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Instructions for use – Infinity Acute Care System – Monitoring Applications VG6.n
217
ECG, arrhythmia, and ST segment
Pacemaker precautions
The M540 has been tested for pacemaker pulse
detection. However, it is impossible to anticipate
every clinically possible waveform characteristic.
For paced patient, the M540 could therefore
miscount heart rates and misinterpret rate-
dependent arrhythmias. False low-rate alarms can
result under the following conditions:
– Fused beats and asynchronous pacemakers,
when coupling intervals are in the range of
+10 to –90 ms
– 700-mV pacer pulses followed by QRS
complexes smaller than 0.5 mV
– Asynchronous pacemaker pulses with
overshoot
– Asynchronous pacemaker with large amplitude
pace pulses with no overshoot and at low heart
rate (30 bpm)
As well, false high-rate alarms can result under the
following condition:
–
Asynchronous pacemaker with large pace
pulse tails and at low heart rate (30 bpm)
Pacer fusion mode
Pacer fusion mode offers increased detection
sensitivity to fused paced beats, thereby reducing
false asystole and low heart rate alarms.
WARNING
Make sure pacer detection is deactivated for
patients without pacemakers. Make sure it is
activated for patients with pacemakers.
Deactivating pacer detection for paced
patients may result in pacemaker pulses being
counted as regular QRS complexes, which
could prevent an asystole alarm from being
detected. Always verify that the pacer
detection status is correct for the patient. Be
aware that setting the ECG filter option to ESU
deactivates pacemaker detection
automatically.
WARNING
Interference from a monitor may cause some
rate-adaptive implantable pacemakers to pace
at unnecessarily high rates. Be extra vigilant
with patients when using these types of
pacemakers.
WARNING
Always keep pacemaker patients under close
surveillance and monitor their vital signs
carefully.
– Do not assess the patient’s condition
exclusively from the heart and respiratory
rate values the monitor displays and the
rate alarms that are generated. Heart rate
meters may continue to count the
pacemaker rate during cardiac arrest or
some arrhythmias.
– Some pacemakers (especially external
pacemakers with body surface electrodes)
emit pulses with amplitudes far exceeding
the 700 mV maximum amplitude specified
for the M540. The M540 may incorrectly
detect these large pacemaker pulses as
valid QRS complexes and may fail to
detect cardiac arrest.
WARNING
Impedance respiration and pacemaker
detection are inoperative when the ESU filter
is selected. Refer to “Electrosurgery“on
page 20 for general safety precautions.