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GE HEALTHCARE B20, User'S Reference Manual

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 Non-invasive blood pressure

14-9

Setting custom mode

You can set up to 4 separate steps for auto NIBP determinations by setting the time interval 
and how many times this interval is repeated.
To set the custom mode:

•

Press the 

NIBP

 key.

•

Select 

Custom Setup

.

•

Set up time interval and repeat times for every series.
The cycle time can be set to 1 to 120 min or OFF.
The repeat option can be set to 1 to 25 times or OFF or cont.

Starting and stopping autocycling:

To start the autocycling, do one of the following:

•

Press the 

NIBP Auto On/Off 

key, or

press the 

NIBP

 key and select 

Start Cycling

.

The bar at the bottom of the NIBP field shows the time remaining to the next 
measurement. 

To stop autocycling:

•

Press the 

NIBP Auto On/Off

  or

press the 

NIBP

 key on the Command Board and select

 Stop Cycling

.

NIBP

Summary of Contents for B20

Page 1: ...GE Healthcare B40 B20 Patient Monitor User s Reference Manual B40 B20 Patient Monitor English 2081504 001 E Paper 2015 General Electric Company All Rights Reserved ...

Page 2: ......

Page 3: ...to change without notice Document no 2081504 001 E October 22 2015 Copyright 2015 General Electric Company All rights reserved GE Medical Systems Information Technologies Inc 8200 West Tower Avenue Milwaukee WI USA Zip 53223 Tel 1 414 355 5000 outside US 800 558 5102 US only Fax 1 414 355 3790 www gehealthcare com GE Healthcare 3F Building 1 GE Technology Park 1 Huatuo Road Shanghai PRC 201203 Tel...

Page 4: ...p 1 Class A Group 1 contains all ISM Industrial scientific and medical equipment in which there is intentionally generated and or used conductively coupled radio frequency energy which is necessary for the internal functioning of the equipment itself Class A equipment is equipment suitable for use in all establishments other than domestic and those directly connected to a low voltage power supply ...

Page 5: ...nd names 1 4 Conventions used in this manual 1 4 Related documentation 1 5 Safety precautions 1 6 Safety message signal words 1 6 Warnings 1 6 Cautions 1 7 Notes 1 7 ESD precautionary procedures 1 8 Disposal 1 8 2 System description Safety precautions 2 1 Warnings 2 1 Cautions 2 1 Principles of functions 2 1 System introduction 2 2 Frame front view 2 3 Frame back view 2 4 Acquisition modules 2 5 E...

Page 6: ... requirements 3 3 To connect the network 3 4 Install the network 3 4 Inserting and removing the E module 3 5 To insert module 3 5 To remove module 3 5 Visual indicators 3 5 Installation checkout 3 6 Recommended tools 3 6 Visual inspection 3 7 Functional inspection 3 7 4 Monitoring basic Using menus 4 1 Starting and ending 4 4 Warnings 4 4 Preparations 4 4 Starting monitoring 4 4 Admitting a patien...

Page 7: ...larm reset silencing audible alarms temporarily 5 11 Other adjustable features 5 13 Displaying limits 5 13 Enabling or disabling alarm audio ON OFF 5 14 Latching alarms 5 15 Enabling or disabling breakthrough alarms 5 16 Changing minimum alarm volume 5 17 Changing reminder volume 5 18 Changing the tone pattern 5 19 Enabling or disabling the alarm remote control 5 20 6 Monitor setup Warnings 6 1 Ov...

Page 8: ... snapshot 6 16 Changing default trend 6 16 Configuring trend pages 6 16 Configuring snapshots 6 17 Setting trend length and scales 6 17 Using Network 6 18 Demo Mode 6 18 7 Trends Safety precautions 7 1 Caution 7 1 Overview 7 1 Trended parameters 7 1 Most common tasks 7 2 Minitrend view 7 3 Minitrend length 7 4 Removing minitrend 7 4 Graphical trend view 7 5 Symbols 7 6 Graphical trend pages 7 7 Ch...

Page 9: ...ng the recording time 8 5 Selecting the recording delay time 8 5 Recording on alarms 8 6 Recording trends 8 7 Recording numerical trends 8 7 Tabular trend format 8 8 Selecting graphical trends 8 8 Inserting recorder paper 8 9 Printing 8 10 Printing settings 8 10 Printing currently displayed screen contents 8 10 Printing all the information 8 10 Changing the printer 8 10 Other adjustable features 8...

Page 10: ...leshooting 10 14 Advanced temperature troubleshooting 10 14 Advanced airway gas troubleshooting 10 15 Advanced entropy troubleshooting 10 15 Other situations 10 16 11 ECG Safety precautions 11 1 Warnings 11 1 Cautions 11 1 Overview 11 2 Displaying ECG and heart rate 11 3 Preparing the patient and placing the electrodes 11 4 Preparing the patient 11 4 Placing the electrodes 11 4 Patient connection ...

Page 11: ... 11 17 ST detection 18 Overview 11 18 NOTES 11 18 Display of ST 11 18 Monitoring the ST segment 11 19 Setting the ST measurement points 11 20 Setting ST alarm limits 11 21 Description of the ST segment measurement algorithm 11 22 12 Impedance respiration Safety precautions 12 1 Warnings 12 1 Cautions 12 1 Overview 12 2 Respiration detection 12 2 Respiration rate source 12 3 Displaying impedance re...

Page 12: ...0 Checklist 13 15 14 Non invasive blood pressure Safety precautions 14 1 Warnings 14 1 Cautions 14 1 Overview 14 2 Direct function keys 14 3 Displaying non invasive blood pressure 14 3 Patient connections 14 4 Selecting a cuff and a cuff hose 14 5 Connecting the cuff hose 14 5 NIBP Setup menu 14 6 Starting 14 7 During measurement 14 7 Autocycling 14 8 Setting cycle time 14 8 Setting custom mode 14...

Page 13: ...e Safety precautions 16 1 Warning 16 1 Caution 16 1 Overview 16 1 Displaying temperature 16 2 Patient connections 16 2 Temp Setup menu 16 3 Changing temperature label 16 3 Combining different temperatures 16 4 Testing temperature 16 4 Changing temperature units 16 4 Checklist 16 4 17 Airway gas Safety precautions 17 1 Warnings 17 1 Cautions 17 2 Overview 17 3 Display of gases 17 4 Airway gases mea...

Page 14: ...ation with E sCAiO N CAiO modules 17 17 Minimum alveolar concentration MAC 17 17 ET balance gas 17 19 Basics of CO2 measurement 17 19 Oxygen measurement interpretation 17 21 Airway gases practicalities 17 21 Ventilation management 17 21 Prevention of the breathing system contamination 17 21 How to prevent effects of humidity 17 22 Oxygen delivery 17 22 Level of anesthesia E sCAiO N CAiO 17 22 Airw...

Page 15: ... electrodes 18 6 Preparing the patient 18 6 Equipment module to connect 18 6 Entropy Setup menu 18 7 Starting sensor check manually 18 8 Setting RE and SE alarm limits 18 8 Entropy measurement limitations 18 10 Checklist 18 10 Abbreviations 1 ...

Page 16: ...B40 B20 Patient Monitor xii ...

Page 17: ...1 Introduction ...

Page 18: ......

Page 19: ...d Entropy Indications for use B20 This device is a portable multi parameter unit to be used for monitoring and recording of and to generate alarms for multiple physiological parameters of adult pediatric and neonatal patients in a hospital environment and during intra hospital transport The device is intended for use under the direct supervision of a licensed health care practitioner The device is...

Page 20: ...tients Printed copies of this manual A paper copy of this manual will be provided upon request Contact your local GE representative and request the part number on the first page of the manual Training requirements No product specific training is required for the use of this monitor CE marking information CE compliance The monior bears CE Mark CE 0459 indicating its conformity with the provisions o...

Page 21: ...o IEC 80601 2 30 EN 1060 3 ANSI AAMI ISO 81060 2 The Entropy parameter conforms to IEC 60601 2 26 The alarm systems of the Monitor conform to IEC 60601 1 8 Exception The ECG parameter conforms to IEC 60601 2 27 with exception of Sub clause 201 12 1 101 15 QRS detection WARNING WARNING In clinical conditions it is reasonable toassume that spurious signals of this type are either random in occurrenc...

Page 22: ...the default settings Section Cleaning and care describes cleaning and daily maintenance procedures Illustrations and names All illustrations in this manual are only examples and may not necessarily reflect your system settings or data displayed in your system If a particular selection is not available in your system the selection is shown grayed in the menu All names used in examples and illustrat...

Page 23: ...piratory modules E sCO E sCAiO Airway Gas Option N CAiO E modules All modules with the prefix E In parameter chapters E modules refers to those modules that measure the parameter s in question Related documentation Installation technical solutions and servicing B40 B20 Technical Reference Manual Options and selections of the software B40 B20 Default Configuration Worksheet Compatible supplies and ...

Page 24: ...se devices and accessories are not designed to be reused Reuse may cause a risk of contamination affect the measurement accuracy and or system performance and cause a malfunction as a result of the product being physically damaged due to cleaning disinfection re sterilization and or reuse There are hazards associated with the reuse of single use sample tubing and adapters Inspect the sensor for si...

Page 25: ...ge to the monitor NETWORK INTEGRITY The monitor resides on the CARESCAPE S 5 and or HL7 network It is possible that inadvertent or malicious network activity could adversely affect patient monitoring The integrity of the network is the responsibility of the hospital Don t modify this device without authorization of manufacturer If this device is modified appropriate inspection and testing must be ...

Page 26: ... the equipment When working with the equipment and specifically when the ESD sensitive parts of the equipment may be touched a grounded wrist strap intended for use with ESD sensitive equipment should be worn Refer documentation provided with the wrist straps for details of proper use ESD precautionary procedure training It is recommended that all potential users receive an explanation of the ESD ...

Page 27: ...2 System description ...

Page 28: ......

Page 29: ...e to withstand unpacked drops from a height of 1 m without damaging the module latches If the device is dropped please service the device before taking it back into use The medical electrical equipment or medical electrical system may be interfered with by other equipment even if that other equipment complies with CISPR EMISSION requirements EXPLOSION OR FIRE Using non recommended batteries could ...

Page 30: ...Your system may not include all these components Consult your local representative for the available components Figure 2 1 Patient monitor components 1 Monitor frame 2 E modules The compatible acquisition modules 3 Extension rack 4 Software VSP C 1 4 2 3 ...

Page 31: ...0 front B20 front 1 Transportation handle 2 Alarm light 3 The Trim knob 4 Command board keys 5 Battery compartment 6 Guide rail for GCX mounting 7 Mains power and battery LEDs 8 On Off key 9 Hemo connectors 10 E module 11 Recorder 10 4 5 6 8 7 9 11 2 1 3 ...

Page 32: ...k Figure 2 4 I O and connectors 1 Receptacle for power cord 2 Serial port 3 Defibrillator connector 4 Nurse call connector 5 Network connector 6 Equipotential connector 7 Multi I O connector NOTE The Multi I O with ports 2 3 4 are optional parts for customer 1 7 3 6 5 4 2 ...

Page 33: ...ion 2 5 Acquisition modules B40 acquisition modules E miniC E sCO E sCAiO N CAiO E Entropy B20 acquisition modules E miniC E Entropy E miniC module Figure 2 5 E miniC 1 Water trap 2 Sample gas inlet 3 Gas outlet 1 2 3 ...

Page 34: ...tor on the water trap 3 Water trap container 4 Gas exhaust connector for the gas exhaust line sampling gas out N CAiO module 1 D fend Pro water trap 2 Gas sample sampling line connector on the water trap 3 Water trap container 4 Gas exhaust connector for the gas exhaust line sampling gas out 1 2 3 4 1 2 3 4 ...

Page 35: ... feature Optional feature Identifier ECG NIBP SpO2 IBP Temperature a Hemo with GE SpO2 X X GE SpO2 X X SpO2 IBP T b Hemo with Masimo SpO2 X X Masimo SpO2 X X Masimo SpO2 IBP T c Hemo with Nellcor SpO2 X X Nellcor SpO2 X X Nellcor SpO2 IBP T d Hemo with GE SpO2 without IBP X X GE SpO2 X SpO2 T e Hemo with Masimo SpO2 without IBP X X Masimo SpO2 X Masimo SpO2 T f Hemo with Nellcor SpO2 without IBP X...

Page 36: ...o invasive pressure channels NOTE Functional only when IBP option is available 8 Start or stop the NIBP auto cycling 9 Reset active alarms 10 Audio pause active alarms 11 Return to normal screen view 12 Start or stop local recording NOTE Functional only when recorder option is available 13 Start or stop the NIBP manual determination 14 Take up to 10 snapshots 15 Activate the Alarms Setup menu 16 V...

Page 37: ...he monitor is mains powered the green mains LED is on When the monitor is battery charging the orange battery LED is on If you wish to have the battery status visible at all times select it in one of the digit fields Monitor Setup Screen Setup Digit Fields Battery You can now see how much time is left for each battery separately both in numbers and as symbols and the total remaining time in number...

Page 38: ...ther monitors e g Dash 3000 4000 5000 Solar 8000 B850 B650 The monitor s information transfer to central station as following All available parameters 3 5 lead ECG NIBP IBP SpO2 Resp Temp Gas Entropy Real time multi parameter waveforms Graphical numerical trends Real time Alarm including Arrhythmia alarms ASYSTOLE VFIB VTACH Brady Tachy Patient admit discharge and patient name update Alarm setting...

Page 39: ...e to this device unless ESD precautionary procedures are followed Type BF IEC 60601 1 protection against electric shock Isolated floating applied part suitable for intentional external and internal application to the patient excluding direct cardiac application Type BF IEC 60601 1 defibrillator proof protection against electric shock Isolated floating applied part suitable for intentional external...

Page 40: ...components have the degree of protection per the n rating SN S N Serial number Date of manufacture This symbol indicates the date of manufacture of this device The four digits identify the year Manufacturer This symbol indicates the name and the address of the manufacturer European authorized representative European Union Declaration of Conformity Rx Only U S Prescriptive Device USA only For use b...

Page 41: ...on on how the battery may be safely removed from the device please consult the service manual or equipment instructions Information on the potential effects on the environment and human health of the substances used in batteries is available at this url http www gehealthcare com euen weee recycling index html Battery operation and remaining capacity The height of the green bar indicates the chargi...

Page 42: ... period displays as a countdown timer Displays in the upper left corner of the screen Underwriters Laboratories product certification mark Medical Equipment with respect to electrical shock fire and mechanical hazards only in accordance with ANSI AAMI ES60601 1 2005 R 2012 and A1 2012 C1 2009 R 2012 and A2 2010 R 2012 CSA CAN CSA C22 2 NO 60601 1 14 IEC 60601 2 26 IEC 60601 2 27 IEC 80601 2 30 IEC...

Page 43: ...95 F Storage and transport temperature 20 to 60 C 4 to 140 F Operating humidity 20 to 90 noncondensing Storage and transport humidity 10 to 90 noncondensing Operating atmospheric pressure 70 to 106 kPa 525 to 795 mmHg Storage and transport atmospheric pressure 70 to 106 kPa 525 to 795 mmHg E miniC module environment Operating temperature 10 to 40 C 50 to 104 F Non operating temperature 25 to 70 C ...

Page 44: ...or USA difference type of plugs should be used for connection to the alternate voltage 13 A 125 V or 6 A 250 V Fuse 250 V 2 5 Ah Battery Exchangeable lithium ion 2 pcs max Battery life 300 cycles minimum to 50 capacity Battery information model SM 201 6 11 1 V 3 52 Ah Charging time 2 hours to 90 per battery pack Operation time Up to 4 5 hours Recorder Power comsumption Standby 1 2 W Printing 10 W ...

Page 45: ...fibrillator synchronization connector Pin 1 2 3 4 7 are grounding Synchronization pulse Pin 5 Pulse width 10 ms 20 positive pulse Delay 35 ms R wave peak to leading edge of pulse Amplitude CMOS compatible 3 5 V min at 1 mA sourcing 0 5 V max at 5 mA sinking Output impedance 200 Ω ...

Page 46: ...r 0 05 to 40 Hz Dagnostic filter 0 05 to 150 Hz Heart rate Measurement range 30 to 300 bpm Measurement accuracy 5 or 5 bpm whichever is greater resolution 1 bpm Heart rate response time IEC 60601 2 27 201 7 9 2 9 101 b 5 Step increase from 80 to 120 bpm average 6 9 s 6 5 to 7 5 s Step decrease from 80 to 40 bpm average 8 2 s 7 6 to 10 0 s The heart rate calculation operates with irregular rhythms ...

Page 47: ... Figure 4a normal amplitude 7 1 s 5 8 to 8 2 s Figure 4a doubled amplitude 4 4 s 4 2 to 4 6 s Figure 4b halved ampli tude 7 0 s 6 1 to 7 5 s Figure 4b normal amplitude 5 8 s 4 5 to 7 4 s Figure 4b doubled amplitude 6 1 s 5 1 to 7 0 s ST ST numeric range 9 to 9 mm 0 9 to 0 9 mV ST numeric accuracy 0 2 mm or 10 whichever is greater within the range of 8 to 8 mm ST numeric resolution 0 1 mm Pacemaker...

Page 48: ...c Neonatal 69 to 1 unspecified Display resolution 1 digit 1 of SpO2 Display averaging Normal 12s Fast 3s Wavelength of SpO2 probe LEDs Infrared LED 940 nm RedLED 660 nm Maximum energy of SpO2 probe LEDs Infrared LED 42 µJ pulse Red LED 62 µJ pulse NOTE This information may be useful to clinicians such as those performing photodynamic therapy Pulse rate Measurement and display range 30 to 250 bpm D...

Page 49: ... tested for accuracy with the following sensors OXY E equivalent to TS E D TS E2 GE TS E4 GE OXY SE equivalent to TS SE 3 OXY F equivalent to TS F D TS F2 GE TS F4 GE TS SA D TS SA4 GE OXY W equivalent to TS W D OXY AP equivalent to TS AP 10 TS AP 25 OXY AF equivalent to TS AF 10 TS AF 25 The sensors were clinically tested for neonatal accuracy with the following sensors OXY SE equivalent to TS SE...

Page 50: ...elength Infrared 900 nm Red 660 nm Total optical output power of the sensor LEDs less than 15 mW This information may be useful to clinicians such as those performing photodynamic therapy Measurement range 1 to 100 Display range 0 to 100 Calibrated against functional oxygen saturation Measurement accuracy Without motion Adult Pediatric 100 to 70 2 digits Neonate 100 to 70 3 digits With motion Adul...

Page 51: ...e 30 to 140 mmHg MAP Adult Pediatric 20 to 260 mmHg Neonate 20 to 125 mmHg Diastolic Adult Pediatric 10 to 220 mmHg Neonate 10 to 110 mmHg Accuracy According to AAMI SP10 2002 4 4 5 2 B accuracy of NIBP parameter was validated against the intra arterial method 1 Default initial inflation pressure Adult Pediatric 135 15 mmHg Neonate 100 15 mmHg Over pressure allowed by independent safety controller...

Page 52: ...sius C Measurement range 10 to 45 C 50 to 113 F Measurement accuracy 0 1 C without temperature sensor Display resolution 0 1 C at 25 to 45 C with reusable probes Probe types supported Use only GE Healthcare recommend temperature YSI probes Temperature self check At start up and then every 10 minutes Probe type time response Reusable skin temperature probe 3 s Reusable adult central temperature pro...

Page 53: ...C module E sCO E sCAiO N CAiO module 1 minute for operation 30 minutes for full specification 1 minute for operation with CO2 O2 and N2O 5 minutes for operation of anesthetic agents 20 minutes for full specification Respiration rate Measurement range E miniC module E sCO E sCAiO N CAiO module 4 to 80 breaths min 4 to 100 breaths min Measurement accuracy E miniC module E sCO E sCAiO N CAiO module 4...

Page 54: ...3m sampling line 3 3 seconds with a 2 or 3m sampling line CO2 rise time E miniC module E sCO E sCAiO N CAiO module 300 ms with nominal flow 260 ms with 120 ml min sampling rate and 2 or 3m sample line CO2 drift 0 1 vol O2 O2 measurement range 0 to 100 vol O2 measurement accuracy 1 vol 2 of reading O2 display resolution 1 for values under 10 and over 10 0 1 for values between 9 9 9 9 O2 total syste...

Page 55: ... vol Sev drift 0 1 vol Des drift 0 3 vol The E sCAiO N CAiO modules automatically identify the anesthetic agent present in the sampled gas and measure the concentration of the identified agent Identification threshold 0 15 vol Identification time 20 s The E sCAiO module automatically identifies mixtures of two anesthetic agents present in the sampled gas and measures the concentrations of the two ...

Page 56: ... activated O2 40 95 error 0 15 vol If N2O compensation is not activated N2O 40 80 increases 0 8 vol If N2O compensation is activated N2O 40 80 error 0 3 vol E sCO E sCAiO N CAiO module Non disturbing gases Ethanol C2H5OH 0 036 Acetone 0 2 Methane CH4 0 3 Isopropanol 0 48 Nitrogen N2 Carton Monoxide CO 100 ppm Nitrous Oxide NO 200 ppm Freon R134A 1 for CO2 O2 and N2O Water vapor Effects of a non di...

Page 57: ...ay range Response Entropy RE State Entropy SE Burst Supression Ratio BSR 0 to 100 0 to 91 0 to 100 Display accuracy 1 or 1 Amplifier input impedance 1 MΩ 50 Hz Defibrillation protection 3000 V 130 J Amplifier frequency range 0 5 to 118 Hz ...

Page 58: ...B40 B20 Patient Monitor 2 30 ...

Page 59: ...3 Installation ...

Page 60: ......

Page 61: ...nclosure in normal use Be careful not to drop modules while detaching Cautions The monitor display is fragile Ensure that it is not placed near a heat source or exposed to mechanical shocks pressure moisture or direct sunlight Do not drop battery or subject to mechanical shock Use only the recommended batteries Malfunction may cause gases to vent SAFETY GROUND PRECAUTION Remove power cord from the...

Page 62: ...ounting hardware Connection to power Testing the battery charge Before installing a battery to the patient monitor verify the battery s state of charge Press the green TEST button on the battery The number of charge level indicator LEDs that illuminate indicates the approximate charge remaining in the battery Four LEDs illuminated 75 100 of full charge capacity Three LEDs illuminated 50 74 9 of fu...

Page 63: ...ion to Network WARNING Do not use with iCentral software V5 0 3 and earlier WARNING Do not use Mobile Care Server software V5 2 and earlier CAUTION Install HL7 network interfaces as specified and only by qualified personnel NOTE Not all the features mentioned following is available you monitor according to your monitor s configuration to set up Pre installation requirements Ensure that the applica...

Page 64: ...r to the network 1 Make sure that the power is switched off 2 Connect the one RJ 45 connector to network port at the back of the monitor 3 Connect the other RJ 45 connector to the corresponding port on the wallbox 4 Turn on the monitor confirm that the network symbol and Network made message are displayed in the upper part of the screen Install the network NOTE To install network please ask the GE...

Page 65: ...Pressing the release latch on the bottom of the module 2 Grasp the module firmly and pull out of the Frame Make sure not to drop it when it comes out Visual indicators Function Specification Explanation External power supply Green LED Indicates when monitor is powered from mains Battery operation Green LED Indicates when monitor is powered from internal batteries Battery condition Orange LED Indic...

Page 66: ...Perform the following visual inspection to the installed monitoring system Carefully inspect the patient monitor if any damage Verify that the patient monitor is properly mounted with specified mounting solutions Verify that the cables between the patient monitor and the connected peripheral devices are intact and properly connected to the right connectors Accessories A rigid cylinder or pipe NIBP...

Page 67: ...ondition the battery to see the procedure for battery conditioning if you receive a a Condition Battery X message NOTE Before taking the patient monitor into use for the first time the battery should be fully charged Keep the monitor connected to the mains until the battery is fully charged Display 1 Verify that all text is readable and all images are clear 2 Verify that the brightness is good Adj...

Page 68: ... message will display in Entropy digital field Recorder 1 Press the Recorder Start Stop key and check that the module starts recording the selected waveforms Press the Recorder Start Stop key again to stop recording 2 Check that the quality of the recordings is acceptable MC or S 5 Network connection NOTE Pre configure the network when install the monitor 1 Check that the CAT 5 cable connector is ...

Page 69: ...4 Monitoring basic ...

Page 70: ......

Page 71: ...commands displayed on the monitor screen To display a menu press one of the Command Board keys Figure 4 1 Example of a menu 1 Menu header 2 List of menu selections 3 Indicates the present selection 4 Adjustment window with other options 5 Short instructions 6 Entry indicator to submenus ...

Page 72: ...items in the menus with the Trim Knob For example to change what is displayed in the ECG display Select the desired function by pressing the menu key ECG Turn the Trim Knob to move the highlight down in the menu to the desired selection ...

Page 73: ...enus are indicated by a symbol They function just like the main menus and contain less frequently used functions Push the Trim Knob to enter an adjustment window or a submenu Turn the Trim Knob to choose the desired option or selection in the window Push the Trim Knob to confirm the selection ...

Page 74: ...nds Note that changing the mode also changes settings such as alarm limits The monitor automatically reconfigures the display when modules are inserted Reconfiguration of the display may take up to 5 seconds Starting monitoring 1 Prepare the patient connections according to the setup picture in the measurement section Use only approved supplies and accessories see the Supplies and Accessories cata...

Page 75: ...rs or numbers for each name and ID NOTE Always observe the monitor and the patient carefully during start up periods and when inserting module NOTE The patient admission happens through Admit Patient selection or automatically when the monitor receives a patient s vital signs Enter demographics 1 Press the Admit Discharge key 2 Select Admit Patient Demographics 3 Enter patient data Height is adjus...

Page 76: ...need to avoid audible alarms press the Silence Alarms key Empty the water trap container of the gas module whenever it is more than half full Automatic saving of patient data The monitor continuously and automatically collects and saves patient data such as trends Saving is activated once the patient is admitted or the monitor receives vital data In the monitor memory the most recent patient data ...

Page 77: ...the monitor from the ON OFF key if the monitor will not be used 4 Clean the monitor according to the instructions see section Cleaning and care Using modes The monitor has seven user modes These user modes are predefined combinations of settings They determine for example what is displayed on the screen and in trends and what the alarm limits are In other words by choosing a specific mode you get ...

Page 78: ...pheral equipment connect to the monitor while in Demo Mode NOTE All the values and waveforms the Monitor displays are fictional NOTE The Demo Mode is only designed for the use of training and demo of operation It is not intended for clinical use or patient monitoring and diagnosis The Demo Mode menu is under service menu of the monitor it s need password to enter Please consult the qualified servi...

Page 79: ...5 Alarms ...

Page 80: ......

Page 81: ...iority medium priority If the alarm is a low priority the measurement value is not flashing 3 In some cases a message in the digit or waveform field gives more detailed information using the color of the parameter An audible alarm is also triggered If enabled also the alarm light flashes red high priority yellow medium priority cyan low priority according to alarm levels Refer to Default Configura...

Page 82: ...itoring equipment After connecting the monitor to the central station and or nurse call system verify the function of the alarm system The functions of the alarm system for monitoring of the patient must be verified at regular intervals Make sure alarms are active and set according to patient condition Only the latest and highest priority alarm is sent to CARESCAPE Network ACCURACY If the accuracy...

Page 83: ...it values of bedside monitor When have the memory error message the monitor will automatically return to default settings include the alarm preset When monitor starting up alarm will beep and light to do self testing automatically Alarm conditions Physiological alarm conditions are triggered by a patient measurement exceeding the parameter limits or by an arrhythmia condition Technical alarm condi...

Page 84: ...evel not at the escalated level For more information about alarm priority escalation see the Default Configuration Worksheet Signal Priority level High Medium Low Informational Alarms in Message Field Solid red background Yellow boundary blue gray background Cyan boundary blue gray background Blue gray background field Alarm reset in Message Field Solid red background with audio pause symbol Yello...

Page 85: ...values 2 Confirm that the following alarm notification events occur The audible alarm sounds the correct tone The alarm light illuminates The SpO2 numeric value flashes in the digit field with the correct color An alarm printout if enabled 3 Audio pause the alarms and confirm that the alarms are paused and that the left side of the alarm indicator light is a correct color 4 Return the parameter al...

Page 86: ...its NOTE For detail information about default limits see Default Configuration Worksheet The default limits can be changed and saved to modes see Changing the user modes page 6 7 Cancel ChangesReturns all the limits to the ones set before entering the Alarms Setup menu if you have not exited the menu yet Arrh Alarms Set arrhythmia alarm whether to create snapshot and enter to Alarms Setup menu Ala...

Page 87: ...e for activating alarms that have been permanently silenced using the Central Silence Apn Turns off audible alarms for apnea respiration rate EtCO2 and FiCO2 limit alarms except the related technical alarms Silence ECG Turns off audible alarms for all HR source ECG Art and Pleth limit and arrhythmia alarms except the related technical alarms Silence Apn ECG Turns off audible alarms for apnea respi...

Page 88: ... through the measurement menus When you are in an XX parameter menu select XX Alarm or enter XX Setup and then select XX Alarm NOTES In NIBP measurement the alarm limits change automatically according to the cuff hose type used If the monitor is connected to the network the alarm limits can also be adjusted using the Central if this feature has been enabled in its configuration If alarm limits are...

Page 89: ...urn the Trim Knob to change the selection OFF or ON Or 1 Select X Alarm in parameter s menu and push the Trim Knob to change the selection OFF or ON If you select the OFF option the symbol appears in the digit field Alarms Setup CVP ADJUST ALARM LIMITS Adjust Limits Sys Alarm Dia Alarm Mean Alarm Alarms Setup Previous Menu ON CVP Sys 320 40 10 40 mmHg Push Trim Knob to turn alarm ON OFF ON ON 320 ...

Page 90: ...its configuration Choosing silence selections 1 Press the Alarms Setup key 2 Select Audio ON OFF menu Silence Apn Turns off audible alarms for apnea respiration rate EtCO2 and FiCO2 limit alarms except the related technical alarms Silence ECG Turns off audible alarms for all HR source ECG Art and Pleth limit and arrhythmia alarms except the related technical alarms Silence Apn ECG Turns off audibl...

Page 91: ... automatically set to 7 Alarms are listed as follow Physiology alarms Action Result Indicator Press audio pause key once Start a 2 minute audio pause period for all alarms except the critical breakthrough alarms for example V Tach See the Default configuration worksheet for details about breakthrough alarm Cease all latched alarms including message and light Alarm light Yes Alarm message Yes and h...

Page 92: ...robe No SpO2 pulse No Px transducer NIBP cuff loose NIBP cuff occlusion Check NIBP Weak pulsation Long measurement time NIBP manual NIBP cuff overpressure NIBP call service error Gas measurements removed Recorder module removed Entropy measurement removed Alarm volume changed Zero ICP separately Recorder system error Recorder cover open Recorder input voltage high Recorder input voltage low Record...

Page 93: ...at you contact the person responsible for the entire configuration Displaying limits You may select the alarm limits to be displayed next to the numerical parameter value 1 Press the Monitor Setup key 2 Select Install Service and enter the password 16 4 34 3 Select Installation Alarm Options 4 Select Show Limits and YES or NO The alarm limits become visible when patient monitoring begins and the m...

Page 94: ...etermine whether the audible alarms can be turned off or not 1 Press the Monitor Setup key 2 Select Install Service and enter the password 3 Select Installation Alarm Options 4 Select Show Audio ON OFF and YES to enable alarm audio off or NO to disable it The default setting will be NO Monitor Setup ...

Page 95: ...o hear a reminder beep every 10 seconds To clear the message field of the no longer active alarm messages and to clear the beep Press the audio pause key once or Press Alarm Reset key once To select latching alarms 1 Press the Monitor Setup key 2 Select Install Service and enter the password 3 Select Installation Alarm Options 4 Select Latching Alarms Yes The default setting will be Yes Monitor Se...

Page 96: ...enable for breakthrough feature With this selection you can determine whether the breakthrough alarms turn off or not 1 Press the Monitor Setup key 2 Select Install Service and enter the password 3 Select Installation Breakthrough Alarm Off close breakthrough alarms feature Pedi turn on breakthrough feature for new fatal alarms including Brady Adult turn on breakthrough feature for new fatal alarm...

Page 97: ...me 1 Press the Monitor Setup key 2 Select Install Service and enter the password 3 Select Installation Alarm Options 4 Select Min Alarm Volume and adjust the minimum alarm volume with the Trim Knob The default setting will be 5 Monitor Setup ...

Page 98: ...r volume 1 Press the Monitor Setup key 2 Select Install Service and enter the password 3 Select Installation Alarm Options 4 Select Reminder Volume and adjust the alarm reminder volume with the Trim Knob The default setting will be 5 Monitor Setup ...

Page 99: ...hoices of alarming tone patterns ISO ISO2 General and IEC To change the tone pattern 1 Press the Monitor Setup key 2 Select Install Service and enter the password 3 Select Installation Alarm Options 4 Select Alarm Tones and ISO ISO2 IEC or General Monitor Setup ...

Page 100: ...entral station adjust alarm settings alarm reset by CIC alarm audio pause and silence all by iCentral To enable the alarm remote control 1 Press the Monitor Setup key 2 Select Install Service and enter the password 3 Select Installation Alarm Options 4 Select Remote Control to Active The default setting will be Inactive Monitor Setup ...

Page 101: ...elect Install Service and enter the password 3 Select Installation Alarm Options 4 Select NurseCall NO The default setting will be NO NOTE For NO selection high electrical level is exported from Nurse call connector when there is medium or high priority alarm NOTE For NC selection low electrical level is exported from Nurse call connector when there is medium or high priority alarm Monitor Setup ...

Page 102: ...B40 B20 Patient Monitor 5 22 ...

Page 103: ...6 Monitor setup ...

Page 104: ......

Page 105: ... monitor The changes need to be saved in the mode to become permanent Before starting to use the monitor check the monitor s settings and what is configured in the different user modes and make necessary changes You need passwords for making the changes see Passwords below NOTE You can find the factory settings of each mode in the Default Configuration Worksheet delivered with each monitor NOTE If...

Page 106: ... date Hours minutes and seconds Day month and year NOTE If the monitor is connected to the Central the monitor follows the Central s time settings and the Time and date menu is not available NOTE You cannot change the monitor s time settings after the patient has been admitted Viewing battery status Through this menu you can check the battery status 1 Press the Monitor Setup key 2 Select Battery S...

Page 107: ...re permanent To change the units 1 Press the Monitor Setup key select Install Service and enter the password 2 Select Installation Units 3 Set the units for height weight and blood pressure NOTE You can change temperature units through Others Temp Setup and CO2 units through Airway Gas CO2 Setup Monitor Setup Installation Units Alarm Options Printer Previous Menu Set unit of height weight and bloo...

Page 108: ...rms excluding Brady Min Alarm Volume Adjust minimum volume of audible alarm tone Reminder Volume Adjust the volume of the audible alarm reminder tone Alarm Tones Choose the IEC ISO ISO2 default or General for alarm tone pattern Remote Control Select active to enable alarm remote control by central station Inactive is the default NurseCall Select NO high electrical level is exported from Nurse call...

Page 109: ...n be changed in the Record Print menu To make the changes permanent save them in user modes Changing the monitor settings 1 Press the Monitor Setup key 2 Select Install Service and enter the password 3 Select Installation Monitor Settings Parameter Settings CO2 Numbers Set humidity compensation type Dry default Wet MAC Type B40 only Set MAC type MAC or MACage Printer Snapshot Printout Previous Men...

Page 110: ...e sync options Unity is time sync to Unity Network NTP is time sync to NTP Server NTP Config to set NTP Server configuration GMT Offset Hours to set offset hours from GMT Greenwich Mean Time GMT Offset Minutes to set offset minutes from GMT Primary Server IP to set primary NTP Server IP address Secondary Serv IP to set secondary NTP Server IP address NOTES DST Offset Hour and DST Offset Minute men...

Page 111: ...ds and snapshot settings Configuring trends and snapshot on page 6 16 To change the alarm limits and volume Adjusting alarm limits on page 5 8 Alarms Setup menu on page 5 6 To change the parameter settings Press a parameter key and go to the setup menu To change the recorder and printer settings Changing the recorder and printer settings on page 6 14 Saving changes in user modes The modifications ...

Page 112: ...all modes from network and saves them in monitor s permanent memory To Network Copies all modes from monitor s permanent memory to network This selection is available only if saving modes to network is enabled in Central NOTE Make a discharge before loading modes Select the user mode To change the current mode to another 1 Press Admit Discharge and select Select Mode 2 Select one of the following ...

Page 113: ...p the screen is arranged according to the startup mode definitions Not all the parameters are used and displayed There is not enough space reserved for all of them You can decide which waveforms and numerical information are displayed and where on the screen they are arranged You can do this for the duration of monitoring or save the changes in the user mode To make the changes permanent save them...

Page 114: ...n module is connected or disconnected The invasive pressure waveforms are displayed only when the transducer is connected to the module Waveforms are always evenly spread to fill the entire waveform area Whenever there are less than 6 waveforms configured on the screen the remaining waveforms are enlarged Changing the waveform to another also changes the numerical field to the right of the wavefor...

Page 115: ...n 1 Press the Monitor Setup key 2 Select Screen Setup Digit Fields and select the paramters If a digit field is turned OFF the remaining digit fields are enlarged to fill the space NOTE Choosing the same parameter in the waveform and digit field makes the previously chosen field disappear Monitor Setup Dight Fields Lower Field 1 Previous Menu Change contents of lower digit field 1 Select OFF to cl...

Page 116: ...the options Trend or None Figure 6 4 Split screen view Modifying the minitrend length You can choose to view minitrend data from the last 5 minute or 30 minute period next to the parameter s waveform field The 5 minute minitrend is updated every 10 seconds and the 30 minute minitrend once every minute To modify the minitrend length 1 Press the Monitor Setup key 2 Select Screen Setup 3 Select Minit...

Page 117: ... 2 Select Sweep Speeds select the parameter and adjust the value Displaying pulse rate Combined heart rate and pulse rate can be displayed next to the ECG waveform The current HR source is displayed with bigger font and the heart rate symbol flashes next to it 1 Press the ECG key 2 Select ECG Setup 3 Select Display with HR and PR PVC or None Changing parameter colors You can select the color of ea...

Page 118: ...rm level NO is the default with VSP software license bradycardia tachycardia asystole Art high low V Fib V Tach Select Delay and OFF or 12 s If the recording delay is OFF the recording starts when an event occurs and continues for 30 seconds or until manually stopped or until the recorder runs out of paper If the delay is 12 seconds default the recording starts when an event occurs and the 12 seco...

Page 119: ...u want to print 4 Select Hours Page for how many hours will be printed on one page 1 2 default 4 6 8 10 12 24 36 48 or 72 hours on one page 5 Select End Time printing starts from selected end time 6 Select Trend Length and select hours to be printed 1 2 4 6 8 default 10 12 24 36 48 or 72 hours Print Record Record Trends Record Numerical Num Trend Type Graphic Trend 2 Previous Menu 5 min Num NIBP H...

Page 120: ...t graphical parameters for each field The field numbers start from the top of the screen Select one parameter for each field on the trend page or turn the field OFF When all the fields are OFF the page is displayed with empty fields The time scale and page number appear at the bottom of the page Field 1 5 can be displayed on screen and Field 6 can be printed If several similar fields are selected ...

Page 121: ...need arrhymia alarms to trigger snapshot please set up in ECG arrhymia alarms menu see Adjusting arrhythmia alarm settings page 11 16 Automatic Print ALL to print all the snapshots immediately after creation ALARMS to print snapshots created on alarms and arrhymia alarms if create snapshot selected YES NO to print only on request NOTE Network laser printer only Setting trend length and scales Pres...

Page 122: ...nel to support Demo Mode The Demo Mode is designed for training and demo of operation before use Under Demo Mode the monitor displays the main vital signs values and waveforms No need accessories central station or any other peripheral equipment connect to the monitor while in Demo Mode NOTE All the values and waveforms the Monitor displays are fictional NOTE The Demo Mode is only designed for the...

Page 123: ...7 Trends ...

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Page 125: ...With the 20 minute trend length the displayed time period is 30 minutes and the resolution 10 seconds With trend lengths from one to 72 hours the displayed time period is 72 hours and the resolution is one minute You can view the trends through Pt Data Trends Trends or you can select graphical minitrends to be displayed continuously next to the waveform fields Monitor Setup Screen Setup Split Scre...

Page 126: ...e screen Select Graphical Numerical or Snapshot Changing trend scales Select Trend Scales Viewing OCRG snaphsot in Neonatal mode When patient mode is Neonatal Press the Pt Data Trends key and select OCRG Snapshots Viewing realtime OCRG in Neonatal mode When patient mode is Neonatal Press the Pt Data Trends key and select OCRG Realtime Printing trends To print the currently viewed trend data select...

Page 127: ...end view You can split the Normal Screen page so that one fourth of the screen on the left hand side continuously shows graphical minitrends beside waveforms Note that the split screen option is available only when the Normal Screen page shows waveforms ...

Page 128: ... last 30 minute period The five minute minitrend is updated every 10 seconds the 30 minute minitrend is updated once every minute To modify the split screen trend view 1 Press the Monitor Setup key 2 Select Screen Setup 3 Select Minitrend Length and choose 5 min or 30 min Removing minitrend To remove the minitrend from the screen 1 Press the Monitor Setup key 2 Select Screen Setup 3 Select Split S...

Page 129: ...trend view Figure 7 2 Graphical trend page 1 Trends menu 2 Measurement trend field 3 Real time ECG 4 Numeric value of a measurement at the trend cursor point 5 Trend page number 6 Snapshot point 7 Time and marker field 7 1 2 3 4 5 6 ...

Page 130: ...on the screen the left end of the line shows the starting point of the trend data gathering The right end of the line shows the last moment the data has been gathered White line indicates which proportion of the data you see on the screen If the line is on the left there is more data to see after the current view If the line is on the right there is more data to see before the current view If the ...

Page 131: ...end Scales Changing trend length and resolution 1 Press the Pt Data Trends key 2 Select Trends Time Scale 3 Select the trend length Table 7 1 Trend length and resolution Trend length on the screen Resolution Trended time period 20 minutes 10 seconds last 30 minutes 1 hour 1 minute last 24 hours 2 hours 1 minute last 24 hours 4 hours 2 minutes last 24 hours 6 hours 3 minutes last 24 hours 8 hours 4...

Page 132: ...d Graphical The recording time of a trend corresponds to the time scale of the graphical trends You can choose the time scale 20 minutes to 72 hours in the trends menu To select the parameters for graphical trend recording 1 Press the Print Record key 2 Select Record Trends 3 Select Graphic Trend 1 and choose the parameter in the opened adjustment menu 4 Select Graphic Trend 2 and choose the param...

Page 133: ...Trends and OCRG 7 9 Numerical trend view Figure 7 3 Numerical trend page 1 Trend menu 2 Page name and number 3 Real time ECG 4 Real time digit fields if the Normal Screen shows waveforms 1 2 3 4 ...

Page 134: ... vertical direction When the highlight reaches the top or the bottom of the view next five minutes of information appear Recording and printing Recording Parameters for recording are chosen during configuration To change the parameters see section Monitor setup 1 Press the Print Record key 2 Select Record Trends 3 Select Record Numerical Printing 1 Press the Pt Data Trends key and select Trends 2 ...

Page 135: ...ch parameter Page 1 Vital parameters Mark Time HR SpO2 NIBP sys dia NIBP mean Art sys dia Art mean CVP mean CO2 ET Page 2 Hemodynamics Mark Time IBP1 Art IBP2 CVP C O REF PCWP Page 3 Gases Mark Time CO2 ET FI O2 ET FI N2O ET FI HAL ET FI Bal ETI MAC RR Page 4 Temperatures and saturations Mark Time T1 T2 Tblood SpO2 SvO2 Page 5 Adequacy of Anesthesia Mark Time RE SE BSR ...

Page 136: ...in the column Mark For configuration see Configuring snapshots in section Setting up the monitor before use Snapshot view A snapshot includes 15 seconds of a waveform and or a graphical trend from the time period that corresponds to the graphical trends timescale and or numerical trends 1 Trends menu 2 Real time ECG 3 Waveform snapshot 4 Time of the snapshot If created on alarm the cause of the al...

Page 137: ...ker field When the cursor hits the saving time of a snapshot marked with an S in the time axis the snapshots that were saved at that time appear In the waveform field you can see the time the snapshot was created Five fields can be displayed on the snapshot page and six fields can be printed In the trend field the graphical trend view or the numerical trends view are displayed according to the sna...

Page 138: ...trigger OCRG Snapshot creation To display the OCRG snapshot record 1 In NEONATAL mode Press the Pt Data Trends key 2 Select OCRG Snapshots You can select Scroll Snapshots and scroll left and right with the Trim Knob to see OCRG snapshots earlier The trigger time and condition also showed on the left menu area You can select Remove Menu to hide the left side menu Press the Trim Knob to show the men...

Page 139: ...rge 3 In the opened window select Yes to erase the trends and to discharge the patient Showing alarm history Press the Pt Data Trends key and select Alarm History This displays a list of the last 20 alarms that have reached the yellow red and cyan alarm level The time and type of occurrence are displayed next to the alarm list items Admit Discharge ...

Page 140: ...B40 B20 Patient Monitor 7 16 ...

Page 141: ...8 Print and record ...

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Page 143: ...imultaneously Selectable paper speed Prints up to 72 hours of graphical and numerical trends Numerical printout with annotation when one or two waveforms are printed Numerical trend resolution selectable Configurable to create a 30 second recording automatically on alarm NOTE Recording on thermal paper may be destroyed when exposed to light heat alcohol and so on Take a photocopy for your archives...

Page 144: ...he Recorder Start Stop key or Press the Print Record key and select Record Waveforms Record to Local To stop the recording Press the Recorder Start Stop key or Press the Print Record key and select Record Waveforms Stop Waveforms You can also use the network recorder by selecting Record to Net The network recorder uses the settings of the central station Print Record ...

Page 145: ...eforms 3 Select Waveform 1 and a parameter for it or select OFF 4 Select Waveform 2 and 3 and their parameters You can record simultaneously up to three waveforms The following menu figure shows which parameters have recordable waveforms Print Record Record Waveforms Record to Net Waveform 1 Start on Alarms Delay Paper Speed Previous Menu ECG1 OFF 25 mm s OFF ON 12 s Change waveform recorded in up...

Page 146: ...he paper speed To see the waveforms more clearly or more generally you can change the paper speed The recorder speed can be 1 6 25 12 5 or 25 mm second 1 Press the Print Record key 2 Select Record Waveforms 3 Select Paper Speed Print Record ...

Page 147: ...an event occurs and continues for 30 seconds or until it is manually stopped or until the recorder runs out of paper If the delay time is set to 12 seconds default the recording starts when an event occurs and the 12 seconds prior to the event are recorded from the recorder memory The recording continues for 18 seconds if the length has been set to 30 seconds or until the recorder runs out of pape...

Page 148: ...ng time is always 30 seconds and the delay always 12 seconds 1 Press the Print Record key 2 Select Record Waveforms 3 Select Start on Alarms and Yes The following alarms start recording All alarm recordings are marked with the alarm source Alarm Recorded parameters Asystole Tachy Brady Art Sys Dia Mean High Low V Fib V Tach ECG1 Art waveforms 25 mm s ECG1 Art waveforms 25 mm s ECG1 Art waveforms 2...

Page 149: ...ds are preconfigured you cannot choose the parameters or change their order The following parameters are printed in the numerical trend record Figure 8 1 Numerical trend printout For pressures either Sys Dia or Mean are recorded depending on the digit format selected in the pressure setups Parameter Printed values and units HR and SpO2 min and NIBP Sys Dia mmHg IBP1 Art Sys Dia or mean mmHg IBP2 C...

Page 150: ...e 8 1 Tabular trend printout Selecting graphical trends You can record graphical trends of two parameters To select the parameters for the graphical trends 1 Press the Print Record key 2 Select Record Trends 3 Select Graphic Trend 1 or Graphic Trend 2 The following figure shows which parameters have graphic trends that you can record Parameter Printed values and units HR SpO2 NIBP or Art CO2 bpm s...

Page 151: ...er holder The paper should unroll from underneath the paper roll 4 Begin to close the door while still holding onto and pulling about 6 to 8 cm of paper then close the door completely You should hear a snap as the door latch is engaged 5 Attempt to print out a annotated strip by pressing the Recorder Start Stop key to make sure you load paper in the correct direction Figure 8 2 Inserting recorder ...

Page 152: ...gs For printing setup details please go to Chapter 6 Monitor Setup see Printer settings page 6 15 Printing currently displayed screen contents To print a trend view 1 Press the Pt Data Trends key 2 Select Trends Graphical Numerical 3 Select the desired trend page with Scroll Pages 4 Select Print Page Printing all the information To print several pages of graphical trend data 1 Press the Print Reco...

Page 153: ...9 Cleaning and care ...

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Page 155: ...of the probe before and after each patient use CABLE SENSOR AFTER CARE Do not immerse sensors or patient cables in water solvents or cleaning solutions Do not reuse sensors intended for single patient use Do not sterilize sensors or patient cables by irradiation steam or ethylene oxide Clean the surface of the probe before and after each patient use Allow sensor and cable to dry completely after c...

Page 156: ...anual If the monitor does not function as it should and troubleshooting cannot solve the problem contact your service or sales representative Do not perform any other cleaning or maintenance procedures than those described in the monitor manuals NOTE Refer to the accessory package for detailed cleaning instructions NOTE For information regarding materials used in accessories see the instructions f...

Page 157: ...econds IBP After connecting IBP cable and transducer check that the message InvBP s not Zeroed will display in message field Airway gas Make sure the acquisition module is connected to the monitor After installing the module Calibrating gas sensor will display in gas waveform field for about 1 minutes Entropy Make sure the acquisition module is connected to the monitor Connect the Entropy sensor c...

Page 158: ...ssages when discharging the battery 2 Reconnect the power cord to the wall outlet and turn on the patient monitor Leave the patient monitor on until the battery is fully recharged and the orange battery charging indicator LED turns off 3 Repeat the steps 1 and 2 once The battery is now conditioned and ready for use However if the Condition Battery X message is still shown on the screen replace the...

Page 159: ... alcohol 10 Ethyl alcohol 80 Isopropyl alcohol 60 Phenol 2 Purified benzine Chloramine 5 Glutaraldehyde 2 Monitor casing Wipe with mild hospital detergent solution Make sure not to leave any liquid spills on any metal part Let dry completely before connecting to power source Check ventilation holes and clean if necessary Modules Wipe the front panel as any monitor casing Do not wash or immerse mod...

Page 160: ...cuff in mild detergent solution Do NOT use alcohol Invasive blood pressure cables Wipe the cables with sterile alcohol based detergent After cleaning rinse surfaces by wiping them with a cloth damped with sterile water Dry with a dry cloth Airway adapter Replace the single use adapter after each patient Sampling line Do not reuse the sampling line Reusing a cleaned sampling line may affect measure...

Page 161: ... used again Traces of alcohol or other organic cleaning solutions may affect measurement Do not force air or oxygen through the water trap Do not allow smoke and dust to enter the water trap While administering nebulized medication disconnect the gas sampling line from the patient circuit for 30 minutes If the message Sample line blocked alarm occurs Replace the sampling line Empty the water trap ...

Page 162: ...B40 B20 Patient Monitor 9 8 Other accessories See the accessory package for instructions for how to clean and check them Do not reuse single use disposable accessories ...

Page 163: ...10 Troubleshooting ...

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Page 165: ...onnected to an electrical wall outlet and to the monitor The module are pushed properly into the frame and the monitor recognizes the module parameter is displayed on the screen and menu selections are active Patient connection cables are attached to the module connectors Trends of the previous patient are erased Alarm limits are suitable for the patient The desired measurements have been selected...

Page 166: ... Monitor is battery powered Batteries are fully charged the size of the green bar indicates the charging level Orange dark Green lit Monitor is battery powered Battery A is empty battery B charge is ok Orange dark Green lit Monitor is battery powered Battery A failure battery B is full Orange flashing Green lit NOTE If both batteries fail the green battery LED is dark Monitor is mains powered Batt...

Page 167: ...ing circuit Arrhythmia paused Arrhythmia paused in ECG Check the patient status Check the electrodes Art disconnect ABP disconnect UAC disconnect IBP line disconnect Check the Art ABP UAC line Check the patient status Asystole No QRS detected in ECG Check the patient status Check the electrodes Battery A temperature high Battery B temperature high Battery temperature too high Replace the battery I...

Page 168: ...ode if desired ECG module error The Hemo module has a communication error Contact authorized service personnel End of 20 min trend data There is more trend data available but not with this resolution Change the time resolution in graphic trends to be more than 20 minutes e g 1 hour 2 hours Scroll the trends to see past data Entropy cable off The Entropy sensor cable is not connected to the Entropy...

Page 169: ...le s nominal flow value This can happen if nebulized medications are given without disconnecting the sample line Check the sample line If the problem persists contact authorized service personnel Mark X A snapshot is created Check the snapshot if desired Memory ERROR Memory issue Contact authorized service personnel Mode data reset Error when loading settings from the flash file z Contact authoriz...

Page 170: ...on between the SpO2 sensor and module No SpO2 pulse Pulse signal is poor Try other measurement sites No printer selected There is no printer selected on the monitor Select a printer see section Print and record chapter Patient discharged The patient has just been discharged For more information see section Starting and ending chapter Patient admitted The current patient has just been admitted For ...

Page 171: ...Replace the water trap Restart needed The monitor should be restarted Restart the monitor Saving to Network Saving trend and information to network Waiting and not interrupt Sample line blocked The sampling line inside or outside the monitor is blocked or the water trap is occluded Change the sampling line and water trap Select inflation limits You are using a hose without an automatic identificat...

Page 172: ... blood circulation slow heart rate associated with artifacts moving or disturbed patient during measurement small air leak Check the patient status Check the NIBP cuff position and attachments Check that the cuff is not damaged Repeat the measurement and check the patient status Zero ICP separately The ICP channel must be zeroed separately from all other invasive pressures In IBP menu to zero ICP ...

Page 173: ...itor alarming for asystole bradycardia pause or inaccurate heart rate when a visible QRS waveform is present The monitor may not be detecting sufficient QRS amplitude 1 Check the ECG signal acquired from the patient 2 View all ECG leads to assess the amplitude of the QRS complexes To ensure correct HR readings a 0 5 mV QRS amplitude is recommended for a normal ECG signal If the QRS amplitude drops...

Page 174: ...Why is the monitor double counting theheart rate alarming for a low heart rate or not detecting pacemaker spikes The monitor is not detecting pacemaker activity Causes may include The pacemaker signal is too weak for the monitor to detect The ECG signal is too weak for the monitor to detect The monitor is detecting atrial pacemaker artifact or non QRS features as beats If the monitor is alarming f...

Page 175: ...the detection sensitivity percentage until the markers correctly identify each inspiration and expiration Symptom Possible cause and solution SpO2 signal is poor Check the sensor and sensor positioning Change the averaging time from slow to normal Note that skin pigment causes differences Make sure that the patient is not shivering Why does the pulse oximeter sometimes read differently than a bloo...

Page 176: ...ing and being moved with every cycle can cause motion artifact A non arterial often erratic looking waveform and a pulse rate that does not coincide with the heart rate on the ECG will result Motion artifact can be reduced if not eliminated by selecting a quieter site on the patient An ear sensor if the hands do not remain still an adhesive sensor on the toe or an adhesive sensor on the little fin...

Page 177: ...ent If a systolic blood pressure cannot be found the monitor searches for a systolic reading by re inflating the cuff at a higher pressure This systolic search may occur once per NIBP determination cycle During a systolic search the maximum cuff inflation pressure will not exceed the normal pressure range of the cuff The monitor may be taking a control measurement If the measured NIBP value exceed...

Page 178: ...asured pressure oscillations during cuff deflation are related to systolic mean and diastolic pressures Changes in the vascular tone of the arterial system can cause these two indirect methods to differ from one another and from direct arterial pressure measurements Invasive arterial blood pressure is a direct method of measuring blood pressure Differences between direct and indirect blood pressur...

Page 179: ...termined by blood gas analysis The major clinical reasons are dead space ventilation ventilation perfusion mismatch a drop in cardiac output alveolar shunts and incomplete emptying of the alveoli Also check the following technical issues integrity of the breathing circuit blood gas analysis corrected to a lower temperature in case of hypothermia NOTE If you are using N2O and the E miniC make sure ...

Page 180: ...ble The measured values are not displayed Check that you have selected the desired parameter to a waveform or digit field The monitor does not start Check that the power cord is properly connected Check that all cables are properly connected Check the fuses and replace them if necessary You cannot perform a measurement or a function Check that the measurement module is properly installed Check tha...

Page 181: ...11 ECG ...

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Page 183: ...the monitor Do not use equipment for positioning floating temporary pacemaker leadwires performing pericardiocentesis or other internal applications HEART RATE ALARM INTERFERENCE Poor cable positioning or improper electrode preparation may cause line isolation monitor transients to resemble actual cardiac waveforms and thus inhibit heart rate alarms To minimize this problem follow proper electrode...

Page 184: ...nd for detecting pacemaker function and myocardial ischemia In Normal Screen when measuring 5 lead ECG you can simultaneously monitor the waveforms of up to three different ECG leads In 3 lead ECG the monitor displays one ECG lead When monitoring the ECG the monitor simultaneously analyzes ST segment changes Figure 11 1 Electrocardiographic ECG measurement connector ECG and impedance respiration c...

Page 185: ...source ECG Art ABP Pleth 8 HR PR value 9 Heart beat detector is flashing with every detected heart beat 10 ST values are always displayed next to ECG2 11 Fourth ST value showing the largest absolute ST value 12 Selected ST leads 13 ST label 14 Message field for parameter messages NOTE The input circuits are protected against the effects of electrosurgery and defibrillation However the ECG waveform...

Page 186: ... all electrodes at least every 24 to 48 hours Use the Multi Link electrosurgical unit ESU ECG patient cable when using the monitor in the presence of an electrosurgical unit This cable with a built in ESU filter helps reduce electrosurgical noise detected on the ECG signal Whenever a cable electrode or V lead is changed the monitor automatically relearns When placing the electrodes avoid bones clo...

Page 187: ... and F LL electrodes should be used Lead Electrodes needed I R RA L LA F LL or N RL II R RA F LL L LA or N RL III LL LA F LL R RA or N RL aVR N RL R RA L LA F LL aVL N RL R RA L LA F LL aVF N RL R RA L LA F LL V5 N RL R RA L LA F LL C5 IEC AAMI AHA Electrode placement R red RA white Just below the right clavicle L yellow LA black Just below the left clavicle C white V brown For the 5 lead placemen...

Page 188: ...or channels ECG2 and ECG3 also a cascaded lead selection Casc is available To select the ECG1 lead Press the ECG key and select ECG1 Lead You can select all leads ECG1 ECG2 and ECG3 in the ECG menu Viewing a cascaded ECG With a 3 leadwire set ECG2 and ECG3 leads are automatically shown as cascaded The same ECG will be displayed in each waveform field Thus more QRS complexes are displayed at the sa...

Page 189: ...Volume Adjusts the pulse heart beat sound volume 0 to 10 When the monitor has detected a QRS complex or a pleth or pressure pulse a beep tone is produced You can raise lower or turn off the volume Adjusting beat sound volume affects also the beat sound volume of the HR source ECG Art or Pleth ECG ECG ECG Setup Beat Sound Volume HR Source Display with HR Filter Pacemaker Grid 5 lead cable 3 AUTO No...

Page 190: ...ont and the heart rate symbol flashes next to the reading Filter Filters the ECG signal high frequency noise and slow respiratory artifacts Monit monitor filter effectively filters the artifacts caused by for example the electrosurgery unit and respiration STfilt ST filter permits more accurate information of the ST segment It filters the high frequency artifacts caused by the electrosurgery unit ...

Page 191: ...3 Select Adjust Limits You can also adjust the limits through Alarms Setup Adjust Limits For detailed instructions see section Alarms ECG ECG ADJUST ALARM LIMITS Adjust Limits HR Alarm PVC Alarm ST Alarms Arrh Alarms Alarms Setup Previous Menu ON OFF HR 250 160 40 30 min Push Trim Knob to adjust alarm limits manually ...

Page 192: ...VC Alarm ON 4 Select Adjust Limits You can also adjust the limits through Alarms Setup Adjust Limits For detailed instructions see section Alarms ECG ECG ADJUST ALARM LIMITS Adjust Limits PVC Alarm ST Alarms Arrh Alarms Alarms Setup Previous Menu ON HR 250 160 40 30 min Push Trim Knob to adjust alarm limits manually PVC 100 20 0 min ...

Page 193: ...figuration Checklist Check that Electrode gel is moist Electrodes have good skin contact Electrodes are positioned correctly Correct leadwire set is selected The trunk cable is connected properly Leadwire set is properly connected to the trunk cable Correct leadwire type is selected in the ECG Setup menu Pacemaker selection in the ECG Setup menu is Show when a pacemaker is used ECG is selected for...

Page 194: ...larms Keep pacemaker patients under close surveillance See ECG specifications for the pacemaker pulse rejection capability of this instrument FALSE CALLS False low heart rate indicators or false Asystole calls may result with certain pacemakers because of pacemaker artifact such as electrical overshoot of the pacemaker overlapping the true QRS complexes NOTES Pacemaker detection is always on The s...

Page 195: ...ose following opitions Hide The pacing spike is filtered away from ECG data Show The pacing spike is filtered away from ECG data but the spike is displayed as a constant height marker Sensit This selection uses a more sensitive pacemaker detection Pacing spike is displayed on ECG NOTE In Neonatal mode pacemaker spike is always hide Checklist Refer to ECG s Checklist on page 11 11 ...

Page 196: ... present and does not exhibit a significant change from the patientís predominant morphology it is possible for those events remain undetected by the system SUSPENDED ANALYSIS Certain conditions suspend arrhythmia analysis When suspended arrhythmia conditions are not detected and alarms associated with arrhythmias do not occur The messages which alert you to the conditions causing suspended arrhyt...

Page 197: ...mplate updating and contextual analysis Continuous correlation attempts to find the best match between each incoming complex and the set of stored learned templates If no match is found with the existing template a new template is stored for the identified new QRS shape Incremental template updating allows information from each beat that correlates over time to be reflected in the associated templ...

Page 198: ...for reference but not for diagnose A physician must analyze the arrhythmia information in conjunction with other clinical findings NOTE Asystole alarm will sound when HR reaches zero Alarm Criteria Asystole HR is decreased to zero the V Fib alarm is not displayed and a beat detection has not occurred in the last two seconds Bradycardia HR below the HR alarm limit Tachycardia HR over the HR alarm l...

Page 199: ...ting allows information from each beat that correlates over time to be reflected in the associated template Contextual analysis uses information from neighboring QRS complexes along with existing template measurements to make the best possible decision regarding the beat s origin e g early wide NOTE A physician must analyze the arrhythmia information in conjunction with other clinical findings Tes...

Page 200: ...vation NOTES ST segment changes may also be affected by such factors as drugs or metabolic and conduction disturbances Since ST is often calculated with a fixed delay from the J point changes in heart rate may affect ST The significance of the ST segment changes needs to be determined by a physician The ST algorithm has been tested for accuracy of the ST segment data ST segment deviations are not ...

Page 201: ...he QRS detection has started During a learning period of 32 accepted beats the median ST values are displayed Also when the cable or the V lead is changed or when an electrode is removed or relearning is started manually the monitor starts to learn the ST segment During the learning period the algorithm uses the isoelectric reference and the J reference points to calculate the ST values The algori...

Page 202: ...he original point is shown as a dashed line When you adjust the J point also the ST point is set according to the selected ST point setting J 20 J 40 J 60 or J 80 The manually set J point remains until the monitor is turned off or reset After a turn off or reset the J point is set automatically Setting the ST point manually ST segment is the component of the ECG trace between the end of the QRS co...

Page 203: ...elect ST Alarms 4 Select Adjust Limits You can also adjust the limits through Alarms Setup Adjust Limits ECG High low ST ADJUST ALARM LIMITS Adjust Limits Lat Alarm Inf Alarm Ant Alarms Alarms Setup Previous Menu ON OFF ST Lat 6 0 2 0 2 0 6 0 mm Push Trim Knob to adjust alarm limits manually OFF I avl v5 ...

Page 204: ...e sophisticated algorithms of monitor search the J and isoelectric ISO points The system learns the ECG and stores the reference QRST complex The algorithm sets the ISO and J points Due to the large variation with QRST complexes the user has possibility to adjust the ST measurement points manually The QRS analysis classifies each beat by using several criteria and rejects distorted complexes from ...

Page 205: ...12 Impedance respiration ...

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Page 207: ...f you notice this use another form of respiration monitoring for instance the E miniC module Electrical interference Electrical devices such as electrosurgery units and infrared heaters that emit electromagnetic disturbance may cause artifacts or disable the respiration measurement completely Movement artifacts Changing position moving the head moving the arms or shivering may result in movement a...

Page 208: ...n rate is calculated from impedance changes and a respiration waveform is displayed Respiration detection is not dependent on the size of the waveform Size is for visual purposes only The dotted lines present the zero line and the detection limit The signal strength produced by a respiration should thus exceed this minimum limit to be included in the respiration rate calculation Peaks within the g...

Page 209: ...c value Figure 12 2 Respiration rate source indication for impedance and CO2 The impedance respiration waveform is displayed next to the RR value also when the RR value is calculated from CO2 To manually select impedance respiration as respiration rate source 1 Select respiration in a waveform or a digit field 2 Press the Others key 3 Select Resp Setup 4 Select Resp Rate Source and select AUTO CO2...

Page 210: ...ble in specific regions including USA Argentina Guam Puerto Rico Saint Croix Saint Thomas and Canada Do not place electrodes on obvious layers of fat or major muscles Make sure the electrode gel is moist Make sure electrodes have good skin contact For a comprehensive list of accessories see the Supplies and Accessories catalog L L R L R A I I I III L A R L R A L A 2 LEAD I LE AD III LEAD II L LA R...

Page 211: ...Setup Screen Setup Waveform Fields or Digit Fields Or Others Resp Setup Screen Setup Waveform Fields or Digit Fields Refer to Changing the Normal Screen layout on page 6 9 for details 2 Check that the measurement is on Press the Others key Select Resp Setup Select Measurement and ON Others Others Resp Setup Normal Screen Set size Resp rate source and alarm Enable or disable Resp measurement Temp S...

Page 212: ...g waveform readability To improve readability increase the waveform size 1 Press the Others key 2 Select Resp Setup 3 Select Size and adjust the waveform size The bar on the left side of the waveform always indicates a 1 Ω reference Others ...

Page 213: ...e In this case the dotted line represents the absolute detection limits When there are lots of artifacts the grids can be adjusted further apart to separate smaller artifacts from larger true respiration peaks The small peaks fall within the grids and are not calculated while the bigger peaks cross the grids and are calculated as true respirations To ensure the correct respiration number adjust th...

Page 214: ...Resp Setup 3 Select Measurement OFF Checklist Check that Electrode gel is moist Electrodes have good skin contact Electrodes are positioned correctly Correct leadwire set is selected The trunk cable is connected properly Leadwire set is properly connected to the trunk cable Correct leadwire type is selected in the ECG Setup menu ECG Resp are selected for screen through Monitor Setup Screen Setup O...

Page 215: ...13 Pulse oximetry ...

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Page 217: ...s been linked to the presence of poor signal strength or artifact due to patient motion during signal analysis This condition is most likely to be encountered when the monitor is used on neonates or infants These same conditions in adults do not impact the SpO2 values to the same extent We recommend the application of the following criteria when using the pulse oximetry function on neonates and in...

Page 218: ...form quality and minimize noise spikes caused by motion conditions Not applicable when monitoring SpO2 with Masimo SET technology Interfering substances can affect the SpO2 reading Improper sensor placement can affect the SpO2 signal and readings Do not allow tape to block the probe light detector During electrosurgery the SpO2 measurement results may be incorrect Using the Maximum sensitivity set...

Page 219: ...at the measuring site Thus the amplitude of the waveform reflects the perfusion The monitor have three options for SpO2 configuration GE Masimo and Nellcor The set up will be preconfigured by the manufacturer according to your choice Depending on the different SpO2 configuration not all SpO2 measurements and settings are available to view or change And also have different performance please refer ...

Page 220: ...e and pleth waveform 1 Scale of plethysmogram 2 Label 3 Oxygen saturation SpO2 value 4 Pulse oximetry message field Patient connections Figure 13 3 Pulse oximetry setup 1 Compatible SpO2 measurement capability 2 Interconnect cable 3 Reusable sensors 4 Disposable sensors 2 1 3 4 2 3 1 2 4 ...

Page 221: ...ient NOTE Use dry and clean sensors only 1 Connect the sensor to the blue connector in the module 2 Clean the application site Remove nail polish artificial fingernails earrings etc clip long fingernails 3 Position the sensor correctly For proper sensor positioning see the Instructions for use accompanying each sensor 4 Attach the sensor to the patient 5 Attach the sensor cable to the wrist or bed...

Page 222: ... the scale changes the message Scale changed is displayed Nellcor and Masimo SpO2 configuration The selection is 1X 2X 4X 8X SpO2 Response GE SpO2 configuration only Selecting the SpO2 averaging time The selections are Normal 12 seconds default setting Fast 3 seconds Averaging Masimo SpO2 configuration only Adjusting the averaging time It can be 2 4 8 10 12 14 16s SpO2 Pulse Oximetry Pleth Scale H...

Page 223: ... configuration only Adjusting alarm delay time in SpO2 Alarm menu Medium priority SpO2 Low alarm appears according to the selection Adjusting the delay time It can be 0s 5s 10s 15s Data update and averaging Nellcor OxiMax data averaging and updating The Nellcor OxiMax algorithm automatically extends the amount of data required for measuring SpO2 and pulse rate depending on the measurement conditio...

Page 224: ...sites with poor perfusion A small pulse wave may be a sign of impaired circulation that may require increased attention Higher scale indicators together with a well defined pulse wave indicate strong circulation and a relaxed patient NOTE Always check the patient and the sensor site if the accuracy of the SpO2 values is questionable Waveform quality NOTE For all technologies except Masimo SET Unde...

Page 225: ... affect the accuracy of measurement especially when using an ear sensor To avoid erroneous readings do not use a blood pressure cuff or arterial blood pressure measurement device or NMT sensor in the same limb as the SpO2 sensor For Masimo SpO2 loss of pulse signal can occur when Sensor is too tight The patient has hypotension severe vasoconstriction severe anemia or hypothermia There is arterial ...

Page 226: ...the device For a properly functioning monitor this difference will be reproducible over time and from monitor to monitor within the performance specifications of the test device GE Trusignal technology clinical studies on neonatal GE Oxy AF and GE Oxy SE sensors have been validated for neonatal accuracy The subject demographics included 28 neonates and 1 infant 15 females and 14 males The subjects...

Page 227: ...imit of agreement 2 2 lower 95 limit of agreement 2 2 between subject variance 10 2 Within subject variance 0 9 Figure 13 5 Bland Altman plot of TruSignal V2 with Oxy W sensor Population mean bias 1 1 upper 95 limit of agreement 4 5 lower 95 limit of agreement 2 3 between subject variance 41 5 within subject variance 1 5 ...

Page 228: ...95 limit of agreement 4 2 lower 95 limit of agreement 1 7 between subject variance 29 2 within subject variance 1 2 Figure 13 7 Bland Altman plot of TruSignal V2 with Oxy AP sensor Population mean bias 1 3 Upper 95 limit of agreement 4 0 lower 95 limit of agreement 1 4 Between subject variance 11 4 within subject variance 1 3 ...

Page 229: ...imit of agreement 3 8 lower 95 limit of agreement 2 0 between subject variance 10 7 within subject variance 1 7 Figure 13 9 Bland Altman plot of TruSignal V2 with Oxy E sensor Population mean bias 0 8 upper 95 limit of agreement 3 9 lower 95 limit of agreement 2 3 between subject variance 20 8 within subject variance 1 7 ...

Page 230: ...95 limit of agreement 5 0 lower 95 limit of agreement 3 4 Between subject variance 22 6 within subject variance 3 6 Figure 13 11 Bland Altman plot of TruSignal V2 with Oxy AF sensor motion conditions Population mean bias 0 6 Upper 95 limit of agreement 3 5 lower 95 limit of agreement 2 3 Between subject variance 10 5 within subject variance 1 7 ...

Page 231: ... selected for each patient size The sensor is completely dry after cleaning Sensor or interconnect cable is plugged to the blue connector in the module Sensor is properly connected to the interconnection cable if used Sensor is positioned correctly to the patient SpO2 is selected for screen through Monitor Setup Screen Setup ...

Page 232: ...B40 B20 Patient Monitor 13 16 ...

Page 233: ...14 Non invasive blood pressure ...

Page 234: ......

Page 235: ... heart rate is present on the monitor screen before performing an NIBP determination NIBP READINGS MAY TIME OUT WHEN USING IABP An IABP balloon pump creates non physiological arterial waveforms These waveforms create an oscillometric signal that may not be interpreted by the NIBP algorithm causing NIBP to time out The patient blood pressure can be monitored from the balloon pump device GE Healthca...

Page 236: ...d at a speed based on the patient s heart rate collecting data from the oscillations produced by the pulsating artery Based on this data the unit calculates values for systolic mean and diastolic pressures Blood pressure measurements determined with this device are equivalent to those obtained by an intra arterial blood pressure measurement device Multiple intra arterial sites were used You can se...

Page 237: ...blood pressure 2 Label 3 Mean pressure value of NIBP 4 Time since the last autocycle measurement 5 NIBP autocycle time indicator NOTE When 60 minutes has passed from the latest NIBP measurement the NIBP numeric value digits turn gray When 245 minutes has passed from the latest NIBP measurement the gray numeric value digits are replaced by a dashed line Starts and stops autocycling measurements Sta...

Page 238: ...ient care accordingly taking into account the patient s cardiovascular status and the effect of an alternative site on blood pressure values proper cuff size and comfort Always measure patient s limb and select appropriately sized cuff according to size marked on cuff or cuff packaging When cuff sizes overlap for a specified circumference choose the larger size cuff If patient is standing sitting ...

Page 239: ...t identification the monitor goes to this selection automatically when you try to start the NIBP measurement You must set the inflation limits manually With these hoses AUTO option is not available NOTES You cannot select A P inflation limits when using an infant cuff The NIBP system incorporates a safety circuit to prevent overpressure or prolonged inflation of the cuff The alarm limits change au...

Page 240: ...cuff size This selection allows you to override the automatic safety limit feature for the hose cuff being used The selections are Auto A P and NEO The selection AUTO is not available when using hoses without identification NOTE You cannot select adult limits with an infant cuff hose NOTE When using very large adult cuffs use Adult limits to prevent Cuff loose message from displaying Previous Menu...

Page 241: ...re detected the monitor automatically holds deflation until the motion stops maximum of 30 seconds If the artifacts prevent proper measurement a new measurement starts automatically When the measurement is ready you can hear a short beep and see the result numbers flashing During measurement Observe the cuffed limb frequently Measurement may impair blood circulation Intervals below 10 minutes and ...

Page 242: ...nized to real time for example if the first measurement was at 12 02 the next measurement is at 12 05 and again at 12 10 5 min interval Setting cycle time The possible intervals for autocycling are 1 2 3 4 5 10 15 20 30 60 90 120 minutes and the custom option To set the cycle time Press the NIBP key on the Command Board and select Cycle Time Select the alternative with the Trim Knob NOTE When you ...

Page 243: ...or every series The cycle time can be set to 1 to 120 min or OFF The repeat option can be set to 1 to 25 times or OFF or cont Starting and stopping autocycling To start the autocycling do one of the following Press the NIBP Auto On Off key or press the NIBP key and select Start Cycling The bar at the bottom of the NIBP field shows the time remaining to the next measurement To stop autocycling Pres...

Page 244: ... five minutes A new NIBP measurement starts immediately after the previous one After five minutes the monitor automatically returns to the previously selected cycling interval or to manual mode To start the measurement do the following press the NIBP key and select Start STAT To stop the measurement do one of the following Press the NIBP Start Cancel key or press the NIBP key and select Stop STAT ...

Page 245: ...apid settling of cuff pressure the monitor will momentarily inflate to a higher pressure then immediately deflate to the target pressure After inflating the cuff the NIBP parameter begins to deflate The oscillations versus cuff pressure are measured to determine the mean pressure and calculate the systolic and diastolic pressures During an NIBP determination the parameter deflates the cuff one ste...

Page 246: ...t has been 16 minutes or less since the last determination and the current blood pressure is similar to the previous reading the monitor will try to make an accelerated determination of blood pressure During irregular rhythms only pulses from the current determination are used in calculating the blood pressure values In order to ensure adequate artifact rejection capability and optimal SuperSTAT N...

Page 247: ...ivering seizures arm movement or bumping against the cuff Proper sizing and position of the cuff are essential to obtaining reliable readings Too large a cuff is better than too small a cuff which may yield falsely high readings The cuff should also fit properly over the brachial artery or whatever artery is being used so that the cuff is sufficiently sensitive to vibrations in the artery Checklis...

Page 248: ...B40 B20 Patient Monitor 14 14 ...

Page 249: ...15 Invasive blood pressure ...

Page 250: ......

Page 251: ...od pressure cable To measure invasive blood pressure you need the IBP configuration in monitor To measure invasive blood pressure a catheter is inserted into an artery or vein The invasive blood pressure setup consisting of connecting tubing a pressure transducer and a fluid source to maintain pressure all connected together by stopcocks is attached to the catheter The transducer is placed at the ...

Page 252: ...vasive pressure measurement connector Direct function keys There is a key for zeroing IBP on the Command Board NOTE Selecting Zero ALL does not zero ICP Zero it separately Zeros all pressure transducers Invasive pressures connector IBP Zero All ...

Page 253: ...n have a combined display of all those waveforms that are selected on the screen This combined display uses the whole waveform field area and the same zero line for all waveforms To select 1 Press the Monitor Setup key and select Screen Setup 2 Select Waveform Fields 3 To combine all waveforms in one field select Combine Pressures and Yes NOTES A pressure channel is activated when a pressure trans...

Page 254: ...ure that there is no air in the line Refer to transducer manufacturer s instructions on how to remove trapped air from the transducer 4 Connect the patient catheter to the pressure line 5 Open the dome stopcock to room air 6 Zero the transducer See Starting with accurate values on page 15 5 7 Open the dome stopcock to pressure catheter and check the quality of the waveform Figure 15 3 Invasive blo...

Page 255: ...n when no pressure is applied to them It is necessary to zero the monitor with the transducer to establish an accurate electrical zero point Also the position of the transducer effects the accuracy of the measurement An error of 10 mmHg of static pressure is introduced for every 13 6 cm 5 4 inches difference in height between the mid heart and the transducer To zero the transducer open the transdu...

Page 256: ...ssure value Mean in large size to the screen You can also choose all values S D M to the screen If the label is ICP also the CPP selection is available see also page 15 8 Response Use the Trim Knob to change the invasive blood pressure averaging time The available values are Normal and B TO B beat to beat With selection Normal normal averaging is used Depending on the label the values are updated ...

Page 257: ...regular The cursor is not available for pressures shown with a combined scale 1 Press the IBP key 2 Select Px Setup Px Cursor 3 Move the cursor up or down by turning the Trim Knob Every time the cursor is moved the time hours and minutes and pressure values are displayed on the screen This way you can keep track of the changes made 4 You can remove the cursor by selecting Remove cursor Note that i...

Page 258: ...nt settings or alarm labels Table 15 1 Invasive blood pressure labels and descriptions Cerebral perfusion pressure Cerebral Perfusion pressure CPP is calculated by subtracting ICP mean pressure from Art mean pressure CPP mean is displayed next to the ICP value NOTE Set the Label of the channel to ICP and the Digit Format to CPP LABEL P1 Art ABP P2 CVP RAP LAP ICP PA RVP UAC UVC Scale mmHg kPa 200 ...

Page 259: ...ms and adjusting see section Alarms Alarms Setup IBP1 ADJUST ALARM LIMITS Adjust Limits Sys Alarm Dia Alarm Mean Alarm Alarms Setup Previous Menu ON OFF IBP1 Sys 320 180 80 40 mmHg Push Trim Knob to turn alarm ON OFF OFF High Low Alarms Setup CVP SpO2 CO2 15 100 8 0 ET 0 3 0 90 ALARM LIMITS AND 10 MIN TRENDS Mean Adjust Limits Auto Limits Default Limits Adiuo ON OFF Alarm Light 100 Alarm Volume 5 ...

Page 260: ...ion to flush the invasive blood pressure line There is a 40 second time out for performing the flushing The digits change to dashes and there are no alarms After 40 seconds or when flushing is completed and patient s pulse detected the pressure digits are displayed and alarms become active If pressure values are outside the alarm limits an alarm is given The monitor functions the same way when blo...

Page 261: ...16 Temperature ...

Page 262: ......

Page 263: ...erics only No waveform is generated or displayed Thermally sensitive resistors thermistors are used to monitor temperature As temperature changes electrical resistance changes Thermistors measure this resistance change and use it to calculate the temperature The signal from the probe is processed by the monitor and is displayed as measured numerics As a measuring probe use only GE Healthcare tempe...

Page 264: ...bility 2 Adapter cable for temperature probes 3 Reusable temperature probe 4 Adapter cable for disposable temperature probe 5 Disposable temperature probe To connect the patient 1 Attach the temperature probe to the patient 2 Connect the adapter cable to the module connector NOTES Use only GE approved temperature accessories For a comprehensive list of accessories see the Supplies and Accessories ...

Page 265: ... a time Temp Alarm Alarms can be adjusted in this menu or in the Alarms Setup menu which opens by pressing the Alarms Setup key Previous Menu Returns to the previous menu level Changing temperature label 1 Press the Others key 2 Temp Setup T1 Label or T2 Label 3 Select the label with the Trim Knob Labels are T1 and T2 or Eso Esophageal temperature Naso Nasopharyngeal temperature Tymp Tympanic temp...

Page 266: ...ture measurement functioning is automatically tested periodically During the test the message Performing temp test is displayed If the test fails the monitor displays the message Temperature error Changing temperature units You can select the temperature unit to be either degrees Centigrade or degrees Fahrenheit 1 Press the Others key 2 Temp Setup Unit 3 Select the unit C or F with the Trim Knob C...

Page 267: ...17 Airway gas ...

Page 268: ......

Page 269: ...patient or user Handle the water trap and its contents as you would any body fluid Infectious hazard may be present E miniC measurement is intended for patients weighing over 5 kg 11 lb Since sample gas may contain anesthetic agents make sure that it is not released in the room Connect the exhaust to a scavenging system to prevent exposure to anesthetic agents Always ensure the correct size and fi...

Page 270: ...nance schedule may cause equipment failure or inaccurate readings PATIENT CROSS INFECTION Returning the sampled gas to the patient circuit causes a risk of patient cross infection PATIENT CROSS INFECTION Always use a bacterial breathing system filter proximal to the patient when returning the sampled gas to the patient circuit If a bacterial breathing system filter is not used a failure in the D F...

Page 271: ...quires manual selection from the monitor menu to compensate for N2O NOTE When monitoring neonatal or other patients that have high respiration rate or low tidal volume The CARESCAPE Respiratory Module and Airway Gas Option shall be used within the limits of respiration rates and tidal volumes to ensure specified measurement accuracy NOTE The monitor also is compatible with the E sCOV and E sCAiOV ...

Page 272: ...2 selected in the Monitor Setup menu 2 Gas waveforms 3 Message field for gases 4 Gas label 5 Digit field for ET and FI gas values 6 Respiration rate 7 Scale NOTE When the measured CO2 and O2 value is outside the specified measurement range the numeric value is gray Figure 17 3 Lower digit field for gases ...

Page 273: ... gas label 5 Digit field for ET and FI gas values 6 MAC 7 Scale NOTE When the measured anesthetic agent value is outside the specified measurement range the numeric value is gray Airway gases measurement setup E miniC module to patient connection 1 E miniC module 2 Gas sampling line 3 Airway adapter with sampling line connector 4 Sampling line connector on the water trap ...

Page 274: ... Option D fend Pro or D fend Pro E miniC Mini D fend Empty the water trap container as soon as it is half full Place the airway adapter between the HME and Y piece Place the airway adapter with all sampling ports upwards Always check the tightness of all connections For a comprehensive list of accessories see the Supplies and Accessories catalog Make sure that the gas sampling line is properly con...

Page 275: ...he adapter with the sampling port upwards This prevents any condensed water from entering the sampling line 7 Check that the airway adapter connections are tight and that the adapter is operating properly 8 If E miniC is used with O2 and or N2O contents higher than 40 make sure that FiO2 Level and N2O Level are set NOTE Check that the sample line is connected to the water trap before connecting th...

Page 276: ... Patient Monitor 17 8 Mask ventilation 1 Mask 2 Bacterial filter 3 Airway adapter 4 Sample line Infant ventilation 1 Endotracheal tube 2 Pediatric airway adapter 3 Fresh gas inlet 4 Sample line 2 1 3 4 2 3 1 4 ...

Page 277: ...e You can select the rate to be calculated from the ECG leads impedance measurement or the CO2 measurement If you select AUTO the rate is automatically calculated from the measured CO2 If impedance measurement is present and the source is AUTO the respiration rate calculation switches back to impedance respiration if you press the Silence Alarms key during an Apnea alarm CO2 Alarm Opens the CO2 al...

Page 278: ... The scale selesctions for O2 waveform are DIFF6 DIFF10 DIFF15 DIFF30 10 60 and 100 Measuremnet Set O2 measurement and alarm on or off O2 Alarm Opens the O2 alarm adjustment menu to change the O2 alarm limits Previous Menu Returns to the previous menu Agent N2O Setup menu NOTE B40 only Airway Gas Airway Gas ...

Page 279: ...tings 4 Select MAC Type To enable the MACage calculation NOTE B40 only Give the patient s age in menu Admit Discharge Admit Patient Demographics Attach a temperature sensor MACage is calculated if it is enabled in the settings and the patient s age is given on the monitor If no age is given the monitor shows normal MAC even if MACage has been selected NOTE The MAC value displayed by the monitor is...

Page 280: ... larger than the exhaust line Scavenging through the anesthesia gas scavenging system Anesthesia machines are equipped with an anesthesia gas scavenging system AGSS and in some machines you can connect the sample gas outlet directly to it See the anesthesia machine s user documentation to find out where and how the sample gas can be connected Connecting directly to the scavenging system 1 Connect ...

Page 281: ...bration Gas CO2 O2 Balance 4 cans pkg with E sCO module US only NOTE Use only the specified GE Healthcare calibration gas for the gas calibration to ensure measurement accuracy Do not use any other calibration gases Check the calibration gas container s labelling to ensure that the calibration gas has not expired NOTE Ensure that the gas regulator is functioning properly before gas calibration Ref...

Page 282: ...d by a message Zero Ok for all measured gases 3 Open the regulator after a message Feed gas is shown The measured gas concentrations are shown in real time in the gas calibration menu Continue feeding the calibration gas until the message Adjust is displayed then close the regulator 4 Check that the displayed gas values match the values on the calibration gas container NOTE If an error occurs duri...

Page 283: ...ts contact authorized service personnel The monitor performs autozeroing after start up The autozeroing intervals are 4 min 15 min 30 min and 60 minutes after start up thereafter every 60 minutes NOTE If you are using separate gas cylinders calibrate each gas separately The time of the last calibration is shown at the bottom of the menu page ...

Page 284: ...piration rate RR up to 80 breaths per minute E miniC has a sample flow of 150 ml min Respiration rate from the CO2 parameter is counted from the frequency of end tidal peak CO2 measurements per minute A sufficient respiration is defined as a difference of at least 1 at least 7 mmHg between the measured inspired fraction and end tidal CO2 Total sample size volume during one respiratory cycle depend...

Page 285: ...value is calculated from the actual measured anesthetic agent and N2O values with empirical formulas based on statistical studies with anesthetized patients The monitor can display two different MAC values MAC or MACage based on different formulas The use of MAC or MACage is selected during installation and configuration The MAC values correspond to those of healthy adults of about 40 years old an...

Page 286: ...1989 MAC values of different anesthetics in oxygen Normal values 40 year old patient and compensated values 65 year old and 3 year old patients The following illustration shows the Agent corresponding to 1 MAC as function of age MAC values of different anesthetics in 65 N2O Normal values 40 year old patient and compensated values 65 year old and 3 year old patients HAL ENF ISO SEV DES N2O 1 MAC 0 ...

Page 287: ...ent respiratory and or circulatory function or improper mechanical ventilator functionality The origin of the CO2 waveform The following illustration shows a normal capnogram In this illustration the letters indicate the following A The gas first exhaled is from the anatomical and apparatus dead space It contains no CO2 because it has not been in the alveoli and no gas exchange has taken place B B...

Page 288: ...ower waveform 1 Expiration 2 Cardiogenic oscillations Cardiogenic oscillations appear when A continuous fresh gas flow is fed into the patient Y piece Sidestream gas sampling is done at the Y piece The patient is ventilated with a long expiration time or low respiration times and when there is a long zero flow at end expiration for some other reason Oscillations can be eliminated by adding a space...

Page 289: ...entilation is usually adjusted to achieve normocapnia where EtCO2 is in the range of 4 5 to 5 5 34 mmHg to 41 mmHg This is called normoventilation as it is the normal situation in healthy people A low EtCO2 concentration EtCO2 4 30 mmHg indicates hyperventilation NOTE A low EtCO2 value in itself is dependent from the ventilation volume vs circulation status lung perfusion This means that in case o...

Page 290: ...uation which identifies all of the pertinent variables of oxygen supply and demand VO2 CO x Hb x 13 8 x SaO2 SvO2 Dependent from the patient s circulation status the mechanical ventilator settings for amongst others FiO2 in the delivered gas mix min 25 should guarantee a sufficient PAO2 and PaO2 Patients with fever may consume oxygen at considerably higher rates Oxygen supply to the breathing syst...

Page 291: ...sions NOTE 47 mmHg is the partial pressure of the saturated water vapor at 37 C The following lists the relationship between gas concentration and its partial pressure Reading in mmHg dry gas ambient pressure in mmHg x gas concentration in 100 Reading in mmHg water vapor saturated gas ambient pressure in mmHg 47 mmHg x gas concentration in 100 Reading in kPa dry gas ambient pressure in mmHg x gas ...

Page 292: ... connected to the water trap Monitor is turned on and self check is performed with the sampling line attached Sampling line is connected to the airway adapter The humidification and or bacteria filter are in correct place Breathing circuit or accessories have no residuals of alcohol based disinfectants Desired gas parameter is selected for screen through Monitor Setup Screen Setup ...

Page 293: ...18 Entropy ...

Page 294: ......

Page 295: ...e proper contact of the ESU return electrode to the patient to avoid burns at monitor measurement sites Also ensure that the ESU return electrode is near the operating area Strong 30 40 Hz magnetic fields may cause erroneous Entropy measurement Do not use devices with such a field close to the module or sensor The Entropy measurement is always to be used only as an adjunct to other physiological p...

Page 296: ...n monitoring The American Society of Anesthesiologists Practice Advisory for Intraoperative Awareness and Brain Function Monitoring Anesthesiology 2006 104 847 64 Clinicians are also recommended to maintain current knowledge of government regulatory practice or research information on brain function monitoring and related topics Entropy is for monitoring the state of CNS by data acquisition of ele...

Page 297: ...ch measures EEG in the frequency range of 0 8 Hz to 32 Hz Its reaction time is 15 seconds SE may be used to assess the effect of certain anesthetic drugs on the brain How to interpret the Entropy values High values of Entropy indicate high irregularity of the signal signifying that the patient is awake A more regular signal produces low Entropy values which can be associated with low probability o...

Page 298: ...suppression indicate very deep hypnosis unconsciousness level Burst suppression generally emerges with Entropy values below 40 but may not appear even with very low Entropy values Entropy range guidelines NOTE Individual patients may show different values These are only guidelines Entropy in typical general anesthesia 1 Awake RE SE 2 Induction RE SE 3 Intubation response RE increases rapidly 4 Mai...

Page 299: ...es and the brain interfere minimally with the signal acquisition See the sensor instructions for use for more detailed information A high quality EEG signal is the prerequisite for successful Entropy calculation Displaying the raw EEG within the Entropy waveform area may help the user to confirm the signal quality Raw EEG on the screen may also enable the clinician to view the EEG for recognizable...

Page 300: ... use and let it dry before attaching the sensor Place the Entropy sensor on the patient s forehead see sensor package for instructions Connect the sensor to the Entropy sensor cable Observe the results of the automatic sensor check in the parameter window The measurement starts automatically after the sensor has passed the check Equipment module to connect 1 Module with Entropy measurement capabil...

Page 301: ...d The selections are RE Only RE diaplays in the horizontal dight field SE Only SE diaplays in the horizontal dight field RE SE RE and RE display in the horizontal dight field All Both RE SE and BSR diplay in the horizontal dight field Check Sensor Start the impedance check of the sensor Bypass Check Start Entropy measurement without completing the impedance check Automatic Check Select ON to start...

Page 302: ... SE value change considerably the monitor should start Entropy sensor checking manually 1 Press the Other key 2 Select Entropy 3 Select Check Sensor Setting RE and SE alarm limits To set the RE alarm limits 1 Press the Other key 2 Select Entropy 3 Select Entropy Alarms 4 Select Adjust Limits Others ...

Page 303: ...s through Alarms Setup Adjust Limits For detailed instructions see section Alarms NOTE The default values for RE and SE alarm are off Please set the alarm on by selecting RE Alarms in Entropy menu Set the SE alarm in the same way Others Others ...

Page 304: ...gidity and patient movement cause artifact and may interfere with the measurement Epileptic episodes may also cause interference Entropy readings may be inconsistent when monitoring patients with neurological disorders traumas or their sequelae Entropy readings may be inconsistent when using benzodiazepines nitrous oxide or ketamine as anesthetics Psychoactive medication or very high opiate doses ...

Page 305: ...t AEP auditory evoked potential AirW airway temperature Alpha Al alpha frequency band AM Anesthesia Monitor Amp amplitude Ant anterior APN apnea Arrh arrhythmia Art arterial pressure ASY asystole ATMP atmospheric pressure ATPD atmospheric ambient temperature and pressure dry gas ATPS ambient temperature and pressure saturated gas AV atrioventricular aVF left foot augmented lead avg average aVL lef...

Page 306: ...bration Calc calculated derived value Calcs calculations CAM Compact Anesthesia Monitor CaO2 arterial oxygen content Casc cascaded ECG cc cubic centimeter CCCM Compact Critical Care Monitor CCM Critical Care Monitor CcO2 capillary oxygen content CCU cardiac coronary care unit CEL Celsius degree CFI cardiac function index CISPR International Special Committee on Radio Interference cmH2O centimeter ...

Page 307: ...delivery index DSC digital signal converter dyn dynamic e estimated ECG electrocardiogram ECG1 first ECG waveform top ECG1 r real time ECG ECG2 second ECG waveform ECG3 third ECG waveform ED emergency department EDV end diastolic volume EDVI end diastolic volume index EE energy expenditure kcal 24h EEG electroencephalogram EEG1 first EEG waveform EEG2 second EEG waveform EEG3 third EEG waveform EE...

Page 308: ...ot describing location FAH Fahrenheit degree FEMG frontal electromyogram FFT fast Fourier transform FI Fi fraction of inspired gas FiAA fraction of inspired anesthetic agent Fib fibrillation FiBal fraction of inspired balance gas FiCO2 fraction of inspired carbon dioxide FiN2 fraction of inspired N2 FiN2O fraction of inspired nitrous oxide FiO2 fraction of inspired oxygen Flow airway gas flow Freq...

Page 309: ...o IABP intra aortic balloon pump IC inspiratory capacity ICP intracranial pressure ICU intensive care unit ID identification Imped impedance impedance respiration in inch Inf inferior Infl inflation limit Insp inspiratory Inv invasive Inv BP invasive blood pressure Irreg irregular Iso isoflurane ISO International Standards Organisation ISM Industrial Scientific and Medical ITBV intrathoracic blood...

Page 310: ...an mean blood pressure mEq milliequivalent MetHb methemoglobin MF median frequency mg milligram min minute Min minimum ml milliliter MLAEP middle latency auditory evoked potential mmHg millimeters of mercury mol mole Monit monitoring ECG filter MRI magnetic resonance imaging Mult multiple Multif PVCs multifocal PVCs MV minute volume MVexp expired minute volume l min MVexp BTPS expired minute volum...

Page 311: ...ifference between gastrointestinal carbon dioxide and end tidal carbon dioxide concentration P STPD pressure in STPD conditions P1 P2 invasive pressure channel identification on module PA pulmonary artery Pa Pascal unit of pressure Paced paced beats PaCO2 partial pressure of carbon dioxide in the arteries PAO2 partial pressure of oxygen in the alveoli PaO2 partial pressure of oxygen in the arterie...

Page 312: ...u pause pressure PR pulse rate Prev previous psi pounds per square per inch pt patient PTC post tetanic count NMT pts patients PVC polyvinylchloride PVC premature ventricular contraction PVloop pressure volume loop PvO2 partial pressure of oxygen in mixed venous blood PVR pulmonary vascular resistance PVRI pulmonary vascular resistance index Px standard pressure label x being 1 2 3 4 5 or 6 QRS QR...

Page 313: ... A R specific absorption rate SD standard deviation SE State Entropy SEF spectral edge frequency SEMG spontaneous electromyogram Sev sevoflurane SI stroke index Skin skin temperature SN S N serial number Spiro patient spirometry SpO2 oxygen saturation Spont spontaneous breathing SQI signal quality index SR suppression ratio SR sinus rhythm SSEP somatosensory evoked potentials ST single twitch NMT ...

Page 314: ...and Tinj injectate temperature TOF train of four NMT TOF ratio of the 4th to the 1st response NMT Trigem trigeminy TV tidal volume TVexp expired tidal volume ml TVinsp inspired tidal volume ml Tx temperature label x being 1 2 3 or 4 or one of the other label choices Tymp tympanic temperature v venous V ventricular V volume V Q ventilation perfusion ratio V0 5 volume expired during the first 0 5 se...

Page 315: ...alcI calculated oxygen consumption index VO2I oxygen consumption index Vol volume V Run ventricular run V Tachy ventricular tachycardia WLAN wireless local area network wt weight X extreme yr year yrs years with Fick equation ...

Page 316: ...Abbreviations A 12 ...

Page 317: ... Service engineer Date Monitor license MAC Address License key Modules Gas module Entropy module Visual Inspection Expected result Observed result OK N A Fail Visual inspection Functional Inspection Expected result Observed result OK N A Fail Start up Display Time and date Parameters measurements Recorder MC or S 5 Network connection Conclusion Notes Signature ...

Page 318: ...B40 B20 Patient Monitor B 2 ...

Page 319: ......

Page 320: ...es GmbH Munzingerstrasse 5 79111 Freiburg Germany Tel 49 761 45 43 0 Fax 49 761 45 43 233 Asian Headquarters GE Medical Systems Information Technologies Asia 1 Huatuo Road Zhangjiang Hi tech Park Pudong Shanghai P R China 201203 Tel 86 21 3877 7888 Fax 86 21 3877 7451 GE Medical Systems Information Technologies a General Electric Company going to market as GE Healthcare www gehealthcare com 0459 ...

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