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EEG and auditory evoked potentials

GENERAL montage

1.

Ground

Montage

Settings

Electrodes

1. Fp1 — T3

2. Fp2 — T4

3. C3 — 01

4. C4 — 02

Ground

Four channels, bipolar

Nine cup electrodes

Checking the EEG measurement

1.

Check that the EEG waveforms are displayed after you have completed patient
connections.

2.

Perform impedance check to ensure proper electrode contact. When the leads
are disconnected, the message

Leads off

is displayed.

3.

Always check the electrode quality.

EEG measurement on the monitor screen

In addition to the numeric parameters and the CSA (Compressed Spectral Array), you
can also see the graphic presentation of EEG in the parameter window. This is a useful
tool as it gives you a graphic presentation of the EEG numeric parameters.

1. EEG channel (numbers 1 to 4), for example Fp1–T3.

2. Blue vertical line represents the parameter selected for

Numeric 2

(e.g., amplitude measured in μV).

3. Red horizontal line represents the parameter selected for

Numeric 1

(e.g., SEF measured in Hz.

4. Black line ends touching the red and blue lines represent

the channel-specific parameters for

Numeric 1

and

Numeric 2

(for instance, SEF and amplitude).

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CARESCAPE Modular Monitors

2062971-001

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Summary of Contents for CARESCAPE

Page 1: ...GE Healthcare CARESCAPE Modular Monitors User s Manual Software version 2 CARESCAPE Modular Monitors English 2062978 001 DVD 2068394 008 paper 2012 General Electric Company All rights reserved ...

Page 2: ...uing product innovation specifications in this manual are subject to change without notice For technical documentation purposes the abbreviation GE is used for the legal entity names GE Medical Systems Information Technologies Inc and GE Healthcare Finland Oy 2 CARESCAPE Modular Monitors 2062971 001 18 December 2012 ...

Page 3: ...1 Trademarks 42 Third party trademarks 42 Manufacturer responsibility 42 2 Safety 43 Safety message signal words 43 System safety 43 System warning safety messages 43 Accessories warnings 43 Cables warnings 44 Defibrillation warnings 44 Electrical warnings 44 Equipment warnings 45 Site requirement warnings 46 System caution safety messages 46 Loss of data 46 Electrical caution 46 Site requirement ...

Page 4: ...m caution 54 B850 system components 55 B850 processing unit front view 56 B850 processing unit back view 56 B850 module frames F7 and F5 57 B850 Tram Rac frames 2A and 4A 58 B650 system components 58 B650 monitor front panel 59 B650 monitor side views 60 B650 monitor back panel 60 B650 pivoting module frame 61 B450 system components 62 B450 monitor front panel 64 B450 monitor side views 64 B450 mo...

Page 5: ...79 CARESCAPE Central Station 79 iCentral 80 Remote alarm box nurse call 80 iPanel software application 81 Equipment symbols 81 User interface symbols 89 4 Monitoring basics 93 Module compatibility limitations 93 Identical modules 93 Connecting and removing modules B850 94 Connecting a PDM or PSM to a frame 94 Removing a PDM or PSM from a frame 94 Connecting other E modules than the PSM to a frame ...

Page 6: ... a touchscreen 103 Selecting menu options with the Trim Knob control 103 Selecting menu options with a mouse 103 Data field entries 103 Entering data with the on screen keyboard 103 Entering data with a keyboard 103 Putting the monitor into operation 104 Operation warnings 104 Operation caution 104 Monitor installation points to note 104 Turning on the monitor 105 Performance check 105 Message abo...

Page 7: ...ings 111 Color selections 112 Parameter configurations 112 Setting up printing options 112 Checking the PDM battery status 113 Checking the monitor battery status 113 Setting the touchscreen off 113 B850 with several screens 113 Other setup changes 113 6 Starting and ending monitoring 115 Monitor and module compatibility 115 Software packages and terminology 115 About the user default settings 115...

Page 8: ...124 About case reset patient discharge 125 Pending software or setting activation 125 Residual physiological data 125 Resetting a case discharging a patient 125 Resetting a case discharging a patient in combination monitoring mode 126 7 Alarms 127 Alarm warnings 127 Alarm cautions 129 Alarm overview 129 Alarm types 129 Alarm conditions 129 Alarm priority levels 130 Alarm priority escalation 130 Ph...

Page 9: ...rd limits 140 Setting arrhythmia alarms 141 Selecting parameter alarm priority levels 141 Setting alarm limits automatically 142 Default auto alarm limits 143 Returning the default alarm limits 143 Turning off all local alarm indicators sleep mode 144 Remote management of alarms 144 Alarm settings after a power loss 144 Alarm data stored in Clinical logs 145 Stored alarm data during a power cycle ...

Page 10: ...dwires 158 Deactivating the ECG leads off alarm 158 Selecting the beat source 158 Setting the beat volume 158 Setting the beep tone during bradycardia and HR low alarms 159 Variable beat tone 159 Aspect ratio and different display sizes 159 Selecting the ECG waveform size 159 Selecting the hemodynamic waveform sweep speed 160 Printing all ECG waveforms 160 Selecting the ECG waveform filter 160 Set...

Page 11: ...L ACS 168 Entering the Location ID for 12SL 168 Setting automatic 12 lead ECG analysis measurements 169 Setting the 12 lead ECG analysis display format 169 Generating a 12 lead ECG analysis report during an ST alarm condition 169 Performing a 12 lead ECG analysis 169 A 12 lead report and the MUSE database 170 Sending a 12 lead ECG report to the MUSE database 170 Viewing or printing saved 12 lead E...

Page 12: ...window 183 Changing the displayed ST leads 183 Adjusting the ST point manually 183 Adjusting the isoelectric measurement ISO point 184 Adjusting the J point 184 About the realtime QRS ST complexes 184 About the reference QRS 185 Saving a reference QRS manually 185 Automatic saving of reference QRS complexes 185 Selecting a saved reference QRS complex for display 185 Erasing a reference QRS 185 Pri...

Page 13: ...measurement checks 196 Respiration measurement on the monitor screen 196 Using the respiration measurement 196 Turning on the respiration measurement 196 Selecting the respiration lead 196 Selecting the respiration waveform size manually 196 Selecting the respiration waveform size automatically 196 Selecting the waveform speed 197 Selecting the waveform sensitivity 197 Relearning the respiration p...

Page 14: ...pO measurement setup 207 SpO2 equipment to patient connection 207 Preparing the SpO2 connection 207 Checking the SpO2 measurement 207 Using the SpO measurement 208 Primary and secondary SpO2 measurement sources 208 Changing the SpO2 waveform size 208 Changing the SpO2 waveform scale 209 Selecting the SpO2 hemodynamic sweep speed 209 Selecting the SpO2 as the primary heart rate source 209 Showing t...

Page 15: ... safety precautions 219 NIBP warnings 219 NIBP cautions 220 NIBP measurement limitations 221 NIBP points to note 221 NIBP measurement setup 222 NIBP equipment to patient connection 222 NIBP module keys 222 Preparing the NIBP patient connection 222 Checking the NIBP measurement 222 NIBP measurement on screen 223 Manual NIBP measurements 223 Starting or stopping a single NIBP measurement from the ma...

Page 16: ...measurement description 228 NIBP measurement technologies 229 TRAM modules NIBP technology 230 PDM modules NIBP technology 231 PSM modules NIBP technology 231 NIBP calibration 232 NIBP troubleshooting 233 12 Invasive pressures 235 Invasive pressures compatibility limitations 235 Invasive pressure safety precautions 235 Invasive pressure warnings 235 Invasive pressure measurement limitations 235 In...

Page 17: ...s the primary heart rate source 241 Variable beat tone 242 Selecting the ventilation mode 242 Showing the pulse rate in the invasive pressure parameter window 242 Showing the CPP value in the ICP parameter window 242 Selecting Smart BP 243 Compensating for intra aortic balloon pump IABP waveform irregularities 243 Selecting the invasive pressure response time 243 Using the IP channel standby 244 U...

Page 18: ...55 Temperature warnings 255 Temperature measurement limitations 255 Temperature points to note 255 Temperature measurement setup 256 Temperature equipment to patient connection 256 Preparing the patient for temperature measurement 256 Checking the temperature measurement 257 Temperature measurement on the monitor screen 257 Using the temperature measurement 257 Temperature mappings 257 Starting th...

Page 19: ...a C O measurement 266 C O catheter selections 266 Selecting the C O injectate probe type 267 Setting a C O right ventricular ejection fraction REF measurement 267 Selecting the C O scale 268 Selecting what to show with C O 268 Setting the Tblood alarm 268 Adjusting the SvO2 from the cardiac output menu 268 Editing calculations 268 Adjusting the wedge from the cardiac output menu 269 Stopping the c...

Page 20: ...ases safety precautions 281 Airway gases warnings 281 Airway gases cautions 283 Airway gases measurement limitations 283 Airway gases points to note 283 Airway gases measurement setup 284 Airway gases equipment to patient connections with CARESCAPE respiratory modules 284 Airway gases equipment to patient connections with compact airway modules anesthesia setup 285 Airway gases equipment to patien...

Page 21: ...ting the O2 scale 294 Selecting the O2 sweep speed 294 Setting O2 alarms 294 Using the CARESCAPE respiratory modules and compact airway modules for AA and N O measurement 294 Selecting the agent scale 294 Selecting the agent sweep speed 294 Setting agent limit alarms 295 Gases alarm priorities 295 Preventing operating room pollution 295 Scavenging through the ventilator reservoir 295 Scavenging th...

Page 22: ...s and compact airway modules 303 Airway gases practicalities 303 Ventilation management 303 Prevention of the breathing system contamination 304 How to prevent effects of humidity 304 Oxygen delivery CARESCAPE respiratory modules and compact airway modules 304 Level of anesthesia E sCAiO E sCAiOV E CAiO E CAiOV E CAiOVX 305 Airway gases troubleshooting 305 17 CO2 with CAPNOSTAT Mainstream CapnoFle...

Page 23: ...arms deactivation with the pause audio key 316 Selecting CO2 average 316 Selecting the FiO2 level 316 Selecting the N2O level 316 Selecting the pump on or off 316 Selecting apnea alarm limit 317 Preventing operating room pollution with CAPNOSTAT Mainstream Dual CO2 and CapnoFlex LF modules 317 Scavenging to scavenging systems 317 Stopping the CO2 measurement 317 Basics of CO measurement 317 Normal...

Page 24: ...ling type 326 Selecting the Patient Spirometry scaling speed 326 Selecting the Patient Spirometry scales 326 Selecting the Patient Spirometry sweep speeds 326 Selecting the displayed Patient Spirometry volume type 326 Changing the Patient Spirometry loop type 327 Saving Patient Spirometry reference loops 327 Selecting a Patient Spirometry reference loop 327 Erasing a Patient Spirometry reference l...

Page 25: ...Stopping the gas exchange measurement 343 Gas exchange measurement basics 343 Gas exchange measurement description 343 How to interpret the gas exchange values 343 Gas exchange practicalities 346 Gas exchange troubleshooting 347 20 Entropy 349 Entropy compatibility 349 Entropy safety precautions 349 Entropy warnings 349 Entropy cautions 350 Entropy indications for use 350 Entropy measurement limit...

Page 26: ...rpret the Entropy values 355 Relation of Entropy values to EEG and patient status 356 Entropy range guidelines 357 Burst suppression ratio BSR 357 Entropy practicalities 357 Entropy troubleshooting 358 Entropy reference studies 359 Entropy reference studies supporting reduction of drugs 359 Entropy reference studies supporting titration of drugs 359 Reference studies regarding pediatric use of Ent...

Page 27: ...ting the NMT measurement in OR after induction 367 Stopping the NMT measurement 367 NMT alternative uses 367 Local nerve and plexus localization 367 NMT measurement basics 368 NMT measurement description 368 How to interpret the NMT values 369 NMT practicalities 370 NMT troubleshooting 370 22 EEG and auditory evoked potentials 373 EEG compatibility 373 EEG safety precautions 373 EEG warnings 373 E...

Page 28: ...d 379 Selecting EEG numeric parameters 379 Selecting the SEF 380 Selecting the EEG frequency scale 380 Selecting the EEG impedance cycle time 380 Selecting the CSA view 380 Selecting the time scale for CSA 380 Selecting the EEG numerical view 380 Checking EEG electrodes 381 Defining an EEG montage 381 Printing EEG 381 Stopping the EEG measurement 381 EEG practicalities 382 EEG measurement descript...

Page 29: ...ng the AEP filter 389 Selecting the AEP cycle 389 Selecting the AEP size 389 Saving AEP responses 390 Selecting a reference AEP 390 Erasing an AEP reference 390 Printing an AEP report 390 Stopping the AEP measurement 390 AEP practicalities 391 AEP measurement description 391 Main peak categories AEP 391 Examples of typical AEP patterns 391 AEP troubleshooting 392 23 Bispectral index 393 BIS compat...

Page 30: ...he BIS values 399 BIS troubleshooting 399 24 Laboratory data 401 About laboratory values 401 Viewing laboratory data 401 Selecting the blood sample site for laboratory values 401 Selecting the blood sample time for laboratory values 402 Temperature correction 402 Entering or loading laboratory values 402 Printing laboratory values 403 25 Calculations 405 About calculations 405 Viewing calculation ...

Page 31: ...Calculating drug titrations 414 Printing the titration table 414 Resuscitation medications 415 Calculating resuscitation medication doses 415 Printing resuscitation medication doses 415 27 Trends 417 Monitor and module compatibility 417 Trend views 417 Graphic trends 417 Viewing graphic trends 417 Graphic trend symbols 418 Changing the time scale of graphic trends 418 Changing the graphic trend sc...

Page 32: ... Description of snapshots 425 Snapshot configuration 425 Manually created snapshots 425 Creating automatic snapshots 425 Viewing snapshots 426 Changing the snapshot time scale 426 Changing snapshot trend scales 427 Printing snapshot pages 427 Selecting snapshots to print automatically 427 Selecting spirometry loops to print with snapshots 427 Erasing snapshots and trends 427 Snapshots and alarm hi...

Page 33: ...ms 436 Printing waveforms for an arrhythmia alarm 436 Printing waveforms for other than arrhythmia alarms 437 Setting the print delay 437 Setting the print duration 437 Setting the print speed 438 Selecting waveforms to print 438 Printing from the main display 438 Printing from the waveforms window 438 Stopping the waveform printing 438 Printing trends 439 Configuration of numeric trends for print...

Page 34: ...other monitored patients 443 Automatic view of remote beds in alarm 444 Selecting the alarm notification type 444 Selecting the notifying alarm priority level 444 Changing the settings for multiple beds 445 Next alarming remote bed to screen 445 Viewing remote patient beds 445 Audio pause for a remote patient bed alarms 446 Manual printing of remote bed waveforms 446 31 Interfacing with peripheral...

Page 35: ... a year checks 455 Regular calibration checks 455 Cleaning and care points to note 456 Permitted detergents 456 Permitted disinfectants 456 Cleaning and care instructions 456 Setting the touchscreen off for cleaning 456 Cleaning non applied parts general instructions 456 Barcode reader cleaning instructions 457 Keyboard and mouse cleaning instructions 457 Cleaning applied parts general instruction...

Page 36: ...sages related to SvO2 measurement 485 Messages related to gases measurement 488 Messages related to spirometry measurement 493 Messages related to gas exchange measurement 495 Messages related to Entropy measurement 496 Messages related to NMT measurement 498 Messages related to EEG and AEP measurements 500 Messages related to BIS measurement 501 Messages related to TC measurement 503 Messages rel...

Page 37: ...37 Temperature 538 Cardiac output 538 Mixed venous oxygen saturation SvO2 539 Airway gases 539 CO2 with CAPNOSTAT Mainstream CapnoFlex LF and Dual CO2 modules 540 Patient Spirometry 541 Gas exchange 541 Entropy 542 Neuromuscular transmission 543 EEG and AEP 543 BIS 544 2062971 001 CARESCAPE Modular Monitors 37 ...

Page 38: ...38 CARESCAPE Modular Monitors 2062971 001 ...

Page 39: ...ce of this manual This manual is intended for clinical professionals Clinical professionals are expected to have a working knowledge of medical procedures practices and terminology required to provide patient care Using the device should never replace nor impede the human intervention and required patient care provided by clinical professionals Training requirements No product specific training is...

Page 40: ...ing monitor specific issues the monitors are referred to as B850 B650 and B450 respectively Where possible the following icons are also used to help identify the monitor Icon Explanation All Bx50 monitors B850 B650 B450 B850 and B650 only B650 and B450 only B850 and B450 only B850 only B650 only B450 only Acquisition module naming conventions In this manual the following naming conventions are use...

Page 41: ...all system settings features configurations or displayed data Names of persons institutions and places and related information are fictitious any similarity to actual persons entities or places is purely coincidental Related documents CARESCAPE Modular Monitors Supplemental Information Manual CARESCAPE Monitor B850 Technical Manual CARESCAPE Monitor B650 Technical Manual CARESCAPE Monitor B450 Tec...

Page 42: ...of Datex Ohmeda Inc Third party trademarks NELLCOR is a trademark of Covidien AG Covidien is a trademark of Covidien AG Masimo SET is a trademark of Masimo Corporation Manufacturer responsibility GE is responsible for the effects on safety reliability and performance of the equipment only if Assembly operations extensions readjustments modifications servicing or repairs are carried out by authoriz...

Page 43: ...warning safety messages The following warning safety messages apply to this monitoring system Accessories warnings WARNING Single use products are not designed to be reused Reuse may cause a risk of cross 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 a...

Page 44: ...ltages To ensure proper defibrillator protection use only the recommended cables and leadwires Electrical warnings WARNING POWER SUPPLY The device must be connected to a properly installed power outlet with protective earth contacts only If the integrity of the protective earth conductor is in doubt disconnect the monitor from the power line and use it with the battery option B650 if available If ...

Page 45: ... kept at hand WARNING If liquid has accidentally entered the system or its parts disconnect the power cord from the power supply and have the equipment serviced by authorized service personnel WARNING DISCONNECTION FROM MAINS When disconnecting the device from the power line remove the plug from the wall outlet first Then you may disconnect the power cord from the device If you do not observe this...

Page 46: ...fy equipment compatibility System caution safety messages The following caution safety messages apply to this monitoring system Loss of data CAUTION LOSS OF DATA Should the monitor at any time temporarily lose patient data the potential exists that active monitoring is not being done Close patient observation or alternate monitoring devices should be used until monitor function is restored If the ...

Page 47: ...601 1 2005 edition This symbol is identified by a white background black triangular band and a black symbol ATTENTION Consult accompanying documents IEC 60601 1 1988 edition This symbol is identified by a white background black triangular band and a black exclamation mark Follow instructions for use This symbol is identified by a blue background and a white symbol Consult operating instructions Op...

Page 48: ... not pull on the cable Indications for use B850 indications for use The CARESCAPE Monitor B850 is a multi parameter high acuity patient monitor intended for use in multiple areas within a professional healthcare facility The CARESCAPE Monitor B850 is intended for use on adult pediatric and neonatal patients and on one patient at a time The CARESCAPE Monitor B850 is indicated for monitoring of hemo...

Page 49: ...halography Entropy Bispectral Index BIS and neuromuscular transmission The CARESCAPE Monitor B650 also provides alarms trends snapshots and events and calculations and can be connected to displays printers and recording devices The CARESCAPE Monitor B650 can be a stand alone monitor or interfaced to other devices It can also be connected to other monitors for remote viewing and to data management ...

Page 50: ...ded use This manual is intended for clinical professionals Clinical professionals are expected to have a working knowledge of medical procedures practices and terminology as required for the monitoring of all patients WARNING SINGLE PATIENT USE This equipment is designed for use on one patient at a time Using this equipment to monitor different parameters on different patients at the same time com...

Page 51: ... device system Consult qualified personnel regarding device system configuration CAUTION The device system should not be used adjacent to or stacked with other equipment Consult qualified personnel regarding device system configuration CAUTION EMC Magnetic and electrical fields are capable of interfering with the proper performance of the device For this reason make sure that all external devices ...

Page 52: ...ent or a large metal object located close to 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 See the documentation provided with the wrist straps for details of proper use Floors should be covered by ESD dissipative carpets or similar Non s...

Page 53: ...E LEAKAGE CURRENT Laser printers are UL 60950 IEC 60950 certified equipment which may not meet the leakage current requirements of patient care equipment This equipment must not be located in the patient environment unless the medical system standard IEC 60601 1 1 is followed Do not connect a laser printer to a multiple socket outlet supplying patient care equipment The use of multiple socket outl...

Page 54: ...s to the patients or users Only use batteries recommended or manufactured by GE The warranty can be voided if non recommended batteries are used WARNING Do not incinerate a battery or store at high temperatures Serious injury or death could result WARNING To prevent liquids from entering the display casing do not tilt the display more than 15 degrees WARNING Do not connect a monochrome display to ...

Page 55: ... between parameter acquisition and input and output devices The processing unit works with multi parameter acquisition devices 3 Acquisition modules Three types of acquisition modules can be used PDM E modules and TRAM module or single parameter Tram Rac module 4 The F7 Frame has seven module slots and the F5 Frame has five module slots that support all E module acquisition modules It supports bot...

Page 56: ... to provide all patient monitor controls on a portable component with a Trim Knob control 12 Barcode reader Used to scan a Technician ID and Patient Information Number from barcodes when admitting patients 13 Keyboard Allows data entry without using the on screen keyboard or a touchscreen display B850 processing unit front view Four M port connectors are located on the processing unit The M ports ...

Page 57: ...ntiality B850 module frames F7 and F5 WARNING Do not touch the electrical connector located within the module housing or frame WARNING B850 ELECTRIC SHOCK Do not use the F7 Frame for standalone use Ventilation holes on the F7 E module Frame will be covered only if installed within an Aisys Avance or Aespire anesthesia machine 1 Defibrillator synchronization F5 and F7 E module Frames provide an int...

Page 58: ...hin the patient environment as long as an additional transformer providing at least basic isolation is used with non medical grade secondary displays and printers Your system may not include all these components Consult your local representative for the available components 1 CARESCAPE Monitor B650 2 19 inch display Touchscreen display that provides abbreviated keypad and Trim Knob control If a no...

Page 59: ...ard Allows data entry without using the on screen keyboard or a touchscreen display 6 Mouse Allows on screen user selections and data entry 7 Barcode reader Used to scan a Technician ID and Patient Information Number from barcodes when admitting patients 8 Remote control Used to provide all patient monitor controls on a portable component with a Trim Knob control 9 Unity Network Interface Device I...

Page 60: ...e width modules 3 Release switch for the pivoting module frame 4 Defibrillator ECG and IABP synchronization E modules only optional 1 Battery cover 2 Lock for battery cover optional B650 monitor back panel 1 Pivoting module frame 2 Slide mount connector for PDM 60 CARESCAPE Modular Monitors 2062971 001 ...

Page 61: ...face between the monitor and acquisition modules There are four pivoting module frame options available Frame with PSM and PDM support Frame with PSM PDM and E module support Frame with PSM PDM and recorder support Frame with PSM PDM E module and recorder support Using the B650 pivoting module frame WARNING Do not touch the electrical connector located within the module housing or frame 1 Press th...

Page 62: ...me Make sure that the frame locks in place and that the red color in the upper part of the switch is no longer visible B450 system components B450 only All components listed below can be used within the patient environment as long as an additional transformer providing at least basic isolation is used with non medical grade secondary displays and printers Your system may not include all these comp...

Page 63: ...m an additional transformer providing at least basic isolation 4 Acquisition modules Two types of acquisition modules can be used PDM and single width E modules 5 Keyboard Allows data entry without using the on screen keyboard or a touchscreen display 6 Mouse Allows on screen user selections and data entry 7 Barcode reader Used to scan a Technician ID and Patient Information Number from barcodes w...

Page 64: ...n standby B450 monitor side views 1 Module slot for one single width module 2 Defibrillator ECG and IABP synchronization E modules only 3 Optional recorder 4 Release latch for recorder 1 Receptacle for power cord 2 Battery slot 3 Release latch for battery door 64 CARESCAPE Modular Monitors 2062971 001 ...

Page 65: ...The IX Network provides access for example to the MUSE server Citrix server and IX printers 5 Connector for Unity Network Interface Device ID 6 Connector for ePort PDM cable 7 Connector for secondary display 8 USB ports 9 Connector for remote on off 10 Power and ground Monitor battery B650 and B450 only WARNING The B450 must always be used with a battery inserted This will ensure the functioning o...

Page 66: ...tion Manual If your B650 monitor has the optional battery slot you can insert a lithium ion battery and use the monitor on battery power With the B450 you can use one or two lithium ion batteries One will always have to be inserted The LED indicators on the monitor front panel indicate whether the monitor is being used on battery or mains power and also whether the battery is charging full or miss...

Page 67: ...ery inserted This will ensure the functioning of the monitor and prevent data loss during possible supply mains interruptions 2 Insert the batteries one at a time with the test indicator facing front and the connector end first all the way into the battery slot 3 Close the battery door carefully 4 To remove a battery open the battery cover and pull the battery out from the cord Checking the batter...

Page 68: ...itor battery yellow This symbol and a message indicating low battery charge appear when there is less than 20 minutes of run time left Monitor battery red This symbol and a message indicating empty battery appear when there is less than 5 minutes of run time left Monitor battery is charging There is a white running bar inside the symbol Battery test button B650 and B450 only When the battery is no...

Page 69: ...l not sound the audible alarms Keep the patient under close surveillance NOTE If there is a power failure e g the supply mains is interrupted and the monitor battery fails the monitor gives a continuous beeping alarm This alarm remains active for as long as there is some residual power left or until it is silenced with the pause audio alarm key or until the power is reconnected B850 The monitor su...

Page 70: ...isition modules You can use different types of acquisition modules with the monitor They provide connection to the patient process patient data signals and send patient data signals to the monitor For a complete list of compatible devices see the CARESCAPE Modular Monitors Supplemental Information Manual The module interface is disabled when the NICU software package is selected with other E modul...

Page 71: ...the PDM 7 Power indicator Illuminates yellow during boot up and turns green after boot up Illuminates green when the PDM module is powered by the monitor Illuminates green when the PDM battery is installed and power is applied to the PDM by pressing the Power On button Not illuminated when no power is applied to the PDM 8 Dual function Power On and Zero All button 9 Defib Sync 10 Tab for removing ...

Page 72: ...f non recommended batteries are used TRAM module front view TRAM and Tram Rac modules with the B850 only The following is an example of a TRAM module TRAM 451N5 The front panel connectors are labeled Some TRAM modules have different NIBP and SpO2 connectors but they are located in the same positions as those shown in the picture TRAM module invasive pressure connectors are labeled BP and non invas...

Page 73: ...x x x Invasive pressures 2 4 4 NIBP x x x x Temperature 2 2 2 or C O 2 or C O C O x or 2 temp x or 2 temp SpO2 Masimo x SpO2 Nellcor x SpO2 GE x x A dual adapter cable is required to monitor two invasive pressure or temperature measurements on a single connector Different SpO2 cables are required for each type of SpO2 processing The cable connectors are not interchangeable TRAM 451 451M and 451N5 ...

Page 74: ... interchangeable Hemodynamic modules Hemodynamic modules are the cardiac output and SvO2 E modules pressure E modules and Tram Rac modules E modules offer a wide variety of parameter acquisition capability to the patient monitoring system Hemodynamic modules are compatible with the CARESCAPE Modular Monitors as follows E COPS E COPSv Monitors B850 B650 B450 E PP E PT E P Monitors B850 B650 B450 Tr...

Page 75: ...450 E CO E COV E COVX E CAiO E CAiOV E CAiOVX Monitors B850 B650 Tram Rac Monitor B850 E module gas parameters Module CO2 N2O O2 Anesthetic agents Agent ID E miniC x E sCO x x E sCOV x x E CO x x E COV x x E COVX x x E sCAiO x x x x x E sCAiOV x x x x x E CAiO x x x x x E CAiOV x x x x x E CAiOVX x x x x x The E sCO E CO E sCOV E COV and E COVX modules automatically compensate for N2O in realtime ...

Page 76: ... Nellcor x Different SpO2 cables are required for each type of SpO2 processing The cable connectors are not interchangeable Tram Rac SpO2 parameters Parameter SpO2 Masimo SpO2 GE SpO2 GE x SpO2 Masimo x Specialty E modules Speciality E modules are the E NMT E EEG E BIS and E ENTROPY They provide measurement for brain monitoring and relaxation They are compatible with all CARESCAPE modular monitors...

Page 77: ...yboard with at least IPX1 protection against ingress of water A washable antibacterial keyboard is specified for use with the monitor It may be connected to the monitor or display via one of the USB connectors The keyboard allows you to enter data without using the on screen keyboard or a touchscreen display Mouse A standard mouse may be connected to the monitor or display via one of the USB conne...

Page 78: ...d to the patient monitor via one of the USB connectors Recorders and laser printers PRN 50 M with the B850 only The monitor can print to a configured network laser printer a PRN 50 M recorder B850 an optional recorder B650 and B450 or a remote recorder in the network You need the IX Network or the S 5 Network for the network printer About the Unity Network Interface Device ID 78 CARESCAPE Modular ...

Page 79: ...r can only display information that the peripheral device sends The parameters sent vary with each peripheral device and are subject to change It is also important to note that alarms vary according to the primary interfaced device In some cases the peripheral device may impose alarm control parameters that you may not be able to change or silence with the monitor s controls CIC Pro Clinical Infor...

Page 80: ...entral Station User s Manual for operating instructions iCentral The S 5 Network Ethernet establishes communication and allows patient data to be sent to an optional iCentral central station See the iCentral and iCentral Client User s Reference Manual for operating instructions Remote alarm box nurse call B850 only 80 CARESCAPE Modular Monitors 2062971 001 ...

Page 81: ...nications System PACS Desktops can be created with customer defined resolutions using the hospital wide login and identification process The iPanel application is used through a Citrix thin client on the monitor so no additional equipment is required at the bedside See the CARESCAPE Modular Monitors Supplemental Information Manual for the iPanel application default settings See the CARESCAPE Monit...

Page 82: ... the battery is being charged Battery monitor The solid green symbol indicates that the monitor is being used on battery power Battery monitor Located on the battery slot cover Battery monitor The battery slot cover is open closed Battery monitor Test button on the battery to check the battery charge level Battery PDM Communication Power indicator On standby button Standby or power indicator 82 CA...

Page 83: ...ower input Signal power output Signal power input output combined ON Power connection to the mains Power supply connector Power switch Display brightness controls Display speaker volume controls USB connectors Ethernet connectors Serial interface 2062971 001 CARESCAPE Modular Monitors 83 ...

Page 84: ...tor for digital or analog source Color video output Video output for analog source Color video output digital Video output for digital source Gas inlet Gas outlet Press to open Zero all Degree of ingress protection Degree of protection against harmful ingress of water Components not marked with and IPX n code are rated as Ordinary no protection against fluid ingress All other IPXn rated components...

Page 85: ...er Direct current Equipotentiality Connect device to a potential equalization conductor Protective earth ground Connectors grounded to the AC power source Defibrillator synchronization connectors WLAN Class 2 Identifier Stacking limit by number Date of manufacture This symbol indicates the date of manufacture of this device The first four digits identify the year and the last two digits identify t...

Page 86: ...itations Temperature limitations Humidity limitations Keep dry Protect from rain Fragile Handle with care This way up This symbol indicates that the waste of electrical and electronic equipment must not be disposed as unsorted municipal waste and must be collected separately Please contact an authorized representative of the manufacturer for information concerning the decommissioning of your equip...

Page 87: ...nion Declaration of Conformity Indicates that the product is certified for both the U S and Canadian markets to the applicable U S and Canadian standards FCC USA only Complies with applicable US government Federal Communications Commission radio frequency interference regulations Prescriptive Device USA only For sale by or on the order of a Physician Russia only GOST R mark Brazil only INMETRO cer...

Page 88: ...strictly Consumables or certain parts may have their own label with an EFUP value less than the product Periodic replacement of those consumables or parts to maintain the declared EFUP shall be done in accordance with the Product Maintenance Procedures This product must not be disposed of as unsorted municipal waste and must be collected separately and handled properly after decommissioning This s...

Page 89: ...this parameter are turned off The symbol may not display at the central station or on a remote bedside monitor Alarm priority indicator High red Indicates a high priority alarm Alarm priority indicator Medium yellow Indicates a medium priority alarm Alarm priority indicator Low cyan Indicates a low priority alarm Alarm volume icon Adjust the minimum alarm tone volume Audio alarms off indicator Dis...

Page 90: ...in the Priority column of the selected alarm in the Alarm Setup Alarm Priorities Reminder volume icon Adjust the volume of the tone that sounds every two minutes when audio alarms are turned off Touch volume icon Adjust the volume of the tone that sounds when a user touches a touchscreen display Home icon Close all menus applications displayed on the monitor Locking setting indicator Indicates thi...

Page 91: ...ery is charging There is a white running bar inside the symbol Monitory battery failure indicator Indicates a missing battery or a battery failure PDM battery charging indicator Indicates the battery is charging PDM battery gauge indicator Indicates the charge level of the battery PDM battery failure indicator Indicates the battery is not available for use Snapshot indicator Indicates the event ha...

Page 92: ...NIBP volume icon Adjust the volume of the tone that sounds when an NIBP measurement result is available Manual NIBP icon Start a manual NIBP measurement Nellcor OxiMax SatSeconds indicator Indicates the amount of time the SpO2 saturation is outside the limits before alarms are generated SpO2 signal strength indicator Indicates the signal strength with three asterisks indicating the strongest signa...

Page 93: ... If such modules have been connected remove the module that has been most recently connected You can also remove both modules and reconnect the new module after five seconds The following modules are considered identical and should not be used simultaneously in the same monitoring system To monitor Select one of these modules ECG NIBP SpO2 Temp IP Resp E PSM E PSMP E PSMW E PSMPW PDM C O IP SvO2 E...

Page 94: ... station until it clicks and stops NOTE The PDM module requires additional time to power up when used without the PDM battery Do not interrupt the startup sequence by unplugging the PDM module Removing a PDM or PSM from a frame 1 Pull the pull tab out and slide the module out of the guides 2 Hold onto the module to make sure it does not drop when it comes out Connecting other E modules than the PS...

Page 95: ...ng and guide the back of the module into the appropriate position 2 Gently push the module into the housing You will hear a click when the module is fully inserted Removing TRAM modules from a Tram Rac housing 1 Push the module into the Tram Rac housing This releases the module and makes it easier to remove 2 Press and hold the release levers found on each side of the front of the module 3 Pull th...

Page 96: ... or PSM to the B650 1 Connect a module by aligning it with the insertion guides on the pivoting module frame 2 Push the module into the module frame until it clicks and stops NOTE The PDM module requires additional time to power up when used without the PDM battery Do not interrupt the startup sequence by unplugging the PDM module Connecting other E modules than PSM to the B650 1 With the module p...

Page 97: ...l labeling of other already connected channels and consequently also the alarm limits Connecting a PDM or PSM to the B450 1 Connect a module by aligning it with the insertion guides of the docking station on the back of the monitor 2 Push the module into the docking station until it clicks and stops NOTE The PDM module requires additional time to power up when used without the PDM battery Do not i...

Page 98: ...o the module frame until it clicks Removing other E modules than PSM from the B450 1 Press the release latch at the bottom of the module 2 While pressing the release latch grasp the module firmly and pull out Main keys Various functions of the monitor can be accessed through the monitor s main menu keys In addition they can be accessed through Remote control optional for all Bx50 monitors M port k...

Page 99: ...s Audible and visual alarm indicators Main menu USB remote control M port keypad Monitor Setup Screen setup Also primary secondary screen with B850 Printing setup Parameter setup Parameter colors Sound volumes PDM battery status Monitor battery status B650 B450 Brightness settings B650 B450 Invasive pressure calibration Password protected functions default setup service calibrations service Main m...

Page 100: ... M port keypad Freeze Snapshot or Unfreeze Freeze or unfreeze the scrolling waveforms Freezing will automatically end after 15 seconds or you can end it manually A snapshot is taken every time this button is pressed Main menu USB remote control M port keypad NIBP Auto Start orNIBP Auto Stop Start or stop automatic non invasive blood pressure measurements at timed intervals After selection the butt...

Page 101: ...ea Split screen area option You may also select Minitrend as an option for this area Waveform area Upper parameter windows Lower parameter windows option Main menu area In addition the information area of the screen displays the following information Patient name if entered Profile name that is being used for patient monitoring PDM battery gauge icon if a PDM module is connected to the monitor You...

Page 102: ...ting deselecting a feature 6 Arrow selector spinner for increasing decreasing a value 7 Help text area 8 Radio button for selecting deselecting a feature 9 Selection key The field below shows the current selection status 10 Exit key for example Previous Menu Close NOTE Not all menus have these same components Menu options In this manual the term select means using the mouse Trim Knob control or to...

Page 103: ...Selecting menu options with a mouse 1 Move the mouse until the pointer arrow is on the menu option you wish to select 2 Click the left mouse button once Data field entries You can use the on screen keyboard or a standard keyboard to type data into a data field Data fields are selected with a touchscreen Trim Knob or mouse Entering data with the on screen keyboard When data entry is required the mo...

Page 104: ...hould not be used adjacent to or stacked with other equipment Consult qualified personnel regarding device system configuration Monitor installation points to note To avoid electrostatic charges building up it is recommended to store maintain and use the equipment at a relative humidity of 30 or greater Floors should be covered by ESD dissipative carpets or similar ESC dissipative products Non syn...

Page 105: ...ower on off switch located on the back of the processing unit to the I on position and turn on the power to the display screen b B650 B450 Press the on standby button located on the monitor front panel The welcoming screen will appear with a status bar indicating the progress of the startup procedure Performance check After turning on the monitor and during operation the monitor runs automatic sel...

Page 106: ...ost and the monitor returns to the user default settings start up mode For more information see the technical manual WARNING The B450 must always be used with a battery inserted This will ensure the functioning of the monitor and prevent data loss during possible supply mains interruptions Power failure alarm B650 only If there is a power failure e g the supply mains is interrupted and the monitor...

Page 107: ...tion see the CARESCAPE Modular Monitors Supplemental Information Manual In addition to the normal screen each profile can have up to five additional pages and some of these may be preconfigured These additional pages are needed for instance when all the measured parameters do not fit on the normal screen page These pages can also include information that is needed only during a specific phase of c...

Page 108: ...isplay brightness For information on how to set the display brightness for B850 displays refer to their user manual Adjusting the display brightness automatically B650 and B450 only With the automatic adjustment the display brightness is automatically set according to the ambient light This same setting also turns on the B650 keyboard light automatically 1 Select Monitor Setup Brightness 2 Select ...

Page 109: ...e selection adjusts the display brightness level automatically 1 Select Monitor Setup Brightness 2 Select the radio button for Automatic adjustment Turning the keyboard light on manually B650 only You can select the keyboard light on or off manually when needed 1 Select Monitor Setup Brightness 2 Select the radio button for Manual adjustment 3 Select Keyboard and set the keyboard light On or Off S...

Page 110: ...ndows to display in the upper parameter area of the screen Selecting parameters to the screen Most parameters appear on screen automatically when their measurement starts However if you cannot see the parameter you are measuring select it to the screen 1 Select Monitor Setup Screen Setup 2 B850 and B450 with the Double Video license Select Screen 1 or Screen 2 tab 3 Select the parameter to the upp...

Page 111: ...e split screen option divides the screen so that you can view graphic and or numeric data of the chosen measurement on the left while still having waveforms and parameter windows visible at the same time 1 Select Monitor Setup Screen Setup 2 B850 and B450 with the Double Video license Select Screen 1 or Screen 2 tab 3 Select Split Screen 4 Select the type of split screen you need from the dropdown...

Page 112: ... Colors 2 Select the Other Parameters tab 3 Select a Common and the colors from the lists b Specific and the colors from the lists c Select the color for the timer through Specific Timer Parameter configurations Before monitoring a patient always check the parameter setup settings and alarm limit values Parameter settings and alarm limit values can be configured by selecting Monitor Setup Paramete...

Page 113: ...tion select the Advanced tab Setting the touchscreen off You can set the touchscreen feature off for 30 seconds at a time when you need to clean the screen The countdown timer appears on the screen 1 Select Monitor Setup 2 Select Touchscreen Off 3 To enable the touchscreen press any monitor hardkey or use the Trim Knob or press Cancel in the Touchscreen Off display for three seconds B850 with seve...

Page 114: ...Setting up the monitor before use 114 CARESCAPE Modular Monitors 2062971 001 ...

Page 115: ...e settings when it is turned on and after a power off situation that lasts more than 15 minutes If there are no user default settings factory default settings are used Invasive pressure labels and PDM or TRAM WARNING When connecting PDM or TRAM the loaded IP labels may affect the channel labeling of other already connected channels and consequently also the alarm limits When monitoring is started ...

Page 116: ... the current site for this channel is FemV RVP if the current site for this channel is RVP P1 to P8 depending on the channel PA PA RA RAP UAC UAC if the software package is NICU otherwise Art UVC UVC if the software package is NICU otherwise CVP Starting monitoring A case automatically starts a patient is admitted when the monitor detects any of the following vital signs ECG impedance respiration ...

Page 117: ...ter patient demographics or load combine the data 4 Start the measurement 5 Zero invasive pressure lines 6 If required change the parameters on screen 7 Check alarm limits and adjust if necessary About the combination monitoring mode The combination monitoring is a licensed feature In combination monitoring mode ECG is acquired from a telemetry receiver system This ECG data acquisition capability ...

Page 118: ...etry System Operator s Manual When combination monitoring is started with a non admitted telemetry patient the printout type selection will be sent to the telemetry transmitter CAUTION Users should be aware that all waveforms may be delayed up to 2 seconds in the combination monitoring mode If the delay needs to be avoided the combination monitoring mode should be discontinued and all waveforms sh...

Page 119: ...ry transmitter monitor selected Entering patient data with a barcode reader You can scan patient data from barcodes if this function has been enabled during configuration For more information see the monitor s technical manual 1 Select the patient information area on the screen or select Data Pages Admit Discharge or Start Reset Case 2 Select the Patient tab 3 Select Scan from Barcode Any informat...

Page 120: ...roving between beds is allowed you can update the bed name when needed 1 Select the patient information area 2 Select the Care Unit Bed tab 3 Select the Bed Name from the dropdown list The new name appears in the upper right corner of the display The unit name is given first then a dash and the bed name for instance UNIT1 BED1 You can also change the name manually through New Unit Bed or through N...

Page 121: ...he ADT server 1 Select the patient information area on the screen 2 Select the Load Patient tab 3 Select Find Patients 4 Select the Medical Record Number and or Last Name field and enter the information you have available You can also add the First Name information but the search does not function with this information only 5 Select Find 6 When the patient list appears select the patient 7 Select ...

Page 122: ...dby option Standby locations are defined during configuration through Monitor Setup Default Setup Care Unit Settings Standby Sites These settings are password protected For more information see the CARESCAPE Modular Monitors Supplemental Information Manual Starting standby 1 Select the patient information area on the screen 2 Select the Standby tab 3 Select the radio button for an appropriate stan...

Page 123: ...ing the transfer All zeroed invasive pressure site labels All invasive pressure transducer zero values for channels 1 to 4 Latest values and timestamps for C O PCWP and NIBP measurements NIBP cuff size NIBP auto cycle on off information NIBP cycle time information if the NIBP auto cycle is on The actions taken by the monitor and the menus that appear depend on whether the monitor has an active pat...

Page 124: ... identification is not the same on the acquisition module and the moniotor this selection erases the patient data from the monitor and continues with the patient currently on the module Erase PDM Data Erase Tram Data This selection erases the patient data from the module Combine Data This selection combines the patient data from the module with that of the monitor even if the patient identificatio...

Page 125: ...tivation after next discharge Setting activation after next case end When you reset a case discharge a patient this activation will automatically take place Follow the instructional texts that appear on screen NOTE If the pending activation cannot be allowed to take place and must be canceled for some reason contact authorized service personnel Residual physiological data To ensure that no physiol...

Page 126: ...nt information field 4 Select the Patient tab 5 Select Reset Case or Discharge Patient and one of the following No No discharge actions take place Telemetry The patient is discharged from the telemetry transmitter but not from the monitor Monitor The patient is discharged from the monitor but not from the telemetry transmitter Both The patient is discharged from the monitor and the telemetry trans...

Page 127: ...uption WARNING Alarms do not sound alarm histories are not stored alarm graphs do not print and alarms are not sent to the network when the alarms are turned off WARNING Alarms do not sound and alarms are not sent to the CARESCAPE Network during Audio Pause WARNING The audible alarm signal may be paused temporarily from a central station or remote monitor WARNING To avoid missed detection of criti...

Page 128: ...f monitors in the same care area are using different monitoring profiles and default configuration settings WARNING MISSED ALARM Do not rely on receipt of certain alarm conditions at a central station remote bedside or alarm notification device when connected to the CARESCAPE Network Notification of any of these alarms will only be given when it is the most recent highest priority active alarm com...

Page 129: ...pear properly Alarm cautions CAUTION Reducing the physiological alarms priority levels lower than the default level can lead to missed detection of serious events and therefore to adverse patient outcome If you adjust the priority levels for non lethal arrhythmias FiCO2 and or EtCO2 alarms lower than the default value keep the patient under close surveillance Alarm overview Alarm types The monitor...

Page 130: ...escalating alarm starts at a designated priority level low or medium and will escalate to the next higher priority level of alarm after a set number of seconds if the alarm condition has not been resolved It is important to note that these escalate up to the next level but will not reset until the condition has been resolved NOTE Alarm priority escalation affects the currently ongoing alarm condit...

Page 131: ...tral station or remote monitor according to the following mapping Feature Message on the bedside monitor Message sent to the CARESCAPE Network and displayed on the central station remote monitor ECG HR ECG high HR ECG HIGH ECG HR ECG low HR ECG LOW ECG ST Ant high ST ANT HIGH ECG ST Ant low ST ANT LOW ECG ST Inf high ST INF HIGH ECG ST Inf low ST INF LOW ECG ST Lat high ST LAT HIGH ECG ST Lat low ...

Page 132: ...d T3 high TBL T3 HIGH Temperature Identical temperature modules TEMP MOD ERR Temperature Temp measurement removed TEMP REMOVED SvO2 SvO2 cable off SVO2 CABL OFF SvO2 SvO2 measurement removed SVO2 REMOVED Gases Gas measurements removed GAS REMOVED Gases Identical gas modules MODULE ERROR Entropy Entropy RE high RE HIGH Entropy Entropy RE low RE LOW Entropy Entropy SE high SE HIGH Entropy Entropy SE...

Page 133: ... light is a solid blue color 4 Return the parameter alarm limit to the original value Alarm indications Alarm icons on the screen Pause audio alarms Selectable from the monitor s main menu Also an indicator of a temporarily paused active audio alarm Audio alarms paused indicator with countdown timer Indicates all audio alarms are paused and the amount of time remaining for the alarm pause period d...

Page 134: ... indicator Adjust the minimum alarm tone volume Description of alarm and information messages Alarm and information messages can be displayed in three areas The parameter window The waveform field Alarm area upper part of the screen In the alarm area up to five alarm or information messages may be displayed from left to right from the newest highest priority alarm to the oldest lowest priority ala...

Page 135: ...s The alarm tones may be configured to sound in one of two different tone patterns Legacy or IEC IEC tones are 60601 1 8 compliant Legacy alarm tones match the tones used on some previous GE monitoring devices For more information see the CARESCAPE Modular Monitors Supplemental Information Manual AVOA alarm tones may differ from the local monitor alarm tones Both the highest priority local alarm t...

Page 136: ...rn of 2 5 beep tones Repeats pattern of 3 beep tones 1 beep tone None Audible tone pattern legacy Repeats pattern of 3 beep tones crisis Repeats pattern of 2 beep tone warning 1 beep tone advisory None Alarm light indicator2 Flashes red Flashes yellow Solid blue No effect Automatic view on alarm audible tone pattern User configurable3 User configurable3 User configurable3 None 1 The IEC audible to...

Page 137: ...urce limit and arrhythmia alarms Apnea ECG Audio Off Turns off audio alarms for all HR and PR source limit arrhythmia apnea EtCO2 FiCO2 respiration rate Ppeak low PEEPe PEEPtot PEEPi and MVexp limit alarms All Alarms Audio Off Turns off all audible alarms except some high priority alarms defined as breakthrough alarms 4 To turn on all audible alarms again select Activate All Audible Alarms or sele...

Page 138: ...cept the specified breakthrough alarms Select once during audio pause Ends the audio pause period Restores all acknowledged and silenced alarms if the alarm condition still exists Pausing alarms for 5 minutes You can pause audible alarms with the pause audio key for 2 or 5 minutes according to the care unit settings You can also pause all alarms for 5 minutes through the Alarms Setup menu 1 Select...

Page 139: ...l Pause audio with combination monitoring When using combination monitoring the pause audio behavior is the following If the telemetry transmitter is in pause audio state also the monitor will be in the same state You can cancel the pause audio at the bedside monitor by selecting the pause audio key This will not affect the telemetry device If the monitor s own pause audio state ends before the te...

Page 140: ...r Monitors Supplemental Information Manual Setting parameter alarm limits Parameter alarm limits may be set in the Alarms Setup menu or in the parameter menus own Alarms tab Alarm limits should not be set beyond reasonable physiological boundaries in order to maintain patient safety Setting outside of reasonable boundaries would cause the alarms to be ineffective 1 Select Alarm Setup from the moni...

Page 141: ...t on Alarm options Atrial Alarms You can select the Alarm Priority Create Snapshot and Print on Alarm options In addition you can set the detection criteria for SV Tachy SVT Length HR for SVT min and Pause Interval Selecting parameter alarm priority levels Escalating an alarm priority increases the priority of the alarm condition or increases the sense of urgency of an alarm signal The alarm prior...

Page 142: ...ugh the low and medium priority settings are allowed for V Tach the alarm will always be high priority if the V Tach duration is more than 30 seconds the HR is higher than the set HR high limit and the HR exceeds 150 beats min In the NICU software package the high priority is enforced at 180 beats min P1 high low to P8 high low CCI high low According to what has been allowed in the Care Unit Setti...

Page 143: ...limit is 2 PVC PVC 10 Not applicable EtCO2 EtCO2 5 EtCO2 5 SpO2 SpO2 5 SpO2 5 Art ABP Fem P1 Sys Dia Mean Value 1 25 10mmHg Value 1 25 1 3kPa Sys Dia Mean Value 0 75 10mmHg Value 0 75 1 3kPa FemV CVP PA RAP RVP LAP ICP CPP P2 8 Sys Dia Mean Value 1 25 5mmHg Value 1 25 0 67kPa Sys Dia Mean Value 0 75 5mmHg Value 0 75 0 67kPa UAC UVC Sys Dia Mean Value 1 25 5mmHg Value 1 25 0 67kPa Sys Dia Mean Valu...

Page 144: ...rs Supplemental Information Manual 1 Select Alarm Setup from the monitor s main menu 2 Select the Audible Visual tab 3 Select Audio Display Off A screen saver replaces the display of patient data Any user input touchscreen button Trim Knob keyboard key mouse click reactivates the alarms and the monitoring screen Remote management of alarms The remote alarm settings are defined in the Care Unit Set...

Page 145: ...e Clinical logs is a service level function and it is password protected The monitor stores a record of patient related local and remote alarms and information messages as well as any adjustments to the alarm limits in the Clinical logs Stored alarm data during a power cycle or power loss If the monitor goes through a power cycle or a loss of power the stored alarm data is not affected The alarm d...

Page 146: ...Alarms 146 CARESCAPE Modular Monitors 2062971 001 ...

Page 147: ...nt sites ensure the following Proper contact of the ESU return electrode to the patient ESU return electrode near the operating area Measurement electrodes leadwires and probes far from the surgical site and the ESU return electrode WARNING This device is intended to record electrocardiograms from surface ECG electrodes It is not meant for positioning floating temporary pacemaker leadwires perform...

Page 148: ...ion and cancel the protection provided by the isolated input WARNING DELAYED ASYSTOLE ALARM The pulsatile heart rate may have a slower response time than the electrical heart rate where there is a low perfusion patient condition When using the IntelliRate feature in this situation the monitor may delay calling an ASYSTOLE patient alarm The user may elect to turn the IntelliRate feature off for pat...

Page 149: ...ure accurate 12 lead analysis when using a 10 leadwire patient cable you must verify that the correct leadwire block is plugged into the appropriate side of the cable The V2 through V6 leadwire block is color coded brown AHA or white IEC ECG measurement limitations E modules used for this measurement are not suitable for use with neonatal patients The monitor will display a Leads off message in an...

Page 150: ... contact with the skin and decreases the quality of electrode signal When preparing the electrode sites avoid bones close to skin obvious layers of fat and major muscles 1 Shave any hair from the electrode site 2 Gently rub the surface of the skin to increase capillary blood flow 3 Clean the skin with alcohol or a mild soap and water solution to remove skin oil and dead or abraded skin cells 4 Dry...

Page 151: ... used IEC AAMI AHA Electrode placement R red RA white Just below the right clavicle L yellow LA black Just below the left clavicle User defined User defined For the 5 lead placement place the precordial electrode according to the physician s preference N black RL green Lower right edge of the rib cage F green LL red Lower left edge of the rib cage 6 lead ECG electrode placement NOTE PDM and PSM on...

Page 152: ...dwire cables for a 12 lead ECG connection note that the 12RL can be used for adult patients only IEC AAMI AHA Electrode placement R red RA white Just below the right clavicle L yellow LA black Just below the left clavicle Ca C1 white Va V1 brown 4th intercostal space right sternal border Cb C5 white Vb V5 brown Left anterior axillary line at C4 V4 level N black RL green Lower right edge of the rib...

Page 153: ...e right sternal border C2 white yellow V2 brown yellow 4th intercostal space left sternal border C3 white green V3 brown green Midway between C2 V2 and C4 V4 C4 white brown V4 brown blue 5th intercostal space mid clavicular line C5 white black V5 brown orange Left anterior axillary line at C4 V4 level C6 white purple V6 brown purple Mid axillary line at C4 V4 and C5 V5 levels Standard resting 10 l...

Page 154: ...ry line at C4 V4 level C6 white purple V6 brown purple Mid axillary line at C4 V4 and C5 V5 levels Checking the ECG measurement 1 Check that the waveforms and parameter values are displayed when the cable is connected to the patient About the ECG analog output signal Maximum delay of the ECG analog output signal is 30 ms with the PDM and 15 ms with E modules Pacemaker pulse indication is included ...

Page 155: ...oring has been started Only the snapshots created on the monitor and the samples of the telemetry transmitter created prior to starting the combination monitoring can be viewed The combination monitoring mode can be enabled through Monitor Setup Default Setup Care Unit Settings Telemetry Monitor or Telemetry and the setting is password protected The monitor needs to be configured to the CARESCAPE ...

Page 156: ...e with the NICU software package This setting is available if the telemetry license is enabled and the combination monitoring mode Monitor or Telemetry has been enabled during configuration The monitor needs to be in the CARESCAPE Network 1 Select the HR parameter window 2 Select a source from the ECG Source list This list contains the monitor and available telemetry transmitter s When you confirm...

Page 157: ...Select a lead from the ECG 3 Lead list If your selection is Cascade the displayed ECG 2 Lead waveform continues into the ECG 3 Lead waveform area Selecting the Va ECG lead NOTE 12RL monitoring The Va lead is the first V lead label used with a 6 leadwire ECG cable for 12RL monitoring 12RL is possible only if the Va is set to V1 The Va Lead Position selection affects the ST numeric trends When using...

Page 158: ... arrhythmia detection This selection will acknowledge the ECG Leads Off alarm but it will not change the measurement mode to fewer leads This selection is not available with combination monitoring 1 Select the HR parameter window 2 Select Deactivate ECG Leads Off Selecting the beat source Not all sources like telemetry ECG TRAM IP provide the necessary status information for this 1 Select the HR p...

Page 159: ...eep sounds including ECG and IP when the SpO2 measurement is available beep frequency changes according to increasing and decreasing SpO2 values If the setting is set to Only SpO2 other beep sounds are not affected by the changing SpO2 values For more information see the CARESCAPE Modular Monitors Supplemental Information Manual Aspect ratio and different display sizes ECG aspect ratio is the rati...

Page 160: ...ect the HR parameter window 2 Select All ECG Waveforms 3 Select Print Page 4 You can stop printing by selecting Stop Printing or Cancel Printing Selecting the ECG waveform filter You can select how the waveform appears on the display and on the printout 1 Select the HR parameter window 2 Select the Advanced tab 3 Select a filter from the Waveform Filter list Choices are Diagnostic TRAM 0 05 to 100...

Page 161: ... using the best available ECG lead will help With a 3 leadwire cable the setting is Single lead and cannot be changed If the measurement mode is changed from the 3 leadwire mode to 5 6 10 lead or 12RL mode the setting changes to Multi lead 1 Select the HR parameter window 2 Select the Advanced tab 3 Select an option from the Lead Analysis list The choices are Single lead EkPro algorithm uses one o...

Page 162: ...R Source list The selection list will only show active measurements and AUTO or IntelliRate Choices are UAC with the NICU software package only PDM with single HR IntelliRate ECG Art ABP Fem UAC Pleth PDM with multiple HR IntelliRate ECG E modules TRAM telemetry transmitters with single HR AUTO ECG Art ABP Fem UAC Pleth E modules TRAM telemetry transmitters with multiple HR AUTO ECG Showing a seco...

Page 163: ...ly and 0 5 mV vertically 1 Select the HR parameter window 2 Select the Advanced tab 3 Select the ECG Grid check box to display the grid ECG alarm limits The HR Alarms can be set to Single or Multiple through Monitor Setup Default Setup Care Unit Settings Parameters ECG This setting is password protected The Single heart rate setting allows you to set one common HR limit for multiple sources e g EC...

Page 164: ... the full arrhythmia license only 1 Select the HR parameter window 2 Select the PVC SVC Alarms or PVC Alarms TRAM or telemetry transmitters tab If the heart rate setting is Single select the Alarms tab 3 Check that the PVC alarm is turned on If a feature is not active the alarm limits are greyed out 4 Select Alarm On to set the alarms 5 Adjust the alarm limits with the arrows Setting SVC alarm lim...

Page 165: ...n electrical interference from equipment e g electrosurgical device Excessive patient movement causing significant artifact e g seizure activity Inability to use standard lead placement e g burns PDM IntelliRate algorithm The PDM uses the IntelliRate algorithm IntelliRate extracts information from multiple physiological signals ECG SpO2 Art and applies rule based logic to determine which heart rat...

Page 166: ... reconstructed from information that is directly recorded in the other channels of the 12 lead ECG The four signals generated by the GE 12RL program are similar but not identical to the standard 12 lead ECG All ECG data generated via 12RL are clearly identified as to which channels have been synthesized The GE 12RL program is intended for use in a monitoring environment Computerized measurements m...

Page 167: ...ther clinical findings ACI TIPI is intended for adult patient populations 12 lead ECG analysis points to note For a 12 lead ECG analysis a 12SL ECG with ACI TIPI license 10 leadwire cable and 10 lead lead electrode placement are required To obtain the most accurate 12 lead ECG analysis you should enter accurate patient demographics This is especially important when storing and comparing 12 lead re...

Page 168: ...ancel or Confirm Selecting Confirm is required before you can complete an ACI TIPI 12 lead ECG analysis Enabling and disabling the 12SL ACS WARNING Acute Coronary Syndrome ACS feature must be used only with patients to whom this measurement is suitable 12SL ACS is an optional higher sensitivity analysis for the detection of acute ischemia and acute infarction designed for a higher risk population ...

Page 169: ...ormat list 4 x 2 5 1 Rhythm 4 x 2 5 3 Rhythms 12 Rhythms Cabrera 5 Select Cancel or Confirm Generating a 12 lead ECG analysis report during an ST alarm condition You can have a 12 lead ECG report automatically generated when an ST alarm condition occurs Automatically generated reports are viewable through 12 Lead Analysis Saved Reports 1 Select the HR parameter window 2 Select 12 Lead Analysis 3 S...

Page 170: ...se 4 Select Print to print the 12 lead report You can also select MUSE Print instead of the two separate steps 3 and 4 above 5 Select Delete to delete the report and return to the real time view 6 To generate a new 12 lead ECG analysis report select Real time View and repeat the procedure for performing a 12 lead ECG analysis Viewing or printing saved 12 lead ECG reports You can view and print 12 ...

Page 171: ...he report was generated 2 Available values including Ventricular Rate PR Interval QRS Duration QT QTc and P R T Axis 3 Diagnostic statements and or error messages 4 Waveform area Up to 15 reports can be stored on the monitor until the patient is discharged Also a PDF report generated by the MUSE can be viewed via the monitor The 12 lead ECG analysis program includes the Gender Specific Criteria an...

Page 172: ...ire cable may be used However when using a 10 leadwire cable do not prepare or connect precordial leads 2 3 4 or 6 12 lead ECG analysis troubleshooting Problem Solution Transmitting a 12 lead report to a MUSE database fails There are communications problems with the network or the MUSE database Contact authorized service personnel Printing a 12 lead analysis report fails There is a printer error o...

Page 173: ... does not coincide with the ISO point s adjustment range Selecting the pacemaker detection With E modules the pacemaker detection is always enabled With PDM TRAM and combination monitoring it must be turned on However you may disable pacemaker event processing by turning off pacemaker detection When pacemaker detection is turned off the monitoring device ignores pacemaker pulse detections which ma...

Page 174: ...pike is placed in the ECG On the ECG waveform pacemaker detection is indicated by uniform upright pacemaker enhancement spikes in the ECG data both displayed and graphed How can pacemaker detection be improved Possible problems include Heart rate double counting Inaccurate alarms for low heart rate or asystole Pacemaker spikes not recognized by the software False PVC detections and arrhythmia alar...

Page 175: ... physician must therefore interpret the arrhythmia information in conjunction with other clinical findings Please take special note of the following ECG waveform conditions Noisy waveforms Noisy portions of ECG waveforms are typically excluded from analysis The exclusions are necessary to reduce the occurrence of inaccurate beat interpretations and or rhythm alarms If the excluded noisy portions o...

Page 176: ...ia detection algorithm sensitivity and specificity is less than 100 sometimes there may be some false arrhythmias detected and also some true arrhythmia events may not be detected This is especially true when the signal is noisy The ECG size and QRS width settings affect arrhythmia detection and heart rate calculation sensitivity If QRS amplitude is low the monitor might not be able to calculate H...

Page 177: ...ms Ventricular Alarms and Atrial Alarms are only adjustable with the full arrhythmia license 4 Select an arrhythmia from the list 5 Select the arrhythmia alarm s Alarm Priority with the arrows 6 Select the check box for Create Snapshot if you wish to activate an arrhythmia snapshot creation 7 Select the check box for Print on Alarm if you wish to activate printing during arrhythmia alarm For arrhy...

Page 178: ... other clinical findings Alarm message Arrhythmia analysis Alarm priority default Arrhythmia detection criteria A Fib Full All other software packages except NICU not available with TRAM According to priority setting Absence of P waves and irregular RR interval Accel Ventric Full According to priority setting Accelerated ventricular rhythm Run of PVCs with a run length of at least six beats and th...

Page 179: ...l Multifocal PVCs Full E modules PDM According to priority setting Over the last 15 beats two or more PVCs with different morphologies are detected Pause Full According to priority setting Coupling interval between two beats exceeds 3 seconds with TRAM and combination monitoring 1 to 5 seconds configurable with E modules and PDM R on T Full According to priority setting Isolated PVC is detected wi...

Page 180: ...tware packages and HR is over the user adjusted HR high limit OR PACU ICU and ED software packages A run of PVCs is detected with a run length of six beats or more and the effective HR exceeds 100 bpm NICU software package A run of PVCs is detected with a run length of six beats or more and the effective HR exceeds 160 bpm VT 2 Full According to priority setting A run of PVCs is detected with a ru...

Page 181: ...ng sufficient QRS amplitude in all analyzed leads Multiple leads are used for arrhythmia processing 1 Assess the patient 2 Check the ECG signal acquired from the patient 3 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 below 0 5 mV or an abnormal QRS width occurs ...

Page 182: ...ad then switch to single lead analysis so all arrhythmia interpretations are based on this single ECG lead ST detection About the ST analysis NOTE Multi lead ST Analysis license only If enabled ST analysis starts automatically after the ECG leads have been connected and QRS detection has started The message Learning displays within each QRS complex window Once the program has completed the learnin...

Page 183: ...th ventricular pacemakers or if the rhythm is considered as from ventricular origin Starting the ST detection 1 Select the ST parameter window or select the HR parameter window and the ST tab 2 Select Setup 3 Select On from the ST Analysis list Selecting leads to the ST window 1 Select the ST parameter window 2 Select Setup 3 Select the leads for display from the ST Window list Choices are ST Lead...

Page 184: ...with TRAM or combination monitoring E modules and PDM automatically set the isoelectric point Manual adjustments may be required if for example a P wave is attached to the QRS wave 1 Select the ST parameter window 2 Select Setup 3 Adjust the ISO Point with the arrows When the ISO Point is adjusted also the ST point changes accordingly and its automatic setting is stopped Adjusting the J point This...

Page 185: ... Reference The current QRS becomes the new reference QRS Automatic saving of reference QRS complexes The QRS reference is not saved during an ST alarm condition only the ST snapshot is saved If a new reference QRS complex is saved and there is no room for another complex then the oldest manual or automatic complex is erased You may want to manually erase QRS complexes to avoid automated erasing A ...

Page 186: ...ction is not available with combination monitoring This setting also determines the length of the ST trend report and you can select it from the Realtime View or the Trend View 1 Select the ST parameter window 2 Select Realtime View or Trend View 3 Select a value from the Trend Scales list ST trend display This feature is not available with combination monitoring Each QRS window displays the curre...

Page 187: ...sor Printing an ST trend report This selection is not available with combination monitoring The length of the ST trend report is the same as the Trend Scales setting for ST trends 1 Select the ST parameter window 2 Select Trend View 3 Select Print Page 4 To stop printing select Cancel Printing Ischemic burden This feature is not available with combination monitoring Ischemic burden provides additi...

Page 188: ... arrows ST alarm limits Depending on what has been selected in the Care Unit Settings for ST alarms you may set the ST alarm limits for a lead group for individual leads or for all leads relative to the patient s current measurements The leads associated with each lead group are as follows Anterior V1 V2 dV2 V3 dV3 V4 dV4 Inferior II III aVF Lateral V5 V6 dV6 I aVL The d in dV2 dV3 dV4 and dV6 abo...

Page 189: ...eads with the arrows and select Update Anterior Set limits for Inferior leads with the arrows and select Update Inferior Set limits for Lateral leads with the arrows and select Update Lateral QT detection This selection is not available with combination monitoring or TRAM With Multi lead QT QTc Analysis license only The administration of some drug types can prolong the QT segment Monitoring QT seg...

Page 190: ...larm On 5 Adjust the alarm limits with the arrows Selecting QT or QTc for analysis This selection is not available with combination monitoring or TRAM 1 Select the HR parameter window 2 Select the QT tab 3 Select QT or QTc from the Show list 190 CARESCAPE Modular Monitors 2062971 001 ...

Page 191: ...equencies for example interference with the signal waveform leading to respiration rate readings inconsistent with the patient s true respiration rate If you notice this use another form of respiration monitoring for instance end tidal CO2 WARNING When using an electrosurgery unit note that the measurement cables do not incorporate means to protect against burns in case of a defective ESU return e...

Page 192: ...rement on the monitor Respiration measurement limitations PSM Impedance respiration is intended for patients over three years old Electrical devices such as electrosurgery units and infrared heaters that emit electromagnetic disturbance may cause artifacts or disable the respiration measurement completely Movement artifacts shivering and interference from the heart may interfere with the respirati...

Page 193: ...d decreases the quality of electrode signal When preparing the electrode sites avoid obvious layers of fat and major muscles 1 Shave any hair from the electrode site 2 Gently rub the surface of the skin to increase capillary blood flow 3 Clean the skin with alcohol or a mild soap and water solution to remove skin oil and dead or abraded skin cells 4 Dry the skin completely before applying the elec...

Page 194: ...ration lead is available with PDM only PDM Not available for 3 lead measurement If you are monitoring with a fixed lead 3 lead cable respiration can only be obtained from the lead for which the cable is manufactured For example if the cable is a fixed lead II cable as indicated by a label on the cable itself respiration can only be obtained from lead II PDM and TRAM Even though the same electrodes...

Page 195: ...ring respiration through the RL LL vector use a standard 5 or 6 leadwire electrode placement except place the RL electrode on the fifth intercostal space on the right side of the chest Impedance respiration lead between V5R and LL provides maximum respiration signal strength minimum noise artifact content and minimum cardiogenic artifact RL LL vector for abdominal breather IEC AAMI AHA Electrode p...

Page 196: ...asurement The respiration measurement does not start automatically so you must select it on 1 Select the impedance respiration parameter window 2 Select the Setup tab 3 Select Respiration Measurement On Selecting the respiration lead NOTE TRAM and PDM only In addition the RL LL respiration lead is available with PDM only 1 Select the impedance respiration parameter window 2 Select the Setup tab 3 ...

Page 197: ...n There is no respiration rate displayed during the relearning process When relearning is complete the Relearn Respiration message will clear and the respiration rate will be displayed The detection threshold and the waveform size update after the new respiration pattern is learned 1 Select the impedance respiration parameter window 2 Select the Setup tab 3 Select Relearn Respiration The detection...

Page 198: ...ctors Enabling the respiration cardiac artifact alarm NOTE PDM and TRAM only The cardiac artifact alarm can be enabled to display the Cardiac artifact message when the respiration rate is within 5 of the ECG heart rate It takes about 30 breaths before the module detects a cardiac artifact alarm condition 1 Select the impedance respiration parameter window 2 Select the Alarms tab 3 Select Cardiac A...

Page 199: ...s shown with a reference bar that corresponds to 100 meaning that the 100 selection uses the whole drawing area The bar is on the left in the waveform display Respiration measurement with PDM and TRAM Eight breaths are averaged and the average amplitude of the respiration waveform is found Detection sensitivity is automatically set at 40 of the average amplitude Sensitivity dotted lines displayed ...

Page 200: ...ion and expiration or set to AUTO PSM If the detection mode is AUTO the grid lines represent the minimum limits The limits in use may be a larger range The following is an example of correct detection Respiration detection is not dependent on the size of the waveform Size is for visual purposes only Why is the monitor detecting cardiac artifact as breaths The breath detection threshold is too low ...

Page 201: ...oblem is still not resolved check the monitor and the SpO2 module cable or sensor for proper functioning WARNING A pulse oximeter should not be used as an apnea monitor A pulse oximeter should be considered an early warning device As a trend toward patient deoxygenation is indicated blood samples should be analyzed by a laboratory CO oximeter to completely understand the patient s condition WARNIN...

Page 202: ...red when patient perfusion is low or signal attenuation is high WARNING B850 only CABLE COMPATIBILITY Tram 451N and Tram 851N modules require Nellcor Oxismart XL cables and sensors Older non Oxismart XL cables must not be plugged in to the SpO2 connector on these modules Use of non Oxismart XL cables may result in erroneous readings WARNING NEONATAL The display of inaccurate pulse oximetry SpO2 va...

Page 203: ... ambient light Electrical interference Electrosurgery Defibrillation May cause inaccurate reading for a short amount of time Excessive patient sensor motion Artifact can simulate an SpO2 reading so that the monitor fails to sound an alarm In order to ensure reliable patient monitoring the proper application of the probe and the signal quality must be checked at regular intervals Sensor placement I...

Page 204: ...ment sources to avoid missed SpO2 alarms SpO2 cautions CAUTION A damaged sensor or a sensor soaked in liquid may cause burns during electrosurgery CAUTION Prolonged monitoring or incorrect sensor application can cause skin irritation or impaired circulation It is recommended that you check the probe site every four hours more frequently in case of poor perfusion or neonatal patients Refer to the i...

Page 205: ...elines when using TruSignal sensors and cables Read the sensor instructions for use of the SpO2 sensor before using it Periodically inspect extension cables and sensors for damage Do not use damaged sensors Refer to the cleaning instructions in the instructions for use of reusable TruSignal sensors Do not use NIBP or constricting instruments on the same appendage as the SpO2 sensor Masimo SET tech...

Page 206: ...xhausted there is no further license granted by MASIMO and they must be discarded This device is covered under one or more patents as set forth at http www masimo com patents htm We recommend the use of Masimo SET sensors for use with Masimo technology Nellcor OxiMax technology and sensor measurement guidelines The following measurement guidelines apply to Nellcor OxiMax The SpO2 waveform correspo...

Page 207: ... manufacturer s instructions to position the sensor s 7 Attach the sensor s to the patient 8 Stabilize the sensor cable s to minimize sensor movement Checking the SpO2 measurement 1 Check that the red light is lit in the sensor 2 Check that the waveforms and parameter values are displayed when the sensor is connected to the patient SpO2 functional testers Some models of commercially available benc...

Page 208: ...The functional test device can then measure how accurately a particular pulse oximeter monitor is reproducing that calibration curve Using the SpO measurement Primary and secondary SpO2 measurement sources It is possible to measure SpO2 from two different measurement sources simultaneously The primary SpO2 source is labeled SpO2 and the secondary SpO2 source is labeled SpO2 2 The following table s...

Page 209: ...te source The primary heart rate can be calculated from the ECG leads SpO2 measurement or invasive pressure waveform NOTE This setting adjusts the primary heart rate source for all of the hemodynamic parameters NOTE HR Alarms must be configured as Single to enable the SpO2 as the primary heart rate source NOTE Primary SpO2 measurement only SpO2 can be the Primary HR Source for all modules except t...

Page 210: ...ds to update the displayed waveform Audible alarms are delayed until an alarm limit violation occurs for at least 5 seconds Selecting the SpO2 averaging time NOTE PSM E MASIMO and PDM and TRAM with Masimo technology and Masimo sensors only The primary SpO2 measurement only You can have an average of the SpO2 measurement on screen instead of the beat to beat values and you can select how many secon...

Page 211: ...st Nellcor OxiMax Saturation Seconds alarm management NOTE PDM and TRAM with primary SpO2 measurement and the Nellcor option only The Saturation Seconds feature has a safety net designed for patients whose saturation is frequently outside the limits but does not remain outside the limits long enough for the Saturation Seconds limit to be reached When three or more limit violations occur within 60 ...

Page 212: ...fluctuate above and below an alarm limit re entering the acceptable range non alarm range several times During such fluctuation the monitor integrates the number of SpO2 saturation points both positive and negative until either the Saturation Seconds limit is reached or the saturation level returns to within the normal range and remains there When an SpO2 saturation value exceeds an alarm limit a ...

Page 213: ...ts Deactivating the SpO2 probe off alarm This feature is meant to be used when ending SpO2 monitoring It should not be used during active SpO2 monitoring This setting can be enabled during configuration If it has been enabled there will be a button on the SpO2 and SpO2 2 tabs that allows you to deactivate the alarm 1 Select the SpO2 parameter window 2 Select the SpO2 or SpO2 2 tab 3 Select Deactiv...

Page 214: ...strength may be determined by the amplitude of the SpO2 waveform SpO2 waveform quality NOTE Not for Masimo SET technology Under normal conditions the SpO2 waveform corresponds to but is not proportional to the arterial pressure waveform The typical SpO2 waveform can help the user find a sensor location with the fewest noise spikes Normal waveform If noise artifact is seen on the waveform because o...

Page 215: ... sensors contain LEDs that emit red light at a wavelength of approximately 663 nm and infrared light at a wavelength of approximately 890 or 940 nm The maximum optical output power for each LED is less than 15mW SpO2 measurement and interference These types of interference can influence the function of SpO2 Incorrect sensor application e g sensor placement on an extremity with a blood pressure cuf...

Page 216: ...c looking waveform caused by the electrosurgical unit s overwhelming interference It can result in grossly inaccurate pulse oximeter results Electrosurgical interference can be minimized by Making sure the pulse oximeter sensor is as far away from the return pad and operating site as possible Making sure the sensor is not between the return pad and operating site Keeping the power cord and sensor ...

Page 217: ...er connecting the SpO2 interface cable and sensor No SpO2 data is displayed due to two secondary SpO2 modules in place at the same time hardware failure or an unrecognized or defective sensor Make sure the accessories are compatible with the module Make sure the sensor is attached to the interface cable and the cable is connected to the module Make sure there is only one secondary SpO2 module conn...

Page 218: ...Pulse oximetry 218 CARESCAPE Modular Monitors 2062971 001 ...

Page 219: ...BP parameter to determine a blood pressure and may extend the time beyond the capabilities of the parameter WARNING Do not apply external pressure against the cuff while monitoring Doing so may cause inaccurate blood pressure values Use care when placing the cuff on an extremity used to monitor other patient parameters WARNING NIBP cuff inflation deflation may lead to inaccurate values from other ...

Page 220: ...the monitor screen before performing an NIBP determination WARNING Accuracy of NIBP measurement depends on using a cuff of the proper size It is essential to measure the circumference of the limb and choose the proper size cuff WARNING 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...

Page 221: ...teries or subclavian compression Compression of the cuff caused by shivering 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 th...

Page 222: ...ect NIBP Start NIBP Cancel or NIBP Auto Start NIBP Auto Stop from the monitor s main menu Preparing the NIBP patient connection 1 Select an appropriate NIBP cuff size for the patient 2 Connect the NIBP cuff hose to the module s NIBP connector 3 Position the NIBP cuff on the patient Place the cuff arrow over the brachial artery or whatever artery is being used Make sure that the cuff index line fal...

Page 223: ...e proportion of the cycling time since the last measurement while the distance between the end of the green bar and the last tick mark indicates the time remaining until the next measurement STAT or Venous Stasis The bar indicates the time that the mode will continue STAT holds multiple measurements for 5 minutes and Venous Stasis continues without measurements for 1 minute with infants and 2 minu...

Page 224: ...ation is not done during these 30 seconds but it will be done after the delayed auto measurement starts Examples with a 5 minute cycling time Completion with less than 30 seconds to the next scheduled measurement Completion after the next scheduled measurement should have started First auto measurement starts 4 59 00 First auto measurement completes 4 59 40 Second auto measurement starts 5 00 20 n...

Page 225: ... minutes the monitor automatically returns to the previously selected cycling interval or manual mode Starting or stopping a Stat NIBP measurement You can set the NIBP measurement to continue for five consecutive minutes 1 Select the NIBP parameter window 2 Select Start Stat 3 Stop the measurement by selecting Stop Stat Venous stasis NOTE PSM only The venous stasis mode initiates inflation and hol...

Page 226: ...When factors prohibit use of the upper arm the clinician must plan patient 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 Adult and child Infant Always measure patient s limb and select appropriately sized cuff according to size marked on cuff or cuff packaging When cuff sizes over...

Page 227: ...Setting the target NIBP inflation pressure NOTE PDM and TRAM only You can manually change the target inflation pressure for the first NIBP measurement 1 Select the NIBP parameter window 2 Check that Auto Initial Inflate is not selected 3 Select a value from the Init Pressure list Selecting the cuff inflation limits NOTE PSM only Black colored Adult Child cuff hoses and blue colored Infant cuff hos...

Page 228: ...until the next NIBP measurement is taken If the new measurement is outside the alarm limits the alarm is activated again NIBP recheck after alarm violation NOTE PDM and PSM only If the NIBP value exceeds the alarm limits and the NIBP alarm priority selection is Escalating a new measurement takes place automatically If the NIBP measurement is taken manually the recheck measurement is taken immediat...

Page 229: ...nfant The initial target pressure preset can be adjusted to a lower or higher initial target pressure PDM and TRAM use the DINAMAP Step Deflation technology During the deflation process the monitor measures two consecutive pulsations in cuff pressure If their amplitude differs by an acceptably small amount and the time interval between the pulsations matches the previous time intervals the pulsati...

Page 230: ...other deviations from ideal conditions e g cuff disturbances and greatly enhances the overall accuracy of the monitor NOTE NIBP values are based on the oscillometric method of non invasive blood pressure measurement taken with a cuff on the arm of adult and child patients and a cuff on the calf of infants The values correspond to comparisons with intra arterial values within ANSI AAMI SP10 and IEC...

Page 231: ...ation as few as four pressure steps may be necessary to complete the process When employing fewer pressure steps the system uses the stored information from the previous blood pressure determination to decide the best pressure steps to take The consistency of pulse sizes are measured to tell if the oscillations taken at a step are good and if more steps are needed If the current blood pressure rea...

Page 232: ...t compares two sequential pulses and uses information and statistics from previous pulses The performance in disturbance or artifact cases is comparable to DINAMAP Classic The measurements do not use ECG information The initial inflation pressure cannot be adjusted it is determined by the patient type adult child or infant The first determination initially pumps up to a target cuff pressure of 170...

Page 233: ...nitor 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 For more information refer to the technical specifications For PDM and PSM the monitor may be taking a control measurement If the measur...

Page 234: ...Non invasive blood pressure 234 CARESCAPE Modular Monitors 2062971 001 ...

Page 235: ...onductive material including earth WARNING Mechanical shock to an invasive blood pressure transducer may cause severe shifts in the zero balance and calibration and cause erroneous readings WARNING Repositioning the patient after a completed zeroing procedure may cause incorrect measurement values WARNING When connecting PDM or TRAM the loaded IP labels may affect the channel labeling of other alr...

Page 236: ... Dual BP BP CO BP or BP Dual Temp or E COP module or when the pressure transducer is disconnected from the or E COPSv E PSMP E PP E P or E PT module E modules A deactivated pressure channel does not release the assigned pressure channel To release an assigned pressure channel remove the module from the system PCWP Follow your care unit s policy and procedures for obtaining PCWP measurements includ...

Page 237: ...ecognizes cable connections activates the display for all the pressure channels used and the pressure values and appropriate waveforms are displayed 2 Make sure that all the transducers are zeroed correctly Invasive pressure measurement on the monitor screen The invasive pressure channel labels are as follows Label Description Art Arterial pressure ABP Arterial blood pressure Fem Femoral arterial ...

Page 238: ...l use the height of two upper parameter windows Using the invasive pressure measurement Invasive pressure measurement mapping Invasive pressure measurements are mapped to one of eight B850 seven B650 or six B450 invasive pressure channels as follows Pressure channel Pressure measurement source P1 PDM Masimo PDM Nellcor TRAM 451 TRAM 451N5 TRAM 451M E PSMP P2 PDM Masimo PDM Nellcor TRAM 451 TRAM 45...

Page 239: ...ucers Prior to monitoring zero transducers at the patient s phlebostatic axis Zeroing the pressure transducers is very important for accurate pressure measurements To avoid inaccurate measurements you must zero the pressure transducers Before measuring invasive pressures Before initiating treatment changes reliant upon pressures data When using a new transducer or tubing After reconnecting the tra...

Page 240: ...stopcock to the patient 7 Check that pressure numerics display on screen Selecting an invasive pressure channel label One channel label can only be mapped to one channel at a time If you select a channel label that is already mapped to another channel the other channel s label will change to the default value 1 Select the invasive pressure parameter window 2 Select the Setup tab 3 Select a channel...

Page 241: ... use the 40 Hz pressure filter 1 Select the invasive pressure parameter window 2 Select the Setup tab 3 Select a numeric value from the Filter Hz list The smaller the filter value the greater the degree of filtering that occurs Selecting the displayed invasive pressure format You can choose to display systolic diastolic or mean pressure values in different formats 1 Select the invasive pressure pa...

Page 242: ...le beep frequency changes according to increasing and decreasing SpO2 values If the setting is set to Only SpO2 other beep sounds are not affected by the changing SpO2 values For more information see the CARESCAPE Modular Monitors Supplemental Information Manual Selecting the ventilation mode NOTE E modules only This setting affects the respiration filter 1 Select the invasive pressure parameter w...

Page 243: ...diac assist device is no longer used Failure to do so could result in incorrect pulse rate readings CAUTION PATIENT HAZARD If you choose to trigger the balloon pump from the monitor contact the balloon pump manufacturer directly for interface requirements as they vary among manufacturers Some trigger modes on certain balloon pump devices may not be compatible with the GE analog output signal and u...

Page 244: ...3 Select Show Cursor 4 You can move the cursor to specific points with the arrows 5 To save the pressure value at the cursor point select Save 6 To stop showing the cursor deselect Show Cursor Setting an arterial invasive pressure disconnection alarm You can set an additional alarm to activate if the mean pressure falls below 10 mmHg 1 33 kPa The arterial disconnection alarm also applies to channe...

Page 245: ...ackage no automatic SPV or PPV are available only the manual SPV can be used NOTE The SPV and PPV measurements are reliable for mechanically ventilated patients with no arrhythmias and when the arterial site selected as the SPV source is providing reliable readings Changing the SPV source 1 Select the invasive pressure parameter window 2 Select Art ABP Fem or UAC 3 Select the Setup tab 4 Select SP...

Page 246: ...start an SvO2 procedure select SvO2 To start a pulmonary capillary wedge pressure procedure select Wedge To start a cardiac output procedure select C O In the Catheter Insertion menu you can also freeze or restart the waveforms and print them To freeze the moving waveforms select Freeze Waveforms At any time select Restart Waveforms to restart the waveforms To print the catheter insertion waveform...

Page 247: ...s select Print PA Waveform To stop printing select Stop Printing or Cancel Printing 6 Inflate the catheter balloon when the Manually Freeze Adjust when ready message displays 7 Select Freeze Adjust once the PCWP waveform is displayed The Wedge Complete message displays 8 Deflate the balloon 9 To adjust the PA wedge value move the cursor up or down with the PCWP Cursor arrows 10 To save the PCWP va...

Page 248: ...t Waveforms or Cancel Printing The PA wedge report contains 20 seconds of waveform data displayed at a waveform speed of 12 5 mm s Starting a new PA wedge measurement You can clear the current wedge measurement and start a new one 1 Select PA invasive pressure parameter window 2 Select Setup 3 Select Wedge 4 Select Restart Wedge Other selections in the Wedge menu There are also two other selection...

Page 249: ...modules displayed values General site name for the specific invasive pressure channels 1 to 8 P1 to P8 Mean Systolic diastolic mean Arterial Art Pulse rate systolic diastolic mean Pulse rate systolic diastolic mean Arterial blood ABP Pulse rate systolic diastolic mean Pulse rate systolic diastolic mean Central venous CVP Mean Systolic diastolic mean Femoral arterial Fem Pulse rate systolic diastol...

Page 250: ...trigger the balloon pump use the 40 Hz pressure filter 4 Primary displayed ECG lead If the balloon pump triggers off the R wave of the ECG review the patient s ECG leads and place the one with the greatest amplitude in the top primary position on the monitor display 5 Pacemaker detection If the patient has a pacemaker be sure the pacemaker detection is turned on Failure to turn pacemaker detection...

Page 251: ...tole is greater than the augmented diastole the displayed systole equals the patient systole Art 160 45 1 3 or more timing Diastolic numerics The displayed diastole switches between the balloon end diastole and the patient end diastole Systolic numerics The displayed systolic numerics switch between the augmented diastole and patient systole 2062971 001 CARESCAPE Modular Monitors 251 ...

Page 252: ...phlebostatic axis 80 Systolic and diastolic pressure values do not display This may be due to the Smart BP option detecting artifact When artifacts are detected only Mean values are displayed Check the patient Turn off the Smart BP if required Invasive pressure waveform is displayed but no numeric values are displayed Zero the channel Invasive pressure numeric values are displayed only for success...

Page 253: ...etric and auscultated blood pressure readings indicating different values The three measurement methods use different technologies Auscultation and oscillometric are both indirect methods of measuring blood pressure In auscultation changes in arterial sounds during cuff deflation are related to systolic and diastolic pressure With oscillometric measurement changes in measured pressure oscillations...

Page 254: ...iratory artifact on the PA waveform use the manual method for wedge measurement Why is monitor displaying the Deflate the balloon message after the balloon was inflated The monitor must detect a 30 decrease in waveform amplitude to initiate a wedge If the waveform does not change accordingly the message will continue to be displayed Use the manual method for PA wedge measurement Why is the display...

Page 255: ...llowing Proper contact of the ESU return electrode to the patient ESU return electrode near the operating area Measurement electrodes leadwires and probes far from the surgical site and the ESU return electrode WARNING When using a dual temperature cable make sure to turn the cable s selection switch to the correct position 400 WARNING The response time of the temperature measurement system when u...

Page 256: ...nel is activated when the module detects a temperature probe A temperature channel is deactivated when a temperature probe is detached from the module A deactivated temperature channel does not release the assigned temperature channel To release an assigned temperature channel remove the module from the system Temperature measurement setup Temperature equipment to patient connection 1 Module with ...

Page 257: ...s The default temperature measuring site labels are as follows T1 T2 general label Skin skin T3 T4 general label AirW airway Eso esophageal Room room Naso nasal Myo myocardial Tymp tympanic Core core Rect rectal Surf surface Axil axillary Blad bladder Using the temperature measurement Temperature mappings Temperature measurements are mapped to one of five temperature channels as follows Temperatur...

Page 258: ...els you can configure up to six user defined channel labels in the care unit settings See the CARESCAPE Modular Monitors Supplemental Information Manual for details Displaying the delta value between two temperature channels NOTE This selection is available when two temperatures are displayed in the same temperature parameter window 1 Select the temperature parameter window 2 Select Show Tx Ty e g...

Page 259: ... patient safety and to protect the device during defibrillation and electrosurgery The monitor automatically calibrates the temperature measurements at startup every 10 minutes for PSM and every minute for PDM and TRAM Temperature troubleshooting Problem Solution Temperature measurement fails Check that the probe adapter is properly connected to the acquisition module Check that the probe is prope...

Page 260: ...Temperature 260 CARESCAPE Modular Monitors 2062971 001 ...

Page 261: ...ctrodes leadwires and probes far from the surgical site and the ESU return electrode WARNING The cardiac output measurement results may be erroneous during electrosurgery WARNING During atrial fibrillation the C O CCO readings may be erroneous C O CCO cautions CAUTION The C O time stamp indicates the time at which the C O value was received by the monitor from the connected device In cases when th...

Page 262: ...Catheters and these settings are password protected Blood temperature measurement Tblood is provided from any supported acquisition module that provides C O measurements The Unity Network Interface Device ID can only be used if no other acquisition module provides C O Depending on the module used not all cardiac output measurements and settings are available to view or change C O measurement setup...

Page 263: ...erature bath probe 5 Injectate fluid 6 Injectate syringe 7 Proximal injectate port 8 PA distal port 9 Balloon inflation valve 10 Swan Ganz thermodilution catheter 11 Balloon C O module key There is one C O module key on the E COP and E COPSv modules Start C O Starts and stops the cardiac output measurement Preparing the C O measurement 1 Connect the C O cable to the acquisition module thermistor a...

Page 264: ...ics from the Measurement tab 3 Set the patient s height and weight The BSA value is calculated automatically once the height and weight have been selected 4 You can return to the Cardiac Output menu by selecting Previous Menu C O measurement modes C O measurements can be taken using the automatic or manual measurement modes Both measurement modes allow you to use up to six C O measurements for cal...

Page 265: ... 10 To take another C O measurement wait for this message to display before injecting the injectate PDM and TRAM Inject When Ready E modules Inject now Taking a manual C O measurement Measuring C O using the manual mode allows you to determine when to begin the injection procedure This mode may be preferred for patients with extreme blood temperature fluctuations or when the automatic mode is unab...

Page 266: ... Select the Measurement tab 3 Select Print The selection is available only if you have not confirmed the C O measurements Editing the C O average 1 Select the cardiac output parameter window 2 Select the Measurement tab 3 Select Edit Average 4 Check the selection boxes for those trials you wish to include in the C O average If you do not wish to include a trial ensure its selection box is not chec...

Page 267: ...he catheter packaging 5 Set the Computation Constant to match the value listed on the catheter packaging Ice Cold temperature below 6 C Room Temp temperate above 18 C Any other injectate temperature value between 6 C and 18 C Selecting the C O injectate probe type NOTE PDM and TRAM only E modules detect the type of injectate probe automatically 1 Select the cardiac output parameter window 2 Select...

Page 268: ...arm 1 Select the cardiac output parameter window 2 Select the Setup tab 3 Select Tblood Alarm 4 Set the Tblood alarm limits as required 5 You can return to the cardiac output menu by selecting Previous Menu Adjusting the SvO2 from the cardiac output menu NOTE E modules and catheters supporting the SvO2 measurement only 1 Select the cardiac output parameter window 2 Select the Setup tab 3 Select Sv...

Page 269: ...drop in blood temperature as the injectate mixes with the blood The peak of the curve indicates the maximum difference in the patient s baseline blood temperature and the temperature of the injectate solution As the mixture passes through the catheter and then out the pulmonary artery the temperature difference decreases as indicated by the curve returning to the baseline A spike is displayed at t...

Page 270: ... be colder than blood temperature Keep the handling and waiting time with a filled syringe before injection as short as possible Warm injectate may lead to erroneous C O values The probe can be a bath probe continuously measuring the cooling bath temperature or the infusion bag temperature Alternatively a flow through probe is used for a closed injectate delivery With an in line system the display...

Page 271: ...ture cable The pulmonary artery catheter may be damaged Replace it What if the cardiac output values are inaccurate When in line is being used along with iced injectate the initial temperature displayed will be the room temperature However when the solution is injected the temperature displayed will decrease Technique It is important to understand the technique used in performing a cardiac output ...

Page 272: ...t s baseline cardiac output may be calculated even if no injection was performed There is no differentiation between temperature change caused by breaths versus injections It simply looks for a change in baseline temperature Baseline blood temperature As little as a half a degree Celsius change in blood temperature due to respiratory noise may cause a C O value to be displayed when an injection ha...

Page 273: ...n injected There may be a change in the patient s blood temperature consistent with an injection Check the patient and the C O setup both the settings and the cables Check for a significant amount of respiratory variation and for rapid IV solution infusion either of which may influence the baseline temperature It may be necessary to use the manual cardiac mode rather than the automatic mode 206297...

Page 274: ...Cardiac output 274 CARESCAPE Modular Monitors 2062971 001 ...

Page 275: ...s WARNING When using an electrosurgery unit note that the measurement cables do not incorporate means to protect against burns in case of a defective ESU return electrode To avoid burns at the monitor measurement sites ensure the following Proper contact of the ESU return electrode to the patient ESU return electrode near the operating area Measurement electrodes leadwires and probes far from the ...

Page 276: ...ty E COPSv 2 Optical module 3 Optical connector 4 Swan Ganz thermodilution catheter Checking the SvO2 measurement 1 Check that the SvO2 value is displayed when the catheter is inserted the measurement has been started and the Warming up message has disappeared 2 Check the position of the catheter regularly 3 Calibrate in vivo and update the Hb value at least every 24 hours SvO2 measurement on scre...

Page 277: ...alibration steps 1 Connect the optical module to the module and let it warm up for 20 minutes 2 Aseptically expose the catheter s optical connector 3 Connect the catheter to the optical module 4 Select the SvO2 parameter window 5 Select the Calibration tab 6 If replacing an existing catheter select New Catheter 7 Select In Vitro Calibration Calibrate to perform in vitro calibration 8 Select Start ...

Page 278: ...e laboratory results a Select a value for Lab ScvO2 b Select a value for Lab Hb 6 Select Save Lab Values to complete calibration Updating the Hb value for SvO2 measurement The patient s Hb value should be updated at least every 24 hours as it affects the SvO2 measurement The Update Hb selection is active after in vivo calibration has been completed with the Save Lab Values 1 Select the SvO2 parame...

Page 279: ... to a photodetector The light is electrically transmitted and analyzed From the amount of reflected light it is possible to measure the amount of light absorbed by hemoglobin and oxyhemoglobin resulting in the SvO2 value The SvO2 value is displayed as a percentage Automatic gain control The intensity of the red and infrared signals can be amplified by four different gains The gain is selected auto...

Page 280: ...Mixed venous oxygen saturation SvO 280 CARESCAPE Modular Monitors 2062971 001 ...

Page 281: ... from the patient s airway while nebulized medications are being delivered WARNING Handle the water trap and its contents as you would any body fluid Infectious hazard may be present WARNING Since sample gas may contain anesthetic agents make sure that it is not released in the room Connect exhaust to a scavenging system to prevent exposure to anesthetic agents WARNING Strong scavenging suction ma...

Page 282: ...lation WARNING A failure in zeroing or calibrating airway gases may cause inaccurate readings WARNING Ensure that the compact airway modules and CARESCAPE respiratory modules are in vertical position when used Tilting them may result in erroneous readings WARNING Since calibration gas contains anesthetic agents always ensure sufficient ventilation of the room during calibration WARNING Do not wash...

Page 283: ...d air or gas to any outlet or tubing connected to the monitor Pressure may destroy sensitive elements Airway gases measurement limitations E modules can be used within their specified performance range with OR PACU ICU and ED software packages E miniC is not suitable for use with patients weighing less than 5 kg 11 lbs Airway gases points to note If anesthetic agents are present use GE Healthcare ...

Page 284: ... the exhaust gas is about 20 Compact airway modules The message Sample line blocked may result if you attach the sampling line to the water trap after the monitor has completed the self check for the module Attach the sampling lines to the water trap before turning on the monitor Airway gases measurement setup Airway gases equipment to patient connections with CARESCAPE respiratory modules 1 CARES...

Page 285: ...ng line 3 Airway adapter with sampling line connector 4 Sampling line connector on the water trap 5 Sample gas outlet gas exhaust 6 Returning sample gas to patient circuit Airway gases equipment to patient connections with compact airway modules critical care setup 1 Compact airway module 2 Gas sampling line 2062971 001 CARESCAPE Modular Monitors 285 ...

Page 286: ...onnected Automatic agent identification is activated in those modules that have this feature 5 Wait until the message Calibrating disappears 6 Connect the sampling line to the airway adapter or the airway adapter to the ventilator circuit Position the adapter with the sampling port upwards to minimize the amount of condensed water possibly entering the sampling line 7 Check that the airway adapter...

Page 287: ...ing line connector on the water trap 4 Water trap container 5 Connectors for Patient Spirometry tubes 6 Gas exhaust connector for the gas exhaust line Compact airway module connectors 1 D fend water trap with washable container 2 Sampling line connector on the water trap 3 Water trap latch 2062971 001 CARESCAPE Modular Monitors 287 ...

Page 288: ... all hospital patients E miniC is indicated for monitoring patients weighing more than 5 kg 11 lbs The device is indicated for use by qualified medical personnel only Airway gases alternative patient connections With E sCAiO E sCO E CAiO E CO and E miniC use an airway adapter and a sampling line With E sCAiOV E sCOV E CAiOV E CAiOVX E COV and E COVX modules use the D lite Pedi lite sensor and a ga...

Page 289: ...er 4 Sample line 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 Checking the airway gases measurement 1 Check that the water trap container is empty 2062971 001 CARESCAPE Modular Monitors 289 ...

Page 290: ...ments MAC x x n a n a MACage x x n a n a Balance gas x x n a n a Gas exchange n a n a n a n a Patient Spirometry n a x n a x Respiration rate x x x x Sampling method Sidestream x x x x Mainstream n a n a n a n a 1 automatic compensation NOTE The measured N2O value is not displayed Airway gases parameters compact airway modules Parameter E CAiO E CAiOV E CAiOVX E CO E COV E COVX CO2 x x x x x x O2 ...

Page 291: ...s not displayed Airway gases parameters E miniC Parameter E miniC CO2 x O2 n a N2O x1 AA n a Agent ID n a Additional measurements MAC n a MACage n a Balance gas n a Gas exchange n a Patient Spirometry n a Respiration rate x Sampling method Sidestream x Mainstream n a 1 automatic compensation NOTE The measured N2O value is not displayed E miniC requires manual selection from the monitor menu to com...

Page 292: ... mm s 12 5 mm s 25 mm s and 50 mm s The smaller the value the slower the sweep speed Setting CO2 limit alarms 1 Select a gas related parameter window 2 Select the CO2 tab Alarms 3 Set high and or low limit values for EtCO2 FiCO2 and Respiration Rate select the parameter and then set the limits Deactivating the apnea alarm NOTE This feature is meant to be used when ending CO2 monitoring It should n...

Page 293: ...level NOTE E miniC and OR PACU ED and ICU software packages only NOTE FiO2 and N2O compensations must be selected manually when E miniC is used The presence of a large concentration of oxygen causes the CO2 level appear lower than the actual value Use this option to compensate for the presence of O2 1 Select a gas related parameter window 2 Select the CO2 tab Setup 3 Select an option from the FiO2...

Page 294: ...g O2 alarms 1 Select a gas related parameter window 2 Select the O2 tab Alarms 3 Check that the required alarm EtO2 or FiO2 is on and set its high and or low limit values Using the CARESCAPE respiratory modules and compact airway modules for AA and N O measurement Selecting the agent scale Every anesthetic agent has its own default scale that the monitor uses when detecting the agent You can chang...

Page 295: ...e to the scavenging system Scavenging through the ventilator reservoir 1 Connect an exhaust line to the sample gas outlet gas exhaust on the module s front panel 2 Attach the other end of the line to the ventilator reservoir Make sure that the reservoir tube diameter is at least 2 to 3 times larger than the exhaust line Scavenging through the anesthesia gas scavenging system Anesthesia machines ar...

Page 296: ...nitor warm up for 30 minutes 2 Attach a regulator to the calibration gas cylinder 3 Attach a new sampling line to the water trap Connect the other end of the sampling line to the regulator on the gas container 4 Select a gas related parameter window Calibration tab 5 Wait until the messages Zero OK and Feed gas appear after each gas on the screen 6 Open the regulator and feed gas until the message...

Page 297: ...E CAiOVX modules differs from that of the other compact airway modules and the CARESCAPE respiratory modules A number of flow restrictors have been changed to create a bigger pressure difference with ambient pressure in the gas sensors The sample flow is however approximately the same 200 ml min A larger pressure difference makes the deformations of the gas concentration curves less sensitive to h...

Page 298: ...ven the monitor shows normal MAC even if MACage has been selected NOTE The MAC value displayed by the monitor is that of exhaled air and it does not always correspond to the amount of anesthetic in the patient s organs CAUTION Patient specific MAC is affected by several factors such as patient age and body temperature MAC and MACage The minimum alveolar concentration MAC concept is based on the as...

Page 299: ...alues Mapleson W W Effect of age on MAC in humans a meta analysis Br J of Anaesthesia 1996 76 179 185 Rampil I J Zwass M Lockhart S Eger E I II Johnson B H Yasuda N Weiskopf R B MAC of I653 in surgical patients Anesthesiology Tram Rac71 3A A269 September 1989 Scheller M S Partridge B L Saidman L J MAC of sevoflurane in humans and the New Zealand white rabbit Anesthesiology 1987 67 A373 ISO21647 20...

Page 300: ... 1 MAC 3 yrs Halothane 0 27 0 14 0 51 Enflurane 0 61 0 31 1 15 Isoflurane 0 41 0 21 0 78 Sevoflurane 0 73 0 37 1 40 Desflurane 2 09 1 1 4 1 ET balance gas CARESCAPE respiratory modules and compact airway modules You can obtain a calculated value for balance gas EtBal End tidal balance gas is the percentage of gas concentration not measured by the gas sensors It is displayed in a parameter window w...

Page 301: ...ow must be increased Anesthetic agent concentration in the circuit is affected by patient uptake breathing system volume and the fresh gas flow It quantifies the speed of wash in and wash out anesthetic agents Basics of CO measurement Normal CO2 waveform The CO2 waveform is referred to as capnogram and it reflects the different stages in breathing The capnogram of a healthy patient under controlle...

Page 302: ...ram during expiration are related to the sidestream gas sampling the continuous gas flow to the Y piece and patient s cardiac contractions which cause intra thoracic pressure changes and therefore flow variations The alterations in expired CO2 waveform are cardiogenic movements of exhaled and circuit gas at the sidestream gas sampling site When the respiratory gas flow drops below the gas sampling...

Page 303: ...th in real time and as a trend The patient oxygen provides breath by breath information about the breathing circuit alveolar ventilation and some vital indicators of adequate oxygenation Oxygram is a mirror image of a capnogram in a steady state in normal patient It is a graphic presentation of changes in O2 concentrations in the airway gas The oxygram reflects the oxygen uptake from the alveoli T...

Page 304: ...or intubation tube and the airway adapter In intensive care the moisture exchanger must be replaced at least every 24 hours Place all airway adapter ports upwards with a 20 to 45 tilt to prevent condensed water from entering the sensor interior and the tubings The airway adapter should be emptied of clearly visible water droplets or replaced with a dry and clean adapter If active humidification is...

Page 305: ...intained constant The lower the fresh gas flow rate the longer the time required to reach the effect of a change in the fresh gas settings Airway gases troubleshooting Problem Solution Airway gas values are too low Check the sampling line and connectors for leakage Check the patient status Airway gas values are too high Check the sampling line for blockage Check the patient status Module does not ...

Page 306: ...ircuit hypoxia disconnection Why is the EtCO2 value considerably lower than the CO2 partial pressure determined 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 corre...

Page 307: ...dings WARNING Remove the airway sampling line from the patient s airway while nebulized medications are being delivered WARNING Handle the water trap and its contents as you would any body fluid Infectious hazard may be present WARNING Since sample gas may contain anesthetic agents make sure that it is not released in the room Connect exhaust to a scavenging system to prevent exposure to anestheti...

Page 308: ... monitoring devices should not be used in close proximity to wireless networking equipment or in the presence of strong electromagnetic fields such as those generated by radio station transmitters citizens band radios cellular phones etc Using a CAPNOSTAT or CapnoFlex LF sensor under the above conditions may cause one or all of the following to occur Artifact may be induced on the capnogram The CO...

Page 309: ... the atmospheric pressure correctly will lead to inaccurate CO2 readings in mmHg and kPa CO2 cautions CAUTION Do not apply pressurized air or gas to any outlet or tubing connected to the monitor Pressure may destroy sensitive elements CO2 points to note Make sure that you are using a water trap that is compatible with the module Dual CO2 AquaKnot CAPNOSTAT Mainstream no water trap CapnoFlex LF CO2...

Page 310: ...monitor s atmospheric pressure setting is correct 4 Check the monitor screen If the message Check calibr adapter appears perform adapter calibration 5 Position the adapter and sensor in upright position in the patient breathing circuit as close to the patient as possible Calibrating the CAPNOSTAT Mainstream sensor Sensor calibration should be performed whenever the message Calibrate sensor appears...

Page 311: ...n should be performed whenever the message Check calibr adapter appears 1 Place the sensor and adapter away from all sources of CO2 including the patient s exhaled breath your exhaled breath and ventilator exhaust valves 2 With the adapter connected to the sensor and the sensor connected to the monitor and when used all sidestream tubing attached and the pump turned on select the gases parameter w...

Page 312: ...thin 60 seconds on the monitor display to ensure that the monitor recognizes blockages 8 Remove the sample line from the CapnoFlex LF module and reinsert it to return the module to normal operation 9 Connect the sample line to the patient s breathing circuit Calibrating the CapnoFlex LF adapter CapnoFlex LF adapter calibration should be performed whenever the message Check calibr adapter appears 1...

Page 313: ...the sidestream setup with Dual CO2 module 1 Connect the sidestream adapter tubing to the inlet connector on the module 2 Connect the scavenging tube to the exhaust connector if N2O or volatile agents are used 3 Attach the 12 7 cm 5 in adapter tubing connector to the airway adapter 4 Secure the water trap to the adapter tubing 5 Connect the nasal cannula or sample line to the water trap 6 Snap the ...

Page 314: ...s exhaled breath your exhaled breath and ventilator exhaust valves 2 With the cable connected to the module select a gas related parameter window Calibration 3 Place the sensor on the cell marked 0 and select Start Calibrating 4 After the message Zeroed appears remove the sensor from the 0 cell and attach it to the cell marked REF The measured EtCO2 value appears in the Connect sensor to REF cell ...

Page 315: ...s are 0 625 mm s 50 mm s 12 5 mm s 25 mm s and 50 mm s The smaller the value the slower the sweep speed Setting CO2 limit alarms 1 Select a gas related parameter window 2 Select the CO2 tab Alarms 3 Set high and or low limit values for EtCO2 FiCO2 and Respiration Rate select the parameter and then set the limits Deactivating the apnea alarm NOTE This feature is meant to be used when ending CO2 mon...

Page 316: ...o compensate for the presence of O2 1 Select a gas related parameter window 2 Select the CO2 tab Setup 3 Select an option from the FiO2 level list Selecting the N2O level NOTE With the anesthetic agent measurement license only Available for OR PACU or ICU software packages only The presence of N2O causes the CO2 value to appear higher than the actual value Use this option to compensate for the pre...

Page 317: ...tems The gas exhaust may be scavenged using the scavenging adapter package 1 Remove the exhaust adapter and tube from the package 2 Attach the connector end of the exhaust tube to the module outlet marked EXHAUST 3 Install the exhaust adapter into the gas scavenging system of the anesthesia delivery system following the anesthesia machine manufacturer s recommended procedure 4 Drape the exhaust tu...

Page 318: ...CO2 concentration The monitor automatically calculates and display the EtCO2 in numbers EtCO2 approximates the alveolar CO2 concentration because it is measured when the patient exhales virtually pure alveolar gas 1a and 1d inhalation 1b and 1c exhalation EtCO2 value EtCO2 value mmHg Indicates 4 5 to 5 5 34 mmHg to 41 mmHg normocapnia 4 30 mmHg hypocapnia 6 45 mmHg hypercapnia Dips in capnogram Th...

Page 319: ...uate alveolar ventilation of a patient can be maintained by monitoring the end tidal carbon dioxide and oxygen concentrations and adequacy of ventilation can be maintained by monitoring airway pressures volumes and spirometry loops Alveolar minute ventilation 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 i...

Page 320: ...he inspiratory and expiratory limbs of the breathing system are useful for collecting condensed water from the breathing system during long lasting anesthesia or mechanical ventilation with active humidification system AquaKnot with the Dual CO2 Always use the Aqua Knot water trap with the Dual CO2 module The water trap holds 7 cc of water The arrow on the Aqua Knot shows the direction of the gas ...

Page 321: ...ck that the Aqua Knot water trap in Dual CO2 is not occluded Why can we see dips in the capnogram during expiration The dips seen in the capnogram during expiration are related to the sidestream gas sampling the continuous gas flow to the Y piece and patient s cardiac contractions which cause intra thoracic pressure changes and therefore flow variations Why is the EtCO2 value considerably lower th...

Page 322: ...CO2 with CAPNOSTAT Mainstream CapnoFlex LF and Dual CO2 modules 322 CARESCAPE Modular Monitors 2062971 001 ...

Page 323: ...ays check the sensor type selection from the monitor Sensor Type Adult or Pediatric Patient Spirometry cautions CAUTION Never connect the loose end of the gas sampling line to the Patient Spirometry connector as this may break the spirometry unit The Patient Spirometry connector is meant for the Patient Spirometry tube only CAUTION Do not apply pressurized air or gas to any outlet or tubing connec...

Page 324: ...on Module Use with monitor E sCAiOV B850 B650 B450 E CAiOV E CAiOVX B850 B650 Patient Spirometry measurement setup Patient Spirometry equipment to patient connection 1 E sCOV or E sCAiOV module With B850 and B650 you can also use the compact airway modules E COV E COVX E CAiOV or E CAiOVX 2 Gas sample gas sampling line connector on the water trap 3 Gas sampling and spirometry tubes 4 D lite Pedi l...

Page 325: ...te sensor 4 Connect the other end of the gas sampling line to the sampling line connector on the module s water trap 5 Make sure that the connections are tight 6 Select the correct sensor type 7 Connect the D lite Pedi lite between the Y piece and the intubation tube in the breathing circuit Checking the Patient Spirometry measurement 1 Check that the water trap is empty 2 Occlude the sampling lin...

Page 326: ...ameter window 2 Select Setup 3 Select an option from the Scaling Speed list Selecting the Patient Spirometry scales You can change the Vol Scale ml Paw Scale and Flow Scale l min unless the automatic scaling is in use Changing Spirometry scales affects Paw and Flow waveform scales and Paw Vol and Flow Vol loop scales With Vol scaling type in use all scales will change when you change one With Inde...

Page 327: ...anics and whenever major changes in the patient s status occur Press the Save Loop module key or 1 Select the Patient Spirometry parameter window 2 Select Loops Save Loop The monitor automatically displays the first saved loop as a reference loop You can save up to six pairs of loops If you save another pair of loops after the sixth one the second oldest reference loop is automatically erased Sele...

Page 328: ...rding to your needs 1 Select the Patient Spirometry parameter window 2 Select MV Vent Alarms 3 Set the alarm limits NOTE If the feature is not active the alarm limits are greyed out Select Alarm On to set the alarms NOTE MV Vent Alarms cannot be selected off except when an interfaced device is used NOTE To enable apnea and technical alarms from the ventilator select the Ventilator Apnea and Techni...

Page 329: ... pressure sensor inside the monitor This measurement method means that there is no gas flow in the double lumen tube but only pressure pick up A respiratory gas sampling line connected to the D lite Pedi lite completes the monitoring system Gas sampling is important to enable compensation of the effect of different gas viscosities on tidal and minute volume calculations Patient Spirometry paramete...

Page 330: ...he inspiratory and expiratory time I E Pressure volume loop Paw Vol loop Flow volume loop Flow Vol loop Airway pressures Airway pressure waveform on the right and pressure volume loop on the left x Paw y Vol 1 Ppeak 2 Pplat 3 Pmean 4 PEEPe 5 PEEPtot 6 PEEPi PEEPtot PEEPe NOTE PEEPe and PEEPi not available in OR and PACU software packages PEEPtot NOTE The following loop illustrates how PEEPtot PEEP...

Page 331: ...tilation or patients with flow limitation Dynamic PEEPi is measured continuously and displayed as a digit but it is also presented graphically in the flow waveform and in loops x1 Time x2 Vol y Flow The clinical significance of PEEPi is in detecting both the respiratory and hemodynamic side effects Respiratory side effects Barotraumas Muscle fatigue Decreased compliance Reduced oxygen delivery Inc...

Page 332: ...wer x Time y Paw 1 PEEPtot 2 End expiratory pressure hold 3 Expiratory flow I E ratio I E ratio is an expression of the relationship of inspiration time to expiration time A typical value 0 5 means that the expiration time is twice the inspiration time The following examples illustrate the difference between I E durations of 1 2 and 1 3 If respiration rate is 10 breaths min respiration cycle 6 sec...

Page 333: ...tra abdominal pressure bleeding ascites Decreased compliance indicates a worsening ventilatory status Typical compliance x Paw y Vol Low compliance x Paw y Vol Airway resistance Raw Airway resistance expresses the relationship between the pressure difference across the airway between the mouth and the alveoli and the rate at which gas is flowing through the airway An increasing airway resistance u...

Page 334: ...relationship between pressure and volume The Flow Vol loop indicates the relationship between flow and volume Paw Vol phases x1 Paw cmH2O y1 Vol ml x2 Time y2 Paw 1 Start of inspiration 2 Inspiration 3 Pause 4 Expiration Normal Paw Vol loop The shape of the Paw Vol loop depends on the patient s respiratory status and the ventilation mode used The normal Paw Vol loop appears if only a small pressur...

Page 335: ...atric loops with a shape that is similar to that of adult loops Typically High airway pressure small diameter of the tube Low compliance Insp Exp leak around tube loop remains open x Paw y Vol Flow Vol phases Flow Vol loop illustrates the relationship between flow and volume Inspiratory flow shows the type of flow pattern used by the ventilator and expiratory flow indicates the resistance during e...

Page 336: ...accurate and trouble free operation of the measurement The D lite Pedi lite sensor is placed close to the patient s airway remember to use D lite for patients whose tidal volume is 15 ml to 2000 ml and Pedi lite for patients whose tidal volume is 15 ml to 300 ml Remember to select the correct sensor type Humidity condensing in the Patient Spirometry ports of the D lite Pedi lite sensor may increas...

Page 337: ...ne is not kinked Values seem unstable Remove the D lite Pedi lite and shake drops away Check that the connectors on the D lite Pedi lite are intact and that connections are tight Strong vibrations in the loop Check the patient status Check the patient and system for water or secretions Why do the monitor and the ventilator show a different compliance value The monitor measures directly at the endo...

Page 338: ...Patient Spirometry 338 CARESCAPE Modular Monitors 2062971 001 ...

Page 339: ...s and Patient Spirometry measurements WARNING The presence of Helium or Xenon in the breathing circuit causes incorrect measurement values WARNING Make sure you select the correct sensor type for the patient D lite for adult patients Pedi lite for pediatric patients WARNING Always check the sensor type selection from the monitor Sensor Type Adult or Pediatric WARNING If the expiration gas flow dur...

Page 340: ...onnected to the monitor Pressure may destroy sensitive elements Gas exchange measurement limitations This measurement is not available in the NICU software package E modules can be used within their specified performance range with OR PACU ICU and ED software packages Only the E CAiOVX and E COVX modules measure gas exchange NOTE Routine calibration checks are required to ensure the measurement ac...

Page 341: ...COVX measure gas exchange Gas exchange patient connections with HME HMEF filter NOTE Always place the HME HMEF filter between the D lite sensor and the patient NOTE By pass flow together with long expiration flow pause time may disturb the measurement Consider using shorter expiration time to diminish the effect In addition you may use a suitable spacer with a 5 to 10 ml dead space e g a straight ...

Page 342: ...e EE RQ parameter window indicates with green color the amount of data that the monitor uses for performing the average calculations When a patient is admitted a case is started no averaged value is displayed until 10 minutes of valid EE and RQ data is available After that the EE and RQ values are gray until there is enough 1 5 of the selected averaging time data to perform reliable calculations 1...

Page 343: ... gas concentration To ensure volume measurement results that are less sensitive to errors the Haldane transformation is applied The Haldane transformation is based on the assumption that nitrogen is an inert gas and an individual will neither consume nor produce it except in the case of air emboli Therefore the amount of nitrogen inhaled is equal to the amount exhaled How to interpret the gas exch...

Page 344: ...ic needs tissue oxygen consumption becomes dependent on oxygen delivery and anaerobic metabolism with lactic acid production will ensue During anaerobic metabolism the VO2 measured from the respiratory gases does not reflect the tissue oxygen needs since an oxygen debt develops in the tissues When aerobic conditions are restored the oxygen debt will be reflected as increased oxygen consumption Car...

Page 345: ...s in ventilation hyperventilation increases RQ hypoventilation decreases it until a new steady state of body CO2 pool has been achieved Analogously the development of an oxygen debt will increase the RQ whereas replenishment of an oxygen debt will reduce the RQ Energy expenditure The energy expenditure cannot be directly measured by indirect calorimetry but it is calculated from the measured gas e...

Page 346: ...n on the average gas exchange can be obtained Several variables can contribute to inaccurate information To ensure correct measurement keep these practical considerations in mind Sampling line To ensure correct module initialization always connect the sampling line and the D fend to the module before turning on the monitor or connecting the module to a monitor that is already on Use a correct samp...

Page 347: ...en concentration and correct if necessary max 85 If the expiration gas flow during the end phase of the patient s expiration is close to zero for more than two seconds before the next inspiration starts the ventilator s bypass flow may affect the measurement You can reduce this effect by adding a suitable spacer with a 5 to 10 ml dead space e g a straight T adapter between the Y piece and the D li...

Page 348: ... check the measurement setup Why does the RQ value sometimes show unphysiological values such as RQ 0 6 Usually this is due to a non steady state the ventilator settings have been changed FiO2 has changed the ventilation is irregular Why is there no EE and RQ data in the trend history If the RQ is out of the physiological range 0 6 or 1 3 the monitor does not store the EE and RQ values in the tren...

Page 349: ...void burns at the monitor measurement sites ensure the following Proper contact of the ESU return electrode to the patient ESU return electrode near the operating area Measurement electrodes leadwires and probes far from the surgical site and the ESU return electrode WARNING DEFIBRILLATOR PRECAUTIONS Patient signal inputs labeled with the CF and BF symbols with paddles are protected against damage...

Page 350: ... other equipment such as EEG module with evoked potentials measurement CAUTION Allow the cable to dry completely after cleaning Moisture and dirt on the connector can affect the measurement accuracy Entropy indications for use The GE Healthcare Entropy module E ENTROPY and accessories are indicated for adult and pediatric patients older than 2 years within a hospital for monitoring the state of th...

Page 351: ...readings Entropy points to note A portion of the Entropy software is derived from the RSA Data Security Inc MD5 Message Digest Algorithm Entropy sensors are disposable for single patient use only and not made with natural rubber latex Make sure that the sensor connectors of the sensor cable are not in contact with fluids Always ensure that the sensor is properly attached to the patient and connect...

Page 352: ...ent 1 Connect the Entropy sensor cable to the module 2 Clean the application site according to the sensor s instructions for use and let it dry before attaching the sensor 3 Place the Entropy sensor on the patient s forehead see sensor package for instructions 4 Connect the sensor to the Entropy sensor cable 5 Observe the results of the automatic sensor check in the parameter window 6 The measurem...

Page 353: ...er window 2 Select Setup 3 Select a value from the Scale µV list Selecting the EEG sweep speed This setting determines the drawing speed for the EEG waveform 1 Press the module key or select the Entropy parameter window 2 Select Setup 3 Select a value from the EEG Sweep Speed list The smaller the value the slower the sweep speed NOTE This setting is available in BIS EEG and Entropy setups Regardle...

Page 354: ...impedance check is performed at the start up whenever a sensor or an electrode is attached If the automatic sensor check has been selected on the check is also performed periodically every 10 minutes 1 Press the module key or select the Entropy parameter window 2 Select Setup 3 Select Check Sensor Automatic Bypassing the Entropy sensor check If the sensor does not pass the impedance check this opt...

Page 355: ...Scandinavica 2004 Volume 48 Issue 2 154 161 2004 Entropy measures irregularity of EEG and FEMG The GE Entropy measurement devices are responsible for EEG and FEMG signal acquisition amplification filtering and digitization and electrode impedance measurement Entropy parameters RE is a fast reacting parameter which measures EEG and FEMG in the frequency range 0 8 Hz to 47 Hz Its reaction time is tw...

Page 356: ...l anesthesia it indicates that the facial muscles are activated This may happen due to noxious stimuli SE value may remain within a constant range if the level of hypnosis is adequate A quick rise in RE may give an early warning of impending wake up Patients emerging from general anesthesia will demonstrate a rise in both the RE and SE values Relation of Entropy values to EEG and patient status En...

Page 357: ...pression 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 practicalities It is very important to ensure good contact between the sensor electrodes and skin With careful skin preparation correct sensor placement and use of correct cable the skull and sinuses between the ele...

Page 358: ...bing equipment from the proximity of the Entropy module or sensor Check the sensor s contact with skin Check electrodes Entropy EEG signal is poor Check the sensor s contact with skin Check electrodes Entropy EEG waveform and numbers do not correspond Check raw EEG as impedance check may cause a temporary increase in the numeric values Check the patient s overall status Entropy readings seem incon...

Page 359: ...ing to the individual needs of adult patients Vanluchene A L G Vereecke H Thas O Mortier E P Shafer S L Struys M M R F Spectral Entropy as an Electroencephalographic Measure of Anesthetic Drug Effect A Comparison with Bispectral Index and Processed Midlatency Auditory Evoked Response Anesthesiology 2004 Volume 101 Issue 1 34 42 In this study by Vanluchene et al using propofol the authors conclude ...

Page 360: ...e 32 Issue 4 485 493 In this study by Davidson et al used Entropy Module on toddlers and children during isoflurane and nitrous oxide anesthesia Davidson A Huang G Rebmann C Ellery C Performance of Entropy and Bispectral Index as measures of anaesthesia effect in children of different ages British Journal of Anaesthesia 2005 95 674 9 In this study by Davidson et al using sevoflurane the authors co...

Page 361: ... measurement cables do not incorporate means to protect against burns in case of a defective ESU return electrode To avoid burns at the monitor measurement sites ensure the following Proper contact of the ESU return electrode to the patient ESU return electrode near the operating area Measurement electrodes leadwires and probes far from the surgical site and the ESU return electrode WARNING DEFIBR...

Page 362: ...oluntary muscle contraction and tension from interfering with the reference search When placing the electrodes make sure that they do not touch each other Do not place electrodes on areas with excessive body hair or lesions If the electrodes are placed incorrectly wrong nerves are stimulated and this causes wrong muscle response When multiple nerves are stimulated the measured response may be affe...

Page 363: ...ode 8 Brown stimulating electrode 9 Electrode black lead connection site ground 10 Electrode green lead connection site recording muscle contraction effect 11 Electrode red lead connection site recording muscle contraction effect NMT module keys There are two keys on the module Start up Starts the search for supramaximal current and reference level Proceeds with the selected measurement cycle Stop...

Page 364: ...nerve 2 Attach the sensor in the groove between thumb and index finger If necessary secure with narrow tape only 3 Make sure that the sensor sets tightly in the groove and that the thumb can move freely Do not immobilize the hand Ulnar nerve and corresponding muscles 1 m adductor pollicis 2 m abductor digiti minimi hypothenar 3 m flexor pollicis brevis thenar 4 n ulnaris 5 medial epicondyle NMT al...

Page 365: ...ors in the graphical trends The values are shown as follows white bars Ratio TOF green dots T1 cyan bars PTC magenta dots Count Using the NMT measurement Starting the NMT measurement Press the Start up module key or 1 Select the NMT parameter window Setup 2 Select Stimulus Mode TOF DBS or ST 3 Select Start with New patient 4 Select Start up Changing the NMT stimulus current 1 Select the NMT parame...

Page 366: ...ount must be below the selected limit in two consecutive measurements Cycle time one minute or more or manual measurement At least one count must be below the selected limit To take this feature into use 1 Select the NMT parameter window Setup 2 Select Recovery Note 3 Select the count limit that will activate the note Measuring deep relaxation When no responses are detected for TOF stimulation the...

Page 367: ...t Start with Recall reference 3 Select Restart Stopping the NMT measurement Press the Stop Continue module key or 1 Select the NMT parameter window Setup 2 Select Stop NMT alternative uses Local nerve and plexus localization Single stimulation pulses may be helpful for determining the correct needle tip position from a local nerve in plexus procedures The NMT module delivers single stimulation pul...

Page 368: ...trodes are needed for electrical stimulation of a peripheral nerve The resulting response can be measured with either two electrodes and a MechanoSensor which measures movements between thumb and index finger or an ElectroSensor using three recording electrodes The monitor searches for the stimulus current needed to activate all the fibers of the stimulated recorded muscles The search begins with ...

Page 369: ...ELAXATION METER Deep Train of four TOF mode In TOF stimulus mode four stimulation pulses are generated at 0 5 second intervals The response is measured after each stimulus and the ratio of the fourth to the first response of the TOF sequence is calculated resulting in TOF With the ElectroSensor T1 is displayed If the reference is successfully found a scale is also included Scale markers represent ...

Page 370: ...t affect the supramaximal current nor the reference value Average lifetime of a MechanoSensor is two years depending on the use The sensor has been validated to last 700 000 twitches Inappropriate function of the measurement is often caused by incorrect accessory connection or misuse of the products Therefore note the following Handle the sensor and cables carefully to maximize their lifetime Piez...

Page 371: ... your observations start a new measurement manually right after the completion of the previous measurement Sometimes the selected cycle time has been so long that the relaxation level has changed considerably between the measurements What can I do if the monitor does not find the supramaximal stimulation current If the monitor is unable to find the supramaximal stimulation current check the electr...

Page 372: ...Neuromuscular transmission 372 CARESCAPE Modular Monitors 2062971 001 ...

Page 373: ...S Proper placement of defibrillator pads in relation to the electrodes is required to ensure successful defibrillation WARNING Make sure that the electrodes leadwires and connectors do not touch any electrically conductive material including earth WARNING When using an electrosurgery unit note that the measurement cables do not incorporate means to protect against burns in case of a defective ESU ...

Page 374: ...atal patients External radiating devices may disturb the measurement EEG points to note EEG is a very small signal and prone to artifacts such as movement shivering sweating eye movement frontal EMG external electrical interference other electrical devices and internal ECG electrical interference Good electrode contacts are imperative for high quality EEG measurement Keep electrical devices as far...

Page 375: ...ize yourself with all of these measurements and their safety statements EEG module keys There are two keys on the module EP Start Stop Starts and stops auditory evoked potential measurement with the defined settings Imp Check Starts the manual measuring of the electrode impedance The same keys can be found on the headbox EEG electrode sites Follow the electrode manufacturer s instructions for the ...

Page 376: ... electrodes if the impedance is too high Attaching EEG electrodes within hair area Preferably use cup electrodes if montage includes placements within hair area 1 Mark the spots on the patient s head according to the montage you have chosen 2 Comb or cut the hair away from the spots and rub the skin with abrasive paste to remove oil and grease 3 Clean the skin with alcohol 4 Attach the electrodes ...

Page 377: ...onitor which montage electrode positioning is used Therefore no menu selections are necessary You can also define your own montage Your own montages will not be automatically recognized when you start the measurement NOTE Since the monitor sets lead positions automatically according to the identification pin make sure that you use preconfigured lead positions If you change them always update the m...

Page 378: ...tor screen In addition to the numeric parameters and the CSA Compressed Spectral Array you can also see the graphic presentation of EEG in the parameter window This is a useful tool as it gives you a graphic presentation of the EEG numeric parameters 1 EEG channel numbers 1 to 4 for example Fp1 T3 2 Blue vertical line represents the parameter selected for Numeric 2 e g amplitude measured in μV 3 R...

Page 379: ...ontage settings according to the instructions Selecting the EEG scale This setting defines the scale for EEG parameter windows waveform and spectral displays 1 Select the EEG parameter window 2 Select EEG tab Setup 3 Select a value from the Scale µV list Selecting the EEG sweep speed This setting determines the drawing speed for the EEG waveform 1 Select the EEG parameter window 2 Select EEG tab S...

Page 380: ...t the time interval for the automatic impedance check 1 Select the EEG parameter window 2 Select EEG tab Setup 3 Select a value from the Imped Cycle list Selecting the CSA view You can choose to view a graphical view of the spectrum as a single continuously updating curve CSA 1 Select the EEG parameter window 2 Select EEG tab View 3 Select CSA Changing the view will erase the previous CSA content ...

Page 381: ...e 8 from the Select Montage list 4 Go through the different menu items and select the options to suit the application For instance to rename the selected montage select Name Montage remove the previous name type the new name in the Name field and then select Enter The name can contain nine characters at the most 5 You can save the montage for later use by selecting Save Montage Yes Your own montag...

Page 382: ... evoked potential measurement EEG is also simultaneously measured from the same electrodes Frontal muscular activity is also assessed by electromyography EMG from one of the EEG channels EEG frequency bands To characterize the spectral content of the signal the following parameters are calculated 1 Delta 2 Theta 3 Alpha 4 Beta 5 Peak frequency 6 50 of power 7 Median frequency 8 95 of power 9 Spect...

Page 383: ... the compressed spectral array of all the monitored channels on the left hand side of the screen EEG CSA SEF 5 min 1 Channel e g Fp1 T3 C3 01 2 Spectral edge frequency SEF red line in the display How to interpret the EEG values To evaluate certain EEG results for example to distinguish epilepsy from other conditions it is necessary to assess these findings together with other symptoms including un...

Page 384: ... closed Beta 13 Hz High activity or drugs Abnormal EEG characteristics Distinguishable characteristics to look for are Asymmetrical EEG between the left and the right hemisphere Burst suppression Suppression and low amplitude Delta activity Epileptic spikes EEG reactivity Existing reactivity in the EEG is a sign of healthy brain activity Accordingly reduced reactivity may indicate a disorder in th...

Page 385: ... seconds to several seconds Technical artifact and EEG To decrease technical artifact the electrode to skin impedance should be low and electrode wires short Wrapping the electrode wires together or adjusting ground electrodes may also help Typical EEG recordings with electrical interference Electrical currents AC These are a common source of interference Try using different low pass or notch filt...

Page 386: ...operly connected and not dried out Check the electrodes contact with skin Perform electrode impedance check Calm the patient since frontal muscle activity can cause artifact Remove sources of external electrical noise for example some lamps from the vicinity of the patient s head ECG may cause artifact change electrode positioning Check that there are not two identical measurement modules in the s...

Page 387: ...erly attached Use better electrodes or prepare the skin better Why are there some baseline fluctuations For instance sweating may cause variations in the electrode impedance In case the fluctuation is disturbing prepare the skin and replace the electrode Measuring auditory evoked potentials AEP Preparing the patient for AEP measurement 1 Prepare the patient and electrodes as you would for EEG meas...

Page 388: ...the AEP tab View 3 Select Start AEP Selecting the AEP channels 1 Select the EEG parameter window 2 Select the AEP tab Setup 3 Select the number of channels from the AEP Channels list Selecting the number of AEP responses You can select the number of responses that will be averaged 1 Select the EEG parameter window 2 Select the AEP tab Setup 3 Select the number of responses from the Responses list ...

Page 389: ...dB peak equivalent sound pressure level Selecting the AEP sweep length You can select the length of the recorded and displayed waveform and of the AEP split screen and AEP view 1 Select the EEG parameter window 2 Select the AEP tab Setup 3 Select a value from the Sweep Length list Selecting the AEP filter You can select the cut off frequency of the high pass filter 1 Select the EEG parameter windo...

Page 390: ... response in the monitor memory Selecting a reference AEP You can select a saved auditory evoked potential as a reference that will be displayed simultaneously with the real time auditory evoked potential 1 Select the EEG parameter window 2 Select the AEP tab View 3 Select a reference AEP from the Reference EP list Erasing an AEP reference NOTE This selection is not available if you have not saved...

Page 391: ...ults are displayed as a waveform During AEP monitoring the AEP electrodes are also used for EEG monitoring The AEP measurement can be started manually repeated automatically after set intervals or the measurement can be continuous with moving averaging Main peak categories AEP Latencies and amplitudes of particular peaks are important information Latency is the time to the peak and amplitude is th...

Page 392: ...e earphones headphones The connector is not in place Check that the plug is firmly pushed into the appropriate connector in the headbox What if all or most of the EP epochs are rejected The signal has too much noise or artifact in the EP measurement band for instance coupled 50 60 Hz may not be seen in the EEG waveform because of filtering Check that the electrode impedances are below 5 kOhm and t...

Page 393: ...rs do not touch any electrically conductive material including earth WARNING When using an electrosurgery unit note that the measurement cables do not incorporate means to protect against burns in case of a defective ESU return electrode To avoid burns at the monitor measurement sites ensure the following Proper contact of the ESU return electrode to the patient ESU return electrode near the opera...

Page 394: ...NING Misinterpretation of BIS can result in incorrect administration of anesthetic agents and or other potential complications of anesthesia or sedation BIS cautions CAUTION Due to elevated surface temperature do not place the BIS device in prolonged direct contact with the patient s skin as it may cause discomfort CAUTION The BIS measurement based on measuring the EEG signal is inherently very se...

Page 395: ...lways be used when interpreting BIS in conjunction with other available clinical signs Reliance on BIS alone for intraoperative anesthetic management is not recommended BIS values should be interpreted cautiously with certain anesthetic combinations such as those relying primarily on either ketamine or nitrous oxide narcotics to produce unconsciousness External radiating devices may disturb the me...

Page 396: ...onnect the patient interface cable to the BISx 3 Secure the BISx to a convenient location preferably close to the patient s head 4 Clean the application site with alcohol and let dry 5 Place the BIS sensor on the patient see sensor package for instructions 6 Connect the sensor to the patient interface cable 7 Observe the results of the automatic sensor check in the parameter window 8 The measureme...

Page 397: ...r the EEG waveform 1 Press the module key or select the BIS parameter window 2 Select the Setup tab 3 Select a value from the EEG Sweep Speed list The smaller the value the slower the sweep speed NOTE This setting is available in BIS EEG and Entropy setups Regardless of where you change it it will affect all three parameters Selecting the BIS smoothing rate Smoothing rate affects the appearance of...

Page 398: ...matic Using the manual BIS sensor check Whenever required you can perform the sensor check manually Press the module key or 1 Select the BIS parameter window 2 Select the Setup tab 3 Select Check Sensor 4 Observe the results on the screen The measurement continues automatically after the sensor has passed the check Testing the BISx In case the measurement does not work and checking the cables and ...

Page 399: ...ed on results from a multi center study of the BIS involving the administration of specific anesthetic agents BIS values and ranges assume that the EEG is free of artifact that can affect its performance Titration of anesthetics to BIS ranges should be dependent upon the individual goals for hypnotic state that have been established for each patient These goals and associated BIS ranges may vary o...

Page 400: ...f tests fail contact authorized service personnel What if the sensor does not pass the sensor check The sensor check may fail for the following reasons Impedance too high Incorrect sensor application Poor sensor connection Defective patient interface cable or sensor To correct the situation Recheck the sensor Reapply the sensor according to instructions Check sensor connection Replace patient inte...

Page 401: ...hey are not convert the values before entering them You can also change the units on the screen They are changed through Monitor Setup Default Setup Care Unit Settings Units Laboratory Values and the settings are password protected For more information see the CARESCAPE Modular Monitors Supplemental Information Manual Viewing laboratory data You can view the most recently saved laboratory data 1 S...

Page 402: ... Temperature Correction selection Formulas used to calculate the values when temperature correction is enabled are given in the CARESCAPE Modular Monitors Supplemental Information Manual Selecting the type of temperature correction 1 Select Data Pages 2 Select Laboratory Data 3 Select the Enter Data tab 4 Select an option from the Temperature Correction list Laboratory Temperature correction has b...

Page 403: ...u have set the Sample Time or it has been sent by the interfaced device If not set it now 6 Select Save to confirm the entered values If you do not select Save new data is lost when you exit the menu Printing laboratory values You can print the most recently saved laboratory data 1 Select Data Pages 2 Select Laboratory Data 3 Select the View tab 4 Select Print 2062971 001 CARESCAPE Modular Monitor...

Page 404: ...Laboratory data 404 CARESCAPE Modular Monitors 2062971 001 ...

Page 405: ... B850 and B650 only A list of displayed input and calculated parameters is given in the CARESCAPE Modular Monitors Supplemental Information Manual 1 Select Data Pages 2 Select Calculations 3 Select Hemo Oxy or Vent tab 4 Select View Parameter data is now displayed in two columns Input Parameters and Calculated Parameters Source data for calculations Several types of data blood gas laboratory are r...

Page 406: ...ng time and date from the Select Lab Data list Selecting source data for ventilation calculations B850 and B650 only 1 Select Data Pages 2 Select Calculations 3 Select the Vent tab 4 Select Edit Input 5 Select the desired sample with corresponding time and date from the Select Lab Data list Estimated values in oxygenation calculations In normal circumstances about 3 of the total arterial oxygen co...

Page 407: ... or Oxy tab 3 Select View 4 Select the Indexed check box at the lower part of the view Those parameters that can be indexed are now displayed as indexed and indexed values are calculated Editing calculation input values Ventilation calculations with the B850 and B650 only 1 Select Data Pages 2 Select Calculations 3 Select Hemo Oxy or Vent tab 4 Select Edit Input 5 Enter or edit the parameter value...

Page 408: ... box has been selected in the calculations Trend menu and Save has been selected to add the calculations to the trends The indexed values are calculated and trended only if the patient s BSA body surface area value is available at the time when the calculations are performed 1 Select Data Pages 2 Select Calculations 3 Select Hemo Oxy or Vent tab 4 Select Trend To navigate between the pages of the ...

Page 409: ...Printing all calculation trends Ventilation calculations with the B850 and B650 only You can print all calculation trends at once 1 Select Data Pages 2 Select Calculations 3 Select Hemo Oxy or Vent tab 4 Select Trend 5 Select Print 2062971 001 CARESCAPE Modular Monitors 409 ...

Page 410: ...Calculations 410 CARESCAPE Modular Monitors 2062971 001 ...

Page 411: ...ml h or cc hr is prescribed The clinician must determine the amount of drug to place in the solution in order to meet the rate dose combination In other cases the physician may order a drug dosage to be infused over a period of time The amount of drug in solution may or may not be specified In this situation the clinician must determine the rate that is needed to infuse the proper drug dosage over...

Page 412: ...int resuscitation medication information for neonates 4 Drug Name list The contents of this list are configured through the Care Unit Settings and they are password protected 5 Additional Drug Allows you to enter a new drug name to the Drug Name list temporarily Any drugs added will only be on the list until the patient is discharged case is ended 6 Patient s Weight Allows you to enter the patient...

Page 413: ... the weight in the patient demographics Changing the patient s weight in the Calculator Titration Table or Resuscitation Medications tab will change the displayed value in all of them 6 Set the Solution Volume 7 Set the Drug Amount Concentration level is automatically calculated 8 Set the Dose Unit if appropriate 9 Set the Dose The Infusion Rate ml h Infusion Time h and Infusion Time min are autom...

Page 414: ...e tab 4 Select the Drug Name 5 If the patient weight was not entered during admission and the selected Dose Unit requires it set the Patient s Weight NOTE Changing the weight in the drug calculator menu does not change the weight in the patient demographics Changing the patient s weight in the Calculator Titration Table or Resuscitation Medications tab will change the displayed value in all of the...

Page 415: ...patient s weight in the Calculator Titration Table or Resuscitation Medications tab will change the displayed value in all of them 5 Select Confirm The monitor will not calculate the dose values until the patient s weight value has been confirmed Printing resuscitation medication doses You can print a list of resuscitation medications and their concentration level delivery method and dose value 1 ...

Page 416: ...Drug calculations 416 CARESCAPE Modular Monitors 2062971 001 ...

Page 417: ...meter is connected This applies to all trend event and snapshot views You can also split the normal screen page so that the left side of the screen continuously shows graphic minitrends beside waveforms The numeric trends include a predefined set of parameters The graphic trend selections include all parameters that can be used If you are viewing trends for parameters for which you do not have a l...

Page 418: ...ist does not show the 20 minute option With the high resolution trends license enabled the 20 minute option is visible even if the cursor is as far as 1 hour from the current time High resolution trends contain 24 hours of trend data This means that when the cursor position is more than 24 hours from the current time the Time Scale list does not show the 2 minute 4 minute and 20 minute options 1 S...

Page 419: ...nd option that provides an increased resolution of 2 seconds for the 2 4 and 20 minute scales The high resolution graphic trend is updated on user request This trend also contains compressed CO2 and impedance respiration waveforms 10 Hz as well as beat to beat ECG heart rate and mean arterial pressure MAP 6 Hz High resolution trend data is not saved over power down situations This means that data ...

Page 420: ...t Print Page Recorder 4 You can stop printing by selecting Stop Printing Depending on what has been configured either the data currently on screen or all data will be printed This configuration is done through Monitor Setup Default Setup Care Unit Settings Printer Numeric Trends Printing and it is password protected For more information see the CARESCAPE Modular Monitors Supplemental Information M...

Page 421: ...ne Gas Cons from the View list Printing gas consumption data You must print the report before discharging the patient ending the case 1 Select Trends 2 Select Machine Gas Cons from the View list 3 Select Print Page to print the currently viewed page Minitrend split screen Minitrend view You can split the normal screen page so that the left side of the screen continuously shows graphic minitrends b...

Page 422: ... Information Manual Selecting the minitrend to screen 1 Select Monitor Setup Screen Setup 2 B850 and B450 with Double Video license Select Screen 1 or Screen 2 tab 3 Select the Split Screen tab 4 Select Minitrend from the Show list Modifying the minitrend length You can select the minitrend length from a selection varying from 1 minute to 120 minutes The 1 minute and 2 minute selections are availa...

Page 423: ...from the CO2 Minitrend or from the Imp Resp Minitrend list b Select Compressed Waveform from the CO2 Minitrend or from the Imp Resp Minitrend list Removing minitrend from the screen 1 Select Monitor Setup Screen Setup 2 B850 and B450 with the Double Video license Select Screen 1 or Screen 2 tab 3 Select the Split Screen tab 4 Select the None from the Show list Time change during a patient case CAU...

Page 424: ...Trends 424 CARESCAPE Modular Monitors 2062971 001 ...

Page 425: ... Snapshots are configured through Profile Settings Trends Snapshot Snapshot and these settings are password protected For more information see the CARESCAPE Modular Monitors Supplemental Information Manual Manually created snapshots You can create a snapshot manually by selecting Freeze Snapshot The monitor saves the image of preconfigured waveforms or trends at that moment in time When a snapshot...

Page 426: ...the time indication box as vertical lines according to the time of the event and shown in the following colors White a snapshot event and during standby Event indicators will be displayed for standby periods at one minute intervals time scale other than 2 minutes or two second intervals time scale 2 minutes Red a high priority alarm event Yellow a medium priority alarm event You can select snapsho...

Page 427: ...utomatically Alarms Snapshots created by alarms print automatically All All snapshots print automatically Selecting spirometry loops to print with snapshots 1 Select Trends 2 Select Snapshot from the View list 3 Select Snapshot Setup 4 Select Print Loop Yes or No Erasing snapshots and trends Snapshots and trends are erased when you end a case discharge a patient when the monitor has been off for m...

Page 428: ...en a PDM or telemetry transmitter is connected to the monitor the saved alarm history and ST history will be transferred to the monitor One snapshot is created for each alarm history The PDM or a telemetry transmitter alarm history has 10 seconds of waveform data from two or three ECG leads and the first arterial invasive pressure line The snapshot will display waveforms only if the snapshot field...

Page 429: ... by selecting Cancel Printing Erasing ST snapshots You cannot erase the initial reference complex 1 Select the ST parameter window 2 Select the reference to be erased in the Erase Reference list Events Description of events Events are timestamps that are shown in their own list An event is created automatically upon an alarm An event records the time of and reason for its creation Some events may ...

Page 430: ...the newest event on top or by Priority with the highest priority alarm on top in chronological order Manually created events and snapshots have the lowest priority 1 Select Trends 2 Select Event from the View list 3 Select Time or Priority from the Sort by list Creating events manually The manual creation of an event enables you to add a special situation to the Event trend view and to describe it...

Page 431: ...elect Event from the View list 3 Select the Show Deleted check box 4 Select the deleted event you wish to undelete and select Undelete Event Printing events You can print alarms and user event in event history reports Depending on the number of saved events one or more pages are printed 1 Select Trends 2 Select Event from the View list 3 Select Print Page 4 You can stop printing by selecting Cance...

Page 432: ...Snapshots and events 432 CARESCAPE Modular Monitors 2062971 001 ...

Page 433: ...IVE LEAKAGE CURRENT Laser printers are UL 60950 IEC 60950 certified equipment which may not meet the leakage current requirements of patient care equipment This equipment must not be located in the patient environment unless the medical system standard IEC 60601 1 1 is followed Do not connect a laser printer to a multiple socket outlet supplying patient care equipment The use of multiple socket ou...

Page 434: ... another printout is initiated for the same laser printer continuous printing is stopped and the second printout is printed After the second printout is finished the continuous waveform printing is restarted NOTE When a print job is canceled from the monitor no more data is sent to the printer However the printer will finish printing all the data it had received before the stop cancel request Reco...

Page 435: ... s power cable 6 ASYNC COMM port Not used 7 M port connector Connect to the CARESCAPE Monitor B850 XE 50 recorder B650 and B450 only B650 B450 1 Built in recorder option NOTE Remote recording is only possible from the B650 or B450 to a GE monitor or a central station remote recording is not possible to the B650 and B450 Printing device selections Changing printer 1 Select Monitor Setup Printing 2 ...

Page 436: ... This is always the print location for reports This is not available if the printout type is Telemetry Waveforms Network 6 According to your location selection above a If you selected Network Select the print device from the Network Device list b If you selected Remote Choose the monitor or central station from the Unit list and then select the print device from the Remote Device list NOTE You may...

Page 437: ...alarm condition High Alarm waveforms print during high priority alarm conditions only All Alarm waveforms print during any alarm condition Setting the print delay NOTE Alarm waveforms arrhythmia and non arrhythmia start by printing 10 seconds of the most recently saved data regardless of the Delay setting 1 Select Monitor Setup Printing 2 Select the Waveforms tab 3 Select a value from the Delay li...

Page 438: ...eforms tab 3 Choose the desired ECG lead parameter for waveforms 1 4 Printing from the main display 1 Select Print Waveforms NOTE If print length has been configured for Continuous you will be required to stop or cancel the print request Printing from the waveforms window 1 Select Monitor Setup Printing 2 Select the Waveforms tab 3 Select Print Waveforms Stopping the waveform printing Stopping a w...

Page 439: ...nting device is not processing another job at the same time 1 Select Trends 2 Select trend type from the View list Graphic Numeric Event Snapshot Machine Gas Cons and ST Snapshot 3 Select desired Time Scale NOTE Time Scale is not selectable in the Numeric Event and Machine Gas Cons views You can however select the Time Interval for printing the Numeric trends 4 Select Print Page Printing reports P...

Page 440: ... AEP printouts Printing care reports manually 1 Select Monitor Setup Printing 2 Select the Reports tab 3 Select Care Report Print Automatic care report printouts The automatic printing of care reports is possible only in the ICU ED and NICU software packages and it is initiated when a patient is discharged An automatically initiated care report consists of a cover page and reports selected in the ...

Page 441: ... 1 Select Data Pages 2 Select Drug Calculations 3 Select Calculator Print Printing titration table 1 Select Data Pages 2 Select Drug Calculations 3 Select Titration Table Print Printing laboratory data and parameter printouts Printing laboratory data NOTE The Laboratory Data menu is accessible also through the Calculations Hemo Oxy and Vent menus 1 Select Data Pages 2 Select Laboratory Data 3 Sele...

Page 442: ...settings Second ID Medical record number Bed number Unit name if the monitor is on the MC Network Hospital name Date and time of the printout Current page total number of pages e g 1 12 Printout title e g alarm waveforms and reports Identification field for a patient identification sticker Notes field for manually written notes Recorder print header Patient name Second ID Medical record number Bed...

Page 443: ...ven through Care Unit Settings Alarms Remote Alarms and they are password protected Enabling or disabling audio pausing remotely for another monitor Allow Audio Pause For Remote Bed Choices are Yes and No CARESCAPE Network only Selecting which remote locations are allowed to pause audio alarms on this monitor Allow Audio Pause From Remote Location Choices are Not Allowed Central or Central and Rem...

Page 444: ...ist 6 Select the type of alarm notification desired from the Alarm Notification list Off Remote alarm notification is turned off NOTE All new monitors appear on the list automatically with the notification setting Off default Message Remote alarm messages display in the alarm area At any time you can select a remote alarm message to open a bed to bed window and view the remote patient s data Auto ...

Page 445: ...larm notification is turned off Message Remote alarm messages display in the alarm area Auto View Bed to bed window opens immediately if no other procedure or setup window is currently open Otherwise a remote alarm message displays in the alarm message area Auto View Always Immediately closes any open procedure or setup windows and opens a bed to bed window 6 Select a setting from the Change All P...

Page 446: ...d alarms NOTE This feature is available with the CARESCAPE Network only You can pause active alarms for the remote bed viewed by selecting Remote from the bed to bed window If the selection is not selectable this option has not been enabled during configuration It is enabled in the Care Unit Settings and it is password protected In addition the remote monitor s settings may prevent remote silencin...

Page 447: ...larms based on the module alarm limits and not those of the ventilator Make sure that the alarm limits on the module are set to match the patient s ventilation requirements to avoid delayed or suppressed ventilator alarm annunciation at the central station and to ensure timely clinical response to important changes in the patient s condition or the ventilator s status Interfacing cautions CAUTION ...

Page 448: ...the Unity Network Interface Device ID You must verify the accuracy of the alarm message and or numerics at the peripheral device itself before initiating treatment treatment should be based on the information presented at the peripheral device Compatible peripheral devices For a list of compatible peripheral devices see the Unity Network Interface Device ID Operator s Manual Unity Network Interfac...

Page 449: ...t labeled ID on the back of the monitor B650 B450 A factory programmed adapter is required for each peripheral device to communicate with the connectivity device Refer to the instructions provided with the interface adapter for adapter setup and installation instructions 1 Interface adapters Once the interface adapter is permanently connected to the peripheral device the cable can be plugged into ...

Page 450: ...hen the measurement source is from an external device connected to the Unity Network Interface Device ID Limit alarms can be turned on or off only Alarm limits or guard limits set for any parameter have no effect as only the limit alarms from the interfaced device are shown In addition they are shown only for those parameters that have their Alarm On activated It should also be noted that if a ven...

Page 451: ...ber of parameters to the monitor In some cases not all are supported or the monitor s software package may determine the set of parameters See the Unity Network Interface Device ID Operator s Manual and the peripheral device manufacturer s manuals for more information Pulse oximeters The SpO2 parameter window displays a saturation value and a pulse rate The Ext indicates the data is from an extern...

Page 452: ...nterfaced continuous cardiac output measurement The C I value for interfaced device is computed using the following equation C I C O BSA The C I value for interfaced device is invalid if BSA from the monitor is not available The CCI value for interfaced device is computed using the following equation CCI CCO BSA The CCI value for interfaced device is invalid if BSA from the monitor is not availabl...

Page 453: ...laser printers and non medical computers WARNING Avoid use of cleaners materials or chemicals that may damage device surfaces labels or cause equipment failures WARNING To prevent liquids from entering the monitor or display casing do not tilt the monitor or display more than 15 degrees WARNING If liquid has accidentally entered the system or its parts disconnect the power cord from the power supp...

Page 454: ...fety precautions Disposal warnings WARNING Do not incinerate a battery or store at high temperatures Serious injury or death could result Disposal cautions 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 each product If you have any questions concerning d...

Page 455: ...y gas measurements is every six months in normal use and every two months in continuous use to ensure that the measurement accuracy remains within specifications Familiarize yourself with instructions regarding the airway gases measurement including the calibration instructions Patient Spirometry If the difference between the inspiratory and expiratory volumes is permanent a flow calibration is re...

Page 456: ... instructions Setting the touchscreen off for cleaning You can set the touchscreen feature off for 30 seconds at a time when you need to clean the screen The countdown timer appears on the screen 1 Select Monitor Setup 2 Select Touchscreen Off 3 You can enable the touchscreen immediately by pressing any monitor hardkey or the Trim Knob or by selecting Cancel in the Touchscreen Off display Cleaning...

Page 457: ... if the reader isn t operating well clean the window with a soft cloth or lens tissue dampened with water or a mild detergent water solution If a detergent solution is used rinse with a clean lens tissue dampened with water only The reader s housing may also be cleaned the same way Keyboard and mouse cleaning instructions Refer to the user documentation provided with the keyboard and mouse for ins...

Page 458: ...t connection is essential for correct measurement D fend D fend Pro and Mini D fend water trap care instructions Empty the container whenever it is more than half full In anesthesia Replace the D fend D fend Pro or Mini D fend water trap every two months or when Replace Water Trap appears In critical care Replace the D fend D fend Pro or Mini D fend water trap every 24 hours for each new patient o...

Page 459: ...ly inserted and the battery door is completely closed Falling batteries could seriously or fatally injure neonatal or other vulnerable patients 1 B650 Open the battery slot by gently turning the lock counter clockwise B450 Open the battery cover by pressing the battery cover release latch down and pulling the battery door open 2 Pull the battery out using the battery strap 3 Insert a new battery a...

Page 460: ...eriously or fatally injure neonatal or other vulnerable patients WARNING PHYSICAL INJURY Do not install the PDM above a patient Leaks from the battery cells can occur under extreme conditions The liquid is caustic to the eyes and skin If the liquid comes in contact with eyes or skin flush with clean water and seek medical attention 1 Open the battery door by gently pulling on the battery door pull...

Page 461: ...battery charge becomes low during normal operation the message Service Monitor Error Code 0xHOST1100 appears near the middle of the screen If this happens contact authorized service personnel 2062971 001 CARESCAPE Modular Monitors 461 ...

Page 462: ...Cleaning and care 462 CARESCAPE Modular Monitors 2062971 001 ...

Page 463: ...o off to create 12SL reports Adjust the patient age on the monitor if it is not correct ACI TIPI on chest or left arm pain not entered report The setting is ON but chest or left arm pain information has not been entered Set the ACI TIPI to off Enter chest or left arm pain information A Fib al area wavef Physiological alarm Check the patient status Accel Ventric al area wavef Physiological alarm Ch...

Page 464: ...rror al area The module has a communication error Check the module Replace the module if necessary ECG measurements removed al area Acquisition module has lost ECG communication Remove the module and then reconnect it Replace the module If the problem persists contact authorized service personnel Failure connecting to transmitter al area Connection to the telemetry transmitter could not be establi...

Page 465: ...ythmia detection is not possible ECG Check the connections Learning wavef ST algorithm is in learning phase message shown e g when ECG measurement is started No action required Missing beat al area wavef Physiological alarm Check the patient status Multifocal PVCs al area wavef Physiological alarm Check the patient status No 10 or 6 lead cable report No 6 or 10 lead ECG cable is attached Connect a...

Page 466: ...us Please wait collecting waveform report There is not enough ECG sample data to run the algorithm Wait for about 10 seconds QT high al area Measurement values are equal to or outside the alarm limits Check the patient status Adjust alarm limits if necessary QTc high al area Measurement values are equal to or outside the alarm limits Check the patient status Adjust alarm limits if necessary R on T...

Page 467: ...ransmitter for more than 5 seconds Wait to see if the condition resolves If the problem persists contact authorized service personnel V Brady al area wavef Physiological alarm Check the patient status V Fib V Tach al area param wavef Physiological alarm Check the patient status V lead A is not V1 or V lead B is not V5 report Va lead is not V1 and or Vb lead is not V5 Check the settings and correct...

Page 468: ...activated param The case has just been started patient admitted on the monitor or the measurement has just been started Wait The message disappears after the monitor detects 3 breaths E modules or the respiration rate is 3 PDM TRAM Artifact param wavef Cardiac artifact has been detected Check the patient status Select alternate leads to monitor Increase sensitivity settings Select alternate lead p...

Page 469: ...ing alarm priorities and escalation times see the CARESCAPE Modular Monitors Supplemental Information Manual Make sure you are familiar with the generic layout of the screen This will help you identify where on screen the following messages appear The message location is indicated with the following abbreviations al area alarm area param parameter window report report view wavef waveform area Mess...

Page 470: ... the sensor See the CARESCAPE Modular Monitors Supplemental Information Manual If the problem persists contact authorized service personnel Interference param The measurement is disturbed Check the sensor Learning param SpO2 algorithm is in learning phase No action required Low battery param The interfaced device has low battery charge Check the interfaced device If the problem persists contact au...

Page 471: ...lse search param Defective or damaged sensor or cable Sensor is off of the patient Detection of a repeatable pulse has stopped Check the sensor and cable Reposition or replace sensor SpO2 alarm setup changed al area Acquisition module has been moved to another channel and the alarm limits or the alarm on off status of this new channel are different from the previous channel You can remove the mess...

Page 472: ...will help you identify where on screen the following messages appear The message location is indicated with the following abbreviations al area alarm area param parameter window report report view wavef waveform area Message Location Explanation What to do Air leakage param Loose cuff or cuff hose Check the cuff and cuff hose Artifacts param Measurement is disturbed by artifact e g patient movemen...

Page 473: ... Check the cuff Cuff loose param Loose cuff or cuff hose Check the cuff and cuff hose Cuff overpressure param NIBP cuff is squeezed during measurement Check NIBP cuff and hoses Repeat the measurement Incorrect infl limits param Adult or child cuff is used but the selected infant mode restricts the inflation pressure too low to be able to measure the blood pressure Adjust NIBP setup Long meas time ...

Page 474: ...am Cuff does not have an automatically detectable cuff ID Select a cuff size from the NIBP setup menu Select inflation limits al area param Cuff does not have an automatically detectable cuff ID Select an inflation limit from the NIBP setup menu Unable to meas Dia param Accurate diastolic pressure is difficult to measure because of artifacts weak pulsation etc Assess the patient and check inflatio...

Page 475: ...ed with the following abbreviations al area alarm area param parameter window report report view wavef waveform area Message Location Explanation What to do 320 mmHg or 43 kPa param Measurement is over range or the sensor is faulty If you pre zero a line with the stopcock closed it creates a high fluid bag pressure and triggers this message In this case you can acknowledge the alarm with the pause...

Page 476: ...ean low Art dia high Art dia low al area Measurement values are equal to or outside the alarm limits Check the patient status Adjust alarm limits if necessary Artifact param If Smart BP is enabled this is normal behavior when zeroing flushing or sampling is performed If Smart BP is not enabled this message indicates that the measurement is disturbed by artifact Check the patient status Check cable...

Page 477: ...or outside the alarm limits Check the patient status Adjust alarm limits if necessary FemV sys high FemV sys low FemV mean high FemV mean low FemV dia high FemV dia low al area Measurement values are equal to or outside the alarm limits Check the patient status Adjust alarm limits if necessary ICP sys high ICP sys low ICP mean high ICP mean low ICP dia high ICP dia low al area Measurement values a...

Page 478: ...ide the alarm limits Check the patient status Adjust alarm limits if necessary No P1 transducer to No P8 transducer al area No transducer connected to the channel indicated in the message or the sensor is faulty Connect a transducer Check the cable and connections Replace the sensor Replace the transducer If the problem persists contact authorized service personnel P1 over range to P8 over range P...

Page 479: ...an low PA dia high PA dia low al area Measurement values are equal to or outside the alarm limits Check the patient status Adjust alarm limits if necessary PR ABP high PR ABP low PR Art high PR Art low PR Fem high PR Fem low PR UAC high PR UAC low al area Measurement values are equal to or outside the alarm limits Check the patient status Adjust alarm limits if necessary Pressure measurement remov...

Page 480: ...se of zeroing perform the zeroing process UAC sys high UAC sys low UAC mean high UAC mean low UAC dia high UAC dia low al area Measurement values are equal to or outside the alarm limits Check the patient status Adjust alarm limits if necessary UVC sys high UVC sys low UVC mean high UVC mean low UVC dia high UVC dia low al area Measurement values are equal to or outside the alarm limits Check the ...

Page 481: ...rm area Message Location Explanation What to do Calibration check param There is a 0 1 C difference between the measured temperature and the internal calibration for the indicated channel Change the cable Change the module If the problem persists contact authorized service personnel Calibration fail param Calibration on the indicated channel failed Check connections Replace the transducer If the p...

Page 482: ...the measurement device Change the cable Change the module If the problem persists contact authorized service personnel Temperature error param Hardware or calibration test failure in the measurement device Change the cable Change the module If the problem persists contact authorized service personnel Temp measurement removed al area Acquisition module temperature cable or temperature probe s have ...

Page 483: ...pires with the Cardiac Output Measurement menu open Wait until the message disappears CO measurement removed al area Acquisition module has been removed Connect the module if you want to restart the measurement C O out of range C O menu The measurement results are invalid Perform a new measurement Confirm C O al area param Measurement data has not been confirmed before trying to exit the Cardiac O...

Page 484: ...interfaced device If the problem persists contact authorized service personnel No injectate temp probe C O menu No injectate temperature probe connected Connect an injectate temperature probe No HR for REF C O menu REF measurement cannot be done Check that the patient s heart rate is being monitored Add HR measurement if needed No module C O menu No C O module connected Connect a C O module to mea...

Page 485: ... near the catheter The temperature sensor may be damaged replace the catheter Tinj high C O menu Injectate temperature is too close to blood temperature or too warm Use colder injectate Tinj low C O menu Injectate temperature is too close to blood temperature or too cold Use warmer injectate Tinj sensor failed C O menu Injectate temperature sensor failure Replace the sensor Unstable Tblood param C...

Page 486: ...contact authorized service personnel Draw blood param An advisory prompt Draw blood as indicated on screen Enter lab results param Calibration sequence requires lab results Enter laboratory results as indicated on screen High Intensity param Catheter floated or up against vessel wall Check the optical module and connections Check the catheter placement Only authorized medical personnel should adju...

Page 487: ...el wall Check the optical module and connections Check the catheter placement Only authorized medical personnel should adjust catheter placement Low Light param Catheter floated or up against vessel wall Check the optical module and connections Check the catheter placement Repeat in vivo calibration No Light param Interfaced device should be checked Check the interfaced device If the problem persi...

Page 488: ...n intensity shift in signal quality level Flush the catheter Check the optical module and connections Check the catheter placement SvO2 temp error al area The temperature of the optical module is out of range for more than 10 minutes Check the optical module and connections Replace the optical module Contact authorized service personnel Wait initializing param Optical module signal is being proces...

Page 489: ...ogress No action required Calibrating gas sensor wavef The measurement has been started and calibration is in progress Wait until the calibration is completed and the message disappears Calibration error param Unsuccessful calibration Authorized service personnel should repeat the calibration procedure Check calibr adapter al area param The adapter is missing obstructed or of a different type than...

Page 490: ...blocked or the water trap is occluded Change sampling line and water trap EtAA high EtAA low where AA Hal Enf Iso Sev or Des al area Measurement values are equal to or outside the alarm limits Check the patient status Adjust alarm limits if necessary EtCO2 high EtCO2 low EtN2O high EtN2O low EtO2 high EtO2 low al area Measurement values are equal to or outside the alarm limits Check the patient st...

Page 491: ...odules al area There are two or more E modules with gas measurement in the system Remove all but one E module with gas measurement Incompatible gas module al area The module is not compatible Replace with compatible gas module See the CARESCAPE Modular Monitors Supplemental Information Manual If the problem persists contact authorized service personnel Incompatible sensor param The sensor is of wr...

Page 492: ...ampling line and water trap Sample gas out param The water trap is not connected the sample gas outflow is blocked or there is a leak inside the module Check water trap connection Remove the blockage from the sample gas outlet Change module if needed Service CO2 module param Technical failure in the module Contact authorized service personnel Service gas module Service gas module and specific erro...

Page 493: ...lumes param The water trap may not be properly connected or there may be a leak in the breathing circuit Tidal volumes detected are so small that inspiration and expiration cannot be distinguished from each other Check the patient status Check the water trap and its connection Check the breathing circuit for leaks Check the loops on screen to locate the problem MVexp MVinsp param Exhaled volume is...

Page 494: ...sor is inoperative or the temperature in the module has increased Contact authorized service personnel TVexp low al area Measured value is outside or equal to the alarm limit Check the patient status Adjust alarm limits if necessary Vent Apnea al area No breathing detected Check the patient status Check the interfaced device Vent Check ventilator al area The interfaced device needs to be checked C...

Page 495: ...evice If the problem persists contact authorized service personnel Ventilator interface removed al area The cable between the Unity Network Interface Device ID and the interfaced device has been removed Reconnect the cable if you want to restart the interface Zeroing error param Zeroing has failed Repeat the zeroing Zeroing param Zeroing is in progress Wait until the zeroing is completed Messages ...

Page 496: ...u may consider removing gas exchange numbers from the screen Out of range param VO2 or VCO2 is below 0 ml min or above 999 ml min Check that the gas sampling line and spirometry lines are correctly connected to the patient airway and to the gas module Check that the correct sensor type D lite Pedi Lite has been selected from the monitor menu Service gas module Service gas module and specific error...

Page 497: ... to the Entropy module Entropy measurement removed al area Acquisition module has been removed Connect the module if you want to restart the measurement Entropy RE high Entropy RE low al area Measurement values are equal to or outside the alarm limits Check the patient status Adjust alarm limits if necessary Adjust drug titration Entropy SE high Entropy SE low al area Measurement values are equal ...

Page 498: ...her high frequency noise Interpret Entropy values with caution Sensor check failed param The sensor has not passed the impedance check Check sensor placement and attachment Confirm proper contact of each electrode in the sensor Replace the sensor Sensor off param The sensor is connected to the cable but not attached to the patient or the sensor type is not correct Check that the sensor is properly...

Page 499: ...removed al area Acquisition module has been removed Connect the module if you want to restart the measurement Reference not stable param The deviation between the four reference search twitches is too big Stop measurement reposition electrodes and restart the measurement Regional Block param Regional block stimulation is in progress Wait until the stimulation is completed Response too weak param T...

Page 500: ...act difference param The electrode impedance check fails Check the contact quality from the active and baseline and electrodes establishment to ensure measurement from the same noise signal Perform a new electrode impedance check Check GND electrode param The ground electrode impedance is over 5 kOhm Check the contact quality from the ground electrode establishment If necessary change the electrod...

Page 501: ...essage location is indicated with the following abbreviations al area alarm area param parameter window report report view wavef waveform area Message Location Explanation What to do Apply sensor param The sensor connection to the patient may be loose Press the BIS sensor electrodes to improve connection Artifact param wavef Signals contain noise or artifact Check sensor contact Remove sources of ...

Page 502: ...communicating or operating properly Test the BISx If the problem persists contact authorized service personnel High BIS impedance al area Electrode impedance is too high Check electrode connections Identical BIS modules al area There are two or more BIS modules in the system Remove all but one BIS module Incompatible DSC param The hardware software is not compatible with the BISx Check and change ...

Page 503: ...e following messages appear The message location is indicated with the following abbreviations al area alarm area param parameter window report report view wavef waveform area Message Location Explanation What to do Calibrating param Calibration is in progress No action required Calibration error param Unsuccessful calibration Authorized service personnel should repeat the calibration procedure Co...

Page 504: ...t authorized service personnel Messages related to trends snapshots and laboratory data For information regarding alarm priorities and escalation times see the CARESCAPE Modular Monitors Supplemental Information Manual Make sure you are familiar with the generic layout of the screen This will help you identify where on screen the following messages appear The message location is indicated with the...

Page 505: ...eform available only for 2min and 4min time scales wavef High Resolution trends license is configured for HR Resp SpO2 CO2 and MAP Change trend resolution to 2 minute or 4 minute time scale for the affected parameter Messages related to various situations For information regarding alarm priorities and escalation times see the CARESCAPE Modular Monitors Supplemental Information Manual Make sure you...

Page 506: ...nel al area Connection to iPanel was lost Re establish the connection If the problem persists contact authorized service personnel Application error pdf al area PDF viewer closes unexpectedly Try to open the MUSE 12SL report again If the problem persists contact authorized service personnel Application error Webmin al area Webmin application closes unexpectedly Try to open Webmin again If the prob...

Page 507: ...ery al area PDM battery is not working properly Check and replace or remove the battery Condition battery A Condition battery B al area Battery A or B is not working properly Replace or remove the battery Condition monitor battery al area Battery is not working properly Replace or remove the battery Configuration change s al area The loaded configuration has changed from the previous one No action...

Page 508: ...ervice personnel Identical unit bed name noticed al area Two or more monitors have the same unit and bed name Contact authorized service personnel Incompatible Module al area The module is not compatible Replace with compatible module See the CARESCAPE Modular Monitors Supplemental Information Manual If the problem persists contact authorized service personnel Incompatible TramRAC al area Incompat...

Page 509: ...onnel Monitor battery empty al area The monitor is used on battery power and there is less than 5 minutes of charge left Charge the battery by using the monitor on mains power Monitor battery low al area The monitor is used on battery power and there is less than 20 minutes of charge left Charge the battery by using the monitor on mains power Monitor disconnected al area The alarming monitor is di...

Page 510: ...ce personnel PDM charging is denied al area The PDM battery cannot be charged because the internal temperature of the monitor is too high Contact authorized service personnel PDM module removed al area Acquisition module has been removed Connect the module if you want to restart the measurements PSM PRESTN module removed al area Acquisition module has been removed Connect the module if you want to...

Page 511: ... may help If the problem persists contact authorized service personnel Replace battery A Replace battery B al area Battery A or B is not working properly Replace the battery Replace monitor battery al area Monitor battery is not working properly Replace the battery Saving al area The recorder is unavailable while printing manual or alarm waveform recording and the recording is saved for later prin...

Page 512: ... the activation Software activation after next discharge al area There is a pending software activation that will take place after you discharge the patient If necessary cancel the activation Speaker failure al area The speaker is not working as it should Contact authorized service personnel Tram module removed al area Acquisition module has been removed Connect the module if you want to restart t...

Page 513: ...12RL twelve reduced leads 12SL twelve simultaneous leads a arterial A auricular A Fib atrial fibrillation A alveolar a AO2 arterio alveolar PO2 ratio AA anesthetic agent AaDO2 alveoli arterial oxygen difference AAMI Association for the Advancement of Medical Instrumentation AC alternating current A C assist control Accel Ventric accelerated ventricular rhythm ACI TIPI acute cardiac ischemia time i...

Page 514: ...ospheric ambient temperature and pressure dry gas ATPS ambient temperature and pressure saturated gas Auto continuous NIBP measurement mode aVF left foot augmented lead avg average aVL left arm augmented lead AVOA automatic view on alarm aVR right arm augmented lead Axil axillary temperature BAEP brainstem auditory evoked potential BE base excess Beta beta frequency band Be beta frequency band per...

Page 515: ...oronary care unit CIC Clinical Information Center CIcalc cardiac index calculated by Fick equation CICU cardiac intensive care unit CISPR International Special Committee on Radio Interference CK MB cardiac muscle type creatine kinase Cl chlorine cmH2O centimeter of water CMRR common mode rejection ratio CNS central nervous system CO2 carbon dioxide COcalc cardiac output calculated by Fick equation...

Page 516: ...ssisted CPU central processing unit Cr creatinine CSA Canadian Standards Association CSA compressed spectral array CT computed tomography CvO2 venous oxygen content CVP central venous pressure d day dB decibel DBS double burst stimulation DC direct current Delta delta frequency band Delta delta frequency band percentage Des desflurane Diagn diagnostic Dia DIA diastolic pressure DIDCA Device IDenti...

Page 517: ...ure ESU electrosurgical unit ESV end systolic volume EDVI end systolic volume index ET endotracheal ET Et end tidal concentration EtAA end tidal anesthetic agent EtBal end tidal balance gas EtCO2 end tidal carbon dioxide EtN2O end tidal nitrous oxide EtO2 end tidal oxygen Exp exp expiratory f frequency F foot describing location F frontal F I E O2 inspiratory mixed expiratory oxygen fraction diffe...

Page 518: ...ot g gram g dl grams per deciliter g l grams per liter GEDI global end diastolic volume index GND ground Graph graphical h hour Hal halothane Hb hemoglobin HbO2 oxyhemoglobin HCO3 bicarbonate Hct hematocrit HDU high dependency unit Hemo hemodynamic Hemo Calcs hemodynamic calculations HFV high frequency ventilation HIS hospital information system HME heat and moisture exchanger HMEF heat and moistu...

Page 519: ...atory ventilation IMV Demand intermittent mandatory ventilation on demand in inch IND induction Inf inferior Infl inflation limit INR international normalized ratio Insp insp inspiratory Insp Pause inspiratory pause time IntelliRate automatic heart rate source selection of PDM IP internet protocol IP invasive blood pressure IPPV intermittent positive pressure ventilation IPPV ASSIST intermittent p...

Page 520: ...VEDP left ventricular end diastolic pressure LVEDV left ventricular end diastolic volume LVSW left ventricular stroke work LCWI left ventricular stroke work index MAC minimum alveolar concentration MACage MAC compensated with patient age patient temperature and atmospheric pressure Man manual Man Spont manual spontaneous MAP mean arterial pressure Max maximum MB megabyte mbar millibar MBC module b...

Page 521: ...ted spontaneous breathing Moder moderate mol mole Monit monitoring MRI magnetic resonance imaging MRN medical record number ms millisecond Multif PVCs multifocal premature ventricular contractions MV minute volume MVexp expired minute volume l min MVexp BTPS expired minute volume in BTPS conditions MVexp STPD expired minute volume in STPD conditions MVinsp inspired minute volume l min MVspont spon...

Page 522: ... Oxy oxygenation OxyCRG oxycardiorespirogram P parietal P partial pressure P pressure Pa Pascal PA pulmonary arterial pressure PAC premature atrial contraction Paced paced beats PaCO2 partial pressure of carbon dioxide in the arteries PACU post anesthesia care unit PaO2 partial pressure of oxygen in the arteries PAO2 partial pressure of oxygen in the alveoli Paw airway pressure Paw Vol Loop pressu...

Page 523: ...xpiratory pressure ICU NICU ED software packages PEEPi intrinsic positive end expiratory pressure ICU NICU ED software packages PEEPistat static intrinsic positive end expiratory pressure ICU ED software packages PEEPtot total positive end expiratory pressure OR PACU software packages pg ml picogram per milliliter pH potential of hydrogen pHa arterial pH pHv mixed venous pH pHv venous pH PIC patie...

Page 524: ...the T wave of the preceding normal beat RA right arm describing location RAM random access memory RAP right atrial pressure Raw airway resistance RCW right cardiac work RCWI right cardiac work index RE response Entropy Rect rectal temperature ref reference REF right ventricular ejection fraction Resp Rate respiration rate total measured RF radio frequency RHb reduced hemoglobin RL reduced leadset ...

Page 525: ... SIMV ASB synchronized intermittent mandatory ventilation assisted spontaneous breathing SIMV CPAP synchronized intermittent mandatory ventilation continuous positive airway pressure SIMVPS synchronized intermittent mandatory ventilation pressure support SjO2 jugular bulb oxygen saturation Skin skin temperature SL simultaneous leads SN serial number SO2 saturated oxygen Spiro Patient Spirometry Sp...

Page 526: ...Master Sync SLV Synchrom Slave Sys SYS systolic pressure T temperature T temporal T BTPS temperature in BTPS conditions T1 first twitch T1 first stimulus as percent of the reference value NMT Tab tabular Tachy tachycardia Tblood blood temperature TC transcutaneous TcCO2 transcutaneous carbon dioxide TcO2 transcutaneous oxygen TCO2 total carbon dioxide Tcorr patient temperature used to correct pH P...

Page 527: ... V Brady ventricular bradycardia V Fib ventricular fibrillation V Tach ventricular tachycardia v venous V1 to V1 V6 ECG lead V1 to ECG lead V1 V6 VA alveolar ventilation VC vital capacity VCO2 carbon dioxide production Vd dead space Vd Vt dead space ventilation Vent ventilator Vent Calcs ventilation calculations WLAN wireless local area network VO2 oxygen consumption VO2calc calculated oxygen cons...

Page 528: ...Abbreviations yr year yrs years 528 CARESCAPE Modular Monitors 2062971 001 ...

Page 529: ... reading Completed Not applicable SYSTEM SAFETY PRECAUTIONS System warnings 53 System caution 54 B850 SYSTEM COMPONENTS B850 system components 55 B650 SYSTEM COMPONENTS B650 system components 58 B450 SYSTEM COMPONENTS B450 system components 62 MONITOR BATTERY Monitor battery 65 ALARM LIGHT Alarm light 69 DISPLAYS Displays 69 ACQUISITION MODULES Acquisition modules 70 EQUIPMENT SYMBOLS Equipment sy...

Page 530: ...tient data and trend data from the S 5 Network 121 USING STANDBY Starting standby 122 End of standby 123 CONTINUING MONITORING How to continue monitoring when a case is not active patient is discharged 123 How to continue monitoring when a case is active patient is admitted 124 CASE RESET PATIENT DISCHARGE Resetting a case discharging a patient 125 Resetting a case discharging a patient in combina...

Page 531: ...mpleted tasks in the table Recommended reading Completed Not applicable SAFETY PRECAUTIONS Alarm warnings 127 Alarm cautions 129 OVERVIEW Alarm types 129 Alarm conditions 129 Alarm priority levels 130 Selecting parameter alarm priority levels 141 Alarm priority escalation 130 Physiological alarms activation criteria 130 CHECKING THE FUNCTION Checking alarm function 133 ALARM INDICATIONS Alarm icon...

Page 532: ...17 Changing the time scale of graphic trends 418 Changing the time scale of graphic trends 418 Graphic trend resolution and the high resolution license 419 NUMERIC TRENDS Viewing numeric trends 419 Changing the time interval of numeric trends 420 IP TRENDS Invasive pressure trends 420 HR TRENDS Heart rate HR trends 420 GAS CONSUMPTION Viewing gas consumption data 421 Printing gas consumption data ...

Page 533: ...e table Recommended reading Completed Not applicable GENERAL MEASUREMENT OVERVIEW ECG warnings 147 ECG cautions 149 ECG measurement limitations 149 ECG points to note 149 ECG equipment to patient connection 150 Checking the ECG measurement 154 PREPARING THE PATIENT Preparing the patient s electrode sites 150 Applying the electrodes to the patient 150 3 lead or 5 lead ECG electrode placement 151 6 ...

Page 534: ...e of ACI TIPI 167 12 lead ECG analysis points to note 167 Enabling and disabling the 12SL ACS 168 PACEMAKER DETECTION Pacemaker detection warnings 172 Selecting the pacemaker detection 173 ARRHYTHMIA DETECTION Arrhythmia monitoring warnings 175 Arrhythmia measurement limitations 176 Setting the arrhythmia category to alarm 177 Setting arrhythmia alarms 177 Arrhythmia alarm messages 178 ST DETECTIO...

Page 535: ...orm sensitivity 197 Setting the respiration alarm limits 197 Turning on or off the respiration rate alarm 197 Setting the apnea alarm delay 198 Enabling the respiration cardiac artifact alarm 198 Respiration alarm priorities 198 Pulse oximetry SpO2 To familiarize yourself with this parameter and its use with the CARESCAPE modular monitors study the topics listed as the recommended reading of this ...

Page 536: ...his parameter and its use with the CARESCAPE modular monitors study the topics listed as the recommended reading of this User s Manual The numbers in brackets refer to the page numbers in the manual As you proceed mark your completed tasks in the table Recommended reading Completed Not applicable GENERAL MEASUREMENT OVERVIEW NIBP warnings 219 NIBP cautions 220 NIBP measurement limitations 221 NIBP...

Page 537: ... the manual As you proceed mark your completed tasks in the table Recommended reading Completed Not applicable GENERAL MEASUREMENT OVERVIEW Invasive pressure warnings 235 Invasive pressure measurement limitations 235 Invasive pressure points to note 235 Checking the invasive pressure measurement 237 Invasive pressure equipment to patient connection 236 ZEROING Zeroing the invasive pressure transdu...

Page 538: ...e label 258 Cardiac output To familiarize yourself with this parameter and its use with the CARESCAPE modular monitors study the topics listed as the recommended reading of this User s Manual The numbers in brackets refer to the page numbers in the manual As you proceed mark your completed tasks in the table Recommended reading Completed Not applicable GENERAL MEASUREMENT OVERVIEW C O warnings 261...

Page 539: ...g the SvO2 measurement 276 SvO2 equipment to patient connection 276 SvO2 CALIBRATION SvO2 calibration in vitro 277 Calibrating a new SvO2 catheter in vitro 277 Calibrating SvO2 in vivo 278 SvO2 SIGNAL QUALITY INDICATORS SvO2 measurement on screen 276 Airway gases To familiarize yourself with this parameter and its use with the CARESCAPE modular monitors study the topics listed as the recommended r...

Page 540: ...anesthesia gas scavenging system 295 Connecting directly to the scavenging system 295 CALIBRATION Calibrating airway gases 296 CO2 with CAPNOSTAT Mainstream CapnoFlex LF and Dual CO2 modules To familiarize yourself with this parameter and its use with the CARESCAPE modular monitors study the topics listed as the recommended reading of this User s Manual The numbers in brackets refer to the page nu...

Page 541: ...he CARESCAPE modular monitors study the topics listed as the recommended reading of this User s Manual The numbers in brackets refer to the page numbers in the manual As you proceed mark your completed tasks in the table Recommended reading Completed Not applicable GENERAL MEASUREMENT OVERVIEW Patient Spirometry warnings 323 Patient Spirometry cautions 323 Patient Spirometry limitations 323 Patien...

Page 542: ...o familiarize yourself with this parameter and its use with the CARESCAPE modular monitors study the topics listed as the recommended reading of this User s Manual The numbers in brackets refer to the page numbers in the manual As you proceed mark your completed tasks in the table Recommended reading Completed Not applicable GENERAL MEASUREMENT OVERVIEW Entropy warnings 349 Entropy cautions 350 En...

Page 543: ...oSensor setup 364 Preparing the MechanoSensor setup 364 NMT alternative connections 364 NMT TRENDS ON SCREEN NMT graphical trends on the monitor screen 365 STARTING THE MEASUREMENT Starting the NMT measurement 365 CHANGING THE CYCLE TIME Changing the NMT cycle time 366 NMT ALTERNATIVE USES NMT alternative connections 364 EEG and AEP To familiarize yourself with this parameter and its use with the ...

Page 544: ...e EEG scale 379 Selecting the EEG sweep speed 379 Selecting your own EEG montage 379 Defining an EEG montage 381 Compressed spectral array CSA 383 AUDITORY EVOKED POTENTIALS Preparing the patient for AEP measurement 387 AEP montage 388 Starting the AEP measurement 388 BIS To familiarize yourself with this parameter and its use with the CARESCAPE modular monitors study the topics listed as the reco...

Page 545: ...t connection 396 Preparing the patient for BIS measurement 396 USING THE MEASUREMENT Selecting the BIS waveform size 397 Selecting the BIS smoothing rate 397 Using the automatic BIS sensor check 398 Using the manual BIS sensor check 398 HOW TO INTERPRET THE VALUES How to interpret the BIS values 399 2062971 001 CARESCAPE Modular Monitors 545 ...

Page 546: ...Skills checklist 546 CARESCAPE Modular Monitors 2062971 001 ...

Page 547: ...content ...

Page 548: ...m GE Medical Systems Information Technologies Inc 8200 West Tower Avenue Milwaukee WI 53223 USA Tel 1 414 355 5000 1 800 558 5120 US only Fax 1 414 355 3790 GE Medical Systems Information Technologies Asia GE China Co Ltd No1 Huatuo Road Zhangjiang Hi tech Park Pudong Shanghai P R China 201203 Tel 86 21 5257 4650 Fax 86 21 5208 2008 www gehealthcare com ...

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