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ECG, arrhythmia, and ST segment
218
Instructions for use – Infinity Acute Care System – Monitoring Applications VG6.n
Device interference with pacemaker
monitoring
The following devices can interfere with pacemaker
monitoring.
Impedance-derived rate response pacemakers
These pacemakers emit pulses that adjust the
pacemaker rate to the respiratory rate. These
pulses could be falsely interpreted as pacer pulses.
For impedance-derived rate response pacemakers,
modify the electrode placement until the blue
spikes on the waveform disappear since they are
not related to real pacer impulses.
Infusion or roller bypass pumps
Interference from these devices can cause pacer
spikes to appear on the waveform although the
ECG appears normal. To determine if the pump is
the cause of the artifact, turn it off, if possible. To
minimize the artifact, choose the lead with the best
signal or replace the electrodes. Rerouting
pressure tubing away from the infusion tubing can
also improve the ECG signals.
Line isolation devices
To minimize the effect of line isolation devices,
which can cause temporary disturbances in the
ECG signal, follow these precautions:
– Choose the lead with the best signal for ECG
monitoring.
– Check the ECG electrodes; replace them, if
necessary.
Transcutaneous
electrical
nerve
stimulators
Signals from transcutaneous electrical nerve
stimulators (TENS) often resemble pacer signals
and can be labeled as such. The M540 can reject
valid QRS complexes, which follow misinterpreted
TENS signals. If TENS signals continue to register
as pacer spikes, deactivate pacer detection (see
page 214).
WARNING
Pay close attention to pacemaker patients
being monitored in Fusion mode because this
mode may increase the risk of falsely
counting pacemaker spikes as QRS
complexes, thus failing to detect cardiac
arrest.
CAUTION
Fusion
mode pacer detection is not intended for
use with large-signal, unipolar pacemakers. It is
intended for use only with bipolar pacemakers.
Observe the following:
– Select
Fusion
mode only in situations where
it becomes necessary to suppress repeated
false asystole and/or false low heart rate
alarms.
– Before selecting
Fusion
mode, be certain that
the patient has a bipolar pacemaker (external
or implanted) and that it is accurately
programmed as appropriate for that patient.
– Do not use
Fusion
mode if you are uncertain
as to what type of pacemaker is being used.
NOTE
The displayed heart rate may be incorrect if the
pacemaker pulse wanders through the ECG
waveform (ineffective pacing). During the
wandering pacemaker test required by
AAMI/ANSI/IEC 60601-2-27, the displayed heart
rate varied between 15 and 30 bpm (rather than
consistently being 30 bpm).