAMS.5Touch MONTAGE.6Touch ERASE ARCHIVED EEG DATA (if data is stored in module).7Touch MONTAGE.8Select 2 or 4 channel.9Select desired channel.10 Touch CLEAR CHANNEL.11 Select desired electrode placement sites.12 Repeat steps 9 through 11 until all channels are defined.To set low cutoff, high cutoff and line frequency filters:1Touch EEG.2Touch SETUP.3Touch INITIAL SETUP.4Touch SYSTEM PARAMS.5Touch FILTERS.6Select desired low cutoff, high cutoff and line frequency values).To display EEG in dual format:1Touch EEG.2Touch DISPLAY FORMAT.3Select DUAL FORMAT ON.To select an EEG label (if using more than one EEG module in one monitor):1Touch EEG.2Stop processing (if started).3Touch SETUP.4Touch INITIAL SETUP.5Touch SYSTEM PARAMS.6Touch SELECT LABEL.7Select desired label.
EEG24-9 DSAThe DSA sub-menu offers the following choices: •SIZEUse the up and down arrows to size the DSA. When you touch SIZE (after processing has started), the display will show a histogram of the EEG data (Histogram Display on page 24-18). As you touch the up and down arrows to change size, you will notice that the histogram changes size. Choose a histogram size which gives the best DSA contrast for your application.• TIME BASETouch TIME BASE to choose the amount of time the X-axis display represents. Touch either 5,10, 20, or 40 min to select a DSA screen time. The active key will highlight.• FREQUENCY RANGETouch the FREQUENCY RANGE key to choose the DSA frequency range. Touch either 10Hz, 15Hz, 20Hz, or 30Hz. The active key will highlight.• DSA TRENDTouch DSA TREND to choose the type of trend you wish to display on top of the DSA. Choose either SEF, PPF, MPF, or TREND OFF. The active key will highlight.AnalogTouch the ANALOG key to show the sub-menu that allows you to set the SIZE of the analog trace, and the SWEEP SPEED of the display. Use the arrow keys to change the size. Touch the desired sweep speed to select.!• The trend time base will change to track the DSA time base.To set the size of DSA:1Touch EEG.2Touch SETUP.3Touch DSA.4Touch SIZE.5Adjust size.To set DSA time base:1Touch EEG.2Touch SETUP.3Touch DSA.4Touch TIME BASE.5Select time base.To set DSA frequency range:1Touch EEG.2Touch SETUP.3Touch DSA.4Touch FREQUENCY RANGE.5Select frequency range.To set DSA trend:1Touch EEG.2Touch SETUP.3Touch DSA.4Touch DSA TREND.5Select trend.To display analog EEG:1Touch EEG.2Touch DISPLAY FORMAT.3Select DUAL FORMAT OFF.4Touch ANALOG.To set the analog size:1Touch EEG.2Touch SETUP.3Touch ANALOG.4Select sizeTo select sweep speed:1Touch EEG.2Touch SETUP.3Touch ANALOG.4Select sweep speed.
Ultraview Care Network24-10TrendsTouch the TREND key in the INITIAL SETUP menu to access the Band Frequency sub-menu. This sub-menu allows you to set the frequency ranges for the five EEG frequency bands (DELTA, THETA, ALPHA, BETA1, BETA 2). Touch the up or down arrow keys to change the upper frequency range for each band. The lowest frequency for each band is set by the upper frequency of the band to its left.The SELECT TRENDS key allows you to choose the various trends to be available for selection from the DISPLAY FORMAT, SETUP, and ARCHIVE menus.You can select any combination of MAG1, MAG2, FBR1, FBR2, SEF, PPF, MPF, or EMG. You may not see all the trend options when you enter the trends sub-menus. This is because you must select which trends appear in the trend sub-menus. Select those trends you wish to have available by accessing the Initial Setup menu, and choosing the trends you want.Setting Trend ParametersMAG1, MAG2, SEF, PPF, MPFThe sub-menu provides keys for changing the trend size and frequency band.BANDTrend parameters are calculated and displayed for the frequency bands set in this menu. For example, magnitude in the alpha band can be calculated by selecting the alpha frequency band for MAG1. You define the frequency range for each band in the Initial Setup Menu.Touch the appropriate keys to select the frequency band for each trend. If more than one band is required, first touch the lowest frequency band (it will be highlighted), then touch the highest (it will also be highlighted). The keys in-between the lowest and highest frequency will be highlighted to indicate that these bands have been selected.The frequency band setting is displayed above the frequency band keys on the message line as follows:BAND x-y x is the lowest frequency band, and y is the highest.If only one band is selected, y is blank since the lowest and highest frequency bands are the same.SIZETrend size should be set using the SIZE ↑ or SIZE ↓ keys so that the trend parameter lies close to the middle of the graph.!• Greek symbols are used to represent the delta, theta, alpha, and beta bands.To add or delete trend:1Touch EEG.2Touch SETUP.3Touch INITIAL SETUP.4Touch TREND.5Touch SELECT TRENDS6Select or de-select trends.To select the trend band:1Touch EEG.2Touch SETUP.3Touch INITIAL SETUP.4Touch TREND.5Select band.6Set frequency.To set the trend size:1Touch EEG.2Touch SETUP.3Touch TREND.4Select trend.5Adjust size.
EEG24-11 FBR1, FBR2The frequency band ratio trends are a trend plot of the ratio (in percent) of total power in one frequency band divided by the total power in a second frequency band.Frequency band ratio trend parameters (FBR1, FBR 2) require a frequency band for the numerator and denominator. The frequency range for each band is defined in the Initial Setup menu.SIZETrend size should be set using the SIZE ↑ or SIZE ↓ keys so that the trend parameter lies close to the middle of the graph.NUMERATOR DENOMINATORTouch the NUMERATOR/DENOMINATOR key and select NUMERATOR. Touch the appropriate keys (DELTA, THETA, ALPHA, BETA 1, BETA 2) to select the frequency band for the numerator. Now touch the DENOMINATOR key, and again choose an appropriate band for the denominator.If more than one band is required, first touch the lowest frequency band, then the highest.The frequency band setting is displayed above the frequency band keys on the message line. You will see the following format for the display:BAND x1-y1/x2-y2where x1 is the lowest frequency band for the numerator, and y1 is the highest frequency band for the numerator. The lowest frequency band for the denominator is x2, and the highest, y2.Time baseTouch TIME BASE to choose the amount of time the X-axis display represents. Touch either 5,10, 20, or 40 min to select a trend screen time. The active key will highlight.EMGSIZETrend size should be set using the SIZE ↑ or SIZE ↓ keys so that the trend parameter lies close to the middle of the graph.FREQUENCYSelect either HI FREQ= or LO FREQ=. Press the FREQ ↑ or FREQ ↓ key until the desired value appears in the XFREQ= key. Repeat for the other key.!• The DSA time base will change to track the trend time base.
Ultraview Care Network24-12Storing a SetupOnce you have set the EEG module’s parameters the way you want them, you may store the current settings to one of six setup keys. Access the Initial Setup menu by first touching the SETUP key from the Main menu, then touching INITIAL SETUP. From the Initial Setup menu, touch STORE SETUP. You will then see six setup keys labeled SETUP #1, SETUP #2, etc. Store the current settings by touching one of the setup keys.Recalling a SetupTo recall a setup, make sure processing is stopped, then touch the SETUP key. Touch RECALL SETUP. You will then see the retain or erase archived EEG data keys if data is stored in the module. If you want to change your setup, you will have to erase any archived EEG data. If you choose to retain archived EEG data, you cannot select another setup.EEG Electrode Lead Selection (Montage)To select which leads you have placed and their placement sites, touch the MONTAGE key (under SYSTEM PARAMS in the Initial Setup) to enter a sub-menu in which the electrodes can be selected and the impedance of each electrode can be measured. First, select either two or four channels for EEG recording. If two channel recording is selected, the CH3 and CH4 keys will be inactive, and the electrode names are removed.The following procedure is used to select electrode names for each channel:1. Touch the desired channel key (CH1, CH2, CH3, CH4).2. Touch the CLEAR CHANNEL key to delete previously defined electrodes for the channel.3. Touch one of the 25 keys in the montage to select the first electrode. The key will flash on and off, and appear in the channel key as the positive input. Select a second electrode. The key will again flash on and off, and your selection will appear in the channel key as the negative or reference input.!• Processing must be stopped before a setup can be stored.• The message EEG Setup Successfully Stored is displayed on the message line when the setup is stored.!• The first electrode name displayed in the channel key is the positive input, while the second electrode name is the negative or reference input.• When selecting the next channel, the electrodes that were selected for the first channel will stop flashing, but will remain highlighted.To store a setup:1Touch EEG.2Touch SETUP.3Touch INITIAL SETUP.4Change desired parameters.5Touch STORE SETUP6Touch the setup key to which you want to store the current setup.To recall a setup: (processing must be off)1Touch EEG.2Touch SETUP.3Touch RECALL SETUP.4Touch ERASE ARCHIVED EEG DATA (if data is stored in module).5Touch RECALL SETUP6Select desired setupTo select EEG electrode leads:1Touch EEG.2Touch SETUP.3Touch INITIAL SETUP4Touch SYSTEM PARAMS.5Touch MONTAGE.6Touch ERASE ARCHIVED EEG DATA (if data is stored in the module).7Select 2 or 4 channel.8Select desired channel.9Touch CLEAR CHANNEL.10 Select desired electrode placement sites.11 Repeat steps 8 through 10 until all channels are defined.
EEG24-13 4. Touch the CLEAR CHANNEL key to erase both electrode names if you make an error when entering the electrode names. Re-enter the pair of electrode names after you clear them.5. Touch each of the channel (CH1, CH2, CH3, CH4) keys in succession to complete the setup.EEG DisplaysDisplay FormatsThe EEG module can display several formats. The formats can be grouped into two types: dual display format, and single display format. The single format displays are:•DSA•ANALOG• TRENDThe dual display formats are:• DSA & TREND• DSA & ANALOG• TREND & ANALOG• TWO TRENDSAnalog EEG DisplayAnalog EEG is displayed as a moving waveform for each channel. The trace moves from left to right. The analog waveform clips or flat-lines when the amplitude exceeds full scale. Figure 24-1: Four-channel analog EEG display!• When the format is Two Trends, the message line indicates whether the upper or lower trend is selected by displaying the trend in reverse video.To display analog EEG:1Touch EEG.2Touch DISPLAY FORMAT.3Select DUAL FORMAT OFF.4Touch ANALOG.
Ultraview Care Network24-14Sweep Speed — This number represents the sweep speed of the displayed and recorded analog trace. The sweep speed can be set to 15, 30, or 50 mm/sec. All EEG channels use the same sweep speed.Amplitude Grid — This grid is drawn under the analog trace and divides the amplitude scale into four segments. A dashed line is drawn at the baseline or center of each display zone. Solid lines are drawn at the top and bottom edge of the zone (peak values), and dotted lines are drawn halfway between the edge of the zone and the baseline. Tick marks are drawn on the Y-axis at each division. Each division represents peak amplitude divided by four. Analog Waveform — This trace sweeps from left to right, reflecting brain electrical activity for the channel monitored. Peak to Peak Signal Amplitude — These numbers indicate the maximum and minimum amplitude ranges of the analog signal (set by user). Electrode labels — These number-letter combinations indicate the electrode lead placement.Time Axis — Time is measured along the X-axis for each analog trace. Each waveform window displays 4-seconds at a sweep speed of 15 mm/sec, 2-seconds at 30 mm/sec, and 1.2-seconds at 50 mm/sec.Freezing the DisplayTo freeze the analog waveform, touch the FREEZE ON/OFF key. The ON section of the key will highlight. Touch the key again to turn off the freeze, and the OFF section of the key will highlight. Freeze mode is used to stop the moving waveform so transient features can be captured and inspected.To enable EMG with trend overlay and analog EEG:1Touch EEG.2Touch DISPLAY FORMAT.3Select FREEZE ON.
EEG24-15 Density Spectral Array (DSA) EEG Display With Trend OverlayProcessed EEG is displayed as a Density Spectral Array (DSA) similar to the pattern shown in the four channel EEG below. The DSA pattern is shown with a SEF trend overlay. Data moves from right to left, and is updated every 4-seconds (5-minute time base).Figure 24-2: Four-channel DSA EEG display with trend overlayReal-time Clock — Displays the time the last epoch was acquired.Time Base — Total time of the DSA plot; ranges from 5- to 40-minutes.Message Line — The following messages can be displayed: NOT PROCESSING, REDISPLAYING, REVIEWED, RECALLED.Electrode Impedance — Electrode impedances are automatically measured and displayed every 5-minutes after processing is started. If electrode impedances are greater than the acceptable range (5 K ohms for each electrode or 2 K ohms differential between the pairs) the impedance values will flash if the impedance of any electrode exceeds 5 K ohms, or if the difference between the electrode pairs exceeds 2 K ohms. If the impedance exceeds 99 K ohms, ++ is displayed.DSA Magnitude (DSA) — Total magnitude of the EEG in the frequency range displayed for the last epoch for channels 1 and 2. The number on the left indicates the left hemisphere magnitude, the right value shows right hemisphere magnitude.Overlay Trend Parameter — Numeric value for channels 1 and 2 of either the Spectral Edge Frequency (SEF), Peak Power Frequency (PPF), or Median Power Frequency (MPF) for the last epoch displayed. The number on the left is the frequency for the left hemisphere of the brain, while the right number is the frequency of the right hemisphere. Artifact Flag — Artifact detection is marked by lighting a pixel on the top line. On color monitors, artifacts will be marked with a red pixel.Event Marker — Used to tag significant clinical events. Can place 52 unique letters; a-z and A-Z. Used in identifying and recalling stored DSA data.To display DSA EEG with trend overlay:1Touch EEG.2Touch DISPLAY FORMAT.3Select DUAL FORMAT OFF.4Touch DSA.5Touch PREVIOUS MENU.6Touch SETUP.7Touch DSA.8Touch DSA TREND.9Select desired trend.   쐅쐈 쐉 씈씉씊
Ultraview Care Network24-16Left Hemisphere Electrode Labels — EEG channels are labeled with lead names selected in the Initial Setup Menu. Here, the left anterior EEG channel is labeled F3-C3, and the left posterior channel is labeled C3-P3.쐅Right Hemisphere Electrode Labels — In this setup, the label for the right anterior channel is F4-C4, and the right posterior channel is labeled C4-P4.쐈Frequency Axis Label — Frequency is displayed along the vertical, or Y axis. The labels indicate the range displayed. The bottom line will always read 0 Hz. The top line will show 10, 15, 20, or 30 Hz, depending on what maximum frequency is chosen.쐉Density Spectral Array (DSA) Display With Trend Overlay — For monochrome monitors, the DSA pattern is formed by packing dots in proportion to signal amplitude at each frequency. Frequencies with higher power have higher dot densities. For color monitors, the DSA pattern is formed using seven levels of grey. The intensity of each pixel is proportional to signal amplitude at each frequency. The Trend Overlay is drawn on top of the DSA pattern. The overlay can indicate the Spectral Edge Frequency (SEF), Median Power Frequency (MPF), or Peak Power Frequency (PPF). On color monitors, it appears as a magenta line.씈Time Axis — The horizontal, or X axis represents time. Two vertical columns of pixels are drawn each update period. The display update rate depends on the time base selected. The time base is the total time of the displayed DSA, and can be set to 5-, 10-, 20- or 40-minutes. The time axis is divided into five equal segments using intensified dots. 씉Frequency Axis — The vertical or Y axis represents the DSA frequency. The vertical axis is divided into five segments. Each segment is equal to the total frequency displayed, divided by five.씊EEG parameter Key — Touch this key to access all EEG menus. If there is more than one EEG module connected to the monitor, then you can label the keys EEG1, EEG2, EEG3, or EEG4.
EEG24-17 Trend DisplaysThe EEG module can trend up to seven EEG parameters:• Two magnitude parameters (MAG 1 and MAG 2)• Two frequency band ratio parameters (FBR 1 and FBR 2)• Spectral edge frequency (SEF)• Peak power frequency (PPF)• Median power frequency (MPF)All trends should be selected before processing starts. Select the frequency band for each trend in the Setup menu. In the figure below, the magnitude of the EEG (MAG 1) is calculated for the frequency bands delta to beta2 and trended. One trend parameter can be displayed at a time for each EEG channel when dual format is off. The trend is drawn as a double wide line. A five point moving average filter is used to smooth the data on the trend plot.Figure 24-3: Four-channel EEG trend display Event Marker — Used to tag significant clinical events. Can place 52 unique letters; a-z and A-Z. Used in identifying and recalling stored trend data. Artifact Flag — Artifact detection is marked by lighting a pixel on the top line. On color monitors, artifacts will be marked with a red pixel. Horizontal Axis — The horizontal, or X-axis represents time. The time base is the total time of the displayed trend, and can be set to 5-, 10-, 20- or 40-minutes. The time axis is divided into five equal segments using intensified dots. Trend Line — The trend line represents the trended EEG parameter and moves from right to left. Vertical Axis — The vertical, or Y-axis represents either the magnitude (in microvolts), frequency (in hertz), or ratio (in percent). When MAG 1, MAG 2, or EMG are displayed, magnitude is shown (values range from 2µV to 900 µV). When SEF, PPF, or MPF are displayed, frequency is shown (values are 5 Hz, 10 Hz, 15Hz, 20Hz, 30Hz). When FBR 1 or FBR 2 are displayed, percent is shown (values range from 10% to 900%).  Band — The EEG band trended (Delta, Theta, Alpha, Beta1, Beta2, or combination. Greek letters are displayed to represent each band).  Trend Value — Shows the type of trend displayed and its numeric value. MAG 1 indicates a magnitude trend. Time Base — Total time of the trend plot; ranges from 5- to 40-minutes.To display EEG trends:1Touch EEG.2Touch DISPLAY FORMAT.3Select DUAL FORMAT OFF.4Touch TREND.5Select desired trend. To change the trend time base:1Touch EEG.2Touch SETUP.3Touch TREND.4Touch TIMEBASE.5Select timebase.
Ultraview Care Network24-18Histogram DisplayThe histogram display is used to set the appropriate scale or size for the DSA display. This helps to optimize the DSA display contrast. The histogram vectors should fill as much of the window as possible without saturating. The histogram display can also be used to see EEG power and frequency changes in each epoch. It provides expanded information for each column of DSA data. The histogram display is only accessed when changing the DSA size after processing has been started.Figure 24-4: EEG display of histograms (4 channels)Amplitude Axis — The vertical, or Y-axis represents the amplitude. The bottom of the Y-axis is always labeled as 0 uV2 (zero microvolts squared). The top of the Y-axis is labeled with the maximum power you select. The power displayed in the above figure (100 uV2) indicates full scale power of the histogram vectors. Frequency Axis — The horizontal, or X-axis represents the frequency range (0 to 30Hz) and is divided into five equal sections with tic marks.To change DSA size:1Touch EEG.2Touch SETUP.3Touch DSA.4Touch SIZE.5Set DSA size.5 Min100100
EEG24-19 Dual Format DisplayYou can display the EEG in two formats simultaneously. Enable dual format from the DISPLAY FORMAT menu. This allows the display of DSA and analog, DSA and trend, trend and analog, or two different trends. In addition, the second display zone can be used to show recalled snapshots of DSA or trends, simultaneously with live DSA or trend data.Figure 24-5: Dual format DSA and analog EEGEMG DisplayThere is one EMG channel that can be used to monitor muscle electrical activity. Select EMG with the EMG ON /OFF key in the Montage menu. The ON section of the key will be highlighted when it is on. Touch the key and select OFF to turn off the EMG channel. The OFF portion of the key will be highlighted.Although EMG uses only one channel, the EMG trend is displayed in each channel so it can be used to compare against EEG when dual format is on.Figure 24-6: EMG display!• EMG is displayed only as a trend. To display DSA EEG with trend overlay and analog EEG:1Touch EEG.2Touch DISPLAY FORMAT.3Select DUAL FORMAT ON.4Touch DSA & ANALOG.5Touch EEG.6Touch SETUP.7Touch DSA.8Touch DSA TREND.9Select desired trend.To enable EMG processing:1Touch EEG.2Touch SETUP.3Touch INITIAL SETUP.4Touch SYSTEM PARAMS.5Touch MONTAGE.6Touch ERASE ARCHIVED EEG DATA (if data is stored in the module).7Touch MONAGE.8Select EMG ON.To view EMG trend:1Touch EEG.2Touch DISPLAY FORMAT.3Select DUAL FORMAT OFF.4Touch TREND.5Touch EMG.
Ultraview Care Network24-20Archiving EEGReviewing EEG DataThe module continuously stores the last 2- to 24-hours of DSA and trend data. The number of hours it can store depends on the amount of memory installed. You can scroll back and forth in half screen increments using the left and right REVIEW keys. Data is not displayed until you remove your finger from the left and right arrow keys. If you keep your finger pressed on one of the arrow keys, you can rapidly scroll to the approximate place in the data. Time and date information for the position in the data is displayed on the message line, as well as any event marks placed in the data.When reviewed data is being displayed, the message REVIEWED is shown in reverse video on line two of the numeric zone.Recalled EEG data (Dual Format Off)You can store and recall snapshots of DSA and trended data. Recalled data is displayed in the same format as live data.When dual format is off, recalled EEG data replaces live data for each channel. When recalled data is being displayed, the message RECALLED is displayed in reverse video on line two of the numeric zone. Recalled EEG Data (Dual Format On)When dual format is on, two data formats (e.g., DSA and analog) are displayed. If recalled data is requested, the recalled EEG data is displayed in the second zone. Recalled data is always displayed below the live data. The message RECALLED tells you that the data in the second zone is recalled data. This can be used to display baseline data below the live data.Live DataTouch the LIVE DATA key to resume displaying live DSA, analog, or trends. This key provides an easy means to return to live data after displaying reviewed data or recalled snapshots.!• When DSA & TRENDS are displayed simultaneously in Dual Format mode, the Review keys scroll through DSA and trend data.To display live data:1Touch EEG.2Touch ARCHIVE.3Touch LIVE DATA.
EEG24-21 Marking EventsAn event can be identified on the DSA or Trend displays by placing an event label on the display at the point where the event occurs. Up to 52 event labels (a-z; A-Z) can be placed on the DSA and Trend displays. The event label is stored and displayed with the DSA and all Trend displays in all four channels.After touching the MARK EVENT key, touch the YES key to place an event label. Touch the NO key to cancel marking an event. Touching either key returns you to the main menu. The next event label to be placed is displayed above the YES/NO keys on the message line. The message appears as follows:MARK EVENT ‘X’‘X’ is a letter a-z; A-Z. If the event label is ‘Z,’ the message Z is the last event mark that can be placed is displayed and the Mark Event key will appear dotted after Z is placed.Storing DSA/Trend SnapshotsFrom the Main menu, touch the ARCHIVE key, touch the STORE SNAPSHOT key then touch the STORE key.The following messages are displayed on the message line:SNAPSHOT = UU (ZZ Snapshots Available)UU is the snapshot number (1 to 44) and ZZ is the number (0 to 44) of snapshots that can still be stored.The number of snapshots that can be stored depends on the amount of memory in the EEG module. The base module can store 11 four-channel or 22 two-channel snapshots. If the module has sufficient memory, then up to 44 snapshots (four-channel) can be stored.!• Event labels will be placed as close in time as possible to the event. The Mark Event key appears dotted when an event label cannot be placed.To mark an event:1Touch EEG.2Touch MARK EVENT.3Touch YESTo store a DSA or trend snapshot:1Touch EEG.2Touch ARCHIVE.3Touch STORE SNAPSHOT.4Touch STORE.
Ultraview Care Network24-22Recalling DSA/Trend SnapshotsTouch the RECALL SNAPSHOT key. Use the arrow keys to choose a snapshot. Touch the RECALL key, then touch DSA to display the density spectral array for the selected snapshot, or touch a trend key to display the trended EEG. Erasing SnapshotsTouch ERASE SNAPSHOT to erase DSA/TRENDS snapshots.Touch the left or right arrow keys to select the snapshot to be deleted. DSA/Trends snapshots are identified by snapshot number, marked events and time and date at which the snapshot was stored. Touch the ERASE key to erase the selected snapshot of DSA/Trends.Printing EEGFrom the Main menu, touch the PRINT key to display a sub-menu in which all displayed DSA and Trends are printed. One print key controls all four EEG channels. The printout is a screen dump of the entire DSA or trend display zone, including all data displayed in the numeric zone (on the right side of the EEG key).Touch the YES key to print the DSA and trend display. Touch the NO key to cancel the printout. !• You can use marked events as a method for keeping track of snapshots that you want to recall. Use the arrow keys to move through the stored data. The message prompt will indicate whether there are any marked events in the snapshot. Note which marked events appear in the message prompt, then recall the snapshot when you see the event label you want. The time and date of each snapshot is also displayed in the message prompt.!• Analog EEG is not printed using the print key. Use the monitors RECORD key to print Analog EEG.• Recording could be terminated if the analog size is changed during the recording.To recall a DSA or trend snapshot:1Touch EEG.2Touch ARCHIVE.3Touch RECALL SNAPSHOT.4Select desired snapshot.5Touch Recall.6Select DSA or trend parameter.To print a stored snapshot:1Touch EEG.2Touch ARCHIVE.3Touch RECALL SNAPSHOT.4Select desired snapshot.5Touch Recall.6Select DSA or trend parameter.7Touch PRINT.8Touch YES.To erase a DSA/ TREND snapshot:1Touch EEG.2Touch ARCHIVE.3Touch ERASE SNAPSHOT.4Select desired DSA/TREND snapshot.5Touch ERASE.To print DSA or Trends:1Touch EEG.2Touch PRINT.3Touch YES.
EEG24-23 Patient PreparationPatient PreparationElectrodes must be properly placed on the patient to obtain the optimum signal. Use small ECG silver/silver chloride electrodes, EEG cup electrodes (silver or gold), or their equivalent. Electrodes are available from Spacelabs Medical.Attach lead wires to the electrodes before applying them to the patient. If you apply lead wires after applying the electrodes, you may displace some of the conductive gel, resulting in signal degradation. Connect all electrodes needed for EEG monitoring. You will need six electrodes (minimum) for four channel operation, and five electrodes (minimum) for two channel monitoring. Missing electrodes will result in loss of EEG waveforms.Prepare the patient for electrode placement as follows:• If possible, choose a site that avoids hair interference, and is as high on the scalp as possible.• Clean each site with a medically approved abrasive cleaner (such as OmniPrep™ or NuPrep™) using a cotton tip applicator in a circular motion to mildly abrade the skin. (The abrasive cleaner should not be used on patients with a history of skin allergies to cosmetics or lotions. As a substitute, use a skin degreaser such as alcohol.)• Use alcohol wipes to further clean each site and remove residual OmniPrep. Then, using dry gauze, rub site briskly, avoiding excessive abrasion of the skin surface.• Ensure that gel is moist in each electrode.• Attach lead wires to electrodes before applying to patient.CAUTION:• Only use patient cables specified by Spacelabs Medical. Other cables may degrade performance and may damage the UCW or PCMS monitor during defibrillation. Do not use stainless steel electrodes.WARNING:• To ensure against any possibility of electric shock, do not touch lead electrodes, or the monitor during defibrillation. The conductive parts of electrodes or any other patient connection should not contact other conductive parts, including the neutral electrode and earth (ground).• Keep the monitor and its power cord and cables away from the electrosurgery unit and its associated cables and power cord.• If electrodes are used adjacent to the electrosurgical site, considerable high frequency current may flow through them, causing patient burns, especially if a defect is present in the return pad of the electrosurgical unit. For this reason, electrodes should be placed as far away from the surgery site as possible.To setup EEG or EMG monitoring:1Attach lead wires to EEG or EMG electrodes.2Apply electrodes3Attach electrode lead wires to patient cable.4Insert module into module slot.5Attach EEG patient cable to module.
Ultraview Care Network24-24• Apply electrodes to the site by pressing around the outer edge of the electrode. DO NOT press on the center of the electrode since this may interfere with proper adhesion. The electrode, especially its center, must lie flat against the patient’s skin.• Select CONTINUOUS IMPEDANCE and measure electrode impedances after all electrodes have been placed and lead wires and patient cable are connected. Acceptable maximum impedances: 5 K ohms for each electrode, 2 K ohms differential between the pairs.Figure 24-7: Electrode applicationPosition as high as possible on the placement sites. Avoid hair interference.Smooth electrode adhesive area to the skin with a circular motion.!• Electrode impedances are automatically measured and displayed every 5-minutes after processing is started. If electrode impedances are greater than the acceptable range (5 K ohms for each electrode or 2 K ohms differential between the pairs) the impedance values will flash if the impedance of any electrode exceeds 5 K ohms, or if the difference between the electrode pairs exceeds 2 K ohms. If the impedance exceeds 99 K ohms, ++ is displayed.
EEG24-25 EEG Electrode PlacementFigure 24-8: Recommended electrode lead placement for the operating roomYou have the choice of monitoring in two channel or four channel mode. Note the changes in the color of the leads when using two channel as opposed to four channel mode. Also, if using the four channel mode, note that an extra lead (CZ - Red Wire) is necessary.Channel # 4 Channel 2 ChannelChannel 1 CZ-F7 (Red/Red) F7-M1 (Red/Red)Channel 2 CZ-F8 (Red/Black) F8-M2 (Black/Black)Channel 3 CZ-M1 (Red/Brown)Channel 4 CZ-M2 (Red/White)Channel 5 EMG (two yellow) EMG (two yellow)2 Ch & 4 Ch Ground (Green) Ground (Green)!• Use the special adaptor to connect CZ (red wire) to the + input of each channel. Use a silver cup for electrode CZ. Attach with conductive paste or collodion.Green Wire(Ground)Red Wire (4 Channel Only)(Right side hasFront View Left Side ViewWhite wire for 4 Channel, Blackfor 2 channel)Brown wire for4 channel, Redfor 2 channel(M1)(M2)(Fp1)(Fp2) (CZ)Yellow Wires (EMG)Black Wire(F8)Red Wire(F7)(EMG)
Ultraview Care Network24-26Figure 24-9: EEG patient connectorFigure 24-10: 10-20 International electrode placement systemThe EEG module contains an electrosurgical interference suppression (ESIS) filter which automatically provides some noise suppression when electrocautery interference is detected.EMG Electrode PlacementUse two yellow EMG lead wires and place the electrodes as shown in the electrode lead placement illustration. The EMG is displayed as a trend, and uses channel five in the EEG module.!• Spacelabs Medical recommends the 10-20 International Electrode Placement System for charting electrode placement on a patient. Use this reference if you require additional information regarding electrode placement.+-+-+-+-+-+-CH 1 CH 2 CH 3 CH 4 GND CH 5EMGEEGRED BLACK BROWN WHITE GREEN YELLOW
EEG24-27 Starting and Stopping ProcessingThe EEG module can operate in either the processing on or off mode. To set up the module, you need to have processing turned off. Processing off is the default mode when you first insert the module into the module housing. The Initial Setup menu allows you to access other menus needed for defining the various configurations you may want to store.Only analog EEG is displayed when the power has first been turned on, or the processing has been stopped. Processing of the data and the display of DSA or trends will start when the START PROC key is touched.START PROCTouch the RETAIN ARCHIVED EEG DATA key to begin processing without erasing EEG data stored in the module. This is useful if processing is suspended, then resumes on the same patient. The key will change to STOP PROC after it is pressed.Touch the ERASE ARCHIVED EEG DATA key to erase all EEG data presently stored in the module. Processing begins and START PROC changes to STOP PROC.STOP PROCTouch the YES key to stop processing and return to the main menu. The STOP PROC key changes back to START PROC. Touch the NO key to return to the main menu without interrupting processing.Continuous ImpedanceTouch the CONTINUOUS IMPEDANCE key to put the module in continuous mode. In continuous mode, the impedance of each electrode is measured and displayed every 2-seconds. Use this mode when the electrodes are first placed on the scalp or when the impedance of an electrode is out of range (absolute above5 K ohms and differential above 2 K ohms), and must be re-applied. Touch the CONTINUOUS IMPEDANCE key again to un-highlight it, and turn off continuous checking. This places the impedance checking in auto mode, which updates every 5-minutes when processing is on.!• You can only access the Initial Setup menu when processing is off.!• EEG/EMG data is corrupted when continuous impedance is selected.To start processing:1Touch EEG.2Touch START PROC.3a Touch ERASE ARCHIVED EEG DATA for each new patient.3b Touch RETAIN ARCHIVED EEG DATA if the data in the module is to be saved.To stop processing:1Touch EEG.2Touch STOP PROC.3Touch YES.To put the module in continuous impedance mode from the Montage screen:1Touch EEG.2Touch SETUP.3Touch INITIAL SETUP.4Touch SYSTEM PARAMS.5Touch MONTAGE.6Touch CONTINUOUS IMPEDANCE.To put the module in continuous impedance mode:1Touch EEG.2Touch SETUP.3Touch ANALOG.4Touch CONTINUOUS IMPEDANCE.
Ultraview Care Network24-28The displayed impedance value will flash to alert you if the values are out of range.FiltersYou can set the low and high cutoff filters and line frequency filter in the system parameter menu. The low cutoff filter determines the lowest frequency that is displayed and processed, and the high cutoff filter determines the highest frequency that is displayed and processed. The LINE FREQ key selects either 50Hz or 60Hz line frequency.Touch the FILTERS key to enter the sub-menu where the high cutoff, low cutoff and line frequency filters are set. Touch one of the keys (0.5Hz, 1.0Hz, 5.0Hz) to select the desired low cutoff filter. The key will be highlighted.Touch one of the keys (20Hz, 32Hz, 50Hz, 70Hz) to select the desired high cutoff filter. The key will be highlighted. Touch LINE FREQ and select 50Hz or 60Hz. The selection will be highlighted.Remote MonitorsThis section covers the differences in display format and user menus between the local bedside monitor and remote monitors. EEG cannot be displayed on a split-screen central monitor and remote monitors do not have access to all keys and functions that are available at the local bedside.Bed Name / Patient Name InterferenceIf the EEG key is not selected then bed name and patient name are displayed at the bottom of the display zone on remote monitors. This conflicts with display of the EEG data. When the EEG key is selected bed name is displayed on the message line instead.Display Formats - Remote BedsideEEG uses one, two or four display zones at the local bedside, depending on how you configure the module. Remote views at bedside monitors only use one display zone to display the remote EEG data.Case #1 - One display zone used at the local bedside (2 EEG channels, dual format off).In this case, the remote display of EEG data is almost identical to the local bedside’s display of that data (refer to Figure 24-11).!• Continuous Impedance is automatically turned off when leaving the montage or analog setup menus.To set the low cutoff, high cutoff or line frequency filters:1Touch EEG.2Touch SETUP.3Touch INITIAL SETUP.4Touch SYSTEM PARAMS5Touch FILTERS6Select desired filter settings.
EEG24-29 Figure 24-11: EEG remote displaypatient name/bed name ONCase #2 - Two display zones used at the local bedside (4 EEG channels, dual format on or 2 EEG channels, dual format off).The local bedside requires two display zones to display EEG data for all EEG channels. The remote bedside can only use one display zone for EEG data, so a special key, labeled NEXT VIEW, is displayed in the EEG menu. This key allows you to toggle between each EEG view. The text displayed above this key indicates how many views are available and which is currently being displayed (refer to Figure 24-12).Figure 24-12: EEG remote bedside displaypatient name/bed name OFFMultiple views with NEXT VIEW keyCase #3 - Four display zones used at the bedside (4 EEG channels, dual format on).The local bedside requires four display zones to display EEG data for all EEG channels. The remote bedside can only use one display zone for EEG data, so a special key, labeled NEXT VIEW, is displayed in the EEG menu. This key allows you to cycle between each EEG view. The text displayed above this key indicates how many views are available and which is currently being displayed. ARCHIVE
25-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.Calculations DirectoryDirectory of Keys - Remote CalcsLOCALTRENDS/CALCSREMOTETRENDS/CALCSBED 1 BED 2 BED 3 BED 4 BED 5 MORESPECIAL FUNCTIONSREMOTE TRENDS/CALCS - Select bedSee next pageUCW/Ultraview 1700Ultraview 1030/1050/1500/1600NOTE: Requires Trend/Calcs enabled
Calculations Directory!• Based on features purchased, more or fewer keys may appear here than on your menu screens.25-2Directory of Keys - Clinical CalcsHEMOCALCSRESPCALCSOXYCALCSRENALCALCSUPDATEDATANEWENTRY INPUTSEDITDAY/TIMEEDIT STOREENTRYDELETEENTRY SCROLLPAGE PRINTFIO2 PaO2 SpO2 PaCO2 PvO2 SvO2 Hgb%mmHg%mmHgmmHg %g/dlmmHgl/minm2PB CO BSANOTE: Labels are dependent on type of calculationCLINICAL CALCS for BED XX CALCS - Select a menu keyEDIT INPUTS MENU - Select input to changeGRAPHICTRENDSTABULARTRENDS CALCSTRENDS/CALCS for BED xxxDRUGCALCSRefer to Trends chapterRefer to page 25-3Refer to page 25-1
25-3!• Based on features purchased, more or fewer keys may appear here than on your menu screens.EDIT INPUTSSTOREENTRYMIXTITRATETITRATIONTABLE PRINTUNITS AMT VOL CONC WEIGHT DOSE RATE DUR TOTALDOSETOTALVOLAMOUNTDOSE mcg mg g mEq units k units m unitsDOSE/MINmcg/minDOSE/HRmcg/hrDOSE/WT/MINmcg/kg/minDOSE/WT/HRmcg/kg/hrVARYRATEDOSETYPEDOSE/MINmcg/minDOSE/HRmcg/hrDOSE/WT/MINmcg/kg/minDOSE/WT/HRmcg/kg/hrDisplays on-screen keypad(Neonate Only)Displays Titrate TablesDisplays on-screen keypadDisplays on-screen keypadSCROLLPAGE PRINTUPDATE DATADRUGUCW/UV1700 onlyDRUG A ...DRUGCALCS Refer to page 25-2Select unitsADULT/NEONATAL DRUG DOSAGE - Select dosage typeEDIT INPUTS MENU - Select input to changeSelect nameADULT DRUG DOSAGE - Select a drug or menu keyADULT/NEONATAL DRUG DOSAGE - Select dose typeDRUGS A - FDOSEADULT TITRATION TABLE - Select dose typeDirectory of Keys - Drug DosageCalculations Directory
Contents25-5 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Setting Up Physiologic Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Setting Up Drug Dosage Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Accessing Calculation Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Updating Data Between Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Display Detail - Physiologic Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Hemodynamic Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Respiration Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Oxygenation Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Renal Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Drug Dosage Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Display Detail - Drug Dosage Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Configurable Drug Names (UCW and Ultraview 1700 Only) . . . . . . . . . . . . . . 24CalculationsOverviewThe Clinical Calculations feature can be divided into two types: (1) Physiologic and (2) Drug Dosage. Physiologic calculations include hemodynamic, respiration, oxygenation, and renal. These calculations use input values entered manually or collected automatically by the system to produce a set of output values. Drug Dosage calculations enable you to determine infusion rates for drugs based on drug concentration, desired dose, patient weight, and type (adult or neonate).Setting Up Physiologic CalculationsValues are entered into the system in several ways. You can take a snapshot of currently monitored inputs by selecting the NEW ENTRY key (refer to Creating a New Entry on page 25-8). You may also specify a day and time to gather input data from the past, although this function is generally limited to the past 24-hours.The system displays a combined total of 200 entries into the four physiologic calculations tables. Each table has an Edit Inputs menu that is used to edit input data. You can also create a record of both input and output data by printing the displayed table.
Ultraview Care Network25-6Setting Up Drug Dosage CalculationsThe Drug Dosage calculation feature enables you to edit the inputs and to store up to six drug records. Titration tables are displayed for each drug record entered.Drug dosage calculations operate similarly to physiologic calculations except that weight is handled differently, and that you must select an ADULT or NEONATE patient type. Refer to Entering Patient Type and Gender on page 3-9 for details on adult/neonate selection.Accessing Calculation DataCalculations can be accessed via the local bedside monitor or from a remote monitor on the network depending upon the options purchased. Contact your system administrator for details if you are unable to access this function.The data displayed in the Calculations table is from the local bedside or the specified remote monitor as selected.Updating Data Between MonitorsThe UPDATE DATA key is used to synchronize calculation data between multiple monitors. For example, if lab data for calculations were entered at the central monitor and stored in the bedside monitor database, using the UPDATE DATA key would provide those values for calculations performed at the bedside.Display Detail - Physiologic CalculationsTables for Physiologic calculations occupy several display zones above the message line, allowing display of waveforms on the remaining display zones of the screen. The Drug Dosage calculations table has a different format, but occupies the same four lower display zones. WARNING:• If the monitor is turned OFF, all clinical calculations data will be lost.To access local or remote calcs:1Touch SPECIAL FUNCTIONS.2a Select LOCAL or REMOTE TRENDS/CALCS.2b If you selected REMOTE TRENDS/CALCS, select a bed.3Touch CALCS.4Select a calcs key (HEMO, RESP, OXY, RENAL).
Calculations25-7 Figure 25-1: Physiologic calculations tableThe top line of the table shows the type of calculations performed, the bed name, and the patient name.A day/time key is displayed at the top of each data column. Each day/time key indicates the day, hour, and minute. The hours can be in either 12-hour or 24-hour format, depending on the system setup. When you use the 12-hour format, A or P are displayed to indicate either a.m. or p.m.Calculation inputs are listed on the top of the table. Output from the calculations are listed under the dividing line at the bottom of the table. Eight columns of data can display on the screen at once, each column appears under the key which corresponds to the day and time at which the data was collected. New data values are entered to the right of existing ones. If the table is full, older entries are shifted left one column. Data columns that do not display remain in memory. A highlighted key indicates a selected column.Scrolling and PagingToggle the PAGE/SCROLL key to SCROLL and use the left or right arrows to move the Calculations table over one column in the desired direction. Newer records display to the right, older records to the left.Toggle the PAGE/SCROLL key to PAGE and use the left or right arrows to move the calculations table over seven columns, or one whole page, in the desired direction. Touch the right arrow key to display the next newer page (seven columns) of records. This key does not function when the newest record is displayed in the table. Touch the left arrow key to display the next oldest page (seven columns) of records. The scrolling stops when the oldest record is displayed on the table.!• All keys appear disabled except for NEW ENTRY and PRINT until at least one record (data column) is displayed in the table.To view calcs data:1Touch CALCS.2Select a calcs key.3a Toggle the PAGE/SCROLL key to SCROLL.3b Use the → or ← keys to move data by one column.-OR-4a Toggle the PAGE/SCROLL key to PAGE.4b Use the → or ← keys to move data by seven columns.
Ultraview Care Network25-8Creating a New EntryTouch the NEW ENTRY key to create a new record for the current day and time and to add the record to the Calculations table. The new record is positioned immediately to the right of existing records. If all the columns on the screen are filled, the display shifts to the left and the new record is displayed in the far right column. The new record’s DAY/TIME key is highlighted and contains the current day and time. The available input values are displayed in the input column and calculated results appear in the output column. Any unavailable inputs or outputs are displayed as question marks.NEW ENTRY does not function when a total of 200 records exist in all the Physiologic calculations tables for the selected system. If you want to make further entries, you must first delete some of the existing entries from one or more of the calculations tables. Editing InputsEach type of calculation displays its own Edit Inputs menu containing the inputs listed in the upper part of the Calcs table. The name of the input and units of measure appear on each EDIT INPUTS key for the Physiologic calculations. Once an input has been edited, the letter e is displayed immediately after the edited value in the table.When you select an input key, the on-screen keypad appears. Refer to Using the On-Screen Keypad (Ultraview 1030/1050/1500/1600 only) on page 3-7 for on-screen keypad operating instructions.If you enter a height and weight in the BSA menu, the system automatically computes a BSA. However, changing the BSA directly invalidates any height or weight previously entered.!• Touch NEW ENTRY, then touch STORE ENTRY to store the entry in the database. Entries that have not been stored remain in the table until you select a different bed or patient, then they disappear.!• The displayed units for pressure values, height, and weight may vary based on your monitor's configuration. Contact your system administrator for details.!• Changing the height and weight in the BSA menu does not affect the height and weight in the Admit/Discharge menu. To create a new entry:1Access Local or Remote Calcs.2Touch NEW ENTRY.3Touch EDIT INPUTS to input new data not available in the system.4Select an input key.5Use the on-screen keypad to input the value.6Touch ENTER on the on-screen keypad.7Touch PREVIOUS MENU.8Touch STORE ENTRY to retain entry in Calcs table.To edit a record:1Access Local or Remote Calcs.2Touch EDIT INPUTS.3Select an input value to edit.4Use the on-screen keypad to change the input value.5Touch ENTER on the on-screen keypad.6Touch PREVIOUS MENU, then STORE ENTRY to retain entry in Calcs table.
Calculations25-9 Refer to Table 1 for adult and neonatal BSA, height and weight values for hemodynamics, oxygenation, and renal calculations.Editing Day and TimeTo create a Calculations record for a specified day and time, create a new entry and highlight the DAY/TIME key. Then touch EDIT DAY/TIME and enter the day and time for the record you want to create.Touch the DAY, HOUR, or MINUTE keys to highlight that key and display the on-screen keypad. The selected parameter and value appear in the on-screen keypad.The hour can appear in either 12-hour or 24-hour format. If the system is set for 12-hour format, use the AM/PM key to select a.m. and p.m. on the DAY/TIME key.When editing minutes and hours, you cannot change the value to a future time.When you have entered the day, hour, and minute via the on-screen keypad, the input values and output calculations reflect data available from the system at the entered time. An e appears under any edited DAY/TIME key.Storing an EntryTouching the STORE ENTRY key after touching the DAY/TIME key stores the record of input values and output calculations in the selected monitor’s database. Up to 100 stored records may be saved in each system.The letter s is displayed under the DAY/TIME key to indicate that the record has been stored. If you edit a record after it has been stored, the letter s is removed because the newly edited changes have not been stored. Storing a record overwrites the data already stored. Table 1: BSA, Height, and Weight CalculationsLabel Name Units Default Value(1030, 1050, 1500, 1600 only) Valid RangeAdult NeonatalBSA Body Surface Area m21.81 0.11 0.03 - 3.69HT Height cmin17066.93513.820 - 2157.9 - 84.6WT Weight kglb70.000154.3241.5003.3070.2 - 250.00.441- 551.156!• Stored records are saved until the system is powered down or until patient data is purged via the Admit/Discharge function.To create a record for a past time:1Access Local or Remote Calcs.2Touch NEW ENTRY.3Highlight the DAY/TIME key on a new or prior entry.4Touch EDIT DAY/TIME.5Select DAY, HOURS, or MINUTES.6Use the on-screen keypad to change.7Touch ENTER on the on-screen keypad.8Touch PREVIOUS MENU, then STORE ENTRY to retain entry in Calcs table.To store an entry:1Access Local or Remote Calcs.2Highlight DAY/TIME key of the entry to be stored.3Touch STORE ENTRY.
Ultraview Care Network25-10Deleting an EntryAfter selecting a DAY/TIME key, you may delete a record by touching the DELETE ENTRY key. A menu is displayed to confirm the deletion. A record previously stored in the database via the STORE ENTRY key will be deleted from the database, as well as from the table.Automatically displayed records, such as cardiac output data, remain in the database. These records reappear, even if deleted, when you leave and then return to a patient or bed.PrintingTouch the PRINT key to print the currently displayed page of the Calculations table. The complete table prints on a 4-channel recorder. On a 2-channel recorder, the top half of the table prints first followed by the bottom half.Hemodynamic CalculationsHemodynamic calculations provide significant data describing cardiovascular system performance.Cardiac output values from a Cardiac Output (CO) module automatically create records in the Hemodynamic Calculation table. When you create a new entry, any current values for HR, MAP, CVP, MPA, and PCWP are displayed in the table. The system will enter the current body surface value into the table, if available. The most recent CO value (if less than 15-minutes old) is also put into the table. If the system locates a CO value, then values for MAP, CVP, MPA, or PCWP not currently available are put into the table from the CO record. Any inputs which remain unavailable display question marks. The DAY/TIME key displays the current time.Table 2: Hemodynamic InputLabel Name Units Default ValueValid RangeHR Heart Rate beats/min 70 0 - 300MAP Mean Arterial Pressure mmHgkPa 80 10.7 -50 - 300 -6.7 - 40.0CVP Central Venous Pressure mmHgkPa101.3-50 - 99 -6.7 - 15.0MPA Mean Pulmonary Artery PressuremmHgkPa152.0-50 - 99-6.7 - 15.0PCWP Pulmonary Capillary Wedge PressuremmHgkPa101.3-50 - 99-6.7 - 15.0CO Cardiac Output I/min 5.0 0 - 40.0To delete an entry:1Access Local or Remote Calcs.2Highlight DAY/TIME of the entry to be deleted.3Touch DELETE ENTRY.4Touch YES.To print calcs data:1Access Local or Remote Calcs.2Touch PRINT.To view current hemodynamic calcs:1Touch CALCS.2Touch HEMO CALCS.
Calculations25-11 Hemodynamic Calculations require several specific pressure values, including CVP, MAP, and PCWP. CVP and MAP are monitored continuously; PCWP is an episodic value. A data substitution may occur if any of these pressure values are not available when you touch NEW ENTRY. When a substitution occurs, one of the error messages listed here displays on the message line.•Warning...RAP has been substituted for CVP.A continuous RAP value is used instead of the continuous CVP value if CVP is not available.•Warning...NIBP has been substituted for MAP.An episodic mean NIBP value which is less than 15-minutes old is used instead of MAP if the continuous MAP value is not available.•Warning...LAP has been substituted for PCWP.A continuous LAP value is used instead of the episodic PCWP value if the PCWP value is not available or is more than 15-minutes old. Table 3: Hemodynamic Output Label Name UnitsCI Cardiac Index L/min2SV Stroke Volume ml/beatSVI Stroke Volume Index ml/beat/m2SVR Systemic Vascular Resistance dynes x sec/cm5SVRI Systemic Vascular Resistance Index (dynes x sec/cm5) x m2PVR Pulmonary Vascular Resistance dynes x sec/cm5PVRI Pulmonary Vascular Resistance Index (dynes x sec/cm5) x m2LVSW Left Ventricular Stroke Work g x min/beatRVSW Right Ventricular Stroke Work g x min/beatLVSWI Left Ventricular Stroke Work Index g x min/beat/m2RVSWI Right Ventricular Stroke Work Index g x min/beat/m2Table 4: Hemodynamic EquationsBSA = Ht 0.725 x Wt 0.425 x 0.007184CI = CO/BSASV = (CO/HR) x 1000SVI = SV/BSASVR = 79.9 x [(MAP-CVP)/CO]SVRI= 79.9 x [(MAP-CVP)/CI]= 79.9 x [(MAP-CVP)]/[CO/BSA]= 79.9 x [(MAP-CVP)]/[CO x 1/BSA]= 79.9 x [(MAP-CVP)/CO] x BSA= SVR x BSA
Ultraview Care Network25-12Respiration CalculationsRespiration calculations describe the performance of the lungs in the ventilation process.Unless you have a ventilator Flexport interface, most input values for Respiration calculations must be manually entered. PVR = 79.9 x [(MPA-PCWP)/CO]PVRI= 79.9 x [(MPA-PCWP)/CI]= 79.9 x [(MPA-PCWP)]/[CO/BSA]= 79.9 x [(MPA-PCWP)]/[CO x 1/BSA]= 79.9 x [(MPA-PCWP)/CO] x BSA= PVR x BSALVSW = 0.0136 x SV x (MAP - PCWP)RVSW = 0.0136 x SV x (MPA - CVP)LVSWI = LVSW / BSARVSWI = RVSW / BSAAssumes pressures are measured in mmHgTable 5: Respiration InputLabel Name Units DefaultValueValidRangeRR Respiration Rate breaths/min 20 0-200PaCO2Partial Pressure of Arterial Carbon DioxidemmHgkPa405.30-1500-20.0VT Tidal Volume ml/breath 500 0-3000PIP Peak Inspiratory Pressure cmH2O 50 0-200PLT Plateau Pressure cmH2O 30 0-200PEEP Positive End Expiratory Pressure cmH2O100-50PECO2Partial Pressure of Expired Carbon DioxidemmHgkPa354.70-1500-20.0Table 4: Hemodynamic Equations (continued)To view current respiration calcs:1Touch CALCS.2Touch RESP CALCS.
Calculations25-13 Oxygenation CalculationsOxygenation calculations provide specific data describing the efficiency with which the body acquires, circulates, and utilizes oxygen in the cardiopulmonary system. Input values for Oxygenation calculations are automatically obtained from SpO2, SvO2, cardiac output modules, or Flexport interfaces. You must manually enter inputs for laboratory blood analysis values.Table 6: Respiration OutputLabel Name UnitsVMIN Minute Volume l/minCst Static Compliance ml/cmH2OCdyn Dynamic Compliance ml/cmH2OVD Dead Space Volume mlVD/VT Dead Space to Tidal Volume Ratio RatioVA Alveolar Ventilation ml/minTable 7: Respiration EquationsVMIN = VT x RR/1000Cst = VT/(PLT-PEEP)Cdyn = VT/(PIP-PEEP)VD = (PaCO2 - PECO2) x (VT/PaCO2)VD/VT = VD/VTVA = (VT - VD) x RRTable 8: Oxygenation InputLabel Name Units Default ValueValid RangeFi02Fractional Inspired Oxygen % 50 0 - 100PaO2Partial Pressure of Arterial Oxygen mmHgkPa10013.30 - 5000 - 70.0SpO2Arterial Oxygen Saturation % 97 0 - 100PaCO2Partial Pressure of Arterial Carbon DioxidemmHgkPa405.30 - 1500 - 20.0PvO2Partial Pressure of Mixed Venous OxygenmmHgkPa385.10 - 990 - 15.0SvO2Mixed Venous Oxygen Saturation % 75 0 - 99To view current oxygenation calcs:1Touch CALCS.2Touch OXY CALCS.
Ultraview Care Network25-14Calculating O2AV, O2AVI, VO2, and VO2I requires a CO value to complete the calculations. The most recent CO value (less than 15-minutes old) is used for these calculations if it is available.Table 9: Oxygenation OutputLabel Name UnitsCTaO2Arterial Oxygen Content ml/dlCTvO2Venous Oxygen Content ml/dlavDO2Arteriovenous Oxygen Content difference ml/dlO2AV Oxygen Availability ml/minO2AVIOxygen Availability Index ml/min/m2VO2Oxygen Consumption ml/minVO2IOxygen Consumption Index ml/min/m2O2ER Oxygen Extraction Ratio NonePAO2Partial Pressure of Alveolar Oxygen mmHgkPaQs/Qt Pulmonary Venous Admixture Shunt %P/F PaO2/FiO2 ratio NoneTable 10: Oxygenation EquationsCTaO2= (1.34 x Hgb x SpO2100) + (0.0031 x PaO2)CTvO2= (1.34 x Hgb x SvO2/100) + (0.0031 x PvO2)avDO2= CTaO2 - CTvO2O2AV = CTaO2 x CO x 10O2AVI= O2AV/BSAVO2= avDO2 x CO x 10VO2I= VO2/BSAO2ER = (CTaO2 - CTvO2)/CTaO2PAO2= [(FiO2/100) x (PB*-47)] - PaCO2 /0.8 Qs/Qt = 100 x [(1.34 x Hgb) + (0.0031 x PAO2) - CTaO2][(1.34 x Hgb) + (0.0031 x PAO2) - CTvO2]* PB = Barometric Pressure
Calculations25-15 Renal CalculationsRenal calculations provide data related to kidney function. Input for Renal calculations, other than a previously entered BSA, must be manually entered. The system automatically computes BSA when you enter a height and weight into this menu. Table 11: Renal InputLabel Name UnitsDefaultValueValid RangeURK Urine Potassium mEq/l 60 0 - 300PLOSM Plasma Osmolality mOsm/L 290 0 - 999UROSM Urine Osmolality mOsm/L 575 0 - 9999SerNa Serum Sodium mEq/l 140 0 - 999CR Serum Creatinine mg/dl 1.10 0 - 9.99UCR Urine Creatinine mg/dl 50.0 0 - 999.9BUN Blood Urea Nitrogen mg/dl 12 0 - 999URNa Urine Sodium mEq/L 90 0 - 999URINE Urine Volume ml/day 2000 0 - 9999Table 12: Renal OutputLabel Name UnitsURNaEX Urine Sodium Excretion mEq/dayURKEX Urine Potassium Excretion mEq/dayNa/K Urine Sodium: Potassium Ratio RatioCOSM Osmolal Clearance ml/dayCH2O Water Clearance ml/dayU/POSM Urine: Plasma Osmolality Ratio RatioFENa Fractional Sodium Excretion %CRCL Creatinine Clearance ml/min/m2NSLOSS Non-Saline Loss ml/dayBUN/CR BUN: Creatinine Ratio RatioU/CR Urine: Serum Creatinine Ratio RatioTo view current renal calcs:1Touch CALCS.2Touch RENAL CALCS.
Ultraview Care Network25-16Drug Dosage CalculationsWhen you touch DRUG CALCS, either the Adult Drug Calcs screen or the Neonatal Drug Calcs screen displays, along with the Drug Dosage menu (refer to Figure 25-2 and Figure 25-3).Table 13: Renal EquationsURNaEX = URNa x URINE/1000URKEX = URK x URINE/1000Na/K = URNa/URKCOSM = (UROSM/PLOSM) x URINECH2O = URINE - COSMU/POSM = UROSM/PLOSMFENa = (URNa/SerNa) x (CR/UCR) x 100CRCL = (UCR/CR) x (URINE/1440) x 1.73/BSANSLOSS = URINE - (URINE x UrNa/SerNa)BUN/CR = BUN/CRU/CR = UCR/CR!• Since only three columns appear on the screen at one time, each illustration includes two screens — one with columns for Drug A, B, and C, and one with columns for Drug D, E, and F.
Calculations25-17 Display Detail - Drug Dosage CalculationsFigure 25-2: Adult drug calcs (drug keys A - F)
Ultraview Care Network25-18Figure 25-3: Neonatal drug calcs (drug keys A - F)Select the DRUG A - F keys as you selected the DAY/TIME keys in other calculations tables. When you begin drug dosage calculations, the patient’s currently stored weight (automatically converted to kilograms) appears in the table. Thereafter, selecting a drug key allows you to edit the data in the column below it.The DRUG A - F keys do not display actual drug names. However each column’s default values are derived from common mixtures of frequently used drugs.Table 14: Drug Dosage EquationsCONC = Amount/VolumeRATE = Dose/ConcDOSE = Rate x ConcTOTAL VOL = Rate x DurationTOTAL DOSE = Dose x Duration
Calculations25-19 Entering Drug Dosage ValuesFrom the Drug Dosage menu you can edit the inputs, store up to six drug records, display two titration tables for each of these drug records, and print any of the displayed information.You can enter drug values for adults or neonates, depending on the current patient type selection (refer to Discharging a Patient on page 3-9 for more information). If NEONATE was selected, the MIX/TITRATE key is displayed. The MIX/TITRATE key toggles to highlight either MIX or TITRATE and affects how calculations are performed when the DOSE is edited.While WEIGHT is the only drug dosage input automatically entered by the system, default values are present when you first display the table. You can edit any value by manually entering a new value. Weight must be entered in kilograms.To begin editing input values, touch a DRUG key. Touch EDIT INPUTS to display the Edit Inputs menu. Touch any input key on the Edit Inputs menu, except UNITS and DOSE (described later), to display the on-screen keypad. During editing, the menu prompt shows the minimum and maximum values you can enter. Touch ENTER in the on-screen keypad to update the Drug Dosage table.Table 15: Drug Dosage CalculationsLabel Name Valid Range Possible Units of MeasureAMT Amount 0.01-9999.99mcg, mg, g, mEq, units, k units, m unitsVOL Volume 1-9999 mlCONC Concentration 0.01-9999.99mcg/ml, mg/ml, g/ml, mEq/ml,units/ml, k units/ml, m units/mlWEIGHT Weight 0.2-250.0 kgDOSE/MIN & DOSE/HR Dose/Time 0.01-9999.99* mcg/xx, mg/xx, g/xx, mEq/xx, units/xx, k units/xx, munits/xxDOSE/WT/MIN&DOSE/WT/HRDose/Weight/Time0.01-9999.99* mcg/kg/xx, mg/kg/xx, g/kg/xx, mEq/kg/xx, units/kg/xx, k units/kg/xx, munits/kg/xxRATE Flow Rates 0.1-999.99 ml/hrDUR Duration 0.1-999.99 hrTOTAL DOSE Total Dose 0.01-9999.9 mcg, mg, g, mEq, units, kunits, m unitsTOTAL VOL Total Volume 0.1-9999.99 ml* where xx is minutes or hoursTo access local or remote calcs and drug calcs:1Touch SPECIAL FUNCTIONS.2a Select LOCAL or REMOTE TRENDS/CALCS.2b If you selected REMOTE TRENDS/CALCS, select a bed.3Touch DRUG CALCS.4Select DRUG A, B, C, D, E, or F.To enter a drug dose value:1Access Local or Remote Drug Calcs.2Touch EDIT INPUTS.3Select the desired key.4Use on-screen keypad to change value.5Touch ENTER on the on-screen keypad.
Ultraview Care Network25-20Changing Units of MeasureUnits of measurement are displayed on the table to the right of the data values. Changing the selected units for AMOUNT may also change the displayed units for CONC. Changing the selected units for DOSE may also change the displayed units for DOSE/WT and TOTAL DOSE.If the values for CONC, DOSE/HR, DOSE/WT/HR, and TOTAL DOSE exceed the range of their currently selected units, that value is divided by 1000 and the units change accordingly. For example, if the value for TOTAL DOSE is 123,456 mg, it will be displayed as 123.46 g. This value is rounded because only two digits can be displayed to the right of the decimal point.WEIGHT is displayed in kilograms (kg), regardless of the system’s setting for weight. Weights in pounds automatically convert to kilograms prior to being displayed.Units SubmenuThis menu allows you to choose one of three types of units (grams, mEq, and units) for AMOUNT or DOSE.Changing the units for AMOUNT may change the units for CONC. Changing the unit type for AMOUNT changes the unit type for DOSE. Either may scale the values and units for CONC, DOSE, DOSE/WT, and TOTAL DOSE up or down for values less than 0.01 or greater than 9999.99.Changing the units for DOSE may change the units for DOSE/WT and TOTAL DOSE. As a result, both the minute and hour values for DOSE and DOSE/WT may change.Dose SubmenuWhen you select DOSE in the Edit Inputs menu, four dose type keys are displayed. Select any of these keys to edit the corresponding value shown in the Drug Dosage Calculations table. The system automatically calculates and displays the changes for the other three dose types in the Drug Dosage Calculations table.The dose type selected for a specific drug defines the dose unit used for that drug’s titration tables. When you store a Drug Calculation record, the dose type is also stored.Storing a RecordTouch STORE ENTRY to store the record and to display the letter s under the associated DRUG key. You can store six records, one for each DRUG key. If you edit a record that has been stored, the system removes the letter s because the newly edited changes have not been stored.To change drug units:1Access Local or Remote Drug Calcs.2Touch EDIT INPUTS.3Touch UNITS.4Select units to change.To store a drug record entry:1Access Local or Remote Drug Calcs.2Select a Drug key.3Touch STORE ENTRY.
Calculations25-21 Displaying Titration TablesThe VARY RATE/DOSE toggle key and DOSE TYPE keys are displayed when you touch TITRATION TABLE. VARY RATE varies the rate (holding the concentration constant) and calculates (titrates) the corresponding dose using the selected dose unit type. VARY DOSE varies the dose (holding the drug concentration constant) and calculates (titrates) the corresponding delivery rate in ml/hr.The DOSE TYPE key displays the DOSE TYPE menu where the dose values are displayed and the Titration table is updated with the selected dose type. This key is disabled whenever VARY RATE is selected, and enabled when VARY DOSE is selected.In the titration tables, flow rate and dose are calculated using the equations below.Figure 25-4: Titration tableFigure 25-4 displays a sample Vary Rate Titration table. The amount and volume is displayed at the top of the table along with the dose and rate units. The units for amount and dose are the same units used in the Drug Dosage table.The drug (A through F) and patient weight are displayed at the top of the table.Dosages can vary between 0.01 and 9999.99 mg/min, and rates can vary between 0.1 and 999.99 ml/hr.The patient type (ADULT or NEONATE) is displayed in the upper left corner of the table.FLOW RATE in ml/hr = DOSE x 60 min/1 hrAMOUNT/VOLUMEDOSE in xx/min = FLOW RATE x AMOUNT x 1hr/60 minVOLUMETo display titration tables:1Access Local or Remote Drug Calcs.2Touch TITRATION TABLE.To vary based on rate/dose:1Access Local or Remote Drug Calcs.2Touch TITRATION TABLE.3Touch VARY RATE/DOSE.
Ultraview Care Network25-22Adjusting the Table RangeUse the SCROLL and PAGE keys in the Titration Table menu to select the range of data displayed in the titration table. The default range is 1-100.PrintingTouch the PRINT key to print the currently displayed page of the Calculations table. The complete table prints on a 4-channel recorder. On a 2-channel recorder, the top half of the table prints first followed by the bottom halfRecalculationsYou can recalculate all Drug Dosage inputs except for the amount/hour entries shown for DOSE and DOSE/WT. In most cases, changing one parameter automatically recalculates and redisplays other parameters under that DRUG key. Table 16 shows adult patient recalculation rules, except where noted in AMOUNT and VOLUME. When TITRATE on the MIX/TITRATE key is selected, DOSE, DOSE/WEIGHT, and FLOW RATE results are the same for Adult and Neonatal.CAUTION:• If any value in the Drug Calculation table is over its designated range, ++++.++ will be displayed for values of AMOUNT, CONC or DOSE, or RATE and the Titration Table becomes inaccessible.To print calcs data:1Access Local or Remote Drug Calcs.2Touch PRINT.
Calculations25-23 Table 16: Drug Dosage RecalculationsEdit Constants ResultsAMOUNTHolds VOLUME constant Calculates CONCHolds DOSE (dose/min) constant Calculates FLOW RATE (ADULT only)Holds DUR constant Calculates TOTAL VOL (ADULT only)Holds DOSE constant Calculates FLOW RATEHolds DUR constant Calculates TOTAL DOSE (NEONATAL only)VOLUMEHolds AMOUNT constant Calculates CONCHolds DOSE/MIN constant Calculates FLOW RATE (ADULT only)Holds DUR constant Calculates TOTAL VOL (ADULT only)Holds DOSE constant Calculates FLOW RATEHolds DUR constant Calculates TOTAL DOSE and VOL (NEONATAL)CONCHolds VOLUME constant Calculates AMOUNTHolds DOSE/MIN constant Calculates FLOW RATEHolds DUR constant Calculates TOTAL VOLWEIGHT Holds DOSE/MIN constant Calculates DOSE/WEIGHT/MINHolds DOSE/HR constant Calculates DOSE/WEIGHT/HRDOSE or DOSE/WEIGHT (TITRATE)Holds WEIGHT constant Calculates other 3 DOSE and DOSE/WEIGHTSHolds CONC constant Calculates FLOW RATEHolds DUR constant Calculates TOTAL DOSE and TOTAL VOLDOSE or DOSE/WEIGHT (MIX)Holds WEIGHT constant Calculates other 3 DOSE and DOSE/WEIGHTSHolds FLOW RATE constant Calculates CONCHolds VOLUME constant Calculates AMOUNTHolds DUR constant Calculates TOTAL DOSEFLOW RATE (TITRATE)Holds CONC constant Calculates DOSE/MIN and DOSE/HRHolds WEIGHT constant Calculates DOSE/WEIGHT/MIN and DOSE/WEIGHT/HRHolds DUR constant Calculates TOTAL VOLFLOW RATE (MIX)Holds DOSE/HR constant Calculates CONCHolds VOLUME constant Calculates AMOUNTHolds DUR constant Calculates TOTAL DOSE and TOTAL VOLDUR Holds DOSE/MIN constant Calculates TOTAL DOSEHolds FLOW RATE constant Calculates TOTAL VOLTOTAL DOSEHolds CONC constant Calculates FLOW RATEHolds DUR constant Calculates DOSE/MIN, DOSE/HR, and TOTAL VOLHolds WEIGHT constant Calculates DOSE/WEIGHT/MIN and DOSE/WEIGHT/HRTOTAL VOLHolds DUR constant Calculates FLOW RATEHolds CONC constant Calculates DOSE/WEIGHT/MIN and DOSE/WEIGHT/HRHolds WEIGHT constant Calculates DOSE/WEIGHT/MIN and DOSE/WEIGHT/HR
Ultraview Care Network25-24Configurable Drug Names (UCW and Ultraview 1700 Only)Using the Drug Name ListTo use the list of drug names:1. Touch the DRUG key in the Drug Calcs Edit Inputs menu.Figure 25-5: Edit Inputs menu2. The DRUG NAME LIST menu appears, enabling you to choose from the master drug list. Select the appropriate drug name and then touch ACCEPT. The drug name and stored default values are transferred into the currently selected drug (A through F). Select CANCEL to remove the selection menu without changing the current settings for the drug. Drug Calcs will display the selected drug name below the key.Figure 25-6: Drug Calcs displayRemote Drug NamesDrug names on local bedside monitors can be edited remotely from the host monitor. The local names can be stored in the remote monitor even if the remote bed does not include the drug in its own stored list. Drug names can be kept consistent by transferring master drugs lists from one bed to another allowing remote bed access to the master drug list.!• The drug default values for drugs A through F can be overwritten and not affect the master drug list entry. However, selecting another drug name for drug A, B, C, D, E, or F will override all previously-edited values and will insert the master default settings. Ensure that the changes are effected after selecting the drug name (and not before).
Note: The values listed here represent commonly published ranges for adults and are for reference purposes only.Note: Acceptable values for individual patients should be determined by hospital protocol and the attending physician.Table 17: Hemodynamic CalculationsVariable Calculation Normal Range*Cardiac Index (CI) COBSA2.5 - 4.0 liters/min/m2Stroke Volume (SV) CO x 1000 HR 60 - 130 ml/beatStroke Volume Index (SVI) SVBSA30 - 65 ml/beat/m2Systemic Vascular Resistance (SVR) MAP - CVP x 79.9 CO 900 - 1400 dynes x sec/cm5Systemic Vascular Resistance Index (SVRI)MAP - CVP x 79.9 CI(Converts to SVR x BSA)1760 - 2600 (dynes x sec/cm5) x m2Pulmonary Vascular Resistance (PVR) MPA - PCWP x 79.9 CO 20 - 130 dynes x sec/cm5Pulmonary Vascular Resistance Index (PVRI)MPA - PCWP x 79.9 CI(Converts to PVR x BSA)36 - 235 (dynes x sec/cm5) x m2Left Ventricular Stroke Work (LVSW) (MAP - PCWP) x SV x 0.0136Left Ventricular Stroke Work Index (LVSWI)(MAP - PCWP) x SVI x 0.0136(Converts to LVSW/BSA)45 - 75 g x min/m2/beatRight Ventricular Stroke Work (RSVW) (MPA - CVP) x SV x 0.0136Right Ventricular Stroke Work Index (RVSWI))(MPA - CVP) x SVI x 0.0136(Converts to RVSW/BSA)4 - 8 g x min/m2/beat(HR = Heart Rate; BSA = Body Surface Area; MAP = Mean Arterial Pulse; CVP = Central Venous Pressure; MPA = Mean Pulmonary Artery Pressure; PCWP = Pulmonary Capillary Wedge Pressure)Table 18: Renal CalculationsVariable Acquisition Method or Calculation UnitsUrine Potassium (URK) Laboratory Measurement mEq/LPlasma Osmolality (PLOSM) Laboratory Measurement mOsm/LUrine Osmolality (UROSM) Laboratory Measurement mOsm/LSerum Sodium (SerNa) Laboratory Measurement mEq/LSerum Creatinine (CR) Laboratory Measurement mg/dlUrine Creatinine (UCR) Laboratory Measurement mg/dlBlood Urea Nitrogen (BUN) Laboratory Measurement mg/dlUrine Sodium (URNa) Laboratory Measurement mEq/LUrine Volume (URINE) Data Entry ml/dayUrine Sodium Excretion (URNaEX) URNa x URINE/1000 mEq/dayUrine Potassium Excretion (URKEX) URK x URINE/1000 mEq/dayUrine Sodium to Urine Potassium Ratio (Na/K) URNa/URK (ratio)Osmolar Clearance (COSM) (UROSM/PLOSM) x URINE ml/dayWater Clearance (CH2O) URINE - COSM ml/dayUrine Osmolality to Plasma Osmolality Ratio (U/POSM) UROSM/PLOSM (ratio)Fractional Sodium Excretion (FENa) (URNa/SerNa) x (CR/UCR) x 100 %Creatinine Clearance (CRCL) (UCR/CR) x URINE/1440) x 1.73/BSA ml/min/m2Non-Saline Loss (NSLOSS) URINE - (URINE x URNa/SerNa) ml/dayBUN to Creatinine Ratio (BUN/CR) BUN/CR (ratio)Urine Creatinine to Serum Creatinine Ratio (U/CR) UCR/CR (ratio)Table 19: Oxygenation CalculationsVariable Calculation Normal Range*Arterial Oxygen Saturation (SaO2)Laboratory Measurement (SaO2) or Pulse Oximetry (SpO2)95 - 100%Partial Pressure of Arterial Oxygen (PaO2)Laboratory Measurement 80 - 100 mmHgMixed Venous Oxygen Saturation (SvO2)Laboratory Measurement or Monitored Valu e 60 - 80%Partial Pressure of Mixed Venous Oxygen (PvO2)Laboratory Measurement 35 - 45 mmHgOxygen Availability (O2AV) CTaO2 x CO x 10 900 - 1100 ml/minOxygen Availability Index (O2AVI) O2AV/BSA 497 - 608 ml/min/m2Arterial Oxygen Content (CTaO2)(1.34 x Hgb x SpO2/100) + (PaO2 x 0.0031) 18 - 20 ml/dlMixed Venous Oxygen Content (CTvO2)(1.34 x Hgb x SvO2/100) + (PvO2 x 0.0031) 14 - 16 ml/dlArterial/Venous Oxygen Difference (avDO2)CTaO2 - CTvO23 - 5.5 ml/dlOxygen Consumption (VO2)avDO2 x CO x 10 200 - 300 ml/minOxygen Consumption Index (VO2I) VO2/BSA 110 - 166 ml/min/m2Oxygen Extraction Ratio (O2ER) VO2/O2AV (Simplifies to avDO2/CTaO2) 1/4 or 0.25Partial Pressure of Alveolar Oxygen (PAO2)[(FiO2/100) x (PB - 47)] - PaCO2/0.8 100 mm HgPulmonary Venous Admixture Shunt (Qs/Qt)100 x[ (1.34 x Hgb) + (0.0031 x PAO2) - CTaO2)](1.34 x Hgb) + (0.0031 x PAO2) - CTvO2Varia ble, depending on FiO2PaO2/FiO2 Ratio (P/F) PaO2/FiO2Varia ble, depending on FiO2(Hgb = Hemoglobin; PB = Barometric Pressure)Table 20: Respiration CalculationsVariable Calculation UnitsRespiratory Rate (RR) Monitored Value or Ventilator breaths/minPartial Pressure of Arterial Carbon Dioxide (PaCO2)Laboratory Measurement mmHgTidal Volume (VT) Ventilator ml/breathPeak Inspiratory Pressure (PIP) Ventilator cmH2OPlateau Pressure (PLT) Ventilator cmH2OPositive End Expiratory Pressure (PEEP) Ventilator cmH2OPartial Pressure of Expired Carbon Dioxide (PECO2)Data Entry mmHgMinute Volume (VMIN) VT x RR/1000 L/minStatic Compliance (Cst) VT/(PLT - PEEP) ml/cmH2ODynamic Compliance (Cdyn) VT/(PIP - PEEP) ml/cmH2ODead Space Volume (VD) (PaCO2 - PECO2) x (VT/PaCO2)mlDead Space to Tidal Volume Ratio (VD/VT) VD/VT (ratio)Alveolar Ventilation (VA) (VT - VD) x RR ml/min
26-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.Trends DirectoryDirectory of KeysLOCALTRENDS/CALCSREMOTETRENDS/CALCSSPECIAL FUNCTIONSNOTE: Requires Trend/Calcs enabledUltraview 1030/1050/1500/1600UCW/Ultraview 1700See next pageBED 1 BED 2 BED 3 BED 4 BED 5 MOREREMOTE TRENDS/CALCS - Select bed
Trends Directory!• Based on features purchased, more or fewer keys may appear here than on your menu screens.26-2Directory of KeysGRAPHICTRENDSTABULARTRENDS CALCS2HRS6HRS12HRS24HRSARTECGHRCHANGE TIME BASETIMEBASETOPGRAPHBOTTOMGRAPHEXPANDON OFFTABULARTRENDSPRINTSIZE CURSOR CURSORRESPRR TEMPTREND PARAMETERSRESPRRECGHRECGABNCHANGE SIZEGRAPHIC TRENDSNOTE: Keys are labeled according to parameters currently being trendedNOTE: Keys are labeled according to parameters currently being trended1MIN5MIN10MIN30MIN15MIN1.5HR1HR3HRPRINT GRAPHICTRENDSTIMEINTERVALPAGESCROLLTABULAR TRENDSCHANGE TIME INTERVALRefer to Printing the Trend Displayin this chapterTRENDS/CALCS for BED xxxDRUGCALCSRefer to Calculations chapterRefer to page 26-1
Contents26-3 TrendsOverviewTrends are a convenient way of displaying numeric data that has been collected for a patient over the last 24-hours. Your monitor can display a graphic trend or tabular trend (depending on the option purchased) of collected numeric data for every parameter except delta temperature and EEG. This data appears in a table format similar to common flowsheets or spreadsheets.Graphic trends can appear in three formats.• Continuous trends represent parameters with continuous monitoring. A solid line connects trend points.• Episodic trends represent parameters that produce individual events. Episodic values are displayed as an x,+, or 0. A dotted line connects each episode.• Histogram trends are displayed as vertical bars starting at a base of zero.The system collects trend values every minute and episodic trend values as they become available. Up to the last 24-hours of collected data in memory is displayed and the system saves trend values for as long as memory limitations allow. In most cases, an episodic trend contains at least 30 values.!• When you suspend alarms with the TONE RESET/ALM SUSPEND key the system may not collect trend data. Contact your system administrator to enable this function.To display a trend:1Touch SPECIAL FUNCTIONS.2a Select LOCAL TRENDS/ CALCS or REMOTE TRENDS/ CALCS.2b If you touched REMOTE TRENDS/CALCS, select a bed.3a Touch GRAPHIC TRENDS.-OR-3b Touch TABULAR TRENDS.(Follow these three steps to start each quickstart in this chapter.)Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Printing the Trend Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Graphic Trends Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Tabular Trends Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Trends Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Ultraview Care Network26-4Display DetailGraphic Trend DisplayFigure 26-1: Graphic trends displayTrend unit of measure (unit labels are not displayed for parameters with one acknowledged unit of measure for example, ECG, RESP, and CO.)Scale value - use SIZE key to selectBed and patient identificationCursorData values for top graph* Upper trend time axisRight axis for bottom graphData values for bottom graph*Lower trend time axis쐅Left axis for bottom graph* When the cursor is displayed, data values reflect those at the cursor location, and the Values at label is displayed. When the cursor is not displayed, data values reflect current values, and the Current Values label is displayed.The system maintains settings for trend displays (time base, parameters, size, etc.) until you change them or display a new patient’s trend.Bed: S114Values atTime: 08:27Left axis:ART (mmHg)SYS = 136MEAN = (96)DIA = 74Left axis:ECGHR = 128Right axis:ABN = 10-6 -5 -4 -3 -2 -1 0 hr030020008:30a 9:30a 10:30a 11:30a 12:30a 1:30p020kpammHgDate: 01 Jun 2003Patient: Smith, A. 쐅
Trends26-5 The messages “No trends available for this bed” or “Trend data not available” appear when trend data has yet to be accumulated for the selected bed.Tabular Trends DisplayYou can view a tabular trend of continuous patient data and episodic patient data acquired within the last 24-hours by touching the TABULAR TRENDS key.Figure 26-2: Tabular trends displayBed identificationPatient nameTimes that data was collectedDate of tabular trendTrended dataUnit of measure for each parameterList of parametersParameters always appear in descending order of priority. Data that is monitored on a continuous basis always precedes episodic data. Episodic values are presented according to the sequence in which they were originally stored. Data older than 24-hours is not displayed.Calculations data does not appear in tabular trends.Printing the Trend DisplayYou can print a copy of the displayed graphic trend or tabular trend at any time. !• When using a 2-channel printer, the top and bottom half of the trend display print consecutively.Bed: 220 Patient: SMITH, JOHN Date: 18 JUN 2003 CURRENTTime 05:30 06:00 06:30 07:00 07:30 08:00 08:30 09:00HR(ECG) b/min 70 75 82 67 76 85 72 77ABN b/min0 0 0000 0 0RR(RESPbr/min814998814 14ART/s mmHg 165 137 165 165 165 165 137 138MAP mmHg 136 136 136 136 136 136 108 109ART/d mmHg 108 80 108 108 108 108 80 81  To print the trend display:1Adjust trend display as desired.2Touch PRINT.
Ultraview Care Network26-6Graphic Trends FeaturesSelecting Trend ParametersThe first time you display a patient’s graphic trend, the highest priority parameter is displayed on the bottom trend graph and the next highest priority parameter is displayed on the top graph. You can view other trends by selecting them from the Trend Parameter menu.Using the CursorThe graphic trends cursor is a solid, vertical line that moves across the entire trend graph (refer to Figure 26-1 on page 26-4). The home position of the cursor is at the extreme right end of the graph. Once the cursor moves from its home position, the CURRENT VALUES label changes to reflect the cursor’s current position. The CURRENT VALUES label now displays VALUES at and the time. These values represent the data acquired from the patient.Selecting a Time BaseThe time base for each trend graph can be set for 2-, 6-, 12-, or 24-hours. The displayed resolution for each time base is:Selecting a Scale SizeYou can adjust the scale for each parameter. Initially, the system selects a scale that includes all monitored values for the displayed parameter. You may adjust the scales using the arrow keys.!• The trend graph continues to update EXCEPT when the cursor is moved from its home position. It updates again when the cursor returns to its home position.• When switching between Graphic Trends and Tabular Trends, the cursor remains in the same position. For example, if the cursor is placed on data 2-hours previous to the current time in Graphic Trends, when moving directly to Tabular Trends, the screen will display the same time frame, and the corresponding data column will be highlighted.2-hours = 1-minute6-hours = 1-minute12-hours = 2-minutes24-hours = 4-minutesTo select a parameter for the top or bottom graph:1Select TOP GRAPH or BOTTOM GRAPH.2Select desired parameter.To move the cursor:1Touch cursor keys as needed.To set a trend graph time base:1Touch TIME BASE.2Select 2, 6, 12, or 24 HRS.To adjust the scale size:1Touch SIZE.2Select desired parameter key.3Use arrow keys to adjust.
Trends26-7 Expanding the Trend DisplayYou may expand the trend display to include only an hour’s worth of information. With EXPAND ON, the TIME BASE key does not operate and updating of the trend graph is suspended on the graph as it is currently displayed. When EXPAND is OFF, the trend graph returns to its original display. Moving the cursor while EXPAND is ON does not change the cursor’s position in the OFF mode.Tabular Trends FeaturesSetting a Time IntervalYou can display acquired data at various time intervals: 1-, 5-, 10-, 15-, and 30-minutes; and 1-, 1.5-, and 3-hours.For continuous data, the value displayed in the tabular trend table is the value taken at the displayed time. It is not an average of all readings taken during that time period.When more than one episodic reading occurs in the same time interval, only the most recent value is displayed. Asterisks to the right of the episodic value indicates that more data entries are available for that time interval.The trend table automatically updates at the end of each time interval. This shifts all data columns to the left to include the new interval.Viewing Off-Screen InformationYou can view up to 22 rows and 7 columns of parameter data on a single screen in a tabular trend.You can view additional parameters by moving rows up or down. When you select PAGE, the arrow keys move the entire page up or down. When you select SCROLL, the arrow keys move the display up or down one parameter row at a time.You can view data collected at other times by moving columns left or right. When you select PAGE, the arrow keys move the display to show an entirely new set of columns. When you select SCROLL, the arrow keys move the display left or right by one column.!• Updating is suspended when you review data while paging or scrolling.To expand the trend display:1Touch either CURSOR key to move the cursor to the desired location.2Select EXPAND ON.To set a time interval1Touch TIME INTERVAL.2Select the desired time interval.To view additional parameters and data (for Tabular Trends):1Select PAGE or SCROLL. 2Use the ↑ and ↓ arrow keys to move parameter rows up or down.To view additional parameters and data (from a different time):1Use the PAGE and SCROLL up and down arrow keys to move parameter rows vertically.-OR-2Use the PAGE and SCROLL left and right keys to move data columns horizontally.
26-8Trends Troubleshooting GuideClinical Situation Possible Cause SolutionCurrent patient data not being added to trends■If alarms are suspended data may not be trended at the bedside monitor.■Turn ON alarms or have your system administrator enable your system to trend while alarms are suspended.■EXPAND key ON(trend data will not be lost).■Change EXPAND to OFF.Resume ECG processing.■Cursor not in home position(trend data will not be lost).■Move the cursor to the extreme right position.PCWP trend not available■PCWP values not saved. ■Save the PCWP values.Incorrect unit of measure displayed■Incorrect unit of measure configured for system.■Contact your system administrator.CALCS data not trending■Trends cannot trend CALCS. ■Use the CALCS menu to display this data.NO TRENDS AVAILABLE FOR THIS BED message isdisplayed■No trend data has yet accumulated for the selected parameter.■Allow sufficient time for data to accumulate.Numerous entries with ??? instead of vital signs■Alarm Suspend was selected frequently.■Contact your system administrator to collect data during Alarm Suspend periods.■ECG/Resp processing suspended. ■Do not suspend ECG processing unless the patient is off the system.■Ensure that ECG/Resp amplitude and signal quality are sufficient.
27-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.Remote KeypadDirectory of Keys - UCW and Ultraview 1700ADMIT/DISCHARGEMONITORCONFIG.TONESMONITOR SETUPPRIVILEGEDACCESSSECURE MODEON OFFRESETMONITORREMOTE KEYPADSTATION ADDRESSCHANGE CLINICALPASSWORDCLINICAL LEVEL - Select ParameterUNITS OFMEASUREUSER MOREALARMSETUPPRESELECTEDRECORDINGSCLINICAL LEVEL: Select ParameterTIME/DATE ACCESSALARM WATCHSETUPCLINICAL LEVEL - Set remote keypad station address: XRECORDERCONFIG.MOUSECONTROL
Contents27-3 Remote KeypadOverviewThe remote keypad option allows you to remotely suspend or adjust alarms, access graphic trends, adjust waveform size, initiate recordings, etc. The zoom function enlarges menu keys on the monitor making them easy to read from across the room.Setting Up the Remote KeypadThe remote keypad is a cordless, hand-held transmitter powered by an internal battery (refer to Figure 27-1). It sends your instructions via infrared signals to the monitor’s receiver. The maximum operating range is 20 feet at an angle of up to 45 degrees on either side of the receiver.The remote keypad provides all of the functions you need to operate your monitor remotely.!• The operational range of the remote keypad is approximately 20 feet.Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Setting Up the Remote Keypad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Selecting a Parameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Operating Menu Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Recording a Waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Programming Access Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Remote Keypad Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Ultraview Care Network27-4Figure 27-1: Remote keypadSetting Up the ReceiverAn optional receiver is required for the Ultraview 1700. The receiver attaches to the side of the monitor and connects to the nurse alert port (J14) on the back of the monitor. A nurse alert may still be used with the monitor by plugging the nurse alert into the port on the rear of the receiver.!• The 90360-03 receiver is only compatible with the Ultraview 1700 S/N 387-1xxxxxx and higher.• The receiver is integrated into the UCW, and no external receiver is required.SPECIALFUNCTIONSHELPZOOM ENTER RECORDTONE RESETALM SUSPENDMONITORSETUPWAVEFORMMENU PREVIOUSMENUNORMALSCREEN97 864 531 2.DEL 0ACCESSCODEPress to activate the keyhighlighted with the cursorPress to place cursor onPress to move cursorup, down, right, or leftPress to enlarge keys forease of viewing at a distancePress to change focusamong multiple applications,Press as necessary toenter a numeric valuePress to delete a previous entryfirst parameter keywithin an application or to place cursor on first or to enter the security code in access modemenu key (or icon)or to position cursor
Remote Keypad27-5 Selecting a ParameterThe parameter (waveform) keys display vertically near the right side of the screen, with parameter number one at the top (except on a split screen central display). Press the WAVEFORM key to activate the parameter (waveform) selection mode.Operating Menu KeysThe menu keys display horizontally across the bottom of the screen with menu key number one at the far left. Press the ZOOM key once to activate the zoom feature, making each key easier to see. Press the ZOOM key again to turn OFF the zoom feature.Recording a WaveformAfter you activate the RECORD key, you have 2-seconds to highlight a parameter (waveform) key. To ensure enough time in making a selection, place the cursor on the parameter (waveform) key and press the cursor for an additional 2-seconds, before you press the RECORD key on the remote keypad.!• The remote keypad cursor remains on the screen for approximately one minute following the last keypad activity or until you touch the touchscreen itself.!• When printing several parameters at the same time or when trying to print an event such as a single abnormal beat, it is easier to use keys on the monitor rather than on the remote keypad to direct the recording.To select a parameter:1Point the remote keypad at the monitor’s receiver.2Press WAVEFORM for parameter number 1.3a Press up or down arrow keys to desired parameter.-OR-3b Press the number of the desired parameter.4Press ENTER.To operate menu keys:1Point the remote keypad at the monitor’s receiver.2Select a parameter key.3Press MENU.4a Press left or right arrow key to desired position.-OR-4b Press the number of the desired menu key.To print data from a waveform zone:1Point remote keypad at the monitor’s receiver.2a Press up or down arrow keys to desired parameter.-OR-2b Press the number of the desired parameter.3Press RECORD.4Repeat step 2a.5Press ENTER.
Ultraview Care Network27-6Programming Access CodesAccess codes ensure that the receiver responds only to a remote keypad with a matching code number. If a keypad’s access code differs from the receiver’s, the command is ignored. This prevents interference from other remote keypads.The programmed access code (1 to 32) is displayed on the monitor. This code is stored in the monitor’s memory and retained whenever the monitor is reset or powered OFF.When programming a monitor's access code, the keypad's access code must initially match the receiver's. The new access code is programmed simultaneously with the keypad's. The monitor temporarily displays the remote keypad's access code, then returns to displaying its own code.!• Remote keypad systems can be operated in an unsecured mode without access codes so that the receiver accepts commands from any remote keypad. When in the unsecured mode, the word ALL appears on the monitor.!• To prevent inadvertently changing other access codes, unplug all other monitors (or move the remote keypad directly in front of the monitor to be programmed) and place your finger over the remote keypad's infrared window during programming (sufficient signal transmits through your finger to program the receiver).To select the unsecured mode:1Touch MONITOR SETUP.2Touch PRIVILEGED ACCESS.3Enter Clinical password.4Touch MORE.5Touch REMOTE KEYPAD STATION ADDRESS.6Select SECURED MODE OFF.To verify a remote keypad’s current access code:1Point the remote keypad at the monitor’s receiver.2Touch ACCESS CODE.3Touch ENTER.To set a remote keypad’s access code:1Point the remote keypad at the monitor’s receiver.2Touch ACCESS CODE.3Select first digit.4Select second digit.5Touch ENTER.To set the monitor’s access code:1Touch MONITOR SETUP.2Touch PRIVILEGED ACCESS.3Enter Clinical password.4Touch MORE.5Touch REMOTE KEYPAD STATION ADDRESS.6Select SECURED MODE ON.7Use the arrow keys to select the number.
27-7 Remote Keypad Troubleshooting GuideClinical Situation Possible Cause SolutionMonitor accepts commands from any keypad■Monitor operating in an unsecured mode.■Select an access code and program both the monitor/receiver and the keypad to that code.During programming, another receiver was inadvertently changed■Remote keypad placed too close to another monitor’s receiver.■Move the keypad directly in front of the receiver to be programmed and place your finger over the keypad window during programming.Monitor does not respond ■Monitor may not support remote keypad.■Press the ACCESS CODE key. If an A is not displayed (below the NORMAL SCREEN key), contact your system administrator or biomed.■Depleted battery in remote keypad. ■Replace battery in remote keypad.
Contents28-1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Setting Up the Secondary Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Copying Stored Values of the Primary Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . 2Restoring a Stored Value. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Copying Primary Attributes to the Secondary . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Resetting Default Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Tracking or Locking Displays. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Adjusting Scaled Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Remote DisplayOverviewThe Ultraview 1700 provides an optional output to a remote-configurable secondary display. This secondary display enables you to view selected parameters from the primary display. The primary monitor is used to control the configuration and waveform display characteristics of the secondary remote display. The secondary display has no touchscreen surface or functional keys.Setting Up the Secondary DisplayThe Configuration menu for the secondary display appears on the primary monitor. The menu functions identically to the primary monitor’s menu although it has three additional keys.Selecting Colors and PrioritiesEach parameter has a specific default color and priority. You can change the colors or priority levels of the parameters to customize the monitor to your specific needs.After making any configuration change, touch STORE to make the secondary display changes permanent. If you do not touch STORE, the system disregards your changes.The PARAMETER CONFIG key allows you to change the system default priorities and colors. The current parameter priority and color default is visible from the DISPLAY PRIORITIES toggle key. The LOCAL key displays the current active !• Your display may not be configured to allow changes to parameter priorities or colors. Contact your hospital system administrator for details.To set up the remote display:1Touch MONITOR SETUP.2Touch SECONDARY CONFIG.3Touch PARAMETER CONFIG.4Select a parameter.5Select the destination priority.6Select a color.7Select the parameter key to be colored (the key and waveform will appear in the chosen color).8Touch STORE to store local color and priority settings.
Ultraview Care Network28-2parameters and the ALL key displays all possible parameters. Each parameter is assigned a display priority, with the highest priority appearing at the top of the screen.Blank parameter keys allow you to force a space above, between, or below other parameters. Blanks can be inserted into any priority template by selecting the blank and putting it into the desired location. This causes a blank zone to be inserted into the corresponding display area and all active parameters with a lower priority to be pushed down.The STORE key stores the current local priority and color settings into non-volatile memory.The RESTORE key restores the last stored local priorities and color settings from memory.The FACTORY DEFAULTS key restores the factory default priority and color settings.Copying Stored Values of the Primary MonitorTouch COPY PRIMARY PRIO/COLOR to duplicate the primary display’s stored settings for priorities and colors on the secondary display. Touch STORE to put these changes into effect.You can use the Copy Primary Prio/Color function to remove blank zones resulting from parameters that were deleted while the secondary display was in Lock mode.Restoring a Stored ValueTouch RESTORE to reset the secondary display’s configuration screen to its last stored changes. Restoring the screen also stops the Copy Primary function (if STORE has not yet been touched).Copying Primary Attributes to the SecondaryTouch COPY PRIMARY PARAM ATTR to copy the primary's current parameter attributes or settings to the secondary display. Parameter colors and priorities are not copied.Use this key to:• Remove any blank zones caused by deleting a parameter while the secondary was locked.• Insert any new parameters added while the secondary was locked.• Change sizes, sweep speeds, full scales ON/OFF, etc., to match the primary monitor’s configuration.To copy the stored values of the primary:1Touch MONITOR SETUP.2Touch SECONDARY CONFIG.3Touch PARAMETER CONFIG.4Touch COPY PRIMARY PRIO/COLOR.5Touch STORE.To restore the last stored configuration:1Touch MONITOR SETUP.2Touch SECONDARY CONFIG.3Touch PARAMETER CONFIG.4Touch RESTORE.To copy the primary monitors configuration:1Touch MONITOR SETUP. 2Touch SECONDARY CONFIG.3Touch PARAMETER CONFIG.4Touch COPY PRIMARY PARAM ATTR.
Remote Display28-3 Resetting Default ValuesTouching FACTORY DEFAULTS resets the secondary display to its factory values. Touch STORE to make these changes permanent.Options that can be reset include:• Relative priorities and colors to factory default configuration of primary• Blanks caused by deleting a parameter while in Lock ModeTouching this key does not insert any new parameters added while the secondary display was in Lock Mode.Tracking or Locking DisplaysIn addition to parameter color and priority, you may configure other attributes of the secondary display to be different from the primary monitor. To make additional adjustments to each display separately, select LOCK after you configure the secondary display. This allows the secondary display to remain largely unchanged when you adjust the primary display. If you need the secondary display to duplicate changes to the primary, set the secondary display to TRACK. Refer to the Table 1 (where X = yes) for the effect of Track and Lock on each display characteristic.To make additional changes to the secondary screen after you select LOCK, return to the Secondary Configuration menu and touch TRACK.Table 1: Remote Display Track and Lock ChartAlways independent of primaryTrack mode copies primaryLock mode copies primaryLock mode does not copy primaryColors/priorities XWaveform size XXSweep speed XXFull scales ON/OFF XXFull scales 4/6 zones X# of minor graticules XScreen/waveform attributes XXAddition of parameter on primary XXDeletion of parameter on primary XXPressure/ECG key labels XXZone size of certain displayed parameters XXTo set factory default values of secondary display: 1Touch MONITOR SETUP.2Touch SECONDARY CONFIG.3Touch PARAMETER CONFIG.4Touch FACTORY DEFAULTS. 5Touch STORE.To lock the secondary display: 1Adjust parameter attributes on primary to reflect how you want the secondary to appear.2Touch MONITOR SETUP.3Touch SECONDARY CONFIGURATION.4Touch PARAMETER CONFIGURATION.5Touch LOCK.
Ultraview Care Network28-4Adjusting Scaled DisplayThe display of parameters in scales for the secondary display is independent of the primary monitor. Scales are adjusted using the same menu as the primary except when a secondary display is enabled, the PRIMARY/SECONDARY key appears in the menu. This key allows you to choose which display you want to change.To adjust the scaled display:1Touch MONITOR SETUP.2Touch PRIVILEGED ACCESS.3Enter Clinical password.4Touch SCALED DISPLAY.5Touch PRIMARY/SECONDARY key to choose display to change.6Select MINOR GRATICULE ON.7Use arrow keys to adjust.
29-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.Patient Data Logger DirectoryDirectory of Keys - Bedside onlyPRIVILEGEDEnter BIOMED BIOMED LEVEL - Serial Port ConfigurationBIOMED LEVEL - Serial Port Settings: Changes committed on exitDIAGNOSTICS DATA ACCESSSETTINGS ASSIGNMENTDATA BITS8STOP BITS1ECHONONECR/LFNONEPARITYNONEXON/XOFFDISABLEBAUD RATE9600Restart monitor after selecting owner for serial portPATIENT DATA LOGGERON OFFLOGGERSETUPALARM LOGGINGON OFFCHECKSUMSON OFFSERIALPORTS1 2Patient Data LoggerPatient Data Logger - SETUP: Change the settingsSAMPLE RATE15 secpasswordDATALOGGERTo access Patient Data LoggerBIOMED LEVEL - Select Parameter Select serial port to assign owner to
Contents29-3 Patient Data LoggerOverviewThe Patient Data Logger option automatically sends patient vital signs from the monitor to an external device, such as a printer or a terminal. Episodic patient data is also sampled and transmitted. The output is in the form of ASCII text byte strings, and is printed using standard RS232 serial communications via the monitor’s serial port. Refer to the Display Detail on page 29-5 for further information.This option continues to send data whether the external device is on-line or off-line. Data transmission can be stopped by reassigning the data port or disabling the Patient Data Logger.Your system administrator (or other designated personnel) must first set up communication between the monitor and the external device by assigning the serial port to Patient Data Logger, and then adjusting the serial port settings. The various serial settings can be adjusted to suit the device attached to the serial port. Refer to the appropriate service manual for more details.Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Display Detail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Data Printouts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Patient Data Logger Troubleshooting Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Ultraview Care Network29-4The sample rate refers to the frequency of data sampling and can be set to time intervals ranging from 5-seconds to 60-minutes. The new sample rate takes effect at once.The data logger output requires a serial cable that swaps pins (refer to Table 1).The serial cable must be properly connected at both ends and the data logger output enabled.!• The option is only available on bedside monitors.• Ensure that any cables or other computer or communications equipment connected to the bedside monitor comply with applicable medical standards.• The combination of PDL baud rate and sample rate must be selected carefully. Slow baud rates, in combination with frequent data transmissions, may cause loss of data. This is especially true if a large amount of patient vital sign data is being monitored. However, some devices cannot accept data at high baud rates. This may limit the range of sample rates at which your device can accept data readings from the monitors.Table 1: Serial Cable PinoutInput Output23324554To set up Patient Data Logger (the user must have System Administrator access):1Touch MONITOR SETUP.2Touch PRIVILEGED ACCESS.3Enter biomed password.4Touch SERIAL PORTS and select a port.5Touch ASSIGNMENT.6Touch DATALOGGER.7Touch PREVIOUS MENU.To set serial settings:8Touch SETTINGS.9Touch the desired setting key(s) to display desired settings.10 Touch NORMAL SCREEN to effect changes.
Patient Data Logger29-5 Display DetailThe Patient Data Logger report is automatically sent to an external device, such as a printer or terminal, once the serial port is assigned and toggled ON.The data fields that appear on this report (ECG, RESP, ART, SpO2, and EtCO2)will vary depending on the parameter modules installed on the system.Figure 29-1: Patient Data Logger report sampleSPACELABS MEDICAL PATIENT DATA LOGGERPATIENT NAME DOE, JOHN Bed # 01 DATE 08 JUN 2003ECG RESP ART mmHg SPO2 EtCO2TIME HR ABN LEAD LEAD2 ST1 ST2 RATE SYS/DIA MEAN % RESP % AGENT %14:55:49 212 0 VI II 2.08 -2.00 52 138/81 109 93 0 0.1 HAL 0.014:55:54 158 0 VI II 2.08 -2.00 47 138/81 109 95 0 0.1 HAL 0.014:55:59 146 0 VI II 2.08 -2.00 39 138/81 110 96 0 0.1 HAL 0.014:56:04 146 0 VI II 2.08 -2.00 36 138/81 110 97 0 0.1 HAL 0.014:56:10 212 0 VI II 2.08 -2.00 47 138/81 109 97 0 0.1 HAL 0.014:56:15 200 0 VI II 2.08 -2.00 53 138/81 110 97 16 5.2 HAL 0.114:56:20 146 0 VI II 2.08 -2.00 43 138/81 110 97 16 5.2 HAL 0.114:56:25 146 0 VI II 1.84 -2.56 36 138/81 109 97 16 5.2 HAL 0.114:56:30 211 0 VI II 1.84 -2.56 43 138/81 110 97 16 5.2 HAL 0.114:56:35 212 0 VI II 1.84 -2.56 53 138/81 110 97 16 5.2 HAL 0.114:56:45 146 0 VI II 1.84 -2.56 36 138/81 110 97 16 5.2 HAL 0.114:56:52 200 0 VI II 1.84 -2.56 39 138/81 109 79 16 5.2 HAL 0.1!• All lines on this report are terminated by a line-feed, carriage-return combination.• Lines may wrap if the line length exceeds the display or printer width.• The report prints a maximum of 132 characters per line and 2 lines per entry.• The report prints data from a maximum of 11 parameter groups (for example, ECG, RESP, ART, etc.). (Fewer parameters are printed if the line length limit is reached.)
Ultraview Care Network29-6Data PrintoutsEach line of the data printout may contain up to 132 characters and is terminated with line feed and carriage return characters.The PDL transmits two types of information: page headers and data lines. The page header appears at the top of each page and contains the patient’s name, the bed number, and the current date. A new page is generated when any the following situations occur:• The end of a page is reached (that is, 50 data lines have been transmitted).• The monitored vital signs parameters change.• The patient name or bed number changes.• The current date changes.Data lines are transmitted at the interval specified at configuration. Each data line contains the time that the data was collected, as well as the data collected for each vital sign parameter being monitored.!• If you are monitoring a large number of parameters and have an 80-column printer, the data from one reading may require more than one line. If your printer has a wrap-around feature, this will be handled automatically. If you prefer that each data reading fit onto one line, condense the printer’s type or use a wide-carriage (132 column) printer.
29-7 Patient Data Logger Troubleshooting GuideClinical Situation Possible Causes SolutionData is displayed with improper spacing or double spacing■The PDL interface sends a carriage return/line feed sequence at each end-of-line. The external device may not be set up properly.■Set the external device for “0” line feed.No data is displayed or printed on the external device■There is a power problem or the cables are faulty. The device may not be set up properly.■Check the power and cables. Ensure that the device is in the online mode and that RS-232 port requirements are satisfied.■Check for RS-232 compatibility at the monitor and at the external device.■Check the monitor port assignments and port connections.Data is lost or garbled ■The cable is faulty. ■Check the cables.■The parity is set incorrectly. ■Verify the baud rates and parity settings.■Baud rate settings may be inappropriate.
30-1!• Based on features purchased, more or fewer keys may appear here than on your menu screens.DNA DirectoryDirectory of Keys - UCW and Ultraview 1700TONES ADMIT/DISCHARGEMONITORCONFIGPRIVILEGEDEnter BIOMED passwordACCESSBIOMED LEVEL: Select ParameterMONITOR SETUPNETWORKSETUPMONITORCALIBRATIONCHANGE BIOMEDPASSWORDTELEMETRYCONFIGURATIONCLINICALMENUMORESERIALPORTSTONECONFIGURATIONBIOMED LEVEL: Select ParameterD N ACONFIGURATIONSECONDARY DISPLAYENABLE DISABLE MORERECORDERSETUPRECORDERCONFIGRefer toIntroductionRefer to chapterchapterSystem AlarmsREMOTEVIEWALARMWATCHRV/AWOFFLOCALTRENDS/CALCSREMOTETRENDS/CALCSSPECIAL FUNCTIONSDATALOGGER DNA
Contents30-3 DNAOverviewThe Dynamic Network Access (DNA) feature allows you to view and control a remote application.Your hospital system administrator (or other designated personnel) must first set up communication between the UCW and Ultraview 1700 and the external computer(s) before DNA can be accessed. Refer to the Universal Clinical Workstation (UCW) and Ultraview 1700 Monitors Service Manual (P/N 070-0470-xx) for more details.!• Ensure that any computer or communications equipment connected to the network comply with applicable medical standards. To set up DNA (must have System Administrator menu access):1Touch MONITOR SETUP.2Touch PRIVILEGED ACCESS.3Enter biomed password.4Touch MORE.5Touch DNA CONFIGURATION.6Enter desired configuration using the keyboard.7Touch OK.8Touch RESET MONITOR.To access DNA:1Touch SPECIAL FUNCTIONS.2Touch DNA.3Touch the desired application icon.Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Contents31-1 System Safety Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Equipment Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Equipment Maintenance Requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Ultraview Care Network Module Compatibility. . . . . . . . . . . . . . . . . . . . . . . . . . 4Ultraview Care Network ProductSpecificationsSystem Safety SpecificationsSystem Introduction and Network Basics on page 1-1 includes information concerning the interconnection of equipment within the Ultraview Care Network. Initial connection of auxiliary line-operated equipment to a monitor must be performed by a hospital biomedical engineer or a Spacelabs Medical Customer Service Representative. For further information or instructions regarding interconnection of units, contact a qualified service person or your local Spacelabs Medical representative.After installation and/or interconnection with other units, the equipment leakage current shall not exceed the local (provincial) acceptable values.Accessory equipment connected to the analog and digital interfaces must be certified according to the respective IEC standards (that is, IEC 950 for data processing equipment and IEC 601-1 for medical equipment). All configurations shall comply with the system standard IEC 601-1-1+A1. Everyone who connects additional equipment to the signal input part or signal output part configures a medical system, and is, therefore, responsible to ensure that the system complies with the requirements of the system standard IEC 601-1-1+A1. If in doubt, consult the technical service department or your local customer service representative.All Spacelabs Medical equipment is intended for use with a fixed mains socket-outlet. If a system is configured using multiple portable socket-outlets, this system must be reviewed for compliance with IEC 601-1-1+A1, including the maximum load and enclosure leakage currents requirements. The multiple portable socket outlet cannot be placed on the floor. If the leakage limit is exceeded, a second Protective Earth, fixed at both ends with a tool, may be necessary. This second Protective Earth must be tested to the requirements of clause 18 of IEC 601-1.Equipment weighing more than 20 kg is not portable. To lift heavy equipment, support under corners and lift according to hospital procedures.Use of patient cables, transducers, sensors and supplies other than those specified by Spacelabs Medical may degrade equipment performance, including defibrillation protection.
Ultraview Care Network31-2Input leakage current for all patient input channels is less than 10 µA making ECG units suitable for direct cardiac application. The maximum non-destructive voltage that can be applied to any input or output connector on the monitors, modules or printers is +5 V. All signal inputs or outputs are for exclusive connection to equipment specified by Spacelabs Medical.Disposal of these devices and all accessories must be in accordance with local and federal laws.When interconnecting equipment, avoid using optional battery operation. If such operation cannot be avoided, the battery-operated instrument must be grounded using the ground terminal on the rear panel or the protective ground (earth) in the power cord.Power Cord: • 3-wire, 18-gauge, hospital grade, or • 3-wire, 0.75mm2, European harmonized.Plug: • 3-terminal polarized, with protective ground.Table 1: Ultraview Care Network Products Power RatingProduct Frequency Electrical Rating Fuse Rating90367/90369 50/60 Hz 100-240VAC2.0-1.0A N/A90385/90363 50/60 Hz 2.5A/100-120V1.3A/220-240V2-T3A/250V2-T3.15A/250V90386 50/60 Hz 1.35A/100-120V0.8A/220-240V2T2A/250V2-T1.25A/250V90479-A 50/60 Hz 2A/115V1A/230-240V2-T2.5A/250V (Slow)2-T1.6A/250V90364/90387/90491/90499/94000 50/60 Hz 100-240V2.0-1.0A N/AWARNING:• To protect against electrical shock, proper grounding is essential.• If a monitor is in battery mode during defibrillation, the monitor must be properly grounded using the ground terminal provided on the rear panel or by using the protective ground in the power cord.• If the integrity of the external protective earth conductor is in doubt, the equipment must be operated from its internal power source (if applicable).WARNING:• Do not use a 3-to-2 plug adapter.• Ground terminal of the plug is connected directly to the frame of the instrument. Any interruption of the grounding connector can create an electric shock hazard.
Ultraview Care Network Product Specifications31-3 Equipment ClassificationAll of the products listed below are classified as “Class 1- ordinary equipment (not protected against harmful ingress of liquids or flammable anesthetic mixtures), continuous operation.” In addition, the 90367, 90369, and 94000 are internally powered.* Refer to Symbols on page 34-1 for type definitions.Table 2: Equipment ClassificationProduct Type* Product Type*90367/90369Depends on module usedBF-Defibrillator-proof with O2/CO2 option*94000B-FHR (Ultrasound)BF-UACF-FECGDepends on module used90478 B 90424 CF-Defibrillator-proof90385/90363 Depends on module used 90482 BF90386 Depends on module used 90496 CF-Defibrillator-proof90387/90364 Depends on module used 90491 Depends on module used90426/29/30 BF-Defibrillator-proof 90513/14 BF-Defibrillator-proof90449/69 B 90515/16 BF-Defibrillator-proof90479 Depends on module used 90499 Depends on module used
Ultraview Care Network31-4Equipment Maintenance RequirementsCorrective or maintenance procedures must be performed by qualified personnel.Periodic maintenance procedures are required every 12 months to verify that:• the equipment is physically sound.• resistance between the chassis ground connector on the rear panel and the protective ground of the mains input is not greater than 0.1 ohm.• isolation resistance between ground and mains is greater than 2 meg-ohm.While the equipment is operating normally verify that:• chassis leakage current is less than 100 µA.• patient leakage current is less than 10 µA (Type CF), 100 µA (Types B and BF).While the equipment is operating in single fault condition verify that:• chassis leakage current is less than 300 µA (100-120 V), 500 µA (220-240 V);• patient leakage current is less than 50 µA (Type CF), 500 µA (Types B and BF).Under non-optimal environmental conditions or periods of intense use, more frequent checks are recommended.If the equipment has been dropped, abused or damaged in any way (if the monitor or module becomes wet, for example), a qualified service person must verify that the unit is working correctly and that all safety features are intact.Visually inspect all patient cables each time the unit is used. Check for worn or damaged plastic covering, frayed or broken wires, cracked connections or any other signs of damage. Do not use cables which exhibit obvious damage.Ultraview Care Network Module CompatibilityIf any function (NIBP, ECG, SpO2, etc.) on your system does not contain a feature described in this manual:• Your product may contain an earlier version of software. Contact your customer service representative and refer to the original documentation that accompanied your system.• Your system configuration may be different from that described in this manual. Refer to notes in this manual describing features where system configuration is likely to impact the available features.Before moving a Ultraview Care Network module from one network to another, be certain that the module software version is compatible with that required by the second network. If in doubt, have a qualified service person verify compatibility between the module and the network.
Contents32-1 Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1TRU-CUFF Noninvasive Blood Pressure Cuffs . . . . . . . . . . . . . . . . . . . . . . . . . 2Cables and Lead Wires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Pulse Oximetry Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Capnography Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490518 Multigas Analyzer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Ultrasound Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Cleaning and SterilizationMonitorsTo clean Ultraview Care Network monitor screens and covers, modules, processors, and printers use a cloth or swab that has been slightly dampened in a solution of warm water and a mild detergent. Avoid solvents which may damage the product cases. Follow your hospital protocol.Touchscreen CleaningThere is not a separate shield over the face of the screen on the UCW or Ultraview 1500. Clean the screen with a soft cloth moistened with either 70% alcohol OR soapy water.Accessories• Where provided, follow the manufacturers' instructions concerning disposable and reusable supplies. • As applicable, follow your hospital protocol concerning cleaning, disinfection and/or sterilization of reusable supplies.Use of patient cables, transducers, sensors or supplies other than those specified by Spacelabs Medical may degrade module performance.CAUTION:• Use of cleaning agents other than those listed may cause degradation to the product’s plastic enclosure and labels. Questions or concerns regarding cleaning issues should be directed to Spacelabs Medical Technical Support.!• Follow your hospital protocol for the handling of blood and body fluids.• Do not allow liquid to enter the monitor.
Ultraview Care Network32-2TRU-CUFF Noninvasive Blood Pressure CuffsTRU-CUFF®Disposable CuffThe disposable cuff wrap is designed for single patient use. It is packaged non-sterile and cannot be soaked, rinsed or sterilized.TRU-CUFF Reusable CuffThe reusable cuff is packaged non-sterile. It may be cleaned and disinfected with an enzymatic detergent and 10% solution of household bleach (5.25% sodium hypochlorite).Cuff Cleaning and DisinfectionMaterials• Enzymatic detergent such as ENZOL (US) or CEDEZYME (UK)• 10% solution of household bleach (5.25% sodium hypochlorite) in distilled water• Soft cloths or bristle brushes• Spray bottlesProcedure1. Prepare the enzymatic detergent and bleach solutions in separate bottles per the manufacturer’s instructions.2. Spray detergent liberally on cuff, allow to sit for one minute.3. Remove detergent with a soft cloth. For persistent contamination, scrub with a soft bristled brush.4. Rinse cuff thoroughly with distilled water.5. Spray bleach solution on the affected area until saturated. Allow the cuff to sit for 5-minutes.6. Remove any excess solution with a soft cloth and rinse again with distilled water. Allow 2-hours for air drying at ambient temperature.
Cleaning and Sterilization32-3 Cables and Lead WiresCleaningTRU-LINK® cables and lead wires may be cleaned with the following agents:• Mild soap and water solution• U.S. Pharmacopeia (USP) green soap• Sodium hypochlorite solution (1:10 dilution of household bleach in water)• Phenolic germicidal detergent solutions (1% aqueous solutions)• Isopropyl alcohol solution (70%)To clean product:1. Prepare cleaning agent according to manufacturer’s instructions.2. Saturate a clean cloth with designated cleaning agent.3. Wipe off exposed surfaces of product.4. Re-wipe product with clean water.5. Wipe dry.Tape adhesive may be removed with Spacelabs Medical’s adhesive tape remover pads (P/N 392196-001).SterilizationTRU-LINK cable and lead wires are provided non-sterile. Following use they may be ethylene oxide (EO) sterilized. Follow standard hospital protocol for processing.!• The compatibility of TRU-LINK products with chemical agents other than the type identified is unknown.• The effective use of any cleaning or disinfecting procedure is subject to the proper preparation of each agent per the manufacturer’s instructions. CAUTION:• Do not immerse connector ends or cables in liquid. CAUTION:• Do not steam autoclave.!• Product is compatible with sterilization process. Actual product sterility is dependent on a qualified sterilization cycle and procedure.
Ultraview Care Network32-4Pulse Oximetry SensorsFor cleaning information see the manufacturer’s instructions enclosed with each sensor.Capnography SensorsThe capnography sensor and cable should be cleaned routinely, especially between patient uses. Before cleaning, make sure the sensor is disconnected from the module and/or monitor. Sensors and cable assemblies may be wiped using a cloth or swab dampened in alcohol or 10% bleach solutions. Mild detergents may also be used initially to remove any residual buildup. Sensor should be wiped immediately following cleaning with distilled water and then dried to remove any cleaning residue. Visually inspect the sensor, cable, and the airway adapters for any sign of physical damage. Verify that the plugs and connectors are in good working condition and that the pins and prongs are not bent. Use a cotton swab dampened with alcohol, or a mild soap, to carefully clean the windows of the sensor head and the calibration cells. Always remove any damaged or questionable sensor or airway adapter from service.CAUTION:• Under no circumstances should sensors be immersed in a solution of any type.• Do not autoclave the sensor.• Never use solvents, acetone, or abrasive cleaning agents.• Do not force the sensor onto the airway adapter.• Avoid undue stress on the sensor head and cable.!• After unpacking, keep the sensor container. When not in use, disconnect the sensor from the module and/or monitor, clean, and place it into the container for safe keeping.• Sensor exposure to cleaning agents should be limited to a maximum of 15- to 20-minutes. Longer intervals of exposure could produce a slight dulling of the original surface finish.
Cleaning and Sterilization32-5 90518 Multigas AnalyzerExteriorThe exterior of the 90518 should be cleaned and disinfected as necessary. Use a clean cloth or swab dampened in a solution of warm water and mild detergent. Squeeze the cloth out thoroughly before use. Disinfect the unit with Hemosol or similar disinfectant.Disposable and reusable patient accessories are available for the 90518.• Disposable accessories are for single-patient use only and must not be sterilized or cleaned for reuse on other patients. Refer to the instructions provided with each patient accessory to determine if the accessory may be cleaned and reused on the same patient.• Reusable accessories can be used on multiple patients after cleaning and/or sterilizing. Refer to the instructions provided with these accessories for details. Instructions provided with patient accessories may contain warnings regarding their use. Read these instructions carefully prior to use. Fan GrillThe analyzer has a fan grill located on the rear panel. It must be kept free from dust and other contaminants. WARNING:• Always turn the unit off and unplug the power cord before cleaning to protect against electrical shock.CAUTION:• Do not allow liquid to enter the interior of the 90518. If this should occur, check the unit for proper operation and verify its performance accuracy prior to reuse.!• The Spacelabs Medical sampling lines are for single-patient use only. Cleaning deteriorates the properties of the sampling line, resulting in slower response time and more frequent occlusions.
Ultraview Care Network32-6BatteriesThe analyzer contains two lead-acid batteries used to provide short-term operation during a power failure. The analyzer retains the operating configuration for up to 5-minutes during an AC power interruption. The batteries should be replaced every year.CO2 ScrubberThe analyzer contains an internal CO2 scrubber which must be replaced every year.Refer to the 90518 Multigas Analyzer Service Manual (P/N 070-0643-xx) for details on replacing the CO2 scrubber, cleaning and sterilization procedures.Ultrasound TransducersBasic cleaning should be performed regularly to ensure continued reliability.1. Keep accessories clean.2. Wipe transducers with a soft cloth moistened with a germicidal solution after each use.3. Wipe off any ultrasound gel on the ultrasound transducers or the monitor as soon as possible.!All batteries should be disposed of properly to protect the environment. Lithium batteries should be fully discharged before disposal. Batteries such as lead-acid (Pb) and nickel-cadmium (Ni-Cd) must be recycled. Please follow your internal procedures and/or local (provincial) laws regarding disposal or recycling.
33-1 Diagnostic MessagesMessage Cause/ActionMONITOR SUPPORTS xx PARAMETERS. ADDITIONAL PARAMETERS MAY OVERLOAD ITData for more than xx parameters is being input to the monitor. System performance may decline. Unplug modules to improve performance.UNABLE TO SUPPORT A NEW MODULE AT THIS TIMEThere is not enough system memory to support a new module. Unplug modules to free memory.UNABLE TO SUPPORT A NEW CHANNEL AT THIS TIMEThere is not enough system memory available to support a new channel. Detach channels to free memory.DIAGNOSTIC ERROR ENCOUNTERED LOADING MODULE Checksum error detected loading module. Module is unsupported.DIAGNOSTIC ERROR ENCOUNTERED LOADING CHANNEL Checksum error detected loading channel. Channel is unsupported.OUT OF MEMORY - DELETING HEMO ENTRY There is not enough system memory available to the application to complete the requested operation. Try again later.OUT OF MEMORY - DELETING RESP ENTRY There is not enough system memory available to the application to complete the requested operation. Try again later.OUT OF MEMORY - DELETING OXY ENTRY There is not enough system memory available to the application to complete the requested operation. Try again later.OUT OF MEMORY - DELETING RENAL ENTRY There is not enough system memory available to the application to complete the requested operation. Try again later.CREATE NEW ENTRY FAILURE - MAXIMUM NUM ENTRIES EXCEEDEDThe maximum number of Calcs entries are in use. Delete existing entries to create new ones.REMOTE MONITOR NOT RESPONDING Calcs timeout expired waiting for remote GDS response. Verify remote monitor is on network, and try again.ERROR READING STORED CALCS DATA Bad return code from GDS on data read. GDS is possibly corrupt. Reboot monitor.ERROR STORING CALCS DATA Bad return code from GDS on data store. GDS is possibly corrupt. Reboot monitor.ERROR DELETING STORED CALCS DATA Bad return code from GDS on data delete. GDS is possibly corrupt. Reboot monitor.NO TRENDS AVAILABLE FOR THIS BED There is no trend data in GDS. Wait one minute and try again.NO OTHER BED ON THE NETWORK HAS ACTIVE PARAMETERSThis message is in response to a remote request. The monitor has determined that there are no beds on the network with active parameters so remote operations are not possible at this time.THERE ARE NO PARAMETERS ACTIVE ON THIS BEDThe selected bed has no active parameters. In order to remotely work with the monitor at the selected bed, it must have active parameters.PARAMETER IS NOT AVAILABLE TO MONITOR Failed attempt to attach to channel. Try again.COMMUNICATIONS WITH REMOTE MONITOR INTERRUPTEDLost connection to remote monitor. Verify that the remote monitor is on the network and retry remote operation.THIS OPERATION WILL CAUSE THE MONITOR TO RESETThe requested operation will reboot the monitor. If you do not want this to occur, touch PREVIOUS MENU or NORMAL SCREEN.THIS INSERTION WILL CAUSE PRIOR ASSIGNMENT TO BE LOSTThe requested zone assignment will cause a previously assigned zone to be lost. Touch PREVIOUS MENU or NORMAL SCREEN to abort the operation.
Ultraview Care Network33-2REMOTE BED SELECT FEATURE IS IN USE BY ANOTHER APPLICATIONThe Remote Bed Select window is in use by another application. Only one application may use this window at one time. Touch the application which is using the Remote Bed Select feature and touch PREVOUS MENU or NORMAL SCREEN to abort the selection. The window will now be available for use.UNABLE TO RECORD THE REQUESTED ALARM CHANNEL(S)Unable to perform the requested operation. Verify that a recorder is selected and operational (has paper) and try again.UNABLE TO RECORD THE REQUESTED CHANNEL(S)Unable to perform the requested operation. Verify that a recorder is selected and operational (has paper) and try again.PARAMETERS NOT AVAILABLE FOR RECORDINGUnable to perform the requested operation. Verify that a recorder is selected and operational (has paper) and try again.CAUTION - MONITOR SETTINGS MAY HAVE CHANGEDThe battery for non-volatile memory has failed. That memory resets the monitor to the default settings and the default settings may not match hospital preferences. Contact your hospital biomed to check Biomed and Clinical Menu settings and Alarm Watch setup. PAPER OUT There is no paper in the fetal chart recorder. Load paper.RECORDER OFF Indication that the fetal chart recorder is powered OFF. Power ON fetal chart recorder.“CHECK CABLE”“NO CONNECTION”Invalid CIM address. Verify that the CIM cable is properly connected to the monitor and the wall outlet.“CHECK CABLE” then “OLD XXX NEWXXX”then “ID CHANGE!” ALTERNATELYThe CIM ID has changed unexpectedly during operation. Verify that the CIM cable is properly connected to the monitor and the wall outlet.ADMIT PATIENT No patient name has been entered. Enter patient name into BirthNet or standalone monitor.Message Cause/Action
34-1SymbolsThe following list of international and safety symbols describes all symbols used on Spacelabs Medical products. No one product contains every symbol.Symbol Description Symbol DescriptionUCW or Ultraview 1700 HELP KeyUCW or Ultraview 1700 MONITOR SETUP KeyUCW or Ultraview 1700 SPECIAL FUNCTIONS KeyUCW or Ultraview 1700 ALARMS KeyUCW or Ultraview 1700 RECORD KeyUCW or Ultraview 1700 PREVIOUS MENU KeyUCW or Ultraview 1700 NORMAL SCREEN KeyUCW or Ultraview 1700 mouse connectionUCW or Ultraview 1700 Keyboard Connection ON — Power Connection to MainsOFF — Power Disconnection from MainsOn Position for Push button Power SwitchOff Position for Push button Power Switch STOP or CANCEL KeyCONTINUE Key START/STOP KeySTART/STOP START (NIBP) KeyOn Direction ON/OFF Television; Video Display RecycleProtective Earth Ground Functional Earth GroundTOnE RESETALM SUSPENDRECORD
Ultraview Care Network34-2ON — Part of the Instrument Only OFF — Part of the Instrument OnlyPartial ON/OFF STAND-BY KeyAll batteries should be disposed of properly to protect the environment. Lithium batteries should be fully discharged before disposal. Batteries such as lead-acid (Pb) and nickel-cadmium (Ni-Cd) must be recycled. Please follow your internal procedures and or local (provincial) laws regarding disposal or recycling.Caution - hazardous voltages. To reduce risk of electric shock, do not remove the cover or back. Refer servicing to a qualified service personnel (U.S.A.).DANGER - High Voltage (International)PAUSE or INTERRUPT Slow RunReplace Fuse Only as Marked FusePower supply jack polarity. (+ / - Signs May be Reversed) Equipotentiality TerminalBatteryReplace only with the appropriate battery.Replace only with the appropriate battery.(+ / - Signs May be Reversed)Alternating Current Direct CurrentBoth Direct and Alternating Current AC/DC InputAmperes HertzVolts WattsTemporary Shut Off of Alarm Tone or Screen Indicators AlarmSymbol Description Symbol DescriptionAHzVW
Symbols34-3ENTER Key PRINT REPORT KeyAttention - Consult Operations or Service Manual for DescriptionRisk of Explosion if Used in the Presence of Flammable AnestheticsIndicator — Remote control Indicator — Local ControlReturn Unit to Monitor Mode Indicator — Out of PaperActivate Recorder for Graphics Recorder PaperIndoor Use Only Auto Mode (NIBP)Output No Output (Terminated)Data Input/Output HELP (Explain Prior Screen) KeyClock/Time Setting Key Input/OutputMonitor SetupSelect Program Options Set Initial Conditions MenuAccess Special Function Menu Normal ScreenReturn to Prior Menu TREND/TIMER KeyGas Exhaust Electrocardiograph or Defibrillator SynchronizationSymbol Description Symbol Description!123?123123A123B123123
Ultraview Care Network34-4Arterial PulseIEC 601-1 Type BF equipment. The unit displaying this symbol contains an F-type isolated (floating) patient-applied part providing an adequate degree of protection against electric shock.IEC 601-1 Type BF equipment which is defibrillator-proof. The unit displaying this symbol contains an F-type isolated (floating) patient-applied part which contains an adequate degree of protection against electric shock, and is defibrillator-proof.IEC 601-1 Type CF equipment. The unit displaying this symbol contains an F-type isolated (floating) patient-applied part providing a high degree of protection against electric shock.IEC 601-1 Type CF equipment. The unit displaying this symbol contains an F-type isolated (floating) patient-applied part providing a high degree of protection against electric shock, and is defibrillator-proof.ETL Laboratory ApprovedIEC 601-1 Type B equipment. The unit displaying this symbol contains an adequate degree of protection against electric shock. Canadian Standards Association ApprovedKeypad Enlarge, ZoomMenu Keys DeleteWaveform/Parameter Keys PCMCIA CardKeep Dry Fragile; handle with careFoot Switch This Way UpEnvironmental Shipping/StorageTemperature LimitationsEnvironmental Shipping/StorageHumidity LimitationsSymbol Description Symbol Descriptionx
Symbols34-5Open Padlock Closed PadlockDown Arrow Up ArrowEvent TEMPtemp TemperatureAntenna Environmental Shipping/Storage Altitude LimitationsNetwork Connection Audio Output, SpeakerRemote Alarm; Nurse Alert Nurse CallSerial Port 1 Serial Port 2External marker push button connection SDLC PortMicrophone Mermaid ConnectorSymbol Description Symbol Description12,200 m1 2SDLC
Ultraview Care Network34-6Note Video OutputWarning About Potential Danger to Human BeingsCaution About Potential Danger to EquipmentNon-Invasive Blood Pressure (NIBP), Neonate Fetal Monitor Connection (Analog)Fetal Monitor Connection RS232 (Digital)Physiological Monitor Connection RS232 (Digital)Input ResetHard Drive Power Indicator LEDActivate Telemetry Recorder Omnidirectional MicrophoneBattery Status Universal Serial BusStand-by Low BatteryGas Sampling Port Gas Return PortSymbol Description Symbol Description!
Symbols34-7Operates on Non-Harmonized Radio Frequencies in Europe Service MessageHappy Face Sad FaceReset Power Indicator LEDMagnifying Glass CompressionFile Cabinet List of RoomsArrows PrinterSymbol Description Symbol Description!
Ultraview Care Network34-8Abbreviations used as symbols are shown below.Symbol Description Symbol Description1 - 32 Access Codes1 Through 32 AIR AirANT 1ANT 2Diversity Antenna System 1Diversity Antenna System 2Arr1ArrNet2Arrhythmia Net 1Arrhythmia Net 2CHchEEG, EMG, or ECG ChannelEEG Channels - CH1, CH2, CH3, CH4EMG Channel - CH5cmH2OCentimeters of WaterCMV Controlled Mechanical VentilationC.O.COcoCardiac OutputDIAdia Diastolic ECGecg ElectrocardiogramEEGeeg Electroencephalogram EMGemg ElectromyogramESIS Electrosurgical Interference Suppression EXT ExternalFECG Fetal Electrocardiogram FHR1FHR2Fetal Heart Rate, Channel 1Fetal Heart Rate, Channel 2GNDgnd Patient Isolated Ground HLOhlo High-Level OutputI:E Inspiration Expiration Ratio Multiview Multi-Lead ElectrocardiogramNIBPnibp Non-Invasive Blood Pressure N2ONitrous OxideO2Oxygen PEEP Positive End Expiratory PressurePRESSpressPRSPressure Pmin Minimum Inspiratory Pressure
Symbols34-9BirthNet, Clinical Browser, CVScan, Data Shuttle, Express Charting, FT1000, FT3000A, Flexchart, Flexform, Flexport, Flextable, Flextools, Flexview, Global Participant Index, Intesys, Maternal Obstetrical Monitor, MOM, Mermaid, Multiview, Neoscan, PCIS, PCMS, PrintMaster, Quicknet, Sensorwatch, Spaceview, TRU-CAP, TRU-CUFF, TRU-LINK, UCW, Ultralite, Ultraview, Ultraview Clinical Messenger, Uni-Pouch, Universal Flexport, Varitrend, Web Source and WinDNA are trademarks of Datex-Ohmeda, Inc.Other brands and product names are trademarks of their respective owners.Ppeak Peak Inspiratory Pressure RESPresp RespirationSDLC Synchronous Data Link ControlSPO2SpO2SpO2SaO2Arterial Oxygen Saturation as Measured by Pulse OximetrySVO2SvO2SvO2Mixed Venous Oxygen Saturation SYSsys SystolicT1T2T3T4Temperature 1Temperature 2Temperature 3Temperature 4UA Uterine Activity or Umbilical ArteryVAC Vacuum connectionSymbol Description Symbol Description

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