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Philips MX400 Instructions For Use Manual

Intellivue series patient monitors.
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In stru ctio ns fo r Use
IntelliVue Patient Monitor
MX400/ 450/ 50 0/ 5 5 0 R e l e a s e K w i t h Re v . K . 1 x . x x
MX600/ 700/80 0 Release J with Re vison J.xx. xx
Patient Monitori ng


Table of Contents

   Summary of Contents for Philips MX400

  • Page 1 MX400/450/500/550/600/700/800 MX400/ 450/ 50 0/ 5 5 0 R e l e a s e K w i t h Re v . K . 1 x . x x MX600/ 700/80 0 Release J with Re vison J.xx. xx...
  • Page 3: Table Of Contents

    Networked Monitoring Using the Integrated PC Using Your Monitor with a Monitor in Companion Mode 2 What's New? What's New in Release K.1 (for MX400/450/500/550 only) What's New in Release K.0 What's New in Release J.0 3 Alarms Visual Alarm Indicators...
  • Page 4 Alarm Recordings 4 Patient Alarms and INOPs Patient Alarm Messages Technical Alarm Messages (INOPs) 5 Managing Patients and Equipment Patient Concepts Equipment Concepts Managing Patients Managing Equipment Care Groups Information Center Compatibility 6 ECG, Arrhythmia, ST and QT Monitoring Skin Preparation for Electrode Placement Connecting ECG Cables Selecting the Primary and Secondary ECG Leads Checking Paced Mode...
  • Page 5 Updating ST Baseline Snippets Recording ST Segments About the ST Measurement Points ST Alarms STE Alarms Viewing ST Maps About QT/QTc Interval Monitoring QT Alarms Switching QT Monitoring On and Off 7 Monitoring Pulse Rate Entering the Setup Pulse Menu System Pulse Source Switching Pulse On and Off Using Pulse Alarms...
  • Page 6 Starting and Stopping Measurements Enabling Automatic Mode and Setting Repetition Time Enabling Sequence Mode and Setting Up The Sequence Choosing the NBP Alarm Source Switching Pulse from NBP On/Off Assisting Venous Puncture Calibrating NBP 11 Monitoring Temperature Making a Temp Measurement Calculating Temp Difference 12 Monitoring Invasive Pressure Setting up the Pressure Measurement...
  • Page 7 Measuring CO2 using M3014A or X2 Measuring Mainstream CO2 using M3016A Measuring Microstream CO2 using M3015A/B Setting up all CO2 Measurements Understanding the IPI Numeric 15 Monitoring Airway Flow, Volume and Pressure Attaching the Flow Sensor Zero Calibration Automatic Purging Manual Purging Gas Compensation Setting up Spirometry...
  • Page 8 Changing the BIS Smoothing Rate Switching BIS and Individual Numerics On and Off Changing the Scale of the EEG Wave Switching BIS Filters On or Off BIS Safety Information 20 Monitoring NMT Stimulation Modes Preparing to Measure NMT Taking NMT Measurements Changing the NMT Measurement Settings Alarms Understanding NMT Numerics...
  • Page 9 26 Event Surveillance Levels of Event Surveillance Event Groups Event Episodes Events Pop-Up Keys Event Triggers The Events Database Viewing Events Annotating Events Documenting Events 27 ProtocolWatch SSC Sepsis Protocol 28 Recording Paper-Strip Recording Electronic Recording 29 Printing Patient Reports Starting Report Printouts Stopping Reports Printouts Setting Up Reports...
  • Page 10 Language Conflict with External Device Drivers 32 IntelliBridge EC10 Connecting an External Device Changing Waves and Numerics Displayed Viewing the IntelliBridge Device Data Window Using Screens with External Device Data Alarms/INOPs from External Devices 33 Using Timers Viewing Timers Timer Setup Pop-up Keys Setting Up Timers Displaying a Timer On The Main Screen Displaying A Clock On The Main Screen...
  • Page 11 38 Maintenance and Troubleshooting Inspecting the Equipment and Accessories Inspecting the Cables and Cords Maintenance Task and Test Schedule Troubleshooting Returning Equipment for Repair Disposing of the Monitor Disposing of Empty Calibration Gas Cylinders 39 Accessories ECG/Resp Accessories NBP Accessories Invasive Pressure Accessories SpO2 Accessories Temperature Accessories...
  • Page 12 M4605A Battery Specifications Measurement Specifications Safety and Performance Tests 41 Default Settings Appendix Country-Specific Default Settings Alarm and Measurement Default Settings Alarm Default Settings ECG, Arrhythmia, ST and QT Default Settings Pulse Default Settings Respiration Default Settings SpO2 Default Settings NBP Default Settings Temperature Default Settings Invasive Pressure Default Settings...
  • Page 13: Introduction

    Introduction These Instructions for Use are for clinical professionals using the IntelliVue MX400/MX450, MX500/ MX550, and MX600/MX700/MX800 patient monitor. This basic operation section gives you an overview of the monitor and its functions. It tells you how to perform tasks that are common to all measurements (such as entering data, switching a measurement on and off, setting up and adjusting wave speeds, working with profiles).
  • Page 14: Safety Information

    Liquid Ingress: If you spill liquid on the equipment, battery, or accessories, or they are accidentally immersed in liquid, contact your service personnel or Philips service engineer. Do not operate the equipment before it has been tested and approved for further use.
  • Page 15: Security Information

    Accessories WARNING Philips' approval: Use only Philips-approved accessories. Using other accessories may compromise device functionality and system performance and cause a potential hazard. Reuse: Never reuse disposable transducers, sensors, accessories and so forth that are intended for single use, or single patient use only. Reuse may compromise device functionality and system performance and cause a potential hazard.
  • Page 16: Introducing The Monitor

    EU countries; that is, Germany, France, and so on. For more information, please visit Philips Product Security Policy Statement Additional security and privacy information can be found on the Philips product security web site at index.wpd Manufacturer Disclosure Statement for Medical Device Security –...
  • Page 17 On connection to a new host monitor, the X2 resumes its role as multi-measurement module, ensuring fully continuous monitoring. Major Parts and Keys MX400/450/500/550 The MX400/450/500/550 monitors have the same parts, controls and indicators. Here the MX400 is shown. Color coded alarm lamps Alarms Off lamp...
  • Page 18: Devices For Acquiring Measurements

    1 Introduction MX600/700 Color coded alarm lamps Alarms Off lamp Power on/Standby switch with integrated LED: Green - On/ Standby, Red - Error AC power LED Mounting quick-release lever (when this is pressed the monitor is not fixed on the mounting) Part number and serial number Hardkeys (Silence, Alarms Off,...
  • Page 19 1 Introduction monitor, and switch on automatically when you turn on the monitor. A green power-on LED indicates when they are drawing power from the monitor. A permanently illuminated, or flashing, red LED indicates a problem with the unit that requires the attention of qualified service personnel. All symbols used on the front panels are explained in “Symbols”...
  • Page 20 1 Introduction The maximum number of specific module types that can be used simultaneously in an FMS-4 is: four pressure modules, four temperature modules, four VueLink or IntelliBridge modules (any combination). Connect the FMS to the monitor via the measurement link cable (MSL). Use the MSL connector on the left-hand side (if you have the appropriate option) to connect an additional MMS.
  • Page 21 1 Introduction unplug it. Reconnecting a module to the same monitor restores its label and measurement settings, such as alarms limits. If you connect it to a different monitor, the module remembers only its label. The connector socket on the front of each module is the same color as the corresponding connector plug on the transducer or patient cable.
  • Page 22 1 Introduction X1 Connectors and Symbols White ECG/Resp connector Blue SpO connector Red NBP connector Combined pressure (red) and temperature (brown) connector - connect either invasive pressure transducer or temperature probe. You might have a version of the MMS that does not have this connector.
  • Page 23 1 Introduction X2 Overview On/Standby switch Power and battery indicators (see “X2 Controls and Indicators” on page 23) 3.5-inch TFT LCD touchscreen QVGA display Alarm lamps (see “X2 Controls and Indicators” on page 23) Battery eject button Hard keys (see “X2 Controls and Indicators”...
  • Page 24 1 Introduction Silence key Active alarm lamp. Red or yellow, depending on alarm level. Blinks until active alarm is acknowledged. Active INOP alarm lamp in light blue. Blinks until active INOP is acknowledged. Alarms off indicator. When alarms are suspended, the lamp is red (or yellow when yellow alarms are suspended), and the alarms off symbol is shown.
  • Page 25 1 Introduction MMS Extensions The MMS extensions connect to the X1 and X2 MMS and use the MMS settings and power. Trend data and measurement settings from the measurements in the extensions are stored in the MMS. WARNING • The MMS extensions can only function when they are connected to an MMS. If the MMS is removed during monitoring, the measurements from both the MMS and the extension are lost.
  • Page 26 1 Introduction The optional M3015A Microstream CO extension adds microstream capnography and optionally either pressure or temperature to the MMS. The optional M3015B Microstream CO extension adds microstream capnography, two pressures and a temperature to the MMS. M3015A M3015B Pressure connectors (red) - M3015A optional Temperature connector (brown) - M3015A optional Inlet Microstream connector CO...
  • Page 27: Operating And Navigating

    1 Introduction The cardiac output measurement in the M3014A is deactivated when the extension is used with an X2 MMS, even if the X2 is connected to an external power supply. The cardiac output measurement is only available when the X2 is connected to a host monitor. M3012A Hemodynamic MMS Extension Cardiac Output (orange;...
  • Page 28 1 Introduction MX400 On the MX400, the permanent keys and the key to access the SmartKeys are on the right of the screen. Monitor information line Other screen elements network connection indicator Silence - acknowledges all active alarms by switching off audible alarm indicators...
  • Page 29 The status line shows messages with information and prompts you for possible (documented in Troubleshooting in the actions (MX400/450/500/550 do not have a reserved space for this feature). Service Guide) bed label - gives access to Equipment...
  • Page 30 1 Introduction Selecting Screen Elements Select a screen element to tell the monitor to carry out the actions linked to the element. For example, Patient Demographics select the Patient Identification element to call up the window, or select the Setup ECG ECG Lead HR numeric to call up the menu.
  • Page 31 1 Introduction Pause Alarms - pauses alarm indicators. Pause duration depends on monitor Alarms Off configuration. If pause duration is infinite, this key is labeled Select again to immediately re-enable alarm indicators. Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps.
  • Page 32 1 Introduction - start/stop manual NBP start NBP STAT measurement measurement - start auto series - stop current automatic stop automatic or STAT NBP measurement within series measurement and measurement series start NBP measurement and stop current NBP measurement measurement series start veni puncture (inflate cuff to set the NBP repeat time subdiastolic pressure)
  • Page 33 1 Introduction access EEG CSA access the EEG montage display external device information access timers access ProtocolWatch set standard or EASI lead placement switch CO pump off new lead setup enter data manually start/stop car seat assessment record Histogram Unit Conversion open the window open...
  • Page 34 1 Introduction Using the Remote Control The remote control provides you with direct access to five hard keys, a navigation knob and a numeric keypad: Hardkeys Silence - acknowledges all active alarms by switching off audible alarm indicators and lamps. Behavior follows the Silence permanent key configuration.
  • Page 35 1 Introduction CAUTION When using a remote control without a cable, it is important that the user knows which remote control is assigned to which monitor. Use the tethering cable delivered with the remote control to attach it to a bed rail or IV pole, or label the remote control with the bed or monitor ID.
  • Page 36: Operating Modes

    1 Introduction Operating Modes When you switch the monitor on, it starts up in monitoring mode. To change to a different mode: Main Setup Select the menu. Operating Modes Select and choose the mode you require. Your monitor has four operating modes. Some are passcode protected. •...
  • Page 37: Understanding Screens

    1 Introduction If you connect an X2 that is powered on (and not in Standby) to a host monitor in Standby mode, the host will leave Standby mode. When connected to a host monitor, with both the host and the monitor in companion mode in Standby mode, leaving Standby on the monitor in companion mode will also make the host leave Standby.
  • Page 38: Connecting Additional Displays To The Monitor

    1 Introduction After a patient discharge, the monitor's default Screen is shown. Modified Screens are still available in Change Screen menu. If the monitor is switched off and then on again, modified Screens are erased from the monitor's memory and cannot be recalled. If a modified Screen was the last active Screen when the monitor was Automat.
  • Page 39: Using The Xds Remote Display

    1 Introduction Using the XDS Remote Display Using the IntelliVue XDS solution it is possible to view an independent monitor screen on an external MX600/700/ display. The XDS solution consists of a medical grade PC-based hardware platform, XDS application software and the XDS connectivity option on the monitor. Depending on the configuration you can also operate the monitor from the external display.
  • Page 40 1 Introduction You can change from one complete profile to another or swap individual settings blocks (display/ monitor settings/measurement settings) to change a subset of a profile. Changes you make to any element within the settings blocks are not saved when you discharge the patient, unless you save them in Configuration Mode.
  • Page 41: Understanding Settings

    1 Introduction Understanding Settings Each aspect of how the monitor works and looks is defined by a setting. There are a number of different categories of settings, including, Screen Settings, to define the selection and appearance of elements on each individual Screen Measurement settings, to define settings unique to each measurement, for example, high and low alarm limits Monitor settings, including settings that affect more than one measurement or Screen and define...
  • Page 42: Changing Wave Speeds

    1 Introduction Switching Numerics On and Off For some measurements, such as EEG, you can choose which numerics to view on the screen. In the measurement's setup menu, select the numeric name to toggle between on and off. Setup EEG For example in the menu, select the EEG numeric name to toggle between on and off.
  • Page 43 1 Introduction Freezing An Individual Wave To freeze a wave, Enter the Wave menu for the measurement by selecting the wave on the screen. Freeze Wave Select The realtime wave is replaced with the frozen wave. Freezing All Waves To freeze all waves on the screen, Freeze Waves Select the SmartKey.
  • Page 44: Using Labels

    1 Introduction Releasing Frozen Waves To release frozen waves, Select a frozen wave. Unfreeze Waves Select All frozen waves are released. Using Labels Every measurement associated with a monitor is identified by a unique label. You may have more than one instance of some measurements, for example pressure, being used simultaneously.
  • Page 45 1 Introduction Measurement selection key with question marks indicating a label conflict. Depending on your configuration, the monitor will either • resolve the conflict automatically, by assigning a new, generic label to the most recently connected conflicting label (e.g. a second FAP label could be changed to ABP) Measurement Selection •...
  • Page 46: Entering Measurements Manually

    1 Introduction To resolve a label conflict: Main Setup Meas. Selection Select the measurement selection key or select , then to display the Measurement Selection window. Select the device whose label you want to correct. Use the measurement selection pop-up keys to resolve the conflict. Select either: Change Label –...
  • Page 47: Changing Monitor Settings

    The MX400/450/500/550 monitors can be configured to automatically adapt the screen brightness to the ambient light conditions. The range within which this adaptation is made is determined by the...
  • Page 48: Checking Your Monitor Revision

    Once you understand the basic operation principles, you can get ready for monitoring. We also recommend working through the E-Learning Education Programs for self-training before using the monitor (available at the Philips Learning Center, english only). Inspecting the Monitor WARNING If the monitor or mounting hardware is mechanically damaged, or if it is not working properly, do not use it for any monitoring procedure on a patient.
  • Page 49: Disconnecting From Power

    1 Introduction Connected devices usually take their power from the monitor. External devices such as gas monitors and those connected via VueLink/IntelliBridge have their own power switches. Power On/Power Off Behavior The general rules determining the behavior of the monitor when connected to, or disconnected from power are as follows: •...
  • Page 50: Networked Monitoring

    WARNING Only connect patient monitors to networks that conform to the network installation instructions provided by Philips for your system. It is possible to assign additional monitoring equipment and a telemetry device to the same patient, resulting in the information from multiple devices being combined in one sector at the Information Center.
  • Page 51 1 Introduction CAUTION When you install any software on the iPC you are responsible for ensuring that the resulting system complies with all relevant local regulations. Starting the iPC Your monitor may be configured to have the iPC start up automatically when the monitor is switched on.
  • Page 52: Using Your Monitor With A Monitor In Companion Mode

    1 Introduction Shutting the iPC Down The iPC will be shut down automatically when the monitor is switched off. If you want to shut down the iPC when the monitor is on, Main Setup Internal PC Select then Internal PC Switch PC off In the menu, select...
  • Page 53 1 Introduction • The host monitor is the master of all ADT information. ADT operations on the monitor in companion mode are disabled, and any pending actions on the monitor in companion mode (for example, admit or end case) are canceled. •...
  • Page 54 1 Introduction...
  • Page 55: What's New

    In this release the MX400/MX450 patient monitors join the IntelliVue monitor family. The monitors are optimized for transport within the hospital environment. The MX400 has a 9-inch display and the MX450 has a 12-inch display. Both monitors can optionally be equipped with an integrated recorder...
  • Page 56: What's New In Release J.0

    2 What's New? What's New in Release J.0 Flexible, Patient-oriented Workflow (with PIIC iX only) With the IntelliVue Information Center iX, more flexible, patient-oriented workflows are supported for admitting, tracking and transferring patients. This allows you to adapt monitor use to the patient data flow models in your specific facility and department.
  • Page 57 2 What's New? • Analysis results included in reports and additional report selections with ST Map. • Remote operation of the 12-Lead Export function at the IntelliVue Information Center. • Remote operation of the 12-Lead Lock/Unlock function at the IntelliVue Information Center. •...
  • Page 58 2 What's New?
  • Page 59: Alarms

    Alarms The alarm information here applies to all measurements. Measurement-specific alarm information is discussed in the sections on individual measurements. The monitor has two different types of alarm: patient alarms and INOPs. Patient Alarms Patient Alarms are red and yellow alarms. A red alarm indicates a high priority patient alarm such as a potentially life threatening situation (for example, asystole).
  • Page 60: Visual Alarm Indicators

    3 Alarms Alarm Delays There is a delay between a physiological event at the measurement site and the corresponding alarm indication at the monitor. This delay has two components: • The general measurement delay time is the time between the occurrence of the physiological event and when this event is represented by the displayed numerical values.
  • Page 61: Audible Alarm Indicators

    INOPs will always light continuously in the left section only. If the screen brightness is configured to automatically adapt to ambient light conditions, the alarm MX400/450/ lamps will also adapt their brightness accordingly.
  • Page 62: Alarm Tone Configuration

    INOP tones • change the alarm sound to suit the different alarm standards valid in different countries. Traditional Audible Alarms (HP/Agilent/Philips/Carenet) • Red alarms and red INOPs: A high pitched sound is repeated once a second.
  • Page 63: Acknowledging Alarms

    3 Alarms • If you want to see a numerical indication of the current alarm volume on a scale from zero to 10, Alarm Volume or change the setting, select the SmartKey. The volume scale pops up. The current setting is indented. To change the setting, select the required number on the scale.
  • Page 64: Pausing Or Switching Off Alarms

    3 Alarms Silence Alternatively, you can acknowledge alarms by pressing the hardkey on the MMS or on the SpeedPoint. The hardkeys follow the behavior configured for the permanent key. A check mark beside the alarm message indicates that the alarm has been acknowledged .
  • Page 65 3 Alarms There are some settings made in Configuration Mode that can affect the availability of the pause alarms functionality. Pause Alarms Alarms Off • permanent key can be removed from the screen to avoid unintentional switching off of alarms. The corresponding hardkey on the SpeedPoint or Navigation Point is then also disabled.
  • Page 66 3 Alarms While Alarms are Paused or Off When red alarms are paused or off: • The red Alarms Paused lamp on the monitor front panel is lit. Al. Paused x:yy Alarms Off In the alarm field, the monitor displays the message , together with the alarms paused symbol or the alarms off symbol.
  • Page 67: Alarm Limits

    3 Alarms To extend the alarm pause time to five or 10 minutes, Alarm Messages Select one of the alarm fields. This calls up the window. PauseAl. 5 min PauseAl. 10 min Select either the pop-up key or the pop-up key .
  • Page 68 3 Alarms Viewing All Alarm Limits Alarm Limits overview window lists the currently set alarm limits for all measurements. If an Apnea alarm delay time is set, this is also shown. The alarms off symbol is shown beside the measurement label of any measurement whose alarm switched off. Alarm Limits Alarm Messages To open the...
  • Page 69 3 Alarms Select a value from the list to adjust the alarm limit. Alternatively, you can use the keys in the measurement alarm limits window, which you access by Alarm Limits selecting the measurement label in the window. Parameter label High red alarm limit (view only) High yellow alarm limit field.
  • Page 70 3 Alarms If you set the yellow alarm limit outside the red alarm limit, the monitor will automatically adapt the red alarm limit. When an ST measurement is in the alarm limits window there are also two pop-up keys available All ST Narrow All ST Wide .
  • Page 71: Reviewing Alarms

    3 Alarms Print Limits • Select the pop-up key to print an overview of all alarm limits on a connected printer. Record Limits • Select the pop-up key to send a recording of the alarm limits to a recorder. Reviewing Alarms You can see which alarms and INOPs are currently active in the respective alarms and INOPs fields at the top of the screen.
  • Page 72: Latching Alarms

    3 Alarms Review Alarms window pop-up keys appear when the window is opened. If alarm pause Active Alarms extension is disabled, the pause pop-up keys are inactive. Selecting the pop-up key Alarm Messages opens the window. Latching Alarms The alarm latching setting for your monitor defines how the alarm indicators behave when you do not acknowledge them.
  • Page 73: Testing Alarms

    3 Alarms All INOPs are non-latching. See “Yellow Arrhythmia Alarms” on page 160 for information on one- star yellow alarms latching behavior. Testing Alarms When you switch the monitor on, a selftest is started. You must check that the alarms lamps light, one after the other, and that you hear a single tone.
  • Page 74 3 Alarms...
  • Page 75: Patient Alarms And Inops

    Patient Alarms and INOPs This chapter lists patient alarms alphabetically, and technical alarms (INOPs) arranged by the source of the INOP and then alphabetically, irrespective of their priority. All alarms and INOPs are listed here; the ones which can appear on your monitor will depend on the model and the individual options. Patient Alarm Messages The measurement labels and abbreviations for pressure, temperature, SpO , and anesthetic agent...
  • Page 76 4 Patient Alarms and INOPs Alarm Message From Condition Indication ***Brady/P xxx<yyy This is the alternative alarm message for *** Press, SpO numeric flashes and alarm limit is ***Brady xxx < yyy Extreme Brady, when the alarm text setting highlighted, red alarm lamp, alarm is Enhanced.
  • Page 77 4 Patient Alarms and INOPs Alarm Message From Condition Indication *** Extreme Brady Heart rate < the extreme brady alarm limit. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone *** Extreme Tachy Heart rate > the extreme tachy alarm limit. numeric flashes and alarm limit is highlighted, red alarm lamp, alarm tone...
  • Page 78 4 Patient Alarms and INOPs Alarm Message From Condition Indication * OtherMon Alarm another assigned Another monitor used for the patient is in an yellow or red alarm lamp and alarm ** OtherMon Alarm monitor alarm condition. Check the detailed alarm tone *** OtherMon Alarm information at the Information Center.
  • Page 79 4 Patient Alarms and INOPs Alarm Message From Condition Indication * R-on-T PVCs ECG/Arrhythmia For HR < 100, a PVC with R-R interval < 1/3 numeric flashes, yellow alarm lamp, the average interval followed by a short yellow audible alarm compensatory pause of 1.25*(the average R-R interval), or two such Vs without compensatory pause occurring within 5 minutes of each other.
  • Page 80 4 Patient Alarms and INOPs Alarm Message From Condition Indication ***Tachy/P xxx>yyy This is the alternative alarm message for *** Press, SpO numeric flashes, alarm limit is Extreme Tachy when the alarm text setting highlighted, red alarm lamp, alarm ***Tachy xxx > yyy is Enhanced.
  • Page 81: Technical Alarm Messages (inops)

    4 Patient Alarms and INOPs Technical Alarm Messages (INOPs) If an INOP interrupts monitoring and alarm detection, the measurement numeric will be replaced . If an INOP may lead to unreliable measurement values, a appears next to the numeric. The measurement labels and abbreviations for pressure, temperature, SpO , and VueLink INOP messages are explained in the individual measurement chapters.
  • Page 82 4 Patient Alarms and INOPs INOP Message, Indication What to do Check Screen Res. The Screen you have selected uses a resolution which is not supported by the display. The monitor will INOP tone show a generic Screen instead until you select a different Screen. Contact your service personnel if you want the Screen deleted from the Profile(s) to avoid this in future.
  • Page 83 4 Patient Alarms and INOPs INOP Message, Indication What to do No Central Monit. There is a problem with the communication to the network. Central monitoring is currently not INOP tone possible (no patient alarms or information). Check the connection. In case the connection is via a telemetry device, the current telemetry use model does not support central monitoring.
  • Page 84 4 Patient Alarms and INOPs INOP Message, Indication What to do Unsupported LAN There is a problem with the communication to the network and central monitoring is currently not INOP tone possible. Check the connection. If the INOP persists, switch off the monitor and contact your service personnel.
  • Page 85 4 Patient Alarms and INOPs INOP Message, Indication What to do Batteries Malfunct The monitor cannot determine the battery status. If this INOP persists, replace the faulty battery or Batt 1 Malfunction batteries. If the condition persists and the monitor is not connected to mains power, this INOP is re- Batt 2 Malfunction issued two minutes after you acknowledge it.
  • Page 86 4 Patient Alarms and INOPs INOP Message, Indication What to do FMS Unsupported The Flexible Module Rack is not supported by your monitor. Contact your service personnel. INOP tone MMS Ext. Unplugged The MMS extension has been disconnected from the Multi-Measurement Module. INOP tone MMS Ext.
  • Page 87 4 Patient Alarms and INOPs INOP Message, Indication What to do Cannot Analyze QT The QT algorithm cannot generate a valid QT value for more than 10 minutes, or 1 minute in the initial phase. Cannot Analyze ST The ST algorithm cannot generate a valid ST value. Possible causes are large variations in the measured ST values for consecutive beats, or ventricular paced beats.
  • Page 88 4 Patient Alarms and INOPs INOP Message, Indication What to do V Lead Off The V electrode (IEC: C electrode) has become detached from the patient or the lead set has been changed. Reattach the electrode or select New Lead Setup in the Setup ECG menu to confirm the Numeric is replaced by -?- for 10 seconds.
  • Page 89 4 Patient Alarms and INOPs INOP Message, Indication What to do NBP Interrupted Check the tubing and cuff for leakages or kinks. Check that you are using the correct cuff size and Numeric is replaced by -?- placement, and that the correct patient category is selected. Try restarting the measurement. INOP tone If the INOP occurs repeatedly, contact your service personnel.
  • Page 90 4 Patient Alarms and INOPs INOP Message, Indication What to do Tven INOPs See <Temp Label> INOPs Tvesic INOPs See <Temp Label> INOPs SpO2 INOPs INOP Message, Indication What to do <SpO₂ Label> Chk Sensor The condition of the signal at the SpO sensor is not as expected.
  • Page 91 4 Patient Alarms and INOPs INOP Message, Indication What to do <SpO₂ Label> Sensor Off The SpO sensor is not properly applied to the patient. Apply the sensor following the instructions Numeric is replaced by -?- supplied by the manufacturer. INOP tone <SpO₂...
  • Page 92 4 Patient Alarms and INOPs INOP Message, Indication What to do <Press Label> Deactivated A Pressure measurement label in the measurement device or extension has been deactivated, either by INOP tone connecting a Temp transducer in the shared Press/Temp socket, or by deactivating the label in the Measurement Selection window.
  • Page 93 4 Patient Alarms and INOPs INOP Message, Indication What to do CO₂ Cal Mode Currently no calibration is running. Accuracy can be checked by placing the transducer on the two cells numeric displays current of the calstick and starting calibration. To start monitoring, leave Cal. Mode. value for accuracy check CO₂...
  • Page 94 4 Patient Alarms and INOPs INOP Message, Indication What to do CO₂NoTransducer There is no CO transducer connected. If you replace the transducer, the new transducer must be from mainstream CO (except calibrated. If you silence this INOP the CO measurement will be switched off.
  • Page 95 4 Patient Alarms and INOPs INOP Message, Indication What to do <SO₂ Label>Light Intens The intensity changed considerably since the last light intensity calibration. This may indicate that the Numeric is replaced by -?- catheter tip is positioned against a blood vessel wall or that there is low blood flow. Reposition the INOP tone catheter (and perform a Light Intensity Calibration).
  • Page 96 4 Patient Alarms and INOPs INOP Message, Indication What to do CCO No Press CCO/CCI cannot be calculated. Make sure that the pressure chosen in the Setup CCO menu under CCO from matches the pressure measured with the arterial catheter for CCO measurement. A at Information Center pressure from an external device cannot be used.
  • Page 97 4 Patient Alarms and INOPs INOP Message, Indication What to do <tcGas Label> Change Site Timer has timed out. Change the application site to avoid skin burns. To reset the Site Timer, Site either calibrate and change the measurement site, or change the measurement site and reset the Site If Heat Switch Off is Timer manually by selecting the appropriate site time from the Setup tcGas menu.
  • Page 98 The semi-reusable sensor cable connected is unknown or not supported by your software revision. INOP tone Replace it with a Philips-supported sensor cable. BIS Cable Usage The semi-reusable sensor cable has exceeded the maximum number of uses. Replace the cable.
  • Page 99 Unsupported sensor connected or sensor type unknown or not supported by your software revision. INOP tone Replace the sensor, using only Philips supported sensors. BIS Sensor Malfunc Malfunction in the sensor hardware, most often caused by liquids permeating into the connectors OR INOP tone patient interface cable (PIC) or DSC or BISx may be faulty.
  • Page 100 4 Patient Alarms and INOPs INOP Message, Indication What to do Spiro Patient Cat. Mismatch of patient size configured in the host monitor and sensor type plugged into the module. Check the instructions on selecting the correct sensor in the chapter on “Spirometry”. Spiro Purge Failed The purge operation could not be completed successfully.
  • Page 101 The VueLink module has not been configured during installation. The installation process should be Config completed by either your biomedical engineering department or the Philips service engineer. INOP tone VueLink INOP abbreviations may differ slightly depending on the device category.
  • Page 102 4 Patient Alarms and INOPs INOP Message, Indication What to do Text Upload Failed Incoming text from the IntelliBridge modules exceeds the maximum limit. Try unplugging one of the INOP tone IntelliBridge modules. If the INOP occurs repeatedly contact your service personnel; a software upgrade may be necessary.
  • Page 103 4 Patient Alarms and INOPs INOP Message, Indication What to do ΔSpO₂ Chk Units The monitor has detected a conflict in the units used for this calculation. Check the unit settings. Numeric is replaced by -?- Sp-vO₂ Chk Sources Not all measurements or values required to perform the calculation are available. Check measurement Numeric is replaced by -?- sources.
  • Page 104 4 Patient Alarms and INOPs INOP Message, Indication What to do cl NBP Serv Batt The battery in the NBP Pod has reached the end of its useful life. It can no longer be charged. Contact INOP tone your service personnel to replace the battery. cl SpO₂...
  • Page 105: Managing Patients And Equipment

    Many services can be used both at the monitor and at the Information Center, resulting in a more efficient workflow. Which services are available will depend on which Information Center you have. The Philips IntelliVue Information Center iX (PIIC iX) provides more services and functionality than the Philips IntelliVue Information Center (PIIC).
  • Page 106: Managing Patients

    5 Managing Patients and Equipment Additionally there are mechanisms to automatically free up equipment that is no longer used. This prevents unnecessary patient mismatches when the equipment is used for the next patient and avoids data of different patients getting mixed. When connected to PIIC iX, equipment states are tracked by the system.
  • Page 107 5 Managing Patients and Equipment Enter Patient Demographics window appears. You can enter data as normal, using the Find Patient keyboard or a barcode scanner, or, with PIIC iX, use the key to search for patient data in connected systems as described in “Using "Find Patient" to Search for Patient Data” on page 107.
  • Page 108 5 Managing Patients and Equipment To search for patient data: Find Patient Select the key. A window opens with an on-screen keyboard. Enter Type in the last name or an ID, or a part of it, and select on the keyboard. Select Patient The search results will be displayed in a window.
  • Page 109 5 Managing Patients and Equipment Enter Select Confirm In the confirmation window, select to stop monitoring for the previous patient or free up the monitor (if confirmation is configured). Check that patient category and paced status are correct for the new patient. Check the current profile and, if necessary, load an appropriate profile.
  • Page 110 5 Managing Patients and Equipment – resets all monitor and measurement settings as well as the active Screen to the settings defined in the default Profile – discharges the patient from the Information Center. Make sure that you have printed out any required reports before discharging. Check that a functioning End Case local or central printer is available before you use To Discharge a Patient...
  • Page 111 5 Managing Patients and Equipment • when no basic vitals (HR, RR, Pulse, SpO , NBP) have been measured for a specified period Is this a New Patient? The pop-up window is entitled . The monitor offers a key to stop monitoring for the previous patient and begin monitoring a new patient and a key to continue monitoring with the current patient data and settings.
  • Page 112 5 Managing Patients and Equipment Patient Information Stored in Monitor Stored in X1 MMS and Stored in X2 MMS and extensions extensions Calculation data (HemoCalc data) Events data WARNING If the monitor is not battery-powered, you cannot monitor during transport. Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power.
  • Page 113 5 Managing Patients and Equipment If the system is configured to support transfer with equipment, the next step is that you move the patient together with the equipment, e.g. multi-measurement module, to the destination bed you Transfer with Equipment have selected. If the equipment is still connected to the source bed, the window opens requesting you to move the patient and equipment, but also offering the possibility to keep the multi-measurement module at the current bed for use with the next patient (with the No Unplug...
  • Page 114 5 Managing Patients and Equipment At the new location, connect the MMS to the monitor. If the monitor detects a patient mismatch, Complete transfer of this a window will open showing your patient's data and asking whether to patient? Select to complete the transfer.
  • Page 115 5 Managing Patients and Equipment Move the patient using the X2 as the transport monitor. At the new location, just before connecting the X2 to the new host monitor: Patient Demographics – open the window. Transfer – select the pop-up key. –...
  • Page 116 5 Managing Patients and Equipment Select Patient If prompted, re-admit the patient to the new monitor: in the window of the new monitor, select the patient in the X2 to retain the data in the X2. This will upload the patient demographics, and, if configured, the measurement settings and trend data stored in the X2 to the monitor.
  • Page 117 5 Managing Patients and Equipment • When a monitor is connected to an Information Center by the wireless IntelliVue Instrument PIIC Telemetry interface, the patient data will automatically be merged in the case of a transfer. This means there is no patient discharge at the monitor and settings and trend data will be retained. You Patient Demographics will see a message on the monitor and the window will automatically...
  • Page 118 5 Managing Patients and Equipment Patient demographics Patient category and paced status Same Patient - see “Patient Mismatch - If Both Patient Data Sets Refer to the Same Patient” on page 118. New Patient - see “Patient Mismatch - If Neither Patient Data Set is Correct” on page 118. After you resolve the mismatch, the monitor displays a confirmation window that shows the patient that has been selected and where data will be erased, if applicable.
  • Page 119: Managing Equipment

    5 Managing Patients and Equipment Patient Information This information is taken from... Patient Category the Multi-Measurement Module, if connected, otherwise the data is taken from the monitor. Date of Birth Height Weight Gender Paced Mode Paced mode is always set to where there is a mismatch in patient information.
  • Page 120 5 Managing Patients and Equipment Adding Equipment (PIIC iX) Add Equipm. By selecting the key you can display a list of all free equipment (not currently assigned to a patient) and select a device for use with this patient. If you add another monitor, you need to confirm this at the selected monitor.
  • Page 121 5 Managing Patients and Equipment This bed is Bed 3, the connection to the Information Center is active. Name of assigned caregiver Patient name, category and paced mode This monitor is assigned to the patient and is the one on which you are viewing the window. Wired connection The top part of the window contains the patient data, with the assigned caregiver and the status of the connection to the Information Center, and the bed label.
  • Page 122 5 Managing Patients and Equipment Using the Patient Area Equipment The patient name, patient category and paced status are normally shown in the window. When a patient has been prepared for transfer, the transfer symbol will be shown: Equipment Enter Patient When you select this area in the window, a menu opens giving access to the Demographics...
  • Page 123 5 Managing Patients and Equipment A current alarm generated by another device. Delayed - indication that data in the window is delayed. Own patient overview window WARNING All data presented in the own patient overview window are delayed for several seconds. If you need realtime data, for example for defibrillation, always use the host monitor ECG instead of telemetry or ECG from another monitoring device.
  • Page 124 5 Managing Patients and Equipment source is a patient monitor connected to the Information Center via IntelliVue Instrument Telemetry (IIT), only the adjust HR alarms setting is available. Viewing and Silencing Other Device Alarms at the Bedside When other devices are assigned to the patient, alarms from those devices will also be indicated on the monitor, in addition to the main indication at the Information Center.
  • Page 125 5 Managing Patients and Equipment The ECG measurement will be activated again at the monitor. [Note that in this case, as the screen switches back to the monitor's own measurements, the SpO T measurement (if present) will no longer be displayed]. In the same way the source is tracked when a telemetry device is directly connected to a monitor, then disconnected and vice versa.
  • Page 126: Care Groups

    5 Managing Patients and Equipment Alarms on/off, SpO Alarm limits, Desat Alarm Limit, NBP Alarm Suppression On/Off, Pulse(SpO ) On/Off, Measurement Mode Repetition Time Measurement Mode and Repetition Time can only be synchronized if SpO comes from a Cableless SpO Pod or a telemetry device.
  • Page 127 5 Managing Patients and Equipment Care Groups in PIIC There are two main types of Care Groups: • standard care group (Bed-based Care Group) - up to 12 patients monitored by up to 4 Information Centers • unit group (Unit-based Care Group) - for a complete unit with up to 64 patients monitored by up to 4 Information Centers Care Groups are configured at the Information Center.
  • Page 128 5 Managing Patients and Equipment Alarm Status Symbols (four alternative display possibilities depending on space available) The highest priority alarm from this bed is a yellow alarm The highest priority alarm from this bed is a red alarm The highest priority alarm from this bed is a yellow INOP The highest priority alarm from this bed is a red INOP...
  • Page 129 5 Managing Patients and Equipment Viewing the My Patients Window This window shows the alarm status, bed name, and patient name for every bed in the Care Group. The window for the Unit group shows first the beds of the Information Center this bed is connected to.
  • Page 130 5 Managing Patients and Equipment The Other Bed window may be configured to display embedded in a specially designed Screen. Change Screen • To display the embedded Other Bed screen element, in the menu, select a Screen designed to show the Other Bed information permanently. Changing the Screen may automatically change the bed shown in the other bed window.
  • Page 131 5 Managing Patients and Equipment Other Bed Pop-Up Keys Other Patients Select the SmartKey or the Other Bed window or embedded screen element to access the associated pop-up keys: Next Wave lets you view waveforms not currently shown in the other bed window. More Vitals lets you view more numerics not currently shown in the other bed window.
  • Page 132: Information Center Compatibility

    5 Managing Patients and Equipment Alarming Beds My Patients • if configured, the Other Bed window, the window or the window may pop up on the Screen (if automatic alarm notification is enabled at the bedside monitor and at the Information Center).
  • Page 133: Ecg, Arrhythmia, St And Qt Monitoring

    To protect the monitor from damage during defibrillation, for accurate ECG information and to protect against noise and other interference, use only ECG electrodes and cables specified by Philips. Some non-authorized electrodes may be subject to large offset potentials due to polarization.
  • Page 134: Selecting The Primary And Secondary Ecg Leads

    6 ECG, Arrhythmia, ST and QT Monitoring Selecting the Primary and Secondary ECG Leads The monitor uses the primary and secondary lead to compute HR and to analyze and detect cardiac arrhythmias. They are also available for recordings and for display on the Information Center. The secondary lead is only used if your monitor is configured for multi-lead (instead of single-lead) arrhythmia analysis.
  • Page 135: Monitoring Paced Patients

    If the pacer spikes have been configured to have a fixed size, they will be displayed in the background as a dotted line. Pacer spikes configured to have a fixed size Defibrillator synchronization marks: If an HP/Agilent/Philips defibrillator is connected, or the 2nd ECG SyncPuls Sync Out channel is configured to and a sync cable is plugged in, the synchronization marks (vertical lines on the ECG wave) are shown on the ECG wave.
  • Page 136: Changing The Size Of The Ecg Wave

    6 ECG, Arrhythmia, ST and QT Monitoring • the normal QRS complex should be either completely above or below the baseline and it should not be biphasic. For paced patients, the QRS complexes should be at least twice the height of pace pulses.
  • Page 137: Changing The Volume Of The Qrs Tone

    6 ECG, Arrhythmia, ST and QT Monitoring Changing the adjustment factor only changes the visual appearance of the ECG wave on the screen. It does not affect the ECG signal analyzed by the monitor. Comparing the wave size to the 1 mV calibration bar on the ECG wave segment can help you to get an idea of the true ECG signal strength.
  • Page 138: Selecting Positions Of Va And Vb Chest Leads (for 6-lead Placement)

    6 ECG, Arrhythmia, ST and QT Monitoring Filter – : The filter reduces interference to the signal. It should be used if the signal is distorted by high frequency or low frequency interference. High frequency interference usually results in large amplitude spikes making the ECG signal look irregular. Low frequency interference usually leads to a wandering or rough baseline.
  • Page 139: Ecg Lead Fallback

    6 ECG, Arrhythmia, ST and QT Monitoring Especially in the precordial leads, which are close to the heart, QRS morphology can be greatly altered if an electrode is moved away from its correct location. ECG Leads Monitored If you are using these leads are available: Resp is measured between electrodes:...
  • Page 140 6 ECG, Arrhythmia, ST and QT Monitoring Electrode labels Electrode colors AAMI EASI AAMI Brown/Yellow White/Yellow Brown/Green White/Green Brown/Blue White/Brown Brown/Orange White/Black Brown/Violet White/Violet Standard 3-Lead Placement RA placement: directly below the clavicle and near the right shoulder LA placement: directly below the clavicle and near the left shoulder LL placement: on the left lower abdomen...
  • Page 141 6 ECG, Arrhythmia, ST and QT Monitoring Standard 5-Lead Placement RA placement: directly below the clavicle and near the right shoulder LA placement: directly below the clavicle and near the left shoulder RL placement: on the right lower abdomen LL placement: on the left lower abdomen V placement: on the chest, the position depends on your required lead selection 6-Lead Placement...
  • Page 142 6 ECG, Arrhythmia, ST and QT Monitoring Chest Electrode Placement V1 on the fourth intercostal space at the right sternal border V2 on the fourth intercostal space at the left sternal border V3 midway between the V2 and V4 electrode positions V4 on the fifth intercostal space at the left midclavicular line...
  • Page 143 6 ECG, Arrhythmia, ST and QT Monitoring Conventional 12-Lead ECG V1 - V6 In conventional 12-Lead ECG using 10 electrodes, an electrode is placed on the right arm, left arm, right leg, and left leg. Six V- electrodes are placed on the chest. The right leg electrode is the reference electrode.
  • Page 144 6 ECG, Arrhythmia, ST and QT Monitoring Modified 12-Lead ECG V1-V6 Angle of Lewis If your institution uses modified 10-lead ECG electrode placement (the Mason-Likar Lead System), place the four limb electrodes close to the shoulders and lower abdomen. The six V electrodes are placed on the chest in the same position as the conventional 12-lead placement.
  • Page 145: Easi Ecg Lead Placement

    6 ECG, Arrhythmia, ST and QT Monitoring EASI ECG Lead Placement Using a standard 5-electrode set in EASI lead placement you can monitor up to 12 standard ECG leads simultaneously and continuously at the bedside. EASI provides a monitoring method for trending ST segment changes that can provide an early indication of ischemia.
  • Page 146: Capture 12-lead

    6 ECG, Arrhythmia, ST and QT Monitoring Capture 12-Lead You can view a 12-Lead ECG on the screen, capture a 12-Lead ECG episode, preview the captured ECG data and then store it and send it to a connected Information Center for analysis. You can download the resulting analysis from the Information Center and also other 12-Lead captures for review at the monitor.
  • Page 147 6 ECG, Arrhythmia, ST and QT Monitoring Changing Settings for a Captured 12-Lead ECG Setup 12 Lead Select the pop-up key to choose settings for filter, gain, etc., if changes are needed. All changes apply to both the display and the printed 12-Lead report. The changes are only applied temporarily and will not be stored.
  • Page 148 6 ECG, Arrhythmia, ST and QT Monitoring Printing the 12-Lead ECG Print Report Print a dedicated 12-Lead ECG report by selecting the pop-up key. When you are working with an Information Center iX that provides 12-Lead analysis, the report contains the 12-Lead analysis results as well as measurement values (e.g. ST values, QT values, HR) which are also downloaded from the Information Center iX.
  • Page 149: Ecg And Arrhythmia Alarm Overview

    6 ECG, Arrhythmia, ST and QT Monitoring Pop-up Keys Selecting this pop-up key lets you Store & Send store the captured 12-Lead ECG in the monitor and send it to the Information Center. Review 12 Lead view a list of 12-Lead captures available at the monitor or at the IntelliVue Information Center, and select one for review.
  • Page 150 6 ECG, Arrhythmia, ST and QT Monitoring Alarm Description Arrhythmia Configuration Arrhythmia Basic Enhanced Arrhythmia Arrhythmia *** Extreme Brady Heart rate < the extreme brady alarm limit ** HR High Heart rate > the high HR alarm limit (see note) (see note) ** HR Low Heart rate <...
  • Page 151: Using Ecg Alarms

    6 ECG, Arrhythmia, ST and QT Monitoring Alarm Description Arrhythmia Configuration Arrhythmia Basic Enhanced Arrhythmia Arrhythmia ** Pacer Not Capt No beat detected for > 1.75*(the averaged R-R interval) with detected pace pulse(s). (For paced patients only) **Pacer Not Pacing No beat and pace pulse detected for >...
  • Page 152: Ecg Safety Information

    6 ECG, Arrhythmia, ST and QT Monitoring You need to know which value has been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range. Setup ECG Δ To see the extreme rate alarms set for your monitor, in the menu, see the menu items ExtrTachy Δ...
  • Page 153 6 ECG, Arrhythmia, ST and QT Monitoring When using electrosurgical (ES) equipment, never place ECG electrodes near to the grounding plate of the ES device, as this can cause a lot of interference on the ECG signal. General: When you are connecting the electrodes or the patient cable, make sure that the connectors never come into contact with other conductive parts, or with earth.
  • Page 154: About Arrhythmia Monitoring

    6 ECG, Arrhythmia, ST and QT Monitoring Line isolation monitor transients: When electrodes or lead wires are loose or detached, the monitor becomes susceptible to switching transients from some types of line isolation monitors. Line isolation monitor transients may resemble actual cardiac waveforms and thus inhibit heart rate alarms.
  • Page 155: Choosing An Ecg Lead For Arrhythmia Monitoring

    6 ECG, Arrhythmia, ST and QT Monitoring Choosing an ECG Lead for Arrhythmia Monitoring It is important to select a suitable lead for arrhythmia monitoring. Guidelines for non-paced patients are: – QRS complex should be tall and narrow (recommended amplitude > 0.5 mV) –...
  • Page 156: Aberrantly-conducted Beats

    6 ECG, Arrhythmia, ST and QT Monitoring Aberrantly-Conducted Beats As P-waves are not analyzed, it is difficult and sometimes impossible for the monitor to distinguish between an aberrantly-conducted supraventricular beat and a ventricular beat. If the aberrant beat resembles a ventricular beat, it is classified as ventricular. You should always select a lead where the aberrantly-conducted beats have an R-wave that is as narrow as possible to minimize incorrect calls.
  • Page 157 6 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Beat Labels Arrhythmia beat labels tell you how the monitor is classifying beats. = Normal = Ventricular Ectopic = Supra-ventricular Premature = Paced = Pacer spike " = Biventricular Pacer Spike = Learning patient's ECG = Artifact (noisy episode) = Insufficient information to classify beats = Inoperative condition (e.g., LEADS OFF)
  • Page 158 6 ECG, Arrhythmia, ST and QT Monitoring Rhythm Status Message Description B or E Paced Rhythm A dominant rhythm of paced beats B, E Irregular HR Consistently irregular rhythm Sinus Brady A dominant rhythm of SV beats preceded by P-waves B, E Sinus Rhythm Sinus Tach...
  • Page 159: Arrhythmia Relearning

    6 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Relearning During a learning phase: • Alarm timeout periods are cleared • Stored arrhythmia templates are cleared • Asystole, Vfib, and HR alarms (when there are enough beats to compute the HR) are active. No other alarms are active.
  • Page 160: Arrhythmia Alarms

    6 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Relearn and Lead Fallback Lead fallback triggers an automatic arrhythmia relearn. WARNING If arrhythmia learning takes place during ventricular rhythm, the ectopics may be incorrectly learned as the normal QRS complex. This may result in missed detection of subsequent events of V-Tach and V- Fib.
  • Page 161 6 ECG, Arrhythmia, ST and QT Monitoring Arrhythmia Alarms and Latching Visual Latching Audible Latching When using arrhythmia analysis, should be on for red alarms, Visual Latching or at least should be on. Because of the transient nature of arrhythmia alarms, many arrhythmia conditions may go unnoticed if alarm latching is off.
  • Page 162 6 ECG, Arrhythmia, ST and QT Monitoring This setting can only be changed in Configuration Mode. ** AFIB ** Irregular HR alarms do not have a timeout period. These alarms can be generated immediately after the corresponding end alarm was generated. ** HR High ** HR Low When...
  • Page 163 6 ECG, Arrhythmia, ST and QT Monitoring If alarm conditions of equal severity from different chains are detected, the alarm condition that occurred most recently is announced. See “ECG and Arrhythmia Alarm Overview” on page 149 for information on which alarms are included in the different arrhythmia options.
  • Page 164: About St Monitoring

    6 ECG, Arrhythmia, ST and QT Monitoring Understanding PVC-Related Alarms PVC-related alarms are detected on the basis of the current ventricular heart rate and the number of consecutive PVCs counted (referred to as PVC Runs). As an example, this diagram illustrates the conditions under which PVC alarms would be generated if the Vent Rhythm Run limit is set to 12, the V-Tach Run Limit is set to 8, and the V-Tach HR Limit is set to 100.
  • Page 165: Switching St Or Ste On And Off

    6 ECG, Arrhythmia, ST and QT Monitoring WARNING Some clinical conditions may make it difficult to achieve reliable ST monitoring, for example: • if you are unable to get a lead that is not noisy • if arrhythmias such as atrial fib/flutter are present, which may cause an irregular baseline •...
  • Page 166: Understanding The St Display

    6 ECG, Arrhythmia, ST and QT Monitoring To change the order in which ST leads are displayed, Setup ST Leads In the menu, choose a lead from the list. Sort Up Sort Down Select the key to move the lead up or down in the list. Understanding the ST Display Your monitor screen may be configured to look slightly different from the illustrations.
  • Page 167 6 ECG, Arrhythmia, ST and QT Monitoring ST View Window ST View Window shows a current ST snippet and numeric with a baseline snippet and numeric. The two snippets are in different colors, so that you can differentiate between them easily and see at a glance which numerics belong to which snippet.
  • Page 168: Updating St Baseline Snippets

    6 ECG, Arrhythmia, ST and QT Monitoring STE View Current Baseline Overlap window opens with the pop-up keys (to select viewing Show Points Hide Points Record STE ST View ST Map Setup ST mode), and arrow keys for scrolling through the available leads. Hide Points The ST point, J-point and ISO point can be hidden using the pop-up key.
  • Page 169 6 ECG, Arrhythmia, ST and QT Monitoring The isoelectric (ISO) point provides the baseline, the ST point is at the midpoint of the ST segment. The J point is where the QRS complex changes its slope; as it is a fixed distance away from the ST point, it can be useful to help you position the ST point correctly.
  • Page 170 6 ECG, Arrhythmia, ST and QT Monitoring Select Point Use the pop-up key to scroll through the points and activate the point you need to adjust, then use the left and right arrow keys to move the measurement point. Each point is highlighted while active.
  • Page 171: St Alarms

    6 ECG, Arrhythmia, ST and QT Monitoring To position the ST-point (3) relative to the J-point: J+60 J+80 J Point select either . Select and use the arrow keys to move the J-Point and position the ST-point at the midpoint of the ST segment. To position the ST-point directly: ST Point select...
  • Page 172: Viewing St Maps

    6 ECG, Arrhythmia, ST and QT Monitoring Viewing ST Maps The monitor can derive a multi-axis portrait (map) from the ST analysis to help you detect changes in ST values. It displays two planes obtained from a multilead ECG in a multi-axis diagram, where each axis represents a lead.
  • Page 173 6 ECG, Arrhythmia, ST and QT Monitoring If a lead is in INOP (the value is being measured but is invalid or unavailable because, for example, the corresponding ECG electrode is off), the area formed by the remaining ST leads is left open. If there is insufficient information (for example, there are less than three chest leads) for a second ST map to be displayed, the currently available ST values are displayed in place of the second ST map.
  • Page 174 6 ECG, Arrhythmia, ST and QT Monitoring In this diagram, V4 was either temporarily switched off, or in INOP, for around 30 seconds. No data was recorded. Consequently, the affected maps are not closed. Viewing an ST Map To display an ST map, Main Setup ST Map •...
  • Page 175: About Qt/qtc Interval Monitoring

    6 ECG, Arrhythmia, ST and QT Monitoring Changing the Trending Interval To determine how frequently the monitor displays a trended sample, Select Interval In Trend view, select Select the required interval from the menu. The interval ranges between 12 seconds to 30 minutes. Printing an ST Map Report To print the most recently viewed (current or trend) window, Main Setup...
  • Page 176 6 ECG, Arrhythmia, ST and QT Monitoring Because of the different algorithm approaches, a QT/QTc measurement from a diagnostic 12-lead program may differ from the realtime measurement on the monitor. Where Can I Find More Information? See the Application Note on QT/QTc Interval Monitoring and the QT Interval Monitoring Quick Guide supplied on your documentation DVD for detailed information on the QT algorithm and performance.
  • Page 177 6 ECG, Arrhythmia, ST and QT Monitoring • Single-Lead mode - a single lead selected from all available leads (except the augmented leads) will be used for QT measurement. QT measurement will stop if the selected lead becomes unavailable. To select the mode, Setup QT Analysis Select the QT numeric to enter the window.
  • Page 178: Qt Alarms

    6 ECG, Arrhythmia, ST and QT Monitoring To set the baseline, Set Baseline • Select and set the value. If no baseline has been set for this patient, the first five minute value after the start of monitoring is automatically set as baseline. If you set a new baseline the previous baseline is discarded. As the ΔQTc alarm is based on the difference between the baseline and the current value, setting an inappropriate new baseline may prevent a ΔQTc alarm from being generated.
  • Page 179: Switching Qt Monitoring On And Off

    6 ECG, Arrhythmia, ST and QT Monitoring Switching Individual QTc Alarms On and Off Each QTc alarm can be switched off individually. Setup QT Analysis QTc High Alarm ΔQTc High To switch an alarm on or off, in the menu, select Alarm to toggle between Changing QTc Alarm Limits...
  • Page 180 6 ECG, Arrhythmia, ST and QT Monitoring...
  • Page 181: Monitoring Pulse Rate

    Monitoring Pulse Rate The pulse numeric counts the arterial pulsations that result from the mechanical activity of the heart in beats per minute (bpm). You can display a pulse from any measured SpO signal (pleth wave), or any arterial pressure (P, ABP, ART, Ao, PAP, UAP, FAP, BAP: see the “Monitoring Invasive Pressure” chapter for an explanation of the pressure labels).
  • Page 182: Switching Pulse On And Off

    7 Monitoring Pulse Rate Switching Pulse On and Off Setup Pulse To switch a particular pulse numeric on or off, enter the menu via the measurement setup menu or wave menu of the pulse source. For example, to switch an SpO pulse numeric on or off, Setup Pulse Pulse...
  • Page 183 7 Monitoring Pulse Rate WARNING Selecting Pulse as the active alarm source for HR/Pulse switches off the arrhythmia alarms listed in the section “ECG and Arrhythmia Alarm Overview” on page 149, including Asystole, Vfib and Vtach ECG/Arrh AlarmsOff alarms, and the heart rate alarms. This is indicated by the message (unless this has been configured off for your monitor), and the crossed-out alarm symbol beside the ECG heart ECG/Arrh AlarmsOff...
  • Page 184 7 Monitoring Pulse Rate...
  • Page 185: Monitoring Respiration Rate (resp)

    Monitoring Respiration Rate (Resp) For the respiratory measurement (Resp), the monitor measures the thoracic impedance between two ECG electrodes on the patient's chest. Changes in the impedance due to thoracic movement produce the Resp waveform on the monitor screen. The monitor counts the waveform cycles to calculate the respiration rate (RR).
  • Page 186: Understanding The Resp Display

    8 Monitoring Respiration Rate (Resp) Lateral Chest Expansion Some patients, especially neonates, expand their chests laterally. In these cases it is best to place the two respiratory electrodes in the right midaxillary and left lateral chest areas at the patient's maximum point of breathing movement to optimize the respiratory wave.
  • Page 187: Changing The Size Of The Respiration Wave

    8 Monitoring Respiration Rate (Resp) • the detection level (a dotted line) is not displayed on the waveform, • the algorithm expects a heart rate and therefore needs at least 3 electrodes attached to the patient. If you are monitoring respiration with only two electrodes, the detection algorithm becomes less sensitive which may result in reduced breath detection performance.
  • Page 188: Changing The Speed Of The Respiration Wave

    8 Monitoring Respiration Rate (Resp) Changing the Speed of the Respiration Wave Resp waveforms are usually viewed at a slower speed than other waveforms. For this reason, the Resp measurement has its own speed control and is not affected by the wave speed settings of the other measurements.
  • Page 189 8 Monitoring Respiration Rate (Resp) This is because of the higher internal impedance of the OR cable set, required for use if electrosurgery is being performed. Rate adaptive pacemakers Implanted pacemakers which can adapt to the Minute Ventilation rate may occasionally react on the Impedance measurement used by patient monitors for the determination of the Resp value and execute pacing with the maximum programmed rate.
  • Page 190 8 Monitoring Respiration Rate (Resp)
  • Page 191: Monitoring Spo2

    Monitoring SpO2 Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier artifact suppression technology (FAST). It provides four measurements: • Oxygen saturation of arterial blood (SpO ) - percentage of oxygenated hemoglobin in relation to the sum of oxyhemoglobin and deoxyhemoglobin (functional arterial oxygen saturation).
  • Page 192: Connecting Spo2 Cables

    Connecting SpO2 Cables Connect the sensor cable to the color-coded socket on the measurement device (MMS or module). You can connect some Philips sensors directly to the measurement device. For other sensors, use the corresponding adapter cable. CAUTION Extension cables: Do not use more than one extension cable (M1941A).
  • Page 193: Spo2 Signal Quality Indicator (fast Spo2 Only)

    9 Monitoring SpO2 During measurement, ensure that the application site: – has a pulsatile flow, ideally with a perfusion indicator value above 1.0. – has not changed in its thickness (for example, due to edema), causing an improper fit of the sensor.
  • Page 194: Assessing A Suspicious Spo2 Reading

    9 Monitoring SpO2 Assessing a Suspicious SpO2 Reading Traditionally, pulse rate from SpO was compared with heart rate from ECG to confirm the validity of the SpO reading. With newer algorithms, such as FAST-SpO , this is no longer a valid criteria because the correct calculation of SpO is not directly linked to the correct detection of each pulse.
  • Page 195 9 Monitoring SpO2 Alarm Delays There is a delay between a change in the oxygen saturation at the measurement site and the corresponding alarm indication at the monitor. This delay has two components: • The general measurement delay time is the time between the occurrence of the saturation change and when the new value is represented by the displayed numerical values.
  • Page 196 9 Monitoring SpO2 Alarm Limit Violation Alarm Limit Deviation from violated Alarm Limit Resulting Alarm Delay Short Mode Medium Mode Long Mode This diagram shows the relationship between the alarm delay and the deviation from the alarm limit. The shaded areas on the diagram show the area in which SpO values can violate the alarm limit without causing an alarm to be indicated.
  • Page 197 9 Monitoring SpO2 Example With Short Mode Alarm Limit Deviation from violated Alarm Limit Resulting Alarm Delay This diagram shows the area for Short mode, with two examples of hypoxia. Progressive hypoxia scenario: SpO value (A) - the values drop steadily and after 10 seconds a value leaves the shaded area.
  • Page 198 9 Monitoring SpO2 Example With Medium Mode Alarm Limit Deviation from violated Alarm Limit Resulting Alarm Delay This diagram shows the area for Medium mode, with two examples of hypoxia. Progressive hypoxia scenario: SpO value (C) - the values drop steadily and after 11 seconds a value leaves the shaded area.
  • Page 199 9 Monitoring SpO2 Progressive hypoxia scenario: SpO value (E) - the values drop steadily and after 16 seconds a value leaves the shaded area. An alarm is indicated immediately. Recovery scenario: SpO value (F) - the values stay within the shaded area for 98 seconds, deviating from the alarm limit by 1% to 3%, before rising again above the alarm limit.
  • Page 200: Pleth Wave

    9 Monitoring SpO2 Adjusting the Desat Limit Alarm The Desat alarm is a high priority (red) alarm notifying you of potentially life threatening drops in oxygen saturation. Setup SpO₂ Desat Limit In the menu, select Adjust the limit. Pleth Wave The Pleth wave is autoscaled to maximum display size.
  • Page 201: Setting Up Tone Modulation

    9 Monitoring SpO2 Setting Up Tone Modulation If tone modulation is on, the QRS tone pitch lowers when the SpO level drops. Remember, the QRS tone is derived from either heart rate or pulse depending on which is currently selected as the active alarm source.
  • Page 202 9 Monitoring SpO2...
  • Page 203: Monitoring Nbp

    Monitoring NBP This monitor uses the oscillometric method for measuring NBP. The NBP measurement is suitable for use in the presence of electrosurgery and during the discharge of a cardiac defibrillator according to IEC 601-2-30:1999/EN 60601-2-30:2000. A physician must determine the clinical significance of the NBP information. Introducing the Oscillometric NBP Measurement Oscillometric devices measure the amplitude of pressure changes (oscillations) in the occluding cuff as the cuff deflates from above systolic pressure.
  • Page 204: Measurement Modes

    10 Monitoring NBP Temporary Loss of Function: The pressurization of the cuff can temporarily cause loss of function of monitoring equipment used simultaneously on the same limb. CAUTION If you spill liquid onto the equipment or accessories, particularly if there is a chance that it can get inside the tubing or the measurement device, contact your service personnel.
  • Page 205: Preparing To Measure Nbp

    Kinked or otherwise restricted tubing can lead to a continuous cuff pressure, causing blood flow interference and potentially resulting in injury to the patient. Make sure that you are using a Philips-approved correct sized cuff and that the bladder inside the cover is not folded or twisted.
  • Page 206 10 Monitoring NBP Recommendations For Measurements Used in Diagnosis of Hypertension To make a measurement for use in the diagnosis of hypertension, follow the steps below: Ensure the patient is comfortably seated, with their legs uncrossed, feet flat on the floor and back and arm supported.
  • Page 207: Starting And Stopping Measurements

    10 Monitoring NBP During Measurements The cuff pressure is displayed instead of the units and the repeat time. An early systolic value gives you a preliminary indication of the systolic blood pressure during measurement. When Unexpected Values are Measured When values measured are higher or lower than expected, check the following potential causes: Possible Cause Solution The patient was talking or moving before or...
  • Page 208: Enabling Automatic Mode And Setting Repetition Time

    10 Monitoring NBP Action to be performed NBP Setup menu SmartKeys MMS hardkey Start/Stop Start/Stop Stop current Auto measurement Start/ Stop Stop NBP Start/Stop Start/Stop Stop current STAT measurement and end series Start/ Stop NBP STAT STAT (for MMS without Pressure/ Temp measurement) NBP STAT Stop NBP...
  • Page 209: Choosing The Nbp Alarm Source

    10 Monitoring NBP Select each sequence in turn and select the number of measurements and the time interval between the measurements. To have measurements continue after the sequence, set the number of measurements for your last Continuous and this cycle will run indefinitely. cycle to CAUTION Continuous...
  • Page 210: Assisting Venous Puncture

    10 Monitoring NBP Assisting Venous Puncture You can use the NBP cuff to cause sub-diastolic pressure. The cuff deflates automatically after a set time (adult/pediatric 170 seconds, neonatal 85 seconds) if you do not deflate it. Setup NBP VeniPuncture In the menu select Puncture vein and draw blood sample.
  • Page 211: Monitoring Temperature

    Monitoring Temperature WARNING Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered by external power: when connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension (865297).
  • Page 212: Calculating Temp Difference

    11 Monitoring Temperature Setup <Temp Label> Label. In the menu, select Select the appropriate label from the list. Temp Trect non-specific temperature label rectal temperature Tart Tskin arterial temperature skin temperature Tcore Tven core temperature venous temperature Tesoph Tnaso esophageal temperature nasopharyngeal temperature Extended Temperature Label Set Label Set...
  • Page 213: Monitoring Invasive Pressure

    Monitoring Invasive Pressure WARNING Measurements from an MMS extension connected to an X2 are not available when the X2 is running on its own battery power. They are only available when the X2 is powered by external power: when connected to a host monitor, to the external power supply (M8023A) or to the Battery Extension (865297).
  • Page 214 12 Monitoring Invasive Pressure WARNING If measuring intracranial pressure (ICP, IC1 or IC2) with a sitting patient, level the transducer with the top of the patient's ear. Incorrect leveling may give incorrect values. Selecting a Pressure for Monitoring Tell the monitor the source of the pressure you want to monitor by selecting an appropriate pressure label.
  • Page 215: Zeroing The Pressure Transducer

    12 Monitoring Invasive Pressure Zeroing the Pressure Transducer To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in accordance with your hospital policy. You must perform a zero: • when you use a new transducer or tubing •...
  • Page 216 12 Monitoring Invasive Pressure CAUTION When using high frequency ventilation, ensure that the tubing from the ventilator does not touch the arterial line, or connect with it indirectly, while zeroing the pressure. This could cause small pressure variations which can interfere with the zero procedure. Using the Zero Hardkey Pressing the Zero hardkey for two seconds on the M1006B Pressure module starts a zero for the pressure currently measured with the module.
  • Page 217: Adjusting The Calibration Factor

    12 Monitoring Invasive Pressure Adjusting the Calibration Factor Each time you use a reusable transducer, compare the calibration factor written on your transducer with the calibration factor shown on the monitor. To ensure accurate measurement, they must be the same. Setup <Press Label>...
  • Page 218: Non-physiological Artifact Suppression

    12 Monitoring Invasive Pressure Using the pop-up keys you can also change the scale or the speed for the wave, freeze the wave or start a printout or recording. Non-Physiological Artifact Suppression Some clinical procedures may affect blood pressure, for example, a flush procedure or a blood sample. Your monitor may be configured to suppress these non-physiological artifacts for a specified duration Artifact Suppr.
  • Page 219: Calibrating Reusable Transducer Cpj840j6

    12 Monitoring Invasive Pressure Extreme Low Limit Low Limit High Limit Extreme High Limit Δ Extreme Low Δ Extreme High You need to know which values have been configured for your monitor. Changing the high and low alarm limits automatically changes the extreme alarm limits within the allowed range. Setup <Press Label>...
  • Page 220 12 Monitoring Invasive Pressure d. Open the port to the manometer. 1 Tubing to manometer 2 Syringe with heparinised solution 3 To pressure connector on monitor 4 Patient connection stoppered 5 Off Move the syringe barrel in and raise the mercury to 200 mmHg (30 kPa). 200 mmHg is the recommended calibration pressure.
  • Page 221: Calculating Cerebral Perfusion Pressure

    12 Monitoring Invasive Pressure Message Corrective Action unable to calibrate - perform No valid zero. Zero the transducer. zero first Calculating Cerebral Perfusion Pressure The monitor can calculate the difference between mean arterial pressure and the intracranial pressure. The difference is labeled CPP. Main Setup Measurements In the...
  • Page 222: Measuring Iap

    12 Monitoring Invasive Pressure Measuring IAP There are two methods to store IAP measurement readings in the monitor: with manual entry or using a pressure waveform. NOTE For both methods, to be able to use the label IAP, it must be made available for manual entry in Configuration Mode.
  • Page 223: Editing The Wedge

    12 Monitoring Invasive Pressure occludes the artery allowing the monitor to record changes in the intrathoracic pressures that occur throughout the respiration cycle. The pulmonary wedge pressure is the left ventricular end diastolic pressure (preload). The most accurate PAWP values are obtained at the end of the respiration cycle when the intrathoracic pressure is fairly constant.
  • Page 224: Identifying The Pressure Analog Output Connector

    12 Monitoring Invasive Pressure Store Wedge Select to store the PAWP value. Print Wedge Record Wedge Select to print the PAWP waveform and any reference waves or record them. While recording or printing, you cannot perform any more Wedge tasks. WARNING Prolonged inflation can cause pulmonary hemorrhage, infarction or both.
  • Page 225: Monitoring Cardiac Output

    Monitoring Cardiac Output The Cardiac Output (C.O.) measurement invasively measures cardiac output and other hemodynamic parameters using a technique called thermodilution. This can be used to determine the flow rate of a system by introducing a cold solution into the system and measuring the resulting drop in temperature at a downstream site.
  • Page 226: Hemodynamic Parameters

    13 Monitoring Cardiac Output Hemodynamic Parameters This table illustrates the hemodynamic parameters available with each method, whether they are measured continuously, and whether they can be shown on the monitor's main screen or in the Hemodynamic Calculations window. PiCCO Method (Transpulmonary Right Heart Thermodilution Thermodilution) Measured and Calculated Hemodynamic...
  • Page 227 13 Monitoring Cardiac Output To open the procedure window, Cardiac Output Setup C.O. Setup CCO • Select in the menu, or Cardiac Output • Select the SmartKey on the Screen, if configured, or • Press the START hardkey on the front of the C.O. plug-in module, if available, or •...
  • Page 228: Accessing The Setup C.o. And Setup Cco Menus

    13 Monitoring Cardiac Output Accessing the Setup C.O. and Setup CCO Menus Setup C.O. C.O. settings can be changed in the menu. To access this menu, • press the C.O. hard key on the C.O. module, or • select any of the discontinuous C.O. numerics (for example, C.O., C.I.) on the screen. Setup CCO CCO/CCI settings can be changed in the menu.
  • Page 229 13 Monitoring Cardiac Output Measuring Pulse Pressure Variation Note: Pulse Pressure Variation can be calculated in two different ways on this monitor - in conjunction with CCO or directly from the pressure measurement. Refer to the Invasive Pressure chapter for information on PPV from pressure.
  • Page 230 13 Monitoring Cardiac Output Setting Up the PiCCO C.O. Measurement C.O. Module C.O. Interface Cable PULSION Pressure Transducer Press Module Pressure Adapter Cable Thermistor Connection Cable Thermistor Connection PULSION Arterial Catheter CVP Line 10 Injectate Temperature Probe Housing 11 Injectate Syringe 12 Injectate Temperature Probe 13 Remote Switch Set up the arterial line using the arterial catheter (transpulmonary catheter) and the transducer kit...
  • Page 231 13 Monitoring Cardiac Output If you are measuring CCO, set up the pressure measurement now. The CCO measurement requires a minimally dampened invasive pressure setup. You must ensure that there are no air bubbles in the pressure line or dome and use only specified accessories. Check that the correct measurement method is selected.
  • Page 232 13 Monitoring Cardiac Output Editing PiCCO C.O. Measurements It is important to identify and reject erroneous trials, as the monitor uses all the measurement trial values you do not reject to calculate the averaged cardiac output. Review the trials. Irregular trials or trials marked with a " "...
  • Page 233: Measuring C.o. Using The Right Heart Thermodilution Method

    13 Monitoring Cardiac Output ?Cal A disturbed pressure signal for CCO was available during the measurement (valid for calibration) No adequate pressure signal for CCO was available during the measurement (no valid calibration data) This trial is more than 15 minutes older than the most recent trial and has expired for CCO calibration (no valid calibration data) Measuring C.O.
  • Page 234 13 Monitoring Cardiac Output Attach the injectate temperature probe housing to the PA line. Plug the C.O. interface cable into the C.O. module or measurement extension module and connect the following devices into the C.O. interface cable: – injectate temperature probe –...
  • Page 235: Documenting C.o. Measurements

    13 Monitoring Cardiac Output Editing and Saving RH C.O. Measurements It is important to identify and reject erroneous measurements (called "trials"), as the monitor uses all the measurement trial values you do not reject to calculate the averaged cardiac output. Review the trials.
  • Page 236: C.o./cco Curve Alert Messages

    13 Monitoring Cardiac Output Injectate Volume, Patient Weight and ETVI Values (PiCCO Only) When deciding on an injectate volume and temperature, you must consider your patient's Ideal Body Weight (IBW) and extra-vascular thermal volume index (ETVI). IBW is based on the patient category, gender and height that you have entered for the patient.
  • Page 237 13 Monitoring Cardiac Output C.O./CCO Curve Alert Possible Causes Messages Noisy baseline A blood temperature baseline drift that could not be compensated was detected during the C.O. measurement. Possible causes are: - Interference may be caused by a ventilator. - Interference may be caused by an infusion pump: infusions of significant volume through the central line should be paused at least 30 seconds before the first thermodilution measurement in a series and should not recommence until the measurement series is...
  • Page 238: C.o./cco Prompt Messages

    13 Monitoring Cardiac Output C.O./CCO Curve Alert Possible Causes Messages Very long curve The decay time of the curve is longer than 15 seconds. Very short curve Decay time of the curve is less than 0.5 seconds. If there is a noisy baseline, part of the baseline may have been mistaken for a thermodilution curve.
  • Page 239: C.o./cco Safety Information

    13 Monitoring Cardiac Output C.O./CCO Warning Messages Possible Causes Verify C.O. setup data A new transpulmonary thermodilution catheter has been connected to the C.O. Interface Cable. Check arterial pressure, CCO cal Poor or invalid pressure signal, for example if pressure was not currently not possible zeroed.
  • Page 240 13 Monitoring Cardiac Output...
  • Page 241: Monitoring Carbon Dioxide

    Sidestream measurement takes a sample of the respiratory gas with a constant sample flow from the patient's airway and analyzes it with a remote CO sensor built into the measurement system. Philips offers the sidestream CO measurement in the M3014A Capnography Extension or the X2 with the optional CO...
  • Page 242: Measurement Principles

    14 Monitoring Carbon Dioxide Low etCO2 values: Leakages in the breathing system or sampling system may cause the displayed etCO values to be significantly too low. Always connect all components securely and check for leaks according to standard clinical procedures. Displacement of the nasal or combined nasal oral cannulas can cause lower than actual etCO readings.
  • Page 243 5% for every 1000 m difference. CAUTION Use the CO measurement with Philips approved accessories only. Refer to the instructions for use provided with the accessory. Preparing to Measure Mainstream CO2 You must perform a zero as described in this procedure each time you use a new airway adapter.
  • Page 244 14 Monitoring Carbon Dioxide CO₂ calibration done at <Date and Time> – When you see the message on the status line, the zero calibration is finished and you can begin monitoring. Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y- section.
  • Page 245 14 Monitoring Carbon Dioxide – expose the sensor to room air and keep it away from all sources of CO including the ventilator, the patient's breath and your own. Start Zero Cal – in the setup menu for the CO , select CO₂...
  • Page 246: Measuring Mainstream Co2 Using M3016a

    14 Monitoring Carbon Dioxide CAUTION Always disconnect the cannula, airway adapter or sample line from the sensor when not in use. Using the Sidestream Sensor Holder The holder delivered with the sensor can be used to clamp the sensor onto an IV pole or a shelf. Push the sensor into the holder until it clicks into position.
  • Page 247 14 Monitoring Carbon Dioxide Preparing to Measure Mainstream CO2 Attach the transducer connector to the CO connector on the M3016A extension. Wait 20 minutes, allowing the transducer to reach its operating temperature and a stable thermal condition. Perform an accuracy check and then, if necessary, calibrate the transducer. Checking Transducer Accuracy WARNING Check transducer accuracy at least once a week or if you doubt the CO...
  • Page 248: Measuring Microstream Co2 Using M3015a/b

    14 Monitoring Carbon Dioxide CO₂ Sens Warmup message until the transducer reaches operating temperature. Wait until this disappears before starting the measurement. To remove the transducer from the airway adapter, open the latch and pull out the airway adapter. WARNING To prevent stress on the endotracheal tube, support the transducer and airway adapter.
  • Page 249 14 Monitoring Carbon Dioxide WARNING When using the IPI numeric (available for adult and pediatric patients), always ensure that the patient's date of birth is entered correctly and that the monitor is displaying the current date. These two pieces of information are used to calculate the age of the patient, which affects the algorithm used to provide the IPI numeric.
  • Page 250: Setting Up All Co2 Measurements

    14 Monitoring Carbon Dioxide Check the table in the Microstream CO Accessories section of the Accessories chapter for typical usage times for the different Microstream accessories. values for non-intubated patients using Microstream accessories will always tend to be lower than for intubated patients.
  • Page 251 14 Monitoring Carbon Dioxide Correction Humidity At installation, the monitor is configured to automatically apply either Body Temperature Pressure Saturated (BTPS) or Ambient Temperature Pressure Setup CO₂ Dry (ATPD). To see which, go to the menu, and scroll down to Hum.
  • Page 252: Understanding The Ipi Numeric

    14 Monitoring Carbon Dioxide WARNING Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established. Prolonged delay: The selected apnea alarm delay may be prolonged by up to 17 seconds, if an apnea occurs during the automatic zero process.
  • Page 253 14 Monitoring Carbon Dioxide Patient Status Requires attention and may require intervention Requires intervention Requires immediate intervention. NOTE The interpretation of the patient's IPI score may change in different clinical environments. For example, patients with specific respiratory difficulties (in contrast to normally healthy patients who are being monitored during sedation or pain management) may require a lower IPI Low Alarm threshold to reflect their impaired respiratory capacity.
  • Page 254 14 Monitoring Carbon Dioxide...
  • Page 255: Monitoring Airway Flow, Volume And Pressure

    Volume and Pressure The M1014A Spirometry Module - labeled as SPIRO - is designed to be used in combination with Philips-branded airway flow sensors and combined CO /airway flow sensors. It produces a real time wave for flow, volume and pressure of respiratory gases together with numerics for analysis of ventilatory mechanics.
  • Page 256: Attaching The Flow Sensor

    Attaching the Flow Sensor CAUTION Use the M1014A Spirometry Module with Philips approved accessories only. Refer to the instructions for use provided with the accessory. Select the appropriate flow sensor. Make sure that you are using the correct sensor for the respective patient category.
  • Page 257 15 Monitoring Airway Flow, Volume and Pressure Install the flow sensor or the combined CO /Flow sensor at the proximal end of the breathing circuit between the elbow and the ventilator Y-piece. Make sure that the spirometry sensor is in a horizontal position with its tubing pointing upwards.
  • Page 258: Zero Calibration

    15 Monitoring Airway Flow, Volume and Pressure circuit). Lavage and suctioning of the airway can then be performed without fluids and mucous accumulating on the airway adapter windows. • Measurement values provided by a ventilator may differ significantly from the values provided by the spirometry module, due to different locations of the flow sensor.
  • Page 259: Manual Purging

    15 Monitoring Airway Flow, Volume and Pressure • If the purge does not sufficiently clear the flow tubing lines, the flow sensor should be replaced • With each purge cycle, a zero calibration is automatically performed Adult Mode The system automatically purges the sensor tubing every ten minutes or less, depending on system conditions.
  • Page 260: Setting Up Spirometry

    15 Monitoring Airway Flow, Volume and Pressure Agent Difference between measured and actual values Actual Gas Composition Gas Compensation Setting Incorrect Agent Percentage Setting Setting up Spirometry Setup Spirometry The following settings can be accessed through the menu. Optimizing Scale Settings Setup Spirometry Optimize Scales In the...
  • Page 261 NOTE • Gas concentrations from the gas analyzer are only available for Philips gas analyzers, not for devices connected via a Vuelink/IntelliBridge module. • If gas concentrations from the gas analyzer are selected but not all data is available, the missing data is taken from manually entered values.
  • Page 262 15 Monitoring Airway Flow, Volume and Pressure...
  • Page 263: Monitoring Tcgas

    Monitoring tcGas The tcGas module measures the partial pressure of the oxygen and carbon dioxide that diffuses through the skin, thereby providing a measure of these gases in the capillary blood. The monitor's settings for altitude and barometric pressure influence the measurement. The tcpO tcpCO measurement is valid for an infant patient not under gas anesthesia.
  • Page 264: Setting The Tcgas Sensor Temperature

    16 Monitoring tcGas Setting the tcGas Sensor Temperature Setup tcGas Transducer Temp. In the menu, select Choose a temperature value appropriate for your patient's age, weight and physical condition in accordance with your hospital policy. Usually, a higher transducer temperature gives a better correlation and a quicker response time. However, higher temperatures also increase the risk of skin burns.
  • Page 265: Setting The Tcgas Barometric Pressure

    Calibrating the tcGas Transducer You can use either a Philips (15210B) or a Radiometer TCC3 calibration unit and a gas cylinder whose pressure indicator is above the 'out-of-gas' zone (black on 15210B, red on TCC3). To maintain accuracy, it is recommended to calibrate the transducer every four hours, even if the monitor does not prompt you to do so.
  • Page 266 16 Monitoring tcGas • you doubt the measurement accuracy • you start a new monitoring period or use a new site Calibration required • the monitor displays the INOP message. Connect the calibration unit to the inlet on the side of the module's calibration chamber using the recommended gas tubing.
  • Page 267: Applying The Tcgas Transducer

    16 Monitoring tcGas Calibration Failure <tcGas Label> transducer or cal. unit malfunction If calibration fails, the monitor displays and the <tcGas Label> Cal Failed INOP for the measurement. Troubleshooting tcGas Calibration Perform each of the following steps, in order, until calibration is successful. Check the calibration unit, then recalibrate, remembering to turn on the gas supply on the calibration unit.
  • Page 268: Finishing Tcgas Monitoring

    16 Monitoring tcGas Apply the transducer as soon as possible after you see the message indicating that calibration is complete. If you wait longer than 30 minutes, the heat supply to the transducer switches off to prevent the electrolyte from drying out and a new calibration is necessary. Optimize the measurement by selecting a site with high capillary density and blood flow, thin epidermis and no cardiovascular disorders.
  • Page 269 16 Monitoring tcGas Setup tcGas CO₂ Correction • In the menu, look at the menu item . If correction is enabled, it is set Metabolism Correction for tcpCO2 production in the epidermis increases the CO value. Your monitor may be configured to CO₂...
  • Page 270 16 Monitoring tcGas...
  • Page 271: Monitoring Intravascular Oxygen Saturation

    Monitoring Intravascular Oxygen Saturation Depending on the probe or catheter used and the measurement location, the two modules, M1011A and M1021A, measure the central venous oxygen saturation or mixed venous oxygen saturation continuously and invasively. The two modules can be differentiated by their size and their labeling. The M1011A is a single-width module (narrow) and is labeled SO .
  • Page 272: Selecting A Measurement Label

    Protocol Watch is in use, to ensure that the correct limits are used for the criteria applied. CAUTION Use the modules with Philips approved accessories only. Refer to the instructions for use provided with the accessory. Selecting a Measurement Label Always select a measurement label before inserting a catheter/probe.
  • Page 273 17 Monitoring Intravascular Oxygen Saturation Optical module Balloon inflation stopcock Hospira fiber optic catheter Optical reference Enter setup/calibration Connect the optical module (Hospira 50131) to the measurement module. Allow the optical module to warm up before you perform a calibration. Although the warm up message disappears from the screen after one minute, Hospira recommends letting the optical module warm up for 15 minutes for best accuracy.
  • Page 274 17 Monitoring Intravascular Oxygen Saturation Inserting the Catheter Remove the inner cover of the catheter tray. Remove the catheter tip from the optical reference. Check the catheter's proper operation (for example: the balloon tip). Prepare and insert the catheter in accordance with standard hospital practice. The SvO catheter is thin and flexible, treat it carefully.
  • Page 275: Preparing To Monitor With The M1011a Narrow Module

    Preparing to Monitor with the M1011A Narrow Module In addition to the module, you need a Philips SO Optical Module and a compatible fiber optic probe or catheter. Use only the accessories listed as applicable for the intended measurement location in the Accessories section.
  • Page 276 17 Monitoring Intravascular Oxygen Saturation After Insertion The SO probe/catheter is thin and flexible, treat it carefully. Avoid kinking, bending or grasping the probe/catheter with forceps or a hemostat. Damage to the fiber results in low intensity light and a sudden decrease in intensity readings.
  • Page 277: Further Information For Both Modules

    17 Monitoring Intravascular Oxygen Saturation Draw a blood sample from the distal port of the catheter and flush the line according to standard hospital practice. Obtain laboratory analysis of the sample using direct measurements. CalibrationValue Select and select from the list the value received from the lab. Hct [%] Hb [mmol/l] Hb [g/dl]...
  • Page 278 17 Monitoring Intravascular Oxygen Saturation...
  • Page 279: Monitoring Eeg

    Monitoring EEG The Electroencephalograph (EEG) module monitors the patient's cerebral function by measuring the electrical activity of the brain. It provides the monitor with two channels of realtime EEG waves, EEG trend information in the form of Compressed Spectral Arrays (CSA), and up to eight of the following numerics: Spectral Edge Frequency - The SEF is the frequency below which a defined percentage of the Total Power lies.
  • Page 280: Using The Eeg Impedance/montage Window

    18 Monitoring EEG EEG Impedance / Montage Check the electrode-to-skin impedance in the window. For good signal quality, keep all lead wires together and away from other electric devices and metallic bodies. Using the EEG Impedance/Montage Window Setup EEG Show Montage EEG Montage To open the window, in the menu, select...
  • Page 281 18 Monitoring EEG Changing the Impedance Limit Setup EEG The impedance limit can be set for all electrodes simultaneously in the menu, or in the Impedance / Montage window using the pop-up keys. If the limit is exceeded during monitoring, an INOP will appear and the graphic impedance indicator will change.
  • Page 282: About Compressed Spectral Arrays (csa)

    18 Monitoring EEG About Compressed Spectral Arrays (CSA) The continuous EEG signal is sampled periodically and this value is stored in a frame. Each frame is processed using Fast Fourier Transformation (FFT) to provide a frequency spectrum displayed as a compressed spectral array (CSA).
  • Page 283: Changing Eeg Settings

    18 Monitoring EEG Setup CSA Window This menu entry lets you On/Off SEF Switch the trendline of the specific numeric on or off. On/Off MDF On/Off PPF Changing EEG Settings Be aware that any changes made to EEG settings apply to both EEG channels. Switching EEG Numerics On and Off Setup EEG Each EEG numeric can be individually switched on or off in the...
  • Page 284: Eeg Reports

    18 Monitoring EEG EEG Reports The content of EEG Reports is always the same and does not need to be configured. Setup EEG Print Report To print an EEG Report, in the menu, select Print Report Alternatively, you can select the CSA and use the pop-up key to start the report.
  • Page 285: Monitoring Bis

    Monitoring BIS Bispectral Index monitoring helps to monitor the level of consciousness of a patient under general anesthesia or sedation in the OR and ICU. The BIS sensor is placed on the patient's forehead to capture electroencephalographic (EEG) signals from which several numerics are derived, including a single BIS value representing the level of consciousness.
  • Page 286: Bis Monitoring Setup

    19 Monitoring BIS BIS Monitoring Setup There are two BIS solutions available for use with the M1034A BIS module: using the Digital Signal Converter (DSC) and BIS Engine or using the BISx. Monitoring BIS Using the DSC and BIS Engine BIS Engine Cable BIS Module BIS Engine...
  • Page 287 19 Monitoring BIS Monitoring BIS using the BISx BIS Module BISx Patient Interface Cable BIS Sensor If you are monitoring BIS using the BISx, a. Connect the BISx to the BIS module b. Use the clip on the rear of the BISx to affix it in a position convenient for your patient, not above the patient's head.
  • Page 288: Bis Continuous Impedance Check

    19 Monitoring BIS BIS Continuous Impedance Check This checks: • the combined impedance of the signal electrodes plus the reference electrode. This is done continuously and does not affect the EEG wave. As long as the impedances are within the valid range, there is no notification of this check or its results. •...
  • Page 289: Bis Window

    19 Monitoring BIS BIS Window Setup BIS Show Sensor To open the BIS window, in the menu, select The window may look slightly different on your monitor. The graphic in the BIS Window automatically adapts to show the type of sensor you are using, showing three or four electrodes as required.
  • Page 290: Changing The Bis Smoothing Rate

    19 Monitoring BIS Changing the BIS Smoothing Rate The smoothing rate defines how the monitor averages the BIS value. Setup BIS Smoothing Rate To change the smoothing rate, in the menu, select then choose either: 15 sec – : this provides increased responsiveness to changes in the patient's state. 30 sec –...
  • Page 291: Bis Safety Information

    19 Monitoring BIS BIS Safety Information For information on the use of BIS in specific monitoring situations and on pharmacological responses to the anesthetic agents Nitrous Oxide (when used as the sole anesthetic agent), Ketamine, and Etomidate, contact Covidien to request a copy of their publication "A Clinician's Guide to the Bispectral Index".
  • Page 292 19 Monitoring BIS...
  • Page 293: Monitoring Nmt

    Monitoring NMT Neuro Muscular Transmission (NMT) and its measurement enables the evaluation of muscle relaxation of patients under Neuromuscular Block by measuring the strength of muscle reaction after electrically stimulating the dedicated motor nerve. The NMT Monitor electrodes are placed on the patients skin over the ulnar nerve, a controllable current source delivers stimulation pulses to two skin surface electrodes for the nerve stimulation, the muscle response is measured with an acceleration sensor.
  • Page 294: Stimulation Modes

    20 Monitoring NMT CAUTION NMT monitoring is intended as an adjunct in patient assessment and must be used in conjunction with observation of clinical signs and symptoms. NMT stimulation can be painful to a non-sedated patient. It is recommended not to stimulate before the patient is adequately sedated.
  • Page 295: Preparing To Measure Nmt

    20 Monitoring NMT Double-Burst Stimulation (DBS) The Double-Burst stimulation pattern consists of a sequence of 3 current pulses delivered every 20 milliseconds (50 Hz), followed by a pause of 750 milliseconds, followed by another sequence of 3 current pulses delivered every 20 milliseconds (50 Hz). With each detected muscle response the DBS DBScnt Count ( ) value is incremented.
  • Page 296: Taking Nmt Measurements

    20 Monitoring NMT Place the distal electrode near the wrist. Place the proximal electrode 2 to 3 cm proximal to the distal electrode. Attach the Black cable clamp cable to the distal electrode, (see figure above). Attach the Red cable clamp cable to the proximal electrode, (see figure above). Place and affix the transducer with a large flat side against the palmar side of the thumb.
  • Page 297 20 Monitoring NMT Confirm Select This automatically determines the supramaximal stimulation current and takes the reference twitch (100%) at this current. If the NMT Module is unable to establish a reference twitch, it uses an internal reference value for single-mode measurements. Clearing a Reference Twitch Clearing the Reference Twitch resets the supramaximal stimulation current and reference twitch to default values.
  • Page 298: Changing The Nmt Measurement Settings

    20 Monitoring NMT Changing the NMT Measurement Settings Selecting the NMT Stimulation Mode Setup NMT In the window: Stimulation Select to enter the Stimulation window. Choose the Stimulation mode required: – – Twitch – (if configured) – (if configured) Measurement Mode Allows the choice between manual and automatic NMT measurements.
  • Page 299: Alarms

    20 Monitoring NMT Selecting the Pulse Width Setting a Pulse Width sets the duration of the stimulation pulse. Setup NMT In the window: Pulse Width Click on to open the Pulse Width window. Select the required setting. Confirm Select if you wish to modify a previously calibrated pulse width. CAUTION Changing the stimulation pulse after calibration invalidates the stored reference data.
  • Page 300 20 Monitoring NMT Dependent upon the selected stimulation mode, the following information is provided: Stimulation Mode Numeric Label Unit Trend Number of Bars Twitch Single-Twitch None TOFrat Train-Of-Four TOFcnt Post-Tetanic-Count 1...20 DBScnt Double-Burst None Auto mode Auto The figure below shows the NMT measurement in mode.
  • Page 301: Guardian Early Warning Scoring

    Guardian Early Warning Scoring Using an MX400/450/500/550 monitor with the appropriate option, you can use Guardian Early MX400/450/ Warning Scoring to get an early warning score based on vital signs and clinical observations collected at 500/550 intervals. The goal of an early warning score is to help you recognize the early signs of deterioration in patients.
  • Page 302 21 Guardian Early Warning Scoring If required, enter your operator data with a barcode scanner. Start collecting vital signs and entering observations. If the patient is continuously monitored, any relevant currently measured vitals will appear automatically in the EWS Screen. Other vitals may be measured by the monitor, or may need to be entered manually: •...
  • Page 303: Understanding Guardian Early Warning Scoring

    21 Guardian Early Warning Scoring One complete set of vitals and observations, together with the calculated score(s), is referred to as a SpotCheck record. Once all the required vitals have been entered or measured, the SpotCheck record will be automatically stored after the configured freeze time. Store Vitals If you want to store values before the end of the freeze time, you can select , to store...
  • Page 304: Viewing Ews Trend Data

    21 Guardian Early Warning Scoring The MEWS score also uses the same color coding and risk levels, which determine the action that is recommended. How does MEWS work in Guardian Early Warning Scoring? MEWS results in a subscore displayed in a circle with the corresponding color, next to each measured or entered value. Actions are only then recommended when all required vitals have been measured or entered, and the MEWS score has been calculated.
  • Page 305: Using Different Types Of Scoring

    21 Guardian Early Warning Scoring Symbols Used in the Trend Views The following symbols can appear in the trend views: Symbol Indicates SPS SpotCheck record - normal range SPS SpotCheck record - outside of normal range Manual SpotCheck record MEWS SpotCheck record MEWS score (color depends on the risk level) SpotCheck record triggered by a deterioration SpotCheck record triggered by an alarm...
  • Page 306 21 Guardian Early Warning Scoring Protocol Select Select the required protocol from the list. Main Setup Select ProtocolWatch Select Protocol Select Select the required protocol from the list.
  • Page 307: Using A Telemetry Device And A Monitor (piic Only)

    X2 is connected via MSL cable to the monitor, or – a telemetry transceiver with a short range radio adapter is assigned to an X2 which is connected (Companion Mode) to an MX400/450, MX500/550, or MX600/700/800 host monitor the data arrive with a minimal delay on the monitor screen.
  • Page 308 22 Using a Telemetry Device and a Monitor (PIIC only) Telemetry Select Setup Telemetry Paired Equipment menu will appear with only one entry Enter here the equipment label of the telemetry device to be paired. Pairing at the monitor is only possible when the monitor already has a connection to the Information Center and the Information Center software version allows pairing at the monitor.
  • Page 309: Use Models With Telemetry

    The monitor is paired with a telemetry transceiver - indirect connection – telemetry data appear on the monitor An X2 is declared as a telemetry device and paired with an MX400/MX450, MX500/MX550, or MX600/700/800 monitor - direct or indirect connection –...
  • Page 310 22 Using a Telemetry Device and a Monitor (PIIC only)
  • Page 311: Trends

    Trends Trends are patient data collected over time and displayed in graphic, tabular or histogram form to give you a picture of how your patient's condition is developing. Trend information is stored in the trends database for continuously-monitored measurements, such as ECG, as well as for aperiodically- measured parameters, such as noninvasive blood pressure.
  • Page 312 23 Trends Trends Pop-Up Keys When you open the graphic, tabular or histogram trends window, a selection of pop-up keys appears to let you navigate through the stored trend data and carry out trends-related tasks. Pop-Up Keys Selecting this pop-up key lets you..Select Group see a pop-up list of trend groups and select a group for viewing.
  • Page 313 23 Trends Viewing Graphic Trends A cursor spanning all measurements in the trend group helps you to navigate through the trends database and shows you your current position in the database. When the cursor is moved across the time line, the values measured at the cursor time are shown in the right hand column. In graphical trends, aperiodic measurement trends are shown as an asterisk, NBP has a special symbol.
  • Page 314 23 Trends To view the Vital Signs trend with one column for each NBP measurement (see “Defining the Column Interval Using the NBP Measurement” on page 317): Interval With the Vital Signs trend open, select Select from the pop-up list. Viewing Histogram Trends The title line of the window shows the label of the trended measurement and the resolution of the data;...
  • Page 315: Setting Up Trends

    23 Trends The cursors are represented by a vertical line from the x-axis and a dotted horizontal line from the y- Lock/ Unlock axis. When two cursors are used, they can be locked using , so that the distance between Lock/ Unlock them is fixed.
  • Page 316 23 Trends To switch off automatic optimum scaling, Segment Optimum Scale • in the menu, select again. Trend Group To add or remove measurements for this trend group or change the order of the existing measurements: Segment Change Group In the menu, select Change Sort Up...
  • Page 317 23 Trends If your configuration restricts the number of measurements trended, you must choose which measurements will be included. A priority list is used to select the trended measurements. To see the measurement priority list for trending, Main Setup Trends In the menu, select Trend Priority...
  • Page 318 23 Trends To use the NBP measurement to determine the column interval: Main Setup Trends Select then Trends Setup VitalSigns In the menu, select Vital Signs Column In the menu, select and then from the pop-up menu. Making Settings for Histograms Trends Main Setup To make settings for histograms, first display the...
  • Page 319: Documenting Trends

    23 Trends Setup Histogram Select Column Value Select Switching the Cursor On and Off Trends To switch the cursor and the summary column on or off, in the window, Setup Histogram Select Cursor Select Setting Initial Cursor Positions Trends To set the positions of the cursors, in the window, Setup Histogram Select...
  • Page 320: Screen Trends

    23 Trends "4 hours @ 12 second resolution" means that the monitor stores trend data every 12 seconds, for the most recent four hours. Aperiodic Trends Database Aperiodic trends do not count toward the maximum number of trends allowed by the trend configuration.
  • Page 321 23 Trends Changing the Selection of Screen Trends Displayed Select the screen trend. Change Trend Select and select the required trend from the list of available trends. Blank Select to remove the selected trend from the Screen. Change Trend If you do not see in the screen trend menu, the trend is aligned to display with the measurement wave.
  • Page 322 23 Trends Horizon View The horizon view presents trend information superimposed over a defined baseline or base range. This helps you visualize changes in your patient's condition since the baseline was set. The horizon view is made up of: • a horizon, drawn in white, as a reference point or baseline to help you visualize changes in your patient's condition.
  • Page 323 23 Trends Be aware that changing the horizon trend scale can change the angle of the trend indicator, without the patient's condition having changed. If a measurement exceeds the outer limits of the scale, the wave will be clipped and you must either reset the horizon or the horizon trend scale to display the values outside the scale limits.
  • Page 324 23 Trends...
  • Page 325: Calculations

    Calculations Calculations are patient data that is not directly measured but calculated by the monitor when you provide it with the appropriate information. Your monitor can perform the following hemodynamic, oxygenation, and ventilation calculations. Hemodynamic Oxygenation Ventilation Cardiac Index (C.I.) Arterial Oxygen Content (CaO Minute Volume (MINVOL) Stroke Volume (SV)
  • Page 326: Viewing Calculations

    24 Calculations Viewing Calculations Calcs Calculations • Select the SmartKey to open the window. Calc Type • Select the field and select the required calculation type for display. Calculations Windows Hemodynamic Calculations This example calculations window shows the window. The ventilation and oxygenation windows are similar.
  • Page 327: Reviewing Calculations

    24 Calculations Pop-Up Keys Selecting this pop-up key lets you..Perform Calc perform the displayed calculation using the currently-input values and store the calculation in the calculations database Print/Record print or record the displayed calculation. On/Off DateTime toggle between showing the date and time or the units for the calculation input values.
  • Page 328: Entering Values For Calculations

    24 Calculations Entering Values for Calculations The monitor automatically enters any available values for calculations. For aperiodically-measured values such as C.O., the monitor will re-use the most recent value in the calculation database until a new value becomes available. If the calculation time is the last C.O. time, values will be used from up to and including 30 minutes before the C.O.
  • Page 329: Documenting Calculations

    24 Calculations Comparing Dynamic Compliance Values If you compare the dynamic compliance value (COMP) from the ventilation calculations with the value from the Spirometry measurement you may see a difference. This comes from the different sampling methods: • The algorithm in the ventilation calculations takes into account only two sets of paired AWP/ AWV data: those from complete expiration and complete inspiration, when AWF is zero.
  • Page 330 24 Calculations...
  • Page 331: High Resolution Trend Waves

    High Resolution Trend Waves High resolution (hi-res) trend waves provide information for fast-changing parameters at a glance. They can help you to recognize trend patterns and to find interrelationships between measurements, by comparing changes in your patient's condition across different hi-res trend waves. The amount of data you can show on a screen depends on the display size and resolution: for example, on an eight inch (20 cm) wave trace on your monitor screen, you can view approximately six minutes of hi-res trend wave trace.
  • Page 332: Printing Hi-res Trend Wave Reports

    25 High Resolution Trend Waves Printing Hi-Res Trend Wave Reports To print hi-res trend waves on reports, you can choose to print either VisibleWaves • - prints all waves and hi-res trend waves currently displayed All Waves • - prints realtime waves and hi-res trend waves for all currently-monitored measurements HiRes Waves •...
  • Page 333: Event Surveillance

    Event Surveillance Events are electronic records of episodes in your patient's condition. You can trigger them manually, or set them to trigger automatically during pre-defined clinical situations. Depending on the level of event surveillance available on your monitor, the information stored for each event episode can include: •...
  • Page 334: Event Groups

    26 Event Surveillance Basic Event Neonatal Event Review Advanced Event Surveillance Event Functionality Surveillance (NER) Option C07 Option C06 Option C04 Annotation Average trend Average trend High Resolution Trend Types of event episode Snapshot events High resolution trend Snapshot events Graphic Event Review Summary view, graphic and Graphic and tabular Event...
  • Page 335: Events Pop-up Keys

    26 Event Surveillance suited for neonatal applications, where the clinical situation may change very quickly. In adult monitoring, where the patient's status typically changes more gradually, a longer trend may be more informative. Event Episode Types Pre-time Post-time Average trend 2 minutes 18 minutes 4 minutes...
  • Page 336: Event Triggers

    26 Event Surveillance Pop-Up Keys Selecting this pop-up key lets you..Vitals View Graphic Event Episode toggle between a tabular and graphic version of the window View currently viewed. Table Graphic Event Review toggle between a tabular and graphic version of the window Review Review...
  • Page 337 26 Event Surveillance indicates a high priority (red) alarm indicates a lower priority (yellow) alarm. This category includes short yellow arrhythmia alarms, which may be configured to be shown as one star alarms ( ) on your monitor. Triggers without asterisk symbols are user-defined triggers. If You Set User-defined Threshold Triggers You can define event triggers that are independent of alarm limits.
  • Page 338 26 Event Surveillance Setting Triggers for NER and Basic Event Surveillance Episode Type determines the pre and post time. Measurements used as event triggers. Activated Current status: Deactivated Main Setup Event Surveill. Setup Events Event Setup Select then followed by to enter the window.
  • Page 339: The Events Database

    26 Event Surveillance Set the trigger for each measurement. Select each trigger name and select either an alarm trigger or a user-defined trigger from the pop-up trigger list. If you select a user-defined trigger, set the required threshold level and delay time. If a deviation trigger is configured, set the deviation and duration.
  • Page 340: Viewing Events

    26 Event Surveillance Viewing Events Event Summary • To see a summary of all the events in every group in the event database, use the window. Event Review • To review all the events in a particular event group, use the window.
  • Page 341 26 Event Surveillance symbol meaning group activated, notification set to ***alarm group activated, notification set to **alarm group activated, notification set to *alarm group activated, notification set to screen prompt group is activated, notification is switched off no symbol group not activated Event Summary Selecting the window calls up the events pop-up keys.
  • Page 342: Annotating Events

    26 Event Surveillance Review Group • To view other event groups, select the pop-up key and select the group from the list. Event Episode Window Event Episode Show Episode To enter the window, select the pop-up key Event Episode Depending on the event group settings, the window shows either 20 minutes of average trend event information, four minutes of high-resolution event information, or 15 seconds of realtime wave information.
  • Page 343 26 Event Surveillance Documenting Event Review Event Review Print/ Record In the window, select the pop-up key . This calls up the event documentation pop-up keys. Record Graphic For a graphic Event Review recording, select the pop-up key. Record Tabular For a tabular Event Review recording, select the pop-up key.
  • Page 344 26 Event Surveillance In graphic event review recordings, events are represented by bars, and each event group is printed on a separate channel. The timeline reflects the period stored in the database, either 24 hours (divided into 4 hour sections) or 8 hours (divided into one-hour sections).
  • Page 345 26 Event Surveillance The second section (2 below) shows the waveforms recorded during the episode. The trigger moment is marked with a triangle and divides the episode into the pre/post time. Any calibration marks and grid marks on the screen are automatically printed on the recording. If there are four measurements in the event group being recorded, two waveforms will be recorded in two separate waveforms segments.
  • Page 346 26 Event Surveillance Event Review Reports The event review report documents all the events stored in the event database for a selected group.
  • Page 347 26 Event Surveillance Event Episode Reports The event episode report documents the patient information from the currently-selected event. See “Event Recordings” on page 343 for an explanation of the report elements.
  • Page 348 26 Event Surveillance Event Summary Reports (Advanced Event Surveillance only). The event summary report shows a graphical view and a tabular view of all events in the database for all groups.
  • Page 349: Protocolwatch

    2008 (published correction appears in Crit Care Med; 36:1394-1396). Crit Care Med 2008 36:296-327.], including the Amendment from October 2011. Philips does not make any claims about their effectiveness to reduce the morbidity or mortality associated with severe sepsis.
  • Page 350 27 ProtocolWatch Sepsis Management Bundle - the recommendations to maintain patient status are listed and can be checked off as they are implemented. The Sepsis Management Bundle ends when 24 hours have passed since the Sepsis Resuscitation Bundle began. The SSC Sepsis protocol may have been configured, to customize it for the specific treatment measures used in your facility.
  • Page 351 27 ProtocolWatch Transferring Patients and Moving Manually Between Phases If a patient has already been diagnosed as having severe sepsis before connecting them to the monitor, Main Setup ProtocolWatch Manual Transition you can select then followed by to go directly to the Sepsis Resuscitation Bundle to monitor treatment.
  • Page 352 27 ProtocolWatch Changing Conditions The window reappears if: • a previously fulfilled criteria is again fulfilled • a new HR or RR criteria is fulfilled, ** RR High ** HR High • the HR or RR value which previously fulfilled the criteria now triggers a ***Tachy xxx >...
  • Page 353 27 ProtocolWatch Authorized Clinician Review Protocol Log To review the protocol, select . You can also print out the log to document the screening phase. Confirm Select to complete the screening phase and, if you have the appropriate monitor option, continue to the Sepsis Resuscitation Bundle phase.
  • Page 354 27 ProtocolWatch Checking The Sepsis Resuscitation Bundle Window Sepsis Resuscitation Bundle During the Sepsis Resuscitation Bundle you can open the window at any time to check the status or to make entries. The recommendations are shown as follows: • Recommendations which are not yet fulfilled are shown in black. They also appear in the list on ProtocolWatch the lower area of the Screen.
  • Page 355 27 ProtocolWatch Ending The Sepsis Management Bundle The Sepsis Management Bundle normally ends 24 hours after the Sepsis Resuscitation Bundle started, ProtocolWatch as documented by the bundle timer on the screen. You are asked to confirm with the key that routine monitoring should now resume. By selecting you can extend the Sepsis Management Bundle phase by an additional 6 hours.
  • Page 356 27 ProtocolWatch...
  • Page 357: Recording

    Recording There are two ways to record data using your monitor. If a paper-strip recorder is available, you can make paper recordings, selecting from a variety of recording types. If no paper-strip recorder is available, or if you want to record data in an electronic form, you can use electronic recording. See “Paper-Strip Recording”...
  • Page 358 Stop key ( ) - stops the current recording. Door latch. Integrated Recorder The optional integrated recorder records numerics for all active measurements and up to three MX400/450 waveforms. Open recorder latch...
  • Page 359 28 Recording Central Recording For central recording from the bedside, your monitor must be connected via a network to an Information Center. You can use either the M1116B 2-Channel Recorder or the standalone M3160A 4-Channel Recorder. Recordings made on the M3160A may look slightly different to those described here.
  • Page 360 28 Recording Stopping Recordings Recordings stop automatically when the preset runtime is over, when the recorder runs out of paper, when you open the recorder door or when the recorder has an INOP condition. Recor- dings • To manually stop a recording, select the SmartKey and then select the pop-up key Stop All Recordng You can also stop a recording by pressing the Stop key on the recorder module.
  • Page 361 28 Recording All ECG Procedure or Delayed Alarm Realtime (RT) HiRes Trend Waves Context Stops automatically automatically automatically if automatically automatically if defined by the limited, manually limited, manually context if continuous if continuous Delay Time 10, 15 seconds 10, 15 seconds none none 6, 5, 4, 3, 2, 1...
  • Page 362 28 Recording Overlap • : define whether the recorded waveforms will be printed overlapping or beside each other. Speed • : choose the recording print speed. Delay Time • : Delayed recordings start documenting on the recorder strip from a pre-set time before the recording is started.
  • Page 363 28 Recording Recording Strip Code The recording strip code printed in the first line of the initial annotation has up to seven characters, specifying recording type, operating mode, application area, patient category, and delay time, if applicable. It is only included when annotations are configured to appear before the waves. Code Meaning Recording type...
  • Page 364 To test if paper is loaded correctly, start a recording. If no printing appears, paper may be loaded backwards. Try reloading the paper. M1116C (MX500/550/600/700/800) and Integrated Recorder (MX400/450) Press the latch on the right side of the recorder door to open the door.
  • Page 365: Electronic Recording

    28 Recording Recorder Status Messages Recorder Status Messages Explanation For example: The named recording is currently running. Local alarm recording running No Central alarm recording available No alarm recording can be made on the selected recorder. Try selecting another recorder. If a local No local alarm recording available recorder was selected, the monitor will try to reroute the recording to a central recorder.
  • Page 366 28 Recording As soon as the monitor is connected to a printer, or to a PC or network with the IntelliVue XDS Application software, it will automatically print the report, or send it to a patient-specific folder as an electronic file. Alarm-Triggered Realtime Reports Here is a sample of a realtime report triggered by an alarm event.
  • Page 367 28 Recording The maximum number of reports that can be stored in the database varies depending on the database configuration and the size of the reports. When the database is full, no new reports can be stored. In this case, print or delete reports to make space available in the database.
  • Page 368 28 Recording...
  • Page 369: Printing Patient Reports

    • to an IntelliVue XDS Application print service, • to an external PC-based print server with Philips server software, • into the print database. Print jobs stored in the database are automatically printed when a print device with a matching paper size becomes available.
  • Page 370 29 Printing Patient Reports When an X2 is connected to a host monitor, reports requested or stored on the X2 can be printed via the host monitor. Reports requested on the X2 when connected to a host monitor will not show any patient alarms or INOPs.
  • Page 371: Stopping Reports Printouts

    29 Printing Patient Reports Stopping Reports Printouts Reports • To stop Reports printing, in the menu, select Delete Report – to stop the current print job Delete All Repts – to cancel all queued report printouts Scheduled Rep. – to select and switch off scheduled reports.
  • Page 372: Setting Up Individual Print Jobs

    29 Printing Patient Reports Setting Up Auto Reports Auto Reports print automatically when a specified trigger occurs. There are two types of Auto Reports: Scheduled Reports, which print at predefined intervals, and End Case Reports, which print when a patient is discharged using the End Case function. An Auto Report can be both a Scheduled Report and an End Case report.
  • Page 373: Checking Printer Settings

    29 Printing Patient Reports Report Type Select and then select the reports template you want the report selected in Step 2 to use. The selection of templates listed depends on the report type selected. Each template includes patient demographic data, and each Realtime Report also includes alarm and INOP information.
  • Page 374: Printing A Test Report

    29 Printing Patient Reports Printing a Test Report A test report can be printed in Configuration mode, refer to the Service Guide for details. Switching Printers On or Off for Reports You can enable or disable printer status to switch individual printers on or off for report printouts. Setup Printers Printer In the...
  • Page 375: Checking Report Status And Printing Manually

    29 Printing Patient Reports Setup Printers Enabled • Enable the new target printer by selecting it in the menu and toggling to As the monitor tries to send the report to the printers in the order they are listed, you must make sure that all the printers above the new target printer are disabled.
  • Page 376: Sample Report Printouts

    29 Printing Patient Reports Printer Status Message Possible causes and suggested action Print job could not be queued The printer queue is full and the monitor cannot accept another report request. (insufficient resources) Wait until some more reports have been printed, then try again, OR Print job could not be queued A report has been triggered that uses a paper size unavailable with the target (queue is full)
  • Page 377 29 Printing Patient Reports The monitor may be configured to leave a space on the top left or right of the report printout to enable Addressograph you to stick a patient address label on it. This setting is called the and it can only be changed in the monitor's Configuration Mode.
  • Page 378 29 Printing Patient Reports Realtime Report Patient demographic information, time stamp Active Alarms and INOPs, followed by vital signs Measurement waves section Cardiac Output Report Patient information Numbered trial curves Trial information in tabular form...
  • Page 379 29 Printing Patient Reports ECG Reports Patient information Numeric block Wave area Below the header on ECG Reports, the numeric block shows the current HR, PVC, and ST values. The wave area shows the printed waves for all available ECG leads. A 1 mV calibration bar is printed at the beginning of each wave.
  • Page 380 29 Printing Patient Reports 12-Lead ECG Report Patient data Analysis data from the Information Center (PIIC iX only) 12-Lead wave area Data related to the wave presentation ST Map with related ST numerics (optional) Administrative data - including optional custom text fields Hospital ID data - Institution, facility and department, if configured Other Reports See the sections on Trends and Calculations and the chapter on Event Surveillance for other example...
  • Page 381: Using The Drug Calculator

    Using the Drug Calculator Drug mixtures for intravenous (IV) drug infusions combine information on drug dose, rate, amount, volume, concentration, and standardized rate. The Drug Calculator helps you to manage infusions by calculating one of these values at a time. Term Definition Units...
  • Page 382: Accessing The Drug Calculator

    30 Using the Drug Calculator Accessing the Drug Calculator Main Setup Calculations Drug Calculator To access the Drug Calculator, select then followed by , or Drug Calc select the SmartKey, if configured. Performing Drug Calculations Using the service Support Tool, a list of drugs can be configured for the monitor containing pre- defined dosage recommendations and unit settings.
  • Page 383 30 Using the Drug Calculator Performing Calculations for a Non-Specific Drug ANY DRUG selection Dose Rate Amount Entry fields for , and Volume 1 ml/hr Calculated standardized rate ( ) and Concentr. concentration ( Weight used for weight-dependent dose units If a list of drugs has not been configured for your monitor, you can use the Drug Calculator to ANY DRUG calculate drug doses for a single, generic drug called...
  • Page 384 30 Using the Drug Calculator Performing Calculations for a Specific Drug Adult Pedi Patient category ( Dose Rate Amount Volume Entry fields for , and 1 ml/hr Concentr. Calculated standardized rate ( ) and concentration ( Reset Values key reverts to the configured values for this drug Weight used for weight-dependent dose units ANY DRUG...
  • Page 385: Charting Infusion Progress

    30 Using the Drug Calculator Charting Infusion Progress Drip Table shows you at a glance how much of the infusion has been administered to your patient and how much time is left. Drip Table Drug Calculator Drip Table • To see the , in the window, select the pop-up key.
  • Page 386: Documenting Drug Calculations

    30 Using the Drug Calculator Documenting Drug Calculations Drug Calculator Record DrugCalc • In the window, select the pop-up key to immediately start a recording of the current drug calculation. Titration Table Print Titr.Tbl • In the window, select the pop-up key to print a report of the current Titration Table.
  • Page 387: Vuelink Modules

    VueLink Modules A VueLink module transmits information from a connected external device to your monitor. Each module can be connected to one of up to three preselected external devices, and supports alarms from the external device. Data from VueLink modules cannot be included in monitor trends when the label is a free-text label.
  • Page 388: Connecting An External Device

    31 VueLink Modules See the documentation supplied with the VueLink module for a list of supported devices and accessories, and for configuration information. Connecting an External Device Insert the module into the FMS or integrated module slot. Check that the device selection LED (3) lights to show that it has correctly identified the external Main Setup Measurements device.
  • Page 389: Viewing The Vuelink Device Data Window

    31 VueLink Modules Viewing the VueLink Device Data Window Mode information from external device Name of external device Type of external device Device Alarms Accepted To view the VueLink device data window, either External Devices • select the setup hardkey on the VueLink module or the SmartKey, and then select the pop-up key for the device, or Setup <External Device>...
  • Page 390: Language Conflict With External Device Drivers

    31 VueLink Modules Device Alarms Ignored When is set, alarms from the external device will not be displayed on the monitor and will not be transmitted to the Information Center. External device alarms status symbols precede some, but not all, measurement labels. the monitor is configured to accept external device alarms, but the alarms are switched off at the external device.
  • Page 391: Intellibridge Ec10

    IntelliBridge EC10 An IntelliBridge EC10 module or Interface board (for MX400/450/500/550) transmits information from a connected external device to your monitor. The IntelliBridge EC5 ID module is used to provide identification information from the external device. Data imported from the external device, for example waveforms, measurement numerics, settings and alarms, can be displayed on the monitor, passed on to an Information Center and included in trends as appropriate.
  • Page 392: Changing Waves And Numerics Displayed

    32 IntelliBridge EC10 The connection status LED (4) will flash green until it has correctly identified the external device and started communication. Check that the connection status LED then lights green continuously indicating that communication has been established. Changing Waves and Numerics Displayed To change the waves and numerics from the IntelliBridge module or Interface board displayed on the Screen, Main Setup...
  • Page 393: Using Screens With External Device Data

    32 IntelliBridge EC10 Using Screens with External Device Data Your monitor may be configured to show external device data permanently on the Screens. Select the device data window to display the pop-up keys that let you access the setup menu and make changes.
  • Page 394 32 IntelliBridge EC10...
  • Page 395: Using Timers

    Using Timers With the Timers function you can set timers to notify you when a specific time period has expired. CAUTION Do not use the timers to schedule critical patient-related tasks. Viewing Timers Timers You can view currently active timers in the window or directly on the Main Screen (if a timer has been substituted for a numeric).
  • Page 396: Timer Setup Pop-up Keys

    33 Using Timers Timer Setup Pop-up Keys Timers When you open the window and select a timer, then select the setup key, the setup window opens and a selection of pop-up keys appear to let you activate and control the timers. Pop-Up Keys Selecting this pop-up key lets you..
  • Page 397: Displaying A Timer On The Main Screen

    33 Using Timers Timers To change the direction, in the window: Setup Select the required timer and display the window. Direction Down Select to switch between Notification No Limit When a timer expires (except a timer), the color changes to red and a message appears in the status line on the Main Screen.
  • Page 398: Displaying A Clock On The Main Screen

    33 Using Timers Main Screen Timer Pop-up Keys When you select a timer displayed on the Main Screen, additional pop-up keys become available: Pop-Up Keys Selecting this pop-up key lets you..Setup <Timer Label> enter the setup screen for the currently selected timer. Change Timer select a different timer for display.
  • Page 399: Respiratory Loops

    Respiratory Loops Using a Spirometry module or a VueLink/IntelliBridge module connected to a ventilator, you can measure and store graphic representations of realtime respiratory loops. Respiratory loops can help you recognize changes in your patient's lung function, and they can also indicate a fault in the airway tubing (for example, if the respiratory loop does not close).
  • Page 400: Capturing And Deleting Loops

    34 Respiratory Loops Loops To open the window, and its associated pop-up keys, Main Setup Loops Loops • select then , or select the SmartKey, if configured. Loops In the window, in addition to the stored loops, two realtime airway waves and up to nine available numerics from the source device can be shown.
  • Page 401: Changing Loops Type

    34 Respiratory Loops Changing Loops Type Loops Loop Type To change the loop type, in the window, select the pop-up key (only available if the source device delivers three waves), then select Press/Volume • to display Pressure/Volume loops Flow/Volume • to display Volume/Flow loops Press/Flow •...
  • Page 402 34 Respiratory Loops...
  • Page 403: Laboratory Data

    Laboratory Data Laboratory data can be entered manually at the Information Center or at the monitor. For details on manual entry at the monitor, see “Entering Measurements Manually” on page 46. Selected laboratory data can be integrated on the monitor - values are then stored in the database and included in trends and reports and can be displayed as a numeric on the main screen.
  • Page 404 35 Laboratory Data...
  • Page 405: Using Batteries

    Follow the instructions in this chapter and refer for further details to the Service Guide. MX500/ MX550 One Philips M4605A rechargeable Lithium Ion battery must be inserted into the battery compartment on the right side of the monitor to use the monitor with battery power. 1 Battery compartment You can switch between battery-powered and mains-powered (AC) operation without interrupting monitoring.
  • Page 406 36 Using Batteries Battery LED The battery LED on the front panel of the monitor is indicated by a battery symbol. Battery LED Battery LED Colors If the monitor is connected to If the monitor is running on mains power, this means battery power, this means battery power is >...
  • Page 407: Checking Battery Charge

    36 Using Batteries Monitoring Time Available: While the monitor is running on battery power, a time is displayed below the battery power gauge. No time is displayed when the monitor is running on external power. This is the estimated monitoring time available with the current battery power. Note that this time fluctuates depending on the system load (the display brightness and how many measurements you carry out).
  • Page 408: Optimizing Battery Performance

    36 Using Batteries Optimizing Battery Performance The performance of rechargeable batteries may deteriorate over time. Battery maintenance as recommended here can help to slow down this process. Display Brightness Setting Main Setup User Interface Brightness Optimum In the menu, select , then .
  • Page 409: Battery Safety Information

    Battery Safety Information WARNING • Use only Philips batteries specified in the chapter on “Accessories”. Use of a different battery may present a risk of fire or explosion. • Do not open batteries, heat above 60°C (140°F), incinerate batteries, or cause them to short circuit.
  • Page 410 36 Using Batteries...
  • Page 411: Care And Cleaning

    Warranty does not cover damage caused by using unapproved substances or methods. Philips makes no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. Consult your hospital's Infection Control Officer or Epidemiologist. For comprehensive details on cleaning agents and their efficacy refer to "Guidelines for Prevention of...
  • Page 412: Cleaning The Equipment

    37 Care and Cleaning Cleaning the Equipment Clean with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap, a diluted non-caustic detergent, tenside, ammonia- or alcohol-based cleaning agent. Do not use strong solvents such as acetone or trichloroethylene. Take extra care when cleaning the screen of the monitor because it is more sensitive to rough cleaning methods than the housing.
  • Page 413: Sterilizing The Equipment

    37 Care and Cleaning Product Name Product Type Ingredients TM/MC Carpe Diem Tb Wipes wipes 0.5% accelerated hydrogen peroxide Super Sani-Cloth wipes isopropanol 55% quaternary ammonium chlorides 0.5% Germicidal Disposable Wipes ® SANI-CLOTH PLUS wipes isopropanol 15% quaternary ammonium chlorides 0.25% Germicidal Disposable Wipes ®...
  • Page 414: Cleaning Batteries And The Battery Compartment

    Open the door and ensure that the paper cavity is dust-free. Re-thread the paper and replace the recorder. Cleaning Batteries and the Battery Compartment Wipe with a lint-free cloth, moistened with warm water (40°C/104°F maximum) and soap. Do not use MX400/450/ strong solvents. Do not soak the battery. 500/550...
  • Page 415: Maintenance And Troubleshooting

    Contact: If you discover a problem with any of the equipment, contact your service personnel, Philips, or your authorized supplier. Inspecting the Equipment and Accessories You should perform a visual inspection before every use, and in accordance with your hospital's policy.
  • Page 416: Inspecting The Cables And Cords

    Examine all system cables, the power plug and cord for damage. Make sure that the prongs of the plug do not move in the casing. If damaged, replace it with an appropriate Philips power cord. Inspect the Measurement Link cable and ensure that it makes good connection with the MMS and the FMS.
  • Page 417: Troubleshooting

    You can disassemble the monitor, MMS, FMS and modules as described in the Service Guide. You will find detailed disposal information on the following web page: The Recycling Passports located there contain information on the material content of the equipment, including potentially dangerous materials which must be removed before recycling (for example, batteries and parts containing mercury or magnesium).
  • Page 418: Disposing Of Empty Calibration Gas Cylinders

    38 Maintenance and Troubleshooting Disposing of Empty Calibration Gas Cylinders Empty the cylinder completely by pushing in the pin of the regulator valve or by pulling out the pin of the fill valve using a tire valve stem wrench or a pair of needle nose pliers. When the cylinder is empty, either remove the valve stem from the fill (or regulator) hole, or drill a hole in the cylinder.
  • Page 419: Accessories

    This chapter lists Philips-approved accessories for use with patient monitors as described in this document. You can order parts and accessories from Philips supplies at or consult your local Philips representative for details. Some accessories may not be available in all countries.
  • Page 420 39 Accessories For use with: Part No. Length 10-Electrode Cable set (5+5) M1663A 2.7 m 10-Electrode Cable set (6+4) M1665A 2.7 m 3-Electrode Cable Sets Description Length AAMI Part No. IEC Part No. OR Grabber shielded 1.0 m M1675A M1678A ICU Grabber shielded 1.0 m M1671A...
  • Page 421 39 Accessories 10-Electrode (5+5) Cable Sets Description Length AAMI Part No. IEC Part No. ICU Grabber, chest, shielded 1.0 m M1976A M1978A ICU Snap, chest, shielded 1.0 m M1602A M1604A OR Grabber, chest, shielded 1.0 m M1979A M1984A For Limb Leads see 5-electrode cable sets 10-Electrode (6+4) Cable Sets Description Length...
  • Page 422 39 Accessories Supported Cables Trunk Cables Length 3-Electrode Cable Set 5-Electrode Cable Set AAMI Part No. IEC Part No. AAMI Part No. IEC Part No. 0.9 m M1540C M1550C M1560C M1570C 2.7 m M1500A M1510A M1520A M1530A 3-Electrode Cable Sets Description Length AAMI Part No.
  • Page 423: Nbp Accessories

    39 Accessories Set Combiners and Organizers Description Part No. Set combiner 3-electrode M1501A 5-electrode M1502A Set organizer Shielded 3-electrode M1503A Shielded 5-electrode M1504A Bedsheet clip M1509A NBP Accessories These cuffs and tubings are designed to have special protection against electric shocks (particularly regarding allowable leakage currents), and are defibrillator proof.
  • Page 424 39 Accessories Adult/Pediatric Reusable Easy Care Cuffs Patient Category Limb Circumference Part No. Tubing (Pack of five) Adult Thigh 44 - 56 cm M4559B (M4559B5) M1598B (1.5 m) Large Adult X-Long 35 - 45 cm M4558B (M4558B5) M1599B (3 m) Large Adult 35 - 45 cm M4557B (M4557B5)
  • Page 425 39 Accessories Adult/Pediatric Single Patient, Gentle Care Cuffs Patient Category Limb Circumference Part No. Tubing Adult (Thigh) 44 - 56 cm M4579B M1598B (1.5 m) Large Adult X-Long 35 - 45 cm M4578B M1599B (3 m) Large Adult 35 - 45 cm M4577B Adult X-Long 27.5 - 36 cm...
  • Page 426: Invasive Pressure Accessories

    39 Accessories Neonatal/Infant Single Patient Cuffs Cuffs Limb Circumference Part No. Tubing A - Luer connector B - ISO 80369-1 compliant connector Size 1 3.1 to 5.7 cm M1866A/B For A-version cuffs: Size 2 4.3 to 8.0 cm M1868A/B M1596B (1.5 m) or M1597B (3 m) Size 3 5.8 to 10.9 cm...
  • Page 427 39 Accessories Transducer, accessories, sensor kits Part No. Reusable pressure transducer 5 µV/V/mmHg sensitivity CPJ840J6 Sterile disposable pressure domes for CPJ840J6 (pack of 50) CPJ84022 Transducer holder for CPJ840J6 (pack of 4) CPJ84046 IV pole mount for CPJ840J6 CPJ84447 Monitoring Line Set for CPJ840J6 CPJ84026 Single channel disposable sensor kit (20) - (EU/EFTA only) M1567A...
  • Page 428 39 Accessories Description Length Quantity Part No. (per box) Triple DPT TP4 with SafeSet, 2 Cannula Sampling Ports, 213 cm (84 in) 989803179821 In-line Reservoir Triple DPT TP4 with SafeSet, 2 Luer Sampling Ports, In-line 213 cm (84 in) 989803179831 Reservoir Transpac and SafeSet are trademarks of ICU Medical, Inc.
  • Page 429: Spo2 Accessories

    Masimo adapter cables, • Philips reusable sensors or adapter cables with part numbers ending in -L (indicates "Long" version) or with a cable longer than 2 m. All listed sensors operate without risk of exceeding 41°C on the skin, if the initial skin temperature does not exceed 35°C.
  • Page 430 39 Accessories The SpO Option A02 may not be available in all countries. Some sensors may not be available in all countries. Philips Reusable Sensors Product Number Description Compatible with Comments Option A01 Option A02 M1191A/B Adult sensor (2 m cable), for patients over No adapter cable 50 kg.
  • Page 431 39 Accessories Philips Disposable Sensors Product Number Description Compatible with Comments Option A01 Option A02 M1901B Identical to OxiMax MAXN Option A01: Use M1943A or M1943AL M1902B Identical to OxiMax MAXI adapter cable. M1903B Identical to OxiMax MAXP Option A02: Must use...
  • Page 432 Oxiband OXI-P/I Pediatric/infant sensor Durasensor Adult finger clip sensor (patient size DS100A-1 > 40 kg) Dura-Y D-YS Y-sensor Extension Cables and Adapter Cables for Philips and Nellcor Sensors Product Number Description Compatible with Comments Option A01 Option A02 M1941A Extension cable (2 m)
  • Page 433 Available from Nellcor/Covidien only. MASIMO LNOP Reusable Sensors The Philips M3001A/M3002A option A01 and the M1020B option A01 SpO Module use Masimo certified pulse oximetry for reduced noise and low perfusion performance with Masimo Sensors under the Masimo NR&LP protocol available from Masimo.
  • Page 434 39 Accessories Product Number Description Compatible with Philips Part Number Option A01 Option A02 LNOP Pdtx Pediatric Sensor (10 - 50 kg) LNOP Inf-L Infant Toe Sensor (3 - 20 kg) LNOP Neo-L Neonatal Sensor (< 3 kg) or Adult adhesive Sensor (> 40 kg)
  • Page 435: Temperature Accessories

    39 Accessories Product Number Description Compatible with Philips Part Number Option A01 Option A02 LNOP MP10 LNCS MP Series Patient Cable (3.0 m) 989803148221 Adapter Cable for Masimo LNCS Sensors Temperature Accessories Temperature Probes Part No. Minimum measurement time for accurate...
  • Page 436: Cardiac Output (c.o.) Accessories

    39 Accessories Temperature Probes Part No. Response Time per ISO 80601-2-56 InnerSense Esophageal Temperature /Feeding Tube, purple (5 989803183631 < 150 seconds French) InnerSense Esophageal Temperature /Feeding Tube, purple (6.5 989803183641 French) InnerSense Esophageal Temperature /Feeding Tube, purple (8 989803183651 French) InnerSense Esophageal Temperature /Feeding Tube, orange (5 989803183561...
  • Page 437: Mainstream Co2 Accessories

    39 Accessories Mainstream CO2 Accessories Description Part No. Sensor M2501A Adult/Pediatric Airway Adapter (reusable) M2513A Infant Airway Adapter (reusable) M2516A Adult Airway Adapter (single-patient use) M2533A Infant Airway Adapter (single-patient use) M2536A Sidestream CO2 Accessories Description Part No. Sensor M2741A Nasal and Oral-Nasal Cannulas Nasal Cannula, Adult M2744A...
  • Page 438: Mainstream Co2 Accessories (for M3016a)

    39 Accessories Mainstream CO2 Accessories (for M3016A) Description Part No. Sensor M1460A Standard Airway Adapter (reusable) M1465A Small Airway Adapter (reusable) 14363A Microstream CO2 Accessories • "FilterLine Set" is a combination of a FilterLine with an Airway Adapter. • "H" in the accessory name indicates suitability for humidified ventilation and longer usage due to the active removal of humidity from the sample line.
  • Page 439: Spirometry Accessories

    39 Accessories Description Part Number Part Number for Long Version Nasal Filterline® O Pediatric 989803179121 Smart CapnoLine® O Adult M2522A 989803160281 Smart CapnoLine® H O Adult 989803177951 989803177961 Smart CapnoLine® O Pediatric M2520A 989803160271 Smart CapnoLine® H O Pediatric 989803177971 989803177981 Smart CapnoLine®...
  • Page 440: Eeg Accessories

    EC2™ Electrode Cream (conductive paste) M1937A BIS Accessories To re-order sensors, contact Covidien llc. BIS sensors are not available from Philips. SO2 Accessories for M1021A Contact your local Hospira representative for information on accessories. They are not available from Philips.
  • Page 441: So2 Accessories For M1011a

    Philips SO Optical Module 989803151591 Pulsion: CeVOX Fiberoptic Probe family (ScvO Contact PULSION for part numbers of compatible probes Edwards: Philips-compatible versions of the PreSep Contact Edwards for part numbers of compatible Catheter (ScvO ) or Swan-Ganz Oximetry Catheter catheters (SvO...
  • Page 442: Recorder Accessories

    Description Part No. For the M1116B recorder: 10 rolls of paper 40477A 80 rolls of paper 40477B For the integrated recorder (MX400/MX450) and the M1116C recorder 10 rolls of paper M4816A 80 rolls of paper M4817A Battery Accessories Description Part No.
  • Page 443: Specifications

    The monitors are intended for use by trained healthcare professionals in a hospital environment. The MX400/MX450/MX500/MX550 monitors are additionally intended for use in transport situations within hospital environments. The monitors are only for use on one patient at a time. They are not intended for home use. Not therapeutic devices.
  • Page 444: Restricted Availability

    Hewlett-Packard-Str. 2 71034 Boeblingen Germany Visit our website at: © Copyright 2013. Koninklijke Philips N.V. All Rights Reserved. BIS Manufacturer's Information BISx, the BIS Engine, the DSC, the Patient Interface Cable and the BIS Sensor are manufactured by Covidien:...
  • Page 445: Symbols

    40 Specifications Trademark and License Acknowledgment PiCCO is a trademark of PULSION Medical Systems AG. Bispectral Index and BIS are trademarks of Covidien llc, and are registered in the USA, EU and other countries. ® ® ® Microstream , FilterLine , and Smart CapnoLine are trademarks or registered trademarks of Oridion Systems Ltd.
  • Page 446 40 Specifications Symbols Electrical input Electrical output Connector has special indicator indicator protection against (In some cases gas electric shocks and is (In some cases gas output indicator) defibrillator proof (Type input indicator) CF according to IEC 60601-1) Gas input indicator Gas output indicator Quick mount release Manufacturer's name...
  • Page 447: Installation Safety Information

    40 Specifications Installation Safety Information WARNING If multiple instruments are connected to a patient, the sum of the leakage currents may exceed the limits given in IEC/EN 60601-1, IEC 60601-1-1, UL 60601-1. Consult your service personnel. Grounding The monitor must be grounded during operation. If a three-wire receptacle is not available, consult the hospital electrician.
  • Page 448 40 Specifications MX400/450 Rear of the Monitor Shown here without the standard spillage cover that protects the connectors. Protective earth screw hole AC power input with clamp Equipotential ground connector Wired network connector (color-coded in orange) Video out connector (digital/analog)
  • Page 449 40 Specifications Optional Interfaces Optional Interface Description Flexible nurse call interface card Dual medical information bus (MIB) RS232 Interface card (color- coded yellow) IntelliBridge EC10 interface board (color-coded dark gray) Advanced system interface: Single medical information bus (MIB) RS232 Interface card (color-coded yellow) Nurse call Additional USB slots...
  • Page 450 40 Specifications Left Side of the Monitor MSL interface link Integrated recorder ECG Sync Output/Analog ECG output connector Right Side of the Monitor Optional USB slot Battery compartment...
  • Page 451 40 Specifications MX500/550 Rear of the Monitor Protective earth screw hole AC power input with clamp Equipotential ground connector Wired network connector (color-coded in orange) Video out connector (digital/analog) USB rear connector (for remote control, keyboard, pointing devices, printer) Optional interfaces Release switch for connected measurement modules Optional Interfaces Optional Interface...
  • Page 452 40 Specifications Optional Interface Description Dual medical information bus (MIB) RS232 Interface card (color-coded yellow) IntelliBridge EC10 interface board (color-coded dark gray) Advanced system interface: Single medical information bus (MIB) RS232 Interface card (color-coded yellow) Nurse call Additional USB slots...
  • Page 453 40 Specifications Left Side of the Monitor MSL interface link 3 slots for measurement modules ECG Sync Output/Analog ECG output connector Right Side of the Monitor Optional USB slot Battery compartment...
  • Page 454 40 Specifications MX600/700/800 Rear of the Monitor Serial/MIB (RS232) interface cards, type RJ45 or Flexible Nurse Call interface card or combination of both (optional) AC power input Protective earth screw hole Equipotential ground connector Measurement link connectors (MSL) (Two standard in MX800, one standard in MX600/700) USB rear connectors (for remote control, keyboard, pointing devices, printer) Serial RS232 connector Nurse Call...
  • Page 455: Monitor Mounting Precautions

    Quick Mount release button when lifting or moving items located under the monitor, such as pole mounts, etc. If in doubt, use the Philips Fix Mount solution to avoid such situations. Refer to the respective IntelliVue Monitor Service Manual, Installation Instructions chapter, for more details.
  • Page 456: Altitude Setting

    To transport such equipment combinations, always support the equipment from below. • Only use the bed hanger for the MX400/450/500/550 on beds with a support below the rail, to ensure that the monitor does not tilt. Repositioning a Monitor on the Mounting Arm Attempts to reposition the monitor should only be performed as described in the mounting hardware manufacturer’s user documentation.
  • Page 457: Physical Specifications

    <12.87 x 11.34 x 7.17 in MX450 Monitor <5.9 kg (<12.9lb) <327 x 288 x 182mm <12.87 x 11.34 x 7.17 in MX400 Monitor <5.2 kg (<11.5lb) <274 x 288 x 178 mm <10.79 x 11.34 x 7.01 in M3001A <650 g (<1.4 lb)
  • Page 458: Environmental Specifications

    40 Specifications Product Maximum Weight W x H x D Comments M1011A <200 g (<7.1 oz) 36 x 99.6 x 102.5 mm Module 1.4 x 3.9 x 4.0 in - Optical Module <200 g (<7.1 oz) 50 x 30 x 120 mm including 2.9 m cable 2.0 x 1.2 x 4.7 in M1027A...
  • Page 459 40 Specifications MX400/450/500/550 Monitor MX400/450/500/550 Monitor Item Condition Range Temperature Range Operating 0 to 40 ºC (32 to 104 ºF) 0 to 35°C (32 to 95°F) when charging the battery 0 to 35°C (32 to 95°F) if an X2 is mounted on the rear.
  • Page 460 40 Specifications X2 (M3002A) and External Power Supply (M8023A) Item Condition Range Humidity Range Operating 15% to 95% Relative Humidity (RH) Storage including transportation 5% to 95% Relative Humidity (RH) Altitude Range Operating -500 m to 3000 m (-1600 to 10000 ft) Storage including transportation -500 m to 4600 m (-1600 to 15000 ft) IP32 (protected against ingress of water when the water is...
  • Page 461 40 Specifications Devices for Acquiring Measurements and 8-Slot Flexible Module Rack Multi-measurement Module M3001A, MMS Extensions M3016A M3015A, M3014A, M3012A, Measurement Modules, and 8-Slot Flexible Module Rack M8048A Item Condition Range Temperature Range Operating 0 to 45°C (32 to 113°F) Non-operating -40 to 70°C (-40 to 158°F) Humidity Range...
  • Page 462: Emc And Radio Regulatory Compliance

    In addition the product complies with: ETSI EN 300 328; AS/NZS 4771+A1; ARIB STD-T66. Class 1 radio equipment. To obtain a copy of the original Declaration of Conformity, please contact Philips at the address given in the “Manufacturer's Information” section of these Instructions for Use.
  • Page 463 (2) this device must accept any interference received, including interference that may cause undesired operation. Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radiofrequency interference and void your authority to operate this equipment.
  • Page 464: Monitor Performance Specifications

    40 Specifications Monitor Performance Specifications MX400/450/500/550 Performance Specifications MX400/450/500/550 Power Specifications Power Consumption <70 W average Line Voltage 100 to 240 V Current 1.2 to 0.5 A Frequency 50/60 Hz Battery Specifications MX400 Operating time (with one fully Basic monitoring configurations 5 hours...
  • Page 465 40 Specifications MX400/450/500/550 Sounds Audible feedback for user input Prompt tone QRS tone, or SpO modulation tone 4 different alarm sounds Remote tone for alarms on other beds in network Tone for Timer expired Display Wave Speeds Available for standard waves 6.25 mm/s, 12.5 mm/s, 25 mm/s, 50 mm/s...
  • Page 466 40 Specifications MX400/450/500/550 Alarm Signal System alarm delay less than 4 seconds The system alarm delay is the processing time the system needs for any alarm to be indicated on the monitor, after the measurement has triggered the alarm. Delay for alarm availability on the...
  • Page 467 40 Specifications MX600/700/800 Trends Resolution 12, 16, 24 or 32 numerics @ 12 sec, 1 minute, 5 minute resolution Information Multiple choices of number of numerics, resolution and duration depending on trend option and application area. For example: neonatal extended 12 numerics, 24 hours @ 12 secs or 32 numerics 32 hours @ 1 minute intensive care extended: 16 numerics 120 hours @ 5 minutes anesthesia extended 32 numerics 9 hours @ 12 seconds...
  • Page 468 40 Specifications MX600/700/800 Buffered Memory Hold Time if powered by AC: infinite without power: at least 8 hours Contents Active settings, trends, patient data, realtime reports, events, review alarms X2 Performance Specifications X2 (M3002A) Performance Specifications Power Specifications Power consumption <12 W average <30 W while battery is loading Operating Voltage...
  • Page 469: Remote Control

    40 Specifications X2 (M3002A) Performance Specifications Buffered Memory Hold Time if powered by host monitor or external power supply: infinite without power: at least 48 hours (typical: >72 hours) Contents Active settings, trends, patient data, realtime reports, review alarms M8023A External Power Supply Performance Specifications M8023A External Power Supply (for M3002A) Performance Specifications Power Specifications Power consumption...
  • Page 470: Interface Specifications

    RJ45 (8 pin) Mode Software-controllable BCC (RxD/TxD cross over) or DCC (RxD/TxD straight through) not available for the advanced system interface MX400/450/500/550 Power 5 V ±5 %, 100 mA (max.) Isolation basic insulation (reference voltage: 250 V; test voltage: 1500 V)
  • Page 471 40 Specifications MX400/450/500/550/600/700/800 IntelliVue Instrument Type Internal WMTS Adapter Telemetry Wireless Network Technology compatible with Philips IntelliVue Telemetry System (ITS), (USA only) cellular infrastructure Frequency Band WMTS, 1395-1400 MHz and 1427-1432 MHz IntelliVue Instrument Type Internal ISM Adapter Telemetry Wireless Network...
  • Page 472 40 Specifications MX400/450/500/550/600/700/800 Video Interface (Independent Connector DVI (digital and analog, single link) display interface option) Pixel clock frequency 31.5 MHz - 119 MHz Digital video signals single link TMDS Analog video signals 0.7 Vpp@75 Ω HSYNC/VSYNC signals DDC signals...
  • Page 473 40 Specifications X2 Interface Specifications X2 (M3002A) Interface Specifications Measurement Link (MSL) Connectors Female ODU (Proprietary) Power 30 V to 60 V input Power Sync. RS-422 compliant input 78.125 kHz (typical) LAN signals IEEE 802.3 10-Base-T compliant Serial signals RS-422 compliant Local signals Provided for connecting MMS extensions ECG Sync Pulse Output...
  • Page 474: Display Specifications

    Pixel size 0.204 mm x 0.204 mm 9" WVGA Type 230 mm active matrix color LCD (TFT) Resolution 800 x 400 (WVGA) MX400 Refresh frequency 60 Hz Useful screen 196.8 mm x 118.1 mm Pixel size 0.246 mm x 0.246 mm...
  • Page 475: M4605a Battery Specifications

    40 Specifications Compatible Devices Compatible Devices Displays (must be approved for medical use) M8031B XGA color 15" LCD touchscreen M8033C SXGA color 17" LCD touchscreen 865299 SXGA color 19" LCD touchscreen M4605A Battery Specifications The battery lifetime is 3 years from manufacturing date or 500 charge/discharge cycles. M4605A Battery Specifications Physical Specifications W x D x H...
  • Page 476 40 Specifications ECG/Arrhythmia/ST Performance Specifications Cardiotach Range Adult/pedi: 15 to 300 bpm Neo range: 15 to 350 bpm Note: for rates equal to or less than 15 bpm, the displayed heart rate is 0. Accuracy ±1% of range Resolution 1 bpm Sensitivity ≥200 µV peak...
  • Page 477 40 Specifications ECG/Arrhythmia/ST Performance Specifications Auxiliary Current Active electrode: <100 nA (Leads off Detection) Reference electrode: <900 nA Input Signal Range ±5 mV ECG/Arrhythmia/ST/QT Range Adjustment Alarm Specifications 15 to 300 bpm Adult:1 bpm steps (15 to 40 bpm) 5 bpm steps (40 to 300 bpm) maximum delay: 10 seconds Pedi/Neo:1 bpm steps (15 to 50 bpm) according to AAMI EC 13-1992...
  • Page 478 40 Specifications ECG/Arrhythmia/ST Supplemental Information as required by AAMI EC11/13, IEC 60601-2-27 Heart Rate Averaging Method Three different methods are used: Normally, heart rate is computed by averaging the 12 most recent RR intervals. For runs of PVCs, up to 8 RR intervals are averaged to compute the HR.
  • Page 479 Unless otherwise specified, this information is valid for SpO measured using the M3001A and M3002A Multi-measurement modules and the M1020B measurement module. The SpO Performance Specifications in this section apply to devices with Philips SpO technology. For SpO Performance Specifications valid for other SpO technologies, refer to the instructions for use provided with these devices.
  • Page 480 M1191T, M1192T, M1193T (Adult), M1196T = 3% (70% to 100%) the reference values M1193T (Neonate) = 4 % (70% to 100%) Philips Disposable Sensors with M1943A(L): M1132A, M1133A (adult/infant), M1134A (adult/infant) = 2 % M1901B, M1902B, M1903B, M1904B, M1131A, M1133A (neonate), M1134A (neonate) = 3 % (70% to 100%) ®...
  • Page 481 40 Specifications Performance Specifications Pulse Oximeter 70% to 100% Calibration Range Alarm Specifications Range Adjustment high and low limit alarms Adult: 50 to 100% 1% steps Pedi/Neo: 30 to 100% Desat Adult: 50% to Low alarm limit 1% steps Pedi/Neo: 30% to Low alarm limit Pulse 30 to 300 bpm Adult:...
  • Page 482 40 Specifications Smart Alarm Delay - Detailed Specifications Deviation from violated Resulting alarm delay according to selected mode alarm limit Short Medium Long 10 sec 10 sec 11 sec >9% 10 sec 10 sec 10 sec Complies with IEC 60601-2-30:1999/EN 60601-2-30:2000. NBP Performance Specifications Measurement Ranges Systolic...
  • Page 483 40 Specifications NBP Performance Specifications Venipuncture Mode Inflation Inflation Pressure Adult 20 to 120 mmHg (3 to 16 kPa) Pediatric 20 to 80 mmHg (3 to 11 kPa) Neonatal 20 to 50 mmHg (3 to 7 kPa) Automatic deflation Adult/pediatric 170 seconds after Neonatal...
  • Page 484 40 Specifications Invasive Pressure Performance Specifications Input Sensitivity Sensitivity: 5 µV/V/mmHg (37.5 µV/V/kPa) Adjustment range: ±10% Load Impedance: 200 to 2000 Ω (resistive) Transducer Output Impedance: ≤3000 Ω (resistive) Frequency Response dc to 12.5 Hz or 40 Hz Zero Adjustment Range ±200 mmHg (±26 kPa) Accuracy...
  • Page 485 40 Specifications Invasive Pressure Alarm Range Adjustment Delay Specifications Bradycardia Difference to low limit 0 to 5 bpm steps max. 14 seconds 50 bpm Clamping at 25 to 100 bpm 5 bpm steps Temp Complies with EN 12470-4:2000 and IEC 60601-2-49:2001. Specified without transducer. Temp Performance Specifications Temp Range...
  • Page 486 40 Specifications M3015A Microstream CO Performance Specifications Rise Time 190 ms for neonatal mode (measured with FilterLine H for neonatal) 240 ms for adult mode (measured with FilterLine H for adult) Sample Flow Rate 50 + 15/-7.5 ml/minute Gas Sampling Delay Maximum: Time 3 seconds (2m sample lines)
  • Page 487 40 Specifications M3014A Sidestream CO Performance Specifications Range 0 to 150 mmHg (0 to 20.0 kPa) Accuracy after 2 minutes warmup: For values between 0 and 40 mmHg: ±2.0 mmHg (±0.29 kPa) For values from 41 to 70 mmHg: ±5% of reading For values from 71 to 100 mmHg: ±8% of reading For values from 101 to 150 mmHg: ±10% of reading At respiration rates above 80 rpm, all ranges are ±12% of actual.
  • Page 488 40 Specifications M3016A Mainstream CO Performance Specifications awRR Range 0 to 150 rpm Accuracy ±2 rpm Warm-up Time 20 minutes with CO transducer attached for full accuracy specification Response Time Less than 125 ms (for step from 10% to 90%) Mainstream CO Humidity Correction Factor Either BTPS or ATPD can be selected as the humidity correction factor for the Mainstream CO...
  • Page 489 40 Specifications Interfering Gas and Vapor Effects On CO2 Measurement Values The specified deviations for M3002A/M3014A are valid when the appropriate corrections are switched on and set correctly. Gas Level Gas or Vapor M3002A/M3014A M3015A (% volume fraction) Additional deviation due to gas interference, measured at 0 - 40 mmHg CO Nitrous Oxide ±1 mmHg...
  • Page 490 40 Specifications Spirometry Performance Specifications Volume Wave (AWV) Range 0 to 100 ml (neonatal) 0 to 400 ml (pediatric) 0 to 3000 ml (adult) Accuracy ±5% or ±3 ml (neonatal) ±12 ml (pediatric) ±90 ml (adult), whichever is greater Scales 50, 100, 200, 600, 800, 1000, 2000, 3000 ml Scale Default 50 ml (neonatal)
  • Page 491 40 Specifications Spirometry Performance Specifications Negative Inspiratory Range -20 to 0 cmH Pressure numeric Resolution 1 cmH Mean Airway Pressure Range 0 to 120 cmH Resolution 1 cmH Plateau Pressure Range 0 to 120 cmH numeric Resolution 1 cmH Positive End-Expiratory Range 0 to 99 cmH Pressure numeric...
  • Page 492 40 Specifications C.O./CCO Performance Specifications Range 0.1 to 25.0 l/min Standard Deviation 10% or 0.3 l/min Display Update 2 seconds nominal Blood Temperature Range 17.0 to 43°C (62.6 to 109,5°F) Injectate Temperature Range -1 to 30°C (30.2 to 86.0°F) C.O./CCO Alarm Range Adjustment Delay...
  • Page 493 Resolution Stability (system) Drift <2% over 24 hours Response Time (10 % to 90 %) 5 seconds The accuracy specification for Edwards Lifesciences’ Philips-compatible catheters has been verified in the saturation range 40%-95%. Alarm Specifications Range Adjustment Delay SO2, SvO2, ScvO2 10% to 100% max.
  • Page 494 40 Specifications EEG Performance Specifications Bandwidth 0.5 Hz to 50 Hz (-3 dB) Low Filter Cut-Off Frequencies 0.5, 1.0, 2.0, and 5.0 Hz (12 dB/octave) High Filter Cut-Off Frequencies 15 Hz (65 dB/octave) 30 Hz (75 dB/octave) 50 Hz (85 dB/octave) Complies with IEC 60601-2-26:1994.
  • Page 495: Safety And Performance Tests

    40 Specifications NMT Performance Specifications Train-Of-Four Stimulation Mode TOF Count (TOFcnt) 0 to 4 (resolution: 1) TOF Ratio (TOFrat) 5 to 150% (resolution: 1) Repeat Time Manual, or 12 sec, 30 sec, 1 min, 5 min, 10 min, 15 min, 30 min, 60 min Minimum Recovery Time 10 sec...
  • Page 496 1 Vrms for conducted disturbances induced by RF fields. Electromagnetic fields with field strengths above 1 V/m and conducted disturbances above 1 Vrms may cause erroneous measurements. Therefore Philips recommends that you avoid using electrically radiating equipment in the close proximity of these measurements.
  • Page 497 40 Specifications IEC 60601-1-2 Immunity test Compliance level Electromagnetic environment guidance test level Power frequency (50/ 3 A/m 3 A/m Power frequency magnetic fields should be 60 Hz) magnetic field a t levels characteristic of a typical location IEC 61000-4-8 in a typical commercial and/or hospital environment In this table, U...
  • Page 498 40 Specifications IEC 60601-1-2 Immunity test Compliance level Electromagnetic environment guidance test level Radiated RF 3 V/m 3 V/m Recommended separation distance: IEC 61000-4-3 80 MHz to 2.5 GHz (1 V/m for respiration 80 MHz to 800 MHz and BIS) d = 1.2√P 80 MHz to 800 MHz for respiration and BIS d = 3.5√P...
  • Page 499 40 Specifications Recommended Separation Distances for WLAN Operation To avoid interference in the presence of other RF sources, following separation distances are recommended; • A separation distance of 1 m to BlueTooth (Class 1), DECT and WLAN devices (if connected to a different WLAN infrastructure) operating in the same frequency band.
  • Page 500 40 Specifications...
  • Page 501: Default Settings Appendix

    Default Settings Appendix This appendix documents the most important default settings of your monitor as it is delivered from the factory. For a comprehensive list and explanation of default settings, see the Configuration Guide supplied with your monitor. The monitor's default settings can be permanently changed in Configuration Mode.
  • Page 502 41 Default Settings Appendix Country-Description Line Frequency Units Units ECG Cable Color Weight Height 50/60 [Hz] IEC, AAMI kg, lb in, cm Bahamas AAMI Bahrain AAMI Bangladesh Barbados AAMI Belarus Belgium Belize AAMI Benin AAMI Bermuda AAMI Bhutan AAMI Bolivia AAMI Bosnia and Herzegovina Botswana...
  • Page 503 41 Default Settings Appendix Country-Description Line Frequency Units Units ECG Cable Color Weight Height 50/60 [Hz] IEC, AAMI kg, lb in, cm Cook Islands AAMI Costa Rica AAMI Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica AAMI Dominican Republic AAMI Ecuador AAMI...
  • Page 504 41 Default Settings Appendix Country-Description Line Frequency Units Units ECG Cable Color Weight Height 50/60 [Hz] IEC, AAMI kg, lb in, cm Guam AAMI Guatemala AAMI Guernsey Guinea AAMI Guinea-Bissau AAMI Guyana AAMI Haiti AAMI Heard Island and McDonald AAMI Islands Holy See, Vatican City State AAMI...
  • Page 505 41 Default Settings Appendix Country-Description Line Frequency Units Units ECG Cable Color Weight Height 50/60 [Hz] IEC, AAMI kg, lb in, cm Lebanon AAMI Lesotho Liberia Libyan Arab Jamahiriya AAMI Liechtenstein AAMI Lithuania Luxembourg Macao Macedonia, The former Yugoslavian Republic of Madagascar Malawi Malaysia...
  • Page 506 41 Default Settings Appendix Country-Description Line Frequency Units Units ECG Cable Color Weight Height 50/60 [Hz] IEC, AAMI kg, lb in, cm New Caledonia AAMI New Zealand AAMI Nicaragua AAMI Niger Nigeria Niue AAMI Norfolk Islands AAMI Northern Mariana Islands AAMI Norway Oman...
  • Page 507 41 Default Settings Appendix Country-Description Line Frequency Units Units ECG Cable Color Weight Height 50/60 [Hz] IEC, AAMI kg, lb in, cm Senegal Serbia Serbia & Montenegro Seychelles AAMI Sierra Leone Singapore Slovakia Slovenia Solomon Islands AAMI Somalia South Africa AAMI South Georgia and the South AAMI...
  • Page 508: Alarm And Measurement Default Settings

    41 Default Settings Appendix Country-Description Line Frequency Units Units ECG Cable Color Weight Height 50/60 [Hz] IEC, AAMI kg, lb in, cm Uganda AAMI Ukraine AAMI United Arab Emirates AAMI United Kingdom United States AAMI United States Minor Outlying AAMI Islands Uruguay AAMI...
  • Page 509: Ecg, Arrhythmia, St And Qt Default Settings

    41 Default Settings Appendix H30 (deviations from H10/H20/ Alarm Settings Factory Default H10/H20/H40 H40) Audible Latching Red&Yellow Alarm Reminder Reminder Time 3 min Alarm Sounds Traditional RedAlarmInterval 10 sec Yel.Al. Interval 20 sec Alarm Low Red Alarm Volume AlarmVol. +2 Yell.AlarmVolume AlarmVol.
  • Page 510 41 Default Settings Appendix Factory defaults H10/H20/H40 H30 (deviations from H10/H20/H40) ECG Settings Adult Pedi Adult Pedi Asystole Thresh. 4.0 sec 4.0 sec 3.0 sec Δ ExtrTachy 20 bpm 20 bpm 20 bpm Tachy Clamp 200 bpm 220 bpm 240 bpm Δ...
  • Page 511 41 Default Settings Appendix Factory defaults H10/H20/H40 H30 (deviations from H10/H20/H40) Arrhythmia Settings Adult Pedi Adult Pedi Afib Irregular HR HR Alarms Short Yellow Short Short Yellow Yellow TimeOut 1st 3 min 3 min 3 min TimeOut 2nd 10 min 10 min 10 min ArrhyOff Message...
  • Page 512: Pulse Default Settings

    41 Default Settings Appendix Factory Defaults ST Settings - Lead I, II, III, V, aVR, aVL, V1- 6, MCL Factory Adult Factory Pedi Factory Neo STE Fem. V1,V4-6, Alarm Limit 1.0 mm 1.0 mm 1.0 mm Factory Defaults QT Settings Factory Adult Factory Pedi Factory Neo...
  • Page 513: Respiration Default Settings

    41 Default Settings Appendix Respiration Default Settings Factory defaults H10/H20/H40 H30 (deviations from H10/H20/H40) Respiration Settings Adult Pedi Adult Pedi High Limit 30 rpm 30 rpm 100 rpm Low Limit 8 rpm 8 rpm 30 rpm Apnea Time 20 sec 20 sec 20 sec Alarms...
  • Page 514: Nbp Default Settings

    41 Default Settings Appendix Alarm Default Settings Adult Pedi Setting Low Alarm Delay (SAD) Short Short Short Label SpO₂ SpO₂ SpO₂ Pulse settings Pulse (SpO₂) For all other Pulse default settings, refer to the Pulse Default Settings table. NBP Default Settings Factory defaults H10/H20/H30 H30 (deviations from H10/H20/H40) NBP Settings...
  • Page 515: Invasive Pressure Default Settings

    41 Default Settings Appendix Invasive Pressure Default Settings ABP, P, P1, P2, P3, P4, Factory defaults H10/H20/H40 H30 (deviations from H10/H20/H40) UAP, ART, Ao, FAP, BAP Adult Pedi Adult Pedi Settings Alarms from Sys. Sys. Sys. High Limit 160/90 (110) 120/70 (90) 90/60 (70) 180/90 (110)
  • Page 516 41 Default Settings Appendix Factory defaults H10/H20/H40 H30 (deviations from H10/H20/H40) CVP, RAP, LAP, UVP Settings Adult Pedi Adult Pedi Mean only Filter 12 Hz 12 Hz 12 Hz Mercury Cal Artifact Suppr. 60 sec 60 sec 60 sec Unit mmHg mmHg mmHg...
  • Page 517: Cardiac Output Default Settings

    41 Default Settings Appendix Factory Defaults ICP, IC1, IC2 Settings Adult Pedi Sys. Low Clamp/Dia. Low Clamp (Mean 0/-5 (-5) 0/-5 (-5) 0/-5 (-5) Low Clamp) Scale Mean only Filter 12 Hz 12 Hz 12 Hz Mercury Cal Artifact Suppr. 60 sec 60 sec 60 sec...
  • Page 518: Co2 Default Settings

    41 Default Settings Appendix CO2 Default Settings Factory defaults H10/H20/H40 H30 (deviations from H10/H20/H40) Settings Adult Pedi Adult Pedi etCO₂ Low etCO₂ High imCO₂ High CO₂ Alarms Unit mmHg mmHg mmHg Scale 40 mmHg 40 mmHg 40 mmHg imCO₂ N₂O Corr. (only M3015A/M3016A) Oxygen Corr.
  • Page 519: Tcgas Default Settings

    41 Default Settings Appendix tcGas Default Settings Factory Adult Factory Pedi Factory Neo tcGas Settings tcpO₂ High Limit 80 mmHg 80 mmHg 80 mmHg tcpO₂ Low Limit 50 mmHg 50 mmHg 50 mmHg tcpO₂ Alarms tcpCO₂ HighLimit 50 mmHg 50 mmHg 50 mmHg tcpCO₂...
  • Page 520: Svo2 Default Settings

    41 Default Settings Appendix Factory Adult Factory Pedi Factory Neo ScvO Settings Low Limit High Limit Alarms Light Intensity Color Yellow Yellow Yellow SvO2 Default Settings Factory Adult Factory Pedi Factory Neo Settings Low Limit High Limit Alarms Light Intensity Color Yellow Yellow...
  • Page 521: Bis Default Settings

    41 Default Settings Appendix Factory Adult Factory Pedi Factory Neo EEG Settings Color Yellow Yellow Yellow BIS Default Settings Factory defaults H10/H20/H40 H30 (deviations from H10/H20/H40) BIS Settings Adult Pedi Adult Pedi Bursts Scale 100µV (or +/- 50µV if Show Gridlines is configured to Yes) Show Gridlines Filters...
  • Page 522: Vuelink Default Settings

    41 Default Settings Appendix Factory Adult Factory Pedi Factory Neo NMT Settings Color Light Green Light Green Light Green 1The NMT Measurement may not be used for neonatal patients and is therefore not supported in the neonatal mode. VueLink Default Settings VueLink Settings Factory defaults Device Alarms...
  • Page 523: Index

    SpO2 learning during ventricular rhythm Nellcor adhesive sensors effect on pressure alarms during levels of analysis (disposable) zero monitoring non-paced patients Philips sensors (disposable) extending pause time monitoring paced patients Philips sensors (reusable) high priority options SvO2 INOP relearning...
  • Page 524 arrhythmia alarms impedance indicators calibration adjusting alarm limits monitoring all yellow on/off monitoring setup pressure chaining numerics pressure transducer latching on/off SvO2 light intensity multiple safety information SvO2, pre-insertion PVC-related alarms smoothing rate calibration status indicators (C.O) sinus and SV rhythm ranges changing capnography switching on/off...
  • Page 525 recorder printhead Cyclic Impedance Check (BIS) accessories clock alarms off (Config Mode) displaying on main screen changing lead sets database choosing electrode sites airway adapter events conventional 12-lead alarms, apnea delay trends external pacing electrodes alarms, awRR date, setting filter settings alarms, specific default profile fusion beat pacemakers...
  • Page 526 setup exhaust gases, removing extension skin preparation extension cable for SpO2 hemodynamic parameters switching numerics on and off external devices high filter (EEG) EEG wave alarms and INOPS high pass filter (BIS) changing scale connecting to VueLink high resolution recording electrical interference connecting via VueLink high-res trend event episodes...
  • Page 527 capnography monitor settings desktop changing mainstream CO2 input devices accessories monitoring shutting down measuring monitoring mode ISO point (ST) maintenance mouse ITBV/ITBVI schedule using visual inspection multi-measurement module management bundle recommendations ECG connector manual detection mode (Resp) J point (ST) and apnea alarms manually triggering events N2O correction...
  • Page 528 ST map reports permanent keys perfusion indicator status log trackball trends reports pf loops operating modes wedge Philips contact information configuration priority list for trends physiological alarms demonstration probes PiCCO method monitoring disposable temperature C.O. passcode protection...
  • Page 529 RCW/RCWI scheduled safety test setting up realtime recording same patient data merge ST map realtime report saving C.O. measurements (RH stopping printouts methods) realtime reports titration table scale content trends ECG wave rear connectors re-routing reports Resp wave Recorder resampling vitals scales reloading paper resolving patient mismatch...
  • Page 530 Nellcor adhesive sensors tone configuration, alarm surgical ECG cable (disposable) tone mod (SpO2) surviving sepsis campaign perfusion indicator tone modulation Philips sensors (disposable) suspended alarm touchscreen Philips sensors (reusable) suspicious SpO2 reading disabling pleth as alarm source SV/SI TP numeric (BIS)
  • Page 531 transferring patients with MMS language conflicts module trend time module options global module setup trend view visible waves and numerics ST map trending interval ST map wave trends changing speed automatic unit conversion scale (CO2) automatic value substitution scale (pressure) database configuration size (CO2) resolution...
  • Page 534 Part Number 453564443141 Published in Germany 11/2013 *453564443141*...

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