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Alarm messages

Priority

Incompatible Welch Allyn device.

Very low

USB Communication failure. Call for service.

Very low

Low battery 30 minutes or less remaining.

Very low

Low SpHb signal quality. Check sensor.

Very low

Low SpO2 signal quality. Check sensor.

Very low

Low perfusion. Check sensor.

Very low

Replace the SpO2 cable.

Very low

SpO2 mode only. Check sensor or cable.

Very low

SpO2 sensor expires in….

Very low

Unexpected restart occurred. Call for service.

Very low

Weight scale not functional. Call for service.

Very low

CO2 not functional. Call for service.

Very low

Filter line disconnected.

Very low

CO2 module temperature is out of range. CO2 might not be accurate.

Very low

Purging filter line.

Very low

Calibration is overdue. CO2 might not be accurate.

Very low

Factory service is overdue. CO2 might not be accurate.

Very low

CO2 auto-zero in progress.

Very low

Respiratory freshness timeout expired.

Very low

Replace RRa sensor.

Very low

RRa background interference detected.

Very low

RRa patient interference detected.

Very low

File system formatted on first-time startup.

Very low

Lost connectivity with host.

Low

The patient has exited bed.

High

Patient turn overdue.

Very low

EarlySense not functional.

Very low

112 Alarms

Welch Allyn Connex

Devices

Содержание Connex IWS

Страница 1: ...Welch Allyn Connex Devices Directions for use Software version 2 3X...

Страница 2: ...ed sensors or cables which would alone or in combination with this device fall within the scope of one or more of the patents relating to this device Nellcor SpO2 Patient Monitoring System with OxiMax...

Страница 3: ...robe well 33 Attach the temperature probe 34 Remove the temperature probe and well 34 Connect the NIBP hose 35 Disconnect the NIBP hose 35 Connect the SpO2 cable or the SpO2 RRa dual cable 35 Disconne...

Страница 4: ...ic keypad 67 Enter a number 68 Close the numeric keypad 68 Open the keyboard 68 Keyboard 68 Enter a letter or number 70 Enter a symbol or special character 70 Enter a diacritical mark 70 Close the key...

Страница 5: ...ssages and priorities 109 Nurse call 113 Patient monitoring 115 Standard and custom modifiers 115 Custom scoring 116 Manual overrides 116 Patient movement 116 Capnography CO2 122 Respiration rate 126...

Страница 6: ...messages 217 Battery power manager messages 217 Configuration Manager messages 218 Printer messages 218 Network messages 219 Problems and solutions 219 Specifications 221 Physical specifications 221 E...

Страница 7: ...information that accompanies the accessories you use Note Some product features described in this publication might not be available in your country For the latest information about products and featu...

Страница 8: ...patients who are well or poorly perfused in hospitals and hospital type facilities The optional Oridion module and accessories are intended for the continuous noninvasive measurement and monitoring of...

Страница 9: ...lthcare facility within the controlled access area of MRI equipment in a hyperbaric chamber in the presence of flammable anesthetics For contraindications of SpO2 and SpHb sensors consult the sensor m...

Страница 10: ...4 Introduction Welch Allyn Connex Devices...

Страница 11: ...ge to the equipment or other property or loss of data This definition applies to both yellow and black and white symbols WARNING Hot surface Do not touch Follow the operating instructions directions f...

Страница 12: ...Best 4 bars Good 3 bars Fair 2 bars Weak 1 bar No signal no bars No connection blank Nurse call recent models Nurse call older models Connected to central station Disconnected from central station Mi...

Страница 13: ...of Type CF applied parts Atmospheric pressure limitation Not for injection Transport and storage temperature range Authorized Representative of the European Community Maximum safe working load limits...

Страница 14: ...8 Symbols Welch Allyn Connex Devices...

Страница 15: ...nitoring and connectivity Connect to the central station and retain patient data Monitor tab Disconnect from the central station but continue monitoring and retain patient data Monitor tab Connected t...

Страница 16: ...lse rate Pulse amplitude bar SatSeconds timer Nellcor feature only SpO2 view toggle Response mode selector Fast mode selected Beats per minute to represent pulse rate Total hemoglobin SpHb SpHb view t...

Страница 17: ...on indicator Averaging mode selector Fast mode selected Patient movement Bed mode Bed exit Patient turn indicator and timer Bed exit Review tab Patient turn indicator Review tab Exit sensitivity indic...

Страница 18: ...l marks appearance differs based on language Symbols key Send patient data Print patient data View tabular trend data View graphical trend data Cancel action Add patient identifiers Retrieve patient l...

Страница 19: ...ings Save configuration settings Select state or view Save to USB flash drive Configure from USB flash drive Restore factory default settings Close Advanced settings Directions for use Screen elements...

Страница 20: ...14 Screen elements Welch Allyn Connex Devices...

Страница 21: ...n this manual could lead to damage to the equipment or other property or loss of patient data General warnings and cautions WARNING Many environmental variables including patient physiology and clinic...

Страница 22: ...sors from patients and disconnect them completely from monitors before bathing WARNING Liquids can damage electronics inside the monitor Prevent liquids from spilling on the monitor If liquids are spi...

Страница 23: ...or back into use WARNING Defective batteries can damage the monitor If the battery shows any signs of damage or cracking it must be replaced immediately and only with a battery approved by Welch Allyn...

Страница 24: ...atient cabling to reduce the possibility of patient entanglement or strangulation When transporting the monitor on a mobile stand properly secure all patient cables and cords to keep them clear of the...

Страница 25: ...and potential shock hazard For accessories that use a USB cable to connect to the monitor disconnect the USB cable from the monitor when you disconnect the accessory WARNING Personal patient injury r...

Страница 26: ...ord Keep the cord away from liquids heat and sharp edges Replace the power cord if the strain relief or cord insulation is damaged or begins to separate from the attachment plug CAUTION Use only the W...

Страница 27: ...by qualified service personnel 6 Reinstall battery pack 7 Mount the wall system on the wall 8 Power on the wall system and verify that it functions normally before using it WARNING The physical asses...

Страница 28: ...22 About warnings and cautions Welch Allyn Connex Devices...

Страница 29: ...ote Your monitor based on size or configuration might not contain all parameters or features illustrated in this section In a standard monitor up to two parameter modules are installed on the left sid...

Страница 30: ...an additional module on the right side Extended monitor right side Equipment setup and basic monitor functions are the same for both models unless otherwise noted in the directions for use Controls i...

Страница 31: ...provides a graphical user interface 7 Battery compartment behind cover Houses the lithium ion battery 8 Blood pressure Supports dual lumen or single lumen hoses 9 Pulse oximetry Nellcor or Masimo rain...

Страница 32: ...rovides a connection to the hospital nurse call system Not available on the 6300 model 5 Fan exhaust 6 Ground lug equipotential terminal Provided for electrical safety testing and as a means for conne...

Страница 33: ...ff when you return it 2 Rheostat Located on each handle Turn clockwise to increase light output turn counterclockwise to decrease light output 3 Exhaust vents Exhaust vents cool the monitor 4 LCD scre...

Страница 34: ...2 75 mm and adult 4 25 mm sizes Front underside views Left USB Comms cover attached Right USB Comms cover removed 1 Retention screws Supports removing and attaching USB Comms cover 2 Blood pressure Se...

Страница 35: ...ed on the wall 2 Ethernet RJ 45 Provides a hardwired connection to the computer network 3 Li ion battery Provides backup power to wall system 4 Nurse call Provides a connection to the hospital nurse c...

Страница 36: ...ounting rail bracket and hardware Secures the wall system to the wall 2 Accessory bin mounting bracket and hardware Secures accessory bin to the wall and provides routing and strain relief for power c...

Страница 37: ...cedure applies to first time setup of the monitor WARNING Risk of fire explosion and burns Do not short circuit crush incinerate or disassemble the battery pack 1 Turn the monitor upside down to acces...

Страница 38: ...wall mount fixture Check the mounting bracket Before you mount the monitor make sure the stand or wall mount fixture has the mounting bracket designed for your monitor Monitors with a standard housin...

Страница 39: ...ated properly Repeat step 1 until the monitor is mounted correctly 3 Tighten the screw on the bracket into the screw hole on the back of the monitor Mount the monitor on the wall For mounting instruct...

Страница 40: ...ing tab on the right and insert it into the probe port of the temperature module 3 Push it into place until it clicks 4 Reattach the cover Use the alignment tab and slide the cover to the left to clic...

Страница 41: ...refinger on the hose connector Note Always grasp the hose by the connector Do not pull on the hose itself 2 Squeeze the side tabs until the connector releases 3 Pull the connector away from the connec...

Страница 42: ...eparate cables at the other end to support RRa and SpO2 measurement 1 Connect the dual cable to the device as shown in the preceding steps The connector is the same as for the standard SpO2 cable 2 Al...

Страница 43: ...Always grasp the cable by the connector Do not pull on the cable itself 2 Squeeze the side tabs until the connector releases 3 Pull the connector away from the connector port Connect the patient movem...

Страница 44: ...supply when it is attached to the monitor 1 On the rear of the monitor loosen the screw on the USB door and open it Note On some monitor stands the monitor mounting bracket partially overlaps the USB...

Страница 45: ...ool For more information refer to the instructions and the service tool installation guide Detach a USB accessory 1 On the rear of the monitor loosen the screw on the USB door and open it 2 Detach the...

Страница 46: ...ring keep the monitor connected to AC power at all times If only battery power is available you must remain in the room with any patient whose vital signs are being monitored continuously Actively mon...

Страница 47: ...ries in the Appendices Unpack the wall system This procedure applies to first time setup of the wall system CAUTION You must follow these instructions exactly to ensure safety and ease of assembly CAU...

Страница 48: ...m is assumed to be shut down WARNING Risk of fire explosion and burns Do not short circuit crush incinerate or disassemble the battery pack 1 Locate the battery compartment indicated by 2 Insert the b...

Страница 49: ...Remove the cardboard end caps and all foam as shown and put aside for recycling CAUTION Do not remove the cardboard securing the handles on the left side of the wall system at this time The cardboard...

Страница 50: ...o studs Mount the wall system within reach of the AC power outlet The power cord is 8 ft 2 44 m long Avoid brightly lit areas Blood pressure tubing is 8 ft 2 44 m long Position the wall system so that...

Страница 51: ...he wall system on the wall until you have completed all preliminary steps 2 Affix the mounting rail bracket to three studs at the selected height using the available screws anchors are provided for ad...

Страница 52: ...he captive retention screws 5 Hang wall system on the mounting rail bracket WARNING Ensure that the ribs on the back of the wall system fully engage the mounting rail bracket The wall system should be...

Страница 53: ...the stud with the remaining screw WARNING Failure to install this security screw may result in personal injury and equipment damage 7 If the wall unit is configured for SpO2 or SpHb connect the sensor...

Страница 54: ...ighten the two retention screws 9 Attach the system power cord to the wall unit Do not plug the cord into an outlet at this time Mount the accessory bin 1 Mount the accessory bin on the accessory bin...

Страница 55: ...nector You just connected the opposite end of the sensor cable to the wall system Ensure the sensor cable is inserted completely then close the protective cover See the sensor manufacturer s direction...

Страница 56: ...to the tubing see the cuff manufacturer s directions for use then store the cuff in the accessory bin Set up the physical assessment instrument handles and specula dispenser 1 Attach the specula disp...

Страница 57: ...ert the probe well into the temperature module The probe well snaps into place when it is fully seated 2 Hold the temperature probe cable connector with the spring tab on the right and insert it into...

Страница 58: ...e thermometer cover insert the battery replace the thermometer cover then place the thermometer in the dock 1 2 1 2 3 Charge the Braun thermometer for 24 hours before first use 4 To switch from Celsiu...

Страница 59: ...hut down the wall system and detach the power cord Then remove the cover from the wall system by loosening the captive retention screws 2 Loosen the two screws on the cable retention clamp and remove...

Страница 60: ...cessories require a license to enable them for use These accessories are packaged with an authorization code and instructions for activating the license using the Welch Allyn Service Tool For more inf...

Страница 61: ...ettings Note Battery powered accessories connected to the device continue to charge while the device is in this mode and connected to AC power The following actions return the display to the active st...

Страница 62: ...To ensure patient safety listen for an audible indicator and watch for visual alerts at power up at least once daily Correct any system errors before using the monitor In addition to the audible indic...

Страница 63: ...date and time 1 Touch the Settings tab 2 Touch the Device tab 3 Touch the Date Time vertical tab 4 To change the date and time values Touch the up and down arrow keys or touch and enter a value Repeat...

Страница 64: ...er the clinician name touch located at the right of the text field and enter characters You can enter up to 32 characters for the clinician s first and last name Enter only 1 character for the middle...

Страница 65: ...me tab includes the following areas Item Area 1 Device Status 2 Content 3 Navigation Device Status area The Device Status area located at the top of the Home screen displays the following monitor info...

Страница 66: ...Estimated battery capacity is displayed in hour s minute s format Touch this area to navigate to the Device tab where you can power down the device This area also provides interactive alarm and infor...

Страница 67: ...ed data Alarm and information messages The Device Status area provides alarm and information messages that are either temporary or exist as long as the condition to which the message applies remains A...

Страница 68: ...me height weight pain temperature respiration and BMI depending on configuration In the Office Spot Check and Intervals Monitoring profiles the Content area also includes a Save button which you use t...

Страница 69: ...ght and height Patient Pulse rate SpO2 Temperature Pain The Content area also includes a Save button which you use to manually save current measurements The Clear button deletes current measurements w...

Страница 70: ...and sends patient data Settings Accesses device configuration settings To navigate to a tab touch the tab in the Navigation area with the corresponding name The active tab is highlighted Display lock...

Страница 71: ...age appears Unlock the display On the locked screen touch in the title bar located at the bottom of the screen The following occurs Patient information appears in the Patient frame The Navigation area...

Страница 72: ...66 Navigation Welch Allyn Connex Devices...

Страница 73: ...umeric keypad appears Numeric keypad The numeric keypad includes the following components Component Name Description Data field Displays the numbers you enter The field name appears above and the rang...

Страница 74: ...within the required range and format the numeric keypad disappears and the entered numbers replace the previous numbers If the number is not within the required range and format OK remains inactive un...

Страница 75: ...touch one of these Any symbol The letters key The symbols key Note The symbols that display match the selected language Diacritical marks key appearance varies in some languages When touched the keybo...

Страница 76: ...1 With the keyboard open touch Symbols and special characters for the selected language appear 2 Touch the appropriate symbol or special character The keyboard returns to its normal layout Enter a dia...

Страница 77: ...rts linear and two dimensional barcodes If you haven t done so already power down the monitor and attach the barcode scanner Use the instructions to attach an accessory Note Refer to the manufacturer...

Страница 78: ...tch to save measurements is enabled in Advanced settings a progress indicator appears onscreen as the device queries an external host system for a matching ID An unsuccessful query results in the mess...

Страница 79: ...alized monitoring of connected monitors This central monitoring system supports the communication of continuously monitored and intermittently acquired episodic data patient vital sign alarms and tech...

Страница 80: ...he patient display patient data and generate alarms and messages When connectivity is restored the monitor resumes sending vital signs trends and episodic data Monitor tab The Monitor tab provides the...

Страница 81: ...profiles to communicate with a central station as well in Advanced settings In these configurations if either the Intervals Monitoring or Spot Check profile is active your device connects to the centr...

Страница 82: ...nitoring profile immediately becomes active If these conditions do not apply proceed to step 4 4 Using the conditions presented in boldface text select and follow the steps below that apply to your pa...

Страница 83: ...t needs to ambulate use the restroom or go off the unit for a test Note If a low battery alarm occurs on the device Pause mode is not available Note While in Pause mode the device retains previously s...

Страница 84: ...sumes Pause time limit expired patient sensors disconnected If the pause time limit runs out before you resume monitoring the device exits Pause mode and alarms might occur Reconnect patient sensors t...

Страница 85: ...ame on the patient list select that patient entry and then touch Select The Home tab appears with patient and or location information filled in according to your monitor s settings Note If patient nam...

Страница 86: ...you select a room and bed 6 Touch OK to return to the Home tab The information is saved Note You have the option to leave some fields blank on the Patient Summary tab However if patient name or locat...

Страница 87: ...SpO2 and pulse rate Monitors configured with the Masimo rainbow SET option may provide continuous monitoring of oxygen saturation of hemoglobin SpO2 total hemoglobin SpHb or SpHbv Acoustic Respiration...

Страница 88: ...Oridion CO2 based Home tab Masimo RRa based Home tab EarlySense patient movement based Home tab 82 Profiles Welch Allyn Connex Devices...

Страница 89: ...et when you complete parameter setup and return to the Home tab These modifiers do not appear on the Review tab After 24 hours of data has been saved for the selected patient any data older than 24 ho...

Страница 90: ...cian s office The profile supports two features that are not available in other profiles Noninvasive blood pressure NIBP averaging programs These programs display the average of multiple NIBP readings...

Страница 91: ...rlySense only X Monitor RRa Masimo only X Configure and use interval timing setting X X Observe and configure alarm limits X X Observe and respond to physiological alarms X X Change patient type adult...

Страница 92: ...nced settings to change profiles The steps to change profiles vary based on several conditions Active versus target profile Established patient context Saved patient measurement data Sensors actively...

Страница 93: ...the Continuous Monitoring profile occurs only once for each continuous sensor attachment If the attempted profile change fails or if you switch to an episodic profile after an automatic change to the...

Страница 94: ...firm the patient and or location context information or select a new patient For example if both patient and location context have been established the following options appear Same patient same locat...

Страница 95: ...al tab The profile change immediately takes effect 4 When patient and or location context are established but no episodic or continuous trend data has been stored a Select the desired profile A confir...

Страница 96: ...90 Profiles Welch Allyn Connex Devices...

Страница 97: ...ON Verify patient identity on the monitor after manual or barcode entry and before printing or transferring patient records Add a patient to the patient list Note If the monitor is configured to retri...

Страница 98: ...screen according to preferences configured in Advanced settings 1 Ensure that you are on the Home tab 2 Scan the patient s barcode with the barcode scanner The Patient ID appears in the Patient frame...

Страница 99: ...twork touch Retrieve list to update the onscreen patient list The monitor retrieves the patient list from the network Note You can enable the monitor to retrieve the patient list from the network in A...

Страница 100: ...also enable scanning of patient barcodes These configurations specified in Advanced Settings include the following The Primary label setting is Patient ID The Primary label setting is Name and the Se...

Страница 101: ...data can be printed from this tab 1 Touch the Review tab Note Measurements that triggered a physiological alarm are highlighted on this tab If your device is configured to monitor patient movement th...

Страница 102: ...or this patient The most recent measurements appear on the right of the table with older measurements to the left 5 Touch the graphical trends button to view a graphical representation of patient meas...

Страница 103: ...records or Delete to permanently remove the records as desired CAUTION Verify patient identity on the monitor after manual or barcode entry and before printing or transferring patient records CAUTION...

Страница 104: ...age in the printouts is defined by the language selected on the monitor Intervals Monitoring report Spot Check report Continuous Monitoring trend data report with capnography Continuous Monitoring tre...

Страница 105: ...the selected patient Touch Cancel to cancel the deletion Note Deleting a patient from the Patients List does not delete saved records Touch the Review tab to see or delete saved records Note For monit...

Страница 106: ...100 Patient data management Welch Allyn Connex Devices...

Страница 107: ...r is the primary alarming source for the patient and any external system such as a Nurse Call or software system is a backup alarm source The external system is only as reliable as its network and can...

Страница 108: ...you must rely on visual alarm notifications maintain a clear line of sight with the monitor For audio alarm notifications set the volume as needed considering the environment and ambient noise levels...

Страница 109: ...ecent of those alarm messages first Information messages instruct you to interact with the monitor in a specific way or provide information that does not require action You can dismiss an information...

Страница 110: ...line of sight with the monitor while audio alarms are disabled Alarm audio paused The audio tone is paused The icon remains until the paused time counts down to 0 Icons in the Device Status area The...

Страница 111: ...to remove the dimming while in use If a loss of connectivity occurs certain alarms become audible until connectivity is restored Patient rest mode can be enabled and disabled from the central station...

Страница 112: ...returns after the pause interval A longer pause interval can be configured in the Advanced tab You start the configured pause interval by touching If you responded to an NIBP alarm and multiple NIBP...

Страница 113: ...limits You can adjust vital sign alarm limits or turn off alarm limit checking for individual parameters WARNING Alarm limits are user adjustable For alarms to function properly you must set or verify...

Страница 114: ...nitoring patients If the patient is being monitored continuously maintain a clear line of sight with the monitor while audio alarms are disabled WARNING If you are relying on audio alarm notifications...

Страница 115: ...r priority Physiological alarms Alarm messages Priority Alarm limit exceeded etCO2 HIGH High Alarm limit exceeded etCO2 LOW High Alarm limit exceeded FiCO2 HIGH Medium Alarm limit exceeded IPI LOW Hig...

Страница 116: ...w battery 5 minutes or less remaining High Searching for SpO2 signal High Communications module did not power on properly Power down the device High Check for occlusion in gas line High Network not fo...

Страница 117: ...low Temperature time limit exceeded Retry temperature measurement Very low Low battery unable to print plug into outlet Very low Printer door is open close to continue Very low Printer not functional...

Страница 118: ...not functional Call for service Very low Filter line disconnected Very low CO2 module temperature is out of range CO2 might not be accurate Very low Purging filter line Very low Calibration is overdue...

Страница 119: ...an alarm that exceeds the preset threshold occurs Nurse Call notification persists until one of the following occurs on the monitor The alarm clears You reset pause or turn off the alarm tone For pau...

Страница 120: ...114 Alarms Welch Allyn Connex Devices...

Страница 121: ...ent noise levels Verify that the alarm is audible to a clinician working at the maximum distance from the monitor Standard and custom modifiers Modifiers enable you to save additional information for...

Страница 122: ...l a keypad appears 2 Enter the manually acquired measurement on the keypad and touch OK The Home tab appears and displays the entered measurement Note Touch Clear to remove all values and correct your...

Страница 123: ...ayed data varies based on your configuration If the patient turn reminder is active the timer counts down to zero and then displays a reminder in the Device Status area to perform and log a patient tu...

Страница 124: ...ble 2 Touch the Alarms tab 3 Touch the Movement vertical tab 4 Ensure that the Exit alarm and Motion alarm controls are set to ON Note If any parameter s alarm limit control is set to OFF you cannot a...

Страница 125: ...s Do not shorten or extend the cable CAUTION Sensor malfunction risk Do not allow patients to jump on the bed or the bed sensor CAUTION Sensor malfunction risk For patients with poor bladder function...

Страница 126: ...s chest area the sensing unit cable extending toward the head of the bed 6 Instruct or assist the patient to lie down in bed Double check the position of the patient and the sensor see step 5 and adj...

Страница 127: ...s a valid measurement Note A low confidence condition that persists beyond 3 minutes triggers a technical alarm Observe and report patient turn events Based on the Turn reminder schedule configured on...

Страница 128: ...breath etCO2 and FiCO2 Controls to pause or restart the CO2 pump as well as to pause CO2 alarms also appear in the frame Note CO2 monitoring is available only with the Continuous Monitoring profile Th...

Страница 129: ...b appears In the Continuous Monitoring profile the modifiers are saved with the next set of measurements sent to the network Configure etCO2 and FiCO2 alarms Follow these steps to set alarm limits for...

Страница 130: ...ling line e g from ambient humidity or breathing unusually humid air the message Purging filter line will appear in the Device Status area If the sampling line cannot be cleared the message Check for...

Страница 131: ...k The CO2 sampling exhaust port located just below the sampling line connection port is for respiratory exhaust only Maintain an open breathing circuit by leaving this port open to vent respiratory ga...

Страница 132: ...etions or a buildup of liquids in the airway tubing might occlude the sampling line requiring more frequent replacement Note When the message Check for occlusion in gas line appears on the screen indi...

Страница 133: ...t alarm limits for RR measurements 1 Verify that you are using the Continuous Monitoring profile Note If Allow profile change is enabled in Advanced settings the device attempts to shift automatically...

Страница 134: ...patient subtypes appear on the Patient Summary tab and on the Home tab as a label in the IPI frame but they do not appear in the Patient frame Note IPI is available only with the Continuous Monitoring...

Страница 135: ...a graph of the IPI numeric values over a user selected period and thus can alert you to changes in the patient s respiratory status In Advanced settings you can select the period displayed The size o...

Страница 136: ...ing of the patient s respiration rate and affect the patient s IPI value 7 Touch the Type list box and select patient type Note If you select Pediatric as a patient type an information message prompts...

Страница 137: ...y sounds are detected through a sensor applied to the patient s neck Note RRa is available only in the Continuous Monitoring profile Note Masimo SpO2 monitoring is required when monitoring RRa Note RR...

Страница 138: ...alarm limits for RRa measurements 1 Verify that you are using the Continuous Monitoring profile Note If Allow profile change is enabled in Advanced settings the device attempts to shift automatically...

Страница 139: ...nts WARNING Patient injury risk The sensor and extension cable are intended only for connection to pulse co oximetry equipment Do not attempt to connect these cables to a PC or any similar device Alwa...

Страница 140: ...rected in the sensor manufacturer s instructions Detaching the sensor during a measurement triggers an alarm NIBP Noninvasive Blood Pressure NIBP frame From the NIBP frame you can measure blood pressu...

Страница 141: ...MAP calculation as secondary content NIBP view 2 displays the MAP calculation as the primary content and the SYS DIA as secondary content Buttons The buttons on the right side of the frame enable you...

Страница 142: ...e automatic measurements Automatic measurements are off Automatic measurements are on Interval Office profile Touch the button to display the Intervals tab where you can start an NIBP averaging progra...

Страница 143: ...NIBP measurement follow these steps to select the appropriate cuff for the patient 1 Measure the circumference of the patient s bare upper arm midway between the elbow and shoulder 2 Choose the approp...

Страница 144: ...ng in either no reading or an inaccurate SpO2 or pulse rate until the flow returns WARNING The blood pressure cuff must be properly positioned to ensure blood pressure accuracy and patient safety Wrap...

Страница 145: ...t You can set the default in Advanced settings 5 Touch the Home tab The new setting takes effect immediately 6 To set up modifiers touch the Patients tab 7 Touch the Manual tab 8 Scroll through the li...

Страница 146: ...ient If there is any question about the accuracy of a measurement verify the measurement using another clinically accepted method WARNING Inaccurate measurement risk Do not use the device or accessori...

Страница 147: ...ng the blood pressure while the cuff is inflating the monitor attempts to measure the blood pressure while deflating the cuff When the measurement is complete the NIBP frame displays the measurement u...

Страница 148: ...intervals Configure the monitor to print automatic measurements as they are completed When the measurement is complete the NIBP frame displays the measurement until the next measurement starts Note In...

Страница 149: ...tely Automatic intervals You can configure the monitor to take automatic NIBP measurements at consistent intervals Use the spin box or keypad to set the desired interval Note An alarm does not turn of...

Страница 150: ...t program intervals Follow these steps to configure the monitor to take automatic NIBP measurements at variable intervals 1 Properly size the blood pressure cuff and position it around the patient s b...

Страница 151: ...e Prolonged impairment of circulation or improper cuff position can cause bruising Current cuff pressures are not dynamically displayed during a Stat reading The Home tab displays the NIBP reading fro...

Страница 152: ...eraging program displays the average of multiple NIBP readings To calculate the average the program takes a set of readings The example below shows a program in progress Number Feature Description 1 N...

Страница 153: ...from the Intervals tab 1 Properly size the blood pressure cuff and position it around the patient s bare upper arm 2 On the Home tab touch The Intervals tab appears 3 Confirm that NIBP averaging is se...

Страница 154: ...BP reading begins when the timer reaches 0 After taking all readings the program displays the average Note If a technical alarm condition occurs while a reading is in progress the reading stops The ti...

Страница 155: ...ight and height input Note When a weight or height measurement is transferred from an attached weight scale to the monitor the measurement displayed on the monitor is within one decimal place 0 1 of t...

Страница 156: ...ofile you are using Temperature frame in Continuous Monitoring profile The size of the Temperature frame and displayed measurements varies based on your configuration The Continuous Monitoring profile...

Страница 157: ...surement site Therefore no temperature readings require adjustments Note For additional guidance addressing core temperature and variations in body temperature by measurement site see the Normal Body...

Страница 158: ...temperature measurement 1 Verify that you are using the Intervals or Continuous profile 2 Touch the Alarms tab 3 Touch the Temperature vertical tab 4 Ensure that the Temperature alarm limit control i...

Страница 159: ...ways take a temperature measurement with a Welch Allyn single use probe cover securely attached Failure to use a probe cover can cause patient discomfort from a heated probe patient cross contaminatio...

Страница 160: ...ury risk Do not exceed the recommended temperature measurement durations in Direct mode Continuous measurement durations of 3 minutes at the oral and rectal sites and 5 minutes at the axillary site ar...

Страница 161: ...the probe into a new probe cover and press the probe handle down firmly 3 Touch the Temperature site control to choose from these measurement sites oral pediatric axillary or adult axillary 4 Hold th...

Страница 162: ...ll 8 Wash your hands to reduce the risk of cross contamination Take a temperature in the Direct mode Direct mode displays the temperature of the probe as long as the probe tip remains in place at the...

Страница 163: ...over and press the probe handle down firmly 3 Touch the Temperature site control to choose from these measurement sites oral pediatric axillary or adult axillary The temperature frame changes to Direc...

Страница 164: ...lized Do not autoclave probes and probe covers Ensure that probe covers are disposed of according to facility requirements or local regulations 1 Remove the rectal temperature probe from the rectal pr...

Страница 165: ...intain the thermometer WARNING Liquids can damage electronics inside the thermometer Prevent liquids from spilling on the thermometer If liquids are spilled on the thermometer dry off the thermometer...

Страница 166: ...isk The following factors can affect ear temperature measurements for up to 20 minutes The patient was lying on his or her ear The patient s ear was covered The patient was exposed to very hot or very...

Страница 167: ...out a sequence of short beeps sounds and the error message POS position error appears 7 When you are finished taking the temperature press the ejector button to eject the used probe cover 8 Return th...

Страница 168: ...e Continuous measurement durations of 3 minutes at the oral and rectal sites and 5 minutes at the axillary site are recommended for accurate measurement Do not continuously measure beyond 10 minutes i...

Страница 169: ...ween views by touching the left side of the frame SpO2 numeric view The numeric view indicates the SpO2 saturation percentage and the pulse amplitude Features of this view differ based on the type of...

Страница 170: ...ary During sensor placement the PI can be used to evaluate the appropriateness of an application site looking for the site with the highest PI number Placing the sensor at the site with the strongest...

Страница 171: ...for use Set up SpO2 Follow these steps to configure SpO2 parameter settings and to set up modifiers 1 Touch the Settings tab 2 Touch the Setup tab 3 Touch the SpO2 vertical tab 4 Select the desired S...

Страница 172: ...signals will occur for that specific parameter 5 Enter the desired upper and lower alarms limits for SpO2 using the up down arrow keys or the keypad 6 If your monitor is configured with a Nellcor SpO2...

Страница 173: ...k The pulse co oximeter can be used during defibrillation but the reading may be inaccurate for up to 20 seconds WARNING Patient injury risk Do not attempt to reprocess recondition or modify any senso...

Страница 174: ...or a sensor misapplied or dislodged severe anemia venous congestion 1 Verify that the sensor cable is connected to the monitor WARNING Patient injury risk The sensor and extension cable are intended o...

Страница 175: ...not available the pulse rate is derived from NIBP If SpO2 is being measured continuously on a patient for an extended period change the sensor location at least every three hours or as indicated by t...

Страница 176: ...to calculate the SpHb value and update the display short approximately 1 minute medium approximately 3 minutes or long approximately 6 minutes SpHb graphical trend view The graphical trend view prese...

Страница 177: ...lights including pulsating strobe lights directed on the pulse co oximeter can prevent it from obtaining readings WARNING The pulsations from intra aortic balloon support can increase the pulse rate d...

Страница 178: ...or sudden and significant changes in pulse rate proximity to an MRI environment moisture in the sensor excessive ambient light especially fluorescent the use of the wrong sensor a sensor misapplied o...

Страница 179: ...ration of sensor use can cause tissue damage Inspect the sensor site periodically as directed in the sensor manufacturer s instructions While SpHb is being measured the displayed SpO2 and pulse rate a...

Страница 180: ...rent color to gray See the timestamp in the NIBP frame for actual time of this measurement After one hour this measurement is cleared from the frame Intervals Monitoring profile Spot Check profile Set...

Страница 181: ...thin one decimal place 0 1 of the measurement displayed by the weight scale Note You cannot manually enter temperature in this frame on a device configured with a SureTemp Plus temperature module Note...

Страница 182: ...Monitoring and Spot Check episodic profiles manual parameters clear from the Home tab after a successful save Note When the device is connected to a central station and in the Continuous Monitoring p...

Страница 183: ...TION Do not overstretch the cords on these handles to prevent damage Always examine patients within a comfortable reach of the wall system to protect the cords CAUTION To minimize the external housing...

Страница 184: ...178 Patient monitoring Welch Allyn Connex Devices...

Страница 185: ...ation for current revision of the monitor 3 Do the following at least monthly Test the speaker by selecting each alarm volume level and listening for the different tones Visually inspect the mobile st...

Страница 186: ...must be installed so that it unwinds from the bottom of the roll as illustrated If the paper roll is not installed correctly the printer will not print properly 4 Advance the end of the roll past the...

Страница 187: ...h to open Choose a coin that fits comfortably in the slot 4 Pull the battery out by pulling the battery label which is visible when you open the battery cover 5 Slide in the new battery Ensure that yo...

Страница 188: ...to the back of the wall system follow these steps to remove the wall system from the wall 1 Touch the Settings tab 2 Touch the Device tab 3 Touch Power down 4 Remove all instrument heads detach all a...

Страница 189: ...Before removing the battery follow the instructions to remove the wall system from the wall 1 Place the wall system on a table or flat work surface so that the back of the wall system faces up 2 Locat...

Страница 190: ...onnel WARNING Liquids can damage electronics inside the device Prevent liquids from spilling on the device If liquids are spilled on the device 1 Power down the device 2 Disconnect the power plug 3 Re...

Страница 191: ...d disinfectants Select an approved cleaning agent from the following tables Section 1 Approved for the Connex Vital Signs Monitor except the Braun ThermoScan PRO dock Cleaning agent Additional informa...

Страница 192: ...ercent chlorine bleach solution 4 Clean the RRa cable and the SpO2 RRa dual cable with a cloth dampened with 70 percent isopropyl alcohol 5 Clean the EarlySense sensor by gently wiping with a soft sli...

Страница 193: ...cannot enter the Advanced settings if sensors or physiological alarms are active or if vital sign measurements are displayed General Specify the language 1 Access the Advanced Settings a Touch the Set...

Страница 194: ...tatus area 4 Do one of the following To continue in the Advanced Settings touch another tab To exit the Advanced Settings and return to the Home tab touch Exit Specify advanced alarm settings 1 Access...

Страница 195: ...tion Delays vertical tab Note Alarm delays are available only for the parameters supported by your configuration SpO2 alarm condition delay Specify the minimum amount of time that an SpO2 alarm condit...

Страница 196: ...a pediatric no breath detected condition must be active in an Oridion CO2 configuration before audio and visual signals occur Neonate no breath detected alarm delay Specify the time that a neonate no...

Страница 197: ...ct to enable manual selection of different profiles and the automatic shift to the Continuous Monitoring profile when a continuous sensor is connected to a patient When disabled the current profile se...

Страница 198: ...he Advanced settings code d Touch OK The General tab will appear 2 Touch the Parameters tab 3 Touch the IPI tab 4 Specify settings Setting Action Description Display IPI Select to display the IPI fram...

Страница 199: ...ed settings code d Touch OK The General tab appears 2 Touch the Parameters tab 3 Touch the SpO2 tab 4 Specify settings Setting Action Description Default view Select a numeric view or a waveform view...

Страница 200: ...ale default Select the default waveform scale in etCO2 measurements Unit of measure Select primary units of measure for the etCO2 display on the Home tab Check calibration Select to start CO2 calibrat...

Страница 201: ...e SpHb display on the Home tab Default averaging Select the default moving window of time used by the parameter to calculate the SpHb value and update the display short approximately 1 minute medium a...

Страница 202: ...pe of patient Clinicians can change the CITs from the default CITs that you set here on the Settings Setup NIBP tab Allow interval program changes Select to enable user to modify interval program sele...

Страница 203: ...the Start intervals button is selected and the start of the first reading Time between Enter the period between the end of one reading and the start of the next reading Keep if or Enter the range that...

Страница 204: ...pensation improves reading accuracy by detecting placement of the probe in the ear canal Unadjusted places thermometer in mode to detect raw ear temperature only Enable pulse timer Select to enable pu...

Страница 205: ...piration rate RR parameter remains available for selection on this screen and is displayable in the Manual parameters frame 5 Enable manual overrides of selected parameter measurements displayed on th...

Страница 206: ...information populates the Patient frame on the Home tab and fields on the Summary tab Select Require patient ID match to save measurements to require that the selected patient ID matches a patient ID...

Страница 207: ...d on ID The monitor initiates the search when the clinician enters or scans the ID from the Clinician tab Returned clinician information populates the Device Status area and fields on the Clinician ta...

Страница 208: ...to specify that clinical data sent to the network appears as Spot Vital Signs LXi data at the network Connect to CS Select to enable connection to the Connex central station Enable clear button on Hom...

Страница 209: ...than 16 characters may be truncated in the user view Enter a maximum of 32 characters Radio band Select the radio band Authentication type Select an authentication scheme Then specify any additional...

Страница 210: ...y the port to match the port used by the server Touch in the Port entry field and enter the port number The range of entry is 0 to 65535 VM IP Enable the device to connect to a Connex Vitals Managemen...

Страница 211: ...ted option to the default values Test Touch Test to test the connection to the configured server 6 Do one of the following To continue in the Advanced Settings touch another tab To exit the Advanced S...

Страница 212: ...206 Advanced settings Welch Allyn Connex Devices...

Страница 213: ...sage column You can dismiss a message by touching the message on the screen or for some messages you can wait for the message to time out To use these tables locate the message that displays on the mo...

Страница 214: ...r horizontally under the patient s mattress with the cable extending toward the head of the bed There is excessive patient movement Low confidence condition Check the patient Replace the bed sensor Us...

Страница 215: ...ating CO2 Move to a location where the ambient temperature enables the module temperature to return to normal and the module to reset before calibrating CO2 Connect or clear filter line Calibration fa...

Страница 216: ...ed You or some other user interrupted the calibration Resume or retry calibration RRa messages Message Possible cause Suggested action Respiratory freshness timeout expired Excessive ambient or enviro...

Страница 217: ...P check connections and tubing for kinks The NIBP tubing on the outside of the device has a kink Check the connections and tubing for kinks Clear the alarm and retry NIBP The NIBP module needs to be c...

Страница 218: ...ulse signal High priority alarm The SpO2 sensor is not attached to the patient s finger Touch the alarm icon or the SpO2 frame to dismiss the alarm Set SpO2 alarm limits to OFF Reattach the SpO2 senso...

Страница 219: ...unctional Call for service A module error occurred Call for service Temperature time limit exceeded Retry temperature measurement The direct mode timed out Remove the probe from the measurement site T...

Страница 220: ...nal Call for service The weight scale is not operating properly Call for service Physical assessment instrument handles Symptom Possible cause Suggested action The lamp does not illuminate There is no...

Страница 221: ...e configuration requires a patient ID to send data Add a patient ID Patient list is full Delete some patients to add more The maximum number of patients was exceeded Delete a patient from the list to...

Страница 222: ...munications Radio out of network range The radio is no longer communicating with the access point Call for service to verify that the device is within the radio coverage area and is configured to the...

Страница 223: ...serted or incompatible USB flash drive Dismiss message and insert a compatible USB flash drive System messages Message Possible cause Suggested action Set date and time The date or time is not set Set...

Страница 224: ...vice Printer messages Message Possible cause Suggested action Low battery unable to print plug into outlet The monitor s battery voltage is too low to support printing Connect the monitor to AC power...

Страница 225: ...addressed in this table do not generate alarm or information messages on the monitor Problem Possible cause Suggested action No SpHb value is displayed An SpO2 only cable is connected to the monitor...

Страница 226: ...ange Use the attached weight scale to retake the measurement The Office profile does not appear in the Profiles tab The Office profile license is not installed Purchases a license and install the lice...

Страница 227: ...or parts applied to patients Type BF defibrillator proof IEC EN 60601 1 Recovery time following defibrillator discharge Less than or equal to 10 seconds Flammable anesthetics WARNING Not suitable for...

Страница 228: ...volume Vital Signs Monitor 6000 Series High priority alarm sound pressure level 47 92 dBA at 1 0 meter Medium priority alarm sound pressure level 45 82 dBA at 1 0 meter Integrated Wall System High pri...

Страница 229: ...setting and a new battery 2After this many full charge and discharge cycles the battery has aged to where its total capacity has been reduced to 70 of its rating 3 This specification is based on a mo...

Страница 230: ...rget Adult 160 mmHg 21 3 kPa StepBP Pediatric 120 mmHg 16 0 kPa StepBP Neonate 90 mmHg 12 0 kPa StepBP Maximum Target Pressure Adult 280 mmHg 37 3 kPa StepBP SureBP Pediatric 280 mmHg 37 3 kPa StepBP...

Страница 231: ...perature measurement range Accuracy Less than 37 0 C 0 2 C 37 0 C to 39 0 C 0 1 C Greater than 39 0 C 0 2 C Less than 96 4 F 0 4 F 96 4 F to less than 98 0 F 0 3 F 98 0 F to 102 0 F 0 2 F 102 0 F to 1...

Страница 232: ...such devices however are adapted for use with the Nellcor OXIMAX or Masimorainbow SET digital calibration system While this will not affect use of the simulator for verifying system functionality dis...

Страница 233: ...red light at a wavelength of approximately 660 nm and infrared light at a wavelength of approximately 900 nm The total optical output power of the sensor LEDs is less than 15 mW This information might...

Страница 234: ...solution 1 Electrical Optical Specifications Masimo pulse oximetry uses multi wavelength sensors that contain light emitting diodes LEDs that emit visible light and infrared light at wavelengths from...

Страница 235: ...at 2 to 4 Hz at an amplitude of 1 to 2 cm and a non repetitive motion between 1 to 5 Hz at an amplitude of 2 to 3 cm in induced hypoxia studies in the range of 70 to 100 SpO2 against a laboratory CO...

Страница 236: ...rates only the specific wavelengths characteristic of the CO2 absorption spectrum Therefore no compensations are required when different concentrations of N2O O2 anesthetic agents and water vapor are...

Страница 237: ...ncy response The device maintains etCO2 accuracy up to 80 breaths min From 81 to 150 bpm accuracy is 12 FiCO2 Units of measure mmHg kPa user selectable Display range 0 to 150 mmHg 0 0 to 20 0 kPa Reso...

Страница 238: ...inimum 1 mA Maximum 4 mA Module Dimensions 135 mm x 75 mm x 1 0mm Weight 800 g Host connection USB Mini B Module power supply Electrical absolute maximum current DC in Minimum 0 3 V Maximum 5 5 V Oper...

Страница 239: ...Pediatric 32 to 160 mmHg 4 3 to 21 3 kPa Factory default 145 mmHg 19 3 kPa Neonate 27 to 120 mmHg 3 6 to 16 0 kPa Factory default 100 mmHg 13 3 kPa Adult 28 to 256 mmHg 3 7 to 34 1 kPa Factory default...

Страница 240: ...eonate 87 1 to 110 0 F 30 6 to 43 3 C Factory default 101 0 F 38 3 C Adult Pediatric Neonate 85 1 to 108 0 F 29 5 to 42 2 C Factory default 94 0 F 34 4 C etCO2 Adult 2 to 150 mmHg 0 3 to 20 0 kPa Fact...

Страница 241: ...30 10 60 31 11 61 Pediatric 20 10 60 21 11 61 Neonate 15 10 60 16 11 61 Motion low confidence RR PR alarm delay 180 180 1800 181 181 1801 Respiration rate RRa Masimo 10 0 60 11 1 61 CO2 10 0 60 11 1...

Страница 242: ...11a Frequency 802 11 b g 2 402 GHz to 2 4835 GHz 802 11a 5 125 GHz to 5 875 GHz Channels Up to 14 in 802 11b g up to 24 in 802 11a country dependent Security encryption authentication WPA2 AES either...

Страница 243: ...b g radio Monitors capable of supporting a combination of CO2 RR or RRa or EarlySense patient movement NIBP SpO2 SpHb pulse rate and temperature Model Description 6700 Standard Includes nurse call Et...

Страница 244: ...238 Specifications Welch Allyn Connex Devices...

Страница 245: ...601 1 2 IEC 60601 1 4 IEC 60601 1 6 IEC 60601 1 8 IEC 80601 2 30 IEC 60601 2 49 IEC 60601 2 51 ISO 80601 2 55 ISO 80601 2 56 ISO 80601 2 61 ISO 10993 IEC 62304 IEC 62366 1 Standards are essentially th...

Страница 246: ...terference This device must accept any interference received including interference that may cause undesired operation This equipment has been tested and found to comply with the limits for a Class B...

Страница 247: ...cations and Media Authority ACMA Radio Compliance Mark RCM New Zealand maintains a Mutual Recognition Agreement MRA with Australia Argentina Autoridad Federal de las Tecnologias de la Informacion y la...

Страница 248: ...dustry Canada IC emissions This device complies with RSS 210 of Industry Canada Operation is subject to the following two conditions 1 this device may not cause interference and 2 this device must acc...

Страница 249: ...ai requisiti essenziali ed alle altre disposizioni pertinenti stabilite dalla direttiva 2014 53 CE Latvian Ar o Welch Allyn deklar ka RLAN device atbilst Direkt vas 2014 53 EK b tiskaj m pras b m un c...

Страница 250: ...244 Standards and compliance Welch Allyn Connex Devices...

Страница 251: ...fect the behavior of medical electrical equipment The monitor complies with all applicable and required standards for electromagnetic interference It does not normally affect nearby equipment and devi...

Страница 252: ...246 Guidance and manufacturer s declaration Welch Allyn Connex Devices...

Страница 253: ...1L 2MQ Reusable Cuff reuse AD LONG 2 tube MQ Reuse 12 2MQ Reusable Cuff reuse LG AD 2 tube MQ Reuse 12L 2MQ Reusable Cuff reuse LG AD LONG 2 tube MQ Reuse 13 2MQ Reusable Cuff reuse THIGH 2 tube MQ So...

Страница 254: ...hose 5 ft 6000 31 BP Single tube blood pressure hose 10 ft 7000 33 BP Neonatal blood pressure hose 10 ft with NeoQuik connector Masimo pulse oximetry for use with devices with SpO2 Part Number Model...

Страница 255: ...t Number Model Description 104771 rainbow RAS 125 sensor box of 10 104772 rainbow Patient cable Nellcor pulse oximetry Part Number Model Description DS 100A OxiMax Durasensor adult oxygen transducer D...

Страница 256: ...ation key Braun ThermoScan PRO 6000 thermometer and accessory dock Part Number Description 06000 900 Dock with thermometer 106743 Dock without thermometer 106744 Wall mount kit 106745 Mobile stand kit...

Страница 257: ...with specula 25021 Diagnostic otoscope with insufflation bulb 20201 Pneumatic otoscope without specula 20200 3 5V pneumatic otoscope with specula 20250 3 5V pneumatic otoscope with 12 diopter lens an...

Страница 258: ...5 Nasal illuminator section only 26538 Complete nasal illuminator 26035 Bivalve nasal speculum 26038 Bivalve nasal speculum with illuminator 27000 Larynx illuminator 27050 Nasopharynx illuminator 2810...

Страница 259: ...standard housing 4900 62 GCX wall mount with channel extended housing 104644 Mounting plate bracket GCX wall mount extended housing 105430 Office LPC monitor mounting kit 105341 CP150 CP250 office car...

Страница 260: ...rship program 1 year S1 6000 C Comprehensive partnership program 1 year with calibration S1 6000 2 Comprehensive partnership program 2 years S1 6000 2C Comprehensive partnership program 2 years with c...

Страница 261: ...O2 S2 6000 O2 5 Biomed partnership program 5 years with CO2 S2 6000 ES Biomed partnership program 1 year with ES S2 6000 ES 2 Biomed partnership program 2 years with ES S2 6000 ES 5 Biomed partnership...

Страница 262: ...d Partnership Program Technical Training CIWSSERREPW TRN Technical online training for Biomeds CIWSSERREP TRN Technical onsite training for Biomeds International Only PRV 001 Preventive SVC WA bench p...

Страница 263: ...80021661 Service manual Connex VSM 2 3X Spanish 80021577 Service manual Connex IWS 2 3X English 80021662 Service manual Connex IWS 2 3X French 80021663 Service manual Connex IWS 2 3X Italian 80021664...

Страница 264: ...THIS WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES EXPRESS OR IMPLIED INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE WELCH ALLYN S OBLIGATION...

Страница 265: ...S WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES EXPRESS OR IMPLIED INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE WELCH ALLYN S OBLIGATION UN...

Страница 266: ......

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