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Philips FM20/30 Instructions For Use Manual

Release j.3 with software revision j.3x.xx patient monitoring.
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In stru ctio ns fo r Use
Avalon Fetal Monitor
FM20/30, FM40/50, Avalon CL
Rel ease J .3 with So ftware Revisi on J. 3x.xx
Patient Monitori ng

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Table of Contents

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   Summary of Contents for Philips FM20/30

  • Page 1 In stru ctio ns fo r Use Avalon Fetal Monitor FM20/30, FM40/50, Avalon CL Rel ease J .3 with So ftware Revisi on J. 3x.xx Patient Monitori ng...
  • Page 3: Table Of Contents

    Disconnecting from Power Power On/Power Off Behavior Monitoring After a Power Failure Troubleshooting 4 FM20/30 Battery Option External Power Supply M8023A Using Batteries Optimizing Battery Performance Storing the Battery Cableless Monitoring with FM20/30 Battery Option Patient Transport Within the Hospital...
  • Page 4 5 Alarms Alarm Mode Nurse Call Systems Visual Alarm Indicators Audible Alarm Indicators Acknowledging Alarms Acknowledging Disconnect INOPs Alarm Reminder Pausing or Switching Off Alarms Alarm Limits Reviewing Alarms Latching Alarms Testing Alarms Alarm Behavior at Power On 6 Patient Alarms and INOPs Alarm Messages Technical Alarm Messages (INOPs) 7 Admitting and Discharging...
  • Page 5 What You Need Cableless Monitoring - Important Considerations Preparing to Monitor Selecting Fetal Heart Sound Changing the Fetal Heart Sound Volume Fetal Movement Profile Troubleshooting Additional Information 12 Monitoring Twin FHRs Important Considerations Monitoring Twins Externally Monitoring Twins Internally Separating FHR Traces Troubleshooting 13 Monitoring Triple FHRs Important Considerations...
  • Page 6 Monitoring DECG Suppressing Artifacts Troubleshooting Testing DECG Mode 18 Monitoring Noninvasive Blood Pressure Introducing the Oscillometric Noninvasive Blood Pressure Measurement Preparing to Measure Noninvasive Blood Pressure Starting and Stopping Measurements Enabling Automatic Mode and Setting Repetition Time Enabling Sequence Mode and Setting Up the Sequence Choosing the Alarm Source Assisting Venous Puncture Calibrating NBP...
  • Page 7 22 Printing the ECG Waveform 23 Paper Save Mode for Maternal Measurements 24 Recovering Data Recovering Traces on Paper Recovering Traces on an OB TraceVue/IntelliSpace Perinatal System Manually Recording Stored Data 25 Care and Cleaning General Points Cleaning and Disinfecting Cleaning and Disinfecting Monitoring Accessories Cleaning and Disinfecting the Tympanic Temperature Accessories Sterilizing...
  • Page 8 Environment Monitoring After a Loss of Power ESU, MRI and Defibrillation Cardiac Pacemakers and Electrical Stimulators Fast Transients/Bursts Symbols on the System 29 Default Settings Appendix Alarm and Measurement Default Settings Recorder Default Settings Index...
  • Page 9: Introduction

    Japan and/or of products that are not currently sold in Japan due to limitations and restrictions under the applicable local laws and regulations in Japan. Please contact your local sales representative and/or Philips Customer Support for details. In this guide: •...
  • Page 10: Confirm Fetal Life Before Using The Monitor

    1 Introduction • Monitor refers to the entire fetal/maternal monitor. Display refers to the physical display unit. Screen refers to everything you see on the monitor's display, such as measurements, alarms, patient data, and so forth. • Whenever a monitor’s identifier appears to the left of a heading or paragraph, it means that the FM30 information applies to that monitor only.
  • Page 11: Introducing The Avalon Family Of Fetal Monitors

    The Avalon fetal monitors also share transducers, accessories, software, and are compatible with the Avalon CL, and Avalon CTS Fetal Transducer Systems. Intended Use The Philips Avalon FM20 (M2702A), FM30 (M2703A), FM40 (M2704A), and FM50 (M2705A) fetal/ maternal monitors are intended for: •...
  • Page 12 1 Introduction WARNING The fetal/maternal monitors are not intended for: • use during defibrillation, electro-surgery, or magnetic resonance imaging (MRI). • Electrocardiography (ECG) measurements on patients connected to electrical stimulator or with cardiac pacemakers. • use of the invasive measurements IUP and fetal DECG, use of the patient module (M2738A) and use of the Avalon CL system in domestic establishments, and those connected directly to the public low-voltage supply network that supplies buildings used for domestic purposes.
  • Page 13 1 Introduction Avalon Fetal/Maternal Monitor FM50 Indicated for use by trained health care professionals whenever there is a need for monitoring the physiological parameters uterine activity, heart rate, electrocardiography (ECG), oxygen saturation, noninvasive blood pressure, and pulse rate, and temperature of pregnant women, and the fetal heart rates of single fetuses, twins, and triplets in labor and delivery rooms and in antepartum testing areas.
  • Page 14 1 Introduction Radio Frequency Interference WARNING • Short range radio connections are subject to interruption due to interference from other radio sources in the vicinity, including microwaves, bluetooth devices, WLAN devices (802.11b,g,n), and cordless phones. Depending on the strength and duration of the interference, the interruption may occur for an extended period.
  • Page 15 Use of the devices in such an environment may present an explosion hazard. • Use only Philips batteries part number M4605A with the FM20 or FM30 with battery option. Use of a different battery may present a risk of fire or explosion. Environmental Specifications: •...
  • Page 16 INOP only Accessories WARNING Philips' approval: Use only Philips-approved accessories. Using non-Philips-approved 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 17 1 Introduction Avalon FM20/FM30 and FM40/ Avalon CL Base Station IntelliVue CL Pods FM50 Avalon CL Transducers Wired Transducers FM20/FM30 M2702A and M2703A FM40/FM50 Avalon CL Base Station M2704A and M2705A 866074 US transducer (wired) Avalon CL US Transducer IntelliVue CL NBP Pod (cableless) (cableless) M2736A...
  • Page 18 1 Introduction Avalon FM20/FM30 and FM40/ Avalon CL Base Station IntelliVue CL Pods FM50 Avalon CL Transducers Wired Transducers Toco+ transducer with ECG/IUP Avalon CL ECG/IUP Transducer capability (wired) (cableless) M2735A 866077 Patient Module for ECG/IUP M2738A...
  • Page 19: What's New

    What's New This section lists the most important new features and improvements to the fetal monitors and their user interface introduced with Release J.3. You may not have all of these features, depending on the fetal monitor configuration purchased. What's New in Release J.3 Avalon CL Transducer System The Avalon CL Transducer System provides cableless monitoring with the Avalon FM20/FM30 and FM40/FM50 with the same functionality and performance as the wired measurement devices (e.g.
  • Page 20 2 What's New Support For Use of Maternal Cableless Measurement Devices The IntelliVue CL measurement Pods are patient-worn, battery-powered measurement devices for and NBP. The devices provide measurement values on the built-in display and communicate them to the fetal monitor using the wireless short range radio (SRR) interface of the Avalon CL base station (see “CL Pods”...
  • Page 21 2 What's New • With the SmartKey you can access the NBP Mode selection and setup, and can directly NBP Modes start and stop a measurement. • With the SmartKey you can quick admit a patient to the monitor. QuickAdmit All new SmartKeys are optional, and have to be configured in Configuration Mode for use (see “SmartKeys”...
  • Page 22: What's New In Release G.0

    2 What's New NBP Configurable Measurement Sequence Up to four measurement cycles can be set up which will run consecutively. For each cycle you can set the number of measurements and the interval between them. By setting the last cycle to run continuously, you can have regular measurements continue after the sequence has run (see “Enabling Sequence Mode and Setting Up the Sequence”...
  • Page 23 2 What's New Non Stress Test (NST) Analysis as Clinical Decision Support (CDS) Application • The optional Trace Interpretation feature allows you to automatically interpret FHR NST Report traces and to generate a printed NST report, equivalent to the NST report functionality in OB TraceVue Rev.
  • Page 24 2 What's New – ConfirmAlarmsOff For a detailed description of the settings see the Configuration Guide. CCV INOP There is a new INOP (technical alarm) after 1 minute of persistent coincidence warning. Coincidence New Demographic Fields • can be entered for complete documentation in an Date of Birth Gestational Age NST Report...
  • Page 25: Basic Operation

    Basic Operation This chapter 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, changing some monitor settings, and setting up the recorder). The alarms section gives an overview of alarms. The remaining sections tell you how to perform individual measurements, and how to care for and maintain the equipment.
  • Page 26: Supported Measurements

    3 Basic Operation Supported Measurements The following Fetal measurements are supported: Measurements FM20 FM30 FM40 FM50 Standard Standard Standard Standard Fetal Heart Rate (FHR) via US (including Twins) Optional Optional Optional Optional Triple FHR via US Standard Standard Standard Standard Toco FHR via Direct ECG (DECG) - Standard...
  • Page 27: Avalon Fm20 And Fm30

    3 Basic Operation Avalon FM20 and FM30 This section outlines the capabilities of your monitor. Avalon FM20 The Avalon FM20 fetal/maternal monitor provides a solution for external fetal monitoring applications, and optional noninvasive maternal vital signs. You can monitor fetal heart rates (FHRs) externally using ultrasound, uterine activity and maternal pulse using an external Toco transducer, and the maternal heart rate (MHR) with maternal ECG electrodes, and optionally, noninvasive blood pressure and maternal oxygen saturation (SpO Measurements are displayed on a 6.5 inch color display as numerics.
  • Page 28: Avalon Fm40 And Fm50

    3 Basic Operation The battery option for the FM20/30 provides support for the in-transport monitoring of all FM20/30 with Battery measurements when disconnected from a power supply. Existing data storage is automatically Option #E25 uploaded to OB TraceVue or IntelliSpace Perinatal after reconnecting it to the system. Trace printing Only during transport is also possible.
  • Page 29: Avalon Cl Transducer System

    3 Basic Operation The Avalon FM50 carries the IP label, indicating that it is capable of intrapartum monitoring. Avalon CL Transducer System The Avalon CL Fetal Transducer System lets you monitor the patient continuously with cableless transducers during the antepartum period, labor, and delivery. You can monitor the fetal heart rate (FHR) using noninvasive CL Ultrasound transducers, or invasively using the CL ECG/IUP transducer or CL Toco MP transducer with the direct electrocardiogram (DECG).
  • Page 30: Getting To Know Your Avalon Fm20/fm30

    3 Basic Operation Getting to Know Your Avalon FM20/FM30 Overview Touchscreen display (tilt and fold) Power LED Paper drawer Paper drawer release Connectors Right Side On/Off switch Power connector with Battery Option On/Standby button with power LED MSL connector...
  • Page 31 Each of the fetal sensor sockets accepts any fetal transducer, one Avalon CL or one Avalon CTS Cableless Fetal Transducer System base station, or an event marker. Bottom There are five optional interfaces available for the Avalon FM20/30 monitor: • LAN/RS232 system interface •...
  • Page 32: Getting To Know Your Avalon Fm40/fm50

    3 Basic Operation Rear Display release Carrying handle Built-in stand Getting to Know Your Avalon FM40/FM50 Front Touchscreen color display Transparent paper guide with tear-off edge Paper eject button Power LED On/Standby button Recorder paper table Fetal sensor sockets Noninvasive blood pressure socket socket Connect any fetal sensor or patient module at the fetal sensor sockets, including an Avalon CL or an Avalon CTS via interface cable (with red connector).
  • Page 33 3 Basic Operation Rear Reserved for future use: protective earth intended for use in system installations Equipotential grounding point Power cord connector Loudspeaker Slot 01 for optional LAN/RS232 system interface (for connection to an obstetrical information and surveillance system) Slot 03 reserved for future use Video output (VGA) Telemetry interface Slot 02 for optional interfaces: Either...
  • Page 34: Connecting The Monitor To Ac Mains

    3 Basic Operation Connecting the Monitor to AC Mains WARNING • Always use the supplied power cord with the earthed mains plug to connect to an earthed AC mains socket. Never adapt the mains plug from the fetal monitor to fit an unearthed AC mains socket.
  • Page 35 3 Basic Operation Connector - for connecting ECG/IUP adapter cables (M2735A Toco transducer only) Toco Transducer with ECG/IUP capability (M2735A) Butterfly belt clip (shown fitted; for use with belts without button holes) Close-up of MECG adapter cable connected to Toco transducer Close-up of active finder LED Connector - for connecting ECG/...
  • Page 36: Getting To Know Your Avalon Cl

    3 Basic Operation Getting to Know Your Avalon CL Front Transducer docking slots On/Standby button with LED Device label LED for optional cableless Pods Docking slot for cableless Pods WARNING • To avoid magnetic interference affecting the mode of the pacemaker, ensure that the Avalon CL base station does not come into close contact with implanted pacemakers.
  • Page 37 3 Basic Operation Docking Slots for Cableless Transducers The Avalon CL base station has three docking slots to hold the CL transducers. The transducers are charged while docked. The base station has a built-in radio interface with an integrated antenna to communicate with the transducers.
  • Page 38 3 Basic Operation Docking Slot for Cableless Measurement Pods The Avalon CL base station has one docking slot to hold an IntelliVue CL Pod. The CL Pod is charged while docked. The LED under the docking slot indicates the battery status of the CL Pod. The base station has a built-in short range radio interface with an integrated antenna to communicate with the CL Pod.
  • Page 39: Cableless Transducers

    3 Basic Operation Rear and Bottom Name plate Manufacturer label Cable reel Cableless Transducers The cableless Avalon CL transducers have a built-in radio interface with an on-board, integrated antenna. The fetal monitor connected to the Avalon CL base station can control the transducer using radio communication.
  • Page 40 3 Basic Operation Transducer finder LED - lights up on the transducer providing the measurement source. CL Toco MP transducers (additionally capable of providing the maternal pulse measurement) Belt button CL Ultrasound transducer CL ECG/IUP transducer Radio Range of CL Transducers The CL transducers have an operating range around the base station of at least 100 m/300 ft in the line of sight.
  • Page 41 3 Basic Operation Radiated Transmission Power The Avalon CL transducers provide all the benefits and flexibility of cableless operation, but do so with an effective radiated transmission power significantly less than that of a typical remote controlled child’s toy or mobile phone. Connector Cap for the CL Toco+ MP Transducer The CL Toco MP transducer is delivered with a connector cap covering the MECG/DECG/IUP...
  • Page 42 Cableless Transducer LED Indication The cableless transducers have a multi-color LED that indicates the status of the transducer with specific colors. This LED remains visible when the transducer is correctly attached to the transducer belt (Philips standard belt). LED Status Meaning...
  • Page 43 3 Basic Operation CL Transducer Battery Battery replacement is recommended after 500 charge/discharge cycles, or if the battery is older than 4 years whatever is reached first. If the battery of a cableless transducer has aged and an exchange of the battery is highly recommended, a prompt message is displayed at the fetal monitor for ca.
  • Page 44: Cl Pods

    Hard keys Measurement identifier For further details, see the IntelliVue Cableless Measurements Instructions for Use. NOTE This monitoring option is not yet available for an FM20/30 #E25. The IntelliVue CL Pods are not supported for the battery option of the FM20/30.
  • Page 45 3 Basic Operation Battery Status LED for CL Pods The CL Pods do not have their own battery status LED, but a small battery gauge on their display. On the Avalon CL base station the battery status LED for the CL Pods is located directly under the docking slot.
  • Page 46: Operating And Navigating

    IntelliSpace Perinatal, via a LAN cable or not. Patient identification Date and time Bed label (when connected to a Philips OB TraceVue/IntelliSpace Perinatal system) Fetal heart sound volume adjust/ indicator Alarm volume adjust/indicator INOP and alarm status area - shows...
  • Page 47 3 Basic Operation Measurement Area Antenna symbol (indicates a cableless measurement from a connected Avalon CL or Avalon CTS system) Configurable alarm limits NST test Audio source symbol Measurement numeric Alarms off symbol Fetal trace recorder - status indicator Avalon CL or Avalon CTS system - status indicator Battery status indicator Status line - shows status and prompt messages Signal quality indicator: good, acceptable, poor...
  • Page 48 3 Basic Operation Icon Description Signal quality indicator: Good Acceptable Poor Fetal trace recorder - status indicator Fetal recorder is on Fetal recorder is off (when is off) Paper Save Mode Fetal recorder is off (when is on) Paper Save Mode There is a user-solvable recorder error (paper out, paper jam, wrong paper scale set) Fetal recorder is defective: call service...
  • Page 49 3 Basic Operation Keys The monitor has three different types of keys. Permanent Keys A permanent key is a graphical key that remains permanently on the screen, giving you fast access to functions. Name Function Acknowledges all active alarms by switching off audible Silence alarm indicators.
  • Page 50 3 Basic Operation SmartKey Name Function Pages the patient. Only enabled if at least one Call Patient CL transducer is currently active Pauses alarm indicators. Pause duration depends on Pause Alarms monitor configuration. If the pause duration is infinite, this key is labeled Alarms Off Select again to immediately re-enable alarm indicators...
  • Page 51: Operating Modes

    3 Basic Operation Pop-Up Keys Pop-up keys are context-sensitive graphical keys that appear automatically on the monitor screen when required. For example, the pop-up key appears when you need to confirm a change. Confirm Using the Touchscreen Select screen elements by pressing them directly on the monitor's screen. Disabling Touchscreen Operation To temporarily disable the touchscreen operation of the monitor, press and hold the Main Screen...
  • Page 52: Automatic Screen Layouts

    3 Basic Operation Mode Description Password Protected Configuration Mode The Configuration Mode is for personnel trained in configuration tasks. You can change and store the default values and patient profiles permanently in the Configuration Mode. These tasks are described in the Configuration Guide.
  • Page 53 3 Basic Operation User Default are a complete configuration stored in the monitor's long-term memory. You can User Defaults store the active settings, modified to your preference, in the (in Configuration Mode). User Defaults In Monitoring Mode, you can load the settings to return to your preferred settings: User Defaults Select the...
  • Page 54 Store Date, Time WARNING Do not change the date and time setting, if the fetal monitor is connected to a Philips OB TraceVue/ IntelliSpace Perinatal system. The monitor uses the OB TraceVue/IntelliSpace Perinatal system date and time, including daylight saving time changes. As long as the fetal monitor is connected to the OB...
  • Page 55: Preparing To Monitor

    Refer to the appropriate measurement section for details of how to perform the measurements you require. Start recording. Switching On: FM20/FM30 Connect the monitor to AC mains and switch the monitor on. FM20/30 – The green power-on LED lights up. – The monitor performs a self-test as it starts up.
  • Page 56 3 Basic Operation Switching On: FM40/FM50 Connect the monitor to AC mains. – The green LED lights up. Press the On/Standby switch. – The monitor performs a self-test as it starts up. , the serial number, and revisions Selftest: OK for the software and firmware are printed on the fetal trace paper (if recorder Auto Start configured to...
  • Page 57 3 Basic Operation To fold the display, pull the display forwards as far as it will go Then push the display all the way back until it clicks shut. If your monitor is wall-mounted, the display should be folded flat. Fastening Belts and Transducers You can use more than one belt if, for example, you are monitoring uterine activity and FHR simultaneously.
  • Page 58 3 Basic Operation Using Belts with Button Fixings Place the transducer belt across the bed, so that the fixing button will face away from the mother when it is fastened. Lie the patient on the bed and arrange the belt around her until it is tight but still comfortable. Fasten the belt by pushing the fixing button through the overlapping section of the belt.
  • Page 59 3 Basic Operation Alternatively, attach the butterfly belt clip to the transducer belt button and use this to attach the transducer to the belt. The clip allows you to slide the transducer for easy repositioning. Using CL Transducers with a Belt Clip The Avalon CL transducers have their own belt clip.
  • Page 60 3 Basic Operation Velcro fixing Belt guides Velcro fixing WARNING When connecting devices for acquiring measurements, always position cables and NBP tubing carefully to avoid entanglement or potential strangulation. Repositioning Transducers A patient possibly wears transducers for long periods without interruption. In rare cases, skin irritations may occur if a transducer is attached to one location for a longer period.
  • Page 61 3 Basic Operation Connecting a Transducer to the Monitor socket Noninvasive blood pressure socket Fetal sensor sockets You can plug a fetal transducer, an ECG/IUP patient module, an Avalon CL or Avalon CTS Cableless Fetal Transducer System interface cable (red connector), or an external event marker into any of the four fetal sensor sockets marked by the fetal symbol, or "Fetal Sensors"...
  • Page 62 3 Basic Operation Interface cable to Avalon CL and Avalon CTS Cableless Fetal Transducer System. Connect the black connector to one of the two black sockets (marked "Tele") on the rear of the monitor. What You See on the Monitor When you connect a transducer or sensor, the measurement numeric appears on the screen.
  • Page 63 3 Basic Operation The blue finder LED on a wired fetal transducer lights up when you touch the measurement on the screen, allowing you to identify the corresponding transducer. Finder LED The white finder LED on a cableless fetal transducer lights up when you touch the measurement on the screen, allowing you to identify the corresponding transducer.
  • Page 64 3 Basic Operation Paper Guide FM40/FM50 The recorder in the FM40 and FM50 features a transparent paper guide which: FM40/50 • facilitates correct alignment of the paper, both during loading and while the recorder is running. See “Loading Paper FM40/FM50” on page 73. •...
  • Page 65 3 Basic Operation Fetal heart rate label Uterine activity label The current monitoring modes (if any transducers are connected to the monitor) are printed. Whenever a transducer's mode is changed, the following are printed: • the time • the date •...
  • Page 66 3 Basic Operation Time stamp printed every ten minutes The trace records maternal parameters also. When measuring noninvasive blood pressure, the annotation is made at the end of the measurement. If the noninvasive blood pressure measurement repetition time is short, the noninvasive blood pressure numeric may not always be printed. The recording of notes (see “Entering Notes”...
  • Page 67 3 Basic Operation Recording Elements A variety of information can appear on the recorder trace. Here is a sample trace with some of the most common elements and their meaning. Each trace header contains the last name and first name, the patient ID, patient date of birth, the current date and time, patient's bed label, and the gestational age of the pregnancy.
  • Page 68 3 Basic Operation Choosing Recorder Speed You can choose a recorder speed of 1, 2, or 3 centimeters per minute (cm/min). The default setting is 3 cm/min. The ACOG technical bulletin on FHR monitoring states that "accurate pattern recognition is difficult if not impossible at 1 cm/min and that 1 cm/min is only recommended for more economic screening.
  • Page 69 3 Basic Operation This reflects exactly when the marker button was first pressed; keeping the button pressed has no influence on the annotation. Tearing Off the Paper CAUTION Never pull on the paper to advance it, as this can cause misalignment of the paper. Always tear off the paper along the perforation.
  • Page 70 Configuration Mode. See “Recovering Traces on Paper” on page 229 for further information. Loading Paper FM20/FM30 CAUTION Using recorder paper that is not approved by Philips can result in accelerated paper fading and can damage the thermal line printhead. This type of damage is not covered by warranty.
  • Page 71 3 Basic Operation To load a pack of paper: FM20/FM30 If the recorder is on, press the recorder SmartKey or the SmartKey to Start/ Stop Stop Recordng turn it off before loading a new pack of paper. Press the paper table release to unlock the paper drawer and then pull the table forward to open it fully.
  • Page 72 3 Basic Operation Unfold the top page of the pack and position the uterine activity scale on the right. Slide the pack into the tray.
  • Page 73 Loading Paper FM40/FM50 CAUTION Using recorder paper that is not approved by Philips can result in accelerated paper fading and can damage the thermal line printhead. This type of damage is not covered by warranty. To load a pack of paper:...
  • Page 74 3 Basic Operation Lift out any remaining paper from the tray. Press and hold the paper eject button to partially eject the paper, thus making it easier to remove. Hinge the transparent paper guide forward. It is held in the closed position by a small protrusion on each side of the holder.
  • Page 75 3 Basic Operation Prepare to place the new pack of paper in the tray with the bottom side down. The bottom side is indicated by the word STOP printed on the final page of the new pack. Unfold the top page of the pack and position the uterine activity scale on the right. Slide the pack into the tray.
  • Page 76 3 Basic Operation Now close the paper guide. Press the recorder SmartKey or the SmartKey to switch on the recorder. Start/ Stop Start Recordng Annotations of trace information are printed on the trace paper (see “Switching the Recorder On and Off”...
  • Page 77 3 Basic Operation Entering Notes Your monitor has a set of 15 factory pre-configured notes (see below). The maximum length of one single note is 30 characters. It is possible to edit the notes in Configuration Mode (see the Configuration Guide). To enter a note: Press the SmartKey to open the...
  • Page 78 3 Basic Operation Signal Quality During monitoring, if the fetal heart rate signal quality fluctuates, and becomes poor, it does not necessarily mean that the transducer needs repositioning. The fluctuation may be caused by fetal movement. Allow time for the signal to stabilize before deciding whether to reposition the transducer (ultrasound), or apply a new electrode (ECG).
  • Page 79 3 Basic Operation Deactivating Cableless Transducers The CL transducers of the Avalon CL are deactivated by redocking them at a base station. To deactivate all cableless transducers at once press the Standby button of the Avalon CL base station. See the Avalon CTS Instructions for Use for the deactivation of the CTS transducers.
  • Page 80 3 Basic Operation • You can connect two Avalon CL base stations with black connectors to an FM40/FM50 (telemetry sockets) • You cannot connect two Avalon CL base stations to an FM40/FM50, if one Avalon CL base station has a red connector, and the other Avalon CL base station has a black connector. •...
  • Page 81 3 Basic Operation • You cannot connect an Avalon CTS and an Avalon CL at the same time to the same fetal monitor. • Monitoring a multiple pregnancy using cableless transducers is supported by the Avalon CL system only. • Using a mixture of wired and cableless fetal transducers is not supported.
  • Page 82 The configuration should be carried out by authorized and qualified service personnel, either by the hospital's biomedical department, or by Philips Support. For a detailed description of the configuration see the Avalon CL Service Guide and the Fetal Monitor Configuration Guide.
  • Page 83 3 Basic Operation select the and then Main Setup Tele Info CL Transducer symbol assigned with the parameter label Cableless measurement symbol and equipment ID Base station symbol with docking indication (the white slot indicates a charging transducer) Remove Find (in Service Mode) Battery Report symbol...
  • Page 84 3 Basic Operation Telemetry When the monitor recognizes a connected Avalon CL or Avalon CTS interface cable (red or black connector), it confirms the recognition with the following status indicators displayed in the lower right-hand corner of the screen: Indicator Avalon CL Avalon CTS A base station is connected to the monitor, but...
  • Page 85 3 Basic Operation About RF Signal Quality Signal transmission can be disturbed if: • the patient is out of range of the receiving area. • there is interference from another, possibly stronger, RF signal (a broadcasting station, for instance). • the patient is near material that absorbs electromagnetic waves (for example, metal-reinforced concrete, elevator doors) or the base station is in an enclosed metal rack.
  • Page 86 3 Basic Operation CL Transducer Unassignment The cableless transducer needs to be unassigned: • before being used with another base station on another patient • to allow cleaning before docking it back onto the base station (e.g. to replace it with a fully charged transducer of the same type) There are three methods to do this: Open the setup menu of the measurement e.g.
  • Page 87 3 Basic Operation Select the pop-up key. A message states then Confirm <cl Measurement> has been removed Unassign the CL Pod with its user interface. See the Cableless Measurement Instructions for Use. Dock the CL Pod at the base station or charger. Calling Patients To call a patient currently not near the fetal monitor and base station select the SmartKey Call Patient...
  • Page 88: After Monitoring

    Pressing any key or selecting any field on the screen will resume monitoring. NOTE If an Avalon CL base station is connected to your FM20/30 monitor, do not turn off the monitor if you need to recharge the batteries of the CL transducers. They can only be recharged if the FM20/30 monitor is on.
  • Page 89: Disconnecting From Power

    A fetal monitor that was switched off prior to a temporary power loss, remains off when power is restored. • When AC mains power is lost, a battery powered monitor (FM20/30) continues to run without interruption on battery power. Monitoring After a Power Failure •...
  • Page 90: Troubleshooting

    Use recommended paper Dirty printhead Clean printhead, see “Cleaning the Print Head” on page 246 FM20/30 only: Paper misaligned due Shut the drawer fully, pushing evenly to drawer not being correctly shut with both hands End of paper noted when pack not...
  • Page 91: Fm20/30 Battery Option

    FM20/30 Battery Option You can switch between battery-powered and mains-powered (AC) operation without interrupting monitoring. The monitor is connected to the AC mains power via the external power supply. NOTE The battery option is not available for the FM40/FM50.
  • Page 92: External Power Supply M8023a

    AC (alternating current) power source of 100 V to 240 V (±10%) and 50/60 Hz (±5%). If this option is used, then the M8023A (option #E25) power supply is included for FM20/30. AC power cord, connected to AC mains socket...
  • Page 93 4 FM20/30 Battery Option Battery LED The possible battery LED status on the right side of the monitor is described in the table below. 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 94 4 FM20/30 Battery Option check the specific cause of the problem by looking at the symbol(s) displayed in the Battery Status window. Battery Status Indicator Battery Malfunction Indicator Alternates with the battery gauge The red exclamation mark on the main screen.
  • Page 95: Optimizing Battery Performance

    4 FM20/30 Battery Option Symbols indicating critical situations are colored red. Battery Status Symbols Battery Malfunction Symbols Battery is empty (Red) incompatible battery Battery not charging as the (Red) battery malfunction temperature is above or below the specified range Battery requires maintenance...
  • Page 96 4 FM20/30 Battery Option Charging the Battery To charge the battery, Connect the monitor to the external power supply (M8023A). Charge the battery until it is full, the battery LED is green, and the battery power gauge is filled. During high load of the monitor (usage of multiple measurements) the battery may not charge. To remedy this: •...
  • Page 97 Battery Safety Information WARNING Use only Philips batteries part number M4605A. Use of a different battery may present a risk of fire or explosion. Do not open batteries, or dispose of them in fire, or cause them to short circuit. They may ignite, explode, leak or heat up, causing personal injury.
  • Page 98: Storing The Battery

    The charging time of the CL transducers can take up to min. 6 hours if they are charged from a FM20/ 30 with battery option. If you charge the CL transducers at the FM20/30 with battery option, be sure to remove all wired transducers from the fetal monitor. Leaving them connected to the fetal monitor can cause the CL transducers not to charge at all.
  • Page 99: Alarms

    Alarms The alarm information here applies to all measurements. Measurement-specific alarm information is contained in the sections on individual measurements. The fetal monitor has two different types of alarm: patient alarms and INOPs. Patient Alarms Patient alarms are red and yellow alarms. A red alarm indicates high priority, such as a potentially life threatening situation (for example, SpO below the desaturation alarm limit).
  • Page 100: Alarm Mode

    5 Alarms alarm. See the performance specifications in “Specifications and Standards Compliance” on page 261 for the system alarm delay specification. Multiple Alarms If more than one alarm is active, the alarm messages are shown in the alarm status area in succession. An arrow symbol next to the alarm message informs you that more than one message is active.
  • Page 101: Audible Alarm Indicators

    INOP tones • change the alarm sound to suit the different alarm standards valid in different countries. Standard Philips Alarms • Red alarms: a high pitched sound is repeated once a second.
  • Page 102 5 Alarms • One-star yellow alarms (short yellow alarms): the audible indicator is the same as for yellow alarms, but of shorter duration. • Standard INOPs: a lower pitched tone is repeated twice, followed by a pause. Changing the Alarm Tone Volume The alarm volume symbol at the top right of the monitor screen gives you an indication of the current volume.
  • Page 103: Acknowledging Alarms

    Cuff NotDeflated Power Loss Tone When power is lost - no power is available from the AC power source or from the battery - a beeper FM20/30 with Battery will sound. The tone can be silenced by pressing the On/Standby button.
  • Page 104: Pausing Or Switching Off Alarms

    5 Alarms Pausing or Switching Off Alarms If you want to temporarily prevent alarms from sounding, for example while you are moving a patient, you can pause alarms. Depending on your fetal monitor configuration, alarms are paused for one, two, or three minutes, or infinitely.
  • Page 105 5 Alarms To Switch Individual Measurement Alarms On or Off This applies to alarm mode Select the measurement numeric to enter its setup menu. Select to toggle between Alarms The alarms off symbol is shown beside the measurement numeric.
  • Page 106 Cuff Overpress Battery Empty FM20/30 monitor with battery option. These INOPs switch all alarms back on again, so that an INOP tone can be sounded. You must remove the INOP condition first, before you can switch off or pause the alarms again.
  • Page 107: Alarm Limits

    5 Alarms Alarm Limits The alarm limits you set determine the conditions that trigger yellow and red limit alarms. WARNING Be aware that the monitors in your care area may each have different alarm settings, to suit different scenarios. Always check that the alarm settings are appropriate before you start monitoring. Viewing Individual Alarm Limits (Alarm Mode "All"...
  • Page 108: Reviewing Alarms

    5 Alarms Extreme Alarm Limits for Heart Rate and Maternal Pulse The extreme rate alarms, Extreme Tachy and Extreme Brady, generated by the active alarm source, either HR or Pulse, are set in Configuration Mode by adding a set value (the ∆ value) to the high and low alarm limits.
  • Page 109: Latching Alarms

    5 Alarms Review Alarms Window Alarms On SpO No Pulse Alarms Silenced ** FHR1 High ** SpO Low window contains a list of up to 300 of the most recent alarms and INOPs with date Review Alarms and time information. If configured to do so, each alarm is shown with the alarm limit active when the alarm was triggered and the maximum value measured beyond this limit.
  • Page 110: Testing Alarms

    5 Alarms audible latching can only be set to . The following table shows the possible Red Only combinations for latching settings: Possible Combinations for Alarm Latching Settings Visual Latching Setting Audible Latching Setting Red & Yellow Red & Yellow Red &...
  • Page 111: Alarm Behavior At Power On

    5 Alarms Measure or simulate the parameter that is out of range, or signal loss. Verify that the visible and audible alarms are working. As an example, to test the FHR alarms: Connect the US transducer to a fetal sensor socket. Enable the FHR alarming (see “Turning Alarms On or Off ”...
  • Page 112 5 Alarms...
  • Page 113: Patient Alarms And Inops

    Patient Alarms and INOPs This chapter lists alarms and technical alarms (INOPs) for the fetal monitors irrespective of their priority. Alarm Messages Fetal alarms are identified by either "FHR" or "DFHR". All other alarms without these identifiers refer to maternal parameters. Alarm Message From Condition...
  • Page 114 6 Patient Alarms and INOPs Alarm Message From Condition Indication MECG The maternal heart rate obtained from the Numeric flashes, red alarm *** Extreme Tachy maternal ECG has risen above the extreme message, alarm tone. ***xTachy xxx>yyy tachycardia limit. xxx denotes the highest measured value, and yy is the extreme tachycardia limit.
  • Page 115: Technical Alarm Messages (inops)

    6 Patient Alarms and INOPs Alarm Message From Condition Indication The pulse rate has dropped below the low Numeric flashes and low limit ** Pulse Low alarm limit. is highlighted, yellow alarm message, alarm tone. The arterial oxygen saturation has exceeded Numeric flashes and high ** SpO High the high alarm limit.
  • Page 116 6 Patient Alarms and INOPs INOP Message Indication What to do Monitor: Display only Perform a visual and functional check of the touch input Check Touch Input device. Contact your service personnel. Monitor: INOP tone The fetal heart rate(s) and maternal heart rate/pulse Coincidence persistently coincide with another.
  • Page 117 Check that there is no paper jam, that the print drawer is Check Paper properly shut, that the paper is loaded with the grid facing Recorder: printout upwards, and that the correct Philips paper is being used. Monitor: INOP tone and/or settings are set to...
  • Page 118 6 Patient Alarms and INOPs INOP Message Indication What to do Monitor: INOP tone The grid scale of the paper in the monitor does not match Wrong Paper Scale the grid scale configured in the monitor. Make sure that Recorder: printout you use the correct paper and scale for your institution: pre-printed: 30-240 in US and Canada, 50-210 in other geographies.
  • Page 119 6 Patient Alarms and INOPs Cableless Transducer INOPs INOP Message Indication What to do Monitor: Display only The remaining monitoring time with this transducer is cl US Batt Empty below 15 minutes. Charge battery. !!cl US Batt Empty CL transducer: LED flashes !!!cl US BattEmpty cl Toco Batt Empty !!clToco BattEmpty...
  • Page 120 6 Patient Alarms and INOPs INOP Message Indication What to do Monitor: INOP tone One or more DECG lead is not attached. Make sure that DFHR1 Leads Off all required leads are attached, and no electrodes have !! DFHR1 Leads Off Numeric is replaced by a -?- been displaced.
  • Page 121 6 Patient Alarms and INOPs INOP Message Indication What to do Monitor: INOP tone Remove the cuff from the patient. The noninvasive blood NBP Equip Malf pressure hardware is faulty. Contact your service Numeric is replaced by a -?- personnel. You can silence this INOP, but the INOP message remains visible until the next measurement is started, or SmartKey is selected.
  • Page 122 6 Patient Alarms and INOPs INOP Message Indication What to do Monitor: INOP tone The temperature of the battery in the CL NBP Pod is cl NBP Batt Temp critically high. Check that the Pod is not covered or CL NBP Pod: display exposed to a heat source.
  • Page 123 6 Patient Alarms and INOPs INOP Message Indication What to do Monitor: INOP tone Excessive patient movement or electrical interference is SpO NoisySignal causing irregular pulse patterns. Try to reduce patient Numeric is replaced by a -?- movement, or to relieve the cable strain on the sensor. Monitor: display only The signal condition of the SpO measurement is poor...
  • Page 124 6 Patient Alarms and INOPs INOP Message Indication What to do Monitor: INOP tone The temperature of the battery in the CL SpO Pod is cl SpO Batt Temp critically high. Check that the Pod is not covered or CL SpO Pod: display exposed to a heat source.
  • Page 125: Admitting And Discharging

    Admitting and Discharging The fetal monitor can store basic patient demographic information used to identify patients. Admit/Discharge on the Monitor This section describes how you admit and discharge patients when using the monitor as a stand-alone device (that is, when not used with an obstetrical information and surveillance system such as OB TraceVue/IntelliSpace Perinatal).
  • Page 126 7 Admitting and Discharging Quick Admitting a Patient to quickly admit a patient using only a limited set of demographic data. Quick Admit Select the SmartKey. Quick Admit Enter the required data (ID fields or last name depending on configuration) with the keyboard or a barcode scanner.
  • Page 127: New Patient Check

    7 Admitting and Discharging New Patient Check The fetal monitor can be configured to ask you in certain situations: • after a specified power-off period • after a specified standby period whether a new patient is now being monitored. The pop-up window is entitled Is this a New Patient? The monitor offers a key to discharge the previous patient and begin monitoring a new patient,...
  • Page 128 7 Admitting and Discharging...
  • Page 129: Non-stress Test Timer

    Non-Stress Test Timer The non-stress test ( ) timer shows the elapsed time for the non-stress test. The timer counts up to the time you set for the NST. Setting NST Autostart/Autostop You can set the recorder so that it starts automatically ( ) when the NST timer is started, NST Autostart and stops automatically (...
  • Page 130: Accessing The Nst Setup Pop-up Keys

    8 Non-Stress Test Timer Accessing the NST Setup Pop-up Keys You control and set up the NST timer (for example, start, stop, or clear the timer, and set the run time) using a selection of pop-up keys that you access via any one of three possible routes: •...
  • Page 131: Non-stress Test Report

    Non-Stress Test Report It is generally accepted that a non stress test ( ) allows you to assess fetal well-being. The monitor's NST report process uses fetal ultrasound (but not DECG) heart rate traces and the Maternal Toco trace to generate a printed report when criteria are met and it is an indication of the fetal well-being. The American term Non Stress Test (NST) is used for antepartum testing.
  • Page 132: Nst Report Status Window

    9 Non-Stress Test Report – - press the pop-up key to trigger a manual request. Manual Record Report – - report is recorded as soon as recorder becomes idle. After Recorder Stop – - if a realtime recording is running, the monitor pauses it. The recording is Immediately continued after the report has been recorded.
  • Page 133 9 Non-Stress Test Report Field Field Content Start time, end time, Elapsed Time: 11:34 – 12:06 time, configured Run time Elapsed time: 32 Run time: 20 Overall one-line NST result NST Criteria*: not met summary Title Trace Interpretation Summary Result Accelerations Accelerations: 2 at: 11:59 12:02 Result: Contractions...
  • Page 134: Nst Criteria

    9 Non-Stress Test Report Field Field Content Guideline/Criteria (*) Interpretation criteria based on guideline "NICHD 2008, v01" Information User-defined criteria for CTG tracing: • valid FHR for 90% of reporting period • baseline heart rate between 120 bpm and 160 bpm •...
  • Page 135: Cross-channel Verification (ccv)

    Cross-Channel Verification (CCV) Misidentification of Heart Rates FHR detection by the monitor may not always indicate that the fetus is alive. Confirm fetal life before monitoring, and continue to confirm that the fetus is the signal source for the recorded fetal heart rate (see “Confirm Fetal Life Before Using the Monitor”...
  • Page 136: Cross-channel Verification Functionality

    10 Cross-Channel Verification (CCV) Cross-Channel Verification Functionality The cross-channel verification functionality (CCV) of the fetal monitors compares all monitored heart rates (maternal and fetal), and indicates automatically whether any two channels are picking up the same signal, or monitoring similar values. If the fetal monitor detects that any channels have the same or similar values, the INOP is Coincidence...
  • Page 137 10 Cross-Channel Verification (CCV) FHR1 (US) FHR2 (US) FHR3 (US) DFHR (DECG) Maternal Pulse (Toco MP) Maternal Pulse (SpO Maternal HR (MECG)
  • Page 138: Coincidence Examples

    10 Cross-Channel Verification (CCV) Coincidence Examples Coincidence of Maternal Pulse and FHR When the maternal pulse and FHR are being monitored, and the measured values are very similar or the same, the coincidence question mark is displayed on the monitor’s screen above both of the corresponding numerics (in this case maternal pulse and FHR).
  • Page 139 10 Cross-Channel Verification (CCV) The coincidence question mark is also printed on the trace paper next to the corresponding FHR and maternal pulse. Printed coincidence question mark on trace FHR1 and pulse traces Coincidence of Twins/Triplets FHRs When both are being monitored, and the measured values are very similar or the same, FHR1 FHR2 the coincidence question mark is displayed on the monitor’s screen above both of the corresponding...
  • Page 140: Recommended Actions For Coincidence Inop

    10 Cross-Channel Verification (CCV) The coincidence question mark is also printed on the trace paper next to FHR1 FHR2 Printed coincidence question mark on trace traces FHR1 FHR2 Recommended Actions for Coincidence INOP Confirm fetal life by palpation of fetal movement or auscultation of fetal heart sounds using a fetoscope, stethoscope, or Pinard stethoscope.
  • Page 141: Monitoring Fhr And Fmp Using Ultrasound

    Monitoring FHR and FMP Using Ultrasound To monitor a single FHR externally, you use an ultrasound transducer attached to a belt around the mother's abdomen. The ultrasound transducer directs a low-energy ultrasound beam towards the fetal heart and detects the reflected signal. Your monitor can also detect fetal movements and print the fetal movement profile ( ) on the trace.
  • Page 142: Limitations Of The Technology

    11 Monitoring FHR and FMP Using Ultrasound Limitations of the Technology All tissues moving towards or away from the transducer generate Doppler echoes. Therefore, the resulting signal that is provided to the monitor’s speaker, and for further fetal heart signal processing, can contain components of the beating fetal heart wall or valves, fetal movements, fetal breathing or hiccup, maternal movements such as breathing or position changes, and pulsating maternal arteries.
  • Page 143 11 Monitoring FHR and FMP Using Ultrasound CAUTION Never use ultrasound transducers connected to more than one fetal monitor on the same patient. • When using an Avalon CL or Avalon CTS you should be aware that FMP is not recommended when the mother is likely to move, and you should disable Fetal Movement Profile (FMP) on the fetal monitor ( ) if the mother is walking.
  • Page 144 11 Monitoring FHR and FMP Using Ultrasound • Gaps in maternal heart rate detection can occur: – if the transducer is not correctly positioned. – due to the pulsation of uterine blood vessels. – if the fetus moves.
  • Page 145: Preparing To Monitor

    Apply a thin layer of ultrasound gel to the underside of the transducer. CAUTION Using ultrasound gel not approved by Philips may reduce signal quality and may damage the transducer. This type of damage is not covered by warranty. Place the transducer on the abdomen, if possible over the fetal back or below the level of the umbilicus in a full-term pregnancy of cephalic presentation, or above the level of the umbilicus in a full-term pregnancy of breech presentation.
  • Page 146: Selecting Fetal Heart Sound

    11 Monitoring FHR and FMP Using Ultrasound Selecting Fetal Heart Sound You can listen to the fetal heart sound from one ultrasound transducer at a time. When the fetal heart sound is selected for an FHR channel, you see the audio source symbol next to the FHR numeric label for that channel.
  • Page 147: Fetal Movement Profile

    11 Monitoring FHR and FMP Using Ultrasound Fetal Movement Profile The Fetal Movement Profile (FMP) parameter detects fetal movements with an ultrasound transducer connected to the monitor. Only the fetus monitored on the FHR1 channel is monitored for FMP. Once you have enabled FMP (see “Switching FMP On and Off” on page 148), it is triggered automatically whenever: •...
  • Page 148 11 Monitoring FHR and FMP Using Ultrasound FMP Statistics FMP statistics are printed every ten minutes. FMP enabled FMP started here Indication of current fetal movement. The FMP statistics are presented as two percentage figures: The first figure shows the percentage of detected fetal movements in the previous ten minutes.
  • Page 149: Troubleshooting

    11 Monitoring FHR and FMP Using Ultrasound Troubleshooting Problem Possible Causes Solutions Erratic trace Fetal arrhythmia Consider monitoring FHR using DECG after the rupture of membranes. Obese patient Erratic display Transducer position not optimal Reposition transducer until signal quality indicator shows a good signal (at least half-full).
  • Page 150: Additional Information

    11 Monitoring FHR and FMP Using Ultrasound Testing Ultrasound Transducers If any of the following tests fail, repeat the test using another transducer. If the second transducer passes the tests, confirming that the first transducer is defective, contact your service personnel. If the second transducer also fails the tests, contact your service personnel.
  • Page 151 11 Monitoring FHR and FMP Using Ultrasound • When you are unable to determine a baseline rate and variability occurs between consecutive contractions There are several ways to verify the source and/or accuracy of the recorded fetal heart rate pattern. These include: Verification of the FHR with: •...
  • Page 152 11 Monitoring FHR and FMP Using Ultrasound • The maternal heart rate may simulate a normal fetal heart rate pattern (i.e., it may mask a FHR deceleration or fetal demise). Especially during pushing with contractions in the second stage of labor, the maternal heart rate may increase to the point where it may equal or exceed the fetal rate.
  • Page 153 11 Monitoring FHR and FMP Using Ultrasound • Maternal body movement - positioning • Maternal expulsive efforts - pushing • Maternal tachycardia/accelerations with contractions • Fetal decelerations, Fetal tachycardia • Delayed return of the fetal heart rate from a deceleration •...
  • Page 154 11 Monitoring FHR and FMP Using Ultrasound Signal Quality Indicator Avalon compared with its predecessor, the Series 50 Signal quality indicator on Avalon fetal monitors: Instead of a traffic light-like design (red – yellow – green) used on the Series 50, the signal quality on the Avalon fetal monitor is indicated by a triangle on the touch screen that is displayed in one of three ways: Avalon fetal monitor signal quality indicator display:...
  • Page 155 11 Monitoring FHR and FMP Using Ultrasound Double-Counting Contractions Excessive, coupling, hypertonus Artifact Double-Counting Comment Reassuring tracing. The excessive uterine activity should prompt discontinuation of any oxytocic agent. Remediation The true fetal rate can be confirmed by auscultation or by fetal scalp electrode. Half-Counting Baseline Rate Baseline Variability...
  • Page 156 11 Monitoring FHR and FMP Using Ultrasound Maternal-Switching (Maternal Insertion) Baseline Rate 170 - Tachycardia Baseline Variability Moderate Accelerations Unable to determine Decelerations Absent Contractions Absent Artifact Maternal insertion, noise Comment The fetus has an elevated baseline rate of about 170 bpm with minimal to moderate variability.
  • Page 157 11 Monitoring FHR and FMP Using Ultrasound Signal ambiguity resulting in unexpected outcome with external fetal heart rate monitoring By Duncan R. Neilson Jr, MD; Roger K. Freeman, MD; Shelora Mangan, RNC, MSN, CNS American Journal of Obstetrics & Gynecology, June 2008 ___________________________________________________________ Antepartal and Intrapartal Fetal Monitoring, 3rd Edition (2007) By Michelle L.
  • Page 158 11 Monitoring FHR and FMP Using Ultrasound Role of Maternal Artifact in Fetal Heart Rate Pattern Interpretation Klapholz, Henry M, MD; Schifrin, Barry S. MD; Myrick, Richard RS Obstetrics & Gynecology, September 1974, Volume 44, Issue 3 ___________________________________________________________...
  • Page 159: Monitoring Twin Fhrs

    Monitoring Twin FHRs The FHRs of twins are externally monitored using two ultrasound transducers. The Avalon CL Transducer system provides the option to monitor twins with cableless transducers. The Avalon CTS system does not have this option. Twin FHRs are monitored throughout labor and delivery. After rupture of the membranes, you can FM30/50 monitor one twin externally using ultrasound, and the other internally using DECG.
  • Page 160: Monitoring Twins Externally

    12 Monitoring Twin FHRs • The fetal sensor socket to which a transducer is connected is identified by the transducer position indicator in the setup menu header: FM20/FM30 FM40/FM50 • The trace recorded for FHR1 is thicker (darker) than that recorded for FHR2. This ensures that the two heart rates are easily distinguishable.
  • Page 161: Monitoring Twins Internally

    12 Monitoring Twin FHRs Example of the screen showing ultrasound monitoring of twin FHRs: FHR 1 Toco parameter FHR 2 Monitoring Twins Internally Monitor one twin using the procedures described in “Monitoring FHR and FMP Using Ultrasound” FM30/50 on page 141. Monitor the second twin using the procedures described in “Monitoring FHR Using DECG”...
  • Page 162 12 Monitoring Twin FHRs Switching Trace Separation On and Off Connect transducers to the monitor to measure FHR. Depending on the measurement method, you need either two ultrasound transducers or, for FM30/FM50, one ultrasound and one Toco transducer, or one CL ECG/IUP transducer (to monitor DECG): Enter the menu by pressing the Main Setup...
  • Page 163 12 Monitoring Twin FHRs The following trace shows trace separation switched on. Only the FHR2 trace is offset. The numerical FHR value displayed on the monitor remains unchanged. Subtract 20 from the recorded trace for FHR2 to obtain the true FHR2 value. For example, if the recorded trace shows 160, then the true FHR is 140.
  • Page 164 12 Monitoring Twin FHRs When Trace Separation is Off To indicate that trace separation is switched off, a dotted line labeled +0 prints across the FHR scale. trace separation switched Standard off here trace separation switched Classic off here...
  • Page 165: Troubleshooting

    12 Monitoring Twin FHRs Troubleshooting Common problems that may occur when monitoring FHR using ultrasound are listed in “Monitoring FHR and FMP Using Ultrasound” on page 141. See also “Monitoring FHR Using DECG” on page 183 for common problems you might encounter when monitoring FHR directly. The following problem may occur when monitoring twins.
  • Page 166 12 Monitoring Twin FHRs...
  • Page 167: Monitoring Triple Fhrs

    Monitoring Triple FHRs If your monitor is equipped with the triplets option, it carries the label. You can monitor triple FHRs externally using three ultrasound transducers. With the Avalon CL Transducer system you can now monitor triplets with cableless transducers. The Avalon CTS system does not have this option.
  • Page 168: Monitoring Triplets

    13 Monitoring Triple FHRs • The transducer Finder LED lets you identify at a glance which transducer is monitoring which heart rate channel. • The fetal sensor socket to which a transducer is connected, is identified by the transducer position indicator in the setup menu header: FM20/FM30 FM40/FM50...
  • Page 169: Classic" Separation Order

    13 Monitoring Triple FHRs really is, while the trace for FHR3 is recorded 20 bpm lower than it really is. The trace for FHR1 is never shifted. The recorder prints a dotted line labeled +20 across the FHR scale, to identify the trace for FHR2.
  • Page 170: Switching Trace Separation On And Off

    13 Monitoring Triple FHRs really is, while the trace for FHR3 is recorded 20 bpm lower than it really is. The trace for FHR2 is never shifted. The recorder prints a dotted line labeled +20 across the FHR scale, to identify the trace for FHR1.
  • Page 171: When Trace Separation Is On

    13 Monitoring Triple FHRs When Trace Separation is On When trace separation is turned on, the recorder prints a dotted line labeled with the three FHRs at the top, and ±20 at the bottom. Examples of the two methods ( ) for determining the trace Standard Classic...
  • Page 172: Troubleshooting

    13 Monitoring Triple FHRs trace separation switched off Classic here Troubleshooting Common problems that may occur when monitoring FHR using ultrasound are listed in “Monitoring FHR and FMP Using Ultrasound” on page 141. The following problem may occur when monitoring triplets. Problem Possible Cause Solution...
  • Page 173: Fetal Heart Rate Alarms

    Fetal Heart Rate Alarms Fetal heart rate (FHR) alarms can give both audible and visual warning of a non-reassuring fetal condition. Your monitor must be configured to alarm mode to enable the FHR alarms (see “Alarms” on page 99). Changing Alarm Settings When you do any of the following actions for any FHR measurement channel, this applies for all active FHR measurements, both ultrasound and DECG: •...
  • Page 174: Changing Signal Loss Delay

    14 Fetal Heart Rate Alarms To change the high alarm limit delay time, select and select the delay time (in seconds) High Delay from the pop-up list. To change the low alarm limit delay time in seconds, select and select the delay time (in Low Delay seconds) from the pop-up list.
  • Page 175: Monitoring Uterine Activity Externally

    Monitoring Uterine Activity Externally You can measure uterine activity externally using a Toco transducer. You can also use a Toco Toco MP, or a CL Toco MP transducer for the same purpose, although they also have more (ECG/ IUP and Pulse) capabilities. The external Toco transducer measures the frequency, duration, and relative strength of contractions, but not their absolute intensity.
  • Page 176: External Toco Monitoring

    15 Monitoring Uterine Activity Externally Abdominal Belt (disposable shown) External Toco Monitoring Prepare for Toco monitoring using the list below. The standard procedures in use in your facility determine the sequence of actions. Fasten the abdominal transducer belt around the patient. Connect the Toco transducer to a free socket on the monitor.
  • Page 177 15 Monitoring Uterine Activity Externally External Toco Monitoring Problem Possible Causes Solutions Quality of the trace deteriorates The belt is incorrectly fastened and is The belt must be tight enough to ensure or the Toco baseline varies too slack or too tight, or the belt has lost good contact between the patient's skin its elasticity.
  • Page 178 15 Monitoring Uterine Activity Externally Testing Toco Transducers If any of the following tests fail, repeat the test using another transducer. If the second transducer passes the tests, confirming that the first transducer is defective, contact your service personnel. If the second transducer also fails the tests, contact your service personnel. To test a Toco transducer: Switch on the monitor and the recorder.
  • Page 179: Monitoring Uterine Activity Internally

    Monitoring Uterine Activity Internally You can monitor intrauterine pressure (IUP) using an intrauterine catheter together with a patient FM30/50 module, Toco , or the CL ECG/IUP or CL Toco MP transducer, after rupture of the membranes and the cervix is sufficiently dilated. What You Need The figure below shows the complete connection chain from the IUP catheter to the fetal monitor using the patient module:...
  • Page 180 16 Monitoring Uterine Activity Internally The figure below shows the complete connection chain from the IUP catheter to the fetal monitor using the Toco+ transducer: Disposable Koala IUP Catheter (M1333A) Reusable Koala IUP Adapter Cable (9898 031 43931) Toco transducer (M2735A) The figure below shows the complete connection chain from the IUP catheter to the fetal monitor using the CL ECG/IUP transducer: Disposable Koala IUP Catheter (M1333A)
  • Page 181: Internal (iup) Monitoring

    16 Monitoring Uterine Activity Internally Internal (IUP) Monitoring Read the instructions that accompany the intrauterine catheter and the adapter cable before you start monitoring. Zero the monitor when instructed. WARNING Do not catheterize if placenta previa is diagnosed, or if uterine bleeding from an undetermined source is present.
  • Page 182: Troubleshooting

    16 Monitoring Uterine Activity Internally Troubleshooting Internal (IUP) Monitoring Problem Possible Causes Solutions No change in pressure during Dry environment or possible extra- Refer to catheter Instructions for Use. contraction. ovular placement of sensor tip. Only pressure peaks can be Zero adjustment is incorrect.
  • Page 183: Monitoring Fhr Using Decg

    Monitoring FHR Using DECG This chapter describes how to monitor a single fetal heart rate via direct ECG (DECG), using a spiral FM30/50 fetal scalp electrode in the intrapartum period. Read and adhere to the instructions that accompany the fetal scalp electrode, the DECG adapter cable, and the attachment electrode.
  • Page 184 17 Monitoring FHR Using DECG include: motion artifacts, arrhythmia, and individual differences in pulse signal quality on the abdominal skin (via Toco MP).
  • Page 185: What You Need

    17 Monitoring FHR Using DECG What You Need You can measure fetal DECG using the equipment combinations shown in the following figures. WARNING Never attempt to connect the fetal scalp electrode to anything other than the correct DECG adapter cable. The figure below shows the complete connection chain from the fetal scalp electrode to the fetal monitor using the Toco transducer.
  • Page 186 17 Monitoring FHR Using DECG The figure below shows the equivalent chain using the CL Toco MP or CL ECG/IUP transducer. Fetal Scalp Electrode, single spiral (989803137631) Fetal Scalp Electrode, double spiral, Europe only, not for USA (989803137641) DECG Adapter Cable (9898 031 37651) with Pre-gelled Attachment Electrode (989803139771) CL Toco MP (866075) or CL ECG/IUP transducer (866077) Avalon CL base station (866074)
  • Page 187: Making Connections

    17 Monitoring FHR Using DECG Making Connections WARNING Follow the instructions supplied with each of the monitoring accessories you are using. Prepare for DECG monitoring using the list below. The standard procedures in use in your facility determine the sequence of actions. If you change the monitoring mode from US to DECG, first disconnect the US transducer.
  • Page 188: Monitoring Decg

    17 Monitoring FHR Using DECG Monitoring DECG To simultaneously measure DECG and MECG, you need the CL ECG/IUP transducer or the patient module for DECG, and a Toco+, CL Toco MP, or CL ECG/IUP transducer for MECG (see “Monitoring Maternal Heart / Pulse Rate” on page 213). Alternatively, you can monitor the maternal pulse rate via pulse oximetry (see “Pulse Rate from SpO2”...
  • Page 189 17 Monitoring FHR Using DECG Check the artifact suppression setting and change it if necessary (see “Suppressing Artifacts” on page 190). Measurement label (DFHR1) Measurement label (Toco) Measurement label (FHR2) Measurement label (HR) 1mV scale bar MECG wave with maternal label DECG wave with fetal label Measurement label (Temp) maternal temperature Measurement label NBP...
  • Page 190: Suppressing Artifacts

    17 Monitoring FHR Using DECG Suppressing Artifacts When the monitor's artifact suppression is on, instantaneous heart rate changes of 28 bpm or more, however caused, are not recorded. Fetal arrhythmia will also be suppressed. If you suspect fetal arrhythmia, switch artifact suppression off. When artifact suppression is off, all recorded fetal heartbeats within the specified range are shown.
  • Page 191: Testing Decg Mode

    17 Monitoring FHR Using DECG Problem Possible Cause Solutions No connection See “Patient Alarms and INOPs” on DFHR1 Unplugged page 113. DFHR2 Unplugged DFHR3 Unplugged Testing DECG Mode See the monitor's Service Guide.
  • Page 192 17 Monitoring FHR Using DECG...
  • Page 193: Monitoring Noninvasive Blood Pressure

    Monitoring Noninvasive Blood Pressure This monitor uses the oscillometric method for measuring NBP. A physician must determine the clinical significance of the NBP information. Introducing the Oscillometric Noninvasive Blood Pressure Measurement Oscillometric devices measure the amplitude of pressure changes in the occluding cuff as the cuff deflates from above systolic pressure.
  • Page 194: Preparing To Measure Noninvasive Blood Pressure

    18 Monitoring Noninvasive Blood Pressure Measurement Limitations NBP readings can be affected by the position of the subject, their physiological condition, the measurement site, and physical exercise. Thus a physician must determine the clinical significance of the NBP information. The measurement may be inaccurate or impossible: •...
  • Page 195 18 Monitoring Noninvasive Blood Pressure Make sure that you are using a Philips-approved correct sized cuff, and that the bladder inside the cover is not folded or twisted. A wrong cuff size, and a folded or twisted bladder, can cause inaccurate measurements. The width of the cuff should be in the range from 37% to 47% of the limb circumference.
  • Page 196 18 Monitoring Noninvasive Blood Pressure Depending on the numeric size, not all elements may be visible. Your monitor may be configured to display only the systolic and diastolic values. If configured to do so, the pulse from NBP will display with the NBP numeric.
  • Page 197: Starting And Stopping Measurements

    18 Monitoring Noninvasive Blood Pressure Starting and Stopping Measurements Use the Setup menu or the SmartKeys to start and stop measurements. Action to be performed Setup menu SmartKeys Start/Stop manual measurement Start/Stop Start Auto series Start/ Stop Stop current automatic measurement Start manual measurement Start Auto series Start NBP...
  • Page 198: Choosing The Alarm Source

    18 Monitoring Noninvasive Blood Pressure 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 cycle to and this cycle will run indefinitely.
  • Page 199: Assisting Venous Puncture

    18 Monitoring Noninvasive Blood Pressure Assisting Venous Puncture You can use the cuff to cause subdiastolic pressure. The cuff deflates automatically after a set time if you do not deflate it. In the menu select Setup NBP VeniPuncture Puncture vein and draw blood sample. Reselect to deflate the cuff.
  • Page 200 18 Monitoring Noninvasive Blood Pressure Problem Possible Causes Solutions Displays zeros for systolic Severe vasoconstriction at cuff site Move cuff to another limb, check for shock, and diastolic values. or verify blood pressure using another Measurement automatically method repeats Erratic blood pressure fluctuations due Try again, if unsuccessful, verify blood to arrhythmias or rapid-acting drugs or pressure using another method...
  • Page 201: Monitoring Maternal Temperature

    Monitoring Maternal Temperature Measuring Tympanic Temperature The tympanic thermometer (866149) measures the patient's temperature in the ear using infrared technology. The result of this measurement can be automatically adjusted to correspond to a different body reference site. The result is displayed on the screen of the thermometer and transmitted to the monitor.
  • Page 202 19 Monitoring Maternal Temperature Base station Thermometer Place the thermometer into its base station, when it is not in use. The base station allows flexible mounting of the thermometer at the point of care. The base station is connected to the monitor's MIB/RS232 interface (optional) with a cable.
  • Page 203 19 Monitoring Maternal Temperature Functional Keys Description of Use Press the start measurement key when you are ready to take a patient's temperature. The pulse timer key can be used to time vital signs you take manually. The pulse timer only functions after you have taken a temperature measurement.
  • Page 204 19 Monitoring Maternal Temperature • build up of earwax in the ear • excessive patient movement during the measurement • absent, defective, or soiled probe covers • probe covers other than the specified probe covers • external environment temperature outside the range of 16ºC-33ºC (60.8ºF-91.4ºF) Ensure that the base station is connected with the appropriate cable to the connector on the monitor.
  • Page 205 19 Monitoring Maternal Temperature Possible INOPs Images Description Patient temperature above measurement range. Patient temperature below measurement range. WARNING • Never apply the probe to the patient when the thermometer is not connected to the base station. • Always use a single-use probe cover to limit patient cross-contamination. •...
  • Page 206: Entering Temperature Manually

    19 Monitoring Maternal Temperature Body Reference Sites and Monitor Labels The tympanic thermometer measures the patient's temperature in the ear. The thermometer can be configured to adjust the result of the measurement to correspond to a different body reference site. The measurement label displayed on the monitor corresponds to the body reference site that is configured.
  • Page 207: Monitoring Spo2

    The pulse oximetry measurement (SpO ) is intended for use with maternal patients. FM30/40/50 Philips pulse oximetry uses a motion-tolerant signal processing algorithm, based on Fourier Artifact Suppression Technology (FAST). It provides two 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 208: Connecting Spo2 Cables

    CAUTION Extension cables: Do not use more than one extension cable (M1941A). Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates "long" cable version). Electrical Interference: Position the sensor cable and connector away from power cables, to avoid...
  • Page 209: Measuring Spo2

    20 Monitoring SpO2 Measuring SpO2 During measurement, ensure that the application site: – has a pulsatile flow, ideally with a signal quality indicator of at least medium. – has not changed in its thickness (for example, due to edema), causing an improper fit of the sensor.
  • Page 210: Spo2 Signal Quality Indicator (fast Spo2 Only)

    20 Monitoring SpO2 SpO2 Signal Quality Indicator (FAST SpO2 only) The SpO numeric is displayed together with a signal quality indicator (if configured and enough space is available) which gives an indication of the reliability of the displayed values. The level to which the triangle is filled shows the quality of the signal; the indicator below shows a medium signal quality.
  • Page 211: Setting Up Tone Modulation

    20 Monitoring SpO2 Alarm Delays There is a delay between a physiological event at the measurement site and the corresponding alarm at the monitor. This delay has two components: • The general system delay time is the time between the occurrence of the physiological event and when this event is represented by the displayed numerical values.
  • Page 212 20 Monitoring SpO2...
  • Page 213: Monitoring Maternal Heart / Pulse Rate

    Monitoring Maternal Heart / Pulse Rate You can monitor the maternal heart/pulse rate using one of four sources: • Maternal pulse from Toco MP or CL Toco MP transducer (pulse rate) • (pulse rate) • Maternal heart rate (MHR) via MECG electrodes •...
  • Page 214: Misidentification Of Mhr For Fhr

    21 Monitoring Maternal Heart / Pulse Rate Misidentification of MHR for FHR To reduce the possibility of mistaking the MHR for FHR, it is recommended that you monitor both maternal and fetal heart rates (see “Confirm Fetal Life Before Using the Monitor” on page 10 and “Cross-Channel Verification (CCV)”...
  • Page 215 21 Monitoring Maternal Heart / Pulse Rate Pre-gelled Foam Electrodes (40493A/B/C/D/E) The figure below shows the equivalent chain using a CL Toco+ MP transducer or a CL ECG/ IUP transducer. Avalon CL base station (866074) CL Toco MP (866075) or CL ECG/IUP transducer (866077) MECG Adapter Cable (M1363A) Pre-gelled Foam Electrodes (40493A/B/C/D/E) To simultaneously measure DECG and MECG, you can use a Toco+, a CL Toco...
  • Page 216 21 Monitoring Maternal Heart / Pulse Rate Applying Electrodes To derive the MHR (when you do not want to view the MECG waveform), you can place the electrodes just below the outer end of the clavicle near each shoulder. MECG Electrodes Making Connections WARNING Follow the instructions supplied with each of the monitoring accessories you are using.
  • Page 217: Monitoring Mecg Wave

    21 Monitoring Maternal Heart / Pulse Rate Monitoring MECG Wave WARNING The fetal/maternal monitor is not a diagnostic ECG device. In particular, the display of fetal/maternal ECG is intended only for evaluating signal quality for fetal/maternal heart rate as derived from the ECG waveform.
  • Page 218 21 Monitoring Maternal Heart / Pulse Rate Viewing the Waveform on the Screen Measurement label (DFHR1) Measurement label (Toco) Measurement label (FHR2) Measurement label (HR) 1mV scale bar MECG wave with maternal label DECG wave with fetal label Measurement label (Temp) maternal temperature Measurement label NBP NOTE The 1mV scale bar for the DECG and MECG wave is not displayed on the screen if you monitor...
  • Page 219: Pulse Rate From Toco Mp

    21 Monitoring Maternal Heart / Pulse Rate Troubleshooting Problem Possible Causes Solutions displayed One or more MECG leads is not Make sure that all required leads are attached MECG Leads Off attached. Numeric is displayed with If the wave is configured to be displayed on the a -?- for 10 seconds;...
  • Page 220: Pulse Rate From Spo2

    21 Monitoring Maternal Heart / Pulse Rate Pulse Rate from SpO2 If you are not monitoring MHR via MECG electrodes, but you are monitoring SpO , the maternal pulse rate is derived from the SpO measurement. The pulse numeric is labeled on the screen.
  • Page 221: Adjusting The Heart Rate / Pulse Alarm Limits

    21 Monitoring Maternal Heart / Pulse Rate Adjusting the Heart Rate / Pulse Alarm Limits To adjust the pulse alarm limits for SpO In the menu, select . This opens the menu. Setup SpO Pulse (SpO ) Setup Pulse (SpO ) Ensure .
  • Page 222 21 Monitoring Maternal Heart / Pulse Rate...
  • Page 223: Printing The Ecg Waveform

    Printing the ECG Waveform You can print the ECG wave onto the trace paper. If you are monitoring both DECG and MECG, FM30/50 both waves will be printed. The start of the wave recording is annotated above the wave with MECG Maternal ECG, with for Direct fetal ECG, and with...
  • Page 224 22 Printing the ECG Waveform MECG waveform on its own MECG Recorder speed DECG and MECG waveforms DECG MECG Recorder speed When the recorder is on, there are two choices for printing the ECG wave: • : This recording mode gives you a six-second ECG strip on the fetal trace paper in fast Separate printout mode.
  • Page 225 22 Printing the ECG Waveform The following trace shows the MECG waveform: FHR1 trace interrupted header MECG Recorder speed FHR1 trace resume • : This recording mode gives you a delayed six-second snapshot of the maternal and/or Overlap direct fetal ECG for documentation on the fetal strip, but without interrupting the fetal trace. It takes 5 minutes to print this six-second snapshot at a recorder speed of 3 cm/min.
  • Page 226 22 Printing the ECG Waveform header MECG Recorder speed To make your choice: Enter the menu. Main Setup Select to enter the menu. Fetal Recorder Fetal Recorder Select to switch between ECG Wave Separate Overlap To print the ECG wave(s): Select the SmartKey (configurable) and the recording trace is started.
  • Page 227: Paper Save Mode For Maternal Measurements

    Paper Save Mode for Maternal Measurements Your monitor's recorder features a Paper Save Mode, where maternal vital signs are recorded using less paper than during a normal trace recording. When Paper Save Mode is enabled, and if the recorder is stopped, it will start automatically to print data from maternal measurements as they occur, and then stops again to save paper.
  • Page 228 23 Paper Save Mode for Maternal Measurements...
  • Page 229: Recovering Data

    Note that the data in the memory is cleared when a software upgrade is performed. CAUTION Only use Philips paper. Using paper other than Philips paper may result in the failure to recover traces. Recovering Traces on Paper The monitor is able to recover traces by printing them out at a high speed from the monitor's backup memory.
  • Page 230: Recovering Traces On An Ob Tracevue/intellispace Perinatal System

    24 Recovering Data printed, letting you see where the trace recovery printout ends, and where the real-time trace continues. • There can be a gap of up to 30 seconds between the trace recovery printout, and the beginning of the real-time trace. Recovering Traces on an OB TraceVue/IntelliSpace Perinatal System The trace recovery data stored in the monitor's backup memory can also be uploaded at high speed to...
  • Page 231 24 Recovering Data The speed of the printout depends on the configured recorder speed and on the amount of trace data available. The fetal trace printed from the trace data contains all data from the real-time trace, with the exception of the maternal heart rate, the pulse numeric, and the ECG wave. Information for scale type, trace separation, and recorder speed are not stored in the trace memory, but is applied when the stored recording starts.
  • Page 232 24 Recovering Data It may be that you only see one entry (the current patient’s data) in the window if Stored Data Recording that patient was monitored for a period long enough to erase any earlier entries. If you make a stored data recording for an old entry (that is, not for the current patient), the recorder performs a fast trace printout of the stored data, advances the paper to the next paper fold, then stops.
  • Page 233: 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 “Guideline for Disinfection and...
  • Page 234: Cleaning And Disinfecting

    25 Care and Cleaning • Place the monitor where there is no chance of contact with, or falling into water or other liquid. • Do not dry equipment using heating devices such as heaters, ovens (including microwave ovens), hair dryers, and heating lamps. •...
  • Page 235: Cleaning And Disinfecting Monitoring Accessories

    25 Care and Cleaning Product Name Product Type Ingredients Bacillol® AF liquid, spray 100 g concentrate contains: Propan-1-ol 45.0 g; Propan-2-ol 25.0 g; Ethanol 4.7 g. Bacillol®25 liquid Ethanol 100 mg/g Propan-2-ol (= 2-Propanol) 90 mg/g; Propan-1-ol (= 1-Propanol) 60 mg/g Meliseptol®...
  • Page 236 25 Care and Cleaning Thoroughly dry all surfaces before using the equipment.
  • Page 237: Sterilizing

    25 Care and Cleaning CAUTION Do not use cleaners and disinfectants such as Spray-Nine™, Phisohex™, Hibiclens™, or Vesta-Syde™ as they may result in damage to the thermometer case. Occasional use of a 10:1 water and hypochlorite mixture or a damp isopropyl alcohol wipe or Cidex™ or ManuKlenz™...
  • Page 238 25 Care and Cleaning...
  • Page 239: Maintenance

    Batteries Preventive Maintenance For the FM20/30 with a battery option refer to “Using Batteries” on page 92. 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.
  • Page 240 26 Maintenance Carry out performance assurance checks as described in the monitor's Service Guide.
  • Page 241: Maintenance Task And Test Schedule

    Ensure that these tasks are carried out as indicated by the monitor's maintenance schedule, or as specified by local laws, whichever comes sooner. Contact a Philips-qualified service professionals if your monitor needs a safety or performance test. Clean and disinfect equipment to decontaminate it before testing or maintaining it.
  • Page 242 26 Maintenance To remove the paper guide: Press the paper eject button to open the paper drawer. Hinge the transparent paper guide forward.
  • Page 243 26 Maintenance A protrusion (A) holds paper guide in closed position. Release the paper guide from one side of the holder.
  • Page 244 26 Maintenance Then remove the paper guide. Refitting is a reversal of the removal procedure. Storing Recorder Paper Recorder paper is not intended for long-term archival storage. Another medium should be considered if this is required. Dyes contained in thermal papers tend to react with solvents and other chemical compounds that are being used in adhesives.
  • Page 245 26 Maintenance • Avoid intensive light (UV light), as this may cause the paper to turn gray, or the thermal print to fade. • Avoid storing the thermal paper in combination with the following conditions: – Papers that contain organic solvents. This includes papers with tributyl and/or dibutyl phosphates, for example recycled paper.
  • Page 246: Cleaning The Print Head

    Switch off the monitor. Open the paper drawer, and remove the paper if necessary, to gain access to the thermal print head. Gently clean the thermal print head with a cotton swab, or soft cloth soaked in isopropyl alcohol. FM20/30 FM40/50...
  • Page 247: Disposing Of The Monitor

    You can disassemble the monitor and the transducers as described in the Service Guide. You will find detailed disposal information on the following web page: http://www.healthcare.philips.com/main/about/Sustainability/Recycling/pm.wpd Do not dispose of waste electrical and electronic equipment as unsorted municipal waste. Collect it separately, so that it can be safely and properly reused, treated, recycled, or recovered.
  • Page 248 26 Maintenance...
  • Page 249: Accessories And Supplies

    All accessories listed for the fetal monitor may not be available in all geographies. To order parts, accessories, and supplies, consult your local Philips representative for details. For customers in the United States, Australia, and Great Britain you can order at www.philips.com/healthcarestore. All accessories and supplies listed here are reusable, unless indicated otherwise.
  • Page 250: Transducers

    27 Accessories and Supplies Transducers Transducer Part Number Avalon Toco Transducer M2734A Avalon Toco Transducer for Toco, DECG, MECG or IUP monitoring M2735A Avalon Toco MP Transducer for Toco and Maternal Pulse M2734B Avalon Ultrasound Transducer M2736A Avalon Ultrasound Transducer USA M2736AA ECG/IUP Patient Module (for DECG, MECG or IUP) M2738A...
  • Page 251 Reusable Koala IUP adapter cable 989803143931 DECG Accessories: Component Compatibility Use the following pictorial guide to check component compatibility for DECG accessories. CAUTION Do not mix accessories from the Philips DECG Solution (marked 1) with those from the QwikConnect Plus Solution (marked 2).
  • Page 252: Mecg Accessories

    27 Accessories and Supplies The Qwik Connect Plus Solution (marked 2) is still compatible, but is no longer sold by Philips. MECG Accessories Accessory Part Number MECG reusable adapter cable M1363A Foam ECG electrodes, snap-fit, for MECG Adapter Cable (disposable)
  • Page 253 27 Accessories and Supplies Adult EasyCare Reusable Cuffs Maternal Patient Category (color) Limb Circumference Bladder Width Part No. Adult Thigh (gray) 45.0—56.5 cm 21.0 cm M4559B Adult Thigh (gray) 45.0—56.5 cm 21.0 cm M4559B5 pack of 5 cuffs Large Adult X-Long (burgundy) 35.5—46.0 cm 17.0 cm M4558B...
  • Page 254: Spo2 Accessories

    Tyco Healthcare. Some sensors may not be available in all countries. Do not use more than one extension cable with any sensors or adapter cables. Do not use an extension cable with Philips reusable sensors or adapter cables with part numbers ending in -L (indicates "Long" version).
  • Page 255 Any finger except thumb. SE sensors work with FM30/40/50, Special Edition (SE) M1192AN as well as with OxiMax-compatible versions of other Philips Small adult, pediatric sensor (1.5 m cable) for monitors. patients between 15 kg and 50 kg. Any finger except thumb.
  • Page 256 27 Accessories and Supplies Philips Disposable Sensors Not available in the USA: Description Comments Product Number Identical to OxiMax MAX-A Requires M1943A (1.0 m) or M1943AL M1904B (3.0 m) adapter cable Identical to OxiMax MAX-P M1903B Identical to OxiMax MAX-N...
  • Page 257 OC-3 adapter cable. OxiCliq N See OxiMax MAX-N Use only on adult patients with FM30/40/50 Masimo LNOP Reusable Sensors Product Number Description Philips Part Number LNOP DC-I Adult Finger Sensor (>30 kg) 989803140321 LNOP DC-IP Pediatric Finger Sensor (10—50 kg) 989803140331...
  • Page 258 27 Accessories and Supplies Product Number Description Philips Part Number LNOP Neo-L Neonatal (<3 kg) or Adult adhesive Sensor (>40 kg) 989803140291 Use only on adult patients with FM30/40/50 Masimo LNCS Disposable Adhesive Sensors Product Name Description Philips Part Number LNCS Adtx Adult Sensor (>30 kg)
  • Page 259: Tympanic Temperature Accessories

    27 Accessories and Supplies Extension / Adapter Cables Description Comments Product No. Extension cable (2 m) For use with Philips reusable sensors and adapter cables M1941A Adapter cable (1.1 m cable) Adapter cable for Philips/Nellcor disposable sensors M1943A Adapter cable (3 m cable)
  • Page 260: Batteries

    For Avalon FM20 or Avalon FM30 with M4605A battery option #E25 Avalon CL Cableless Smart transducer Consists of one Philips Lithium Ion Battery 989803184861 Battery Replacement Kit (Part No. 453564107871), a tool to open and close the cableless transducer for battery replacement and two replacement O-ring seals.
  • Page 261: Specifications And Standards Compliance

    Specifications and Standards Compliance The monitors are intended to monitor a mother and her fetus(es), which from an electrical safety point of view, are one person. Environmental Specifications The monitor may not meet the given performance specifications, if stored and used outside the specified temperature and humidity ranges.
  • Page 262 28 Specifications and Standards Compliance Transducers (M2734A/M2734B/M2735A/M2736A/M2738A) Temperature Range Operating 0°C—40°C (32°F—104°F) Storage/Transportation -20°C—60°C (-4°F—140°F) Humidity Range Operating <95% relative humidity @ 40°C (104°F) Storage/Transportation <90% relative humidity @ 60°C (140°F) Altitude Range Operating -500—3.000 m (-1.640—9.840 ft) Storage/Transportation -500—13.100 m (-1.640—43.000 ft) NOTE Do not locate the M2738A ECG/IUP Module directly on the patient’s skin when operated at an environmental temperature above 37°C (98.6°F).
  • Page 263: Physical Specifications

    Source Description Patient alarms and INOPs See the sections on Patient Alarms and INOPs, Standard Philips Alarms, and ISO/IEC Standard Audible Alarms in the Instructions for Use. Ultrasound Doppler Direct transmission of Doppler echoes to the speaker of the fetal monitor.
  • Page 264 External (powered by fetal monitor) Mode of Operation Continuous operation Interface cable connector type Connector color Red for FM20/30 left side or FM40/50 front fetal connector socket Black for FM40/50 rear telemetry connector socket Interface cable length 1.5 m (4.11 ft)
  • Page 265 28 Specifications and Standards Compliance Avalon CL Transducers Avalon CL Transducers (866075/866076/866077) Shock Resistance Withstands a 1.5 m drop to concrete surface with possible cosmetic damage only. Water Ingress Protection Code IP 68 (immersion up to 1 m water depth for 5 hours) Dimensions Avalon CL Toco MP Transducer...
  • Page 266: Interface Specifications

    28 Specifications and Standards Compliance Interface Specifications Fetal Monitors Interface Specifications Network Standard 100-Base-TX (IEEE 802.3 Clause 25) Connector RJ45 (8 pin) Isolation Basic isolation (reference voltage: 250 V; test voltage: 1500 V) MIB/RS232 Standard IEEE 1073-3.2-2000 Connectors RJ45 (8 pin) Mode Software-controllable BCC (RxD/TxD cross over) or...
  • Page 267: Performance Specifications

    28 Specifications and Standards Compliance Avalon CL Radio Avalon CL Radio Interface Specifications Electronic Article Surveillance (EAS) EAS tag inside the housing (58 kHz) Short Range Radio Interface* Type Internal SRR interface Technology IEEE 802.15.4 Frequency Band 2.4 GHz ISM (2.400—2.483 GHz) Modulation Technique DSSS (O—QPSK) Effective radiated power...
  • Page 268 With a new and fully charged battery min. 8 hours Battery Charge time From a "low battery" indication to a "fully charged" indication <3 hours Charge time with Avalon FM20/30 From a "low battery" indication to a "fully Battery Option #E25 charged" indication >6 hours. Fetal / Maternal Specifications...
  • Page 269 28 Specifications and Standards Compliance Performance Specifications US Intensity (M2736A/AA) Average output power P = (7.4 ± 0.4) mW Peak-negative acoustic pressure p_ = (40.4 ± 4.3) kPa Output beam intensity (I = (2.38 ± 0.59) mW/cm sata (= spatial average - temporal average intensity) Spatial-peak temporal average intensity I = (15.0 ±...
  • Page 270 28 Specifications and Standards Compliance Performance Specifications Update Rate Display 1 per second Printer ~4 per second Auto Offset Correction 3 seconds after connecting the transducer, the Toco value is set to 20 units Auto Zero Adjust Toco value is set to zero following a negative measurement value for 5 seconds Performance Specifications Maternal Pulse from Toco...
  • Page 271 28 Specifications and Standards Compliance Performance Specifications Performance Specifications Type DECG Single Lead ECG (derived from Fetal Scalp Electrode) MECG Single Lead ECG (derived from RA and LA electrodes) Measurement Range 30—240 bpm Resolution Display 1 bpm (display update rate 1 per second) Recorder 1/4 bpm Wave Speed (Global Speed)
  • Page 272 28 Specifications and Standards Compliance Fetal Heart Rate (Ultrasound/DECG) Alarm Specifications FHR Alarm Limits Range Bradycardia (low limit) 60—200 bpm adjustable in 10 bpm steps Default: 110 bpm Tachycardia (high limit) 70—210 bpm adjustable in 10 bpm steps Default: 170 bpm FHR Alarm Delay Range Bradycardia (low limit) Delay 10—300 seconds in steps of 10...
  • Page 273 28 Specifications and Standards Compliance Maternal ECG Supplemental Information as required by IEC 60601-2-27 Response Time of Heart Rate HR change from 80—120 bpm: 10 seconds Meter to Change in Heart Rate HR change from 80—40 bpm: 14 seconds Tall T-Wave Rejection Capability M2735A 1.2 mV T-Wave amplitude M2738A...
  • Page 274 28 Specifications and Standards Compliance Performance Specifications Auto Mode Repetition Times 1, 2, 2.5, 3, 5, 10, 15, 20, 30, 45, 60, or 120 minutes Venipuncture Mode Inflation Inflation Pressure 20—120 mmHg (3—16 kPa) Automatic deflation after 170 seconds *1: Clinical investigation with the auscultatory reference method •...
  • Page 275 M1191T, M1192T, M1194A, M1194AN, M1196A, M1196T = 3% values and the reference (70%—100%) values Philips Disposable Sensors with M1943A(L): M1131A, M1901B, M1903B, M1904B = 3% (70%—100%) M1133A, M1134A = ±2% (70%—100%) NellcorPB® Sensors with M1943A(L): MAX-A, MAX-AL, MAX-P, MAX-N, D-25, D-20, N-25, OxiCliq A, P, N = 3% (70%—100%)
  • Page 276 28 Specifications and Standards Compliance Alarm Specifications Range Adjustment Delay Bradycardia Difference to low limit 0—50 bpm 5 bpm steps max. 14 seconds Clamping at 30—100 bpm 5 bpm steps Tympanic Temperature Complies with: • EN 12470-5 (Clinical thermometers - Part 5:2003: Performance of infra-red thermometers) •...
  • Page 277 28 Specifications and Standards Compliance Displayed Temperature Measurement Range Mode Range °C Range °F Rectal (ear + 1.16°C) 34.2—42.0 93.6—107.6 Caution: ASTM E1965-98 specifies 34.4°C—42.2°C (94°F—108°F) Ambient Temperature Range Mode Range °C Range °F Operating 10%—95% RH, non- 16.0—33.0 60.8—91.4 condensing Storage up to 95% RH, non- -25.0—55.0...
  • Page 278: Recorder Specifications

    28 Specifications and Standards Compliance Recorder Specifications Built-in Thermal Array Fetal Trace Recorder Mechanism Thermal Array Recorder Paper & Printing Type Standard Z-fold paper Standard Speeds (real-time traces) 3 cm/min, 2 cm/min, 1 cm/min Fast Print Speed (stored traces) Max. 20 mm/s Print speed is variable and depends on the print load ECG Wave Print Speed...
  • Page 279 28 Specifications and Standards Compliance Recorder Symbols Symbol Description Beginning of the date/time annotation Warning (INOP) Measurement from a cableless transducer (printed next to measurement label) Measurement from a cableless maternal measurement Pod (SpO or NBP) Pulse from SpO Pulse from Toco MP Pulse from NBP Trace separation +20 bpm (in label) Trace separation -20 bpm (in label)
  • Page 280: Compatible External Displays: Fm40/fm50 Only

    You can write to Philips at this address: Philips Medizin Systeme Boeblingen GmbH Hewlett-Packard-Str. 2 71034 Boeblingen Germany Visit our website for local contact information at: www.healthcare.philips.com © Copyright 2014. Koninklijke Philips N.V. All Rights Reserved. Trademark Acknowledgment Oxisensor II, Oxi-Cliq...
  • Page 281: Regulatory And Standards Compliance

    1 and the Avalon CL transducers of this system are class 1 under the scope of the R&TTE Directive. To obtain a copy of the original Declaration of Conformity, please contact Philips at the address given in the “Manufacturer's Information” on page 280 section of this manual.
  • Page 282 28 Specifications and Standards Compliance Radio The Avalon CL Transducer System complies with the following major international radio standards: • ETSI EN 300 220-1:2012 • ETSI EN 300 220-2:2012 • ETSI EN 301 489-1:2011 • ETSI EN 301 489-3:2003 • FCC 47 CFR Part 95 •...
  • Page 283 28 Specifications and Standards Compliance Electromagnetic Compatibility (EMC) The device and its accessories, listed in the accessories section, comply with the following EMC standards: • IEC 60601-1-2:2007 / EN 60601-1-2:2007+AC:2010 Take special precautions regarding electromagnetic compatibility (EMC) when using medical electrical equipment.
  • Page 284 28 Specifications and Standards Compliance EMC Testing CAUTION Fetal parameters, especially ultrasound and ECG, are sensitive measurements involving small signals, and the monitoring equipment contains very sensitive high gain front-end amplifiers. Immunity levels for radiated RF electromagnetic fields and conducted disturbances induced by RF fields are subject to technological limitations.
  • Page 285 In the table below, the term "device" refers to the Avalon FM20/30/40/50 fetal monitor together with its accessories. The table gives details of the electromagnetic emissions, and how these are classified, for the device, and the electromagnetic environments in which the device is specified to technically function.
  • Page 286 For the Avalon FM40/FM50 with all establishments and those directly connected to accessories. the public low-voltage supply network that For the Avalon FM20/30 fetal monitor supplies buildings used for domestic purposes. whenever used with the IUP/ECG patient module M2738A. For the Avalon CTS Interface Cable (M2731- 60001/M2732-60001) whenever used with the Avalon CTS Cableless Fetal Transducer System.
  • Page 287 Any changes or modifications to this equipment not expressly approved by Philips Medical Systems may cause harmful radio frequency interference and void your authority to operate this equipment.
  • Page 288 28 Specifications and Standards Compliance de brouillage, et (2) l'utilisateur de l'appareil doit accepter tout brouillage radioélectrique subi, même si le brouillage est susceptible d'en compromettre le fonctionnement. L'utilisation de cet appareil de télémesure est permise seulement dans les hôpitaux et établissements de soins de santé.
  • Page 289 28 Specifications and Standards Compliance Table 3 - Guidance and Manufacturer's Declaration: Electromagnetic Immunity Conducted RF Immunity Test EN/IEC 61000-4-6 Electromagnetic Environment Guidance: IEC 60601-1-2 Test Level Recommended Separation Distance (d) Compliance Level over 150 kHz to 80 MHz (in Meters, at Frequency Range Tested) for Ultrasound and ECG Measurements 3.0 V 3.0 V...
  • Page 290 These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people. If you require further information or assistance, please contact Philips Support. Recommended Separation Distances from Other RF Equipment The device is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled.
  • Page 291 Configuration Mode. Automat. Default When power is lost - no power is available from the AC power source, or from the battery - a beeper FM20/30 with Battery will sound. The tone can be silenced by pressing the On/Standby button.
  • Page 292 Use (this document). Power-On/Off Switch - FM20/ Keyboard connection indicator FM30 without Battery Option (optional) Power-On/StandBy button - Serial/MIB connector FM40/FM50 and FM20/30 with (optional) Battery Option Power-On LED USB interface (optional) Electrical Class II equipment, in Analog interface indicator for...
  • Page 293 28 Specifications and Standards Compliance Symbol indicating the monitor IP 21 Ingress Protection code according has the triplets option to IEC 60529 (protection against ingress of water when the water is dripping vertically) Symbol indicating the monitor is Type CF equipment, not capable of intrapartum defibrillation proof monitoring...
  • Page 294 28 Specifications and Standards Compliance Association Of Radio Industries Wireless Medical Telemetry And Businesses T108 (Avalon CL Service (Avalon CL frequency frequency band used e.g. in Japan) band used e.g. in North America) IC-ID (Industry Canada ID) One IC-ID labeling for each built in radio: OBR, SRR Japanese Radio marking: Radio mark + [R]-symbol + ID Taiwan Radio Label (NCC Logo) + ID Korea radio mark: KC logo, KCC ID number, and...
  • Page 295 Default Settings Appendix This appendix documents the most important default settings of your fetal monitor and the Avalon CL Base Station with the cableless transducers as they are delivered from the factory. For a comprehensive list and explanation of default settings see the Configuration Guide supplied with your fetal monitor. The monitor's default settings can be permanently changed in Configuration Mode.
  • Page 296 29 Default Settings Appendix NBP Default Settings Factory Default Settings Mode Manual Repeat Time 15 min Alarms from Sys. 90/50 (60) Low Limit 160/90 (110) High Limit 60 mmHg VP Pressure Done Tone Veni Puncture Start Time Synchronized Alarms Color Reference Auscultatory CL NBP Default Settings...
  • Page 297 29 Default Settings Appendix SpO2 Default Settings Factory Default Settings Desat Limit Low Limit High Limit 20 seconds Desat Delay 10 seconds Low Alarm Delay 10 seconds High Alarm Delay 10 seconds Average NBP Alarm Suppr. Alarms Color Cyan Pulse Default Settings Pulse (SpO ) 120 bpm High Limit...
  • Page 298 29 Default Settings Appendix Manually Entered Values Default Settings Manual Entered Values Default Settings (fixed) Label Temp °C Unit Color White Interval Msmnt Recorder Default Settings Setting Choice Default 1, 2, or 3 cm/min 3 cm/min Recorder Speed Scale Type Internat'l Trace Style FHR1 Thin...
  • Page 299 OB TraceVue/IntelliSpace single-hose disposable cuffs Perinatal System SpO2 accessories date setting cableless monitoring Philips sensors (disposable) DECG Avalon CL Philips sensors (reusable) DECG INOPs cableless transducers transducer accessories DECG specifications assignment...
  • Page 300 intravascular dyshemoglobins FMP and twins accessories FMP statistics alarm limits connection illustration functional arterial oxygen saturation early systolic blood pressure default settings electrodes ECG specifications specifications global settings electrical safety tests waveform printing electrical surgery precautions. See ESU MECG alarm limits methemoglobin (SpO2) electrodes infection control...
  • Page 301 OB TraceVue FAST technology recorder paper connection to OB TraceVue/ performance specifications recorder specifications IntelliSpace Perinatal System Philips sensors (disposable) recorder speed LAN connection Philips sensors (reusable) recorder troubleshooting operating modes signal quality recording elements configuration mode...
  • Page 302 Toco sensitivity ultrasound specifications Toco specifications understanding screens Toco MP transducer Toco+ transducer using the adapter cable touch tone volume uterine activity touchscreen operation external monitoring trace actions internal monitoring separation on/off monitoring uterine activity tearing off traces trace recovery on OB TraceVue/ troubleshooting uterine activity IntelliSpace Perinatal System trace recovery on paper...
  • Page 304 Part Number 453564526791 Published in Germany 11/14 *453564526791*...

This manual is also suitable for:

Avalon clFm40/50

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