Wellue JR2000B Portable Patient Monitor User Manual
- June 16, 2024
- Wellue
Table of Contents
Wellue JR2000B Portable Patient Monitor
Specifications:
- Environment:
- Temperature: Working 0 ~ 40 (C), Transport and Storage -20 ~ 60 (C)
- Humidity: Working 20% ~ 85%, Transport and Storage 10% ~ 95%
- Warranty: 12 months for main unit, 6 months for accessory (except man-made damage)
- Date of Production and S/N NO.: Check the back label of the device
- Life Expectancy: Main unit – 5 years, Built-in lithium battery – 500 charges and discharges
Chapter 1: Introduction
For an overall introduction to the monitor, please refer to the General Information section. For various messages displayed on the screen, please refer to the Screen Display section. For basic operating instructions, please refer to the Button Function section. For allocation of interface sockets, please refer to the Interfaces section. For important facts to be noted during the battery recharging procedure, please refer to the Battery Recharging section.
1.1 General Information
Make sure to read this manual, all safety information, and specifications before using the Portable Patient Monitor. Please note that this equipment is not intended for family usage.
Transport and Storage:
The device should be transported and stored according to the agreement,
avoiding rain and snow splash and mechanical collision.
It should be stored in a dry and well-ventilated room, away from strong
sunlight and other corrosive gases.
Important Note:
The monitor should only be used by qualified personnel and in compliance with relevant National Standards. Failure to do so may result in damage or improper functioning of the monitor.
FAQs
- Q1: Can the Portable Patient Monitor be used at home?
- A1: No, this equipment is not intended for family usage. It should only be used by qualified personnel.
- Q2: What is the warranty period for the main unit and accessory?
- A2: The warranty for the main unit is 12 months, and for the accessory is 6 months (except for man-made damage).
- Q3: How long is the life expectancy of the main unit and the built-in lithium battery?
- A3: The main unit has a life expectancy of 5 years, while the built-in lithium battery has a life of 500 charges and discharges.
Portable Patient Monitor
(8 inch)
Model:JR2000B
User Manual
Statement
1 Our company owns all rights to this unpublished work and intends to maintain
this work as confidential. Our company may also seek to maintain this work as
an unpublished copyright. This publication is to be used solely for the
purposes of reference, operation, maintenance, or repair of equipment. No part
of this can be disseminated for other purposes. 2In the event of inadvertent
or deliberate publication, Our company intends to enforce its rights to this
work under copyright laws as a published work. Those having access to this
work may not copy, use, or disclose the information in this work unless
expressly authorized by Our company to do so. 3 All information contained in
this publication is believed to be correct. Our company shall not be liable
for errors contained herein nor for incidental or consequential damages in
connection with the furnishing, performance, or use of this material. This
publication may refer to information and protected by copyrights or patents
and does not convey any license under the patent rights of , nor the rights of
others. Our company does not assume any liability arising out of any
infringements of patents or other rights of third parties. 4Content of this
manual is subject to changes without prior notice. PROPERTY OF ALL RIGHTS
RESERVED Responsibility on the manufacturer party Our company is responsible
for safety, reliability and performance of this equipment only in the
condition that: all installation, expansion, change, modification and repair
of this equipment are
conducted by Our company qualified personnel; and, applied electrical
appliance is in compliance with relevant National Standards; and, the monitor
is operated under strict observance of this manual. NOTE This equipment is not
intended for family usage. Important! Before use, carefully read this manual,
all safety information and
specifications. The warranty for main unit is 12 months, and 6 months for
accessory, except
man-made damage. Transport: According to agreement, additionally, it should
avoid rain and snow
splash and mechanical collision. Storage: The device should be stored in a dry
and well-ventilated room, away
from strong sunlight and other corrosive gases. Date of production and S/N NO.
: See the back label of the device. The life for main unit is 5 years. The
built-in lithium battery has a life of 500 charges and discharges.
Warning This monitor is not a device for treatment purpose. It is important
for the hospital or organization that employs this equipment to carry out a
reasonable maintenance schedule. Neglect of this may result in machine
breakdown or injury of human health. Upon request, Our company may provide,
with compensation, necessary circuit diagrams, calibration illustration list
and other information to help qualified technician to maintain and repair some
parts, which Our company may define as user serviceable. Warranty
1
Workmanship & Materials topplor Our company guarantees new equipment other
than accessories to be free from defects in workmanship and materials for a
period of one year (six months for multi-site probes and SpO2 sensor) from
date of shipment under normal use and service. ‘s obligation under this
warranty is limited to repairing, at ‘s option, any part which upon ‘s
examination proves defective. THIS WARRANTY IS EXCLUSIVE AND IS IN LIEU OF ALL
OTHER WARRANTIES, EXPRESSED OR IMPLIED, INCLUDING WARRANTIES OF MERCHANT
ABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE. Exemptions 1It’s obligation or
liability under this warranty does not include any transportation or other
charges or liability for direct, indirect or consequential damages or delay
resulting from the improper use or application of the product or the
substitution upon it of parts or accessories not approved by Our company or
repaired by anyone other than a authorized representative. 2This warranty
shall not extend to any instrument which has been subjected to misuse,
negligence or accident; any instrument from which ‘s original serial number
tag or product identification markings have been altered or removed, or any
product of any other manufacturer. Safety, Reliability and Performance Our
company is not responsible for the effects on safety, reliability and
performance of the JR2000B Portable Patient Monitor if: JR2000B assembly
operations, extensions, re-adjusts, modifications or repairs are
carried out by persons other than those authorized by . the Portable Patient
Monitor is not used in accordance with the instructions for use, or
the electrical installation of the relevant room does not comply with NFPA 70:
National Electric Code or NFPA 99: Standard for Health Care Facilities
(Outside the United States, the relevant room must comply with all electrical
installation regulations mandated by the local and regional bodies of
government). Return Policy Return Procedure In the event that it becomes
necessary to return a unit to , the following procedure should be followed:
Obtain return authorization. Contact the Our company Service Department and
obtain a Customer Service Authorization number. The number must appear on the
outside of the shipping container. Return shipments will not be accepted if
the number is not clearly visible. Please provide the model number, serial
number, and a brief description of the reason for return. Freight policy. The
customer is responsible for freight charges when equipment is shipped to our
company for service (this includes customs charges). Preface 1This manual
gives detailed description to Portable Patient Monitor concerning its
performance, operation, and other safety information. Reading through this
manual is the first step for the user to get familiar with the equipment and
make the best out of it. 2Following symbols indicates some important facts
that you have to pay special attention to: Warning Points to be noted to avoid
injury to the patient and the operator. Caution Points to be noted to avoid
damage to the equipment.
2
Chapter 1
Introduction
For an overall introduction to the monitor, please refer to General
Information. For various messages displayed on the screen, please refer to
Screen Display. For basic operating instructions, please refer to Button
Function. For allocation of interface sockets, please refer to Interfaces. For
important facts to be noted during the battery recharging procedure, please
refer to
Built-in Battery. Warning 1 Portable Patient Monitor is intended for clinical
monitoring application with operation only granted to appropriate MEDICAL
INSTRUMENT staff. 2 There could be hazard of electrical shock by opening the
monitor casing. All servicing and future upgrading to this equipment must be
carried out by personnel trained and authorized by . 3Possible explosion
hazard if used in the presence of flammable anesthetics. 4The user must check
that equipment and accessories function safely and see that it is in proper
working condition before being used. 5Alarm must be set up according to
different situation of individual patient. Make sure that audio sounds can be
activated when alarm occurs. 6 Do not use cellular phone in the vicinity of
this equipment. High level of electromagnetic radiation emitted from such
devices may result in strong interference with the monitor performance. 7Do
not touch the patient, table nearby, or the equipment during defibrillation.
8The equipment and devices connected to it should form an equipotential body
to ensure effective grounding. 9When the monitor is used with Electrosurgery
equipment, the operator (surgeon and nurse) must give top priority to the
patient safety.
1.1 General Information
Environment: Temperature Working 0 ~ 40 (C) Transport and Storage -20 ~ 60 (C)
Humidity Working <= 85 % Transport and Storage <= 93 % Altitude Working -500
to 4,600m(-1,600 to 15,000ft)
Transport and Storage -500 to 13,100m(-1,600 to 43,000ft) Power Supply 100~250
(V)AC, 50/60 (Hz) Pmax=40VA FUSE T 1.6A General instruction: Patient Monitor
(Figure 1-1) is adaptable to adult, pediatric and neonatal usage. It can
monitor vital signals as ECG, Respiratory Rate, SpO2, NIBP, TEMP, and
ETCO2(optional). It integrates parameter measuring modules, display and
recorder in one device, featuring in compactness, lightweight and portability.
Replaceable built-in battery facilitates transportation of patient. Large
high-resolution display provides clear view of 5 waveforms and full monitoring
parameters. The POWER switch is on the left quarter of the front panel (in
Figure 1- 1). The POWER indicator(in Figure 1- 1) and the BATT indicator ( in
Figure 1- 1) lights when the device is
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powered on. The ALARM indicator flashes or lights when alarm occurs ( in
Figure 1- 1).The sockets of the sensors are at the right side. The recorder
socket is at the left side. Other sockets and power plug-in are at the back.
message area
wavefor m area
parameter area
Hotkey icon area
Figure 1- 1 Portable Patient Monitor Hotkey icon explain:
icon explain(from left to right)silenceprintfeezepatient informationTrend
review nibpparameter set;hotkey sw;screen change;menu Portable Patient Monitor
performs monitoring of: ECG Heart Rate (HR), 3 or 5-channel ECG waveforms, S-T
segment analysis, Arrhythmia RESP Respiratory Rate (RR) Respiration Waveform
SpO2 Oxygen Saturation (SpO2), Pulse Rate (PR) SpO2 Plethysmogram NIBP
Systolic Pressure (NS), Diastolic Pressure (ND), Mean Pressure (NM) TEMP
Temperature DATA CO2 CO2 waveforms CO2 DATA JR2000B provides extensive
functions as visual & audible alarm, storage and report printout for trend
data, NIBP measurements, and alarm events, and drug dose calculation function
is provided either. The monitor is a user-friendly device with operations
conducted by a few buttons on the front panel (Figure 1- 1) and a rotary knob
(Figure 1- 1). Refer to Button Functions for details.
1.2 Screen Display
The display of JR2000B may be color or monochrome liquid crystal display. The
patient parameters, waveforms, alarm messages, bed number, date, system status
and error messages can be reflected from the screen. 1Message Area
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The Message Area is at top of the screen displaying operating state of the monitor and
status of the patient.
The messages and their meanings are:
2BED NO
Bed number of the monitored patient
3ADU
Type of patient
4″2006-5-13″ Current date
5″13:51:32″ Current time
The above messages appear on the screen throughout the monitoring process.
Other information of the Message Area comes up only with respective monitoring status.
They are:
Signs indicating the operating status of the monitor and the sensors are displayed at
the right side of time numeric. When appears, this message will cover the sex and
name information of the patient. ” ” Indicates that all sounds are disabled manually. It appears z SILENCE button is
pressed for more than 1 seconds. ” ” flag for alarm SILENCE. Press “SILENCE” button once (more than 1 second)
to manually mute the alarm sound and this flag appears at the same time. The SILENCE status terminates when you discharge the status or new alarm occurs. ” ” Is the mark indicating that the alarm volume is closed. When select the “OFF” item in the ALARM SETUP menu, this mark appears indicating that the operator has permanently closed the audio alarm function. This audio alarm function can resume only after the operator discharges the closing alarm volume setup. NOTE When ” ” mark appears, the system can not give the audio alarm prompt. Therefore, the operator should be considerate in using this function. One method of discharging this status is in the ALARM SETUP menu, select the item that the alarm volume is in Non-close. Another method is to press the SILENCE button so as to make the mark change into a” “. Then press SILENCE button again, the system will immediately restores the normal alarm status. Alarm message is displayed at the right most area. “FREEZE” appears when the waveforms are frozen. Waveform/Menu Area 1five waveforms can be displayed at the same time. The waveforms from top to bottom
are: ECG I, ECG II, SpO2 Plethysmogram, RESP (possibly coming from ECG module).
Waveforms to be displayed are user-selectable. Refer to Tracing Waveforms Selection for details. 2The names of the waveforms are to their left. Gain and filter of this ECG channel are displayed as well. A 1mv scale is marked on the left of ECG waveform. The same menu always appears at a fixed area on the screen. When the menu is displayed, some waveforms become invisible. The size of the menu is also fixed, covering the lowest 2, 3 or 4 waveforms. 3The waveforms are refreshed in a user-set rate. Refer to the related chapters for details of
sweep speed.
Parameter Area Parameters are displayed at a fixed position.
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1ECG: Heart Rate ( Unit: bpm) ST-segment analysis of Channel 1 & 2 (Unit: mv)
2NIBP: (From left to right) Systolic, Mean, Diastolic (Unit: mmHg or kPa)
3SpO2: SpO2 (Unit: %) 4RESP: Respiration Rate (Unit: breath/min) 5TEMP:
Temperature (Unit: or ) 6The above monitoring results are displayed in the
Parameter Area. The parameters refresh every second, except that NIBP values
refresh each time the measurement is over. User can select the monitor
parameters, and the screen display will change accordingly. Alarm indicator:
In normal mode, no indicator lights. In alarm mode, the alarm indicator lights
or flashes.
1.3 Button Function
All the operations to the monitor are through the buttons and a knob at the
bottom of the screen. The names of the buttons are above them. They are (from
left to right, Figure 1-3):
Figure 1- 3 Buttons and Knob NIBP (Figure 1- 3) Press to inflate the cuff to
start a blood pressure measurement. When measuring, press to cancel the
measurement and deflate the cuff. SILENCE(ALARM)(Figure 1- 3) symbol appears
in the Message Area. Push this button for more than 1 second to mute all kinds
of sounds (including alarm sound, heart beat, pulse tone, key sound). At the
same time, a ” “symbol appears in the Message Area. Push this button again to
restore all kinds of sounds and the ” “symbol appears from the screen.
Note 1 If new alarm occurs in Alarm Pause/Silence status, the system will
discharge Pause/Silence status automatically. For specific rules, see Chapter
Alarm. 2The system will begin to give alarm information again once there exist
alarm-triggering event. Nevertheless, remember pushing SILENCE button can
permanently shut off audible alarm sound of ECG LEAD OFF and SPO2 SENSOR OFF
alarms. FREEZE(Figure 1- 3) Press this button and the system will access the
FREEZE status. In this status the user may review the waveform of 40 seconds.
Also, the frozen waveform can be printed out. In the FREEZE status, press this
button again to discharge the FREEZE status. For detailed information, refer
to related chapter: Freeze. MENU(Figure 1- 3) Press this button to call up the
SYSTEM MENU, in which the user may set up system information and perform
review operation. For detailed information, refer to related chapter: System
Menu and related chapter: Trend and Event.
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POWER(Figure 1- 3) POWER ON/OFF switch Rotary knob(Figure 1- 3) The user may
use the rotary knob to select the menu item and modify the setup. It can be
rotated clockwise or counter-clockwise and pressed like other buttons. The
user may use the knob to realize the operations on the screen and in the
system menu and parameter menu. Method to use the knob to operate on the
screen: The rectangular mark on the screen that moves with the rotation of the
knob is called “cursor”. Operation can be performed at any position at which
the cursor can stay. When the cursor is in the waveform area, the user may
immediately modify the current setup. When the cursor is in the parameter
area, the user may open the setup menu of the corresponding parameter module
so as to set up the menu items of the module. Operating method: Move the
cursor to the item where the operation is wanted Press the knob One of the
following four situations may appear: 1. The cursor with background color may
become into the frame without background color, which implies that the content
in the frame can change with the rotation of the knob. 2. Menu or measuring
window may appear on the screen, or the original menu is replaced by the new
menu. 3. A check mark “” appears at the position, indicating that the item is
confirmed. 4. The system immediately executes a certain function. Rotary Knob
1e square frame that moves with the knob turning is referred to as “cursor”. 2
en the cursor is placed at any of the first six items, the user can change the
current settings. 3When at any of the last six items, related parameter menu
can be called up for setting changes. Operation is as follows: When you move
the cursor to a certain item, and press the knob, then: 1. A menu pops up, or
the current menu is replaced by a new one; or, 2. The cursor frame turns to
dotted line, indicating contents in the frame can be changed by turning the
knob; or, 3. A “” mark appears indicating “selected”; or, 4. A certain
function executes.
1.4 Interfaces
For the convenience of operation, the different kinds of interfaces are in
different parts of the monitor. At the left side are the connectors to patient
cables and the sensors, as shown in Figure 1- 4.
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Figure 1- 4 left Side
This symbol means “BE CAREFUL”. Refer to the manual.
Indicates that the instrument is IEC-60601-1 Type CF equipment. The unit
displaying this symbol contains an F-Type isolated (floating) patient applied
part providing a high degree of protection against shock, and is suitable for
use during defibrillation. Other symbols in the monitor are explained in
chapter Patient Safety.
Figure 1-5 On the rear panel are the following sockets, shown in Figure 1-5
Power Supply: 90~250 (VAC), 50/60 (Hz) Equipotential Grounding Equipotential
grounding terminal for connection with the hospital’s grounding system. FUSE:
T1.6A/250V
5MM GND connect internet connect Warning
1Through network interface only Clinical Information Center can be connected
in. 2 Accessory equipment connected to the analog and digital interfaces must
be certified according to the respective IEC standards (e.g. IEC 60950 for
data processing equipment and IEC 60601-1 for MEDICAL INSTRUMENT equipment).
Furthermore all configurations shall comply with the valid version of the
system
8
standard IEC 60601-1-1. Everybody who connects additional equipment to the
signal input part or signal output part configures a MEDICAL INSTRUMENT
system, and is therefore responsible that the system complies with the
requirements of the valid version of the system standard IEC 60601-1-1. If in
doubt, consult the technical service department or your local representative.
1.5 Built-in Battery
Patient Monitor is equipped with a rechargeable battery. The battery in the
Monitor can automatically recharge when connected to AC INPUT until it is
full. A symbol ” ” is displayed on the bottom of the screen to indicate the
status of recharging, in which the yellow part represents the relative
electric energy of the battery.
Warning Don’t pull off battery when the monitor is working. When operating on
battery, the monitor will prompt alarm and shut off automatically when the
energy is low. When the electric energy is going out, the monitor will sound
continuous level 1 alarm beeping and display “BATTERY TOO LOW” in the Message
Area. Connect the monitor to AC power at this moment can recharge the battery
while operating. If keep operating on the battery, the monitor will shut off
automatically (about 5 minutes since alarming) upon exhaustion of the battery.
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Chapter 2
Getting Started
Open the package and check Connect the power cables Power on the monitor
Connect patient sensors Check the recorder NOTE To ensure that the monitor
works properly, please read Chapter Patient Safety, and follow the steps
before using the monitor.
2.1 Open the Package and Check
Open the package and take out the monitor and accessories carefully. Keep the
package for possible future transportation or storage. Check the components
according to the packing list. Check for any mechanical damage. Check all the
cables, modules and accessories. If there is any problem, contact the
distributor immediately.
2.2 Connect the Power Cables
Connection procedure of the AC power line: Make sure the AC power supply
complies with following specification: 100~250 VAC,
50/60 Hz. Apply the power line provided with the monitor. Plug the power line
to INPUT
interface of the monitor. Connect the other end of the power line to a
grounded 3-phase power output. NOTE 1Connect the power line to the jack
special for hospital usage. 2Make sure that the POWER lamp now lights. If it
does not light, check your local power supply. If the problem still exists,
contact the local Customer Service Center. 3The battery need to be charged
after transportation or storage. If the power supply is not properly connected
before turning on the monitor, it may not work properly because of
insufficient power. Connect the power supply to charge the battery.
2.3 Power on the Monitor
Press POWER to power on the monitor. Then a beep will be heard and at the same
time the indicator will flash twice in yellow and red. After 10 seconds or so,
the system will enter monitoring screen after self-test, and you can perform
normal monitoring now.
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During self-test, the software version will display. NOTE 1If the monitor
finds any fatal error during self-test, it will alarm. 2 Check all the
functions that may be used to monitor and make sure that the monitor is in
good status. 3 The battery must be recharged to the full electricity after
each use to ensure adequate electricity reserve. 4The interval between twice
press of POWER should be more than 1 minute.
Warning If any sign of damage is detected, or the monitor displays some error
messages, do not use it on any patient. Contact bioMEDICAL INSTRUMENT engineer
in the hospital or Customer Service Center immediately.
2.4 Connect Patient Sensors
Connect all the necessary patient sensors between the monitor and the patient.
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Chapter 3
System Menu
PATIENT MANAGE , MONITOR SETUP, ALARM MENU, MAINTAIN, RECALL, DRUG CALG, DEMO
or EXIT DEMO, HELP
Patient Monitor features flexible configurations. You can configure various
aspects of the monitor, including the parameters to be monitored, sweeping
speed of the waveforms, audio signal volume, and printout text.
Press the “MENU” hot key on the lower right part of the screen to call up
“SYSTEM MENU”. The configuration is realized through operations on the SYSTEM
MENU, as shown below.
Figure 3- 1 SYSTEM MENU Figure 3- 2 PATIENT SETUP
3.1 Patient Information Setup
NOTE
To erase present patient data, refer to the section of New Patient Enrolment for
details.
Pick “PATIENT MANAGE” in SYSTEM MENU to call up the following menu.
You can setup the following patient record: Figure 3- 2 PATIENT SETUP
DEPARTMENT Department in which the patient receives treatment.
D NO
Patient bed number (Range: 1-200)
PACE
Pace ON or OFF
SEX
Patient gender (Available options: “F” for Female, “M” for Male)
PAT TYPE
Patient type (Available options: ADU, PED, and NEO)
NEW PATIENT Admission of new patient
Also in this menu, the user may select “NEW PATIENT” item to access “CONFIRM TO
UPDATE PATIENT” dialog box as shown below, in which the user decide whether to
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monitor a new patient. Figure 3- 3
Figure 3- 3 NEW PATIENT Menu
Figure 3- 4 CONFIRM SAVE DEFAULT
CONFIG
Pick YES to erase stored record of the previous patient and exit the menu.
Pick NO to refuse the new patient and keep the previous information and exit the menu.
Note
Selecting “YES” will delete all information about the currently monitored patient.
3.2 Default Setup
Note Select any item in this sub-menu to cancel the current setup and use the selected default setup. In this sub-menu, the user can select both the factory default and the user-defined default. Also in this sub-menu, the user can save the current system configuration as a user-defined default configuration. But at this time, the old user-defined configuration will be replaced by the current one. To restore all settings of parameter menu and the ECG lead, gain, and filter to default settings, select the desired default, and pick EXIT to call up the following menu: Figure 3- 4 CONFIRM SAVE DEFAULT CONFIG Pick YES to erase stored record of the previous patient and exit the menu. Pick NO to refuse the new patient and keep the previous information and exit the menu. NOTE After selecting “EXIT” item, the “CONFIRM SAVE DEFAULT CONFIG” dialog box will pop up, in which the user may choose YES to confirm the selection or NO to give up the selection.
3.3 Trend Function
Pick RECALL in the SYSTEM MENU, as shown in the figure below. Figure 3- 5 RECALL
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Figure 3- 5 RECALL
Figure 3- 6 NIBP RECALL
3.3.1 NIBP Recall
The monitor can review the latest 1000 NIBP measurement data.
Pick NIBP RECALL in the SYSTEM MENU to invoke the result and time of the latest 10
measurements, as shown in the figure below. Figure 3- 6 NIBP RECALL
Data is listed chronologically from the latest to the earliest. 10 measurements can be
displayed in one screen. Pick UP-DOWN to view other trend curve up to 1000 results. Pick
REC to print out all measurement data of NIBP RECALL.
3.3.2 Alarms recall Can review about 1000 records of recent alarms, and review
alarm parameters and waveform. 3.3.3 Trend graph review Can display the latest
1-hour trend graph in increment of one data every second or every 5 seconds
Can display the latest 96-hour trend graph in increment of one data every
minute or every 5 minutes or 10 minutes. Select “trend graph “in the menu, you
will see the below window:
Figure 3-7 trend graph
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vertical axis indicates the measurement value, horizontal axis indicates
measurement time, the symbol” “is trend graph cursor,the measured data of the
position indicated by the cursor was shown below the graph,while the
measurement time was shown above the graph. All the trends are displayed as
continuous curve(expect for NIBP).On NIBP trend graph,”SYS”is for Systolic
blood pressure; and “DIA”is for diastolic blood pressure, “MAP”is for mean
blood pressure.
Select different parameters for trend graph display Select option for ”
parameter selection ” , press the knob when it appears the exact parameter you
want, you will see the relevant trend graph then.
Select 1-hour or 96-hour trend: Select option for ” Resolution ” , if want to
review trend graph within 1-hour, select resolution 1second or 5 seconds; if
want to review trend graph within 96-hour, select resolution 1minute or 5
minutes or 10 minutes.
To review trend graph even more earlier or latter: If there’s an” “press the
“right”buttonturn the knob clockwise, to review the latter graph, and if
there’s ” “press the “left”buttonturn the knob anti-clockwise, to review
earlier graph.
To revise display scale: Use the “Adjust Amplitude” button to revise the
vertical scale and the trend curve scale will change accordingly. the data
greater than the maximum will be represented using the maximum data.
How to get exact data for a specific moment on current trend graph: Select the
cursor, and turn the knob left or right, the cursor will move accordingly,
time changes too, the data will be shown below the horizontal axis. If
there’s” “on right side of the screen, when cursor move to this position,the
trend graph will automatically come to next page; while if there’s ” “on the
left side of screen, when cursor move to this position,the trend graph will
automatically come to a former page, so you can see the earlier trend graph
then.
Operation examples: To review NIBP trend graph for past 1-hour
press”menu”buttonthen press”system menu” select”recall”optionthen select”trend
graph” select parameterselect”parameter selection”optionturn the knobuntil
there is “NIBP”
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select”resolution”option, can select “1 second”or”5 seconds” select”left &
right”turn the knobcheck the change on time and trend curve stop when it comes
to the time period you want to recheck, can revise the display scale to see
more clearly. (by press the “adjust amplitude” button) if want to know exact
data for a specific moment on current trend graph, select the cursor,move the
cursor to the exact position to check, time will be shown above, and measure
data will be shown at bottom. press “quit” to exit trend graph.
3.3.4 trend table review recent 336-hour trend table can be shown with
resolution 1 minute, 5 minutes, 10 minutes, 30 minutes, 60 minutes. Press
“system menu”and then press “trend table review”, you will see below interface
Figure 3-8 trend table The time relevant to each group of trend data is
displayed in the left side of column, with the date in parentheses.The event
column will show the events have been marked, which corresponds to the time
marked the event. The parameters in the trend table can be divided into 10
groups as below: HRSPO2PRSYSMAPDIARRT1T2TD The display of NIBP trend data has
its particularity.Beside the measured value, time for NIBP measurement is also
displayed under “Measuring Point”. If there are multiple measured values
during this time period, only one value can be displayed on screen,others will
be displayed at “MORE” with a “*” means there are two or more measurement
results.
How to review trend table with different resolution: Select cursor, then
select ” resolution ” , turn the knob to revise the option, then select
different time interval.
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To review trend table even more earlier or latter: If there’s an” “press the
“upper”buttonturn the knob clockwise, to review the latter table, and if
there’s ” “press the “down”buttonturn the knob anti-clockwise, to review
earlier table.
Select different parameters for trend table Select “left & right”, can review
one of the parameters among the 14 of them.there’s ” ” on the right side of
the parameter, which means can come to the right page; there’s ” ” on the left
side of the parameter, which means can come to the left page. Monitor
Information
3.4 Monitor Information
Select the [VERSION] item in the “SYSTEM MENU” to know the software version of
the monitor.
Figure 3- 9 Version Figure 3- 10 Monitor Info
Figure 3- 11 Monitor Setup
Select the [DEVICE CONFIG LIST] to know the configuration of the monitor. Figure
3- 10 Monitor Info
3.5 Monitor Set
Select the [MONITOR SETUP] item in the “SYSTEM MENU” to know Below Figure 3- 11 Monitor Setup 3.5.1 Alarm Limit The system can display and setup the alarm limit. The method is:
17
ALM LEV: selectable from HIGH, MED, LOW. Level HIGH represents the most
serious case. ALM REC: pick “ON” to enable report printing upon ECG alarm. ALM
HI: used to set up the upper limit of ECG alarm. ALM LO: used to set up the
lower limit of ECG alarm. Select “SELECTION” item in “SYSTEM MENU” to access
“SELECTION” sub-menu, in which the user may set up the alarm limit. Set “ALM
LIMIT” to ON to display the alarm limits of the parameters displayed on the
screen or OFF to hide the alarm limits. 3.5.2 Length of Alarm Records The
system may record the information prior to and after the occurring of alarm if
physiological alarm occurs. Three recording time is provided: 8s, 16s and 32s,
which are the total length of the time prior to and after the alarm. For
example, 8s contains the respective information of 4s before and after the
alarm. 16s contains the respective information of 8s before and after the
alarm, etc. The user may select different recording time based on clinical
requirement. The method is listed below; Select “ALARM SETUP” in “MONITOR
SETUP” to access the sub-menu of “ALARM SETUP”. In the “ALARM REC TIME” item,
the user may choose the length of alarm record. There are three options for
user to select: 8s, 16s or 32s. 3.5.3 Time Setup Select “TIME SETUP” item in
“MONITOR SETUP” menu to access the sub-menu of “TIME SETUP” as shown below.
System time is in format of year, month, day, hour, minute and second. Pick
the item you wish to modify and turn the knob, the figure will increase or
decrease by 1 at each switch. Then select “EXIT” item to return to the
previous menu.
18
Figure 3- 12 TIME SETUP Figure 3- 13 MARK EVENT Menu Figure 3- 14 RECORD Menu
3.5.4 Mark Event
There are four types of events that you can define.
Select “MARK EVENT” item in “MONITOR SETUP” to call up the following menu:
Figure 3- 13 MARK EVENT Menu
To mark the event: Use the rotary knob to select one from event A, B, C and D. There is a
“@” signal for the one selected. To cancel your selection, repress the knob at selected item.
Press EXIT to return to the previous menu.
You can use event function:
To differentiate the patient events that have impact on parameter monitoring, such as dose
taking, injection, therapy status, etc.
3.5.5 Recorder Setup
Select “RECORD” in “MONITOR SETUP” menu to call up the following menu:
Figure 3- 14 RECORD Menu
In the sub-menu, the user may select the waveforms to be output in “REC WAVE1” and
“REC WAVE2” items.
ECG1-ECG The first to the seventh ECG waveform on the screen (there are seven
7
ECG waveforms in full leads display) (If no ECG waveform is currently
displayed on the screen, this item cannot be picked)
SPO2
SpO2 Plethysmogram.
RESP
RESP waveform (If no RESP waveform is currently displayed on the
screen, this item cannot be picked,).
OFF
No display for this waveform
RT REC TIME represents “real-time recording time”, for which two selections
are available: CONTINUAL and 8S. “CONTINUAL” means once pressing the
`REC/STOP’ button on the recorder or on the panel, the recorder will
continuously print out the waveform or parameter until this button on the
recorder is pressed again.
TIMING REC TIME represents “time interval between two times of timing
recording”. 10 selections are available: “OFF, 10MIN, 20MIN, 30MIN, 40MIN,
19
50MIN, 1HOUR, 2HOURS, 3HOURS and 4HOURS”. It means that the system will
trigger the recording operation according to the selected time interval. The
recording time is fixed at 8 seconds. NOTE 1RT REC TIME has the priority
compared with TIMING REC TIME. REC RATE has two selections: 25.0 and 50.0
mm/s. REC GRID is used to decide output format: OFF is without grid, and ON is
with grid. CLEAR REC TASK can be used by the user to stop recorder from
printing out too many tasks that are triggered by alarm events. 2The recorder
is an optional part. 3 If two same waveforms are selected, one of them is
switched to a different waveform automatically.
3.6 Maintenance
Select “MAINTAIN” item in “SYSTEM MENU” access “ENTER MAINTAIN PASSWORD”
dialog box as shown below, in which the user may enter password and set up the
user-defined maintenance settings. The user may not execute the factory
maintenance function, which is only available for appointed personnel of the
Company. The user may select “STATUS” to access “STATUS” sub-menu, in which
the user may view the information of the monitor start up and errors detected.
Figure 3- 15 ENTER MAINTAIN PASSWORD
Figure 3- 16 STATUS
In “STATUS” sub-menu, the user may use rotary knob to select “UP-DOWN” item and
then turn the knob clockwise or counter-clockwise to view the monitor information such as
start up time, alarm and the like. The user may select the “REC” item by using knob to
print out the currently displayed information via the recorder. Figure 3- 16 STATUS
For user default, enter the user key and press the “CONFIRM” key to access “USER
MAINTAIN” menu. Following is the detailed description on the settings able to be realized
in this menu.
20
Figure 3- 17 User Maintain Figure 3- 18 COLOR SELF-DEFINE Figure 3-19 Input
Demo Key
LANUGAGE: two selections are available:CHINESE and ENGLISH. LEAD: refers to
the net No. COLOR SELF-DEFINE: is used by the user to define the color of the
waveform
displayed on the screen. Five colors can be chosen from green, cyan, red,
yellow and white. Figure 3- 15 COLOR SELF-DEFINE
3.7 DEMO function
Select the [DEMO] item in the “SYSTEM MENU” to call up the “ENTER DEMO
PASSWORD”. After entering the password, the system enters DEMO status. Figure
3-19 Input Demo Key The purpose of waveform demonstration is only to
demonstrate the machine performance, and for training purpose. In clinical
application, this function is not forbidden because the DEMO will mislead the
MEDICAL INSTRUMENT staff to treat the DEMO waveform and parameter as the
actual data of the patient, which may result in the delay of treatment or
mistreatment. Therefore before entering this menu, you shall enter password.
3.8 Parameters setup
Set ECGRESPTEMPSPO2NIBPCO2parameters.
21
Chapter 4
Patient Safety
The Portable Patient Monitor is designed to comply with the International
National Safety requirements for MEDICAL INSTRUMENT electrical equipment. This
device has floating inputs and is protected against the effects of
defibrillation and electrosurgery. If the correct electrodes are used and
applied in accordance with the manufacturer instructions, the screen display
will recover within 10 seconds after defibrillation.
This symbol indicates that the instrument is IEC60601-1 Type CF equipment. The
unit displaying this symbol contains an F-Type isolated (floating) patient
applied part providing a high degree of protection against shock, and is
suitable for use during defibrillation.
Warning Do not touch the patient, bed or instrument during defibrillation.
Environment Follow the instructions below to ensure a completely safe
electrical installation. The environment where the JR2000B Portable Patient
Monitor will be used should be reasonably free from vibration, dust, corrosive
or explosive gases, extremes of temperature, humidity, and so on. For a
cabinet mounted installation, allow sufficient room at the front for operation
and sufficient room at the rear for servicing with the cabinet access door
open. The Portable Patient Monitor operates within specifications at ambient
temperatures between 0 and 40. Ambient temperatures that exceed these limits
could affect the accuracy of the instrument and cause damage to the modules
and circuits. Allow at least 2 inches (5cm) clearance around the instrument
for proper air circulation. Grounding the Portable Patient Monitor To protect
the patient and hospital personnel, the cabinet of the JR2000B Portable
Patient Monitor must be grounded. Accordingly, the JR2000B Portable Patient
Monitor is equipped with a detachable 3-wire cable which grounds the
instrument to the power line ground (protective earth) when plugged into an
appropriate 3-wire receptacle. If a 3-wire receptacle is not available,
consult the hospital electrician. If completeness of the protective grounding
wire is in doubt, the equipment must be operated with internal power supply.
Warning Do not use a 3-wire to 2-wire adapter with this instrument. Connect
the grounding wire to the equipotential grounding terminal on the main system.
If it is not evident from the instrument specifications whether a particular
instrument combination is hazardous or not, for example due to summation of
leakage currents, the user should consult the manufacturers concerned or else
an expert in the field, to ensure that the necessary safety of all instruments
concerned will not be impaired by the proposed combination.
22
Equipotential Grounding Protection class 1 instruments are already included in
the protective grounding (protective earth) system of the room by way of
grounding contacts in the power plug. For internal examinations on the heart
or the brain, the JR2000B Portable Patient Monitor must have a separate
connection to the equipotential grounding system. One end of the equipotential
grounding cable (potential equalization conductor) is connected to the
equipotential grounding terminal on the instrument rear panel and the other
end to one point of the equipotential grounding system. The equipotential
grounding system assumes the safety function of the protective grounding
conductor if ever there is a break in the protective grounding system.
Examinations in or on the heart (or brain) should only be carried out in
MEDICAL INSTRUMENTly used rooms incorporating an equipotential grounding
system. Check each time before use that the instrument is in perfect working
order. The cable connecting the patient to the instrument must be free of
electrolyte.
Warning 1If the protective grounding (protective earth) system is doubtful,
the monitor must be supplied by inner power only. Condensation Make sure that
during operation, the instrument is free of condensation. Condensation can
form when equipment is moved from one building to another, thus being exposed
to moisture and differences in temperature. 2Possible explosion hazard if used
in the presence of flammable anesthetics. Explanation of Symbols in the
Monitor
1s symbol means ‘BE CAREFUL ‘. Refer to the manual.
2is symbol indicates that the instrument is IEC60601-1 Type CF equipment. The
unit displaying this symbol contains an F-Type isolated (floating) patient
applied part providing a high degree of protection against shock, and is
suitable for use during defibrillation. This symbol indicates that the
instrument is IEC60601-1 Type CF equipment. The unit displaying this symbol
contains an F-Type isolated (floating) patient applied part providing a high
degree of protection against shock, and is suitable for use during
defibrillation.
3Equipotential grounding system
4 Protective earth ground
5Partial On/Off
23
Chapter 5
Care / Cleaning
5.1 System Check
Before using the monitor, do the following: check if there is any mechanical
damage; check all the outer cables, inserted modules and accessories; check
all the functions of the monitor to make sure that the monitor is in good
condition. If you find any damage on the monitor, stop using the monitor on
patient, and contact our engineer of the hospital or our Customer Service
immediately. The overall check of the monitor, including the safety check,
should be performed only by qualified personnel once every 6 to 12 month, and
each time after fix up. You should check the synchronism of the defibrillator
in the frequency described in the hospital regulations. At least every 3
months, it should be checked by a qualified customer service technician. All
the checks that need to open the monitor should be performed by qualified
customer service technician. The safety and maintenance check can be conducted
by persons from Our company. You can obtain the material about the customer
service contract from the local office. The circuits diagrams, parts lists and
calibration instructions of the monitor can be provided by the manufacturer.
Warning 1. If the hospital or agency that is responding to using the monitor
does not follow a
satisfactory maintenance schedule, the monitor may become invalid, and the
human health may be endangered. 2. Refer the battery replacement only to our
service technician. Note To ensure maximum battery life, it is recommended
that, at least once a month, the monitor be run on battery until it turns
itself off and then recharged.
5.2 General Cleaning
Warning Before cleaning the monitor or the sensor, make sure that the
equipment is switched off and disconnected from the power line. The Monitor
must be kept dust-free. Regular cleaning of the monitor shell and the screen
is strongly recommended. Use only non-caustic detergents such as soap and
water to clean the monitor shell.
Note
24
Please pay special attention to the following items: 1. Avoid using ammonia-
based or acetone-based cleaners such as acetone. 2. Most cleaning agents must
be diluted before use. Follow the manufacturer’s
directions carefully to avoid damaging the monitor. 3. Don’t use the grinding
material, such as steel wool etc. 4. Don’t let the cleaning agent enter into
the chassis of the system. 5. Don’t leave the cleaning agents at any part of
the equipment. 6. If there is any sign that the ECG cable may be damaged or
deteriorated, replace it with a new one instead of continuing its application
on the patient. Reusable TEMP Probes 1. The TEMP probe should not be heated
above 100 (212 ). It should only be
subjected briefly to temperatures between 80 (176) and 100 (212). 2. Only
detergents containing no alcohol can be used for disaffection. 3. The rectal
probes should be used, if possible, in conjunction with a protective rubber
cover. 4. To clean the probe, hold the tip with one hand and with the other
hand rubbing the
probe down in the direction of the connector using a moist lint-free cloth.
Disposable TEMP probe must not be re-sterilized or reused. For protecting
environment, the disposable TEMP probe must be recycled or disposed of
properly.
5.3 Cleaning Agents
Examples of disinfectants that can be used on the instrument casing are listed
below: Diluted Ammonia Water Diluted Sodium Hyoichlo (Bleaching agent).
Note The diluted sodium hyoichlo from 500ppm(1:100 diluted bleaching agent) to
5000ppm (1:10 bleaching agents) is very effective. The concentration of the
diluted sodium hyocihlo depends on how many organisms (blood, mucus) on the
surface of the chassis to be cleaned. Diluted Formaldehyde 35% — 37%, Hydrogen
Peroxide 3% Alcohol, Isopropanol
Note 1 the monitor and sensor surface can be cleaned with hospital-grade
ethanol and dried in air or with crisp and clean cloth. 2 Our company has no
responsibility for the effectiveness of controlling infectious disease using
these chemical agents. Please contact infectious disease experts in your
hospital for details.
25
5.4 Sterilization
To avoid extended damage to the equipment, sterilization is only recommended
when stipulated as necessary in the Hospital Maintenance Schedule.
Sterilization facilities should be cleaned first. Recommended sterilization
material: Ethylate, and Acetaldehyde. Appropriate sterilization materials for
ECG lead, blood pressure cuff are introduced in Chapters ECG/RESP Monitoring,
Chapter NIBP Monitoring respectively.
Caution Follow the manufacturer’s instruction to dilute the solution, or adopt
the lowest
possible density. Do not let liquid enter the monitor. No part of this monitor
can be subjected to immersion in liquid. Do not pour liquid onto the monitor
during sterilization. Use a moistened cloth to wipe up any agent remained on
the monitor.
5.5 Disinfection
To avoid extended damage to the equipment, disinfection is only recommended
when stipulated as necessary in the Hospital Maintenance Schedule.
Disinfection facilities should be cleaned first. Appropriate disinfection
materials for ECG lead, SpO2 sensor, blood pressure cuff, TEMP probe, and CO2
cable are introduced in Chapters 12-18 respectively.
Caution Do not use EtO gas or formaldehyde to disinfect the monitor.
26
Chapter 6
Alarm
This chapter gives general information about the alarm and corresponding
remedies. Alarm setup and prompt messages are provided in respective parameter
setup
sections.
6.1 Alarm Modes
6.1.1 Alarm Level Each alarm, either technical or physiological, has its own
level. For alarm of higher level, when it occurs, the system will give prompt
in a more alert way. Some alarm’s level can be set by the user via software.
Others can not by changed once defined by the system. Alarms in JR2000B are
divided into three levels, that is, high, medium and low. High-level alarm
indicates the patient’s life is in danger or the monitor under using has
serious problem in technical respect. It is the most serious alarm. Medium-
level alarm means serious warning. Low-level alarm is a general warning.
Alarms are classified into three categories, which are physiological alarm,
technical alarm and general alarm. Physiological alarm refer to those alarms
triggered by patient’s physiological situation which could be considered
dangerous to his or her life, such as heart rate (HR) exceeding alarm limit
(parameter alarms). Technical alarm refer to system failure which can make
certain monitoring process technically impossible or make monitoring result
unbelievable. Technical alarm is also called System Error Message. General
alarm belongs to those situations that can not be categorized into these two
cases but still need to pay some attention. JR2000B has preset the alarm level
for the parameters. You can also modify the alarm level using the method
described in this chapter. Alarm level of the System Error Message (technical
alarm) is pre-set in the system. All technical alarm level and general alarm
level, some of the physiological alarm level are pre-set in the system and can
not be changed by user. 6.1.2 Alarm Modes When alarm occurs, JR2000B may raise
the user’s attention in at least three ways, which are audio prompt, visual
prompt and description. Audio and visual prompt is given by TFT/touch screen
display device, the speaker on the display device and the alarm indicator.
Description is displayed on the screen. Physiological alarm is displayed in
the Physiological Alarm area. Most of technical alarms are displayed in the
Technical Alarm area. Technical alarms related to NIBP measurement are
displayed in the NIBP Technical Alarm area at the bottom of NIBP parameter
area. NOTE 1 The Physiological Alarm area is on the upper right part of the
screen. The
27
Technical Alarm area is to the left side of the Physiological Alarm area.
2 If JR2000B is connected to the external alarm prompt system (e.g. the alarm
speaker and indicator connected onto the rear panel of JR2000B ), when alarm occurs,
the external alarm prompt system responds in the same way as the JR2000B .
3The concrete presentation of each alarm prompt is related to the alarm level.
Alarm prompt of the parameter exceeding the alarm limit.
When physiological alarm of the monitored parameter exceeds the alarm limit, besides
using the above-mentioned three ways to give the alarm prompt, the monitor also gives
alarm by making the monitored parameter flash in the frequency of 1Hz. If at this time the
upper and lower limits of the parameter are displayed, they will flash in the same frequency
(1Hz).
Screen Display
When an alarm occurs, the parameter triggering the alarm flashes. “*” signal appears on the
screen indicating the occurrence of alarm. Red “***” indicates high-level alarm, yellow
“*” indicates medium-level alarm, and yellow “” indicates low-level alarm. Technical
alarm will not prompts “*” signal.
Lamp light
The high/medium/low-level alarms are indicated by the system in following different
visual ways:
Alarm level
Visual prompt
High
Alarm indicator flashes in red with high frequency.
Medium
Alarm indicator flashes in yellow with low frequency.
Low
Alarm indicator lights on in yellow.
Alarm Sound
The high/medium/low-level alarms are indicated by the system in following different audio
ways:
Alarm level Audio prompt
High
Mode is “DO-DO-DO——DO-DO, DO-DO-DO——DO-DO”, which is
triggered once every 8 seconds.
Medium
Mode is “DO-DO-DO”, which is triggered once every 24 seconds.
Low
Mode is “DO-“, which is triggered once every 24 seconds.
NOTE When alarms of different levels occur at the same time, the monitor prompts
the one of the highest level.
6.1.3 Alarm Setup
The setup of the alarms can be realized in the alarm menu.
Press the “ALARM SETUP” button on the MONITOR SETUP menu to call up “ALARM
SETUP” menu (default menu) as shown below. In the “ALM SEL” item, the user may set
up the information about common alarm setup (represented by “COMMON ALM SETUP”)
and the alarm setup of each parameter.
28
Figure 6- 1 ALARM SETUP COMMON ALM SETUP Select “COMMON ALM SETUP” selection
in “ALM SEL” item. This operation may call up the dialog box as the default
one. ALARM VOL: which has three selections: OFF, LOW, MED and HIGH. ALM REC
TIME: which has three selections: 8S, 16S, 32S. ALM PAUSE TIME: refers to the
alarm suspension time span, which has three
selections: 1MIN, 2MIN, 3MIN. PARA ALM TYPE: which has two selections: LATCH,
UNLATCH. LATCH refers to
the situation once alarm occurs, the system will alarm always until the
intervention of the operator (press PAUSE or SILENCE on the panel). UNLATCH
refers to the situation that once the alarm condition is discharged, the alarm
will disappear automatically. Alarm setup of each parameter In “ALARM SETUP”
menu select “ALM SEL” item to set up the alarm information of following
parameters. They are HR, ST, PVC, SPO2, NIBP, RESP, TEMP. For example: Method
to set up alarm information of HR: Step 1: Select “HR ALM SETUP” in “ALM SEL”
item to call up the dialog box “ALARM SETUP” for HR only. Step 2: Five items
are available for the user to set up, which are HR ALM (on/off of the alarm
switch), ALM LEV(alarm level), ALM REC(alarm recording switch), ALM HI (higher
limit of HR alarm), ALM LO (lower limit of HR alarm). When use the knob to
select each item and press the knob, a pull-down list appears for the user to
choose his desired selection. The method for setting the alarm information of
other parameters is the same as HR.
29
6.2 Alarm Cause
Alarm occurs when: 1.Physiological alarm is evoked; 2. Alarm for error of the
system (technical alarm) is evoked; 3. General alert occurs. A. Conditions
that activate the parameter alarms: When the measurement value exceeds the
alarm limit and the alarm is set “ON”. Alarm will not activate if the alarm is
set “OFF”. B. Conditions that activate the system alarms (technical alarm):
Upon the system error, the monitor prompts alarm immediately and proceeds
corresponding remedy, stops all monitoring and eliminates the final results in
order to avoid faulted treatment. If more than one error occur, they will be
displayed by turns. C. General alert In some circumstances, alerts will behave
as physiological alarm but in normal sense, we don’t regard them as real
patient health related items.
6.3 SILENCE and PAUSE
SILENCE Press the SILENCE button on the panel for more than 1 seconds can shut
off all
sounds until the SILENCE button is pressed again. When the system is in
SILENCE status, any newly generated alarm will discharge the SILENCE status
and make the system give normal status giving audio and visual alarm. PAUSE
Press the SILENCE button on the panel once to close all audio and visual
prompt and description about all the physiological alarms and to make the
system enter ALARM PAUSE status. The rest seconds for alarm pause is displayed
in the Physiological Alarm area. And the symbol is displayed in the System
Prompt area. The user may set up the time for Alarm Pause in the ALARM SETUP
menu. Three selections are available: 1min, 2min and 3min. When in the PAUSE
status, press the SILENCE button to restore the normal alarm status. Besides,
during PAUSE status, newly occurring technical alarm will discharge the PAUSE
status and the system will access the normal alarm status. The symbol
disappears, too. NOTE Whether an alarm will be reset depends on the status of
the alarm cause. But by pressing SILENCE button can permanently shut off audio
sound of Lead Off/Sensor Off alarms.
6.4 Parameter Alarm
The setup for parameter alarms is in their menus. In the menu for a specific
parameter, you
30
can check and set the alarm limit, alarm status. The setup is isolated from
each other. When a parameter alarm is off, a symbol displays near the
parameter. If the alarms are turned off individually, they must be turned on
individually. For the parameters whose alarm is set to ON, the alarm will be
triggered when at least one of them exceeds alarm limit. The following actions
take place: 1. Alarm message displays on the screen as described in alarm
mode; 2. The monitor beeps in its corresponding alarm class and volume; 3.
Alarm lamp flashes; 4. Store all parameter values during the alarm and 4,8 or
16 second waveform prior to
and after alarm. 5. If alarm recording is on, the recorder starts alarm
recording. For further information
on alarm recording, please refer to Chapter Recording.
6.5 When an Alarm Occurs
NOTE When an alarm occurs, you should always check the patient’s condition
first. The alarm message appears at the top of the screen on the right side.
It is needed to identify the alarm and act appropriately, according to the
cause of the alarm. 1. Check the patient’s condition. 2. Identify the cause of
the alarm. 3. Silence the alarm, if necessary. 4. When cause of alarm has been
over, check that the alarm is working properly. You will find the alarm
messages for the individual parameter in their appropriate parameter chapters
of this manual.
6.6 ST Segment Alarm
The monitor records 2-channel ECG waveforms 4, 8, or 16 seconds prior to and
after the alarm (totally 8, 16, or 32 seconds) (which can be selected in the
ECG SETUP menu). All parameter values during the alarm will also be recorded.
6.7 Arrhythmia Alarm
The monitor records 2-channel ECG waveforms 4 seconds prior to and after the
alarm (totally 8 seconds). All measurement results during the alarm will also
be recorded.
31
Chapter 7
ECG/RESP Monitoring
7.1 What Is ECG Monitoring
Monitoring the ECG produces a continuous waveform of the patient’s cardiac
electric activity to enable an accurate assessment of his current
physiological state. Only proper connection of the ECG cables can ensure
satisfactory measurement. On the Normal Display, JR2000B provides display of
2-channel ECG waveforms. The patient cable consists of 2 parts(See Chapter
Accessories and Ordering
Information for detail information of the ECG accessories); The cable that
connects to the monitor; The lead set that connects to the patient. Using a
5-lead set, the ECG can derive up to two waveforms from two different leads.
For requested lead, you may choose from the left side of ECG waveform. The
monitor displays the Heart Rate (HR), ST segment and Arrhythmia analysis. All
of the parameters above can be set as alarm parameters. NOTE In the default
settings of , the ECG waveforms are the first two waveforms from top in the
Waveform Area.
7.2 Precautions during ECG Monitoring
Warning 1Do not touch the patient, table nearby, or the equipment during
defibrillation. 2Use only the original JR2000B ECG cable for monitoring. 3
When connecting the cables and electrodes, make sure no conductive part is in
contact with the ground. Verify that all ECG electrodes, including neutral
electrodes, are securely attached to the patient. NOTE Interference from a
non-grounded instrument near the patient and ESU interference can cause
inaccuracy of the waveform.
7.3 Monitoring Procedure
7.3.1 Preparation 1. Prepare the patient’s skin prior to placing the
electrodes. The skin is a poor conductor of electricity, therefore preparation
of the patient’s skin is
important to facilitate good electrode contact to skin. Shave hair from sites,
if necessary. Wash sites thoroughly with soap and water. (Never use ether or
pure alcohol, because
this increases skin impedance).
32
Rub the skin briskly to increase capillary blood flow in the tissues and
remove skin scurf and grease.
2. Attach clip or snap to electrodes prior to placement. 3. Put the
electrodes on the patient. Before attaching, apply some conductive jelly on
the electrodes if the electrodes are not electrolyte self-supplied. 4. Connect
the electrode lead to the patient’s cable. 5. Make sure the monitor is ready
with power supply.
Warning 1. Check everyday whether there is skin irritation resulted from the
ECG
electrodes. If so, replace electrodes every 24 hours or change their sites. 2.
Verify lead fault detection prior to the start of monitoring phase. Unplug the
ECG cable from the socket, the screen will display the error message “ECG LEAD
OFF” and the audible alarm is activated. Note For protecting environment, the
electrodes must be recycled or disposed of properly. 7.3.2 Installing ECG lead
Placing the Electrodes for ECG Monitoring Electrode placement for 5-lead set
(Figure 8- 2) Red (R) electrode – Be placed near the right shoulder, directly
below the clavicle. Yellow (L) electrode – Be placed near the left shoulder,
directly below the clavicle. Black (N) electrode – Be placed on the right
hypogastrium. Green (F) electrode – Be placed on the left hypogastrium. White
(C) electrode – Be placed on the chest as illustrated in the F Figure 8- 3
Note: the following table gives the corresponding lead names used in Europe
and America respectively. (Lead names are represented by R, L, N, F and C
respectively in Europe, whose corresponding lead names in America are RA, LA,
RL, LL and V.)
Figure 7-1 Electrode placement for 5-lead set NOTE To ensure patient safety,
all leads must be attached to the patient. For 5-lead set, attach the
C-electrode to one of the indicated positions as below
33
Warning 1When using Electrosurgery equipment, leads should be placed in a
position in equal distance from Electrosurgery electrotome and the grounding
plate to avoid cautery. Electrosurgery equipment wire and ECG cable must not
be tangled up. 2The placing of the ECG leads will depend on the type of
surgery that is being performed. For example, with open chest surgery the
electrodes may be placed laterally on the chest or on the back. In the
operating room, artifacts can sometimes affect the ECG waveform due to the use
of ES (Electrosurgery) equipment. To help reduce this you can place the
electrodes on the right and left shoulders, the right and left sides near the
stomach, and the chest lead on the left side at mid-chest. Avoid placing the
electrodes on the upper arms, otherwise the ECG waveform will be too small.
Warning When using Electrosurgery equipment, never place an electrode near the
grounding plate of the Electrosurgery device, otherwise there will be a great
deal of interference with the ECG signal. Using 5-lead ECG set The default
setting is ECG CH1 corresponding to Channel II, and ECG CH2 to Channel I, you
can modify the setting to meet your needs. You can set them to correspond to
any two from I, II, III, AVR, AVL, AVF and V. If you set both to the same
value, one of them will be adjusted to another option automatically. (Figure
8- 4)
F
Figure 7- 2 ECG lead NOTE If a ECG waveform is not accurate, while the
electrodes are tightly attached, try to change the lead. NOTE Interference
from a non-grounded instrument near the patient and ESU interference can cause
inaccuracy of the waveform. Normal QRS complex should be: Tall and narrow with
no notches. With tall R-wave completely above or below the baseline. With
pacer spike no higher than R-wave height.
34
With T-wave less than one-third of the R-wave height. With P-wave much smaller
than the T-wave. For getting 1 mv calibrated ECG wave, pick the ECG CAL button
in the ECG SETUP menu. A message “when CAL, can’t monitor! ” prompts on the
screen.
Figure 7-3 Standard ECG Waveform Warning Do not touch the patient, table
nearby, or the equipment during defibrillation.
7.4 ECG Menu
ECG SETUP Menu Pick the ECG hot key on the screen, and the following menu will
popup.
Figure7-4 ECG SETUP menu ECG alarm setting HR ALM: pick “ON” to enable prompt
message and data record during the ECG
alarm; pick “OFF” to disable the alarm function, and there will be a beside
“ECG”. ALM LEV: selectable from HIGH, MED, LOW. Level HIGH represents the most
serious case. ALM REC: pick “ON” to enable report printing upon ECG alarm. ECG
alarm is activated when the heart beat exceeds set ALM HI value or falls below
ALM LO value. NOTE Please set the alarm limits according to clinical condition
of individual patient. The
35
upper limit shall not exceed 20 beat/min higher than the patient’s heart rate.
HR FROM ECG, SpO2, AUTO and BOTH may detect heart rate. AUTO distinguishes
heart rate source according to the quality of signal. By picking ECG, the
monitor prompts HR and activates HR beep. By picking SpO2, the monitor prompts
PULSE and activates pulse beep. BOTH mode displays HR and PR simultaneously,
when this item is picked, PR parameter is displayed to the right side of SpO2.
As for the sound of HR or PR in BOTH mode, HR is given the priority, i.e., if
HR is available, whose sound will be sent out, but if HR is not available,
then the sound will be for PR. HR CHANNEL “CH1” to count the heart rate by CH
1 waveform “CH2” to count the heart rate by CH 2 waveform “AUTO” the monitor
selects a channel automatically LEAD TYPE Used to select either 5 LEADS or 3
LEADS. SWEEP Available options for SWEEP are 12.5, 25.0, and 50.0 mm/s. ST
ANALYSIS Pick this item to access ST ANALYSIS menu, the detailed information
about the menu is to be discussed in the following section. ARR ANALYSIS Pick
this item to access ARR ANALYSIS menu, the detailed information about the menu
is to be discussed in the following section. OTHER SETUP Pick this item to
access ECG SETUP menu as shown below:
Figure 7-5 ECG SETUP menu In the sub-menu, following functions are available:
BEAT VOL Four selections are available: OFF, LOW, MED, HIGH. HIGH indicates
maximum volume. OFF indicates no sound. PACE “ON” detected signal will be
marked by a ” ” above the ECG waveform. “OFF” for non-pacemaking patient NOTE
If monitoring a patient with the pacemaker, set “PACE” to ON. If monitoring a
36
patient without pacemaker, set “PACE” to OFF. If “PACE” is on, the system will
not perform some types of ARR analysis. For detailed information, please refer
to the section: ARR ALARM. In the table, the ARR type marked by All types
applies to the analysis in all situations, marked by Non-paced applies only to
the analysis in the situation when the patient does not use pacemaker. ECG CAL
Pick this item to start calibrating ECG. The method to end CAL: re-select the
ECG CAL key in the menu or re-select the lead name on the screen. DEFAULT Pick
this item to access the ECG DEFAULT CONFIG dialog box, in which the user may
select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT CONFIG is to be
used. After selecting any of the items and exiting the dialog box, the system
will pop up the dialog box asking for the user’s confirmation.
Warning For pacemaker patient, the pacing impulse analysis function must be
switched on, otherwise, the pacing impulse may be counted as normal QRS
complex, which results in failure of “ECG LOST” error detection. Note: For
monitor with ST segment & Arrhythmia analysis software, refer to ST Segment
Monitoring and Arrhythmia Analysis for details. NOTE When Pacer Switch is On,
the Arrhythmia events related to PVCs will not be monitored. At the same time,
the ST analysis will not be performed either.
7.5 ECG Alarm Information and Prompt
Alarm Message Alarms occurring in the process of ECG measurement contain two
types: physiological alarm and technical alarm. Prompt message may also appear
in the mean time. For the audio and visual features during the appearance of
these alarms and prompt messages in the process of ECG measurement, please
refer to the related description in Chapter Alarm. In the screen,
physiological alarm messages and the prompt messages able to trigger alarms
(general alerts) all displayed in the alarm area of the monitor while
technical alarms and prompt messages unable to trigger alarms are then
displayed in the information area of the monitor. This section does not
describe the content about Arr. and ST analysis. Among physiological alarms,
those belonging to the type that the parameter has exceeded the limits may
activate the recorder to automatically output the parameters and related
measured waveforms when the alarms occur on the condition that the alarm
record switch in the related menu is On. Tables below describe respectively
the possible various alarms those may occur during the measurement.
37
Physiological alarms:
Message
Cause
Alarm level
ECG LOST HR TOO HIGH OR TOO LOW
Technical alarms:
No ECG signal of the patient is detected. HR measuring value is above the upper or below the alarm limit
HIGH User-selectable
Message Cause
Alarm level
Remedy
ECG LEAD OFF
ECG COMM STOP
HR ALM LMT ERR
ECG electrodes fall off the skin or ECG cables fall off the monitor.
Occasional communication failure
Functional safety failure
LOW HIGH HIGH
ECG NOISE
ECG measuring signal is greatly interfered.
LOW
Prompt messages (include general alerts):
Make sure that all electrodes, leads and patient cables are properly
connected. If failure persists, notify our engineer or service staff.
Stop using HR alarm function, notify our engineer or service staff. Make sure
the patient is quiet, the electrodes are properly connected and AC power
system is well grounded.
Message
Cause
Alarm Level
HR EXCEED HR measuring value exceeds the measurement range. HIGH
7.6 ST Segment Monitoring
ST segment monitoring function is shutoff by default. You can switch it to ON
when necessary.
NOTE When setting ST ANALYSIS on, the monitor will select “DIAGNOSTIC” mode.
You can set it to “MONITOR” mode or “OPERATE” mode as required. However at
this time ST value has been severely distorted. It is available to measure the
variance of ST segment with ST analysis at the
waveform tracks for selected lead. The corresponding ST measurement result
displays numerically at ST1 and ST2 in the Parameter Area. The trend can be
viewed with table or graphic form. Measurement unit of ST segment: mv.
Measurement symbol of ST segment: “+” = elevating, “-” = depressing.
Measurement range of ST segment: -2.0 mv, ~ + 2.0 mv. Pick the ST ANALYSIS
item in the ECG SETUP menu to access the ST ANALYSIS sub-menu as shown below.
7.6.1 ST ANALYSIS menu
38
Figure 7-6 ST ANALYSIS menu
ST analysis alarm setting ST ANAL: the switch for ST analysis. Set it to ON to activate the ST analysis or OFF
to disable the ST analysis. ST ALM: pick “ON” to enable prompt message and data record during the ST analysis
alarm; pick “OFF” to disable the alarm function, and there will be a beside ST. ST
alarm is activated when the result exceeds set ST HI value or falls below ST LO value. ALM LEV: used to set up the ST alarm level. There are three selections: HIGH, MED
and LOW. ALM REC: pick “ON” to enable report printing upon ST analysis alarm. ALM HI: used to set up the upper limit of ST alarm. The max. higher limit is 2.0. The
minimum higher limit is 0.2 larger than the set lower limit. ALM LOW: used to set up the lower limit of ST alarm. The minimum lower limit is
2.0. The max. lower limit is 0.2 lower than the set higher limit.
ST analysis alarm limits
Max. ST HI Min. ST LO
Step
ST 2.0 mv
-2.0 mv
0.1
DEF POINT pick this item to access the DEF POINT window, in which the position
of ISO and ST point can be set up.
ISO Base point. Default is 78 ms.
ST
Measurement point.
Figure 7-7 DEF POINT window The operator can adjust the position of both ISO
and ST measurement points. The reference point is the position where the peak
of R-wave locates (see Figure 8- 10).
39
R Wave
T P
Q S
ISO
ST
-78 ms
+109 ms
Figure 7-8 DEF Point
} ST Value
The ST measurement for each beat complex is the vertical difference between the two
measurement points.
NOTE
The ST measurement point should be adjusted if the patient’s HR or ECG
morphology changes significantly. Adjusting ISO, ST
These two points can be adjusted turning the knob.
When adjusting ST measurement point, the system will show the ST Measurement Point
Window. The QRS complex template displays in the window (If the template is not
established, a horizontal line will display. If the channel is not at ON position, a horizontal
line will also display). It is adjustable of the highlight bar in the window. You may select
ISO or ST, then switch the knob left or right to move the cursor line. When the cursor is at
the required position, you may select the base point or the measurement point.
NOTE
Abnormal QRS complex is not considered in ST segment analysis.
ST Alarm Message
Note: The alarm limits for two ST measurements are identical. No setting of alarm limits
can be made only for one channel.
Among physiological alarms, those belonging to the type that the parameter has exceeded
the limits may activate the recorder to automatically output the parameters and related
measured waveforms when the alarms occur on the condition that the alarm record switch
in the related menu is On.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages during ST measurement.
Physiological alarms:
Message
Cause
Alarm Level
STI TOO LOW
ST measuring value of channel 1 is below the lower alarm limit.
User-selectable
40
ST2 TOO HIGH ST2 TOO LOW
ST measuring value of channel 2 is above the upper alarm limit.
ST measuring value of channel 2 is below the lower alarm limit.
User-selectable User-selectable
Technical alarms:
Message
Cause
ST ALM Functional LMT ERR safety failure
Alarm Level
HIGH
Remedy
Stop using ST alarming function, notify our engineer or service staff.
Prompt messages (include general alerts):
Message
Cause
Alarm Level
ST1 EXCEED ST2 EXCEED
ST measuring value of channel 1 exceeds the measurement range.
ST measuring value of channel 2 exceeds the measurement range.
HIGH HIGH
7.7 Arr. Monitoring
Arrhythmia Analysis The arrhythmia algorithm is used to monitor ECG of neonate
and adult patient in clinical, detect the changing of heart rate and
ventricular rhythm, and also save arrhythmia events and generate alarming
information. Arrhythmia algorithm can monitor paced and non-paced patients.
Qualified personnel can use arrhythmia analysis to evaluate patient’s
condition (such as heart rate, PVCs frequency, rhythm and ectopic beat) and
decide the treatment. Besides detecting changing of ECG, arrhythmia algorithm
can also monitor patients and give proper alarm for arrhythmia. The arrhythmia
monitoring is shutoff by default. You can enable it when necessary. This
function can call up the doctor’s attention to the patient’s heart rate by
measuring
and classifying the arrhythmia and abnormal heart beat and triggering the
alarm. The monitor can conduct up to 13 different arrhythmia analyses. The
monitor can store the latest 60 alarm events when taking arrhythmia analysis
to a
peculiar buffer. The operator can edit these arrhythmia events through the
menu below. Pick the item ARR ANALYSIS in ECG SETUP menu to access the ARR
ANALYSIS sub-menu. ARR ANALYSIS Menu
Figure 7-9 ARR ANALYSIS Menu
41
ARR ANAL: Pick “ON” during monitoring. Default set is “OFF”. ALM: Pick “ON” to enable prompt message and data record when alarm occurs; pick
“OFF” to disable the alarm function, and there will be a beside “PVCs”. ALM LEV: selectable from HIGH, MED, LOW. Level HIGH represents the most
serious case. ALM REC: pick “ON” to enable report printing upon PVCs alarm. ALM HI: PVCs alarm is activated when the PVCs exceeds set PVCs ALM HI value.
PVCs alarm upper limits:
Max
Min
Step
PVCs
10
1
1
PVCs alarm and prompt message:
Among physiological alarms, those belonging to the type that the parameter has exceeded
the limits may activate the recorder to automatically output the parameters and related
measured waveforms when the alarms occur on the condition that the alarm record switch
in the related menu is On.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during PVCs measurement.
Physiological alarms:
Message
Cause
Alarm Level
PVCs TOO HIGH PVCs measuring value is above upper alarm limit. User-selectable
Technical alarms:
Message
Cause
Alarm Level Remedy
PVCs ALM Functional LMT ERR safety failure
HIGH
Stop using PVCs alarming function, notify bioMEDICAL INSTRUMENT engineer or service staff.
ARR RELEARN Pick this item to start a learning procedure.
ARR ALARM Pick this item to access the ARR ALARM dialog box to set arrhythmia
alarm parameters.
Set ALM to ON/OFF to enable/disable the alarm function; Set REC to ON/OFF to
enable/disable alarm record function, turn the knob under LEV column to set alarm level to
HIGH, MED or LOW.
Figure7-10 ARR ALARM Menu
42
You can pick ALL ALM ON to enable alarm function of all arrhythmia types and pick ALL
ALM OFF to disable this function. Likewise, you can pick ALL REC ON to enable
recording function for all arrhythmia types and pick ALL REC OFF to disable this function.
Changing the ALM LEV can reset alarm level of all arrhythmia types to the same value.
NOTE
If there are more than 60 Arrhythmia events, the latest will be retained.
ARR ALARM
The alarm is triggered when an Arrhythmia occurs. If the ALM is ON, the alarm sounds
and the alarm indicator flashes. If the REC is ON, the alarm record will be printed out (4
seconds prior to and after the alarm, with the ECG waveforms of analysis channel).
Physiological alarms:
Arr. Type
Applicable Patient Type
Occurring Condition
Prompt
Alarm Level
ASYSTO All patients LE
No QRS is detected for 4 consecutive seconds
ASYSTOLE
User-selecta ble
Fibrillatory wave for consecutive 4
VFIB /VTAC
Without pacemaker
seconds; or The number of continuous Vent beats is larger than the upper limit of cluster Vent beats (>5). The RR
VFIB/VTAC
User-selecta ble
interval is less than 600ms.
VT>2
Without pacemaker
3 < the number of cluster PVCs < 5
VT>2
User-selecta ble
COUPLE Without 2 consecutive PVCs
T
pacemaker
COUPLET
User-selecta ble
BIGEMI Without Vent Bigeminy
NY
pacemaker
BRGEMINY
User-selecta ble
TRIGEM Without Vent Trigeminy
TRIGEMIN User-selecta
INY
pacemaker
Y
ble
A type of single PVC under the condition that HR<100R-R interval
R ON T
Without pacemaker
is less than 1/3 the average interval, followed by a compensating pause of 1.25X the average R-R interval(the
R ON T
User-selecta ble
next R wave advances onto the
previous T wave).
Single PVCs not belonging to the type
PVC
Without of above mentioned PVCs. pacemaker
PVC
User-selecta ble
TACHY All patients BRADY All patients
BEAT Without MISS pacemaker
5 consecutive QRS complex , RR interval is less than 500ms.
TACHY
User-selecta ble
5 consecutive QRS complex, RR interval is longer than 1.5s.
BRADY
User-selecta ble
When HR is less than 100 beats/min.,
no heart beat is tested during the period
1.75 times of the average RR interval; or
BEAT MISS
User-selecta ble
When HR is larger than 100 beats/min.,
no beat is tested with 1 second.
43
No QRS complex and pacing pulse are
PNP
With pacemaker
availabe during the period 1.75 times of the average R-R interval (only
PNP
considering patients with pacemaker.)
When pacing pulse is available, no
PNC
With pacemaker
QRS exists during the period 1.75 times of the average RR interval (only
PNC
considering patients with pacemaker.)
User-selecta ble
User-selecta ble
Patient type:
All patients: refers to perform Arr.analysis on patients either with pacemakers or without
pacemakers.
Without pacemaker: refers to perform Arr. Analysis only on the patients without
pacemakers.
With pacemaker: refers to perform Arr. Analysis only on the patients with pacemakers.
Prompt message:
Message
Cause
Alarm Level
ARR LEARNING
The QRS template building required for Arr. Analysis is in process.
NOTE
Arrhythmia name displays in the Alarm Message Area.
No alarm
7.8 Measuring RESP
7.8.1 How to measure RESP? The monitor measures respiration from the amount of
thoracic impedance between two ECG electrodes. The change of impedance between
the two electrodes, (due to the thoracic movement), produces a respiratory
waveform on the screen. 7.8.2 Setting Up RESP measurement 1For RESP
monitoring, it is not necessary for additional electrodes, however, the
placing of electrodes is important. 2 Some patients, due to their clinical
condition, expand their chest laterally, causing a negative intrathoracic
pressure. In these cases it is better to place the two RESP electrodes
laterally in the right axillary and left lateral chest areas at the maximum
point of breathing movement to optimize the respiratory waveform. NOTE It is
not recommended using the RESP monitoring on patients who are very active, as
this can cause false alarms. Checklist for RESP Monitoring 1. Prepare the
patient’s skin prior to placing the electrodes. 2. Attach snap or clip to the
electrodes and attach the electrodes to the patient as
described below. 3. Switch on the monitor. 7.8.3 Installing electrode for RESP
measurement
44
Placing the Electrodes for Respiratory Monitoring
L Yellow R Red
N Black
F Green
Figure 7-13 Electrodes placement (5-lead)
NOTE
Place the red and green electrodes diagonally to optimize the respiration waveform.
Avoid the liver area and the ventricles of the heart in the line between the RESP
electrodes so as to avoid cardiac overlay or artifacts from pulsating blood flow. This is
particularly important for neonates.
7.8.4 RESP menu
RESP SETUP Menu
Pick RESP hot key on the screen to call up the following menu:
Figure 7-14 RESP SETUP Menu
RESP alarm setting ALM: pick “ON” to enable prompt message and data record during the RESP alarm;
pick “OFF” to disable the alarm function, and there will be a
beside “RESP”.
ALM REC: pick “ON” to enable report printing upon RESP alarm.
RESP alarm is activated when the respiration rate exceeds set ALM HI value or falls below
ALM LO value.
RESP alarm limits: APNEA ALM: to set the standard of judging an apnea case. It ranges from 10 to 40
seconds, increases / decreases by 5. SWEEP: Available options are 6.25, 12.5 and 25.0 mm/s.
WAVE AMP: The user may set up the displaying amplitude of the RESP waveform.
45
The selections are 0.25, 0.5, 1, 2, 3, 4, 5. HOLD TYPE: AUTO/MANUAL
adjustable. When it is AUTO mode, HOLD HI and
HOLD LO menus cannot be used and the monitor automatically calculates the RESP
RATE. HOLD HI and HOLD LO: When the HOLD TYPE is MANUAL, the user can use the
knob to pick either HOLD HI or HOLD LO and turn the knob to adjust the two
dashed lines in the RESP WAVEFORM area respectively. The positions of the
dashed lines will be used to calculate the upper and lower limits of RESP RATE
by the monitor. DEFAULT: pick this item to access the RESP DEFAULT CONFIG
dialog box, in which the user may select whether the FACTORY DEFAULT CONFIG or
the USER
DEFAULT CONFIG is to be used. After selecting any of the items and exiting the dialog box, the system will pop up the dialog box asking for the user’s confirmation RESP Alarm Msessage Among physiological alarms, those belonging to the type that the parameter has exceeded the limits may activate the recorder to automatically output the parameters and related measured waveforms when the alarms occur on the condition that the alarm record switch in the related menu is On.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during RESP measurement.
Physiological alarms:
Message
Cause
RR TOO HIGH RESP measuring value is above upper alarm limit.
RR TOO LOW RESP measuring value is below lower alarm limit.
RESP APNEA
RESP can not be measured within specific time interval.
Technical alarms:
Alarm Level User-selectable User-selectable
HIGH
Message
Cause
Alarm Level Remedy
RESP ALM Functional LMT ERR safety failure
HIGH
Prompt message (general alerts):
Stop using RESP alarming function, notify our engineer or service staff.
Message
Cause
Alarm Level
RR EXCEED RR measuring value exceeds the measure range. HIGH
46
Chapter 8
SpO2 Monitoring
8.1 What is SpO2 Monitoring
SpO2 Plethysmogram measurement is employed to determine the oxygen saturation
of hemoglobin in the arterial blood. If, for example, 97% hemoglobin molecules
in the red blood cells of the arterial blood combine with oxygen, then the
blood has a SpO2 oxygen saturation of 97%. The SpO2 numeric on the monitor
will read 97% .The SpO2 numeric shows the percentage of hemoglobin molecules
which have combined with oxygen molecules to form oxyhemoglobin. The
SpO2/PLETH parameter can also provide a pulse rate signal and a plethysmogram
wave. 8.1.1 How the SpO2 / PLETH Parameter Works Arterial oxygen saturation is
measured by a method called pulse oximetry. It is a
continuous, non-invasive method based on the different absorption spectra of
reduced hemoglobin and oxyhemoglobin. It measures how much light, sent from
light sources on one side of the sensor, is transmitted through patient tissue
(such as a finger or an ear), to a receiver on the other side. The sensor
measurement wavelengths are nominally 660nm for the Red LED and 940nm for
Infrared LED. Maximum optical power output for LED is 4 mW. The amount of
light transmitted depends on many factors, most of which are constant.
However, one of these factors, the blood flow in the arteries, varies with
time, because it is pulsating. By measuring the light absorption during a
pulsation, it is possible to derive the oxygen saturation of the arterial
blood. Detecting the pulsation gives a PLETH waveform and pulse rate signal.
The SpO2 value and the PLETH waveform can be displayed on the main screen.
Warning Pulse oximetry can overestimate the SpO2 value in the presence of Hb-
CO, Met-Hb or dye dilution chemicals. 8.1.2 SpO2 / Pulse Monitoring Warning
1ES (Electrosurgery) equipment wire and SpO2 cable must not be tangled up. 2Do
not put the sensor on extremities with arterial catheter or venous syringe.
Note Do not perform SpO2 measuring and NIBP measuring in same arm at one time,
because obstruction of blood flow during NIBP measuring may adversely affect
the reading of SpO2 value.
8.2 Precautions during SpO2/Pulse Monitoring
Note Make sure the nail covers the light window; The wire should be on the
backside of the hand. Note SpO2 value always displays at the same position.
Pulse Rate will display when HR FROM
47
is set at “SPO2”, “BOTH” in the ECG SETUP menu. Note SpO2 waveform is not
proportional to the pulse volume.
Warning 1Verify sensor cable fault detection before beginning of monitoring
phase. Unplug the SpO2 sensor cable from the socket, the screen will display
the error message “SPO2 SENSOR OFF” and the audible alarm is activated. 2 Do
not use the sterile supplied SpO2 sensors if the packaging or the sensor is
damaged and return them to the vendor. 3Prolonged and continuous monitoring
may increase jeopardy of unexpected change of dermal condition such as
abnormal sensitivity, rubescence, vesicle, repressive putrescence, and so on.
It is especially important to check the sensor placement of neonate and
patient of poor perfusion or immature dermogram by light collimation and
proper attaching strictly according to changes of the skin. Check per 2~3
hours the sensor placement and move it when the skin deteriorates. More
frequent examinations may be required for different patients.
8.3 Monitoring Procedure
SpO2 plethysmogram measurement 1. Switch on the monitor. 2. Attach the sensor
to the appropriate site of the patient finger. 3. Plug the connector of the
sensor extension cable into the SpO2 socket on the
JR2000B.
Figure8-1mounting of the sensor
8.4 Limitations for Measurement
Measurement Limitations In operation, the accuracy of oximetry readings can be
affected by: High-frequency electrical noise, including noise created by the
host system, or noise
from external sources, such as electrosurgical apparatus, which is admitted by
the host system. Do not use oximeters and oximetry sensors during magnetic
resonance imaging (MRI) scanning. Induced current could potentially cause
burns. Intravascular dye injections Excessive patient movement Improper sensor
application Sensor temperature (maintain between 28°C and 42°C for best
operation )
48
Placement of the sensor on an extremity that has a blood pressure cuff,
arterial catheter, or intravascular line.
Significant concentrations of dysfunctional hemoglobin, such as
carboxyhemoglobin and methemoglobin.
External illumination more than 5,000 lumens/square meter (typical office
lighting) Venous pulsations It is recommended to use SpO2 sensors described in
chapter Accessories and Ordering
Information.
8.5 SpO2 Menu
SPO2 SETUP Menu Pick the SPO2 hot key on the screen to call up the SPO2 SETUP
menu as shown below.
Figure 8-2 SPO2 SETUP menu Warning Setting the SpO2 upper alarm limit to 100%
is equivalent to switching off the alarm on upper limit. High oxygen levels
may predispose a premature infant to retrolental fibroplasia. Therefore, the
upper alarm limit for oxygen saturation must be carefully selected in
accordance with commonly accepted clinical practices. SpO2 alarm setting ALM:
pick “ON” to enable prompt message and data record during the SpO2 alarm;
pick “OFF” to disable the alarm function, and there will be a beside “SpO2”.
ALM REC: pick “ON” to enable report printing upon SpO2 alarm. SWEEP Available
options are 12.5, 25.0 mm/s. PR SOUND Pulse beep volume. Options are OFF,
HIGH, MED, LOW. AVG TIME 4S, 8S, 16S represent times that SpO2 average value
is counted. DEFAULT: Pick this item to access the SPO2 DEFAULT CONFIG dialog
box, in which the user may select whether the FACTORY DEFAULT CONFIG or the
USER DEFAULT CONFIG is to be used. After selecting any of the items and
exiting the dialog box, the system will pop up the dialog box asking for the
user’s confirmation.
49
8.6 Alarm Description and Prompt
SpO2 Alarm Message
Among physiological alarms, those belonging to the type that the parameter has exceeded
the limits may activate the recorder to automatically output the parameters and related
measured waveforms when the alarms occur on the condition that the alarm record switch
in the related menu is On.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during SpO2 measurement.
Physiological alarm:
Message
Cause
Alarm Level
SPO2TOO HIGH SpO2 measuring value is above upper alarm limit. User-selectable
SpO2 TOO LOW SpO2 measuring value is below lower alarm limit. User-selectable
PR TOO HIGH
PR measuring value is above upper alarm limit. User-selectable
PR TOO LOW
PR measuring value is below lower alarm limit. User-selectable
Technical alarms:
Message
SPO2 SENSOR OFF
Cause
SpO2 sensor may be disconnected from the patient or the monitor.
Alarm Level LOW
Remedy
Make sure that the monitor and the patient are in correct connection with the
cables.
Prompt message (include general alerts):
Message
Cause
Alarm Level
SEARCH PULSE NO PULSE
SpO2 module is searching for pulse.
No alarm
SpO2 module cannot detect SpO2 signal for a long time.
HIGH
8.7 Maintenance and Cleaning
Care and Cleaning Warning
Before cleaning the monitor or the sensor, make sure that the equipment is
switched off and disconnected from the power line. Do not subject the sensor
to autoclaving. Do not immerse the sensor into any liquid. Do not use any
sensor or cable that may be damaged or deteriorated. For cleaning: Use a
cotton ball or a soft mull moistened with hospital-grade ethanol to wipe the
surface of the sensor, and then dry it with a cloth. This cleaning method can
also be applied to the luminotron and receiving unit. The cable can be cleaned
with 3% hydrogen dioxide, 7% isopropanol, or other active reagent. However,
connector of the sensor shall not be subjected to such solution.
50
Chapter 9
TEMP Monitoring
9.1 TEMP Monitoring
TEMP monitoring setup If you are using disposable TEMP probes you need to plug
the TEMP cable into the
monitor and then connect the probe to the cable. With a reusable TEMP probe
you can plug the probe directly into the monitor Apply the TEMP probe(s)
securely to the patient. Switch on the system. Warning 1Verify probe cables
fault detection before beginning of monitoring phase. Unplug the temperature
probe cable from the socket, the screen will display the error message “TEMP
SENSOR OFF” and the audible alarm is activated. 2The calibration of the
temperature measurement is necessary for every two years (or as frequently as
dictated by your Hospital Procedures Policy). When you need calibrate the
temperature measurement, contact the manufacture please. Note 1Disposable TEMP
probe can only be used once for one patient. 2The self-test of the temperature
measurement is performed automatically once per hour during the monitoring.
The test procedure lasts about 2 seconds and does not affect the normal
measurement of the temperature monitoring.
9.2 TEMP SETUP Menu
Pick the TEMP hot key on the screen to call up the TEMP SETUP menu shown as
below:
Figure 9-1 TEMP SETUP Menu TEMP alarm setting ALM: pick “ON” to enable prompt
message and data record during the TEMP alarm; pick “OFF” to disable the alarm
function, and prompt the symbol beside TEMP numeric. ALM LEV: used to set up
the alarm level, selectable from HIGH, MED or LOW. ALM REC: used to start/stop
recording TEMP alarms. Pick “ON” to enable report printing upon TEMP alarm.
Alarm for TEMP occurs when the measured temperature exceeds set alarm high
limit or falls below alarm low limit.
51
TEMP alarm limits:
Max. TEMP HI
Min. TEMP LO
Step
TEMP
50
0
0.1
UNIT
To set temperature unit (ºC or ºF).
DEFAULT
Pick this item to access the TEMP DEFAULT CONFIG dialog box, in which the user may
select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT CONFIG is to
be used. After selecting any of the items and exiting the dialog box, the system will pop up
the dialog box asking for the user’s confirmation.
9.3 TEMP Alarm message
Among physiological alarms, those belonging to the type that the parameter has exceeded the limits may activate the recorder to automatically output the parameters and related measured waveforms when the alarms occur on the condition that the alarm record switch in the related menu is On. Tables below describe the possible physiological alarms, technical alarms and prompt messages occurring during TEMP measurement. Physiological alarms:
Message
Cause
Alarm Level
TEMP TOO HIGH TEMP TOO LOW
Measuring value of sensor is above upper alarm limit.
Measuring value of sensor is below lower alarm limit.
User-selectable User-selectable
Technical alarms:
Alarm Message
TEMP SENSOR OFF
TEMP ALM LMT ERR
Cause Temperature cable may be disconnected from the monitor.
Functional safety failure
Alarm Level Remedy
LOW
Make sure that the cable is properly connected.
HIGH
Stop using alarming function of TEMP module, notify our engineer or service staff.
Prompt message:
Message
Cause
Alarm Level
TEMP EXCEED Measuring value of sensor is beyond measuring range. HIGH
52
Chapter 10
NIBP Monitoring
10.1 Introduction
Reference to the European standard EN 1060-1: Specification for Non-invasive
sphygmomanometers Part 1, General requirements.
The Non-invasive Blood Pressure (NIBP) module measures the blood pressure
using the oscillometric method.
It is applicable for adult, pediatric, and neonatal usage. There are three
modes of measurement available: manual, automatic and continuous.
Each mode displays the diastolic, systolic and mean blood pressure. In the
MANUAL mode, only one measurement is conducted for each time. In the AUTO
mode, the measurement is cycled; you can set the interval time to
1/2/3/4/5/10/15/30/60/90/120/180/240/480 minutes. In the continuous mode, the
monitor measures the blood pressure as many times as
possible in five minutes. Warning 1. You must not perform NIBP measurements on
patients with sickle-cell disease or under any condition which the skin is
damaged or expected to be damaged. 2. For a thrombasthemia patient, it is
important to determine whether measurement of the blood pressure shall be done
automatically. The determination should be based on the clinical evaluation.
3. Ensure that the correct setting is selected when performing measurements on
children. It may be dangerous for the children to use an over pressure level.
10.2 NIBP Measuring
10.2.1 NIBP Measuring Warning
Before starting a measurement, verify that you have selected a setting
appropriate for your patient (adult, pediatric or neonate.)
Do not apply the cuff to a limb that has an intravenous infusion or catheter
in place. This could cause tissue damage around the catheter when infusion is
slowed or blocked during cuff inflation.
Make sure that the air conduit connecting the blood pressure cuff and the
monitor is neither blocked nor tangled.
1. Plug in the air hose and switch on the system. 2. Apply the blood pressure
cuff to the patient’s arm or leg following the instructions
below (Figure 10- 1). Ensure that the cuff is completely deflated. Apply the
appropriate size cuff to the patient, and make sure that the symbol “” is
over the appropriate artery. Ensure that the cuff is not wrapped too tightly
around the limb. Excessive tightness may cause discoloration and eventual
ischemia of the extremities.
53
Figure 10- 1 Applying Cuff
Note
The width of the cuff should be either 40% of the limb circumference (50% for
neonates) or 2/3 of the upper arm length. The inflatable part of the cuff should be long
enough to encircle 50-80% of the limb. The wrong size of cuff can cause erroneous
readings. If the cuff size is in question, then use a larger cuff.
Size of reusable cuff for neonate/children/adult
Patient Type
Limb perimeter
Cuff width
Hose
Infant Child Adult Large Adult Thigh
10 ~19 cm 18 ~ 26 cm 25 ~ 35 cm 33 ~ 47 cm 46 ~ 66 cm
8 cm 10.6 cm 14 cm 17 cm 21 cm
1.5 m or 3m
Size of disposable cuff for neonate/children/adult
Size No.
Limb perimeter
Cuff width
Hose
1
3.1 ~ 5.7 cm
2.5 cm
2 3
4.3 ~ 8.0 cm 5.8 ~ 10.9 cm
3.2 cm 4.3 cm
1.5 m or 3 m
4
7.1 ~ 13.1 cm
5.1 cm
Make sure that the cuff edge falls within the range of mark <->. If it does not, use a
larger or smaller cuff that fits better.
3. Connect the cuff to the air hose. The limb chosen for taking the measurement should
be placed at the same level as the patient’s heart. If this is not possible you should
apply the following corrections to the measured values: If the cuff is placed higher than the heart level, add 0.75 mmHg (0.10 kPa) for each
inch of difference. If it is placed lower than the heart level, deduct 0.75 mmHg (0.10 kPa) for each inch
of difference.
4. Check whether the patient mode is appropriately selected. Access PATIENT SETUP
menu from SYSTEM MENU and pick PAT TYPE item and turn the knob to select the
required patient type.
5. Select a measurement mode in the NIBP SETUP menu. Refer to the following
paragraphs Operation Hints for details
6. Press the NIBP button on the front panel to start a measurement.
Operation Hints
1. To start auto measuring:
Access NIBP SETUP menu and pick the INTERVAL item, in which the user may choose
the selections other than MANUAL to set up the time interval for auto measurement. After
that, press NIBP button on the front panel to start the auto measuring according to the
selected time interval.
54
Warning Prolonged non-invasive blood pressure measurements in Auto mode may be
associated with purport, ischemia and neuropathy in the limb wearing the cuff.
When monitoring a patient, examine the extremities of the limb frequently for
normal color, warmth and sensitivity. If any abnormality is observed, stop the
blood pressure measurements. 2. To stop auto measuring: During auto measuring
press NIBP button on the front panel at any time to stop auto measurement. 3.
To start a manual measuring: Access NIBP SETUP menu and pick the INTERVAL
item. Select the MANUAL
selection. Then press the NIBP button on the front panel to start a manual
measurement. During the idle period of auto measuring process, press the NIBP
button on the front panel at any time to start a manual measurement. Then
press the NIBP button to stop manual measurement and the system continues
executes auto-measuring program according to selected time interval. 4. To
start a manual measuring during the AUTO mode: Press NIBP button on the front
panel. 5. To stop a manual measuring Repress the NIBP button again. 6. To
perform continuous measuring: Access NIBP SETUP menu and pick the CONTINUAL
item to start the continuous measurement. The monitor will measure as many
times of NIBP as possible within 5 minutes. Warning Prolonged non-invasive
blood pressure measurements in Auto mode may be associated with purport,
ischemia and neuropathy in the limb wearing the cuff. When monitoring a
patient, examine the extremities of the limb frequently for normal color,
warmth and sensitivity. If any abnormality is observed, stop the blood
pressure measurements. 7. To stop continuous measuring: During continuous
measuring press NIBP button on the front panel at any time to stop continuous
measurement. Note If you are in doubt about the accuracy of any reading(s),
check the patient’s vital signs by an alternative method before checking the
functioning of the monitor. Warning If liquid is inadvertently splashed on the
equipment or its accessories, or may enter the conduit or inside the monitor,
contact local Customer Service Center. Measurement Limitations To different
patient conditions, the oscillometric measurement has certain limitations. The
measurement is in search of regular arterial pressure pulse. In those
circumstances when the patient’s condition makes it difficult to detect, the
measurement becomes unreliable and measuring time increases. The user should
be aware that the following conditions could
55
interfere with the measurement, making the measurement unreliable or longer to
derive. In some cases, the patient’s condition will make a measurement
impossible. Patient Movement Measurements will be unreliable or may not be
possible if the patient is moving, shivering or having convulsions. These
motions may interfere with the detection of the arterial pressure pulses. In
addition, the measurement time will be prolonged. Cardiac Arrhythmia’s
Measurements will be unreliable and may not be possible if the patient’s
cardiac arrhythmia has caused an irregular heartbeat. The measuring time thus
will be prolonged. Heart-lung Machine Measurements will not be possible if the
patient is connected to a heart-lung machine. Pressure Changes Measurements
will be unreliable and may not be possible if the patient’s blood pressure is
changing rapidly over the period of time during which the arterial pressure
pulses are being analyzed to obtain the measurement. Severe Shock If the
patient is in severe shock or hypothermia, measurements will be unreliable
since reduced blood flow to the peripheries will cause reduced pulsation of
the arteries. Heart Rate Extremes Measurements can not be made at a heart rate
of less than 40 bpm and greater than 240 bpm. 10.2.2 NIBP monitoring screen
NIBP measurement result and corresponding message are displayed as follows:
10.3 NIBP SETUP menu
Pick the NIBP hot key on the screen to call up the NIBP menu shown as below:
Figure 10-2 NIBP SETUP Menu
56
NIBP alarm setting ALM: pick “ON” to enable prompt message and data record
during the NIBP alarm;
pick “OFF” to disable the alarm function, and there will be a beside “NIBP”.
ALM LEV: selectable from HIGH, MED to LOW. HIGH represents the most serious
case. ALM REC: pick “ON” to enable report printing upon NIBP alarm. Sys alm
hi, sys alm lo, mean alm hi, mean alm lo, dia alm hi, dia alm lo are for the
user to set up the alarm limit for each type of pressure. NIBP alarm is
activated when the pressure exceeds set upper alarm limits or falls below
lower alarm limits. NIBP alarm limits: Adult Mode : SYS 40-270 mmHgDIA 10-215
mmHg Mean 20-235 mmHg Pediatric Mode: SYS 40-200 mmHgDIA 10-150 mmHg Mean
20-165 mmHg Neonatal Mode: SYS 40-135 mmHgDIA 10-100 mmHg Mean 20-110 mmHg
RESET Restore measurement status. Pick this item to restore initial settings
of the pressure pump. When the pressure does not work properly and the system
fails to give message for the problem, pick this item to activate self-test
procedure, thus restore the system from abnormal performance. CONTINUAL Start
continuous measuring. When this item is picked, the menu will disappear
automatically. INTERVAL Interval time for automatic measuring. Available
selections: 1/2/3/4/5/10/15/30/60/90/120/180/240/480 minutes. Press NIBP
button on the front panel to start the first auto measuring. Pick MANUAL
selection in INTERVAL item to set up the measuring mode to MANUAL. UNIT Pick
this item to set measurement unit. (Option: mmHg or kPa) CALIBRATE Calibrate
the cuff pressure reading with a calibrated reference manometer. Pick the
CALIBRATE item to start the calibration and the item will change into STOP
CAL, which if picked, the system will stop calibration. DEFAULT Pick this item
to access the NIBP DEFAULT CONFIG dialog box, in which the user may select
whether the FACTORY DEFAULT CONFIG or the USER DEFAULT CONFIG is to be used.
After selecting any of the items and exiting the dialog box, the system will
pop up the dialog box asking for the user’s confirmation. WARNING The
calibration of the NIBP measurement is necessary for every two years (or as
frequently as dictated by your Hospital Procedures Policy). The performance
should be checked according to the following details. Procedure of the
Pressure Transducer Calibration: Replace the cuff of the device with a rigid
metal vessel with a capacity of 500 ml 5%. Connect a calibrated reference
manometer with an error less than 0.8 mmHg and a ball
57
pump by means of a T-piece connector and hoses to the pneumatic system. Set
the monitor in CALIBRATE mode. Inflate the pneumatic system to 0, 50 and 200
mmHg by ball pump separately. The difference between the indicated pressure of
the reference manometer and the indicated pressure of the monitor will not
exceed 3 mmHg. Otherwise, please contact our customer service. PNEUMATIC This
item is used for air leakage test. Turn the knob to pick the item to start the
air leakage test. Then the item will change into STOP PNEUM, which if picked,
the system will stop air leakage test.
WARNING This pneumatic test other than being specified in the EN 1060-1
standard is to be used by the user to simply determine whether there are air
leaks in the NIBP airway. If at the end of the test the system gives the
prompt that the NIBP airway has air leaks, please contact the manufacturer for
repair. Procedure of the air leakage test: 1. Connect the cuff securely with
the socket for NIBP air hole. 2. Wrap the cuff around the cylinder of an
appropriate size. 3. Access the NIBP SETUP menu. 4. Turn the knob to the
PNEUMATIC item and press the knob. Then the prompt “Pneum
testing…” will appear on the bottom of the NIBP parameter area indicating that
the system has started performing pneumatic test. 5. The system will
automatically inflate the pneumatic system to about 180mmHg. 6. After 20
seconds or so, the system will automatically open the deflating valve, which
marks the completion of a pneumatic measurement. 7. If no prompt appears on
the bottom of the NIBP parameter area, it indicates that the airway is in good
situation and no air leaks exist. However if the prompt “PNEUMATIC LEAK”
appears in the place, it indicates that the airway may have air leaks. In this
case, the user should check for loose connection. After confirming secure
connections, the user should re-perform the pneumatic test. If the failure
prompt still appears, please contact the manufacturer for repair.
10.4 Maintenance and Cleaning
Warning Do not squeeze the rubber tube on the cuff. Do not allow liquid to
enter the connector socket at the front of the monitor. Do not wipe the inner
part of the connector socket when cleaning the monitor. When the reusable cuff
is not connected with the monitor, or being cleaned,
always place the cover on the rubber tube to avoid liquid permeation.
Reusable Blood Pressure Cuff The cuff can be sterilized by means of
conventional autoclaving, gas, or radiation sterilization in hot air ovens or
disinfected by immersion in decontamination solutions, but remember to remove
the rubber bag if you use this method. The cuff should not be dry-cleaned. The
cuff can also be machine-washed or hand-washed, the latter method may prolong
the
58
service life of the cuff. Before washing, remove the latex rubber bag, and for
machine-washing, close the Velcro fastening. Allow the cuff to dry thoroughly
after washing, then reinsert the rubber bag. To replace the rubber bag in the
cuff, first place the bag on top of the cuff so that the rubber tubes line up
with the large opening on the long side of the cuff. Now roll the bag
lengthwise and insert it into the opening on the long side of the cuff. Hold
the tubes and the cuff and shake the complete cuff until the bag is in
position. Thread the rubber tubes from inside the cuff, and out through the
small hole under the internal flap. Disposable Blood Pressure Cuffs Disposable
cuffs are intended for one-patient use only. Do not use the same cuff on any
other patient. Do not sterilize or use autoclave on disposable cuffs.
Disposable cuffs can be cleaned using soap solution to prevent infection. Note
For protecting environment, the disposable blood pressure cuffs must be
recycled or disposed of properly.
59
Chapter 11
CO2 Measuring
(Optional)
11.1 General
This chapter offers some relevant data concerning CO2 monitoring.
The monitor provides two kinds of CO2 measuring methods as per the requirements of
users, which are MainStream(optional) and SideStream(optional) .
This module can be applied in operation room, monitor units etc, it can measure the CO2
partial pressure or concentration of patient Air Way, obtain EtCO2, Inspired Maximum
CO2 (InsCO2), Air Way Respiration Rate (AwRR), and display CO2 concentration
waveforms. The parameter symbols displayed on the screen are defined as following:
CO2EtCO2 INS: InsCO2
AWRR: Air Way Respiration (AwRR)(Resp. times/MIN)
Note
1Don’t use the device in the environment with flammable anesthetic gas.
2 The device can only be operated by personnel having taken professional training and
familiar with this manual.
Warning
CO2 module shall be avoided from crash and vibration.
11.1.1 Monitoring Procedure
Principle of CO2 measurement is primarily based on the fact that CO2 molecule can absorb
4.3um infrared ray. Absorption intensity is proportional to CO2 concentration of patient
sample, the CO2 concentration will compute from the detecting CO2 absorption intensity
of patient sample. The relation between partial pressure and percentage of CO2
concentration is given below : P(mmHg) = Percentage(%) * Pamp( ambient pressure )
Of CO2 MainStream and CO2 SideStream modules, whichever is selected by the user,
Autorun measuring mode is adopted. Rate for waveform sampling is 31 msec/time. The
operating series for the two modules are respectively:
MainStream work sequence: After the system is powered on, CO2 module automatically
begins warming-up for about 45S to 90S. Then the sensor motor is activated. After 5S to
10S, the light source of infrared ray is opened. After 10S, the system enters the normal
measuring status.
SideStream work sequence: Except the procedures that after being powered on, the system
needs not warming-up and the air pump should be activated, other procedures are the same
as those in MainStream sequence.
CO2 measurement setups:
Verify the type of the configured CO2 module (MainStream or SideStream);
For MainStream, connect the sensor to the receptacle of CO2 module. For SideStream,
plug the water trap onto its fixing chassis. Add a permanently used nafion tube between the
sampling line and the watertrap to further remove the influence of water vapor.
Power on the system. For MainStream, technical prompt information of “CO2 WARM UP”
is always displayed on the screen until the sensor reaches to the operating temperature.
After CO2 module is activated and enters the normal status, for MainStream, “MAIN” is
displayed following CO2 waveform identifier, and for SideStream, the “SIDE” is displayed
60
following CO2 waveform identifier.
Figure 11- 1 Sidestream Connection Mainstream Sensor
Airway Adapte
Figure 11- 2 Mainstram Connection Do not use the sterile supplied CO2 Water
trap set (for side stream including water
trap and sample line and cannula) and Air adapter (for main stream) if the
packaging or the sensor is damaged and return them to the vendor. “CO2 WARM
UP” or “CO2 SENSOR START UP” displayed on the screen indicates that the sensor
is in warm-up or starting-up. After the information disappears from the
screen, the standard measurement can then be generated. Monitor has water trap
beside it, which is used to prevent the moisture or water drops produced by
patient’s respiration from entering the module. The sample line and the water
trap are one-off consumables that can not be repeatedly used by different
patients.
11.2 CO2 Menu
Parameter setup and adjustment Turn the knob to select and press CO2 hot key
on the screen to activate “CO2 Setup” menu as shown below:
61
Figure 11- 3 CO2 Setup Menu
Following functions can be realized via CO2 SETUP menu.
ALM: select “ON” to enable and store alarm prompt when CO2 parameters have
alarms. Select “OFF” to disable alarm and display beside CO2. The default is “ON”.
ALM REC: select “ON” to generate output from the recorder ever since CO2
parameter alarm occurs. The default is “OFF”.
ALM LEV: select from HIGH, MED and LOW. Level HIGH represents the most
serious alarm, followed by Level MED and Level LOW with a decrease of seriousness.
Change in “ALM LEV” can only affect the physiological alarm levels of CO2 parameters
including EtCO2 upper limit, EtCO2 lower limit, InsCO2 upper limit, AwRR upper limit
and AwRR lower limit. The default alarm level is “MED”.
CO2 ALM HI: to adjust the upper alarm limit of EtCO2. If the measuring value is
larger than CO2 upper alarm limit, “CO2 TOO HIGH” appears on the screen. After the
measuring value returns to the normal one, the information disappears.
CO2 ALM LO: to adjust the lower alarm limit of EtCO2. If the measuring value is
smaller than CO2 lower alarm limit, “CO2 TOO LOW” appears on the screen. After the
measuring value returns to the normal one, the information disappears.
INS ALM HI: to adjust the upper alarm limit of InsCO2. If the measuring value is
larger than InsCO2 upper alarm limit, “INS TOO HIGH” appears on the screen. After the
measuring value returns to the normal one, the information disappears.
AWRR ALM HI: to adjust the upper alarm limit of AwRR. If the measuring value is
larger than the upper alarm limit of AwRR, “AWRR TOO HIGH” appears on the screen.
After the measuring value returns to the normal one, the information disappears.
AWRR ALM LO: to adjust the lower alarm limit of AwRR. If the measuring value is
smaller than the lower alarm limit of AwRR, “AWRR TOO LOW” appears on the screen.
After the measuring value returns to the normal one, the information disappears.
UNIT: to change the display units of CO2 and InsCO2 parameters. “mmHg” and
“kPa” are available for selection.
SWEEP: to adjust the display rate of CO2 waveforms with “6.25 mm/s”, “12.5 mm/s”,
or “25.0 mm/s” selectable.
Exit: to close CO2 SETUP menu.
Note
“APNEA ALM” cannot be closed.
When various alarms occur simultaneously, the alarm information of highest level
will be displayed on the screen.
OTHER SETUP: pick this item in the menu to call up CO2 more setup sub-menu.
62
Figure 11- 4 CO2 More Setups Menu Now we introduce you to the functions of
each item in CO2 SETUP submenu. WAVE SCALE: to adjust full scale size of CO2
waveform display area with “LOW”
or “HIGH” selectable. The default value is “LOW”. WORK MODE: to change the
work mode of CO2 with “MEASURE” mode or
“STANDBY” mode selectable. The default is “STANDBY” mode. When it is required
to monitor CO2, select “WORK” mode. “STANDBY” mode disables the air pump in
SideStream module, the sensor and the IR (infrared ray) source in MainStream
module, thus decreases the power consumption and extends the life cycles of IR
source and the whole CO2 module. Note When not using CO2 monitoring function,
it is suggested not to connect MainStream sensor or SideStream water trap and
to adjust to “STANDBY” mode. O2 COMPEN: to perform compensate operations as
per the selection of the user. BALANCE GAS: ROOM AIR, N2O, HELIUM. Anaesthesia
Agent: The intensity of the Anaesthesia Agent GAS TEMP: Current Temperature of
the gas Barometric: Current Atmospheric Pressure ETCO2 Period: The period to
calculate the ETCO2, Per breath, 10s, 20s
Figure 11- 5 CO2 More Setups Menu To perform the ZERO. The usage of the module
will be display in the MENU.
Note 1. If Compensate item is not correctly set as per the operation
conditions, the result will
be far from the actual value, thus leading to severe misdiagnosis. 2. The
default of Water Vapor Compensate is on. Turn it off when measuring dry gas,
63
such as when performing regular maintenance or measurement validation by using
dry calibrated gas. 3. The default of BTPS is on. Turn it on when measuring
the VA saturated “damp” gas under the body temperature and ambient pressure
and turn it off when measuring the “dry” gas under the ambient temperature and
pressure. 4. Operate by strictly observing the Compensate operation method.
DEFAULT: pick this item to access the CO2 DEFAULT CONFIG dialog box, in which
the user may select whether the FACTORY DEFAULT CONFIG or the USER DEFAULT
CONFIG is to be used. After selecting any of the items and exiting the dialog
box, the system will pop up the dialog box asking for the user’s confirmation.
EtCO2 upper alarm limit: when parameter value exceeds this limit, there will
be alarm for exceeding the upper limit. Default: Adult: 50 mmHg Pediatric: 50
mmHg Neonatal: 45 mmHg EtCO2 lower alarm limit: when parameter value is
smaller than the lower limit, there will be alarm for exceeding lower limit.
Default: Adult: 15 mmHg Pediatric: 20 mmHg Neonatal: 30 mmHg InsCO2 upper
alarm limit: when parameter value exceeds this limit, there will be alarm for
exceeding upper limit. Default: Adult: 4 mmHg Pediatric: 4 mmHg Neonatal:
4mmHg AwRR upper alarm limit: when parameter value exceeds this limit, there
will be alarm for exceeding upper limit. Default: Adult: 30 rpm Pediatric: 30
rpm Neonatal: 100 rpm AwRR lower alarm limit: when parameter value is smaller
than the limit, there will be alarm for exceeding lower limit. Default: Adult:
8 rpm Pediatric: 8 rpm Neonatal: 30 rpm APNEA Time: Selections are 10S to 40S,
Default: 20S. Work Mode: MainStream: Standby, Measurement; SideStream:
Standby, Measurement. Default: Measurement Compensate Method: MainStream:
General/O2/N2O/DES/ALL SideStream: General/O2/N2O/DES/ALL Default Methods:
General. Pump Rate: 100 200 ml/min. Default: 100 ml/minUnit:
mmHg/kPa.Default: mmHg Waveform Sweep: 25.0/12.5/6.25 (mm/s) Default: 25.0
mm/s Waveform Scale: LOW/HIGH Default: LOW Besides, for alarm function of CO2
module, refer to Chapter Alarm, for its recording function, refer to Chapter
Recording, and for information about alarm event review, graphic and tabular
trend of CO2 parameters, refer to Chapter Trend and Event.
11.3 Alarm Information and Prompt
Among physiological alarms, those belonging to the type that the parameter has
exceeded the limits may activate the recorder to automatically output the
parameters and related measured waveforms when the alarms occur on the
condition that the alarm record switch in the related menu is On.
64
Tables below describe the possible physiological alarms, technical alarms and prompt messages occurring during CO2 measurement. Physiological alarms:
Message
Cause
Alarm Level
CO2 TOO HIGH OR LOW
EtCO2 measuring value is above upper alarm or below lower limit.
User-selectable
INS TOO HIGH
InsCO2 measuring value is above alarm limits.
User-selectable
AWRR TOO HIGH OR LOW
CO2 APNEA
Technical alarms:
Message
CO2 SENSOR OFF
CO2 NO WATERTRAP
CO2 WATERTRAP OCCLUDE
CO2 SIGNAL LOW OR TOO LOW CO2 BAROMTRC TOO LARGE CO2 PNEUMATIC LEAK CO2 SIGNAL
NOISY OR SATURATE CO2 CALCULATION ERR CO2 SENSOR FAULT CO2 SENSOR TEMP HIGH OR
LOW CO2 WATCHDOG TIMEOUT CO2 OTHER INFORMATION ERR
CO2 COMM ERR
AwRR measuring value is above upper or below lower alarm limit.
In specific time interval, no RESP can be detected using CO2 module.
User-selectable HIGH
Cause
Mainstream sensor is not properly connected or has fallen off. Sidestream
water trap is not properly connected or has fallen off.
Sidestream water trap is occluded.
Alarm Level
LOW
Remedy
Make sure that mainstream sensor is properly connected.
LOW LOW LOW
Make sure that sidestream water trap is soundly connected.
Make sure that sidestream water trap functions smoothly.
MED
MED
M
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