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Viewing real-time patient data

2001989-200E

ApexPro™

7-23

The ST value shown in the ECG parameter window is the lead with the greatest ST
deviation. This may or may not be the lead that is in alarm, since a lead with a lesser
deviation from the isoelectric line may have changed more than the lead with the
greatest deviation.

NOTE

ST numerics are always calculated with reference to 1X size. Displaying the
ECG waveform at a different size does

not

affect the ST values.

NOTE

When a new dominant beat is detected or a relearn occurs, the arrhythmia
program calculates ST based on the new beat. This could affect the ST values
displayed. This may not necessarily represent a change in the patient’s condition.
The clinician needs to assess the patient any time there is an ST change.

NOTE

Adjustable ST alarms are only available when using a CIC Pro center running
software version 5 or later. If your CIC Pro center is running an earlier version of
software, this feature is not available. Contact your sales/service representative
for more information.

ST deviation alarm

When any individual ST value is beyond the limit, an ST deviation alarm occurs. It is
considered a parameter alarm, and the default alarm level is

Warning

. This can be

modified in the parameter alarm level setup.

When the ST program is turned on, or a relearn is done with ST on, the ST
deviation values are set for all leads of ST.

The current ST value is determined in all eight leads.

The ST value in the ECG parameter window turns red to indicate an alarm.

ST limits can also be adjusted individually in the patient’s

Alarm Control

tab.

NOTE

ST limits can also be adjusted at the CIC Pro center from

Monitor Setup

>

ECG

.

Adjusting ST limits

ST alarm limits and levels for telemetry patients are typically controlled by the
default ST alarm levels from the CIC Pro center. Some bedside monitors allow users
to adjust ST alarm limits and levels at the bedside when the patient is admitted in
combination monitoring mode. For more information on adjusting ST limits, refer to
the bedside monitor operator’s manual.

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Summary of Contents for ApexPro

Page 1: ...GE Healthcare ApexPro English 2028341 001 CD 2028340 001E paper 2007 2008 General Electric Company All rights reserved ApexPro Telemetry System Operator s Manual Software Version 4 ...

Page 2: ...Systems Information Technologies Listed below are GE Medical Systems Information Technologies trademarks used in this document All other trademarks contained herein are the property of their respective owners APEX APEXPRO DASH DINAMAP SOLAR and TRAM are trademarks of GE Medical Systems Information Technologies registered in the United States Patent and Trademark Office CENTRALSCOPE CD TELEMETRY CD...

Page 3: ...f those previously distributed devices Exceptions The CIC Pro Clinical Information Center and telemetry server are suitable for use in the specified electromagnetic environment For more information refer to the appropriate service manual R TTE directive The ApexPro 420 460 MHz transmitters and receiver system conform to the R TTE Directive 1999 5 EC For more information refer to the appropriate se...

Page 4: ...the device is used in accordance with the instructions for use All publications conform with the product specifications and applicable IEC publications on safety and essential performance of electromedical equipment as well as with applicable UL and CSA requirements and AHA recommendations valid at the time of printing The quality management system complies with the international standards ISO 900...

Page 5: ... Warnings 1 4 Cautions 1 12 Notes 1 16 Equipment symbols 1 16 Equipment compliance 1 17 IEC UL and EN 60601 1 device classification 1 17 FCC compliance information statement 1 18 Industry Canada 1 18 2 Equipment overview 2 1 Introduction 2 2 ApexPro telemetry system 2 2 Transmitters 2 2 Antenna system 2 3 Receiver system 2 3 Server 2 3 CIC Pro center 2 4 Optional components 2 4 Apex oximeter 2 4 X...

Page 6: ...center 4 4 Verifying proper operation 4 4 Customizing the system 4 4 Licenses instituted 4 5 Defaults persistent 4 6 Service level defaults 4 6 User level defaults persistent 4 7 Control settings temporary 4 17 Alarm volume 4 18 5 Alarms 5 1 Alarm notification 5 2 Alarm categories 5 3 Patient status alarms 5 3 System status alarms 5 4 Managing patient alarms 5 4 Enable transmitter pause 5 5 Pausin...

Page 7: ...trode placement 6 4 Electrode placement for pediatric patients 6 6 Verify status 6 6 Maintaining quality ECG signal 6 6 Special considerations for 6 leadwire monitoring 6 7 V FAIL message 6 7 Relearn 6 7 Admitting 6 7 Terminology 6 8 Factors guiding the admit process 6 9 The source of the ECG data 6 10 The source of the patient demographic information 6 10 The monitor moves roves from room to room...

Page 8: ...all in unit patient beds 7 9 Stopping a print job 7 10 Stop printing to a laser printer 7 10 Stop printing to a local digital writer 7 10 Monitored parameters 7 11 Adjusting parameter control settings 7 11 ECG 7 11 ECG control settings 7 11 Monitoring pacemaker patients 7 13 Multi vector pace detection 7 15 Pace help 7 16 Lead analysis 7 16 Multi Lead analysis 7 16 Single Lead analysis 7 16 Single...

Page 9: ...Events directory 8 3 Viewing the Events directory 8 3 Printing the Events directory 8 4 Counting how many events occurred 8 4 Identifying the most recent occurring event 8 4 Deleting a stored event or data sample 8 5 Viewing or printing an Event strip 8 5 Full disclosure data 8 6 Full disclosure strip 8 7 Viewing or printing a full disclosure strip 8 7 Full disclosure page 8 9 Viewing or printing ...

Page 10: ...ents 9 5 Initiating a graph all patients request 9 5 Stopping a print job 9 6 Stop printing to a laser printer 9 6 Stop printing to a local digital writer 9 6 Adjusting print control settings 9 6 Enable transmitter graph 9 7 Alarm graphs enabled disabled 9 8 Graph paper out indicator 9 8 A Abbreviations and symbols A 1 Abbreviations A 2 Symbols A 8 B Customized defaults worksheet B 1 Alarms Off se...

Page 11: ...rate and or false asystole D 2 Problem False ventricular calls D 2 Problem ARR Suspend D 3 Pacemaker troubleshooting D 3 Interface connector ports D 4 Problem Inaccurate pacemaker detection D 4 Notes D 4 ST troubleshooting D 5 Problem ST numerics changed to Xs D 5 SpO2 messages D 5 NBP D 7 Troubleshooting D 7 NBP status messages D 7 Messages D 8 Alarm messages D 8 Graph messages D 9 Transmitter re...

Page 12: ...ower specifications E 5 Environmental specifications E 5 Operating conditions E 5 Transport and storage conditions E 5 Physical specifications E 5 FCC compliance information E 5 Certifications E 6 ApexPro receiver system E 6 Performance specifications E 6 Network requirements E 6 Power requirements E 6 Environmental specifications E 7 Operating conditions E 7 Transport and storage conditions E 7 P...

Page 13: ...2001989 200E ApexPro 1 1 1 Introduction ...

Page 14: ...s of the CIC Pro Clinical Information Center It uses the CIC Pro software version 5 or later user interface for procedures navigation and illustration purposes If your system uses an earlier CIC Pro software version you may notice minor discrepancies between what you see on the equipment and the information presented in this manual Refer to the documentation provided with your system for the most ...

Page 15: ... at the bottom of the page The revision letter changes whenever the document is updated Style Definition Bold Indicates hardware items such as keys labels or connectors Bold and italicized Indicates software items such as menus menu options or screen text Italics Emphasizes a word Indicates menu options or control settings to select consecutively Indicates keyboard keys to select simultaneously Re...

Page 16: ...lemetry system is intended to provide ECG data via Ethernet to the computer platform for processing The ApexPro is also intended to provide physiologic data over the Unity network to clinical information systems for display Safety statements The safety statements presented in this chapter refer to the equipment in general and in most cases apply to all aspects of the device There are additional sa...

Page 17: ...TAL SPILLS To avoid electric shock or device malfunction liquids must not be allowed to enter the device If liquids have entered a device take it out of service and have it checked by a service technician before it is used again WARNING ACCURACY If the accuracy of any value displayed on the monitor central station or printed on a graph strip is questionable determine the patient s vital signs by a...

Page 18: ...e Alarm Pause Breakthrough feature for alarm notification during an alarm pause This may result in a hazard to the patient Only crisis alarms break through an alarm pause WARNING BEFORE INSTALLATION Compatibility is critical to safe and effective use of this device Please contact your local sales or service representative prior to installation to verify equipment compatibility WARNING BEFORE USE B...

Page 19: ...om the device If you do not observe this sequence there is a risk of coming into contact with line voltage by inserting metal objects such as the pins of leadwires into the sockets of the power cord by mistake WARNING DISPOSAL Dispose of the packaging material observing the applicable waste control regulations and keeping it out of children s reach WARNING DUST COVERS If the dust covers for the in...

Page 20: ... patient at risk and compromising patient safety WARNING EMC INTERFERENCE Magnetic and electrical fields are capable of interfering with the proper performance of the device For this reason make sure that all external devices operated in the vicinity of the monitoring system comply with the relevant EMC requirements X ray equipment or MRI devices are a possible source of interference as they may e...

Page 21: ...vice system configuration The device system should not be used adjacent to or stacked with other equipment If adjacent or stacked use is necessary the device system should be tested to verify normal operation in the configuration in which it is being used Consult qualified personnel regarding device system configuration The use of accessories transducers and cables other than those specified may r...

Page 22: ...informed experts for proper use In all cases safe and proper operation should be verified with the applicable manufacturer s instructions for use and system standards IEC 60601 1 1 EN 60601 1 1 must be complied with WARNING LEAKAGE CURRENT TEST When interfacing with other equipment a test for leakage current must be performed by qualified biomedical engineering personnel before using with patients...

Page 23: ... of applying it properly WARNING POWER SUPPLY All power line devices must be connected to a properly installed power outlet with protective earth contacts only If the installation does not provide for a protective earth conductor disconnect the device from the power line and operate it on battery power if possible All devices of a system must be connected to the same power supply circuit Devices w...

Page 24: ...es in a way that they may present a stumbling hazard For devices installed above the patient adequate precautions must be taken to prevent them from dropping on the patient Cautions Caution statements identify a potential hazard or unsafe practice which if not avoided could result in minor personal injury or product property damage The following caution statements apply to this system CAUTION ADJU...

Page 25: ...sposable devices are intended for single use only They should not be reused as performance could degrade or contamination could occur CAUTION DISPOSAL At the end of its service life the product described in this manual as well as its accessories must be disposed of in compliance with the guidelines regulating the disposal of such products If you have questions concerning disposal of the product pl...

Page 26: ...e socket outlet MPSO for a system because it could result in unacceptable enclosure leakage currents CAUTION NEGLIGENCE GE does not assume responsibility for damage to the equipment caused by improperly vented cabinets improper or faulty power or insufficient wall strength to support equipment mounted on such walls CAUTION POWER REQUIREMENTS Before connecting the device to the power line check tha...

Page 27: ...must maintain an RF environment free from unintentional interference Refer to the service manuals for more information CAUTION VENTILATION REQUIREMENTS Set up the device in a location which affords sufficient ventilation The ventilation openings of the device must not be obstructed The ambient conditions specified in the technical specifications must be ensured at all times CAUTION When using the ...

Page 28: ...TYPE CF APPLIED PART Isolated floating applied part suitable for intentional external and internal application to the patient including direct cardiac application Paddles outside the box indicate the applied part is defibrillator proof Medical Standard Definition F type applied part floating isolated complying with the specified requirements of IEC EN UL 60601 1 Medical Standards to provide a high...

Page 29: ...ainst electrical shock ApexPro transmitter Type CF Defibrillation proof applied part ApexPro CH transmitter Type CF Defibrillation proof applied part Degree of protection against harmful ingress of water ApexPro transmitter IPX3 IEC 60529 1 ApexPro CH transmitter IPX7 IEC 60529 2 Receiver system Ordinary Equipment enclosed equipment without protection against ingress of water Degree of safety of a...

Page 30: ...RF transmission power from the antenna conforms to the general public FCC limit of Specific Absorption Rate SAR 1 6 W kg The maximum SAR value measured from this device was 0 01 W kg This device must not be co located or operating in conjunction with any other antenna or transmitter Industry Canada Low Power Licence Exempt Radiocommunication Devices All Frequency Bands RSS 210 This telemetry devic...

Page 31: ...2001989 200E ApexPro 2 1 2 Equipment overview ...

Page 32: ...pexPro CH transmitters ApexPro antenna system ApexPro receiver system Server hosting the ApexPro software CIC Pro center Apex oximeter Xpod oximeter Accutracker DX blood pressure monitor Dinamap Pro 100 200 300 and 400 series monitor ApexPro telemetry system Transmitters NOTE All references to transmitters are intended to include both the ApexPro and ApexPro CH transmitters unless otherwise noted ...

Page 33: ...nsmitter refer to Optional components on page 3 7 Antenna system The antenna system sends data to the receiver system Data is then transmitted via a dedicated Ethernet connection to the server for further processing and viewing For more information refer to the ApexPro CH Telemetry System Antenna Equipment Reference manual Receiver system The receiver system sends data via a dedicated Ethernet con...

Page 34: ...d Digital data is stored in Graphic Trends and Vital Signs For setup information refer to Apex oximeter on page 3 8 Xpod oximeter CAUTION Do not use the Xpod oximeter on neonatal patients It is not designed for use on neonates An Xpod oximeter can be connected to a transmitter in order to measure arterial oxygen saturation SpO2 peripheral pulse rate PPR and perfusion quality and send the data for ...

Page 35: ...owever alarms that are silenced at the CIC Pro center will not be silenced at the monitor Refer to the Dinamap Pro 100 400 Operation Manual for detailed information A Dinamap PRO 100 200 300 and 400 monitor can be connected to a transmitter in order to monitor SpO2 NBP and temperature and send the data for display at the CIC Pro center For setup information refer to Dinamap PRO monitors on page 3 ...

Page 36: ...2 6 ApexPro 2001989 200E Equipment overview ...

Page 37: ...2001989 200E ApexPro 3 1 3 Equipment setup ...

Page 38: ...ollowed by two slow flashes The transmitter begins functioning after the two slow flashes When any of the transmitter s buttons are pushed the lead LEDs flash twice Change Battery When the battery power is running low the change battery LED flashes Verify Leads When pressed the lead LEDs flash twice If a lead is valid its LED stays lit for one minute Pause Alarm When the Pause Alarm condition occu...

Page 39: ...en pressed with an IMPACT wf paging system version II or later also available in the same care unit the View on Demand feature also called the Apex Graph Button Push feature is enabled The IMPACT wf server generates a sample page of the patient s ECG waveform and any other enabled monitored non arrhythmia parameters If pressed again it generates both an IMPACT wf update and a standard ECG waveform...

Page 40: ...w battery condition occurs approximately two hours before the battery loses power the Change Battery message displays at the CIC Pro center with an audible System Warning alarm When the battery is dead the Change Battery message displays at the CIC Pro center with an audible System Warning alarm and the patient goes into NO TELEM NOTE When replacing batteries remove the old batteries and follow yo...

Page 41: ...dwire set into the transmitter align the leadwire pins with the connector on the top of the transmitter then push the leadwire set firmly into the transmitter 307C To disconnect the leadwire set from the transmitter grasp the molded end or the combiner firmly and pull away from the transmitter Electrode attachment 1 Attach leadwires to the transmitter by plugging the Multi Link leadwire set into t...

Page 42: ...ent 1 Connect the leadwire to the transmitter but do not connect the leadwire to a patient 2 Insert batteries in the transmitter and close the battery door 3 Wait for the transmitter to start up The LEDs will first flash rapidly and then flash slowly twice Wait until the LEDs are done flashing 4 Press the Verify Leads button All the LEDs flash twice to indicate the button was pushed 5 Look for LED...

Page 43: ... accessory devices in the prescribed manner may result in a loss of alarms ECG cables must be attached to the transmitter while using any accessory device such as oximeter Dinamap Pro monitors etc Xpod oximeter CAUTION Use only Nonin SpO2 probes with the oximeter The reliability of SpO2 data obtained with any other probe has not been verified The Xpod oximeter uses the battery power supplied by th...

Page 44: ...sult in reduced battery life Battery installation CAUTION GE recommends that you always replace both batteries at the same time Re using old batteries or using a combination of old and new batteries in the Apex oximeter will compromise functionality of the transmitter and increase the risk of fire hazard NOTE When replacing batteries remove the old batteries and follow your local recycling or disp...

Page 45: ...d cannot be reinserted into their retaining slot do not use them on the transmitter and keep them out of pediatric patients reach 1 Connect the non sensor end of the SpO2 probe into the 9 pin connector on the top of the oximeter 2 Plug one end of the interconnection cable into the INTFC connector on the oximeter Plug the other end into the INTFC connector labeled 2 on its dust cover on the transmi...

Page 46: ...nsmitters are different and are not interchangeable 423A Accutracker DX The blood pressure monitor allows telemetry monitoring of a patient s NBP data The blood pressure cuff is connected to the blood pressure monitor which measures and displays systolic and diastolic blood pressures using the auscultatory method Digital values are also displayed at the CIC Pro center and stored in Graphic Trends ...

Page 47: ...ge interval of 15 minutes If the lithium battery is completely drained the unit will not function The internal lithium battery is not user replaceable The unit must be returned for service if the lithium battery needs to be replaced For optimum performance follow these guidelines Store with four good AA alkaline batteries installed Change the batteries when the message Low Batt displays Install fo...

Page 48: ...cable to the 6 pin connector on the side of the monitor near the air hose connector 407A 3 Secure the cable by screwing on the metal cable cap then insert the monitor into the nylon pouch 411A 4 Attach the blood pressure cuff hose to the white plastic fitting on the patient cable Turn the fitting to the right approximately one quarter turn Some connector models will click when they are connected M...

Page 49: ...on its dust cover The interface cable is already connected to the blood pressure monitor because it is a branch of the patient cable Ensure that the transmitter s patient leadwires are properly connected The leadwires must be connected for telemetry transmission of NBP data NOTE Use a microphone pad to maintain the best microphone position Use a cuff anchor to maintain the blood pressure cuff s po...

Page 50: ...3 14 ApexPro 2001989 200E Equipment setup ...

Page 51: ...2001989 200E ApexPro 4 1 4 System setup ...

Page 52: ...arameters is not compatible Erroneous patient data may result NOTE When the monitor is set for Combo mode the second V lead can not be viewed or manipulated NOTE Users should be aware of a possible time discrepancy between the waveforms from the telemetry device and the waveforms hard wired to the display device Users should not consider these waveforms to be synchronous If absolute synchronicity ...

Page 53: ...x Run the CIC Pro center application 2 Primary display Display real time and stored patient data control windows and various system level operations Up to two displays may be connected to the CIC Pro center simultaneously 3 Secondary display optional Display stored patient data 4 Standard mouse and keyboard Enter data navigate menus and choose options 5 External speakers Sound audible patient stat...

Page 54: ...ice manual Verifying proper operation Before using this device you should confirm that the CIC Pro center application and alarms are operating properly 1 Check that the CIC Pro center is displaying waveforms and numerical data from selected patient monitors and telemetry beds 2 Check that the CIC Pro center notifies you of an alarm condition when you verify the alarm function For more information ...

Page 55: ...IC Pro center from the multi patient viewer click Setup CIC Licensing 049A Licenses are divided into the following categories View View real time patient information for a maximum of 16 patients from the multi patient viewer and one patient from the single patient viewer Monitor Admit and discharge patients modify parameter limits manage Alarm Control and silence alarms Review Review historical pa...

Page 56: ...service and clinical personnel User level defaults User level defaults are not password protected and can be configured by any qualified user To view the CIC Defaults window from the multi patient viewer click Setup CIC CIC Defaults 053A Service level defaults CAUTION QUALIFIED PERSONNEL The service mode is intended for use only by qualified personnel with training and experience in its use The co...

Page 57: ...ults persistent In user mode all of the controls except alarm volume are view only You must be in the Service mode to set defaults For more information refer to the appropriate CIC Pro center service manual Telemetry unit defaults This option sets telemetry unit default settings You must be in the Service mode to set the Telemetry Unit Defaults at the CIC Pro center To view the telemetry unit defa...

Page 58: ...ECG 1 Designate the primary ECG lead for printing Lead II is the default Waveform 2 to 4 Choose other ECG leads to print or choose Off to disable printing an ECG lead Choices are Off I II III V aVR aVL and aVF Selecting option V indicates the V lead being monitored e g V2 NOTE Temporary changes may be made for a specific patient via the single patient viewer Monitor Setup Graph Setup Transmitter G...

Page 59: ...ary changes may be made for a specific patient via the single patient viewer Monitor Setup ECG Lead Analysis Designate Single Lead or Multi Lead analysis for ECG and arrhythmia analysis Multi Lead is the default NOTE Temporary changes may be made for a specific patient via the single patient viewer Monitor Setup ECG ST Analysis Enable or disable ST Analysis Choices are On or Off Off is the default...

Page 60: ...ient Age Set Patient Age Choices are 0 2 Years 3 11 Years 11 13 Years and Adult See Patient age on page 4 10 NOTE Temporary changes may be made for a specific patient via the single patient viewer Admit Transmitter Alarm Pause Enable or disable transmitter alarm pausing Choices are Enable Disable or Off This option sets the unit default for all telemetry patients admitted to the CIC Pro center NOT...

Page 61: ... have been modified through Telemetry Unit Defaults ECG Display Lead is II Multi Lead analysis Telemetry Unit Defaults Tab Sheet Setting Age Chosen In The Admit Tab Sheet When Patient Admitted Resulting Limits Unit Default Alarm Level Brady Resulting Alarm Level Adult Adult 0 2 years 3 10 years 11 13 years 50 150 90 200 60 180 50 150 Advisory Advisory Advisory Advisory Advisory Crisis Crisis Advis...

Page 62: ...ratio of 0 4 fixed Alarm Graph location at the CIC Pro center where patient was admitted TTX manual graph location at the CIC Pro center where patient was admitted Print window location at the CIC Pro center where patient was admitted Telemetry alarm control defaults This option sets the telemetry default alarm limits and alarm level settings In user mode all of the controls are view only You must...

Page 63: ...arning ST V mm 2 0 2 0 Warning ST V2 mm 2 0 2 0 Warning ST V3 mm 2 0 2 0 Warning ST V4 mm 2 0 2 0 Warning ST V5 mm 2 0 2 0 Warning ST V6 mm 2 0 2 0 Warning ST aVR mm 2 0 2 0 Warning ST aVL mm 2 0 2 0 Warning ST aVF mm 2 0 2 0 Warning NBP S mmHg 80 200 Warning NBP D mmHg 20 120 Warning NBP M mmHg 40 140 Warning SPO2 90 105 Warning SPO2 R bpm 50 150 Warning RR breaths min 5 30 Warning ...

Page 64: ...evels ASYSTOLE1 1 The default alarm level for Asystole and VFIB VTACH cannot be moved from the Crisis level Crisis VFIB VTAC Crisis V TACH Crisis VT 2 Crisis V BRADY Crisis ACC VENT Advisory PAUSE Advisory TACHY Advisory BRADY Advisory R ON T Message COUPLET Message BIGEMINY Message TRIGEMINY Message PVC Message IRREGULAR Message ATRIAL FIB Message System Alarm Levels Levels CHANGE BATTERY System ...

Page 65: ...for binding printed reports Choices are none top bottom left and right Include Set print characteristics You may set any or none of these options Choices are Graybar Arrhythmia Annotations and Heart Rate Line Time Designate how much data shows on an individual report line Choices are 15sec 30sec and 1min Strip Duration Designate how much data is included in the strip The maximum strip duration is ...

Page 66: ...closure data if contact with a monitor has been lost Choices are 5 mins 30 mins 1 2 4 8 and 12 hours WARNING POTENTIAL DATA LOSS Do not allow a NO COMM patient offline event to exceed the time limit selected in the Offline Storage setting The patient s full disclosure data is deleted if the time limit is exceeded For more information refer to the appropriate CIC Pro center service manual Start Dat...

Page 67: ... a view only overview of the admitted telemetry patients NOTE Each row contains information for one telemetry patient The second line of an entry shows the current software level for the patient bed in question Tower The telemetry server system for this patient Receiver The receiver slot assigned to this patient Unit Bed The unit and bed assigned to this patient Type The type of patient Tele Bed o...

Page 68: ...IC Pro center follow these steps 1 From the multi patient viewer click CIC Setup CIC Defaults to display the current alarm volume 053A 2 Click the down arrow next to Current and select the desired volume setting The current alarm level determines the actual alarm volume NOTE The Minimum Alarm Volume is set between OFF and 100 in the service mode The Current Alarm Volume cannot be set below the Min...

Page 69: ...2001989 200E ApexPro 5 1 5 Alarms ...

Page 70: ... Pro center only displays on screen alarm indicators for viewed out of unit patient beds The CIC Pro center notifies you of patient or system status alarm conditions using audible tones on screen indicators or both audible tones and on screen indicators The alarm tones used to identify alarm conditions are identified in Patient status alarms on page 5 3 and System status alarms on page 5 4 The fol...

Page 71: ... events Crisis alarms sound until silenced by the user Warning Serious but non life threatening events Warning alarms sound until the condition is resolved Advisory Events that require monitoring but are not serious or life threatening Advisory alarms sound until the condition is resolved Message Additional information only The CIC Pro center s response to patient status alarms is as follows Indic...

Page 72: ...C Pro center s response to system status alarms is as follows Managing patient alarms To support a patient s unique arrhythmia or parameter condition you can temporarily adjust a patient s Parameter Limits And Alarm Levels See Adjusting alarm control settings on page 5 8 The bedside monitors automatically stores a 10 second strip for all Advisory Warning or Crisis arrhythmia events The CIC Pro cen...

Page 73: ...er Pause option active check box available either Enabled or Disabled must be selected for the Transmitter Alarm Pause option in the Telemetry Unit Defaults tab sheet Pausing alarms at the transmitter WARNING Alarms do not sound and alarm graphs do not print during an ALARM PAUSE condition CAUTION All alarms except Crisis alarms are ignored while the alarm pause is active NOTE The Enable Transmitt...

Page 74: ... off The Alarm Pause Breakthrough feature allows any Crisis level alarm to break through interrupt an alarm pause and sound at the CIC Pro center In other words when this feature is turned on in the Telemetry Unit Defaults tab sheet Crisis level alarms will sound at the CIC Pro center even if an alarm pause is in effect The chart below illustrates the function of the Alarm Pause Breakthrough featu...

Page 75: ...larm condition you can silence audible alarms from the CIC Pro center for one minute by clicking the Silence Alarms button located on the display screen or by pressing the Silence Alarms key located on the keyboard This sends a silence notification to the bedside monitor For most GE monitors this silence notification will silence the alarms for up to one minute However the viewed bedside monitors ...

Page 76: ...u make to the settings apply to the selected patient only and are adopted by the patient s monitor Some control settings for non GE acquisition devices that are interfaced via the Unity Network Interface Device or the OCTANET interface device are not adjustable It may be necessary to use the scroll bar at the right side of the window to view the appropriate alarm The control settings that are blue...

Page 77: ...You may change any of the undimmed setting options When an option appears dimmed you cannot change it Adjusting the parameter limit values WARNING ALARM CONTROL SETTINGS If you adjust parameter limits or alarm levels at the CIC Pro center these setting changes are also implemented by the bedside monitor You must notify the bedside caregiver that you changed the parameter limit or alarm levels of t...

Page 78: ...owing tasks Choose a different control setting to adjust Click the close button on the top right side of the window to close the window 6 A message window with the information regarding the last change made Select Yes to accept the change or No to cancel the change Adjusting telemetry Alarms On Off control settings WARNING Alarms do not sound alarm histories are not stored and alarm graphs do not ...

Page 79: ... steps a Click the down arrow to display a list of reasons for pausing the alarm b Select the desired reason This text is displayed in addition to the ALL ALARMS OFF message in the patient s window at the CIC Pro center 2 To turn off alarms for this telemetry patient click OFF WARNING The telemetry alarms remain off until you manually select ON again Alarms Off Reason Text Displayed At CIC Pro cen...

Page 80: ...s are service level defaults and are password protected 1 Click CIC Setup A set of tabs displays 2 Click on the Service Password tab to bring it to the front 318B 3 Use the keyboard to enter the service password then click the Apply button The Current Permission entry changes from User to Service CAUTION The service mode is intended for use only by qualified personnel with training and experience ...

Page 81: ...se the limit by 5 click on the up or down arrow button To increase or decrease the limit in increments other than 5 use the keyboard to enter a new limit value 3 Once you have set the desired limit click on the Apply button for the changes to take effect NOTE If you make only one change you do not need to click on the Apply button The change will take effect automatically and the Apply button will...

Page 82: ...l click the Apply button for the changes to take effect 5 If you are finished making changes to the Telemetry Alarm Control Defaults tab sheet click the OK button Arrhythmia alarm levels To make a change in the telemetry unit default alarm level for arrhythmia alarms first access the Telemetry Alarm Control Defaults tab as described in the Telemetry Alarm Control Defaults section in this chapter T...

Page 83: ...l and with great caution Adjusting these alarms to a lower priority level may result in reduced awareness of conditions that indicate the loss of patient monitoring NOTE Some alarm conditions may have a higher priority level at the bedside monitor In Combo mode the alarm levels come from the telemetry settings For example LEADS FAIL can be set to Crisis at a bedside monitor but the telemetry setti...

Page 84: ...arm help For additional information about alarms click on the Alarm Help button at the bottom right side of the Alarm Control tab sheet An Alarm Help window displays 323B You can click on the buttons in this window to hear how each type of alarm sounds When you are finished browsing the window click on the Close Window button to close the window and return to the single patient viewer Printing pat...

Page 85: ...g the alarming patient bed Stop printing to a laser printer Complete the following procedure to stop printing all print jobs sent to the laser printer 1 From the multi patient viewer click CIC Setup CIC Defaults The CIC Defaults window displays 2 Under Printer Writer click Cancel Print Jobs for the printer you want to stop printing to 3 After making your selection complete one of the following tas...

Page 86: ...5 18 ApexPro 2001989 200E Alarms ...

Page 87: ...2001989 200E ApexPro 6 1 6 Managing patients ...

Page 88: ... Choose flat non muscular areas to place electrodes then follow the established prep protocol for your unit Below is a suggested guideline for skin preparation 1 Shave or clip hair from skin at chosen sites 2 Thoroughly cleanse the site with alcohol or a mild soap and water solution Be sure to remove all oily residue dead skin cells and abrasives 3 Dry the skin completely before applying the elect...

Page 89: ... Right leg and left leg electrodes should be placed on a non muscular surface on the lower edge of the rib cage NOTE When using a 6 leadwire set the V leads must be labelled correctly Choices for Va V1 to V6 Choices for Vb V2 toV6 For more information refer to User level defaults persistent on page 4 7 Leadwire Software Label AHA Color AHA Label IEC Color IEC Label RA right arm white RA red R LA l...

Page 90: ...d left leg electrodes should be placed on a non muscular surface on the lower edge of the rib cage The precordial electrode should be placed according to the clinician or physician s preference 3 leadwire electrode placement WARNING Do not monitor pacemaker patients with a 3 leadwire set when reliable pacer detection is required Pacer pulse detection can be erratic when only a single vector is mon...

Page 91: ...2 limit alarm with warning or advisory as configured by the user will supersede the existing Leads Fail system warning alarm When a 5 leadwire electrode configuration is not desirable a 3 leadwire set can be used The following is a suggested configuration for a 3 leadwire electrode placement 370A 373A Right arm and left arm electrodes should be placed just below the right and left clavicle Left le...

Page 92: ...d to the patient s electrodes verify lead quality electrode status and transmitter function For more information refer to Maintaining quality ECG signal on page 6 6 For more information refer to Transmitters on page 2 2 Maintaining quality ECG signal Electrodes are disposable and applied only once Attempts to replace a loose electrode guarantees excessive motion artifact and results in false alarm...

Page 93: ...ent is switched from 6 leadwire monitoring to 5 leadwire monitoring while admitted to the CIC Pro center a V FAIL message will appear The CIC Pro center assumes that the telemetry patient is being monitored for six leads and that the sixth lead has failed In situations where the admitted telemetry patient has been switched from 6 to 5 leadwire monitoring the associated V FAIL message can be cleare...

Page 94: ...edside The bed names are temporarily allocated to a particular slot on the CIC Pro center An admitted bed can be moved to another available slot at the CIC Pro When a telemetry patient is discharged from an unlocked patient window an Admit button is displayed in the patient window Telemetry monitoring Telemetry monitoring occurs when patient vital signs data is transmitted by a transmitter to a te...

Page 95: ...CT ALGORITHMS ARRHYTHMIA PROCESSING AND CALCULATIONS BASED ON PATIENT AGE After manually updating or automatically retrieving patient demographic information from a network database always confirm that the entered patient s date of birth matches the patient s actual date of birth Otherwise the appropriate age related algorithms arrhythmia detection and calculations will not be applied A bedside mo...

Page 96: ...itor moves roves from room to room When the monitor moves roves from room to room and is not a transmitter always admit the patient at the monitor NOTE Before you admit a patient at a monitor that moves roves you must complete the following procedure in the order it is presented to ensure the correct bed number is identified at the CIC Pro center 1 Turn off the monitor when you are storing it 2 Ke...

Page 97: ...mes in specific multi patient viewer locations windows These beds are locked into position and are always displayed whether a patient is admitted to them or not To change the display of locked beds contact your biomedical engineering department Admitting a patient This section covers the following tasks Look for an empty patient window displaying an Admit button Enter the patient demographics Ente...

Page 98: ...y patient windows are available Use the following procedures in the order presented to remove displayed patient beds from the multi patient viewer before you can admit a new patient See Removing viewed out of unit patient beds on page 7 6 See Viewing patient beds from another in unit CIC Pro center on page 7 5 See Discharging an admitted patient on page 6 19 c When a Discharged message is displaye...

Page 99: ...ay or as a Quantitative Sentinel QS NOTE When using the patient s last name as your search criteria remember to delete the default patient identification number 999999999 from the Patient ID data field NOTE When using a patient identification number as your search criteria the CIC Pro center cannot successfully search for and match patient identification numbers containing lowercase letters The CI...

Page 100: ...nfirm that the entered patient s date of birth matches the patient s actual date of birth Otherwise the appropriate age related algorithms arrhythmia detection and calculations will not be applied c Verify you selected the correct information by reviewing the displayed demographic information i When this is the correct demographic information go to Enter the bed number on page 6 15 ii When this is...

Page 101: ...s locked only the current bed number is displayed Complete the procedure To automatically enter the patient demographics on page 6 12 or To manually enter the patient demographic information on page 6 14 When the bed is a telemetry bed select the bed name displaying an asterisk e g ICU4 When the bed is a monitor select the bed number identifying the monitor When the bed is a monitor or in Combo mo...

Page 102: ...nt click Cancel to close this window and return to the Admit window Make any necessary corrections to the patient information before trying to re establish the Combo monitoring mode 4 Verify the patient s window located in the multi patient viewer is displaying parameter data and waveforms When the patient s data appears in the patient window the patient is being monitored by the CIC Pro center Wh...

Page 103: ...ient window is not available When the message Change disallowed patient would be unmonitored displays you will not be allowed to move the patient Move a patient to a different bed Complete the following procedure to move an in unit patient to a different bed 1 From the multi patient viewer click on the patient you want to move The single patient viewer displays 2 From the single patient viewer cli...

Page 104: ...atient you want to move click No to cancel this action and display the multi patient viewer Move a telemetry patient to a different transmitter At some time you may need to replace an admitted patient s transmitter with a different transmitter Complete the following procedure to start telemetry monitoring using a replacement transmitter 1 Exchange the transmitters 2 From the Admit window under ECG...

Page 105: ...discharge click Yes This will discharge the patient The CIC Pro center displays a message similar to the following in the patient window Discharging patient and then displays the multi patient viewer In the multi patient viewer the discharged patient window displays one of the following types of information When a telemetry patient is discharged from a locked patient window the message Discharged ...

Page 106: ...36 alarm histories are transferred to the monitor The ECG limits Arrhythmia Alarm Levels and display defaults are recalled from the monitor defaults NOTE It is not likely that the Combo or Rover Combo monitoring modes are used when the patient monitor type is OPERATING ROOM NOTE Users should be aware of a possible time discrepancy between the waveforms from the telemetry device and the waveforms f...

Page 107: ...e monitor s ECG settings if telemetry is not admitted Use the telemetry ECG settings if telemetry IS admitted The following ECG settings are affected when you select an ECG setting source Arrhythmia Alarm Levels HR PVC and ST parameter alarm levels ECG SIZE DETECT PACE ARRHYTHMIA ST ANALYSIS LEAD ANALYSIS HR HIGH LIMIT and HR LOW LIMIT PVC LIMIT and PVC state Beat Pause interval ST Limits For more...

Page 108: ... When discharging from telemetry but remaining admitted to the monitor exiting Combo mode the ECG setting source monitor or telemetry depends on the COMBO DEFAULT SOURCE selection TELE DEFINED When exiting Combo mode the ECG settings return to the monitor s ECG custom defaults USER DEFINED When exiting Combo mode the ECG settings for the current patient persist until the patient is discharged from...

Page 109: ...2001989 200E ApexPro 7 1 7 Viewing real time patient data ...

Page 110: ...urce transmitter every two seconds If differences are detected the display is refreshed with new patient data Multi patient viewer The multi patient viewer displays a snapshot of real time parameter data for a maximum of 16 patients You can do the following real time tasks from the multi patient viewer View abbreviated real time patient data View a snapshot of real time Graphic Trends data for a m...

Page 111: ...Function Auto Display When enabled the Auto Display button is selectable from the menu bar Clicking the Auto Display button while viewing the multi patient viewer automatically completes the following tasks Removes any un locked unoccupied beds Adds at least one empty patient window with an Admit button Resizes the remaining patient windows to maximize the amount of displayed patient data View Oth...

Page 112: ...ol settings Patient Data Display stored patient data See Chapter 8 System Utilities Access web access server data View all ECG Display waveforms for ECG leads I II III V aVR aVL and aVF If a 6 leadwire set is connected Vb waveforms also display Sample Record and store a 10 second sample of a patient s real time ECG data Data samples are stored in Events directory Monitor Parameter numeric data and...

Page 113: ...row of alarm buttons display across the top of the multi patient viewer and show the unit name bed number and the cause of the alarm The color of the alarm button indicates the severity of the patient alarm condition Red indicates a Crisis alarm condition yellow indicates a Warning alarm condition an Advisory alarm condition or a System Warning Another name for this row of alarm buttons is the Ala...

Page 114: ...t bed Complete the following procedure to view networked out of unit patient beds 1 From the multi patient viewer click View Other A list of networked care units floors or hospitals displays 2 Click the sign next to the desired unit floor or hospital to display the list of viewable beds 3 Select the bed you want to view and click OK The single patient viewer displays for this patient 4 To close th...

Page 115: ... Right click on the patient you want to configure and select Configuration The Real time Trend Graph window displays Click on the patient you want to configure The single patient viewer displays From the single patient viewer click Real time View to display the real time window 2 Click Configuration to display the Real time Trend Graph window 3 Ensure that the Display Real time Trend Graph checkbo...

Page 116: ...Trend Graph control settings Option Function Display Real time Trend Graph Display a real time trend window with a maximum of two real time parameter trends To display the Real time Trend Graph click in the empty check box to fill the box with a check mark Display Parameter 1 Display the first real time parameter trend To display one real time parameter trend click in the empty check box to fill t...

Page 117: ...cting the Graph All function Otherwise only the single patient viewer data prints The following conditions apply when using the Graph All function When you press the Graph Stop button on the local digital writer the current patient s graph stops and the writer begins to print a 10 second graph for the next patient When a patient s data is currently graphing or is being saved to graph when a Graph ...

Page 118: ...o the printer Stop printing to a laser printer Complete the following procedure to stop printing all print jobs sent to the laser printer 1 From the multi patient viewer click CIC Setup CIC Defaults The CIC Defaults window displays 2 Under Printer Writer click Cancel Print Jobs for the printer you want to stop printing to 3 After making your selection complete one of the following tasks from the C...

Page 119: ...Device You may view parameter settings for any out of unit patient However you cannot adjust these settings To permanently change the parameter default settings refer to the appropriate CIC Pro center service manual NOTE The Dinamap PRO monitors alarm limits are not configurable at the CIC Pro center but they can be silenced at the CIC Pro center However alarms that are silenced at the CIC Pro cen...

Page 120: ...ern Remove the V Fail message or activate the second V lead when changing between a 5 and 6 leadwire set on the ApexPro CH transmitter NOTE The heart rate value appears briefly as Xs during the relearn process and returns to numerics when the relearn is complete Size Set the waveform size 1X is standard Detect Pace Set the pacemaker detection mode Pace 1 Alternate pacemaker detection mode when Pac...

Page 121: ... only occur with the pace program activated Arrhythmia Set the arrhythmia detection level Full Detect all arrhythmia conditions defined by the software Lethal Detect lethal arrhythmia conditions Off Turn off arrhythmia detection Arrhythmia detection remains off until you choose Full or Lethal or the patient is discharged NOTE OFF appears dimmed and is not selectable when the following option is se...

Page 122: ...cemaker patients under close observation CAUTION FDA POSTMARKET SAFETY ALERT The United States FDA Center for Devices and Radiological Health issued a safety bulletin October 14 1998 This bulletin states that minute ventilation rate adaptive implantable pacemakers can occasionally interact with certain cardiac monitoring and diagnostic equipment causing the pacemakers to pace at their maximum prog...

Page 123: ...to minimize the possibility of counting pacemaker artifact as QRS complexes during ASYSTOLE If the monitor does not adequately detect paced beats in the Pace 2 mode then the user may wish to try the Pace 1 mode When either pace mode is enabled the software places an artificial spike on the waveform whenever the pacemaker triggers When pacemaker detection is on it is indicated by a P in the patient...

Page 124: ...earned whenever Lead Analysis is changed Multi Lead analysis Multi Lead analysis simultaneously examines ECG leads I II III and V whether they are displayed or not to help eliminate false alarms and improve the ability of the system to Detect beats which occur isoelectric to a single chest lead Discriminate artifact that appears in one lead compared to the other lead vectors Provide a smart lead f...

Page 125: ...e selectable at the CIC Pro center However your selection is temporary and will revert back to the transmitter s default displayed lead NOTE When the clinical situation dictates monitoring a lead other than the default lead you can move the leads and or electrodes to view a different lead Be aware that the label on the display and on the printout will show the default lead label Lead Analysis Mult...

Page 126: ...d disabling the Alarm Pause Breakthrough feature also suspend arrhythmia analysis WARNING VENTRICULAR ARRHYTHMIAS The arrhythmia analysis program is intended to detect ventricular arrhythmias It is not designed to detect atrial or supraventricular arrhythmias with the exception of atrial fibrillation Occasionally it may incorrectly identify the presence or absence of an arrhythmia Therefore a phys...

Page 127: ...wing is an alphabetical list of the Arrhythmia messages that are displayed when full arrhythmia is selected and the condition occurs Definitions of each condition are included The CIC Pro center s response to each condition is determined by the alarm level to which the arrhythmia has been assigned ACC VENT Adult Accelerated ventricular occurs when six or more ventricular beats are detected with an...

Page 128: ... control displays a PVC counter in the ECG parameter window When off the PVC counter is not displayed Use the mouse to turn the PVC Limit control On or Off The PVC limits are preset in Alarm Control defaults R ON T Occurs when a ventricular complex is detected within the repolarization period of a non ventricular beat TACHY Tachycardia is four R to R intervals at a heart rate greater than the set ...

Page 129: ...or more ventricular beats is detected with an average heart rate greater than or equal to 160 beats per minute 3 10 years Occurs when a run of six or more ventricular beats is detected with an average heart rate greater than or equal to 140 beats per minute 11 13 years Occurs when a run of six or more ventricular beats is detected with an average heart rate greater than or equal to 130 beats per m...

Page 130: ...he CIC Pro center NOTE AFIB alarms can only be adjusted at the CIC Pro center If AFIB is not available enabled at a bedside monitor in Combo mode you will not be able to immediately adjust the alarm You must discharge the patient from the bedside monitor adjust the alarm setting at the CIC Pro center and then admit the patient at the bedside monitor ST analysis The patient s most dominant normal b...

Page 131: ...version of software this feature is not available Contact your sales service representative for more information ST deviation alarm When any individual ST value is beyond the limit an ST deviation alarm occurs It is considered a parameter alarm and the default alarm level is Warning This can be modified in the parameter alarm level setup When the ST program is turned on or a relearn is done with S...

Page 132: ...oximeter functions as a stand alone device and displays digital values for SpO2 and pulse rate When the Apex oximeter is connected to the transmitter digital values for SpO2 and pulse rate are also displayed at the CIC Pro center NOTE When monitoring SpO2 using an transmitter an SpO2 waveform is neither generated nor displayed on the Apex oximeter or CIC Pro center Additionally no alarm histories ...

Page 133: ...wer displays 2 From the single patient viewer click Monitor Setup 3 Click SPO2 Resp to display the control window NOTE The SpO2 tab is labeled SpO2 Respiration because respiration monitoring settings are available on this tab sheet for bedside monitored patients only Respiration monitoring is not an option for telemetry patients Therefore only SpO2 information appears on this tab sheet when monito...

Page 134: ... allow tape to block the probe light detector WARNING PATIENT SAFETY Prolonged monitoring may require changing the probe site periodically Move the probe if there is any sign of skin irritation or impaired circulation Change the probe site AT LEAST every four hours to prevent ischemic skin necrosis If required reduce the application periods to HALF the times recommended above If a probe is damaged...

Page 135: ...iously applied in your facility for SpO2 monitoring should be used in the event that the SpO2 value from the equipment cannot be validated by the above criteria CAUTION Do not use the Apex or Xpod oximeter on neonatal patients It is not designed for use on neonates Signal and data validity It is extremely important to determine that the probe is attached to the patient correctly and the data is ve...

Page 136: ...d window at the CIC Pro center Oximeter device SPO2 PROBE OFF SPO2 PROBE Dinamap Pro monitors SPO2 NO DATA SPO2 PROBE If any of the listed messages appear check the position of the probe or replace the probe See SpO2 messages on page D 5 If the problem persists call GE Service or contact your sales service representative Pressures The Pressures tab sheet allows you to view and modify settings spec...

Page 137: ...g tasks Non invasive blood pressure control settings Option Function Auto Turn Off automatic NBP measurements When turned On at the monitor NBP measurements are acquired automatically at regular intervals NOTE This option does not apply to telemetry beds and cannot be turned on from the CIC Pro center Cuff Size Set the inflation pressure used during the first NBP measurement and for calculating th...

Page 138: ...essures and mean blood pressures with Dinamap Pro using the auscultatory method When the blood pressure monitor is connected to an transmitter digital values are also displayed at the CIC Pro center Patient preparation Blood pressure cuff selection and application are important Inappropriate selection or improper application of the cuff will result in erroneous measurements Most people use their n...

Page 139: ...se in the following illustration 408A Microphone placement A microphone is used to hear the Korotkoff sounds K sounds that the blood pressure monitor uses to determine the systolic and diastolic pressure readings The microphone can be placed in a microphone pad and adhered to the patient s arm under the blood pressure cuff or alternatively it can be placed directly into the microphone pocket insid...

Page 140: ...side out to expose the microphone pocket 3 Open the Velcro pocket flap and gently insert the microphone into the pocket 4 When the microphone is completely inserted close the Velcro flap over the microphone cable and turn the cuff right side out 5 Replace the bladder and exit the bladder hose and microphone cable out of the same exit site either right arm or left arm as marked on the cuff Safety c...

Page 141: ...number displayed is the last measurement interval set as the default Use the YES button or the NO button on the blood pressure monitor to increase or decrease the interval INT at which the blood pressure readings are taken The available measurement intervals are MAN manual or 5 6 7 8 9 10 15 20 25 30 35 40 45 50 55 60 90 120 or 240 minute intervals When the desired measurement interval is reached ...

Page 142: ...he minimum cuff deflate pressure 5 When the minimum pressure has been set press the NEXT button to select DYNAMIC INFLATE or FIXED INFLATE Press the YES button to turn dynamic inflate on or press the NO button for fixed inflate When dynamic inflate is turned on the blood pressure cuff inflation pressure automatically ranges 30 mmHg above the most recent systolic reading Fixed inflate always inflat...

Page 143: ... as the change delta limit at which the blood pressure monitor will reject a systolic diastolic or pulse pressure reading and attempt a new measurement Contact technical support for more information about setting these limits Software and hardware versions To verify what software and hardware versions your blood pressure monitor has turn on the blood pressure monitor while holding down the LAST bu...

Page 144: ...7 36 ApexPro 2001989 200E Viewing real time patient data ...

Page 145: ...2001989 200E ApexPro 8 1 8 Viewing stored patient data ...

Page 146: ...be available locally at the Solar 9500 monitor Time focus data When parameter data is collected and stored the stored patient data is linked to a specific time focus When viewing an area of interest for one type of patient data e g Vital Signs you can view another type of patient data e g Graphic Trends that was collected and stored at that same time focus As a result when viewing a patient s para...

Page 147: ... with the other data review tools If it is not displayed you can display the directory by clicking Events NOTE To review stored non ECG parameter data use the FD Strip and FD Page data review tools Viewing the Events directory Complete the following procedure to view the Events directory 1 From the multi patient viewer click on the patient you want to view The single patient viewer displays 2 From...

Page 148: ...st The list sorts itself by event category 3 Use the scroll bar to move up or down through the list The quantity of each event category is listed in square brackets next to the event name e g V TACH 2 Identifying the most recent occurring event Complete the following procedure to identify the most recent occurring event 1 From the single patient viewer click Patient Data Events The Events director...

Page 149: ...y event time or by event type 3 Use the scroll bar to move up or down through the list of events and data samples 4 Click the single event or data sample you want to delete or hold down CNTRL and continue to click the left mouse button to select multiple events or data samples 5 Click the delete event button This button is located under the Events directory and has a red colored X on it A window d...

Page 150: ...view of the Full Disclosure function For more information refer to the CIC Pro Clinical Information Center Operator s Manual An admitted patient s parameter waveforms and numeric data is continually collected for a maximum of 72 hours license dependent After the maximum hours of data collection have elapsed the oldest data is deleted to accommodate newer data NOTE The amount of full disclosure dat...

Page 151: ... more information refer to the CIC Pro Clinical Information Center Operator s Manual Viewing or printing a full disclosure strip NOTE Requires a laser printer to print NOTE When viewing the full disclosure strip the arrhythmia label text follows the waveform event and is displayed to the left of the cursor Complete the following procedures to view or print a full disclosure strip Display the full ...

Page 152: ...on changes to Stop Click Stop to stop the scan at any time 5 Print button Print the full disclosure waveform and parameter numeric data displayed in the FD Strip window The print duration of the FD Strip is determined by the in the Strip Duration setting in the Full Disclosure Defaults window 6 Close button Close the FD Strip window 7 View All ECG Display all of the available ECG leads and paramet...

Page 153: ...procedures to view the stored full disclosure waveforms Display the FD Page window 1 From the multi patient viewer click on the patient you want to view The single patient viewer displays 2 From the single patient viewer click Patient Data FD Page The full disclosure page displays NOTE When you select a specific time focus or an alarm event from the Events Event Strip Graphic Trends or Vital Signs...

Page 154: ...t them at a laser printer or a digital writer A patient s parameter numeric data is continually collected for a maximum of 24 hours After the maximum hours of data collection have elapsed the oldest data is deleted to accommodate the newer data FD Page window Item Description 1 Time and date stamp for this row of waveform data 2 Zoom box Click inside the small blue colored zoom box to display an e...

Page 155: ...e same data values those graphic trend waveform areas will overlap each other The overlapping waveform colors will not blend together This is a normal behavior As the trend values change the waveform shape will also change allowing its individual waveform color to become visible NOTE If you position the time cursor inside a visible gap of trended data parameter numerics are displayed Depending upo...

Page 156: ...se to toggle to half screen format 1 Graphic Trends window 2 Graphic trend scales 3 Graphic trend buttons Identify the trended data and the associated parameter numeric values Click on a graphic trend button to change the scale of this graphic trend 4 Range Display the selected time range from 15 minutes to 24 hours 5 Scroll bar Move backward or forward in time 6 Event summary Display a brief over...

Page 157: ...hoose from 15 30 minutes or 1 2 4 8 12 24 hours Adjust the trend scale size Complete the following steps to adjust the scale size of a parameter trend 1 From the Graphic Trends window click on the parameter trend you want to adjust A window displays the parameters scales available for the selected parameter trend 2 Choose the desired scale The window closes and the scale setting is automatically a...

Page 158: ...a digital writer NOTE In order to print to a digital writer a laser printer cannot be connected to the CIC Pro center NOTE When printing graphic trends data from telemetry patients to a digital writer the time duration of the printed output is as follows To print the displayed graphic trends data click print button located in the top right corner of the Graphic Trends window Vital signs data The C...

Page 159: ...t and NBP measurements were taken at 10 10 10 15 and 10 20 then data for all other parameters on the list is only available for the same times NOTE Episodic data is displayed at the closest time interval for the selected time If the time for the measurement occurred before or after the displayed time an ellipses symbol is appended after the episodic value The CIC Pro center also retrieves AFIB tre...

Page 160: ...atients can be printed to a digital writer Complete the following procedure to print periodic and episodic trend data in a tabular format to a laser printer 1 From the single patient viewer click Patient Data Vital Signs The Vital Signs window displays 2 Click the down arrow next to the Vital Signs sort tool and choose the data group you want to display The data sorts itself by your chosen categor...

Page 161: ...waveform from the Calipers window Complete the following procedure to print or view a waveform from the Calipers window 1 From the multi patient viewer click on the patient you want to view The single patient viewer displays 2 From the single patient viewer click Patient Data Then choose the data review tool you want to use to locate a waveform segment or waveform strip you want to measure NOTE Wh...

Page 162: ... amplitude for displayed waveforms and compare the interval of multiple waveform complexes 3 Calculated measurement label Click and drag to reposition 4 Measurement options Measurement Choose one of the following leads to measure I II III V AVR AVL and AVF For telemetry only a second V lead would be available for display Reference Fill the Enable box with a check mark and choose one of the followi...

Page 163: ...e lost when the window is closed Reports The following reports are available for telemetry patients if a laser printer is configured for the CIC Pro center These reports are enabled and configured through Webmin For more information refer to the appropriate CIC Pro center service manual Patient discharge summary report The Patient Discharge Summary report automatically prints to a configured laser...

Page 164: ...ter for transmitter battery status report Print transmitter battery status report Once the report has been configured perform the following steps to print on demand 1 Click on the Browser button on the CIC Pro center display 2 Select the Battery Status Report from the favorites window in the lower right hand corner of the screen NOTE The favorite may be named different depending on how the system ...

Page 165: ...Viewing stored patient data 2001989 200E ApexPro 8 21 Item Description 1 Favorites link 2 Transmitter Battery Status Report 3 Print icon ...

Page 166: ...8 22 ApexPro 2001989 200E Viewing stored patient data ...

Page 167: ...2001989 200E ApexPro 9 1 9 Printing ...

Page 168: ...nter or patient monitor Telemetry bed parameter data The following table identifies the telemetry bed parameter data available to print from a CIC Pro center or GE patient monitor Graph location The Graph Setup for an individual patient determines where the data prints out graph location Other operating conditions may exist that affect the graph location Telemetry bed parameter data Data printed f...

Page 169: ... at the CIC Pro center where the patient was first admitted No graph location for a telemetry patient When no graph location is defined for a telemetry patient at the time of admission the message Saving displays Graphs are not sent to printers outside the unit Printing real time data In addition to patient alarm graphs printing automatically you can print a continuous strip for a single patient o...

Page 170: ...ndard ECG waveform graph at the CIC Pro center The IMPACT wf page is labeled Sample when this data is displayed on the IMPACT wf receiver and stored in history Additionally all pagers assigned to the patient receive a page Automatic alarm graphs When configured a graph prints automatically when a patient experiences a Crisis or Warning alarm condition Arrhythmia alarm graphs run until the end of t...

Page 171: ...ll Patients request is initiated this patient s data will not be included in the Graph All Patients graph This patient s data will print independently of the Graph All Patients graph Clicking on the ECG parameter window for a patient whose data is saving will cancel the Graph All Patients request for that patient If while a Graph All Patients request is in progress an arrhythmia alarm occurs for a...

Page 172: ...efaults window Click Apply to apply your changes without closing the CIC Defaults window Stop printing to a local digital writer Complete the following procedure to stop printing all print jobs sent to a local digital writer 1 Locate the digital writer 2 Press the Graph Stop button located on the front of the digital writer to stop the print job Adjusting print control settings To temporarily adju...

Page 173: ...s ECG 1 Set the lead and its associated waveform to print first Waveform 2 Set the ECG lead or parameter and its associated waveform to print second Waveform 3 Set the ECG lead or parameter and its associated waveform to print third Waveform 4 Set the ECG lead or parameter and its associated waveform to print fourth Graph Location Choose from available printers to set the graph location of the man...

Page 174: ...on in the Telemetry Unit Defaults tab sheet to set it for all patients admitted to the CIC Pro center NOTE You must be in service mode to change the telemetry unit defaults Graph paper out indicator When there is no graph paper in the writer or the door is open the message Graph Paper Out Door Open is displayed at the top of the screen When printing to a laser printer a similar status message is d...

Page 175: ...2001989 200E ApexPro A 1 A Abbreviations and symbols ...

Page 176: ...ndex AD adult ADU alarm display unit AFIB atrial fibrillation ALRM alarm AMI acute myocardial infarctions ANT anterior Arr Arrhy arrhythmia ART arterial Auto automatic Aux auxiliary A V arterial venous AVG average AVOA automatic view on alarm B BIS bispectral index BP blood pressure Brady bradycardia BT blood temperature C C celsius Cal calibrate Calc calcs calculation s cc cubic centimeter CC com...

Page 177: ...ssociation CVP central venous pressure D D diastolic DES desflurane DIDCA direct interface device connection adapter DSC digital signal converter E E expired e g for example ECG electrocardiograph eDO2I estimated delivered oxygen index EEG electroencephalograph EMC electromagnetic compatibility EMI electromagnetic interference ENF enflurane ESU electrosurgical cautery unit et al and others ET CO2 ...

Page 178: ...alloon pump ICG impedance cardiography ICP intracranial pressure ICU intensive care unit ID identification in inches INDV individual INF infusion inferior Inject injectate INSP inspired INT interior ISO isoflurane IT injectate temperature IV intravenous J J ST measurement point K kg kilogram L L LD lead L left l liter LA left arm LA left arterial LAN local area network ...

Page 179: ...veolar concentration MAP mean arterial pressure Min minimum mm millimeters mmHg millimeters of mercury MPSO multiple portable socket outlet MRI magnetic resonance image ms milliseconds mV millivolt N N A not applicable N2O nitrous oxide NBP NIBP non invasive blood pressure Neo neonatal O O2 oxygen O2CI oxygen consumption index OR operating room P P pace PA pulmonary artery PAD pulmonary artery dia...

Page 180: ...R R right R rate R TTE Radio and Telecommunication Terminal Equipment RA right arm RA right artial REF reference Reprep re prepare RES resistance Resp respiration RF radio frequency RHY rhythm RL right leg RR respiration rate S S systolic sec second SEV sevoflurane SIM simulator Sol solution SP special SpO2 arterial oxygen saturation pulse oximetry SQI signal quality index ST interval of ventricul...

Page 181: ...achycardia TC transcutaneous Tech technical Temp TMP TP temperature TFC thoracic fluid content TIR technical information report U UAC umbilical artery catheter UO urometer UVC umbilical venous catheter V V volt V version V ventrical lead Vent ventilator VFib ventricular fibrillation VI velocity index VOA view on alarm Vol volume VTach ventricular tachycardia W WF WFS waveform s X X multiplier 2X X...

Page 182: ...A 8 ApexPro 2001989 200E Abbreviations and symbols Symbols and degree s greater than less than minus number percent plus or minus inches µ micro ...

Page 183: ...2001989 200E ApexPro B 1 B Customized defaults worksheet ...

Page 184: ...arm levels on page B 3 Alarms Off selection This telemetry setting is located in CIC Setup CIC Defaults Telemetry Unit Defaults Allow Alarms Off On this CIC Circle one Yes No Telemetry unit default Default setting Graph Setup Default Locations for this CIC Manual Alarm Print Window Waveforms ECG 1 II Waveform 2 V Waveform 3 Off Waveform 4 Off Transmitter Graph On Alarm Graph Always On Event Marker...

Page 185: ... 0 2 0 Warning V Brady Crisis ST V2 mm 2 0 2 0 Warning Acc Vent Advisory ST V3 mm 2 0 2 0 Warning Pause Advisory ST V4 mm 2 0 2 0 Warning Tachy Advisory ST V5 mm 2 0 2 0 Warning Brady Advisory ST V6 mm 2 0 2 0 Warning R on T Message ST AVR mm 2 0 2 0 Warning Couplet Message ST AVL mm 2 0 2 0 Warning Bigeminy Message ST AVF mm 2 0 2 0 Warning Trigeminy Message NBP S mmHg 80 200 Warning PVC Message ...

Page 186: ...B 4 ApexPro 2001989 200E Customized defaults worksheet ...

Page 187: ...2001989 200E ApexPro C 1 C Maintenance ...

Page 188: ...CAUTION Failure on the part of the responsible hospital or institution employing the use of this monitoring equipment to implement a satisfactory maintenance schedule may cause undue equipment failure and possible health hazards Check with your biomedical department to be sure preventive maintenance and calibration is complete Qualified service personnel should repair or replace damaged equipment ...

Page 189: ...n to disinfect or sterilize must be made per your institution s requirements with an awareness of the effect on the integrity of the transmitter and leadwire WARNING Disconnect AC powered equipment from the power line before cleaning or disinfecting its surface Turn off the power to battery powered equipment before cleaning or disinfecting its surface WARNING CONTAMINATED LEADWIRES Contaminated le...

Page 190: ...ride solutions Abrasive cleaners or solvents of any kind Acetone Ketone Betadine Alcohol based cleaning agents Sodium salts CAUTION Never autoclave or steam clean devices cables or leadwires CAUTION Do not attach the device to a patient until it is thoroughly dry Results of improper cleaning Appearance of waveforms when the device is not connected to a patient causing false alarms instead of a Lea...

Page 191: ...t lint free cloth using the following solution as recommended in the APIC Guidelines for Selection and Use of Disinfectants 1996 Sodium hypochlorite 5 2 household bleach minimum 1 500 dilution minimum 100 ppm free chlorine and maximum 1 10 dilution Any sodium hypochlorite wipe product that meets the above guidelines of can be used NOTE Wring excess disinfectant from wipe before using NOTE Any cont...

Page 192: ...the connector ends Metal connections can be pulled away from the connectors 3 For general cleaning of cables and leadwires wipe using a lightly moistened cloth with a mild soap and water solution Then wipe and air dry 4 For disinfecting the cables and leadwires wipe exterior with a soft lint free cloth using the following solution as recommended in the APIC Guidelines for Selection and Use of Disi...

Page 193: ...ot use excessive drying techniques such as oven forced heat or sun drying Sterilizing NOTE EtO sterilization is not recommended but may be required for cables and leadwires Frequent sterilization will reduce the useful life of cables and leadwires Sterilize with ethylene oxide gas EtO at a maximum temperature of 50 C 122 F After EtO sterilization follow the recommendations from the sterilizer manu...

Page 194: ...C 8 ApexPro 2001989 200E Maintenance ...

Page 195: ...2001989 200E ApexPro D 1 D Troubleshooting ...

Page 196: ...k on the patient s ECG tab 2 Click on the Relearn button IF PROBLEM CONTINUES Change to Single Lead ECG detection and processing 1 Click on the patient s ECG tab 2 Click on Single Lead in the Lead Analysis section 3 Click on the ECG leads in the Display section and change top ECG waveform to display the lead with the greatest amplitude At least 0 5 mV amplitude is required for QRS detection Proble...

Page 197: ... by uniform upright pacemaker enhancement spikes in the ECG data both displayed and graphed NOTE To improve pacemaker detection reposition the electrodes and ensure a good skin preparation to maximize R wave detection Perform a relearn any time lead positions are changed For more information refer to Electrode placement on page 6 2 During telemetry monitoring the pacemaker signal is acquired from ...

Page 198: ... connector ports The inside port labeled 2 on the dust cover is for use with continuous monitoring serial devices such as SpO2 The outside port labeled 1 on the dust cover is for use with episodic monitoring serial devices such as NBP Problem Inaccurate pacemaker detection Solution Use pacemaker processing 1 Click on the patient s ECG tab 2 In the Detect Pace section select either Pace 1 or Pace 2...

Page 199: ...lem ST numerics changed to Xs Solution An ST value changes to Xs when the patient s dominant morphology has not been detected 16 times in the last 30 seconds The program waits one minute and then automatically relearns ST numerics will be displayed after the relearn IF PROBLEM CONTINUES 1 Check for morphology change 2 Check for noise on ECG 3 Relearn a Click on the patient s ECG tab b Click on the...

Page 200: ... TELEM The NO TELEM alarm occurs in two situations 1 The patient moves out of range If the transmitter is out of range for more than 30 seconds the NO TELEM message displays Should a LEADS FAIL condition occur prior to a NO TELEM condition the LEADS FAIL condition takes priority The LEADS FAIL message is displayed along with the NO TELEM message 2 Transmitter batteries are extremely low or dead If...

Page 201: ... centimeters around the arm Refer to the NBP cuffs for proper fitting size 2 Check for residual air left in the cuff from a previous measurement This could indicate a hardware problem that may require service 3 Make sure the cuff is not too tight or too loose 4 Make sure the cuff and the heart are at the same level otherwise hydrostatic pressure will offset the NBP value 5 Watch for pulsus paradox...

Page 202: ...g the measurement Check the patient and try another measurement SENSOR This message appears when the K sounds on the measurement were too weak or not enough sounds were detected Reposition the microphone and try another measurement This message can also appear if the deflate rate is not properly adjusted If the problem persists contact your local sales service representative WEAK PULSE The patient...

Page 203: ...O TELEM message displays Should a LEADS FAIL condition occur prior to a NO TELEM condition the LEADS FAIL condition takes priority The LEADS FAIL message is displayed along with the NO TELEM message 2 Transmitter batteries are extremely low or dead If batteries are extremely low or completely dead the NO TELEM message appears a CHANGE BATTERY message appears in the patient s bed window and the aud...

Page 204: ...are low There is approximately 1 hour of use left after this message appears If the batteries are extremely low or completely dead a NO TELEM message flashes and an audible alarm sounds LEADS FAIL All leads have failed right leg lead failed right arm lead failed leadwires unplugged or reference lead failed If set to System Warning or System Advisory level a system alarm occurs This will self silen...

Page 205: ...xists Restart the system If this condition persists contact GE Technical Support Unit Bed IS UNMONITORED A telemetry patient is admitted but is not displayed and therefore is unmonitored on any CIC Pro center If an alarm occurs on an unmonitored bed the information will appear in the alarm text line and an audible tone will sound You must view the patient first if you would like to silence the ala...

Page 206: ...D 12 ApexPro 2001989 200E Troubleshooting ...

Page 207: ...2001989 200E ApexPro E 1 E Technical specifications ...

Page 208: ...y type ANSI NEDA 15 A 1 5V AA alkaline 2 required Battery life ApexPro 40 hours ApexPro CH 120 hours typical without accessories Polarity Electronic reverse polarity protection Battery integrity Transmitted and indicated via LED Leads Fail indication Transmitted and indicated via LED Channel spacing 25 kHz Frequency stability 0 0001 of assigned channel frequency Bit rate 10 kbps Antenna Formed by ...

Page 209: ... CH IEC 60529 IPX7 rating can survive inadvertent submersion Input configuration 3 5 or 6 electrodes Frequency range ApexPro 420 to 460 MHz or 584 to 613 975 MHz programmable synthesizer The frequency range depends on the PCB installed ApexPro CH 608 025 613 975 MHz Modulation ApexPro GMSK ApexPro CH GFSK Serial I O ports 2 Alarm pause Transmitted and indicated via LED Graph request Transmitted Ev...

Page 210: ...he Medical Devices Directive 93 42 EEC 608 025 to 613 975 MHz FCC Part 95 ApexPro CH ECG gain accuracy 5 15 Hz Common mode rejection 100 dB minimum 60 Hz Defibrillator protection 5000 VDC 360 joules into 100 ohm Defibrillator recovery time Defibrillator recovery time recovers within 5 seconds Pacemaker detection ApexPro 2 mV to 700 mV RTI 100 µsec to 2 msec either polarity ApexPro CH 2 mV to 700 m...

Page 211: ...this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service Video output 1024 X 768 75 Hz Power supply 300 watt ATX dual redundant Temperature 10 to 35 C 50 to 95 F Relative humidity 15 to 80 non condensing Altitude 0 to 3048m 0 to 10000 ft Acoustic noise Less than 52 dB sound pressure at 5 to 28 C 41 to 82 F Temperat...

Page 212: ...rnational Frequency step resolution Synthesized tuning to any transmitter 25 kHz spacing Receiver system capacity 1 to 4 quad receiver modules 4 to 16 receivers Frequency stability 0 0003 3 PPM of assigned channel frequency Bit rate 10 kbps Sensitivity 8 7 µV 90 dB minimum for 1 bit error million bits received Physical IEEE 802 3 compatible physical connector via 10 base T Serial protocol 19200 ba...

Page 213: ...res the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service Certifications UL IEC EN 60601 1 CAN CSA C22 2 No 601 1 IEC EN 60601 1 2 IEC EN 60601 1 4 CE marked to the Medical Device Directive 93 42 EEC Temperature 5 to 40 C Relative humidity 15 to 90 non condensing Temperature 20 to 50 C Relative humidity 15 to 90 non condensing Pressure...

Page 214: ...E 8 ApexPro 2001989 200E Technical specifications ...

Page 215: ...6 19 display primary 4 3 secondary 4 3 E ECG calipers 8 17 control settings 7 11 electrode placement 6 3 3 leadwire 6 5 5 leadwire 6 4 6 leadwire 6 3 pediatric patients 6 6 measurements 8 17 setting source 6 21 signal 6 6 skin preparation 6 2 troubleshooting arrhythmia D 2 pacemaker D 3 ST D 5 electrode placement 6 3 events directory 8 2 F FCC compliance 1 18 RF exposure 1 18 full disclosure 8 7 G...

Page 216: ... data 9 3 telemetry data 9 2 transmitter graph 9 7 R R TTE CE 1 real time data 7 2 real time trend window 7 6 reference lead 8 18 S secondary display 4 3 single patient viewer 7 3 SpO2 7 24 control settings 7 25 messages D 6 signal 7 27 ST analysis 7 22 ST troubleshooting D 5 stored data 8 2 T transmitter graph 9 7 transmitters 2 2 battery 3 3 buttons LEDs 3 2 electrodes 3 5 leadwires 3 5 V vital ...

Page 217: ......

Page 218: ...3 5 D 79111 Freiburg Germany Tel 49 761 45 43 0 Fax 49 761 45 43 233 Asia Headquarters GE Medical Systems Information Technologies Asia GE China Co Ltd 24th Floor Shanghai MAXDO Center 8 Xing Yi Road Hong Qiao Development Zone Shanghai 200336 P R China Tel 86 21 5257 4650 Fax 86 21 5208 2008 GE Medical Systems Information Technologies a General Electric Company going to market as GE Healthcare www...

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