touchECG

User manual

Rev. 14 – 05.03.2021
1936
 touchECG

All rights reserved © Cardioline SpA.

CARDIOLINE® is a registered trademark of Cardioline SpA.
Android™ is a Google Inc. trademark.
This publication may not be reproduced, in whole or in part, in any form or manner, without prior written authorisation
by:

Cardioline Spa
Via Linz, 151
38121 Trento
Italy
 touchECG

Contents

1. GENERAL INFORMATION ................................................................................................................................ 1

1.1. Minimum Requirements for the computer/tablet/smartphone......................................................... 1
1.2. Licensing terms ....................................................................................................................................... 1
1.3. Other important information ................................................................................................................. 2
2. SAFETY INFORMATION .................................................................................................................................... 3
2.1. Warnings on Bluetooth........................................................................................................................... 6
2.1.1. Potential sources of interference of Bluetooth ........................................................................... 6
2.1.2. Obstacles for the wireless signal ................................................................................................... 7
2.1.3. Reducing the effects of the interference of other wireless devices........................................... 7
3. SYMBOLS AND LABEL ...................................................................................................................................... 8
3.1. Explanation of the symbols .................................................................................................................... 8
3.2. Device label ............................................................................................................................................. 8
4. INTRODUCTION ............................................................................................................................................... 9
4.1. Purpose of the manual ........................................................................................................................... 9
4.2. Recipients ................................................................................................................................................ 9
4.3. Intended use............................................................................................................................................ 9
4.4. Description of the device ....................................................................................................................... 10
4.5. General overview .................................................................................................................................... 11
4.5.1. Main buttons and icons ................................................................................................................. 13
5. PREPARATION FOR USE................................................................................................................................... 18
5.1. Installing the software ............................................................................................................................ 18
5.1.1. Installation on Windows................................................................................................................. 18
5.1.2. Installation on Android ................................................................................................................... 20
5.2. Launching touchECG ............................................................................................................................... 21
5.2.1. Start-up with manual entry of Ward Id ......................................................................................... 24
5.3. Connecting and configuring the HD+ acquisition unit ......................................................................... 25
5.3.1. Connecting the HD+ acquisition unit to the Windows tablet/computer ................................... 25
5.3.2. Connecting the HD+ acquisition unit to the Android tablet/computer ..................................... 26
5.3.3. Configuring the HD+ acquisition device........................................................................................ 28
5.4. Virtual keyboard configuration (Windows version only) ..................................................................... 30
5.5. Printer configuration (Android version only) ........................................................................................ 30
5.6. Start from command line (Windows version only) ............................................................................... 33
 touchECG

5.7. System installation .................................................................................................................................. 35

6. EXECUTION OF THE EXAMINATION ............................................................................................................... 36
6.1. General procedure .................................................................................................................................. 36
6.2. Before acquisition ................................................................................................................................... 36
6.2.1. Preparing the patient ..................................................................................................................... 36
6.2.2. Connecting the patient .................................................................................................................. 37
6.3. Viewing the ECG ...................................................................................................................................... 39
6.3.1. Changing the trace display mode .................................................................................................. 42
6.3.2. Leads disconnected ........................................................................................................................ 43
6.3.3. Bookmark ........................................................................................................................................ 44
6.4. Entering patient data .............................................................................................................................. 45
6.4.1. Patient window ............................................................................................................................... 45
6.4.2. Manually entering the patient's data............................................................................................ 47
6.4.3. Entering patient details from the Examinations Archive ............................................................. 48
6.4.4. Entering patient details from a work list ...................................................................................... 49
6.5. Acquisition of an ECG examination. ...................................................................................................... 51
6.5.1. Automatically acquiring an ECG examination .............................................................................. 51
6.5.2. Review mode acquisition of an ECG examination (Windows version only) ............................... 52
6.5.3. Manual mode acquisition of an ECG examination ....................................................................... 57
6.6. Previewing an ECG examination ............................................................................................................ 58
6.6.1. Changing the display and printout mode ..................................................................................... 61
6.6.2. Modifying patient details ............................................................................................................... 62
6.6.3. Modifying the automatic interpretation....................................................................................... 63
6.6.4. Identifying an urgent ECG examination ........................................................................................ 64
6.6.5. Printing out and saving an ECG examination ............................................................................... 64
6.6.6. Transmitting an ECG examination ................................................................................................. 65
6.6.7. Sending an ECG examination by email ......................................................................................... 66
6.7. Test Archive ............................................................................................................................................. 66
7. CONNECTIVITY, RECEIVING WORK LISTS AND TRANSMITTING ECG EXAMINATIONS ................................ 70
7.1. General information ............................................................................................................................... 70
7.2. Receiving a work list ............................................................................................................................... 71
7.3. Uploading an exam ................................................................................................................................. 72
7.4. Sending an examination by email .......................................................................................................... 73
7.5. Saving an examination in SCP and PDF format ..................................................................................... 74
7.6. Connectivity formats and protocols ...................................................................................................... 74
 touchECG

7.6.1. GDT (in the Windows version only) ............................................................................................... 74

7.6.2. Cardioline Standard ........................................................................................................................ 75
7.6.3. Cardioline DICOM ........................................................................................................................... 76
7.6.4. Text file (in the Windows version only)......................................................................................... 76
7.6.5. XML (in the Windows version only)............................................................................................... 78
8. DEVICE SETTINGS............................................................................................................................................. 79
8.1. General information ............................................................................................................................... 79
8.2. Summary of settings ............................................................................................................................... 81
8.2.1. PACS ................................................................................................................................................. 81
8.2.2. ECG .................................................................................................................................................. 82
8.2.3. Manual (Windows version only) .................................................................................................... 82
8.2.4. Auto ................................................................................................................................................. 83
8.2.5. Connectivity .................................................................................................................................... 83
8.2.6. Other ............................................................................................................................................... 85
8.2.7. License ............................................................................................................................................. 86
8.2.8. Safety ............................................................................................................................................... 86
8.3. Protection of the Settings ...................................................................................................................... 86
8.4. Virtual Keyboard Management (Windows version only) ..................................................................... 88
9. SET THE DEVICE IN ACCORDANCE WITH GDPR (General Data Protection Regulation) – Windows
only 89
9.1. General information ............................................................................................................................... 89
9.2. Encrypt the folder containing the database ......................................................................................... 89
9.3. Enable the audit trail .............................................................................................................................. 90
9.4. Enable the “Delete test after sending” setting. .................................................................................... 90
10. UPDATING THE SOFTWARE AND OPTIONS ................................................................................................... 91
10.1. Updating the software ............................................................................................................................ 91
10.1.1. Updating on Windows.................................................................................................................... 91
10.1.2. Updating on Android ...................................................................................................................... 91
10.2. Updating enabled options ...................................................................................................................... 91
10.2.1. General information ....................................................................................................................... 91
10.2.2. Entering the activation code.......................................................................................................... 92
11. MAINTENANCE AND TROUBLESHOOTING .................................................................................................... 93
11.1. General information ............................................................................................................................... 93
11.2. Operation check ...................................................................................................................................... 93
11.3. Bluetooth ................................................................................................................................................. 93
 touchECG

11.4. Troubleshooting table ............................................................................................................................ 94

11.5. Messages and solutions table ................................................................................................................ 94
12. TECHNICAL SPECIFICATIONS ........................................................................................................................... 97
12.1. Filter features .......................................................................................................................................... 99
12.2. Harmonised standards applied .............................................................................................................. 100
12.3. Accessories .............................................................................................................................................. 100
13. WARRANTY....................................................................................................................................................... 101
 touchECG
1. GENERAL INFORMATION

1. GENERAL INFORMATION

This manual is an integral part of the device and should always be available as support material to the clinical
practitioner or the operator. Strict compliance with the information contained in this manual is an essential
prerequisite for the proper and reliable use of the device.
Have the operator read the manual thoroughly, as a great deal of the information is only described once.

1.1. Minimum Requirements for the computer/tablet/smartphone

touchECG can be installed on any computer (PC, tablet, notebook, etc.) with the following minimum
requisites:

Operating System ............................ Windows: Windows 7, Windows 8.1, Windows 10

Android: Android 4.4 KitKat (API 19) or higher
Processor ........................................ Quad core 1.6 GHz or higher
RAM ................................................ Windows: 2GB or more
Android: 1 GB or more
Free space on Hard Disk .................. 8 GB or more
Monitor........................................... Windows: 640 x 480 pixels or more
Android: Tablet: 7” or more
Smartphone: Samsung 4.7” or more
Bluetooth ........................................ Bluetooth 2.1 +EDR
Printer............................................. Laser (colour/BW)
Additional applications .................... Windows: Email application which supports the EML format (only
required for the email File Upload feature)
Android: Acrobat “PDF” file format viewer

1.2. Licensing terms

By installing the software, the terms and conditions described as follows are accepted.
Object of this agreement is the consent of a use licence for the software and the operating manual.
Cardioline SpA guarantees a personal licence, non-exclusive and non-transferable, for use of the software
and the attached documents. The software and accompanying documents are protected by copyright. The
user must comply with copyright law dispositions.
All rights relative to the software are the property of Cardioline SpA. The transferral of software onto
another computer by means of the network or data channel is not permitted.
The programs and the attached documents cannot be changed, copied, merged with other programs or
made available to third parties.
The user is deemed responsible for any damage stemming from non-compliance with the copyright, or from
violation of the conditions reported in this agreement.

1
 touchECG
1. GENERAL INFORMATION

1.3. Other important information

This manual was written with the utmost care. Should you find any details which do not correspond to those
contained in this manual, please inform Cardioline SpA, who will proceed to correct such inconsistencies as
soon as possible.

The information contained in this manual is subject to change without notice.

All changes will be in compliance with the regulations governing the manufacturing of medical equipment.

All trademarks mentioned in this document are property of their respective owners. Their protection is
guaranteed.
No part of this manual may be reprinted, translated or reproduced without the manufacturer's written
authorisation.

The codes relating to this manual are listed below.

Language Code
English 36519163_EN

2
 touchECG
2. SAFETY INFORMATION

2. SAFETY INFORMATION

Cardioline SpA will be held responsible for the safety, reliability and functionality of the devices only if:
1. Assembly, modification or repair operations are carried out by Cardioline SpA or by one of its
Authorised Assistance Centres;
2. The device must be used in compliance with the instructions contained in the user manual.

Always contact Cardioline SpA should you wish to connect any devices not mentioned in this manual.

Warnings
 This manual provides important information on the proper use and safety of the device. Failure to
comply with the described operating procedure, improper use of the device, ignoring the
specifications and recommendations supplied, may cause severe physical injuries to the operators,
patients and bystanders, or may damage the device.
 The device cannot be modified in any way.
 Do not use the device if you suspect it is malfunctioning.
 The device captures and presents the data that reflects the physiological condition of the patient;
this information can be examined by specialist medical staff and will be useful in providing an
accurate diagnosis. In any event, the data cannot be used as the only means to make an accurate
diagnosis of the patient.
 The operators for whom this device is intended must have the required competence regarding
medical procedures and the treatment of patients. They must also be sufficiently trained in using the
device. Have the operator carefully read and understand the contents of the operator manual and
the other annexed documents before using the device for clinical applications. Inadequate
knowledge or training could be at a greater risk for the physical safety of operators, patients and
bystanders, or could damage the device.
 US Federal Legislation restricts the sale of this device to prescription by a doctor.
 The device is designed for use only with the HD+ acquisition unit. Refer to the HD+ user manual for
the risks and warnings associated with it and for its user instructions.
 This device may be installed on a tablet, desktop computer or laptop (hereinafter the support
device), which satisfies the minimum requirements indicated in para. 1.1. To ensure the electrical
safety of the operator and patient during its operation, the following precautions must be observed:
 If the support device is battery powered, do not connect it to an external power supply (for
recharging) or other electrical equipment (e.g. to another computer via USB or to a LAN
network) when using it in the patient area.

3
 touchECG
2. SAFETY INFORMATION

 If the support device is powered off the mains, it may not be used in the patient area. When
used in the patient area, it must be powered with an isolation transformer and shielded
cables must be used to connect it to the LAN. The power cable shielding (when present)
must be connected to an earthing system appropriate for the area where the device is used.
This will avoid electric shocks caused by different earth potentials which could exist between
the various points of an electricity distribution system, or else by failures of the external
equipment connected to the mains.
 The HD+ acquisition unit for use with the device is protected against defibrillation. Check the HD+
unit's cables for cracks and breakage before using it.
 Refer to the HD+ unit's user manual for the risks and warnings associated with it.
 This device is designed to be used only with the electrodes specified in this manual. Strictly follow
the correct clinical procedures to prepare the skin before the application of the electrodes and
monitor the patient in order to avoid any irritation, inflammation or other skin reactions. The
electrodes are designed for short-term applications and must be promptly removed once the
examination is complete.
 The ECG electrodes may cause skin irritation; check the skin for any irritations or inflammations.
 To prevent any infections, use the disposable components (e.g. the electrodes) only once. To ensure
safety and use efficiency, do not use electrodes after their expiration date.
 The quality of the signal produced by the device may be adversely affected by the use of other
medical equipment such as defibrillators and ultrasound machines.
 The risks associated with the use of the device together with other equipment, such as pacemakers
and other stimulators, depend on the support device on which it is installed. The signal may be
subject to disturbance in any case.
 The use of the device in combination with other high frequency (HF) surgical equipment depends on
the support device in question.
 The operation may be adversely affected by the presence of strong magnetic fields such as those
produced by electro surgery equipment.
 The use of the device in the presence of diagnostic imaging equipment, such as Magnetic Resonance
(MR) or Computer Axial Tomography (CAT), in the same room, depends on the support device in
question.
 The software reports the battery level of the HD+ unit. The low battery warning is designed to work
solely with the HD+ unit using the batteries indicated in its user manual. If the battery level is low,
replace the HD+ unit's batteries and observe its user instructions.
 Using a support device equipped with a GPRS or WLAN unit may interfere with other nearby
equipment. Check with local authorities or with providers of the spectrum of your structure to find
out whether any restrictions apply to use of the device in your area.
 Do not leave the patient cable unattended in the presence of children as they could be accidentally
strangled.
 Do not leave the electrodes unattended in the presence of children as they could cause suffocation
if accidentally swallowed.

4
 touchECG
2. SAFETY INFORMATION

 If you are printing PDF files, you need to set up a corresponding program so that the document is in
no way adapted or scaled. If you are using Acrobat Reader, you need to select “Actual Size” in “Page
management and size.” Otherwise you may get nondiagnostic quality prints.
 In the case of Android, we recommend using printers approved by Cardioline, for which the
diagnostic quality of prints is ensured.

Attention
 The device does not require any calibration or special instrumentation for correct use and
maintenance.
 The Glasgow algorithm is intended for automatic interpretation of ECGs at rest. The automatic
interpretation provided by touchECG can only be considered if HD+ is used to acquire ECGs at rest. If
HD+ is used to acquire signals while the patient is moving (for example during a stress test) the
automatic interpretation may not be valid.
 The Glasgow 12-lead resting ECG Analysis Algorithm has specific criteria for patients of different
ages, gender and race. If the option is enabled, the algorithm can provide the doctor with an
automatic interpretation, which generates diagnostic messages on the ECG report. Validation is
required by a cardiologist or a doctor.

Notes
 The movements of the patient may generate excessive noise and affect the quality of the ECG
tracing or the correct analysis of the device.
 An appropriate preparation of the patient is important in order to guarantee a proper application of
the ECG electrodes and the correct operation of the device.
 The incorrect positioning of the electrodes for the detection of the algorithm depends on the normal
physiology and on the order of the ECG leads and tries to identify the most likely exchange.
However, it is recommended to check the positioning of the electrodes of the same group (limbs or
chest).
 If the electrodes are not properly connected to the patient, or one or more patient leads are
damaged, the display will indicate that the leads in question are disconnected. When the ECG is
printed, these leads will come out on paper as a square wave.
 The accuracy of the measurements taken by this device complies with the specific requirement of
standard IEC 60601-2-25.
 The device is a Class IIa in compliance with Directive 93/42/EEC.
 The device is a “prescription device” under the terms of FDA regulations.
 The HD+ unit must be connected to the support device running the software before use.

5
 touchECG
2. SAFETY INFORMATION

2.1. Warnings on Bluetooth

2.1.1. Potential sources of interference of Bluetooth

It is important to learn how to minimise wireless interference that may cause slow performance and
disconnections from Bluetooth devices.
Specifically, there might be interferences and it is required to make an operation check if the following are
found:
 Inability to couple a Bluetooth device to the computer/tablet
 Intermittent HD+ disconnections
 Loss of the ECG signal.

Possible causes of interference of the Bluetooth signal may be:

 Microwave ovens: using microwave ovens close to the computer/tablet may cause interference.
 Satellite TV: the coaxial cable and connectors used with some satellite dishes may cause
interference. Check whether the cables are damaged thus causing radio interferences (RF leakage).
Replace the cables if interference is suspected.
 Power supply: some external electricity sources such as power lines, electrical railroad tracks and
power stations, may cause interference. Avoid placing the computer/tablet near wall power lines or
close to junction boxes.
 2.4 GHz or 5 GHz telephones: cordless telephones operating in the 2.4 GHz or 5 GHz range may cause
interference with other wireless devices when used to place calls.
 Wireless RF video: wireless video transmitters that operate in the 2.4 GHz or 5 GHz range may cause
interference with other wireless devices.
 Wireless speakers: wireless speakers that operate in the 2.4 GHz or 5 GHz range may cause
interference with other wireless devices.
 Certain external VDUs and LCD displays: certain displays emit harmonic interferences, especially in
the 2.4 GHz band between channels 11 and 14. These interferences may be stronger if using a
notebook computer with a closed display and a connected external monitor.
 Inadequately shielded cables: external hard disks or other devices with poorly shielded cables can
interfere with wireless devices. If disconnecting or switching off the device reduces the
interferences, try replacing the cable that connects the device to the computer/tablet.
 Other wireless devices: other wireless devices that operate in the 2.4 GHz or 5 GHz band (nearby
microwave transmitters, wireless cameras, baby monitors, WiFi devices) may cause interferences
with Bluetooth connections.
 Enabling GPS operation: if the GPS function is enabled on the device in use, it may create
interference with the Bluetooth signal. If losses of Bluetooth signal packets are noted, it is
recommended to disable the GPS function.

6
 touchECG
2. SAFETY INFORMATION

2.1.2. Obstacles for the wireless signal

The position of the device and the construction materials may affect Bluetooth performance. If possible,
avoid obstacles or move the Bluetooth device for the signal to travel through fewer obstacles. For example,
avoid placing the computer/tablet under a metal desk and the HD+ device on top of a desk.

Below is a chart showing the radio signal-blocking ability of the most common devices:

Material Potential interference

Wood Low
Synthetic material Low
Glass Low
Water Medium
Bricks Medium
Marble Medium
Plaster High
Concrete High
Bulletproof glass High
Metal Very high

2.1.3. Reducing the effects of the interference of other wireless devices

If a lot of wireless devices are connected to the computer/tablet or nearby, it may be required to encode the
channels used by the WiFi devices.
To reduce the interference between WiFi devices and Bluetooth to the minimum try these solutions:
 Change channels of the wireless network;
 Connect to a 5 GHz wireless network (if possible);
 Place the HD+ close to the computer/tablet.
 Reduce to the minimum the number of Bluetooth devices connected to the computer/tablet or
nearby.

7
 touchECG
3. SYMBOLS AND LABEL

3. SYMBOLS AND LABEL

3.1. Explanation of the symbols

Symbol Description

Comply with the instructions in the use manual

CE marking – compliance with the European Union directives

Refer to the user instructions

Manufacturer

3.2. Device label

Windows

Android

8
 touchECG
4. INTRODUCTION

4. INTRODUCTION

4.1. Purpose of the manual

This manual covers the touchECG product.
The manual represents a guide for the execution of the following operations:
 Reasonable use of the device, of the function keys and of the sequence of menus.
 Preparation of the device for use (Section 5)
 Acquisition, printing and storage of ECG traces (Section 6)
 Connectivity and transmission of ECG tracings. (Section 7)
 System configuration (Section 8)
 Updating the device (Section 10)
 Troubleshooting (Section 11)

4.2. Recipients
This manual is intended for professional healthcare operators. They are therefore presumed to have specific
knowledge of medical procedures and terminology, as required by clinical practice.

4.3. Intended use

touchECG is designed to monitor and diagnose cardiac function. However, a Cardiologist must validate the
results of the analysis run by the ECG.
touchECG is intended for use in hospitals, clinics and outpatient departments of any size. It is also suitable
for use by medical staff at the patient's home and in an emergency (ambulance).

touchECG is designed for use with the Cardioline HD+ device. The Cardioline HD+ device acquires the ECG
signal and sends it via Bluetooth to the PC on which the touchECG software is installed. touchECG software is
designed to only work with the Cardioline HD+ device.

 The device acquires, analyses, displays and prints out electrocardiograms.

 The device interprets the data for review by a doctor.
 The device is intended for use by a doctor or by healthcare personnel on behalf of an authorised
doctor in clinical facilities. It is not intended as the only means for determining the diagnosis.
 The device's interpretation of the ECG analysis is only significant if used together with an additional
analysis by a physician and with an assessment of all the patient's other significant data.

9
 touchECG
4. INTRODUCTION

 The device can be used on adult and paediatric patients.

 The device must not be used as a physiological monitoring of vital signs.

4.4. Description of the device

touchECG is a 12-lead diagnostic electrocardiograph which displays, acquires, prints and stores ECG traces
for adults and children. It also calculates the principal global ECG parameters.

The device can be supplied with the optional 12-lead Glasgow resting ECG interpretation algorithm, with
specific criteria for patients of different age, sex and race. If this option is enabled, the algorithm can provide
the referring physician with an automatic report, generating diagnostic messages in the ECG report.
For further information on the resting ECG interpretation algorithm, see the Instruction Manual for doctors
for its use with adults and children (see list of accessory equipment).

The device can be configured with the DICOM® function.

The device installs on any PC, tablet or notebook with the minimum requisites listed in para. 1.1.
It prints out in the following formats: standard or Cabrera 3, 3+1, 3+3, 6 or 12 channel in automatic mode,
and 3, 6 or 12 printout channels of the rhythm strip.

The touchECG device includes:

1. Dongle with touchECG software
2. User manual

The device can be sold as a system that may include, depending on the sale configurations:
1. HD+ unit
2. HandyVAQ suction-operated patient cable
3. Computer (tablet or all-in-one PC)
4. Thermal battery-powered printer (Windows version only)
5. Trolley (tablet model or digital model)

Each device in the system comes with its own user manual and accessories.

Note: the Glasgow Algorithm Interpretation is always loaded on the device but can be enabled or disabled
according to the acquired options. The Glasgow interpretation program can only be enabled or disabled by
using the activation code provided by Cardioline (see Para. 10.2).
The Glasgow interpretation program runs the automatic interpretation as well as the readings on the ECG
traces. In any case, if the Glasgow interpretation program is disabled, only the readings are printed, whereas
the automatic interpretation is not printed.

10
 touchECG
4. INTRODUCTION

4.5. General overview

The program windows are divided into three main areas:

 Top bar (1):

at the top, it displays the window's main information, e.g. patient first and last name, messages and
so on.

 Side bar (2):

on the right, it contains the window's function buttons.
Two different displays are available, that may be selected from the Settings page (see para. 8.2.6):
˗ “Complete user interface”, showing all available controls,
˗ “Quick user interface", showing some controls only.

Some buttons, such as trace speed, width, filter and so on, allow you to select parameter values and
change when clicked on to reflect the current value. The trace speed button, for instance, allows you
to select a different value with each click, and cycles through the possible rates (5, 10, 25, 50 mm/s).
It changes to display the currently selected value (5, 10, 25 or 50).
Other buttons activate/deactivate their value and change to reflect this.

 Central area (3):

the central area displays the contents of the window, for example the traces in the main window.

 Lower bar (4):

at the bottom, depending on the window, it is used to show the continuous rhythm track or to show
informational messages.

11
 touchECG
4. INTRODUCTION

3
2

4
Main window with full User Interface

2
3

4
Main window with quick User Interface

12
 touchECG
4. INTRODUCTION

4.5.1. Main buttons and icons

We list all commands available in touchECG.

For a detailed description of the commands and their functions, refer to the chapters describing the
respective application windows.

Top bar

Icon Description

Patient first and last name (if entered)

HD+ connected / not connected

QRS sound on / off

Attention!

Cardiac frequency (with value in bpm)

HD+ battery level

Number of tests to be sent

Number of pages to print (only for Windows version)

Side bar
C indicates the controls only featured in the full user interface
W indicates the controls only featured in the Windows version

Button Version Name Description

Main window

Menu 1

Open menu Opens the secondary menu.

Selects the trace speed

C Speed
5, 10, 25, 50 mm/s

Selects the trace amplitude

C Amplitude
5, 10, 20 mm/mV

13
 touchECG
4. INTRODUCTION

Selects the muscle filter

25 Hz, 40 Hz, 150 Hz, off

Note: The 150 Hz filter only works on 1000 Hz

acquisitions and is only available in the
C Muscle filter
Windows version.
Note: The 25 Hz filter is stronger than the 40
Hz filter.
Setting the filter to “off” disables muscle
filtering of the traces.
Selects the trace format
C Format 6+6, 3x1 (I-II-II), 3x1 (aVL, aVR, aVF), 3x1 (v1,
v2, v3), 3x1 (v4, v5, v6), 12x1

Opens the patient database for entering the

Id
patient details.

Auto Starts automatic 10s ECG acquisition

Starts acquisition in review mode

CW Review
Available in the Windows version only.
Starts/stops manual mode acquisition
CW Manual
Available in the Windows version only.
Menu 2

Close menu Closes the secondary menu.

Examination archive Opens the examination archive

Settings Opens the settings window

Launches an external application (if so

W Launch App
configured in the settings)

Close Closes touchECG

Patient window

New patient Opens a new patient

Searches for a patient in the examinations

Search
archive

Work list Opens the work list window

14
 touchECG
4. INTRODUCTION

Closes the patient window and saves the

OK
entered data.
Closes the patient window without saving the
Back
entered data.
Examinations archive window

Display Displays the selected examination

Transmit Transmits the selected examination

Transmit all Transmits all untransmitted examinations

Printing Prints out the selected examination

Sends the selected examination by email (as

Send email
a PDF report)

Remove Deletes the selected examination

Closes the examinations archive and saves

Ok the database data for the selected
examination.
Closes the examinations archive without
Back saving the database data for the selected
examination.
Work list window
Updates the work list by downloading it
Update
again.
Deletes the order selected from the list
Delete (locally, not on the server from which the list
has been downloaded).
Closes the window, saves the selection and
OK
loads the selected patient data.
Closes the window without saving the
Back selection or loading the selected patient
data.
Settings

Update license Updates the program's active options.

Save Closes and saves the settings.

15
 touchECG
4. INTRODUCTION

Back Closes without saving the settings

Examination preview window

Menu 1

Open menu Opens the secondary menu.

Selects the trace speed

Speed
25, 50 mm/s
Selects the trace amplitude
Amplitude
5, 10, 20 mm/mV
Selects the muscle filter
25 Hz, 40 Hz, 150 Hz, off

Note: The 150 Hz filter only works on 1000 Hz

Muscle filter acquisitions and is only available in the
Windows version.
Note: The 25 Hz filter is stronger than the 40
Hz filter. Setting the filter to “off” disables
muscle filtering of the traces.

Selects the trace format

Format
6x2, 3x4, 3x4+1, 3x4+3, 12x1

Turns the "urgent" status of the examination

Urgent
on/off.

Transmit Transmits the acquired examination

Printing Prints out the acquired examination

Save / Update Saves / updates the acquired examination

Closes the window and returns the main

Back
window in real time
Menu 2

Close menu Closes the secondary menu.

Enables / disables the calipers tool.

W Calipers
Available in the Windows version only.
Sends the acquired examination by email (as
Send email
a PDF report)

16
 touchECG
4. INTRODUCTION

Launches an external application (configured

W Launch App in the settings)
Available in the Windows version only.
Review window
Selects the trace speed
Speed
25, 50 mm/s
Selects the trace amplitude
Amplitude
5, 10, 20 mm/mV
Selects the muscle filter
25 Hz, 40 Hz, 150Hz, off

Note: The 150 Hz filter works only on

Muscle filter
acquisitions at 1000 Hz. The 25 Hz filter is
stronger than the 40 Hz filter.
Setting the filter to “off” disables muscle
filtering of the traces.
Selects the trace format
Format
6+6, 12x1
Opens the Patient database for entering the
Id
patient details.
Acquires a 10s ECG corresponding to the
Auto
selected portion of the trace.
Closes the window and returns the main
Back
window in real time

17
 touchECG
5. PREPARATION FOR USE

5. PREPARATION FOR USE

5.1. Installing the software

5.1.1. Installation on Windows

Installation on Windows operating system may take place in two ways:

 Insert the supplied CD into your computer (possibly provided as part of the system) and:
a. double click on the setup.exe file, if an internet connection is available
Note: this mode uses the ClickOnce technology described below.
b. Click on the touchECG.application file, if an internet connection is not available.
Note: this mode uses the ClickOnce technology described below.
c. double-click on the touchECG_Setup.msi file
Note: this mode uses the ClickOnce technology described below.

 Download the installation software from the internet, if an internet connection is available, by
typing: ttp://update.cardioline.com/touchecg in the address bar of the browser and clicking Install
Note: this mode uses the ClickOnce technology described below.

Note: if there is no Internet connection to install the application, the touchECG.application file in the
installation archive must be launched.
The software installation is launched automatically after having launched the setup program and is
completed when the touchECG program begins and a desktop icon is created.

18
 touchECG
5. PREPARATION FOR USE

Confirmation window

Installation progress window

The installation modes that use the Microsoft ClickOnce technology make it possible to:

 Install the program automatically;

 Manage the automatic updates of the program, by downloading them directly from internet when
available and when an internet connection is available.


19
 touchECG
5. PREPARATION FOR USE

5.1.2. Installation on Android

It is possible to install TouchECG on Android operating system simply from the Android Play Store:

1. Launch the Play Store by clicking on its icon (in the App list)

Play Store Icon

2. Search for “touchECG” in the search bar.

Search for “touchECG”

3. Select TouchECG and click on INSTALL.

20
 touchECG
5. PREPARATION FOR USE

.
Select TouchECG and click on INSTALL

4. Wait for the installation to be completed. Completion of the installation is notified in the top bar of
the home page or in the standby screen.

Installation completed

5.2. Launching touchECG

To launch the touchECG program, simply click on its desktop icon or in the applications list.

touchECG icon

21
 touchECG
5. PREPARATION FOR USE

Alternatively, you can select the program from the list of installed programs:
1. On Windows operating system, click on the Windows button in the application bar (see picture
below) to open the main Windows menu.

Windows button

On Android operating system, go the applications list.

2. In the list of applications (App) select touchECG.

Select touchECG

NOTE: from TouchECG version 3.42 onwards, with Android operating system, the first time the program is
launched a message is displayed, asking permission to access to the device’s memory.

Permission for access must be granted, otherwise the program ends.

Permissions may be entered manually from the menu Settings > Permissions > Memory permissions.

Note: The program starts up with “Quick user interface” default

Note: if the “Boot Screen” mode is selected (see par. 5.2.1) TouchECG is started with a home screen that lets
you enter the Ward ID.

22
 touchECG
5. PREPARATION FOR USE

Once the program is launched the following window is displayed:

Start page

If no HD+ has been configured yet (see para. 5.3), TouchECG will start in DEMO mode showing a screen with
sample traces. Video traces are marked with the word “DEMO,” just as saved and printed tests.
Demo mode can be also enabled by selecting HD+ “Demo” in settings (see para. 8.2).

DEMO Mode

23
 touchECG
5. PREPARATION FOR USE

For the ClickOnce version for Windows, every week, when the program is closed, the software automatically
searches for any available updates and alerts to this with a dialogue window.

Dialogue window”

If any updates are available, you will be prompted to download them.

Click on OK to download and install the updates; click on Ignore to skip this step. If you ignore the updates,
the program will no longer check for them when it launches. After a week, the automatic check for updates
is resumed.
Once the updates have been downloaded, they install automatically and a dialogue window displays the
progress.

5.2.1. Start-up with manual entry of Ward Id

It is possible to set up TouchECG for it to start with a window to manually enter the Ward ID. This feature is
useful if the device is often moved between wards with different Ward ID or in case of replacement
equipment.

If the Boot Screen setting is enabled (see par. 8.2), upon start-up the window pictured below is displayed, in
which the Ward ID may be entered.
The entered Ward ID is also saved in the program settings and becomes the default one.

Boot Screen for entering the Ward ID.

24
 touchECG
5. PREPARATION FOR USE

5.3. Connecting and configuring the HD+ acquisition unit

To acquire the ECH signal, the HD+ unit must be connected to the computer running touchECG (configured
appropriately).

HD+ transmits via Bluetooth. Before making the connection, make sure that Bluetooth is available and
enabled on the computer. If the computer does not have an integrated Bluetooth interface, use a USB
Bluetooth adapter.

Note: the HD+ unit must be enabled to connect to touchECG. If the HD+ unit was purchased previously to or
separately from touchECG, check with Cardioline SpA that it is properly enabled.

5.3.1. Connecting the HD+ acquisition unit to the Windows tablet/computer

Power up the computer running touchECG and check that Bluetooth is available and enabled, then proceed
as follows:

1. Insert the HD+ unit's batteries and turn it on.

2. On the computer/tablet device, click on the Bluetooth devices icon in the Windows application bar
and select Add a Bluetooth device.

Bluetooth Devices Icon

Add a Bluetooth device window

3. In the Manage Bluetooth devices window, wait for the HD+ to be detected and added to the list of
devices, with a name like HDPlusxxxxxxxx (where xxxxxxxx is the device's serial number) and the
wording “Ready for pairing”.

25
 touchECG
5. PREPARATION FOR USE

4. Click on the device and select Pair. Wait for the pairing procedure to complete, after which the HD+
will be connected to the system (the word “Connected” will display beneath the device).

Manage Bluetooth devices window

5.3.2. Connecting the HD+ acquisition unit to the Android tablet/computer

Power up the device running touchECG and check that Bluetooth is available and enabled, then proceed as
follows:

1. From the computer/tablet device, open Settings and go to the Bluetooth section.
2. Ensure Bluetooth connectivity is enabled (picture below A).
3. Insert the HD+ unit's batteries and turn it on.
4. Click on the Search button (picture below B) to start HD+ search and wait for the HD+ device to be
detected and added to the list of devices (picture below C), with a name like HDPlusxxxxxxxx (where
xxxxxxxx is the device's serial number).

B
A
C

Bluetooth activation and HD+ search

26
 touchECG
5. PREPARATION FOR USE

5. Click on the device to perform the pairing. Wait for the pairing procedure to complete, after which
the HD+ will be connected to the system.

HD+ Pairing

27
 touchECG
5. PREPARATION FOR USE

5.3.3. Configuring the HD+ acquisition device

Once the HD+ unit is connected to the computer, you must configure touchECG to communicate with it.

Proceed as follows:
1. Launch touchECG (see para. 5.2).

2. Click on Open menu and then Settings (see para. 8.2)

3. Open the System tab and open the HD+ serial number dropdown menu which contains a list of all
devices paired with the computer. Now select the serial number of the HD+ to want to connect to.

4. Click on Save to save this setting.

28
 touchECG
5. PREPARATION FOR USE

Settings window

Now touchECG will connect with the HD+ and the message “Searching for HD+” will display in the message
area.
If the selected HD+ is not enabled to work with touchECG, the message “HD+ NON E' LICENZIATO PER IL
TOUCHECG 3” (HD+ NOT LICENSED FOR TOUCHECG 3) will display. Contact Cardioline SpA to enable the
acquisition unit.
If touchECG is unable to connect to the acquisition unit, because it is out of range or switched off, the
message “HD+ not found" will display. Check that the acquisition unit is switched on and within range.

When the connection to the HD+ is successful, the message “HD+ found" displays in the message area.

Note: the list of acquisition units paired with the computer always includes the "DEMO” device. Selecting this
unit launches touchECG demo mode, which displays traces and runs the application even though no actual
acquisition unit is connected. The demo mode trace was acquired with an ECG simulator and includes special
signal conditions including disconnected leads and abnormal rhythms.

29
 touchECG
5. PREPARATION FOR USE

5.4. Virtual keyboard configuration (Windows version only)

If not using a physical external keyboard but the virtual keyboard installed on the computer/tablet, it must
be configured appropriately.
In particular, after making sure that the "Virtual keyboard" is set to On (see par. 8.2.6) it must be set to the
“anchored” mode by clicking on symbol A in the picture and ensuring the keyboard does not overlap the
application.

Virtual keyboard

Virtual keyboard configured correctly Virtual keyboard configured incorrectly

Note: if Windows is in tablet mode, it enables the virtual keyboard by default directly from the PC settings
and, in this case, the “Virtual Keyboard" option in the touchECG must be disabled.

5.5. Printer configuration (Android version only)

In case of Android operating systems, you should configure the printer first to print acquired examinations.
You can print directly from your Android device using the Google Cloud Print service. To do so, you should be
provided with:
 A PC supporting Google Chrome
 A printer connected to your computer via USB or network cable

30
 touchECG
5. PREPARATION FOR USE

 A Google account which must be the same on your computer and the Android device you want to
print from.

You also need to configure the printer by following the steps below:
1. Add your printer to Google Cloud Print:
a. Start Chrome on your computer
b. Click on Menu in the top right corner (it looks like three horizontal lines)

c. Click on Settings
d. Click on Show Advanced Options.

e. Scroll down the list and click on Manager in the Google Cloud Printing section.
f. Click on Add printers.

31
 touchECG
5. PREPARATION FOR USE

g. Click on the printer you want to add to Google Cloud Print.

h. Click on Add printer(s).

2. Add Google Cloud Print app to your Android tablet:

a. Start Play Store from the Home screen of the device or from the application list.
b. Click on the search field and type “cloud print.”

c. Click on Search (a magnifying glass will appear).

d. Select Cloud Print by Google Inc.
e. Click on Install.

32
 touchECG
5. PREPARATION FOR USE

3. Print from your Android tablet: if the Google account configured on your tablet is the same enabled
on your computer, you can print from the tablet on the configured printer. To do so, follow the
instructions provided under section 6.6.5 and select a printer from the window that is automatically
opened by the programme.

Attention: we recommend in any case the use of printers approved by Cardioline, for which the diagnostic
quality of prints is ensured.

Note: to be able to print, make sure that:

 If the printer is connected to a PC via USB, the PC is switched on
 If the printer is connected to a PC via network cable, the router to which it is connected is switched
on.

Note: The printer manufacturer can make printing configurations alternative to that described available.
Cardioline is not able to provide support on configurations different from that described. We recommend
referring to the instructions provided by the printer manufacturer.

5.6. Start from command line (Windows version only)

In some particular cases (for example in the event of touchECG software integrations with external systems)
the program may need to be launched from a command line.
To do this, create a text file with “.cmd” or “.bat” extension containing the command:

For ClickOnce version:

%AppData%"\Microsoft\Windows\Start Menu\Programs\Cardioline\touchECG\touchECG.appref-
ms"

Other commands can be added, each separated by a comma‘,’ and enclosed in inverted commas ‘”’.
For Standard setup version:
%AppData%"\Microsoft\Windows\Start Menu\Programs\Cardioline\touchECG\touchECG.lnk"

33
 touchECG
5. PREPARATION FOR USE

Other commands can be added, each separated by a space ‘ ’.

Command Description Syntax

-n The application is launched in standard mode. -n
-a The application is launched by retrieving the -a
plugin configured to receive the work list,
loading the first patient and starting the
acquisition in AUTO mode immediately.
-g The application is launched by retrieving the -g
plug-in configured for the reception of the work
list, loading the first patient and opening the
display window in real time.
-w The application starts by recalling the plugin -w
configured to receive the work list, loading the
first patient and opening the Patient window.
-f Path of the plug-in file for the reception of work -f <PATHFILE>
lists E.g. ClickOnce:
-d,C:\temp\wl\
E.g. Standard setup:
-d C:\temp\wl\
-d Path of the folder where the received work list -d <PATH>
is saved E.g. ClickOnce:
-d,C:\temp\gdt\input\
E.g. Standard setup:
-d C:\temp\gdt\input\
-pg Name of the dl plug-in file for the reception of -pg <NAME>
work lists E.g. ClickOnce:
-pg,Cardioline.TouchPlugWebApp
E.g. Standard setup:
-pg Cardioline.TouchPlugWebApp
-ps Name of the dl plug-in file for the transmission -ps <NAME>
of examinations E.g. ClickOnce:
-ps,Cardioline.TouchPlugWebApp
E.g. Standard setup:
-ps Cardioline.TouchPlugWebApp
-u Username for the plug-in -u <USERNAME>
E.g. ClickOnce:
-u,uploader
Es. Standard setup:
-u uploader
-p Password for plug-in -p <PASSWORD>
E.g. ClickOnce:
-p,Cardioline
E.g. Standard setup:
-p Cardioline
-l Plug-in url address or connection string -l <URL>

34
 touchECG
5. PREPARATION FOR USE

Command Description Syntax

E.g. ClickOnce:
-l,http://213.209.216.187:9091/ecgwebapp/rest
Es. Standard setup:
-l http://213.209.216.187:9091/ecgwebapp/rest
-c Allows you to use a custom user configuration -c <PATHFILE>
E.g. ClickOnce:
-c,C:\temp\user.config
E.g. Standard setup:
-c C:\temp\user.config

Where:
<NAME> = name of the dl plug-in file written without the “dl” extension
<PATH> = path written with “\” at the end
<PATHFILE> = path and file name
<URL> = web address/url

Example of a complete string for the ClickOnce version:

%AppData%"\Microsoft\Windows\Start Menu\Programs\Cardioline\touchECG\touchECG.appref-
ms"
"-g,-d,C:\temp\gdt\input\,-pg,Cardioline.TouchPlugWebApp,-ps,Cardioline.TouchPlugWebApp,-u,uploader,-
p,cardioline,-l, http://213.209.216.187:9091/ecgwebapp/rest".

Note: there must be NO space between the topics for the ClickOnce version.

Example of a complete string for the Standard setup version:

%AppData%"\Microsoft\Windows\Start Menu\Programs\Cardioline\touchECG\touchECG.lnk"
-pg -Cardioline.TouchPlugWebApp -a

Note: there must ALWAYS be a space between the topics.

5.7. System installation

As indicated in par. 4.4 the device can be supplied as a touchECG System, consisting of the touchECG
software, the HD + acquisition unit, the Cardioline HD + Bluetooth Dongle, the computer, the trolley and the
other listed devices.
Each device has its instructions for use. Refer to them for the installation of the individual devices (e.g. of the
trolley) and to the touchECG System manual for indications relating to the system.

35
 touchECG
6. EXECUTION OF THE EXAMINATION

6. EXECUTION OF THE EXAMINATION

6.1. General procedure

To acquire an ECG proceed as follows:
1. Start touchECG (see para.5.2)
2. Prepare and connect the patient (par. 6.2)
3. Turn on the HD+ acquisition device by pressing the central button (see the relevant manual)
4. Check the quality of the traces on the display and make sure there are no error messages (para. 6.3).
5. Complete the patient details, if necessary (para. 6.4)
6. Acquire the examination (see para. 6.5) by pressing button:
 Auto or the central button on the HD+ acquisition device for an automatic ECG acquisition,
 Review (only available in the Windows version) to review the whole acquired tracing
 Manual (only available in the Windows version) for manual ECG acquisition.

NOTES: If the work flow allows it, it is good practice to connect the patient to the device and to enter his/her
ID data before recording a tracing. This minimises artefacts on the tracings introduced during connection of
the patient and positioning of electrodes.

6.2. Before acquisition

6.2.1. Preparing the patient

Ensure that the patient fully understands the procedure and knows what to expect before connecting the
electrodes.
 Privacy is very important to allow the patient to be relaxed.
 Reassure the patient that the procedure is painless, and that he/she will only feel the electrodes on
the skin.
 Make sure that the patient is relaxed and in a comfortable position. If the table is narrow, insert the
hands of the patient under the buttocks to ensure the muscles are relaxed.
 Once the electrodes are connected, ask the patient to remain still and not to talk. Explain that this is
important to ensure a good ECG acquisition.

36
 touchECG
6. EXECUTION OF THE EXAMINATION

It is important that the patient's skin be perfectly clean. There is a natural electrical resistance on the surface
the skin, generated by sources such as hair, sebum, and dry or dead skin. Adequately prepare the skin to
minimise the aforementioned effects and optimise the quality of the ECG signal.
To prepare the skin:
 If necessary, shave the skin area where the electrode must be applied.
 Wash the area with hot soapy water.
 Dry the skin vigorously with an abrasive pad, such as a 2x2 or 4x4 gauze, to remove dead skin cells
and fat.

Note: Pay attention not to cause abrasions, discomfort or bruises on the skin. Always observe the utmost
clinical discretion when preparing the patient.

6.2.2. Connecting the patient

It is important to position the electrodes properly in order to acquire a good electrocardiographic signal.
Indeed low impedance ensures a better waveform, reducing noise. Quality electrodes should be used.

Connect the electrodes as follows:

1. Expose the arms and legs of the patient to connect the relevant leads.
2. Position the electrodes on the flat and fleshy parts of the arms and legs.
3. If a limb is not available, position the electrodes on a blood-supplied stump.
4. Attach the electrodes to the skin as indicated in the following figure. Test the correct adherence, and
therefore the good contact, by pulling the electrode. If the electrode moves freely, replace it. If the
electrode does not move easily, a good electrical contact is ensured.

Correct positioning of the electrodes

37
 touchECG
6. EXECUTION OF THE EXAMINATION

Note: It is important to locate the fourth intercostal space for an accurate positioning and monitoring of the
precordial leads. It is possible to locate the fourth intercostal space starting from the first intercostal space.
Given the variable conformation of the patient, palpating the first intercostal space accurately can be
difficult. Therefore, it is advisable to locate the second intercostal space by first palpating the small bone
protrusion known as the Angle of Louis, formed by the junction of the manubrium and the body of the
sternum. This protrusion of the sternum identifies the junction point of the second rib, and the space
immediately below it corresponds to the second intercostal space. Palpate and count following the trunk until
the fourth intercostal space is located.

IEC electrode AAMI electrode Position

Fourth intercostal space to the right of the

C1 C1 Red V1 V1 Red
sternum.

Fourth intercostal space to the left of the

C2 C2 Yellow V2 V2 Yellow
sternum.
Midway position between electrodes V2/C2
C3 C3 Green V3 V3 Green and
V4/C4.
Fifth intercostal space on the left of the
C4 C4 Brown V4 V4 Blue
midclavicular line.

Between electrodes V4 and V6.

C5 C5 Black V5 V5 Orange

C6 C6 Violet V6 V6 Violet Level with electrode V4 at left midaxillary line.

On the deltoid muscle, the forearm or left

L L Yellow AL LA Black
wrist.
L
On the deltoid muscle, the forearm or right
R R Red RA RA White
wrist.
AA

F F Green LL LL Red On the thigh or the left ankle.

N N Black RL RL Green On the thigh or the right ankle.

Reference table for the connection to the patient

38
 touchECG
6. EXECUTION OF THE EXAMINATION

6.3. Viewing the ECG

If touchECG is connected to an HD+ unit, turned on and connected to a patient, the touchECG start window
is the real time signal display page. The message “Real-time start” displays in the message area.
The centre of the screen is dedicated to displaying the traces, and the display mode can be set with the
buttons in the side bar, as described below (para. 6.3.1).

Since touchECG acquires and temporarily stores the entire trace acquired when it is launched and connected
to an active HD+, the bottom of the screen (A) displays a continuous trace which corresponds to the entire
trace acquired up to that time.
The lead displayed in the continuous trace can be modified from the Settings menu (see par. 8.2) or by
clicking on the continuous trace itself.
On the blue continuous trace there are time markers identifying the duration of the acquired signal,
identified at 1s intervals for the first 10s, and 10s intervals for the first minute, and at 1 min intervals
thereafter.
Any bookmarks (see par.6.3.3) are marked on the continuous trace as vertical orange lines identified by a tag
indicating the progressive number.

Rhythm lead

The top bar displays a set of information icons whereas the side bar contains the buttons that correspond to
the functions available which, depending on whether the “Quick user interface” setting is active or not, allow
you to modify the track display mode, acquire a test, access the settings menu, and so on.

In case of signal loss caused by Bluetooth problems, the “Attention” icon appears in the top bar. If more than
4 ms of signal are lost, the message “Weak signal” also appears.
The signal can be acquired just the same, but if the acquired signal were to show consecutive signal losses of
at least 100 ms or an overall loss of 1 s, the test would be classified as low quality (see par. 6.6).

Attention icon

Note: By default the touchECG is set to “Quick user interface”. Should you wish the “Full user interface” it
must be selected from the settings (see par. 8.2.6).

39
 touchECG
6. EXECUTION OF THE EXAMINATION

A
Real time display window with Full user interface

A
Real time display window with Quick user interface

40
 touchECG
6. EXECUTION OF THE EXAMINATION

Information icons – top bar

 Patient ID Followed by the patient's first and last name, if entered, to

identify the patient. It also enables to enter the patient’s data
(Par. 6.4).

 HD+ connected / not Indicates whether the HD+ device is connected via Bluetooth.
connected

 Heartbeat sound on / off Indicates whether the heartbeat sound is on or off. If it is on,
the unit beeps for each heartbeat.

 Attention! Indicates that some leads are disconnected or that there is

signal loss.

 Cardiac frequency Followed by the number of beats (bpm).

 HD+ battery level Indicates the HD+ unit's battery level.

Available buttons – side bar:

C indicates the controls only featured in the full user interface
W indicates the controls only featured in the Windows version

Menu 1

 Open menu Opens secondary menu, Menu 2.

 C Speed Selects the trace speed

5, 10, 25, 50 mm/s
 C Amplitude Selects the trace amplitude
5, 10, 20 mm/mV
 C Muscle filter Selects the muscle filter
25 Hz, 40 Hz, 150 Hz, off
Note: The 150 Hz filter only works on 1000 Hz acquisitions
and is only available in the Windows version.
Note: The 25 Hz filter is stronger than the 40 Hz filter.
Setting the filter to “off” disables muscle filtering of the
traces.
 C Format Selects the trace format
6+6, 3x1 (I-II-II), 3x1 (aVL, aVR, aVF), 3x1 (v1, v2, v3), 3x1
(v4, v5, v6), 12x1
 Id Opens the patient window for entering the patient details
(para. 6.4)

41
 touchECG
6. EXECUTION OF THE EXAMINATION

 Auto Starts automatic 10s ECG acquisition (para. 6.5.1)

 CW Review Starts acquisition in review mode (para. 6.5.2)

Available in the Windows version only.
 Manual Starts/stops acquisition in manual mode (para. 6.5.3)

Menu 2

 Close menu Closes the secondary menu and returns to Menu 1.

 Examination Opens the examination archive (para. 6.7)

archive
 Settings Opens the settings window (para. 7)

 W Launch App Launches an external application (configured in the

settings)
 Close Closes touchECG.

6.3.1. Changing the trace display mode

If full user interface mode is enabled (“Quick user interface” setting = Off) it is possible to change the speed,
amplitude, format and muscle filter applied to the tracings by clicking on the corresponding buttons.
Each button cycles through its available values, and applies them to the traces. For example, the speed
button can take the values 5, 10, 25 and 50 mm/s, and each time you click the button it will move to the next
value in the sequence.
The button itself displays the value.

We list the values of the parameters and the button labels below.

Tracings display format:

Speed

 5 mm/s

 10 mm/s

 25 mm/s

 50 mm/s

42
 touchECG
6. EXECUTION OF THE EXAMINATION

Amplitude

 5 mm/mV

 10 mm/mV

 20 mm/mV

Muscle filter

 25 Hz

 40 Hz

 150 Hz Note: The 150 Hz filter only works on 1000 Hz acquisitions and
is only available in the Windows version.
 off

Note: the 25 Hz filter is stronger than the 40 Hz filter. Setting the filter to “off” disables
muscle filtering of the traces.

Format

 6+6

 3x1 (I-II-II)

 3x1 (aVL, aVR, aVF)

 3x1 (v1, v2, v3)

 3x1 (v4, v5, v6)

 12x1

6.3.2. Leads disconnected

If any electrodes are disconnected, the message “Lead disconnected" displays in the message area, followed
by the list of leads in question, and the icon Attention displays in the top bar.

The waveforms of the disconnected leads are displayed as square waves (see below).

43
 touchECG
6. EXECUTION OF THE EXAMINATION

If all the leads are disconnected, all ECG traces display as square waves and the message “Lead
disconnected: all" displays. In the same way, if the disconnected lead is N/RL, the message “Lead
disconnected: all" displays and all leads display as square waves.

If the patient cable is connected from the connector on the HD+ unit, the ECG traces display as flat lines.

Real time display window with disconnected lead.

6.3.3. Bookmark

The real time display window allows you to assign bookmarks to events and interesting points of the signal
by clicking with the mouse (or with your finger if using a touchscreen device) in the trace area at the time of
interest.

The selected event is marked with vertical orange line identified by a progressive number visible in the
continuous trace at the bottom of the screen.
If a test is acquired, the bookmark is also shown in the ECG test.
In the Windows version the bookmark is included in the ECG test acquired in Review mode as well as in the
test acquired in automatic acquisition mode (see par. 6.5.1 and 6.5.2). In the Android version, which does
not include the Review feature, the bookmark is shown in the test acquired in automatic mode (see para.
6.5.1 and 6.5.2).

You can set touchECG to enter bookmarks automatically as set intervals. The “Automatic bookmark" function
in Settings (para. 8.2) enables you to select the interval in minutes between bookmarks.
The “Save test on Bookmark” function, on the other hand, automatically creates a 10 s test on every
bookmark. If the automatic print function is active, the created test is also printed out.

44
 touchECG
6. EXECUTION OF THE EXAMINATION

Bookmarks highlighted on the continuous trace

6.4. Entering patient data

You can enter patient details before acquiring an ECG examination by pressing the Id button in the real time
window or the Id field in the top bar, which opens the Patient window.

Id button

The data can be entered manually or automatically by selecting the patient from a work list or the
examinations archive.

6.4.1. Patient window

The window is organised into 3 sections, each of which has a number of entry fields.
The sections are:
 Main information: the basic patient details
 Clinical information: weight, height, therapy, etc.
 Other information: contact details

Patient window

45
 touchECG
6. EXECUTION OF THE EXAMINATION

We describe the fields and buttons in the side bar below.

Fields:

Main information

 ID the patient's identification code alphanumeric text field

 Name the patient's name alphanumeric text field

 Surname the patient's surname alphanumeric text field

 Gender the patient's gender multiple-choice button: unknown /

male / female / not specified
 Date of birth date of birth of the patient Numerical field (use ‘/’, ‘-‘ or ‘space’ to
enter the date). The X button allows
the date entered to be deleted.
 Age the patient's age Free numerical field or calculated
automatically if a valid date of birth is
entered. The age can be expressed in
years, months, weeks or days.
Note: If the age is not entered before requiring an ECG, it will be
interpreted by default relative to a 50-year-old male. The interpretation
text will include the wording “Interpretation done without knowledge of
the patient's age".
Note: If the age zero (0) is used, the interpretation will use the default
settings for a 50 year old male. The interpretation text will include the
wording “Interpretation done without knowledge of the patient's age".
 Race the patient's race Multiple-choice button: not specified /
caucasian / black / oriental. The field
will display or not according to the
chosen setting. If it is not visible, the
default value is “not specified”.

Clinical information

 Weight and unit of the patient's weight Numerical field. The units can be
measurement chosen from kg/g/lb/oz
 Height and unit of the patient's height Numerical field. The units can be
measurement chosen from cm/in/mm
 Systolic the patient's systolic pressure, in numerical field
mmHg
 Diastolic the patient's diastolic pressure, numerical field
in mmHg

46
 touchECG
6. EXECUTION OF THE EXAMINATION

 SpO2 the patient's oxygen saturation numerical field

 Pharmacological the patient's pharmacological alphanumeric text field

therapy therapy
 Technician the technician administering the alphanumeric text field
examination
 Reasons for study diagnosis already confirmed or alphanumeric text field
suspected, or main symptom

Other information

 E-mail address the patient's email address alphanumeric text field

 Address the patient's physical address alphanumeric text field

 Order number the reservation number for the alphanumeric text field
examination
(visible or editable depending on
the selected configuration)

Buttons – side bar:

 New patient Deletes any existing patient data and creates a new patient

 Search Finds a patient in the examinations archive (para. 6.4.3)

 Work list Finds a patient in a work list (par. 6.4.4)

 OK Closes the patient window and saves the entered data.

 Back Closes the patient window without saving the entered data.

Note: Make sure that the data have been deleted and re-entered before running an ECG for a new patient;
the patient details are not reset automatically after the examination. The patient details are only deleted
automatically when the device is switched off or you press New patient.

6.4.2. Manually entering the patient's data

The data can be entered manually into the fields in the Patient window.
Once entered, you can save the details by clicking OK or abort the operation with Back.

47
 touchECG
6. EXECUTION OF THE EXAMINATION

6.4.3. Entering patient details from the Examinations Archive

Click on Search in the patient window to search for a patient in the local archive; select a patient and load his
details.

Search button

It is possible to restrict the search by filling in all or part of the Id, Name, Surname fields of the Patient
window before clicking the Search button.
touchECG will only search in the local archive for tests in which the patient records match the entered data,
starting from the ID and then moving on to the surname and lastly, the name.

Alternatively, you can launch a search in the Examinations Archive by entering the word you are looking for
in the Search field. touchECG will search the local archive only for examinations in which the word in
question is found in the Id or Name/Surname fields.

The following fields are displayed in order for each examination:

 Id: the patient's identification code
 Name and surname: the patient's name and surname
 Year of birth / age: the patient's year of birth and age
 Gender: the patient's gender
 Stat: the examination's urgent flag (Yes = urgent examination)
 Trx: the examination's transmitted flag (Yes = examination transmitted)
 Report: indicates whether the interpretation of the examination has been confirmed by a doctor or
not
 Date of examination: date and time of the examination
 Connectivity: connectivity option associated with the examination (linked to the HD+ unit used to
acquire the ECG, as described in par. 10).

Click on the column labels (e.g. “ID” or “Name and Surname) to order the list in increasing/decreasing order
by the field in question.

You can select an examination by clicking on its line in the list and use OK and Back to save the data or abort
the operation.

48
 touchECG
6. EXECUTION OF THE EXAMINATION

Local archive search window

Buttons – side bar:

 OK Closes the examinations archive and saves the database data

for the selected examination.
 Back Closes the examinations archive without saving the database
data for the selected examination.

6.4.4. Entering patient details from a work list

The connectivity function (if available on the support device) enables you to load the patient details
automatically by selecting them from a work list. For details on configuring the ECG unit, see par. 7.

Click on Work List in the patient window to download and display a work list.

Work list button

You can select an order from the displayed work list by clicking on the line in question, and then select it
(OK), delete (Delete) or abort (Back).
You can also update the work list by pressing Update to download it again.

49
 touchECG
6. EXECUTION OF THE EXAMINATION

Work list

Buttons – side bar:

 Update Update the work list, deleting the current list and downloading
it again.
 Delete Deletes the order selected from the list (locally, not on the
server from which the list has been downloaded).
 OK Closes the window, saves the selection and loads the selected
patient data.
 Back Closes the window without saving the selection or loading the
selected patient data.

50
 touchECG
6. EXECUTION OF THE EXAMINATION

6.5. Acquisition of an ECG examination.

The ECG can be acquired in three ways:
 Automatic mode (Auto button or middle button on the HD+): acquires a 10s ECG which may be
saved and printed out as an examination.
 In review mode (Review button): displays the trace acquired so far; you can select 10s portions of
this and save and print them out as examinations. This function is not available if the “Quick user
interface” setting is enabled. This button is only enabled after at least 10 seconds of acquisition.
 Manually (Manual button): prints a continuous ECG of variable duration (saving is not available). This
function is not available if the “Quick user interface” setting is enabled.

6.5.1. Automatically acquiring an ECG examination

10 s of tracing can be acquired in automatic mode by pressing the Auto button in the real time display
window or by clicking the central button on the HD+ acquisition device.
Once you press Auto, the program acquires 10s of data and creates an examination.

Auto button

During acquisition, the display will show “Waiting for 10s automatic acquisition" in the message area.
touchECG acquires and temporarily stores the entire trace received from the time the HD+ unit was
switched on and connected. This way, when you press Auto, touchECG analyses the last 10s of trace and if
the data are valid (without disconnected leads or dropouts) immediately creates the examination without
acquiring other data.
On the other hand, if the last 10s of trace are not valid, the program waits for the next 10s to be acquired. In
this case the user can force acquisition of the traces by pressing QA Override (this button is enabled once
Auto has been pressed). This way the electrocardiograph will create an examination of the data acquired up
to that moment.
Likewise, if 10s of signal have not yet been acquired, touchECG waits for them to arrive, but in this case you
cannot force acquisition (QA Override is disabled).

QA Override button

51
 touchECG
6. EXECUTION OF THE EXAMINATION

QA Override button enabled

Once the acquisition is completed, the trace is displayed as a printout preview which you can print out, save,
edit by changing the patient details, etc., as described in para. 6.6.

Note: The temporary storage capacity is 30 minutes. Once exhausted, touchECG deletes the first minute and
continues storing new data. This means that the device's memory always holds the last 30 minutes of signal.

Note: the QA Override button is only enabled after you press Auto, and only if the last 10s of trace are not
valid for creating an examination.

6.5.2. Review mode acquisition of an ECG examination (Windows version only)

Click on Review in the real time display window to access ECG examination Review mode.
This mode displays a preview of the entire trace recorded since the unit was launched and connected to an
HD+ unit up to when you press the Review button, for 30 minutes at most.
This preview then allows you to select 10s portions for creating ECG examinations.

Review button

The centre of the window displays a portion of the trace in the selected format, the duration of which
depends on the size of the screen. The bottom bar displays the continuous trace. The portion of trace
displayed at the centre is highlighted in orange on the continuous trace as shown in figure (A).

52
 touchECG
6. EXECUTION OF THE EXAMINATION

To change the part of trace displayed, click on the continuous trace (with the right mouse button or double-
clicking in the case of a touch screen): this will display a part of the trace centred on the on the point in
which you have clicked.
If the recorded trace is long and cannot be displayed entirely in the bottom bar, a scrolling bar appears
enabling you to scroll and display the continuous trace.

Bookmarks (par. 6.3.3) are indicated as orange vertical lines.

You can set the speed, amplitude, format and muscle filter applied to the traces by clicking on the respective
buttons.
Each button cycles through its available values, and applies them to the traces. For example, the speed
button can take the values 5, 10, 25 and 50 mm/s, and each time you click the button it will move to the next
value in the sequence.
The button itself displays the value.

Click on Id to set the patient details for the examination, as described in par. 6.4.

10s ECG printout:

Click on the trace in central area to select 10s of trace starting from the point on which you clicked. The 10s
portion is highlighted in grey, in both the central area and on the continuous trace.
The Auto button is enabled and you can therefore record an examination using the selected 10s portion (par.
6.6).

PDF printing of variable duration ECG:

It is possible to save all the recorded track or a part of it by moving the markers on the continuous track and
pressing the Save PDF button. The save format will respect the following views: 12x1, 3x3, 1x1, while gain,
speed and muscle filter will be applied as selected by the user.

53
 touchECG
6. EXECUTION OF THE EXAMINATION

Bookmark

A
Display in Review mode

Selecting 10s of trace

54
 touchECG
6. EXECUTION OF THE EXAMINATION

Saving registration

Buttons – side bar:

 Speed Selects the trace speed

5, 10, 25, 50 mm/s
 Amplitude Selects the trace amplitude
5, 10, 20 mm/mV
 Muscle filter Selects the muscle filter
25 Hz, 40 Hz, 150 Hz, off
Note: The 150 Hz filter only works on 1000 Hz acquisitions and
is only available in the Windows version.
Note: the 25 Hz filter is stronger than the 40 Hz filter. Setting
the filter to “off” disables muscle filtering of the traces.
The 150 Hz filter is only applied on 1000 Hz acquisition
 Format Selects the trace format
6+6, 3x1 (I-II-II), 3x1 (aVL, aVR, aVF), 3x1 (v1, v2, v3), 3x1 (v4,
v5, v6), 12x1, 1x1 (compacted)
 Id Opens the patient window for entering the patient details
(para. 6.4)

55
 touchECG
6. EXECUTION OF THE EXAMINATION

 Print PDF To save an exam in PDF format corresponding to the selected

path or to the whole exam (if no area has been selected).
 Auto Creates an ECG examination using the selected 10s portion
(par.6.6)
Closes the window and returns to the main window in real
 Back
time with the same data as the patient's personal data or with
clean personal data, depending on the user's response to the
question proposed.

Tracings display format:

Speed

 5 mm/s

 10 mm/s

 25 mm/s

 50 mm/s

Amplitude

 5 mm/mV

 10 mm/mV

 20 mm/mV

Muscle filter

 25 Hz

 40 Hz

 150 Hz Note: The 150 Hz filter only works on 1000 Hz acquisitions and
is only available in the Windows version.
 off

Note: the 25 Hz filter is stronger than the 40 Hz filter. Setting the filter to “off” disables muscle
filtering of the traces.

Format

56
 touchECG
6. EXECUTION OF THE EXAMINATION

 6+6

 12x1

Note: The temporary storage capacity is 30 minutes. Once exhausted, touchECG deletes the first minute and
continues storing new data. This means that the device's memory always holds the last 30 minutes of signal.

6.5.3. Manual mode acquisition of an ECG examination

Pressing the Manual key on the real time display screen starts continuous printing of the ECG tracing. The
printout can be interrupted by pressing Stop, which is enabled as soon as manual mode is launched.

The output of the manual print is set from the "Output" field on the Manual Settings tab. It may be, for
Windows environments printer, PDF or both, for the Android version only PDF will be possible.

PDF printing will only contain the default rhythm derivation, as well as printing the compacted 1x1.

For Windows versions only:

The remaining number of pages for printing is shown in the top bar with the printer icon. The icon
disappears when all of the pages are printed. On each printed page there is also the relative page number.

Pages to print

If the support device's default printer is a PDF file writer, manual printing creates multiple PDF files in
sequence.

For both Windows and Android versions:

When the Manual print button is pressed, the print process is started or stopped.

Each of the printed pages features:

 Header:
o On the left: surname, name, ID;
o In the centre: date and time of acquisition, page number;
o On the right: cardiac frequency;
 Footer:
o On the left: amplitude, speed, filters;

57
 touchECG
6. EXECUTION OF THE EXAMINATION

o In the centre: department name

o On the right: device model, software version.

Buttons – side bar:

 Stop Stops the manual ECG printout.

6.6. Previewing an ECG examination

After the ECG examination has been created, as described in par. 6.5.1 and 6.5.2, this is shown as a print
preview. Bookmarks (par.6.3.3) are indicated as orange vertical lines on the traces.

The print preview shows at the top the boxes with patient’s data (A), automatic measurements and
interpretation (B), if enabled on the device.
In the Android version it is possible to click on the icon at the top right to collapse or expand this section, so
as to leave more room to the tracings.
It is possible to change the patient details (clicking on area A, see par.6.6.2) and the interpretation (clicking
on area B, see par.6.6.3), using the calipers tools (enabled/disabled with the Caliper button) and zoom (by
“pinching” the touchscreen or using the mouse scroll button for a normal screen) as support for the medical
report.

Note: the calipers instrument is only available in the Windows version.

Note: if the acquired signal were to show consecutive signal losses of at least 100 ms or an overall loss of 1 s,
the test would be classified as low quality and this indication would appear in the interpretation box.

If full user interface mode is enabled (Quick user interface setting = Off) it is also possible to change the
speed, amplitude, format and muscle filter applied to the tracings by clicking on the corresponding buttons
(see par. 6.6.1). The changes are applied to both the preview and the printed and saved examination (if any).

The Urgent button enables you to attribute the “Urgent” status to the examination, as described in par.
6.6.4, while the Transmit, Print and Save buttons enable you to transmit the examination to an external
system, print and save it (par. 6.6.4 and 6.6.6).
Finally, the Launch App button launches an external application, as configured in the Settings (e.g. a web
browser), while Send email sends the examination by email as a PDF (par. 6.6.7).

58
 touchECG
6. EXECUTION OF THE EXAMINATION

A B

Examination preview window with Full user interface

A B

The preview window with Quick user interface

59
 touchECG
6. EXECUTION OF THE EXAMINATION

Available buttons – side bar:

C indicates the controls only featured in the full user interface
W indicates the controls only featured in the Windows version

Menu 1

 Open menu Opens secondary menu, Menu 2.

 C Speed Selects the trace speed

25, 50 mm/s
 C Amplitude Selects the trace amplitude
5, 10, 20 mm/mV
 C Muscle filter Selects the muscle filter
25 Hz, 40 Hz, 150 Hz, off
Note: The 150 Hz filter only works on 1000 Hz acquisitions
and is only available in the Windows version.
Note: The 25 Hz filter is stronger than the 40 Hz filter.
Setting the filter to “off” disables muscle filtering of the
traces.
 C Format Selects the trace format
6x2, 3x4, 3x4+1, 3x4+3, 12x1
 C Urgent Turns the "urgent" status of the examination on/off.

 Transmit Transmits the acquired examination to an external system

 Printing Prints out the acquired examination

 Save / Update Saves / updates the acquired examination

 Erase and repeat It allows you to delete the exam from the local archive and
keep the same personal data of the patient by returning to
real-time mode.
 Back Closes the window and returns to the main window in real
time with the same data as the patient's personal data or
with clean personal data, depending on the user's response
to the question proposed.

60
 touchECG
6. EXECUTION OF THE EXAMINATION

Menu 2

 Close menu Closes the secondary menu and returns to Menu 1

 W Calipers Enables/disables the calipers tool

Available in the Windows version only.

 Send email Opens a new email message to send the acquired

examination as a pdf
 W Launch App Launches an external application (if so configured in the
settings).
Available in the Windows version only.

6.6.1. Changing the display and printout mode

If full user interface mode is enabled (“Quick user interface” setting = Off) it is possible to change the speed,
amplitude, format and muscle filter applied to the tracings by clicking on the corresponding button. The
display mode applies to both the printout and the saved file (if any).
Each button cycles through its available values, and applies them to the traces. For example, the speed
button can take the values 25 and 50 mm/s, and each time you click the button it will move to the next value
in the sequence.
The button itself displays the value.

All possible values of the parameters and the button labels are listed below:

Tracings display format:

Speed

 50 mm/s

 25mm/s

Amplitude

 5 mm/mV

 10 mm/mV

 20 mm/mV

61
 touchECG
6. EXECUTION OF THE EXAMINATION

Muscle filter

 25 Hz

 40 Hz

Note: The 150 Hz filter only works on 1000 Hz acquisitions and

 150 Hz
is only available in the Windows version.
 off

Note: the 25 Hz filter is stronger than the 40 Hz filter. Setting the filter to “off” disables muscle
filtering of the traces.

Format

 6x2 5 seconds of 6 leads in 6 channel format.

2.5 seconds of 12 leads in 3 channel format.

 3x4

2.5 seconds of 12 leads in 3 channel format; the fourth channel

 3x4+1
is a rhythm strip of 10 second lead defined by the user
(Rhythm Traces).
2.5 seconds of 12 leads in 3 channel format plus a strip of 10
 3x4+3
second leads defined by the user (Rhythm traces), in a 3-
channel format.
 12x1 10 seconds of 12 leads in 12 channel format.

 AVG Middle complexes

6.6.2. Modifying patient details

You can open the Patient window to modify the current patient data by clicking on the patient ID area as
show in figure (A).
The data can be entered/edited manually as described in par.6.4.2 or from a work list, as described in par.
6.4.4.

Note: if you access the Patient window from the examination preview window, the automatic patient details
entry options from the examinations archive are not available.

62
 touchECG
6. EXECUTION OF THE EXAMINATION

6.6.3. Modifying the automatic interpretation

If the program's interpretation option is enabled and “Automatic interpretation” is enabled in Settings, an
automatic interpretation is added to the examination. With the “Automatic interpretation” function (Par.
8.2.2) you can choose whether to display the automatic interpretation text in summary or extended mode,
or not display it at all.
The interpretation can be modified, or entered if not present, by clicking on the Interpretation area, as
shown in figure (B).

The automatic interpretation window allows you to edit the interpretation text, assign an overall evaluation
to the examination (Unknown, Normal, Abnormal, Borderline) and enter the name of the doctor.

The acquired examination is in the “Not Confirmed” status until the name of the doctor is entered in the
“Doctor” field of the Automatic Interpretation window. This way the examination switches to the
“Confirmed” status. Vice-versa, if the “Doctor” field remains empty or is deleted, the examination switches
to the “Not Confirmed” status.

Window for editing the interpretation

Buttons

 OK Closes the window, saves the data and changes the test status
to “Confirmed” if the “Doctor” field is filled in. The current
printing format (speed, amplitude, sampling rate, trace format,
muscle filter) is also saved in the test.
If the “Doctor” field is empty, the test will be “Not confirmed”
and any previously saved printing format will be deleted.

63
 touchECG
6. EXECUTION OF THE EXAMINATION

 Back Closes the window without saving the data and leaves the
examination's status set to “Not Confirmed".

Note: if the name of a doctor is not entered, the status of the examination remains “Not Confirmed”.

6.6.4. Identifying an urgent ECG examination

The acquired examinations can be identified as “urgent”, for example for flagging as such in Cardioline
ECGWebApp or in an external archive.

Once the examination has been created, you can flag it as “urgent” by clicking on Urgent. When this key is
pressed, the corresponding icon changes and the acquired examination is given the "urgent" status. Pressing
the key again toggles the "urgent" status.

Urgent on/off button

If the automatic saving option is enabled, the examination is re-saved automatically every time the "urgent"
status is modified (i.e. every time the Urgent button is pressed). If on the other hand the automatic saving
option is not enabled, the examination must be saved manually at each modification by pressing the
Save/Update button.

If an examination must be acquired urgently, it can be started without entering the patient's data, but simply
by pressing the Auto key on the real time display screen.
The resulting examination can be printed, saved or transmitted as it is without the patient's details, or you
can enter the details as described in para. 6.6.2.

You can enable the “Auto Stat” option in Settings to flag all acquired examinations as urgent. This is useful
when the program is used in an ambulance or an emergency ward. You can always cancel the urgent flag by
pressing the Urgent button.

Note: To transmit the examination as urgent, it must be sent after having modified the status.

6.6.5. Printing out and saving an ECG examination

If the automatic printing option is enabled (par. 8.2), the examination is printed automatically at the end of
the acquisition. Likewise, if the automatic saving option is enabled (par. 8.2), the examination is saved
automatically at the end of the acquisition.
If these options are not enabled, you can print out and save the examination with the Print and Save/Update
buttons (to save an examination or overwrite an existing one).

If you press Save/Update, the examination is saved in the local touchECG database and, if the settings are
correct (par. 8.2), on the computer as well, as an SCP file and/or PDF in the specified folders.

64
 touchECG
6. EXECUTION OF THE EXAMINATION

Each of the printed pages features:

 Header:
o On the left:
 patient data: ID, surname, name, gender, date of birth, race;
 examination data: height, weight, age, systolic and diastolic blood pressure,
SpO2, medications, notes, technician, order number
o In the centre: automatic measurements;
o On the right: automatic interpretation (if enabled);

 Footer:
o On the left: amplitude, speed, filters;
o In the centre: department name
o On the right: device model, software version.

Note: if the support device's default printer is a PDF file writer, printing launches this writer which creates a
PDF file.

Attention: If you are printing PDF files, you need to set up a corresponding program so that the document is in
no way adapted or scaled. If you are using Acrobat Reader, you need to select “Actual Size” in “Page
management and size.” Otherwise you may get non diagnostic quality prints.

Note: In case of Android operating systems, you should configure the printer first as described in section 5.5.

6.6.6. Transmitting an ECG examination

touchECG can transmit an examination to an external system (e.g. a Cardioline ECGWebApp system, an
examination management system, a CIS/PCS DICOM system, etc.), as described in par. 7.

If the automatic transmission option is enabled (par. 8.2), the examination is transmitted automatically at
the end of the acquisition. If the program fails to transmit the examination (no network connection, for
instance), the automatic transmit function periodically attempts to send the untransmitted examinations
until it is successful in doing so.

If the automatic transmission option is not enabled, you can transmit the examination by pressing the
Transmit button. See par. 7.3 for further details.
If one or more tests fail/s to send the application will try sending again until it is successful. When the
examination has been transmitted, the system displays the message “Examination transmitted".
If the user tries to close the application when there are still tests that need to be sent, a message window
will open warning the user that there are unsent tests.

65
 touchECG
6. EXECUTION OF THE EXAMINATION

Icon for tests to be sent

You can also transmit a specific examination or all untransmitted examinations from the examinations
archive window, as described in par.6.7.

Note: if the automatic transmit function is enabled, the automatic save function is also enabled.

Note: if the delete test after sending feature is enabled (only available if the Privacy option is active) the
test(s) is deleted after being transmitted successfully.

6.6.7. Sending an ECG examination by email

At the end of acquisition, you can send the examination by email by clicking on Email in Menu 2.
touchECG creates and opens a new email message in the computer's default email application, and attaches
the examination as a PDF report.

You can also send the examination by email from the examinations archive window, as explained in par. 6.7.

Note: in the Windows version, to send the examination by email, your email application must support the EML
format.

Note: in the Windows version, if no email application is configured, you will be prompted to open the “eml”
file with an application.

6.7. Test Archive

touchECG has an internal archive of completed examinations, which can store up to 1000 ECG's.
The examinations can be saved automatically or manually at the end of acquisition, as described in par. 6.6.4
To access the archive and display the list of saved examinations, open the Examinations Archive window by
clicking Examinations Archive in Menu 2 of the real time display window.

66
 touchECG
6. EXECUTION OF THE EXAMINATION

1 2

Opening the Examinations Archive window

Examinations archive window

The top left of the screen displays the number of examinations in the archive.
The following fields are displayed in order for each examination:
 Id: the patient's identification code
 Name and surname: the patient's name and surname

67
 touchECG
6. EXECUTION OF THE EXAMINATION

 Year of birth / age: the patient's year of birth and age

 Gender: the patient's gender
 Stat: the examination's urgent flag (Yes = urgent examination)
 Trx: the examination's transmitted flag (Yes = examination transmitted)
 Report: indicates whether the interpretation of the examination has been confirmed by a doctor or
not
 Date of examination: date and time of the examination
 Connectivity: connectivity option associated with the examination (linked to the HD+ unit used to
acquire the ECG, as described in par. 10.2).

Click on the column labels (e.g. “ID” or “Name and Surname) to order the list in increasing/decreasing order
by the field in question.
The “Search" field allows you to search for an examination containing the string entered in the “ID” or
“Name and Surname" fields.
In the Test Archive window you can select a test by clicking on the corresponding line to display it, transmit it
to an external system, print it out, send it by email as a PDF report or delete it, using the respective buttons.
You can also select multiple tests (only for Windows version) by clicking on the corresponding lines while
holding down the CTRL key. It is therefore possible to perform the same action on all selected tests using the
corresponding buttons: transmit them to an external system, print them out or delete them.

If you click on Delete you are prompted to confirm the action.

Displaying the examination opens the preview window described in par. 6.6.

Transmit all transmits all so far untransmitted examinations at the same time.

If you select an examination, you can automatically load the patient details associated with it by pressing Ok.
This closes the Examinations Archive window and loads the patient details into the real time display window.

Buttons

 Opens and displays the selected examination in preview mode

Display
(par. 6.6)
Transmits the selected test to an external system (see par. 7.3)

Transmit If the “Delete after sending” setting is enabled, the test is
deleted after transmission.
Transmits all non-transmitted tests to an external system (par.

7.3)
Transmit all
If the “Delete after sending” setting is enabled, the tests are
deleted after transmission.
 Printing Prints out the selected examination

 Send email Sends the selected examination by email (as a PDF report)

68
 touchECG
6. EXECUTION OF THE EXAMINATION

 Remove Deletes the selected examination

 OK Closes the window and loads the patent data associated with
the selected examination.
 Back Closes the window without loading the patent data associated
with the selected examination.

69
 touchECG
7. CONNECTIVITY, RECEIVING WORK LISTS AND TRANSMITTING ECG EXAMINATIONS

7. CONNECTIVITY, RECEIVING WORK LISTS AND

TRANSMITTING ECG EXAMINATIONS

7.1. General information

Using the support device technology (LAN, WiFi, GPRS, etc.), touchECG can connect to the internet and
external systems to receive work lists and transmit acquired examinations.

As described in par. 4.4, touchECG may be equipped with two different connectivity options, with different
protocols:
 Standard connectivity: for connection to external systems using a standard internet protocol
(http/https). In this mode, touchECG can connect to Cardioline ECGWebApp or other on-line systems
(e.g. GDT systems).
The following protocols are available:
o Receiving work lists:
˗ Cardioline: for connection with Cardioline ECGWebApp or with other systems in the
network
˗ GDT: for connection to GDT systems (only available in the Windows version)
˗ Text file: for importing work lists generated by other systems (only available in the
Windows version)
˗ XML: to connect with systems that support this Protocol (only available in the
Windows version)
o Transmitting examinations
˗ Cardioline: for connection with Cardioline ECGWebApp or with other systems in the
network
˗ GDT (Standard): for connection to GDT systems (only available in the Windows
version)
˗ XML: to connect with systems that support this Protocol (only available in the
Windows version)

 DICOM connectivity (optional): for connecting to external systems running the DICOM protocol. This
allows you to integrate the system into any PACS DICOM system for managing hospital work flows.
The following protocols are available:
o Receiving work lists:
˗ Cardioline: for connecting with DICOM systems

70
 touchECG
7. CONNECTIVITY, RECEIVING WORK LISTS AND TRANSMITTING ECG EXAMINATIONS

o Transmitting examinations
˗ Cardioline: for connection with Cardioline ECGWebApp

It is possible to implement other communication protocols, as well as allow the Android version to
communicate through the GDT and XML protocols.
Through ad hoc projects it is also possible to include other communication formats and protocols.

touchECG, finally, can export examinations as SCP and PDF files to specific folders on the computer and send
PDF examination reports via email.

Note: as indicated in par. 10, the connectivity options (Standard / DICOM) as well as the interpretation
options (none / Glasgow) are not linked to the touchECG software but to the HD+ acquisition unit in question.
It follows that whether an examination is transmitted in Standard or DICOM mode depends on the HD+ unit
used to acquire the examination.

7.2. Receiving a work list

touchECG can receive work lists from external systems, from which you can select the order corresponding
to the examination to be administered and thus automatically load the patient details associated with the
examination.

To receive a work list, click on Id in the real time display window (1) and then Work List in the Patient window
(2), as described in par. 6.4.

2
Id button in the real time display window and Work list button in the Patient window.

The work list is downloaded and displayed, and you can select an order to load (thus also loading the patient
details) or delete from the list.
See par. 6.4.4 for further details about work lists.

71
 touchECG
7. CONNECTIVITY, RECEIVING WORK LISTS AND TRANSMITTING ECG EXAMINATIONS

The work list can be acquired automatically (option -g) using the command line and, if necessary, always
automatically by launching the acquisition of a test in Auto mode (option -a) ; while if you only want to go
directly to the work list screen without making the choice of the first patient, you can use the -w option.

Work List display window

7.3. Uploading an exam

TouchECG can transmit examinations to an external system via internet.
The examinations can be transmitted automatically or manually at the end of acquisition, as described in
par. 6.6.6, or by accessing the Examinations Archive by selecting the examination in question and clicking on
Transmit. From the Examinations Archive you can also transmit all untransmitted examinations together with
Transmit all.
See par. 6.7 for further details about the Examinations Archive.

72
 touchECG
7. CONNECTIVITY, RECEIVING WORK LISTS AND TRANSMITTING ECG EXAMINATIONS

Examinations archive window

7.4. Sending an examination by email

Examinations can be emailed as PDF attachments.
This can be done either from the preview window at the end of acquisition (par. 6.6), or from the
Examinations Archive (par. 6.7) using the Send email button.

Send email button

Note: in the Windows version, to send the examination by email, your email application must support the EML
format.

Note: in the Windows version, if no email application is configured, the message “Could not send, no email
application installed” will be displayed.

73
 touchECG
7. CONNECTIVITY, RECEIVING WORK LISTS AND TRANSMITTING ECG EXAMINATIONS

7.5. Saving an examination in SCP and PDF format

Once an ECG has been acquired, it can be saved automatically or manually, as described in par. 6.6.4.
In particular, at each save (automatic or manual) the examination is also exported as a SCP and/or PDF file in
the folder indicated in “scp folder" and “pdf folder" in the OTHER tab in Settings (par. 8.2). If no folder is
specified, the examination is saved in the default folder:

Windows:
C:\Users\[NomeUtente]\Documents\touchECG\scp
C:\Users\[NomeUtente]\Documents\touchECG\pdf

Android:
/storage/emulated/0/Documents/touchECG/scp
/storage/emulated/0/Documents/touchECG/pdf

If you set the “Filename format" you can specify the structure of the filenames of saved PDF and SCP files.

The “Automatic SCP export" and “Automatic PDF export" options automatically export the examinations
after they have been acquired.

You can also export the SCP / PDF files after completing the examination, by clicking Display in the
Examinations Archive. This opens the examinations Preview window, which contains the commands for
processing examinations, including saving (see para. 6.6 and 6.7).
If the setting "Include filtered data in the SCP file" is enabled (see par. 8.2.6) the filtered tracks are saved in
the SCP file, with the same filter applied on the screen. Vice versa, the raw data are saved.

7.6. Connectivity formats and protocols

7.6.1. GDT (in the Windows version only)

GDT mode allows you to connect to systems using the GDT format.
You can then receive worklists and send examinations in GDT format.
To launch TouchECG automatically from a GDT system, launch the program from the command line as
described in Par. 5.5.
To connect to GDT systems, click on “GDT” in the “Receiving protocol”, “Transmission protocol" and
“Protocol configuration" fields in the CONNECTIVITY tab in Settings (see para. 8.2)
You must also configure the fields which appear after having selected “Protocol Configuration”:

 Work list folder: path of the folder containing the work lists created by the GDT system
 Examinations folder: path of the folder in which touchECG saves the GDT format examinations, for
uploading to the GDT system

74
 touchECG
7. CONNECTIVITY, RECEIVING WORK LISTS AND TRANSMITTING ECG EXAMINATIONS

ATTENTION: if the name of the file with the GDT extension is also entered in the path of the exam
folder, the system creates a file with exactly that name while otherwise a causal name with the GDT
extension is created.
Eg :
Exam folder C: \ GDT \ OUT \ RX_EDP.GDT => a file is created in the chosen folder with the name
RX_EDP.GDT
Exam folder C: \ GDT \ OUT => a file is created in the chosen folder with the causal name ADNAN £
432423DFDSF £ 43.GDT

 Attach PDF examination: if enabled, allows you to attach a PDF examination report to the GDT
examination file

GDT settings

As mentioned, the structure and content of the PDF report which is attached to the GDT test is defined
according to the touchECG settings.

7.6.2. Cardioline Standard

If the Standard Connectivity option is available, Cardioline mode allows you to connect to the Cardioline
ECGWebApp application.
This means you can receive work lists prepared in Cardioline ECGWebApp and send SCP format examinations
to it.

To connect to Cardioline ECGWebApp, click on “Cardioline” in the “Receiving protocol”, “Transmission

protocol" and “Protocol configuration" fields in the CONNECTIVITY tab in Settings (see para. 8.2)
You must also configure the fields which appear after having selected “Protocol Configuration”:

 Connection URL: address of the server running Cardioline ECGWebApp to which you wish to connect
 Username: username used by touchECG to automatically access Cardioline ECGWebApp (this must
be a user authorised to transmit examinations – for details, refer to the Cardioline ECGWebApp user
manual)

75
 touchECG
7. CONNECTIVITY, RECEIVING WORK LISTS AND TRANSMITTING ECG EXAMINATIONS

 Password: password for the username with which touchECG automatically accesses Cardioline
ECGWebApp

Cardioline connectivity settings

7.6.3. Cardioline DICOM

If the DICOM connectivity option is available, touchECG can connect to external DICOM systems.

To connect in DICOM mode, click on “Cardioline” in the “Receiving protocol”, “Transmission protocol" and
“Protocol configuration" fields in the CONNECTIVITY tab in Settings (par. 8.2)
You must also configure the fields which display when you click on “Protocol configuration":

 Connection URL: IP address

 Username: not required
 Password: not required

7.6.4. Text file (in the Windows version only)

Text file mode allows you to receive work lists as text files.
For each order in the work list there must be a text file containing the patient details with a structure similar
to the following:

ID FIRSTNAME LASTNAME SEX BIRTHDATE RACE

WEIGHT WEIGHTUM HEIGHT HEIGHTUM SYSTOLIC DYSTOLIC
DRUG NOTES TECHNICIAN EMAIL ADDRESS ACCESSIONNUMBER
STAT
123456 mario rossi 1 19730512 1
90 0 190 0 80 120
drugs notes Dr. Bianchi m@email.it via linz 2 acess01
1

76
 touchECG
7. CONNECTIVITY, RECEIVING WORK LISTS AND TRANSMITTING ECG EXAMINATIONS

All or only some of the fields may be present, and they must be separated by tab characters. The fields
correspond to the following details and take the following values:

 ID: Patient ID – alphanumeric string

 Firstname: First name – alphanumeric string
 Lastname: Last name – alphanumeric string
 Sex: Sex – 0 = unknown, 1 = male, 2 = female
 Birthdate: date of birth – string in format YYYYMMDD (e.g. 19901231: year = 1900, month = 12, day
= 31)
 Race: Race – 0 = not specified , 1 = caucasian, 2 = black, 3 = oriental
 Weight: Weight – integer, followed by unit 0 = kg, 1 = lb
 Weightum: Unit of measurement of weight – 0 = kg, 1 = lb
 Height: height – integer
 Heightum: Unit of measurement of height – 0 = cm, 1 = in
 Systolic: Systolic pressure – integer
 Diastolic: Diastolic pressure – integer
 Drug: Pharmacological therapy – alphanumeric string
 Note: Additional remarks – alphanumeric string
 Technician: Name of technician administering the examination – alphanumeric string
 Email: Email address of patient – alphanumeric string
 Address: Physical address of patient – alphanumeric string
 Accession number: Reservation number – alphanumeric string
 Stat: “urgent” examination status – 0 = not urgent, 1 = urgent

To import a work list as a text file, select “Text file” in the “Receiving protocol” and “Protocol configuration”
fields in the CONNECTIVITY tab of Settings (par. 8.2)
You must also configure the fields which display when you click on “Format configuration":

 Work list folder: folder containing the text format work list
 Format: indicates the format of the work list (only “Standard” is currently available)

Note: Text file mode is only available for receiving work lists, it cannot be used for transmitting examinations.

77
 touchECG
7. CONNECTIVITY, RECEIVING WORK LISTS AND TRANSMITTING ECG EXAMINATIONS

Text file settings

7.6.5. XML (in the Windows version only)

XML mode allows you to connect to systems using the XML format.
You can then receive work lists in XML format and send tests in XML format.
To connect in XML mode, select “XML” in the “Receive protocol”, “Send protocol” and “Protocol
configuration” fields in the CONNECTIVITY tab of the Settings (see par.8.2)
You must also configure the fields which appear after having selected “Protocol Configuration”:

 Examinations folder: path of the folder in which touchECG saves the XML format examination file.

XML settings

78
 touchECG
8. DEVICE SETTINGS

8. DEVICE SETTINGS

8.1. General information

The Settings window is accessible from the real time display window, by pressing Open menu (to open the
secondary menu) and then Settings.

2
Opening the Settings window

The Settings window has several panels, each of which has data entry fields:

 System: basic touchECG settings (HD+ unit, language, AC filter, etc.);

 ECG: signal acquisition settings (muscle filter, QTc, type of interpretation, etc.);
 Manual: trace display and manual printout settings (grid, trace format, speed, etc.);
 Auto: automatic printout settings (trace format, speed, number of copies, etc.);
 Connection: connectivity settings;
 Other: other settings (save mode, bookmarks, etc.);
 License: lists enabled options and updates.
 Security: set a security code (PIN) that allows access to the settings section to be protected.

79
 touchECG
8. DEVICE SETTINGS

Use Save and Back to save or cancel any changes.

Settings Window

Buttons

 Updates the program active options (Interpretation / DICOM).

Update license
Active only in the “License” tab.
 Save Closes the window and saves the changes.

 Closes the window without saving the changes.

Back

80
 touchECG
8. DEVICE SETTINGS

8.2. Summary of settings

8.2.1. PACS

Field Function Possible values

Connection type Bluetooth connection type: standard or via Standard / Cardioline
Cardioline HD + Bluetooth Dongle. Dongle
HD+ serial number Serial number of the HD+ unit you wish to Dropdown menu with a list
connect of acquisition units paired
with the computer
HD+ auto off Time after which, if there is no acquisition, the Deactivated / 5 min / 15
HD+ acquisition device is switched off min / 30 min
automatically.
Language Language used for display and printing. English / Italian / German /
French / Spanish /
Portuguese / Czech /
Turkish / Russian / Polish
AC filter Value of the filter to eliminate disturbance Off / 50 Hz / 60 Hz
introduced by the electrical mains. The value
must correspond to the mains frequency (e.g.
60 Hz in the USA and 50 Hz in Europe).
HD+ sampling freq. Sampling frequency of the HD+ acquisition 500 / 1000 Hz
device (the higher the frequency, the higher (1000 Hz Windows version
the bandwidth of the signal). only)
Antialias filter Filter which smooths out the signal On/Off
Rhythm lead Selects the continuous trace to be displayed in v1 / v2 / v3 / v4 / v5 / v6 / I
the real time display window / II / III / aVR / aVL / aVF /
-aVR (inverted aVR)
QRS sound Turns the heartbeat sound on / off. If on, the On/Off
real time display window beeps at every
heartbeat.
Unit of measurement of Units of height (cm, in, mm) cm/in/mm
patient height
Unit of measurement of Units of weight (kg or lb) kg/lb
patient weight
Display race Visibility of the race field in the patient's data Yes/No
and in print.
Reservation number Display/modify the reservation number field Concealed / Print only /
Modifiable

81
 touchECG
8. DEVICE SETTINGS

8.2.2. ECG

Field Function Possible values

Muscle filter Filter to reduce muscle noise applied to the Off / 25Hz / 40Hz / 150 Hz
tracings. (150 Hz Windows version
only)
Automatic interpretation Selects whether and what type of automatic Off / Short / Extended
interpretation to use. If off, the interpretation
is not included in the examination and in the
print. If “short” the short strings are used, if
“extended” the long strings are used.
Only available if touchECG has the
Interpretation option.
Show examination status Selects whether to include “Report confirmed On / Off
by..." or “Report not confirmed" in the
examination
QTcB Activates the QT corrected calculation of On/Off
Bazett
QTcF Activates the QT corrected calculation of On/Off
Fredericia
Auto Stat Automatically sets the urgent flag for all On/Off
examinations
Automatic bookmark (min) Sets automatic bookmarking during Numerical field
acquisition. Indicates the interval between
bookmarks.
Department name Name of the department (included in the Alphanumeric text field
printout and the examination)
Disable the lead fail screen Allows turning off the display of the square On/Off
waves in case of lead fail, so that you can see
the real signal. Useful for patients with high
impedance or with under-performing
electrodes.

8.2.3. Manual (Windows version only)

Field Function Possible values

Lead sequence Order in which tracings are displayed and Standard / Cabrera
printed.
Trace format Tracings display format. 12x1, 6+6, 3x1
Speed mm/s Trace speed in display and manual printout. 50/25/10/ 5 mm/sec
Amplitude mm/mV Trace amplitude in display and manual 20/10/5/2.5 mV/mm
printout.
Grid Selects the type of grid to use in printouts. Blank / Partial / Complete

82
 touchECG
8. DEVICE SETTINGS

Field Function Possible values

Grid colour Selects the colour of the grid to use in Colour / Black and white
printouts.

8.2.4. Auto

Field Function Possible values

Printing format Automatic mode trace printout format 12x1 / 6x2 / 3x4 / 3x4+1 /
3x4+3 / 12 complex
Rhythm lead 1 1st rhythm lead (3x4+1 e 3x4+3) From I to V6 (default II)
Rhythm lead 2 2nd rhythm lead (3x4+3) From I to V6 (default V1)
Rhythm lead 3 3rd rhythm lead (3x4+3) From I to V6 (default V5)
Speed mm/s Auto printout traces speed. 25 / 50 mm/s
Automatic print Automatic printing of examination at the end On/Off
of acquisition in automatic mode.
Extra copies Number of printed copies. If 0, only the 0 - 5 (default 0)
Windows version only original copy is printed, if 1 the original + 1
copy are printed, if 2 the original + 2 copies are
printed, and so on.
Add Median Page To include the Median page and the vector On / Off
ECG in the exported PDF document.
Save exam in filtered Save the exams in filtered mode, with this On / Off
mode mode it will no longer be possible to change
the muscle filter once saved

8.2.5. Connectivity

Field Function Possible values

Device # Device ID Alphanumeric text field
Department ID Department ID It lets you enter one Alphanumeric text field
Ward/Department ID only or several IDs, each
separated by the characters ',', '\', '\n', ' ', '|' or
';'.
Boot Screen It lets you start TouchECG with a screen for On/Off
manual Ward ID entry (see para.5.2.1). It is
disabled by default.
Automatic transmission Allows to automatically transmit an exam On/Off
when it’s saved. If enabled, the automatic save
function is enabled as well.
Delete test after sending This allows the test to be deleted after having On/Off
been sent successfully.

83
 touchECG
8. DEVICE SETTINGS

Field Function Possible values

Receiving protocol Sets the work list receive protocol. Blank / GDT / Cardioline /
Text file / XML
Transmission protocol Sets the examination transmit protocol. Blank / GDT / Cardioline /
XML
Protocol configuration Sets which protocol to configure. Which fields Blank / GDT / Cardioline /
display depends on this parameter. Text file / XML
Note: DICOM connectivity is achieved by using “Cardioline” protocol and configuring it as described in par.
7.6.3.
Protocol configuration – GDT (Windows version only)
Work list folder Path of the folder containing the work lists Alphanumeric text field
created by the GDT system (selectable with the
mouse using the "Browse" button).
Examination folder Path of the folder in which touchECG saves the Alphanumeric text field
GDT format examinations, for uploading to the
GDT system (selectable with the mouse using
the "Browse" button).
Attach PDF examination If enabled, allows you to attach a PDF On/Off
examination report to the GDT examination
file
Protocol configuration – Cardioline
Connection URL Standard connectivity: Alphanumeric text field
Address of the server running Cardioline
ECGWebApp to which you wish to connect

DICOM connectivity:
IP address
Username Standard connectivity only: Alphanumeric text field
username with which touchECG automatically
accesses Cardioline ECGWebApp
Password Standard connectivity only: Alphanumeric text field
password for the username with which
touchECG automatically accesses Cardioline
ECGWebApp
Protocol configuration – Text file (Windows version only)
Work list folder Folder containing the text format work list Alphanumeric text field
(selectable with the mouse using the "Browse"
button).
Format Format of the work list (only “Standard” is Standard
currently available)
Protocol configuration – XML (Windows version only)
Test folder Path of the folder in which touchECG saves the Alphanumeric text field
test file in XML format (selectable with the
mouse using the "Browse" button).

84
 touchECG
8. DEVICE SETTINGS

8.2.6. Other

Field Function Possible values

SCP auto export Sets automatic export to the specified folder of On/Off
the SCP format examination file after
acquisition.
SCP folder Path of the folder to which the SCP files are Alphanumeric text field
exported (selectable with the mouse using the
"Browse" button).
PDF auto export Sets automatic export to the specified folder of On/Off
the PDF format examination file after
acquisition.
PDF folder Path of the folder to which the SCP files are Alphanumeric text field
exported (selectable with the mouse using the
"Browse" button)..
Filename format Sets the format of exported file names, with Alphanumeric text field
the following options:
{ID}_{PATIENTID}_{FIRSTNAME}_{LASTNAME}_{
GENDER}_{BIRTHDATE}_{AGE}_{TIMEOFACQUI
SITION}_{ACCESSIONNUMBER}_{CART}_{CONFI
RMED}
Database path Path of folder in which the program's database Alphanumeric text field
Windows version only is created and saved (selectable with the
mouse using the "Browse" button).
Virtual keyboard Turns the virtual keyboard on/off. On/Off
Send statistics / errors Enables you to send the log file automatically On/Off
to the Cardioline server for assistance and
support.
Launch application If set, configures the system to launch an Alphanumeric text field
Windows version only external application when the respective
button is pressed in the real time display
window. The value is the path of the
application in question.
Automatic DPI Enables the program to adapt the graphics On / Off
automatically according to the DPI of the
monitor being used. If it is disabled it uses
standard as default.
Quick user interface For quick viewing of the display window in real On / Off
time, in which only a few buttons are shown
(see par. 4.5).
Kiosk mode If enabled, it allows you to launch the On / Off
Windows version only application in “Kiosk” mode, i.e. full screen
with full PC control (no other application can
be used at the same time).
Available only on Windows 10 operating

85
 touchECG
8. DEVICE SETTINGS

Field Function Possible values

system.
E-mail address This allows the email address which the tests Alphanumeric text field
are to be emailed to, to be changed. By
default, the address is:
noreply@yourdomain.com.

8.2.7. License

Field Function Possible values

HD+ license Checks whether the connected HD+ unit is Read only
licensed for touchECG.
Type of interpretation Indicates the active interpretation type: none Read only
(no automatic interpretation available) or full
analysis (Glasgow)
Connectivity Indicates the active connectivity option: Read only
standard (standard internet connectivity) or
DICOM (compatible with the DICOM protocol)
Privacy Indicates the active option for the privacy Read-only
mode, which enables the features described in
paragraph 9.
Activation code Allows you to enter a code to update the Alphanumeric text field
active options (par.10)

8.2.8. Safety

Field Function Possible values

Safety Allows you to enable the protection of the On / Off
settings. If “Security” = On when accessing the
settings window, the PIN must be entered
PIN Security code Numerical text field (4
digits)
Verification PIN Confirmation of the security code Numerical text field (4
digits)

8.3. Protection of the Settings

You can set a security code (PIN) that allows access to the settings section to be protected. In this way you
can prevent the settings from being changed accidentally or by unauthorised personnel.
Proceed as follows to enable the protection of the settings:
 set the "Security" field to "On"

86
 touchECG
8. DEVICE SETTINGS

 enter the digits of the security code in the "PIN" field

If the value entered in the "verify PIN" field differs from the one entered in the "PIN" field, an error
message appears in the lower bar of the application and the settings cannot be saved
 enter it again to confirm the value of the security code in the "verify PIN" field

The security code must be numerical and a maximum of 4 digits.

Click on Save to save this setting.

Subsequent log-ins to the Settings section will require the PIN to be entered, as shown in the figure, which
must be entered in the text field shown.

Buttons

 OK Confirm the PIN and if correct, it allows you to access the

Settings.
If the PIN is not correct, an error message is shown in the
lower bar of the application
 Back Closes the window without opening the Settings.

87
 touchECG
8. DEVICE SETTINGS

8.4. Virtual Keyboard Management (Windows version only)

Recommended parameters are provided below to manage the virtual keyboard correctly to use the
touchECG.

VERSION DEVICE SETTINGS

Windows 10 Touchscreen system with
 Disable the "Virtual keyboard" setting from
Anniversary no physical keyboard
touchECG
 Enable the "Tablet mode" or "Show virtual
keyboard” when tablet mode is not enabled from
Windows

(refer to the Microsoft Windows guide)

Windows 10 Touchscreen tablet with no You can choose whether to control activation of the
physical keyboard virtual keyboard from the touchECG or from the
operating system.
In the latter case, follow the instructions such as in
the Windows Anniversary Edition.
If you want to control the opening of the virtual
keyboard from the touchECG, make the following
settings:
 Ensure the "tablet mode" is disabled from the
Windows settings.
 Always from the Windows settings, disable "Show
virtual keyboard when tablet mode is not
enabled"
 Enable "Virtual Keyboard" from the touchECG
settings
Windows 7 Touchscreen tablet with no Use the default settings
Windows 8 physical keyboard

88
 touchECG
9. SET THE DEVICE IN ACCORDANCE WITH GDPR (General Data Protection Regulation) – Windows only

9. SET THE DEVICE IN ACCORDANCE WITH GDPR (General

Data Protection Regulation) – Windows only

9.1. General information

touchECG, Windows version from v. 3.40 onwards – if fitted with the Privacy option, it provides a series of
features (described in the table below) that can be used by the Data Controller in order to comply with the
minimum requirements of EU Regulation 2016/679, known as GDPR (General Data Protection Regulation).

GDPR requirement Solution

Access control Through the use of username and password at Operating System level and
installing an instance (each one with its own database to which only the
corresponding user can access) of touchECG for each user.
Data at rest protection By the system administrator, activating the encryption features of the
operating system.
Audit trail Through the log of the Windows operating system, which traces the
operations performed on the system. Moreover, touchECG allows you to
reduce the number of tests saved in the local memory to limit data exposure.
Patient data removal (right It is possible to delete the examinations from the archive and to activate the
to be forgotten) automatic cancellation of the examinations after the transmission (where the
use scenario foresees it).

9.2. Encrypt the folder containing the database

Proceed as follows to encrypt the folder containing the touchECG database:
 Locate the database path from the Settings window > OTHER > “Database path”;

 Using the Windows File Explorer tool, open the folder that contains the database folder, for example
C:\Users\a.falappi\AppData\Local\touchECG;
 Select the database folder, right-click and select “Properties”;
 Click “Advanced” and check the selection “Encrypt content..”

89
 touchECG
9. SET THE DEVICE IN ACCORDANCE WITH GDPR (General Data Protection Regulation) – Windows only

9.3. Enable the audit trail

The audit trail feature is automatically enabled if the software is normally installed from the CD through the
Standard setup, whereas for the ClickOnce version, it must be enabled as follows:
 Download it from the website: http://update.cardioline.com/touchECG/EnableEventViewer.zip
 Extract the file into a local folder and run the “EnableEventViewer.cmd” command with
administrative privileges;
 Check the touchECG option “Enable audit trail” in event viewer under “windows\application logs”.

9.4. Enable the “Delete test after sending” setting.

To enable the “Delete test after sending” setting, see par. 8.2.5.

90
 touchECG
10. UPDATING THE SOFTWARE AND OPTIONS

10. UPDATING THE SOFTWARE AND OPTIONS

10.1. Updating the software

10.1.1. Updating on Windows

Every week when the program is closed, if an active network connection is available, touchECG checks for
any software updates on-line. If any are available, you can download and install them automatically as
described in par. 5.1.

10.1.2. Updating on Android

For Android systems, updates will be made available directly on Play Store. These updates will therefore be
notified in Play Store as soon as available, and it will be possible to download them from there and install
them with the usual procedures for Android apps.

10.2. Updating enabled options

10.2.1. General information

The options available on touchECG are controlled by the HD+ unit connected to it. Indeed, depending on the
options enabled on the HD+, the corresponding touchECG options are enabled or not. It follows that
depending on the acquisition unit in use and its enabled options, the touchECG may have different enable
functionality.

In particular, the following options are available:

 HD+ license: enables the unit to connect to and communicate with touchECG
 Interpretation: enables the Glasgow automatic interpretation algorithm
 DICOM connectivity: enables connection to external systems using the DICOM protocol
 Privacy: this is used to enable the settings to guarantee compliance with GDPR (General Data
Protection Regulation).

The options enabled on the HD+ unit connected to touchECG are summarised in the LICENZA (LICENSE) tab
in Settings (par. 8.2).

Note: since the available functions depend on the HD+ unit you are using, these functions will be reflected in
the acquired examinations.

91
 touchECG
10. UPDATING THE SOFTWARE AND OPTIONS

For example, an examination acquired by an HD+ without the interpretation option enabled will not have an
automatic interpretation, while an examination acquired to the same touchECG with an HD+ unit with the
interpretation option enabled will have an automatic interpretation.
In the same way, an examination acquired by an HD+ unit without the DICOM connectivity option cannot be
transmitted to a PACS system, while an examination acquired to the same touchECG but with an HD+ unit
with its DICOM connectivity option enabled can be transmitted to a PACS system.

Settings window – LICENSE tab

10.2.2. Entering the activation code

To update the available options, and activate new ones, you must enable them on the HD+ unit.

To do so, request the activation code for the options in question from Cardioline SpA.
Once you have the code, connect the HD+ unit you wish to update to the computer and select it in the
Settings window, as described in par. 5.3.
You can now open the LICENZA (LICENSE) tab and enter the activation code in the respective field. If the
code is valid, the Update license button enables; click on it to start the update process.

Update license button

When the update completes, the new enabled options are listed in the LICENZA (LICENSE) tab.

92
 touchECG
11. MAINTENANCE AND TROUBLESHOOTING

11. MAINTENANCE AND TROUBLESHOOTING

11.1. General information

touchECG is software and as such is maintenance-free.

For the maintenance of the HD+ acquisition unit, refer to its user manual.
In the same way, for the maintenance of the support device, refer to the user manual supplied with the
computer.

If necessary, contact Cardioline SpA or an authorised distributor for assistance or to report malfunctions and
anomalies.

Note: the computer should not be serviced in the patient area; make sure that you have taken all necessary
precautions to eliminate electrical hazards (see par. 2).

11.2. Operation check

You can check the operation of touchECG and its connection to the HD+ unit with an ECG simulator, to
acquire a standard 12 lead ECG of known amplitude, so that you can check that the signal displayed by
touchECG is conforming to the generated signal.

11.3. Bluetooth
No issues related to “pairing” the HD+ Cardioline device with the touchECG system have been found on
tested systems.

Please also note that the correct start-up procedure of the HD+ system and touchECG is:
 first switch on the HD+ unit
 then start touchECG

This prevents having to place the HD+ device in error (fast flashing blue). If this problem arises it is advisable
to wait for the HD+ to switch off automatically or remove the batteries and turn it back on.
If the Bluetooth signal is “lost”, the user is warned by a message that appears.

If you repeatedly experience any Bluetooth related problems it is advisable to proceed as follows:
 Move the HD+ closer to the touchECG;
 Disable WiFi on the tablet/computer being used;

93
 touchECG
11. MAINTENANCE AND TROUBLESHOOTING

 Set the sampling rate to 500hz;

 Replace the BT antenna or, if internal, use an external Bluetooth key verified by Cardioline;
 Ensure both the HD+ device and the tablet have fully charged batteries, otherwise replace the
batteries or charge them; both devices should always have the maximum available charge;
 Disable automatic updates on Windows systems
 Disable or remove antivirus and firewall client programs.

11.4. Troubleshooting table

Problem Cause Solution

touchECG does not Bluetooth signal weak or with Approach the HD+ unit to touchECG
connect to the HD+ interference

touchECG does not The HD+ is switched off Turn it on

connect to the HD+
touchECG does not HD+ received an incorrect Turn the HD+ unit off and back on again
connect to the HD+ Bluetooth connection or the HD+
acquisition device flashes
unexpectedly
When REALTIME The HD+ unit's battery is exhausted Replace the battery
launches, the HD+ unit
turns off

11.5. Messages and solutions table

Message Cause Solution

General errors
Database full, delete some tests or Examinations archive Delete some or all examinations from the
the ones that have already sent full Examinations Archive window to make
will be automatically eliminated. space for new ones.
If you are unable to delete the
examinations, touchECG will delete them
automatically, starting with previously
transmitted ones
Database almost full, delete some Examinations archive Delete some or all examinations from the
tests. almost full Examinations Archive window to make
space for new ones and avoid automatic
deletion.
The old transmitted examinations Automatic deletion of Delete some or all examinations from the
have been deleted transmitted Examinations Archive window to make
examinations due to the space for new ones and avoid automatic

94
 touchECG
11. MAINTENANCE AND TROUBLESHOOTING

Message Cause Solution

Examinations Archive deletion.
being full.
Check the electrodes: Bad contact of the skin Check that the electrodes are properly
with the electrodes connected to the patient.
HD+ SEARCH The system is searching Information message. No problem
for the acquisition unit. associated with this message. Wait for the
system to connect to the HD+ unit.
HD+ IS NOT LICENSED FOR The HD+ has been Use another acquisition unit or contact
TOUCHECG 3 identified but it is not Cardioline SpA for a license (par. 10)
licensed for connection
to touchECG.
HD+ NOT FOUND No connection could be The HD+ unit has not been found and no
made with the HD+ unit. connection was made. Check that HD+ is
switched on and near the computer.
HD+ BATTERY LOW, PLEASE HD+ battery low. Replace the battery.
CHANGE
START REALTIME Start of real time Information message. No problem
acquisition. associated with this message.
WAITING FOR AUTOMATIC 10s of signal not Information message. No problem
ACQUISITION 10 SECONDS: available for the associated with this message. Wait for the
examination system to acquire 10s of signal.
WAITING FOR ACQUISITION OF AT 10s of signal not Information message. No problem
LEAST 10 SECONDS: available for printout associated with this message. Wait for the
system to acquire 10s of signal.
Error settings NOT saved The settings have not Check that the entries are valid and in the
been saved correct format
Database found! touchECG has opened Information message. No problem
the application database associated with this message.
DATABASE UPDATED touchECG has opened Information message. No problem
SUCCESSFULLY the application database associated with this message.
Database error check writing The touchECG database The database or folder does not have
permits is write protected write permissions; try entering them.
Failed loading, error in archive The examination in the If the error persists, delete the
database is corrupted examination from the archive
SYSTEM INITIALISATION The touchECG system is Information message. No problem
booting up associated with this message.
Failed email, no email programme Error in crating the Configure an email program and try again.
installed email due to the fact
that no email
application has been
configured on the
computer
PRINT ERROR, PLEASE CHECK The printer is not ready Check that the printer is online and ready
PRINTER

95
 touchECG
11. MAINTENANCE AND TROUBLESHOOTING

Message Cause Solution

PRINTER NOT FOUND No printer is configured Add a printer to the system
in the system
Not saved, no more space on disc The touchECG database Contact Cardioline support or delete the
or insufficient permits has an error database (all saved examinations will be
lost); touchECG will create a new one.
PDF creation error File save error Check the save path and permissions
Error on SCP file creation File save error Check the save path and permissions
FOLDER NOT FOUND, PLEASE Plugin configuration Check the settings of the plugins enabled
CHECK PLUGIN SETTINGS AGAIN error in the touchECG settings
FILE NOT FOUND, PLEASE CHECK Plugin configuration Check the settings of the plugins enabled
PLUGIN SETTINGS AGAIN error in the touchECG settings
PLUGIN CONNECTION NOT Plugin configuration Check the settings of the plugins enabled
CONFIGURED error in the touchECG settings
GENERIC ERROR Application error Contact Cardioline support
NOTHING TO SEND No examinations Acquire an examination and save it to the
available to send application database
PATIENT ACQUIRED Working List acquired Information message. No problem
associated with this message.
CONNECTION IN The system is Information message. No problem
PROGRESS...PLEASE WAIT connecting to an associated with this message.
internal or external
system
RECEIVED TESTS/UPDATED TESTS Examinations have been Information message. No problem
COUNT: sent to an internal or associated with this message.
external system
SENT TEST Examination sent Information message. No problem
successfully. associated with this message.
SENT TEST COUNT: Number of Information message. No problem
examinations sent associated with this message.
FILE NOT COMPATIBLE The GDT configuration Check that the file matches the
file is not compatible specifications of para. 7.6.1.
PRINTING IN PROGRESS The print job of an ECG Information message. No problem
test has been launched associated with this message. Wait for the
printer to complete printing
WEAK BLUETOOTH SIGNAL Communication is Error message. Move the HD+ device
problematic with HD+ toward the touchECG. For the Windows
version, in case of continuing lost packets
and if the sampling frequency is set at
1000 Hz, change the sampling frequency
to 500hz. In any case check the
instructions of par. 2.1.

96
 touchECG
12. TECHNICAL SPECIFICATIONS

12. TECHNICAL SPECIFICATIONS

ECG acquisition (HD+ unit)

ECG leads ..........................................12-leads (I, II, III, aVR-L-F, V1-6)
Patient cable......................................10 replaceable wire patient lead
CMRR ................................................115dB
DC input impedance ..........................100MΩ
A/D converter ....................................24 bit, 32000 samples/second/channel
Front-end sampling frequency ...........32000 samples/second/channel
Sampling frequency for signal Windows: 1000 samples/second/channel
analysis..............................................Android: 500 samples/second/channel
A/D conversion ..................................20 bit
Resolution .........................................<1 μV/LSB
Dynamic range...................................+/- 400 mV
Bandwidth .........................................Windows: Performances equivalent to 0.05-300 Hz
Android: Performances equivalent to 0.05-150 Hz
Pacemaker detection .........................Hardware detection coupled with digital convolution filter
De fibrillation protection....................AAMI/IEC standard
Front-end performance .....................ANSI/AAMI IEC 60601-2-25:2011
Data transfer .....................................Bluetooth 2.1+ EDR with “secure pairing”
Processing
Operating system ..............................Windows / Android
Pacemaker detection .........................Hardware recognition (HD+ acquisition unit)
Lead-fail detection .............................Independent for all leads
Cardiac frequency range ....................30 - 300 bpm
Sampling frequency Windows: 1000 samples/second/channel
Android: 500 samples/second/channel
Base line stabilisation.........................Fully digital diagnostic high pass filter
AC filter .............................................Adaptive 50/60 Hz digital filter
Muscle filters .....................................Linear phase digital diagnostic high-pass filter (according to 60601-2-
25 2nd ed.)
50/60 Hz AC interference adaptive digital filter
Digital low pass filter (for printout and display):
Windows: 25/40/150 Hz
Android: 25/40 Hz

97
 touchECG
12. TECHNICAL SPECIFICATIONS

ECG acquisition mode ........................Automatic (12 leads), Manual (3/6 leads), Review (12 leads)
Lead configuration .............................Standard, Cabrera
ECG measurements ...........................All leads, medians, corrected
HR
Average RR
PR Interval
QRS Duration
QT and QTc (Hodges formula) intervals
QTc Bazett interval
QTc Fridericia interval
max R[V5];[V6] and S[V1]
Sokolow-Lyon Index
P, R, T axis
ECG interpretation.............................Glasgow algorithm for adults, paediatric, STEMI (optional)
ECG interpretation parameters ..........Race, sex, age, drugs
Memory.............................................Internal archive up to 1000 ECGs
Processing Options
Interpretation ....................................Glasgow algorithm for adults, paediatric, STEMI
Connectivity ......................................DICOM
Exported formats
SCP-PDF-XML-GDT .............................Standard format
DICOM...............................................Included in DICOM connectivity option
HL7 ....................................................Optional
Connectivity
USB-LAN-WiFi ....................................Dependent on support device (computer)
Printing
Resolution .........................................Variable in relation to printer
Paper type .........................................Variable in relation to printer
Sensitivity/gain ..................................5, 10, 20 mV/mm
Automatic print speed .......................25, 50 mm/s
Automatic print .................................3, 3+1, 6, 12 channels; Standard or Cabrera;
Automatic print formats ....................12x1, 6x2, 3x4, 3x4+1, 3x4+3
Manual print speed............................5, 10, 25, 50 mm/sec
Manual printing .................................3, 6, 12 channels; Standard or Cabrera;
Manual print formats.........................12x1, 6+6, 3x1

98
 touchECG
12. TECHNICAL SPECIFICATIONS

12.1. Filter features

The device adopts different filtering techniques in order to process the signal and make it easier for the
cardiologist to make the diagnosis.

The device implements a high-pass linear-phase filter, with a cutoff frequency of 0.67Hz, to remove the drift
of the entirely digital baseline.

The filter effectively reduces the artefacts induced by the respiratory movement without introducing
distortions on the reproduction of the ST segment, as specifically recommended in "cf. Paul Kligfield et al.,
Recommendations for the Standardization and Interpretation of the Electrocardiogram Part I, Circulation.
2007;115:1306-1324”:

To reduce artifactual distortion of the ST segment, the 1990 AHA document recommended that the
low-frequency cutoff be 0.05 Hz for routine filters but that this requirement could be relaxed to 0.67
Hz or below for linear digital filters with zero phase distortion. The ANSI/AAMI recommendations of
1991, affirmed in 2001, endorsed these relaxed limits for low-frequency cutoff for standard 12-lead
ECGs, subject to maximum allowable errors for individual determinants of overall input signal
reproduction. These standards continue to be recommended

The high-pass filter meets the requirements set by IEC 60601-2-25 2nd Ed. in terms of low-frequency
impulse response:

“A 0,3 mV × s (3 mV for 100 ms) impulse input shall not produce a displacement greater than 0.1 mV
outside the region of the impulse.”

The acquisition (sampling and filtering) system of the device complies with AHA recommendations (Paul
Kligfield et al., Circulation 2007) for both paediatric and adult ECGs. The high frequency response of the
system is 150Hz or 300Hz, depending on the filter applied.

The device also offers the option of applying, only in display and printing mode, digital linear-phase filters
with a cutoff frequency of 25Hz or 40Hz, which reduce the bandwidth of the printed signal in order to
reduce the effects of high frequency noise ("muscular" noise). As a consequence of the application of these
filters, the resulting signal no longer meets the minimum requirements on the high frequency response
reported in the above recommendations.

The device can also be configured to selectively eliminate interference induced by the electricity network
(50Hz or 60Hz, depending on the country where the device is installed).
The network filter complies with the requirements of IEC 60601-2-25 2nd Ed.

99
 touchECG
12. TECHNICAL SPECIFICATIONS

12.2. Harmonised standards applied

STANDARD DESCRIPTION
EN ISO 15223-1 Medical devices - Symbols to be used with medical device
labels, labelling and information to be supplied - Part 1:
General requirements
EN 1041 Information supplied by the manufacturer of medical devices
EN ISO 13485 Medical devices - Quality management systems -
Requirements for regulatory purposes
EN ISO 14971 Medical devices - Application of risk management to medical
devices
EN 60601-2-25 Medical electrical equipment - Part 2-25: Particular
requirements for the basic safety and essential performance of
electrocardiographs.
Partly applied – Applied in conjunction with HD+
IEC 60601-1-11 Medical electrical equipment -- Part 1-11: General
requirements for basic safety and essential performance --
Collateral standard: Requirements for medical electrical
equipment and medical electrical systems used in the home
healthcare environment.
Partly applied – Applied in conjunction with HD+
EN 62304 Medical device software - Software life cycle processes
EN 62366 Medical devices - Application of usability engineering to
medical devices

12.3. Accessories

CODE DESCRIPTION
81018027 HD+

100
 touchECG
13. WARRANTY

13. WARRANTY

Cardioline SpA guarantees this device for a period of 24 months from the date of sale. The date of purchase
shall be proven by a document, issued upon delivery, which shall be submitted in the case of any claim under
the warranty.
The warranty covers restoring the device operation free of charge for malfunctions relating to installation or
the software itself.
This warranty does not cover defects resulting from:
 tampering, third party negligence, including servicing or maintenance by unauthorised personnel;
 failure to comply with the user instructions, improper use or use of the equipment other than that
for which it was manufactured;
 damage caused by fires, explosions or natural disasters;
 use of unauthorised software;
 other circumstances not attributable to manufacturing defects.

Cardioline Spa declines all liability for any damage which may be caused, directly or indirectly, to persons or
property as a consequence of non-compliance with all the prescriptions specified in the manual, especially
warnings regarding installation, safety, use and maintenance of the equipment, as well as non-operation of
the equipment.
For restoration/repairs, contact Cardioline SpA or an authorised service centre. Labour is free of charge while
the risks and costs of transport are borne by the customer.
The warranty expires after 24 months from the date of purchase; any subsequent assistance will be charged
at normal labour rates.
Any derogation from the present warranty conditions shall be valid only if expressly approved by Cardioline
SpA.

101
Head Office and Production
Via Linz, 151
38121 Trento
Italy
T. +39 0463 850125
F. +39 0463 850088

Sales Office:
Via F.lli Bronzetti, 8
20129 Milan, Italy
T. +39 02 94750470
F. +39 02 94750471