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NeuroMuscular Transmission Module, M-NMT

Document No. 800 1018-1

3

2

 

FUNCTIONAL DESCRIPTION

2.1

 

Measurement principle

2.1.1

 

Nerve stimulation

There are three stimulus modes in the NeuroMuscular Transmission Module: Train of Four (TOF),

Double Burst 3,3 (DBS) and Single Twitch (ST).
In the Train of Four 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 and first response of the

TOF sequence is calculated (TOF%).
NOTE: If the first response does not exceed a certain signal level, TOF% is not calculated due to

poor accuracy.
Double burst (3,3) stimulation includes two bursts with a 750 ms interval. Both bursts consist of

three pulses separated by 20 ms intervals. The responses of both bursts are measured, and the

ratio of the second and first response is calculated (DBS%). EMG responses are measured

immediately after the first stimulus pulse of both bursts.
In Single Twitch stimulation, one stimulation pulse is generated. The response is measured after

the stimulus. In order to prevent decurarization of the stimulated area, the measurement is

automatically stopped after 5 minutes stimulation in 1 sec cycle time.

Tetanic/PTC

Tetanic/PTC (Post Tetanic Count) can measure deeper relaxation than TOF. The tetanic stimulation

is produced when Start is chosen under Tetanic/PTC. The length of stimulation is 5 seconds. The

stimulation generates pulses with a frequency of 50 Hz and with a selected pulse width and

current. After tetanic stimulation and a three second delay, Single Twitch stimulation is produced

to detect the post tetanic count (PTC). PTC describes the number of responses detected after

tetanic stimulation. If there is no response, the measurement will be stopped. If responses will not

fade away, a maximum of 20 responses will be calculated. If more can be detected, the PTC value

is displayed only as '> 20' and measurement will be stopped. If the TOF, DBS or ST measurement

cycle was on when tetanic stimulation started, the cycle will continue after the PTC. After

completing the PTC measurement during 1 minute TOF, DBS or another PTC measurement is not

possible. This is to avoid erroneous readings due to post tetanic potentiation.

Содержание M-NMT

Страница 1: ...notice Document No 800 1018 1 June 2001 Datex Ohmeda Inc 3030 Ohmeda Drive 53707 7550 MADISON WIS USA Tel 1 608 221 1551 Fax 1 608 222 9147 www us datex ohmeda com Datex Ohmeda Division Instrumentarium Corp P O Box 900 FIN 00031 DATEX OHMEDA FINLAND Tel 358 10 394 11 Fax 358 9 146 3310 www datex ohmeda com Instrumentarium Corp All rights reserved ...

Страница 2: ......

Страница 3: ... board 4 2 3 Connectors and signals 6 2 3 1 Module bus connector 6 2 3 2 Front panel connector 7 3 Service procedures 8 3 1 General service information 8 3 2 Service check 9 3 2 1 Recommended tools 9 3 3 Disassembly and reassembly 13 4 Troubleshooting 14 4 1 Troubleshooting chart 14 4 2 Troubleshooting flowchart 15 5 Service Menu 16 5 1 NMT menu 17 6 Spare parts 19 6 1 Spare part list 19 6 1 1 NMT...

Страница 4: ... check form A 1 TABLE OF FIGURES Figure 1 NeuroMuscular Transmission Module M NMT 1 Figure 2 Principle of response measurement 4 Figure 3 Serial communication and opto isolation 5 Figure 4 Stimulator block diagram 5 Figure 5 Module troubleshooting flowchart 15 ...

Страница 5: ...ingle width plug in module designed for use with the S 5 Anesthesia and Compact Anesthesia Monitors The module contains peripheral nerve stimulation and response measurement which supports electromyography EMG The module can also be used as a nerve locator for regional nerve blocking with a regional block cable However in this case there is no response measurement Figure 1 NeuroMuscular Transmissi...

Страница 6: ... Manual 10 s 12 s 15 s 20 s 1 min 5 min 15 min Measurement intervals for ST Manual 1 s 10 s 20 s 1 2 2 Stimulator Stimulus pulse Square wave constant current Pulse width 100 200 or 300 µs Stimulus current range 10 70 mA with 5 mA steps Stimulus current accuracy 10 or 3 mA whichever is the greater Max load 3 kΩ Max voltage 300 V 1 2 3 Regional block mode Stimulation modes Single twitch Intervals 1 ...

Страница 7: ...he response is measured after the stimulus In order to prevent decurarization of the stimulated area the measurement is automatically stopped after 5 minutes stimulation in 1 sec cycle time Tetanic PTC Tetanic PTC Post Tetanic Count can measure deeper relaxation than TOF The tetanic stimulation is produced when Start is chosen under Tetanic PTC The length of stimulation is 5 seconds The stimulatio...

Страница 8: ...iple of response measurement EMG measurement The EMG response is measured as integrated muscle activity The EMG measurement starts 3 ms after the stimulation and lasts 15 ms The 3 ms delay helps to prevent the effect of stimulation artifact Mechano sensor measurement Response is measured as movement of the thumb which is the area of positive signal 2 1 3 Regional block A regional block cable can b...

Страница 9: ... Figure 3 Serial communication and opto isolation Stimulator The constant current stimulator generates pulses whose amplitude is independent of the load The main components of the stimulator are a transformer a capacitor and a transistor The transformer produces a high voltage which charges the capacitor and the transistor adjusts the pulse width and amplitude of the current Patient Constant curre...

Страница 10: ...or X1 Pin No I O Signal 1 I RESET_RS485 2 I 15 VDC 3 I 15 VDIRTY 4 I 15 VDC 5 I O DATA_RS485 6 I O DATA_RS485 7 Ground Shield 8 I RESET_RS485 9 I CTSB 10 O RTSB 11 I RXDB 12 O TXDB 13 Ground Shield 14 I 32 VDIRTY 15 I GroundDIRTY 16 I CTSC 17 O RTSC 18 I RXDC 19 O TXDC 20 ON STANDBY 21 PWM_ECG 22 RXDD_RS232 23 TXDD_RS232 24 I 5 VDC 25 I 5 VDC ...

Страница 11: ... Document No 800 1018 1 7 2 3 2 Front panel connector NMT connector NMT Pin No Signal 6 8 9 0 1 2 4 5 7 3 1 2 3 4 5 6 7 8 9 10 EMG Signal EMG Signal Not Used Stimulus Stimulus Ground Not Connected Sensor Identification 5 V Mechanical Signal ...

Страница 12: ...should be returned to Datex Ohmeda for repair Datex Ohmeda is always available for service advice Please provide the unit serial number full type designation and a detailed description of the fault The Datex Ohmeda NMT Stimulator order code 871251 is recommended for functional checks CAUTION Only trained personnel with appropriate equipment should perform the tests and repairs outlined in this sec...

Страница 13: ...onitor software of revision 01 However most of the procedures also apply to monitors which contain some other monitor software type revision 3 2 1 Recommended tools Tool Order No Notes NMT simulator 871251 M NMT ElectroSensor M NMT MechanoSensor M NMT Sensor Cable 3 kΩ resistor Screwdriver Detach the module box by removing the two screws from the back of the module Be careful with the loose latch ...

Страница 14: ... NMT header with related information appear in the chosen digit field 5 Enter the service menu Monitor Setup Install Service password 16 4 34 Service password 26 23 8 Take down the information regarding NMT software by selecting SCROLL VERS and turning the ComWheel 6 Enter the NMT module service menu Parameters NMT Check that the Timeouts Bad checksums and Bad c s by mod values are not increasing ...

Страница 15: ...he switch on the simulator to Fade off and turn the knob to max Check Cable on the service menu now states only EMG 10 Start NMT measurement TOF by pressing the START UP key on the module When the message Supramax search changes to Setting reference in the digit field check that the supramaximal current detected is less than 70 mA i e the Current set value on the service menu is less than 700 11 C...

Страница 16: ...k that on the service menu the values for T1 T2 and Ratio are still within 950 1059 In the digit field the DBS value should be within 95 105 Count is 2 and T1 is within 95 105 16 Change the stimulus mode to Single Twitch Stimulation ST NMT Setup Stimulus Mode ST Check that the module starts to give only one stimulus pulse with a 1 second interval Note the time when the ST stimulation started Check...

Страница 17: ...r Transmission Module M NMT in the following way See the exploded view of the module 1 Remove the two screws from the back of the module 2 Pull the module box slowly rearward and detach it from main body Be careful with the loose latch and spring locking pin 3 Detach the NMT board by removing the two screws located near the front panel frame disconnect the cables and pull out the front panel frame...

Страница 18: ...lip Supramax not found Loose electrodes or loose stimulus clip Stimulus electrodes attached to wrong place Patient is relaxated Change or attach the electrodes or clip Change the place of the stimulus electrode Response too weak Loose stimulus electrodes Measuring electrodes attached to wrong place Patient is relaxated Change or attach the electrodes Change the place of the meas electrodes Ref not...

Страница 19: ...ce the original NMT sensor cable Does another module work in the same slot Does the test pass with another sensor Does the test pass with another NMT sensor cable Are the NMT input board wires connected Does the test pass with another NMT input board Does the test pass with another sensor Does the test pass with another NMT sensor cable Does the test pass with another sensor Does the test pass wit...

Страница 20: ...tex Ohmeda S 5 monitors Document No 800 1018 1 16 5 SERVICE MENU 1 Press the Monitor Setup key 2 Select Install Service password 16 4 34 3 Select Service password 26 23 8 4 Select Parameters 5 Select NMT ...

Страница 21: ... 3 should always be used for normal monitoring The settings 1 and 2 are for research purposes only Record Data Record Data prints out the displayed service data and circuit board information id serial number and software id onto the Recorder Module M REC Service Data Cable shows the type of cable being used Cable check value shows the bit amount From the following chart you can check the value for...

Страница 22: ...ry Bad checksums is a cumulative number that indicates how many times communication from the module to the monitor has failed Bad c s by mod is a cumulative number that indicates how many communication errors the module has detected The monitor starts counting these items at power up and resets to zero at power off The non zero values do not indicate a failure but the continuous counting more than...

Страница 23: ... M NMT Rev 00 01 887487 2 Latch 879181 9 EMC cover M NMT 886320 3 Spring pin 879182 10 Cross cylinder head screw M3x12 628700 4 Cross recess screw M3x8 black 616215 11 NMT input board 887184 5 Front panel unit M NMT 887186 12 Membrane keypad 880101 6 Cross cylinder head screw M3x6 61721 13 Front panel sticker see 6 1 3 7 Metal frame 879184 The front panel unit includes the connector and input boar...

Страница 24: ... 01 Order No DA 892217 DE 886003 EN 886002 ES 887498 FI 888873 FR 886004 IT 887542 JA 888318 NL 887370 NO 893572 PT 895240 SV 887369 6 1 5 Front panel stickers for S 5 modules round buttons Front panel stickers that are related to the Compact Module type and adaptation Adaptation codes DA Danish DE German EN English ES Spanish FI Finnish FR French IT Italian JA Japanese NL Dutch NO Norwegian PT Po...

Страница 25: ...NeuroMuscular Transmission Module M NMT Document No 800 1018 1 21 7 EARLIER REVISIONS This manual also supports earlier module revision 00 ...

Страница 26: ...Datex Ohmeda S 5 monitors Document No 800 1018 1 22 ...

Страница 27: ...APPENDIX A Service Check Form M NMT Document No 800 1018 1 23 APPENDIX A ...

Страница 28: ...Datex Ohmeda S 5 monitors 24 Document No 800 1018 1 ...

Страница 29: ...applicable Fail Test Failed OK N A Fail OK N A Fail 1 Internal parts 2 External parts 3 Installation 4 Recognition 5 Module software NMT 6 Communication and memories 7 Membrane keys 8 ElectroSensor recognition 9 Stimulus current test 10 Supramaximal current 70 mA 11 TOF measurement with NMT simulator T1 950 1059 T2 950 1059 T3 950 1059 T4 950 1059 Ratio 950 1059 TOF 95 105 Count 4 T1 95 105 12 Noi...

Страница 30: ...ponse 15 DBS measurement with NMT simulator T1 950 1059 T2 950 1059 Ratio 950 1059 DBS 95 105 Count 2 T1 95 105 16 ST measurement with NMT simulator T1 950 1059 Count 1 T1 95 105 17 Automatic measurement off 18 MechanoSensor recognition 19 Electrical safety check 20 Functioning after electrical safety check 21 Final cleaning Notes Used Spare Parts Signature ...

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