I n t e l l i V u e M P 4 0 / 50 a n d M P 60 / 7 0/ 9 0

I NS TR UCTI ON S FOR US E

IntelliVue Patient Monitor

MP 40 / 5 0 an d MP 60 / 7 0 / 9 0
R e l ea s e B . 0 w i th S of tw a r e R e v i s i o n B . 0 x. x x

P a t i e nt M o n i t o r i n g
Part Number M8000-9001D
Printed in Germany 11/03
Re-order Number: 453563499331

*M8000-9001D*
M8000-9001D

1Table Of Contents
1 Basic Operation 1

Introducing the IntelliVue Family 2

IntelliVue MP40/MP50 2
MP40/MP50 Major Parts and Keys 3
IntelliVue MP60/MP70 4
MP60/MP70 Major Parts and Keys 4
MP90 Major Parts and Keys 5
Remote Alarm Device 5
Related Products 6
Flexible Module Server (M8048A) 6
Measurement Modules 6
Multi-Measurement Server (M3001A) 8
M3015A and M3016A Measurement Server Extensions 9
M3012A Hemodynamic Measurement Server Extension 10
Anesthetic Gas Module (AGM) 10
Operating and Navigating 11
Using the Touchscreen 12
Using the MP60/MP70/MP90 SpeedPoint 12
Using the MP40/MP50 Navigation Point 13
Using a Mouse or Trackball 13
Using Keys 13
Permanent Keys 14
SmartKeys 14
Hardkeys 15
Pop-Up Keys 15
Using the On-Screen Keyboard 16
Using the On-Screen Calculator 16
Operating Modes 16
Disabling Touchscreen Operation 17
Using a Second Display 17
Tailoring Your Monitor 17
Understanding Screens 17
Switching to a Different Screen 18
Using the Visitor Screen 18
Changing a Screen’s Content 18
Understanding Profiles 18
Swapping a Complete Profile 20
Swapping a Settings Block 20
Default Profile 20
Locked Profiles 20
Changing Measurement Settings 20
Switching a Measurement On and Off 21

i
 Switching Numerics On and Off 21
Adjusting a Measurement Wave 21
Changing a Wave Speed 21
Using Labels 21
Changing Measurement Labels (e.g. Pressure) 22
Resolving Label Conflicts 22
Changing Monitor Settings 23
Adjusting the Screen Brightness 23
Adjusting Touch Tone Volume 23
Setting the Date and Time 23
Checking Your Monitor Revision 23
Getting Started 24
Inspecting the Monitor 24
Switching On 24
Setting up the Measurement Modules 24
Starting Monitoring 24
Disconnecting from Power 25
Networked Monitoring 25
Using Remote Applications 25

2 What’s New? 27

What’s New in Release B.0? 27

What’s New in Release A.2? 28

3 Alarms 29

Visual Alarm Indicators 30

Audible Alarm Indicators 30
Alarm Tone Configuration 30
Traditional Audible Alarms (HP/Agilent/Philips/Carenet) 31
ISO/IEC Standard 9703-2 Audible Alarms 31
Changing the Alarm Tone Volume 31
Minimum Volume for No Central Monitoring INOP 31
Acknowledging Alarms 32
Acknowledging Disconnect INOPs 32
Alarm Reminder (ReAlarm) 32
Pausing or Switching Off Alarms 32
To Pause All Alarms 33
To Switch All Alarms Off 33
To Switch Individual Measurement Alarms On or Off 33
While Alarms are Paused or Off 33
Restarting Paused Alarms 33
Resetting Arrhythmia Alarm Timeouts 34
Extending the Alarm Pause Time 34
Alarm Limits 34
Viewing Individual Alarm Limits 34
Viewing All Alarm Limits 35

ii
 Changing Alarm Limits 36
About Automatic Alarm Limits (AutoLimits) 37
Documenting Alarm Limits 37
Reviewing Alarms 38
Alarm Messages Window 38
Review Alarms Window 38
Understanding Alarm Messages 39
Latching Alarms 39
Viewing the Alarm Latching Settings 39
Alarm Latching Behavior 40
Silencing Latched Alarms from an Information Center 40
Testing Alarms 40
Alarm Behavior at On/Off 40

4 Patient Alarms and INOPs 41

Patient Alarm Messages 41

Technical Alarm Messages (INOPs) 47

5 Managing Patients 65

Admitting a Patient 65
Patient Category and Paced Status 66
Quick Admitting a Patient 66
Editing Patient Information 67
Discharging a Patient 67
Transferring a Patient 68
Transferring a Centrally Monitored Patient 68
Transferring a Patient with an MMS 69
Resolving Patient Information Mismatch 69
Manually Resolving Patient Mismatch 69
Patient Mismatch - If One Set of Patient Data is Correct 70
Patient Mismatch - If Neither Patient Data Set is Correct 70
Patient Mismatch - If Both Patient Data Sets Are Correct 71
Automatically Resolving Patient Mismatch 71
Care Groups 71
Understanding Care Group Symbols 72
Viewing the Care Group Overview Bar 73
Viewing the My Care Group Window 73
Viewing the Other Patient Window 74
Using Care Group Alarms 74

6 ECG, Arrhythmia, and ST Monitoring 75

Placing ECG Electrodes 75

Connecting ECG Cables 75
Selecting the Primary and Secondary ECG Leads 76
Checking Paced Status 76
Understanding the ECG Display 77

iii
Monitoring Paced Patients 77
Setting the Paced Status (Pace Pulse Rejection) 78
Avoiding Pace Pulse Repolarization Tails 78
Changing the Size of the ECG Wave 78
To Change the Size of an Individual ECG Wave 78
To Change the Size of all the ECG Waves 79
Changing the Volume of the QRS Tone 79
Changing the ECG Filter Settings 79
Choosing EASI or Standard Lead Placement 80
About ECG Leads 80
ECG Leads Monitored 80
Changing Lead Sets 80
ECG Lead Fallback 81
ECG Lead Placements 81
Standard 3-Lead Placement 81
Standard 5-Lead Placement 82
Chest Electrode Placement 83
10-Lead Placement 84
Conventional 12-Lead ECG 84
Modified 12-Lead ECG 85
Choosing Standard or Modified Electrode Placement 86
Labelling 12-Lead ECG Reports 86
Capture 12-Lead 86
EASI ECG Lead Placement 87
ECG, Arrhythmia, and ST Alarm Overview 88
Using ECG Alarms 89
Extreme Alarm Limits 89
ECG Alarms Off Disabled 89
HR Alarms When Arrhythmia Analysis is Switched Off 89
HR Alarms When Arrhythmia Analysis is Switched On 89
ECG Safety Information 89
About Arrhythmia Monitoring 91
Arrhythmia Options 91
Where can I find more information? 91
Switching Arrhythmia Analysis On and Off 92
Choosing an ECG Lead for Arrhythmia Monitoring 92
Aberrantly-Conducted Beats 92
Atrial Fibrillation and Flutter 92
Intermittent Bundle Branch Block 93
Understanding the Arrhythmia Display 93
Viewing Arrhythmia Waves 93
Arrhythmia Beat Labels 93
Arrhythmia Status Messages 94
Rhythm Status Messages 94
Ectopic Status Messages 95

iv
Arrhythmia Relearning 95
Initiating Arrhythmia Relearning Manually 95
Automatic Arrhythmia Relearn 96
Arrhythmia Relearn and Lead Fallback 96
Arrhythmia Alarms 96
Yellow Arrhythmia Alarms 97
Arrhythmia Alarms and Latching 97
Switching Individual Arrhythmia Alarms On and Off 97
Switching All Yellow Arrhythmia Alarms On or Off 97
Adjusting the Arrhythmia Alarm Limits 97
Arrhythmia Alarm Timeout Periods 97
Arrhythmia Alarm Chaining 99
Understanding PVC-Related Alarms 100
About ST Monitoring 101
Switching ST On and Off 101
Selecting ST Leads for Analysis 101
Understanding the ST Display 102
Updating ST Baseline Snippets 103
Recording ST Segments 103
Adjusting ST Measurement Points 104
ST Alarms 106
Single- or Multi-lead ST Alarming 106
Changing ST Alarm Limits 106

7 Monitoring Pulse Rate 107

Entering the Setup Pulse Menu 107

System Pulse Source 107
Switching Pulse On and Off 108
Using Pulse Alarms 108
Selecting the Active Alarm Source: HR or Pulse? 108
Alarm Source Selection Disabled 109
Changing HR/Pulse Alarm Limits 109
Extreme Alarm Limits 109
QRS Tone 109

8 Monitoring Respiration Rate (Resp) 111

Lead Placement for Monitoring Resp 111

Optimizing Lead Placement for Resp 111
Cardiac Overlay 111
Lateral Chest Expansion 112
Abdominal Breathing 112
Understanding the Resp Display 112
Changing Resp Detection Modes 112
Auto Detection Mode 112
Manual Detection Mode 113
Resp Detection Modes and Cardiac Overlay 113

v
Changing the Size of the Respiration Wave 113
Changing the Speed of the Respiration Wave 113
Using Resp Alarms 114
Changing the Apnea Alarm Delay 114
Resp Safety Information 114

9 Monitoring SpO2 115

Selecting an SpO2 Sensor 116

Applying the Sensor 117
Connecting SpO2 Cables 117
Measuring SpO2 118
Assessing a Suspicious SpO2 Reading 118
Understanding SpO2 Alarms 119
Adjusting the Alarm Limits 119
Adjusting the Desat Limit Alarm 119
Pleth Wave 119
Perfusion (Pleth) Indicator 120
Setting SpO2/Pleth as Pulse Source 120
Setting Up Tone Modulation 120
Setting the QRS Volume 120
Calculating SpO2 Difference 120

10 Monitoring NBP 121

Introducing the Oscillometric NBP Measurement 121

Measurement Limitations 122
Measurement Methods 122
Preparing to Measure NBP 122
Correcting the Measurement if Limb is not at Heart Level 123
Understanding the NBP Numerics 123
Starting and Stopping Measurements 124
Enabling Automatic Mode and Setting Repetition Time 124
Choosing NBP Alarm Source 125
Assisting Venous Puncture 125
Calibrating NBP 125

11 Monitoring Temperature 127

Making a Temp Measurement 127

Calculating Temp Difference 128

12 Monitoring Invasive Pressure 129

Setting up the Pressure Measurement 129

Selecting a Pressure for Monitoring 130
Zeroing the Pressure Transducer 130
Zeroing ICP 130
Determining a Pressure’s Most Recent Zero 131
Zeroing a Pressure Measurement 131

vi
 Using the Zero Hardkey 131
Zeroing All Pressures Simultaneously 131
Troubleshooting the Zero 132
Adjusting the Calibration Factor 132
Displaying a Mean Pressure Value Only 132
Changing the Pressure Wave Scale 132
Optimizing the Waveform 133
Non-Physiological Artifact Suppression 133
Choosing the Pressure Alarm Source 133
Calibrating Reusable Transducer CPJ840J6 134
Making the Pressure Calibration 134
Troubleshooting the Pressure Calibration 135
Calculating Cerebral Perfusion 135
Measuring Pulmonary Artery Wedge Pressure 136
Editing the Wedge 137
Identifying the Pressure Analog Output Connector 137

13 Monitoring Cardiac Output 139

Hemodynamic Parameters 140

Using the C.O. Procedure Window 141
Accessing the Setup C.O. and Setup CCO Menus 142
Changing the C.O. Results Table Contents 142
Entering the HemoCalc Window 142
Viewing the Temperature Unit 142
Measuring C. O. Using the PiCCO Method 142
Measuring Continuous Cardiac Output 142
Setting Up the PiCCO C.O. Measurement 143
Performing PiCCO C.O. Measurements 144
Editing PiCCO C.O. Measurements 144
Saving and Calibrating PiCCO C.O. Measurements 145
CCO Calibration Status Indicators 145
Measuring C.O. Using the Right Heart Thermodilution Method 145
Setting up RH C.O. Measurements 146
Ice-Bath Setup for RH Thermodilution C.O. Measurements 146
Setting the Computation Constant 146
Performing RH C.O. Measurements 147
Editing and Saving RH C.O. Measurements 147
Documenting C.O. Measurements 147
C.O. Injectate Guidelines 148
Guidelines for Right Heart Thermodilution C.O. Injectate 148
Guidelines for PiCCO C.O. Injectate 148
Injectate for Patients with High ETVI Values (PiCCO Only) 149
C.O./CCO Curve Alert Messages 149
C.O./CCO Prompt Messages 150
C.O./CCO Warning Messages 151
C.O./CCO Safety Information 151

vii
 14 Monitoring Carbon Dioxide 153

Using the Mainstream CO2 Extension (M3016A) 154

Preparing to Measure Mainstream CO2 154
Checking Transducer Accuracy 154
Calibrating the Transducer 155
Attaching and Removing the CO2 Transducer 155
Using the Microstream CO2 Extension (M3015A) 156
Preparing to Measure Microstream CO2 156
Setting up Microstream CO2 Measurements 156
Using Microstream Accessories 156
Using the FilterLine and Airway Adapter 157
Removing Exhaust Gases from the System 157
Setting up Mainstream and Microstream 158
Adjusting the CO2 Wave Scale 158
Setting up CO2 Corrections 158
Changing CO2 Alarms 158
Changing the Apnea Alarm Delay 159
Deriving Alarms From awRR 159
Changing awRR Alarm Limits 159

15 Monitoring tcGas 161

Identifying tcGas Module Components 161

Setting the tcGas Sensor Temperature 162
Using the tcGas Site Timer 162
Setting the tcGas Site Timer 162
Restarting the tcGas SiteTimer 163
Disabling the tcGas Site Timer 163
Setting the tcGas Barometric Pressure 163
Remembraning the tcGas Transducer 163
New/Dried Out Transducers 164
Storing tcGas Transducers 164
Calibrating the tcGas Transducer 165
Calibration Failure 166
Troubleshooting tcGas Calibration 166
Applying the tcGas Transducer 167
Selecting the tcGas HeatPowerDisplay Mode 168
Zeroing the tcGas Relative Heat Power 168
Finishing tcGas Monitoring 168
TcGas Corrections 168
Temperature Correction for tcpCO2 168
Metabolism Correction for tcpCO2 168

16 Monitoring SvO2 169

Preparing to Monitor SvO2 170

Carrying out a Pre-insertion Calibration 170

viii
Inserting the Catheter 171
Performing a Light Intensity Calibration 171
Performing In-Vivo Calibration 172
Setting Up the In-Vivo Calibration 172
Making the In-Vivo Calibration 172
Calculating Oxygen Extraction 172

17 Using the AGM 173

Understanding the AGM Display 173

AGM Major Parts and Keys 174
Watertrap 174
AGM Rear Panel 174
Understanding the Gas Measurement 175
Connecting AGM Accessories 175
Using the AGM Setup Menus 176
Choosing Numerics for Display 176
Humidity Correction for CO2 176
Adjusting Wave Scales 176
Changing the Apnea Alarm Delay 177
Deriving Limit Alarms from awRR 177
Alarms and Zero Calibration 177
Automatic Alarm Suppression 177
Agent Identification 178
If Agent ID is Set to Manual 178
If Agent ID is Set to Auto 178
Exchanging Agents 178
Agent ID During Emergence from Anesthesia 178
Removing Gas from the Circuit 179
Returning the Gas Sample 179
Removing the Gas Sample 179
Entering AGM Standby Mode 179
Zero Calibration 180
Automatic Zero Calibration 180
Carrying Out Manual Zero Calibration 180
Suppressing Zero Calibration 180
Using the AGM During a Cardiopulmonary Bypass 180
AGM Safety Information 181

18 Monitoring EEG 183

EEG Monitoring Setup 184

Using the EEG Impedance/Montage Window 184
Choosing an EEG Electrode Montage 185
Changing the Impedance Limit 185
About Electrode-to-Skin Impedance 186
Impedance Indicators 186
About Compressed Spectral Arrays (CSA) 187

ix
 Displaying CSAs 188
Changing EEG Settings 188
Switching EEG Numerics On and Off 188
Changing the Scale of the EEG Waves for Display 188
Changing Filter Frequencies 189
Changing the Speed of the EEG Wave 189
EEG Reports 189
EEG Safety Information 190
EEG and Electrical Interference 190

19 Monitoring BIS 191

BIS Monitoring Setup 192

BIS Continuous Impedance Check 193
BIS Cyclic Impedance Check 193
Starting a Cyclic Impedance Check 193
Stopping a Cyclic Impedance Check 193
BIS Impedance Check Window 194
BIS Impedance Indicators 194
Changing the BIS Smoothing Rate 195
Switching BIS and Individual Numerics On and Off 195
Changing the Scale of the EEG Wave 195
Switching BIS Filters On or Off 195
BIS Safety Information 196

20 Trends 197

Viewing Trends 197

Viewing Graphic Trends 197
Viewing Vital Signs Trends 198
Trends Pop-Up Keys 198
Setting Up Trends 199
Choosing Which Measurements are Trended 199
Choosing Trend Measurement Groups 199
Changing Parameter Scales 200
Choosing Trend Resolution 200
Documenting Trends 201
Screen Trends 202
Changing the Selection of Screen Trends Displayed 203
Changing the Screen Trend Time 203

21 Calculations 205

Viewing Calculations 205

Calculations Windows 206
Calculations Pop-Up Keys 206
Reviewing Calculations 207
Performing Calculations 207
Entering Values for Calculations 208

x
 Automatic Value Substitution 208
Automatic Unit Conversion 208
BSA Formula 208
Documenting Calculations 209

22 Event Surveillance 211

Event Groups 211

Event Episode 212
Episode Types 212
Event Triggers 212
Viewing Events 213
Events Pop-Up Keys 213
Event Counter 214
Event Summary View 214
Event Review Window 215
Event Episode Window 216
The Event Counter 216
Counting Combi-Events 216
Counting Neonatal Event Review (NER) Events 217
Levels of Event Surveillance 217
Setting Up and Using Event Surveillance 217
Setting Up Events 218
Triggering Events Manually 218
Annotating Events 219
The Event Database 219
Documenting Events 219
Documenting Event Review 219
Documenting an Event Episode 219
Event Recordings 220
Event Review Recordings 220
Event Episode Recordings 221
Event Reports 221
Event Review Reports 222
Event Episode Reports 223

23 Recording 225

Starting and Stopping Recordings 226

Starting Recordings 226
Extending Recordings 226
Stopping Recordings 226
Quickstarting Realtime Recordings 226
Overview of Recording Types 227
ECG Capture Recordings 227
Creating and Changing Recordings Templates 228
Changing ECG Wave Gain 228
Recording Priorities 229

xi
Sample Recording Strip 229
Recording Strip Code 230
Recorded Waveforms 230
Maintaining Recording Strips 230
Reloading Paper 231
Recorder Status Messages 231

24 Printing Patient Reports 233

Starting Reports Printouts 233

Stopping Reports Printouts 234
Setting Up Reports 234
Setting Up ECG Reports 234
Setting Up Vital Signs and Graphic Trend Reports 235
Setting Up Auto Reports 236
Setting Up Individual Print Jobs 237
Checking Printer Settings 238
Switching Printers On Or Off for Reports 238
Dashed Lines on Reports 238
Unavailable Printer: Re-routing Reports 239
Printer Status Messages 239
Sample Report Printouts 239
Alarm Limits Report 240
Realtime Report 241
Cardiac Output Report 242
ECG Reports 243
Other Reports 243

25 Using the Drug Calculator 245

Performing Drug Calculations 246

Converting Units 246
Charting Drip Progress 247
Using the Titration Table 247
Documenting Drug Calculations 247

26 VueLink Modules 249

Connecting an External Device 250

Changing VueLink Waves and Numerics Displayed 250
Viewing the VueLink Device Data Window 250
Using VueLink Screens 251
Switching VueLink On and Off 251
Alarms/INOPs From External Devices 251
Language Conflict with External Device Drivers 252

27 Respiratory Loops 253

Using the Loops Window 254

xii
 28 Care and Cleaning 255

General Points 255

AGM Accessories 256
Cleaning 256
Disinfecting 256
Cleaning Monitoring Accessories 257
Sterilizing 257
Cleaning the Recorder Printhead 257
Cleaning the Batteries and Battery Compartment 257

29 Using the Batteries 259

Battery Power Indicators 259

Battery LED 260
Battery Status on the Main Screen 260
Battery Status Window 261
Viewing Individual Battery Status 261
Documenting Battery Status 261
Replacing Batteries 262
Maintaining Batteries 262
Display Brightness Setting 262
Checking Battery Charge 263
Charging Batteries 263
Reconditioning Batteries 263
Unequally-Charged Batteries 263
Battery Safety Information 264

30 Maintenance and Troubleshooting 265

Inspecting the Equipment and Accessories 265

Inspecting the Cables and Cords 265
Service Task Schedule 266
Troubleshooting 267
Disposing of the Monitor 267
Disposing of Empty Calibration Gas Cylinders 267

31 Accessories 269

ECG/Resp Accessories 269

Trunk Cables 269
3-Electrode Cable Sets 269
5-Electrode Cable Sets 270
10-Electrode Cable Sets 270
3-Electrode One Piece Cables 270
5-Electrode One Piece Cables 270
Set Combiners and Organizers 271
NBP Accessories 271
Adult/Pediatric Multi-Patient Comfort Cuffs and Disposable Cuffs 271

xiii
 Reusable Cuff Kits 271
Adult/Pediatric Antimicrobial Coated Reusable cuffs 272
Adult/Pediatric Soft Single Patient Single-Hose Disposable Cuffs 272
Neonatal/Infant Cuffs (Disposable, non-sterile) 272
Invasive Pressure Accessories 273
SpO2 Accessories 273
Temperature Accessories 276
Cardiac Output (C.O.) Accessories 276
Mainstream CO2 Accessories 277
Microstream CO2 Accessories 277
tcGas Accessories 279
EEG Accessories 279
BIS Accessories 279
BIS Sensors 279
Other BIS Accessories 280
AGM Accessories 280
SvO2 Accessories 280
Recorder Accessories 281

32 Installation and Specifications 283

Intended Use 283

Indication for Use 283
Manufacturer’s Information 284
Responsibility of the Manufacturer 284
Trademark Acknowledgement 284
Symbols 285
Installation Safety Information 286
Connectors 286
MP40/MP50 287
MP60/MP70 288
MP90 289
Altitude and Barometric Pressure 290
Monitor Safety Specifications 290
Physical Specifications 291
Environmental Specifications 292
M4605A Battery Specifications 294
Monitor Performance Specifications 294
Measurement Specifications 298
ECG/Arrhythmia/ST 298
Respiration 301
SpO2 301
NBP 302
Invasive Pressure and Pulse 304
Temp 305
CO2 306
Cardiac Output / Continuous Cardiac Output 308

xiv
 tcGas 308
SvO2 309
EEG 310
BIS 310
Anesthetic Gas Module 311
Safety and Performance Tests 313
Electromagnetic Compatibility (EMC) Specifications 313
Accessories Compliant with EMC Standards 313
Electromagnetic Emissions 314
Avoiding Electromagnetic Interference (Resp and BIS) 314
Electromagnetic Immunity 315
Recommended Separation Distance 315
Recommended separation distances from portable and mobile RF communication equipment316
Electrosurgery Interference/Defibrillation/Electrostatic Discharge 317
Fast Transients/Bursts 317
Restart time 317

33 Default Settings Appendix 319

Alarm Default Settings 320

ECG, Arrhythmia, and ST Default Settings 320
Pulse Default Settings 323
Respiration Default Settings 324
SpO2 Default Settings 324
NBP Default Settings 325
Temperature Default Settings 325
Invasive Pressure Default Settings 326
Cardiac Output Default Settings 326
CO2 Default Settings 327
tcGas Default Settings 328
SvO2 Default Settings 328
AGM Default Settings 328
EEG Default Settings 329
BIS Default Settings 329
VueLink Default Settings 330

xv
xvi
 1

1Basic Operation
This Instructions for Use is for clinical professionals using the IntelliVue MP40/50 (M8003A/
M8004A) and MP60/70/90 (M8005A/M8007A/M8010A) patient monitors. Unless otherwise
specified, the information here is valid for all the IntelliVue patient monitors.
The basic operation section gives you an overview of the monitor and its functions. It tells you how to
perform tasks that are common to all measurements (such as entering data, switching a measurement
on and off, setting up and adjusting wave speeds, working with profiles). The alarms section gives an
overview of alarms. The remaining sections tell you how to perform individual measurements, and how
to care for and maintain the equipment.
Familiarize yourself with all instructions including warnings and cautions before starting to monitor
patients. Read and keep the Instructions for Use that come with any accessories, as these contain
important information about care and cleaning that is not repeated in this book.
This guide describes all features and options. Your monitor may not have all of them; they are not all
available in all geographies. Your monitor is highly configurable. What you see on the screen, how the
menus appear and so forth, depends on the way it has been tailored for your hospital may not be
exactly as shown here.
In this guide:
• A warning alerts you to a potential serious outcome, adverse event or safety hazard. Failure to
observe a warning may result in death or serious injury to the user or patient.
• A caution alerts you to where special care is necessary for the safe and effective use of the product.
Failure to observe a caution may result in minor or moderate personal injury or damage to the
product or other property, and possibly in a remote risk of more serious injury.
• Monitor refers to the entire patient monitor. Display refers to the physical display unit. Display
Screen and Screen refer to everything you see on monitor’s display, such as measurements, alarms,
patient data and so forth.

1
1 Basic Operation Introducing the IntelliVue Family

Introducing the IntelliVue Family

The Philips IntelliVue family of patient monitors offers a monitoring solution optimized for the
surgical, cardiac, medical and neonatal care environments. Combining patient surveillance and data
management, it allows multi-measurement monitoring by linking separate modules with “plug-and-
play” convenience.
Your monitor stores data in trend, event, and calculation databases. You can see tabular trends (vital
signs) and document them on a local or remote printer. You can view measurement trend graphs, with
up to three measurements combined in each graph, to help you identify changes in the patient’s
physiological condition. You can view fast-changing measurement trends with beat to beat resolution
and see up to four high resolution trend segments. Event surveillance enhances documentation and
review of physiologically significant events by automatically detecting and storing up to 50 user-
defined clinical events over a 24 hour period.
There is a choice of monitor configurations, as explained below. All models can also use computer
devices such as a mouse, a trackball and a keyboard.

IntelliVue MP40/MP50
The IntelliVue MP40/MP50 (M8003A/M8004A)
patient monitor has a 12-inch TFT LCD flat panel
SVGA display. The standard input devices for the MP50
are the Touchscreen and integrated navigation point; the
MP40 is supplied with an integrated navigation point
only. Up to six waves can be shown on MP40/MP50
Screens, as well as the 12-Lead ECG Screen.
The MP40/MP50 can be connected to one Multi-
Measurement Server (MMS) and any one of the
measurement server extensions. The IntelliVue family
plug-in measurement modules can be connected to its
four integrated plug-in module slots with plug-and-play convenience (the only exception is the SvO2
module, M1021A, which cannot be used with the MP40/MP50). The integrated module slots replace
the Flexible Module Server (M8048A), which cannot be used with the MP40/MP50.

2
Introducing the IntelliVue Family 1 Basic Operation

MP40/MP50 Major Parts and Keys

MP40/MP50 left side
1 Color-coded alarm lamps
2 Alarms off lamp
3 Model indicator
4 ECG out
5 Navigation Point
6 Part number and serial number
7 Quick-release mounting release
8 Plug-in module slots

MP40/MP50 front panel

1 On/Standby switch
2 On/Standby LED
3 Error LED
4 Battery status LED
5 AC power operation LED
6 “read the documentation” symbol
7 Mounting quick- release lever

MP40/MP50 LED Colors and their Meanings

On/Standby LED Green when monitor is switched on

Error LED Red if there is a problem with the monitor

Battery LED Green, yellow, and red.

See the “Battery LED” on page 260 for details
AC Power Green when monitor is connected to mains power

3
1 Basic Operation Introducing the IntelliVue Family

IntelliVue MP60/MP70
The IntelliVue MP60/MP70 (M8005A/M8007A) patient monitors integrate the display unit, with a
15” color LCD display, and the data processing unit into one. Up to eight waves can be shown on the
screens, as well as the 12-Lead ECG Screen. The MP60 uses the SpeedPoint as its primary input device
while the MP70 uses touch screen operation but may have an optional SpeedPoint.
The monitors can be connected to the Multi-Measurement Server (MMS) and any one of the
measurement server extensions, and to the Flexible Module Server (M8048A). The IntelliVue family
plug-in measurement modules can be connected to its FMS module slots with plug-and-play
convenience.
The MP60/MP70 has two integrated slots for plug-in modules. You can combine one each of the
following modules in these slots: Pressure, Temperature, C.O., and VueLink. You can also use the two-
slot recorder module in the integrated slots.

MP60/MP70 Major Parts and Keys

1 Color coded alarm lamps
1 2 3 4 2 Alarms Off lamp
3 Display
4 Model indicator
5 SpeedPoint (optional for MP70)
6 Part number and serial number
7 Mounting adapter release
5 8 AC power LED
9 Error LED
10 Power on/standby switch
11 Power on LED
11 10 9 8 7 6

4
Introducing the IntelliVue Family 1 Basic Operation

MP90 Major Parts and Keys

In the MP90, the display and the processing unit are separate components. It offers both touchscreen
and the Remote SpeedPoint as standard input devices.

AC Power LED

Power on LED

Power on Switch
Error LED

Display Unit Processing Unit

Remote Alarm Device

The Remote Alarm Device provides audio and visual indicators of alarms, in addition to those shown
on the display.

1 2
1 Two color coded alarm lamps (right-hand lamp flashes
red or yellow for patient alarms, left-hand lamp flashes
light blue for INOPs)
2 Alarms off lamp - when illuminated it indicates that all
patient alarms are deactivated.

3 3 Speaker - for alarm prompts, QRS tones and so forth

4 Monitor power on /standby switch. Press to switch
monitor on remotely. Press and hold for one second to
turn monitor off.
5 5 Power on LED - green when monitor is on
4

5
1 Basic Operation Related Products

Related Products
Related products extend the measurement capabilities of your monitor. None of the related devices
have their own power on/standby switches. They take their power from the monitor, and switch on
automatically when you turn on the monitor. A green power-on LED indicates when they are drawing
power from the monitor. A permanently illuminated, or flashing, red LED indicates a problem with
the unit that requires the attention of qualified service personnel.

Flexible Module Server (M8048A)

MP60/70/90 The flexible module server (FMS) lets you use up to eight plug-in physiological measurement modules.
only With the MP90 (M8010A) you can connect two FMSs to use up to 10 measurement modules.
Connect the FMS to the monitor via the measurement server link cable (MSL). Use the MSL
connector on the left-hand side to connect additional measurement servers. Use the connector on the
right to connect to the monitor.

1 Multi-Measurement
Server
2 Measurement server
extension
3 Measurement server
mount
4 Flexible Module Server
5 BIS engine
6 Power on LED
7 Interruption indicator

Measurement Modules
You can use up to eight measurement modules with the Flexible Module Server (M8048A), two
additional modules in the integrated module slots in the MP60/MP70, and up to four in the integrated
slots in the MP40/MP50. Available modules are:
• Invasive blood pressure, with up to five pressure modules simultaneously (M1006B)
• Temperature, with up to four temperature modules simultaneously (M1029A)
• Oxygen saturation of arterial blood (SpO2) (M1020B)
• Cardiac output (M1012A), and Continuous cardiac output with M1012A Option #C10
• Transcutaneous gas (M1018A)
• Mixed venous oxygen saturation - SvO2 (M1021A) MP60/70/90 monitor only
• Recorder (M1116B)
• VueLink device interface, with up to four VueLink modules simultaneously (M1032A)
• EEG (M1027A)
• Bispectral Index - BIS (M1034A)

6
Related Products 1 Basic Operation

You can plug and unplug modules during monitoring. Insert the module until the lever on the module
clicks into place. Remove a module by pressing the lever upwards and pulling the module out.
Reconnecting a module to the same monitor restores its label and measurement settings, such as alarms
limits. If you connect it to a different monitor, the module remembers only its label.
The connector socket on the front of each module is the same color as the corresponding connector
plug on the transducer or patient cable.
Press the Setup key on the module’s front to display the measurement’s setup menu on the monitor
screen. When the setup menu is open, a light appears above the key. Some modules have a second key.
On the pressure module, for example, it initiates a zeroing procedure.

Example Module (Pressure)

1 Module name
PRESS
2 Setup key LED
3 Setup key to enter setup menu of 1
measurement modules or VueLink
2 Press
device data window
4 Connector socket for patient cable/ 3 5
transducer 80x80
5 Second module-specific key, for
example Zero 4

7
1 Basic Operation Related Products

Multi-Measurement Server (M3001A)

The Multi-Measurement Server (MMS) can simultaneously monitor 3-, 5- or 10-lead ECG (including
arrhythmia and ST monitoring), respiration, SpO2, NBP and either invasive pressure or temperature.
Depending on the monitor model, you can connect it to the monitor via a cable or mount it either on
the left side of the FMS or on the back of the monitor, as shown here.

MMS mounted on rear of MP40/MP50

(left) and MP60/MP70

8
Related Products 1 Basic Operation

M3001A Connectors and Symbols

1 White ECG/Resp connector
5 2 Blue SpO2 connector
3 Red NBP connector
4 & Combined pressure (red) and temperature
5 (brown) connector - connect either invasive
4 pressure transducer or temperature probe.
You might have a version of the MMS that
does not have this connector.
3

2
1

6
NBP Start/Stop key -
6 starts or stops NBP
7 measurements
7
NBP STAT key - starts NBP
STAT series of
measurements
9
OR
Zero key - initiates a zero procedure for the
8 connected pressure transducer when
pressed and held for a second
8
Silence: acknowledges all active
alarms by switching off audible
alarm indicators and lamps. Takes behavior
from SmartKey configuration
9 MSL cable connector to the monitor

M3015A and M3016A Measurement Server Extensions

The optional M3015A Microstream CO2 Extension adds microstream capnography and either
pressure or temperature to the MMS. The optional M3016A Mainstream CO2 Extension adds
mainstream capnography and either pressure or temperature to the MMS. The measurement server
extensions connect to the MMS and use the MMS settings and power.
The measurement server extensions must not be disconnected during monitoring. When the
connection to the measurement server is broken, settings revert to default and any stored trend
information is lost.

9
1 Basic Operation Related Products

M3015A Microstream
M3016A Mainstream
1
1

2 2

4
3
5
6

1 Pressure connector (red) 4 Inlet

2 Temperature connector (brown) 5 Microstream connector CO2
3 Mainstream connector CO2 (optional) 6 Gas sample outlet

M3012A Hemodynamic Measurement Server Extension

Pressure connectors
Connection to MMS
The M3012A Hemodynamic (red)
Measurement Server Extension
(HMSE) can be connected to the
M3001A Multi-Measurement Server to
provide the following additional
measurements: Temperature, Pressure,
an additional Pressure or Temperature,
and C.O. and CCO measurements.

Cardiac Output connector Temperature connectors (brown)

(orange; optional)

Anesthetic Gas Module (AGM)

See the AGM section of this Instructions for Use.

10
Operating and Navigating 1 Basic Operation

Operating and Navigating

Everything you need to operate the monitor is contained on its screen. Almost every element on the
screen is interactive. Screen elements include measurement numerics, waveforms, screen keys,
information fields, alarms fields and menus.
The configurability of the monitor means that often you can access the same element in different ways.
For example, you might be able to access an item through its on-screen setup menu, via a hard key, or
via a SmartKey. This Instructions for Use always describes how to access items via an on-screen menu.
You may use which ever way you find most convenient.

1 2 3 4 5 6 7 8 9

10

ABP Zero done at 11 Nov 02 7:31 am 11

18 17 16 15 14 13 12

Monitor information line Other screen elements

1 network connection indicator 10 alarm status area - shows active alarm messages
2 bed label 11 status line - shows information messages and prompting you for action
3 patient identification 12 close all open menus and windows and return to main screen
4 patient category 13 enter Main Setup menu
5 paced status 14 scroll right to display more SmartKeys
6 date and time 15 SmartKeys - these change according to your monitor’s configuration
7 access the profiles menu 16 scroll left to display more SmartKeys
8 current screen name/enter 17 Pause Alarms - pauses alarm indicators. Pause duration depends on monitor
change screen menu configuration. If pause duration is infinite, this key is labeled Alarms Off. Select again to
immediately re-enable alarm indicators.
9 adjust volume/level indicator 18 Silence - acknowledges all active alarms by switching off audible alarm indicators and
lamps permanently or temporarily, if alarm reminder (ReAlarm) is configured on.

11
1 Basic Operation Operating and Navigating

Select a screen element to tell the monitor to carry out the actions linked to the element. For example,
select the Patient Identification element to call up the Patient Demographics window, or select
the HR numeric to call up the Setup ECG menu. Select the ECG wave segment to call up the ECG
lead menu. The network indicator and bed label elements show menus whose function is documented
in the Information Center Instructions for Use.

Using the Touchscreen

Select screen elements by pressing them directly on the monitor’s screen.

Using the MP60/MP70/MP90 SpeedPoint

MP60/70/90
Only
1

6
SpeedPoint (MP60/MP70
only) Remote SpeedPoint
7

1 Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps. Behavior
follows the Silence permanent key configuration.
2 Alarms Off/Pause Alarms- pauses alarm indicators. Behavior follows the Pause Alarms permanent key
configuration.
3 Main Screen - close all open menus and windows and return to the main screen.
4 Back - go back one step to the previous menu.
5 SpeedPoint knob - rotate and tilt to highlight elements. Press to select.
6 Function keys on remote SpeedPoint - function identical to the first five SmartKeys configured for a
screen.
7 On/standby key

Rotate the SpeedPoint knob left or right. With each click, the highlight jumps to the neighboring
screen element. Alternatively, tilt the knob to move it in the direction of a screen element. A cursor
moves across the screen, following the direction of the knob. Any screen element under the cursor is
highlighted. When you reach the screen element you want, press the knob to select the element.
Using the remote SpeedPoint, you can operate the monitor from a distant location such as at the foot
of the bed. The remote SpeedPoint can also be used with the MP40/MP50.

12
Operating and Navigating 1 Basic Operation

Using the MP40/MP50 Navigation Point

MP40/MP50
only
1 Silence- acknowledges all active alarms by
switching off audible alarm indicators and
lamps. Exact behavior depends on permanent
key configuration
2 Alarms Off/Pause Alarms- pauses alarm
indicators. Exact behavior depends on Pause
Alarms permanent key configuration
3 Main Screen - closes all open menus and
windows and return to the main screen.
4 Back - takes you back one step to the previous
menu.
5 Navigation Point knob

Setup To use the navigation point, rotate it left or right. With

each click, the highlight jumps to the neighboring
Alarm Messages
screen element. The element under the cursor is
Alarm Limits highlighted. When you reach the screen element you
Alarm Volume want, press the knob to select the element.
My Care Group The elements at the top of the Screen are grouped
together for ease of navigation. Select any item at the
Screens
top of the Screen to open the Setup menu; scroll down
Profiles the menu to highlight the element you want then press
Admit/Discharge the navigation point to select the element.
Paced No

Using a Mouse or Trackball

If you are using a mouse or trackball, select screen elements by clicking on them (press and release the
left mouse button). While you are moving the mouse, a cursor appears and a highlight shows your
current position.

Using Keys
The monitor has four different types of keys.

13
1 Basic Operation Operating and Navigating

Permanent Keys
A permanent key is a graphical key that remains on the screen all the time to give you fast access to
functions.

Pause Alarms - pauses alarm indicators. Pause duration depends on monitor

configuration. If pause duration is infinite, this key is labeled Alarms Off.
Select again to immediately re-enable alarm indicators.

Silence - acknowledges all active alarms by switching off audible alarm indicators and
lamps.

Main Screen - close all open menus and windows and return to the main screen.

Main Setup - enter main setup menu.

SmartKeys
A SmartKey is a configurable graphical key, located at the bottom of the main screen. They give you
fast access to functions. Their availability, and the order in which they appear on your screen, depends
on how your monitor is configured.

enter profile menu change screen

set alarm limits enter patient identification menu to

admit/discharge/transfer

change alarm volume change QRS volume

end case to discharge a patient view information for patients in other

beds
enter standby mode - suspends patient
monitoring. All waves and numerics change screen brightness (not for
disappear from the display. All settings independent displays)
and patient data information are
retained.
review beat labels (annotate
arrhythmia wave)
re-learn arrhythmia

change amplitude (size) of ECG wave enter cardiac output procedure

14
Operating and Navigating 1 Basic Operation

start veni puncture (inflate cuff to start NBP STAT measurement

subdiastolic pressure)
- start/stop manual NBP measurement
- start auto series stop automatic or STAT NBP
- stop current automatic measurement measurement and measurement series
within series
set the NBP repeat time

access patient reports zero invasive pressure transducer

start a delayed recording Realtime Record SmartKey to access pop-

up recording keys

access wedge procedure window access the Loops window

review vital signs trend review graph trend

access event surveillance access calculations

access the calculator access the Drug Calculator

suppress AGM zero display VueLink information

start 12-Lead Capture (only available access remote applications (if Application
if Information Center is connected) Server is connected)

Hardkeys
A hardkey is a physical key on a monitoring device, such as the zero pressure key on the MMS or a
setup key on a module.

Pop-Up Keys
Pop-up keys are task-related graphical keys that appear automatically on the monitor screen when
required. For example, the confirm pop-up key appears only when you need to confirm a change.

15
1 Basic Operation Operating Modes

Using the On-Screen Keyboard

Use this as you would a conventional keyboard. Enter the information by selecting one character after
another. Use the Shift and capital Lock keys to access uppercase letters. Use the Back key to delete
single characters, or use the Clr key to delete entire entries. Select Enter to confirm what you have
entered and close the on-screen keyboard.
If a conventional keyboard is connected to the monitor, you can use this instead of or in combination
with the on-screen keyboard.

Using the On-Screen Calculator

You can use the on-screen calculator to perform any of Calculator
the standard operations for which you would normally
use a handheld calculator.
♦ To access the on-screen calculator, select the
Calculator SmartKey, or select Main Setup
-> Calculations -> Calculator. MC MR M+ Back

√ C/CE

Operating Modes
When you switch the monitor on, it starts up in monitoring mode. To change to a different mode:
1 Select the Main Setup menu.
2 Select Monitor.
3 Select Operating Modes and choose the mode you require.
Your monitor has four operating modes. Some are passcode protected.
• Monitoring Mode: This is the normal, every day working mode that you use for monitoring
patients. You can change elements such as alarm limits, patient category and so forth. When you
discharge the patient, these elements return to their default values. Changes can be stored
permanently only in Configuration Mode. You may see items, such as some menu options or the
altitude setting, that are visible but ‘grayed out’ so that you can neither select nor change them.
These are for your information and can be changed only in Configuration Mode.
• Demonstration Mode: Passcode protected, this is for demonstration purposes only. You must not
change into Demonstration Mode during monitoring. In Demonstration Mode, all stored trend
information is deleted from the monitor’s memory.

16
Tailoring Your Monitor 1 Basic Operation

• Configuration Mode: Passcode protected, this mode is for personnel trained in configuration tasks.
These tasks are described in the Configuration Guide. During installation the monitor is configured
for use in your environment. This configuration defines the default settings you work with when
you switch on, the number of waves you see and so forth.
• Service Mode: Passcode protected, this is for trained service personnel.
When the monitor is in Demonstration Mode, Configuration Mode, or
Config
Service Mode, this is indicated by a box with the mode name in the center
of the Screen and in the bottom right-hand corner. Select this field to
change to a different mode.

Disabling Touchscreen Operation

♦ To temporarily disable touchscreen operation of the monitor, press and hold the Main
Screen permanent key. A padlock will appear on the Main Screen permanent key.
♦ Press and hold the Main Screen permanent key again to re-enable the touchscreen operation.

Using a Second Display

A second display, showing the same Screen as the main display, can be connected to any of the
monitors, for viewing only.
A second display showing a different Screen can be connected to the MP90, for viewing only. The
second Screen cannot be operated using any input device. You can change the selection of screen
elements shown on the Screen of the second display in the monitor’s Configuration Mode.
To choose Screens for two displays,
1 Select Profiles in the monitor info line of the primary display,
2 Select Display 1, then select the Screen you want to display on the primary display from the
list of available Screens.
3 Select Display 2, then select the Screen you want to display on the second display from the list
of available Screens.
The second display Screen may take a few seconds to load.

Tailoring Your Monitor

You can tailor your monitor’s default settings.

Understanding Screens
Your monitor comes with a set of preconfigured screens, optimized for common monitoring scenarios
such as OR adult, or ICU neonatal. A screen defines the overall selection, size and position of waves,
numerics and SmartKeys on the monitor screen when you switch on. You can easily switch between
different screens during monitoring. Screens do NOT affect alarm settings, patient category and so
forth.

17
1 Basic Operation Tailoring Your Monitor

Switching to a Different Screen

1 To switch to a different Screen, select the current Screen name in the monitor info line,
or select the Change Screen SmartKey.
2 Choose the new screen from the pop-up list.
When you switch from a complex to a less complex screen layout, some measurements may not be
visible but are still monitored in the background. If you switch to a more complex screen with, for
example, four invasive pressure waves but you have only two pressures connected to the monitor, the
“missing” two pressures are either left blank or the available space is filled by another measurement.

Using the Visitor Screen

If a visitor Screen is configured for your monitor, you can use it to clear the screen of all waves and
numerics but continue to monitor the patient with active alarms and trend storage at the bedside and
Information Center.
♦ To activate this Screen, select the Screen name in the monitor info line to open the Screen
menu, then select the name of the Visitor Screen configured for your monitor from the list of
available Screens.
♦ Select any element on the Screen to open the Screen menu and select a different Screen to show
waves and numerics again.

Changing a Screen’s Content

If you do not want to change the entire screen content, but only some parts of it, you can substitute
individual waves. When you select a wave for display, its numeric is usually automatically selected
along with it. Permanently storing the change can be done only in Configuration Mode.
1 Select the wave segment on the monitor screen where you want the new wave to appear. This calls
up the Wave menu.
2 In the Wave menu, select Change Wave.
3 From the wave list, select the wave you want.

Understanding Profiles
Profiles are predefined monitor configurations. They let you change the configuration of the whole
monitor so you can adapt it to different monitoring situations. The changes that occur when you
change a complete profile are more far reaching than those made when you change a Screen. Screens
affect only what is shown on the display. Profiles affect all monitor and measurement settings.
The settings that are defined by Profiles are grouped into three categories. Each category offers a choice
of ‘settings blocks’ customized for specific monitoring situations. These categories are:
• Display (screens)
– Each profile can have a choice of many different predefined screens. If you are using a second
display, each display can have its own individual screen selection. When you change the profile,
the screen selection configured for the new profile becomes active.
• Monitor Settings
– Each profile can have a choice of different predefined monitor settings. These relate to the
monitor as a whole; for example, display brightness, alarms off/paused, alarm volume, QRS tone
volume, tone modulation, prompt tone volume, wave speed, resp wave speed, pulse source.

18
Tailoring Your Monitor 1 Basic Operation

• Measurement Settings
– Each profile can have a choice of different predefined measurement settings. These relate directly
to individual measurements, for example, measurement on/off, measurement color, alarms limits,
NBP alarm source, NBP repeat time, temperature unit (oF or oC) pressure unit (mmHg or kPa).

Profiles
Profile : Profile A

Patient Category: Adult Measurement A

Paced : No Measurement B

Display : S-014 Measurement C

Meas Settings: Measurement A Measurement D

Monitor Settings: Monitor A

Profiles Menu, showing current settings Available choices in measurement

menu

You can change from one complete profile to another or swap individual settings blocks (display
screen/monitor settings/measurement settings) to change a subset of a profile. Changes you make to
any element within the settings blocks are not saved when you discharge the patient, unless you save
them in Configuration Mode.
You might find it helpful to think of the three categories in terms of a restaurant menu. The Screens
are like the first course, offering you a choice of “starters” (many different screen configurations from
which you can choose the one that best suits your requirements). The Monitor Settings category is like
the main course, offering a choice of different “main dishes” from which you can pick one. The
Measurement Settings are like the dessert course. From these you build your meal. You can choose one
from the “starters”, one from the main course, then one from the dessert or simply pick one or two
courses without having a full meal.
Depending on your monitor configuration, when you switch on or discharge a patient the monitor
either continues with the previous profile, or resets to the default profile configured for that monitor.

WARNING If you switch to a different profile, the patient category and paced status normally change to the setting
specified in the new profile. However some profiles may be setup to leave the patient category
unchanged. Always check the patient category, and all alarms and settings, when you change profiles.

When you leave Demonstration Mode, or Service Mode, the monitor uses the default profile.

19
1 Basic Operation Changing Measurement Settings

Swapping a Complete Profile

1 Select Profiles in the monitor info line, or select the Profiles SmartKey.
2 In the Profiles menu, select Profile.
3 Chose a profile from the pop-up list.
4 Confirm your selection.

Swapping a Settings Block

1 Select Profiles in the monitor info line, or select the Profiles SmartKey.
2 In the Profiles menu, select Display or Measmnt. Settings or
Monitor Settings to call up a list of the settings blocks in each category.
3 Choose a settings block from the pop-up list.
4 Confirm your selection.

Default Profile
Your monitor has a default profile that it uses when you leave Demonstration, or Service modes, or
when you discharge a patient. This profile is indicated by a diamond .

Locked Profiles
Some profiles are locked, so that you cannot change them, even in Configuration Mode. These are
indicated by this lock symbol.

Changing Measurement Settings

Each measurement has a setup menu in which you can adjust all of its settings. You can enter a setup
menu:
• via the measurement numeric - select the measurement numeric to enter its setup menu. For
example, to enter the Setup ECG menu, select the HR (heartrate) numeric.
• via the Setup hardkey (on plug-in modules) - press the Setup hardkey on the module front.
• via the Main Setup SmartKey - if you want to setup a measurement when the measurement is
switched off, use the Main Setup SmartKey and select Measurements. Then select the
Measurement name from the popup list. With this SmartKey you can access any setup menu in the
monitor.
This guide always describes the entry method using the setup menu. But you can use any method you
prefer.

20
Using Labels 1 Basic Operation

Switching a Measurement On and Off

When a measurement is off, its waves and numerics are removed from the monitor’s screen. The
monitor stops data acquisition and alarming for this measurement. A measurement automatically
switches off if you disconnect its module or measurement server. If you disconnect a transducer, the
monitor replaces the measurement numeric with question marks.
1 Enter the measurement’s setup menu and select the measurement.
2 Select the measurement name to toggle between on and off. The screen display indicates the active
setting.

Switching Numerics On and Off

For some measurements, such as EEG, you can choose which numerics to view on the screen.
♦ In the measurement’s setup menu, select the numeric name to toggle between on and off.
For example in the Setup EEG menu, select the EEG numeric name to toggle between on and off.

Adjusting a Measurement Wave

♦ To quickly adjust wave-related measurement settings (such as speed or size), select the
measurement wave itself. This displays the measurement Wave menu, which has only wave-
related measurement settings.

Changing a Wave Speed

Lowering the wave speed compresses the wave and lets you view a longer time period. Increasing the
speed expands the waveform, giving you a more detailed view.
Changing the speed of one wave changes the speed of all other waves, except respiratory waves such as
Resp, CO2, N2O, O2, which are usually viewed at a slower speed, and waves from EEG and BIS,
which also have an independent speed control setting.
1 Enter the Wave menu for the desired measurement by selecting the wave.
2 Select Speed (or Resp Speed).
3 Select the speed you want.

Using Labels
You can measure multiple invasive pressures and temperatures simultaneously. The monitor uses labels
to distinguish between them. The default settings defined in the profile (such as measurement color,
wave scale, and alarm settings) are stored within each label. When you assign a label to a measurement,
the monitor automatically applies these default settings to the measurement. The labels assigned are
used throughout the monitor, in reports, recordings, and in trends.

21
1 Basic Operation Using Labels

Changing Measurement Labels (e.g. Pressure)

To change a measurement label of a measurement with multiple labels (invasive pressure, temperature,
or SpO2),
1 Enter the Wave menu of the measurement.
2 Select Label.
3 Choose a label from the list.
The monitor automatically applies the scale, color, etc. settings stored in the Profile for the label you
select. You can change scale settings in Monitoring Mode, but color can only be change in the
monitor’s Configuration Mode.
Any labels already being used in the monitor are shown “grayed-out” in the list and cannot be selected.

Give me an example Let’s imagine you used a Press module to monitor your previous patient’s CVP.
Now you want to use the same module to measure ABP with a new patient. You’ve set up your arterial
line. When you connect the pressure transducer to the module, the pressure shown on the screen still
uses the CVP color and wave scale and is labeled CVP. To rectify this, just change the pressure label to
ABP. Now the pressure has the correct color, the wave is shown in the correct scale, and the
appropriate alarm limits for ABP are active.

Resolving Label Conflicts

Each label is unique, that is, it can only be assigned once. You cannot monitor two pressures labelled
“ICP” at the same time. If you need to use two identical pressures, you must assign different labels to
them, for example, P and ICP.

Measurement labels are stored in the measurement device. If you try to use two
measurement devices that have identical labels, the monitor displays the conflict
indicator.

Measurement Selection
To resolve a label conflict,
1 Select the conflict indicator or select
Main Setup -> FMS 6 CVP Plugged
Measurement Selection to
display the Measurement Selection FMS 7 CVP Unplugged
window. This lists conflicting devices.
2 Select the line that shows the device
whose label you want to correct.
3 From the pop-up keys, choose from:
– Change Label: change the conflicting device’s label to a different label.
– Plug/Unplug: disable the conflicting device by “virtually” unplugging it. It retains its label for
future use but becomes invisible to the monitor.
– Modify Driver (VueLink only) - change the VueLink device driver.

22
Changing Monitor Settings 1 Basic Operation

Changing Monitor Settings

♦ To change monitor settings such as date and time, brightness, or QRS tone volume, select the
Main Setup SmartKey and then select the setting you want to change, or select User
Interface to enter a submenu where you can change user interface settings.

Adjusting the Screen Brightness

1 Select the Brightness SmartKey.
2 Select the appropriate setting for the screen brightness. 10 is the brightest, 1 is the least
bright.
If you are using an MP90 with an external display, the Brightness SmartKey does not adjust the
brightness of this display. See the instructions supplied with the external display for instructions.

Adjusting Touch Tone Volume

The touch tone volume is the tone you hear when you select any field on the monitor screen. To adjust
the touch tone volume,
1 In the Main Setup menu, select User Interface
2 Select TouchToneVolume, then select the appropriate setting for the touch tone volume: 10 is
the loudest and 1 is the quietest. Selecting zero switches the touch tone volume off.

Setting the Date and Time

If your monitor is connected to an Information Center, the date and time are automatically taken from
this. Once it is set, the internal clock retains the setting even when you switch off the monitor.

WARNING Changing the date or time will affect the storage of trends and events.

1 Select the Date, Time screen element from the monitor’s info line to enter the Date, Time
menu.
2 Select, in turn, the Year, Month, Day, Hour (in 24 hour format, only) and Minute as
necessary.
3 Select Store Date, Time to change the date and time.

Checking Your Monitor Revision

♦ Select Main Setup -> Revision to open the Revision Window.
The monitor revision will be shown in the format a.bc.de, where a.b indicates the major monitor
release, c indicates the revision of the hardware purchased, and d and e indicate the software revision. If
the Revision Screen shows B.05.60, then the monitor has the hardware revision 5 and the
software revision 60 from the B.0 monitor release.

23
1 Basic Operation Getting Started

Getting Started
Once you understand the basic operation principles, you can get ready for monitoring.

Inspecting the Monitor

WARNING Do not use the system for any monitoring procedure on a patient if you suspect the monitor is not
working properly, or if it is mechanically damaged.

1 Before you start to make measurements, carry out the following checks on the monitor including
all connected Measurement Servers, modules, or measurement server extensions.
– Check for any mechanical damage.
– Check all the external cables, plug-ins and accessories.
2 Plug the power cord into the AC power source. If you are using an MP40/MP50 monitor, ensure
that the battery has sufficient power for monitoring. When you use a battery for the first time, you
must charge it, following the instructions given in the section “Charging Batteries” on page 263.
3 Check all the functions of the instrument that you need to monitor the patient, and ensure that the
instrument is in good working order.

Switching On
♦ Press the on/off switch on the monitor for one second. The monitor performs a self test and is then
ready to use. If you see a message such as CO2 Sensor Warmup wait until it disappears before
starting monitoring that measurement. Connected devices usually take their power from the
monitor. External devices such as AGM and those connected via VueLink have their own power
switches.

Setting up the Measurement Modules

1 Decide which measurements you want to make.
2 Connect the required modules, Measurement Servers, or measurement server extensions.
3 Check that you have the correct patient cables and transducers plugged into the modules. The
module connectors are color-coded to the patient cables and transducers for easy identification.

Starting Monitoring
After you switch on the monitor,
1 Admit your patient to the monitor.
2 Check that the profile, alarm limits, alarm and QRS volumes, patient category and paced status
and so forth are appropriate for your patient. Change them if necessary.
3 Refer to the appropriate measurement section for details of how to perform the measurements you
require.

24
Disconnecting from Power 1 Basic Operation

Disconnecting from Power

The On/Standby switch does not disconnect the monitor from the ac power source. To disconnect,
unplug the power cable.

Networked Monitoring
If your monitor is connected to a network, a network symbol is displayed in the upper left corner next
to the bed label.
Select Bed Label from the monitor info line to see details of the Care Group, the equipment label
and technical information about the network.

Using Remote Applications

If your monitor is connected to a Philips Application Server, you can access applications hosted
remotely on the Application Server and display and operate them on the bedside monitor screen. The
Application Server provides portal technology to allow information access through a web browser,
terminal emulation, or served applications. The applications available depend on the Application
Server configuration: see the device documentation for details.
To display remote applications on the monitor,

1In the Main Setup menu, select Remote Applics, or select the
Remote Applications SmartKey.
2 Select the required application from the pop-up list of available applications.
3 Operate the application with your preferred monitor input device: touchscreen, SpeedPoint,
navigation point or mouse.

25
1 Basic Operation Using Remote Applications

26
 2

2What’s New?
This section lists the most important new features and improvements to the monitor and its user
interface introduced with each release. Further information is provided in other sections of this book.
You may not have all of these features, depending on the monitor configuration purchased by your
hospital.

What’s New in Release B.0?

IntelliVue MP40/MP50 The MP40/MP50 patient monitor is a new addition to the IntelliVue
patient monitor family. It uses the same measurement devices as the MP60/MP70/MP90 monitors
and shares the same technological platform and user interface, but is more compact in size and can be
operated by battery.

M3012A Measurement Server Extension The new Hemodynamic Measurement Server Extension
extends measurement capability by adding two additional pressures and Cardiac Output.

M1020B SpO2 Module New SpO2 measurement module, M1020B, enables dual SpO2
measurement without the need to use the VueLink module. Two options are available:
– Option A01 for use with Philips reusable and disposable sensors and Nellcor “R-Cal” disposable
sensors.
– Option A02 for use with Nellcor OxiMax sensors, including the MAX-FAST forehead sensor.
M1020B Option A02 for use with Nellcor OxiMax sensors may not be available in all countries.

PV Loops: compares graphic representations of airway waves to help detect changes in the patient
airway condition.

High-resolution waves per Screen: the number of high-resolution waves that can be shown on a
Screen is increased, limited only by the Axx Option purchased.

Alarms symbols: New alarm symbols are introduced, and “short” yellow alarms were renamed “one-
star” yellow alarms (yellow arrhythmia alarms).

Aperiodic measurements available as Screen Trends: patient trend information for NBP, C.O., C.I.,
and Wedge can now be permanently displayed on the Screen in tabular and graphical form.

27
2 What’s New? What’s New in Release A.2?

What’s New in Release A.2?

12-Lead ECG recordings: 12-Lead ECG waves and numerics can be sent to a connected recorder

High-Resolution Trend Report: high-resolution trend report can be sent to a connected printer

ST Snippets ST snippets, showing a one second wave segment for each measured ST lead, can be
permanently displayed on the Screen or called up as required.

EEG Wave Speed: new EEG-specific wave speeds have been added to the list of wave speeds available

Drug Calculator: this new feature helps you to calculate drug dosages for your patients

On-Screen Calculator: a mathematics calculator can be used on the Screen

Visitor Screen: this new Screen is designed to hide sensitive patient information from the Screen.
Monitoring and alarm generation function as usual.

Touch selection volume control: The volume of the audio prompt given when a screen element is
selected is now adjustable

VueLink interface: the VueLink on-screen appearance and controls are improved

M3001A: Trend upload from the Multi-Measurement Server (M3001A) improved

Screen Trends: lets you display patient trend information in graphic form permanently on the Screen

Alarm Limits Page: lets you view and control alarm settings for all measurements in one window

New Option for Event Surveillance: a new neonatal event review option #C04 is introduced

Second display To simultaneously show two different Screens, a second display can be connected to
the MP90. The second display is for viewing only.

28
 3

3Alarms
The alarm information here applies to all measurements. Measurement-specific alarm information is
discussed in the sections on individual measurements.
The monitor has three alarm levels: red, yellow, and INOP.

Red and yellow alarms are patient alarms. A red alarm indicates a high priority patient alarm such as a
potentially life threatening situation (for example, asystole). A yellow alarm indicates a lower priority
patient alarm (for example, a respiration alarm limit violation). Yellow arrhythmia alarms are specific to
arrhythmia-related patient conditions (for example, ventricular bigeminy).

INOPs are technical alarms, they indicate that the monitor cannot measure or detect alarm conditions
reliably. If an INOP interrupts monitoring and alarm detection (for example, LEADS OFF), the
monitor places a question mark in place of the measurement numeric and an audible indicator tone
will be sounded. INOPs without this audible indicator indicate that there may a problem with the
reliability of the data, but that monitoring is not interrupted.
Alarms are indicated after the alarm delay time. This is made up of the system delay time plus the
trigger delay time for the individual measurement. See the specifications section for details.

If more than one alarm is active, the alarm messages are shown in the
↑ ** HR HIGH
alarm status area in succession. An arrow symbol next to the alarm
message informs you that more than one message is active.
The monitor sounds an audible indicator for the highest priority alarm. If more than one alarm
condition is active in the same measurement, the monitor announces the most severe. If more than one
alarm of the same severity is active in the same measurement, it announces the most recent. Your
monitor may be configured to increase alarm indicator volume automatically during the time when the
alarm is not acknowledged.

29
3 Alarms Visual Alarm Indicators

Visual Alarm Indicators

Alarm message: An alarm message text appears in the alarm status area at the top of the screen
indicating the source of the alarm. If more than one measurement is in an alarm condition, the message
changes every two seconds, and has an arrow ( ) at the side. The background color of the alarm
message matches the alarm priority: red for red alarms, yellow for yellow alarms, and light blue for
INOPs. The asterisk symbols (*) beside the alarm message match the alarm priority: *** for red alarms,
** for yellow alarms, * for yellow arrhythmia alarms. INOPs are displayed without asterisks.
Depending on how your monitor is configured, it may display alarm limit violation messages
• in text form, for example “**SpO2 LOW” or
• in numeric form, for example “**SpO2 94<96”, where the first number shows the maximum
deviation from the alarm limit, and the second number shows the currently set limit.

Flashing numeric: The numeric of the measurement in alarm flashes.

Bright alarm limits: If the alarm was triggered by an alarm limit violation, the corresponding alarm
limit on the monitor screen is shown more brightly.

Alarm lamp: A lamp on the monitor’s front panel flashes. This has the same color as the alarm
priority.

Nurse call systems: Alarm conditions are indicated on any device connected to the nurse call relay, if
configured to do so.

Audible Alarm Indicators

The audible alarm indicators configured for your monitor depend on which alarm standard applies in
your hospital. Audible alarm indicator patterns are repeated until you acknowledge the alarm by
switching it off or pausing it. or until the alarm condition ceases (if audible alarm indication is set to
non-latching).

WARNING Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm
volume to a low level or off during patient monitoring may result in patient danger. Remember that
the most reliable method of patient monitoring combines close personal surveillance with correct
operation of monitoring equipment.

Alarm Tone Configuration

The audible alarm indicators of your monitor are configurable. In the monitor’s Configuration Mode,
you can:
• increase the alarm volume of unacknowledged alarms at regular intervals
• change the interval between alarm sounds (ISO/IEC Standard 9703-2 alarms only)
• change the base volume of the red and yellow alarm tones and the INOP tones
• change the alarm sound to suit the different alarm standards valid in different countries.

30
Audible Alarm Indicators 3 Alarms

Traditional Audible Alarms (HP/Agilent/Philips/Carenet)

• Red alarms: A high pitched sound is repeated once a second.
• Two-star yellow alarms: A lower pitched sound is repeated every two seconds.
• One-star yellow alarms (arrhythmia alarms): The audible indicator is the same as for yellow alarms,
but of shorter duration.
• INOPs: an INOP tone is repeated every two seconds.

ISO/IEC Standard 9703-2 Audible Alarms

• Red alarms: A high pitched tone is repeated five times, followed by a pause.
• Two-star yellow alarms: A lower pitched tone is repeated three times, followed by a pause.
• One-star yellow alarms (arrhythmia alarms): The audible indicator is the same as for yellow alarms,
but of shorter duration.
• INOPs: a lower pitched tone is repeated twice, followed by a pause.

Changing the Alarm Tone Volume

♦ The alarm volume symbol at the top right of the monitor screen gives you an
indication of the current volume. To change the volume, select the volume symbol
and then select the required volume from the pop-up selection.

♦ If you want to see a numerical indication of the current alarm volume on a scale
from zero to 10, select the Alarm Volume SmartKey. The volume scale pops up. Alarm
Volume
The current setting is indented. To change the setting, select the required number
on the scale. Any settings that are inactive (“grayed out”) have been disabled in the
monitor’s Configuration Mode.

When the alarm volume is set to zero (off), the alarm volume symbol reflects this. If you
switch the alarm volume off, you will not get any audible indication of alarm conditions.

Minimum Volume for No Central Monitoring INOP

If your monitor is connected to a Central Station, and the connection is interrupted, the INOP
message No Central Monit. will appear, accompanied by an INOP tone. To help ensure that
this INOP, and any other active alarm, is not overlooked, the INOP and alarm tones may be
configured to have a minimum volume. In this case, INOP and alarm tones will sound even if the
monitor alarm volume is set to zero.

31
3 Alarms Acknowledging Alarms

Acknowledging Alarms
To acknowledge all active alarms and INOPs, select the Silence permanent
key. This switches off the audible alarm indicators and alarm lamps. Alternatively,
you can acknowledge alarms by pressing the Silence hardkey on the MMS or Silence
on the SpeedPoint. The hardkeys follow the behavior configured for the
permanent key.

A check mark beside the alarm message indicates that the alarm has been
acknowledged. If the monitor is configured to re-alarm, a dashed check mark will
be shown.

If the condition that triggered the alarm is still present APNEA

after the alarm has been acknowledged, the alarm message
stays on the screen with a check mark symbol beside it.
If the alarm condition is no longer present, all alarm indicators stop and the alarm is reset.
Switching off the alarms for the measurement in alarm, or switching off the measurement itself, also
stops alarm indication.

Acknowledging Disconnect INOPs

Acknowledging an INOP that results from a disconnected transducer switches off the associated
measurement. The only exception is ECG/Resp: acknowledging a disconnect INOP for ECG leads
does not switch off the ECG and Resp measurements. Acknowledging a disconnect INOP at the
Information Center switches off the audible INOP indicator but does not switch off the measurement.
Unplugging an MMS or a plug-in module automatically switches off its measurements.

Alarm Reminder (ReAlarm)

If Alarm Reminder is configured on for your monitor, you will get an audible reminder of alarm
conditions that remain active after you have acknowledged the alarm. This reminder may take the form
of a repetition of the alarm tone for a limited time, or an unlimited repetition of the alarm tone (this is
the same as a new alarm). There is no alarm reminder for INOPs.
In Configuration Mode, you can set the interval between silencing the alarm and sounding the
reminder tone to one, two, or three minutes.

Pausing or Switching Off Alarms

If you want to temporarily prevent alarms from sounding, for example while you are moving a patient,
you can pause alarms. Depending on your monitor configuration, alarms are paused for one, two, or
three minutes, or infinitely.
To view the alarm pause setting chosen for your unit,
1 Select Main Setup -> Alarm Settings
2 Check the Alarms Off setting.
This setting can only be changed in the monitor’s Configuration Mode.

32
Pausing or Switching Off Alarms 3 Alarms

To Pause All Alarms

♦ Select the Pause Alarms permanent key. If your monitor is configured to
infinite pause time, the permanent key is labelled Alarms Off, and selecting it Pause
switches alarms off. Alarms
♦ Or press the Alarms hardkey on the MMS SpeedPoint. The hardkeys follow the
behavior configured for the permanent key.

To Switch All Alarms Off

You can only switch alarms off permanently if your monitor is configured to allow infinite alarms
pause and the permanent key is labelled Alarms Off.

♦ Select the Pause Alarms permanent key. If your monitor is configured to

infinite pause time, the permanent key is labelled Alarms Off. Alarms
♦ Or press the Alarms hardkey on the MMS SpeedPoint. The hardkeys follow the Off
behavior configured for the permanent key.
Pausing alarms infinitely is the same as switching them off.

To Switch Individual Measurement Alarms On or Off

1 Select the measurement numeric to enter its setup menu.
2 Select Alarms to toggle between On and Off.
The alarms off symbol is shown beside the measurement numeric.

While Alarms are Paused or Off

• The red Alarms Paused lamp on the monitor front panel is lit.

• In the alarm field, the monitor displays the message ALARMS PAUSED 1:28
Alarms Paused or Alarms Off, together with
the alarms paused symbol and the remaining pause
time in minutes and seconds, or alarms off symbol.

• No alarms are sounded and no alarm messages are

shown. ALARMS OFF

• INOP messages are shown but no INOP tones are

sounded.
• The nurse call relay is not active.

Restarting Paused Alarms

♦ To manually switch on alarm indication again after a pause, select the permanent key
Pause Alarms (or Alarms Off ) again.
Alarm indication starts again automatically after the pause period expires. If the monitor is configured
to stay paused infinitely, you must select Alarms Off again to restart alarm indication.

33
3 Alarms Alarm Limits

Resetting Arrhythmia Alarm Timeouts

♦ To reset the arrhythmia alarm timeout period, select the Alarms Off or Pause Alarms
permanent key and then reselect it.

Extending the Alarm Pause Time

If your monitor has extended alarm pause enabled, you can extend the alarm pause time. Use this to
prevent alarms being indicated, for example, while you are washing a patient or carrying out a
procedure. Only extend the alarm pause time when you are sure that clinical personnel are available to
monitor the patient’s condition closely.
To extend the alarm pause time to five or 10 minutes,
1 Select one of the alarm fields. This calls up the Alarm Messages window.
2 Select either the pop-up key Pause Al. 5 min or the pop-up key Pause Al. 10 min.
Each time you select one of these pop-up keys, the Alarm Pause Time is reset to five (or 10)
minutes.

Alarm Limits
The alarm limits you set determine the conditions that trigger yellow and red limit alarms. For some
measurements (for example, BIS and SpO2), where the value ranges from 100 to 0, setting the high
alarm limit to 100 switches the high alarm off, and switching the low alarm limit to 0 switches it off. In
these cases, the alarms off symbol is not displayed.

WARNING Be aware that the monitors in your care area may each have different alarm settings, to suit different
patients. Always check that the alarm settings are appropriate for your patient before you start
monitoring.

Viewing Individual Alarm Limits

HR
120
50
85 You can usually see the alarm limits set for each measurement next to the
measurement numeric on the main screen.
If your monitor is not configured to show the alarm limits next to the numeric,
Alarm limits you can see them in the appropriate measurement setup menu. Select the
measurement numeric to enter the menu and check the limits.

34
Alarm Limits 3 Alarms

Viewing All Alarm Limits

The Alarm Limits overview window lists the currently set alarm limits for all measurements. If an
Apnea alarm delay time is set, this is also shown. The Alarms Off symbol is shown beside the
measurement label of any measurement whose alarm switched off.

To open the Alarm Limits window, either select any alarm field to open the Alarm
Messages window, then select the Alarm Limits pop-up key, or select the Alarm
Limits SmartKey, if configured.

Alarm Limits

ST-V4

ST-V5
Graphic view of current
ST-V6 yellow and red alarm
limits and currently
monitored measurement
SpO2 value
Pulse (SpO2)

NBPs

ABPs

PAPd

AWRR

Apnea Time

Measurement labels, with alarms Current yellow alarm limits

off symbol where appropriate

You can use the pop-up keys that open with the Alarm Limits window to perform common tasks:
– All Al. On/All Al. Off,
– All Narrow/All Wide to set narrow or wide alarm AutoLimits for all measurements
– Print Limits/Record Limits to print a list of all current alarm limit settings on a
connected printer or recorder.

35
3 Alarms Alarm Limits

Changing Alarm Limits

To change individual measurement alarm limits using the measurement’s Setup Menu,
1 in the measurement’s setup menu, select the alarm limit you want to change. This calls up a list of
available values for the alarm limit.
2 Select a value from the list to adjust the alarm limit.
Alternatively, you can use the keys in the measurement Change Limits window, which you access by
selecting the measurement label in the Alarm Limits window.

High red alarm (view only) High yellow alarm field

Up/down arrow keys for

HR
changing high yellow alarm
limits

Alarms On/Off key - select to

toggle between alarms on or off
Alarms
On/Off Preview Alarm AutoLimits for a
measurement before applying
Select to apply wide AutoLimits
Select to apply narrow
AutoLimits

Up/down arrow keys for

changing low yellow alarm limits

15-min trend, showing alarm Graphic view of alarm limits Low yellow alarm field
limits and monitored with currently measured value Low red alarm (view only)
measurement values

To change alarm limits,

1 In the Change Limits window,
– if you are using touch, select the up or down arrow buttons to adjust the high and low alarm
limits as required.
– if you are using a SpeedPoint, position the cursor in the high yellow alarm field, then press the
knob inwards. Rotate the knob to the left or right to adjust the limit. Press the knob again to set
the displayed limit.
2 Repeat to set the low yellow alarm limit.
If you set the yellow alarm limit outside the red alarm limit, the monitor will automatically set the red
alarm to the yellow alarm limit.

36
Alarm Limits 3 Alarms

About Automatic Alarm Limits (AutoLimits)

The monitor can automatically set alarm limits suited to your individual patient, using the Automatic
Alarm Limits function. This tells the monitor to adapt the alarm limits of selected measurements to the
measured vital signs within a defined safe limit. The monitor calculates safe AutoLimits for each
patient based on the measured values from the last 12 seconds.
The defined safe limits never exceed the non-pathological range.
Limits Narrow sets limits close to the currently measured values for situations where it is critical
for you to be informed about small changes in your patient’s vital signs.
Limits Wide sets limits further away from the currently measured values for situations where small
changes are not so critical.
♦ Use the keys in the Change Limits window to apply AutoLimits for individual measurements.
These keys are not available if AutoLimits have been disabled for the measurement in the monitor’s
Configuration Mode.

High alarm limit, wide

High alarm limit, narrow

Alarm
limits Low alarm limit, narrow
Low alarm limit, wide

Measurement value
Lower limit Upper limit
clamps clamps

AutoLimits are not available for all measurements. The list of measurements for which AutoLimits can
be used is defined in the monitor’s Configuration mode.
Use the Change Limits window to check AutoLimits before you apply them to ensure that they are
appropriate for your individual patient and their clinical condition. Once applied, AutoLimits are
shown on the monitor screen just like manually-set alarm limits. If the AutoLimits are not appropriate
for your patient, you must set alarm limits manually. The limits remain unchanged until you set them
again or change them manually.

Documenting Alarm Limits

The alarm limits pop-up keys appear with the Alarm Limits and Change Limits windows.
♦ Select the Print Limits pop-up key to print an overview of all alarm limits on a connected
printer.
♦ Select the Record Limits pop-up key to send a recording of the alarm limits to a recorder.

37
3 Alarms Reviewing Alarms

Reviewing Alarms
To review the currently active alarms and INOPs, select any of the alarm status areas on the monitor
screen. The Alarm Messages window pops up. All alarms and INOPs are erased from the
monitor’s alarm history when you discharge a patient, or if you change to Demonstration Mode.

Alarm Messages Window

The Alarm Messages window shows all the currently active alarms and INOPs in chronological
order, beginning at the top with the most recent. INOPs are shown on the left hand side and patient
alarms are shown on the right hand side. Any active red alarms are shown first, followed by yellow
alarms. Acknowledged alarms or INOPs are shown with the check mark symbol.
The Alarm Messages window pop-up keys appear when the window is opened. If alarm pause
extension is disabled, the pause pop-up keys are inactive (“grayed-out”). Selecting the Review
Alarms pop-up key opens the Review Alarms window.

Alarm Review Pause Al. Pause Al.

Limits Alarms 5 Min. 10 Min.

Review Alarms Window

Review Alarms
The Review Alarms window
contains a list of up to 100 of the most 5 Apr 16:55:18 *** Apnea
recent alarms and INOPs with date and 5 Apr 16:55:18 ** ABPs HIGH (120 >95)
time information. If configured to do so,
5 Apr 16:55:18 Alarms On
each alarm is shown with the alarm limit
active when the alarm was triggered and 5 Apr 16:45:15 ** SpO2 NON-PULSAT.
the maximum value measured beyond 5 Apr 16:44:57 Alarms Off
this limit. The Review Alarms 5 Apr 16:44:46 ** awRR LOW (14<15)
window also shows any changes made to 5 Apr 16:44:39 ** SpO2 LOW (95<99)
the Alarms On/Off or Silence status.
5 Apr 16:44:28 ** ABPs HIGH (120>95)
The information in the Review Alarms
window is deleted when a patient is
discharged, when the monitor is
switched off for longer than one minute,
and when you enter Demonstration Mode.
The Review Alarms window pop-up keys appear when the window is opened. If alarm pause
extension is disabled, the pause pop-up keys are inactive. Selecting the Active Alarms pop-up key
opens the Alarm Messages window.

Alarm Active Pause Al. Pause Al.

Limits Alarms 5 Min. 10 Min.

38
Understanding Alarm Messages 3 Alarms

Understanding Alarm Messages

If you do not immediately understand an INOP or alarm message, refer to its help text.
♦ In the Alarm Messages window, select the INOP message. This calls up a help window with
an explanation of the INOP message and, where appropriate, a suggested solution for the problem.

Alarm Messages
Resp LEADS OFF ** awRR LOW
LL LEAD OFF

The lead LL has become detached from the patient or

the lead set has been changed. Attach the missing
electrode or select <New Lead Setup> to confirm the
new lead set

Latching Alarms
The alarm latching setting for your monitor defines how the alarm indicators behave when you do not
acknowledge them. When alarms are set to non-latching, their indicators end when the alarm
condition ends. Switching alarm latching on means that visual and/or audible alarm indications are still
displayed or announced by the monitor after the alarm condition ends. The indication lasts until you
acknowledge the alarm.

Viewing the Alarm Latching Settings

To see the alarm latching setting for your monitor
1 In the monitor’s Main Setup menu, select Alarms.
2 Select Alarm Settings, and see the Visual Latching and Audible Latching
settings.
You can change this setting only in the monitor’s Configuration Mode. You should be aware of the
settings chosen for your unit. There are three possible choices each for visual and audible latching, Red,
Red and Yellow, and Off. These choices can be combined to give the following settings:

Visual Latching R&Y R&Y R&Y R R Off

Audible latching R&Y R Off R Off Off

39
3 Alarms Testing Alarms

Alarm Latching Behavior

Red and Yellow Measurement Non-latching Visual and audible Visual latching,
Alarms alarms latching audible non-latching
Alarm has not been Alarm condition Alarm tone on. Alarm lamp on. Alarm message. Flashing numerics.
acknowledged. still present.
Alarm condition All audible and visual Alarm tone on. Alarm message. Flashing
no longer present. alarm indicators Alarm lamp on. numerics.
automatically stop. Alarm message. Audible alarm indicators
Flashing numerics. automatically stop.
Alarm has been Alarm condition Audible alarm acknowledged. Alarm lamp off. Alarm message. Flashing
acknowledged. still present. numerics. Audible alarm reminder (if configured).
Alarm condition Audible and visual alarm indicators automatically stop.
no longer present.

INOPs and short yellow arrhythmia alarms are always non-latching.

Silencing Latched Alarms from an Information Center

Alarms set to visual latching only cannot be silenced at an Information Center. If you need to be able
to silence bedside monitor alarms at an Information Center, you must make sure that the configured
latching settings include an audible element.

Testing Alarms
When you switch the monitor on, a selftest is started. You must check that the alarms lamps light, one
after the other, and that you hear a single tone. This indicates that the visible and audible alarm
indicators are functioning correctly.

Alarm Behavior at On/Off

When you switch alarms on, the settings defined in the currently active Profile are used.
If the monitor is switched off for longer than one minute and then switched on again, or after a loss of
power lasting longer than one minute, or when a patient is discharged, the monitor can be configured
to restore either the alarm settings from the monitor's configured default Profile, or the most recently
used alarm settings. After any of these situations, you should check that the alarm settings are
appropriate for your patient, and if necessary, select the correct Profile and patient category.
If power is lost for less than one minute, the alarm settings prior to the power loss are restored.

40
 4

4Patient Alarms and INOPs

This chapter lists patient alarms and technical alarms (INOPs) alphabetically, irrespective of their
priority. INOPs start on page 47.

Patient Alarm Messages

The measurement labels and abbreviations for pressure, temperature, SpO2, and anesthetic agent
alarms are explained in the individual chapters.
Note that yellow arrhythmia alarms (“short yellow alarms”) may be shown with one or with two stars,
depending on the monitor and Information Center revision you are using.

Alarm Message From Condition Indication

***APNEA or CO2, Resp, Respiration has stopped for longer than numeric flashes, red alarm
***APNEA xxx sec AGM the preset apnea time. “xxx” denotes the lamp, alarm tone.
Apnea duration.
***ASYSTOLE ECG No QRS detected for a period greater numeric flashes, red alarm
than the asystole threshold (in the lamp, alarm tone.
absence of Vfib or chaotic ECG).
**awRR HIGH CO2, Resp, The airway respiration rate has exceeded numeric flashes and high limit
AGM the high alarm limit. is highlighted, yellow alarm
lamp, alarm tone.
**awRR LOW CO2, Resp, The airway respiration rate has dropped numeric flashes and low limit
AGM below the low alarm limit. is highlighted, yellow alarm
lamp, alarm tone.
**BIS HIGH BIS The Bispectral Index value has exceeded numeric flashes and high limit
the high alarm limit. is highlighted, yellow alarm
lamp, alarm tone.
**BIS LOW BIS The Bispectral Index value has dropped numeric flashes and low limit
below the low alarm limit. is highlighted, yellow alarm
lamp, alarm tone.
***BRADY (Pulse) Press, SpO2 The heart rate from the Pulse signal has numeric flashes and alarm
or fallen below the bradycardia limit. xxx limit is highlighted, red alarm
***BRADY xxx<yyy denotes the lowest measured value; yyy lamp, alarm tone.
is the bradycardia limit.
**CCO/CCI HIGH CCO Continuous Cardiac Output or CC numeric flashes and high alarm
Index is above the high alarm limit. limit is highlighted, yellow
alarm lamp, alarm tone.

41
4 Patient Alarms and INOPs Patient Alarm Messages

Alarm Message From Condition Indication

**CCO/CCI LOW CCO Continuous Cardiac Output or CC numeric flashes and low alarm
Index is below the low alarm limit. limit is highlighted, yellow
alarm lamp, alarm tone.
**CPP HIGH CPP The CPP value has exceeded the high numeric flashes and high limit
alarm limit. is highlighted, yellow alarm
lamp, alarm tone
**CPP LOW CPP The CPP value has fallen below the low numeric flashes and low limit
alarm limit. is highlighted, yellow alarm
lamp, alarm tone.
***DESAT or SpO2 The SpO2 value has fallen below the numeric flashes, red alarm
***DESAT xxx<yyy desaturation alarm limit. xxx denotes lamp, alarm tone.
the lowest measured value, and yyy is
the desaturation limit.
**et <Agent label> AGM The end tidal agent high alarm limit has numeric flashes and high limit
HIGH been exceeded. is highlighted, yellow alarm
lamp, alarm tone.
**et <Agent label> AGM The end tidal agent value has fallen numeric flashes and low alarm
LOW below the low alarm limit. limit is highlighted, yellow
alarm lamp, alarm tone.
**etCO2 HIGH CO2, Resp, The end tidal CO2 high alarm limit has numeric flashes and high limit
AGM been exceeded. is highlighted, yellow alarm
lamp, alarm tone.
**etCO2 LOW CO2, Resp, The end tidal CO2 value has fallen numeric flashes and low limit
AGM below the low alarm limit. is highlighted, yellow alarm
lamp, alarm tone.
**etO2 HIGH O2, AGM The end tidal O2 high alarm limit has numeric flashes and high limit
been exceeded. is highlighted, yellow alarm
lamp, alarm tone.
**etO2 LOW O2, AGM The end tidal O2 value has fallen below numeric flashes, and low limit
the low alarm limit. is highlighted, yellow alarm
lamp, alarm tone.
***EXTREME BRADY ECG The bradycardia limit has been numeric flashes and alarm
exceeded. limit is highlighted, red alarm
lamp, alarm tone.
***EXTREME TACHY ECG The tachycardia limit has been numeric flashes and alarm
exceeded. limit is highlighted, red alarm
lamp, alarm tone.
**HR HIGH ECG The heart rate high alarm limit has been numeric flashes and high limit
exceeded. is highlighted, yellow alarm
lamp, alarm tone. The sound
switches off after 5 seconds if
Arrhythmia is On.
**HR LOW ECG The heart rate has fallen below the low numeric flashes and low limit
alarm limit. is highlighted, yellow alarm
lamp, alarm tone. The sound
switches off after 5 seconds if
Arrhythmia is On.
**imCO2 HIGH CO2, Resp, The inspired minimum CO2 high alarm numeric flashes and high limit
AGM limit has been exceeded. is highlighted, yellow alarm
lamp, alarm tone.

42
Patient Alarm Messages 4 Patient Alarms and INOPs

Alarm Message From Condition Indication

**in <Agent label> AGM The inspired agent high alarm limit (3.4 numeric flashes, high limit is
HIGH vol.%) has been exceeded. highlighted, yellow alarm
lamp, alarm tone.
**in <Agent label> AGM The inspired agent value has fallen numeric flashes, low limit is
LOW below the AGT low alarm limit (1.0 highlighted, yellow alarm
vol.%). lamp, alarm tone.
**inN2O HIGH N2O, AGM The inspired N2O high alarm limit has numeric flashes, high limit is
been exceeded. highlighted, yellow alarm
lamp, alarm tone.
**inO2 HIGH O2, AGM The inspired O2 high alarm limit has numeric flashes, high limit is
been exceeded. highlighted, yellow alarm
lamp, alarm tone.
**inO2 LOW O2, AGM The inspired O2 value has fallen below numeric flashes, low limit is
the low alarm limit. highlighted, yellow alarm
lamp, alarm tone.
***inO2 LOW OXYGEN O2, AGM The inspired O2 value has fallen below numeric flashes, low limit is
18 vol.%. highlighted, red alarm lamp,
alarm tone.
*/**IRREGULAR HR ECG/ Consistently irregular heart rhythm. numeric flashes, yellow alarm
Arrhythmia lamp, short yellow audible
alarm.
*/**MISSED BEAT ECG/ No beat detected for 1.75*R-R interval, numeric flashes, yellow alarm
Arrhythmia or if HR>120bpm no beat detected for lamp, short yellow audible
one second (non-paced patients only). alarm.
*/**MULTIFORM PVCs ECG/ Two differently shaped Vs detected, numeric flashes, yellow alarm
Arrhythmia each occurring at least twice within the lamp, short yellow audible
last 300 beats and at least once within alarm.
the last 60 beats.
**NBP HIGH NBP The measured NBP value is above the numeric flashes and high limit
high alarm limit. is highlighted, yellow alarm
s, d, or m after the label indicates lamp, alarm tone.
whether the systolic, diastolic or mean
pressure has crossed the limit.
**NBP LOW NBP The measured NBP value is below the numeric flashes and low limit
low alarm limit. is highlighted, yellow alarm
s, d, or m after the label indicates lamp, alarm tone.
whether the systolic, diastolic or mean
pressure has crossed the limit.
*/**NON-SUSTAIN VT ECG/ A run of Vs having a ventricular HR>V- numeric flashes, yellow alarm
Arrhythmia Tach HR limit, but lasting for less than lamp, short yellow audible
the V-Tach Run limit has been detected. alarm.
*/**PACER NOT CAPT ECG/ A missed beat with a pace pulse was numeric flashes, yellow alarm
Arrhythmia detected. lamp, short yellow audible
(paced alarm.
patients only)
*/**PACER NT ECG/ A missed beat without a pace pulse was numeric flashes, yellow alarm
PACING Arrhythmia detected. lamp, short yellow audible
(paced alarm.
patients only)

43
4 Patient Alarms and INOPs Patient Alarm Messages

Alarm Message From Condition Indication

*/**PAIR PVCs ECG/ A non-ventricular contraction, followed numeric flashes, yellow alarm
Arrhythmia by two ventricular contractions, lamp, short yellow audible
followed by a non-ventricular alarm.
contraction has been detected.
*/**PAUSE ECG/ No beat detected for a period greater numeric flashes, yellow alarm
Arrhythmia than the pause threshold. lamp, short yellow audible
alarm.
***<Pressure> PRESS The pressure is non-pulsatile and the numeric flashes, red alarm
DISCONNECT mean pressure is continuously less than lamp, alarm tone.
10mmHg (1.3kPa). This alarm occurs
only with arterial pressures (P, ABP,
ART, AO, UAP, PAP).
**<Pressure> HIGH PRESS The measured pressure value is above numeric flashes, high limit is
the high alarm limit. s, d, or m after the highlighted, yellow alarm
label indicates whether the systolic, lamp, alarm tone.
diastolic or mean pressure has crossed
the limit.
**<Pressure> LOW PRESS The measured pressure value is below numeric flashes and low limit
the low alarm limit. s, d, or m after the is highlighted, yellow alarm
label indicates whether the systolic, lamp, alarm tone.
diastolic or mean pressure has crossed
the limit.
**PULSE HIGH PRESS The pulse rate has exceeded the high numeric flashes and high limit
SpO2 alarm limit. is highlighted, yellow alarm
lamp, alarm tone.
**PULSE LOW PRESS The pulse rate has dropped below the numeric flashes and low limit
SpO2 low alarm limit. is highlighted, yellow alarm
lamp, alarm tone.
*/**PVCs/min HIGH ECG/ More premature ventricular numeric flashes, yellow alarm
Arrhythmia contractions have been detected in a lamp, short yellow audible
minute than the limit. alarm.
*/**R-ON-T PVCs ECG/ For HR <100, a PVC with R-R interval numeric flashes, yellow alarm
Arrhythmia < 1/3 the average interval followed by a lamp, short yellow audible
compensatory pause of 1.25 x average alarm.
R-R interval or two such Vs without
compensatory pause occurring within 5
minutes of each other. (When HR
>100, 1/3 R-R interval is too short for
detection.).
**RR HIGH RESP The respiration rate has exceeded the numeric flashes and high limit
high alarm limit. is highlighted, yellow alarm
lamp, alarm tone.
**RR LOW RESP The respiration rate has dropped below numeric flashes and low limit
the low alarm limit. is highlighted, yellow alarm
lamp, alarm tone.
*/**RUN PVCs HIGH ECG/ A run of PVCs greater than 2 was numeric flashes, yellow alarm
Arrhythmia detected. lamp, short yellow audible
alarm.
**<SpO2 label> SpO2 The arterial oxygen saturation has numeric flashes and high limit
HIGH exceeded the high alarm limit. is highlighted, yellow alarm
lamp, alarm tone.

44
Patient Alarm Messages 4 Patient Alarms and INOPs

Alarm Message From Condition Indication

**<SpO2 label> LOW SpO2 The arterial oxygen saturation has fallen numeric flashes and low limit
below the low alarm limit. is highlighted, yellow alarm
lamp, alarm tone.
**ST<n> HIGH ECG/ The ST elevation in lead <n> is higher numeric flashes and high alarm
Arrhythmia than the limit. limit is highlighted, yellow
(Adult alarm lamp, alarm tone.
patients only)
**ST<n> LOW ECG/ The ST depression in lead <n> is lower numeric flashes and low alarm
Arrhythmia than the limit. limit is highlighted, yellow
(Adult alarm lamp, alarm tone.
patients only)
**SvO2 HIGH SvO2 The SvO2 value has exceeded the high numeric flashes and high alarm
limit. limit is highlighted, yellow
alarm lamp, alarm tone.
**SvO2 LOW SvO2 The SvO2 value has fallen below the low numeric flashes and low alarm
limit. limit is highlighted, yellow
alarm lamp, alarm tone.
*/**SVT ECG/ A run of supraventricular beats greater numeric flashes, yellow alarm
Arrhythmia than the SVT run limit has been lamp, alarm tone.
detected and the HR has exceeded the
SVT HR limit.
***TACHY (Pulse) Press, SpO2 The heart rate from the Pulse signal has numeric flashes, alarm limit is
or exceeded the tachycardia limit. xxx highlighted, red alarm lamp,
***TACHY xxx>yyy denotes the highest measured value; yyy alarm tone.
is the tachycardia limit.
**Tblood HIGH C.O. The blood temperature value has numeric flashes, high alarm
exceeded the high alarm limit. limit is highlighted, yellow
alarm lamp, alarm tone.
**Tblood LOW C.O. The blood temperature value has fallen numeric flashes, low alarm
below the low alarm limit. limit is highlighted, yellow
alarm lamp, alarm tone.
**tcpO2 HIGH/ tcGas The tcpO2 or tcpCO2 value has numeric flashes, high alarm
**tcpCO2 HIGH exceeded the high alarm limit. limit is highlighted, yellow
alarm lamp, alarm tone.
**tcpO2 LOW/ tcGas The tcpO2 or tcpCO2 value has fallen numeric flashes, low alarm
**tcpCO2 LOW below the low alarm limit. limit is highlighted, yellow
alarm lamp, alarm tone.
**<Temperature TEMP The temperature has exceeded the high numeric flashes and high limit
label> HIGH alarm limit. is highlighted, yellow alarm
lamp, alarm tone.
**<Temperature TEMP The temperature has fallen below the numeric flashes and low limit
label> LOW low alarm limit. is highlighted, yellow alarm
lamp, alarm tone.
*/**VENT BIGEMINY ECG/ A dominant rhythm of N, V, N, V (N = numeric flashes, yellow alarm
Arrhythmia supraventricular beat, V = ventricular lamp, short yellow audible
beat) was detected. alarm.

45
4 Patient Alarms and INOPs Patient Alarm Messages

Alarm Message From Condition Indication

***VENT FIB/TACH ECG A fibrillatory waveform for 4 numeric flashes, red alarm
consecutive seconds was detected. lamp, alarm tone.
*/**VENT RHYTHM ECG/ A dominant rhythm of adjacent Vs > numeric flashes, yellow alarm
Arrhythmia vent rhythm limit and ventricular HR < lamp, short yellow audible
VTach HR limit was detected. alarm.
*/**VENT TRIGEMINY ECG/ A dominant rhythm of N, N, V, N, N, numeric flashes, yellow alarm
Arrhythmia V (N = supraventricular beat, V = lamp, short yellow audible
ventricular beat) was detected. alarm.
***VTACH ECG, Ventricular tachycardia has been numeric flashes, yellow alarm
Arrhythmia detected (Consecutive PVCs exceed V- lamp, short yellow audible
Tach Run limit and HR exceeds V-Tach alarm.
HR limit).

46
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

Technical Alarm Messages (INOPs)

The measurement labels and abbreviations for pressure, temperature, SpO2, anesthetic agent, and
VueLink INOP messages are explained in the individual chapters.

INOP Message, Indication Source What to do

ABP INOPS PRESS See <Pressure label> INOPS (under P).
AGENT MIXTURE AGM The Gas Analyzer has detected more than one agent in the gas
Numerics shown with -?- sample. Agent measurement accuracy is likely to be reduced.
AGM ACCURACY? AGM Gas Analyzer measurement accuracy may be reduced. Check
Numerics shown with -?- that the gas inlet, watertrap, and gas outlet tubing are not
occluded. If this INOP persists, contact your service personnel.
AGM ALARM SUPPRESS AGM Gas Analyzer alarms will be suppressed until breathing activity
is first detected.
AGM INCOMPATIBLE AGM This version of the Gas Analyzer is not supported. Contact
INOP tone your service personnel.

AGM MALFUNCTION AGM There is a problem with the Gas Analyzer hardware. Check the
Numerics replaced by -?-, INOP tone connection to the monitor. Switch the Gas Analyzer off and
then on again. If this INOP persists, contact your service
personnel.
AGM NO BREATH AGM No breath detected. Check the patient connections.
Numerics replaced by -?-
AGM NOT AVAILABLE AGM The Gas Analyzer is either disconnected or switched off.
INOP tone.
AGM OCCLUSION AGM Make sure that the sample line and exhaust line tubing is not
Numerics replaced by -?-, INOP tone kinked. Check the airway adapter for a build up of water.
Empty the fluid and reposition the adapter if necessary. Ensure
that the airway adapter port is facing upwards. Try replacing
the sample line, watertrap, or exhaust line. If this INOP
persists, contact your service personnel.
AGM SELFTEST AGM The Gas Analyzer selftest is running. Wait until this INOP
Numerics replaced by -?- disappears to start monitoring.
AGM STANDBY AGM To resume gas monitoring, select Exit Standby in the Setup
GA menu.
AGM UNABLE TO MEAS AGM No action necessary. This situation usually corrects itself after a
Numerics replaced by -?-, INOP tone few seconds.
AGM UNPLUGGED AGM Make sure that the Anesthetic Gas Module is connected to the
INOP tone. monitor. All AGM measurements are off while the AGM is
unplugged.
AGM WARMUP AGM The Gas Analyzer has not yet reached operating temperature
Numerics shown with -?- and the measurement accuracy may be reduced.
AGM ZERO FAILED AGM A Gas Analyzer zero calibration failed. Check the exhaust tube
Numerics shown with -?- for an occlusion or kinking and replace if necessary. Manually
start another zero. If the zero has failed more than once, contact
your service personnel.
AGM ZERO RUNNING AGM Autozero in progress. If first auto zero fails then system will
First zero: numerics shown with -?-, retry; if the retry fails then the AGM MALFUNCTION INOP is
Second zero: numerics replaced by activated.
-?- ,INOP tone

47
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

INOP Message, Indication Source What to do

AGT ID MALFUNCTION AGM There is a problem with the automatic agent identification. To
Numerics replaced by -?-, INOP tone continue monitoring, switch to manual agent selection. The
(in Auto mode) Gas Analyzer numeric cannot reliably be derived. Contact your
service personnel.
<AGT> CHANGE SCALE AGM The wave of the agent shown is clipped (DES/ENF/HAL/SEV/
ISO). Select a more appropriate wave scale to display the whole
wave.
AGT ID ZERO FAILED AGM An automatic agent identification zero calibration failed. To
Numerics replaced by -?-, INOP tone continue monitoring, switch to manual agent selection.
(in Auto mode) Contact your service personnel.
<AGT> MEAS DISTURBED AGM The agent numeric cannot be reliably derived. If this INOP
Numerics replaced by -?- persists, contact your service personnel.
AGT MEAS RESTARTNG AGM The agent measurement is restarting. Wait until this INOP
disappears before resuming monitoring.
<AGT> UNABLE TO MEAS AGM The Gas Analyzer currently cannot measure the agent shown
Numerics replaced by -?-, INOP tone (DESFL/ENFL/HALOTH/SEVOFL/ISOFL). If this INOP
persists, contact your service personnel.
ALL ECG ALARMS OFF ECG/ All ECG alarms have been switched off, or the HR alarm
Arrhythmia source is not ECG. To resume ECG alarm generation, switch
ECG alarms on or select ECG as the alarms source.
Ao INOPS PRESS See <Pressure label> INOPS (under P).
ART INOPS PRESS See <Pressure label> INOPS (under P).
AWRR OVERRANGE AGM The measured respiration rate is higher than the maximum
Numerics shown with -?- measurable range.
BAD SERVERLINK Monitor 1) An MMS with an incompatible software revision is
INOP tone connected to the monitor. This combination does not allow
monitoring, OR
2) You cannot use this combination of monitor, MMS and
cable. Switch off the monitor and contact your service
personnel.
BATTERIES EMPTY or BATT 1/ Batteries The estimated remaining battery-powered operating time of
BATT 2 EMPTY the indicated battery or batteries is less than 10 minutes.
INOP tone, battery LED flashes Replace the batteries immediately.
During this INOP, alarms cannot be If the condition persists, this INOP is re-issued one minute
paused or switched off. after you acknowledge it.
BATTERIES INCOMPAT or BATT Batteries The indicated batteries cannot be used with this monitor.
1/BATT 2 INCOMPAT Replace with the correct batteries (M4605A).
INOP tone, battery LED flashes
BATTERIES LOW or BATT 1/ Batteries The estimated battery-powered operating time remaining is less
BATT 2 LOW than 20 minutes.
INOP tone, battery LED flashes
BATTERIES MALF or BATT 1/ Batteries The monitor cannot determine the battery status. If this INOP
BATT 2 MALFUNCTION persists, replace the faulty battery or batteries.
INOP tone, battery LED flashes Place the batteries in a different monitor. If the same INOP is
During this INOP, alarms cannot be shown, contact your service personnel.
paused or switched off.

48
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

INOP Message, Indication Source What to do

BATT 1/BATT 2 MISSING Batteries The monitor requires two batteries but can detect only one
Battery LED flashes functioning battery. Replace the missing or faulty battery
During this INOP, alarms cannot be immediately.
paused or switched off.
BIS DSC DISCONN BIS DSC is not properly connected OR either DSC or BIS engine
INOP tone may be faulty.
Make sure that the DSC is properly connected to the BIS
Engine. If INOP persists, replace DSC with a known good one
of the same type.
If INOP persists replace BIS engine.
Silencing this INOP switches the measurement off.
BIS DSC INCOMPT BIS DSC is not supported by the BIS engine or new DSC
INOP tone connected to an old BIS engine. A software upgrade may be
required. Contact your service personnel.
BIS DSC MALFUNC BIS Electrocautery used during self-test OR malfunction in the
DSC hardware.
Make sure not to use electrocautery during the self-test
procedure. Disconnect and reconnect the DSC to the BIS
engine. If the INOP persists, replace the DSC or contact your
service personnel.
BIS DSC UPDATE BIS DSC update currently being carried out. This INOP will
INOP tone disappear when the DSC update is finished. Do not disconnect
the DSC during the update. No action is needed.
BIS ENGINE DISCONN BIS BIS engine not connected OR Module Cable defective.
INOP tone Make sure that the Module Cable is properly connected. If
INOP persists, replace the Module Cable.
Silencing this INOP switches the measurement off.
BIS ENGINE INCOMPAT BIS BIS Engine software is not supported. A software upgrade may
INOP tone be required. Contact your service personnel.

BIS ENGINE MALFUNC BIS Malfunction in the BIS engine hardware. Disconnect and
INOP tone reconnect the BIS engine. If the INOP persists, replace BIS
engine.
BIS EQUIP MALF There is a malfunction in the BIS hardware. Unplug and replug
INOP tone the BIS Interface Module. If the INOP persists, contact your
service personnel.
BIS HIGH IMPEDANCE BIS Impedance of one or more electrode(s) is above the valid range,
INOP tone may sound most often caused by bad skin preparation. Check the sensor
montage and press the electrode pads firmly. If this INOP
persists, replace the sensor(s) in question using correct skin
preparation.
If INOP persists, contact your service personnel.
BIS IMPEDANCE CHCK BIS The Cyclic Impedance check is running. It will stop
INOP tone may sound automatically if all impedances are within the valid range. If
any electrodes do not pass the impedance test, check the sensor
montage and press the electrode pads firmly.
To manually stop the Cyclic Impedance Check, select
Cyclic Check Off in the Setup BIS menu.
BIS ISOELECTRC EEG BIS No discernible EEG activity is detected for longer than one
minute.
Check the patient. Check that the electrodes are properly
connected.

49
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

INOP Message, Indication Source What to do

BIS LEAD OFF BIS One or more electrodes have no skin contact and therefore
INOP tone impedances cannot be measured. Check the sensor montage
and press the electrode pads firmly.
If this INOP persists, replace the sensor(s) in question, using
correct skin preparation.
BIS OVERCURRENT BIS Unplug and replug the BIS module. If the INOP persists,
INOP tone contact your service personnel.

BIS SENSOR DISCONN BIS The sensor is not properly connected to the patient interface
INOP tone cable (PIC) and/or the PIC is not properly connected to DSC,
or the sensor/PIC/DSC may be faulty.
Check all the connections.
Disconnect and reconnect the PIC and DSC.
If the INOP persists, replace the sensor.
If the INOP persists, replace PIC. If INOP persists, contact
your service personnel.
BIS SENSOR INCOMPT BIS Unsupported sensor connected or sensor type unknown.
INOP tone Replace the sensor, using only Philips supported sensors.

BIS SENSOR MALFUNC BIS Malfunction in the sensor hardware, most often caused by
INOP tone liquids permeating into the connectors OR patient interface
cable (PIC) or DSC may be faulty.
Replace the sensor. Manually initiate a Cyclic Impedance
Check. Make sure all electrodes pass the test. Make sure that
the both sides of the PIC connector (between PIC and sensor)
are dry. If you are not sure that the connector is dry, replace the
PIC until it has dried. If this INOP persists, contact your
service personnel.
BIS SENSOR USAGE BIS Excessive sensor usage. Replace sensor.
INOP tone A Cyclic Impedance Check will start automatically.

BIS SQI < 15% (INOP tone) BIS If the signal quality is below 50%, BIS numerics cannot be
OR reliably derived.
If the signal quality is below 15%, no BIS numerics can be
BIS SQI < 50% (no INOP tone) derived.
This may occur as a result of artifacts such as those generated
from motion or the presence of electrocautery devices. Make
sure the sensor is properly attached to the patient. Manually
initiate a Cyclic Impedance Check. Make sure all electrodes
pass the test. Make sure the patient is completely relaxed (even
small motions of the facial muscles affect the signal quality).
BIS UNPLUGGED BIS Plug in the BIS Interface Module. Silencing this INOP
INOP tone switches off the measurement.

CANNOT ANALYZE ECG Arrhythmia The arrhythmia algorithm cannot reliably analyze the ECG
data. Check the ECG signal quality of the selected primary and
secondary leads. If necessary, improve lead position or reduce
patient motion.
If you are not getting a reliable HR because the signal is below a
minimum amplitude, unstable, or contains artifact, and you
have tried to improve the system performance by choosing
another lead and changing electrodes, you should consider
turning arrhythmia analysis off.

50
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

INOP Message, Indication Source What to do

CANNOT ANALYZE ST ST The ST algorithm cannot generate a valid ST value. Possible
causes are large variations in the measured ST values for
consecutive beats, or ventricular paced beats. Review the ECG
signal quality and the ST measurement points.
If the patient has a ventricular pacemaker, ST analysis is not
possible.
CCI NO BSA C.O. CCI cannot be calculated because the patient's body surface
CCI numeric unavailable area is unknown. Enter the patient weight and height to
INOP tone provide the BSA for CCI calculation.
CCO BAD PRESS SIGN C.O. The arterial pressure wave can currently not be used for pulse
numeric displays -?- contour calculation for CCO or CCI measurement. Possible
INOP tone causes are air bubbles in the tubing or a physiological
condition, for example severe arrhythmia.
CCO NO <Pressure label> C.O. CCO/CCI cannot be calculated. Make sure that the pressure
numeric displays -?- chosen in the Setup CCO menu under CCO From
INOP tone may sound matches the pressure measured with the arterial catheter for
CCO measurement. A VueLink pressure cannot be used. Select
another pressure label, either ABP, Ao, ART or UAP.
CCO NO CALIBRATION C.O. The CCO measurement is currently not calibrated.
numeric displays -?-
CCO NOT SUPPORTED C.O. A catheter for transpulmonary C.O. measurements has been
numeric displays -?- unplugged and replaced with a Right Heart C.O. catheter, or
INOP tone the measurement mode has been changed manually. Silencing
this INOP switches the measurement off.
CCO/CCI OVERRANGE C.O. The measured CCO or CCI value is not within the specified
numeric displays -?- range for CCO/CCI measurement.
INOP tone
CCO <Pressure label> C.O. The arterial pressure selected for pulse contour calculation for
INVALID CCO is available but currently invalid. Make sure the pressure
numeric displays -?- transducer is connected and the zero calibration is valid.
INOP tone may sound
CCO PRESS OVERRANG C.O. The mean value of the arterial pressure values used for pulse
numeric displays -?- contour calculation for CCO is below 0 mmHg or above 300
INOP tone mmHg.
CCO PULSE OVERRANG C.O. The pulse rate of the pressure used for pulse contour
numeric displays -?- calculation for CCO is below 30 bpm or above 240 bpm.
INOP tone
CCO/Tbl NO TRANSD C.O. No transducer attached to the module or catheter
Numeric displays -?- disconnected.
INOP tone
CCO RECALIBRATE C.O. The most recent CCO or CCI calibration was made over 8
numeric displays -?- hours ago. You should recalibrate CCO or CCI with
transpulmonary C.O. measurements at least every 8 hours or
when the hemodynamic condition of the patient has changed.
CHARGER MALFUNCT Batteries There is a problem with the battery charger in the monitor.
INOP tone, battery LED flashes Connect the monitor to mains power and contact your service
personnel.
CHECK AGENT AGM The agent selected for monitoring does not match the agent
Numerics replaced by -?-, INOP tone detected by the Gas Analyzer. Check that the correct agent is
selected.

51
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

INOP Message, Indication Source What to do

CHECK ALARM LAMPS Monitor Perform a visual check of the alarm lamp to establish whether
INOP tone. there is a problem. Contact your service personnel to check the
internal connections to the alarm lamps.
CHECK FLEX TEXTS Monitor Check the names of the monitor menus, for example the labels
INOP tone for screens, profiles, event or trend group names, before you
resume monitoring. If they are unexpected, there may be a
problem with the monitor software. Contact your service
personnel.
CHECKINTERNVOLTAGE Monitor There is a problem with the voltages (5V,12V) in the monitor.
INOP tone. Contact your service personnel.
CHECK KEYBOARD Monitor Perform a visual and functional check of the keyboard. Contact
INOP tone your service personnel.

CHECK MAIN BOARD 2 Monitor There is a problem with the second main board in the monitor.
INOP tone. Contact your service personnel.
CHECK MONITOR TEMP Monitor The temperature inside the monitor is too high. Check that the
INOP tone monitor ventilation is not obstructed. If the situation
continues, contact your service personnel.
CHECK MOUSE DEVICE Monitor Perform a visual and functional check of the mouse input
INOP tone. device. Contact your service personnel.
CHECK MSL VOLTAGE Monitor/ There is a problem with the voltage of the Measurement Server
INOP tone Measuremt Link (MSL). Contact your service personnel.
Server
CHECK NETWORK CONF Monitor The monitor is receiving network topology information from
INOP tone more than one source, e.g.the Database Server and an
Application Server. Contact your service personnel.
CHECK NURSE RELAY Monitor There is a problem with the connection to the nurse relay.
INOP tone Contact your service personnel.
CHECK SCREEN RES Monitor The Screen you have selected uses a resolution which is not
INOP tone supported by the display. The monitor will show a generic
Screen instead until you select a different Screen.
Contact your service personnel if you want the Screen deleted
from the Profile(s) to avoid this in future.
CHECK SPEEDPOINT Monitor Perform a visual and functional check of the SpeedPoint input
INOP tone. device. Contact your service personnel.
CHECK TOUCH INPUT Monitor Perform a visual and functional check of the touch input
device. Contact your service personnel.
CHECK WAVES Monitor The options purchased with this monitor may not support the
INOP tone number of waves required to show the selected Screen, so some
waves or high resolution trends are missing from the Screen.
Select a different Screen with fewer waves.
Contact your service personnel if you want the Screen deleted
from the Profile(s) to avoid this in future.
C LEAD OFF ECG The C electrode has become detached from the patient or the
HR numeric is displayed with a -?- for lead set has been changed. Reattach the electrode or select New
10 seconds. INOP tone. Lead Setup in the Setup ECG menu to confirm the
new lead set.
CO2 AUTO ZERO CO2 The automatic zero calibration is in progress. This typically
Numeric is replaced by a - ? - takes 10 seconds. During this time the CO2 values may not be
if the Autozero lasts >15 sec, INOP updated, or they may be replaced by -?-. Wait until the zero
tone sounds. calibration is complete to resume monitoring.

52
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

INOP Message, Indication Source What to do

CO2 CAL MODE CO2 Currently no calibration is running. Accuracy can be checked
CO2 numeric displays current CO2 by placing the transducer on the two cells of the calstick and
value for accuracy check starting calibration. To start monitoring, leave Cal. Mode.
CO2 CAL RUNNING CO2 Wait until calibration is finished.
Numeric is replaced by a - ? -
CO2 CHANGE SCALE CO2 The CO2 wave is clipped. Select a more appropriate wave scale
to display the whole wave.
CO2 CHECK CAL CO2 The CO2 value is outside the measurement range. Perform an
Numeric is replaced by a - ? - accuracy check for both calstick cells and, if necessary,
INOP tone. recalibrate the transducer.
C.O. EQUIP MALF C.O. There is a problem with the C.O. hardware. Contact your
Numeric is replaced by a - ? - service personnel.
INOP tone.
CO2 EQUIP MALF CO2 The Measurement Server Extension is faulty. Unplug and
Numeric is replaced by - ? - replug the Measurement Server with Extension. If you are using
INOP tone. the mainstream method, unplug and replug the transducer or
try another transducer. If the INOP persists, contact your
service personnel.
CO2 FAILED CAL CO2 Make sure that the Cal cell was changed between CAL1 and
Numeric is replaced by -?- CAL2. Repeat the calibration. If the INOP reappears, try
INOP tone. another transducer. If the INOP persists, contact your service
personnel.
CO2 MEAS DISTURBED CO2 The Gas Analyzer etCO2 or imCO2 numeric cannot be reliably
Numeric is replaced by -?-. (AGM) derived. If this INOP persists, contact your service personnel.
INOP tone.
CO2 NO TRANSDUC CO2 There is no CO2 transducer connected. If you replace the
Numeric is replaced by - ? - transducer, the new transducer must be calibrated. If you
INOP tone. silence this INOP the CO2 measurement will be switched off.
CO2 NO TUBING CO2 Either the FilterLine is disconnected, or an incorrect line is
Numeric is replaced by - ? - attached. Check the connection. If necessary, connect another
INOP tone. Microstream Filterline (only Microstream accessories can be
used).
If you silence this INOP, the measurement will be switched off.
CO2 OCCLUSION CO2 The FilterLine or exhaust tube is blocked. Check the FilterLine
Numeric is replaced by a - ? - and exhaust tube, then disconnect and reconnect the
INOP tone. FilterLine. If the INOP persists, connect a new FilterLine.
CO2 OVERRANGE CO2 The CO2 value is higher than the measurement range. If you
Numeric is replaced by - ? - suspect a false high value, contact your service personnel.
INOP tone.
CO2 PURGING CO2 The Filterline is being purged to remove an occlusion in the
Numeric is replaced by a - ? - line or airway adapter. If the occlusion is removed, the INOP
INOP tone. will disappear. If not, the INOP CO2 OCCLUSION is
displayed.
CO2 SENSOR WARMUP CO2 Wait until the sensor reaches operating temperature and the
Numeric is displayed with a - ? - INOP disappears.
Microstream CO2: INOP tone.
Mainstream CO2: no INOP tone
CO2 UNABLE TO MEAS CO2 The Gas Analyzer currently cannot measure CO2. If this INOP
Numeric is replaced by -?-. INOP tone (AGM) persists, contact your service personnel.

53
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

INOP Message, Indication Source What to do

C.O. UNPLUGGED C.O. Plug in the C.O. module. Silencing this INOP switches off the
numeric displays -?- measurement.
INOP tone.
CO2 UPDATE FW CO2 The software in the Measurement Server Extension does not
Numeric is replaced by a - ? - match the software in the MMS. Contact your service
INOP tone. personnel.
CO2 WAIT CAL2 CO2 Calibration on the first calstick cell is complete. Place the
Numeric is replaced by a - ? - transducer on the other calstick cell and start the CAL2
calibration cycle.
CPP CHK SOURCES CPP Not all measurements or values required to perform the
Numeric is replaced by a - ? - calculation are available. Check the measurement sources.
CPP CHK UNITS CPP The monitor has detected a conflict in the units used for this
Numeric is replaced by a - ? - calculation. Check the unit settings.
CUFF NOT DEFLATED NBP Remove the cuff from the patient. Make sure that the tubing is
Numeric is displayed with a - ? - not kinked or twisted and that the correct patient category is
INOP tone. selected. Try repeating the measurement.
You can silence the INOP, but the INOP message remains
During this INOP, alarms cannot be visible until the next NBP measurement is started or the Stop
paused or switched off. All SmartKey is selected.
[Adult or pediatric patients: The NBP cuff pressure has exceeded
15mmHg (2kPa) for more than 3 minutes.
Neonatal patients: The NBP cuff pressure has exceeded 5mmHg
(0.7kPa) for more than 90 seconds.]
CVP INOPS PRESS See <Pressure label> INOPS (under P).
ECG EQUIP MALF ECG Contact your service personnel.
Numeric is displayed with a - ? - The ECG hardware is faulty.
INOP tone.
<ECG LEAD> LEAD OFF ECG Not all the required leads for ECG monitoring are connected.
Numeric is displayed with a - ? - Check the ECG connections and make sure that the electrode
INOP tone. indicated by <ECG lead> (RA, LA, LL, RL, V) electrodes is
attached. In EASI mode, all 5 electrodes must be connected.
ECG EL. NOISY <ECG LEAD> ECG The ECG signal from the named ECG electrodes (RA, LA, LL,
RL, V) is noisy. Check the ECG connections and make sure
that the electrode indicated is attached.
ECG NOISY SIGN. ECG The ECG signal is too noisy. Check that the electrodes are
INOP tone. properly placed and have not dried out. Remove any possible
sources of signal noise (such as power cords) from the area
around the cable and the patient.
The ECG signal may be saturated or overloaded.
EEG EQUIP MALFUNC EEG The EEG hardware is faulty. Contact your service personnel.
INOP tone
EEG IMPEDANCE HIGH or EEG The signal electrode in one or both channels exceeds the user-
EEG1 and/or EEG2 IMPED. selected impedance limit, or the impedance of a single electrode
HIGH exceeds the limit. Check the impedance. If the impedance is
too high, reconnect the electrodes according to the EEG
monitoring setup guidelines.If the INOP persists, contact your
service personnel.
EEG LEADS OFF EEG Connect specified electrodes (start with reference electrode).
EEG<X> LEAD(S) OFF Lead electrodes are not connected to the patient’s head.
[X = lead label]

54
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

INOP Message, Indication Source What to do

EEG LINE NOISE EEG Excessive line noise has been detected in either channel EEG1
EEG 1 or 2 LINE NOISE or EEG2, or in both EEG channels.
Keep all cables together and away from metallic bodies, other
cables & radiated fields.
EEG MUSCLE NOISE EEG Too much power above 30 Hz has been detected in channel
EEG 1 or 2 MUSCLE NOISE EEG1 or EEG2, or both.
Check the Electrode-to-Skin Impedance and reposition the
electrode away from possible muscle activity, if necessary.
EEG NO TRANSDUCER EEG The trunk cable is disconnected from the EEG plug-in module.
INOP tone Reconnect the trunk cable.

EEG UNPLUGGED EEG Plug in module. Silencing this INOP switches off the
INOP tone measurement.

EEG OVERRANGE, or EEG Input signal is too high in one or both channels. This is usually
caused by interfering signals such as line noise or electrosurgery.
EEG<X> OVERRANGE
X denotes the EEG channel.
FMS UNPLUGGED FMS Make sure that the Flexible Module Server is connected to the
INOP tone. monitor. All FMS measurements are off while the FMS is
unplugged.
GAS CONTAMINANT AGM The Gas Analyzer has detected a contaminant gas in the gas
Numerics may be shown with -?- sample. Check the breathing system for the presence of
INOP tone. contaminating gases and flush if needed.
ICP INOPs PRESS See <Pressure label> INOPS (under P).
INTERNAL.COMM.MALF Monitor There is a problem with I2C Bus communication in the
INOP tone monitor. Contact your service personnel.

LA LEAD OFF ECG The LA electrode has become detached from the patient or the
Numeric is displayed with a -?- for 10 lead set has been changed. Reattach the electrode or select New
seconds; INOP tone. Lead Setup in the Setup ECG menu to confirm the
new lead set.
LAP INOPs PRESS See <Pressure label> INOPS (under P).
LEADS OFF ECG Check that all of the required ECG leads are attached, and that
Numeric is displayed with a -?- for 10 none of the electrodes have been displaced.
seconds; INOP tone.
LL LEAD OFF ECG The LL electrode has become detached from the patient or the
Numeric is displayed with a -?- for 10 lead set has been changed. Reattach the electrode or select New
seconds; INOP tone. Lead Setup in the Setup ECG menu to confirm the
new lead set.
MEASSRV UNSUPPORTD Monitor The measurement server is not supported by the monitor.
Contact your service personnel.
MMS UNPLUGGED MMS Make sure that the Multi-Measurement Server is connected to
INOP tone. the monitor. All MMS measurements are off while the MMS is
unplugged.
MSL POWER HIGH Monitor The power consumption of the devices connected to the
Measurement Server Link (MSL) cable is too high. If this
situation continues, the MSL will be switched off. Contact
your service personnel.
MSL POWER OFF Monitor The power consumption of the devices connected to the
INOP tone. Measurement Server Link (MSL) cable was too high for too
long and the MSL has been switched off. Contact your service
personnel.

55
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

INOP Message, Indication Source What to do

MSL POWER OVERLOAD Monitor The power consumption of the devices connected to the
INOP tone. Measurement Server Link (MSL) cable is much too high or
there has been a short circuit. The MSL has been switched off.
Contact your service personnel.
N2O CHANGE SCALE AGM The N2O wave is clipped. Select a more appropriate wave scale
to display the whole wave.
N2O MEAS DISTURBED AGM The Gas Analyzer numeric cannot reliably be derived. If this
Numerics replaced by -?-. INOP tone INOP persists, contact your service personnel.
N2O UNABLE TO MEAS. AGM The Gas Analyzer currently cannot measure N2O. If this
Numerics replaced by -?-. INOP tone INOP persists, contact your service personnel.
NBP CUFF OVERPRESS NBP The NBP cuff pressure exceeds the overpressure safety limits.
Numeric displayed with -?- ; INOP Remove the cuff from the patient. Make sure that the tubing is
tone. not kinked or twisted and that the correct patient category is
During this INOP, alarms cannot be selected. Try restarting the measurement.
paused or switched off. You can silence this INOP, but the INOP message remains
visible until the next measurement is started or the Stop All
SmartKey is selected.
NBP EQUIP MALF NBP Remove the cuff from the patient. The NBP hardware is faulty.
Numeric is displayed with a -?- Contact your service personnel.
INOP tone. You can silence this INOP, but the INOP message remains
visible until the next measurement is started or the Stop All
SmartKey is selected.
NBP INTERRUPTED NBP Check the tubing and cuff for leakages or kinks. Check that
Numeric is displayed with a -?- you are using the correct cuff size and placement, and that the
INOP tone. correct patient category is selected. Try restarting the
measurement.
If the INOP occurs repeatedly, contact your service personnel.
You can silence this INOP, but the INOP message remains
visible until the next measurement is started or the Stop All
SmartKey is selected.
This INOP arises when the measurement needed longer than
the maximum time for inflation, deflation or the total
measurement.
NBP MEASURE FAILED NBP Check that you are using the correct cuff size and placement,
Numeric is displayed with a -?- and that the correct patient category is selected. Try restarting
INOP tone. the measurement.
You can silence this INOP, but the INOP message remains
visible until the next measurement is started or the Stop All
SmartKey is selected.
Check the condition and suitability of the patient for NBP
monitoring. Use another cuff to continue measuring.
NO CENTRAL MONIT. Monitor There is a problem with the communication to the network.
INOP tone Central monitoring is currently not possible (no patient alarms
or information). Check the connection. Contact your service
personnel.
O2 CHANGE SCALE AGM The O2 wave is clipped. Select a more appropriate wave scale to
Numerics replaced by -?- display the whole wave.
O2 EQUIP MALF AGM There is a problem with the Gas Analyzer O2 sensor. If this
INOP tone INOP persists, contact your service personnel.
O2 MEAS DISTURBED AGM The Gas Analyzer numeric cannot reliably be derived. If this
Numerics replaced by -?-. INOP tone INOP persists, contact your service personnel.

56
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

INOP Message, Indication Source What to do

O2 UNABLE TO MEAS AGM The Gas Analyzer currently cannot measure O2. If this INOP
Numerics replaced by -?-. INOP tone persists, contact your service personnel.
O2 ZERO FAILED AGM An O2 zero calibration failed. Contact your service personnel.
Numerics replaced by -?-. INOP tone
P INOPS PRESS See <Pressure label> INOPS (under P).
PAP INOPS PRESS See <Pressure label> INOPS (under P).
<Pressure label> ARTIFACT PRESS A non-physiological event is detected (for example, a flush or
Numeric displayed with -?- blood sample). A resulting high limit alarm will be suppressed.
<Pressure label> PRESS You have connected a measurement device (module or
DEACTIVATED measurement server) that uses a label the monitor has already
INOP tone assigned to a different source. To activate the new source,
choose a new label in the Measurement Selection window.
<Pressure label> EQUIP PRESS Contact your service personnel.
MALF The pressure hardware is faulty.
Numeric displayed with -?-
INOP tone.
<Pressure label> NO PRESS Make sure that the pressure transducer is connected to the
TRANSDUCER measurement server or module server.
Numeric is displayed with a -?- If you silence this INOP, the measurement will be switched off.
INOP tone.
<Pressure label> NOISY PRESS This INOP can only arise when a pressure is selected as the
SIGNAL pulse source. It occurs when the pulse detector finds a pulse
Pulse numeric is displayed with a -?- rate above 350bpm. This is usually caused by movement
INOP tone. artifact or electrical interference.
<Pressure label> NON- PRESS This INOP can only arise when a pressure is selected as the
PULSATILE pulse source. It occurs when the pulse rate being measured is
Pulse numeric is displayed with a -?- less than 25 beats per minute or the amplitude is less than three
INOP tone. mmHg.
Check the catheter and connections to the patient.
<Pressure label> PRESS Make sure that the measurement has been properly prepared
OVERRANGE and zeroed, and that the transducer is level with the heart. If
Numeric is displayed with a -?- this INOP persists, try another transducer.
INOP tone. Possible causes are a measured pressure outside the allowed
pressure range, or a broken wire to the transducer.
<Pressure label> REDUCE PRESS Increase the scale for the pressure wave.
SIZE
<Pressure label> TRANSDUC PRESS Contact your service personnel.
MALF The transducer is faulty.
Numeric is displayed with a -?-
INOP tone.
<Pressure label> PRESS The pressure measurement is switched on but the accessories
UNPLUGGED have been unplugged. Silencing this INOP switches off the
measurement.
<Pressure label> PRESS Perform a zero and check the calibration of the transducer.
ZERO+CHECK CAL
Numeric is displayed with a -?-
RA LEAD OFF ECG The RA electrode has become detached from the patient or the
Numeric is displayed with a -?- lead set has been changed. Reattach the electrode or select New
INOP tone. Lead Setup in the Setup ECG menu to confirm the
new lead set.
RAP INOPS PRESS See <Pressure label> INOPS (under P).

57
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

INOP Message, Indication Source What to do

REM.ALARMDEV.MALF Monitor There is a problem with the connection to the remote alert
INOP tone device. Contact your service personnel to check the remote
alert device and its connections.
RESP EQUIP MALF RESP Contact your service personnel. The RESP hardware is faulty.
Numeric is displayed with a -?-
INOP tone.
RESP ERRATIC RESP The monitor has detected too many artifacts in the measured
Numeric is displayed with a -?- Resp signal. Check that the RA and LL electrodes are correctly
attached and have not dried out.
RESP LEADS OFF RESP Not all the required leads for Resp monitoring are attached.
Numeric is displayed with a -?- Make sure that the RA and LL leads are attached.
INOP tone.
RL LEAD OFF ECG The RL electrode has become detached from the patient or the
Numeric is displayed with a -?- for 10 lead set has been changed. Reattach the electrode or select New
seconds; INOP tone. Lead Setup in the Setup ECG menu to confirm the
new lead set.
SETTINGS MALFUNC. Monitor The monitor cannot use the predefined settings for
INOP tone. monitoring. Contact your service personnel.
SOME ECG ALARMS OFF Arrhythmia This message appears (if configured to do so) when the on/off
settings of the yellow arrhythmia alarms differ from the current
Profile.
SPEAKER MALFUNCT. Monitor Contact your service personnel to check the speaker and the
INOP tone connection to the speaker.

∆SpO2 CHK SOURCES SpO2 Not all measurements or values required to perform the
Numeric is displayed with a -?- Difference calculation are available. Check measurement sources.
∆SpO2 CHK UNITS SpO2 The monitor has detected a conflict in the units used for this
Numeric is displayed with a -?- Difference calculation. Check the unit settings.
<SpO2 label> DEACTIVATED SpO2 You have connected a measurement server that uses a label the
INOP tone monitor has already assigned to a different source. To activate
the new source, choose a new label in the Measurement
Selection window.
<SpO2 label> EQUIP MALF SpO2 The MMS is faulty. Unplug and replug the MMS. If the INOP
Numeric is replaced by a -?- persists, contact your service personnel.
INOP tone.
<SpO2 label> ERRATIC SpO2 Check the sensor placement. Try another adapter cable and
Numeric is replaced by a -?- sensor. If the INOP persists, contact your service personnel.
INOP tone.
<SpO2 label> EXTD. UPDATE SpO2 The update period of displayed values is extended due to an
Label is displayed with a -?- NBP measurement on the same limb or an excessively noisy
(questionable numeric) signal.

<SpO2 label> INTERFERNCE SpO2 There is too much interference, caused by a high level of
Numeric is replaced by a -?- ambient light and/or electrical interference. Cover the sensor to
INOP tone. minimize ambient light. If the INOP persists, make sure that
the sensor cable is not damaged or positioned too close to
power cables .
<SpO2 label> LOW PERF SpO2 Accuracy may be compromised due to very low perfusion.
Label is displayed with a -?- Stimulate circulation at sensor site. If INOP persists, change
(questionable numeric) the measurement site.

58
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

INOP Message, Indication Source What to do

<SpO2 label> NOISY SIGN. SpO2 Excessive patient movement or electrical interference is causing
Numeric is replaced by a -?- irregular pulse patterns. Try to reduce patient movement or to
INOP tone. relieve the cable strain on the sensor.
<SpO2 label> NON-PULSAT. SpO2 Check the perfusion at measurement site. If necessary,
Numeric is replaced by a -?- stimulate circulation or change measurement site. If the INOP
INOP tone. is due to NBP measurement on the same limb, wait until the
NBP measurement is finished.
<SpO2 label> NO SENSOR SpO2 Make sure the SpO2 sensor is connected. If the INOP persists,
Numeric is replaced by a -?- try another adapter cable and sensor. If you silence this INOP,
INOP tone. the measurement will be switched off.
<SpO2 LABEL> POOR SIGNAL SpO2 The signal condition of the SpO2 measurement is poor and
Label is displayed with a ? measurement accuracy may be compromised.
(questionable numeric)
<SpO2 LABEL> PULSE? SpO2 The detectable pulsations of the SpO2 signal are outside the
Numeric is replaced by -?- specified pulse rate range.
INOP tone
<SpO2 LABEL> SEARCHING SpO2 SpO2 is analyzing the patient signal to derive Pulse, SpO2 and
Numeric unavailable Perf values. Please wait until the search analysis is complete.

<SpO2 label> SENSOR MALF SpO2 The SpO2 sensor or adapter cable is faulty. Try another adapter
Numeric is replaced by a -?- cable and sensor. If the INOP persists, contact your service
INOP tone. personnel.
<SpO2 LABEL> SENSOR OFF SpO2 The SpO2 sensor is not properly applied to the patient. Apply
Numeric is replaced by -?- the sensor following the instructions supplied by the
INOP tone manufacturer.

<SpO2 LABEL> UNKN.SENSOR SpO2 The connected sensor or adapter cable is not supported by the
Numeric is replaced by a - ? - SpO2 measurement. Use only specified sensors and cables.

<SpO2 LABEL> UPGRADE SpO2 The SpO2 measurement is currently in UPGRADE mode.
Label is displayed with a -?-, numeric is Monitoring is not possible in this mode.
unavailable
Sp - vO2 CHK SOURCES Sp - vO2 Not all measurements or values required to perform the
Numeric is displayed with a -?- calculation are available. Check measurement sources.
Sp - vO2 CHK UNITS Sp - vO2 The monitor has detected a conflict in the units used for this
Numeric is displayed with a -?- calculation. Check the unit settings.
SvO2 CAL FAILED SvO2 The calibration failed. Check the catheter-to-Optical-Module
SvO2 numeric is displayed with ? connection. Manually restart the calibration. Try another
catheter and Optical Module. If the catheter is already inserted,
perform an in-vivo calibration.
SvO2 CAL MODE SvO2 Pre-insertion calibration is complete, but the catheter tip is still
SvO2 numeric displays -?- inside the optical reference. The catheter is now ready for
insertion.
SvO2 CAL REQUIRED SvO2 There is no valid calibration data in the Optical Module.
SvO2 numeric displays -?-. Perform either a pre-insertion or an in-vivo calibration.
INOP tone may sound
SvO2 CONFIGURATION SvO2 The Optical Module has been configured to SaO2 Mode. Use
SvO2 numeric displays -?-. Change to SvO2 in the Setup SvO2 menu to
INOP tone reconfigure to SvO2 Mode.
SvO2 CONNCT OPTMOD SvO2 The Optical Module was disconnected during data storage.
SvO2 numeric displays -?-. Reconnect the Optical Module for at least 20 seconds.
INOP tone

59
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

INOP Message, Indication Source What to do

SvO2 EQUIP MALF SvO2 The SvO2 Module or Optical Module is faulty. Unplug and
SvO2 numeric displays -?-. replug the Optical Module and SvO2 module. Exchange the
INOP tone modules. If the INOP persists, contact your service personnel.
SvO2 IN-VIVO CALIB SvO2 The in-vivo calibration is not yet complete. Lab values must be
SvO2 numeric displays -?-. stored to the Optical Module to complete the calibration.
Either continue with the next steps of the current calibration or
recall the previous calibration.
SvO2 LIGHT INTENS SvO2 The intensity changed considerably since the last light intensity
SvO2 numeric displays -?- or numeric calibration. This may indicate that the catheter tip is positioned
is displayed with ? against a blood vessel wall or that there is low blood flow.
INOP tone with -?- display Reposition the catheter and perform a light intensity
calibration.
SvO2 LOW LIGHT SvO2 The optical signal levels are too low. Check that the catheter is
SvO2 numeric displays -?- or numeric either in the optical reference or inserted into the patient.
is displayed with ? Check the catheter-to-Optical Module connection. If INOP
INOP tone may sound persists, try another catheter and Optical Module.
SvO2 NO OPTMOD SvO2 Connect the Optical Module. If the INOP persists, try another
SvO2 numeric displays -?-. Optical Module. Silencing this INOP switches the
INOP tone measurement off.
SvO2 OPTMOD DEFECT SvO2 The Optical Module memory is faulty, and calibration data
cannot be stored for transport or during power failure. If this
feature is needed, use another Optical Module.
SvO2 OPTMOD WARMUP SvO2 The Optical Module has not yet reached the operating
SvO2 numeric is displayed with ? temperature. Wait a few minutes until warm-up is finished.
SvO2 PRE-INS CALIB SvO2 The pre-insertion calibration is running. This typically takes
SvO2 numeric displays -?- one minute. During this time SvO2 alarms are switched off.
INOP tone Wait until the calibration is complete.
SvO2 UNABL TO MEAS SvO2 The signal is out of the normal range, and no SvO2 value can
SvO2 numeric displays -?-. be derived. Perform an in-vivo calibration. If the INOP
INOP tone persists, try another Optical Module and catheter.
SvO2 UNPLUGGED SvO2 Measurement switched on and SvO2 module unplugged from
SvO2 numeric displays -?-. the rack.
INOP tone
SVR/SVRI CHK SOURCES SVR/SVRI Not all measurements or values required to perform the
Numeric is displayed with a -?- calculation are available. Check measurement sources.
SVR/SVRI CHK UNITS SVR/SVRI The monitor has detected a conflict in the units used for this
Numeric is displayed with a -?- calculation. Check the unit settings.
SVR/SVRI SET CVP USED SVR/SVRI A CVP value is required for this calculation, but is not
numeric displays - ? - currently being measured. The monitor is using the CVP value
preset in the Setup SVR menu.
Tart INOPS TEMP See <Temp label> INOPs (under T)
Tblood NO TRANSDUC C.O. No transducer attached to the module or catheter
Numeric displays -?- disconnected.
INOP tone
Tblood OVERRANGE C.O. Tblood out of range 17°C - 43°C.
Numeric displays -?-
Tcore INOPS TEMP See <Temp label> INOPs (under T).

60
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

INOP Message, Indication Source What to do

tcpO2 (or tcpCO2 or tcGas) tcGas A calibration failed. Check the cal. unit, gas pressure, and
CAL FAILED tubing connections, then restart the cal. If the cal. has failed
Numeric displays -?- more than once, remembrane the transducer and restart the
INOP tone. calibration. If this INOP persists, contact your service
personnel.
tcpO2 (or tcpCO2 or tcGas) tcGas Calibration is required before applying the transducer to the
CAL REQUIRD patient.
Numeric displays -?- Insert a membraned transducer into the cal. chamber on the
INOP tone. module, connect the cal. unit to the cal. chamber, open the gas
valve and start the calibration. If this INOP occurs during a
calibration, there may be a module or transducer malfunction:
contact your service personnel.
tcpO2 (or tcpCO2 or tcGas) tcGas Wait until the tcpO2/tcpCO2 calibration is finished.
CAL RUNNING
Numeric displays first -?- , then
numeric is displayed with a ?
tcpO2 (or tcpCO2 or tcGas) tcGas Site Timer due to time out in 15 minutes or less.
CHECK TIME
tcpO2 (or tcpCO2 or tcGas) tcGas Site Timer has timed out. Change the application site to avoid
CHANGE SITE skin burns. To reset the Site Timer, either calibrate and change
If Heat Switch Off is configured to Yes, the measurement site, or change the measurement site and reset
numeric displays -?- the Site Timer manually by selecting the appropriate site time
INOP tone. from the Setup TCGas menu.
tcpO2 (or tcpCO2 or tcGas) tcGas There is a malfunction in the transducer or module. Connect
EQUIP MALF another transducer. If this INOP persists, contact your service
Numeric displays -?- personnel.
INOP tone.
tcpO2 (or tcpCO2 or tcGas) tcGas No transducer is connected to the tcpO2/tcpCO2 module.
NO TRANSDUC Silencing the alarm switches off the measurement.
Numeric displays -?-
INOP tone.
tcpO2 (or tcpCO2 or tcGas) tcGas The transducer has not yet reached the selected temperature
STABILIZING and/or skin hyperemization is not yet finished. This INOP will
Numeric is displayed with a ? disappear within three minutes.
tcpO2 (or tcpCO2 or tcGas) tcGas Module switched on and unplugged from rack. Silencing this
UNPLUGGED INOP switches off the measurement.
Numeric displays -?-
INOP tone.
<Temp label> - <Temp TEMP Not all measurements or values required to perform the
label> CHK SOURCES Difference calculation are available. Check measurement sources.
Numeric is displayed with a -?-
<Temp label> - <Temp TEMP The monitor has detected a conflict in the units used for this
label> CHK UNITS Difference calculation. Check the unit settings.
Numeric is displayed with a -?-
<Temp label> DEACTIVATED TEMP You have connected a measurement device (module or
INOP tone measurement server) that uses a label the monitor has already
assigned to a different source. To activate the new source,
choose a new label in the Measurement Selection window.
<Temp label> EQUIP MALF TEMP Contact your service personnel.
Numeric is displayed with a -?- The temperature hardware is faulty.
INOP tone.

61
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

INOP Message, Indication Source What to do

<Temp label> NO TEMP Make sure the TEMP probe is connected to the MMS or
TRANSDUCER module.
Numeric is displayed with a -?- If you silence this INOP, the measurement will be switched off.
INOP tone.
<Temp label> UNPLUGGED TEMP The temperature measurement is switched on but the
INOP tone accessories have been unplugged. Silencing this INOP switches
off the measurement.
<Temp label> OVERRANGE TEMP Try changing the application site of the transducer.
Numeric is displayed with a -?- [The temperature is less than -1°C, or greater than 45°C.]
INOP tone.
Tesop INOPS TEMP See <Temp label> INOPs (under T).
Tnaso INOPS TEMP See <Temp label> INOPs (under T).
TOO MANY AGENTS AGM More agents are detected than agent channels are available.
Check that both agent channels are switched on in the gas
analyzer setup menu
Trect INOPS TEMP See <Temp label> INOPs (under T).
Tskin INOPS TEMP See <Temp label> INOPs (under T).
Tven INOPS TEMP See <Temp label> INOPs (under T).
UAP INOPS PRESS See <Pressure label> INOPS (under P).
UNSUPPORTED LAN Monitor There is a problem with the communication to the network
INOP tone and central monitoring is currently not possible. Check the
connection.If the INOP persists, switch off the monitor and
contact your service personnel.
USER I/F MALFUNCT. Monitor Perform a visual and functional check of all the monitor input
INOP tone. devices. Contact your service personnel.
UVP INOPS PRESS See <Pressure label> INOPS (under P).
<VueLink option> CHK VueLink No cable or the wrong cable connected to the VueLink module,
CABLE or incorrect device selected. Silencing this INOP switches the
INOP tone. measurement off.
VueLink INOP abbreviations may differ slightly depending on
the device category.
<VueLink option> CHK VueLink The wrong external device has been selected on the VueLink
CONF. module, or the external device has not been correctly setup, or
INOP tone. the wrong cable has been used to connect the device to the
VueLink module.
VueLink INOP abbreviations may differ slightly depending on
the device category.

62
Technical Alarm Messages (INOPs) 4 Patient Alarms and INOPs

INOP Message, Indication Source What to do

<VueLink option> CHECK VueLink No information was received from the external device. The
SETUP device may be switched off or disconnected.
INOP tone. VueLink INOP abbreviations may differ slightly depending on
the device category.
VueLnk EQUIP MALF VueLink Malfunction in the VueLink module. If this message appears
INOP tone. repeatedly, the module must be replaced. Contact your service
personnel.
VueLink INOP abbreviations may differ slightly depending on
the device category.
VueLnk NO CONFIG VueLink The VueLink module has not been configured during
INOP tone. installation. The installation process should be completed by
either your biomedical engineering department or the Philips
service engineer.
VueLink INOP abbreviations may differ slightly depending on
the device category.
VueLnk UNPLUGGED VueLink The VueLink module has been unplugged from the rack, or the
INOP tone. whole rack has been disconnected. Silencing this INOP
switches off the measurement.
VueLink INOP abbreviations may differ slightly depending on
the device category.

63
4 Patient Alarms and INOPs Technical Alarm Messages (INOPs)

64
 5

5Managing Patients
The monitor displays physiological data and stores it in the trends as soon as a patient is connected.
This lets you monitor a patient who is not yet admitted. It is however important to fully admit patients
so that you can clearly identify your patient on recordings, reports and networking devices. During
admission you enter data that the monitor needs for safe and accurate operation. For example, the
monitor uses patient category (Adult, Neo or Pedi) to determine the way the monitor processes and
calculates some measurements, and the safety and alarm limits that apply to the patient.
All patient information entered at the bedside is automatically communicated to the Information
Center and vice versa.

Admitting a Patient
You can admit a patient at either the bedside or the Information Center. When you admit a patient,
the patient’s name appears on the bedside monitor and the Information Center.

Use the Patient Demographics window and its Patient Demographics

associated pop-up keys to admit, discharge, and Last Name
transfer (ADT) patients. To open the Patient First Name
Demographics window:
MRN
1 Select the patient name field or select the Patient Cat. Adult
Admit/Dischrge SmartKey. Paced No
2 Clear any previous patient data by selecting Gender
the Dischrge Patient or End Case Date Of Birth
pop-up key and then Confirm. Age
If you do not erase data from the previous Height
patient, it appears in the trends with the new Weight
patient’s data. The monitor makes no BSA (D)
distinction between the old and the new Notes (1):
patient data. Notes (2):

3 Enter the patient information: select each

field and use the on-screen keyboard or
choose from the pop-up list of alternatives to
input information. If a a conventional keyboard is connected to the monitor you can use this to
enter patient information.
– Last name: Enter the patient’s last name (family name), for example Smith.
– First name: Enter the patient’s first name, for example Joseph.

65
5 Managing Patients Quick Admitting a Patient

– MRN: Enter the patient’s medical record number (MRN), for example 12345678
– Patient Cat: Choose the patient category, either Adult, Pediatric, or Neonatal.
– Paced: Choose Yes or No (You must use “Yes” if your patient has a pacemaker).
– Gender: Choose male or female.
– DOB: Enter the patient’s date of birth. Enter this in the form dd/mm/yyyy.
– Age: The monitor calculates the patient age automatically.
– Height: Enter the patient’s height.
– Weight: Enter the patient’s weight.
– BSA: The monitor calculates the body surface area automatically.
– Notes: Enter any extra information about the patient or treatment.
4 Select Confirm. The patient status changes to admitted.

Patient Category and Paced Status

The patient category setting determines the algorithm the monitor uses to process and calculate some
measurements, the safety limits that apply for some measurements, and the alarm limit ranges.
The paced setting determines whether the monitor shows pacemaker pulses or not. When Paced is
set to No, pace pulse are filtered and therefore do not show in the ECG wave.

WARNING Patient Category and Paced status will always contain a value, regardless of whether the
patient is fully admitted or not. If you do not specify settings for these fields, the monitor uses the
default settings from the current profile, which might not be correct for your patient.

Patient category Changing the patient category may change the arrhythmia and NBP alarm limits.
Always check alarm limits to make sure that they are appropriate for your patient.

Paced status For paced patients, you must set Paced to yes. If it is incorrectly set to no, the monitor
could mistake a pace pulse for a QRS and fail to alarm during asystole.

Quick Admitting a Patient

Use Quick Admit only if you do not have the time or information to fully admit a patient. Complete
the rest of the patient demographic details later. If you do not, the patient name will be not be written
on reports and on information stored in the database or sent to an Information Center.
1 Open the Patient Demographics window.
2 Clear any previous patient data by selecting the pop-up key Dischrge Patient and then
Confirm.
3 Enter the patient category and paced status for the new patient.
4 Select Confirm.
The patient name field shows no patient admitted and the patient name space on printed reports
is blank. You can discharge an “unadmitted” patient, but the documentation will not display a patient
name. To fully admit this patient, select the Patient Demographics window again and complete
the fields. This enables you to transfer this patient.

66
Editing Patient Information 5 Managing Patients

Editing Patient Information

To edit the patient information after a patient has been admitted, select the patient name field on the
Main Screen to open the Patient Demographics window, and make the required changes.

Discharging a Patient
You should perform a discharge even if your previous patient was not admitted. A discharge:
– clears the information in the Patient Demographics window
– erases all patient data (such as trend, event, calculation data) from the monitor, measurement
servers and Information Center
– resets patient category and paced settings to the settings defined in the default Profile
– resets all monitor and measurement settings as well as the active Screen to the settings defined in
the default Profile
– discharges the patient from the Information Center.
If the monitor is not connected to an Information Center, make sure that you have printed out any
required reports before discharging to avoid losing patient data.
1 Select the patient name field to display the Patient Demographics window and associated pop-up
keys.
2 Select the pop-up key for either:
– End Case - to first print any configured end case reports, discharge the patient and erase the
patient database, then enter standby mode. If an End Case SmartKey is configured for your
monitor, you can also select this instead and then confirm.
Select the Cancel End Case pop-up key to end the End Case procedure.
– Dischrge Patient - to discharge patient and return to default settings (no printout). The
monitor displays the Patient Demographics window, with no patient admitted.

67
5 Managing Patients Transferring a Patient

Transferring a Patient
Different sets of patient- and measurement-related data are stored in the monitor and the Multi-
Measurement Server. Understanding this will help you to understand what happens to patient data
when you transfer patients.

Patient Information Stored in Monitor Stored in MMS and extensions

Patient demographics (name, yes yes
DOB, MRN)
Monitor settings (alarm pause yes no
time, alarm volume)
Measurement settings for all yes most recent 8 hours of
measurements (alarm limits, information, for all MMS and
measurement on/off, etc.) extensions measurements

Trend data yes, all measurements (up to a most recent 8 hours of

maximum of 16 or 32, depending information, for all MMS and
on your database configuration) extensions measurements
Calculation data (HemoCalc yes no
data)
Events data yes no

WARNING The monitor is not battery-powered. You cannot monitor during transport.

Transferring a Centrally Monitored Patient

If your monitor is connected to the Information Center, you can move patients and re-admit them at
new locations within the network without re-entering the patient demographic information.
1 Select the Patient Demographics window. Select the Transfer pop-up key.
2 Select Confirm to move the patient to the transfer list in the Information Center. The monitor
displays the message Patient prepared for transfer.
3 When the monitor is at its new location, reconnect it to the local area network (LAN). If the
patient is not already admitted at the Information Center, the monitor automatically admits the
patient now.
4 Select Confirm to retain the patient demographic information.
If you accidentally transfer a patient, use Re-admit to restore this patient’s data to the Information
Center. If you are not connected to the network, select Clear Transfer to leave transfer mode.The
patient data remains in the monitor.

68
Resolving Patient Information Mismatch 5 Managing Patients

Transferring a Patient with an MMS

To transfer a patient with an MMS,
1 Disconnect the MMS from the original monitor.
2 Silence the resulting MMS UNPLUGGED INOP.
3 Move the patient with the measurement server and connect the MMS at the new monitor.
4 If prompted, re-admit the patient to the new monitor: in the Patient Selection window,
select Continue MMS to retain the data in the MMS. This will upload the patient
demographics, and, if configured, the measurement settings and trend data stored in the MMS to
the monitor. Verify that the settings for patient category and paced mode are correct.
Remember to discharge the patient from the original monitor to clear this data before starting to
monitor a new patient.

Resolving Patient Information Mismatch

When you connect an MMS to a monitor, or a monitor to the network, the monitor compares patient
category, paced status, and a unique patient identification number that is internally stored in both the
MMS and the monitor. The monitor indicates a mismatch if the information is not identical.
Depending on your monitor’s configuration, this mismatch may be automatically resolved or you may
have to resolve it manually. If your monitor is configured to resolve mismatches automatically,
depending on the configuration, either the monitor or the Multi-Measurement Server data is
automatically retained.

Manually Resolving Patient Mismatch

The patient mismatch is indicated by question marks (???) beside the questionable fields in the Monitor
Info Line and in the Patient Demographics window. The monitor displays a message such as
Different patients in Central and Monitor. The Patient Selection window
automatically opens so you can decide which patient data to use. You do not have to resolve the
mismatch immediately, however, the indicators remain until you do. There can be up to three columns
of data in the Patient Selection window if the patient is different in the Information Center,
monitor, and MMS.
After you resolve the mismatch, the monitor displays a confirmation window that explains the
consequences of your choice, telling you where the patient will be continued/discontinued. Confirm
your choice. The monitor automatically displays the Patient Demographics window after
confirmation. Verify that the settings shown are correct for the patient.
Gender, date of birth, height, weight, and nursing notes do not generate a mismatch. If these fields are
different on different devices, the monitor resolves them itself. For example, it may take date of birth
from the Information Center, whilst taking gender from the MMS. Always check the Patient
Demographics after combining patients, to ensure that you are satisfied with the results. Change them
if necessary.

WARNING After resolving a patient mismatch, check that the monitor settings (for example, patient category,
alarm limits) are correct for the patient.

69
5 Managing Patients Resolving Patient Information Mismatch

Patient Mismatch - If One Set of Patient Data is Correct

♦ If there is a mismatch between an Patient Selection

Information Center and a monitor, Central Monitor
choose the data set you want to
Last name DOE MILLER
continue using for this patient,
either: First name JOHN
MRN 1234HG9556
Continue Central: to continue with
the patient demographics from the Patient Cat Adult Neo
Information Center, discharge the Paced No Yes
patient in the monitor, and use the
default monitor profile.
Continue Monitor: to continue with Continue Continue New Same
the patient in the monitor and Central Monitor Patient Patient
discharge the patient in the
Information Center, permanently
deleting all data in the Information
Center.

♦ If there is a mismatch between a Patient Selection

monitor and a measurement server, Monitor MeasServ
choose the data set you want to
Last name MILLER ADAMS
continue using for this patient,
either: First name PETER
MRN
Continue Monitor: to continue with
the patient demographics, trend Patient Cat Neo Neo
data, and settings in the monitor. Paced Yes No
This discharges the patient in the
measurement server, and resets all
MMS settings to the defaults Continue Continue New Same
currently active for the monitor. Monitor MMS Patient Patient
Continue MMS: to upload the data
- patient demographics, trend data
(if configured), and measurement
settings (if configured) - stored in the MMS to the monitor. This clears all data in the monitor,
resets the monitor to the default Profile, and discharges the patient in the monitor.

Patient Mismatch - If Neither Patient Data Set is Correct

A patient mismatch where neither set of patient data is correct might occur if you connect a new MMS
to a monitor in order to prepare for a new patient, before you actually start measuring.
♦ Select New Patient if you are sure that none of the information is correct. This discharges all
patients, erases all data in both the monitor and MMS, resets all settings to the default Profile, and
lets you admit a new patient.

70
Care Groups 5 Managing Patients

Patient Mismatch - If Both Patient Data Sets Are Correct

A patient mismatch where both sets of patient data are correct might occur if you admit a new patient
at the monitor (or Information Center) before the patient arrives at your unit and then connect the
MMS that was used during the patient transport to the monitor.
♦ Select Same Patient if the patient information is different, but you are sure it is the same
patient. This merges the demographics and updates them in the Information Center, monitor, and
MMS, according to this table. Be aware that your monitor may be configured to merge trend data
from the MMS and the monitor, and to upload measurement settings from the MMS to the
monitor.

Patient Information This information is taken from...

Patient name the monitor, if the patient was admitted there. For centrally-admitted
MRN patients, this information is taken from the Information Center.

Screen Notes
Patient Category the Multi-Measurement Server.
Date of Birth
Height
Weight
Gender
Paced Status Paced status is always set to Yes where there is a conflict in patient
information.
Trend data if there is newer trend data stored in the MMS, it is uploaded to the
monitor.

Automatically Resolving Patient Mismatch

Your monitor can be configured to automatically resolve mismatches in one of two ways.
• continue using the patient in the MMS, and delete the old data in the monitor. This is suitable for
transport monitors.
• continue with the patient in the monitor, and delete the data in the MMS.

Care Groups
If your monitor is connected to an Information Center, you can group up to 12 bedside monitors in
one Care Group. This lets you:
• view information on the monitor screen from another bed in the same or in a different Care Group.
• be notified of yellow or red alarm conditions at the other beds in the Care Group.
• see the alarm status of all the beds in the Care Group on each monitor screen.
Monitors must be assigned to Care Groups at the Information Center. See the Information Center
documentation for instructions.

71
5 Managing Patients Care Groups

Understanding Care Group Symbols

The Care Group monitors’ status is shown in symbol form in the Care Group overview bar.

Care Group Symbols

The highest priority alarm at this monitor
is an INOP condition

The highest priority alarm at this monitor

is a yellow alarm

The highest priority alarm at this monitor

is a red alarm

The alarms at this monitor are suspended

No data is available from the chosen

monitor

The alarms are on but there are no

currently active alarms at this monitor

The monitor is in standby mode

The monitor is in Demonstration Mode

DEMO

This is the currently displayed monitor

This is a telemetry bed

This bed is on a wireless network

72
Care Groups 5 Managing Patients

Viewing the Care Group Overview Bar

In the overview bar, flashing symbols indicate active alarms, symbols that are not flashing indicate
alarms that have been acknowledged. The bed label and patient name for any Care Group beds in
alarm condition rotate on the right. Selecting a bed symbol calls up the Other Patient window
for that bed.

Bed 3 Jones, Mary

If the Care Group overview bar is not visible on your monitor, select a Screen which has been
configured to show the bar.

Viewing the My Care Group Window

This window shows the alarm status, bed name, My Care Group
and patient name for every bed in the Care -?- Bed 1 Smith, Mary
Group. ** Bed 2 Jones, Paul
To enter the My Care Group window, *** Bed 3 Murphy, Sarah
♦ select the Other Patients SmartKey, if
configured, or
♦ in the Main Setup menu, select My Care
Group.
Use the My Care Group pop-up keys to navigate
through the Care Groups:
My Unit lets you view a list of all the Information Centers in your Care Unit. Select an Information
Center to see a list of the monitors connected to it. Select any monitor to see the Other Patient
window for that bed.
Other Units lets you view a list of all the Care Units in your Care Domain. Select any Care Unit
to view a list of the Information Centers connected to it. Select an Information Center to see a list of
the monitors connected to it. Select any monitor to see the Other Patient window for that bed.

73
5 Managing Patients Care Groups

Viewing the Other Patient Window

This window shows a subset of the waveform and numeric information from a selected monitor.
♦ To open the window, select the patient name or bed label in the My Care Group window, or
select the bed symbol in the Care Group overview bar. You can also use the My Care Group pop-
up keys.

Bed Name, Patient Name

NO TRANSDUC ** HR HIGH

HR
110
Next More Next My Care
Wave Vitals Bed Group

Use the pop-up keys to navigate through the Care Group:

Next Wave lets you view waveforms not currently shown in the other bed window.
More Vitals lets you view more numerics not currently shown in the other bed window.
Next Bed lets you view waveforms and numerics from the next available bed.
My Care Group lets you call up the Care Group window.

Using Care Group Alarms

If automatic alarm notification is enabled at the beside monitor and at the Information Center, alarm
conditions in the Care Group will be indicated at all the monitors in the Care Group. In
Configuration Mode, you can choose whether the Other Patient window or the My Care Group
window should pop up as notification, or you can switch notification off permanently. The prompt
Care Group alarm also appears, announced by an audible tone.
In Monitoring Mode you can temporarily enable or disable automatic alarm notification at the bedside
monitor, for example if you want to carry out a procedure:
1 Select the network symbol on the monitor screen to call up the Network menu.
2 Select Auto Window to toggle between the settings Enabled and Disabled.
This setting resets to the default at discharge and when the monitor is switched on. Always re-enable
the Auto Window as soon as possible.

74
 6

6ECG, Arrhythmia, and ST

Monitoring
The electrocardiogram (ECG) measures the electrical activity of the heart and displays it on the
monitor as a waveform and a numeric. This section also tells you about arrhythmia monitoring (see
page 91) and ST monitoring (see page 101).

Placing ECG Electrodes

1 Prepare the patient’s skin. Good electrode-to-skin contact is important for a good ECG signal, as
the skin is a poor conductor of electricity.
– shave hair from sites, if necessary
– wash sites thoroughly with soap and water. We do not recommend using ether or pure alcohol,
because this dries the skin and increases the resistance.
– dry skin thoroughly by rubbing briskly to increase capillary blood flow in the tissues and remove
dead skin cells and oil.
2 Attach the clips or snaps to the electrodes before placing them. If you are not using pre-gelled
electrodes, apply electrode gel to the electrodes before placement.
3 Place the electrodes on the patient according to the lead placement you have chosen.

CAUTION To protect the monitor from damage during defibrillation, for accurate ECG information and to
protect protection against noise and other interference, use only ECG electrodes and cables specified by
Philips.

Connecting ECG Cables

1 Attach the electrode cable to the patient cable.
2 Plug the patient cable into the white ECG
connector on the measurement server. An ECG
waveform and numeric appears on the monitor
display.
ECG Connector

75
6 ECG, Arrhythmia, and ST Monitoring Selecting the Primary and Secondary ECG Leads

Selecting the Primary and Secondary ECG Leads

The monitor uses the primary and secondary lead to compute HR and to analyze and detect cardiac
arrhythmias. They are also available for recordings and for display on the Information Center.
The secondary lead setting is used only if your monitor is configured for multi-lead (instead of single-
lead) arrhythmia analysis. It determines which additional lead will be used for arrhythmia analysis.

You should choose a lead as primary or secondary lead

that has the following characteristics:
• the QRS should be either completely above or below
the baseline and it should not be biphasic
• the QRS should be tall and narrow
• the P-waves and T-waves should be less than 0.2 mV

To select a lead as primary or secondary lead:

♦ In the Setup ECG menu, select Primary Lead or Secondary Lead, then select the
appropriate lead. You can assign any available lead whether it is currently displayed or not.

Checking Paced Status

It is important to set the paced status correctly when you start monitoring ECG.
♦ To change the paced status in the Setup ECG menu, select Paced, then select Yes or No.

WARNING Pace pulse rejection must be switched on for paced patients by setting “Paced” to Yes. Switching pace
pulse rejection off for paced patients may result in pace pulses being counted as regular QRS
complexes, which could prevent an asystole alarm from being detected.
Some pace pulses can be difficult to reject. When this happens, the pulses are counted as a QRS
complex, and could result in an incorrect HR and failure to detect cardiac arrest or some arrhythmias.
Keep pacemaker patients under close observation.

76
Understanding the ECG Display 6 ECG, Arrhythmia, and ST Monitoring

Understanding the ECG Display

Your display may be configured to look slightly different.

Lead 1 mV calibration bar Pace pulse marks Defibrillator synchronization marks

label of
the HR
displayed M
wave

ECG 1mV EASI

Filter
label EASI lead placement label Current heart rate alarm limits Current heart rate

ECG numeric: This is derived from the monitored ECG.

Pace pulse markers: These are shown if the Paced status has been set to Yes and the patient has a
paced signal.
Defibrillator synchronization marks: If an HP/Agilent/Philips defibrillator is connected, the
synchronization marks (vertical lines on the ECG wave) are shown on the ECG wave.

ST numerics in ECG wave: ST numerics can be configured to show underneath the ECG wave on
the bottom left.

Monitoring Paced Patients

An ECG optimized for monitoring a paced patient should look like this:

Normal Beats Pace Pulses/Beats

You should choose a lead as primary or secondary lead that has these characteristics:
• the normal QRS should be either completely above or below the baseline and it should not be
biphasic. For paced patients, the QRS complexes should be at least twice the height of pace pulses.
• the QRS should be tall and narrow
• the P-waves and the T-waves should be less than 0.2 mV.

77
6 ECG, Arrhythmia, and ST Monitoring Changing the Size of the ECG Wave

Setting the Paced Status (Pace Pulse Rejection)

♦ In the Setup ECG menu, select Paced to toggle between Yes and No. Paced
You can also change the paced status in the Patient Demographics window.
When Paced is set to Yes:
– Pace Pulse Rejection is switched on. This means that pacemaker pulses are
not counted as extra QRS complexes.
Non-Paced
– pace pulse marks are shown on the ECG wave as a small dash
– the paced symbol is displayed on the main screen.
When Paced is set to No, pacer spikes are not shown in the ECG wave.

Avoiding Pace Pulse Repolarization Tails

Some unipolar pacemakers display pace pulses with repolarization tails. These tails may be counted as
QRSs in the event of cardiac arrest or other arrhythmias.
If you note a visible repolarization tail, choose a lead that decreases the size of the repolarization tail.

Repolarization tail
(note width)

Changing the Size of the ECG Wave

If any of the displayed ECG waves is too small or clipped, you can change the size of one or all of the
ECG waves on the screen.
Changing the adjustment factor only changes the visual appearance of the ECG wave on the screen. It
does not affect the ECG signal analyzed by the monitor.
Comparing the wave size to the 1 mV calibration bar on the ECG wave segment can help you to get an
idea of the true ECG signal strength. If you choose a fixed adjustment factor, the 1 mV calibration bar
will be the same size for all the displayed ECG waves. If you choose AutoSize, the calibration bar may
be a different size for each wave.

To Change the Size of an Individual ECG Wave

1 Select the wave segment you want to change. This calls up the lead menu for this segment.
2 In the lead menu, select Size Up to increase wave size or Size Down to decrease the size.
Selecting AutoSize lets the monitor choose the optimal adjustment factor for all displayed ECG
waves.

78
Changing the Volume of the QRS Tone 6 ECG, Arrhythmia, and ST Monitoring

To Change the Size of all the ECG Waves

To change the size of all the ECG waves on the screen by a fixed adjustment factor,
1 In the Setup ECG Lead menu, select Adjust Size.
2 Select the required adjustment factor from the line of pop-up keys.
– Size x0.5 to halve the wave size
– Size x1 to display the wave without zoom
– Size x2 to double the wave size
– Size x4: to multiply the wave size by four
– Previous Size: to return one step to the previous size
– Auto Size: to let the monitor choose the optimal adjustment factor for all the ECG waves.

Changing the Volume of the QRS Tone

The QRS tone is derived from either the HR or Pulse, depending on which is currently selected as the
alarm source. The QRS volume can be set from 0 to 10 (0 means off).
♦ To change the QRS volume, in the Setup ECG menu select QRS Volume and then select the
appropriate volume from the pop-up list.

Changing the ECG Filter Settings

The ECG filter setting defines how ECG waves are smoothed. A letter indicating the filter type is
shown underneath the lead label on the monitor display. Filter settings do not affect ST measurement.
12-Lead ECG captures are analyzed in the PIC using the diagnostic filter and displayed on the
Information Center using the filter setting from the bedside monitor. Any changes you make to the
filter setting at the bedside monitor may take up to a minute to be reflected at a connected Information
Center. For this reason, you should wait one minute between changing the filter setting and sending a
12-lead capture to an Information Center.
♦ To change the filter setting, in the Setup ECG menu, select Filter and then select the
appropriate setting.
– Monitor: Use under normal measurement conditions.
– Filter: The filter reduces interference to the signal. It should be used if the signal is distorted
by high frequency or low frequency interference. High frequency interference usually results in
large amplitude spikes making the ECG signal look irregular. Low frequency interference usually
leads to a wandering or rough baseline. In the operating room, the Filter reduces artifacts and
interference from electrosurgical units. Under normal measurement conditions, selecting
Filter may suppress the QRS complexes too much and thus interfere with ECG analysis.
If AutoFilter is set to On in Configuration Mode, the filter setting will automatically be set to
Filter if electromagnetic interference is detected.
– Diag (Diagnostic): Use when diagnostic quality is required. The unfiltered ECG wave is
displayed so that changes such as R-wave notching or discrete elevation or depression of the ST
segments are visible.
The setting Diag selects the highest available ECG bandwidth which is 0.05 to 150 Hz for the
Adult and 0.5 to 150 Hz for the Pedi and Neo patient category. The term “diagnostic” relates

79
6 ECG, Arrhythmia, and ST Monitoring Choosing EASI or Standard Lead Placement

only to the ECG bandwidth requirements for diagnostic electrocardiographic devices as

outlined in the ANSI/AAMI standard EC11-1991.

Choosing EASI or Standard Lead Placement

If EASI™ monitoring is available on your monitor, you must enable either standard lead placement or
EASI lead placement.
♦ In the Setup ECG menu, select Lead Placement and then Standard or EASI.
EASI is shown beside the 1mV calibration bar on the ECG wave on the display, and EASI is marked
on any recorder strips and printouts.
See the section on EASI ECG Lead Placement for electrode placement diagrams.

About ECG Leads

To make it possible to compare measured ECG signals, the electrodes (or lead sets) are placed in
standardized positions, forming so-called “leads.” To obtain ECG signals optimized for use in
diagnosis and patient management in different care environments, different lead sets in varying lead
placements can be used. You can use either standard lead placements or EASI lead placements with this
monitor.
When placing electrodes, choose a flat, non-muscular site where the signal will not be interfered with
by either movement or bones. Correct lead placement is always important for accurate diagnosis.
Especially in the precordial leads, which are close to the heart, QRS morphology can be greatly altered
if an electrode is moved away from its correct location.

ECG Leads Monitored

If you are using these leads are available: Resp is measured
between electrodes:
a 3-electrode set I, II, III RA and LL
a 5-electrode set I, II, III, aVR, aVL, aVF, V and MCL RA and LL
a 10-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 RA and LL
an EASI 5-electrode set I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I and A

Changing Lead Sets

To change the ECG lead set,
1 Remove the electrodes and then replace them as required.
2 If the new lead set has more leads than the previous, the monitor automatically recognizes the new
lead placement. If the new lead set has fewer leads, then you must select New Lead Setup in the
Setup ECG menu. If you remove electrodes without selecting New Lead Setup, the monitor
may issue a Leads Off INOP message.

80
ECG Lead Fallback 6 ECG, Arrhythmia, and ST Monitoring

ECG Lead Fallback

If fallback is configured on and there is a leads off INOP in the primary lead (and in the secondary
lead, if you are using multi-lead monitoring) for longer than 10 seconds, and if another lead is
available, this available lead automatically becomes the primary lead. This is known as lead fallback.
When the Leads Off condition is corrected, the leads are automatically switched back.
Lead fallback can be switched on and off in the monitor’s Configuration Mode.

ECG Lead Placements

The labels and colors of the ECG electrodes differ according to the standards that apply for your
hospital. The electrode placement illustrations in this chapter use the AAMI labels and colors.

Electrode labels Electrode colors

AAMI EASI IEC AAMI IEC
RA I R White Red
LA S L Black Yellow
LL A F Red Green
RL N N Green Black
V E C Brown White
V1 C1 Brown/Red White/Red
V2 C2 Brown/Yellow White/Yellow
V3 C3 Brown/Green White/Green
V4 C4 Brown/Blue White/Brown
V5 C5 Brown/Orange White/Black
V6 C6 Brown/Violet White/Violet

Standard 3-Lead Placement

RA placement: directly below the clavicle
and near the right shoulder
RA LA
I +
- LA placement: directly below the clavicle
- and near the left shoulder
-
LL placement: on the left lower abdomen
III

II

LL
+
+

81
6 ECG, Arrhythmia, and ST Monitoring ECG Lead Placements

Standard 5-Lead Placement

LA RA placement: directly below the clavicle and

near the right shoulder
RA I
aVR LA placement: directly below the clavicle

L
aV
and near the left shoulder

III RL placement: on the right lower abdomen

V

aVF
II LL placement: on the left lower abdomen

V placement: on the chest, the position

RL depends on your required lead selection

LL

82
ECG Lead Placements 6 ECG, Arrhythmia, and ST Monitoring

Chest Electrode Placement

For accurate chest electrode placement and measurement, it is important to locate the fourth
intercostal space.
1 Locate the second intercostal space by first palpating the Angle of Lewis (the little bony
protuberance where the body of the sternum joins the manubrium). This rise in the sternum is
where the second rib is attached, and the space just below this is the second intercostal space.
2 Palpate and count down the chest until you locate the fourth intercostal space.

V1 placement: on the fourth

Angle of intercostal space at the right sternal
Lewis border

V2 placement: on the fourth

intercostal space at the left sternal
2 border
3

4 V1 V2
V7 V3 placement: midway between the
V4R V3R
VE V3
V5
V6 V2 and V4 electrode positions
V4

V4 placement: on the fifth

intercostal space at the left
midclavicular line

V5 placement: on the left anterior

axillary line, horizontal with the V4
electrode position

V6 placement: on the left midaxillary line, horizontal with the V4 electrode position

V3R to V6R placement: on the right side of the chest in positions corresponding to those on the left

VE placement: over the xiphoid process

V7 placement: on posterior chest at the left posterior axillary line in the fifth intercostal space

V7R placement: on posterior chest at the right posterior axillary line in the fifth intercostal space

83
6 ECG, Arrhythmia, and ST Monitoring ECG Lead Placements

10-Lead Placement
When monitoring 12-leads of ECG, using a 10-Electrode Lead Placement, it is important to correctly
place electrodes and to label all 12-lead ECG reports with the correct lead placement.

Conventional 12-Lead ECG

In conventional 12-Lead ECG using 10 electrodes, an electrode is placed on the right arm, left arm,
right leg, and left leg. Six V- electrodes are placed on the chest. The right leg electrode is the reference
electrode.

84
ECG Lead Placements 6 ECG, Arrhythmia, and ST Monitoring

Modified 12-Lead ECG

If your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System),
place the four limb electrodes close to the shoulders and lower abdomen.
The six V electrodes are placed on the chest in the same position as the conventional 12-lead
placement.

LA
Angle of Lewis

RA

RL LL

85
6 ECG, Arrhythmia, and ST Monitoring Capture 12-Lead

Choosing Standard or Modified Electrode Placement

If your institution uses modified 10 Lead ECG electrode placement (the Mason-Likar Lead System),
you must switch Mod. Lead Placment to On in the monitor. To do this,
♦ in the Setup ECG menu, select Mod. LeadPlacement to toggle between On and Off.
– When Mod. Lead Placment is set to On, 12 Lead ECG Reports will be labelled 12 Lead
ECG Report (Mason-Likar), and captured 12-lead ECGs will be labelled Mason-
Likar to the right of the bandwidth annotation at the Information Center.
– When Mod. LeadPlacment is set to Off, 12 Lead ECG Reports will be labelled 12
Lead ECG Report, and captured 12-lead ECGs will not be annotated at the Information
Center.

WARNING Do not use ECG analysis interpretation statements and measurements for 12-lead ECGs obtained
using the modified (Mason-Likar) limb electrode placement.This may lead to misdiagnosis since the
modified (Mason-Likar) limb electrode placement does not look the same as the conventional 12-lead
ECG and may mask inferior infarction due to calculated axis, R, P and T wave magnitudes shifts and
ST slope.
Do not export 12-lead ECGs obtained using the modified (Mason-Likar) limb electrode placement.
Captured 12-Lead ECGs using the modified (Mason-Likar) limb electrode placement exported from
the Information Center are not annotated with the Mason-Likar label.

Labelling 12-Lead ECG Reports

To label 12-lead ECG monitor reports and Captured 12-lead ECGs reports:
♦ In the Setup ECG menu, select Mod. LeadPlacement to toggle between On and Off.
When Mod LeadPlacement is set to On:
– 12 Lead ECG Reports will be labelled 12 Lead ECG Report (Mason-Likar).
– Captured 12-lead ECGs will be labelled Mason-Likar to the right of the bandwidth annotation at
the Information Center.
When Mod. LeadPlacement is set to Off,
– 12 Lead ECG Reports will be labelled 12 Lead ECG Report.
– Captured 12-lead ECGs will have no annotation next to the bandwidth annotation at the
Information Center.

Capture 12-Lead
If the monitor is connected to an Information Center, the Capture 12-Lead SmartKey may be
configured to show on the screen. Selecting this exports 12-Lead ECG information to the Information
Center for analysis. For details see the Instructions for Use supplied with the Information Center.

86
EASI ECG Lead Placement 6 ECG, Arrhythmia, and ST Monitoring

EASI ECG Lead Placement

Using a standard 5-electrode set in EASI lead placement you can monitor up to 12 standard ECG leads
simultaneously and continuously at the bedside. EASI-derived 12-lead ECGs and their measurements
are approximations to conventional 12-lead ECGs. As the 12-lead ECG derived with EASI is not
exactly identical to the 12-lead conventional ECG obtained from a electrocardiograph, it should not be
used for diagnostic interpretations.
Respiratory monitoring is also possible with the EASI placement; respiration is measured between the I
and A electrodes.
Place the electrodes as accurately as possible to obtain the best quality EASI measurements.
When EASI lead placement is selected, EASI is shown beside the 1mV calibration bar on the ECG
wave on the display, and EASI is marked on any recorder strips and printouts.

EASI Monitoring During INOP Conditions If one of the derived EASI leads has an INOP
condition (for example, LEADS OFF), a flat line is displayed. After 10 seconds, the directly acquired
EASI AI, AS, or ES lead (depending on which is available) is displayed with the corresponding lead
label. This causes an arrhythmia relearn.

EASI Electrode Placement

1 E (V) Brown on the lower sternum at the
level of the fifth intercostal
space
2 A (LL) Red on the left midaxillary line at
the same level as the E electrode
3 S (LA) Black on the upper sternum
4 I (RA) White on the right midaxillary line at
the same level as the E electrode
5 N Green reference electrode - can be
anywhere, usually below the
sixth rib on the right hip

87
6 ECG, Arrhythmia, and ST Monitoring ECG, Arrhythmia, and ST Alarm Overview

ECG, Arrhythmia, and ST Alarm Overview

The ECG, arrhythmia, and ST alarms available depend on which measurements are switched on, and
the arrhythmia option enabled for your monitor.
• Cardiotach alarms are available when HR is on and the active alarm source is ECG
• Basic arrhythmia alarms are available when Arrhythmia is switched on
• Advanced arrhythmia alarms are available when Arrhythmia is switched on and the Advanced
Arrhythmia option has been enabled for your monitor
• ST alarms are available when ST analysis is switched on and ST leads are selected for analysis.

Cardiotach Alarms Alarms with Basic Alarms with Enhanced ST Alarms

Arrhythmia Option Arrhythmia Option
***Asystole ***Ventricular Tachycardia **Supraventricular Tach **ST <Lead> High
***Ventricular **Pacer Not Capture **Missed Beat **ST <Lead> Low
Fibrillation/Tachycardia **Pacer Not Pacing **Pause
***Extreme Bradycardia
**Frequent PVCs (PVC > **Irregular HR
***Extreme Tachycardia limit/min)
**Ventricular Rhythm
**High heart rate **Run PVCs High
**Low heart rate
**Pair PVCs
**R-on-T PVCs
**Ventricular bigeminy
**Ventricular trigeminy
**Nonsustained V-Tach
**Multiform PVCs

88
Using ECG Alarms 6 ECG, Arrhythmia, and ST Monitoring

Using ECG Alarms

ECG alarms can be switched on and off and the high and low alarm limits changed just like other
measurement alarms, as described in the Alarms section. Special alarm features which apply only to
ECG are described here.

Extreme Alarm Limits

The extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source,
either HR or Pulse, are set in Configuration Mode by adding a set value to the high and low alarm
limits. You need to know what value has been configured for your monitor. Changing the high and
low alarm limits automatically changes the extreme alarm limits within the allowed range.
♦ To see the extreme rate alarms set for your monitor, in the Setup ECG menu, see the menu items
∆ExtrTachy and ∆ExtrBrady.

ECG Alarms Off Disabled

Be aware that your hospital department may have decided to disable the setting ECG Alarms Off in
the monitor’s Configuration Mode. In this case, HR alarms cannot be switched off in Monitoring
Mode. If you try to switch off the HR alarms, you will see the message To activate enter
Config and enable Alarms Off.

HR Alarms When Arrhythmia Analysis is Switched Off

When arrhythmia analysis is switched off, only these HR-related alarms will be detected:
• the asystole alarm
• the ventricular fibrillation/ventricular tachycardia alarm
• the extreme tachycardia/extreme bradycardia alarms
• the high heart rate/low heart rate alarms.

HR Alarms When Arrhythmia Analysis is Switched On

WARNING When arrhythmia analysis is on, all yellow alarms connected with ECG are short (one-star). This
means that the yellow alarm lamp and the tones are active for a configured number of seconds only,
after which the flashing numeric and the alarm message remain for up to three minutes. Red alarms
behave as usual.

ECG Safety Information

CAUTION Interference from instruments near the patient and ESU interference can cause problems with the
ECG wave. See the monitor specifications for more information.

89
6 ECG, Arrhythmia, and ST Monitoring ECG Safety Information

WARNING Defibrillation and Electrosurgery: Do not touch the patient, or table, or instruments, during
defibrillation.
After defibrillation, the screen display recovers within 10 seconds if the correct electrodes are used and
applied in accordance with the manufacturers instructions.
When using electrosurgical (ES) equipment, never place ECG electrodes near to the grounding plate of
the ES device, as this can cause a lot of interference on the ECG signal.

General: When you are connecting the electrodes or the patient cable, make sure that the connectors
never come into contact with other conductive parts, or with earth. In particular, make sure that all of
the ECG electrodes are attached to the patient, to prevent them from contacting conductive parts or
earth.

During surgery: Use the appropriate orange electrode ECG safety cable for measuring ECG in the
operating room. These cables have extra circuitry to protect the patient from burns during cautery, and
they decrease electrical interference. These cables cannot be used for measuring respiration.

Pacemaker failure: During complete heart block or pacemaker failure to pace/capture, tall P-waves
(greater than 1/5 of the average R-wave height) may be erroneously counted by the monitor, resulting
in missed detection of cardiac arrest.

Patients exhibiting intrinsic rhythm: When monitoring paced patients who exhibit only intrinsic
rhythm, the monitor may erroneously count pace pulses as QRS complexes when the algorithm first
encounters them, resulting in missed detection of cardiac arrest.
The risk of missing cardiac arrest may be reduced by monitoring these patients with low heart rate limit
at or slightly above the basic/demand pacemaker rate. A low heart rate alarm alerts you when the
patient’s heart rate drops to a level where pacing is needed. Proper detection and classification of the
paced rhythm can then be determined.

Filtered ECG signal from external instruments: Instruments such as defibrillators or telemetry units
produce a filtered ECG signal. When this signal is used as an input to the bedside monitor, it is filtered
again. If this twice-filtered signal is passed to the arrhythmia algorithm, it may cause the algorithm to
fail to detect pace pulses, pacemaker non-capture, or asystole, thus compromising paced patient
monitoring performance.

External pacing electrodes: When a pacemaker with external pacing electrodes is being used on a
patient, arrhythmia monitoring is severely compromised due to the high energy level in the pacer pulse.
This may result in the arrhythmia algorithm’s failure to detect pacemaker noncapture or asystole.

Fusion beat pacemakers: Pacemakers that create fusion beats (pace pulse on top of the QRS complex)
cannot be detected by the monitor’s QRS detector.

Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Volume may
occasionally react on the Impedance measurement used by patient monitors for the determination of
the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp
measurement can prevent this.

90
About Arrhythmia Monitoring 6 ECG, Arrhythmia, and ST Monitoring

About Arrhythmia Monitoring

Arrhythmia analysis provides information on your patient’s condition, including heart rate, PVC rate,
rhythm, and ectopics. The monitor uses the user-selected primary and secondary ECG leads for single-
lead or multi-lead arrhythmia analysis. During arrhythmia analysis, the monitor continuously
• optimizes ECG signal quality. This is important for arrhythmia analysis. The monitor continuously
filters the ECG signal to remove baseline wander, muscle artifact, and signal irregularities. Also, if
the Patient Paced status is set to Yes, pace pulses are filtered out to avoid processing them as QRS
beats.
• detects beats, for example, QRS complexes, identifying them for further analysis.
• measures signal features such as R-wave height, width, and timing.
• creates beat templates, and classifies and labels beats to aid in rhythm analysis and alarm detection.
• examines the ECG signal for ventricular fibrillation, asystole, and noise.

Arrhythmia Options
Your monitor has either the basic or the enhanced arrhythmia option. Both options provide rhythm
and ectopic status messages and beat labelling. The number of rhythms being classified, events being
detected, and alarms generated differs according to the option. The alarms available with the different
options are listed in the section “ECG, Arrhythmia, and ST Alarm Overview” on page 88, the rhythm
and ectopic messages detected are listed in “Arrhythmia Status Messages” on page 94.

Where can I find more information?

See the Application Notes on ST and Arrhythmia supplied on your documentation CD-Rom for
detailed information on the arrhythmia algorithm and its clinical application.

91
6 ECG, Arrhythmia, and ST Monitoring Switching Arrhythmia Analysis On and Off

Switching Arrhythmia Analysis On and Off

1 In the Setup Arrhythmia menu, select Arrhythmia to toggle between On and Off.
2 Select the Confirm pop-up key which appears at the bottom of the screen.
Be aware that when arrhythmia analysis is switched off,
– the message Arrythmia OFF appears beside the ECG wave, if configured to do so
– only the HR-related alarms are detected (the asystole alarm, the ventricular fibrillation/ventricular
tachycardia alarm, the extreme tachycardia/extreme bradycardia alarms, the high heart rate/ low
heart rate alarms)
– HR High and HR Low alarms behave like normal yellow alarms, no timeout periods are active.

Choosing an ECG Lead for Arrhythmia Monitoring

It is important to select a suitable lead for arrhythmia monitoring.
Guidelines for non-paced patients are:
– QRS should be tall and narrow (recommended amplitude > 0.5 mV)
– R-Wave should be above or below the baseline (but not bi-phasic)
– T-wave should be smaller than 1/3 R-wave height
– the P-wave should be smaller than 1/5 R-wave height.
For paced patients, in addition to the above, the pace pulse should be:
– not wider than the normal QRS
– the QRS complexes should be at least twice the height of pace pulses
– large enough to be detected, with no re-polarization.
To prevent detection of P-waves or baseline noises as QRS complexes, the minimum detection level for
QRS complexes is set at 0.15 mV, according to AAMI-EC 13 specifications. Adjusting the ECG wave
size on the monitor display (gain adjustment) does not affect the ECG signal which is used for
arrhythmia analysis. If the ECG signal is too small, you may get false alarms for pause or asystole.

Aberrantly-Conducted Beats
As P-waves are not analyzed, it is difficult and sometimes impossible for the monitor to distinguish
between an aberrantly-conducted supraventricular beat and a ventricular beat. If the aberrant beat
resembles a ventricular beat, it is classified as ventricular. You should always select a lead where the
aberrantly-conducted beats have an R-wave that is as narrow as possible to minimize incorrect calls.
Ventricular beats should look different from these ‘normal beats’. Instead of trying to select two leads
with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia
monitoring. Extra vigilance is required by the clinician for this type of patient.

Atrial Fibrillation and Flutter

Since P-waves are not analyzed, it is not possible to discriminate atrial rhythms. If there is constant
variance in the R-R interval, the rhythm is classified as Irregular. It is extremely important for accurate
analysis of the rhythm to have p-waves with an amplitude of less than 1/5 the height of the R-wave or
< 0.15 mV. If the p-waves are larger than this, they may be counted as QRS complexes.

92
 Understanding the Arrhythmia Display 6 ECG, Arrhythmia, and ST Monitoring

Intermittent Bundle Branch Block

Bundle branch and the other fascicular blocks create a challenge for the arrhythmia algorithm. If the
QRS during the block changes considerably from the learned normal, the blocked beat may be
incorrectly classified as ventricular, causing false PVC alarms. You should always select a lead where the
bundle branch block beats have an R-wave that is as narrow as possible to minimize incorrect calls.
Ventricular beats should look different from these ‘normal beats’. Instead of trying to select two leads
with a narrow R-wave, it may be easier to just select one lead and use single lead arrhythmia
monitoring. Extra vigilance is required by the clinician for this type of patient.

Understanding the Arrhythmia Display

Your monitor screen may look slightly different from the illustration.

Rhythm status message

Beat label Pace pulse marks
PVC Numeric HR Numeric
II P P P Paced Rhythm PVC HR
M Pair PVCs

Delayed 1mV
2 75
Delayed arrhythmia wave Ectopic status message

Viewing Arrhythmia Waves

♦ To review arrhythmia beat labels, in the Setup Arrhythmia menu, select Annotate Arrhy.
The wave showing the primary ECG lead will be delayed by six seconds and shown on a grey
background. Beat labels will be annotated above the ECG wave and Delayed will be written
beside it.
♦ To return to the normal ECG primary lead display, select Annotate Arrhy again.

Arrhythmia Beat Labels

Arrhythmia beat labels tell you how the monitor is classifying beats.
N = Normal
V = Ventricular Ectopic
S = Supra-ventricular Premature
P = Paced
' = Pacer spike
L = Learning patient's ECG
A = Artifact (noisy episode)
? = Insufficient information to classify beats
I = Inoperative condition (e.g., LEADS OFF)
M = Pause or missed beat

93
6 ECG, Arrhythmia, and ST Monitoring Understanding the Arrhythmia Display

Arrhythmia Status Messages

The monitor displays two types of status messages:
• Rhythm Status Messages -- to indicate the patient’s rhythm.
• Ectopic Status Messages -- to indicate the presence of ectopic beats.
These status messages are shown on the right hand side of the primary ECG wave. They are updated
every second, with the exception of the Sinus and Supraventricular (SV) rhythm messages.
The Sinus and SV rhythm messages are updated based on the current heart rate, taking into account
the patient category (adult, pediatric, or neonatal). For the message to change from one rhythm status
to another, the HR must be in the new range for five beats.
If you have basic arrhythmia capability, you will get only messages for the alarms provided with this
level.

Rhythm Status Messages

The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.

Rhythm Status Message Description B or E

ASYSTOLE No QRS for 4 consecutive seconds in absence of vent fib or chaotic B, E
signal
VENT FIB/TACH A fibrillatory wave for 4 consecutive seconds B, E
V-TACH A dominant rhythm of adjacent Vs and a HR > the V-Tach Heart B, E
Rate Limit
SUST V-TACH Ventricular tachycardia rhythm for more than 15 seconds E
VENT RHYTHM A dominant rhythm of adjacent PVCs and a HR ≤ the V-Tach HR E
Limit
VENT BIGEMINY A dominant rhythm of N, V, N, V E
VENT TRIGEMINY A dominant rhythm of N, N, V, N, N, V E
PACED RHYTHM A dominant rhythm of paced beats B, E
IRREGULAR HR Consistently irregular rhythm E
SINUS BRADY A dominant rhythm of SV beats preceded by P-waves B, E
SINUS RHYTHM
SINUS TACHY
SV BRADY A dominant rhythm of SV beats not preceded by P-waves B, E
SV RHYTHM
SV TACHY
UNKNOWN ECG Rhythm cannot be determined B, E
RHYTHM
LEARNING ECG Algorithm is learning the ECG beat morphology B, E
LEARNING RHYTHM Algorithm is learning the rhythm of the classified beats B, E
CANNOT ANALYZE ECG signal is predominantly invalid and therefore cannot be B, E
ECG analyzed

94
Arrhythmia Relearning 6 ECG, Arrhythmia, and ST Monitoring

Ectopic Status Messages

The label B or E indicates basic (B) or enhanced (E) arrhythmia capability.

Ectopic Status Message Explanation B or E

(No message displayed) No ectopic activity within the last minute
RUN PVCs More than 2 consecutive PVCs within the last minute E
PAIR PVCs Pair PVCs within the last minute E
PACER NOT CAPT Pause with pace pulse (paced patient only) within the last minute B, E
PACER NOT PACE Pause without pace pulse (paced patient only) within the last minute B, E
PAUSE No beat detected for 1.75 x average R-R interval for HR <120, or E
No beat for 1 second with HR >120 (non-paced patient only), or
No beat detected for more than the set pause threshold.
R-ON-T PVCs R-ON-T detected within the last minute E
MULTIFORM PVCs Multiform PVCs detected within the last minute E
FREQUENT SVPBs SVPB count within last minute is greater than 5 E
SVPBs 1-5 SVPBs in the last minute with a sinus rhythm and no Vs E
SV BEATS SV count within last minute and rhythm status is PACED B, E
PACED BEATS Paced beat count within last minute and rhythm status is NOT B, E
PACED

Arrhythmia Relearning
During a learning phase:
• Alarm timeout periods are cleared
• Stored arrhythmia templates are cleared
• Asystole, Vfib, and HR alarms (when there are enough beats to compute the HR) are active. No other
alarms are active.

Initiating Arrhythmia Relearning Manually

1 To initiate relearning manually, in the Setup Arrhythmia menu, select Relearn Arrhy.
– While the monitor is learning, the delayed arrhythmia wave displays the beat label L and the
rhythm status message LEARNING ECG.
– Next, the monitor determines the dominant rhythm. The beats are labeled N, and the rhythm
status message changes to LEARNING RHYTHM.
2 After relearning is complete, you should check the delayed arrhythmia wave to ensure that the
algorithm is labeling the beats correctly.
3 If beats are still not classified correctly, check that the ECG is optimized for arrhythmia
monitoring. You may need to select a different lead or change the electrodes or electrode positions
if there is excessive noise, unstable voltage, low amplitude, or large P- or T-waves.

95
6 ECG, Arrhythmia, and ST Monitoring Arrhythmia Alarms

Automatic Arrhythmia Relearn

Arrhythmia relearning is initiated automatically whenever:
• ECG monitoring is switched on
• The ECG Lead or Lead Label is changed manually, or when fallback occurs
• A Leads Off INOP condition (that has been active for > 60 seconds) ends.
If you are monitoring multi-lead arrhythmia and there is a change in one lead only, relearning happens
only in the affected lead. During this learning phase, the system will continue monitoring using the
other lead. Therefore, the delayed arrhythmia wave is not labeled L and there is no LEARNING ECG
rhythm status message. In addition, alarm timeout periods are maintained, stored arrhythmia
templates are maintained for the operative lead, and all alarms switched on are active.

Arrhythmia Relearn and Lead Fallback

Lead fallback triggers an automatic arrhythmia relearn.

WARNING If arrhythmia learning takes place during ventricular rhythm, the ectopics may be incorrectly learned as
the normal QRS complex. This may result in missed detection of subsequent events of V-Tach and V-
Fib.
For this reason you should:
• take care to initiate arrhythmia relearning only during periods of predominantly normal rhythm and
when the ECG signal is relatively noise-free
• be aware that arrhythmia relearning can happen automatically
• respond to any INOP messages (for example, if you are prompted to reconnect electrodes)
• be aware that a disconnected EASI electrode triggers an arrhythmia relearn on all leads
• always ensure that the arrhythmia algorithm is labeling beats correctly.

Arrhythmia Alarms
Arrhythmia alarms can be switched on and off and the high and low alarm limits changed just like
other measurement alarms, as described in the Alarms section. Special alarm features which apply only
to arrhythmia are described here.
The different alarms detected and generated by the monitor depend on the level of arrhythmia analysis
that is enabled. For a complete list of arrhythmia alarms and INOPs, see the Alarms chapter.
The monitor detects arrhythmia alarm conditions by comparing ECG data to a set of pre-defined
criteria. An alarm can be triggered by a rate exceeding a threshold (for example, HR >xx), an abnormal
rhythm (for example, Ventricular Bigeminy), or an ectopic event (for example, Pair PVCs).

96
Arrhythmia Alarms 6 ECG, Arrhythmia, and ST Monitoring

Yellow Arrhythmia Alarms

Yellow arrhythmia alarms are short yellow alarms specific to arrhythmia-related patient conditions.
Depending on your monitor and Information Center revision, they may be shown with one or two
stars.

WARNING When arrhythmia analysis is on, all yellow alarms connected with ECG are short (one-star). This
means that the yellow alarm lamp and the tones are active for a configured number of seconds only,
after which the blinking numeric and the alarm message remain for up to three minutes. Red alarms
behave as usual.

Arrhythmia Alarms and Latching

When using arrhythmia analysis, Visual Latching and Audible Latching should be on
for red alarms, or at least Visual Latching should be on. Because of the transient nature of
arrhythmia alarms, many arrhythmia conditions may go unnoticed if alarm latching is off. Alarm
latching settings are defined in Configuration Mode.

Switching Individual Arrhythmia Alarms On and Off

Some arrhythmia alarms can be individually switched on or off. They are:
Pacer not capture, Pacer not pace, Non-Sustain VT, Vent Rhythm, Run PVCs, Pair PVCs, R-on-T
PVCs, V.Bigeminy, V.Trigeminy, Multif.PVCs, Pause, SVT, Irregular HR, Missed Beat, PVCs/min.
♦ To switch individual alarms on or off, in the Setup Arrhythmia menu, select the alarm from
the list to toggle between On and Off. The monitor displays the INOP message SOME ECG
ALRMS OFF.

Switching All Yellow Arrhythmia Alarms On or Off

All yellow arrhythmia alarms can be switched on and off together. To do this,
♦ In the Setup Arrhythmia menu, select All Yellow Off or All Yellow On.

Adjusting the Arrhythmia Alarm Limits

Some arrhythmia alarms have limits which can be individually adjusted. They are:
Vtach HR, Vtach Run, PVCs/min, Vent Rhythm, SVT HR, SVT Run, Asystole Thresh., Pause
Threshold.
1 To adjust alarm limits, in the Setup Arrhythmia menu, select the alarm to be adjusted.
2 Select the appropriate setting from the pop-up list.

Arrhythmia Alarm Timeout Periods

Be aware that the audible and visible indications of alarms may be inhibited
• if a more serious alarm condition is active
• if a timeout period is in effect for a particular alarm
• if a timeout period is in effect for a higher alarm in that chain.

97
6 ECG, Arrhythmia, and ST Monitoring Arrhythmia Alarms

When a yellow arrhythmia alarm is generated, it triggers visible and audible indicators. It also
automatically initiates a timeout, or inhibitory period. During this period, the same alarm condition
will not generate another alarm. When the timeout period is over, an alarm will be generated again if
the condition still persists. Timeout periods are defined for your hospital in Configuration Mode.
♦ To view the timeout period configured for your monitor, in the Setup Arrhythmia menu,
see the menu items TimeOut 1st and TimeOut 2nd.
♦ To reset the timeout period, select the Alarms Off or Pause Alarms permanent key and
then reselect it.

98
Arrhythmia Alarms 6 ECG, Arrhythmia, and ST Monitoring

Arrhythmia Alarm Chaining

When arrhythmia analysis is switched on, multiple alarm conditions may be present. Announcing all of
the detected alarm conditions would be confusing, and might hide a more serious condition. For this
reason, arrhythmia alarms are prioritized in three alarm “chains”: PVC Alarms; Beat Detection Alarms,
and Rate Alarms.
Only the highest priority alarm condition in each chain is announced. Lower priority alarms in the
same chain will not be announced while an alarm is active or during the configured timeout period. If
alarm conditions of equal severity from different chains are detected, the alarm condition that occurred
most recently is announced. The exception is Irregular HR, which only occurs if no other alarms are
occurring.
See “ECG, Arrhythmia, and ST Alarm Overview” on page 88 for information on which alarms are
included in the different arrhythmia options.

Red Arrhythmia Alarms

Asystole

Vent Fib/Tach

V-Tach

Extreme Tachy/Extreme Brady

Yellow Arrhythmia Alarms

PVC Alarms Chain Beat Detection Alarms Chain Rate Alarms Chain
higher priority

Non-sustain VT/ SVT

Pause
Vent Rhythm
Pacer Not Captured/ HR High/ HR Low
Run PVCs Pacer Not Pacing/
Missed Beat
Pair PVCs
First level
timeout
R-on-T PVCs
lower priority

period
Second level
Vent Bigeminy
timeout
Irregular HR period
Vent Trigeminy
(occurs only if no other
PVCs > xx/min arrhythmia alarms are
present)
Multiform PVCs

– If there is an active Vent Bigeminy alarm, a PVCs > xx/min will not be triggered because it is
lower on the same chain. However, a high HR alarm will become active because it is on a
different chain.
– Higher priority alarms supersede previous alarms. For example, if a Vent Trigeminy alarm is active
and a Pair PVCs occurs, the Pair alarm will be activated.

99
6 ECG, Arrhythmia, and ST Monitoring Arrhythmia Alarms

Understanding PVC-Related Alarms

PVC-related alarms are detected on the basis of the current ventricular heart rate and the number of
consecutive PVCs counted (referred to as PVC Runs). Changing one alarm limit automatically changes
linked alarm limits.

Example: This diagram illustrates the conditions under which PVC alarms would be generated if the
Vent Rhythm Run limit is set to 12, the V-Tach Run Limit is set to eight, and the V-Tach HR Limit
is set to 100.

V-Tach Run Limit

** Non-Sustain ***V-Tach
**Pair VT PVC Run ≥ 8
Ventricular Heart Rate

PVCs PVC Run < 8

PVC = HR > 100
HR > 100
2
V-Tach
Heart Rate
100 Limit
** Run PVCs ** Vent Rhythm
PVC Run > 2 but ≤ 12 PVC Run > 12
HR ≤ 100 HR ≤ 100

1 2 3 4 5 6 7 8 9 10 11 12 Ventricular Rhythm
Number of Consecutive PVCs (PVC Run) Run Limit

You will see that

• if both the V-Tach Heart Rate Limit and the V-Tach Run Limit are exceeded, a red V-Tach alarm is
generated
• if the ventricular heart rate exceeds the V-Tach Heart Rate Limit but not the V-Tach Run Limit, a
yellow Non-Sustain VT alarm is generated.

100
About ST Monitoring 6 ECG, Arrhythmia, and ST Monitoring

About ST Monitoring
The monitor performs ST segment analysis on normal and atrially paced beats and calculates ST
segment elevations and depressions. This information can be displayed in the form of ST numerics and
snippets on the monitor.
All available leads can be monitored continuously. The ECG waveform does not need to be displayed
on the Screen for ST Segment analysis.

WARNING This monitor provides ST level change information; the clinical significance of the ST level change
information should be determined by a physician.

Switching ST On and Off

♦ To switch all ST monitoring on or off, in the Setup ST Analysis menu, select ST Analysis
to toggle between On and Off.
ST monitoring is automatically switched off if the Patient Category is not Adult. You should consider
switching ST monitoring off manually if:
• you are unable to get a lead that is not noisy
• arrhythmias such as atrial fib/flutter cause irregular baseline
• the patient is continuously ventricularly paced
• the patient has left bundle branch block.

Selecting ST Leads for Analysis

♦ To switch ST monitoring for individual leads on or off, in the Setup ST Analysis menu,
select Setup ST Leads. In the pop-up window, the leads in the left column under Choices
are the leads you can choose from, and the leads in the right-hand column Selected are the
leads chosen to be displayed. Select the ST leads on the left and use the arrow keys to move the
leads from one list to the other, then select Done to apply the changes.

101
6 ECG, Arrhythmia, and ST Monitoring Understanding the ST Display

Understanding the ST Display

Your monitor screen may be configured to look slightly different from the illustrations.

Current HR Current heart rate

ST Numerics Up to 12 ST numerics plus the alarm limits
ST index can be displayed on the monitor
screen. They can be configured to show beside
the measurement numerics, beside the ECG
wave, or beside the ST snippet. ST numerics
ST-II 1.2
A positive ST value indicates ST segment
ST-V 2.5
elevation; a negative value indicates depression.
ST-aVR -3.0
ST numerics are displayed in the order in
which you select ST leads for analysis. If there
is additional space in the field assigned to ST numerics, the monitor will display extra numerics in the
order in which they appear in the Setup ST Analysis -> Setup ST Leads -> Choices
list. Any ST leads switched on for analysis that do not fit in the assigned numerics field are shown in
succession in place of the last ST numeric.

ST Index The ST index numeric (STindx) is the sum of the absolute values for the ST leads V2, V5,
aVF. Because it is based on absolute values, it is always a positive number. If you haven’t selected one of
the leads V2, V5, and aVF for ST analysis, the STindx numeric will display a question mark “?”.
♦ To switch the ST index numeric on or off for display, in the Setup ST Analysis menu,
select ST-Index to toggle between On and Off.

ST Snippets ST snippets show a one second wave segment for each measured ST lead. The most
recent snippet is drawn in the same color as the ECG wave, usually green, superimposed over the
stored baseline snippet, drawn in a different color. The comparison shows any deviation in the
measurement since the baseline snippet was stored, for example as a result of a procedure carried out on
the patient.
The information is updated once per minute.
If you do not see ST snippets on the Screen, select the Screen name in the Monitor Info Line and select
a Screen configured to show snippets from the pop-up list of available Screens.

ST Baseline Window The ST Baseline Window shows an ST snippet drawn on a grid that divides the
one second of information into sections. The current ST numeric and the ST numeric stored with the
baseline are shown, as well as the difference between these two numerics.
A “?” in front of the difference numeric indicates that the ST measurement points were adjusted since
the baseline snippet was stored.
The Baseline Window it opens with the ST pop-up keys Next Lead, Previous Lead, Update
Baseline, Record ST, Change ST Lead, and Adjust ST Points to let you carry out
common ST tasks.
♦ To view the ST Baseline window, select any snippet on the Screen.

102
Updating ST Baseline Snippets 6 ECG, Arrhythmia, and ST Monitoring

ST label and ST Baseline

numeric
ST-II
Baseline ST numeric -0.8
and difference since 1.9
baseline was stored ?-2.7

1mV calibration
bar
Current snippet

ST baseline ST Baseline stored at 14 Feb 03 9:38

Timestamp of most recently stored baseline snippet

Updating ST Baseline Snippets

ST analysis requires valid samples to measure and store a snippet. ST Snippets and ST values are
updated every minute. If there is artifact in the signal, it may take longer for an ST snippet and an ST
value to appear.
The first baseline is stored automatically after ST monitoring is started, or when a new patient is
admitted. To update ST baselines,
1 Select an ST snippet to open the ST Baseline window.
2 In the ST Baseline window, select Update Baseline to store all current snippets as
baselines. This deletes all previously-stored baselines.

Recording ST Segments
♦ To record all currently available ST snippets and baselines, in the ST Baseline window, select
the pop-up key Record ST.

103
6 ECG, Arrhythmia, and ST Monitoring Adjusting ST Measurement Points

Adjusting ST Measurement Points

The ST measurement for each beat complex is the vertical difference between two measurement points.
The isoelectric point provides the baseline for the measurement and the ST point provides the other
measurement point. It is positioned with reference to the J-point.

R-wave peak at 0 msec

J point default = 48 msec

T
P

Difference = ST
value
Q
S
Isoelectric point default= -80 msec ST measurement point default = J + 60 msec

The ST measurement points need to be adjusted when you start monitoring, and if the patient's heart
rate or ECG morphology changes significantly. Artifactual ST segment depression or elevation may
occur if the isoelectric point or the ST point is incorrectly set.
To adjust the ST measurement points,
1 In the Setup ST Analysis menu, select Adjust ST Points to open the Adjust ST
Points window. Alternatively, you can use the Adjust ST Points pop-up key in the ST
Baseline window.
2 Select a suitable ECG lead for ST measurement, with a visible J-point and a visible P wave. To see
the ST snippet for the other ECG leads, select the Next Lead or Previous Lead pop-up keys.
3 Use the Select Point pop-up key to scroll through the points and activate the point you need
to adjust, then use the arrow keys to move the measurement point. Each point is highlighted while
active.

104
Adjusting ST Measurement Points 6 ECG, Arrhythmia, and ST Monitoring

ST label and the ST

numeric that would Adjust ST Points
apply using the ST-I
current points 0.0

1mV
calibration
bar
Cursors for
adjusting ST
points
ST Points adjusted at 04 Apr 03 11:38
Timestamp of
most recent ST ISO Point -80 J Point 48 ST Point J+60
point adjustment

Highlighted ST point

The ISO-point cursor positions the isoelectric point relative to the R-wave
peak. The relation is shown beside the ISO-point in milliseconds. Position the
ISO-point in the middle of the flattest part of the baseline (between the P and
ISO Q waves or in front of the P wave).

The J-point cursor positions the J-point relative to the R-wave peak. It helps
you to correctly position the ST-point.
Position the J-point at the end of the QRS complex and the beginning of the
ST segment.

The ST-point is positioned a fixed distance from the J-point, either J + 60

or J + 80. Move the J-Point to position the ST-point at the midpoint of
the ST segment.

4 To update the ST snippet shown in the Adjust ST Points window, select the Update pop-up
key.
5 Select the Apply Changes pop-up key to activate the new ST measurement points and
recalculate all ST values.
The most recent ST Points adjustment time is displayed in the Adjust ST Points window.
This information is cleared when a patient is discharged or when a new Profile is loaded into the
monitor.

105
6 ECG, Arrhythmia, and ST Monitoring ST Alarms

ST Alarms
ST alarms are yellow alarms. Each ST lead has its own alarm limit. ST alarms are triggered when an ST
value exceeds its alarm limit for more than one minute. Switching ST alarms off switches off alarms for
all ST leads.
If more than one ST measurement is in alarm, the monitor only displays the alarm message of the ST
lead which is currently furthest from its set alarm limits.

Single- or Multi-lead ST Alarming

Be aware that if multi-lead ST alarming is switched on, only alarms involving more than one ST lead
will be announced.
To choose individual or multi-lead ST alarming,
♦ In the Setup ST Analysis menu, select ST Alarm Mode and select either Single ST or
Multi ST.

Changing ST Alarm Limits

The monitor can detect alarms on each ST lead separately, so you can set high and low ST alarm limits
individually for each ST lead. You can also set separate alarm limits for single-lead and multi-lead ST
monitoring. Set the high and low alarm limits based on your assessment of the patient's clinical
condition, unit protocols, physician orders or medication specified limits. A good guideline is + 1.0
mm or - 1.0 mm from the patients's ST, or follow your hospital protocol.
1 In the Setup ST Analysis menu, select ST Alarm Mode and select Single ST or
Multi ST.
2 Select the alarm to be adjusted.
3 Select the appropriate setting.

106
 7

7Monitoring Pulse Rate

The pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in
beats per minute (bpm). You can display a pulse from any measured SpO2 signal (pleth wave) or any
arterial pressure (ABP, ART, Ao, PAP, UAP, P: see the pressure section for an explanation of the
pressure labels). The displayed pulse numeric is labeled and color-coded to match its source wave. If
the pulse numeric is not displayed, see the Setup Pulse menu to check whether it is switched on.

Entering the Setup Pulse Menu

If a pulse numeric is displayed on the screen, select it to enter the Setup Pulse (Pulse Source)
menu. If no pulse numeric is visible, in the Setup SpO2 menu or an Setup arterial pressure menu,
select Pulse (Pulse Source).

System Pulse Source

The currently active system pulse source is shown in the setup menus of the pulse source
measurements. The pulse rate chosen as system pulse:
• is monitored as system pulse and generates alarms when you select pulse as the active alarm source
• is sent via the network to the Information Center, if available
• is trended in the HighRes Trends and stored in the monitor’s databases.
To define which pulse rate is used as system pulse,
1 In the Setup Pulse menu, select System Pulse.
2 Select one of the SpO2 or arterial pressure labels from the pop-up list, or select Auto.
If you select Auto, the monitor automatically chooses a pulse rate to be used as system pulse. It
looks through the list from top to bottom and activates the first pulse rate that is switched on and
available.

107
7 Monitoring Pulse Rate Switching Pulse On and Off

Switching Pulse On and Off

To switch a particular pulse numeric on or off, enter the Setup Pulse menu via the measurement
setup menu or wave menu of the pulse source. For example, to switch an SpO2 pulse numeric on or
off,
1 Enter the Setup Pulse menu by selecting the Pulse numeric or by selecting Pulse in the
Setup SpO2 menu.
2 In the Setup Pulse menu, select Pulse (Pulse source) to toggle between On and
Off.
To switch the system pulse on or off, in any Setup Pulse (Pulse Source) menu, check
which measurement is currently selected as pulse source. Enter the Setup Pulse menu for this
pulse source and then switch off the pulse measurement as described.

Using Pulse Alarms

You can change pulse rate alarm limits in the Setup Pulse menu accessed via any Pulse source, or
in the Setup ECG menu. Changing the alarm limits for a specific Pulse numeric changes the alarm
limits for all pulse rate alarms and heart rate alarms.
Pulse alarms are only generated when the active alarm source is set to Pulse and a pulse source is set as
system pulse.

Selecting the Active Alarm Source: HR or Pulse?

In most cases the HR and Pulse numerics are identical. In order to avoid simultaneous alarms on HR
and Pulse, the monitor uses either HR or Pulse as its active alarm source. To change the alarm source,
select Alarm Source in the Setup ECG or Setup Pulse menu, then select either
– HR: if you want the HR to be the alarm source for HR/Pulse.
– Pulse: If you select Pulse as the active alarm source, the monitor will prompt you to confirm your
choice. Be aware that if you select Pulse as the alarm source, all arrhythmia and ECG HR alarms
are switched off.
– Auto: If the Alarm Source is set to Auto, the monitor will use the heart rate from the ECG
measurement as the alarm source whenever the ECG measurement is switched on and a valid
heart rate is available. If the heart rate becomes unavailable, for example if leads become
disconnected, and if a Pulse source is switched on and available, the monitor will automatically
switch to Pulse as the alarm source, using the pulse rate from the measurement currently selected
as system pulse. While Pulse is the alarm source, all arrhythmia and ECG HR alarms are switched
off. If the HR becomes available again, the monitor automatically uses this as alarm source.

WARNING Selecting Pulse as the active alarm source for HR/Pulse switches off the arrhythmia alarms listed in the
section “ECG, Arrhythmia, and ST Alarm Overview” on page 88, and the heart rate alarms. This is
indicated by the message All ECG Alarms Off (unless this has been configured off for your
monitor), and the crossed-out alarm symbol beside the ECG heart rate numeric.
High and low pulse rate and extreme bradycardia and extreme tachycardia alarms from pulse are active.

108
Using Pulse Alarms 7 Monitoring Pulse Rate

Alarm Source Selection Disabled

If Alarm Source Selection is disabled, you cannot change the alarm source. If you try to change the
source, the monitor displays the message To activate enter Config and enable
AlarmSourceSel. Alarm source selection can only be re-enabled in Configuration Mode.

Changing HR/Pulse Alarm Limits

As Pulse and HR share the same high and low alarm limits, if you change the alarm limit in the
Setup Pulse menu, the high or low alarm limits for HR in the Setup ECG menu change
automatically, and vice versa. The only exceptions are caused by a low limit clamp for each
measurement: the lowest value for Pulse when derived from SpO2 is 30 bpm; for HR 15 bpm, and for
Pressure 25 bpm.

Extreme Alarm Limits

The extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source,
either HR or Pulse, are set in Configuration Mode by adding a set value to the high and low alarm
limits. You need to know what value has been configured for your monitor. Changing the high and
low alarm limits automatically changes the extreme alarm limits within the allowed range.
♦ To see the values added to the high and low limit alarms to create the extreme rate alarms for your
monitor, in the Setup ECG menu, see the menu items ∆ExtrTachy and ∆ExtrBrady.

QRS Tone
The active alarm source is also used as a source for the QRS tone. You can change the tone volume in
the Setup SpO2 and Setup ECG menus and the QRS tone modulation in the Setup SpO2 menu.

109
7 Monitoring Pulse Rate Using Pulse Alarms

110
 8

8Monitoring Respiration Rate

(Resp)
For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two
ECG electrodes on the patient’s chest. Changes in the impedance due to thoracic movement produce
the Resp waveform on the monitor screen. The monitor counts the waveform cycles to calculate the
respiration rate (RR).

Lead Placement for Monitoring Resp

Correct patient skin preparation techniques for electrode placement are important for Resp
measurement: you will find this information in the chapter on ECG.
The Resp measurement uses the standard ECG cable sets and lead placements. You can use any of the
different types of ECG cable sets - 3-lead, 5-lead, or 10-lead, using either standard or EASI™
placement - to measure Resp, as long as you use ICU ECG cables.
The Resp signal is always measured between two of the ECG electrodes. If you are using standard ECG
electrode placement, Resp is measured between the RA and LL electrodes. If you are using EASI™
ECG electrode placement, Resp is measured between the I and A electrodes.

Optimizing Lead Placement for Resp

If you want to measure Resp and you are already measuring ECG, you may need to optimize
placement of the two electrodes between which Resp will be measured for some patients. Repositioning
ECG electrodes from standard positions, especially when you are using EASI™ ECG electrode
placement, results in changes in the ECG waveform and may influence ST and arrhythmia
interpretation.

Cardiac Overlay
Cardiac activity that affects the Resp waveform is called cardiac overlay. It happens when the Resp
electrodes pick up impedance changes caused by the rhythmic blood flow. Correct electrode placement
can help to reduce cardiac overlay: avoid the liver area and the ventricles of the heart in the line
between the respiratory electrodes. This is particularly important for neonates.

111
8 Monitoring Respiration Rate (Resp) Understanding the Resp Display

Lateral Chest Expansion

Some patients, especially neonates, expand
their chests laterally. In these cases it is best
to place the two respiratory electrodes in the
right midaxillary and left lateral chest areas at
the patient’s maximum point of breathing
movement to optimize the respiratory wave.

Abdominal Breathing
Some patients with restricted chest movement breathe mainly abdominally. In these cases, you may
need to place the left leg electrode on the left abdomen at the point of maximum abdominal expansion
to optimize the respiratory wave.

Understanding the Resp Display

The Resp measurement is displayed on the monitor as a continuous wave and a numeric respiration
rate. If the detected respiration rate is close to the heart rate, this is indicated by the text HR = RR next
to the respiration wave if you are in manual monitoring mode. Your monitor screen may look slightly
different from the illustration.

1 Ohm calibration bar Manually-set Resp detection level Resp numeric

and label
Resp

RR

1 Ohm
22

Changing Resp Detection Modes

The Resp detection level can be set either automatically or manually.
♦ To change the resp detection mode, in the Setup Resp menu, select Auto/Man to toggle
between the settings.

Auto Detection Mode

In Auto Detection Mode, the monitor adjusts the detection level automatically, depending on the wave
height and the presence of cardiac artifact. Note that in Auto Detection Mode, the detection level (a
dotted line) is not displayed on the waveform.
Use Auto Detection Mode for situations where:
• the respiration rate is not close to the heart rate

112
Changing the Size of the Respiration Wave 8 Monitoring Respiration Rate (Resp)

• breathing is spontaneous, with or without continuous positive airway pressure (CPAP)

• patients are ventilated, except patients with Intermittent Mandatory Ventilation (IMV).

Manual Detection Mode

In Manual Detection Mode you must set the Resp detection level.
♦ In the Setup Resp menu, select Manual Up or Manual Down. Use the dotted detection level
line in the Resp waveform to determine when the desired level is reached.
Once set, the detection level will not adapt automatically to different respiration depths. It is important
to remember that if the depth of breathing changes, you may need to change the detection level.
Use Manual Detection Mode for situations where:
• the respiration rate and the heart rate are close.
• patients have Intermittent Mandatory Ventilation.
• respiration is weak. Try repositioning the electrodes to improve the signal.

Resp Detection Modes and Cardiac Overlay

In Auto Detection Mode: If you are monitoring Resp and the ECG is switched off, the monitor
cannot compare the ECG and Resp rates to detect cardiac overlay. The respiration detection level is
automatically set higher to prevent the detection of cardiac overlay as respiration.

In Manual Detection Mode: Cardiac overlay can in certain situations trigger the respiration counter.
This may lead to a false indication of a high respiration rate or an undetected apnea condition. If you
suspect that cardiac overlay is being registered as breathing activity, raise the detection level above the
zone of cardiac overlay. If the Resp wave is so small that raising the detection level is not possible, you
may need to optimize the electrode placement as described in the section ”Lateral Chest Expansion”.

Changing the Size of the Respiration Wave

WARNING When monitoring in Manual Detection Mode, make sure to check the respiration detection level after
you have increased or decreased the size of the respiration wave.

♦ In the Setup Resp menu, select Size Up to increase the size of the wave or Size Down to
decrease it.

Changing the Speed of the Respiration Wave

Resp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp
measurement has its own speed control and is not affected by the wave speed settings of the other
measurements.
♦ In the Setup Resp menu, select Resp Speed. Choose the required speed from the pop-up list.
This defines the speed at which the wave is drawn across the screen in millimeters per second (mm/
s).

113
8 Monitoring Respiration Rate (Resp) Using Resp Alarms

Using Resp Alarms

Resp alarms can be switched on and off and the high and low alarm limits can be changed just like
other measurement alarms, as described in the Alarms chapter.

Changing the Apnea Alarm Delay

The apnea alarm is a high priority red alarm used to detect apneas. The apnea alarm delay time defines
the time period between the point where the monitor cannot detect any respiration activity and the
indication of the apnea alarm.
1 In the Setup Resp menu, select Apnea Time.
2 Select the appropriate setting.

Resp Safety Information

WARNING Respiration detection level If you do not set the detection level for the respiration correctly in manual
detection mode, it may not be possible for the monitor to detect apnea. If you set the detection level
too low, the monitor is more likely to detect cardiac activity, and to falsely interpret cardiac activity as
respiratory activity in the case of apnea.

Apnea The respiration measurement does not recognize obstructive and mixed apneas — it only
indicates an alarm when a pre-adjusted time has elapsed since the last detected breath.
The safety and effectiveness of the respiration measurement method in the detection of apnea,
particularly the apnea of prematurity and apnea of infancy, has not been established.

Interference If operating under conditions according to the EMC Standard EN 60601-1-2 (Radiated
Immunity 3V/m), field strengths above 1V/m may cause erroneous measurements at various
frequencies. Therefore it is recommended to avoid the use of electrically radiating equipment in close
proximity to the respiration measurement unit.

Resp Accessories To monitor respiration, use only the non-OR ECG accessories listed in the Resp
section of the accessories chapter. You cannot measure respiration if you are using an orange OR ECG
cable set. This is because of the higher internal impedance of the OR cable set, required for use if
electro-surgery is being performed.

Rate adaptive pacemakers: Implanted pacemakers which can adapt to the Minute Volume may
occasionally react on the Impedance measurement used by patient monitors for the determination of
the Resp value and execute pacing with the maximum programmed rate. Switching off the Resp
measurement can prevent this.

114
 9

9Monitoring SpO2
Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artefact
suppression technology (FAST). It provides four measurements:
• Oxygen saturation of arterial blood (SpO2) - percentage of oxygenated hemoglobin in relation to the
sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation).
• Pleth waveform - visual indication of patient’s pulse.
• Pulse rate (derived from pleth wave) - detected pulsations per minute.
• Perfusion indicator - numerical value for the pulsatile portion of the measured signal caused by
arterial pulsation.

115
9 Monitoring SpO2 Selecting an SpO2 Sensor

Selecting an SpO2 Sensor

Patient weight (kg) Patient weight (lb)

Adult Adult Adult Adult Adult

Adult

Adult

Pedi Pedi

Pedi Pedi Pedi

Pedi

Infant
Infant
Neo

Philips
Philips Oxisensor
OxiCliq/
Part Nr: OxiMax MAX-

Reusable sensors Disposable sensors

Preferred sensor types
Alternative sensor types

This chart guides you in selecting the correct sensor type. Find the patient’s weight on the vertical axes.
The heavy-bordered areas at this weight indicate that the sensor on the horizontal axis is a “best choice”
for this patient. The areas with light borders indicate a “good choice”. The recommended application
site is shown as a white dot in the picture.
For example, the best reusable sensor for a 35kg pediatric is the M1192A, applied to the toe or finger.
Alternatively, you could use M1194A applied to the ear.
Familiarize yourself with the instructions for use supplied with your sensor before using it.
If you are measuring SpO2 with the M3001A Multi-Measurement Server or the SpO2 measurement
module M1020B, Option A01, use Philips reusable and disposable sensors and Nellcor “R-Cal”
disposable sensors. If you are measuring SpO2 with the SpO2 measurement module M1020B Option
A02, use Nellcor OxiMax sensors.

CAUTION Do not use OxiCliq disposable sensors in a high humidity environment, such as in neonatal incubators
or in the presence of fluids, which may contaminate sensor and electrical connections causing
unreliable or intermittent measurements. Do not use disposable sensors on patients who have allergic
reactions to the adhesive.

116
Applying the Sensor 9 Monitoring SpO2

Applying the Sensor

1 Follow the SpO2 sensor’s instructions for use, adhering to all warnings and cautions.
2 Remove colored nail polish from the application site.
3 Apply the sensor to the patient. The application site should match the sensor size so that the sensor
can neither fall off, nor apply excessive pressure. When using the M1195A Infant Finger Sensor,
select a finger or toe with a diameter of between 7 and 8 mm (0.27” and 0.31”). When applying a
M1193A neonatal sensor do not overtighten the strap.
4 Check that the light emitter and the photodetector are directly opposite each other. All light from
the emitter must pass through the patient’s tissue.

WARNING Loose Sensor: If a sensor is too loose, it might compromise the optical alignment or fall off. If it is too
tight, for example because the application site is too large or becomes too large due to edema, excessive
pressure may be applied. This can result in venous congestion distal from the application site, leading
to interstitial edema, hypoxemia and tissue malnutrition. Skin irritations or lacerations may occur as a
result of the sensor being attached to one location for too long. To avoid skin irritations and
lacerations, periodically inspect the sensor application site and change the application site at least every
four hours.
Venous Pulsation: Do not apply sensor too tightly as this results in venous pulsation which may
severely obstruct circulation and lead to inaccurate measurements.
Ambient Temperature: Never apply an SpO2 sensor at ambient temperatures from above 37 oC
because this can cause severe burns after prolonged application.
Extremities to Avoid: Avoid placing the sensor on extremities with an arterial catheter, or intravascular
venous infusion line.

Connecting SpO2 Cables

♦ Connect the sensor cable to the MMS. If you are using a disposable
sensor, plug the sensor into the adapter cable and plug this cable into
the MMS. Plug reusable sensors directly into the MMS.
SpO2

CAUTION Extension cables: Do not use more than one extension cable (M1941A).
Electrical Interference: Position the sensor cable and connector away from power cables, to avoid
electrical interference.
Humidity: For neonatal patients, make sure that all sensor connectors and adapter cable connectors are
outside the incubator. The humid atmosphere inside can cause inaccurate measurements.

117
9 Monitoring SpO2 Measuring SpO2

Measuring SpO2
1 Select the correct patient category setting (adult/pediatric and neonatal), as this is used to optimize
the calculation of the SpO2 and pulse numerics.
2 During measurement, ensure that the application site:

– has a pulsatile flow, ideally with a perfusion indicator value above 1.0.
– has not changed in its thickness (for example, due to edema), causing an improper fit of the
sensor.

WARNING Inspect the application site every two to three hours to ensure skin quality and correct optical
alignment. If the skin quality changes, move the sensor to another site. Change the application site at
least every four hours.
Using an SpO2 sensor during MR imaging can cause severe burns. Minimize this risk by positioning
the cable so that no inductive loops are formed. If the sensor does not appear to be operating properly,
remove it immediately from the patient.

CAUTION Injected dyes such as methylene blue, or intravascular dyshemoglobins such as methemoglobin and
carboxyhemoglobin may lead to inaccurate measurements.
Interference can be caused by:
• High levels of ambient light. (Hint: cover application site with opaque material.)
• Electromagnetic interference.
• Excessive patient movement and vibration.

Assessing a Suspicious SpO2 Reading

Traditionally, pulse rate from SpO2 was compared with heart rate from ECG to confirm the validity of
the SpO2 reading. With newer algorithms, such as FAST-SpO2, this is no longer a valid criteria
because the correct calculation of SpO2 is not directly linked to the correct detection of each pulse.
When pulse rate is very low, or strong arrhythmia is present, the SpO2/Pleth pulse rate may differ from
the heart rate calculated from ECG but this does not indicate an inaccurate SpO2 value.
If you doubt the measured SpO2, use the pleth wave and perfusion indicator instead to assess the signal
quality.

118
Understanding SpO2 Alarms 9 Monitoring SpO2

Understanding SpO2 Alarms

This refers to SpO2 specific alarms. See the Alarms section for general alarm information. SpO2 offers
high and low limit alarms, and a high priority desat alarm. You cannot set the low alarm limit below
the desat alarm limit.

CAUTION If you measure SpO2 on a limb that has an inflated NBP cuff, a non-pulsatile SpO2 INOP can occur.
If the monitor is configured to suppress this alarm there may be a delay of up to 60 seconds in
indicating critical patient status, such as sudden pulse loss or hypoxia.

Adjusting the Alarm Limits

In the Setup SpO2 menu:
• Select High Limit then choose the upper alarm limit.
• Select Low Limit then choose the lower alarm limit.

WARNING High oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a
consideration do NOT set the high alarm limit to 100%, which is equivalent to switching the alarm
off. Transcutaneous pO2 monitoring is recommended for premature infants receiving supplemental
oxygen.

Adjusting the Desat Limit Alarm

The Desat alarm is a high priority (red) alarm notifying you of potentially life threatening drops in
oxygen saturation.
1 In the Setup SpO2 menu, select Desat Limit.
2 Adjust the limit.

Pleth Wave
The Pleth wave is autoscaled to maximum display size. It decreases only when the signal quality
becomes marginal. It is NOT directly proportional to the pulse volume. If you need an indication of
change in pulse volume, use the perfusion indicator.

minimum size for reliable SpO2 value

119
9 Monitoring SpO2 Perfusion (Pleth) Indicator

Perfusion (Pleth) Indicator

The perfusion indicator gives a numerical value for the pulsatile portion of the measured signal caused
by the pulsating arterial blood flow.
As pulse oximetry is based on the pulsatile nature of the signal, you can also use the perfusion indicator
as a quality indicator for the SpO2 measurement. Above 1 is optimal, between 0.3-1 is acceptable.
Below 0.3 is marginal; reposition the sensor or find a better site.

Setting SpO2/Pleth as Pulse Source

1 In the Setup SpO2 menu, select Pulse (SpO2) to enter the Setup Pulse menu.
2 In the Setup Pulse menu, select System Pulse and select SpO2 from the pop-up list.

Setting Up Tone Modulation

If tone modulation is on, the QRS tone pitch lowers when the SpO2 level drops. Remember, the QRS
tone is derived from either heart rate or pulse depending on which is currently selected as the active
alarm source.
♦ In the Setup SpO2 menu, select Tone Modulation to toggle between Yes (for on) and No
(for off ).

Setting the QRS Volume

♦ In the Setup SpO2 menu, select QRS Volume and set the appropriate QRS tone volume.

Calculating SpO2 Difference

When a second SpO2 measurement is present (either through the SpO2 module or through VueLink),
the monitor displays both SpO2 values, and calculates the difference between them. The second value
is subtracted from the first.
1 From the Main Setup menu, select Measurements.
2 From the ∆SpO2 Setup menu, select First SpO2.
3 Choose the first measurement source.
4 Select Second SpO2.
5 Choose the second measurement source.

120
 10

10Monitoring NBP
This monitor uses the oscillometric method for measuring NBP. In adult and pediatric mode, the
blood pressure measurements determined with this device comply with the American National
Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-1992) in relation to
mean error and standard deviation, when compared to intra-arterial or auscultatory measurements
(depending on the configuration) in a representative patient population. For the auscultatory reference,
the fifth Korotkoff sound was used to determine the diastolic pressure.
In neonatal mode, the blood pressure measurements determined with this device comply with the
American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10-
1992) in relation to mean error and standard deviation, when compared to intra-arterial measurements
in a representative patient population.
A physician must determine the clinical significance of the NBP information.

Introducing the Oscillometric NBP Measurement

Oscillometric devices measure the amplitude of pressure changes in the occluding cuff as the cuff
deflates from above systolic pressure. The amplitude suddenly increases as the pulse breaks through the
occlusion in the artery. As the cuff pressure decreases further, the pulsations increase in amplitude,
reach a maximum (which approximates to the mean pressure), and then diminish.
Studies show that, especially in critical cases (arrhythmia, vasoconstriction, hypertension, shock),
oscillometric devices are more accurate and consistent than devices using other noninvasive measuring
techniques.

WARNING Patient Category: Select the correct patient category setting for your patient. Do not apply the higher
adult inflation, overpressure limits and measurement duration to neonatal patients.
Intravenous infusion: Do not use the NBP cuff on a limb with an intravenous infusion or arterial
catheter in place. This could cause tissue damage around the catheter when the infusion is slowed or
blocked during cuff inflation.
Skin Damage: Do not measure NBP on patients with sickle-cell disease or any condition where skin
damage has occurred or is expected.
Unattended measurement: Use clinical judgement to decide whether to perform frequent unattended
blood pressure measurements on patients with severe blood clotting disorders because of the risk of
hematoma in the limb fitted with the cuff.

121
10 Monitoring NBP Preparing to Measure NBP

CAUTION If you spill liquid onto the equipment or accessories particularly if there is a chance that it can get
inside the tubing or the MMS, contact your service personnel.

Measurement Limitations
Measurements are impossible with heart rate extremes of less than 40 bpm or greater than 300 bpm, or
if the patient is on a heart-lung machine.
The measurement may be inaccurate or impossible:
• if a regular arterial pressure pulse is hard to detect
• with cardiac arrhythmias
• with excessive and continuous patient movement such as shivering or convulsions
• with rapid blood pressure changes
• with severe shock or hypothermia that reduces blood flow to the peripheries
• with obesity, where a thick layer of fat surrounding a limb dampens the oscillations coming from the
artery
• on an edematous extremity.

Measurement Methods
There are three methods of measuring NBP:
• Manual - measurement on demand.
• Auto - continually repeated measurements (between one and 120 minute adjustable interval).
• STAT - rapid series of measurements over a five minute period, then the monitor returns to the
previous mode. Use only on supervised patients.

Preparing to Measure NBP

1 Connect the cuff to the air tubing.
2 Plug the air tubing into the red NBP connector. Avoid compression or restriction of pressure tubes.
Air must pass unrestricted through the tubing.

NBP

122
Preparing to Measure NBP 10 Monitoring NBP

3 Make sure that you are using a Philips-approved correct sized cuff and that the bladder inside the
cover is not folded or twisted.
A wrong cuff size, and a folded or twisted bladder, can cause inaccurate measurements. The width
of the cuff should be in the range from 37% to 47% of the limb circumference. The inflatable part
of the cuff should be long enough to encircle at least 80% of the limb.
4 Apply the cuff to a limb at the same level as the patient’s heart. If it is not, you must use the
measurement correction formula to correct the measurement.
The marking on the cuff must match the artery location. Do not wrap the cuff too tightly around
the limb. It may cause discoloration, and ischemia of the extremities. Inspect the application site
regularly to ensure skin quality and inspect the extremity of the cuffed limb for normal color,
warmth and sensitivity. If the skin quality changes, or if the extremity circulation is being affected,
move the cuff to another site or stop the blood pressure measurements immediately. Check more
frequently when making automatic or stat measurements.

Correcting the Measurement if Limb is not at Heart Level

To correct the measurement if the limb is not at heart level, to the displayed value

add 0.75mmHg (0.10kPa) for each centimeter deduct 0.75mmHg (0.10kPa) for each centimeter
higher or lower or
add 1.9mmHg (0.25kPa) for each inch higher. deduct 1.9mmHg (0.25kPa) for each inch lower.

Understanding the NBP Numerics

Alarm source Measurement Mode

Time of last
Sys. NBP mmHg Cuff Auto
151 Auto 60min 17:15 measurement
Mean
120
90

Alarm limits Systolic Diastolic Mean pressure

Depending on the NBP numeric size, not all elements may be visible. If you have parallel alarm
sources, the sources are displayed instead of the alarm limits. During measurement, the cuff pressure is
displayed instead of the units and the repeat time. An early systolic value gives you a preliminary
indication of the systolic blood pressure during measurement. The NBP measurement is suitable for
use in the presence of electrosurgery and during the discharge of a cardiac defibrillator according to
IEC 601-2-30/EN 60601-2-30.

123
10 Monitoring NBP Starting and Stopping Measurements

Starting and Stopping Measurements

Use the Setup menu, SmartKeys or the MMS hardkey to start and stop measurements.

Action to be performed NBP Setup menu SmartKeys MMS hardkey

Start/Stop manual measurement Start/Stop Start/Stop

Start Auto series

Stop current automatic
measurement
Stop Automatic, Manual or STAT Stop All ---
measurement AND series

Start STAT measurement NBP STAT STAT (for MMS

without Pressure/Temp
measurement)

Stop current STAT measurement Start/Stop Start/Stop

and end series

NBP STAT STAT (for MMS

without Pressure/Temp
measurement)

CAUTION Use clinical judgement to decide whether to perform repeated series of STAT measurements because of
the risk of purpura, ischemia and neuropathy in the limb with the cuff.

Enabling Automatic Mode and Setting Repetition

Time
1 In the Setup NBP menu, select Auto/Man.
2 Toggle between Auto/Man, if necessary, to pick the measurement method.
3 If making an automatic measurement, select Repeat Time and set the time interval between two
measurements.
If you change the Profile or patient category, any currently active automatic NBP measurement and
automatic measurement cycle stops and the NBP numeric clears.

124
Choosing NBP Alarm Source 10 Monitoring NBP

Choosing NBP Alarm Source

You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in
parallel. Only one alarm is given, with the priority of mean, systolic, diastolic. In the Setup NBP
menu, select Alarms from and choose from:

Menu option Pressure value monitored

Sys. systolic
Dia. diastolic
Mean mean
Sys&Dia systolic and diastolic in parallel
Dia&Mean diastolic and mean in parallel
Sys&Mean systolic and mean in parallel
S&D&M all three pressures in parallel

Assisting Venous Puncture

You can use the NBP cuff to cause sub-diastolic pressure. The cuff deflates automatically after a set
time (adult/pediatric 170 seconds, neonatal 85 seconds) if you do not deflate it.
1 In the NBP Setup menu select VeniPuncture.
2 Puncture vein and draw blood sample.
3 Reselect VeniPuncture to deflate the cuff.
During measurement, the NBP display shows the inflation pressure of the cuff and the remaining time
in venous puncture mode.

Venous puncture measurement mode

Cuff pressure
Time left in venous
puncture mode
NBP VP 01:45
(60)
Calibrating NBP
NBP is not user-calibrated. Cuff-pressure transducers must be verified and calibrated at least once a
year by a qualified service professional. See the Service Guide for details.

125
10 Monitoring NBP Calibrating NBP

126
 11

11Monitoring Temperature
You can measure temperature using the MMS, one of the measurement server extensions, or the
temperature plug-in module. You cannot measure invasive pressure and temperature simultaneously in
one MMS or server extension. Temp measurement automatically switches on when you connect a
probe. You can switch the measurement off manually.

Making a Temp Measurement

1 Select the correct type and size of probe for your patient.
2 If you are using a disposable probe, connect the probe to the temperature cable.
3 Plug the probe or temperature cable into the temperature connector socket.

Temp connector socket

4 Apply the probe to the patient. You are advised to use a protective rubber cover on rectal probes.
5 In the Setup <Temp> menu, select Label and choose a label to indicate temperature type.
Choose from

Temp non-specific temperature label. Trect rectal temperature

Tart arterial temperature Tskin skin temperature
Tcore core temperature Tven venous temperature
Tesoph esophageal temperature Tnaso nasopharyngeal temperature

6 Check that the alarm settings (on or off, high and low limits) are appropriate for this patient and
this type of temperature measurement.

127
11 Monitoring Temperature Calculating Temp Difference

Calculating Temp Difference

The monitor can calculate the difference between two temperature values by subtracting the second
value from the first. The difference is labeled with the first letters of the first measurement and the first
letters of the second. For example, Tco-sk indicates the value is the calculated difference between core
temperature (Tcore) and skin temperature (Tskin).
1 In the Setup Main menu, select Measurements.
2 In the Setup ∆Temp menu, select First Temp.
3 Label the measurement source as appropriate.
4 Select Second Temp.
5 Label the measurement source as appropriate.

128
 12

12Monitoring Invasive Pressure

You can measure pressure using the Multi-Measurement Server (MMS), one of the measurement
server extensions or the pressure plug-in module. You cannot measure invasive pressure and
temperature simultaneously in one MMS or server extension.

WARNING Make sure that the applied parts never come into contact with other conductive parts, or with earth.

Setting up the Pressure Measurement

1 Plug in the pressure cable.

MMS Module

2 Prepare the flush solution.

3 Flush the system to exhaust all air from the tubing. Ensure that the transducer and stopcocks are
free of air bubbles.

WARNING If air bubbles appear in the tubing system, flush the system with the infusion solution again. Air
bubbles may lead to a wrong pressure reading.

4 Connect the pressure line to the patient catheter.

5 If you are using an infusion pressure cuff with the pressure line, attach the pressure cuff to the fluid
to be infused. Inflate it according to your standard hospital procedure, then start the infusion.

129
12 Monitoring Invasive Pressure Selecting a Pressure for Monitoring

6 Position the transducer so that it is level with the heart, approximately at the level of the
midaxillary line.

WARNING If measuring intracranial pressure (ICP) with a sitting patient, level the transducer with the top of the
patient’s ear. Incorrect leveling may give incorrect values.

Selecting a Pressure for Monitoring

Tell the monitor which pressure you want to monitor by selecting its pressure label. The label is a
unique identifier for each type of pressure. When you chose a label, the monitor uses that label’s stored
color, wave scale and alarm settings.
1. In the Setup <Press> menu, select Label.
2. Select the appropriate label from the list.

Label Description Label Description

ABP Arterial blood pressure PAP Pulmonary artery pressure
ART Arterial blood pressure (alternative) RAP Right atrial pressure
Ao Aortic pressure UAP Umbilical arterial pressure
CVP Central venous pressure UVP Umbilical venous pressure
ICP Intracranial pressure P Non-specific pressure label
LAP Left atrial pressure

Zeroing the Pressure Transducer

To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in
accordance with your hospital policy (at least once per day). You must perform a zero:
• when you use a new transducer or tubing
• every time you reconnect the transducer cable to the monitor
• if you think the monitor’s pressure readings are not correct.

Zeroing ICP
Your hospital guidelines may require you to zero the ICP transducer less frequently than other
transducers, due to the need for aseptic conditions. When you zero an ICP transducer, the zero values
are automatically stored and you will not be prompted to repeat the zero procedure.
If you want to simultaneously zero all pressures except ICP, disconnect the ICP transducer from the
measurement server or module while zeroing. Reconnecting the transducer recalls the stored values.

130
Zeroing the Pressure Transducer 12 Monitoring Invasive Pressure

WARNING If you select the label ICP, the measurement device uses the most recently stored zero. Therefore, make
sure you zeroed the transducer correctly in accordance with the transducer manufacturer’s instructions
and your hospital policy. When you use a transducer that you cannot rezero after placement, ensure
that you keep the measuring device with the patient so that you are certain you have the correct zero
data for this patient.

Determining a Pressure’s Most Recent Zero

The monitor displays the most recent zero on the status line. If this has “timed-out” after you have
performed a zero, redisplay the information by entering the pressure’s setup menu.

Zeroing a Pressure Measurement

WARNING Invasive pressure alarms (and pulse alarms, if derived from invasive pressure) are temporarily
suppressed until 30 seconds after the transducer finishes zeroing.

1 Turn off the stopcock to the patient.

2 Vent the transducer to atmospheric pressure, to compensate for the static and atmospheric pressure
exerted on the transducer.
3 In the setup menu for the pressure, select Zero <Press>.
4 When you see the message <Press> zero done at <date and time> on the status line,
(for example, ABP zero done at 13 Mar 02 23.35) close the stopcock to atmospheric
pressure, and open the stopcock to the patient.

Using the Zero Hardkey

Selecting the Zero hardkey on the M1006B Pressure module starts a zero for the pressure currently
measured with the module.
Selecting the Zero hardkey on the M3001A Multi-Measurement Server starts zeros the pressure being
measured by the measurement server and any connected measurement extensions.

Zeroing All Pressures Simultaneously

WARNING Before zeroing all pressures, make sure that all pressure transducers are vented to atmospheric pressure.

If you are measuring pressures with more than one measuring device, using the Zero SmartKey to
initiate the zeroing calls up a list of all active pressures. Select the pressure you want to zero or select
All Press to zero all pressures simultaneously.

131
12 Monitoring Invasive Pressure Adjusting the Calibration Factor

Troubleshooting the Zero

The status line lists the probable cause of an unsuccessful zero:

Message Corrective Action

unable to zero - The hardware is faulty. Contact your service personnel.
equipment
malfunction
unable to zero - Make sure the transducer is vented to air and try again. If this fails, the hardware
excessive offset may be faulty. Replace the adapter cable and try again. If it fails, replace the
unable to zero - transducer and try again. If it still fails, contact your service personnel.
unstable signal
unable to zero - Make sure that the transducer is connected and try again. If this fails, exchange
no transducer the adapter cable and try again. If this fails, exchange the transducer.
unable to zero - Make sure that the transducer is vented to air, not to the patient, and try again.
pulsatile
pressure
unable to zero - Try pressing the Zero key again. If this fails, replace the transducer and adapter
timed out cable and contact your service personnel.
switch <Press> on Pressure measurement is switched off. To switch it on, in the Setup Pressure
first menu, select the pressure’s label.

Adjusting the Calibration Factor

Each time you use a reusable transducer, compare the calibration factor written on your transducer
with the calibration factor shown on the monitor. To ensure accurate measurement, they must be the
same.
1 In the Setup <Press> menu, select Cal. Factor.
If the value here does not match that on the transducer, select the corresponding value from the
list now in accordance with your hospital’s procedure.
2 To confirm you want to use the new calibration factor, select the Confirm popup.

Displaying a Mean Pressure Value Only

Use this when you want to see only the mean pressure.
♦ In the pressure’s setup menu, select Mean Only. Toggle between On to display mean pressure
value only, and Off to display all pressure values (systolic, diastolic and mean).

Changing the Pressure Wave Scale

1 Select the label of the pressure wave whose scale you want to set to enter the Setup menu.
2 In the Setup <Press> menu, (for example ABP) select Scale.
3 Select a value from the pop-up list:
– a positive value sets the top gridline. The bottom gridline is set at zero.
– a negative value sets the bottom gridline. The middle gridline is set at zero.

132
Optimizing the Waveform 12 Monitoring Invasive Pressure

Optimizing the Waveform

♦ In the Setup <Press> menu, select Optimum Scale to let the monitor select the best
minimum and maximum scales for the current wave.

Non-Physiological Artifact Suppression

Some clinical procedures may affect blood pressure, for example, a flush procedure or a blood sample.
Your monitor may be configured to suppress these non-physiological artifacts for a specified duration
(Artifact Suppression is configured to 30, 60, or 90 seconds). During artifact suppression,
the monitor shows the INOP message <Pressure label> ARTIFACT, and a question mark is
shown beside the pressure numerics. Pressure alarms and the Pulse Non-Pulsatile INOP are
suppressed during the configured period. The CPP high alarm is not suppressed.

Choosing the Pressure Alarm Source

WARNING Make sure you set alarm limits for the correct label. The alarm limits you set are stored for that
particular label only. Changing the label may change the alarm limits.

You can monitor for alarm conditions in systolic, diastolic and mean pressure, either singly or in
parallel. Only one alarm is given at a time, in this order of priority: mean, systolic, diastolic.
♦ In the Setup <Press> menu, select Alarms from and choose the source.

Menu option Pressure value monitored

Sys. systolic
Dia. diastolic
Mean mean
Sys&Dia systolic and diastolic in parallel
Dia&Mean diastolic and mean in parallel
Sys&Mean systolic and mean in parallel
Sys&Dia&Mean all three pressures in parallel

♦ Select and set the High Limit and Low Limit for the pressure(s) you have selected.

WARNING If you are using an intra-aortic balloon pump connected to the M1006B #C01 module, do not
defibrillate unless the pump cable is disconnected.

133
12 Monitoring Invasive Pressure Calibrating Reusable Transducer CPJ840J6

Calibrating Reusable Transducer CPJ840J6

Depending on your monitor’s configuration, you may be able to perform a calibration in monitoring
mode. Perform a mercury calibration when you use a new transducer, and at regular intervals according
to your hospital policy. You require:
• standard sphygmomanometer.
• sterile 10cc syringe with heparinised solution.
• 3-way stopcock.
• approximately 25cm of tubing.

Making the Pressure Calibration

WARNING Never perform the invasive pressure calibration while a patient is being monitored.

1 Zero the transducer.

2 Connect the syringe and manometer.
a. Attach the tubing to the manometer.
b. Connect the 3-way stopcock to the stopcock that is not connected to the patient catheter when
you measure a patient.
c. Attach the syringe to one port and the manometer tubing to the other port.
d. Open the port to the manometer.

tubing to manometer

Syringe with
heparinised
Patient solution
connection
stoppered
Off
PRESS M1006A T

PRESS ZERO

12
PIN

3 Move the syringe barrel in and raise the mercury to 200mmHg (30kPa). 200mmHg is the
recommended calibration pressure.
4 In the Setup Pressure menu, select Cal. Press.

134
Calculating Cerebral Perfusion 12 Monitoring Invasive Pressure

5 Select the calibration pressure from the list, for example 200 mmHg.
6 Select Confirm to recalculate the calibration factor using the applied pressure.
7 When the monitor displays <Press> calibration done at <date and time>, remove
the manometer tubing, syringe and extra stopcock. We recommend you replace the transducer
dome and tubing with sterile ones.
8 Label the transducer with the calibration factor shown in the Cal. Factor field in the pressure’s
setup menu.
9 Reconnect the patient and start measuring again.

Troubleshooting the Pressure Calibration

The status line lists the probable cause of an unsuccessful calibration.

Message Corrective Action

unable to calibrate - Contact your service department. The pressure hardware is faulty.
equipment malfunction
unable to calibrate - Make sure that you have selected the value for Cal. Press that
out of range you are applying to the transducer, and repeat the calibration.
unable to calibrate - no Make sure that the transducer is connected and try again.
transducer
unable to calibrate - Make sure there are no disturbances to the transducer, and repeat
unstable signal the calibration.
unable to calibrate - No valid zero. Zero the transducer.
perform zero first

Calculating Cerebral Perfusion

The monitor can calculate the difference between mean arterial pressure and the intracranial pressure.
The difference is labeled CPP.
1 In the Main Setup menu, select Measurements.
2 In the Setup CPP menu, select ABP, ART or Ao as the arterial pressure source.

135
12 Monitoring Invasive Pressure Measuring Pulmonary Artery Wedge Pressure

Measuring Pulmonary Artery Wedge Pressure

Pulmonary Artery Wedge Pressure (PAWP) values, used to assess cardiac function, are affected by:
• Fluid status
• Myocardial contractility
• Valve and pulmonary circulation integrity
Obtain the measurement by introducing a balloon-tipped pulmonary artery flotation catheter into the
pulmonary artery. When the catheter is in one of the smaller pulmonary arteries, the inflated balloon
occludes the artery allowing the monitor to record changes in the intrathoraic pressures that occur
throughout the respiration cycle. The pulmonary wedge pressure is the left ventricular end diastolic
pressure (preload).
The most accurate PAWP values are obtained at the end of the respiration cycle when the intrathoraic
pressure is fairly constant. Use the ECG waveform to determine the waveform of the wedge pressure.
You can use the respiration waveform as a reference when assessing the PAWP waveform, to ensure
constant measurement timing relative to the respiratory cycle. The monitor displays the PAWP value
for up to 24 hours or until you admit a new patient.

WARNING The pressure receptor in the catheter records pressure changes that occur only in front of the
occlusion. Even though the catheter tip is in the pulmonary artery, the receptor records pressure
changes transmitted back through the pulmonary circulation from the left side of the heart.
While performing the wedge procedure, the monitor switches off the pressure alarms for pulmonary
artery pressure (PAP).
Due to a slight measurement delay, you should not use Microstream (sidestream) CO2 as a direct
reference for determining the end expiratory point in the pressure curve.

To start the Wedge procedure,

1 In the Main Setup menu, select Wedge to display the wedge procedures window.
2 Prepare and check the pressure line according to your hospital policy. If the PAP waveform scale is
set to Optimum prior to the wedge procedure, it is possible that after wedging the catheter, the
resulting pressure waveform will fall below the lower scale. In this case, the wedge waveform will
not be displayed or recorded properly. To avoid this, switch out of optimum scale before
performing a wedge procedure.
3 Use the Reference Wave 1 and 2 popup keys to select any ECG or respiratory wave as
reference waves.
4 Select Wave Speed if you want to synchronize all displayed waves to your preferred speed.
5 Inflate the balloon when the monitor prompts you: Ready for balloon inflation. The
waveform changes from the PAP to the PAWP wave. The measurement takes approximately 12
seconds. On completion, the monitor stores the PAWP waveform display and prompts you to
deflate the balloon. If the monitor cannot detect a wedging waveform you must use Store
Trace to store the wedge and two reference waves manually.
6 Deflate the balloon when the monitor prompts you: Ready for balloon deflation and
verify that the waveform returns to pulmonary artery shape.
7 If you need to start a new measurement, select Restart Wedge.

136
Editing the Wedge 12 Monitoring Invasive Pressure

Editing the Wedge

1 Select the Edit Wedge pop-up key to see the stored waveforms.
2 The monitor displays a cursor in the waveform at the PAWP mean value. It also displays any
previously stored value and the time it was stored.
3 Move the cursors up, down, right and left to set them on the correct wedge position.
4 Select Store Wedge to store the PAWP value.
5 Select Print Wedge to print the PAWP waveform and any reference waves or Record Wedge to
record them. While recording or printing, you cannot perform any more Wedge tasks.

WARNING Prolonged inflation can cause pulmonary hemorrhage, infarction or both. Inflate the balloon for the
minimum time necessary to get an accurate measurement.
If the pulmonary artery flotation catheter drifts into the wedge position without inflation of the balloon, the
pulmonary artery pressure waveform assumes a wedged appearance. Take appropriate action, in accordance
with standard procedures, to correct the situation.
If the PAWP (mean) is greater than the PAP (systolic), deflate the balloon and report the incident in
accordance with hospital policy, because the pulmonary artery could be accidently ruptured, and the wedge
value derived will not reflect the patient’s hemodynamic state, but will merely reflect the pressure in the
catheter or balloon.

Identifying the Pressure Analog Output Connector

analog output
(module M1006B,
option C01 only)

137
12 Monitoring Invasive Pressure Identifying the Pressure Analog Output Connector

138
 13

13Monitoring Cardiac Output

The Cardiac Output (C.O.) measurement invasively measures cardiac output and other hemodynamic
parameters using a technique called thermodilution. This can be used to determine the flow rate of a
system by introducing a cold solution into the system and measuring the resulting drop in temperature
at a downstream site. The temperature change is displayed as a curve in the C.O. procedure window,
and the monitor calculates the C.O. value from this curve. The C.O. value is inversely proportional to
the area under the curve. As cardiac output varies continuously, a series of measurements must be
carried out to achieve a reliable C.O. average value. Always use the average of multiple thermodilution
measurements for therapy decisions.
The measurements can be carried out using the right heart thermodilution method or the PiCCO
method (transpulmonary thermodilution).
• The right heart method is available with
– C.O. module M1012A, standard and option #C10
– M3012A Hemodynamic Measurement Server Extension, options #C05 and #C10
• The PiCCO method is available with
– C.O. module M1012A, option #C10
– M3012A Hemodynamic Measurement Server Extension. option #C10
The PiCCO method additionally lets you measure Continuous Cardiac Output (CCO) by performing
pulse contour analysis on the blood pressure waveform.

139
13 Monitoring Cardiac Output Hemodynamic Parameters

Hemodynamic Parameters
This table illustrates the hemodynamic parameters available with each method, whether they are
measured continuously, and whether they can be shown on the monitor’s resting display or in the
HemoCalc Window.

PiCCO Method
(Transpulmonary
Thermodilution) Right Heart Thermodilution

Measured and Calculated Hemodynamic Continu Resting HemoCalc Contin Resting HemoCalc
Parameters and Indexes ous? Display Window uous? Display Window
Blood Temperature (Tblood) Y Y N Y Y N
C.O./C.I.: Cardiac Output N Y Y N Y Y
CCO/CCI: Continuous Cardiac Output Y Y Y (in the Not available
C.O. field)
SVR/SVRI: Systemic Vascular Resistance N and Y Y Y N N Y
SV/SI: Stroke Volume/SV Index N and Y Y Y N N Y
*dPmax: Left Ventricular Contractility Index Y Y N Not available
CFI: Cardiac Function Index N Y N Not available
ITBV/ITBVI: Intrathoracic Blood Volume N Y Y Not available
*EVLW/EVLWI: Extravascular Lung Water N Y Y Not available
*GEDV/GEDVI: Global End-Diastolic Volume N Y Y Not available
PVR/PVRI: Pulmonary Vascular Resistance Not available N N Y
LCW/LCWI: Left Cardiac Work N N Y N N Y
RCW/RCWI: Right Cardiac Work Not available N N Y
RVSW/RVSWI: Right Ventricular Stroke Work Not available N N Y

* currently not available in the U.S.A or in clinical environments under FDA control.

140
Using the C.O. Procedure Window 13 Monitoring Cardiac Output

Using the C.O. Procedure Window

The C.O. procedure window displays up to six trials (measurement curves) with the trial number and
the C.O. value under the thermodilution curve. When you open the window, a line of pop-up keys
automatically appears to let you carry out C.O.-related tasks. This example shows the procedure
window for the transpulmonary (PiCCO) Method. The window may be configured to look slightly
different on your monitor.
To open the C.O. procedure window,
♦ Select Cardiac Output in the Setup C.O. or Setup CCO menu, or
♦ Select the Cardiac Output SmartKey on the screen, or
♦ Press the START hardkey on the front of the C.O. plug-in module, or
♦ Press a remote start switch, if you are using one.

Trial curves Results table of current trial Trial curve scale Averaged values

Cardiac Output (Transpulmonary)

o
0.3 C

Trial #1 #2 #3
CCO-CAL Cal Cal Cal Average Unit

C.O. 8.53 11.4 8.49 8.51 l/min

CFI 5.5 6.0 5.5 5.5
C.I 4.42 5.88 4.40 4.41 l/min/m2
ITBVI 996 1225 998 996
ml/m2
ETVI 6.0 5.0 6.1 o
Setup Tinj 2.0 2.0 2.0 C
information InjVol 10 10 10 ml

Continuously
CathCt InjVol C.I. 4.40 C.O. 8.49 Tblood 37.0
Current trial measured
number BSA 1.93 numeric

Curve alert
message field Tblood

Thermodilution
curve of current
trial

Ready for new measurement

Prompt
message field

Start Stop Select Accept/ Save C.O.& Print/ Table Hemo Change Setup
C.O. C.O. Trial Reject Cal CCO Record Contents Calc Scale C.O.

141
13 Monitoring Cardiac Output Accessing the Setup C.O. and Setup CCO Menus

Accessing the Setup C.O. and Setup CCO Menus

C.O. settings can be changed in the Setup C.O. menu. To access this menu,
♦ press the C.O. hard key on the C.O. module
♦ select any of the discontinuous C.O. numerics (for example, C.O., C.I.) on the screen.
CCO/CCI settings can be changed in the Setup CCO menu. To access this menu,
♦ select any of the continuously measured hemodynamic numerics (CCO, CCI.) on the screen.

Changing the C.O. Results Table Contents

To change the measurement parameters shown in the results table of the C.O. procedure window,
♦ select the Table Contents pop-up key and choose from the list of available parameters.

Entering the HemoCalc Window

♦ From the C.O. procedure window, select the pop-up key HemoCalc to open the HemoCalc
window.

Viewing the Temperature Unit

The temperature unit is visible in the Setup C.O. menu in Monitoring Mode, but inactive (“grayed
out”). It can be changed in Configuration Mode.

Measuring C. O. Using the PiCCO Method

The PiCCO method combines transpulmonary thermodilution and pulse contour analysis on the
blood pressure waveform. A fluid with a known volume and temperature is injected into the right
atrium through a CVP catheter. The injectate bolus mixes with the blood in the heart and the change
in blood temperature is measured with a thermistor at the distal end of an arterial catheter placed in
one of the bigger systemic arteries, for example, the femoral or the axillary artery.
If CVP is not measured continuously, the monitor uses a preset, static CVP value to calculate the SVR/
SVRI (you will see the INOP message SVR SET CVP USED).
The PiCCO Method requires a pressure measurement made using either the M1006B Pressure
module, or a M3001A MMS, or a measurement server extension M3015A, M3016A, or M3012A. (A
VueLink pressure may not be used.) You will also need a conventional central venous (CVP) line and
an arterial catheter from Pulsion Medical Systems. You must use the approved catheters and puncture
locations.

Measuring Continuous Cardiac Output

Every time C.O. is measured with the PiCCO method, the monitor uses this C.O. value and the result
of the pulse contour analysis to calculate a patient-specific calibration factor. The monitor uses this
value to compute CCO and the other continuous hemodynamic parameters. CCO values are
calculated on a beat-to-beat basis and then averaged over a 12-second time frame. The calculated values
are displayed as numerics on the monitor screen.

142
Measuring C. O. Using the PiCCO Method 13 Monitoring Cardiac Output

Setting Up the PiCCO C.O. Measurement

C.O. Module Press Module
1 Set up the arterial line using the arterial
catheter (transpulmonary catheter) and
the transducer kit from Pulsion Medical
Systems. It must be placed in one of the C.O.
Interface
bigger systemic arteries, for example, the Cable
Pulsion
femoral or the axillary artery. You must Pressure
Transducer
use the approved catheters and puncture Pressure
Adapter
locations. Remote
Cable
Switch

2 Set up the central venous line.

3 Connect the injectate temperature probe
housing to the venous line. Injectate
Temperature
Probe
4 Plug the C.O. interface cable into the Thermistor
Connection
C.O. module or measurement server Cable
Injectate
extension and connect the following Syringe

devices to the C.O. interface cable: Thermistor

Connection
– Injectate temperature probe
CVP
– Thermistor connector Injectate Line
Temperatur
e Probe
– Remote start switch (if used). Housing
Follow your hospital standards to avoid
unintentional extraction of the C.O.
catheter. Secure the cable using the
Pulsion Arterial
mounting clip shipped with each C.O. Catheter

interface cable. You may also find it

helpful to loop the C.O. interface cable,
tape the loop, and attach it to the
undersheet of the patient's bed using a
safety pin.
5 If you are measuring CCO, set up the
pressure measurement now. The CCO measurement requires a minimally dampened invasive
pressure setup. You must ensure that there are no air bubbles in the pressure line or dome and use
only specified accessories.
6 Check that the correct measurement method is selected.
If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically
recognizes the method used. If not, in the Setup C.O. menu, select Method and then select
Transpulmonary.
7 Check that the Tinj Probe Type setting in the Setup C.O. menu matches the type of
injectate temperature probe used. The probe type is usually printed on the plug of the probe.
To change the probe type, in the Setup C.O. menu, select Tinj Probe Type to call up a list
of available probes.
– 23001: it is recommended to use this probe with cold injectate
– M1646: this probe can be used with room temperature injectate or with cold injectate.

143
13 Monitoring Cardiac Output Measuring C. O. Using the PiCCO Method

8 Check that the correct arterial catheter constant is selected.

If the catheter is recognized by the monitor, the catheter constant is automatically displayed and
cannot be changed manually. If it is not recognized, in the C.O. procedure window, select CathCt
and use the pop-up keypad to enter the correct value. The catheter constant is usually written
either on the catheter or on the catheter packaging.
9 Make sure that the injectate volume setting matches the injectate volume you will use. To change
the volume, in the C.O. procedure window, select InjVol and select the correct injectate volume
from the pop-up list.
If there is a problem with the volume or temperature you have chosen, the monitor will issue a curve
alert message to inform you of this.
10 If you are measuring CCO or CCI, check that the correct pressure source is selected in the
Setup CCO menu. The pressure label under CCO from must match the pressure measured with
the arterial catheter. To change the pressure source, select CCO from to call up a list of available
pressure labels and select the correct label.
11 If you are measuring CCO or CCI, verify that the correct alarm source is selected in the menu item
Alarms From. To change the alarm source, select Alarms From and choose either CCO or CCI.

Performing PiCCO C.O. Measurements

If you are measuring CCO, all measurements should be conducted within 15 minutes. Older
measurements “expire” for CCO calibration.
1 Enter the C.O. procedure window.
2 When you see the message ...Ready for new measurement, start the measurement by
selecting the pop-up key Start C.O. or pressing the Start hardkey on the C.O. module, or
pressing the remote start switch.
3 When you hear the ready tone and see the message ...Stable baseline, inject now!,
inject the solution into the CVP catheter.
At the end of the measurement the thermodilution curve, cardiac output, index values, ITBV and
EVLW values and any curve alerts are displayed and a message will appear “...Wait before
starting new measurement”.
4 When you see the ...Ready for new measurement message, repeat the procedure until you
have completed the measurements you want to perform. You can perform a maximum of 6
measurements before editing. If you perform more than 6 measurements without rejecting any, the
oldest will automatically be deleted when a 7th curve is stored.

Editing PiCCO C.O. Measurements

It is important to identify and reject erroneous trials, as the monitor uses all the measurement trial
values you do not reject to calculate the averaged cardiac output.
1 Review the trials. Irregular trials or trials marked with a “?” should be reviewed carefully. Consider
the similarity of the values and the shape of the C.O. curve. A normal C.O. curve has one smooth
peak and returns to the temperature baseline level after the peak.
2 Reject unsatisfactory trials by selecting the trial curve. Discard conspicuously different values. If all
values are different from each other, there may be true hemodynamic instability caused, for
example, by severe cardiac arrhythmia. To reject a trial, select its trial curve to toggle between

144
Measuring C.O. Using the Right Heart Thermodilution Method 13 Monitoring Cardiac Output

accepted and rejected. The background of rejected trials is red and the background of accepted
trials is green. The monitor recalculates the average values after you reject trials.

Saving and Calibrating PiCCO C.O. Measurements

When you have finished editing the trials, you must save the results. This closes the measurement
series, sends the average C.O. numeric to be displayed on the main screen, and stores the averaged
values in the trends and calculations databases.
Before the monitor can calculate CCO, you must calibrate the measurement. You should also calibrate
CCO every eight hours, or if the hemodynamic condition of the patient changes consistently in the
same direction over 15 minutes, or if there are large or sudden changes in the patient’s condition.
The monitor only uses C.O. measurements from within the last 15 minutes for calibrating CCO.
To save and calibrate,
♦ In the C.O. procedure window, select the pop-up key Save C.O. & Cal CCO to use the
averaged C.O. value to calibrate Continuous Cardiac Output (CCO).
Your monitor may be configured to have two separate pop-up keys, Save C.O. and Cal CCO,
instead of the combined Save C.O. & Cal CCO.

WARNING CCO calibration is patient-specific. When the C.O. module or measurement server extension is
plugged in after the patient has changed, make sure that the correct CCO calibration is used. When in
doubt perform a new CCO calibration first.

CCO Calibration Status Indicators

Each measurement trial is tagged with a calibration status indicator next to its trial number. Reflecting
the quality of the pressure signal during the thermodilution measurement, this tag indicates each trial’s
validity to be used in a CCO calibration.

CAL A pressure signal for CCO was available during the measurement (valid for calibration)
?CAL A disturbed pressure signal for CCO was available during the measurement (valid for
calibration)
N/A No adequate pressure signal for CCO was available during the measurement (no valid
calibration data)
EXP This trial is more than 15 minutes older than the most recent trial and has expired for CCO
calibration (no valid calibration data)

Measuring C.O. Using the Right Heart

Thermodilution Method
In the right heart thermodilution method, a fluid of known volume and temperature is injected into
the right atrium through the proximal port of a pulmonary artery (PA) (Swan-Ganz) catheter. The
injectate bolus mixes with the blood in the right ventricle and the change in blood temperature is
measured with a thermistor at the distal end of the catheter in the pulmonary artery.

145
13 Monitoring Cardiac Output Measuring C.O. Using the Right Heart Thermodilution Method

Setting up RH C.O. Measurements

C.O. Module
1 Set up the PA line using a PA catheter.
2 Attach the injectate temperature probe
housing to the PA line. C.O. Interface Cable

3 Plug the C.O. interface cable into the

C.O. module or measurement server
extension and connect the following
Remote Start Switch
devices into the C.O. interface cable:
– injectate temperature probe
Thermistor
– remote start switch (if used). Connector

Follow your hospital standards to avoid Injectate

Temperature Thermistor
Connection
unintentional extraction of the C.O. Probe
Cable
catheter. Secure the cable using the
mounting clip shipped with each C.O.
interface cable. You may also find it
helpful to loop the C.O. interface cable, Injectate
Syringe
tape the loop, and attach it to the Injectate
Temperature
undersheet of the patient's bed using a Probe Housing
safety pin.
PA Catheter
4 Plug the thermistor connection cable of
the PA catheter into the thermistor
connector.
5 Connect the injectate temperature probe
to the injectate temperature probe
housing.
6 Check that the correct measurement
method is selected.
If a catheter is already connected to the Cardiac Output Interface Cable, the monitor automatically
recognizes the method used. If not, in the Setup C.O. menu, select Method and then select
Right Heart.

Ice-Bath Setup for RH Thermodilution C.O. Measurements

If you are using the flow-through method illustrated above, the injectate temperature is measured at
the time of injection by the temperature probe in the injectate temperature probe housing.
If you are using the ice-bath setup, the injectate temperature probe and the injectate are both placed in
an ice-bath and the probe measures the temperature of the contents of the ice bucket.

Setting the Computation Constant

Check that the correct Computation Constant is entered in the C.O. procedure window. This can
be found in the documentation supplied with the catheter and is based on the injectate volume,
injectate temperature and catheter type. To change the value, in the C.O. procedure window, select
Computation Constant and use the pop-up keypad to enter the correct value.

146
Documenting C.O. Measurements 13 Monitoring Cardiac Output

Performing RH C.O. Measurements

1 Enter the C.O. procedure window.
2 When you see the message ...Ready for new measurement, select the pop-up key Start
C.O.
3 When you hear a ready tone and see the message ...Inject now!, inject the solution into the
right atrial port of the Swan-Ganz catheter. The optimal injection rate is 2.5 ml/second.
At the end of the measurement the thermodilution curve, cardiac output, index values and curve
alerts (if necessary) are displayed and a message will appear ...Wait before starting new
measurement.
4 When you see the ...Ready for new measurement message, repeat the procedure until you
have completed the measurements you want to perform. You can perform a maximum of six
measurements before editing. If you perform more than six measurements without rejecting any,
the oldest will automatically be deleted when a seventh curve is stored.

Editing and Saving RH C.O. Measurements

It is important to identify and reject erroneous measurements (called “trials”), as the monitor uses all
the measurement trial values you do not reject to calculate the averaged cardiac output.
1 Review the trials. Irregular trials or trials marked with a “?” should be reviewed carefully. Consider
the similarity of the values and the shape of the C.O. curve. A normal C.O. curve has one smooth
peak and returns to the temperature baseline level after the peak.
2 Reject unsatisfactory trials by selecting the trial curve. Discard conspicuously different values. If all
values are different from one other, there may be true hemodynamic instability caused, for
example, by severe cardiac arrhythmia. To reject a trial, select its trial curve to toggle between
accepted and rejected. The background of rejected trials is red and the background of accepted
trials is green. The monitor will recalculate the average values after you reject trials.
3 Save average C.O. values. To close a measurement series, you must save the average values by
selecting the pop-up key Save C.O. This sends the average C.O. numeric to be displayed on the
main screen, and stores the averaged values in the trends and calculations databases.

Documenting C.O. Measurements

You can document C.O. measurements on the default printer or recorder.
1 In the C.O. procedure window, select the pop-up key Print/Record.
2 From the pop-up list, choose:
– Print Results to print the contents of the C.O. procedure window
– Record Results to record the contents of the C.O. procedure window
– Record Trial to send an individual trial curve to the recorder.

147
13 Monitoring Cardiac Output C.O. Injectate Guidelines

C.O. Injectate Guidelines

The greater the injectate volume and the colder the temperature, the more accurate the measurement.
Reduced injectate volume or higher injectate temperature may reduce the specified accuracy.
For adult patients, to ensure the greatest measurement accuracy, use a cold injectate of 10 ml volume, if
not contra-indicated by the patient's condition. Your choice of injectate volume should be based on the
injectate temperature and the patient’s cardiac output.

Guidelines for Right Heart Thermodilution C.O. Injectate

If you are using the right heart thermodilution method, the use of injectate with a temperature less
than 8°C lower than the blood temperature may cause incorrect values for the thermodilution.

Guidelines for PiCCO C.O. Injectate

If you are using the PiCCO method, the use of injectate with a temperature less than 12°C lower than
the blood temperature may cause incorrect values for the thermodilution and CCO calibration.

C.O. (l/min)

Tblood = 37°C
25.0

15.0

12.5 Tinj < 7°C

7.50

2.50
Tinj < 25°C

1.50
1.25
0.75
0.25

2 10 20

Injectate volume (ml)

148
C.O./CCO Curve Alert Messages 13 Monitoring Cardiac Output

Injectate for Patients with High ETVI Values (PiCCO Only)

The dilution of injectate is also influenced by the extravascular tissue. The accuracy of the PiCCO
method may be reduced in patients with high extra-vascular thermal volume index (ETVI) values. You
should use a higher injectate volume and/or colder injectate in these patients, based on this table.

Patient Weight Cold Injectate Room Temperature Injectate

ETVI < 10 ETVI ≥ 10 ETVI < 10 ETVI ≥ 10
< 3 kg 2 ml 2 ml 3 ml Use cold injectate
< 10 kg 2 ml 3 ml 3 ml
< 25 kg 3 ml 5 ml 5 ml
< 50 kg 5 ml 10 ml 10 ml
< 100 kg 10 ml 15 ml 15 ml
≥ 100 kg 15 ml 20 ml 20 ml

C.O./CCO Curve Alert Messages

After each measurement trial, the monitor analyzes the thermodilution curve. If the curve appears
abnormal, a curve alert message appears in the C.O. procedure window. A question mark symbol (“?”)
appears next to the cardiac output numeric if any of these messages appear.

C.O./CCO Curve Alert Messages Possible Causes

Tinj off scale The Tinjectate is out of the range -1°C and 30°C. Cool down or heat
up the injectate or change the injectate solution and repeat the
measurement.
Noisy Baseline A blood temperature baseline drift that could not be compensated
was detected during the C.O. measurement.
Interference may be caused if the patient is on a ventilator.
Interference may also be caused by an infusion pump: infusions of
significant volume should be paused 30 seconds before a
thermodilution measurement and should not recommence until the
measurement series is completed.
Temperature Baseline May occur if patient is recovering from open heart surgery, or if
Drift patient was cooled down for surgery and is in the process of regaining
normal body temperature when the measurement is made.
Small signal, more The peak of the transpulmonary thermodilution curve was below
indicator required 0.1ºC. Increase injectate volume and/or lower injectate temperature.
Injectate Temperature The difference between the blood and injectate temperatures is too
too High small. The calculated value for C.O. may not be accurate.
High ETVI, use cold The ETVI value is too high. The accuracy of the transpulmonary
injectate or greater thermodilution measurement may be reduced. Increase injectate
inj. volume volume and/or lower injectate temperature following the guidelines
given in the section “Guidelines for PiCCO C.O. Injectate” on
page 148.

149
13 Monitoring Cardiac Output C.O./CCO Prompt Messages

C.O./CCO Curve Alert Messages Possible Causes

Disturbed Injection The injection should be performed quickly and with a steady
pressure. Shaking or unsteady pressure may cause this message to
appear.
Check Injectate The recorded Tinj signal is uncharacteristic for the M1646 injectate
Temperature Probe Type temperature probe. The probe may be defective or an incorrect probe
type may have been used.
Unsteady Baseline There is a noisy baseline, and thermal baseline drift.
Multiple Peaks Caused by faulty injection technique.
Abnormal Decay Time May be caused by low cardiac output. Calculated value for C.O. may
not be accurate.
Very Long Curve The decay time of the curve is longer than 15 seconds.
Very Short Curve Decay time of the curve is less than 0.5 seconds. If there is a noisy
baseline, part of the baseline may have been mistaken for a
thermodilution curve. Calculated value for C.O. may not be accurate.
Irregular Curve Any combination of curve alert messages.
Delayed Injection Injection is given more than 15 seconds after Start C.O. is
selected. Calculated value for C.O. may not be accurate.

C.O./CCO Prompt Messages

Prompt messages appear in the C.O. procedure window if a C.O. measurement trial must be
terminated.

C.O./CCO Prompt Messages Possible Causes

Curve Below Baseline, May be caused by thermal baseline drift. No C.O. value
measurement terminated calculated.
Excessive Curve Height, The curve exceeds the upper limit. This may be caused by an
measurement terminated injectate that was too cold. No C.O. value calculated.
Unstable Baseline, The baseline is unstable. Wait until the baseline is stable before
injection not recommended injecting. If this does not occur within a reasonable time,
injection is possible but the accuracy of the measured values may
be reduced.
Excessive baseline drift, No measurement is possible. Measured values are incorrect.
don’t inject now

150
C.O./CCO Warning Messages 13 Monitoring Cardiac Output

C.O./CCO Warning Messages

Warning messages contain important information about the C.O. measurement.

C.O./CCO Warning Messages Possible Causes

Next measurement erases Six curves are stored, this is the maximum possible. If another
older curve measurement is stored, the oldest thermodilution curve will be erased.
Previous C.O. Setup Data A C.O. module or measurement server extension has been plugged in
replaced with different C.O. setup data from the previous data. The new C.O.
setup data is read from the new C.O. device, and replaces the current
data. The message disappears when the Start C.O. pop-up key is
pressed.
Verify the C.O. Setup A new transpulmonary thermodilution catheter has been connected to
Data the C.O. Interface Cable.
Check arterial pressure, Poor or invalid pressure signal, for example if pressure was not zeroed.
CCO cal currently not
possible
Verify the Computation A new catheter has been plugged in, or the computation constant has
Constant been changed and Start C.O. has not been selected.
Previous Comp. Constant A new C.O. module or measurement server extension with a different
replaced computation constant from the current one has been connected. The
new computation constant is read from the new C.O. device, and
replaces the current one. The message disappears when Start
C.O.is selected.

C.O./CCO Safety Information

WARNING Catheter constant: Make sure that the arterial catheter constant for the measurement is appropriate
to the catheter used.

Computation Constant: Make sure that the computation constant for the measurement is
appropriate to the injectate volume, injectate temperature and catheter type used.

IABP: Do not perform transpulmonary thermodilution measurements on patients undergoing IABP

treatment.

CCO accuracy: Accuracy of the CCO measurement and all the derived values may be influenced by
patients with valve diseases or artificial valves.

C.O. and MRI: Do not use the Cardiac Output Interface Cable in Magnetic Resonance Imaging
(MRI) Applications.

Aortic graft patients: Do not use an arterial catheter in the arteria femoralis when it is contra
indicated, for example, with patients who have an aortic graft.

151
13 Monitoring Cardiac Output C.O./CCO Safety Information

CAUTION During the cardiac output measurement procedure the blood temperature alarms are inactive. This is
indicated by a crossed-out alarm symbol next to the temperature numeric. Making alarms inactive
during this procedure prevents false alarms. The alarms are automatically reactivated when you have
completed the measurement procedure.

152
 14

14Monitoring Carbon Dioxide

Use the CO2 measurement to monitor the patient’s respiratory status and to control patient
ventilation.
There are two methods for measuring carbon dioxide in the patient’s airway:
• Mainstream measurement uses a CO2 sensor attached to an airway adapter directly inserted into the
patient’s breathing system. This method is available with the M3016A Mainstream CO2 Extension
to the M3001A Multi-Measurement Server.
• Sidestream (Microstream) measurement samples a probe of the respiratory gas with a constant
sample flow from the patient’s airway and analyzes it with a remote CO2 sensor built into the
measurement system. Philips uses the advanced Microstream method of sidestream CO2
measurement which is available in the M3015A Microstream CO2 Extension to the M3001A
Multi-Measurement Server.
In both cases, the measurement principle is infrared transmission, where the intensity of infrared light
passing the respiratory gas is measured with a photo detector. As some of the infrared light is absorbed
by the CO2 molecules, the amount of light passing the gas probe depends on the concentration of the
measured CO2.
The partial pressure is calculated from the gas concentration by multiplying the concentration value
with the ambient pressure.
The measurement provides:
• a CO2 waveform.
• an end tidal CO2 (etCO2) value: the CO2 value measured at the end of the expiration phase.
• an inspired minimum CO2 (imCO2): the smallest value measured during inspiration.
• an airway respiration rate (awRR): the number of breaths per minute, calculated from the CO2
waveform.
Depending on the Max Hold setting configured for your monitor, the etCO2 numeric shows either
the highest CO2 value measured within the configured time period (Max Hold set to 10 sec or 20
sec) or the etCO2 numeric shows breath-to-breath value (Max Hold set to Off).
During calibration, the monitor measures and displays the instantaneous CO2 concentration.

153
14 Monitoring Carbon Dioxide Using the Mainstream CO2 Extension (M3016A)

WARNING Correlation: The etCO2 readings do not always correlate closely with blood gas values, especially in
neonatal patients and patients with pulmonary disease, pulmonary embolism or inappropriate
ventilation.
Pharmaceuticals in aerosols: Do not measure CO2 in the presence of pharmaceuticals in aerosols.

Using the Mainstream CO2 Extension (M3016A)

The M3016A Measurement Server Extension measures partial pressure of carbon dioxide in a patient’s
expired gas using the mainstream method. When using the appropriate accessories you can use the
mainstream CO2 measurement with ventilated adults, pediatric and neonatal patients.

WARNING Infra-red radiation: Do not expose the airway adapter or M1460A transducer to infra-red radiation
during use. This may cause incorrect readings.

Preparing to Measure Mainstream CO2

1 Attach the transducer connector to the CO2 connector on the measurement extension.
2 Wait 20 minutes, allowing the transducer to reach its operating temperature and a stable thermal
condition.
3 Perform an accuracy check and then, if necessary, calibrate the transducer.

Checking Transducer Accuracy

WARNING Check transducer accuracy at least once a week or if you doubt the CO2 readings.

1 In Setup CO2 menu, select Cal. Mode to switch on calibration mode.

2 Look at the calibration value displayed in the Setup CO2 menu next to Start Cal 1:. Is it
the same as the value on the calstick? If not, calibrate the transducer now.
3 Place the transducer on the low cell of the calstick (labelled 0.0 mmHg or “ZERO”). The reading
on the screen should be zero within ±1 mmHg within one minute.
4 Place the transducer on the high cell of the calstick. The reading on the screen should be within ±1
mmHg of the value on the calstick within one minute.
5 If both readings are in range, you can leave calibration mode and begin monitoring. If either of the
readings is out of range, calibrate the transducer.

154
Using the Mainstream CO2 Extension (M3016A) 14 Monitoring Carbon Dioxide

Calibrating the Transducer

1 Check that the windows on the calstick are clean and clear.
2 Place the transducer on one of the calstick cells and select Start Cal 1.
3 Enter the calibration value printed on the calstick then press Confirm to start calibration.
4 When the message CO2 CAL 1 calibration done - start CAL 2 calibration
appears, put the transducer on the other cell and select Start Cal 2 then press Confirm.
5 When you see the message CO2 calibration completed. Leave calibration
mode., calibration is complete.
6 Select Cal Mode to switch calibration mode off. You cannot monitor in calibration mode.

Attaching and Removing the CO2 Transducer

Airway Adapter
1 Open the latch and place the
transducer onto the airway adapter.
Place the airway adapter in the
patient’s breathing circuit between
the endotracheal tube and the Y- CO2 Transducer
piece. You may see the CO2 SENSOR
WARM UP message until the
transducer reaches operating
temperature. Wait until this
disappears before starting the
measurement.

2 To remove the transducer from the

airway adapter, open the latch and
pull out the airway adapter.

155
14 Monitoring Carbon Dioxide Using the Microstream CO2 Extension (M3015A)

WARNING To prevent stress on the endotrachial tube, support the transducer and airway adapter.
To avoid infection, use only sterilized airway adapters.

Using the Microstream CO2 Extension (M3015A)

The M3015A Microstream CO2 Extension measures the partial pressure of carbon dioxide in a
patient’s expired gas using Microstream technology.
In intubated patients, a sample of the respiratory gas is drawn from the patient’s breathing circuit
through an airway adapter and a gas sampling tube. In non-intubated patients, the gas sample is drawn
through a nasal or oral-nasal cannula.
When using the appropriate accessories, you can use the Microstream CO2 measurement with adult,
pediatric, and neonatal patients.

Preparing to Measure Microstream CO2

Use appropriate accessories for:
• the patient type (adult, pediatric or neonatal),
• the ventilation situation (including humidification)
• the duration - short term use, up to 24 hours (typically OR), or long term use (typically ICU).
All accessories are for single patient use only.

Setting up Microstream CO2 Measurements

WARNING • Explosion hazard: Do not use Microstream measurement in the presence of flammable anesthetic
mixtures, such as flammable anesthetic mixture with air, oxygen or nitrous oxide.
• Low etCO2 values: Leakages in the breathing system or sampling system may cause the displayed
etCO2 values to be significantly too low.

Using Microstream Accessories

M3015A can be operated with the special Microstream accessories only. Refer to the instructions for
use provided with the accessory.
For intubated patients, you can use a Microstream Airway Adapter and a FilterLine sample tube (or a
FilterLine Set, which is a ready-made combination of the two) for non-humidified ventilation. Use the
FilterLine H, or FilterLine H Set for humidified ventilation.
For non-intubated patients, the gas sample is taken through a Nasal FilterLine, or a Smart CapnoLine
(which is a combined oral-nasal FilterLine). In parallel to the measurement of the CO2, oxygen (O2)
may be delivered to the patient to support gas exchange. This is done by using an O2/CO2 FilterLine,
or a Smart CapnoLine O2 (a combined oral-nasal O2/CO2 FilterLine).

156
Using the Microstream CO2 Extension (M3015A) 14 Monitoring Carbon Dioxide

Using the FilterLine and Airway Adapter

1 Attach the female Luer connector to the CO2 inlet connector on the measurement extension by
pushing the socket cover down and screwing the connector into place.

inlet connector cover

outlet connector

2 Check that the FilterLine is not kinked.

3 Change the FilterLine if a “CO2 OCCLUSION” INOP appears on the monitor or if the readings
become extremely erratic.
Disconnect the FilterLine during suctioning and nebulizing therapies.
For best results change the FilterLines for non-humidified use (with orange connectors) after 24 hours
of continuous use and the FilterLines H, for humidified use, (with yellow connectors) after 72 hours of
continuous use.
CO2 values for non-intubated patients using Microstream accessories will always tend to be lower than
for intubated patients. If values appear extremely low, check whether the patient is breathing through
the mouth or whether one nostril is blocked

Removing Exhaust Gases from the System

WARNING Anesthetics: When using the Microstream CO2 measurement on patients who are receiving or have
recently received anesthetics, connect the outlet to a scavenging system, or to the anesthesia machine/
ventilator, to avoid exposing medical staff to anesthetics.

Use an exhaust tube to remove the sample gas to a scavenging system. Attach it to the Measurement
Server Extension at the outlet connector.

157
14 Monitoring Carbon Dioxide Setting up Mainstream and Microstream

Setting up Mainstream and Microstream

These tasks are common to both mainstream and Microstream (sidestream) measurements.

Adjusting the CO2 Wave Scale

1 In the CO2 Wave menu or the Setup CO2 menu, select Scale.
2 Choose a suitable scale range from the pop-up list.

Setting up CO2 Corrections

Temperature, water vapor in the patient’s breath, barometric pressure, and the proportions of O2 and
N2O in the mixture all influence CO2 absorption. If values seem inaccurately high or low, check that
the monitor is using the appropriate corrections.

Correction
Altitude Altitude is set during installation. The monitor automatically applies an appropriate
correction.
O2 The monitor automatically makes standard 45% correction (mainstream measurement
only).
Humidity At installation, the monitor is configured to automatically apply either Body Temperature
Pressure Saturated (BTPS) or Standard Temperature Pressure Dry (STPD). To see
which, go to the Setup CO2 menu, and scroll down to look at HumidtyCorr.
N2O In the Setup CO2 menu, select N2O Corr and to toggle between on and off. If N2O
is present in the ventilation gas mixture, you must turn this on.
If the N2O correction is not available in the Setup CO2 menu, the CO2
measurement in your Measurement Server Extension does not require N2O correction.

Changing CO2 Alarms

This refers to CO2 specific alarms. See the Alarms section for general alarm information.
1 In the Setup CO2 menu, select etCO2 High or imCO2 High and choose the upper alarm
limit.
2 Select etCO2 Low and choose the lower alarm limit.

158
Setting up Mainstream and Microstream 14 Monitoring Carbon Dioxide

Changing the Apnea Alarm Delay

This determines the time limit after which the monitor alarms if the patient stops breathing.
1 In the Setup CO2 menu, select awRR.
2 In Setup awRR menu, select Apnea Time.
3 Choose the apnea alarm delay time.

WARNING Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly
the apnea of prematurity and apnea of infancy, has not been established.
Prolonged delay: The selected apnea alarm delay may be prolonged by up to 17 seconds, if an apnea
occurs during the automatic zero process. This applies to the Microstream (M3015A) measurement
only.

Deriving Alarms From awRR

1 In the Setup CO2 menu, select awRR.
2 In the Setup awRR menu, select Alarms.
3 Choose On to derive alarms from the airway respiration signal or Off to disable them.

Changing awRR Alarm Limits

1 In the Setup CO2 menu, select awRR.
2 Select High Limit to set the upper alarm limit.
Select Low Limit to set the lower alarm limit.
3 Select the appropriate setting.

159
14 Monitoring Carbon Dioxide Setting up Mainstream and Microstream

160
 15

15Monitoring tcGas
The tcGas module measures the partial pressure of the oxygen and carbon dioxide that diffuses through
the skin, thereby providing a measure of these gases in the capillary blood.
The monitor’s settings for altitude and barometric pressure influence the measurement. The tcpO2/
tcpCO2 measurement is valid for an infant patient not under gas anesthesia. Anesthetic agents, such as
halothane, can cause incorrect or drifting readings.
Transcutaneous measurements cannot replace arterial blood gas monitoring. However, you can use
transcutaneous monitoring to reduce the frequency of arterial sampling. The values at tissue level will
not be the same as those measured arterially because the measurement is transcutaneous. They correlate
with (track closely) the arterial values. For example, a drop in transcutaneous values usually indicates a
corresponding drop in arterial values.
Transcutaneous values will not always correlate with blood samples taken from the capillary blood of
the heel (heelsticks or astrups).

Identifying tcGas Module Components

1 press to enter Setup tcGas menu tcGas
M1018A
2 press to start calibration
3 calibration chamber 1
O2/CO2 CAL
4 transducer connector
2
80 x 70
3

161
15 Monitoring tcGas Setting the tcGas Sensor Temperature

Setting the tcGas Sensor Temperature

1 In the Setup tcGas menu, select Transducer Temp.
2 Choose a temperature value appropriate for your patient’s age, weight and physical condition in
accordance with your hospital policy.
Usually, a higher transducer temperature gives a better correlation and a quicker response time.
However, higher temperatures also increase the risk of skin burns. Most physicians prefer a
temperature between 42°C (107° F) and 44°C (111° F), and a site time of four hours or less.
Usually, the higher the transducer temperature, the less the site time should be. Whenever you
change the temperature setting, the monitor forces you to make a new calibration.

Using the tcGas Site Timer

Availability and behavior of the site timer depend on your monitor’s configuration.

WARNING Prolonged continuous monitoring may increase the risk of undesirable changes in skin characteristics,
such as irritation, reddening, blistering or burns. If the site timer is disabled, the transducer will heat
indefinitely while on a patient. Change the site regularly, in accordance with medical procedures in
your hospital.

Setting the tcGas Site Timer

The site timer helps reduce the risk of skin burn by ensuring that the transducer is used at one site for
no longer than a predefined period. It reminds you when this period expires.
1 In the Setup tcGas menu, select Site Time.
2 Choose the time you want the transducer to remain on the measurement site. The optimum time
depends on the transducer temperature and your patient’s skin sensitivity.
The site timer starts automatically when you remove the calibrated transducer from the calibration
chamber. If you return the transducer to the chamber and then remove it again, the site time continues
to count down the remaining time; it does not start a new time period. The time remaining before the
site timer expires appears in the status line which is visible as long as the Setup tcGas menu is
open. When the time expires, the monitor sounds a tone and a displays a change site INOP. The
monitor either switches off the transducer heating or continues monitoring, depending on its
configuration. Although you can reuse the transducer for up to two hours after the heating is switched
off, without making a new calibration, you are recommended to recalibrate before applying it to a
patient. After two hours without heat, you must recalibrate.
During the initial few minutes of use, the monitor eliminates false alarms by temporarily suppressing
tcGas alarms. It displays the “STABILIZING” INOP. After you apply the transducer to the skin, the
instrument reading slowly assumes a steady value. The reading stabilizes when the measurement site is
warm and local hyperemization is complete. This takes 10 to 20 minutes for the tcpO2 reading and
three to seven minutes for tcpCO2.

162
Setting the tcGas Barometric Pressure 15 Monitoring tcGas

Restarting the tcGas SiteTimer

To restart the site timer without recalibration (for example, after the site time has elapsed):
1 In the Setup tcGas menu, select Site Time.
2 Enter and confirm your desired time.

Disabling the tcGas Site Timer

Depending on your monitor’s configuration, you might be able to disable the site timer. Remember,
this means that the transducer heats indefinitely while on a patient.
1 In Setup tcGas menu, select Site Timer and switch this to Disabled.
2 Select the Confirm popup key.

Setting the tcGas Barometric Pressure

Altitude and barometric pressure affect tcGas values. The monitor derives barometric pressure from its
altitude setting. If you want to set the true barometric pressure you must do this before starting a
calibration - changes after calibration do not influence tcGas values. The monitor remembers this
pressure setting until you enter a new one.
1 In the Setup tcGas menu, select AmbientPress.
2 Enter the current barometric pressure reading indicated by your barometer.
3 Select the Confirm popup key.

Remembraning the tcGas Transducer

CAUTION The tcGas transducer is thin and flexible. You must treat it with care. Avoid kinking, bending or
pulling the cable.

Remembrane the transducer if the electrolyte in your transducer has dried out or:
• if the transducer is new
• if you are using the transducer with a new patient
• if the membranes are damaged (scratched or wrinkled)
• after five days of continued use or 28 days of storage.

163
15 Monitoring tcGas Remembraning the tcGas Transducer

1 Unscrew the protection cap from the transducer and

hook the O-ring remover under both O-rings to remove
them.

2 Remove both of the clear plastic membranes using your

fingers.

3 Clean the transducer head, including the groove and

rim, with absorbent paper to remove all old electrolyte
(old electrolyte causes incorrect values) and apply
approximately two drops of electrolyte solution to the
transducer head.

4 Press the transducer head downwards into an unused

membrane replacer until the replacer retracts as far as it
can and you hear a click. Discard used replacer.

5 Remove any surplus electrolyte solution on the outside of the membranes with a soft tissue.
6 Make sure that the new membranes are secured by two O-rings on the transducer. If any air
bubbles are visible under the membranes, repeat this procedure - air bubbles will cause incorrect
readings.
7 After 24 hours you can calibrate the transducer. You must remembrane all new and dried out
transducers twice before calibration.

New/Dried Out Transducers

Remembrane all new or dried out transducers twice before using. After the first remembraning, unplug
the transducer from the module and leave it for 24 hours with the cap on. Remembrane again before
calibrating.

Storing tcGas Transducers

If you need to store a sensor for more than 24 hours, protect it for up to 28 days by putting two drops
of electrolyte solution into the cap. Screw the cap on the sensor. Remembrane if it dries out or after 28
days.

164
Calibrating the tcGas Transducer 15 Monitoring tcGas

Calibrating the tcGas Transducer

You can use either a Philips (15210B) or a Radiometer TCC3 calibration unit and a gas cylinder whose
pressure indicator is above the ‘out-of-gas’ zone (black on 15210B, red on TCC3). To maintain
accuracy, it is recommended to calibrate the transducer every four hours, even if the monitor does not
prompt you to do so. You MUST calibrate when:
• you remembrane the transducer
• you change the transducer heat setting
• you doubt the measurement accuracy
• you start a new monitoring period or use a new site
• the monitor displays the “calibration required” INOP message.
1 Connect the calibration unit to the inlet on the side of the module’s calibration chamber using the
recommended gas tubing. Different tubing will cause inaccurate measurements.

2 Plug the transducer cable into the module. Swing the calibration chamber cover open and insert
the transducer into the chamber. Close the cover to secure the transducer. Set the transducer
temperature at the monitor now.

3 On the 15210B calibration unit, turn the timer control clockwise as far as you can. On the
Radiometer calibration unit, press the button with the green arrow once.

165
15 Monitoring tcGas Calibrating the tcGas Transducer

4 Press CAL on the module until the light above the key comes on and wait (three - 20 minutes) for
the “calibration complete” message to appear on the monitor. Alternatively, in the Setup tcGas
menu, select Start Calibration. To save gas on 15210B, if the timer control dial is not in the
start position when the monitor displays the calibration complete message, turn the dial counter-
clockwise to the start position. For TCC3, if the green light is still flashing when INOP “tcGas
CalRunning” disappears, press the green arrow button again.

Calibration Failure
If calibration fails, the monitor displays “...tcGas transducer or Cal Unit malf” and the
CAL FAILED INOP for the measurement.

Troubleshooting tcGas Calibration

Perform each of the following steps, in order, until calibration is successful.
1 Check the calibration unit, then recalibrate, remembering to turn on the gas supply on the
calibration unit. If the pressure indicator reading is in the out of gas zone, there is insufficient gas
in the cylinder. Connect the gas tubing firmly to the calibration unit and to the module’s
calibration chamber.
2 If Step 1 fails, check whether you need to activate the transducer (necessary if the electrolyte has
dried out or if you have a new transducer). Remembrane the transducer, removing the old
membranes, and cleaning the transducer head thoroughly.
3 Calibrate a second time.
4 If Step 2 is unsuccessful, calibrate again. This calibration may be required to stabilize the
electrochemical system in the transducer.
5 Only if the above steps are unsuccessful (you have activated and remembraned the transducer and
calibration has still failed twice), replace the transducer.

166
Applying the tcGas Transducer 15 Monitoring tcGas

Applying the tcGas Transducer

1 Peel protection film from fixation ring. Using a finger, press the sticky side of the ring on to clean,
dry skin. Press around the outside to ensure a good seal. Apply three to five drops of contact fluid
in the ring’s center. Remove transducer from chamber.

2 Align the arrow on the transducer with the tab on the ring and fasten by turning turn a quarter-
turn clockwise. Wait 10-20 minutes for readings to stabilize.

3 Apply the transducer as soon as possible after you see the “...calibration complete” message. If you
wait longer than 30 minutes, the heat supply to the transducer switches off to prevent the
electrolyte from drying out and a new calibration is necessary.
Optimize the measurement by selecting a site with high capillary density and blood flow, thin
epidermis and no cardiovascular disorders. Most physicians use the abdomen, chest and back.

WARNING You must either remove the transducer before defibrillating, or remembrane and calibrate the
transducer after defibrillating.

CAUTION To avoid transducer damage, remove it from the patient during high frequency surgical procedures.

167
15 Monitoring tcGas Finishing tcGas Monitoring

Selecting the tcGas HeatPowerDisplay Mode

The heat power display gives an indication of the skin’s perfusion below the transducer and of the
transducer’s contact with the skin. If the transducer loses contact, the heat power value drops
significantly. When perfusion is poor you need less heat power to maintain the transducer temperature.
♦ In the Setup tcGas menu, select HeatPowerDisplay to toggle between Relative and
Absolute. Choose Relative when the skin temperature is stable (the STABILIZING INOP
disappears). This indicates subsequent changes in the relative heat power (and therefore changes in
perfusion or transducer contact) since the last zeroing.

Zeroing the tcGas Relative Heat Power

When you start a calibration, the HeatPowerDisplay is set to Absolute. When you switch to
Relative, it automatically zeros. Zero again if you change application site.

Finishing tcGas Monitoring

♦ Replace the transducer in the calibration chamber.
When changing the application site after a measuring period, some users leave the fixation rings in
position to allow them to quickly move the transducer from site to site. Always unscrew the transducer
from the fixation ring before removing the fixation ring from the skin.

TcGas Corrections
Transcutaneous pCO2 values tend to be higher than arterial values due to the metabolic processes of
the skin and the effect of heating on the blood under the transducer. Depending on your monitor’s
configuration, one or both of these corrections may automatically apply.

Temperature Correction for tcpCO2

The transducer temperature causes an increase in partial CO2 pressure. Your monitor may be
configured to correct this.
♦ In the Setup tcpGas menu, look at the menu item CO2 Correction. If correction is enabled,
it is set to On.

Metabolism Correction for tcpCO2

CO2 production in the epidermis increases the CO2 value. Your monitor may be configured to
automatically deduct a metabolism factor (only applies when CO2 Correction is on).
♦ In the Setup tcGas menu, look at the value shown for the menu item MetabolismFactor.
This is deducted from the CO2 value.

168
 16

16Monitoring SvO2
MP60/70/90 The SvO2 module measures the percentage of mixed venous oxygen saturation continuously and
monitors invasively using the Abbott Laboratories OptiCath family of catheters routed via the right side of the
only heart into the pulmonary artery. Can be used only with the MP60/MP70/MP90 monitors.

WARNING Injected dyes, such as methylene blue, or intravascular dyshemoglobin may lead to inaccurate
measurements.
Do not monitor oxygen saturation during infusion of I.V. fat emulsion or other turbid substances
through the distal lumen of the OptiCath catheter. These liquids might temporarily modify the blood
scattering and absorption characteristics at the catheter tip. This interferes with the optical
measurement of oxygen saturation. After infusion is complete, you can again monitor oxygen
saturation accurately.
During injection of the bolus for thermodilution cardiac output measurements, the SvO2
measurement might be disturbed.

169
16 Monitoring SvO2 Preparing to Monitor SvO2

Preparing to Monitor SvO2

In addition to an SvO2 module, you need an Abbott Laboratories OptiCath catheter, and 50131-04
Optical Module. Use only the Abbott accessories listed in the Accessories section.

1 optical module
2 balloon
inflation 4
stopcock
3 Abbott fiber
optic catheter 5
4 optical
reference
5 enter setup/
calibration

1
3
2

Connect the optical module (Abbott 50131-04) to the SvO2 module. Allow the optical module to
warm up before you perform a calibration. Although the warm up message disappears from the screen
after one minute, Abbott recommends letting the optical module warm up for 15 minutes for best
accuracy. Please refer to the instructions for the optical module.
To avoid false alarms during the pre-insertion calibration and insertion of the catheter into the patient,
the monitor automatically suspends alarms during the pre-insertion calibration, for up to three minutes
after you remove the catheter tip from the optical reference. After light intensity calibration, or after
three minutes (whichever comes first), the monitor returns to the alarm state it was in prior to pre-
insertion calibration.

Carrying out a Pre-insertion Calibration

WARNING It is strongly recommended to carry out a pre-insertion calibration prior to all insertions. If this is not
possible, you must perform an in-vivo calibration after insertion.

Refer to the instructions for use that accompany the catheter. Do not use the catheter if the packaging
is damaged. If you have to disconnect the monitor from the patient (for example, when transferring the
patient from one location to another), you must disconnect at the SvO2 module. The catheter should
remain in the optical module, otherwise you need to recalibrate.
1 Remove outer wrapping from catheter tray to uncover optical connector.
2 Place the optical module on the catheter tray in the space provided and open the lid.

170
Inserting the Catheter 16 Monitoring SvO2

3 Place the optical connector into the optical module (with the label “TOP” facing upwards) and
close the lid.
4 In the Setup SvO2 menu, select Start Pre-InsCal. Ensure that the tip of the catheter is still
in the optical reference.
5 Insert the catheter when you see the message SvO2 calibration completed - catheter
ready for insertion. If the calibration fails, repeat the calibration before inserting the
catheter. If it fails a second time, replace the optical module.

Inserting the Catheter

1 Remove the inner cover of the catheter tray.
2 Remove the catheter tip from the optical reference. Check the catheter's proper operation (for
example: the balloon tip).
3 Prepare and insert the catheter in accordance with standard hospital practice.
The SvO2 catheter is thin and flexible, treat it carefully. Avoid kinking, bending or grasping the
catheter with forceps or a hemostat. Damage to the fiber results in low intensity light and sudden
decrease in intensity readings. Refer to the documentation provided with the fibre-optic catheter,
paying special attention to any precautions, warnings or contraindications.
Secure the optical module directly or in close proximity to the patient, to avoid placing excessive
tension on the catheter, which would result in movement of the catheter tip from the optimal position
in the patient. Position the optical module to avoid contact with liquids, because fluid entering the
catheter-optical module connection may impair light transmission.
If you place the catheter in the patient without performing the pre-insertion calibration, you must
perform an in-vivo calibration once the catheter is in place.

Performing a Light Intensity Calibration

Perform a light intensity calibration after the catheter is in its proper position. When the catheter is
positioned properly, the light intensity indicator must cover at least two small divisions above the
midpoint.

SvO2

67
80
60

♦ In the Setup SvO2 menu, select Start Light Cal.

Calibration is complete after a few seconds. If you doubt existing light intensity readings, recalibrate.

171
16 Monitoring SvO2 Performing In-Vivo Calibration

Performing In-Vivo Calibration

Perform an in-vivo calibration:
• if you place the catheter in a patient without performing a pre-insertion calibration.
• if the catheter was disconnected from the optical module.
• when the catheter has been in the patient for 24 hours.
• if any significant change in light intensity occurs that the monitor cannot correct automatically.

Setting Up the In-Vivo Calibration

Check for:
• proper positioning of the catheter in the patient.
• relatively stable oxygen saturation in patient.
• that the SvO2 light intensity indicator covers at least two divisions above the midpoint.

Making the In-Vivo Calibration

1 Be prepared to draw a blood sample from the patient.
2 In the Setup SvO2 menu, select Start In-VivoCal.
3 To clear the distal lumen, draw off and discard at least 2 ml of blood before taking the sample.
4 Draw a blood sample from the distal port of the catheter and flush the line according to standard
hospital practice.
5 Obtain laboratory analysis of the sample using direct measurements.
6 Compare the results with the stored calibration value displayed in the Setup SvO2 menu. If the
difference is less, or equal, to 4%, you can skip the next step.
7 If there is a difference of more than 4% between the stored value and the laboratory value, select
CalibrationValue to adjust the stored value. Selecting Recall PreviousC recalls the
previously stored calibration value.
8 Complete the calibration by selecting Store In-VivoCal (even if you did not adjust the
calibration value). This updates the data stored in the optical module.

Calculating Oxygen Extraction

Oxygen extraction is the difference between the measured SpO2 and SvO2 values. If you are
monitoring SpO2 and SvO2, the monitor can calculate this value and display it as a numeric.
♦ To switch oxygen extraction calculation on or off, in the Setup Sp-vO2 menu, select Sp-vO2
and toggle between On and Off.
♦ If more than one SpO2 value is available, you must choose which value is used in the calculation.
In the Setup Sp-vO2 menu, select SpO2 Source and select the required source.
If one of the calculation sources becomes unavailable, the monitor displays the INOP
Sp-vO2 CHK SOURCES for one minute. After this time, the calculation automatically switches off.
If the missing source becomes available again, the calculation automatically switches on again.

172
 17

17 Using the AGM

The M1026A Anesthetic Gas Module (AGM) measures patients’ anesthetic and respiratory gases. It
can measure and display waves and numerics for 3 respiratory gases, and it can automatically identify 5
anesthetic agents and display waves and numerics for one of these.
The module measures the Airway Respiration Rate (awRR) and provides end tidal (et) and inspired
(in) values for the following gases:

Respiratory Gases Anesthetic Agents

Carbon dioxide (CO2) Halothane
Nitrous oxide (N2O) Isoflurane
Oxygen (O2) Enflurane
Sevoflurane
Desflurane

Understanding the AGM Display

The AGM can send waves and numerics for all measured gases for display on the monitor screen. This
example shows the CO2, O2, and N2O waves and numerics. Your display may be configured to look
different.

CO2
etCO2 etO2
inO2
O2 imCO
N2O etN2O awRR rpm
inN2O

173
17 Using the AGM AGM Major Parts and Keys

AGM Major Parts and Keys

Airway Gases LED

Airway Gases Key
Power On/Off Airway Gases

switch

Power LED
Watertrap
The setup airway gases LED lights when the Setup Gas Analyzer menu is open, when the module
is first switched on (for 5 - 10 seconds), and if there is a problem with the communication between the
AGM and the monitor.

Watertrap
The watertrap prevents water and other fluids from passing into the
AGM and causing contamination and/or internal occlusions. It has a
water reservoir in which fluids are collected, two water separation
filters, and two shut-off fuses as a backup mechanism for the water
separation filters.
The watertrap is for multi-patient use. It must be exchanged at least
every two weeks.

AGM Rear Panel

600VA max.

T1.6 H 250V

100-240V 50-60 Hz

Fuses
60/140 Equipotential
Gas Outlet RS232 Power
Grounding
Connector Inlet
Terminal

Make sure all devices connected to the RS232 connectors are isolated. Make sure that the anesthetic
gas outlet at the rear of the module is connected to the gas scavenging system.
See the Service Documentation supplied with the device for further information on connecting
devices.

174
Understanding the Gas Measurement 17 Using the AGM

Understanding the Gas Measurement

The AGM uses a technique called Non-Dispersive Infrared Gas Concentration Measurement (NDIR)
to measure the concentration of certain gases.
The gases which can be measured by the AGM absorb infrared (IR) light. Each gas has its own
absorption characteristic. The gas is transported into a sample cell, and an optical IR filter selects a
specific band of IR light to pass through the gas. For multiple gas measurement, such as in the AGM,
there are multiple IR filters. The higher the concentration of gas in a given volume the more IR light is
absorbed. This means that higher concentrations of IR absorbing gas cause a lower transmission of IR
light. The amount of IR light transmitted after it has been passed through an IR absorbing gas is
measured. From the amount of IR light measured, the concentration of gas present can be calculated.
This calculation provides the gas measurement value.

Connecting AGM Accessories

The AGM accessories and part numbers are listed in the accessories section.
1 Insert a watertrap by gently pushing it up and in, following the instructions supplied with the
watertrap.
2 Switch on the AGM. This allows time for the module to warm up while connections to the patient
are being made.
3 Connect the gas sample tubing to the Luer connector of the watertrap, following the instructions
supplied with the tubing.
4 Connect the other end of the gas sample tubing to the patient via the airway adapter.

CAUTION Airway Adapter: Use a Philips Airway Adapter and position it so that the part connecting to the gas
sample tube is pointing upwards. This prevents condensed water from passing into the gas sample tube
and causing an occlusion. Philips airway adapters have a built-in port extending from the adapter wall,
which reduces the risk of a blockage occurring.

Watertrap: To minimize the risk of internal contamination, never leave the AGM running without a
watertrap attached (except during a watertrap exchange).

Gas Sample Tube: Do not use the gas sample tube if it is kinked, as it may cause an occlusion or
leakage.

Room Ventilation Make sure that the room in which the AGM is used is well-ventilated with fresh air.
Gases or fumes that mix with and contaminate the room air may degrade measurement accuracy.

WARNING Ensure that the connections are tight. Any leak in the system can result in erroneous readings due to
ambient air mixing with patient gases.

175
17 Using the AGM Using the AGM Setup Menus

Using the AGM Setup Menus

Many AGM settings can be changed just like other measurement settings. These are described in the
chapter on Basic Operation, only AGM-specific settings are described here.
To change settings for individual gases, enter the setup menu for the individual gas:
♦ select the measurement numeric on the monitor screen, or
♦ select the required gas label in the Setup Gas Analyzer menu.
To change AGM settings, enter the Setup Gas Analyzer menu:
♦ select one of the AGM numerics on the monitor screen and then select the menu item Gas
Analyzer, or press the Airway Gases hardkey on the AGM.

Choosing Numerics for Display

For each gas the AGM measures, you can choose which numerics are displayed with the waveform on
the screen:
– et displays the endtidal numerics,
– in displays the inspiratory numerics,
– et+in displays both endtidal and inspiratory numerics.
– Off switches off measurement of that particular gas.
No waveforms or numerics will be shown for gases set to Off, and no alarms will be generated.
To change the displayed numeric, in the Setup <Gas Label> menu, select the label of the gas
measured to call up a pop-up list of numerics available and then select the numeric you want to display.
As the inspired minimum is measured for CO2 (imCO2), the numeric label is im instead of in.

Humidity Correction for CO2

The AGM is configured to correct the CO2 measurement for either Body Temperature Pressure
Saturated (BTPS), to account for humidity in the patient’s breath, or Ambient Temperature Pressure
Dry (ATPD).
♦ In the Setup CO2 menu, see the menu item Humidity Corr. to see which correction
applies. It is either Wet for BTPS or Dry for ATPD.

Adjusting Wave Scales

1 In the Wave menu or the Setup menu for the gas, select Scale.
2 Choose a suitable scale range from the pop-up list.

176
Changing the Apnea Alarm Delay 17 Using the AGM

Changing the Apnea Alarm Delay

The apnea alarm delay time determines the time limit after which the monitor alarms if the patient
stops breathing.
1 In the Setup CO2 menu, select awRR.
2 In the Setup awRR menu, select Apnea Time.
3 Choose the apnea alarm delay time.

WARNING The safety and effectiveness of the respiration measurement method in the detection of apnea,
particularly the apnea of prematurity and apnea of infancy, has not been established.

Deriving Limit Alarms from awRR

1 In the Setup CO2 menu, select awRR.
2 In the Setup awRR menu, select Alarms.
3 Select On to derive alarms from the airway respiration signal or Off to disable them.

Alarms and Zero Calibration

When a zero calibration is in progress, the physiological alarm detection is suspended. When the
calibration is finished, the AGM resumes alarm detection. If an alarm condition is present after the
zero calibration, the alarm will be activated within the specified alarm delay time.

WARNING If an apnea occurs during a zero calibration, the time delay between the start of apnea and the
activation of the apnea alarm could be up to 16 seconds plus the configured apnea delay time.

Automatic Alarm Suppression

Your monitor can be set to suppress alarms until it detects that a patient has been connected to the
AGM (when a breath is detected). This feature is called No Al til Breath and can be set to On or
Off in the monitor’s Configuration Mode.

177
17 Using the AGM Agent Identification

Agent Identification
Setting the agent identification mode to Agent Id: Manual lets you choose the anesthetic agent
manually. If you choose the setting Agent Id: Auto, the AGM automatically identifies the
predominant anesthetic agent in the breathing circuit.
♦ To change the agent identification mode, in the Setup AGT menu, select Agent Id: to toggle
between the settings Auto and Manual.

If Agent ID is Set to Manual

To change the agent monitored, when Agent Id is set to Manual:
♦ In the Setup <Agent label> menu, select Agent to call up a pop-up list of available agents
and select the agent you want to monitor. For example, Setup HAL.
If the manually selected agent does not match the agent detected, the INOP CHECK AGENT appears.

If Agent ID is Set to Auto

As soon as the AGM has detected the agent, a waveform and numerics for this agent appears on the
monitor screen, if they are configured to be displayed. During the process of identification, the generic
label AGT is shown as a placeholder.
For an anesthetic agent to be detected by automatic agent identification, its concentration must exceed
the identification threshold. The presence of other substances in the patient such as methanol or
acetone can influence the agent identification and lead to incorrect values and incorrect identification.

Exchanging Agents
If the anesthetic agent administered to the patient changes, a mixture of both gases is detected by the
AGM during the transition. The time needed to complete the exchange depends on the type of
anesthesia (low flow or high flow), and the characteristics of the agents administered
(pharmacokinetics). During the exchange, you will see the INOP message AGT MIXTURE and -?-
next to the affected numerics.
If you are using automatic agent identification, when one of the agents decreases below its threshold
and the other agent predominates, the monitor will recognize the exchange.
If you are using manual agent identification, you must change the agent in the Agent Setup menu
to match the administered agent.

Agent ID During Emergence from Anesthesia

If automatic agent identification is selected during emergence from anesthesia and the agent
concentration falls below the identification threshold, the agent will no longer be identified. The agent
label will remain on the display and the numeric will show 0.00 % until the monitor detects that a
patient is no longer connected. After this, the generic label AGT will be shown.
♦ To display the correct agent and value, change to manual identification and select the agent
manually.

178
Removing Gas from the Circuit 17 Using the AGM

Removing Gas from the Circuit

If inhalation anesthetics are used during anesthesia, pollution of the operating room should be
prevented by either returning the filtered gas sample to the breathing circuit or by disposing of the gas
sample.
Your hospital policy may not permit the use of gas return systems.

Returning the Gas Sample

Use an M1656A Gas Exhaust Return Filter and M1655A Exhaust Return Tubing as instructed in the
documentation supplied with the filter to return the gas sample to the patient’s breathing circuit.

Removing the Gas Sample

To remove the gas sample from the breathing circuit, a scavenging system must be connected to the gas
exhaust port. Use either:
• a gas exhaust scavenging tube
• a suction bottle reservoir, where the suction pressure does not exceed 0.3-0.4mm Hg
• a scavenging interface.

Entering AGM Standby Mode

During standby, the AGM gas sample intake pump is automatically switched off to increase the pump
lifetime. The message AGM STANDBY is shown on the monitor. When you exit standby, you do not
need to wait for the AGM to warm up to resume monitoring.
The AGM standby mode is linked to the monitor standby mode:
• If the monitor enters standby mode, the AGM also enters standby mode.
• If the monitor leaves standby mode, the AGM automatically also leaves standby mode.
• If the AGM enters or leaves standby mode, this does not affect the monitor.
The AGM enters standby mode automatically when no breath is detected for a configured period of
time (if CO2 is less than 4 mmHg).
To enter or leave standby mode manually:
• in the Setup Gas Analyzer menu, select Set to Standby or Exit Standby.

179
17 Using the AGM Zero Calibration

Zero Calibration
The AGM zero calibration maintains the accuracy of the AGM gas measurements by sampling and
analyzing room air. It takes about 10 to 15 seconds to complete and may not be interrupted. If a zero
calibration fails, a second zero calibration is performed automatically. During the zero calibration, the
waveform is flat and numerics are not updated.

Automatic Zero Calibration

A zero calibration is carried out automatically after the module has been switched on, and then 8, 15,
30, 45, and 90 minutes after monitoring has been started. After that, a zero calibration is triggered
every 8 hours or if a measurement drift is detected. If the AGM was in standby when one of the above
triggers for zero calibration occurred, the zero calibration is carried out when the AGM leaves standby.

Carrying Out Manual Zero Calibration

♦ To manually start a zero calibration, in the Setup Gas Analyzer menu, select Zero Cal, then
select the Confirm pop-up key.

Suppressing Zero Calibration

To temporarily prevent an automatic zero calibration from being started,
♦ in the Setup Gas Analyzer menu, select No Zero for 5min.
Selecting No Zero for 5min again before the timer has timed out resets the timer to five minutes.

Using the AGM During a Cardiopulmonary Bypass

During a cardiopulmonary bypass, the anesthesiologist may cease periodic mechanical ventilation. In
these cases, it is important to note that an active AGM will continue to suck gases from the patient-
ventilator circuit during that time. This will cause the airway pressure to drop if no active measures are
taken to keep the patient-ventilator circuit stable. To stop the AGM from sucking gases out of the
circuit, either:
• activate the AGM standby mode or
• disconnect the sample line from the AGM or from the patient-ventilator circuit.

180
AGM Safety Information 17 Using the AGM

AGM Safety Information

To avoid condensed water collecting in the gas sample tube, position the AGM at or above the patient
level. Do not set up the AGM in a position where liquid could spill onto it.

WARNING Detecting leaks: Any leak in the tubing and connections from the patient to the AGM may result in
dilution of the gas mixture with ambient air. If this leak exceeds a certain magnitude, the value of gases
and anesthetic agents displayed on the monitor may differ significantly from the actual concentration
in the patient’s breathing circuit. Erroneous values may lead to inappropriate intervention and patient
safety may be at risk.

Unexpected values: If an unexpected gas concentration value appears on the monitor, or if the waves
appear to be flatter than normal, visually inspect the entire tubing and replace if necessary. If no
occlusion or leakage can be found, replace the watertrap with a new one and check the values.

CAUTION AGM ports: Do not apply excessive pressure to the AGM inlet or outlet ports, for example from a
syringe, as this may cause damage to the pneumatic and optical systems.

Cleaning: Switch off the AGM during cleaning, as an intake of cleaning fluids or fumes may damage
the device.

181
17 Using the AGM AGM Safety Information

182
 18

18Monitoring EEG
The Electroencephalograph (EEG) module monitors the patient’s cerebral function by measuring the
electrical activity of the brain. It provides the monitor with two channels of realtime EEG waves, EEG
trend information in the form of Compressed Spectral Arrays (CSA), and up to eight of the following
numerics:

Spectral Edge Frequency (SEF): The SEF is the frequency below which a defined percentage of the
Total Power lies. The percentage is set in Configuration Mode.

Mean Dominant Frequency (MDF): The MDF is the mean value of the frequency which dominates
the measured EEG.

Peak Power Frequency (PPF): The PPF is the frequency with the highest measured amplitude.

Total Power (TP): The TP numeric indicates the power in the measured frequency band.

Percentage of total power in each frequency band:

– Alpha waves (8 to 13 Hz)
– Beta waves (13 to 30 Hz)
– Theta waves (4 to 8 Hz)
– Delta waves (0.5 to 4 Hz).

183
18 Monitoring EEG EEG Monitoring Setup

EEG Monitoring Setup

1 Plug the trunk cable into the EEG module in the Flexible Module Server.
2 Prepare the patient’s skin prior to placing the electrodes. Good electrode-to-skin contact is
important for a good EEG signal, as the skin is a poor conductor of electricity.
– Shave hair from sites, if necessary.
– Wash sites thoroughly with soap and water. We do not recommend using ether or pure alcohol,
because this dries the skin and increases the resistance.
– Use a skin preparation paste to remove skin cells and oil before placing the electrodes.
3 Select the desired electrode montage in the Setup EEG menu or in the EEG Impedance/
Montage window.
4 Attach the reference electrode first.
5 Place the electrodes on the patient’s head according to the selected montage. Use electrode gel if
you are not using pre-gelled electrodes. Remember to select a site where the signal will not be
interfered with by muscle artifacts.
6 Connect the electrode connector end to the trunk cable.
7 Check the electrode-to-skin impedance in the EEG Impedance/Montage window.
8 For good signal quality, keep all lead wires together and away from other electric devices and
metallic bodies.

Using the EEG Impedance/Montage Window

♦ To open the window, in the Setup EEG menu, select Show Montage, or select the Show
Montage pop-up key.
The window may be configured to look slightly different on your monitor.

Electrode locations on the patient’s head. The symbols Wiring and impedance values for the
represent the electrode-to-skin impedance. selected montage

EEG Impedance/Montage

+ - - +
EEG 1 EEG 2
1 1 kOhm 1 1

ImpedanceLimit:5kOhm
EEG 1: F3-P3
EEG 2: F4-P4
Montage A

184
Using the EEG Impedance/Montage Window 18 Monitoring EEG

Choosing an EEG Electrode Montage

1 To activate one of the five pre-configured electrode montages, select the arrow beside the label in
the EEG Impedance/Montage window and choose a montage from the list.
2 Attach the electrodes as illustrated in the EEG Impedance/Montage window.
The five default electrode montage configurations can be modified and renamed in Configuration
Mode.

Montage Name EEG1+ EEG1- Label1 EEG2+ EEG2- Label2

Mont.A Fp1 T3 Fp1-T3 Fp2 T4 Fp2-T4
Mont.B O1 T3 O1-T3 O2 T4 O2-T4
Mont.C F3 C3 F3-C3 F4 C4 F4-C4
Mont.D C3 P3 C3-P3 C4 P4 C4-P4
Mont.E Fp1 T5 Fp1-T5 Fp2 T6 Fp2-T6

The electrode locations are labeled according to the international 10-20 electrode placement system.

Changing the Impedance Limit

The impedance limit can be set for all electrodes simultaneously in the Setup EEG menu, or in the
EEG Impedance/Montage window using the pop-up keys. If the limit is exceeded during
monitoring, an INOP will appear and the graphic impedance indicator will change.
To change the impedance limit, either
♦ use the pop-up keys that appear with the EEG Impedance /Montage window, or
♦ in the Setup EEG menu, select Impedance Limit to call up a list of selections between 1 and
30 kOhm, then select the required limit from this list.

185
18 Monitoring EEG Using the EEG Impedance/Montage Window

About Electrode-to-Skin Impedance

Electrode-to-skin impedance is the main quality indicator for the measured EEG signal. During
normal EEG monitoring, electrode-to-skin impedance is measured continuously and disconnected
electrodes are detected. The impedance value for each single, independent signal electrode is displayed
in the EEG Impedance/Montage window. If the measured electrode-to skin impedance of one or
more electrodes is above the limit, an INOP will be issued.
For impedance measurement at least two electrodes, plus the reference electrode, must be connected.

Impedance Indicators

Electrode/Skin Impedance Symbol Color Displayed Action

Impedance
Value
Electrode not connected red no value connect electrode

Noisy signal gray 60 kΩ (fixed) check electrode-to-skin

connections

Electrode connected, impedance yellow measured value check limit, check

above limit (e.g 15 kΩ) electrode-to-skin contact
Electrode connected, impedance green measured value no action necessary
at or below limit (e.g. 3 kΩ)

186
About Compressed Spectral Arrays (CSA) 18 Monitoring EEG

About Compressed Spectral Arrays (CSA)

The continuous EEG signal is sampled periodically and this value is stored in a frame. Each frame is
processed using Fast Fourier Transformation (FFT) to provide a frequency spectrum displayed as a
compressed spectral array (CSA).
The CSAs provide an overview of the patient’s EEG values over time. They can be configured to be
shown on the resting display of your monitor. The CSAs may be configured to look slightly different
on your monitor.
Selecting the CSA opens the EEG pop-up keys to let you carry out EEG monitoring tasks.

Fp1-T3 Filter:0.5 - 30 Hz Montage: Montage A Fp2-T4

CSA1 Buffer: A (2 Sec) SEF (90%) PPF Fp2-T4

The CSA contains the following information

Status line Lead label for example, Fp1-T3, Fp2-T4
CSA label CSA1 or CSA2 according to EEG channel
Montage label for example, Montage A
Filter settings for example, 1-30 Hz
Buffer label and time the buffer and interval between spectral lines on the CSA
Current SEF Threshold can only be changed in Configuration Mode
Spectral lines The energy at each frequency is computed and displayed as a spectral line

Trendlines EEG values are sampled at configured time intervals and displayed as color-coded trendlines.
Trendlines are available for the three frequency numerics (SEF, PPF, MDF)
Annotations: INOP marker
?
Filter change marker

Montage change marker

187
18 Monitoring EEG Changing EEG Settings

Displaying CSAs
To show the CSAs on the resting display (if your monitor has a Screen preconfigured to do this),
1 Select the Change Screen SmartKey to call up a list of available preconfigured screens.
2 From this list, select the screen configured by your unit to show CSAs.
3 In the Setup EEG menu, select Setup CSA to enter the Setup CSA submenu to define the
appearance of the CSA on the monitor display(s).

Setup CSA This menu entry lets you

Buffer choose one of the three pre-configured buffers
Trend SEF/MDF/PPF switch the trendline of the specific numeric on or off
Smoothing CSA see whether smoothing of spectral lines is on or off. This can only be changed
in Configuration Mode.

Changing EEG Settings

Be aware that any changes made to EEG settings apply to both EEG channels.

Switching EEG Numerics On and Off

Each EEG numeric can be individually switched on or off in the Setup EEG menu.
1 In the Setup EEG menu, select the numeric label.
2 Select On/Off to toggle between the settings.

Changing the Scale of the EEG Waves for Display

This only changes the visual appearance of the wave. It does not affect the signal analyzed by the
monitor or printed in reports or recordings.
1 In the Setup EEG menu, select Wave Scale to call up a list of wave scales.
2 Select the required scale from this list.
Scaling information is displayed with each EEG wave.
• If Show Gridlines is set to On in Configuration Mode, gridlines and the current wave scale
values are shown with the EEG wave.
• If Show Gridlines is set to Off in Configuration Mode, the current wave scale is indicated by a
size bar beside the EEG wave.

188
Changing the Speed of the EEG Wave 18 Monitoring EEG

Changing Filter Frequencies

The low and high pass filters screen out undesirable interference from the raw EEG wave display. The
current EEG filter frequency settings are shown in the header of the CSA. Changing filter settings
affects the EEG wave and all the EEG numerics. Whenever the filter setting is changed, a filter change
marker appears next to the spectral lines.
To change the filter settings:
1 In the Setup EEG menu, select Low Filter or High Filter to call up a list of available
frequencies.
2 Select the required frequency from this list.

Changing the Speed of the EEG Wave

The EEG measurement has its own speed control and is not affected by the wave speed settings of the
other measurements.
♦ In the Setup EEG menu, select EEG Wave Speed. Choose the required speed from the pop-up
list. This defines the speed at which the wave is drawn across the screen in millimeters per second
(mm/s).

EEG Reports
The content of EEG Reports is always the same and does not need to be configured.
♦ To print an EEG Report, in the Setup EEG menu, select Print Report.
Alternatively, you can select the CSA and use the Print Report pop-up key to start the report.
♦ To modify the buffer and trendline settings on the CSA Report, in the Setup EEG menu, select
Setup CSA and then select CSA on Report. If you do not change these settings, the
monitor will use the default settings SEF Trendlines: On, Buffer: C.

CSA on Report This menu entry lets you

Buffer choose one of the three pre-configured buffer times
Trend SEF/MDF/PPF switch the trendline of the specific numeric on or off
Smoothing CSA see whether smoothing of spectral lines is on or off. This can only be changed
in Configuration Mode.

189
18 Monitoring EEG EEG Safety Information

EEG Safety Information

EEG Configuration and Monitor Upgrades The A.2 monitor release (software revision A.20.xx)
introduced a new feature that lets you rename EEG montages. It is not possible to clone EEG settings
between montages with different names, therefore all EEG settings are reset to factory defaults during
any upgrade/downgrade/cloning actions that mix releases/software revisions/configurations before A.2/
A.20.xx with subsequent versions. You must check that all EEG settings are correct before resuming
monitoring with a monitor that has been upgraded or cloned.

WARNING Do not touch the patient, or table, or instruments during defibrillation.

When connecting electrodes and/or patient cables, ensure that the EEG leads and connectors do not
come into contact with other conductive parts or earth.

High-frequency Surgery To reduce the hazard of burns in the high-frequency surgical neutral
electrode connection, the EEG electrodes should not be located between the surgical site and the
electro-surgical unit return electrode.

EEG and Electrical Interference

CAUTION Interference from a non-grounded instrument near the patient and electrosurgery interference can
cause problems with the waveform and the CSA.
Radiated field strengths above 1 V/m and patient signals ≤ 50 µV may cause noise on the EEG waves
at various frequencies. Therefore, it is recommended to avoid the use of electrical radiating equipment
in close proximity to the patient monitor. The noise does not influence the measurement accuracy.
Interference from ECG can be eliminated by adjusting the low filter settings.

190
 19

19Monitoring BIS
Bispectral Index monitoring helps to monitor the level of consciousness of a patient under general
anesthesia or sedation in the OR and ICU. The BIS sensor is placed on the patient’s forehead to
capture electroencephalographic (EEG) signals from which several numerics are derived, including a
single BIS value representing the level of consciousness. See the chapter on Specifications for the BIS
intended use statement.
The BIS Module provides the monitor with an EEG wave and the following numerics:

Bispectral Index (BIS). The BIS numeric reflects the patient’s level of consciousness. It ranges from
100 (fully awake) to 0 (suppression; no electrical brain activity).

Signal Quality Index (SQI). The SQI numeric reflects signal quality and provides information about
the reliability of the BIS, SEF, TP, and SR numerics during the last minute.
It ranges from 0 to 100%:
SQI < 15%: the numerics cannot be derived
SQI 15% to 50%: the numerics cannot be reliably derived
SQI 50% to 100%: the numerics are reliable.

Electromyographic Activity (EMG). The EMG numeric reflects the electrical power of muscle
activity and high frequency artifacts.
EMG < 55 dB: this is an acceptable EMG
EMG ≤ 30 dB: this is an optimal EMG
(note that the minimum possible EMG is approximately 25 dB).

Suppression Ratio (SR). The SR is the percentage of time over the last 63-second period during
which the EEG is considered to be in a suppressed state.

Spectral Edge Frequency (SEF). The SEF is the frequency below which 95% of the Total Power is
measured.

Total Power (TP). The TP numeric indicates the power in the frequency band 0.5 to 30 Hz. The
useful range is 30 - 100 dB.

191
19 Monitoring BIS BIS Monitoring Setup

BIS Monitoring Setup

BIS Engine

BIS Digital Signal

Interface Converter
Module

Patient
BIS Interface Cable
Engine
Cable

BIS Sensor

1 Connect the BIS Engine to the BIS Interface Module using the BIS Engine Cable.
2 Connect the digital signal converter (DSC) to the digital signal converter port on the rear of the
BIS Engine.
3 Attach the patient interface cable (PIC) to the digital signal converter.
4 Attach the BIS Sensor to the patient following the instructions supplied with the sensor.
Make sure that the patient’s skin is dry. Be aware that a wet sensor or a salt bridge may cause
erroneous BIS and impedance values.
A variety of sensors are available for use in the OR and ICU environments: see the chapter on
accessories for information.
5 Connect the BIS Sensor to the patient interface cable.
As soon as a valid sensor is detected, the impedances of all electrodes are measured automatically
and the impedance value for each electrode appears in the Impedance Check Window.
6 Use the attachment clip to secure the digital signal converter near, but not above the level of the
patient’s head.

192
BIS Continuous Impedance Check 19 Monitoring BIS

BIS Continuous Impedance Check

This checks:
• the combined impedance of the signal electrodes plus the reference electrode.
This is done continuously and does not affect the EEG wave. As long as the impedances are within
the valid range, there is no notification of this check or its results.
• the impedance of the ground electrode.
This is done every ten minutes and takes approximately 4 seconds. It causes an artifact in the EEG
wave, and the message Ground Check is shown on the monitor screen during the check. If the
ground electrode does not pass this check, another check is started. This continues until the ground
electrode passes the check.
If the Continuous Impedance Check interferes with other measurements, it can be switched off. To do
this:
1 In the Setup BIS menu, select Cont.Imp.Check.
2 Select On/Off to toggle between the settings.

CAUTION Switching the continuous impedance check off will disable automatic notification to the user of
impedance value changes, which may lead to incorrect BIS values. Therefore, this should only be done
if the check interferes with or disturbs other measurements.

BIS Cyclic Impedance Check

This measures the exact impedance of each individual electrode consecutively for approximately four
seconds.
It causes a disturbed EEG wave, and the message BIS IMPEDANCE CHCK is shown on the monitor
screen during the check.

Starting a Cyclic Impedance Check

The Cyclic Impedance Check is automatically started when a sensor is connected. To manually start a
Cyclic Impedance Check:
♦ select Cyclic Check in the BIS Setup menu to toggle between On and Off, or
♦ select Start Cyclic Check in the BIS Impedance Check Window.

Stopping a Cyclic Impedance Check

The Cyclic Impedance Check stops automatically if the impedances of all electrodes are within the
valid range. To manually stop a Cyclic Impedance Check:
♦ select Cyclic Check in the BIS Setup menu to toggle between On and Off, or
♦ select Stop Cyclic Check in the BIS Impedance Check Window.
If you stop a Cyclic Impedance Check before the ground electrode has passed, a ground electrode
impedance check will be started automatically. This cannot be switched off.

193
19 Monitoring BIS BIS Impedance Check Window

BIS Impedance Check Window

♦ To open the BIS Impedance Check Window, in the Setup BIS menu, select Show Sensor.
The graphic in the BIS Impedance Check Window automatically adapts to show the type of sensor you
are using, showing three or four electrodes as required. Each symbol in the graphic represents an
electrode and illustrates the most recently-measured impedance status of the electrodes. Although BIS
may still be measured when the electrode status is red or yellow, for best performance, all electrodes
should be green.
In addition, if the measured electrode-to skin impedance of any electrode or electrode combination is
above the limit, or if disconnected electrodes are detected, an INOP will be issued, either BIS HIGH
IMPEDANCE or BIS LEAD OFF.

Reference Electrode Ground Electrode Signal Electrode(s)

BIS Impedance Check - Quatro Sensor

Good High Lead Off Good

kOhm 3 109 XXX 2

Last Cyclic Check: 11:05

Start Cyclic Check
Last Ground Check: 11:25

Time of the most recent impedance checks Measured electrode impedance

BIS Impedance Indicators

Electrode-to-Skin Message Displayed Symbol Color Action

Impedance Impedance
Value
Electrode has no skin Lead no value red Reconnect electrode, or check
contact Off the sensor-to-skin contact. If
necessary, clean and dry skin.
Too much signal noise, Noise no value gray Check sensor-to-skin contact.
impedance cannot be Press sensor more firmly to
measured skin. If necessary, clean and dry
skin.
Impedance above limit High measured value yellow Check sensor-to-skin contact.
in kOhm Press sensor more firmly to
skin. If necessary, clean and dry
skin.
Impedance within Good measured value green No action necessary
valid range in kOhm

194
Changing the BIS Smoothing Rate 19 Monitoring BIS

Changing the BIS Smoothing Rate

The smoothing rate defines how the monitor averages the BIS value.
♦ To change the smoothing rate, in the Setup BIS menu, select BIS Smoothing Rate then
choose either:
– 15 seconds: this provides increased responsiveness to changes in the patient’s state
– 30 seconds: this provides a smoother BIS trend with decreased variability and sensitivity to
artifacts.

Switching BIS and Individual Numerics On and Off

To switch the BIS measurement on or off:
♦ In the Setup BIS menu, select BIS to toggle between On and Off.
To switch individual numerics provided by the BIS Module on or off:
♦ In the Setup BIS menu, select SQI, TP, SEF, SR, or EMG to toggle between On and Off.

Changing the Scale of the EEG Wave

Changing the scale only changes the visual appearance of the wave. It does not affect the signal
analyzed by the monitor or printed in reports or recordings.
The scale information shown depends on whether gridlines are switched on or off for display. This is
set in Configuration Mode.
1 In the Setup BIS menu, select Change Scale to call up a list of wave scales.
2 Select the required scale from this list.
• When gridlines are switched off, you can choose from the available scale values: 50 µV, 100 µV,
200 µV, and 500 µV. Scaling information is displayed as a vertical bar on the EEG wave together
with its height equivalent in µV.
• When gridlines are switched on, scales are defined as a range, either ± 25 µV, ± 50 µV, ± 100 µV,
or ± 250 µV. Scaling information is shown in the form of gridlines.

Switching BIS Filters On or Off

The low and high pass filters screen out undesirable interference from the raw EEG wave display. The
notch filter removes line frequency interference. Filter settings affect the EEG wave and the SEF and
TP values, but they do not affect the BIS, EMG, SR, and SQI values.
The filter settings are set in Configuration Mode. You can switch all the filters on or off together in
Monitoring Mode.
1 In the Setup BIS menu, select Filters.
2 Select On/Off to toggle between all filters On or Off.

195
19 Monitoring BIS BIS Safety Information

BIS Safety Information

Due to limited clinical experience in the following applications, BIS values should be interpreted
cautiously in patients with know neurological disorders, those taking psychoactive medications, and in
children below the age of 1.

WARNING Conductive Parts The conductive parts of sensors and connectors should not contact other
conductive parts, including earth.

High-frequency Surgery To reduce the hazard of burns in the high-frequency surgical neutral
electrode connection, the BIS sensor should not be located between the surgical site and the electro-
surgical unit return electrode.

Defibrillation The BIS sensor must not be located between defibrillator pads when a defibrillator is
used on a patient connected to the patient monitor.

Securing Cables To minimize the risk of patient strangulation, the patient interface cable (PIC) must
be carefully placed and secured.

CAUTION Revisions The system will only function if all component revisions are compatible. Otherwise, an
incompatibility INOP is displayed.
If the DSC has an older software revision than the BIS Engine, the DSC will automatically be
upgraded by the BIS Engine. Do not disconnect the DSC from the BIS Engine, or disconnect the BIS
Interface Module from the monitor, or switch the monitor power off within the first ten seconds after
connection, as this will disrupt a possible software upgrade and cause damage to the DSC.

Impedance Checks Impedance checks may influence data acquisition of other

electroencephalographic devices.

196
 20

20Trends
Trends are patient data collected over time and displayed in graphic or tabular form to give you a
picture of how your patient’s condition is developing.

Viewing Trends
♦ To open the tabular trends window, select the Vitals Trend SmartKey.
♦ To open the graphic trends window, select the Graph Trends SmartKey. Vitals
Trend

The trend windows open displaying the most recent data and are updated as new data
is stored. A timescale along the bottom of the screen shows you where you are in the Graph
trends database. The choice of measurements is defined by the trend measurement Trends

group chosen; measurements cannot individually be chosen for inclusion.

Your monitor screen may look slightly different to the examples shown here.

Viewing Graphic Trends

In the graphic trends view, the measured values are plotted on a graph along a time axis.

Graph Trends: All

HR
SpO2

ABP

9 Apr
Graph Trend
Select Select Print/ Vitals
Group Interval Record Trend

197
20 Trends Viewing Trends

Viewing Vital Signs Trends

The Vital Signs window shows measurement values and the time of measurement in a table.

Vital Signs: All

HR
PAPs
PAPd
PAPm
etCO2
awRR
RR

9 Apr
Vital Signs
Select Select Print/ Graph
Group Interval Record Trends

Multiple value measurements are split into the required number of lines. As you navigate through the
trend database, the currently-selected column is highlighted.
A question mark (?) beside a value means that the data may not be reliable, due perhaps to an INOP
condition in the measurement. If you see a “?”, you should try to resolve the problem with the
measurement signal.

Trends Pop-Up Keys

Depending on the trends view you choose, a selection of pop-up keys appears to let you navigate
through the stored events and carry out trends-related tasks.

Pop-Up Keys Selecting this pop-up key lets you....

Select see a pop-up list of trend groups available and choose a group for viewing.
Group
Select see a pop-up list of available data resolution settings to choose the level of detail shown
Interval in the trend view.
Print/ print a tabular or graphic trends report, depending on the contents of the window
Record currently open. The report will use the current trend interval settings.
move the cursor one step to the left or right to navigate through the trends database
timeline.

move the cursor one page to the left or right to navigate through the trends database
timeline.

198
Setting Up Trends 20 Trends

Pop-Up Keys Selecting this pop-up key lets you....

jump to the beginning or the end of the trends database to see the most recent or oldest
trend information stored.
scroll up and down the screen to see measurement trends that do not fit in the current
view.

Vitals open the current trend view in tabular form. The displayed time period and resolution
Trend stay the same.
Graph open the current trend view in graphic form. The displayed time period and resolution
Trends stay the same.

Setting Up Trends
Your monitor provides trends for continuously-monitored measurements, such as the ECG signal, as
well as for aperiodically-measured parameters, such as Cardiac Output. Each measurement value
counts as one measurement for the trend database. Some measurements can serve as a source for more
than one measurement, for example you can choose up to three CO2 measurements (etCO2, imCO2
and awRR) for trending.
Multi-value measurements will only be trended if a trend is available for each value within the
measurement. For example, an ABP trend would require three components to be available for
trending.

Choosing Which Measurements are Trended

The monitor stores trend information for all monitored measurements, if configured to do so. If your
configuration restricts the number of trended measurements, you must choose which measurements
will be included. A priority list, defined in the monitor’s Configuration Mode, is used to select the
trended measurements.
To see the measurement priority list for trending,
1 In the Main Setup menu, select Trends.
2 Select Trend Priority.
To add measurements to the priority list,
1 Select the pop-up key Add and choose from the pop-up list of available measurements.
2 Use the Sort Up and Sort Down pop-up keys to change the priority order.
3 Select the Store pop-up key to save your changes.

Choosing Trend Measurement Groups

The pop-up list of trend measurement groups that appears when you select the pop-up key Select
Group lets you choose a defined group of measurements for displaying in the trends windows and
printing in trends reports. The group settings define the list of measurements, the order of
presentation, and whether the waveforms overlap on the display and on reports. The group All
includes all the currently-monitored measurements. Trend measurement groups are defined in the
monitor’s Configuration Mode.
You can add groups to the list that appears when the Select Group pop-up key is selected. To do
this,

199
20 Trends Setting Up Trends

1 In the Main Setup menu, select Trends.

2 Select Trend Groups.
3 Select the pop-up key Add and choose a group from the list of available groups that have been
defined in Configuration Mode.
4 Select Store to save your changes.

Changing Parameter Scales

You can set separate scale settings for adult, pediatric, and neonatal patient trend information to define
how the trend waveform will appear on the screen and in trend reports. To do this,
1 In the Main Setup menu, select Trends.
2 Select Parameter Scales.
3 Select the measurement or parameter you want to change from the list.
4 Select the pop-up key Change to call up the Scale menu.
5 In the Scale menu, select the parameter label you want to define settings for. Select Adult,
Pedi, and Neo and use the pop-up keypad to enter new upper and lower scale definitions.
6 Select Store to save your changes.

Choosing Trend Resolution

Trend resolution is the frequency with which data is captured and stored in the trend database by the
monitor. As the monitor has a fixed amount of memory space available for storing trend information,
the higher the data resolution you choose, the shorter the period that can be stored. High-resolution
data is especially suited for neonatal applications, where the clinical situation may change very quickly.
In adult monitoring, where the patient’s status typically changes more gradually, a longer trend may be
more informative.

Example database configuration In this example, we see that the monitor stores the most recent data
at the highest resolution, older data are stored at a lower resolution.
“2 hours @ 12 second resolution” means that the monitor stores trend data every 12 seconds, or five
times a minute, for the most recent two hours.

- 48 - 24 -4
hours hours hours now
time
4 hours @12 second resolution
24 hours @ 1 minute resolution
48 hours @ 5 minute resolution

The resolution, database period, and the number of measurements trended is set in Configuration
Mode.

200
Documenting Trends 20 Trends

Documenting Trends
To print a Vital Signs or Graphical Trends report,
♦ in the Vitals Trend or Graph Trends window, select the pop-up key Print to print a
report for the trend group currently on the monitor screen.
Reports include the most recent information and extend backwards in time according to the
configuration. Trends reports can be printed on central or local printers.
To make a Vital Signs recording,
♦ in the Vital Trend window, select the Print/Record pop-up key, then select the
Record Vitals pop-up key.
Vital Signs recordings print patient demographic information and the content of the current
Vitals Trend window on the recorder strip.

201
20 Trends Screen Trends

Screen Trends
Trends configured to display permanently on special monitor Screens are called screen trends. Each
screen trend shows graphic trend information for one measurement, rather than for a trend group. All
continuously-monitored measurements can be displayed as screen trends.
♦ If you do not see screen trends on the monitor Screen, select a different Screen, one that is
configured to show screen trends.
♦ To view the information from a screen trend in more detail, select the screen trend to open the
<Measurement Label> Trend menu, then select Vitals Trend or Graph Trends
to open one of the trend windows.
♦ To switch between graphic and tabular views of aperiodic measurement Screen Trends (NBP, C.O.,
C.I. or Wedge), select the screen trend to open the <Measurement Label> Trend menu,
then select Change View.

Measurement waves/ Measurement

HiRes waves Screen trends numerics

ABP
240

50
-15 min

202
Screen Trends 20 Trends

Changing the Selection of Screen Trends Displayed

Grouped screen trends If a measurement wave, numeric, and screen trend are configured to form a
group, changing one automatically changes the others. Grouped elements often have the same color.
To change the selection of grouped screen trends on the Screen,
♦ Select the measurement wave then select Change Wave in the wave menu. This automatically
changes the wave, numeric, and screen trend simultaneously.
If the wave has been replaced by the screen trend, select the screen trend then select
Change Trend in the trend menu.

Independent screen trends To change a screen trend that is independent of any waves and numerics,
♦ select the screen trend to open the <Measurement Label> Trend menu, then select
Change Trend. Select a different screen trend from the list of available screen trends.
If the screen trend is grouped with a measurement wave and/or numeric, the menu entry
Change Trend will not be visible.

Overlapping screen trends If you want to display two or more screen trends overlapping,
♦ select the screen trend to open the <Measurement Label> Trend menu, select Change
Trend, then select Add Trend and select a screen trend from the pop-up list.
If a screen trend is grouped with an overlapping wave, the screen trend will contain the same
overlapping measurement trends. If a screen trend is grouped with a non-overlapping wave, you
cannot display overlapping trends in that screen trends field.
As screen trends are only available on specially configured Screens, you cannot add screen trends to a
Screen in Monitoring Mode.

Changing the Screen Trend Time

To change the period of measurement trend information displayed in a screen trend,
1 Select the screen trend to open the <Measurement Label> Trend menu
2 Select Setup Trends
3 In the Setup Trends menu, select ScreenTrend Time and select a time from the pop-up
list. You can choose either 30 minutes, or one, two, four, or twelve hours.

203
20 Trends Screen Trends

204
 21

21Calculations
Calculations are patient data that is not directly measured but calculated by the monitor when you
provide it with the appropriate information.
Your monitor can perform the following hemodynamic, oxygenation, and ventilation calculations.

Hemodynamic Oxygenation Ventilation

Cardiac Index (C.I.) Arterial Oxygen Content (CaO2) Minute Volume (MINVOL)
Stroke Volume (SV) Venous Oxygen Content (CvO2) Compliance (COMP)
Stroke Index (SI) Arteriovenous Oxygen Content Dead Space (Vd)
Systemic Vascular Resistance (SVR) (avDO2) Dead Space/Tidal Volume
Systemic Vascular Resistance Index (SVRI) Oxygen Availability Index (O2AVI) Ratio (Vd/TV)

Pulmonary Vascular Resistance (PVR) Oxygen Consumption (VO2) Alveolar Ventilation

Oxygen Consumption Index (ALVENT)
Pulmonary Vascular Resistance Index (PVRI)
(VO2I)
Left Cardiac Work (LCW)
Oxygen Extraction Ratio (O2ER)
Left Cardiac Work Index (LCWI)
Alveolar-Arterial Oxygen
Left Ventricular Stroke Work (LVSW) Difference (AaDO2)
Left Ventricular Stroke Work Index (LVSWI) Percent Arteriovenous Shunt
Right Cardiac Work (RCW) (Qs/Qt)
Right Cardiac Work Index (RCWI)
Right Ventricular Stroke Work (RVSW)
Right Ventricular Stroke Work Index (RVSWI)
Extra Vascular Lung Water Index (EVLWI)
Intrathoracic Blood Volume Index (ITBVI)
Global End Diastolic Volume Index (GEDVI)

The hemodynamic calculations available depend on the Cardiac Output measurement method being
used and the regulatory standards that apply for your hospital: see the C.O. chapter for availability
details.

Viewing Calculations
♦ Select the Calculations SmartKey to open the Calculations window.
♦ Select the Calc Type field and select the required calculation type for display. Calculations

205
21 Calculations Viewing Calculations

Calculations Windows
This example calculations window shows the hemodynamic calculations window. The ventilation and
oxygenation windows are similar.

Calculations Indexed
input values Output Calculation type
calculation
values
values

Calculations
C.O. Hemodynamic
HR
ABPs BSA C.I.
ABPd SV SI
ABPm SVR SVRI
PAPs PVR PVRI
PAPd LCW LCWI
PAPm LVSW LVSWI
PAWP RCW RCWI
CVPm RVSW RVSWI

Calculations
Resample Perform Print/ On/Off On/Off Cardiac Hemo
Vitals Calc Record DateTime Ranges Output Review

Calculations Pop-Up Keys

Depending on the calculations group you choose, a selection of pop-up keys will appear to let you
navigate through the stored events and carry out calculations-related tasks.

Pop-Up Keys Selecting this pop-up key lets you....

Resample tell the monitor to override the values in the calculations database and use the most
Vitals recent continuously monitored values. Resampling sets the calculation time to the
current time, and displays the corresponding values for the previous second.
Resampled values are indicated by a preceding asterisk (*) in Calculations, Graph
Trends, and Vital Signs screens.
Perform perform the displayed calculation using the currently-input values.
Calc
Print/ print or record the displayed calculation.
Record
On/Off toggle between showing the date and time or the units for the calculation input
DateTime values.
On/Off toggle between showing the normal ranges or the units for the calculation output
Ranges values.
Cardiac access the C.O. procedure window.
Output

206
Reviewing Calculations 21 Calculations

Pop-Up Keys Selecting this pop-up key lets you....

Hemo open the hemodynamic calculations review window.
Review
Ventil open the ventilation calculations review window.
Review
Oxy open the oxygenation calculations review window.
Review
access more calculations pop-up keys, if available.

Reviewing Calculations
♦ To enter the calculations review window, select the Oxy Review, Ventil Review, or Hemo
Review pop-up key as required.
The review window lists all the input and output values for each measurement in the calculations
group. The timeline in the review window lists the times the calculations were performed.
♦ To review individual calculations, select the calculation in the Calculation Review window and
then select the Original Calc pop-up key.

Performing Calculations
You must check that all input values are appropriate for your patient before performing calculations.
1 Select the Calculations SmartKey to open the Calculations window.
2 Select the Calc Type field and select the required calculation type for display.
3 Check the calculation time in the Calc Time field.
When you enter the calculation window, this field will show either the current time or the time of
the most recent available C.O. measurement, depending on your monitor configuration.
– To choose a different calculation time, select the Calc Time field. This calls up a list showing
the timestamps of calculations performed earlier. Select a time from this list, or select
Select Time to enter a time of your choice.
– To enter the current time, select the Resample Vitals pop-up key. If you choose the current
time, the monitor will resample all the required values that are continuously monitored.
4 Enter any values that must be entered or edited manually. Select the value field and then use the
pop-up keypad to enter the required values. Select Enter to confirm each entered value.

207
21 Calculations Entering Values for Calculations

Entering Values for Calculations

The monitor automatically enters any available values for calculations. For aperiodically-measured
values such as NBP or C.O., the monitor will re-use the most recent value in the calculation database
until a new value becomes available.
♦ To enter calculations values manually or edit automatically-entered values, select the value field to
open the on-screen keyboard and use this to enter the correct value. Values edited manually are
marked with an asterisk symbol (*).
If you enter a value that has more decimal places than allowed for a particular input, the value you
enter will be rounded off after you select Enter. If you enter a value which cannot be stored, the
message Warning: Value out of range will appear. Enter a new value.
In hemodynamic calculations, if the systolic and diastolic pressures are manually entered, the mean
pressure is calculated and marked with an asterisk. The formula used to estimate the mean pressure is
[systolic + (diastolic x 2)] / 3.

Automatic Value Substitution

If the monitor cannot find a value required for calculation, it automatically tries to find an equivalent
source for this value. For example, if C.O. is required but unavailable, the monitor automatically looks
for CCO as a alternative source of C.O. values.

Automatic Unit Conversion

The monitor needs consistent units for performing calculations. It automatically converts units where
necessary before it performs the calculation, for example, pressures sourced in kPa, cmH2O, or mbar
are automatically converted to mmHg, or to cmH2O for ventilation calculations.

BSA Formula
Your monitor provides both the Boyd and Dubois formulas for the calculation of body surface area
(BSA). For calculations, the monitor uses the setting defined in the Patient Demographics menu. All
calculation results that use BSA are indexed to the selected formula.
♦ To check the current setting, select the patient name to enter the Patient Demographics menu.
BSA(B) indicates that the Boyd formula is used; BSA(D) indicates that the Dubois formula is
used.

208
Documenting Calculations 21 Calculations

Documenting Calculations
♦ To send a Calculations recording to a connected recorder, in the Calculations window, select
the Print/Record pop-up key, then select the Record Calc pop-up key.
Calculations recordings print the patient demographic information and the content of the current
Calculations window on the recorder strip.
♦ To print a report for the calculation group currently on the monitor screen, select the pop-up key
Print Calc. To print the Calculations Review window, select the pop-up key Print in the
Calculations Review window. All the calculations in the current group will be printed in the report.
Calculation Reports can be printed on central or local printers.
This example report shows the oxygen calculation group. Ventilation and hemodynamic calculation
reports are similar.

Patient information

Calculation group
Three columns of
calculations input and
output values, with
times, units and
ranges, where
appropriate

209
21 Calculations Documenting Calculations

210
 22

22Event Surveillance
Events are electronic records of episodes in your patient’s condition. You can trigger them manually, or
set them to trigger automatically during pre-defined clinical situations. The information the monitor
stores for each event episode includes:
• waveforms for up to four measurements of your choice
• numeric vital signs for all the measurements monitored
• any alarm conditions active when the event episode was triggered
• any annotations connected with the event.
The event group you select defines which measurement waveforms are recorded during the event
episode. You can navigate through the event database to view events retrospectively, and you can
document events on a recording or report marked with the patient name, bed label, and the data and
time.
There are two levels of event surveillance. To determine which level of surveillance you have, check the
Event Surveillance Setup menu. Basic offers only one event group, whilst advanced offers up to six
event groups. This section documents advanced surveillance. Basic event surveillance functions as a
subset of advanced.

Event Groups
The active event group
• monitors the patient’s signals to detect event triggers
• defines which waveforms are recorded in the event data
Only one event group can be active at a time. Any other defined event groups do not monitor for event
triggers. Event groups are defined in Configuration Mode.

211
22 Event Surveillance Event Episode

Event Episode
When an event occurs, information for
a predefined duration is stored. This is Event trigger Event time
the event episode. It can start from the
trigger moment or include information
from a defined period before the Event pre- Event post-time
trigger, called the event pre-time. The time
episode time after the event is called the
event post-time. The event time is the
period after the trigger during which a
further event can change a single event Event Episode
to a combined event (combi-event).
Manually-triggered event episodes
document patient information from the
time leading up to the event trigger;
they do not have a post-time.

Episode Types
The episode type defines the level of detail captured in an event episode. The higher the data
resolution, the shorter the period that the monitor can store in its memory. High-resolution data is
suited for neonatal applications, where the clinical situation may change very quickly. In adult
monitoring, where the patient’s status typically changes more gradually, a longer trend may be more
informative.

Event Episode Types Pre-time Post-time Event time

Average trend 5 minutes 15 minutes 2 minutes
20 minutes, five samples per minute 10 minutes 10 minutes
15 minutes 5 minutes
HiResTrnd 1 minute 3 minutes = post-time
Four minutes, four samples per second. 2 minutes 2 minutes
Neonatal Event Review (NER) is a subset of 3 minutes 1 minute
HiResTrnd
Realtime Wave Snapshot 5 seconds 10 seconds = post-time
15 seconds 10 seconds 5 seconds

Event Triggers
You can trigger event capture manually, for example, if you want to record a patient’s condition before
a procedure. You can also set events to trigger automatically, when the patient’s values cross a
predefined threshold value, or when a particular measurement or procedure is carried out, for example,
when an NBP measurement or a Cardiac Output or Wedge procedure is carried out.
If you use alarm limits as event triggers, the event capture is triggered automatically when your
patient’s values violate set alarm limits, or when a specified alarm condition, such as apnea, occurs.

212
Viewing Events 22 Event Surveillance

If you set user-defined event triggers, you can define event triggers that are independent of alarm limits.
You must set a threshold value and a threshold time for the trigger. If you set the trigger threshold to
12 seconds, the monitor triggers an event if the threshold is violated for more than 12 seconds.
If more than one trigger is available for the measurements in the active event group, the trigger
condition may be AtLeast1Par, AtLeast2Par, AtLeast3Par, or All4Par. If the trigger is
AtLeast1Par (this is short for ‘at least one measurement parameter’), the monitor starts an event
capture if a trigger occurs in any of the active event group’s measurements. If the trigger is
AtLeast3Par, the monitor captures events when three or more trigger thresholds from the active
event group measurements are violated. The trigger condition for event groups is set in the monitor’s
Configuration Mode.

Viewing Events
• To see a summary of all the events in every group in the event database, use the Event Summary.
• To review all the events in a particular event group, use the Event Review window.
• To review individual event episodes in detail, use the Event Episode window.

To start viewing events, either:

♦ in the Main Setup menu, select Event Surveillance and then select the event view
you require from the list, or
♦ select the Event Surveillance SmartKey and then select the event view
you require from the list.

Events Pop-Up Keys

Depending on the events view you choose, a selection of the events pop-up keys let you navigate
through the stored events and carry out events-related tasks.

Pop-Up Keys Selecting this pop-up key lets you....

Event open the Event Surveillance Setup menu.
Setup
Show open the Event Episode window to review the selected event in
Episode detail.
Show open the Event Review window.
Review
Review choose a different event group for reviewing in the Event Review
Group window.
Trigger simultaneously change the Review and Trigger groups.
Group
Manual start a manually-triggered event capture.
Event
move the cursor left or right to the next event to navigate through the
events database. Placing the cursor over an event highlights it and shows
the event values for the selected event.

213
22 Event Surveillance Event Counter

Pop-Up Keys Selecting this pop-up key lets you....

jump to the first or last event in the event database.

Vitals Graphic toggle between a tabular and graphic version of the Event Episode
View View window currently viewed.
Table Graphic toggle between a tabular and graphic version of the Event Review
Review Review window currently viewed.
Delete delete the currently-selected event from the database. The monitor asks
Event you to confirm this deletion. You cannot retrieve deleted events.
Select access the list of available annotations to add a nursing note for the
Annot. current event episode.
Print/ access the printing and recording pop-up keys to document events.
Record

Event Counter
Vertical bars mark
events in the Event Counter Event Counter (Graphic)
graphic Event
Summary view. The
timeline shows the position of the stored events in the event database. Selecting this view activates a
cursor that lets you navigate across the timeline and select individual events for review in the
Episode Review window. It also calls up the events pop-up keys.

Event Summary View

The Event Summary view
shows the number of stored
events in each event group
and the total number of
events in the database. The
trigger symbol indicates the
active trigger group.
Event Summary Event Summary (Graphic)
Selecting the Event Summary
calls up the events pop-up
keys.

214
Event Review Window 22 Event Surveillance

Event Review Window

♦ To enter the Event Review window, select the graphic event summary, if available, or select the
events pop-up key Show Review.
♦ When you open the Event Review window, it automatically shows the event group with the
most recent event. To view other event groups, select the pop-up key Review Group and select
the group from the list.

Event Review

Event counter Combi 1 Single 2 Manual 0 (Total 3)

HR (Pulse)
Graphic All
representation of
trigger threshold

Event trigger SpO2

and trigger
All
values
84 < 90

Resp
All
Trigger symbol
Manual
Total 3
Standard
Timeline

Event bars: Each event bar represents one event. The height indicates the event severity. Bars that
extend over more than one channel represent combi-events. Manually-captured events are marked with
a bar above the timeline instead of in the measurement channels.

Event values: Event information for the currently-selected event is shown on the left of the review
window. The trigger measurement is highlighted.
– If an alarm triggers the event, the monitor shows the alarm conditions that triggered the event.
– If the event trigger was user-defined, instead of an alarm condition the monitor shows for
example SpO2 94<96, where the second number is the current event trigger threshold and the
first number is the maximum deviation from the set limit.

Trigger threshold: The horizontal lines show the trigger thresholds. Gaps in the line indicate that the
trigger was inactive for a while, possibly because alarms were switched off or because there was an
INOP condition in the group measurements.

Timeline: The timeline at the bottom indicates the period currently stored in the event database.

215
22 Event Surveillance Event Episode Window

Event Episode Window

♦ To enter the Event Episode window, select the pop-up key Show Episode.
Depending on the event group settings, the Event Episode window shows either 20 minutes of
average trend event information, four minutes of high-resolution event information, or 15 seconds of
realtime wave information.

Event Episode
Trigger event values,
HR
highlighted
Brady
104 < 110

SpO2
Follow-on event
values
Desat
71 < 85

Resp
Timeline, showing
episode Pre/Post-
time

Active event group

7 Jul
NER

The event values to the left of the measurement channels show the trigger threshold set and the
maximum amount by which this limit was exceeded. In this example, ABP Sys HIGH 120 > 90
tells you that 120 was the highest ABP value measured during the event time and that the ABP trigger
threshold was set to 90 when the event was triggered. If the event was manually-triggered, the event
value boxes display “manual”.

The Event Counter

The event counter in the Event Summary view and in the Event Review window counts the total
number of events in the database. If more than one event group was set as trigger group within the
event history, the event counter also counts the event group totals.

Counting Combi-Events
If one or more events occur during the same Event Time, the monitor combines them and displays
them as distinct events in one event episode, called a combi-event. The first event is the trigger event,
and the others are follow-up events. For example, if an apnea event is followed 40 seconds later by a
brady event, the brady event is not counted as a single event but as part of the apnea event.

216
Levels of Event Surveillance 22 Event Surveillance

Counting Neonatal Event Review (NER) Events

For neonatal events (NER; formerly “OxyCRG”), apnea events (A), bradycardia events (B), and
combinations of these events are counted and classified by the event counter in the Event Summary. If
they are associated with a Desaturation (D), this is also marked. Manual events (M) are counted
separately. In the example below, A(D):2(1) indicates that two apnea events occurred and one of
them was associated with a desaturation.

16 Stored Events: A(D):2(1) B(D):7(1) AB (D): 1(1) D:6 M:0

Levels of Event Surveillance

You should be aware which level of event surveillance is used in your hospital, basic, advanced, or
NER. This table lists the differences.

Option C06, Basic Option C07, Advanced Event Option C04, Neonatal
Event Functionality Event Surveillance Surveillance Event Review (NER)

Event groups 1 5 + NER NER

Measurements per group 3 4 3

Triggers per measurement 1 2 1

Trigger types Simple Combined Simple

Average trend Average trend High Resolution Trend

High resolution trend
Types of event episode Snapshot events
Summary view, graphic Summary view, graphic and Graphic and tabular
Event Review window, tabular Event Review window,
graphic Event Review window, graphic graphic and tabular
Event Episode window and tabular Event Episode window
Event views Event Episode window
25 events for 24 hours 25 events for 24 hours 25 events for 24 hours
25 events for 8 hours 25 events for 8 hours
50 events for 8 hours 50 events for 8 hours
Database capability 50 events for 24 hours 50 events for 24 hours

Setting Up and Using Event Surveillance

Before you can use event surveillance, you must choose the active event group and the event triggers.

217
22 Event Surveillance Setting Up and Using Event Surveillance

Setting Up Events
1 Set the active event group. In the Event Setup menu, select the name of the Trigger Group and
then select the required group from the pop-up list. The trigger symbol marks the active group.
The measurements and trigger condition for the group automatically change to reflect the new
event group. These settings can be changed in the monitor’s Configuration Mode.
2 Select the name of the trigger group to enter the Event Setup <Group Name> window.
Event Setup
3 Set the episode
type. Group Name Standard
Select the name of Episode Type Average Trend (20 min)
the current episode Trigger Condition At least one param.
type and select an
episode type from All ***/**
HR
alarms
the pop-up list. The (Pulse)
pre/post episode ** High
SpO2 **/*** Low
time for the selected
episode type is All ***
Resp
displayed. alarms

4 Set the trigger for

each measurement.
Select each trigger
name and select either an alarm trigger or a user-defined trigger from the pop-up trigger list.
The asterisk symbols beside the trigger tell you that the event trigger uses alarm triggers:
*** indicates a high priority (red) alarm,
** indicates a lower priority (yellow) alarm.
Triggers without asterisk symbols are user-defined triggers.
– If an alarm is an event trigger, no events of this kind are triggered if alarms are switched off.
Changing alarm limits changes the event trigger definitions.
– If you choose a user-defined trigger, you must set a trigger threshold and trigger threshold time.
Select each trigger threshold time box to call up a list of available threshold times and select the
required time from this list.
5 Select OK to confirm your changes.

Triggering Events Manually

♦ To manually trigger an event in the currently active event group, select the SmartKey
Manual Event.
The event data documents patient information for the time leading up to the trigger moment and uses
the settings of the active event group.

218
The Event Database 22 Event Surveillance

Annotating Events
1 To annotate an event, in the Event Episode window, select the pop-up key
Select Annotation.
2 Select the required annotation from the pop-up list of available annotations for the currently active
event group.
Up to 20 annotations can be configured to let you add commonly-used clinical notes to event episodes
for documentation purposes. To see the complete list of available annotations, in the Event Setup
menu, select Event Annotation.

The Event Database

The maximum number of events that can be stored in the event database depends on the database
configuration and the level of event surveillance used. The event database is set up in the monitor’s
Configuration Mode. Events are stored in the monitor’s event database for the configured lifetime,
either 8 hours or 24 hours. Deleted events cannot be retrieved. Events are automatically deleted when:
• their configured lifetime is over
• the storage capacity of the database is exceeded (storing a further event deletes the oldest event in the
memory)
• a patient is discharged.
As the event database is cleared when you discharge a patient, you should ensure that you have
documented any events you require for the patient records before you confirm the discharge.

Documenting Events
You can print a report or make a recording of the events history stored in the database or of individual
event episodes.

Documenting Event Review

1 In the Event Review window, select the pop-up key Print/Record. This calls up the event
documentation pop-up keys.
2 For a graphic Event Review recording, select the Record Graphic pop-up key.
For a tabular Event Review recording, select the Record Tabular pop-up key.
To print an Event Report, select the Print Review pop-up key.

Documenting an Event Episode

1 In the Event Episode window, select the pop-up key Print/Record. This calls up the event
documentation pop-up keys.
2 To make an Event Episode recording, select the Record pop-up key.
To print an Event Episode, select the Print Episode pop-up key.

219
22 Event Surveillance Documenting Events

Event Recordings
Event recordings can be sent to a locally-connected M1116B recorder module.

Event Review Recordings

Each event review Recording

Patient
information
Event
total per
recording strip strip Event types and medical event
code record no. group
begins with a
summary of the 90MIN
23 Jan 02 10:43
Green, Sarah
ICU 37
37549201

events stored in
the event Standard: Combi: 0 Single: 2 Manual: 1 (Total: 3)

database. Neuro: Combi: 0 Single: 0 Manual: 2 (Total: 2)

Event Hemo: Combi: 0 Single: 0 Manual: 2 (Total: 2)
Recording strip group
Ventil: Combi: 0 Single: 1 Manual: 1 (Total: 2)
s
annotation is Arrhy/ST: Combi: 0 Single: 0 Manual: 1 (Total: 1)
explained in the NER: A(D):0(0) B(D):2(1) AB(D):1(1) D:0 M:2 (Total: 5)
Recording All Groups: Combi: 0 Single: 5 Manual: 9 (Total: 15)
chapter.
Total
events in
database

In graphic event review recordings,

events are represented by bars, and each
event group is printed on a separate Standard

channel.
Neuro
The timeline reflects the period stored in
the database, either 24 hours (divided
into 4 hour sections) or 8 hours (divided 09:00 11:00 15:00 19

into one-hour sections).

In tabular event
review recordings, # Time Group Parameter 1 Parameter 2 Parmeter 3

the events stored in 1 23 Jan 02 07:56 Neuro Resp BIS LOW 51<60 ABP
the event database 2 23 Jan 02 07:59 Standard HR(Pulse) TACHY 201>180 ST-II SpO2
are shown in
3 23 Jan 02 08:02 Neuro Resp HIGH 76>60 BIS ABP
chronological order,
with a number and 4 23 Jan 02 08:12 Standard HR(Pulse) ST-II Manual SpO2

time-stamp. 5 23 Jan 02 08:32 Standard HR(Pulse) ST-II SpO2 LOW 95<96

...

The measurements in the event group are shown in the next columns, marked “Parameter 1, Parameter
2...”, along with the event values measured at the time of the event. For each event, the trigger values are
shown.
This section of the recording is A4 or letter size, so that it fits in a patient file.

220
Documenting Events 22 Event Surveillance

Event Episode Recordings

Event episode recordings are divided into four sections.

1 The first section shows the patient information and the event 1.
group of the episode with the event values for the group 91MIN Green, Sarah 37549201
23 Jan 02 10:43 ICU 3
measurements. The trigger symbol marks the event trigger.
Standard:HR(Pulse)
TACHY 130>120
2 The second section shows the waveforms recorded during the SpO2
episode. The trigger moment is marked with a triangle and Resp HIGH 80>75
divides the episode into the pre/post time. Any calibration marks
and grid marks on the screen are automatically printed on the
recording.
If there are four measurements in the event group being recorded, two waveforms will be recorded in
two separate waveforms segments.

-5 sec
2. 3. 4.
6.25 mm/sec +10 sec HR 130 bpm **TACHY
SPO2 98% **Resp HIGH
RR 80 rpm HR 130 bpm
II Pulse 130 bpm
CVP (-?-) mmHg
No intervention SpO2 98%
req. PERF 4.9
Pleth
RR 80 rpm
**TACHY
**Resp HIGH NBP EQUIP MALF
Resp

3 The third section shows the most important vital signs information, including numerics, active
alarms, and any annotations made on the event episode.
4 The fourth section shows the numerics for all the currently monitored vital signs and any alarm
conditions or INOPs active at the time the event was triggered.

Event Reports
Event reports can be printed on A4 and letter size paper on a printer connected locally or centrally to
your monitor.

221
22 Event Surveillance Documenting Events

Event Review Reports

The event review report documents all the events stored in the event database.

222
Documenting Events 22 Event Surveillance

Event Episode Reports

The event episode report documents the patient information from the currently-selected event. See the
section on event recordings for an explanation of the report elements.

223
22 Event Surveillance Documenting Events

224
 23

23Recording
The M1116B plug-in recorder records numerics for all active measurements and up to three
waveforms. You can use it for local recording mounted either in the monitor’s FMS or in the
Integrated Module Slot.
For central recording from the bedside, your monitor must be connected via a network to an
Information Center. You can use either the M1116B recorder or the standalone M3160A 4-Channel
Recorder. Recordings made on the M3160A may look slightly different to those described here. See the
documentation supplied with the Information Center for information on the 4-Channel Recorder.

Continue LED
Flashes if a continuous recording is
ongoing

RUN/CONT key
Starts a delayed recording or extends
the current recording

STOP key
Stops the current recording

225
23 Recording Starting and Stopping Recordings

Starting and Stopping Recordings

The recordings pop-up keys let you start and stop recordings. Select the Realtime Record
SmartKey to call up the line of pop-up keys. Scroll right or left to see any pop-up keys not displayed.

Start Start Start Start Start Start Select Setup Stop all
Delayed RT A RT B RT C HiResTrd ECG Capt Waves Recording Recordng

Starting Recordings
To start any type of recording, select the Realtime Record SmartKey and then select the pop-up
key of the recording type you want to start. Alternatively, you can select the Main Setup SmartKey,
select Recordings, then select the recording type.
Select the SmartKey Delayed Record to immediately start a delayed recording. You can also start
a delayed recording by pressing the RUN/CONT key on the recorder module.

Extending Recordings
Timed (non-continuous) recordings stop when their runtime is over. Continuous recordings continue
until stopped manually or by an INOP condition.
♦ To make an ongoing recording continuous, press the RUN/CONT key on the recorder module.
♦ To extend an ongoing recording by its runtime, reselect its Start pop-up key.

Stopping Recordings
Recordings stop automatically when the preset runtime is over, when the recorder runs out of paper, or
when the recorder has an INOP condition.
To manually stop a recording,
♦ Press the STOP key on the recorder module, or
♦ Select the Realtime Record SmartKey and then select the pop-up key Stop all Recordng.

Quickstarting Realtime Recordings

You can start realtime recordings on a locally-connected recorder without using a preconfigured
template by defining the most important recording settings.
1 Select the Realtime Record SmartKey.
2 Select the pop-up key Select Waves and use the pop-up keys to choose up to three
measurement waves to be printed on the recording. If you want fewer than three waves on the
recording, select the pop-up key Blank for an empty wave channel.
3 When you have finished selecting waves, recording speed pop-up keys will appear. Use these keys
to set the recording speed.
4 Select the Start pop-up key.
Quickstart recordings use default values for any recorder settings not defined: runtime is continuous,
overlapping is set to non-overlapping, default recording speed is 25 mm/sec.

226
Overview of Recording Types 23 Recording

Overview of Recording Types

The Recording Type is always shown “grayed out” in the Setup Recording menu. This table
details settings for local recordings.

Procedure or
Delayed Alarm Realtime (RT) ECG Capt HiResTrnd Context
manual automatic, manual manual manual manual, use the
triggered by context window’s
Type of defined alarm pop-up keys to start
recording conditions
M1116B or M1116B and M1116B M1116B and M1116B M1116B M1116B
M3160A M3160A M3160A

from the start from the start from the start from the start from the start defined by the
Information trigger minus the trigger minus the trigger trigger, in trigger minus context
recorded delay time delay time realtime delay time
up to 3 up to 3 up to 3 all ECG waves up to 3 high- up to 3 waves, or
currently resolution trends specific to the
monitored and (beat-to-beat) context, e.g. a C.O.
Number of available waves trial curve or a
waves wedge procedure
50, 25, 12.5, 50, 25, 12.5, 50, 25, 12.5, 25 mm/sec 1, 2, 2.5, 3, 6 defined by the
Speed 6.25, 2.5 mm/sec 6.25, 2.5 mm/sec 6.25, 2.5 mm/sec cm/min context
15, 20, 25, or 30 15, 20, 25, or 30 15 seconds or 4 seconds per 10 minutes, or defined by the
Runtime seconds seconds continuously wave continuously context
automatically automatically automatically if automatically automatically if defined by the
limited, limited, manually context
manually if if continuous
Stops continuous
10, 15 seconds 10, 15 seconds none none 6, 5, 4, 3, 2, 1 defined by the
Delay Time minutes context
up to 3 waves up to 3 waves up to 3 waves none up to 3 waves defined by the
Overlap context

ECG Capture Recordings

An ECG Capture recording shows a 4 second recording of each lead with a calibration bar preceding
each ECG lead. All available leads are recorded sequentially in the standardized lead order. The
recording is realtime, that is, the information recorded is not simultaneous.

227
23 Recording Creating and Changing Recordings Templates

Creating and Changing Recordings Templates

To save you defining recording settings each time you start a recording, you can create templates for
commonly-used types of recordings in the Setup Recording menu. You can create templates for
one delayed recording, one alarm recording, three realtime recordings, and one high resolution
recording. ECG Capture recordings do not need to be configured, they always use the same format.
Changing recordings templates changes the settings that will be used each time a recording of this
name is triggered.
1 Select the Realtime Recordings SmartKey to call up a line of recordings pop-up keys.
2 Select the pop-up key Setup Recording to enter the Setup Recordings menu.
3 Select Name to call up a pop-up list of available templates. Select the name of the template you
want to create or change. Each recording name is linked to a recording type, either delayed, alarm,
realtime, and high res trends, which is shown grayed out underneath the recording name.
Recording names can be changed in the monitor’s Configuration Mode.
4 Design the template by selecting each menu item and entering the information for the template.
• Recorder: choose which recorder the recording will print to (Local, Central 2-Ch. or Central 4-
Ch.).
• Channels 1 - 3: choose which waveform to record in each channel. If the wave assigned to a
recording channel in a particular template is not available when a recording is triggered, the channel
is left blank on the recording strip. The pop-up list of available (currently monitored) waves differs
according to the recording type:
– Realtime and delayed recordings: the list shows all the currently available waves.
– Alarm recordings: in addition to all the currently available waves, you can choose Alarm Par to
always record the measurement in alarm in the chosen recorder channel
– High-resolution recordings: the list shows all the available beat-to-beat waves.
• Overlap: define whether the recorded waveforms will be printed overlapping or beside each other.
• Speed: choose the recording print speed.
• Delay Time: Delayed recordings start documenting on the recorder strip from a pre-set time
before the recording is started. This interval is called the “Delay Time” and can be set to 10 or 15
seconds.
• Runtime: see how long this type of recording is configured to run. This can only be changed in the
monitor’s Configuration Mode. Continuous recordings run indefinitely.

Changing ECG Wave Gain

The ECG Gain setting in the Setup Recording menu defines how every recorded ECG wave,
irrespective of template or recording type, will appear on the recorder strip. This does not affect the
displayed ECG wave, or printed ECG reports. To change the ECG gain setting for recordings,
1 In the Setup Recording menu select ECG Gain
2 Select the required setting:
– Auto: the wave recording will use the same scale as the ECG wave on the monitor screen
– 5 mm/mV, 10 mm/mv, 20 mm/mV: the wave recording will use a scale of 5, 10, or 20
millimeters per millivolt.

228
Recording Priorities 23 Recording

Recording Priorities
Manually-started recordings have priority over automatically-started recordings. If an
automatically- triggered alarm recording is running, and a realtime or delayed recording is manually
started, the alarm recording is stopped and the manually-requested recording is started.

More recent manually-started recordings have priority over older manually-started recordings. If a
manually-started recording is running, and another manually-started recording is triggered, then the
older recording is stopped and the more recent manually-started recording is started.

Alarm recordings are prioritized according to alarm priority. If an alarm recording triggered by a
yellow alarm is running and a new alarm recording is triggered by a red alarm, the yellow alarm
recording is stopped and the red alarm recording is started.

Sample Recording Strip

The information printed on the recording strip includes the patient name and MRN, bed number,
date and time of recording, recording speed, and recording code. Active alarm and INOP messages as
well as numerics for all currently monitored measurements are also printed.
Recording strip annotations are printed at the beginning of the recording strip and updated at regular
intervals, every 15 minutes for recordings made at speeds lower than 6.25 mm/s, and every 60 seconds
for recordings made at speeds greater or equal to 6.25 mm/s.
This sample recording strip shows a typical initial annotation:

Recording Recording speed Measurement numerics

strip code
90DIN 25 mm/sec PAP 28/15 /21) mmHg
23 Jan 02 10:43 NBP 120/80 (90) mmHg 23 Jan 02
Patient Green, Sarah 37549201 10:31
information C.O.
and medical *** EXTREME BRADY C.I.
record no. ** ABPs HIGH CCO -?- l/min
** PAPd HIGH CCI
Alarms CCO NO CALIBRATION etCO2 40 mmHg
and imCO2 0 mmHg
SOME ECG ALARMS OFF
INOPs
ABP REDUCE SIZE awRR
RR 15 rpm
Tnaso 37.0×C
HR 120 bpm Tblood 37.0×C
SPO2 95% SV 94 ml
Pulse 120 bpm SI 48 ml/m2
PERF 10.0
ABP 120/70 (91) mmHg

229
23 Recording Sample Recording Strip

Recording Strip Code

The recording strip code printed in the first line of the initial annotation has up to seven characters,
specifying recording type, operating mode, application area, patient category, and delay time, if
applicable.

Code Meaning
Recording type 90 Realtime
8A Delayed
0B Alarm
91 Context (Procedures)
Operating mode M Monitoring
D Demo
C Configuration
S Service
Application area I ICU
O OR
C CCU
N NICU
Patient category A Adult
P Pediatric
N Neonatal

Recorded Waveforms
A selection of up to three waveforms is recorded, marked with wave labels and wave scale information.
Wave scale information can be in the form of a calibration bar, like the 1 mV calibration bar for ECG,
or calibration steps before the waveform starts.

Maintaining Recording Strips

Recording ink sometimes fades when covered with transparent tape. Avoid covering any part of a
recording that is clinically relevant (annotation or waveforms) when taping a recording strip to a
patient record or other patient documentation.

230
Reloading Paper 23 Recording

Reloading Paper
1 Use the latch on the right side of the recorder door to pull the door open.
2 Remove the empty core.
3 Insert a new roll so that it fits snugly into its housing and the paper end is
feeding from the top.
4 Pull out some paper and fold along the front edge at a 45° angle. This makes it easier to feed the
paper under the roller as shown.
5 Feed the paper through and pull some paper out from the top of the roller.

6 Close the recorder door.

7 To test if paper is loaded correctly, start a recording. If no printing appears,
paper may be loaded backwards. Try reloading the paper.

CAUTION When the recorder is disabled (by removal from the FMS, door open, or out of paper), any alarm
recordings will be sent to the central station recorder, if there is one. If no recorder is available, alarm
recordings may be lost during the time the recorder is disabled. The message no alarm recording
available will be displayed.

Recorder Status Messages

Recorder Status Messages Explanation
<Recording name> running The named recording is currently running.
No <alarm recording name> No alarm recording can be made on the selected recorder.
available If available, try selecting another recorder. Alarm
recordings will be lost.
<Recorder name> out of paper The named recorder is out of paper.
<Recorder name> door open The door of the specified recorder is open.
<Recorder name> not supported The M1116A recorder is not supported. Connect a
M1116B plug-in recorder.

231
23 Recording Recorder Status Messages

232
 24

24Printing Patient Reports

Starting Reports Printouts

Most patient reports can be printed by selecting Main Setup - > Reports (or the Reports
SmartKey) and then selecting the report name in the top half of the Reports menu. Report names
are shown only for reports that have been correctly set up.
Data from the time of the print request is printed, even if the print job is delayed in the printer queue.

Report types Report contents How to start printing reports

Vital Signs Report depends on selected trend group, data In the Vital Signs window, select Print/Record,
resolution, and period. then select Print
Graphic Trends Report In the Graphic Trends window, select Print
Events Reports Event Episode with up to 5 episodes In the Events window, select the pop-up key
Graphic or tabular Event Review Print/Record, then select the pop-up key
Print Review or Print Episode
EEG Report EEG Waves, numerics, CSAs, and In the Setup EEG menu, select Print Report
current settings
ECG Reports Depends on format selected Select the ECG Report SmartKeys, if configured
Cardiac Output Report Trial curves and numerics In the Cardiac Output window, select the pop-
up key Print/Record
Wedge Report Wedge numerics and reference wave In the Wedge window, select the Print Wedge
pop-up key
Calculations Report Hemodynamic, Oxygenation, or In the Calculations windows, select the
Ventilation Review Print/Record pop-up key
Drug Calculator Titration Table In the Titration Table window, select the
Report Print Titr.Tbl pop-up key
Drip Table In the Drip Table window, select the Print
Drip Tbl pop-up key
Alarm Limits Report Graphic and numeric report of all In the Alarm Limits window, select Print
current alarm limits Limits
Realtime Reports, patient data and numerics, and either: Select the Realtime Reports SmartKey, if
including oxyCRG all displayed waves OR all measured configured
Reports (Neonatal waves OR all measured RT waves Or all
Event Review) measured HiRes waves, OR oxyCRG
waves (RT waves: ECG Primary lead,
Pleth, Resp; HiRes waves: btbHR, HiRes
SpO2, HiRes Resp)

233
24 Printing Patient Reports Stopping Reports Printouts

Stopping Reports Printouts

♦ To stop Reports printing, in the Reports menu, select
– Stop Report to stop the current print job
– Stop All Reports to cancel all queued report printouts
– Scheduled Rep. to toggle to Off and switch off scheduled reports.

Setting Up Reports
Before you can print ECG, Vital Signs, Graphic Trends, or Auto Reports, you must define the report
content. Typically, report content will be defined once for your monitor. As the content of context-
linked reports, such as Cardiac Output, Calculations, and Wedge, is defined by the content of the
procedure window, these reports do not need to be set up.
To set up reports:
1 In the Reports menu, select the name of the report you want to set up in the lower half of the
reports menu to enter its individual setup menu.
2 Select each entry in the individual reports setup menus and choose the required setting as described
in the individual sections.
The content you define in the individual Setup Reports menus will be used in all reports of this
type: for example, if you set a print speed of 50 mm/sec in the ECG Reports menu, every ECG report
will be printed at this speed, irrespective of format.

Setting Up ECG Reports

The settings you choose in the ECG Reports menu apply for all ECG reports printed.

ECG Reports This menu entry lets you...

ReportLeadLayout see which report layout has been configured for your monitor, Internat. or
Cabrera. This setting can only be changed in Configuration Mode.
ECG Gain set the required ECG Gain. This defines how ECG waves will appear on the
ECG report printouts.
Choose 5 mm/mV, 10 mm/mV, or 20 mm/mV.
Speed set the report print speed. Select either 25 mm/sec or 50 mm/sec.
Annotation toggle between the settings On and Off to choose whether the printed ECG
wave should be annotated with beat labels or not. See the chapter on ECG for a
list of beat labels. Pace pulse marks are automatically printed beside the wave for
paced patients.

234
Setting Up Reports 24 Printing Patient Reports

Setting Up Vital Signs and Graphic Trend Reports

The procedure for setting up Vital Signs and Graphic Trend reports is identical. The settings you
choose in the Setup Vital Signs Report and Graphical Trend Report menus apply for all
Vital Signs and Graphic Trend reports printed.

Vital Signs Report/ This menu entry lets you...

Graphic Trend Report
Trend Group choose from a list of available trends to define which will be printed on
the report. The available choices depend on your monitor configuration;
possible choices include All, Cardiac, Hemo, Resp, Neuro, Temp,
Gases, or trend information from a VueLink device.
Period choose the period of time for which trend data should be printed on the
report. Choose either 1, 2, 3, 6, 12, 24, 48 hours. If Automatic
Period is set to On, all trend data for the current patient will be
printed, irrespective which trend period is selected.
Interval (Vital Signs Reports only) choose the resolution of the trend data
printed on the report. Choose either 12 seconds, 1 minute,
5 minutes, 15 minutes, 30 minutes, or 1 hour.

235
24 Printing Patient Reports Setting Up Reports

Setting Up Auto Reports

Using Auto Reports you can set up to four individual reports to print automatically when a specified
trigger occurs. There are two types of Auto Report:
• Scheduled reports can be set up to print at predefined intervals, starting at a predefined time
of day. The start time you set applies for every following day. For example, if you set a start time of
07:00 and a repeat time of six hours, the first report will print at 07:00 every day, the next at 13:00
and so on.
• End case reports print automatically when you select End Case to discharge a patient.

Auto Reports This menu entry lets you...

Auto Report select the name for the Auto Report you want to set up. The default
names are A, B, C, and D.
Report assign a report type to the Auto Report name. The available reports are
Vital Signs, Graphic Trends, Events, ECG A, ECG B,
EEG, Realtime Report, User A, or User B.
End Case Report toggle to On if you want the Auto Report you are setting up to print as
an End Case Report, toggle to Off if the Report is a Scheduled Report
only.
Scheduled Rep. toggle to On if you want the Auto Report you are setting up to print as
a Scheduled Report, toggle to Off if the Report is an End Case Report
only.
Start Hour set a time of day or a time interval as a print trigger for a scheduled
Start Minute report.
Rep. Freq.(Hr) – to set the time of day at which you want the report to print
Rep. Freq.(Min) every day: select Start Hour and Start Minute and
select the required time from the pop-up list
– to set the time interval in minutes between two scheduled
reports: select Rep. Freq. (Hr) and Rep. Freq.
(Min) and select the time interval from the pop-up list.
If you are setting up an end case report, these settings will be
inactive (“grayed-out”).

Be aware that the monitor’s memory for reports is limited. If the memory is full, Auto Reports cannot
be printed and the information may be lost.

236
Setting Up Individual Print Jobs 24 Printing Patient Reports

Setting Up Individual Print Jobs

To adjust the appearance of individual print jobs, in the Reports menu, select Setup Reports to
enter the Setup Reports menu, and then select the appropriate settings.
The menu items Report Type, Report Size, and Orientation may be inactive (“grayed-
out”) in this menu for reports that can only be started in a special window.

Setup Reports Selecting this menu item lets you...

Report choose the report you want to print. Available reports are Realtime Report,
Vitals Report, Graph Report, Event Episode, Event
Review, ECG Report A, ECG Report B, EEG Report, C.O.
Report, Wedge Report, Alarm Limits, Calc. Report, Calc.
Review, User Report A, and User Report B.
Report Type Each template includes patient demographic data, alarm and INOP information.
Choose which additional information you want the printout to contain. The setting
selected for Report defines which Report Types are displayed in the menu:
Visible Waves for all waves currently visible, in the order they appear on the
screen.
All Waves to print all measured waves,
RT Waves for all currently measured realtime waves, according to the monitor’s
priority list.
HiRes Waves to print all measured HiRes waves
OxyCRG Waves to print the OxyCRG/Neonatal Event Review waves
Vital Signs for trend information in tabular form.
Graph Trend for trend information in graphic form.
ECG3X4, ECG6X2, ECG12X1, ECG4X2, ECG8X1 define a template for ECG
reports.
EEG to define a template for EEG reports
Episode to print a single patient event episode.
Review to print an overview of patient events
Alarm Limits for a list of all currently set alarm limits.
Report Size choose the paper size to be used for the report: Unspecified to use the default size
for the template chosen, or Universal, A4, Letter, LrgUniversal, A3, or
Ledger.
The list of available sizes depends on the connected printers.
Orientation choose the orientation of the report printout: Unspec. to use the default size for the
template chosen, or Landscape or Portrait.
Target choose which printer the print job will be sent to: Unspec. to use the default
Device printer, or the printer name defined at the Information Center or in the monitor’s
Configuration Mode (for example, lj_lpt1).

237
24 Printing Patient Reports Checking Printer Settings

Checking Printer Settings

The printer settings for your monitor are defined in Configuration Mode. The printer settings Paper
Size, Resolution, Color Support, and Duplex Option for the active printer are visible but
inactive (“grayed-out”) in the Setup Printers menu.
Printer names for locally-connected printers can be defined in Configuration Mode. You can see
whether a specified printer is centrally or locally connected in the Setup Printers menu under
Port: Local <name> indicates locally-connected printers, Remote <name> indicates
centrally-connected printers.
♦ To enter the Setup Printers menu, in the Reports menu, select Setup Printers.

Switching Printers On Or Off for Reports

In Monitoring Mode, you can enable or disable the printer status to switch individual printers on or off
for report printouts.
1 In the Setup Printers menu, select Printer and then select the name of the device you want
to switch on or off for Reports printing from the pop-up list.
2 Select Printer Status to toggle between the settings Enable and Disable. If you set this to
Disable, no reports will be printed to the named printer.
If the monitor detects that no printer of a particular type is available, the Enable/Disable setting
will automatically be set to Disable and “grayed out”.

Dashed Lines on Reports

If a section of a wave on a report is drawn with dashed lines, this tells
you that a setting that affects the appearance of the wave on the
screen was changed while the report was printing.
For example, if you change the wave scale while a report is printing,
the wave scale and wave size are changed immediately on the
monitor screen and on the report. To indicate that the scale
information printed at the beginning of the report no longer matches the currently used scale, the wave
will be printed using dashed lines, starting from the moment the change took place.
Some examples of settings that cause dashed lines in reports if changed during printing are: Filter
mode, ECG lead placement, wave scale, measurement unit, paced/non-paced setting, and
measurement mode. Note that as ECG waves are drawn with a fixed gain on reports (either 10 mm/
mV or 20 mm/mV), changing the ECG wave scale will not cause dashed-line reports.
To avoid dashed lines on reports, wait 15 seconds after changing a setting before you trigger a report.

238
Unavailable Printer: Re-routing Reports 24 Printing Patient Reports

Unavailable Printer: Re-routing Reports

If you send a report to be printed on a printer that is not available, for example, because it has run out
of paper, this print job is suspended and stored in the monitor’s memory.
If the target device of this print job was set to Unspecified, the monitor will periodically try to
resend the print job to the first printer listed in the Setup Printers menu under Printer that
is set to Enabled and that has paper of the correct size.
To allow the report to print, you must either solve the problem with the target printer, or re-route the
print job to another printer with paper of the correct size. To re-rout a print job,
♦ Enable the new target printer by selecting it in the Setup Printers menu and toggling to
Enabled. As the monitor tries to send the report to the printers in the order they are listed, you
must make sure that all the printers above the new target printer are disabled.
If the target device of the print job was set to a specific printer, re-routing is not possible.

Printer Status Messages

Printer Status Message Possible causes and suggested action
Print job could not The printer queue is full and the monitor cannot accept another report
be queued request. Wait until some more reports have been printed, then try again,
OR
A report has been triggered that uses a paper size unavailable with the
target printer. Try another printer, if available, or change the paper size of
the print request.
Cancelling all Stop All Reports has been selected in the Report menu, OR
print jobs
The Operating Mode has been changed from Monitoring Mode to
Demonstration or Service Mode.
Cancelling N print When a patient is discharged, all queued print jobs are cancelled. “N” is the
jobs due to patient number of print jobs queued.
discharge
Printing failed: no A report has been triggered which has not been correctly set up. Enter the
report configured setup menu for the report type to set up the report.
Printer <Printer The chosen device is unavailable. Check that the printer is properly
name> unavailable - connected and that paper is available. The requested report will start
job suspended printing when the printer becomes available.
Job on <Printer A report cannot be started on the requested printer.
name> failed Make sure the printer is plugged in, switched on, and has paper loaded. Try
another printer, if available. If this problem persists, call your service
personnel.

Sample Report Printouts

Each report header contains the patient’s bed label, last name and first name, the patient ID, the date
and time, and the name of the report. The report footer contains the hospital label and page number,
and the last page contains a note to mark the report end.

239
24 Printing Patient Reports Sample Report Printouts

The monitor may be configured to leave a space on the top left or right of the report printout to enable
you to stick a patient address label on it. This setting is called the Addressograph and it can only be
changed in the monitor’s Configuration Mode.

Alarm Limits Report

Patient Name

Measurement
labels, with
alarms off symbol
where alarms are
switched off

Graphic view of current alarm limits in

relation to currently monitored
measurement value

240
Sample Report Printouts 24 Printing Patient Reports

Realtime Report

Patient
demographic
information,
time stamp

Active Alarms
and INOPs,
followed by
vital signs

Measurement
waves section,
including HiRes
waves

241
24 Printing Patient Reports Sample Report Printouts

Cardiac Output Report

Patient
information

Numbered trial
curves

Trial information
in tabular form

242
Sample Report Printouts 24 Printing Patient Reports

ECG Reports
Patient
information
Numeric
block

Wave area

Below the header on ECG Reports, the numeric block shows the current HR, PVC, and ST values.
The wave area shows the printed waves for all available ECG leads. A 1 mV calibration bar is printed at
the beginning of each wave. With the 3X4, 6X2, and 2X4 formats, a rhythm stripe prints a longer
section of the ECG wave from the primary ECG lead for ECG rhythm evaluation. The ECG signal
bandwidth, the patient’s paced status, the ECG gain, and the print speed are printed at the bottom of
the wave area. Pace pulse marks are automatically printed beside the wave for paced patients. Beat
labels can be set to print on the rhythm stripe.

ECG Report type Available Formats Available Paper Sizes

12-Lead ECG 3X4 landscape A4, letter, A3, ledger
6X2 landscape A4, letter, A3, ledger
12X1 portrait A4 and letter only
12X1 landscape A4, letter, A3, ledger
Multi-lead ECG 2X4 landscape A4, letter, A3, ledger
8X1 portrait A4 and letter only
8X1 landscape A4, letter, A3, ledger

Other Reports
See the sections on Trends and Calculations and the chapter on Event Surveillance for other example
reports.

243
24 Printing Patient Reports Sample Report Printouts

244
 25

25Using the Drug Calculator

Drug mixtures for intravenous (IV) drug infusions combine information on drug dose, rate, amount,
volume, concentration, and standardized rate. The Drug Calculator helps you to manage infusions by
calculating one of these values at a time.

Term Definition Units

Dose total quantity of drug to be delivered to the amount units per time or per kg/
patient over time time, if the drug is weight-dependent
Rate volume of the mixture to be delivered to the ml/hour
patient over time
Amount amount of drug to be added to diluent to ng, mcg*, mg, g, mU, U, where g
make up a mixture stands for gram and U for unit
Volume quantity of mixture of diluent and drug ml

Concentration ratio of the amount of drug to the solution amount units per ml
volume
Standardized 1ml volume of the mixture to be delivered to ml/hr
Rate the patient per hour

*Be aware that your hospital may use either ‘µg’ or ‘mcg’ as an abbreviation for microgram. These
abbreviations are equivalent.

WARNING Before you administer any drug, always check that the correct drug, dose, and time are selected.
Consult your pharmacy if you have questions.
Decisions on the choice and dosage of drugs administered to patients must always be made by the
physician in charge. The Drug Calculator performs calculations based on the values input during use,
it does not check the plausibility of the calculations performed.

245
25 Using the Drug Calculator Performing Drug Calculations

Performing Drug Calculations

1 To access the Drug Calculator, select Main Setup -> Calculations ->
Drug Calculator, or select the Drug Calculator SmartKey.

2 Enter three of these four values: dose, amount, volume, Drug Calculator
and rate of the infusion solution.
Any Drug
To enter values, select the correct unit, then select each
value field and use the pop-up keypad to enter the correct Dose 2.00 mg/min
value.
Rate 480.00 ml/hour
3 If you have chosen a weight-relevant dose unit, you must
Amount 25.00 mg
enter the patient weight now or choose a different unit.
The patient weight from the Patient Volume 100.00 ml
Demographic window is entered automatically in the Concentr 0.250 mg/ml
Drug Calculator window when the Drug Calculator is 1 ml/hr 0.004 mg/min
accessed. To change the patient weight, select the
Weight key then use the on-screen keypad to enter the Weight - lb
correct value. This will not change the patient weight
stored in the patient demographic information. Any
changes made to the patient weight in the patient demographic information while the Drug
Calculator is open will not affect the Drug Calculator.
4 When you have entered three values, the Drug Calculator automatically calculates the unknown
fourth value and shows it in the highlighted field. Standardized rate and concentration are also
calculated.

Converting Units
To convert measurement units for drug calculation values, Unit Conversion
1 In the Drug Calculator window, select the pop-up key
Fahrenheit Celsius
Unit Conversion to open the Unit Conversion
window.
2 Select the field under the unit you know and use the on- Inch Centimeter
screen keypad to enter the known value. The converted
value automatically appears in the adjacent field. Kilogram
Pound

246
Performing Drug Calculations 25 Using the Drug Calculator

Charting Drip Progress

Drip Table
The Drip Table shows you at
a glance how much of the Amount Volume Drip Time
Any Drug
infusion has been
administered to your patient
and how much time is left. Dose 3.88 mcg/min

♦ To see the Drip Table, in Rate 931.20 mcg/min

the Drug Calculator Amount 25.00 mcg

window, select the Drip
Volume 100.00 ml
Table pop-up key.
Weight ? lb
If the DripTime exceeds 24
hours, the DripTime
timestamp shows - - :- - : - - . DripTime 0:06:26 hr:min:sec

Using the Titration Table

Use the Titration Table to see Titration Table
at a glance what dose your
Any Drug
patient would receive of a Weight ? lb
drug at different infusion Dose 3.88 mcg/min Amount 25.00 mcg
rates. Rate 931.20 mcg/min Volume 100.00 ml
The higher the infusion rate Rate Dose Rate Dose Rate Dose Rate Dose
entered, the bigger the steps
between table entries.
♦ To see the Titration
Table, in the Drug
Calculator window,
select the pop-up key
Titr.Table.

Documenting Drug Calculations

♦ In the Drug Calculator window, select the pop-up key Record DrugCalc to immediately start
a recording of the current drug calculation.
♦ In the Titration Table window, select the pop-up key Print Titr. Tbl to print a report of
the current Titration Table.
♦ In the Drip Table window, select the pop-up key Print Drip Tbl to print a report of the
current Drip Table.

247
25 Using the Drug Calculator Performing Drug Calculations

248
 26

26VueLink Modules
A VueLink module transmits information from a connected external device to your monitor. Each
module can be connected to up to three external devices, and supports alarms from the external device.
Although the external device may transmit more information, the number of waves and numerics you
can view simultaneously on your monitor’s main screen depends on the module type. Type A modules
support one wave and two numerics, type B modules support two waves and six numerics.

Module: Type Max Max External Devices

Wave numeric
Auxiliary A 1 2 standalone measurement module
Ventilator B 2 6 ventilators
Gas Analyzer B 2 6 gas analyzers
Anesthesia Machine B 2 6 anesthesia machines
Auxiliary Plus B 2 6 external multi-measurement devices

a module name a VueLink M1032A T g

b device label b
VENTILATOR
PB 7200a/ae
B

SIEMENS

c selection LED c
900C/D/E NEO
SIEMENS
900C/D/E AD

d setup key d VueLink

f
e external device cable connector
f setup indicator LED 60x145
g module type (A or B)

The device labels (b) on the module indicate for which external devices the module is configured. The
selection LED (C) shows which device is currently active. The device label text may differ slightly from
the labels on the external devices.
See the documentation supplied with the VueLink module for a list of supported devices and
accessories, and for configuration information.

249
26 VueLink Modules Connecting an External Device

Connecting an External Device

1 Insert the module into the FMS or integrated module slot.
2 Check that the device selection LED (c) lights to show that it has correctly identified the external
device. If not, select Main Setup -> Measurements -> <VueLink Device Name> to
enter the setup menu for the connected device, headed Setup <VueLink Device Name>.
3 In the device setup menu, select Device, select the correct device from the list, and confirm the
selection.
4 Connect the external device to the module (e) and switch it on.
Once the VueLink device has been correctly connected, you can select the VueLink SmartKey and
then select the Setup VueLink pop-up key to access the Setup VueLink menu for the
connected device.

CAUTION Selecting the wrong device can cause unpredictable system behavior. Rectify this by switching off the
external device when it is safe to do so, and selecting the correct device.

Changing VueLink Waves and Numerics Displayed

To change the waves and numerics from the VueLink module displayed on the Screen,
1 Select Main Setup -> Measurements -> <VueLink Device Name> to enter the setup
menu for the connected device, headed Setup <VueLink Device Name>.
2 Select the item you want to change, then select the new item from the pop-up list,
or
Select Show Device Data to view the device data window.
3 Close the setup menu. The monitor takes a few seconds to activate the change.

Viewing the VueLink Device Data Window

To view the VueLink device data window,
either
• select the setup hardkey on the VueLink
module or the VueLink SmartKey,
and then select the <Device Name>
pop-up key, or
• in the Setup <Device Name>
menu, select Show Device Data.
Selecting the device data window opens
the setup menu for the connected device.

250
Using VueLink Screens 26 VueLink Modules

Using VueLink Screens

Your monitor may be configured to show
VueLink device data permanently on the Screens.
Select the device data window to display the
VueLink pop-up keys that let you access the
setup menu and carry out VueLink tasks.

Switching VueLink On and Off

♦ To switch VueLink measurements on and off, in the Setup VueLink menu, select
Device Interface to toggle between the settings On and Off.

Alarms/INOPs From External Devices

The VueLink module itself generates INOPs, but does not generate alarms. If the external device’s
alarms are on, the module transmits these to the monitor. A message in the VueLink info window tells
you either Device Alarms Ignored or Device Alarms Accepted or No Alarms
Available. External device alarms status symbols precede some, but not all, measurement labels.

the monitor is configured to accept external device alarms,

but the alarms are switched off at the external device.
! alarms status of this external measurement is unknown

Alarms from external devices are:

• all transmitted to the monitor. For all numerics configured in the Setup VueLink menu, an
alarm condition is announced at the monitor. For one or more measurements not configured in the
Setup VueLink menu, an alarm is announced as a text message for the highest priority alarm.
Priority is determined at the external device.
• always non-latching on the monitor.
• announced as a flashing numeric while the alarm condition persists.
• announced audibly and visibly at the Information Center.

251
26 VueLink Modules Language Conflict with External Device Drivers

Language Conflict with External Device Drivers

You should avoid language conflicts between the VueLink module device driver and the monitor. Be
aware that if you connect a VueLink module with a different operating language to the monitor, the
monitor will show:
• measurement labels in the monitor language
• alarm and INOP texts in the VueLink module device driver language.

252
 27

27Respiratory Loops
Using a VueLink module connected to a ventilator, you can measure and store graphic representations
of realtime respiratory loops to help you recognize changes in your patient’s lung function over time.
Respiratory loops can help in early detection of patient airway changes, and they can also indicate a
fault in the airway tubing (the respiratory loop does not close).
You can measure either
• Pressure-volume (PV) loops, plotting pressure and volume, or
• Pressure-flow loops, plotting pressure and flow
A maximum of six loops of each kind can be stored as reference. Each stored loop is automatically
assigned a different color.
Note that you cannot store Loops from different patients and different source devices in the same list.
This prevents you from inadvertently comparing information from different patients.

253
27 Respiratory Loops Using the Loops Window

Using the Loops Window

Select a loop on the Screen or the Loops SmartKey, if configured, to open the Loops window and
its associated pop-up keys.

Loops: Ohmeda 7900

Loop capture in progress......

Loops
Capture Select Change
Loop Loop Device

• Source device: The device used as the source for the loop information is indicated in the window
title.
• Waves: On the left, up to three realtime airway waves and six available numerics from the source
device can be shown.
• Loops: are shown on the right, with timestamps color-coded to match the corresponding loop.

– A filled-in rectangle marks loops currently shown in the Loops window

– A rectangle outline marks loops not currently shown.
• Status Messages: at the bottom of the window provide information on the loop capture process.
Use the Loops pop-up keys to carry out the following tasks:
Capture Loop: capture the current loop and display it in the Loops window. The monitor will
prompt you to save the loop for reference, either in addition to or in place of previously stored loops.
Select Loops: view the list of stored loops and change the selection of loops displayed in the
Loops window, or delete loops from the list.
Change Device: view a list of source devices and change the selection.

254
 28

28Care and Cleaning

Use only the Philips-approved substances and methods listed in this chapter to clean or disinfect your
equipment. Warranty does not cover damage caused by using unapproved substances or methods.
Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for
controlling infection. Consult your hospital’s Infection Control Officer or Epidemiologist. For
comprehensive details on cleaning agents and their efficacy refer to “Guidelines for Prevention of
Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health Care and Public-
Safety Workers” issued by the U.S. Department of Health and Human Services, Public Health Service,
Centers for Disease Control, Atlanta, Georgia, February 1989. See also any local policies that apply
within your hospital, and country.

General Points
Keep your monitor, modules, Multi-Measurement Server, measurement server extensions, AGM, and
Flexible Module Server, cables and accessories free of dust and dirt. After cleaning and disinfection,
check the equipment carefully. Do not use if you see signs of deterioration or damage. If you need to
return any equipment to Philips, decontaminate it first.
Observe the following general precautions:
• Always dilute according to the manufacturer’s instructions or use lowest possible concentration.
• Do not allow liquid to enter the case.
• Do not immerse any part of the equipment in liquid.
• Never submerge any part of the system.
• Do not pour liquid onto the system.
• Do not allow cleaning or disinfecting agent to remain on any of the equipment surfaces - wipe it off
immediately with a cloth dampened with water.
• Never use abrasive material (such as steel wool or silver polish).
• Never use bleach.
• Remove cleaning and disinfecting agents with a damp cloth and dry with a clean cloth.

CAUTION If you spill liquid on the equipment, battery, or accessories, contact your service personnel or Philips
service engineer.

255
28 Care and Cleaning AGM Accessories

AGM Accessories
Do not clean or disinfect the gas sample tube (M1658A), airway adapter (13902A or M1612A), or gas
exhaust return filter (M1656A).

Cleaning
Clean with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap, a diluted
non-caustic detergent, tenside, ammonia- or alcohol-based cleaning agent. Do not use strong solvents
such as acetone or trichloroethylene. You may clean and disinfect the AGM gas exhaust return line
(M1655A). Do not immerse or soak the tubing.
Take extra care when cleaning the screen of the monitor because it is more sensitive to rough cleaning
methods than the housing. Do not permit any liquid to enter the monitor case and avoid pouring it on
the monitor while cleaning. Do not allow water or cleaning solution to enter the connectors of the
Multi-Measurement Server, the measurement server extensions and measurement modules. Wipe
around, not over, connector sockets.

CAUTION To clean the touch-enabled display, disable the touch operation by switching off the monitor during
the cleaning procedure, or by selecting and holding the Main Screen key until the padlock symbol
appears on it, indicating that touch operation is disabled. Select and hold again to re-enable touch
operation. Unplug a mouse before cleaning it. Switch off the monitor to disable an attached
SpeedPoint Device before cleaning the device.

Recommended cleaning agents are:

Tensides (dishwasher detergents) Edisonite Schnellreiniger, Alconox

Ammonias Dilution of Ammonia <3%, Window cleaner
Alcohol Ethanol 70%, Isopropanol 70%, Window cleaner

Disinfecting
CAUTION Solutions: Do not mix disinfecting solutions (such as bleach and ammonia) as hazardous gases may
result.
Hospital policy: Disinfect the product as determined by your hospital’s policy, to avoid long term
damage to the product.

Clean equipment before disinfecting. Recommended disinfecting agents are:

Alcohol based Ethanol 70%, Isopropanol 70%, Cutasept, Hospisept, Kodan Tinktur
forte, Sagrosept, Spitacid, Sterilium fluid
(only Ethanol 70% and Isopropanol 70% are tested and qualified)
Aldehyde based Cidexactivated dialdehyde solution, Gigasept
(only Cidex is tested and qualified)

256
Cleaning Monitoring Accessories 28 Care and Cleaning

Cleaning Monitoring Accessories

To clean, disinfect and sterilize reusable transducers, sensors, cables, leads, the AGM watertrap
(M1657B), and so forth, refer to the instructions delivered with the accessory.

Sterilizing
Sterilization is not recommended for this monitor, related products, accessories or supplies unless
otherwise indicated in the Instructions for Use that accompany the accessories and supplies.

Cleaning the Recorder Printhead

If you run recordings at low speed (1 or 2cm/min) for extended periods, deposits of paper debris may
collect on the print head making recordings unevenly fainter in horizontal stripes.
1 Remove the recorder.
2 Open the recorder door and un-thread the paper from behind the rubber roller.
3 Tear off or roll up the excess paper into the roll chamber to get it out of your way.
4 Thread the cloth cleaning strip instead of paper around the rubber roller until approximately two
inches of the strip come out from the top of the roller.

5 Close the recorder door, aligning both ends of the strip over the top of the door.
6 Holding the top end of the cleaning strip between your thumb and forefinger, pull the strip
through and out of the recorder.
7 Open the door and ensure that the paper cavity is dust-free. Re-thread the paper and replace the
recorder.

Cleaning the Batteries and Battery Compartment

MP40/MP50 Wipe with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap. Do not use
Only strong solvents. Do not soak the battery.

257
28 Care and Cleaning Cleaning the Batteries and Battery Compartment

258
 29

29Using the Batteries

IntelliVue
MP40/MP50 To use the MP40/MP50
only monitor with battery power,
two Philips M4605A
rechargeable Lithium Ion
batteries must be inserted into
the battery compartment at
the rear of the monitor. The
MP60/MP70/MP90 monitors
cannot be powered by battery.
You can switch between
battery-powered and mains-
powered (AC) operation
without interrupting
monitoring.
The batteries recharge
automatically whenever the
monitor is connected to mains
power.
Battery operation may not be
available in all geographies.
Battery compartment

Battery Power Indicators

The battery LED and battery status information on the Main Screen, in combination with INOP
messages and prompts, help you keep track of the battery power status. The indicators always show the
remaining capacity in relation to the battery’s actual maximum capacity, which may lessen as the
battery ages. You can see the actual capacity in the Battery Status window.
When both batteries are empty the monitor switches off automatically.

259
29 Using the Batteries Battery Power Indicators

Battery LED
The battery LED on the front panel of the
monitor is indicated by a battery symbol.

Battery LED

Battery LED Colors If the monitor is connected to If the monitor is running on

mains power, this means battery power, this means
Green batteries full

Yellow batteries charging

Red, flashing less than 10 minutes power

remaining
Red, flashes intermittently battery malfunction battery malfunction

Red, flashes once when on/ not enough battery power left to
standby switch is pressed power monitor

Battery Status on the Main Screen

Battery status information can be configured to display
permanently on all Screens. It shows the status of each of the 1 2
batteries detected and the combined battery power remaining.

Battery status symbols: These symbols tell you the status of the batteries detected and which battery
compartment they are in, either 1 or 2.

Battery power gauge: This shows the remaining battery power in the combined batteries. It is divided
into sections, each representing 20% of the total power. If three and a half sections are shaded, as in
this example, this indicates that 70% battery power remains. If no batteries are detected, question
marks are shown.

Battery malfunction symbols: If a problem is detected with the battery, these symbols alternate with
the battery status symbols to indicate which battery is affected. They may be accompanied by an INOP
message or by a battery status message in the monitor information line providing more details.

Battery status symbols Battery malfunction symbols, colored red

1 2
Battery 1 Battery Battery Incompatible Battery Battery is One battery
is present compartment requires battery malfunction missing, insert is very low on
2 is empty maintenance battery power

260
Battery Power Indicators 29 Using the Batteries

Battery Status Window

♦ To access the Battery Status window and its associated pop-up keys, select the battery status
information on the Screen, or select Main Setup -> Battery.

Battery Status

1 2 Battery 1 Battery 2

Capacity
full charge: 1852 mAh 2134 mAh
remaining: 1247 mAh 1088 mAh
Voltage: 11.8 V 11.6 V
Current: -2451 mA -1005 mA
Temperature: 26.2 °C 29.3 °C
TimeToEmpty: 72 min ±10% est. 1 min avg)

Capacity, Full Charge tells you how much power each battery can hold when fully charged.
Capacity, Remaining tells you how much power is left in each battery.
Time To Empty tells you approximately how long you can continue to use the monitor with these
batteries. Note that this time fluctuates depending on the system load (how many measurements and
recordings you carry out), the age of the battery, and the remaining capacity of the battery.
Time To Full is shown in place of Time To Empty If the monitor is connected to mains
power, and tells you much time is left until the batteries are fully charged.

Viewing Individual Battery Status

♦ To view information for individual batteries, select the pop-up key Battery 1 or Battery 2.

Documenting Battery Status

To print the information in the Battery Status window on a connected recorder,
1 Select the battery status information on the Screen to open the Battery Status window
2 Select the Record Status pop-up key.

261
29 Using the Batteries Replacing Batteries

Replacing Batteries
You can replace batteries without switching off the
monitor, if you replace them one at a time and if the
remaining battery has sufficient power. The Battery
Missing INOP is suppressed for 30 seconds while you
exchange each battery.
To replace batteries,
1 Press the battery compartment latch to open the
battery compartment door.

2 To replace battery 1, rotate the battery retainer until the battery can
be removed.
To replace battery 2, rotate the battery retainer until the battery can
be removed.
3 Pull gently on the canvas strap to move the battery towards you, then
grasp the battery and pull it out fully.
4 Slide the new battery into position, making sure that the positive and
negative poles are facing in the correct direction, as outlined on the inside of the battery
compartment door.
5 Repeat with the second battery if required.
6 Center the battery retainer and close the battery compartment door.

Maintaining Batteries
The performance of rechargeable batteries may deteriorate over time. Maintaining your batteries as
recommended here can help to slow down this process.

Display Brightness Setting

♦ In the Main Setup menu, select User Interface -> Brightn. - > Optimum. This
selects a level of brightness suitable for most monitoring locations that uses less battery power than
brighter settings.
Satisfy yourself that this level of brightness is suitable for your monitoring location.
Note that your monitor may be configured to dim or brighten the display brightness automatically
when you disconnect from power, to suit the most common transport scenario
(“TransportBrightn” setting).

262
Maintaining Batteries 29 Using the Batteries

Checking Battery Charge

♦ To check the charge status of a battery in a monitor, see the battery power gauge on the Screen or
select Main Setup -> Battery to enter the Battery Status window.
♦ To check the charge status of a battery that is not connected to a monitor or battery charger, press
the black dot marked “PUSH” on the labeled side of the battery. The remaining charge is indicated
by four LEDs on the electronic fuel gauge directly above the dot. Each LED represents 25% of
charge. If all LEDs are lit, the battery is fully charged, if only one LED is lit, 25% charge is left.

Charging Batteries
Batteries can be charged in monitors used to monitor patients. Charging is quicker in unused
monitors. Contact your local Philips representative for information on external battery chargers.
1 Insert the batteries into a monitor connected to mains power. The battery LED will light yellow to
indicate that charging is in process.
2 Charge the battery until it is full, the battery LED is green, and the battery power gauge is fully
shaded.

Reconditioning Batteries
CAUTION Do not use a monitor being used to monitor patients to recondition batteries. The monitor switches
off automatically when the battery is empty.

You must recondition a battery when its “battery requires maintenance” symbol shows on the Screen.
To recondition a battery,
1 Insert the battery into a monitor connected to mains power.
2 Charge the battery until it is completely full. Open the Battery Status window and check
that the Time to Charge is zero hours and zero minutes.
3 Disconnect the monitor from mains power, and let the monitor run until the battery is empty and
the monitor switches itself off.
4 Reconnect the monitor to the mains power and charge the battery until it is completely full again.
Open the Battery Status window and check that the Time to Charge is zero hours
and zero minutes.
Contact your local Philips representative for information on external battery chargers.

Unequally-Charged Batteries
If two batteries in a monitor are unequally charged, the monitor can compensate by causing the fuller
battery to discharge faster. For this mechanism to work, the charge state of the two batteries should not
differ by more than 50%.

263
29 Using the Batteries Battery Safety Information

Battery Safety Information

WARNING Do not open batteries, or dispose of them in fire, or cause them to short circuit. They may ignite,
explode, leak or heat up, causing personal injury.

CAUTION Do not disassemble, heat above 212°F (100°C) or incinerate the batteries, to avoid the risk of fire and
burns. Keep batteries out of the reach of children and in their original package until you are ready to
use them.
If battery leakage should occur, use caution in removing the battery. Avoid contact with skin. Clean
the battery compartment according to the instructions.

264
 30

30Maintenance and
Troubleshooting

WARNING Schedule: Failure on the part of the responsible individual hospital or institution employing the use of
this equipment to implement a satisfactory maintenance schedule may cause undue equipment failure
and possible health hazards.
Contact: If you discover a problem with any of the equipment, contact your service personnel, Philips,
or your authorized supplier.

Inspecting the Equipment and Accessories

You should perform a visual inspection before every use, and in accordance with your hospital’s policy.
With the monitor switched off:
1 Examine unit exteriors for cleanliness and general physical condition. Make sure that the housings
are not cracked or broken, that everything is present, that there are no spilled liquids and that there
are no signs of abuse.
2 If the MMS and Server Extensions are mounted on the monitor, make sure that they are locked
into place and do not slide out without releasing the locking mechanism.
3 Inspect all accessories (cables, transducers, sensors and so forth). If any show signs of damage, do
not use.
4 Switch the monitor on and make sure the backlight is bright enough. Check that screen is at its full
brightness. If the brightness is not adequate, contact your service personnel or your supplier.

Inspecting the Cables and Cords

1 Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the
plug do not move in the casing. If damaged, replace it with an appropriate Philips power cord.
2 Inspect the Measurement Server Link cable and ensure that it makes good connection with the
MMS and the FMS. Make sure that there are no breaks in the insulation.
3 If the MMS is not mounted directly on the monitor, inspect the cable connecting it to the
monitor. Make sure the connectors are properly engaged.

265
30 Maintenance and Troubleshooting Service Task Schedule

4 Inspect the patient cables, leads and their strain reliefs for general condition. Make sure there are
no breaks in the insulation. Make sure that the connectors are properly engaged at each end to
prevent rotation or other strain.
5 Apply the transducer or electrodes to the patient, and with the monitor switched on, flex the
patient cables near each end to make sure that there are no intermittent faults.

Service Task Schedule

The following tasks, documented in the service manual, are for Philips-qualified service professionals
only.
Carry out the tasks as indicated by the monitor’s maintenance schedule, or as specified by local laws.
Contact a Philips-qualified service provider if your monitor needs a safety or performance test. Clean
and disinfect equipment to decontaminate it before testing or maintaining it.

Maintenance Schedule Frequency

Safety checks according to IEC 60601-1 At least once every two years, or as needed, after any repairs
where the power supply is replaced, or if the monitor has been
dropped.
Synchronization of the monitor and At least once every two years, or as needed.
defibrillator (only if hospital protocol
requires use of monitor during
defibrillation)
Replace backlight 25,000 hours (about three years) of continuous usage, or as
needed.
Performance assurance for all At least once every two years, or if you suspect the measurement
measurements not listed below. values are incorrect.
NBP calibration Once a year, or as specified by local laws.
Microstream CO2 calibration and At least once a year or after 4000 operating hours.
performance test
Microstream CO2 preventive At least once every three years or after 15,000 operating hours.
maintenance
BIS performance test Optional (Philips recommends once a year)
AGM preventive maintenance (gas span At least once a year or if you suspect the measurement values are
calibration check, ambient pressure incorrect.
check, flow rate check, pump check,
leakage check, internal Nafion tubing
and bacterial filter replacement and so
forth as described in AGM service
manual)
AGM ventilator fan At least every six months.

266
Troubleshooting 30 Maintenance and Troubleshooting

Troubleshooting
If you suspect a problem with an individual measurement, read the Instructions for Use and
doublecheck that you have set up the measurement correctly.
If you suspect an intermittent, system-wide problem call your service personnel. You may be asked for
information from the status log. To view the status log,
1 In the Main Setup menu, select Revision.
2 Select a pop-up key according to the status log you want to consult, for example, to check the
status log for the MMS, select the M3001A pop-up key.
3 View the status log by selecting the Stat Log pop-up key.

Disposing of the Monitor

WARNING To avoid contaminating or infecting personnel, the environment or other equipment, make sure you
disinfect and decontaminate the monitor appropriately before disposing of it in accordance with your
country’s laws for equipment containing electrical and electronic parts. For disposal of parts and
accessories such as thermometers, where not otherwise specified, follow local regulations regarding
disposal of hospital waste.

You can disassemble the monitor, MMS, FMS and modules as described in the Service Guide.
– There is no metal molded into the plastic case, and there are no metal sprays on the plastic.
– All plastic parts with a weight greater than 10g (0.35 ounces) are marked with the ISO code for
identification.
– The sheet metal card cage uses only one kind of steel.
– The screen has a touch resistor laminate.
– You can recycle the paper Instructions for Use.

Disposing of Empty Calibration Gas Cylinders

1 Empty the cylinder completely by pushing in the pin of the regulator valve or by pulling out the
pin of the fill wave using a tire valve stem wrench or a pair of needle nose pliers.
2 When the cylinder is empty, either remove the valve step from the fill (or regulator) hole, or drill a
hole in the cylinder.
3 Write “Empty” on the cylinder and dispose of it appropriately for scrap metal.

WARNING Ensure that the cylinder is completely empty before trying to remove the valve stem or drill the tank.

267
30 Maintenance and Troubleshooting Disposing of Empty Calibration Gas Cylinders

268
 31

31Accessories
You can order parts and accessories from Philips supplies at www.medical.philips.com or consult your
local Philips representative for details.

WARNING Reuse: Never reuse disposable transducers, sensors, accessories and so forth that are intended for single
use, or single patient use only.
Philips’ approval: Use only Philips-approved accessories.
Packaging: Do not use a sterilized accessory if its packaging is damaged.

ECG/Resp Accessories
This symbol indicates that the cables and accessories are designed to have special
protection against electric shocks (particularly regarding allowable leakage currents),
and are defibrillator proof.

Trunk Cables

Length 3-Electrode Cable Set 5-Electrode Cable Set 10-Electrode

Cable set
AAMI IEC AAMI IEC AAMI/IEC
Part No. Part No. Part No. Part No. Part No.
0.9m M1540C M1550C M1560C M1570C n/a
2.7m M1500A M1510A M1520A M1530A M1949A

3-Electrode Cable Sets

Description Length AAMI Part No. IEC Part No.

OR 1.0m M1601A M1611A

269
31 Accessories ECG/Resp Accessories

Description Length AAMI Part No. IEC Part No.

ICU Grabber shielded 1.0m M1603A M1613A
ICU snap shielded 1.0m M1605A M1615A
ICU Clip non-shielded 0.45m M1608A M1618A
ICU Clip non-shielded 0.7m M1609A M1619A

5-Electrode Cable Sets

Description Length AAMI Part No. IEC Part No.

OR Grabber shielded 1.0m/1.6m M1621A M1631A
ICU Grabber shielded 1.0m/1.6m M1623A M1633A
ICU Snap shielded 1.0m/1.6m M1625A M1635A
ICU Clip non-shielded 0.7m/1.3m M1629A M1639A

10-Electrode Cable Sets

Description Length AAMI Part No. IEC Part No.

OR Grabber - extremities 1.0m/1.6m M1973A M1974A
OR Grabber - chest 1.0m M1979A M1984A
ICU Extremities 1.0m/1.6m M1968A (grabber) M1971A (grabber)
ICU Chest 1.0m M1976A (grabber) M1978A (grabber)

3-Electrode One Piece Cables

AAMI 3-Electrode Length AAMI IEC 3-electrode One IEC

One Piece Cables Part No. Piece Cables Part No.
OR Grabber 1.9m M1970A OR Grabber M1980A
ICU Snap 1.9m M1972A ICU Grabber M1981A

5-Electrode One Piece Cables

AAMI 5-electrode Length AAMI IEC 5-electrode One IEC

One Piece Cables Part No. Piece Cables Part No.
OR Grabber 2.5m M1975A OR Grabber M1985A
ICU Snap 2.5m M1977A ICU Grabber M1986A

270
NBP Accessories 31 Accessories

Set Combiners and Organizers

Set combiners and organizers Part No.

Set combiner 3-electrode M1501A
5-electrode M1502A
Set organizer Shielded 3-electrode M1503A
Shielded 5-electrode M1504A
Bedsheet clip M1509A

NBP Accessories
These cuffs and tubings are designed to have special protection against electric shocks
(particularly regarding allowable leakage currents), and are defibrillator proof. You can
use them during electrosurgery.

Adult/Pediatric Multi-Patient Comfort Cuffs and Disposable Cuffs

Patient Category Limb Bladder Disposable Reusable cuff Tubing

Circumference Width cuff Part No.
Part No.
Adult (Thigh) 42 to 54 cm 20 cm M1879A M1576A M1598B (1.5m)
Large Adult 34 to 43 cm 16 cm M1878A M1575A or
M1599B (3m)
Adult 27 to 35 cm 13 cm M1877A M1574A
Small Adult 20.5 to 28 cm 10.5 cm M1876A M1573A
Pediatric 14 to 21.5 cm 8 cm M1875A M1572A
Infant 10 to 15 cm 5.5 cm M1874A M1571A

Reusable Cuff Kits

Cuff Kits Part No.

Infant, pediatric, small adult, adult M1577A
Small adult, adult, large adult, thigh M1578A
Infant, pediatric, small adult, adult, large adult, thigh M1579A

271
31 Accessories NBP Accessories

Adult/Pediatric Antimicrobial Coated Reusable cuffs

Patient Category (color) Limb Bladder Width Part No. Tubing

Circumference
(cm)
Adult Thigh (grey) 45 - 56.5 21.0 cm M4559A M1598B
(1.5m) or
Large Adult X-Long (burgundy) 35.5 - 46.0 17.0 cm M4558A
M1599B (3m)
Large Adult (burgundy) 35.5 - 46.0 17.0 cm M4557A
Adult X-Long (navy blue) 27.5 - 36.5 13.5 cm M4556A
Adult (navy blue) 27.5 - 36.5 13.5 cm M4555A
Small Adult (royal blue) 20.5 - 28.5 10.6 cm M4554A
Pediatric (green) 13.8 - 21.5 8.0 cm M4553A
Infant (orange) 9 - 14.8 5.4 cm M4552A

Adult/Pediatric Soft Single Patient Single-Hose Disposable Cuffs

Patient Category Limb Circumference Bladder Part No. Tubing

(cm) Width
Adult (Thigh) 45 - 56.5 cm 20.4 cm M4579A M1598B (1.5m)
Large Adult X-Long 35.5 - 46 cm 16.4 cm M4578A or

Large Adult 35.5 - 46 cm 16.4 cm M4577A M1599B (3m)

Adult X-Long 27.5 - 36.5 13.1 cm M4576A
Adult 27.5 - 36.5 cm 13.1 cm M4575A
Small Adult 20.5 - 28.5 cm 10.4 cm M4574A
Pediatric 15.0 - 21.5 cm 8.0 cm M4573A
Infant 9 - 15 cm 5.6 cm M4572A

Neonatal/Infant Cuffs (Disposable, non-sterile)

Cuffs Limb Circumference Bladder Width Part No. Tubing

(cm)
Size 1 3.1 to 5.7 cm 2.2 cm M1866A M1596B (1.5m)
Size 2 4.3 to 8.0 cm 2.8 cm M1868A or
M1597B (3m)
Size 3 5.8 to 10.9 cm 3.9 cm M1870A
Size 4 7.1 to 13.1 cm 4.7 cm M1872A

272
Invasive Pressure Accessories 31 Accessories

Invasive Pressure Accessories

These transducers and accessories are designed to have special protection against electric
shocks (particularly regarding allowable leakage currents), and are defibrillator proof.
If you are using the M3012A Hemodynamic Measurement Server Extension, and you
want to measure temperature and invasive pressure at the same time, we recommend
that you use the pressure transducer CPJ840J6, with a round module connector piece, and
not a transducer with a square connector. Pressure transducers with square connectors may
make it difficult to connect the adjacent Temperature connector at the same time.

Transducer, accessories, sensor kits Part No

Reusable pressure transducer 5 µV/.V/mmHg sensitivity CPJ840J6
Sterile disposable pressure domes for CPJ840J6 (pack of 50) CPJ84022
Transducer holder for CPJ840J6 (pack of 4) CPJ84046
IV pole mount for CPJ840J6 CPJ84447
Single channel disposable sensor kit (20) - (EU/EFTA only) M1567A
Dual channel disposable sensor kit (20) (EU/EFTA only) M1568A
Transducer holder for M1567/8A (EU/EFTA only) M2271A
IV pole mount for M1567/8A (EU/EFTA only) M2272C
Adapter cable for disposable sensor kit 3,0m for M1567/8A M1634A
Pressure transducer kits
PiCCO monitoring kit, 30cm pressure line, includes PV4046 injectate temperature PV8103
sensor housing for M1646A
PiCCO monitoring kit, 150cm pressure line, includes PV4046 injectate temperature PV8115
sensor housing for M1646A
PiCCO monitoring kit, 150cm pressure line, includes PV4046 injectate temperature PV8115CVP
sensor housing for M1646A and central venous pressure line
PULSION Pressure Interface Cable for disposable pressure transducer PMK 206

SpO2 Accessories
The Nellcor sensors Oxisensor N-25, I-20, OxiCliq N, and I contain natural rubber latex which may
cause allergic reactions. Disposable sensors are not available in USA from Philips. Purchase Nellcor
OxiCliq sensors and adapter cables directly from Tyco Healthcare.
Do not use more than one extension cable with any sensors or adapter cables. Do not use an extension
cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates “Long”
version).
All listed sensors operate w/o risk of exceeding 41oC on the skin if ambient temperature is below 37oC.
The M1020B SpO2 module with Option A02 may not be available in all countries.
Make sure you choose the correct accessories from the following table for the SpO2 measurement
device you are using, either

Standard: Multi-Measurement Server M3001A and Standard SpO2 module M1020B, Option A01,
or

273
31 Accessories SpO2 Accessories

OxiMax: OxiMax Module SpO2 module M1020B, Option A02.

OxiMax sensors may not be available in all countries.

Product Description Standard OxiMax Comments

Number
Philips reusable sensors.
M1191A Adult finger sensor, for patient size yes no Cable: silicone; sensor
>30kg. Cable length 2 m. housing: silicone.
M1191AL M1191A with longer cable (3 m). yes no M1191AL may not be
available in all
countries.
M1192A Pediatric foot/finger sensor/adult yes no Cable: polyurethane;
finger. Cable length 1.5 m. sensor housing:
M1193A Neonatal foot/adult finger sensor. yes no silicone.
M1194A Adult/pediatric ear clip sensor. Cable yes no Cable: polyurethane;
length 1.5 m. sensor housing:
polyurethane.
M1195A Infant finger sensor. Cable length yes no Cable: polyurethane;
1.5 m. sensor housing:
silicone.
Philips disposable sensors. Not available in the USA.
M1904B Identical to OxiMax MAX-A yes yes Standard: Use adapter
M1903B Identical to OxiMax MAX-P yes yes cable M1943A or
M1943AL.
M1902B Identical to OxiMax MAX-I yes yes
OxiMax: Must use
M1901B Identical to OxiMax MAX-N yes yes adapter cable
M1943NL.
NELLCOR disposable sensors (must be ordered from Nellcor)
OxiMax Adult finger sensor (patient size yes yes Standard: Use adapter
MAX-A >30kg) cable M1943A or
M1943AL.
OxiMax OxiMax MAX-A with long cable yes yes
MAX-AL OxiMax: Must use
adapter cable
OxiMax Pediatric foot/hand sensor (patient yes yes
M1943NL.
MAX-P size 10-50 kg)
OxiMax Infant foot/hand sensor (patient size yes yes
MAX-I 3-20 kg)
OxiMax Adult finger or neonatal foot/hand yes yes
MAX-N sensor (patient size >40 kg or <3 kg)

274
SpO2 Accessories 31 Accessories

Product Description Standard OxiMax Comments

Number
MAX-FAST Forehead sensor no yes Needs M1943NL
OxiMax Adult nasal sensor no yes adapter cable.
MAX-R
OxiMax SC- Adult softcare sensor no yes
A
OxiMax SC- Neonatal softcare sensor no yes
NEO
OxiMax SC- Preterm infant softcare sensor no yes
PR
Oxisensor II Adult sensor (patient size >30kg) yes no Needs M1943A
D-25 adapter cable.
Oxisensor II Pediatric sensor (patient size 10-50 kg) yes no
D-20
Oxisensor II Infant sensor (patient size 3-20 kg) yes no
I-20
Oxisensor II Neonatal sensor (patient size <3 kg or yes no
N-25 >40 kg)
OxiCliq A See OxiMax MAX-A yes yes Standard: Use adapter
OxiCliq P See OxiMax MAX-P yes yes cable M1943A or
M1943AL together
OxiCliq I See OxiMax MAX-I yes yes with OC3 adapter
OxiCliq N See OxiMax MAX-N yes yes cable.
OxiMax: Must use
adapter cables
M1943NL and OC3
adapter cable.
Oxiband Adult / neonatal sensor no yes Needs M1943NL
OXI-A/N adapter cable.
Oxiband Pediatric / infant sensor no yes
OXI-P/I
Durasensor Adult finger clip sensor no yes
DS100A
Dura-Y D-YS Y-sensor no yes
Extension / Adapter Cables
M1941A Extension cable yes yes For use with Philips
reusable sensors and
adapter cables. Cable:
polyurethane, 2 m.

275
31 Accessories Temperature Accessories

Product Description Standard OxiMax Comments

Number
M1943A Adapter cable (1.1 m cable) yes no Adapter cable for
M1943AL Adapter cable (3 m cable) yes no Philips/Nellcor
disposable sensors.
M1943NL OxiMax adapter cable (3 m cable) no yes Adapter cable for
Philips disposable/
Nellcor disposable
and reusable sensors.
OC 3 Adapter Cable for OxiCliq sensors yes yes Available from
Nellcor only.

Temperature Accessories
Temperature Probes Part No. Minimum measurement time
for accurate readings
Reusable
General purpose probe 21075A 90 sec
Small flexible vinyl probe (Infant/Pediatric) 21076A 60 sec
Attachable surface probe 21078A 60 sec
Disposable
General purpose probe M1837A 90 sec
Skin probe 21091A 60 sec
Esophageal/Stethoscope Probe (12 French) 21093A 180 sec
Esophageal/Stethoscope Probe (French 18) 21094A 210 sec
Esophageal/Stethoscope Probe (French 24) 21095A 310 sec
Foley Catheter Probe (12 French) M2255A 180 sec
Foley Catheter Probe (16 French) 21096A 180 sec
Foley Catheter Probe (18 French) 21097A 180 sec
Adapter cable 1.5m 21082B
Adapter cable 3.0m 21082A

Cardiac Output (C.O.) Accessories

See Pressure accessories for PULSION continuous cardiac output accessories.

276
Mainstream CO2 Accessories 31 Accessories

Description Part No
Common Accessories
Accessories Set of ice buckets 14455A
Remote handswitch 15244A
PiCCO inline temperature probe for Latex free M1646A
warmer injectate
Right Heart Thermodilution
C. O. Interface Cables 2.7 meter cable (right heart only) M1642A
2.4 m + 2.4 m cable M1643A
Injectate Probes 2.4m injectate temp. probe 23001A
0.5m injectate temp. probe 23001B
Ice bath temp. probe (right heart only) 23002A
Transpulmonary Thermodilution
C. O. Interface Cables 2.4 m + 2.4 m cable M1643A
Injectate Probes (2.4m) injectate temp. probe (reusable) 23001A
(0.5m) injectate temp. probe (reusable) 23001B
Pressure Transducer Kits (PULSION) PV 8003 (30cm pressure line)
PV 8010 (100cm pressure line)
PV 8015 (150cm pressure line)
Pressure Interface Cable for disposable PULSION PMK 206
pressure transducer

Mainstream CO2 Accessories

Description Part No.

CO2Transducer Sensor M1460A
Standard Airway Adapter (reusable) M1465A
Small Airway Adapter (reusable) 14363A

Microstream CO2 Accessories

• “FilterLine Set” is a combination of a FilterLine with an Airway Adapter.
• “H” in the accessory name indicates suitability for humidified ventilation and longer usage due to
the active removal of humidity from the sample line.
• “Smart CapnoLine” is a combined oral-nasal FilterLine.
• “Smart CapnoLine O2” is a combined oral-nasal-O2-CO2 FilterLine.
• “NIV Line” is a nasal FilterLine suitable for mask ventilation (for example, C-PAP).

277
31 Accessories Microstream CO2 Accessories

• “Single purpose” means CO2 measurement only, “dual purpose” means CO2 measurement and O2
delivery.

Ventilation Environment Patient Description Quantity Part No.

Weight
Intubated Non- ≥ 2 kg Airway Adapter Adult/Pediatric 25 M1990A*
humidified FilterLine 25 M1925A*
FilterLine OR Set Adult/ 25 M1922A*
Pediatric
FilterLine Set Adult/Pediatric 25 M1920A
< 2 kg Airway Adapter Infant/Neonatal 25 M1996A*
FilterLine 25 M1925A*
FilterLine H Set Infant/Neonatal: use M1923A
Humidified ≥ 2 kg Airway Adapter Adult/Pediatric 25 M1990A*
FilterLine H 25 M1926A*
FilterLine H Set Adult/Pediatric 25 M1921A
< 2 kg Airway Adapter Infant/Neonatal 25 M1996A
FilterLine H 25 M1926A
FilterLine H Set Infant/Neonatal 25 M1923A
Non- Nasal, CO2, > 45 kg Nasal FilterLine Adult 25 M1927A
intubated, ≥ 12 hours use 10-45 kg Nasal FilterLine Pediatric 25 M1928A
single-purpose
< 10 kg Nasal FilterLine Neonatal 25 M1929A
Nasal, CO2, > 45 kg CapnoLine H Adult 25 M4689A
≥ 24 hours use 10- 45 kg CapnoLine H Intermediate 25 M4690A
< 10 kg CapnoLine H 25 M4691A
Infant/Neonatal
Oral-nasal, > 55 kg Smart CapnoLine Adult 25 M2526A
CO2, 20-55 kg Smart CapnoLine Intermediate 25 M2525A
≥ 12 hours use
10-20 kg Smart CapnoLine Pediatric 25 M2524A
Non- Nasal, CO2 + > 45 kg CapnoLine H O2 Adult 25 M4680A
intubated, O2, 10 - 45 kg CapnoLine H O2 Pediatric 25 M4681A
dual-purpose up to 12 hours
use
Oral-nasal, > 55 kg Smart CapnoLine O2 Adult 25 M2522A
CO2 + O2, 20-55 kg Smart CapnoLine O2 25 M2521A
up to 12 hours Intermediate
use
10 - 20 kg Smart CapnoLine O2 Pediatric 25 M2520A
Mask, single C-PAP, CO2, > 45 kg NIV Line Adult 25 M4686A
purpose up to 12 hours 10 - 45 kg NIV Line Intermediate 25 M4687A
use
*Accessories supported for use with monitor but no longer orderable

278
tcGas Accessories 31 Accessories

tcGas Accessories
This symbol indicates that the specified transducer (but not its membranes) is designed
to have special protection against electric shocks (particularly regarding allowable
leakage currents), and is defibrillator proof.

Description Part No.

12x tc Accessory Kit (O-ring remover, absorbent paper, electrolyte solution, 15209-60010
replacement membrane)
tc Application Kit (4x25 disposable fixation rings, 4x20ml contact fluid) 15209-60020
Calibration gas - 6 gas bottles 15210-60010
Calibration gas - 6 gas bottles (Europe and Japan only) 15210-64010
Replacement tubing (5 tubes) M2205A
tcpO2/CO2 transducer M1918A
Calibration unit 15210B
Radiometer TCC3 calibration unit (available from Radiometer) n/a

EEG Accessories
Description Part No.
Trunk Cable 2.7m M2268A
Trunk Cable, 1.0 m M2269A
Reusable 80-cm-long 5-lead cables with 10mm silver/silverchloride leadwired cup M1931A
electrodes (Adult)
Reusable 80-cm-long 5-lead cables with 6mm silver/silverchloride leadwired cup M1932A
electrodes (Pediatric/Neonatal)
Reusable 80 cm 5-lead cables with clip M1934A
Disposable EEG electrodes M1935A
EC2™ Electrode Cream (conductive paste) M1937A

BIS Accessories
Use only Aspect BIS sensors with the BIS module. The sensor is a silver/silverchloride electrode array
that uses Aspect’s patented ZipPrep technology and a proprietary connector. The sensor is for single
patient use only. Check its shelf-life before use.
The patient interface cable has an estimated lifetime of one year. Do not scrap it when disposing of the
BIS sensor.

BIS Sensors
To re-order sensors outside North America, contact your nearest Philips sales office and quote the
Philips ordering number. In North America, contact Aspect Medical Systems.

279
31 Accessories AGM Accessories

Description Pieces per pack Philips Ordering No Aspect Part No

BIS Sensor Quatro (formerly Sensor XP) 50 M1997A 186-0106
BIS Sensor Plus 50 M4546A 186-0076
BIS Sensor Pediatric 25 M1998A 186-0110
BIS Sensor Extend 50 n/a 186-0160

Other BIS Accessories

Order the following parts from your nearest Philips sales office and quote the Philips ordering number

Description Philips Ordering No

BIS Engine Cable - Short (0.8 m) M1034-61610
BIS Engine Cable - Long (2.0 m) M1034-61620
PIC PLUS Cable M1034-61630
BIS Universal Clamp Mount M1180A #C32
BIS FMS Mount (Flexible Module Server) M1180A #C33

AGM Accessories
Description Pieces per Pack Part No.
Elbow Airway Adapter 20 13902A
Straight Airway Adapter 20 M1612A
Gas Exhaust Return Line 1 M1655A
Gas Exhaust Return Filter 20 M1656A
Watertrap 25 M1657B
Gas Sample Tube (2.6m) 20 M1658A

SvO2 Accessories
Contact your Abbott representative to order Abbott Critical Care Systems accessories. They are not
available from Philips.

Description Abbott Part No.

Optical Module P50131-04

280
Recorder Accessories 31 Accessories

Description Abbott Part No.

Opticath Fiber-optic Catheters P575-EH
P575-EH10CM
P7110-E
P7110-EH
P7110-EP-H
P7110-EP8
P7110-EP8-H
P7110-PZ8-H
P575-EH
P575-EH10CM
U440

Recorder Accessories
Description Part No.
10 rolls of paper 40477A
80 rolls of paper 40477B

281
31 Accessories Recorder Accessories

282
 32

32Installation and Specifications

The specifications in this section apply to the MP40, MP50, MP60, MP70, and MP90 patient
monitors, unless otherwise stated.
The monitors are not user installable. They must be installed by qualified service personnel.

Intended Use
The monitor is intended to be used for monitoring, recording, and alarming of multiple physiological
parameters of adults, pediatrics, and neonates in health care facilities. The device is to be used in health
care facilities by trained health care professionals. The monitor is for single patient use only. It is not
intended for home use. Rx only: U.S. Federal Law restricts this device to use by or on the order of a
physician. Not a therapeutic device.
The transcutaneous gas measurement (tcGas) is restricted to neonatal patients only. EASI 12-lead ECG
is only for use on adult and pediatric patients. ST Segment monitoring is restricted to adult patients
only. Assessment of EASI-derived 12-Lead ST measurements is recommended for patients that meet
the following requirements of age: 33 to 82, height: 147 to 185 cm (58 to 73 in), weight: 53 to 118 kg
(117 to 261 lb), height-to-weight ratio: 1.41 to 2.99 cm/kg (0.25 to 0.54 in/lb). The ECG
measurement is intended to be used for diagnostic recording of rhythm and detailed morphology of
complex cardiac complexes (according to AAMI EC 11).
Bispectral Index (BIS) monitoring is for use in monitoring the state of the brain by data acquisition of
EEG signals in the intensive care unit, operating room, and for clinical research. The Bispectral Index,
a processed EEG variable, may be used as an aid in monitoring the effects of certain anesthetic agents.1

Indication for Use

The monitor is indicated for use by health care professionals whenever there is a need for monitoring
the physiological parameters of patients.

1.See Gan TJ, Slass P, Windsor A, Payne F, Rosow C, Sebel P, Manberg P. Bispectral Index Monitoring
Allows Faster Emergence and Improved Recovery from Propofol, Alfentanil, and Nitrous Oxide An-
esthesia. Anesthesiology, October 1997; (4) 87:808-15.

283
32 Installation and Specifications Manufacturer’s Information

Manufacturer’s Information
You can write to Philips at this address
Philips Medizin Systeme Boeblingen GmbH
Hewlett-Packard Str. 2
71034 Boeblingen
Germany
Visit our website at: www.philips.com.
© Copyright 2002 - 2003. Koninklijke Philips Electronics N.V. All Rights Reserved.
The information contained in this document is subject to change without notice.
Philips makes no warranty of any kind with regard to this material, including, but not limited to, the
implied warranties of merchantability and fitness for a particular purpose. Philips shall not be liable for
errors contained herein or for incidental or consequential damages in connection with the furnishing,
performance or use of this material.

Responsibility of the Manufacturer

Philips considers itself responsible for any effects on safety, reliability and performance of the
equipment only if:
• assembly operations, extensions, re-adjustments, modifications or repairs are carried out by persons
authorized by Philips.
• the electrical installation of the relevant room complies with national standards.
• the instrument is used in accordance with the instructions for use.
To ensure safety, use only those parts and accessories specified for use with the monitor. If other parts
are used, Philips is not liable for any damage that these parts may cause to the equipment.
See your sales contract for product warranty information.

Trademark Acknowledgement
PiCCOΤΜ is a trademark of Pulsion Medical Systems AG.
Bispectral Index and BIS are trademarks of Aspect Medical Systems Inc, and are registered in the USA,
EU and other countries.
OxisensorΤΜ II, Oxi-CliqΤΜ, and OxiMaxΤΜ are trademarks of Tyco Healthcare Group LP, Nellcor
Puritan Bennett Division.
Microstream, FilterLine, and Smart CapnoLine are trademarks or registered trademarks of Oridion
Systems Ltd.
Citrix® and ICA® (Independent Computing Architecture) are registered trademarks of Citrix
Systems, Inc.
Other product and company names mentioned in this book may be trademarks of their respective
owners.

284
Symbols 32 Installation and Specifications

Symbols
These symbols appear on the monitor and its associated equipment.

Symbols

Refer to accompanying Protective earth RS232 connector

documents RS-232

Standby Equipotential Identifies year

2002-
grounding 06 and month of
manufacture

Connection direction Alternating current Connection direction

indicator indicator

Electrical input Electrical output Connector has

indicator indicator special protection
(On some older measurement (On some older measurement against electric
servers and extensions, modules, servers and extensions, modules, shocks and is
and Anesthetic Gas Modules, this and Anesthetic Gas Modules, this defibrillator proof
symbol may indicate the gas symbol may indicate the gas
input.) output.)

Gas output indicator Gas input indicator Quick mount release

FMS Power On Serial/MIB connector Interruption indicator

Indicator - Ready for
operation

Mouse connection Keyboard Printer connection

indicator connection indicator
indicator

285
32 Installation and Specifications Installation Safety Information

Symbols

Parallel interface Nurse call relay Digital video device

indicator for connection indicator connection indicator
connection to parallel for connection to
printer independent display

Measurement 12 Volt DC LAN LAN connection

server link connection, for indicator for
connection connection to wireless connection to a wired
indicator device network

Philips Analog interface Digital interface

remote indicator for indicator for
device connection to any connection to any
(SpeedPoint or Alarm Device) analog video display digital video display
connection indicator
12 Volt DC LAN
12V connection, for Battery symbol LAN connection
connection to wireless indicator for
LAN/SER
devices connection to serial
interface

Installation Safety Information

WARNING If multiple instruments are connected to a patient, the sum of the leakage currents may exceed the
limits given in IEC/EN60601-1. Consult your service personnel.

Grounding The monitor, AGM and MP90 processing unit must be grounded during operation. If a
three-wire receptacle is not available, consult the hospital electrician. Never use a three-
wire to two-wire adapter.
Equipotential If the monitor, AGM or MP 90 processing unit are used in internal examinations on the
Grounding heart or brain, ensure that the room incorporates an equipotential grounding system to
which the monitor, MP 90 processing unit and AGM all have separate connections.
Combining equipment Combinations of medical equipment with non-medical equipment must comply with
IEC 60601-1-1.
Fusing The monitor uses double pole/neutral fusing.

Connectors
The actual placement of boards and configuration of connections for your monitor depends on how
your hardware has been configured. See the symbols table on page 285 to see which symbols are used
to mark the connections.

286
Installation Safety Information 32 Installation and Specifications

MP40/MP50

MP40/MP50 Rear of monitor

1 Space for optional
interface boards, e.g.
serial/MIB (RS232)
connectors, or
optional parallel
printer connection
2 Equipotential
grounding
10
3 Protective earth
4 AC power inlet
5 Wired network
1 connector
6 Remote alarm
connector
7 Analog video out
connector
8 Wireless network
2 3 4 5 6 7 8 9 connector
9 Battery compartment
10 Measurement Server
Link connector

MP40/MP50 Left side of monitor

1 MMS and one extensions
1
2 Plug-in module slots
3 ECG analog (sync) output
connector
3

287
32 Installation and Specifications Installation Safety Information

MP60/MP70

Right side of monitor (MP60/70)

1 1 Serial/MIB (RS232) connectors
(optional), type RJ45
2 2 Parallel printer connector
3 Keyboard connector
3 4 Mouse/trackball connector
5 Main measurement server link (MSL)
4
6 Wired network connector
5 7 Wireless network connector
8 Analog video out connector
6 9 Equipotential ground connector
10 AC power input
7
11 Protective earth screw hole

8 9 10 11

Left side of monitor (MP60/70)

1 MMS patient cable connectors
2 Slot for integrated recorder module
3 Additional measurement server link
(MSL) cable (alternative or additional to
1 MSL on right of monitor)
4 ECG analog (sync) output connector

3 4

WARNING Connect only medical devices to the ECG output connector socket.

288
Installation Safety Information 32 Installation and Specifications

MP90

MP 90 (rear of processing unit)

2 3 4 5 6 7 8 9 10

1
11

21 20 19 18 17 16 15 14 13 12

1 Serial/MIB (RS232) connectors, type RJ45 12 ECG Sync out

2 Serial/MIB (RS232) connectors, type RJ45 13 Wired network connector
3 Independent display - remote alarm device connector 14 Wireless network connector
4 Keyboard connector 15 Primary measurement server link
5 Independent display - remote SpeedPoint connector 16 Parallel printer connector
6 Independent display - mouse/trackball connector 17 Additional measurement server link
7 Independent display - keyboard connector 18 Remote SpeedPoint connector
8 Independent display analog video out connector 19 Mouse/trackball connector
9 Primary display - analog video out connector 20 Remote alarm connector
10 Independent display - digital video out connector 21 Flexible nurse call interface
11 Primary display - digital video out connector

289
32 Installation and Specifications Altitude and Barometric Pressure

MP 90 (front of processing unit)

3 4 5 6 7 8

1 AC Power LED 5 Power supply

2 Error LED 6 AC power input
3 Power on LED 7 Protective earth screw hole
4 Power on switch 8 Equipotential grounding point

Altitude and Barometric Pressure

Altitude and barometric pressure affect tcGas and CO2 measurements. The monitor must be
configured at installation to the correct altitude and barometric and pressure values for your hospital
site.

Monitor Safety Specifications

The monitors, together with the Multi-Measurement Server (M3001A), and the Flexible Module
Server (M8048A), all modules and measurement server extensions, comply with the Medical Device
Directive 93/42/EEC (CE0366). In addition, the product complies with
IEC 60601-1:1988 + A1:1991 + A2:1995; EN60601-1:1990 + A1:1993 + A2:1995; UL 2601-1:1994;
CAN/CSA C22.2#601.1-M90:1993; JIS T 1001-1992; IEC 60601-1-1+A1:1995; EN 60601-1-
1+A1:1995; IEC 60601-1-2:1993; EN 60601-1-2:1993.
Classification (according to IEC 60601-1): Class 1, Type CF, Continuous Operation.
The possibility of hazards arising from software errors was minimized in compliance with EN1441,
EN60601-1-4 and IEC 60601-1-4.
This ISM device complies with Canadian ICES-001. Cet appareil ISM est conforme a la norme NMB-
001 du Canada.

290
Monitor Safety Specifications 32 Installation and Specifications

WARNING To minimize the risk of causing severe burns during MR imaging, ensure that transducers, sensors and
cables are positioned so that no inductive loops are formed. If the measurement does not appear to be
operating properly, remove all transducers, sensors and cables immediately from the patient.

Physical Specifications

Product Max Weight W x H x D Comments

M8003A/M8004A IntelliVue MP40/ < 8.6 kg < 365 x 330 x 217 mm including M3001A, recorder,
MP50 (with navigation point) < 19 lb 14 x 13 x 8.5 in and battery, without options

M8005A IntelliVue MP60 < 10 kg < 405 x 360 x 170 mm without handle and speedpoint
(with speedpoint) < 22.05 lb 15.95 x 14.17 x 6.69 in device, without options
M8007A IntelliVue MP70
(with touchscreen operation)
M8010A IntelliVue MP90 < 10 kg 342 x 108 x 505 mm including AC cable, cable cover
< 22.05 lb 13.47 x 4.25 x 19.88 in and feet

M3001A < 650g 188 x 96.5 x 51.5 mm

Multi-Measurement Server (MMS) < 1.4lb 7.4 x 3.8 x 2 in
M3015A < 550 g 188.0 x 96.5 x 38.5 mm
Measurement Server Extension - < 1.21 lb 7.4 x 3.8 x 1.5 in
Microstream CO2
M3016A < 450 g 188.0 x 96.5 x 38.5mm
Measurement Server Extension - < 0.99 lb 7.4 x 3.8 x 1.5 in
Mainstream CO2
M3012A < 550 g 98 x 40 x 190 mm
Hemodynamic Measurement Server
Extension
M8048A < 3500g < 320 x 120 x 35 mm without plug-in modules
Flexible Module Server (FMS) < 7.7lb 12.6 x 4.7 x 5.3 in
M1026A < 8.2 kg 370 x 90 x 467 mm
Anesthetic Gas Module (AGM) < 18 lb 14.6 x 3.5 x 18.4 in
M8025A < 300 g 62 x 125 x 63 mm
Remote Alarm Device < 0.7 lb 2.4 x 5 x 2.5 in
M8026A < 400 g 103 x 139 x 63 mm
Remote SpeedPoint < 0.9 lb 4 x 5.5 x 2.5 in
M8031A < 4.9 kg 408 x 333 x 85 mm with mounting bracket
XGA Touchscreen LCD Display < 10.8 lb 16 x 13.1 x 3.4 in
M1006B 190 g (6.7 oz) 36 x 99.6 x 97.5 mm
Invasive Press Module Option #C01: 1.4 x 3.9 x 3.8 in
225 g (7.9 oz)
M1029A 215 g (7.6 oz) 36 x 99.6 x 97.5 mm,
Temperature Module 1.4 x 3.9 x 3.8 in

M1012A 225 g (7.9 oz.) 36 x 99.6 x 97.5 mm

Cardiac Output Module 1.4 x 3.9 x 3.8 in

291
32 Installation and Specifications Monitor Safety Specifications

Product Max Weight W x H x D Comments

M1018A 350 g (11.3 oz) 72.5 x 99.6 x 97.5 mm,
Transcutaneous Gas Module 2.9 x 3.9 x 3.8 in
M1020B < 250 g 36 x 99.6 x 97.5 mm
SpO2 Module 1.4 x 3.9 x 3.8 in
M1021A 460 g 72.5 x 99.6 x 97.5 mm
Mixed Venous Oxygen Saturation (13.04 oz) 2.9 x 3.9 x 3.8 in)
Module
M1027A 210 g (7.4 oz) 36 x 99.6 x 97.5 mm
Electroencephalograph Module 1.4 x 3.9 x 3.8 in

M1034A 215 g 36 x 99.6 x 97.5 mm

BIS Interface Module 7.6 oz 1.4 x 3.9 x 3.8 in
- DSC Digital Signal Converter 130 g (4.6 oz) 66 x 25 x 107 mm Integral Cables: 3.7m (12ft)
(without 2.6 x 1.0 x 4.25 in DSC-BIS Engine cable; 0.15m
cabling) (0.5ft) DSC-PIC PLUS cable
- BIS Engine 170 g (6.0 oz) 43 x 93 x 95 mm
1.7 x 3.7 x 3.8 in
M1032A 240 g (8.4 oz) 36 x 99.6 x 97.5 mm
Vuelink Module 1.4 x 3.9 x 3.8 in

M1116B 507.5 g 73 x 99.6 x 97 mm

Thermal Array Recorder Module 17.9 oz. 2.9 x 3.6 x 3.9 in.

Environmental Specifications
The monitor may not meet the performance specifications given here if stored or used outside the
specified temperature and humidity ranges.

Monitor M8003A, M8004A, M8005A, M8007A, M8010A

Item Condition Range
Temperature Range Operating 0 to 35 oC (32 to 95 oF)
Non-operating -20 to 60 oC (-4 to 140 oF)
Battery storage -20 to 50 oC (-4 to 122 oF)
Humidity Range Operating 20% to 85% Relative Humidity (RH) (non condensing)
Non-operating 5% to 85% Relative Humidity (RH)
Altitude Range Operating 0 m to 3000 m (10000 ft)
Non-operating 0 m to 12000 m (40000 ft)

292
Monitor Safety Specifications 32 Installation and Specifications

Measurement Server M3001A, Measurement Server Extensions M3015A, M3016A, M3012A,

Measurement Modules, and Flexible Module Server M8048A
Item Condition Range
Temperature Range Operating 0 to 45 oC (32 to 113 oF)
Non-operating -40 to 70 oC (-40 to 158 oF)
Humidity Range Operating 95% Relative Humidity (RH) max. @ 40 oC (104 oF). M3015A
only non-condensing.
Non-operating 90% Relative Humidity (RH) max. @ 65 oC (150 oF)
Altitude Range Operating -500 m to 4600 m (-1600 to 15000 ft)
Non-operating -500 m to 15300 m (-1600 to 50000 ft)

Anesthetic Gas Module M1026A

Item Condition Range
Temperature Range Operating 15 to 40 oC (59 to 104 oF)
Non-operating -40 to 65 oC (-40 to 149 oF)
Humidity Range Operating up to 95% Relative Humidity (RH) max. @ 40 oC (104 oF)
(non-condensing)
Non-operating up to 95% Relative Humidity (RH) max. @ 65 oC (150 oF)
Altitude Range Operating -305 m to 3048 m(-1000 to 10000 ft)
Non-operating -305 m to 5486 m (-1000 to 18000 ft)
Warmup Time After switching on: 2 minutes to measure, 8 minutes for full
accuracy

Thermal Array Recorder Module M1116B

Item Condition Range
Temperature Range Operating +5 to 45 oC (41 to 113oF)
Non-operating -10 to 70 oC (14 to 158 oF)
Humidity Range Operating 95% Relative Humidity (RH) max @ 40oC (104oF) (non
condensing)
Non-operating 95% Relative Humidity (RH) max @ 65oC (150oF) (non
condensing)
Altitude Range Operating up to 3048 m (10000 ft)
Non-operating up to 3048 m (10000 ft)

Remote SpeedPoint M8026A

Item Condition Range
Temperature range Operating 0 ... 55 °C (32 ...130 °F)
Storage -20 … 60 °C (-4 ... 140 °F)

293
32 Installation and Specifications M4605A Battery Specifications

Remote SpeedPoint M8026A

Item Condition Range
Humidity range Operating 95 %RH max. at 40 °C (100 °F)
Storage 85 %RH max. at 50 °C (120 °F)
Altitude range Operating -500 … 4.600 m (-1600 ... 15000 ft)
Storage -500 … 13.100 m (-1600 ... 43000 ft)

M4605A Battery Specifications

MP40/MP50 Two batteries are required to operate the monitor.
Only
M4605A Battery Specifications
Physical Specifications
WxDxH 149 mm (5.866 in) x89 mm (3.504 in) x 19.8 mm (0.78 in)
Weight 490 g (1.08 lb) per battery
Performance Specifications
Nominal Voltage 10.8 Volt
Rated Capacity at discharge C/5 6000 mAh
Continuous Discharge Capability 6.5 A
Environmental Specifications
Temperature Range Discharge 0 to 50°C (32 to 122°F)
Charge 0 to 45°C (32 to 113°F)
Storage -20 to 60°C (-4 to 140°F)
Humidity Range 40% to 95% Relative Humidity (RH)
Battery Type Smart Battery 10.8V, 6000mAh, Lithium Ion
Safety complies with UL 1642 (UL Recognized) and EN 61960-2:2001
Electromagnetic Compatibility (EMC) complies with the requirements for FCC Type B computing Device,
and EN 61000-4-2 and EN 61000-3
Communication Standard complies with the SMBus specification v1.1

Monitor Performance Specifications

MP40/50, MP60/70/90
Power Specifications Power consumption MP60/70/90: < 145 W
MP40/50: < 100 W
Line Voltage 100 to 240 V ~
Current 1.6 to 0.7 A
Frequency 50/60 Hz ~

294
Monitor Performance Specifications 32 Installation and Specifications

MP40/50, MP60/70/90
Battery Specifications Operating Time Basic monitoring configuration: 5 hours
MP40/MP50 (with 2 new, fully (Brightness set to Optimum, MMS connected, NBP
charged batteries) measurement every 15 minutes)
Extended monitoring configuration: 4 hours
(Brightness set to Optimum, MMS and measurement
server extension connected, NBP every 15 minutes, Recorder,
Pressure, Temperature modules connected)
Charge Time When monitor is off: 4 hours
When monitor is in use: 5 to 12 hours, depending on monitor
configuration
Indicators Alarms Off red (crossed-out alarm symbol) LED
Alarms red/yellow/cyan LED
On/Standby green LED
AC Power green LED
Error red LED
Battery LED (MP40/ red/yellow/green LED
50 only)
Sounds Audible feedback for user input
Prompt tone
QRS tone, or SpO2 modulation tone
4 different alarm sounds
Trends Resolution 12, 16, 24 or 32 numerics @ 12 sec, 1 minute, 5 minute
resolution
Information Multiple choices of number of numerics, resolution and
duration depending on trend option and application area.
For example:
neonatal extended 12 numerics, 24 hours @ 12 secs or 32
numerics 32 hours @ 1 minute
intensive care extended: 16 numerics 120 hours @ 5 minutes
anesthesia extended 32 numerics 9 hours @ 12 seconds
Events Information trigger condition and time, event classification and associated
detailed view of episode data
Episode data configurable, either:
4 minutes of high resolution trend or
20 minutes of numerics trend @ 12 sec. resolution or
15 seconds of 4 waves @ 125 samples/sec. (Snapshot)
including all current numerics, alarms and inops
Capacity (max) 25 or 50 events for either 8 or 24 hours
Alarm signal System delay less than 3 seconds
Pause duration 1,2,3 minutes or infinite, depending on configuration
Extended alarm pause 5 or 10 minutes
Review Alarms Information all alarms / inops, main alarms on/off, alarm silence and time
of occurrence
Capacity 100 items

295
32 Installation and Specifications Monitor Performance Specifications

MP40/50, MP60/70/90
Real Time Clock Range from: January 1, 1997, 00:00 to: December 31, 2080, 23:59
Accuracy < 2 seconds per day (typically)
Hold Time infinite if powered by AC; otherwise at least 48 hours (typical:
> 72 hours)
Buffered Memory Hold Time if powered by AC: infinite
without power: at least 48 hours (typical: > 72 hours)
Contents: Active settings, trends, patient data, realtime
reports, events, review alarms

MMS M3001A Performance Specifications

Trends Trend Data Buffered if powered by monitor mains connection via MSL: infinite
Memory without power applied: at least 6 hours
Contents trend data, patient identification and all active settings

Monitor Interface Specifications

Network Standard IEEE 802.3 10-Base-T
Connector RJ45 (8 pin)
Isolation 1.5 kV
Parallel Printer Port Standard IEEE 1284-I
Connector DB-25
Signals Level 1 and Level 2 (switchable)
Isolation 1.5 kV
Communication Compatibility (for example Centronics), Nibble, ECP, EPP
Modes
Dual PS/2 Inputs Input Voltage 5V ±5%
Output Current 250mA (comb. max) to connected PS/2 devices
Dual MIB/RS232 Standard IEEE 1073-3.2-2000
Connectors RJ45 (8 pin)
Mode Software-controllable
BCC (RxD/TxD cross over) or
DCC (RxD/TxD straight through)
Power 5V +/- 5%, 100mA (max.)
Isolation 1.5kV
MIB-ready/RS-232 Measurement data Numerics, alarms and INOPs, patient demographics, waves (up
Interface exported to external to 7; maximum number depends on the sample rate of the
(not available in all systems: selected waves).
geographies)
ECG Output/Marker Input (1/4” stereo phone jack with tip, ring, sleeve)
General Connector 1/4” phone each with tip, ring, sleeve
Isolation 500 V

296
Monitor Performance Specifications 32 Installation and Specifications

Monitor Interface Specifications

ECG Output Signal Gain 320 to 3200
(ring, tip) Full Scale on Display 3.2Vpp
Gain Error <20%
Baseline Offset <150mV
Bandwidth 1 to 80Hz
Output Impedance ECG Output (ring): <2.2KΩ±20%
ECG Output/Marker Input (tip) <2.5kΩ ±20%
Signal delay ≤30ms
Marker Input Signal Type 0 to -12V, negative edge pulse
Requirements Pulse Source <7kΩ
(tip) Impedance
Pulse Fall Time <100µs
Pulse Duration >4ms
Flexible Nurse Call Connector 20 pin MDR (Mini D-Ribbon), active open and closed contacts
Relay 3.5 mm phone jack, active closed contact only
Contact <= 100 mA, <= 24 V DC
Isolation 1.5 kV
Delay < (Configured Latency + 0.5 sec)
Wireless Network Connector 8 pin Mini-DIN
Device Interface Signals RD+/-, TD+/-: IEEE 802.3 10Base-T, PWR, GND
12.5 V ±20%, 3.5 W continuous
Remote Application Technology Citrix® and ICA® (Independent Computing Architecture)
Support client, Tunneling Control Engine (TCE)
Capabilities a monitor connected to a Philips Application Server can show a
Windows NT application on the monitor display. The
application can be controlled by the monitor user input devices.

Display Specifications
Refresh rate 60 Hz
Sweep Speeds 6.25, 12.5, 25 and 50 mm/s with ±5% accuracy (guaranteed
only for integrated displays)
Integrated SVGA Resolution 800 x 600
Display, MP40/50 Refresh frequency 60 Hz
Useful screen 246 x 184.4 mm
Pixel size 0.3075 x 0.3075 mm
Integrated XGA Display, Resolution 1024 x 768
MP60/70 Refresh frequency 60 Hz
Useful screen 304 x 228 mm (12 x 9 in)
Pixel size 0.297 x 0.297 mm
External SXGA Display Resolution 1280 x 1024 pixel
(e.g. M8033A), MP90 Refresh frequency 60 Hz or 75 Hz
only
Useful screen depends on size of display
Pixel size depends on size of display

297
32 Installation and Specifications Measurement Specifications

Display Specifications
Video Interface MP40/ Specifications must be the same as the integrated display
50, MP60/70
Video Interface SVGA Horizontal Frequency 37.5 kHz
MP40/MP50 Video Signals TTL
Connector 15 pin D-SUB
Video Interface MP90 Horizontal Frequency 48.4 kHz or 60.0 kHz or 64.0 kHz
SXGA (MP90 only), Video Signals 0.7 Vpp @ 75 Ohm, HSYNC/VSYNC Signals TTL
XGA
DDC Signals I2C compliant, 5V, 100 mA (max) (M8010 only)
Connector 15 pin D-SUB
Digital Video Video Signals Single Link TMDS
(M8010A only) DDC Signals I2C compliant
DDC Power 5V, 100mA (max)
Connector DVI

Compatible Devices
Printers PCL5 capability required HP Laserjet 1200 (monochrome)
HP Laserjet 2100 (monochrome)
HP DeskJet 2500 C+ (color)
Displays (must be approved for medical use)
MP60/70/90 M1097A option A02 : XGA color 15” LCD touchscreen
M1097A option A01 XGA color 15” LCD
MP90 M8033A SXGA color 17” LCD touchscreen
MP40/50/60/70/90 M3080A option H65 15” CRT
Wireless Network Type Proxim Range LAN2 7920
Technology Frequency Hopping Spread Spectrum (FHSS)
Frequency Band 2.4 GHz ISM Band
Weight 300g max.

Measurement Specifications
See the Appendix on Default Settings for a list of the settings the monitor is initially shipped with.

ECG/Arrhythmia/ST
Complies with IEC 60601-2-25:1993 + A1:1999 /EN60601-2-25:1995 + A1:1999, IEC 60601-2-27/
EN60601-2-27:1994 and AAMI EC11/EC13:1992.

ECG/Arrhythmia/ST Performance Specifications

Cardiotach Range Adult/pedi: 15 to 300 bpm
Neo range: 15 to 350 bpm
Accuracy ±1% of range
Resolution 1 bpm
Sensitivity ≥200 µVpeak

298
Measurement Specifications 32 Installation and Specifications

ECG/Arrhythmia/ST Performance Specifications

PVC Rate Range 0 to 300 bpm
Resolution 1 bpm
ST Numeric Range -20 to +20 mm
Accuracy ±0.5 mm or 15%, whichever is greater
Resolution 0.1 mm
Sinus and SV Rhythm Brady Adult: 15 to 60 bpm
Ranges Pedi: 15 to 80 bpm
Neo: 15 to 90 bpm
Normal Adult:60 to 100 bpm
Pedi: 80 to 160 bpm
Neo: 90 to 180 bpm
Tachy Adult: > 100 bpm
Pedi: >160 bpm
Neo: >180 bpm
Bandwidth Diagnostic Mode Adult: 0.05 to 150Hz
Neo/pedi: 0.5 to 150Hz
Monitoring Mode Adult: 0.5 to 40Hz
Neo/pedi: 0.5 to 55Hz
Filter Mode Adult/neo/pedi: 0.5 to 20Hz
Differential Input Impedance >2MΩ RA-LL leads (Resp)
>5MΩ at all other leads (at 10Hz including patient cable)
Common Mode Rejection Ratio Diagnostic mode: >86 dB (with a 51 kΩ/47 nF imbalance).
Filter mode: >106 dB (with a 51 kΩ/47 nF imbalance).
Electrode Offset Potential Tolerance ±500mV
Auxiliary Current Active electrode: <100 nA
(Leads off Detection) Reference electrode: <900 nA
Input Signal Range ±5 mV

ECG/Arrhythmia/ST Alarm
Specifications Range Adjustment
HR 15 to 300 bpm Adult:1 bpm steps (15 to 40 bpm)
maximum delay: 10 seconds according 5 bpm steps (40 to 300 bpm)
to AAMI EC 13-1992 standard Pedi/Neo:1 bpm steps (15 to 50 bpm)
5 bpm steps (50 to 300 bpm)
Extreme Tachy Difference to high limit 0 to 50 bpm 5 bpm steps
Clamping at 150 to 300 bpm 5 bpm steps
Extreme Brady Difference to low limit 0 to 50 bpm 5 bpm steps
Clamping at 15 to 100 bpm 5 bpm steps
Run PVCs 2 PVCs Not adjustable by user
PVCs Rate 1 to 99 PVCs/minute 1 PVC
Vent Tach HR 20 to 300 bpm 5 bpm

299
32 Installation and Specifications Measurement Specifications

ECG/Arrhythmia/ST Alarm
Specifications Range Adjustment
Vent Tach Run 3 to 99 PVCs/minute 1 PVC
Vent Rhythm Run 2 to 99 PVCs/minute 1 PVC
SVT HR 120 to 300 bpm 5 bpm
SVT Run 3 to 99 SV beats 1 SV beat
ST High -19.8 to +20 mm 0.2 mm
ST Low -20 to +19.8 mm 0.2 mm

ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13

Respiration Excitation Waveform Sinusoidal signal, 260 µA, 39 kHz
Noise Suppression RL drive gain 44 dB max., max. voltage 1.8 Vrms
Time to Alarm for Vent Tachycardia Gain 0.5, Range 6.5 to 8.4 seconds, Average 7.2 seconds
Tachycardia 1mVpp,206 bpm Gain 1.0 Range 6.1 to 6.9 seconds, Average 6.5 seconds
Gain 2.0, Range 5.9 to 6.7 seconds, Average 6.3 seconds
Vent Tachycardia Gain 0.5, Range 5.4 to 6.2 seconds, Average 5.8 seconds
2 mVpp,195bpm Gain 1.0, Range 5.7 to 6.5 seconds, Average 6.1 seconds
Gain 2.0, Range 5.3 to 6.1 seconds, Average 5.7 seconds
Tall T-Wave Rejection Capability Exceeds ANSI/AAMI EC 13 Sect. 3.1.2.1(c)
minimum recommended 1.2 mV T-Wave amplitude
Heart Rate Averaging Method Three different methods are used:
Normally, heart rate is computed by averaging the 12 most
recent RR intervals.
For runs of PVCs, up to 8 RR intervals are averaged to compute
the HR.
If each of 3 consecutive RR intervals is greater than 1200 ms
(that is, rate less than 50 bpm), then the 4 most recent RR
intervals are averaged to compute the HR.
Response Time of Heart Rate Meter to Change in HR change from 80 to 120 bpm:
Heart Rate Range: [6.4 to 7.2 seconds] Average: 6.8 seconds
HR change from 80 to 40 bpm:
Range: [5.6 to 6.4 sec] Average: 6.0 seconds
Heart Rate Meter Accuracy and Response to Ventricular bigeminy: 80 bpm
Irregular Rhythm Slow alternating ventricular bigeminy: 60 bpm
Rapid alternating ventricular bigeminy: 120 bpm
Bidirectional systoles: 90 bpm
Accuracy of Input Signal Reproduction Methods A and D were used to establish overall system error
and frequency response.

300
Measurement Specifications 32 Installation and Specifications

Respiration

Respiration Performance Specifications

Respiration Rate Range Adult/pedi: 0 to 120 rpm
Neo: 0 to 170 rpm
Accuracy at 0 to 120 rpm ±1 rpm
at 120 to 170 rpm ±2 rpm
Resolution 1 rpm
Bandwidth 0.3 to 2.5Hz (–6dB)
Noise Less than 25mΩ (rms) referred to the input

Respiration Alarm
Specifications Range Adjustment Delay
High Adult/pedi: 10 to 100 rpm under 20 rpm: 1 rpm steps max. 14 seconds
Neo: 30 to 150 rpm over 20 rpm: 5 rpm steps
Low Adult/pedi: 0 to 95 rpm under 20 rpm: 1 rpm steps for limits from 0 to 20 rpm: max. 4
Neo: 0 to 145 rpm over 20 rpm: 5 rpm steps seconds
for limits above 20 rpm: max. 14
seconds
Apnea Alarm 10 to 40 seconds 5 second steps

SpO2
Unless otherwise specified, this information is valid for SpO2 measured using M3001A measurement
server and M1020B measurement module.
Complies with EN 865:1997/ISO9919:1992.
Measurement Validation: The SpO2 accuracy has been validated in human studies against arterial
blood sample reference measured with a co-oximeter. Display Update Period: Typical: 2 seconds,
Maximum: 30 seconds. Max. with NBP INOP suppression on: 60 seconds.

301
32 Installation and Specifications Measurement Specifications

SpO2 Performance Specifications

SpO2 Range 0 to 100%
M3001A and Philips Reusable Sensors:
M1020B M1191A, M1192A1SD = ±2.5% (70% to 100%)
Option #A01 M1193A, M1194A, M1195A1SD = ±3% (70% to 100%)
Accuracy Philips Disposable Sensors with M1943A(L):
SD = Standard M1901B, M1902B, M1903B, M1904B 1SD = ±3% (70% to 100%)
Deviation NellcorPB® Sensors with M1943A(L):
MAX-A, MAX-AL, MAX-P, MAX-I, MAX-N, D-25, D-20, I-20, N-
25, OxiCliq A, P, I, N 1SD = ±3% (70% to 100%)
M1020B MAX-A, MAX-AL, MAX-P, MAX-I, MAX-FAST, SC-A, MAX-N
Option #A02 (Adult): 2% (70% to 100%)
Accuracy OxiCliq A, P, I, N (Adult) 2.5% (70% to 100%)
SD = Standard MAX-N (Neonate), SC-NEO, SC-PR, Oxiband OXI-A/N, OXI-P/I:
Deviation 3% (70% to 100%)
MAX-R, OxiCliq N (Neonate): 3.5% (70% to 100%)
Oxiband OXI-A/N (Neonate): 4% (70% to 100%)
Resolution 1%
Pulse Range 30 to 300 bpm
Accuracy ±2% or 1 bpm, whichever is greater
Resolution 1 bpm
Transducers Wavelength range: 500 to 1000 nm
Emitted Light Energy: ≤ 15mW
Pulse Oximeter Calibration Range 70 - 100%

SpO2 Alarm
Specifications Range Adjustment Delay
SpO2 Adult: 50 to 100% 1% steps (0, 1, 2, 3,... 30)
Pedi/Neo: 30 to 100% + 4 seconds
Desat Adult: 50 to Low alarm limit 1% steps
Pedi/Neo: 30 to Low alarm limit
Pulse 30 to 300 bpm Adult: max. 14 seconds
1 bpm steps (30 to 40 bpm)
5 bpm steps (40 to 300 bpm)
Pedi/Neo:
1 bpm steps (30 to 50 bpm)
5 bpm steps (50 to 300 bpm)
Tachycardia Difference to high limit 0 to 50 bpm 5 bpm steps max. 14 seconds
Clamping at 150 to 300 bpm 5 bpm steps
Bradycardia Difference to low limit 0 to 50 bpm 5 bpm steps max. 14 seconds
Clamping at 30 to 100 bpm 5 bpm steps

NBP
Complies with IEC 60601-2-30:1999/EN60601-2-30:2000.

302
Measurement Specifications 32 Installation and Specifications

NBP Performance Specifications

Measurement Ranges Systolic Adult: 30 to 270 mmHg (4 to 36 kPa)
Pedi: 30 to 180 mmHg (4 to 24 kPa)
Neo: 30 to 130 mmHg (4 to 17 kPa)
Diastolic Adult: 10 to 245 mmHg (1.5 to 32 kPa)
Pedi: 10 to 150 mmHg (1.5 to 20 kPa)
Neo: 10 to 100 mmHg (1.5 to 13 kPa)
Mean Adult: 20 to 255 mmHg (2.5 to 34 kPa)
Pedi: 20 to 160 mmHg (2.5 to 21 kPa)
Neo: 20 to 120 mmHg (2.5 to 16 kPa)
Accuracy Max. Std. Deviation: 8 mmHg (1.1 kPa)
Max. Mean Error: ±5 mmHg (±0.7 kPa)
Heart Rate Range 40 to 300 bpm
Measurement Time Typical at HR > 60bpm
Auto/manual: 30 seconds (adult)
25 seconds (neonatal)
Stat: 20 seconds
Maximum time: 180 seconds (adult/pediatric)
90 seconds (neonates)
Cuff Inflation Time Typical for normal adult cuff: Less than 10 seconds
Typical for neonatal cuff: Less than 2 seconds
Initial Cuff Inflation Pressure Adult: 165 ±15 mmHg
Pedi: 130 ±15 mmHg
Neo: 100 ±15 mmHg
Auto Mode Repetition Times 1, 2, 2.5, 3, 5, 10, 15, 20, 30, 45, 60 or 120 minutes
STAT Mode Cycle Time 5 minutes
Venipuncture Mode Inflation
Inflation Pressure Adult 20 to 120 mmHg (3 to 16 kPa)
Pediatric 20 to 80 mmHg (3 to 11 kPa)
Neonatal 20 to 50 mmHg (3 to 7 kPa)
Automatic deflation Adult/pediatric 170 seconds
after Neonatal 85 seconds

Measurement Validation: In adult and pediatric mode, the blood pressure measurements determined
with this device comply with the American National Standard for Electronic or Automated
Sphygmomanometers (ANSI/AAMI SP10 - 1992) in relation to mean error and standard deviation,
when compared to intra-arterial or auscultatory measurements (depending on the configuration) in a
representative patient population. For the auscultatory reference the 5th Korotkoff sound was used to
determine the diastolic pressure.
In neonatal mode, the blood pressure measurements determined with this device comply with the
American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP10 -
1992 and AAMI/ANSI SP10A -1996) in relation to mean error and standard deviation, when
compared to intra-arterial measurements in a representative patient population.

303
32 Installation and Specifications Measurement Specifications

NBP Alarm Specifications Range Adjustment

Systolic Adult: 30 to 270 mmHg (4 to 36 kPa) 10 to 30 mmHg: 2 mmHg (0.5 kPa)
Pedi: 30 to 180 mmHg (4 to 24 kPa) > 30 mmHg: 5 mmHg (1kPa)

Neo: 30 to 130 mmHg (4 to 17 kPa)

Diastolic Adult: 10 to 245 mmHg (1.5 to 32 kPa)
Pedi: 10 to 150 mmHg (1.5 to 20 kPa)
Neo: 10 to 100 mmHg (1.5 to 13 kPa)
Mean Adult: 20 to 255 mmHg (2.5 to 34 kPa)
Pedi: 20 to 160 mmHg (2.5 to 21 kPa)
Neo: 20 to 120 mmHg (2.5 to 16 kPa)

NBP Overpressure Settings

Adult > 300 mmHg (40 kPa) > 2 sec not user adjustable
Pedi > 300 mmHg (40 kPa) > 2 sec
Neo > 150 mmHg (20 kPa) > 2 sec

Invasive Pressure and Pulse

Complies with IEC 60601-2-34:2000/EN60601-2-34:2000.

Invasive Pressure Performance Specifications

Measurement Range –40 to 360 mmHg
Pulse Rate Range 25 to 350 bpm
Accuracy ±1% Full Range
Resolution 1 bpm
Input Sensitivity Sensitivity:5µV/V/mmHg (37.5µV/V/kPa)
Adjustment range:±10%
Transducer Load Impedance:200 to 2000 Ω (resistive)
Output Impedance:≤3000 Ω (resistive)
Frequency Response dc to 12.5 Hz or 40 Hz
Zero Adjustment Range: ±200 mmHg (±26 kPa)
Accuracy ±1 mmHg (±0.1 kPa)
Drift Less than 0.1mmHg/°C (0.013 kPa/°C)
Gain Accuracy Accuracy ±1%
Drift Less than 0.05%/°C
Non linearity Error of ≤ 0.4% FS (@CAL 200 mmHg)
and Hysteresis
Overall Accuracy (including ± 4% of reading or ± 4 mmHg (± 0.5 kPa), whichever is greater
transducer)

304
Measurement Specifications 32 Installation and Specifications

Invasive Pressure Performance Specifications

Analog Output Range -0.4 V to 3.6 V
available only with Level 1 V / 100 mmHg
M1006B #C01 (@ Accuracy ± 3% full scale
CAL 200 mmHg)
Offset ± 30 mV
Resolution 8 Bit (@ 5 V range)
Signal delay 20 ms
Volume displacement of CPJ840J6 0.1 mm3 /100 mmHg

Invasive Pressure Alarm Specifications Range Adjustment Delay

Pressure –40 to 360 mmHg -40 to 30 mmHg max. 12
(–5.0 to 48 kPa) 2 mmHg (0.5 kPa) seconds
> 30 mmHg
5 mmHg (1 kPa)
Pulse 25 to 300 bpm Adult:
1 bpm steps (25 to 40 bpm)
5 bpm steps (40 to 300 bpm)
Pedi/Neo:
1 bpm steps (25 to 50 bpm)
5 bpm steps (50 to 300 bpm)
Tachycardia Difference to high limit 0 to 5 bpm steps max. 14
50 bpm seconds
Clamping at 150 to 300 5 bpm steps
bpm
Bradycardia Difference to low limit 0 to 5 bpm steps max. 14
50 bpm seconds
Clamping at 25 to 100 bpm 5 bpm steps

Temp

Temp Performance Specifications

Temp Range –1 to 45 oC (30 to 113 oF)
Resolution 0.1oC (32.2 oF)
Accuracy ±0.1 oC (±0.2 oF)
Average Time Constant Less than 10 seconds
Alarms Range –1 to 45 ºC (30 to 113 ºF)
Adjustment -1 to 35 oC (30 to 95 oF): 0.5 oC (1.0 oF) steps
35 to 45 oC (95 to 113 oF): 0.1 ºC (0.2 oF) steps

Temp Alarm Specifications Range Adjustment

–1 to 45 ºC (30 to 113 ºF) -1 to 35 oC (30 to 95 oF), 0.5 oC (1.0 oF) steps
Temp High/Low Alarms 35 to 45 oC (95 to 113 oF), 0.1 ºC (0.2 oF) steps

305
32 Installation and Specifications Measurement Specifications

CO2
Complies with EN864/ISO9918

M3015A Microstream CO2 Performance Specifications

CO2 Range 0 to 98mmHg (0 to 13 kPa), or 13% CO2, whichever is lower
Accuracy after 4 minutes warmup: ±4 mmHg or 12%, whichever is greater
after 20 minutes warmup:
0 to 40 mmHg (0 to 5.3 kPa):±2.2 mmHg (±0.3 kPa)
Above 40 mmHg (5.3 kPa):±(5.5% + (0.08%/mmHg above 40 mmHg)) of
reading
These specifications are valid for 21% O2 and N2 balance, up to 35°C
ambient temperature, up to 60 rpm in adult mode and 100 rpm in neonatal
mode. Outside of these conditions the accuracy reaches at a minimum ±4
mmHg or ±12% of the reading, whichever is greater.
Resolution Numeric: 1.0 mmHg (0.1 kPa)
Wave: 0.1 mmHg (0.01 kPa)
awRR Range 0 to 150 rpm
Accuracy 0 to 40 rpm: ±1 rpm
41 to 70 rpm: ±2 rpm
71 to 100 rpm: ±3 rpm
>100 rpm: ±5% of reading
Warm-up Time 20 minutes for full accuracy specification
Rise Time 190 ms for neonatal mode
(measured with FilterLine H for neonatal)
240 ms for adult mode
(measured with FilterLine H for adult)
Sample Flow Rate 50 ±7.5 ml/minute
Gas Sampling Delay Time Typical:2.3 seconds
Maximum:3 seconds
Sound Pressure Acoustic noise: < 45 dBA
Total System Response Time The total system response time is the sum of the delay time and the rise time.

Microstream CO2 Humidity Correction Factor

Either BTPS or STPD can be selected as the humidity correction factor for the Microstream CO2
readings. The formula for the correction calculation is:

P BTPS = ( P STPD ⋅ 094 )

306
Measurement Specifications 32 Installation and Specifications

M3016A Mainstream CO2 Performance Specifications

CO2 Range –4 to 150 mmHg (-0.5 to 20.0 kPa)
Accuracy after 20 minutes warmup and calibration:
For values between 0 and 40 mmHg:±2.2 mmHg (±0.29 kPa)
For values between 40 and 76 mmHg:±5.5% of reading
The specifications are valid for 45% O2 and N2 or N2O balance. Outside
these conditions the accuracy reaches at a minimum the requirements of
EN864/ISO9918.
Resolution Numeric: 1.0 mmHg (0.1 kPa)
Wave: 0.1 mmHg (0.01 kPa)
Stability ±1.0 mmHg over a 7 day period
awRR Range 0 to 150 rpm
Accuracy ±2 rpm
Warm-up Time 20 minutes with CO2 transducer attached for full accuracy specification
Response Time Less than 125 ms (for step from 10% to 90%)

Mainstream CO2 Humidity Correction Factor

Either BTPS or STPD can be selected as the humidity correction factor for the Mainstream CO2
readings. The formula for the correction calculation is:

P abs
P STPD = P BTPS ⋅ -----------------------------
P abs – P H2O

Where p = partial pressure, Pabs = absolute pressure, and PH2O = 47 mmHg @37°C and 100% RH.

CO2 Alarm
Specifications Range Adjustment Delay
etCO2 High 20 to 95 mmHg (2 to 13 kPa) 1 mmHg (0.1 kPa) M3016A: less than 14 seconds
etCO2 Low 10 to 90 mmHg (1 to 12 kPa) M3015A: less than18 seconds.

imCO2 High 2 to 20 mmHg steps of 1 mmHg (0.1 M3016A: less than 14 seconds
(0.3 to 3.0 kPa) kPa) M3015A: less than18 seconds.
awRR High Adult/pedi: 10 to 100 rpm under 20 rpm: 1 rpm M3016A: less than 14 seconds
Neo: 30 to 150 rpm steps M3015A: less than18 seconds.
awRR Low Adult/pedi: 0 to 95 rpm over 20 rpm:5 rpm M3015A:
Neo: 0 to 145 rpm steps settings < 20 rpm: less than 8 seconds
> 20 rpm: less than 18 seconds
M3016A
settings < 20 rpm: less than 4seconds
> 20 rpm: less than 14 seconds
Apnea delay 10 to 40 seconds 5 second steps set apnea delay time + 4 seconds
(M3016A) or 8 seconds (M3015A)

307
32 Installation and Specifications Measurement Specifications

Cardiac Output / Continuous Cardiac Output

C.O./CCO Performance Specifications

C.O. (right heart) Range 0.1 to 20.0 l/min
Accuracy Instrument Specification (electrical):+ 3% or 0.1 l/min
System Specification:+ 5%.or 0.2 l/min
Repeatability Instrument Specification (electrical):+ 2% or 0.1 l/min
System Specification:+ 3%.or 0.1 l/min
C.O. Range 0.1 to 25.0 l/min
(transpulmonary) Accuracy Instrument Specification (electrical):+ 4% or 0.15 l/min
System Specification:+ 5% or 0.2 l/min
Repeatability Instrument Specification (electrical):+ 2% or 0.1 l/min
System Specification:+ 3% or 0.1 l/min
EVLW Range 10 to 5000 ml
not available in USA Standard Deviation 10% or 1 ml/kg
ITBV Range 50 to 6000 ml
Accuracy + 10% or 30 ml
Repeatability + 5% or 20 ml
CCO Range 0.1 to 25.0 l/min
Standard Deviation 10% or 0.3 l/min
Display Update 2 seconds nominal
Blood Temperature Range 17,0 to 43°C (62,6 to 109,4°F)
Injectate Temperature Range -1 to 30°C

C.O./CCO Alarm Specifications Range Adjustment Delay

TBlood 17 to 43°C Steps of 0.5°C (17 to 35°C) 10 seconds after the value
Steps of 0.1°C (35 to 43°C) exceeds the set limit range
Steps of 1°F (63 to 95°C)
Steps of 0.2°F (95 to 109°C
CCO 0.1 to 25.0 l/min 0.1 l/min (0.1 to10.0 l/min) 10 seconds after the value
0.5 l/min (10.0 to 25.0 l/min) exceeds the set limit range

tcGas
Complies with IEC 60601-2-23:1999/EN60601-2-23:2000.

tcGas Performance Specifications

tcpO2 Range 0 to 750 mmHg (0 to 100 kPa)
Accuracy 0.5% (+ 1 digit)
Resolution 1 mmHg (0.1 kPa)
Overall Accuracy 0 to 160 mmHg + 5 mmHg
(incl. transducer) 0.0 to 21.3 kPa + 0.7 kPa
>160 mmHg (21.3 kPA) + 3% of reading
tcpO2 Temperature Drift < 0.1% / oC
tcpO2 Test Signal 60 mmHg (8.0 kPa)

308
Measurement Specifications 32 Installation and Specifications

tcGas Performance Specifications

tcpO2 Drift, including transducer < 1 mmHg / h @ 10% O2
tcpO2 response time, including transducer < 30 s
tcpCO2 Range 5 to 200 mmHg (0.7 to 26.7 kPa)
Accuracy 1.0% (1 + digit)
Resolution 1 mmHg (0.1 kPa)
Overall Accuracy 0 to 76 mmHg + 5 mmHg
(incl. transducer) 0.0 to 10.1 kPa + 0.7 kPa
>76 mmHg (10.1 kPa) + 10% of reading
tcpCO2 Temperature Drift < 0.1% / oC
tcpCO2 Test Signal 40 mmHg (5.3 kPa)
tcpCO2 Drift, including transducer < 1 mmHg / h @ 5% CO2
tcpCO2 response time, including transducer < 50 s
Warm-up Time < 3 minutes
Site Timer 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 7, or 8 hours. Change Site alarm
when site time is expired and configurable automatic heating
switch-off
Transducer Heating Available Temperatures -
37.0°C, 41.0 to 45°C in steps of 0.5°C

tcGas Alarm Specifications Range Adjustment Alarm Delay

tcpO2 10 to 745 mmHg 10 to 30 mmHg: 1 mmHg 10 seconds after the
1.0 to 99.5 kPa 1.0 to 4.0 kPa: 0.1 kPa value exceeds the set
32 to 100 mmHg: 2 mmHg limit range.
4.2 to 13 kPa: 0.2 kPa
105 to 745mmHg: 5 mmHg
13.5 to 99.5 kPa: 0.5 kPa
tcpCO2 10 to 195 mmHg 10 to 30 mmHg: 1 mmHg
1.0 to 26 kPa 1.0 to 4.0 kPa: 0.1 kPa
32 to 100 mmHg: 2 mmHg
4.2 to 13 kPa: 0.2 kPa
105 to 195 mmHg: 5 mmHg
13.5 to 26 kPa: 0.5 kPa

SvO2

SvO2 Performance Specifications

SvO2 Range 10% to 100%
Accuracy ± 2 % (i.e. ± 2 units), 1 standard deviation over 40 % to 100 %
range.
Resolution 1%
Stability (system) Drift < 2% over 24 hours
Response Time (10 % to 90%) 5 seconds

309
32 Installation and Specifications Measurement Specifications

SvO2 Alarm Specifications Range Adjustment Delay

SvO2 10% to 100% 1% max. 15+4 seconds after value goes beyond the
low/high alarm limit settings

EEG
Complies with IEC 60601-2-26:1994/EN60601-2-26:1994.

EEG Performance Specifications

Leakage Current <=10 µA @ 110Vac
Input Signal Range 1 mVp-p
Differential Input Impedance >15 MΩ @ 10 Hz
Max. DC Input Offset Voltage ±320 mV
Input Protection Against defibrillation (5 kV) and electrosurgery
Common Mode Rejection >105 dB @ 5kΩ imbalance and 60 Hz
Noise <0.4 µVRMS (1 to 30 Hz)
Electromagnetic Susceptibility <10 µVp-p @ 3 V/m, 26-1000 MHz
Electrode Impedance Range 0 to 30 kΩ
Measurement Accuracy ±1 kΩ
Bandwidth 0.5 Hz to 50 Hz (–3 dB)
Low Filter Cut-Off Frequencies 0.5, 1.0, 2.0, and 5.0 Hz
(12 dB/octave)
High Filter Cut-Off Frequencies 15 Hz (65 dB/octave)
30 Hz (75 dB/octave)
50 Hz (85 dB/octave)

BIS

BIS Performance Specifications

Bispectral Index (BIS) Range 0 - 100
Signal Quality Index (SQI) Range 0 - 100%
EMG Range 0 - 100dB
Suppression Ratio (SR) 0 - 100%
Spectral Edge Frequency (SEF) 0.5 - 30.0Hz
Total Power (TP) 0 - 100 dB
Noise <0.3µV RMS (2.0µV peak-to-peak)
Wave Scale With gridlines on: ± 25µV, ± 50µV, ± 100µV, ± 250µV
With gridlines off: 50µV, 100µV, 200µV, 500µV
Update Frequency (BIS Numeric) 2048 ms
Bandwidth 0.25 - 100Hz (-3dB)

310
Measurement Specifications 32 Installation and Specifications

BIS Performance Specifications

High Pass Filters 0.25 Hz, 1 Hz, 2 Hz (-3dB)
Low Pass Filters 30 Hz, 50 Hz, 70 Hz, 100 Hz (-3dB)
Notch Filters (for line frequency) 50 Hz, 60 Hz
Impedance Measurement Range 0 to 999 kΩ

BIS Alarm Specifications Range Adjustment Alarm Delay

BIS High/Low Alarm 0 - 100 1 Max. 2 seconds

Anesthetic Gas Module

Complies with ISO 9918 (1993)/EN 864 (1996), ISO 11196 (1977), EN 12598 (1999)/ISO 7767.

AGM Performance Specifications

CO2 Range 0 to 76 mmHg
Accuracy 1.5 mmHg (0 - 40 mmHg)
2.5 mmHg (40 - 60 mmHg)
4.0 mmHg (60 - 76 mmHg)
Resolution 1 mmHg
Rise Time 410 msec typical
O2 Range 0 to 100 vol%
Accuracy 2.5 vol% or 5% relative which ever is greater
Resolution 1 vol%
Rise Time 450 msec typical
N2O Range 0 to 85 vol%
Accuracy 1.5 vol% + 5% relative
Resolution 1 vol%
Rise Time 510 msec typical
Halothane Range 0 - 7.5 vol%
Enflurane Accuracy Halothane: 0.2 vol% + 4.0% relative
Isoflurane Enflurane, Isoflurane: 0.1 vol% + 4.0% relative
Resolution 0.05
Rise Time Halothane: < 740 ms
Enflurane: < 620 ms
Isoflurane: < 610 ms
Sevoflurane Range 0 - 9.0
Accuracy 0.1 vol% + 4.0% relative
Resolution 0.05
Rise Time < 570
Desflurane Range 0 - 20.0
Accuracy 0.1 vol% + 6.0% relative
Resolution 0.05 (0-10) 0.1 (10.1 - 20)
Rise Time < 540

311
32 Installation and Specifications Measurement Specifications

AGM Performance Specifications

awRR Range 0 to 60 rpm
Accuracy + 2 rpm
Resolution 1 rpm
Detection Criteria 6 mmHg variation in CO2.
Agent ID Response Time 15 s
1
Agent Thresholds HAL, ISO, ENF 0.20 vol%
SEV 0.24 vol%
DES 0.30 vol%
1. During warmup, the thresholds are three times the values listed.

All Performance and accuracy specifications are valid based on gas sample tubing M1658A, including
watertrap M1657B, and airway adapter 13902A.
Humidity Correction: For CO2 the humidity correction can be set to “wet” or “dry”.
Wet: p [mmHg] = c [Vol%] * (p_abs - p_H2O)/100
Dry: p [mmHg] = c [Vol%] * p_abs /100
Where p = partial pressure, c = gas concentration, p_abs = pressure in breathing circuit, p_H2O = 47
mmHg, partial pressure of water vapor of exhaled gas (37 oC, 100% rh).
For all other gases the readings are always given as dry values.
Sample Flow Rate: 150 ml/min.
Sample Delay Time: All measurements and alarms are subject to a delay of 3 seconds.
Total System Response Time = the sum of the delay time and the rise time.

312
Safety and Performance Tests 32 Installation and Specifications

AGM Alarm
Specifications Range Adjustment Delay
etCO2 High 20 to 76 mmHg (2.7 to 10.1 kPa) 1 mmHg (0.1 kPa) less than 18 seconds
etCO2 Low 10 to 75 mmHg (1.3 to 10.0 kPa)
imCO2 High 2 to 20 mmHg (0.3 to 2.7 kPa) 1 mmHg (0.1 kPa)
inO2 90 to 800 mmHg 10 mmHg
12 to 107 kPa 1 kPa
18 to 100 vol% 1 vol%
inN2O 0 to 660 mmHg 10 mmHg
0 to 88 kPa 2 kPa
0 to 82 vol% 2 vol%
in/et 0 to 60 mmHg 1 mmHg
HAL/ISO/ENF 0.0 to 8 kPa 0.1 kPa
0.0 to 7.5 vol% 0.1 vol%
in/et SEV 0 to 72 mmHg 1 mmHg
0.0 to 9.6 kPa 0.1 kPa
0.0 to 9.0 vol% 0.1 vol%
in/et DES 0 to 160 mmHg 2 mmHg
0.0 to 21.2 kPa 0.2 kPa
0.0 to 20.0vol% 0.2 vol%
awRR High Adult/pedi: 10 to 60 rpm under 20 rpm: 1 rpm
Neo: 30 to 60 rpm over 20 rpm:5 rpm
awRR Low Adult/pedi: 0 to 55 rpm settings < 20 rpm: less than 8 seconds
Neo: 0 to 55 rpm > 20 rpm: less than 18 seconds
Apnea delay 15 to 40 seconds 5 second steps set apnea delay time + 8 seconds

Safety and Performance Tests

You must observe any national regulations on the qualification of the testing personnel and suitable
measuring and testing facilities. See the maintenance section for a list of required tests. Safety and
performance tests, and what to do if the instrument does not meet these specifications are described in
the Installation and Service guide.

Electromagnetic Compatibility (EMC) Specifications

Take special precautions regarding electromagnetic compatibility (EMC) when using medical electrical
equipment. You must operate your monitoring equipment according to the EMC information
provided in this book. Portable and mobile radio frequency (RF) communications equipment can
affect medical electrical equipment.

Accessories Compliant with EMC Standards

All accessories listed in the accessories section comply with the requirements of IEC 60601-1-2.

WARNING Using accessories other than those specified may result in increased electromagnetic emission or
decreased electromagnetic immunity of the monitoring equipment.

313
32 Installation and Specifications Safety and Performance Tests

Electromagnetic Emissions
The monitor is suitable for use in the electromagnetic environment specified in the table below. You
must ensure that it is used in such an environment

Emissions test Compliance Avoiding Electromagnetic Interference

Radio Frequency (RF) emissions Group 1 The monitor uses RF energy only for its internal function.
Therefore, its RF emissions are very low and are not likely to
cause any interference in nearby electronic equipment
RF emissions CISPR 11 Class A The monitor is suitable for use in all establishments other
Harmonic emissions IEC 61000-3-2 n/a than domestic and those directly connected to the public
low-voltage power supply network that supplies buildings
Voltage fluctuations IEC 61000-3-3 n/a used for domestic purposes

Avoiding Electromagnetic Interference (Resp and BIS)

The respiration (Resp) and BIS measurements are very sensitive measurements that measure very small
signals. Technological limitations don't allow higher immunity levels than 1V/m for radiated RF
electromagnetic fields and 1Vrms for conducted disturbances induced by RF fields. Electromagnetic
fields with field strengths above 1 V/m and conducted disturbances above 1Vrms may cause erroneous
measurements. Therefore Philips recommends that you avoid using electrically radiating equipment in
the close proximity of these measurements.

WARNING The monitor should not be used next to or stacked with other equipment. If you must stack the
monitor, you must check that normal operation is possible in the necessary configuration before you
start monitoring patients.

314
Safety and Performance Tests 32 Installation and Specifications

Electromagnetic Immunity
The monitor is suitable for use in the specified electromagnetic environment. The user must ensure
that it is used in the appropriate environment as described below.
IEC 60601-1-2 Electromagnetic environment
Immunity test test level Compliance level guidance
Electrostatic ± 6 kV contact ± 6 kV contact Floors should be wood, concrete, or
discharge (ESD) ± 8kV air ± 8kV air ceramic tile. If floors are covered
IEC 61000-4-2 with synthetic material, the relative
humidity should be at least 30%.
Electrical fast ± 2 kV for power supply lines ± 2 kV for power supply Mains power quality should be that
transient/burst ± 1 kV for input/output lines lines of a typical commercial and/or
IEC 61000-4-4 ± 1 kV for input/output lines hospital environment
Surge ± 1 kV differential mode ± 1 kV differential mode Mains power quality should be that
IEC 61000-4-5 ± 2 kV common mode ± 2 kV common mode of a typical commercial and/or
hospital environment
Voltage dips, <5% UT <5% UT Mains power quality should be that
short (> 95% dip in UT) for 0.5 (> 95% dip in UT) for 0.5 of a typical commercial and/or
interruptions cycles cycles hospital environment. If the user of
and voltage 40% UT 40% UT the monitor requires continued
variations on (60% dip in UT) for 5 cycles (60% dip in UT) for 5 cycles operation during power mains
power supply interruptions, it is recommended
input lines 70% UT 70% UT that the monitor is equipped with
IEC 61000-4- (30% dip in UT) for 25 cycles (30% dip in UT) for 25 an internal battery or is powered
11 < 5% UT cycles from an uninterruptible power
(> 95% dip in UT) for 5 sec < 5% UT supply.
(> 95% dip in UT) for 5 sec
Power frequency 3 A/m 3 A/m Power frequency magnetic fields
(50/60 Hz) should be a t levels characteristic of
magnetic field a typical location in a typical
IEC 61000-4-8 commercial and/or hospital
environment

In this table, UT is the a.c. mains voltage prior to application of the test level.

Recommended Separation Distance

WARNING The monitor, equipped with a wireless network interface, intentionally receives RF electromagnetic
energy for the purpose of its operation. Therefore, other equipment may cause interference, even if that
other equipment complies with CISPR emission requirements.

In the following table, P is the maximum output power rating of the transmitter in watts (W)
according to the transmitter manufacturer and d is the recommended separation distance in metres
(m). The values given in brackets are for respiration and BIS.
Portable and mobile RF communications equipment should be used no closer to any part of the
monitor, including cables, than the recommended separation distance calculated from the equation
appropriate for the frequency of the transmitter.
Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey, should be
less than the compliance level in each frequency range (over the frequency range 150 kHz to 80 MHz,
field strengths should be less than 1 V/m for respiration and BIS and 3 V/m for all other functions).

315
32 Installation and Specifications Safety and Performance Tests

Interference may occur in the vicinity of equipment marked with this symbol:

IEC 60601-1-2
Immunity test test level Compliance level Electromagnetic environment guidance
Conducted RF 3 VRMS 3 VRMS Recommended separation distance:
IEC 61000-4-6 150 kHz to 80 Mhz (1 V for respiration
RMS d = 1, 2 P
and BIS)
for respiration and BIS::

d = 3, 5 P

Radiated RF 3 V/m 3 V/m Recommended separation distance:

IEC 61000-4-3 80 Mhz to 2.5 GHz (1 V/m for respiration 80 MHz to 800 MHz
and BIS) d = 1, 2 P

80 MHz to 800 MHz for respiration and BIS::

d = 3, 5 P

800 MHz to 2,5 GHz

d = 2, 3 P

800 MHz to 2,5 GHz for respiration and BIS

d = 7, 0 P

Field strengths from fixed transmitters, such as base stations or radio (cellular, cordless) telephones and
land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted
theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an
electromagnetic site survey should be considered. If the measured field strength in the location in
which the monitor is used exceeds the applicable RF compliance level above, the monitor should be
observed to verify normal operation. If abnormal performance is observed, additional measures may be
necessary, such as reorienting or relocating the monitor.
These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption
and reflection from structures, objects, and people.

Recommended separation distances from portable and mobile RF

communication equipment
The monitor is intended for use in an electromagnetic environment in which radiated RF disturbances
are controlled. The customer or user of the monitor can help prevent electromagnetic interference by
maintaining a minimum distance between portable and mobile RF communications equipment and
the monitor as recommended below, according to the maximum output power of the communications
equipment.

316
Safety and Performance Tests 32 Installation and Specifications

Frequency of transmitter 150 kHz to 80 MHz 150 kHz to 800 MHz 800 MHz to 2,5 GHz

d = 1, 2 P d = 1, 2 P d = 2, 3 P
for respiration and BIS: for respiration and BIS: for respiration and BIS:
Equation d = 3, 5 P d = 3, 5 P d = 7, 0 P

Rated max. output power

of transmitter (W) Separation distance (m) Separation distance (m) Separation distance (m)
0.01 0.1 (0.4) 0.1 (0.4) 0.2 (0.7)
0.1 0.4 (1.1) 0.4 (1.1) 0.7 (2.2)
1 1.3 (3.5) 1.3 (3.5) 2.3 (7.0)
10 3.8 (11.1) 3.8 (11.1) 7.3 (22.1)
100 12.0 (35.0) 12.0 (35.0) 23.0 (70.0)

Electrosurgery Interference/Defibrillation/Electrostatic Discharge

The equipment returns to the previous operating mode within 10 seconds without loss of any stored
data. Measurement accuracy may be temporarily decreased while performing electro-surgery or
defibrillation. This does not affect patient or equipment safety. Do not expose the equipment to x-ray
or strong magnetic fields (MRI).

Fast Transients/Bursts
The equipment will return to the previous operating mode within 10 seconds without loss of any
stored data. If any user interaction is required, the monitor indicates with a technical alarm (INOP).

Restart time
After power interruption, an ECG wave will be shown on the display after 30 seconds maximum.

317
32 Installation and Specifications Safety and Performance Tests

318
 33

33Default Settings Appendix

This appendix documents the most important default settings of your monitor as it is delivered from
the factory. For a comprehensive list and explanation of default settings, see the Configuration Guide
supplied with your monitor. The monitor’s default settings can be permanently changed in
Configuration Mode.
Settings are only entered once per table row if they are the same for all patient categories.

319
33 Default Settings Appendix Alarm Default Settings

Alarm Default Settings

Alarm Settings Factory Default
Alarm Volume 5
Alarms Off 3 min.
Pause Al. 5min Enabled
Pause Al. 10min Enabled
Auto Alarms Off Off
Alarm Off Reminder Off
Visual Latching Red & Yell (for Anesthesia configurations (option H30) Visual Latching: Red)
Audible Latching Red & Yell (for Anesthesia configurations (option H30) Audible Latching: Off )
Alarm Reminder On
Reminder Time 3 min
Alarm Sounds Traditional
Red Alarm Interval 10 sec
Yel. Al. Interval 20 sec
Alarm Low 4
Red Alarm Volume AlarmVol +2
Yell. Alarm Volume AlarmVol +0
Inop Volume AlarmVol +0
Auto Increase Vol. 2 Steps
Increase Vol Delay 20 sec
Keep Blinking No
Relay 1 Sensitiv. R&Y&I
Relay 2 Sensitiv. Red & Yell
Relay 3 Sensitiv. Red
Inop Relay Latency 5 sec
Yel. Relay Latency 2 sec
Alarm Text Standard
No Centr Mon Min Vol 6

ECG, Arrhythmia, and ST Default Settings

ECG Settings Factory Adult Factory Pedi Factory Neo
High Limit 120 bpm 160bpm 200 bpm
Low Limit 50 bpm 75 bpm 100 bpm
Alarms On
Alarm Source HR
ECG On
QRS Volume 1
Primary Lead II

320
ECG, Arrhythmia, and ST Default Settings 33 Default Settings Appendix

ECG Settings Factory Adult Factory Pedi Factory Neo

Secondary Lead V
Analysis Mode Multi-lead
Lead Placement Standard
Mod. Lead Placment Off
Filter Monitor
Speed 25mm/s
Auto Filter Off
Default ECG Size x1
Color Green
Asystole Thresh 4.0 sec 3.0 sec
∆ ExtrTachy 20 bpm
Tachy Clamp 200 bpm 220 bpm 240 bpm
∆ ExtrBrady 20 bpm
Brady Clamp 40 bpm 50 bpm
ALL ECG IN. On
Fallback On
Alarms Off Enabled
Alarm Source Sel. Enabled

321
33 Default Settings Appendix ECG, Arrhythmia, and ST Default Settings

Arrhythmia Settings Factory Adult Factory Pedi Factory Neo

Arrhythmia On (for Anesthesia (H30) options Arrhythmia: Off.) Off
Pause Threshold 2.0 sec 1.5 sec
VTach HR 100 120 150
VTach Run 5
Vent Rhythm 14
SVT HR 180 200 210
SVT Run 5
PVCs/min 10 5 5
Non-Sustain On
Vent Rhythm On
Run PVCs On
Pair PVCs On
R-On-T PVCs On
V.Bigeminy On
V.Trigeminy On
PVCs/min On
Multif.. PVCs On
Pacer N. Cap On
Pacer N. Pac On
Pause On
Missed Beat On
SVT On
IrregularHR On
TimeOut 1st 3 min
TimeOut 2nd 10 min
Arrhy Off Message Yes
SOME ECG IN On

Note for H30 Options: The default settings for Arrhythmia alarms for the Anesthesia configurations
(H30 options) are: all Arrhythmia Alarms: On, and the individual alarms Pair PVCs, R-On-T PVCs,
V.Bigeminy, V.Trigeminy, PVCs/min, Multif. PVCs, Pause, Missed Beat, Irregular HR Off. Note that
all Arrhythmia alarms are inactive as long as Arrhythmia is off.

Lead-independent ST Settings Factory Adult Factory Pedi Factory Neo

ST Alarm Mode Single ST
Alarms On
ST Analysis On Off: ST is only available for Adult patients
ST-Index On
ISO Point -80 ms
J Point 48 ms
ST Point J+60

322
Pulse Default Settings 33 Default Settings Appendix

Lead I, II, III, V, aVR, aVL, aVF, V1-6,

Factory Adult Factory Pedi Factory Neo
MCL Settings
ST(Label) On Off
For Alarm Mode = Single-ST
ST(Label) High +2.0 mm
ST(Label) Low -2.0 mm
For Alarm Mode = Multi-ST
ST(Label) High +1.0 mm
ST(Label) Low -1.0 mm

Pulse Default Settings

Pulse Settings Factory Adult Factory Pedi Factory Neo
Alarm Source HR
Pulse (Label) On
System Pulse SpO2
Alarms Off Enabled
Alarm Source Sel. Enabled

Pulse Alarm Settings Factory Adult Factory Pedi Factory Neo

Pulse (SpO2) on
Pulse Alarms on
High Limit 120 bpm 160 bpm 200 bpm
Low Limit 50 bpm 75 bpm 100 bpm
∆ Extr Brady 20 bpm
Brady Clamp 40 bpm 50 bpm
∆ Extr Tachy 20 bpm
Tachy Clamp 200 bpm 220 bpm 240 bpm

Pulse alarms use the settings of the currently selected Pulse alarm source.

323
33 Default Settings Appendix Respiration Default Settings

Respiration Default Settings

Resp Settings Factory Adult Factory Pedi Factory Neo
High Limit 30 rpm 100 rpm
Low Limit 8 rpm 30 rpm
Apnea Time 20 sec
Alarms On
Resp On (for Anesthesia configurations (option H30): Resp Off )
Auto/Manual Auto (Trigger Mode)
Resp Speed 6.25mm/s
Color Yellow

SpO2 Default Settings

SpO2 Settings Factory Adult Factory Pedi Factory Neo

Alarms On
QRS Volume 1
Tone Modulation Yes
Tone Mod. Type Enhanced
Speed 25mm/s
Perfusion On
Average 10 sec
NBP Alarm Suppr. On
Color Cyan

SpO2 Alarm Default Settings

Setting adult pediatric neonatal

Desat Limit 80 80 80
Low Limit 90 90 85
High Limit 100 100 95
Desat delay 20 sec 20 sec 20 sec
High Alarm delay 10 sec 10 sec 10 sec
Low Alarm delay 10 sec 10 sec 10 sec
Parameter Alarms On/Off on on on
Label SpO2 SpO2 SpO2
Pulse Settings
Pulse (SpO2) On/Off on on on
Pulse Alarms On/Off on on on
Pulse High Limit 120 bpm 160bpm 200 bpm

324
NBP Default Settings 33 Default Settings Appendix

SpO2 Alarm Default Settings

Setting adult pediatric neonatal

Pulse Low Limit 50 bpm 75 bpm 100 bpm
∆ Extr Brady 20 bpm 20 bpm 20 bpm
Brady Clamp 40 bpm 40 bpm 50 bpm
∆ ExtrTachy 20 bpm 20 bpm 20 bpm
Tachy Clamp 200 bpm 220 bpm 240 bpm

NBP Default Settings

NBP Settings Factory Adult Factory Pedi Factory Neo
Auto/Manual Auto Manual
Alarms from Sys.
High Alarm Limit 160/ 90 (110) 120/ 70 (90) 90 / 60 (70)
Low Alarm Limit 90 / 50 (60) 70 / 40 (50) 40 / 20 (24)
Alarms On
NBP On
Repetition Time 15 min (for Anesthesia configurations (H30 options) Repetition Time: 5 mins)
Unit mmHg
Done Tone Off
Start Time Synchronized
VP Pressure 60 mmHg 40 mmHg 30 mmHg
Reference Auscultatory Invasive
Color Red

Temperature Default Settings

Temp Settings Factory Adult Factory Pedi Factory Neo
Low Limit 36
High Limit 39
Alarms On
0C
Unit
Range 35...43
Color Green

325
33 Default Settings Appendix Invasive Pressure Default Settings

Invasive Pressure Default Settings

ABP, ART, Ao, UAP, P Settings CVP, RAP, LAP, UVP Settings
Invasive Pressure
Settings Factory Adult Factory Pedi Factory Neo Factory Adult Factory Pedi Factory Neo
Alarms from Sys. Mean
High Limit 160/ 90 (110) 120/ 70 (90) 90/ 60 (70) 14 / 6 (10) 10 / 2 (4) 10 / 2 (4)
Low Limit 90/ 50 (70) 70/ 40 (50) 55/ 20 (35) 6 / -4 (0) 2 / -4 (0) 2 / -4 (0)
Alarms On On
Scale 150 100 100 20
Speed 25mm/s 25mm/s
Mean Only No Yes
Filter 12 Hz 12 Hz
Mercury Cal. Yes Yes
Artifact Suppr. 60 sec 60 sec
Unit mmHg mmHg
Color Red Cyan

PAP Settings ICP Settings

Invasive Pressure
Settings Factory Adult Factory Pedi Factory Neo Factory Adult Factory Pedi Factory Neo
Alarms from Diastolic Mean
High Limit 35 / 16 (20) 60 / 4 (26) 60 / 4 (26) 14 / 6 (10) 10 / 2 (4) 10 / 2 (4)
Low Limit 10 / 0 (0) 24 / -4 (12) 24 / -4 (12) 6 / -4 (0) 2 / -4 (0) 2 / -4 (0)
Alarms On On
Scale 20 20
Speed not applicable not applicable
Mean Only 12 Hz Yes
Filter Yes 12 Hz
Mercury Cal. No Yes
Artifact Suppr. 60 sec 60 sec
Unit mmHg mmHg
Color Yellow Magenta

Cardiac Output Default Settings

C.O. Settings Factory Adult Factory Pedi Factory Neo
Auto-Calibration On
Tblood High Limit 39.0 ºC

326
CO2 Default Settings 33 Default Settings Appendix

C.O. Settings Factory Adult Factory Pedi Factory Neo

Tblood Low Limit 36.0 ºC
Tblood Alarm On/Off On
0
Temperature Unit C
Color Green

CCO/CCI Settings Factory Adult Factory Pedi Factory Neo

Settings common to CCO and CCI
Alarms from CCO
CCO from ABP
Color Green
CCO
Alarms On
CCO High Limit 8.5 l/min 3.7 l/min 1.3 l/min
CCO Low Limit 4.0 l/min 2.6 l/min 0.3 l/min
CCI
Alarms On
CCI High Limit 4.3 l/min/m2 3.7 l/min/m2 5.2 l/min/m2
CCI Low Limit 2.0 l/min/m2 2.6 l/min/m2 1.2 l/min/m2

CO2 Default Settings

CO2 Alarm Settings Factory Adult Factory Pedi Factory Neo

etCO2 low 30
etCO2 high 50
imCO2 high 4
CO2 Alarms on
Unit mmHg
Scale 40 mmHg
ImCO2 on
N2O Corr Off
Humidity Corr BTPS
Max Hold Off
AwRR On
AwRR Alarms On
AwRR high limit 30 100
AwRR low limit 8 30
Apnea time 20 secs
Color Yellow

327
33 Default Settings Appendix tcGas Default Settings

tcGas Default Settings

tcGas Settings Factory Adult Factory Pedi Factory Neo
tcpO2 High 80 mmHg
tcpO2 Low 50 mmHg
tcpO2 Alarms On
tcpCO2 High 50 mmHg
tcpCO2 Low 30 mmHg
tcpCO2 Alarms On
Site Time 4.0 hours
Disable Timer Not Allowed
Heat Switch Off (i.e., after Site Timer No
elapsed)
Transducer Temp. 43.0 °C
CO2 Correction (Severinghaus) On
Metabolism Factor 8 mmHg
TcGas Unit mmHg
0C
Temperature Unit
tcpO2 Color Blue
tcpCO2 Color Green

SvO2 Default Settings

SvO2 Settings Factory Adult Factory Pedi Factory Neo

Low Limit 60%
High Limit 80%
Alarms On
Light Intensity On
Color Yellow

AGM Default Settings

AGM Settings
AGM Alarms On No Al. til breath On
CO2 et + im imCO2 High Adult/Pedi/Neo: 4 mmHg
etCO2 Low Adult/Pedi/Neo: 30 mmHg etCO2 High Adult/Pedi/Neo: 50 mmHg
Apnea Time 20 sec
awRR Low Adult/Pedi: 8 rpm awRR High Adult/Pedi: 30 rpm
Neo: 30 rpm Neo: 60 rpm
O2 et + in

328
EEG Default Settings 33 Default Settings Appendix

AGM Settings
inO2 Low Adult/Pedi/Neo: 18 % inO2 High Adult/Pedi/Neo: 100 %
N2O et + in inN2O High 80 %
Agent Channel et + in
etHAL Low Adult/Pedi/Neo: 0 % etHAL High Adult/Pedi/Neo: 1.6 %
inHAL Low Adult/Pedi/Neo: 0 % in HAL High Adult/Pedi/Neo: 2 %
etISO Low Adult/Pedi/Neo: 0 % etISO High Adult/Pedi/Neo: 2.5 %
inISO Low Adult/Pedi/Neo: 0 % inISO High Adult/Pedi/Neo: 3 %
etENF Low Adult/Pedi/Neo: 0 % etENF High Adult/Pedi/Neo: 3.3 %
inENF Low Adult/Pedi/Neo: 0 % inENF High Adult/Pedi/Neo: 4 %
etSEV Low Adult/Pedi/Neo: 0% etSEV High Adult/Pedi/Neo: 5 %
inSEV Low Adult/Pedi/Neo: 0% inSEV High Adult/Pedi/Neo: 6 %
etDES Low Adult/Pedi/Neo: 0 % etDES High Adult/Pedi/Neo: 10 %
inDES Low Adult/Pedi/Neo: 0 % inDES High Adult/Pedi/Neo: 15 %

EEG Default Settings

EEG Settings Factory Adult Factory Pedi Factory Neo
TP, SEF, MDF, PPF, Delta, On
Theta, Alpha, Beta
SEF Threshold 90 %
Numeric Average 8 sec
Wave Scale 100uV (or +/- 50uV if Show Gridlines is configured to Yes)
Show Gridlines No
Speed 25 mm/s
Low Filter 0.5 Hz
High Filter 30 Hz
Impedance Limit 5 kOhm
Smoothing CSA On
Color Yellow

BIS Default Settings

BIS Settings Factory Adult Factory Pedi Factory Neo

SQI On
EMG On
SR On
SEF Off
TP Off
Scale 100uV (or +/- 50uV if Show Gridlines is configured to Yes)
Show Gridlines No

329
33 Default Settings Appendix VueLink Default Settings

BIS Settings Factory Adult Factory Pedi Factory Neo

Speed 25 mm/s
Filters On
Low Filter 2 Hz
High Filter 70 Hz
Notch Filter On
High Alarm Limit 70
Low Alarm Limit 20
Alarms On
Smoothing Rate 30 sec
Color Yellow

VueLink Default Settings

Device Alarms Ignored
Color Green

330
 1Index
# address, Philips 284 window 35
addressograph (printer configuration alarm limits
10-lead placement (ECG) 84 setting) 240 changing 36
12-lead placement (ECG) 84 adjusting ST measurement points 104 checking 34
3-lead placement (ECG) 81 adjusting wave scale (AGM) 176 manually adjusting 36
4-channel recorder 225 narrow 37
adjusting wave scale (pressure) 132
5-lead placement (ECG) 82 report 240
adjusting wave size (CO2) 158 setting 34
A adjustments 284 switching auto limits on/off 37
admit using automatic limits 37
AAMI ECG lead labels 81 editing information 67 wide 37
aberrantly conducted beats 92 patient demographics 65 alarm recording 227
AC power input 288 quick admit 66 choosing recorded measurements 228
accessories admitting a patient 65 alarm source selection, disabled 109
10-electrode cable sets 270 advanced event surveillance 217 alarm status area 11
3-electrode cable sets 269 agent identification alarm volume 31
3-electrode one piece cables 270 auto 178 alarms
5-electrode cable sets 270 changing auto/manual 178 active 29
5-electrode one piece cables 270 during emergence from anesthesia 178 active SpO2 source 120
Abbott Critical Care Systems 280 exchanging agents 178 alphabetical listing 41
Aspect Medical Systems 279 identification threshold 178 alphabetical listing of patient
C.O. 276 manual 178 messages 47
CO2 156 AGM and AGM zero calibration 177
ECG 269, 279 alarms during zero cal 177 apnea delay 159
EEG 279 auto alarm suppression 177 apnea delay time (Resp) 114
NBP calibration (zero) 180 arrhythmia 29
adult cuffs 272 choosing numerics displayed 176 audible indicators 30
comfort cuffs 271 connecting accessories 175 awrr limits 159
disposable cuffs 271 connection ports 174 chaining 99
multi-patient comfort cuff kits 271 gases measured 173 CO2 specific 158
neonatal/infant cuffs humidity correction 176 CO2, apnea delay 159
(disposable) 272
maintenance schedule, overall 266 CO2, awRR 159
reusable cuffs 271
maintenance schedule, ventilator desat, SpO2 119
single-hose disposable cuffs 272 fan 266 effect on pressure alarms during
Nellcor 273 major parts and keys 174 zero 131
pressure 273 rear panel 174 extending pause time 34
Pulsion 273 removing gas samples from the from external devices 251
recorder paper 281 circuit 179 high priority 29
resp 269, 279 setting apnea alarm delay time 177 INOP 29
set combiners and organizers 271 Setup Gas Analyzer menu 176 ISO/IEC standard 9703-2 31
SpO2 273 watertrap 174 limit, SpO2 302
Nellcor adhesive sensors wave scale, adjusting 176 NBP source 125
(disposable) 273 zero calibration 180 patient messages 41, 47
Philips sensors (disposable) 273
airway adapter pausing 32
Philips sensors (reusable) 273
CO2, microstream accessory 157 physiological 41
SvO2 280
alarm pleth as source 120
tcpO2/tcpCO2 281
suspended symbol 33 red 29
temperature 276
volume, changing 31 reminder 32
trunk cables 269
alarm latching 39, 40, 97 restarting 33
active alarms 29 reviewing 38
alarm limit

i
 reviewing messages 38 initiating 95 basic event surveillance 217
reviewing window 38 arrhythmia learning, initiating 96 battery
selftest 40 arrhythmia monitoring and display brightness 262
SpO2 high and low limits 119 aberrantly conducted beats 92 battery compartment location 259
SpO2 specific 119 and defibrillation 90 charge status 263
ST 106 atrial fibrillation and flutter 92 malfunction symbols 260
SvO2, behavior during intermittent bundle branch block 93 power gauge 260
measurement 170 reconditioning 263
non-paced patients 92
switching on and off 33 replacing 262
paced patients 92
temperature 127 safety information 264
testing 40 arrhythmia on/off 92
arrhythmia options 88, 91 battery LED 260
tone configuration 30
traditional 31 arrhythmia relearning 95 battery status 259
visual indicators 30 initiating 95 battery status recording 261
VueLink and external devices 251 on lead fallback 96 battery status window 261
yellow 29 with EASI INOP 87 battery symbol 286
alphabetical listing of alarms 41 arrhythmia status messages 94 beat labels
alternating current symbol 285 arterial catheter constant (PiCCO) 144 arrhythmia 93
analog interface symbol 286 arterial pressure source 135 beat-to-beat recording 227
analog output arterial pulsation 115 BIS
ECG 288 arterial values 161 performance test 266
pressure 137 artifact suppression (pressure) 133 BIS cables
analog video out connector 288 Aspect Medical Systems Inc 284 securing 196
anesthetic gas module assembly 284 BIS Continuous Impedance Check 193
performance specifications 311 BIS Cyclic Impedance Check 193
ATPD correction for AGM (Ambient
annotating events 219 Temperature Pressure Dry) 176 BIS engine
annotation atrial fibrillation and flutter 92 software revision 196
recording strip 229 BIS filters
audio button 8
apnea alarm delay on/off 195
audlatching (arrhythmia alarms) 97
CO2 159 BIS Ground Check 193
auto agent identification 178
apnea alarm delay (AGM) 177 BIS Impedance Check Window 194
auto alarm limits
apnea alarm delay time (RESP) 114 BIS Impedance Indicators 194
switching on/off 37
apnea alarms using 37 BIS monitoring 191
and Resp detection modes 114 setup 192
auto alarm suppression (AGM) 177
Application Server 25 BIS numeric 191
auto detection mode (Resp) 112
arrhythmia BIS numerics
auto ECG wave gain (recordings) 228
levels of analysis 88, 91 on/off 195
auto reports
arrhythmia alarms 29, 96 BIS safety information 196
setup 234
adjusting alarm limits 97 BIS smoothing rate
all yellow on/off 97 automatic arrhythmia relearn 96
changing 195
chaining 99 automatic NBP
repeat time 124 BIS software
latching 97
updating 196
multiple 99 autosize
pvc-related alarms 100 ECG wave 78 Bispectral Index monitoring 191
short yellow 89 average trend events 212 blood pressure. See also NBP (non-invasive)
sinus and SV rhythm ranges 301, 302 or PRESS (invasive)
awRR alarm 159
timeout periods 97 limits 159 Brightness SmartKey 23
yellow 97 brightness, adjusting 23
awRR alarms
arrhythmia alarms on/off 97 AGM 177 BSA formula (trends) 208
arrhythmia analysis BTPS correction for AGM (Body
how it works 91 B Temperature Pressure Saturated) 176
arrhythmia beat labels 93 buffer (EEG) 187
backlight
arrhythmia display 93 maintenance interval 266 buffer (EEG) on reports 189
arrhythmia learning balloon inflation, wedge measurement 136 buffer (EEG) on screen 188
during ventricular rhythm 96
basic arrhythmia option 88, 91

ii
C how the measurement works 139 measuring microstream 156
cardiac output report 242 method, mainstream 153
C.I. 140 method, microstream 153
cardiac overlay
C.O. 139 and Resp detection modes 113 method, sidestream 153
accessories 276 when measuring Resp 111 microstream accessories 156
calibrating measurements (PiCCO) 145 microstream extension 156
cardiotach alarms 88
curve alert messages 149 removing exhaust gases 157
documenting measurements 147 catheter transducer, calibrating 155
editing measurements (PiCCO) 144 SvO2, insertion 171 transducer, using 155
editing measurements (RH catheter constant, setting (PiCCO) 144 troubleshooting 158
method) 147 catheter preparation wave scale, adjusting 158
flow-through method 146 SvO2 170 code
hemocalc window 142 cautions 1 recording 230
hemodynamic parameters available 140
CCO combi-events 216
injectate guidelines 148
calibration status indicators 145 Compressed Spectral Arrays (CSA) 187
PiCCO method 142
choosing the correct pressure source 144 computation constant (RH) 146
Procedure window 141
how the measurement works 139
prompt messages 150 configuration
PiCCO method 142
results table 142 trends database 200
right heart thermodilution method 145 central recorder
configuration mode 17
saving measurements (PiCCO) 145 choosing 228
conflict
setup for PiCCO method 143 CFI 140
label 21
setup for RH method 146 chaining 99
connecting BIS accessories 192
setup menu 142 changing ECG lead sets 80
temperature unit 142 connecting temperature probe 127
changing EEG wave scale 188
C.O. warning messages 151 connection direction indicator symbol 285
changing EEG wave speed 189
C.O./CCO safety information 151 connection direction symbol 285
changing recording templates 228
Calc Type 205 connector
changing Resp detection mode 112 AC power input 288
calculating cerebral perfusion 135
changing Resp wave size 113 additional MSL 288
calculating oxygen extraction 172 analog video out 288
changing Resp wave speed 113
calculating temperature difference 128 ECG analog (sync) output 287, 288
changing ST alarm limits 106
calculations 205 equipotential ground 288
changing wave scale
pop-up keys 206 marker input 297
EEG 195
calculations reports 209 measurement 8
channels measurement server 8
calculations review 207 recorder 228 MMS patient cable 288
calibrating checking battery charge 263 mouse 288
CO2 transducer 155
checking paced status 76 MSL 288
tcGas transducer 165
cleaning printer 288
calibrating C.O. measurements 145 protective earth 288
infection control 255
calibration method 256 Quick Link 8
AGM zero 180 monitoring accessories 257 recorder module 288
interval, NBP 266 recommended substances 256 trackball 288
NBP 125 recorder printhead 257 transducer 8
pressure 134 wired network 288
CO2
pressure transducer 134 wireless network 288
airway adapter 157
SvO2 light intensity 171 connectors 286
alarms, apnea delay 159
SvO2 required equipment 169 serial/MIB 287, 288
alarms, awRR 159
SvO2, in-vivo 172
alarms, specific 158 context recordings 227
SvO2, pre-insertion 170
awRR alarm limits 159 continuous cardiac output 139
calibration status indicators (C.O) 145 checking transducer accuracy 154 Continuous Impedance Check (BIS) 193
capnography correction, humidity 158
mainstream 9 conventional 12-lead ECG 84
correction, N2O 158
microstream 9 corrections 158 correcting the NBP measurement 123
capture loop 254 FilterLine 157 corrections
carbon dioxide, see CO2 153 mainstream extension 154 CO2 158
measuring mainstream 154 CO2, humidity 158
cardiac output

iii
 CO2, N2O 158 display brightness 262 ECG output 296
counting events 216 disposal ECG primary lead
CPAP (RESP) 113 gas cylinder 267 choosing 76
CSA (Compressed Spectral Arrays) 187 parts and accessories 267 ECG report 243
cuff documenting events 219 lead layout 234
pressure, NBP 123 dPmax 140 ECG reports
selection, NBP 123 DSC (BIS) setup 234
curve alert messages (C.O.) 149 software revision 196 ECG safety information 89
Cyclic Impedance Check (BIS) 193 dyshemoglobins ECG secondary lead 76
intravascular (SpO2) 118 choosing 76
D ECG wave
E
autosize 78
damage
early systolic blood pressure, NBP 123 calibration bar 78
mechanical 24
EASI ectopic status messages (arrhythmia
data resolution (trends) 200
activating 80 monitoring) 95
database
ECG monitoring 87 editing C.O. measurements (PiCCO
events 219 method) 144
lead placement 87
database configuration editing C.O. measurements (RH method)
trends 200 EASI lead labels 81
C.O.
date, setting 23 ECG 75
saving measurements (RH
accessories 269, 279
default settings 319 method) 147
changing lead sets 80
tailoring 17 editing recording templates 228
choosing electrode sites 80
defibrillation conventional 12-lead 84 EEG
and arrhythmia monitoring 90 external pacing electrodes 90 accessories 279
and ECG monitoring 90 filter settings 79 buffer time 187
and monitoring BIS 196 fusion beat pacemakers 90 changing wave speed 189
during EEG monitoring 190 intrinsic rhythm 90 setting report buffer time 189
synchronization marks 77 modified 12-lead 84 setting screen buffer time 188
defibrillator input 296 New Lead Setup 80 EEG configuration and monitor
defibrillator proof symbol 285 pacemaker failure 90 upgrades 190
defibrillator synch rate adaptive pacemakers 90 EEG Impedance/Montage Window 184
maintenance interval 266 unfiltered 79 EEG monitoring 183
wave size 78 changing filter frequencies 189
delay time
recording 228 ECG alarms off (Config Mode) 89 changing wave scale 188
delayed recording 227 ECG analog (sync) output 287, 288 choosing electrode montages 185
ECG analog output 288 CSAs 187
deleting events 219
electrical interference 190
demonstration mode 16 ECG cable
electrode-to-skin impedance 186
for operating room 90
desat alarm, SpO2 119 gridlines 188
ECG cables, connecting 75 impedance quality indicators 186
detection modes (Resp) 112
ECG connector 75 international 10-20 electrode placement
device driver
language conflict with monitor 252 ECG display 77 system 185
ECG electrode colors 81 safety information 190
diagnostic (ECG filter setting) 79
setup 184
digital interface symbol 286 ECG electrode placement
skin preparation 184
during electrosurgery 90
digital video device connection symbol 286 switching numerics on and off 188
ECG gain
disabling touch operation 17 EEG wave
in recordings 228
discharging a patient 67 changing scale 195
in reports 234
disinfecting electrical input symbol 285
ECG lead labels 81
infection control 255 AAMI 81 electrical interference
recommended substances 256 EASI 81 during EEG monitoring 190
display IEC 81 electrical output symbol 285
arrhythmia 93 ECG lead placement electrode colors (ECG) 81
ECG 77 choosing EASI/Standard 80 electrode montage
Resp 112
ECG leads monitored 80 EEG 185
ST 102
electrode placement (ECG) 75

iv
 conventional 12-lead 84 EVLW/EVLWI 140 help
modified 12-lead 84 exchanging anesthetic agents 178 INOPS 39
electrode placement (Resp) 111 exclamation mark symbol 285 hemodynamic calculations 205
with abdominal breathing 112 exhaust gases, removing 157 hemodynamic parameters 140
with lateral chest expansion 112 high filter (EEG) 189
extension cable for SpO2 117
electrode-to-skin impedance (BIS) 194 high pass filter (BIS) 195
extensions 284
electrode-to-skin impedance (EEG) 186 high resolution recording 227
external devices
electromyographic activity numeric alarms and INOPS 251 HiResTrnd event episodes 212
(BIS) 191
connecting 250 HR = RR (Resp) 112
electrosurgery connecting to VueLink 249
and ECG 90 HR alarms
external pacing electrodes when arrhythmia off 89
EMC interference and ECG monitoring 90
Resp 114 HR alarms off (Config Mode) 89
extreme bradycardia alarm 89, 109 HR from (heart rate source) 108
emergence from anesthesia
extreme rate alarms 89, 109 humidity correction
and agent identification 178
extreme tachycardia alarm 89, 109 AGM 176
EMG numeric (BIS) 191
CO2 158
end case F
discharging a patient 67 I
report, printing 67 fallback (ECG) 81
end case reports FAST IEC ECG lead labels 81
setup 236 Fourier artefact suppression Impedance Check Window (BIS) 194
technology 115
enhanced arrhythmia option 88, 91 Impedance Indicators (BIS) 194
filter (ECG) 79
entering values impedance quality indicators 186
calculations 208 filter frequencies (EEG) 189
IMV (Resp) 113
equipotential ground connector 288 FilterLine
independent display connection
CO2, microstream accessory 157 symbol 286
equipotential grounding symbol 285
filters infection control
event annotation 219
BIS 195 cleaning 255
event counter 216
flexible module server - see FMS 6 disinfecting 255
event counting (oxyCRG/NER) 217
FMS sterilizing 255
event database 219 connecting to monitor 6 Information Center
event episode 212 example module 6 central recording 225
types 212 modules 6 injectate guidelines for C.O. 148
event episode recording 221 functional arterial oxygen saturation 115 injectate volume setting (C.O.) 144
event episode reports 237 fusion beat pacemakers INOP alarms 29
Event Episode window 216 and ECG monitoring 90
INOPs
event groups 211 from external devices 251
G
event manual trigger 218 silencing 32
event post-time 212 gas cylinder input
event pre-time 212 empty, disposing of 267 defibrillator 296
event recording 219 gas input symbol 285 installation 284
event report 222 gas output symbol 285 connectors 286
event review recording 220 GEDV/GEDVI 140 Instructions for Use 1
event review reports 237 getting started 24 Integrated Module Slot 225
Event Review window 215 graphic trends 197 IntelliVue family 2
reports setup 234 intermittent bundle branch block 93
event snapshots 212
graphic trends report 201 intermittent mandatory ventilation
Event Summary view 214
gridlines (EEG) 188, 195 (Resp) 113
event surveillance 211
Ground Check (BIS) 193 interruption symbol 285
event surveillance levels 217
grouped screen trends 203 intravascular dyshemoglobins (SpO2) 118
event time 212
intrinsic rhythm 90
event triggers 212 H
in-vivo calibration, SvO2 172
event values 216
hardkeys 15 ITBV/ITBVI 140
events pop-up keys 213

v
K cords 265 maintenance, calibration 266
measurements, schedule 266 maintenance, performance test 266
keyboard connection symbol 285 microstream CO2 266 measuring 156
keys microstream CO2, calibration 266 mismatch
hardkeys 15 microstream CO2, performance patient data, resolving 69
pop-up 15 test 266
MMS
SmartKeys 14 schedule 265
connecting to FMS 8
visual inspection 265
L connecting to monitor 8
major parts and keys
MMS patient cable connector 288
label conflict resolution 21 MP40 MP50 2, 3
modifications 284
labels malfunction symbols
battery 260 modified 12-lead ECG 84
resolving conflict 22
manual agent identification 178 module
language conflicts with device driver 252 connecting 7
latching manual detection mode (Resp) 113
reconnecting 7
alarms 39 and apnea alarms 114
removing 7
alarms, behavior 40 manually triggering events 218 setup key 7
latching arrhythmia alarms 97 manufacture date symbol 285 setup menu 7
LCW/LCWI 140 manufacturer’s information 284 tcGas 161
marker input connector 297 unplugging 7
lead fallback
VueLink 249
and arrhythmia relearning 96 Mason-Likar lead system 84
VueLink Type A and Type B 249
lead fallback (ECG) 81 max hold setting (CO2) 153
modules
lead labels (ECG) MDF (mean dominant frequency) 183 setting up 24
AAMI 81 mean dominant frequency (MDF) 183 monitor
IEC 81 mean pressure calculation (trends) 208 inspecting before use 24
lead placement measured signal starting monitoring 24
activating EASI/Standard 80 pulsatile portion of 115 switching on 24
for Resp measurement 111 tailoring 17
measurement
leads monitored (ECG) 80 adjusting a wave 21 monitor (ECG filter setting) 79
Leads Off INOP (ECG) 81 modules monitor defaults 319
LED setting up 24 monitor settings
battery status 260 preparation 24 changing 23
levels of arrhythmia analysis 88, 91 setting up 20
monitoring
levels of event surveillance 217 settings 19
preparation 24
switching on and off 21
line frequency interference (BIS) 195 monitoring BIS 191
wave speed, changing 21
local recorder monitoring EEG 183
measurement connector 8
choosing 228 monitoring mode 16
measurement points, ST 104
loops 253 mouse
measurement server
low filter (EEG) 189 using 13
connector 8
low pass filter (BIS) 195 ECG connector 75 mouse connection symbol 285
LVCI 140 measurement server extension mouse connector 288
M3015A 9 MP40 MP50
M
M3016A 9 major parts and keys 2, 3
M1116B 225 measurement server link cable 6 MR imaging and the SpO2 transducer 118
M3160A recorder 225 measurement server link connection MSL cable 6
main screen overview 11 symbol 286 MSL connector 288
mainstream capnography 9 mechanical damage 24 MSL, additional connector 288
mainstream CO2 154 merging patient data 71 multi-lead ST alarming 106
measuring 154 methemoglobin (SpO2) 118 multi-measurement server (MMS) 8
maintenance MIB connector 287, 288
AGM 266 microstream capnography 9 N
AGM ventilator fan 266 microstream CO2 156 N2O correction
BIS, performance test 266 accessories 156 CO2 158
cables 265 maintenance schedule 266
narrow alarm limits 37

vi
navigating 11 O discharge 67
mouse 13 end case 67
SmartKeys 14 operating 11 information mismatch 69
trackball 13 mouse 13 transfer 68
NBP SmartKeys, using 14 patient alarm messages 41
adult cuffs 272 trackball 13
patient demographics 65
alarm source 125 operating modes 16
patient report
ANSI/AAMI SP10-1992 121 configuration 17
cardiac output 242
automatic mode, enabling 124 demonstration 16
ECG 243
calibrating 125 monitoring 16
passcode protection 16 patient reports
calibration interval 266
service 17 contents 239
comfort cuff kits 271
comfort cuffs 271 operating room ECG cable 90 patient trends
cuff pressure 123 viewing 197
orange ECG cable 90
cuff, applying 123 paused alarms 32
organizers 271
cuff, selecting 123 extending time 34
Oridion Systems Ltd 284 restarting 33
cuff, tightness 123
disposable cuffs 271 Original Calc pop-up key 207 peak power frequency (PPF) 183
how the measurement works 121 oscillometric NBP measurement performance 284
measurement correction 123 method 121
performance specifications
measurement limitations 122 output
anesthetic gas module 311
measurement methods, auto 122 ECG 296
pressure 298, 304
measurement methods, manual 122 overlap
measurement methods, stat 122 performance test 313
in recordings 228
measurement, starting 124 performing calculations 207
overlapping screen trends 203
measurement, stopping 124 perfusion indicator 115, 118, 120
oxyCRG event counting 217
neonatal cuffs (disposable) 272 pf loops 253
numeric 123 OxyCRG event episodes 212
Philips contact information 284
numerics 123 oxygen extraction 172
physiological alarms 29
oscillometric method 121 oxygenation calculations 205
pediatric cuffs 272 PIC cable (BIS)
preparing to measure 122 P securing 196
repeat time 123 PiCCO method
pace pulse rejection (ECG) C.O. 142
repeat time for automatic 124
about 76 CCO 142
repetition time, setting 124
switching on/off 78 setup 143
reusable cuffs 271
single-hose disposable cuffs 272 paced patients placing electrodes (Resp) 111
site inspection 123 arrhythmia monitoring 92
pleth alarm source 120
start/stop button 8 repolarization tails 78
safety information 90 pleth wave 119
time of last measurement 123
units 123 setting status 90 pleth waveform 115
venous puncture 125 paced status plug-in recorder 225
neonatal event counting 217 checking 76 pop-up keys 15
neonates pacemaker failure 90 events 213
Resp electrode placement 112 paper power on symbol 285
network connection indicator 11 reloading (recorder) 231 PPF (peak power frequency) 183
network connector, wired 288 paper size preparing skin
for reports 237 for ECG 75
network connector, wireless 288
parallel interface symbol 286 PRESS
networked monitoring 25
parallel printer connection symbol 286 zero button 8
non-invasive blood pressure. See NBP
parameter scales pressure
non-paced patients
trends 200 alarms during zero 131
arrhythmia monitoring 92
parts and accessories 284 arterial source 135
notch filter (BIS) 195 calibration pressure 134
passcode protection 16
numerics cerebral perfusion, calculating 135
explanation of NBP display 123 patient performance specifications 298, 304
admit 65 wave scale 132
nurse call 33
category, NBP 121 wave size 132
nurse call relay connection symbol 286

vii
 wedge 136 Q setup menu 228
wedge, editing 137 starting and stopping 226
zeroing the transducer 130 QRS tone 109 types 227
pressure accessories 273 changing volume 23 wave overlap 228
pressure analog output 137 QRS tone pitch, SpO2 120 wave scale 228
QRS volume, changing 79 waveforms recorded 230
pressure artifact suppression 133
quick admit 66 wedge 137
pressure of NBP cuff 123 with the plug-in recorder 225
pressure transducer Quick Link connector 8
recording delay time 228
calibration 134 quick mount release symbol 285
recording events 219
zeroing 131
R reference waves, wedge measurement 136
pressure-flow loops,pressure-volume
loops 253 rejecting pace pulses 76
radiated field immunity
primary lead (ECG) Resp 114 related products
choosing suitable 76 power-on LED 6
rate adaptive pacemakers
selecting 76 problem LED 6
and ECG monitoring 90
switching on 6
print job RCW/RCWI 140
suspended 239 relearning arrhythmia 95
realtime recording 227
print speed reliability 284
realtime report
for recordings 228 reloading recorder paper 231
sample report 241
printer remembraning tcGas transducer 163
realtime reports
unavailable 239 content 237 reminder, alarm 32
printer connection symbol 285 reconditioning batteries 263 remote alarm device
printer connector 288 alarms
reconnecting a module 7
printer settings 238 remote device 5
recorder 225
printers remote applications 25
4-channel 225
disabling 238 choosing 228 remote SpeedPoint 12
status messages 239 cleaning the print head 257 removing a module 7
printing paper accessories 281 removing gas samples (AGM) 179
C.O. measurements 147 recorder module connector 288 repairs 284
calculations reports 209 recorder status messages 231 replacing batteries 262
event reports 219
recording repolarization tails 78
status log 267
alarm 227 report
trends reports 201
annotation 229 cardiac output 242
wedge 137
battery status 261 ECG 243
priority list for trends 199 beat-to-beat 227 event review 222
probes C.O. measurements 147
disposable temperature 127 reports
central 225
alarm limits 240
procedure recordings 227 changing recording type 228
calculations 209
profiles 18 channels 228
choosing paper size 237
patient category 19 choosing recorder 228
choosing templates 237
screens, predefined 18 choosing recording speed 228
contents 239
swapping 20 context 227
end case 236
swapping setting block 20 creating templates 228
patient trends 201
prompt messages delayed 227
re-routing 239
C.O. 150 ECG gain 228
scheduled 236
extending 226
protective earth 288 setting up 234
high resolution 227
protective earth symbol 285 stopping printouts 234
local 225
pulse numerics for SpO2 118 preventing fading ink 230 re-routing reports 239
Pulsion Medical Systems AG 284 procedure 227 resampling vitals 206
pv loops 253 realtime 227 resolution
recording strip 229 trends 200
PVC-related alarms 100
recording strip code 230 resolving patient mismatch 69
PVR/PVRI 140 reloading paper 231 resp accessories 269, 279
runtime 228
Resp alarms
setting the runtime 228

viii
 apnea alarm delay time 114 Resp wave 113 EEG 184
Resp detection level scales SmartKeys 14
and apnea detection 114 for trends waveforms 200 smoothing rate (BIS) 195
Resp detection modes scheduled reports 236 snapshots
and cardiac overlay 113 screen events 212
changing 112 adjusting brightness 23 specifications 283
Resp display 112 disabling touch operation 17 altitude 290
Resp electrode placement 111 elements 12 arrhythmia 298
Resp monitoring screen trend time 203 barometric 290
and cardiac overlay 111 screen trends 202 spectral edge frequency (SEF) 183
Resp safety information 114 screens spectral edge frequency numeric (BIS) 191
Resp wave changing content 18 speed
changing size 113 switching 18 recording 228
changing speed 113 tailoring 17 SpeedPoint 12
restarting paused alarms 33 secondary lead (ECG) SpeedPoint, remote 12
results table (C.O.) 142 choosing suitable 76
SpO2
selecting 76
retrolental fibroplasia (SpO2) 119 accessories 273
SEF (spectral edge frequency) 183 active alarm source 120
review
calculations 207 SEF numeric (BIS) 191 alarms specific to 119
on/off 195 arterial pulsation 115
reviewing alarm messages 38
selecting the primary lead (ECG) 76 assessing suspicious reading 118
reviewing alarms 38
selecting the secondary lead (ECG) 76 calculating difference between
reviewing alarms window 38 values 120
selftest
RH method connecting the cables 117
alarms 40
computation constant 146 disposable sensors 116
sensor extension cable 117
rhythm status messages (arrhythmia
disposable SpO2 116 FAST technology 115
monitoring) 94
SpO2 116 measurement sources for difference
right heart thermodilution method
(C.O.) 145 sensor temperature calculation 120
tcGas 162 Nellcor adhesive sensors
right heart thermodilution setup
serial LAN interface 286 (disposable) 273
(C.O.) 146
serial/MIB connector symbol 285 perfusion indicator 115, 118, 120
rs-232 interface symbol 285 Philips sensors (disposable) 273
runtime service mode 17
Philips sensors (reusable) 273
setting recording runtime 228 set combiners 271 pleth as alarm source 120
RVSW/RVSWI 140 setting the arterial catheter constant pleth wave 119
(PiCCO) 144 pleth waveform 115
S setting the computation constant (RH) 146 pulse numerics 118
setting up QRS tone 120
safety 284
event surveillance 218 selecting a sensor 116
maintenance interval 266
trends 199 signal quality 118
monitor 290
setting up reports 234 site inspection 118
safety information site selection 117
batteries 264 settings
tone modulation 120
BIS 196 default 319
SpO2 desat alarm 119
C.O./CCO 151 setup key, module 7
ECG 89 SpO2 limit alarms 119
setup menu, module 7
Resp 114 Sp-vO2 172
Setup Recording menu 228
safety test 313 SQI numeric
short yellow alarms 89
same patient data merge 71 on/off 195
signal quality index numeric (BIS) 191
sample report SQI numeric (BIS) 191
signal quality of SpO2 118
cardiac output 242 SR numeric (BIS) 191
ECG 243 sinus and SV rhythm ranges 301, 302 on/off 195
realtime report 241 site timer ST
saving battery power 262 tcGas 162 numerics in ECG wave 77
scale skin preparation ST alarms 106
ECG wave 78 ECG 75 adjusting alarm limits 106

ix
 multi-lead 106 measurement settings 19 CO2, calibrating 155
st alarms 88 monitor 17 pressure, zeroing 130
ST display 102 monitor settings 18 tcGas, calibrating 165
predefined screens 18 tcGas, remembraning 163
ST measurement points
profiles 18 transducer connector 8
adjusting 104
profiles, measurement settings transferring a patient 68
standard 10-lead placement 84 settings 19
standard 3-lead placement 81 profiles, monitoring settings 18 transport brightness setting 262
standard 5-lead placement (ECG) 82 screens 17 trend time
switching screens 18 screen trends 203
standby symbol 285
tcGas trends
start/Stop button 8
sensor temperature 162 automatic unit conversion 208
starting monitoring 24 automatic value substitution 208
transducer, calibrating 165
status line 11 transducer, remembraning 163 database configuration 200
status log tcGas site timer 162 measurement groups 199
printing 267 resolution 200
tcpO2/tcpCO2
status messages screen trends 202
accessories 281
printer 239 setting parameter scales 200
technical alarms messages setup 199
recorder 231
see INOPs 47 viewing 197
status messages (arrhythmia) 94
temperature 127 trends pop-up keys 198
ectopic 95
accessories 276
rhythm 94 trends priority list 199
alarm settings 127
sterilizing connecting probe to monitor 127 triggers
infection control 255 difference, calculating 128 for events 212
stopping reports printouts 234 first 128 troubleshooting
suppression ratio (BIS) 191 label 127 CO2 158
surgical ECG cable 90 making a measurement 127 trunk cables
probe, disposable 127 accessories 269
suspended alarm 33
probe, selecting 127 Tyco Healthcare Group LP 284
suspended print jobs 239 second 128
suspicious SpO2 reading 118 tcGas sensor 162 U
SV/SI 140 temperature probe
unfiltered ECG signal 79
SvO2 connecting 127
Abbott Critical Care, accessories 169 unplugging a module 7
templates
accessories 280 creating for recordings 228 upgrading
alarms 170 effect on EEG configuration 190
templates for reports 237
calibration equipment 169 user interface settings
testing alarms 40
catheter insertion 171 changing 23
catheter preparation 170 time, setting 23
in-vivo calibration 172 Tinj Probe Type 143 V
light intensity calibration 171 tone configuration, alarm 30 V electrode placement (ECG) 83
measurement principle 169 tone mod (SpO2) 120
monitoring 170 venous puncture 125
tone modulation 120 ventilation calculations 205
SVR/SVRI 140
total power (TP) 183 viewing arrhythmia waves 93
switching on
total power numeric (BIS) 191 viewing trends 197
monitor 24
touchscreen 12 visible waves report 237
symbols 285
disabling 17
battery 260 vislatching (arrhythmia alarms) 97
TP (total power) 183
synchronization marks (defibrillator) 77 vital signs
TP numeric (BIS) reports setup 234
systolic blood pressure, NBP, early 123
on/off 195
vital signs report 201
T trackball connector 288
volume
trackball, using 13 alarm 31
tabular trends 198
trademarks 284 VueLink
tailoring
transcutaneous values 161 alarm messages 251
changing screen content 18
default settings 17 transducer device driver conflicts 252
CO2, accuracy 154 language conflicts 252

x
 module 249
module options 249
module setup 250
visible waves and numerics 249

W
warnings 1
watertrap (AGM) 174
wave
adjusting 21
changing speed 21
scale (AGM) 176
scale (CO2) 158
scale (pressure) 132
size (AGM) 176
size (CO2) 158
size (pressure) 132
wave scale (EEG)
changing 195
wave size
Resp 113
wave size (ECG)
changing 78
wave speed (EEG) 189
wave speed (Resp) 113
wedge
balloon inflation 136
editing 137
printing 137
pulmonary artery 136
recording 137
reference waves 136
wide alarms limits 37
window
battery status 261
wired network connection symbol 286
wireless device connection symbol 286

Y
yellow arrhythmia alarms 97
yellow arrhythmia alarms on/off 97

Z
zero
effect on pressure alarms 131
zero button 8
zero calibration
AGM 180
and AGM alarms 177
zeroing
pressure transducer 130

xi