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3.10 Continuous Non-Invasive Blood Pressure Measurement

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Switching on the cNIBP mode and setting the parameters of its operation is carried out using
the fields and icons located in the cNIBP channel window:

3.10.5. Limitations of cNIBP Method

The method of continuous measurement of NIBP used in the device has some restrictions on
the conditions of its use.

The use of the continuous NIBP mode is available only at the adult profile
type. When using pediatric or neonatal profiles, it is not possible to enable
cNIBP mode.

When using the manual mode of measuring blood pressure, it is also impos-
sible to enable the cNIBP mode.

For the correct operation of the mode, it is necessary to have ECG, PPG, NIBP channels con-
nected to the patient and the availability of data on these channels.

In the case of asystole via the ECG channel or a weak signal via the PPG channel, the parame-
ters of the continuous NIBP mode are not calulated. For some types of arrhythmias that lead to
extremely unstable PWTT values, the calculation of cNIBP readings is also impossible.

Do use the cNIBP mode on patients with intense sharp and frequent changes
in blood pressure, because this can lead to frequent starts of NIBP meas-
urement for calibration purposes.

If it is impossible to calculate blood pressure by the continuous method, one of the following
messages will be displayed in the cNIBP window:

Message

Description of the situation

Troubleshooting

PWTT: data
capture

Not enough data to calculate blood pressure,
waiting for additional PWTT data (in a few
seconds)

Wait until the readings appear.

PWTT: waiting
NIBP

Calibration blood pressure measurement re-
quired (will be done automatically))

Wait the automatic start of blood pressure
measurement and the appearance of
readings.

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Summary of Contents for MPR6-03

Page 1: ...Patient Monitor MPR6 03 User Manual RM 501 01 000 01 01 UM Version 7 05 2020 ...

Page 2: ...2 ...

Page 3: ...gs of Pulse Oxymetry Module 46 1 3 14 Settings of NIBP Module 47 1 3 15 Settings of the Thermometry Module 48 1 3 16 Settings of the Capnometry Module 49 1 3 17 Settings of Multigas Module 50 1 3 18 Settings of the IBP Module 51 1 3 19 System Reset 52 1 4 ALARMS 53 1 4 1 Alarm System 53 1 4 2 Alarm Messages 54 1 4 3 Silencing the Audible Alarm 55 1 4 4 Alarms of the Pulse Oximetry Module 56 1 4 5 ...

Page 4: ...9 Disinfection of the Accessories of Multigas Module 123 2 6 INVASIVE BLOOD PRESSURE MEASUREMENT IBP 124 2 6 1 IBP Window 125 2 6 2 IBP Measurement Procedure 125 2 6 3 Disinfection of the Pressure Transducer Cable 127 3 ADDITIONAL FEATURES 128 3 1 TRENDS 128 3 1 1 Graphical Trends 129 3 1 2 Tabular Trends 131 3 1 3 Recording and Viewing Waveform Fragments 133 3 1 4 Built in Thermal Printer 134 3 1...

Page 5: ...nsor 174 3 11 6 Disinfection of the Reusable Airway Adapters 175 3 12 DEPTH OF ANAESTHESIA AND SEDATION MODULE 176 3 12 1 Basics of the Depth of Anesthesia and Sedation Evaluation 176 3 12 2 Preparing for the Monitoring of the Depth of Anesthesia 177 3 12 3 Settings of the Depth of Anesthesia Module 178 3 12 4 Evaluation of the Brain Activity 180 3 12 5 Disinfection of the External Depth of Anesth...

Page 6: ... device can also determine the heart rate HR and warn about the development of abnor mal heart rhythm for example asystole changes in the peripheral pulse frequency by PPG respiratory disorders deviations values of normal blood pressure and CO2 concentration and other life threatening conditions for the patient The device analyzes the electrocardiogram with the definition of the type of heart rhyt...

Page 7: ...e converted into a signal using a strain gauge pressure sensor which after appropriate processing is used to calculate the pressure and pulse value The operation of the respiratory gas analysis module is based on the principle of two channel non dispersive optical absorption spectroscopy in which the beam of an infrared emitter passes through the gas sample under study in the measuring chamber and...

Page 8: ...patient s body Various types of pressure cuffs are used neonatal pediatric adult shoulder hereinafter re ferred to as adult and adult thigh differing in size and volume and suitable for all categories of patients Thermal sensors are used in two types surface skin and intracavitary universal Two tem perature sensors can be connected to the device at once to measure the temperature at two different ...

Page 9: ...capabilities of the device Your device depending on its version may not have all of them For the convenience of operation you can make your own device settings therefore the screen layout settings of alarm thresholds operating parameters etc depend on the user s settings and may not coincide with those given in this manual The manufacturer may without prior notice make changes to the design cir cu...

Page 10: ...by immersion is prohibited prevent liquid from getting inside the cuff and connecting hose during disinfection do not allow the use of cuffs containing talcum powder to prevent clogging of the pneumatic path timely empty the water trap never allow it to be completely filled do not carry the operating device with a full reservoir of the water trap and do not remove it when the device is running bec...

Page 11: ...ve earth Device on off button Capnometer activation button Activation button of non invasive blood pressure single measurement Button to stop freeze curves on the screen Alarm silence for 2 minutes 123 Button for on off mode Large numbers F button programmable function IBP1 Port for the transducer of the 1 st IBP channel IBP2 Port for the transducer of the 2 nd IBP channel T1 Port for the sensor o...

Page 12: ...external DC source option Symbols on the display Trend window Alarm sound window Settings of general parameters Calculator window Silence of all alarms Stopping graphs on the screen HR signal source Pulse oximetry Masimo SET technology optional Operating room mode on off for the ECG channel Enable disable pacemaker detection optional Audible alarm for this channel is enabled Audible alarm for this...

Page 13: ... a thermal printer in the tabular trend window and in the wave form fragments window The color of the paper on the icon white the printer is ready yellow the printer is busy red no paper in the printer Pulse perfusion bar ECG scale bar Battery fill level is proportional to energy green when charging yellow when discharg ing Zero calibration of the IBP channel and the sidestream capnometry channel ...

Page 14: ...ly and verti cally TFT color touchscreen 15 1024х768 pixels 1 10 Infoport for connecting of external modules available 1 11 Operation with a centralized monitoring system with sim ultaneous connection of monitors up to 32 1 12 Operation with a centralized monitoring system via radio channel optional 1 13 Connection of USB flash available 1 14 Maximum number of simultaneously displayed graphic curv...

Page 15: ...d expiration EtCO2 EtO2 ЕtN2О capnogram respiratory rate optional 2 13 Depth of anesthesia evaluation optional 2 14 Evaluation of respiratory mechanics parameters optional 2 15 Non invasive monitoring of the patient s metabolic needs optional 3 ECG channel 3 1 Leads I II III aVL aVR AvF V1 V6 3 2 Synthesized 12 channel ECG derived from 5 electrodes available 3 3 Simultaneous displaying of any curv...

Page 16: ...ce of 2 channels Digital 5 4 Temperature measurement range 0 50 С 5 5 Temperature measurement accuracy 0 1 С 5 6 Type of sensors Surface intracavitary optional 6 Non invasive blood pressure measurement 6 1 Measurement principle Combined with a preliminary meas urement at the phase of compression adult Oscillometric pediatric neonatal 6 2 Digital displaying of arterial pressure Systolic diastolic m...

Page 17: ...to 240 min with an adjustment step of 1 min 8 cNIBP channel continuous non invasive blood pres sure measurement 8 1 Pulse wave transit time measurement PWTT Continuous 8 2 Display of PWTT determined diastolic systolic and mean BP Continuous 8 3 Calibration Automatic by oscillometric method en suring measurement accuracy for a specific patient 8 4 cNIBP calibration threshold Adaptive automatic and ...

Page 18: ... mois ture absorber 11 4 Self cleaning mode of the measuring line and measuring cuvette Automatic when moisture appears in the cuvette 11 5 Compensation for the nitrous oxide influence on the measured CO2 concentration Manual 11 6 Measurement range 0 15 or 0 115 mmHg 11 7 Display mode of concentration in or partial pressure in mmHg Available 11 8 Measurement error of CO2 concentration absolute in ...

Page 19: ...ng the accuracy of measurements of CO2 con centration in the presence of associated gases N2O anesthetics display of digital parameters EtCO2 FiCO2 respiratory rate alarm thresholds 0 15 0 115 mmHg Available Available 14 4 Monitoring of О2 О2 concentration measurement range 0 100 14 5 N2О concentration measurement range 0 100 14 6 Range of the anesthetics monitoring halothane Hal enflurane Enf iso...

Page 20: ...ation volume Available Available Available Available 16 2 Displaying of curves of flow volume and pressure in the breathing circuit Automatic 17 Patient metabolic needs monitoring channel Optional 17 1 Monitored parameters VO2 oxygen consumption VCO2 carbon dioxide elimination REE resting energy expenditure RQ respiratory quotient Available Available Available Available 17 2 MOV minute volume inpu...

Page 21: ...g 20 1 Recorded trends HR PR SpO2 arterial pressure Т 2 channels temperature difference per fusion index RR ST analysis EtCO2 cardiac index СI brain activity index AI oxygen consumption VO2 resting energy expenditure REE op tional 20 2 Trend view Graphical tabular 20 3 Memory mode Automatic 20 4 Non volatile memory Available 20 5 Resolution of trend displaying 15 or 60 sec 20 6 Memory size 240 hou...

Page 22: ...AINS indicator informs about the operation of the power supply system off no voltage In this case turned on device will operate from the internal battery green mains voltage is supplied to the device the device battery can be charged In this case when the device is turned on its operation will occur from the mains red when the device is on a malfunction of the power supply system while further ope...

Page 23: ...bol appears on the screen and above it the time in seconds remaining until the signal is re stored Press the button again to restore the sound alarm ahead of time 11 Manipulator encoder to control the device 12 Lamp ALARM for additional attention blinks red when an alarm is triggered Figure 1 2 Patient Monitor MPR6 03 front view The surface of the liquid crystal display of the device shall be prot...

Page 24: ...tor for the ECG patient cable 8 Connector for the NIBP cuff 9 Port for the 2 nd thermo channel for connecting a temperature sensor 10 Infoport for the mainstream CO2 sensor 11 Pneumatic connector for the respiratory mechanics module 12 Connector for microflow line for sampling Figure 1 4 Patient Monitor MPR6 03 side view panel of ports and connectors Figure 1 5 Water trap Clips for attaching to th...

Page 25: ...cting it to the mains and to the patient taking into account the fact that an intense external illumina tion on the device screen reduces the contrast of the image on it The device must be connected to a three pole socket with a functional protective grounding cir cuit see Fig 1 7 a Do not plug the device into a socket without grounding see Fig 1 7 b or a power extender without grounding see Fig 1...

Page 26: ...ture for at least 12 hours in a packed state It is PROHIBITED during operation to work with the removed rear panel of the device if it is connected to the power sup ply to remove the cover of the device and replace the fuse without disconnecting the de vice from the mains disinfection of the powered on device the power plug must be removed from the socket immersion of the device housing sensors an...

Page 27: ... the defibrillator During temperature monitoring it is necessary before the first use of the intracavitary temperature sensor sterilize it since the sen sor is supplied non sterile During non invasive blood pressure monitoring it is necessary to use medical assessment when conducting frequent automatic blood pressure measurements in patients with serious disorders of the blood coagulability due to...

Page 28: ...nnect the device power cable to the corresponding socket on its rear panel see Fig 1 3 item 5 The POWER indicator on the front panel of the device lights up green the device is ready for operation from the mains To operate the device from the internal battery no additional manipulations are re quired the POWER indicator does not light up and after turning on the device the BAT flashes red For a re...

Page 29: ...invasive pressure measurement module Disinfection of the external parts of the device and electrical connectors of the sensors shall be carried out only by wiping with a gauze sponge soaked in a disinfectant solution 3 hydrogen peroxide with the addition of 0 5 detergent type Lotos according to MU 287 113 previously wrung out from excess solution to exclude disinfecting solution getting inside the...

Page 30: ...er p 1 3 5 6 Thermometry window p 2 3 7 Status of the built in battery The fill level of the symbol corresponds to the battery energy and the color corresponds to its mode of operation charge discharge limit discharge p 3 4 8 Current time and date hour min sec day month year p 1 3 6 9 NIBP window p 2 4 10 Status and alarm messages and icons p 1 4 11 Device operating profile adult pediatric neonata...

Page 31: ...in in all cases immediately interrupts the blood pressure measurement The FREEZE button is intended for stopping freezing of the graphical curves on the device screen while the flashing symbol is indicated Pressing this button again resumes the sweep Also this button is used to record fragments of ECG waveforms in manual mode In a FREEZE mode you cannot view trends and saved waveforms enter the me...

Page 32: ...and anesthetic gases IBP invasive blood pressure window NCOV non invasive monitoring of cardiac output channel of the central hemodynamics MetaBqf window of metabolics AI depth of anesthesia window PWTT continuous blood pressure measurement window VCapno1 window of graphical curves of respiratory mechanics channel VCapno2 window of digital parameters of respiratory mechanics channel When you selec...

Page 33: ... highlighted in a different color Use the buttons to set the required value Press OK button to confirm the changes or Cancel to discard The internal clock continues to run even in the off state of the device how ever if the device is stored for a long time without switching on clock may fail or the time cannot be memorized In this case turn on the device for several hours and then set the time and...

Page 34: ...alue You can set any volume level from 0 to 100 in 10 steps Press OK button to confirm the changes or Cancel to discard For the patient safety it is strongly not recommended to disable the audible alarm completely The alarm volume value is automatically set to 30 each time the device is turned on Device stores the volume of the pulse signal when the it is turned off but after system reset or a lon...

Page 35: ...required mode by pressing Indicated HR PR value depends on the parameter HR calc by and can be defined by SpO2 PPG or ECG channel The symbol has the color of the selected channel yellow or green respectively If the selected curve is not available for some reason then the calculation of the HR PR is automatically performed according to another curve and af ter the restoration of the registration of...

Page 36: ...t see p 3 7 If the device is equipped with multigas module the window of general parameters contains the field a field for setting the 1MAC coefficients The setting of the 1MAC coefficients for each gas is carried out in accordance with p 1 3 10 If the device contains the respiratory mechanics module the window of general parameters has fields to compensate the transport delay between the flow cur...

Page 37: ...arameters in measur ing modules The type and name serial number in the group of the profile are indicated on the device dis play by a corresponding icon When you change the profile device switches to the correspond ing operation mode with user presets or factory settings These settings are independent for each profile and are automatically saved in non volatile memory when modified by the user To ...

Page 38: ...the Yes button then the set of profile parameters is set in accordance with the table Profiles Unit Adult Pediatric Neonatal Patient gender Female Female Female Patient weight kg 80 35 3 5 Patient height cm 160 140 55 Age years 20 4 30 days Bottom threshold SpO2 Top threshold SpO2 90 90 80 95 Bottom threshold PR Top threshold PR 1 min 1 min 50 120 75 160 100 200 Bottom threshold HR Top threshold H...

Page 39: ... 99 99 Bottom threshold FiО2 Top threshold FiО2 10 99 10 99 10 99 Bottom threshold EtN2O Top threshold EtN2O 1 70 1 70 1 70 Bottom threshold FiN2O Top threshold FiN2O 1 70 1 70 1 70 Bottom threshold EtAX Top threshold EtAX 0 1 6 0 0 1 6 0 0 1 6 0 Bottom threshold FiAX Top threshold FiAX 0 1 6 0 0 1 6 0 0 1 6 0 Bottom threshold SYS1 SYS2 Top threshold SYS1 SYS2 mmHg mmHg 90 160 70 120 55 90 Bottom ...

Page 40: ...est value The highest value Alarm on off Setting the alarm thresholds for the mean NIBP pressure MAP value and for the ST segment offset for all leads StDev is performed in the menu of general parameters p 1 3 8 There are several ways to set the required threshold value Select the required digit of the digital threshold value for correction by clicking on it it will be highlighted in a different c...

Page 41: ...3 0 21 0 0 1 Bottom threshold of 1 st 2 nd temperature channel С 20 0 42 0 0 1 StDev Top threshold of ST segment offset mm 19 0 20 0 0 1 Bottom threshold of ST segment offset mm 20 0 19 0 0 1 EtCO2 Top threshold of expiratory gas concentration mmHg 0 5 15 0 1 120 0 1 1 Bottom threshold of expiratory gas concentra tion mmHg 0 1 14 9 1 119 0 1 1 FiCO2 Top threshold of inspiratory gas concentration m...

Page 42: ...p one lower than the bottom one All set threshold values are stored in internal memory when the device is turned off Threshold values are restored to default values after long term storage reset to factory settings or system reset see p 1 3 9 Setting of digital parameters is similar to the setting of alarm thresholds The presentation of the input window for a digital parameter depends on the type ...

Page 43: ... of digital parameters in the PPG and IBP channels The ECG scale values correspond to the amplification of the ECG curve x0 2 x0 5 x1 0 x2 0 x4 0 x20 0 A detailed description of the parameters of the ECG module is presented in p 2 2 Default values scale 1 0 mV lead I ECG filter filter cable type 4 elect ECG curves 1 mode Nrm sweep speed 25 mm s averaging time 16 s When you select an ECG lead that ...

Page 44: ...r about all arrhythmias at once If it is allowed to generate messages for all types of arrhythmias in the list then the icon of the list of arrhythmias is displayed in gray If the display of messages about at least one type of arrhythmia is disabled then the icon is displayed in yellow If arrhythmia analysis is disabled the icon is displayed in red Arrhythmia analysis function is disabled by defau...

Page 45: ...of the values of these parameters located in the respirogram window Press on the required sweep speed and set the apnea interval in accordance with p 1 3 10 Default parameters sweep speed 12 5 mm s apnea time 10 s Decreasing the sweep speed compresses the curve to view the data over a longer period of time Increasing the sweep speed stretches the curve for more detailed examination of the curve ...

Page 46: ... window that appears after clicking Default values sweep speed 25 mm s averaging time 16 s Decreasing the sweep speed compresses the curve to view the data over a longer period of time Increasing the sweep speed stretches the curve for more detailed examination of the curve Increasing the averaging time reduces the influence of artifacts on the accu racy of the saturation and heart rate parameters...

Page 47: ...ield When the automatic BP measurement mode is turned on the counter value of the BP meas urement period is additionally displayed in the NIBP channel window and the symbol P man ual is replaced by A automatic on the measurement start icon To start NIBP measurement including for the first measurement in automatic mode click on the start icon To interrupt the NIBP measurement in progress click on t...

Page 48: ...l window After switching on the T1 T2 mode the value of the temperature difference between the chan nels T1 and T2 will be displayed on the T2 display channel Switching back to T2 mode is similar It is necessary to connect both temperature sensors to measure the tem perature difference T1 T2 If the symbols are displayed at least in one of the channels then in the display mode of the temperature di...

Page 49: ...if there is N2O in the breathing gas mixture and available only in the version of the capnometry module without the N2O measurement channel Default values scale 10 80 mmHg sweep speed 12 5 mm s apnea interval 10 s N2O concentration in the breathing mixture 0 Decreasing the sweep speed compresses the curve to view the data over a longer period of time Increasing the sweep speed stretches the curve ...

Page 50: ...ction the monitored anesthetic gases must be set manually The waveforms are displayed only for gases selected in the window of digital parameters CO2 curve is always displayed on the screen and cannot be disabled Input of the 1MAC concentration values for each of the gases is intended to calculate the total MAC value minimum alveolar concentration The MAC calculation is performed for those gas es ...

Page 51: ...nd IBP2 Each chan nel has its own set of independently settable parameters The setting of the sweep speed and averaging time is performed synchro nously with the parameters of the ECG channel in the ECG channel window p 1 3 11 You can set IBP alarm thresholds for systolic and diastolic blood pressure and data displaying format separately for each channel A detailed description of the IBP module pa...

Page 52: ...raphs appear on the screen The screen view and all the device parameters will take their default values When performing a system reset all data accumulated in the trends are erased The system reset procedure takes about 30 seconds Trend view mode is blocked until the system reset is completed with the message Initialization of trends Wait ...

Page 53: ... to control alarms remotely pause suppression mute and reset of alarms from the central station computer In this case enhanced physical control of the patient s condition is required Patient alarms have three forms of presentation Light alarm Text information in the output window of the corresponding channel and the icon with the channel symbol in the general message window Sound alarm The appeara...

Page 54: ... one second after another in accordance with the priority of their danger to the patient in the ta bles below messages on technical alarms are highlighted with filling When the monitored parameters are out of the set alarm thresholds text messages are not dis played the light alarm is blinking and the corresponding parameter has color filling If the graph window of a channel is not displayed disab...

Page 55: ...uired parameter on the touch screen After pressing the symbol will be replaced by which means that the sound alarm for this parameter is disabled Complete silencing set the parameters Alarm volume and Techn alarms to the 0 state p 1 3 7 The red symbol on the screen indicated the complete silence of the audible alarms see Fig 1 8 position 19 It cannot be disabled by pressing it For the patient safe...

Page 56: ...every 5 s The same on a yellow back ground SрО2 value is more than top threshold 4 Three short beeps every 5 s The same on a red background HR value is less than bottom threshold 4 Flashing HR value HR value is less than bottom threshold by 4 8 Two short beeps every 5 s The same on a yellow back ground HR value is less than bottom threshold 8 Three short beeps every 5 s The same on a red backgroun...

Page 57: ...put window Sound alarm Light alarm SpO2 sensor failure Sensor failure PPG Two tone every 5 s Technical alarms are highlighted with gray fill this alarm is triggered if the device has previously recorded readings via the pulse oximetry channel ...

Page 58: ...y 5 s The same on a red background RR value is less than bottom thresh old 20 Flashing RR value RR value is less than bottom thresh old on 20 40 Two short beeps every 5 s The same on a yel low background RR value is less than bottom thresh old 40 Three short beeps every 5 s The same on a red background RR value is more than top threshold 20 Flashing RR value RR value is more than top threshold on ...

Page 59: ... same on a red background DIA value is less than bottom threshold 4 Flashing DIA value DIA value is less than bottom threshold on 4 8 Two short beeps every 5 s The same on a yellow back ground DIA value is less than bottom threshold 8 Three short beeps every 5 s The same on a red background DIA value is more than top threshold 4 Flashing DIA value DIA value is more than top threshold on 4 8 Two sh...

Page 60: ... 200 150 mmHg for adult pediatric neonatal modes respectively Overpressure NIBP instead of BP The measurement time reached 180 180 90 sec for adult pediatric neo natal modes respectively NIBP meas time exceeded NIBP Two tone every 5 s instead of BP The pneumatic path is not air tight Cuff damage NIBP Two tone every 5 s instead of BP After release the pressure in the cuff is more than 15 15 5 mmHg ...

Page 61: ...rm situation Message output window Sound alarm Light alarm Т С value is less than bottom threshold 2 Flashing Т1 Т2 value Т С value is less than bottom threshold on 2 4 Two short beeps every 5 s The same on a yellow back ground Т С value is less than bottom threshold 4 Three short beeps every 5 s The same on a red background Т С value is more than top threshold 2 Flashing Т1 Т2 value Т С value is ...

Page 62: ...value FiCО2 value is more than top threshold on 5 10 Two short beeps every 5 s The same on a yellow back ground FiCО2 value is more than top threshold 10 Three short beeps every 5 s The same on a red background No breathing No breathing APNEA capno Continuous signal RSP 0 Thermal stabilization of the measuring cham ber elements is in progress Warming capno Periodic zero autocalibration is in progr...

Page 63: ...he measuring chamber emitter Off Emitter Fail capno Two tone every 5 s Failure of the measuring chamber photode tector Off Photodetector Fail capno Two tone every 5 s Capnometer compressor failure Off Compressor Fail capno Two tone every 5 s Capnometer pressure sensor failure Off Pressure Sen sor Fail capno Two tone every 5 s Technical alarms are highlighted with gray fill this alarm is triggered ...

Page 64: ...ss than bottom threshold 5 Flashing FiXXX value FiXXX value is less than bottom threshold on 5 10 Two short beeps every 5 s The same on a yellow back ground FiXXX value is less than bottom threshold 10 Three short beeps every 5 s The same on a red background FiXXX value is more than top threshold 5 Flashing FiXXX value FiXXX value is more than top threshold on 5 10 Two short beeps every 5 s The sa...

Page 65: ...by the CAPNO button or No breath signal at the multigas input more than 1 hour Off by user multi gas Technical alarms are highlighted with gray fill XXX gas name CO2 O2 N2O AX1 AX2 HAL ISO DES SEV ENF this alarm is triggered if the device has previously recorded readings via the multigas chan nel ...

Page 66: ...d 4 Flashing DIA val ue of IBP1 IBP2 channel DIA value is less than bottom threshold on 4 8 Two short beeps every 5 s The same on a yellow back ground DIA value is less than bottom threshold 8 Three short beeps every 5 s The same on a red background DIA value is more than top threshold 4 Flashing DIA val ue of IBP1 IBP2 channel DIA value is more than top threshold on 4 8 Two short beeps every 5 s ...

Page 67: ...ts with limited motor activity optoe lectronic SрО2 sensors of the following types are designed finger clip adult and pediatric see Fig 2 1 a finger rubber adult and pediatric see Fig 2 1 b neonatal universal see Fig 2 2 a neonatal disposable see Fig 2 2 b The set of sensors in your device is determined when ordering To connect 1 m sensors to the device use the adapter supplied with the device To ...

Page 68: ...ability of the measurement results the finger and hand must be motionless 2 1 2 Application of Neonatal SpO2 Sensors The monitor can be equipped with various neonatal sensors intended for newborn babies see Fig 2 2 a b In addition sensors a are applicable for children of any age as well as for adult patients in cases where it is necessary to install and securely fix the sensor in non standard loca...

Page 69: ...n satura tion of venous blood is 40 60 the device measures the total saturation of pulsating arterio venous blood which leads to an underestimation of the SpO2 measurement results while the actual saturation of arterial blood remains the same and the measurement error is proportional to the degree of compression and respectively the degree of pulsation of venous blood A simi lar phenomenon occurs ...

Page 70: ...of the SpO2 measurement The full span of the filling column corresponds to 10 while the filling level o above 1 optimal o 0 2 1 acceptable o 0 08 0 2 boundary move the sensor to a more suitable place o less than 0 08 SpO2 readings are blocked it is necessary to take measures to re store normal blood circulation If there are any doubts about the measured SpO2 value then the signal qual ity should b...

Page 71: ...bstructed blood circulation in the hand can cause unstable operation of the device and unreliable readings Direct sunlight or bright directional artificial lighting can falsify measured values If necessary cover the sensor installed on the patient with a tissue or a sheet To exclude failure of local blood circulation up to press necrosis and to ob tain reliable measurements reinstall the SрО2 sens...

Page 72: ...ssing of signals received in the red and infrared spectrum in order to compensate for interfer ence from light absorption by venous blood Patents Masimo SET technology protected by the respective patents listed on the website www masimo com patents htm No Implied License Possession or purchase of this device does not convey any express or implied license to use the device with unauthorized sensors...

Page 73: ...bling to reduce the possibility of pa tient entanglement or strangulation Check alarm limits each time the device is used to ensure that they are appropriate for the patient being monitored CONTROL To start working with the module connect the corresponding sensor to the SpO2 connector on the side panel of the device and select the photoplethysmogram curve in one of the con figurable graphical wind...

Page 74: ...d PR are displayed on the main screen MEASUREMENTS If the accuracy of any measurement does not seem reasonable first check the patient s vital signs by alternate means and the check the pulse oximeter for proper functioning Inaccurate measurements may be caused by Incorrect sensor application or use it is necessary to ensure that the used sensor match es the patient category and the application ar...

Page 75: ...d pressure cuff is inflated on the same extremity as the one with a SpO2 sensor at tached The patient has hypotension severe vasoconstriction severe anemia or hypothermia There is arterial occlusion proximal to the sensor The patient is in cardiac arrest or is in shock The device can be used during defibrillation but the readings may be inaccurate for a short time Masimo SET technology uses advanc...

Page 76: ...and newborns with congenital heart defects with cyanosis with SpO2 val ues ranging from 60 to 100 compared to the readings of a laboratory CO oximeter This range of values is plus or minus one standard deviation which covers 68 of patients 3 The measurement error using Masimo SET technology with LNOP LNCS sensors in the presence of movements was validated in blood studies under conditions of induc...

Page 77: ...ors When selecting an SpO2 sensor make sure that the sensor used is appropriate for the pa tient category and overlap area For more information on overlap areas see the accompany ing operation instructions The tables below indicate some of the recommended sensor types with the application ar ea and patient weight 1 Reusable Sensors Masimo LNOP LNOP patient cable is required No Sensor Description A...

Page 78: ... Finger 3 kg 40 kg 2330 LNCS NeoPt Sensitive skin neonate adhesive Foot Palm 1 kg 5 Patient Cables LNOP No Sensor Description 1173 PC04 Patient cable LNOP 4 feet 1 2 m 1005 PC08 Patient cable LNOP 8 feet 2 4 m 1006 PC12 Patient cable LNOP 12 feet 3 6 m 6 Patient Cables LNCS No Sensor Description 2017 LNC 4 Patient cable LNCS 4 feet 1 2 m 1814 LNC 10 Patient cable LNCS 8 feet 2 4 m 2013 LNC 14 Pati...

Page 79: ...nsor dis conned Two tone every 5 s SpO2 sensor is disconnected from patient Sensor reset Two tone every 5 s The SрО2 sensor is out of order replace the sensor Sensor failure Two tone every 5 s SрО2 sensor is incompatible with the Masimo SET module or is faulty replace the sensor Unrecognized Sensor Two tone every 5 s The module is out of order replace the monitor Failure of operation Two tone ever...

Page 80: ... this license you may be held liable for copyright infringement Nothing in this license provides for any rights of the Purchaser other than those provided for in 17 USC 117 Section 17 of the United States Copyright Law Section 117 information located at https www law cornell edu uscode text 17 117 5 Use restrictions As a Purchaser you may physically transfer the Product from one location to anothe...

Page 81: ...re of the Software including the related documentation by the U S Gov ernment or any of its agencies shall be governed solely by the terms of this Agreement and shall be pro hibited except to the extent expressly permitted by the terms of this Agreement ...

Page 82: ...eratures and chemical sterilization methods associated with immersion of the sensors in liquid is not allowed for the disinfection of the sensors DO NOT DISINFECT SENSORS BY IMMERSION IN A DISIN FECTING SOLUTION it is not recommended to use strong agents intended mainly for disinfection of premises and instruments e g clindesin for the disinfection of the sen sors Their use can lead to damage to t...

Page 83: ...ve the protective film from their adhesive surface When using old electrodes with a long shelf life or when their gel layer dries out apply contact paste or sev eral drops of physiological 0 9 sodium chloride solution to the central part of the electrode The use of electrodes with a large reserve of storage life and their careful ap plication to the patient is a prerequisite for getting a high qua...

Page 84: ... to the appearance of a constant potential between the elec trodes Its level depends on material of the electrode surface state of the electrode surface properties of the electrode conductive medium skin cleanliness exposure of the patient to electric currents and fields including electrical stimulation defibrillator or tissue impedance studies The magnitude of the polarization potential even at h...

Page 85: ...g 11 the number of registered ventricular premature beats VPBs 1 min 12 symbol for setting the number of curves in the ECG window 13 the number of registered supraventricular premature beats SVPBs 1 min 14 symbol of the ECG derivation synthesis mode control 15 abbreviation of the rhythm source 16 the total number of registered heartbeats 1 min 17 the field for setting the ECG scale manual auto 18 ...

Page 86: ...ts size can be changed for this you need to set the desired value of the ECG Scale parameter see it 1 3 8 Changing of the ECG curve scale only changes its appearance on the screen and does not affect the ECG signal itself analyzed by the device The scale of the ECG curve is 5 0 mV 2 0 mV 1 0 mV 0 4 mV 0 2 mV 0 05 mV correspond to the sensitivity of the ECG channel 2 5 10 25 50 200 mm mV relative e...

Page 87: ...ct of the electrodes with the patient s skin is not good enough the message Bad contact of electrodes may appear in the ECG window In this case it is necessary to use electrodes of better quality or apply a con tact paste or a few drops of physiological 0 9 sodium chloride solution to the central part of the electrode If the electrodes are broken or if the patient s cable is in poor contact with t...

Page 88: ...eir formation as well as the level of alarm that occurs when a message appears are as follows Message Conditions of formation Level alarm signal ASYSTOLE No signal or signal with amplitude 70 μV within the last 6 seconds Special VENT FIBRILLA TION Chaotic signal or fibrillation curve within the last 4 seconds High VENT TACHYC ARDIA Ventricular rhythm heart rate 100 beats min for the last 6 contrac...

Page 89: ...plexes are not associated with P waves VR Ventricular rhythm When situations of ventricular rhythm ventricular tachycardia or ventricular fibrillation flutter occur PM Pacemaker At least 5 pulses in the last 30 seconds An indeterminate source of rhythm There is no dominant rhythm or not enough in formation for a reliable determination The display of most of the messages listed in the Table can be ...

Page 90: ...r formed These messages are as follows MISSED BEATS BRADYCAR DIA TACHYCARDIA IRREGULAR RHYTHM The following example illustrates the automatic recording mechanism when changing arrhyth mia analysis messages No message no record MULTIFORM VPC VPCs that differ from previous ones are detected recording VENT BIGEMINY bigeminy situation occured recording MULTIFORM VPC bigeminy episode ended no record No...

Page 91: ...rizontal axis is the duration of the cardiointer vals 0 2 s in one division The vertical axis represents the number of cardiointervals of a cer tain value in to the total number of cardiointervals HRV indicators are displayed to the right of the histogram МО moda the duration of the most frequent cardiointerval in seconds АМО moda amplitude number of moda values in to the total number of cardio in...

Page 92: ...ion is enabled using the symbol for setting the ECG channel operat ing mode it 1 3 11 select the S12 mode When using the standard scheme of applying electrodes it is necessary to set the mode Nrm After switching on the synthesis mode you can select for displaying also V1 V6 leads 2 2 7 Features of the Operation with a Pacemaker PM The device automatically detects the presence of pacemaker pulses O...

Page 93: ...pply electrodes in the shoulder girdle area on the right and left and in the lower abdomen on the right and left Avoid placing elec trodes on the shoulders as the ECG signal in this case can be very weak When monitor is used simultaneously with equipment generating high frequency currents HFC the ECG waveform may be distorted Distortions of the ECG curve disappear immediate ly after stopping their...

Page 94: ...gram Select the required sweep speed of RSP curve 6 2 or 12 5 mm sec Check the compliance of the displayed curve with the patient s breathing pattern if necessary set the required alarm thresholds set the RR display mode by the respirogram it 1 3 8 and check the measured value in the respiratory rate window see Fig 2 15 1 control symbol of RR sound alarm 2 setting of the RR top alarm threshold 3 s...

Page 95: ...s for measuring T C so it is possible to simultaneously measure the temperature at two points for example the central and surface temperature of the patient s body For this purpose the device is equipped with surface and intracavity tempera ture sensors The device starts to measure the temperature when temperature sensors are connected to the corresponding connectors of the device while any of the...

Page 96: ...s of adhesive tape The temperature measurement time depends on the quality of the thermal contact of the sensor with the patient s body and the required measurement accuracy and is usually up to several minutes while the maximum measurement accuracy is achieved when the temperature read ings are stabilized and almost do not change For accurate temperature measurement it is necessary to create good...

Page 97: ...The applied reusable temperature sensors do not require calibration or adjustment during the entire service life including their replacement If there are any doubts about their accuracy then it can be easily checked by comparison with a control known good thermometer To carry out the test connect the tested sensor to the device and place it together with the con trol thermometer into the armpit fo...

Page 98: ... When disinfecting the sensor cable by pulling it through the disinfectant sponge do not apply excessive tensile force to it Sterilization of the intracavitary sensor is carried out by full immersion except for the connect or in a 6 hydrogen peroxide solution in accordance with the requirements of MU 287 113 It is allowed to use other sterilizing agents for example Deoxon 1 and Dezoxon 4 Russia or...

Page 99: ...the cuff to a limb with skin lesions at the site of application It is necessary to apply the cuff to the intact skin of the limb When carrying out frequent automatic blood pressure measurements in pa tients with serious bleeding disorders use medical reports due to the risk of hematomas appearing on the limb with a cuff Do not apply a cuff to a limb with a SpO2 sensor as this may distort oxygen sa...

Page 100: ...f is completely deflated see Figure 2 20 Make sure the cuff extension hose is not kinked or pinched Connect the cuff to the extension hose and the other end to the corresponding fitting of the device Figure 2 19 Blood pressure cuff width Figure 2 20 Proper cuff placement The accuracy of measuring blood pressure depends on the correct applica tion of the cuff It is necessary that the fabric fits sn...

Page 101: ...e process of adaptation a tight fit of the cuff to the body is ensured the volume of the cuff is taken into account as well as the value of the patient s blood pressure and heart rate Adap tation allows to shorten the time for subsequent measurements and adjust to the current volume of the cuff which allows the use of shoulder cuffs of different sizes but the size of the cuff shall correspond to t...

Page 102: ...ement start symbol in the NIBP channel window or after pressing the NIBP button on the front panel of the device The set blood pressure measurement mode is saved even when the device is turned off however after a system reset the initial default values are re stored AUTO measurement mode with a measurement interval of 5 minutes When taking blood pressure measurements in automatic mode regularly ch...

Page 103: ...on mmHg kPa 14 results of the last BP measurement systolic Figure 2 21 Window of NIBP channel If the pressure in the cuff is not enough to take a measurement the device automatically performs additional inflation When the required level of pressure in the cuff is reached device performs an automatic step wise removing the air from it After determining the systolic diastolic and mean pressure a rap...

Page 104: ... tightly plugging its hole The untighten cuff must be replaced If you use the untighten cuff your BP measurements may be distorted 2 4 4 Cuff Disinfection Disinfection of the cuff is carried out in accordance with the requirements of MU 287 113 by wiping it with a 3 solution of hydrogen peroxide with the addition of 0 5 neutral detergent of the Lotos type it is allowed to use other disinfectants o...

Page 105: ...s unable to create the pressure in the cuff within 20 sec Pediatric Neonatal profiles or 60 sec Adult profile Connect the cuff to the device Place the cuff on the limb When using a large cuff set the Adult profile if not set CUFF DAMAGE The pneumatic path is not tight Replace the cuff When using a large cuff set the Adult profile if it is not set Contact customer service OVERPRESSURE The protectio...

Page 106: ...s safety system of the NIBP channel Contact customer service Compressor failure Malfunction of the NIBP channel compressor Contact customer service Power system failure Malfunction of the NIBP channel batteries Contact customer service Pressure channel failure Malfunction of the blood pressure measurement channel Contact customer service NIBP MODULE FAILURE Triggering of the protection system Cont...

Page 107: ...nsor can lead to failure of the gas analysis module CO2 concentration can be displayed on the screen as partial pressure mmHg or as a percent age of concentration depending on the mode selected by the user in the field for setting the units of measurement of CO2 concentration see it 1 3 16 2 5 1 Preparing to measure the concentration of gases in the breathing mixture When using the version of the ...

Page 108: ...POINTED UP see Figure 2 24 A large breathing dead space reduces the accuracy of the gas measure ment Et so it is recommended to attach the airway adapter directly to the patient s endotracheal tube Select the required type of capnograph sidestream in the menu of general parameters set tings it 1 3 8 Switch on the device and display the capnogram curve in one of the configurable graphical win dows ...

Page 109: ...for setting the type of output curve 7 live trend of EtCO2 8 icon of capnometer zero setting 9 field for setting the size of EtCO2 live trend Figure 2 25 Window of capnometry channel 1 top alarm threshold for EtCO2 2 control symbol of sound alarm for EtCO2 3 bottom alarm threshold for EtCO2 4 top alarm threshold for FiCO2 5 field for setting the measurement units of CO2 concentration 6 measured va...

Page 110: ...sures to protect it from moisture Water trap is the main barrier to protect the measuring path from liquid Here the moisture of the analyzed sample is separated and condensed and accumulated in a special removable mois ture collecting tank which must be emptied periodically as it fills During long term operation of the capnometry module at high humidity of the analyzed gas a significant amount of ...

Page 111: ...onnect the sampling line from the device and let it run for 10 30 minutes In case of a sudden interruption of the registration of respiratory cycles the device signals this with the alarm message No breathing APNEA in the window of the breathing channel and 20 s after that if breathing has not been restored a continuous sound alarm is triggered while the time of the cessation of breathing and the ...

Page 112: ...the pneumatic path If after 8 se conds the passability is not restored the cap nometer automatically turns off with the message OFF OCCLUSION Eliminate the source of the occlusion replace or purge the line in case of failure con tact the customer service OFF OCCLUSION Disconnected automatically after detecting a path occlusion Replace or purge the line it 2 5 7 Turn the capnometer off and on using...

Page 113: ...in the injected sample The reasons for the measurement error in addition to untightness can also be the ingress of a significant amount of moisture into the measuring chamber and the formation of fatal film on the optical elements or their contamination The elimination of these reasons can only be done in the conditions of the service center The measurement accuracy of the module can be affected b...

Page 114: ...he conditions of a service center When working with a capnometer use only dry sampling lines no drops inside During long term operation in case of accumulation of condensate in the line and the formation of drops it shall be timely replaced with a new dry one and the used one can be blown out and dried Re member that the formation of drops inside the line can be identified by a capnometer as a oc ...

Page 115: ...1 10 10 1 15 0 2 abs 0 4 rel 0 6 rel N2О 0 25 25 1 100 1 5 3 Hal Enf Iso 0 1 1 5 5 0 15 0 2 not defined Sev 0 1 1 5 5 8 8 0 15 0 2 0 4 not defined Des 0 1 1 5 5 10 10 15 15 18 18 0 15 0 2 0 4 0 6 1 not defined О2 0 100 2 the threshold for determining the primary anesthetic is 0 15 0 4 in the ISO accuracy mode In addition to the concentration of the above gases the device displays the calculated MA...

Page 116: ...e the level of its ends o To prevent moisture accumulation in the airway adapter it shall be positioned so that its nipple where the sampling line is connected is always POINTED UP see Fig 2 24 o A large breathing dead space reduces the accuracy of the gas measurement Et so it is recommended to attach the airway adapter directly to the patient s en dotracheal tube If there are gas anesthetics in t...

Page 117: ...uring is ensured only with the correct choice of anesthetic gas For devices with automatic detection of anesthetic agent a selection of parameters Ax1 and Ax2 is available in the menu Ax1 is the primary agent the substance with the highest concen tration Ax2 is a secondary active agent substance with a lower concentration level in relation to Ax1 2 5 8 2 Monitoring The breathing curves for the sel...

Page 118: ...sthetics 7 the total MAC value 8 field of settings the alarm thresholds for Et it 1 3 10 9 field for setting the unit of measurement of gas concentration 10 field for setting the gas type only for anesthetics 11 1MAC concentration for each anesthetic input in accordance with it 1 3 8 12 field of settings the alarm thresholds for Fi it 1 3 10 13 sound alarm on off п 1 4 3 14 graphical curve on off ...

Page 119: ... still below 40 ml min the self cleaning cycle is repeated at least three times o If the occlusion is not removed the module turnes off with a corresponding message It is necessary to remove the occlusion usually it is enough to change the sampling line or to clean the container of the water trap During the long term operation of the gas analysis module and high humidity of the analyzed gas a sign...

Page 120: ...ngs on the fittings If the reason for the loss of the path tightness is inside the device contact the service to find and eliminate it If during the tightness test the path is closed for a long time then after the purge attempt the diagnostic message Long occlusion appears After re moving the blockage the message is cleared and the module switches to the measurement mode B Checking the gas concent...

Page 121: ... oxygen sensor installed in the device due to the features of its operation principle has a limited average service life 1 2 years depending on the intensity of use During operation when the oxygen sensor is replaced or the measurement error increases calibration may be required For calibration it is allowed to use atmospheric air approximately 21 oxygen or preferably a compressed oxygen source wi...

Page 122: ... performed at the fac tory Calibration is performed in the same way in the Service menu 2 5 8 4 Self Testing System of the Gas Analysis Module The self diagnostic system monitors the operating conditions of the module and in necessary cases occlusion of the path or ingress of moisture into it automatically takes measures to elim inate the causes that interfere its normal operation In case of failu...

Page 123: ...t the input of the gas analysis module Turn on the module with the CAPNO button or switch the device off and on again 2 5 9 Disinfection of the Accessories of Multigas Module To disinfect the water trap remove it from the connector panel of the device by pressing the latches and pulling it towards you and disconnect the removable reservoir container see Fig 1 5 2 35 Disinfection of the removable w...

Page 124: ... distort measurement results Connect the pressure measurement line to the patient s catheter If using a pressurized infusion line connect the cuff to the infusion bag Pump it up according to your healthcare routine then start injecting the solution Position the transducer at heart level approximately at the mid axillary line Figure 2 36 Connection of the system to the patient When measuring intrac...

Page 125: ...f IBP2 channel 15 ripple frequency for IBP channel 16 mean pressure 17 number of IBP channel 18 bottom alarm threshold for systolic blood pressure Figure 2 37 Window of invasive blood pressure channel 2 6 2 IBP Measurement Procedure When operating a channel zero offset can occur i e non zero readings at zero pressure for example after changing a transducer or after long term operation In this case...

Page 126: ...isualization of pressure wave signals set up a filter that emphasizes or smoothes the wave details To adjust the required filter band click on the display field of this parameter Fig 2 37 position 5 and select the required filter band in the appearing window it 1 3 18 A narrower signal bandwidth lower number corresponds to a smoother signal Wide bandwidth allows to display higher frequency signals...

Page 127: ...essure trans ducer pressure measurement line etc after a single use shall be disposed of in accordance with the procedure established in a medical institution When disinfecting the cable by pulling it through the disinfectant sponge do not apply excessive tensile force to it Do not allow liquid to get on the cable connector pins this can lead to its failure The use of high temperatures and chemica...

Page 128: ...without switching on or after a system reset Check the correctness of setting the date and time before operation and if necessary correct them in accordance with it 1 3 6 because time and date in trends are determined by the internal clock of the device When FREEZE mode is enabled it is not possible to view trends and saved waveforms To enter the trend view mode click on the trend window display s...

Page 129: ...uttons for turning pages of the trend 4 buttons for moving the trend by 1 3 of the page 5 symbol for selecting the scale duration of the trend page 6 date and time of the end of the displayed trend page 7 enable disable the particular trend up to 13 buttons 8 name of the trend line 9 trend readings in the cursor position 10 selection of the trend type 11 close trend window 12 button for precise po...

Page 130: ...he desired on off symbol 7 of the corresponding trend located next to the parameter sign Turning on a trend is marked with a green label and turning it off with a red cross the trend is not displayed on the chart The data stored in the trend memory is divided into multiple records The beginning of each re cording is determined by the date and time when the device was turned on i e the beginning of...

Page 131: ...n of the trend page 5 buttons for turning pages of the trend 6 button to move the trend line by line 7 icon for starting canceling printing on a thermal printer displayed if there is a built in thermal print er in the device 8 symbol for selecting the type of trend 9 close trend window 10 parameters registered by the device corresponding to the time value displayed on the left Figure 3 2 Window of...

Page 132: ...4 An example of a printout of tabular trends is shown in Fig 3 3 1 mark of the beginning of the trend recording and time values 2 version and configuration of the device 3 device identifier serial number or MAC address 4 names of the output parameters 5 parameters registered by the device corresponding to the displayed time value position 1 Figure 3 3 Example of printing tabular trends on a printe...

Page 133: ...t displayed on the screen 5 values of parameters registered by the device at the moment of recording fragments 6 icon for starting canceling printing on a thermal printer displayed if there is a built in thermal print er in the device 7 symbol for selecting the type of trend 8 close trend window 9 buttons for moving along the recorded fragments 10 field for selecting the type of the second curve 1...

Page 134: ...neously on 3 channels Width of paper used for printing is 50 mm To print tabular trends enter the tabular trends viewing window see it 3 1 2 using the buttons see Fig 3 2 positions 4 5 select the desired fragment of the trend and with the scale setting symbol see Fig 3 2 position 4 set the scale for printing press the symbol for printing on a thermal printer Fig 3 2 position 7 The se lected fragme...

Page 135: ...am The device allows forming and displaying oxycardiorespirogram a graphical presentation of trends in arterial blood oxygen saturation heart rate and respiratory rate with an increased reso lution in the time domain compared to the standard form of trend display The display scale on the horizontal time axis is 8 min and cannot be changed The readings of arterial blood oxygen saturation are displa...

Page 136: ...rms are displayed in accordance with it 1 4 4 1 4 11 it 2 1 4 it 2 2 4 it 3 9 5 it 3 12 6 Below there is a list of events stored in the log Event Record in the log Device is turned on Monitor loading Profile loading profile type Changing of profile Profile loading profile type Sound alarm disabled Sound alarm OFF Changing of alarm limits Change limits parameter top thershold bottom threshold The d...

Page 137: ...3 1 Trends 137 You can also choose the display mode to show alarms and events to show only physiological alarms of high and medium priority ...

Page 138: ...10 minutes in the general parameters setting menu it 1 3 8 To disable the digital mode you must select the Off value of the Run digital mode parameter The transition to the digital mode occurs automatically after the time set in the menu after the last operator s action with the touch screen encoder or control buttons or after pressing the 123 button on the front panel of the device Figure 3 7 Dig...

Page 139: ...dney function To enter the mode of working with calculators click on the symbol of the calculators window The display will show the dose calculation calculator window and the titration table To change the type of calculator press the calculator selection symbol in the upper right corner You will see the window of calculator selection Select the required calculator Entering digital values in the ca...

Page 140: ...there are values from Drug A to Drug E Enter the required value for the Dose of the drug Check if the entered values are correct The calculated hourly and daily dose will be displayed at the bottom of the calculator win dow Each drug is measured in its own measurement units The units of measurement for all drugs are listed below For drugs А B C D Еuphyllin Dobutamin Dopamin Adrenalin Isoprenalin L...

Page 141: ...hour 1 100 Drug E МЕ kg hour 1 100 To work with the titration table enter the amount of the drug the volume of the solution and the rate of administration of the drug solution These three parameters are interconnected and when one of them is modified the others are recalculated based on the drug dose entered in the calculator If the dose of the drug is changed the parameters of the titration table...

Page 142: ... icon next to the input parameter To switch the input mode click on the icon After entering the input parameters patient s weight and height cardiac output Q stroke volume SV pulse rate mean pressure left ventricular ejection time LVET the calculator displays the following values body area systemic vascular resistance SVR systemic vascular resistance index SVRI cardiac index CI stroke volume index...

Page 143: ...diac output saturation of arterial blood with oxygen SpO2 partial pressure of СО2 at the end of expiration PetСО2 О2 concentration at the inspiration FiO2 saturation of venous blood with oxygen SvO2 oxygen tension in arterial blood PaO2 oxygen tension in venous blood PvO2 concentration of hemoglobin Hb atmospheric pressure Patm the calculator displays the following values body area oxygen content ...

Page 144: ...ghlighted manual input or darkened measured by the device icon next to the input parameter To switch the input mode click on the icon Setting digital parameters in accordance with it 1 3 10 Entered manually or measured by the device After entering the input parameters the calculator displays the following values Tidal volume Vt Respiratory minute volume MV Respiration rate RSP Ratio of dead space ...

Page 145: ...atient s gender height and weight as well as the level of creatinine in the blood plasma are used as input parameters All input parameters are entered manually After entering the input parameters the calculator displays the GFR in ml min Estimated GFR range 0 180 ml min The present calculations are applicable only for patients with chronic renal failure CRF and shall not be applied to patients wit...

Page 146: ... is off If the BATTERY indicator blinking in red when the device is running and there is a yellow bat tery symbol on the screen that means the battery is discharged the filling level of this symbol is proportional to the degree of remaining charge The operating time of the device in autonomous mode depends on the battery capacity the de gree of its previous charge and the time elapsed after that t...

Page 147: ...Battery Training Battery training is a cycle of full discharge and subsequent full charge Sometimes it may take several discharge charge cycles to restore capacity It is recommended regulary train the battery to maintain its capacity To completely discharge the battery disconnect the device from the mains After that turn on the device sensors and peripherals can be left unconnected and let it work...

Page 148: ...urement is activated too often Reducing of the battery capaci ty Fully charge the battery Increase the period between blood pressure measurements Train the battery if unsuccess ful replace The device does not operate from the battery Full battery discharge Charge the battery Red Battery indicator Battery malfunction Charger malfunction Replace the battery Contact customer service ...

Page 149: ...the connector latch is fixed To disconnect the on board power cable from the device hold down the connector housing and press button 3 on its side surface and then undock Connector 2 of the on board power cable is a standard automobile connector of the Cigarette lighter type equipped with a built in fuse 5 A Connect it to the corresponding socket in the vehicle After connecting the device to the o...

Page 150: ...twork via a radio channel using a radio module in stalled inside the device The Ethernet connector is not used in this case and may be blind or missing The basis of the centralized monitoring system is the CardioNet software developed by the Triton Electronic Systems company It allows to view on the computer screen and save in memory the data recorded by the device or a group of devices up to 32 u...

Page 151: ...ding time is about several minutes on the USB flash disconnect it from the device and connect it to a personal computer When recording the device creates the following directory structure folders on the disk ROOT disk root directory 12FFFFFF a directory with a name corresponding to the serial number or MAC address of the device 12060106 25 timestamp directory in the format year month date hour min...

Page 152: ...uipped with a set of installation equipment 3 8 1 Wall Mount Installation Equipment 1 Check the installation kit 2 Remove the KROMAX TECHNO 8 Bracket from the package 3 Remove the plate from the bracket 4 Take M6x12 screws from the kit pocket G 5 Attach the plate to the back of the monitor ...

Page 153: ...uipment 153 6 Mount the bracket on the wall according to the instructions in the kit 7 Mount the monitor on the bracket 8 Fix 9 Adjust the angle of the monitor and tighten the handle 10 Installation of equipment completed ...

Page 154: ...press out the spring loaded stopper pull the monitor up by the handle keeping the spring loaded stopper in the released state 3 Place the monitor on the trolley fix the trolley with wheel brakes bring the monitor to the mounting plate on the trolley for screw mounting screw the trolley plate to the holes in the rear wall of the monitor for the quick release mounting option lower the monitor along ...

Page 155: ...I 3 9 1 Settings of the Channel of Non Invasive Measurement of Hemodynamic Pa rameters Before using the NCOV channel on a new patient it is necessary to establish the gender weight height and age of the patient it 1 3 8 To show the channel of non invasive measurement of hemodynamic parameters on the display select the NCOV hemodynamic parameters channel in the graphical curves display window it 1 ...

Page 156: ... for more standardization of the interpretation of values it is recommended to take into account the following o External influences that can increase the variability of blood pressure reduce the ac curacy of a single determination of parameters o The middle of the cuff on the patient s shoulder should be at the same level as the heart i e approximately at the level of the fourth intercostal space...

Page 157: ...Do not change the posture or position of the pa tient s arm the position and or tension of the cuff physical activity between duplicate launches of the channel The level of readings can fluctuate from minute to minute The average value of two or more measurement cycles performed on one hand reflects the value of parameters more accu rately than a single measurement 3 9 3 Result Reliability Assessm...

Page 158: ...t important areas for parameter measurement are the second third and fourth areas Examples of standard oscillograms are shown in Figure 3 13 Figure 3 13 Oscillograms of the standard form Typical unreliable oscillograms The algorithm for determining hemodynamic parameters automatically evaluates the general view of the recorded curve and rejects distorted curves before displaying on the screen Neve...

Page 159: ...l fibrillation If you get the following oscillograms Fig 3 15 restart the channel Figure 3 15 Unreliable oscillograms distortion in the second section record is not fin ished record is not finished distortion in the second section distortion in the forth section distortion in the forth section ...

Page 160: ...nnel manual or automatic as well as the interval are set in the parameters of the NIBP channel To determine the parameters of hemodynamics make the following steps Before using the NCOV channel on a new patient set the gender weight height and it 1 3 8 If necessary adjust the alarm thresholds for the CI and SI parameters Prepare the patient and apply the cuff according to the recommendations in it...

Page 161: ...hort beeps every 5 s The same on a yel low background CI value is more that top thresh old 8 Three short beeps every 5 s The same on a red background SI value is less than bottom threshold 4 SI below threshold Flashing SI value SI value is less than bottom threshold on 4 8 Two short beeps every 5 s The same on a yel low background SI value is less than bottom threshold 8 Three short beeps every 5 ...

Page 162: ...NIBP method the following studies were taken into account as well as own research for example Gu Young Jeong Kee Ho Yu and Nam Gyun Kim Continuous Blood Pressure Monitoring using Pulse Wave Transit Time Kalju Meigas Rain Kattai and Jaanus Laas Continuous Blood Pressure monitorng using pulse wave delay Summarizing the data obtained in the ECG and PPG channels it is possible to determine the delay t...

Page 163: ...ating systolic mean and diastolic blood pressure are determined based on the current PWTT value Device measures PWTT continuously in the presence of data from the ECG and PPG channels even if the continuous NIBP mode is disabled When the SpO2 sensor is placed on the same arm as the cuff the pressure in the patient s arm decreases during the NIBP measurement and the PWTT value increases This can le...

Page 164: ...measurements even with a stable PWTT value Figure 3 19 shows the typical behavior of the adaptive threshold after a BP measurement by the cuff The threshold is displayed as two curves symmetrical about the horizontal axis because the same threshold is compared with both positive and negative dPWTT values Noise curve along the horizontal axis zero line current dPWTT value Figure 3 19 A particular c...

Page 165: ...s reducing the influence of errors in single meas urements of NIBP on the value of the coefficients The results of calibration measurements are taken into account with weighting factors that take into account the reliability and age of the cor responding result Due to this more recent results usually contribute more to the calculation of the coefficients of the straight line In addition to the dep...

Page 166: ... display will show the cNIBP data Fig 3 20 1 absence of data in the dPWTT trend including calibration moments 2 thresholds for triggering extraordinary calibration measurements of NIBP on the cuff 3 dPWTT trend 4 field for setting the type of output curve 5 BP value calculated by PWTT systolic diastolic mean 6 field for setting the cNIBP mode 7 field for manual setting of the dPWTT thresholds 8 fi...

Page 167: ...channels In the case of asystole via the ECG channel or a weak signal via the PPG channel the parame ters of the continuous NIBP mode are not calulated For some types of arrhythmias that lead to extremely unstable PWTT values the calculation of cNIBP readings is also impossible Do use the cNIBP mode on patients with intense sharp and frequent changes in blood pressure because this can lead to freq...

Page 168: ...No clear correlation between ECG and PPG signals the results of PWTT measurements are very different from each other check the quality of ECG and PPG sig nals if necessary reinstall the SpO2 sen sor and or replace the ECG electrodes In these cases dashes will be displayed instead of continuous NIBP readings If it is impossible to start extraordinary calibration measurements of blood pressure the c...

Page 169: ...modules supplied by Triton Electronic Systems Ltd are compatible with the monitor The external mainstream CO2 sensor is connected to the device through the Infoport con nector installed on the left side panel of the device Fig 1 4 position 10 The module is connected to the ventilation circuit using matching devices adapters of sampling lines ventilation adapters of various types which enable monit...

Page 170: ...ter mainstream in the general parameters setting menu it 1 3 8 Switch on the window of capnogram curve display in one of the configurable graph ical curve display windows it 1 3 5 Wait until the end of the warm up interval of the capnograph The capnograph warm up interval is about 2 minutes In this case the mes sage Warming up is displayed in the capnogram output field Carry out zero calibration o...

Page 171: ...new value Digital parameter setting limits Designati on Parameter Setting simit Discretene ss Apnea interval duration 10 60 1 Т Respiratory gas temperature C 0 50 0 1 To set alarm thresholds and CO2 concentration units click on the corresponding parameter val ue display field located in the gas analysis parameters window Alarm threshold setting limits Designatio n Parameter Setting simit Discreten...

Page 172: ... Fig 2 15 is the RR value measured by the capno gram when the capnogram RR is selected as the source for calculating the RR in accordance with it 1 3 8 1 field for setting the scale of capnogram 2 field for setting the capnogram sweep speed 3 field for setting the interval of apnea 4 field for setting the mode of averaging readings by EtCO2 5 field for setting the type of breathing circuit 6 field...

Page 173: ...O2 value is calculated taking into account that FiCO2 concentration is zero Incorrect setting of the circuit type leads to incorrect readings of EtCO2 and FiCO2 If the message Zero calibration required appears in the channel window of the capnogram during monitoring it means that the calibration condition is violated and it is necessary to repeat the calibration it 3 11 4 Before start ing the cali...

Page 174: ...ogen For calibration in the service menu it is necessary Wait for the warming of the mainstream CO2 sensor until the message Warming up disap pears in the capnogram window Holding down the FREEZE button enter the service menu of the device Annex 2 Select the type of gas used for calibration air or nitrogen Fill the measuring chamber of the airway adapter connected to the mainstream CO2 sensor with...

Page 175: ...ot provided 3 11 6 Disinfection of the Reusable Airway Adapters Disinfection of reusable airway adapters is carried out in the following order Wash adapters in warm soapy water and then immerse them in liquid disinfectant or gluteraldehyde pasteurized or cold sterilized fter washing and sterilizing the adapters rinse them inside and outside with distilled water and then wipe with a clean cloth tha...

Page 176: ... influence a person s consciousness is inhibited which is appearing in EEG changes Typical signs of the anesthetics effect are narrowing of the EEG spectrum a decrease in high frequency components and an increase in low frequency ones the appearance of a pronounced irregularity of the spectrum a significant decrease in the electromyographic component EMG caused by the electrical activity of facial...

Page 177: ...crease in the level of noise in the EEG The control of values of these parameters is car ried out in a separate window of EEG signal quality indicators p 3 12 4 To track the dynamics of the patient s state change the values of the brain activity index AI and the level of the EMG component are displayed in the graphical trend window Range of AI presentation in graphic form is from 0 to 100 rel unit...

Page 178: ...ace state of electrodes surface properties of electrode conducting medium skin cleanness influence of electric current and electric field on a patient including electrostimula tion defibrillator effect and analysis of tissues impedance Value of polarization potential even on quality electrodes can reach tens or even hundreds milli volts Excessive polarization can result in such problems as saturat...

Page 179: ...ngth of the trend window is 1 hour The EEG scale parameter determines the height of half of the EEG curve output window i e with the established EEG scale of 100 μV the size of the EEG output window will correspond to 100 μV Alarm threshold setting limits Name Parameter Setting limit Discreteness АI Upper alarm threshold of the brain activity index 1 мин 10 100 1 Lower alarm threshold of the brain...

Page 180: ...27 Channel window of the external depth of anaesthesia and sedation module When the channel of the external depth of anesthesia and sedation module is turned on the brain activity index AI is saved in the system trend of the device p 3 1 To assess the brain activity index it is necessary Connect the module to the device taking the connector housing on the module cable Fig 3 25 position 4 firmly in...

Page 181: ...hesia stage I light sedation 60 80 stage II coma sedation 40 60 stage III surgery is possible 30 40 stage IV deep anaesthesia appearance of BS patterns burst suppresion 20 30 stage V deepening of anaesthesia in comparison with stage IV duration of sup pression episodes can be up to 10 seconds 10 20 stage VI deepening of anaesthesia in comparison with stage V duration of sup pression episodes usual...

Page 182: ...ower than the lower threshold Three short every 5 seconds The same on the red background AI value is less than 4 higher than the lower threshold AI value flashing AI value is higher than the upper threshold by 4 8 Two short every 5 seconds The same on the yel low background AI value is more than 8 higher than the upper threshold Three short every 5 seconds The same on the red background The impeda...

Page 183: ...n 183 4 CALIBRATION The device is calibrated by the bodies of the State Metrological Service and the metrological service of legal entities accredited for the right of calibration Calibration frequency once a year ...

Page 184: ...in ac cordance with it 3 4 1 3 4 2 2 Carry out of the built in accumulator training in accordance with it 3 4 3 The operating time from a fully charged battery shall be at least 1 hour Several discharge charge cycles are allowed to restore the battery capaci ty 3 Check the perfor mance of measuring channels and their sensors 1 Make a visual inspection of the reusable sensors of the measuring chann...

Page 185: ...rt of the device Electromagnetic interference when the device is not grounded Ensure normal operating condi tions it 1 2 2 User settings and internal clock are not saved Consequences of long term stor age of the device without switching on Turn on the device for several hours in case of failure contact the service No sound alarm at all for the particular channel The alarm volume is set to zero Ala...

Page 186: ...isconnected automatically after a long more than 1 hour absence of a breathing signal at its input Activate again via the correspond ing icon or restart the device turn off and on again Message about occlusion of the capnometer path Fatal occlusion of the capnometer pneumatic path Replace or purge the sampling line see it 2 5 7 then turn off and then turn on the device in case of failure contact t...

Page 187: ...ecom mendations of the corresponding sections of the present manual For advice please contact the manufacturer Triton Electronic Systems Ltd by phone 7 343 304 60 50 7 343 304 60 57 or email info treat on com 7 STORAGE When storing unpacked the device shall be kept indoors at temperatures from 10 С to 35 С and relative humidity no more than 80 at an ambient temperature of 25 С The air must be free...

Page 188: ...cturer packing in a fixed condition by all types of cov ered transport without limitation of distance according to the transportation regulations on the current type of transport The device shall be transported at air temperature from 50 to 50 С After transportation under nega tive temperatures device should be sustained before unpacking in normal climatic condi tions within 12 hours 9 DISPOSAL Af...

Page 189: ...l printer and thread the tape through the paper exit slot see Figure A1 1 Close the cover of the thermal printer until latching of lock Check the paper color on the printer symbol in the trend display it shall change to white Figure A1 1 Replacing paper in the built in thermal printer Close the paper cover securely after replacing paper If the paper cover is not closed all the way the thermal prin...

Page 190: ...settings of the cali bration coefficients which will inevitably affect the measurement accuracy of the device To enter the service menu of the device press and hold the FREEZE button on the front panel of the device for 2 seconds The service menu window appears on the display Figure A 2 1 Service menu of the device Depending on the type of module used for gas analysis the appearance of the service...

Page 191: ...ve measurement of hemodynamic parameters FLOW respiratory mechanics module MASIMO pulse oximetry channel module using Masimo SET MS 2040 technology If there is no module in the device or if the module is external but not con nected the symbols are displayed opposite its designation Software versions of modules in your device may differ from shown in Fig ure A2 1 The demo mode is intended only to d...

Page 192: ...uchscreen calibration touch the screen in the specified point In the lower left corner the symbol indicates the first point suggested for pressing Press in the center of the symbol with the greatest possible accuracy for example with a pencil Perform the same procedure for the second point Then you will the third point marked with the symbol This point is intended to check the proper calibration I...

Page 193: ...193 ...

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