Agilent Technologies M4735A User Manual
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Agilent Technologies M4735A User Manual

Heartstream xl defibrilator/monitor
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  • Page 1 $JLOHQW 0$ +HDUWVWUHDP ;/ 'HILEULOODWRU0RQLWRU 8VHU·V *XLGH...
  • Page 3 User’s Guide 0$ +HDUWVWUHDP ;/ 'HILEULOODWRU0RQLWRU...
  • Page 4 Publication number M4735-91900 THIS PRODUCT IS NOT INTENDED The information in this guide applies to FOR HOME USE. the M4735A Heartstream XL, release A.00. This information is subject to IN THE U.S., FEDERAL LAW change without notice. RESTRICTS THIS DEVICE TO...
  • Page 5 Index This guide uses the following conventions: :$51,1* Warning statements describe conditions or actions that can result in personal injury or loss of life. &$87,21 Caution statements describe conditions or actions that can result in damage to the equipment or loss of data. 127( Notes contain additional information on usage.

  • Page 7: Table Of Contents

    Contents Introduction Overview ..........................1-2 Intended Use ......................... 1-4 Defibrillation Therapy ......................1-4 Indications for AED Therapy ..................1-5 Contraindications for AED Therapy ................1-5 Indications for Manual Defibrillation Therapy ............... 1-6 Contraindications for Manual Defibrillation Therapy ............ 1-6 Precautions for Manual Defibrillation Therapy .............. 1-6 Noninvasive Pacing Therapy (Optional) ................
  • Page 8 Contents Getting Started Getting Acquainted ....................... 2-2 Basic Orientation ......................2-2 Manual Mode Controls ....................2-5 Display Buttons ....................... 2-6 Display Layout ........................ 2-7 Connecting to Power ......................2-9 Inserting the Battery ...................... 2-10 Removing the Battery ....................2-11 Low Battery Warning ....................2-12 Using a Data Card (Optional) .....................
  • Page 9 Contents Monitoring the ECG Overview ..........................4-2 Connecting the ECG Patient Cable ..................4-3 Applying Monitoring Electrodes ..................4-4 Electrode Placement ....................... 4-5 Selecting the Lead ......................... 4-7 Setting the Heart Rate Alarm ....................4-9 Disabling the HR Alarm ..................... 4-10 Adjusting the ECG Size ......................
  • Page 10 Contents Defibrillating in Manual Mode Manual Mode Display ......................6-2 Enabling Manual Mode ......................6-2 Defibrillating in Manual Mode ..................... 6-3 Using External Paddles ....................6-3 Using Multifunction Defib Electrode Pads ..............6-5 Defibrillation Procedure ....................6-6 1. Select Energy ......................6-6 2.
  • Page 11 Contents Pacing (Optional) Pacing Operational Controls ....................8-2 Demand Mode Versus Fixed Mode ..................8-2 Monitoring During Pacing ....................8-3 Preparing for Pacing ......................8-3 Performing Pacing ........................ 8-5 Changing Pacing Modes ....................... 8-8 Defibrillating During Pacing ....................8-8 Troubleshooting ........................8-9 Storing, Retrieving &...
  • Page 12 Contents Setting Up and Configuring the Heartstream XL Connecting/Disconnecting Patient Cables ................10-2 Pads/Paddles Patient Cable ................... 10-3 SpO2 Patient Cable ....................... 10-5 ECG Patient Cable ......................10-6 Configuring the Heartstream XL ..................10-7 Accessing the Configuration Menu ................10-7 Configurable Parameters ....................
  • Page 13 Contents Maintaining the Heartstream XL Operational Checks ......................11-2 Every Shift ........................11-2 Every Month ......................... 11-2 Every Three Months ..................... 11-2 Using External Paddles ....................11-3 Using Pads ........................11-4 Battery Capacity Test ....................11-6 Battery Maintenance ......................11-7 Recharging Batteries .....................
  • Page 14 Contents Troubleshooting System Messages ........................ 12-2 Momentary Messages ....................12-5 Troubleshooting Tips ......................12-7 Calling for Service ......................12-8 United States of America ....................12-8 Canada .......................... 12-8 Other International Areas ....................12-8 Specifications & Safety Specifications ........................13-2 Defibrillator ........................13-2 ECG Monitoring ......................
  • Page 15 1 Introduction The M4735A Heartstream XL Defibrillator/Monitor is designed to meet your resuscitation and monitoring needs. This guide provides instructions for safe and proper operation, set-up, configuration, and care of your M4735A Heartstream XL Defibrillator/Monitor. In this chapter, you’ll find general information that you should become famil- iar with before using the defibrillator/monitor.

  • Page 16: Introduction

    Overview Overview The M4735A Heartstream XL Defibrillator/Monitor is a lightweight, porta- ble, semi-automatic external defibrillator. It offers two modes of operation for defibrillation: Automated External Defibrillation (AED) Mode Manual Mode Both modes incorporate a low energy SMART Biphasic waveform for defibrillation.
  • Page 17 These events can be printed as they occur or as part of an Event Summary. The M4735A Heart- stream XL Defibrillator/Monitor also enables you to store data and events on an optional Data Card for downloading to CodeRunner Web Data Manage- ment Systems.

  • Page 18: Intended Use

    Intended Use Intended Use The M4735A Heartstream XL Defibrillator/Monitor is for use in the hospital by qualified medical personnel trained in the operation of the device and qual- ified by training in basic life support, advanced cardiac life support, or defibrillation.

  • Page 19: Indications For Aed Therapy

    The AED algorithm is not designed to handle erratic spiking problems caused by a properly or improperly functioning pacemaker. In patients with cardiac pacemakers, the M4735A Heartstream XL Defibrillator/Monitor may have reduced sensitivity and not detect all shockable rhythms. The AED algorithm is not intended for children under 8 years of age. For chil-...

  • Page 20: Indications For Manual Defibrillation Therapy

    Asynchronous defibrillation is the initial treatment for ventricular fibrillation and ventricular tachycardia, in patients who are pulseless and unresponsive. The SMART Biphasic waveform utilized in the M4735A Heartstream XL Defibrillator/Monitor has undergone clinical testing in adults. These trials support the waveform’s effectiveness for defibrillation of ventricular tachyarrhythmias at the 150J setting.

  • Page 21: Noninvasive Pacing Therapy (Optional)

    Noninvasive Pacing Therapy (Optional) Noninvasive Pacing Therapy (Optional) The M4735A Heartstream XL Defibrillator/Monitor provides noninvasive transcutaneous pacing by delivering a monophasic, electrical stimulus to the heart. This stimulus is intended to cause cardiac depolarization and myocar- dial contraction. The medical care provider selects the stimulus current and rate settings.

  • Page 22: Indications

    Safety Considerations General warnings and cautions that apply to use of the M4735A Heartstream XL Defibrillator/Monitor are provided in Chapter 13. Additional warnings and cautions specific to a particular feature are provided in the appropriate section of this guide.

  • Page 23: Documentation And Training

    M4735A Heartstream XL Defibrillator/Monitor Quick Reference Card, and About Sealed Lead Acid Batteries, an application note on battery maintenance. Training tools available for use with the M4735A Heartstream XL include: Using the M4735A Heartstream XL Defibrillator/Monitor, a work- book Heartstream XL User Training CD-ROM (optional) For additional online documentation and training, please visit our website: www.agilent.com/healthcare/heart...
  • Page 24 Documentation and Training 1-10 Introduction...

  • Page 25: Getting Started

    Connecting to AC Power Inserting the battery Inserting the optional Data Card (if desired). 127( To connect cables to the Heartstream XL, refer to “Setting Up and Configur- ing the Heartstream XL” in chapter 10. M4735A Heartstream XL Defibrillator/Monitor...

  • Page 26: Getting Acquainted

    Getting Acquainted Getting Acquainted This section provides an overview of the Heartstream XL controls, connec- tions, and display layout. A review of control functionality is also provided. Basic Orientation Review the figure for a general layout of the controls, where the patient cables connect, and where to insert the battery and Data Card.
  • Page 27 Figure 2-2 Heartstream XL (Back) Printer ECG Connector Connector ECG Input Jack AC Power 127( If your Heartstream XL does not have the SpO or Pacing option, disregard these controls and the related information described in this section. M4735A Heartstream Defibrillator/Monitor...
  • Page 28 Getting Acquainted Defibrillation Controls Defibrillation controls consist of an energy select knob and a set of softkeys that perform the function displayed as a label above each button. These controls assist in both AED and Manual Mode defibrillation. Audiovisual Controls Adjusts the volume of voice prompts and the QRS beeper.

  • Page 29: Manual Mode Controls

    ECG strip when pressed. Manual Mode Controls Manual Mode controls provide access to manual defibrillation, and synchronized cardioversion and optional pacing functionality. Figure 2-3 Manual Mode Controls: Energy Select Knob and Pacing Controls M4735A Heartstream Defibrillator/Monitor...

  • Page 30: Display Buttons

    Getting Acquainted Display Buttons Energy Can enable both Manual Mode and AED Mode. The AED Select On position activates AED Mode. Manual On enables Knob Manual Mode, synchronized cardioversion and pacing (optional). Button below the display (far left) that enables synchronized cardioversion when first pressed in Manual Mode;...

  • Page 31: Display Layout

    If power is off for more than two minutes, the Inci-  dent Timer resets to zero ( ). If an Event Summary is printed, the inci- dent timer will be set to zero the next time the unit is turned on. M4735A Heartstream Defibrillator/Monitor...
  • Page 32 Getting Acquainted Figure 2-5 AED Mode Display Layout (ECG and SpO disabled) System Message Momentary Message ECG Gain User Message 150J Current Charge Shocks: 0 Shocks Delivered 00:15:02 Incident Timer Defibrillation PAUSE ANALYZE SHOCK Soft Keys User messages accompany voice prompts to guide you through the defibrilla- tion process.

  • Page 33: Connecting To Power

    (See “Battery Maintenance” on page 11-7). It is recommended that a second, charged battery be available at all times. 127( The Heartstream XL will take longer to charge to the desired energy level when using only AC Power and without the battery. M4735A Heartstream Defibrillator/Monitor...

  • Page 34: Inserting The Battery

    Connecting to Power Inserting the Battery To insert the battery, slide it into the battery receptacle as shown in Figure 2-7. Then push the battery in until you hear an audible click. Figure 2-7 Inserting the Battery 2-10 Getting Started...

  • Page 35: Removing The Battery

    Connecting to Power Removing the Battery To remove the battery from the Heartstream XL, press the black battery eject button and pull the battery out, as shown in Figure 2-8. Figure 2-8 Removing the Battery M4735A Heartstream Defibrillator/Monitor 2-11...

  • Page 36: Low Battery Warning

    Connecting to Power Low Battery Warning The message /RZ %DWWHU\ is displayed when the battery is low and needs recharging. This message indicates that the battery has sufficient remaining capacity to provide only about ten minutes of monitoring time and five shocks before the Heartstream XL shuts off.

  • Page 37: Using A Data Card (Optional)

    CodeRunner Web also allows you to erase patient data from a Data Card, allowing the card to be reused for another patient. 127( It’s recommended that you use a designated data card to configure one or more defibrillator/monitor. M4735A Heartstream Defibrillator/Monitor 2-13...

  • Page 38: Inserting A Data Card

    Using a Data Card (Optional) Inserting a Data Card To insert a Data Card: 1. Make sure the Heartstream XL is powered off. 2. Press up on the release latch to open the door to the Data Card compart- ment. 3.

  • Page 39: Removing A Data Card

    Using a Data Card (Optional) Removing a Data Card To remove the Data Card, press the black eject button (see Figure 2-9) and pull the Data Card from the compartment. Figure 2-10 Removing the Data Card M4735A Heartstream Defibrillator/Monitor 2-15...
  • Page 40 Using a Data Card (Optional) 2-16 Getting Started...

  • Page 41: Defibrillating In Aed Mode

    Mode. It explains the prompts that guide you through the defibrillation pro- cess and describes how prompts vary depending upon the disposition of the patient and the configuration of your device. For information on storing, retrieving, and printing patient information acquired in AED Mode, see Chapter 9. M4735A Heartstream XL Defibrillator/Monitor...
  • Page 42 )LJXUH  $(' 0RGH 2YHUYLHZ If Patient is: l Unresponsive l Not Breathing l Pulseless Attach Pads Insert Data Card (Optional) Rotate Energy Select Knob to AED On If Instructed, $1$/<=( Press No Shock Shock Advised Advised 6+2&. Press Check Patient at completion of shock series within a shock series Pulse...

  • Page 43: Overview

    The process begins only after you have: assessed that the patient is unresponsive, not breathing, and pulseless, turned the Energy Select knob to AED On prepared for defibrillation by attaching pads and cables, and inserting a Data Card (if desired). M4735A Heartstream XL Defibrillator/Monitor...

  • Page 44: Defibrillation (Using The Default Configuration)

    Overview The defibrillation process is dependent upon the configuration of your Heart- stream XL, as described in the following paragraphs. Defibrillation (using the default configuration) In its default configuration, the defibrillation process is: Turn the Energy Select knob to AED On. )LJXUH  (QHUJ\ 6HOHFW .QRE Manual On AED On...

  • Page 45: Defibrillation (With A Modified Configuration)

    If Rhythm Monitoring is off, you need to observe the patient during idle times $1$/<=( and determine when to press The following sections describe the defibrillation process in detail. They also describe what happens at the completion of a shock series and if a shockable rhythm is not detected. M4735A Heartstream XL Defibrillator/Monitor...

  • Page 46: Preparation

    Preparation Preparation If the patient is: unresponsive not breathing pulseless Then: 1. Apply multifunction defib electrode pads to the patient, as directed on the package. Use the anterior-apex electrode placement. 2. Connect the pads to the pads patient cable, as shown in Figure 3-3. 3.

  • Page 47: Defibrillating

    If they are, it pro- ceeds to step 2. If the pads patient cable is not properly attached, you are prompted to &RQQHFW 3DGV &DEOH. )LJXUH  &RQQHFW 3DGV &DEOH 'LVSOD\ Connect Pads Cable Shocks: 0 00:00:02 M4735A Heartstream XL Defibrillator/Monitor...
  • Page 48 Defibrillating Once the cable is connected, the Heartstream XL will ensure the pads have adequate contact with the patient’s skin. Contact quality is measured by monitoring the electrical impedance between the two pads. If the pads have not been applied or are not making proper contact with the patient, you are prompted to $SSO\ 3DGV and &KHFN &RQQHFWLRQV.
  • Page 49 )LJXUH  3UHVV $1$/<=( 'LVSOD\ LEAD SpO2 SELECT ON/OFF Lead II Press Analyze Shocks: 0 00:15:02 ANALYZE PAUSE 127( ECG Analysis is always performed through multifunction defib electrode pads. Analysis can not be performed through monitoring electrodes. M4735A Heartstream XL Defibrillator/Monitor...
  • Page 50 Defibrillating $1$/<=( If device-initiated analysis is on, you do not need to press ; ECG analysis begins automatically. )LJXUH  $QDO\]LQJ 'LVSOD\ LEAD SpO2 ALARM SELECT ON/OFF Pads Analyzing Do Not Touch Patient Shocks: 0 00:00:08 STOP ANALYSIS +DQGOLQJ RU WUDQVSRUWLQJ WKH SDWLHQW GXULQJ (&* DQDO\VLV FDQ FDXVH LQFRUUHFW RU :$51,1* GHOD\HG GLDJQRVLV 3-10...
  • Page 51 Heartstream XL automatically charges to 150J. Charg- ing is accompanied by an intermittent charge tone. )LJXUH  &KDUJLQJ 'LVSOD\ LEAD SpO2 ALARM SELECT ON/OFF Pads Charging to 150J Shocks: 0 00:00:10 M4735A Heartstream XL Defibrillator/Monitor 3-11...
  • Page 52 Defibrillating 6+2&. If shock advised, press Once charging is complete, the charge tone becomes continuous. Make sure no one is touching the patient or anything connected to the patient. 6+2&. Call out clearly and loudly "Stand Clear." Then press to deliver a shock to the patient.

  • Page 53: Automatic Re-Analysis On

    If Automatic Re-analysis is off, the Heartstream XL monitors the ECG for potentially shockable rhythms provided Rhythm Monitoring is on and $1$/<=( prompts you to press if one is detected. You can initiate analysis $1$/<=( without being prompted by pressing M4735A Heartstream XL Defibrillator/Monitor 3-13...

  • Page 54: Pausing For Cpr

    Pausing for CPR Pausing for CPR The Heartstream XL prompts you to &KHFN 3DWLHQW &KHFN 3XOVH Dt the completion of a shock series or when no shock is advised . This default configuration will allow eight seconds to check the pulse, then prompts you as follows: )LJXUH  3UHVV 3DXVH 'LVSOD\ LEAD SpO2...
  • Page 55 If instructed, $1$/<=( press 3$86( If you do not press , the Heartstream XL begins monitoring the ECG rhythm provided Rhythm Monitoring is on. You may initiate ECG analysis at any time by pressing $1$/<=( M4735A Heartstream XL Defibrillator/Monitor 3-15...

  • Page 56: Monitoring Rhythm

    Monitoring Rhythm Monitoring Rhythm When the Heartstream XL is not analyzing, defibrillating, or paused, Rhythm Monitoring alerts you to potentially shockable rhythms (provided Rhythm Monitoring is set to the default configuration, 2Q). The message 0RQLWRULQJ 5K\WKP appears on the display to let you know this feature is active and remains on the display for the duration of the monitoring.
  • Page 57 Active SpO2 and heart rate alarms are suspended during the pause duration, as well. 5(680( Press to restore rhythm monitoring. Active SpO and heart rate alarms are also restored. M4735A Heartstream XL Defibrillator/Monitor 3-17...

  • Page 58: Erc Protocol

    ERC Protocol ERC Protocol The Heartstream XL can be configured to support the European Resuscitation Council (ERC) Guidelines for Resuscitation. If (XURSHDQ 3URWRFRl is configured to 2Q, the defibrillation process described in this chapter is the same, with the exception of how the Pause state functions (see “Pausing for CPR” on 3-14). As described, you can enter a Pause state: at the completion of a shock series, or when no shock is advised...
  • Page 59 (the default setting is 60 seconds). when no shock was advised, the duration is equal to the 16$ 7LPHU configuration setting, where NSA is an acronym for No Shock Advised (the default setting is 180 seconds). M4735A Heartstream XL Defibrillator/Monitor 3-19...

  • Page 60: Troubleshooting

    Troubleshooting Troubleshooting When the Heartstream XL detects a problem, it provides display and/or voice prompts to guide you to resolution. The table below lists the prompts you may encounter in AED Mode, the cause, and the suggested corrective action. Prompts related to the battery and Data Card are discussed in Chapter 12. 7DEOH  7URXEOHVKRRWLQJ LQ $(' 0RGH Prompt Possible Cause...
  • Page 61 Wait for analysis or charging to complete prior to pressing the The key pressed does not func- key. tion while in a pause state. 5(680( Press prior to pressing the key. M4735A Heartstream XL Defibrillator/Monitor 3-21...
  • Page 62 Troubleshooting 3-22 Defibrillating in AED Mode...

  • Page 63: Monitoring The Ecg

    ECG size. For information on how to apply multifunction defib electrode pads, follow the directions on the pads packaging. 127( For information on storing, and retrieving, and printing patient information acquired while monitoring, see Chapter 9. M4735A Heartstream XL Defibrillator/Monitor...

  • Page 64: Overview

    Overview Overview The Heartstream XL can be used for short or long-term ECG monitoring. The ECG monitoring function allows you to monitor through: multi-function defib electrode pads, or 3- or 5-lead ECG monitoring electrodes, as configured. When the Heartstream XL is turned on, the ECG acquired is shown on the dis- play.

  • Page 65: Connecting The Ecg Patient Cable

    2. Push the patient cable firmly into the ECG receptacle, until the white por- tion is no longer visible. )LJXUH  (&* 3DWLHQW &DEOH &RQQHFWRU5HFHSWDFOH To disconnect the ECG patient cable, gently pull the white patient cable connector out of the ECG receptacle. M4735A Heartstream XL Defibrillator/Monitor...

  • Page 66: Applying Monitoring Electrodes

    Applying Monitoring Electrodes Applying Monitoring Electrodes Proper application and placement of electrodes is essential for reliable moni- toring. Good contact between the electrode and the skin reduces the effects of motion artifact and signal interference. %H VXUH WKDW WKH HOHFWURGHV GR QRW FRPH LQ FRQWDFW ZLWK RWKHU FRQGXFWLYH PDWHULDOV :$51,1* HVSHFLDOO\ ZKHQ FRQQHFWLQJ RU GLVFRQQHFWLQJ WKH HOHFWURGHV WRIURP WKH SDWLHQW To apply electrodes:...

  • Page 67: Electrode Placement

    LA/L RA Right Arm R Right LA Left Arm L Left RL Right Leg* N Negative* LL Left Leg F Foot RL/N LL/F * Not used for 3-lead. 7DEOH  /HDG (&* /HDG )RUPDWLRQ Lead reference M4735A Heartstream XL Defibrillator/Monitor...
  • Page 68 Applying Monitoring Electrodes )LJXUH  3UHFRUGLDO /HDG (OHFWURGH 3ODFHPHQW Lead Location forth intercostal space, at right sternal margin forth intercostal space, at left sternal margin midway between V2/C2 and V4/C4 fifth intercostal space, at left midclavicular line same level as V4/C4, on anterior axillary line same level as V4/C4, at left mid axillary line...

  • Page 69: Selecting The Lead

    )LJXUH  (&* 0RQLWRULQJ 'LVSOD\ LQ $(' 0RGH LEAD SpO2 HR ALARM SELECT ON/OFF Lead II Monitoring Rhythm Shocks: 3 00:00:49 ANALYZE PAUSE 127( To change to a different V Lead, move the electrode rather than pressing the Lead Select softkey. M4735A Heartstream XL Defibrillator/Monitor...
  • Page 70 Selecting the Lead )LJXUH  (&* 0RQLWRULQJ 'LVSOD\ LQ 0DQXDO 0RGH SpO2 LEAD HR ALARM SELECT ON/OFF Pads Shocks:0 Sync 00:00:08 SYNC DISARM ON/OFF The message /HDGV 2II is displayed in the System Message area accompanied by a beep when a lead is disconnected or the electrodes have poor patient con- tact.

  • Page 71: Setting The Heart Rate Alarm

    +HDUW UDWH DODUPV DUH WHPSRUDULO\ VXVSHQGHG LQ $(' 0RGH GXULQJ (&* DQDO\VLV RU :$51,1* ZKHQ LV SUHVVHG IRU WKH GXUDWLRQ RI WKH SDXVHG SHULRG  +HDUW UDWH DODUPV DUH 3$86( DOVR VXVSHQGHG ZKLOH FKDUJLQJ IRU GHILEULOODWLRQ DQG GHOLYHULQJ D VKRFN M4735A Heartstream XL Defibrillator/Monitor...

  • Page 72: Disabling The Hr Alarm

    Disabling the HR Alarm Disabling the HR Alarm If the heart rate is outside the HR alarm limits, an alarm sounds. To disable the +5 $/$50 alarm, press appears to indicate that the alarm is disabled. Adjusting the ECG Size To increase or decrease the size of the ECG, press on the gain con- trol,...

  • Page 73: Troubleshooting

    Do not l Radio frequency inter- open the electrode pack- age until immediately ference (RFI) is causing prior to use. artifact. l Relocate or turn off equip- ment that may be causing RFI. M4735A Heartstream XL Defibrillator/Monitor 4-11...
  • Page 74 Troubleshooting Situation Cause Solution l No sound l Adjust the volume. QRS Volume l Too low l Check configurations. l Too loud l The QRS beeper is con- l Check that the QRS QRS beeper inau- dible or beeps do figured to Off.
  • Page 75 5 Monitoring SpO This chapter will provide information about: how pulse oximetry works selecting and applying the correct sensor monitoring SpO discontinuing SpO M4735A Heartstream XL Defibrillator/Monitor...

  • Page 76: Monitoring Spo2

    Introduction Introduction Pulse oximetry is a noninvasive method of continuously measuring oxygen saturation (SpO ) in arterial blood. The resultant SpO reading indicates the percentage of hemoglobin molecules in the arterial blood which are saturated with oxygen. SpO monitoring is one of the tools available to assist in assess- ing a patient’s cardiac and respiratory systems.

  • Page 77: Understanding Pulse Oximetry

    All of the light from the emitter must pass through the patient’s tissue. The sensor site should be free of vibration and excessive motion. Power cables should be kept away from the sensor cable and connec- tor. M4735A Heartstream XL Defibrillator/Monitor...

  • Page 78: Selecting A Sensor

    Selecting a Sensor Selecting a Sensor Table 5-1 shows the SpO sensors that may be used with the Heartstream XL. 7DEOH  $SSURYHG 6HQVRUV Sensor Type Patient Patient Size Ideal Site M1191A Reusable Adult > 50 kg Finger M1192A Reusable Small adult 15-50 kg Finger...

  • Page 79: Reusable Sensors

    Disposable sensors should be used only once and then discarded. They can be relocated to a different application site on the patient if the first location does not give the desired results. Disposable sensors must not be reused on differ- ent patients. M4735A Heartstream XL Defibrillator/Monitor...

  • Page 80: Applying The Sensor

    Applying the Sensor Applying the Sensor Follow the manufacturer’s directions for applying and using the sensor, mak- ing sure to observe any warnings or cautions. For the best results: Make sure the sensor is dry. If the patient is moving, secure the sensor cable loosely to the patient. Avoid excessive pressure at the sensor site;...

  • Page 81: Connecting The Sensor Cable

    1. Hold the connector with the flat side up so that the part number is visible. 2. Insert the connector into the receptacle and push until the blue portion of the connector is no longer visible. )LJXUH  &RQQHFWLQJ WKH 6HQVRU &DEOH M4735A Heartstream XL Defibrillator/Monitor...

  • Page 82: Monitoring

    Monitoring Monitoring To monitor SpO 1. If the Heartstream XL is not on, turn the Energy Select knob to AED On or Manual On. 2. Apply the appropriate sensor to the patient. 3. Make sure the sensor cable is connected to the Heartstream XL. 212)) 4.

  • Page 83: Setting Alarms

    SpO2 SpO2 LEAD HR ALARM ALARM SELECT ON/OFF Pads Pulse 78 Monitoring Rhythm Shocks: 3 00:00:49 ANALYZE PAUSE $/$50 Press to turn off the alarm. Refer to “Setting Alarms” if subse- !Ã quent alarms are desired. M4735A Heartstream XL Defibrillator/Monitor...

  • Page 84: Discontinuing Spo2 Monitoring

    Discontinuing SpO2 Monitoring Discontinuing SpO Monitoring 212)) To shut off SpO monitoring, press once. Nothing should appear $/$50 below the softkey. )LJXUH  6S2 0RQLWRULQJ 2II SpO2 LEAD HR ALARM SELECT ON/OFF Pads Monitoring Rhythm Shocks: 3 00:00:49 ANALYZE ANALYZE PAUSE Caring for Sensors Refer to the manufacturers instructions for care and cleaning of sensors.

  • Page 85: Troubleshooting

    RF interference, sor to site with less or optical interference. movement. Secure the sensor cable loosely to the patient Reduce sources of electrical, RFI, or optical interference. M4735A Heartstream XL Defibrillator/Monitor 5-11...
  • Page 86 Troubleshooting 7DEOH  7URXEOHVKRRWLQJ ZKHQ 0RQLWRULQJ 6S2 !Ã Problem or Message Possible Cause Corrective Action /LJKW ,QWHUI The level of ambient Cover sensor with an !Ã light is so high that the opaque material. sensor cannot obtain an Check sensor for dam- reading.
  • Page 87 Mode features such as synchronized cardioversion and pacing, see Chapter 7: Performing Synchronized Cardioversion and Chapter 8: Pacing (Optional). For information on storing, retrieving, and printing patient information acquired in Manual Mode, see Chapter 9: Storing, Retrieving, and Printing. M4735A Heartstream XL Defibrillator/Monitor...

  • Page 88: Defibrillating In Manual Mode

    Manual Mode Display Manual Mode Display The following figure (Figure 6-1) identifies the major elements for the Manual Mode display. Unlike the AED Mode display, Manual Mode gives you access to synchronized cardioversion and self-selected energy levels. )LJXUH  0DQXDO 0RGH 'LVSOD\ Sp02 SpO2 LEAD...

  • Page 89: Defibrillating In Manual Mode

    1. If needed, insert a Data Card (as described in “Using a Data Card (Optional)” on 2-13). 2. Turn the Energy Select knob to Manual On. 3. Remove paddles by simultaneously pulling them up and out of the holders. M4735A Heartstream XL Defibrillator/Monitor...
  • Page 90 Defibrillating in Manual Mode 4. Apply conductive matter. 127( Do apply conductive matter by rubbing paddles together. Improper usage will result in a "Paddles On" event that will be registered in the Event Summary and may damage paddles. 5. Apply paddles to patient’s chest, using the anterior-apex placement. 127( To optimize patient contact, adjust paddle pressure and placement.

  • Page 91: Using Multifunction Defib Electrode Pads

    3. If you are using multifunction electrode pads, apply as directed on the package. Use either the anterior-apex or anterior-posterior electrode placement, as appropriate. 4. Connect the pads to the pads patient cable, as shown in Figure 6-3. )LJXUH  &RQQHFWLQJ 3DGV WR WKH 3DWLHQW &DEOH M4735A Heartstream XL Defibrillator/Monitor...

  • Page 92: Defibrillation Procedure

    Defibrillating in Manual Mode Defibrillation Procedure Once you have prepared to defibrillate in Manual Mode, perform the follow- ing steps. 1. Select Energy To select the energy setting, move the Energy Select knob to the desired energy level as shown in Figure 6-4. Energy choices range from 2 to 200 joules, with the suggested level for adults being 150 joules.

  • Page 93: Charge

    Simply move the Energy Select knob to desired energy level as before. The defibrillator charges to the selected energy level automatically. :DLW XQWLO WKH FXUUHQW FKDUJH UHDFKHV WKH VHOHFWHG HQHUJ\ OHYHO EHIRUH UHDGMXVWLQJ :$51,1* WKH VHOHFWHG HQHUJ\ OHYHO M4735A Heartstream XL Defibrillator/Monitor...

  • Page 94: Shock

    Defibrillating in Manual Mode 3. Shock Confirm that a shock is still indicated. Make sure no one is touching the patient or anything connected to the patient. Call out loudly and clearly "Stand Clear!" 6+2&. If using pads paddles, press to deliver a shock to the patient.

  • Page 95: Entering Aed Mode

    Manual On to AED On. ECG and/or SpO2 monitoring are defaulted enabled in AED Mode. If these settings are still active, the alarms set in Manual Mode remain active when you switch to AED Mode. M4735A Heartstream XL Defibrillator/Monitor...
  • Page 96 Entering AED Mode 6-10 Defibrillating in Manual Mode...

  • Page 97: Performing Synchronized Cardioversion

    There are three ways to monitor ECG for synchronized cardioversion: multifunction defib electrode pads, 3- or 5-lead monitoring electrodes, or external paddles attached to the M4735A Heartstream XL You may also use an external Agilent or Hewlett Packard ECG monitor while performing synchronized cardioversion.

  • Page 98: Using Multifunction Defib Electrode Pads

    Using Multifunction Defib Electrode Pads Using Multifunction Defib Electrode Pads To prepare for synchronized cardioversion using multifunction defib electrode pads, perform the following steps: 1. If needed, insert a Data Card (as described in “Using a Data Card (Optional)” on 2-13). 2.

  • Page 99: Using 3 Or 5-Wire Ecg Leads

    4. Connect the ECG cable to the Heartstream XL. (See Figure 6-3.) 5. Press Sync On. /($' 6. Use to select the best lead that displays a large QRS complex. (See 6(/(&7 “Selecting the Lead” on page 4-7.) M4735A Heartstream XL Defibrillator/Monitor...

  • Page 100: Using External Paddles

    Using External Paddles Using External Paddles To prepare for synchronized cardioversion using external paddles, perform the following steps. 1. If needed, insert a Data Card (as described in “Using a Data Card (Optional)” on 2-13). 2. Apply monitoring electrodes, if desired. (See “Applying Monitoring Elec- trodes”...

  • Page 101: Delivering A Synchronized Shock

    )LJXUH  &KDUJLQJ LQ 6\QF 0RGH SpO2 SpO2 LEAD HR ALARM SELECT ON/OFF ALARM Pads 87 J Shocks:0 Sync 00:00:8 SYNC DISARM ON/OFF M4735A Heartstream XL Defibrillator/Monitor...
  • Page 102 Delivering a Synchronized Shock If desired, you may increase or decrease the selected energy level after &+$5*( pressing by moving the Energy Select knob until the desired energy level is displayed. The defibrillator charges to the modified energy level automatically. Wait until the current charge reaches the selected energy level before proceeding.

  • Page 103: Using External Ecg Monitors

    When the patient is already connected to the bedside monitoring equipment, there is an external monitoring cable which plugs into the ECG Output jack of the bedside monitor and connects to the M4735A Heartstream XL ECG Input for monitoring. To use an external monitor with the Heartstream XL, perform the following steps: 1.
  • Page 104 Disabling Sync Mode Performing Synchronized Cardioversion...

  • Page 105: Pacing (Optional)

    Paced pulses are delivered through multi- function defib electrode pads that are applied to the patient’s bare chest. This chapter explains the pacing option available with the Heartstream XL and describes how to perform pacing. M4735A Heartstream XL Defibrillator/Monitor...

  • Page 106: Pacing Operational Controls

    Pacing Operational Controls Pacing Operational Controls In Manual Mode, the following pacing operational controls are displayed on the handle of the Heartstream XL. )LJXUH  3DFLQJ &RQWUROV 0DQXDO 0RGH RQO\ Demand Mode Versus Fixed Mode The Heartstream XL can deliver paced pulses in either demand or fixed mode. In demand mode, the pacer only delivers paced pulses when the patient’s heart rate is lower than the selected pacing rate.

  • Page 107: Monitoring During Pacing

    2. Connect the pads to the patient cable. (See Figure 6-3.) 3. If needed, insert a Data Card (as described in “Using a Data Card (Optional)” on 2-13). 4. Turn the Energy Select knob to Manual On. M4735A Heartstream XL Defibrillator/Monitor...
  • Page 108 Preparing for Pacing In addition, for demand mode pacing: 1. Apply monitoring electrodes. (See “Applying Monitoring Electrodes” on page 4-4.) /($' 2. Use to select the best lead with an easily detectable R-wave (See 6(/(&7 “Selecting the Lead” on page 4-7.) If you do not select a lead (i.e. pads is the selected ECG source), /HDG , is automatically selected when the pacing function is turned on.

  • Page 109: Performing Pacing

    2. Verify that the dot markers appears near the middle of the QRS complexes of the ECG. If the dot markers do not appear, or are in the wrong location, adjust the ECG size or select another lead. (See “Monitoring the ECG” in Chapter 4.) M4735A Heartstream XL Defibrillator/Monitor...
  • Page 110 Performing Pacing 3. Press to change to fixed mode, if in demand mode or if R-wave Mode detection is unreliable. The pacing dialogue box displays the current mode. To switch back to demand mode, press again. Mode 4. Adjust the rate to the desired number of paced pulses per minute (ppm). Press up ( ) or down ( ), on...
  • Page 111 ECG monitoring electrodes connections. In either case, if a problem occurs a system message is displayed. 127( The pacing window remains on as long as the pacing function is enabled. M4735A Heartstream XL Defibrillator/Monitor...

  • Page 112: Changing Pacing Modes

    Changing Pacing Modes Changing Pacing Modes If paced pulses are being delivered, you must stop pacing before changing the pacing mode. For example: Start 1. Press to stop pacing. Stop 2. Press to change the Mode. Mode 3. Adjust the rate, if needed. Start 4.

  • Page 113: Troubleshooting

    .H\ ,QDFWLYH Make sure Manual Mode is Pacer , or one of the other active before pressing pacing function keys, is or one of the other Pacer pressed when Manual Mode is not active. pacing function keys. M4735A Heartstream XL Defibrillator/Monitor...
  • Page 114 Troubleshooting 8-10 Pacing (Optional)

  • Page 115: Storing, Retrieving & Printing

    This chapter describes how the Heartstream XL creates an Event Summary, or patient record, for later retrieval and printing. Marking events for storage in the Event Summary and printing individual events as they occur are also dis- cussed. M4735A Heartstream XL Defibrillator/Monitor...

  • Page 116: Overview

    To print an Event Summary stored on the Data Card, the information must first be downloaded to the Agilent Technologies CodeRunner Web data man- agement system. Refer to the CodeRunner Web User’s Guide for download instructions.

  • Page 117: Marking Events

     VHFRQG GHOD\, the strip is 9 seconds and includes 6 seconds pre- ceding the event and 3 seconds following the event. If 1R 'HOD\ is configured, a 3 second ECG strip prints in real time. To stop printing before the entire strip Strip is printed, press M4735A Heartstream XL Defibrillator/Monitor...

  • Page 118: Events Recorded

    Events Recorded Events Recorded The following events and related information are stored in the Event Sum- mary: 7DEOH  (YHQW ,QIRUPDWLRQ Event Types Related Information Stored Power Change Power on, Power off, Continued use, Battery low. Pads Change Pads on, Pads off. AED Mode Analysis Analyzing, Analysis Stopped, Artifact Detected, Cannot Analyze, Shock Advised,...
  • Page 119 SpO2 value and SpO2 alarm limit. Mark ECG waveform with annotation ( , Epi, Atro, Lido, or Other). Print Strip ECG waveform. Sync Sync on, Sync off, Sync pace marker. Pacing Pacer start, Pacer stop, Pacer settings. M4735A Heartstream XL Defibrillator/Monitor...

  • Page 120: Creating A Patient Record

    Creating a Patient Record Creating a Patient Record The Heartstream XL creates an Event Summary patient record for each new patient. Each record is assigned a unique incident number. The Heartstream XL keeps the Event Summary in its internal memory until you begin caring for a new patient.

  • Page 121: Printing The Internal Event Summary

    03 Jan 00 12:41:00 Analyzing 12:41:03 Shock Advised 12:41:11 Last Event 03 Jan 00 01:09:04 Shock #1 12:41:17 Analyzing 12:41:24 Total Shocks 2 Shock Advised 12:41:31 Incident: 0000045 Shock #2 12:41:38 Serial Number 123456789 Manual Mode 12:41:42 M4735A Heartstream XL Defibrillator/Monitor...
  • Page 122 Printing the Internal Event Summary The Event Summary also includes waveforms and the appropriate annotation for each of the following events: 7DEOH  (YHQW 6XPPDU\ ,QIRUPDWLRQ Event Waveform Information Stored Shock Advised 11 seconds of ECG just prior to the message 6KRFN $GYLVHG No Shock Advised 11 seconds of ECG just prior to the...

  • Page 123: Printing Events

    SpO2 or Heart Rate 6 seconds 6 seconds just prior to alarm viola- Alarm Violation tion, plus 6 seconds after alarm violation. 6 seconds 6 seconds just prior to marking, plus Mark pressed 6 seconds after button pressed. M4735A Heartstream XL Defibrillator/Monitor...
  • Page 124 Printing Events Printing is configured independently for each of these events. You can stop the printing before it has printed the entire strip by pressing Strip To print additional events that you observe in the course of caring for your patient, press Strip 127(...

  • Page 125: 10 Setting Up And Configuring The Heartstream Xl

    10 Setting Up and Configuring the Heartstream XL This chapter describes how to set-up and configure your Heartstream XL. Chapter 10 covers: Connecting Patient Cables Configuring the Heartstream XL M4735A Heartstream XL Defibrillator/Monitor 10-1...

  • Page 126: Connecting/Disconnecting Patient Cables

    Connecting/Disconnecting Patient Cables Connecting/Disconnecting Patient Cables This section describes how to connect and disconnect the: Pads/Paddles Patient Cable ECG Patient Cable (3- or 5-lead) SpO2 Patient Cable 10-2 Setting Up and Configuring the Heartstream XL...
  • Page 127 1. Align the white arrow on the patient cable with the white arrow on the defibrillator’s cable connector, as shown in Figure 10-1. 2. Insert the cable into the connector. Push until you hear it click in place. )LJXUH  $WWDFKLQJ WKH 3DWLHQW &DEOH IRU 3DGV DQG ([WHUQDO 3DGGOHV M4735A Heartstream XL Defibrillator/Monitor 10-3...
  • Page 128 Connecting/Disconnecting Patient Cables To disconnect the patient cable from the defibrillator: 1. Rotate the green locking mechanism on the cable in the direction of the green arrow (clockwise), until it stops (as shown in Figure 10-2). 2. Hold the locking mechanism in this position as you pull the cable out. )LJXUH  'LVFRQQHFWLQJ WKH 3DGV3DGGOHV 3DWLHQW &DEOH 10-4 Setting Up and Configuring the Heartstream XL...

  • Page 129: Spo2 Patient Cable

    2. Insert the connector into the receptacle and push until the blue portion of the connector is no longer visible. )LJXUH  &RQQHFWLQJ WKH 6S2 3DWLHQW &DEOH To disconnect the SpO patient cable, gently pull the connector out of the receptacle. M4735A Heartstream XL Defibrillator/Monitor 10-5...

  • Page 130: Ecg Patient Cable

    Connecting/Disconnecting Patient Cables ECG Patient Cable To connect a 3- or 5-lead ECG patient cable: 1. Align the keyed patient cable connector with the slot on the ECG receptacle, as shown in Figure 10-4. 2. Push the patient cable firmly into the ECG receptacle, until the white por- tion is no longer visible.

  • Page 131: Configuring The Heartstream Xl

    There is a special combination of softkeys that, when pressed simultaneously, turn the Heartstream XL on in Configuration Mode. For the purposes of executing this procedure, softkeys are assigned numbers as shown in Figure 10-5. )LJXUH  6RIWNH\ 1XPEHUV M4735A Heartstream XL Defibrillator/Monitor 10-7...

  • Page 132: Configurable Parameters

    Configuring the Heartstream XL To turn the Heartstream XL on in Configuration Mode: 1. If the device is already on, turn the Energy Select knob to Off. 2. While holding down softkeys 4 & 5, turn the Energy Select knob to AED On.
  • Page 133 Leads & Pads / displayed, if an internal pacemaker is Leads Only detected. (&* /HDG &DEOH Selects the monitoring electrodes source. 3-lead / 5-lead 456 %HHSHU Provides an audible beep with each QRS On / Off complex detected. M4735A Heartstream XL Defibrillator/Monitor 10-9...
  • Page 134 Configuring the Heartstream XL 7DEOH  $(' 6HWWLQJV Setting Parameter Description Choices $(' 6KRFN 6HULHV Defines the maximum number of shocks to 2, 3, 4 deliver before prompting &KHFN 3DWLHQW &KHFN 3XOVH ,I 1HHGHG %HJLQ &35. 6KRFN 6HULHV 7LPHU Defines the number of seconds that must pass 30, 60, 90, before the next shock is considered the first 120, 150, 180,...
  • Page 135 If (XURSHDQ 3URWRFRO is set to 2Q, the setting for the 6KRFN 6HULHV 7LPHU must be < 127( 3RVW 6KRFN &35 7LPHU < 16$ 7LPHU. Also, the 6KRFN 6HULHV 7LPHU can not be config- ured to either 2II or . M4735A Heartstream XL Defibrillator/Monitor 10-11...
  • Page 136 Configuring the Heartstream XL 7DEOH  0DQXDO 6HWWLQJV Parameter Description Choices 6\QF $IWHU 6KRFN Determines if the Sync function stays on On, Off after a synchronized shock is delivered. 'LVSOD\ 6KRFN Determines if the number of shocks On, Off &RXQWHU delivered appears on the display during an event.

  • Page 137: Modifying The Configuration

    Returning to the Default Configuration Press simultaneously, while in the main configuration menu, to return all settings to their default settings. Although there is no visi- ble change in the display, default settings are restored. M4735A Heartstream XL Defibrillator/Monitor 10-13...

  • Page 138: Saving Settings To A Data Card

    Configuring the Heartstream XL Saving Settings to a Data Card Configuration settings may be saved to a Data Card and used to load the same configuration into other Heartstream XLs or to restore the configuration, if necessary. To save the configuration: 1.

  • Page 139: 11 Maintaining The Heartstream Xl

    The battery maintenance procedures specified must be strictly adhered to in order to ensure that your batteries have the energy required to operate the defibrilla- tor and deliver the appropriate therapy. M4735A Heartstream XL Defibrillator/Monitor 11-1...

  • Page 140: Operational Checks

    Operational Checks Operational Checks The following operational checks are intended to quickly verify the viability of the Heartstream XL. Perform these checks regularly, at the intervals speci- fied, along with visual inspection of the device and all cables, controls, acces- sories and supplies.

  • Page 141: Using External Paddles

    2:07 (h:mm remaining) ___ AC Power Cord Defib Test: Pass/External Paddles ___ Printer Paper Pacer Test: Not tested ___ Data Card ___ Ancillary Supplies ___ SpO2 Sensor %H VXUH WR VDIHO\ GLVFKDUJH H[WHUQDO SDGGOHV :$51,1* M4735A Heartstream XL Defibrillator/Monitor 11-3...

  • Page 142: Using Pads

    Operational Checks Using Pads To perform the Shift/System Check using multifunction defib electrode pads: 1. Turn the Heartstream XL off. 2. Connect the M1781A 50 ohm test load to the pads patient cable (instead of pads). 3. If a Data Card is routinely used, insert a Data Card into the Heartstream XL.
  • Page 143 4. Remove the battery from the Heartstream XL and verify that the charging indicator on the front of the defibrillator/monitor is no longer lit. Replace the battery. Printer - make sure the printer: has sufficient paper prints properly M4735A Heartstream XL Defibrillator/Monitor 11-5...

  • Page 144: Battery Capacity Test

    Operational Checks Battery Capacity Test To perform a Battery Capacity Test: 1. Turn the Heartstream XL off. 2. Label the Heartstream XL to indicate to others that testing is in progress and the battery may not be used. 3. Insert a charged battery. Mark 4.

  • Page 145: Battery Maintenance

    After each use, or if the message /RZ Charge the battery %DWWHU\ is displayed. Perform a Battery Capacity Test At the time of purchase and every three months thereafter. Store the battery appropriately When not in use. M4735A Heartstream XL Defibrillator/Monitor 11-7...

  • Page 146: Recharging Batteries

    Battery Maintenance Recharging Batteries You may charge batteries while they are in either the Heartstream XL or the optional M4747A Battery Charger Kit. If the battery is being charged while in the defibrillator/monitor (with the Heartstream XL powered off) a discharged battery will typically be 90% charged after 3 hours (at 25 C), as indicated by the Batt Charge LED on the front panel turning from amber to green.

  • Page 147: Battery Capacity

    Properly dispose of batteries according to local regulations. 'R QRW GLVDVVHPEOH SXQFWXUH RU LQFLQHUDWH EDWWHULHV %H FDUHIXO QRW WR VKRUW WKH :$51,1* EDWWHU\ WHUPLQDOV EHFDXVH WKLV FRXOG UHVXOW LQ D ILUH KD]DUG M4735A Heartstream XL Defibrillator/Monitor 11-9...

  • Page 148: Loading Printer Paper

    Loading Printer Paper Loading Printer Paper To load printer paper: 1. Slide the printer door to the right until the paper roller pops up. 2. If there is an empty or low paper roll in the printer, pull up on the plastic removal tab to remove the roll.
  • Page 149 4. Pull the end of the paper past the paper roll. 5. Slide the printer door to the right and hold it open. Press the roller down over the paper and release the door. )LJXUH  /RDGLQJ 3DSHU M4735A Heartstream XL Defibrillator/Monitor 11-11...

  • Page 150: Cleaning Instructions

    Cleaning Instructions Cleaning Instructions Cleaning the Heartstream XL The following cleaning products may be used to clean the exterior surfaces of the Heartstream XL, as well as the battery and data card: Isopropyl alcohol (70% in water) Mild soap and water Chlorine bleach (3% in water) Quaternary ammonium compounds, such as Lysol (10% in water) When cleaning, be sure to avoid pouring fluids on the device and do not allow...

  • Page 151: Cleaning Paddles, Pads, Electrodes & Cables

    To clean the SpO sensor and cable, follow the manufacturer’s instructions. 127( For information about paddle sterilization procedures, see the M4741-91000 Agilent Technologies Sterilizable Paddles Owner’s Guide. M4735A Heartstream XL Defibrillator/Monitor 11-13...

  • Page 152: Supplies & Accessories

    Approved supplies and accessories for the Heartstream XL are listed in l. To order: In the USA, call 1-800-225-0230. Outside the USA, contact your local Agilent Technologies Sales Office, your authorized Agilent Technologies Dealer or Distributor, or visit our Medical Supplies website at: www.healthcare.agi- lent.com/mpgsupplies/.
  • Page 153 Sterilizable External Paddles M4746A External Paddles with PCI M17898 Adult Adapter (clips onto external paddle) Pads Cables M3507A Agilent Pad Connector Cable M3508A Heartstream Pad Connector Cable 05-10200 Heartstream Pads Adapter (DP2 & DP6), use with M3507A M4735A Heartstream XL Defibrillator/Monitor 11-15...
  • Page 154 Supplies & Accessories 7DEOH  8SJUDGHV 6XSSOLHV DQG $FFHVVRULHV Part Number Description ECG Cables M1500A 3-lead ECG Trunk Cable (AAMI) M1605A 3-lead ECG Lead Set with Snaps (AAMI) M1510A 3-lead ECG Trunk Cable (IEC) M1615A 3-lead ECG Lead Set (IEC) M1520A 5-lead ECG Trunk Cable (AAMI) M1625A...

  • Page 155: Disposing Of The Heartstream Xl

    Prior to disposing of the Heartstream XL, remove the battery. Then dispose of the device and its accessories in accordance with local regulations. 'LVSRVDO RI WKH GHYLFH ZLWK WKH EDWWHU\ LQVHUWHG SUHVHQWV D SRWHQWLDO VKRFN KD]DUG :$51,1* M4735A Heartstream XL Defibrillator/Monitor 11-17...
  • Page 156 Disposing of the Heartstream XL 11-18 Maintaining the Heartstream XL...

  • Page 157: 12 Troubleshooting

    In addition, this chapter provides general troubleshoot- ing tips and information on calling for service. 127( For instructions for repair or for further technical information, refer to the M4735-90900 Heartstream XL Service Manual. M4735A Heartstream XL Defibrillator/Monitor 12-1...

  • Page 158: System Messages

    System Messages System Messages System messages remain on the display until the specified action is taken or no longer relevant. Each new message displayed is accompanied by three beeps to alert you. Table 12-1 lists system messages. 7DEOH  6\VWHP 0HVVDJHV Message Description Corrective Action...
  • Page 159 1R 3DGGOHV &RQQHFWHG The paddles are not properly connected to Check that external paddles are con- the Heartstream XL. nected. M4735A Heartstream XL Defibrillator/Monitor 12-3...
  • Page 160 System Messages 7DEOH  6\VWHP 0HVVDJHV &RQWLQXHG Message Description Corrective Action 6S2 &DEOH 2II The SpO cable is not connected to the Attach the SpO cable to the Heartstream device. l Cover the sensor with an opaque 6S2 /LJKW ,QWHUI The level of ambient light is so high that the sensor cannot obtain an SpO reading...

  • Page 161: Momentary Messages

    Patient impedance is too high. properly. l Replace the pads, if necessary l Reload printer paper. &KHFN 3ULQWHU Printer paper is absent or jammed; the l Make sure the door is closed properly. printer door is not closed properly. M4735A Heartstream XL Defibrillator/Monitor 12-5...
  • Page 162 System Messages 7DEOH  &RQWLQXHG 0RPHQWDU\ 0HVVDJHV Message Possible Cause Corrective Action l The incident is more than 2 hours in l None. A new Data Card can not be 'DWD &DUG )XOO duration, causing the Data Card to fill. inserted during an incident. l An empty Data Card was not inserted l Use one Data Card per incident/ for the incident, causing the Data Card...

  • Page 163: Troubleshooting Tips

    Corrupt data card may prevent the unit Take the Data Card out replace it with will not power on. from powering on. new Data Card, if possible. Then, attempt to turn the Heartstream XL on. M4735A Heartstream XL Defibrillator/Monitor 12-7...

  • Page 164: Calling For Service

    Calling for Service Calling for Service For telephone assistance, call the Response Center nearest to you, or visit our website at: www.healthcare.agilent.com/mpgcsd/. United States of America Medical Response Center Tel: (800) 548-8833 Canada Eastern Region Central & Western Regions Tel: (800) 361-9790 Tel: (800) 268-1221 Other International Areas Australia...

  • Page 165: 13 Specifications & Safety

    13 Specifications & Safety This section provides: Specifications for the Heartstream XL Symbol definitions for symbols appearing on the Heartstream XL Clinical Performance Summary data Safety related information Electromagnetic compatibility information M4735A Heartstream XL Defibrillator/Monitor 13-1...

  • Page 166: Specifications

    Specifications Specifications Defibrillator Waveform: Biphasic Truncated Exponential. Waveform parameters adjusted as a function of patient impedance. Shock Delivery: Via multi-function defib electrode pads or paddles. Delivered Energy Accuracy: Charge Time: Less than 3 seconds to 200 Joules with a new, fully charged M3516A SLA battery pack at 25º...
  • Page 167 (if printing while in Sync mode) An audible beep sounds with each detected R-wave, while a tick mark on the monitor and printed strip indicate the discharge points. Synchronizer delay is less than 60 msec from peak R-wave to peak current of the defibrillation discharge. M4735A Heartstream XL Defibrillator/Monitor 13-3...
  • Page 168 Specifications AED Mode AED Energy Profile: Fixed energy (150 Joules). AED Shock Series: 2, 3, or 4 shocks per series. Shock Series Timer: off, 30, 60, 90, 120, 150, 180, or 210 seconds. Text and Voice Prompts: Extensive text/audible messages guide user through protocol. AED Controls: On, Off, Pause/Resume, Analyze/Stop Analysis, Shock, Lead Select, SpO2 On/Off, SpO2 Alarms, HR Alarms, ECG Gain, Vol- ume, Strip, Summary, Mark.

  • Page 169: Ecg Monitoring

    30 to 100, 60 to 140, 90 to 160, and 120 to 200 bpm. Hands Free Defibrillation Patient Cable Length: 7 ft (2.13 m). ECG Cable Length: 12 ft (3.7 m). Common Mode Rejection: Greater than 90 dB measured per AAMI standard for cardiac monitors (EC 13). M4735A Heartstream XL Defibrillator/Monitor 13-5...
  • Page 170 Specifications ECG Size: 2.5, 5, 10, 20, 40 mm/mV. Frequency Response: AC Line Filter: 60 Hz or 50 Hz. Pads ECG for Display: Monitor (.15-40 Hz) or EMS (1-30 Hz). Pads ECG for Printer: Monitor (.15-40 Hz) or EMS (1-30 Hz). Leads ECG for Display: Monitor (.15-40 Hz) or EMS (1-30 Hz).
  • Page 171 (specificity >95%) for adult defibrillation rhythms a. From Agilent Technologies ECG rhythm databases. b. American Heart Association (AHA) AED Task Force, Subcommittee on AED Safety & Efficacy. Automatic External Defibrillators for Public Access Use: Recommendations for Specifying and Reporting Arrhythmia Analysis Algorithm Performance, Incorporation of New Waveforms, and Enhancing Safety.

  • Page 172: Display

    Specifications Display Size: 115 mm x 86 mm Type: EL - Electroluminescent Resolution: 320 x 240 pixels Sweep Speed: 29 mm/s nominal (stationary trace; sweeping erase bar). Viewing Time: 4 seconds. Battery Type: 2 Ah, 12V, rechargeable, Sealed Lead Acid. Dimensions: 2.4"...

  • Page 173: Thermal Array Printer

    Vertical Stripe Boundaries/Pacer/Sync Tick Marks. Event Printing: Mark key automatically documents ECG and events during defibrillation episodes. The Mark key can annotate the event with one of the following labels: Epinephrine (Adrenaline), Atropine, Lidocaine, and Other. M4735A Heartstream XL Defibrillator/Monitor 13-9...

  • Page 174: Noninvasive Pacing

    Specifications Auto Printing: The printer can be configured to automatically print on Mark, Charge, Shock and Alarm. Delayed Printing: The printer can be configured to run real time or with a 6 second delay. Reports: The following can be printed: Event Summary, Configuration, Extended Self Test, System Log, Battery Capacity Test, Shift/System Check.

  • Page 175: Spo2 Pulse Oximetry

    Events can be marked with a Mark symbol and, if configured for drug annota- tion, the following labels can be added: Epinephrine (Adrenaline in U.K. & Australia), Atropine, Lidocaine, or Other. The Summary key on the front panel is used to print the internal Event Sum- mary. M4735A Heartstream XL Defibrillator/Monitor 13-11...

  • Page 176: Environmental

    Specifications Data Card Event Summary: The Data Card stores continuous ECG wave- forms and events on a Type II PCMCIA card, SanDisk SDP3B 8MB ATA FlashDisk. One 8MB card can store approximately 2 hours of continuous ECG waveforms and events. General Dimensions: 19.0 cm(H) x 37.6 cm(W) x 34.6 cm(L)
  • Page 177 Altitude: Operating: up to 15,000 ft. Storage: up to 15,000 ft. Shock: Agilent Technologies, Section 760 Class B1 Drop Test (200 G’s, < 3 msec pulse). Vibration: Agilent Technologies, Section 759 Class B1 Vibration. Water Resistance: Meets IEC 601-2-4, IPX0.

  • Page 178: Symbol Definitions

    Symbol Definitions Symbol Definitions The following table lists the meaning of each symbol shown on the Heartstream XL and the M3516A battery: 7DEOH  'HILEULOODWRU DQG %DWWHU\ 6\PEROV Symbol Definition Defibrillation Shock. Attention - See operating instructions in user’s guide. Input.
  • Page 179 Symbol Definitions 7DEOH  'HILEULOODWRU DQG %DWWHU\ 6\PEROV Symbol Definition Biphasic energy is being used. Must be recycled or disposed of properly. Unlock. Audio Speaker Protective earth ground. Alternating current. Dangerous voltage. M4735A Heartstream XL Defibrillator/Monitor 13-15...
  • Page 180 Symbol Definitions 7DEOH  $EEUHYLDWLRQV DQG $FURQ\PV Abbreviation/ Definition Acronym Alternating Current Automated External Defibrillator Electrocardiogram Pulse oximetry Batt Battery ECG Out Monitoring Signal from Defibrillator 13-16 Specifications & Safety...
  • Page 181 The following table lists the symbols that appear on the Heartstream XL ship- ping carton: 7DEOH  6KLSSLQJ &DUWRQ 6\PEROV Symbol Definition Atmospheric pressure range. Temperature range. Relative humidity range. Recyclable paper product. Fragile. Right side up. Do not get wet. M4735A Heartstream XL Defibrillator/Monitor 13-17...
  • Page 182 Symbol Definitions 7DEOH  6KLSSLQJ &DUWRQ 6\PEROV Symbol Definition Shelf life. Long-term storage conditions. Short-term transport storage. 13-18 Specifications & Safety...

  • Page 183: Clinical Performance Summary

    The 150J SMART Biphasic waveform defibrillated 98% of VF patients in the first series of three shocks or less, compared with 69% of patients treated with monophasic waveform shocks. Outcomes are summarized in Clinical SummaryTable 13-4: M4735A Heartstream XL Defibrillator/Monitor 13-19...

  • Page 184: Conclusion

    Clinical Performance Summary 7DEOH  &OLQLFDO 6XPPDU\ Biphasic Patients Monophasic Patients P Value Number/(Percent) Number/(Percent) (chi-square) Defibrillation Efficacy Single shock only 52/54 (96%) 36/61 (59%) <0.0001 <2 shocks 52/54 (96%) 39/61 (64%) <0.0001 <3 shocks 53/54 (98%) 42/61 (69%) <0.001 Patients Defibrillated 54/54 (100%) 49/58 (84%)

  • Page 185: Safety Considerations

    DVVHVV GDWD DFTXLUHG IURP SDGV LQ DQ DQWHULRUSRVWHULRU SRVLWLRQ 8VH RQO\ ZLUH $& SRZHU FRUGV ZLWK SURQJHG JURXQGHG SOXJV :$51,1* .HHS KDQGV DQG IHHW FOHDU RI SDGGOH HOHFWURGH HGJHV 8VH \RXU WKXPEV :$51,1* WR GHSUHVV WKH VKRFN EXWWRQV RQ WKH SDGGOH KDQGOH M4735A Heartstream XL Defibrillator/Monitor 13-21...
  • Page 186 Safety Considerations &$87,21 Conductive parts of electrodes and associated connectors for applied parts, including the neutral electrode, should not contact other conductive parts including earth. 'R QRW DOORZ PXOWLIXQFWLRQ GHILE HOHFWURGH SDGV WR WRXFK HDFK RWKHU RU WR WRXFK :$51,1* RWKHU (&* PRQLWRULQJ HOHFWURGHV OHDG ZLUHV GUHVVLQJV HWF &RQWDFW ZLWK PHWDO REMHFWV PD\ FDXVH HOHFWULFDO DUFLQJ DQG SDWLHQW VNLQ EXUQV GXULQJ GHILEULOODWLRQ DQG PD\ GLYHUW FXUUHQW DZD\ IURP WKH KHDUW...
  • Page 187 HQYLURQPHQWDO VSHFLILFDWLRQV FDQ UHVXOW LQ GHYLFH RU DFFHVVRU\ PDOIXQFWLRQ 0HGLFDO HOHFWULFDO HTXLSPHQW ZKLFK GRHV QRW LQFRUSRUDWH GHILEULOODWRU SURWHFWLRQ :$51,1* VKRXOG EH GLVFRQQHFWHG GXULQJ GHILEULOODWLRQ (OHFWULF VKRFN KD]DUGV H[LVW LQWHUQDOO\ 'R QRW UHPRYH DVVHPEO\ VFUHZV :$51,1* 5HIHU VHUYLFLQJ WR TXDOLILHG SHUVRQQHO M4735A Heartstream XL Defibrillator/Monitor 13-23...
  • Page 188 Safety Considerations &$87,21 This device has not been evaluated for use with electrosurgery equipment. 127( This device and accessories are not intended for home use. &$87,21 Do not discharge the defibrillator with the paddles shorted together. 3URSHUO\ GLVSRVH RI RU UHF\FOH GHSOHWHG EDWWHULHV DFFRUGLQJ WR ORFDO UHJXODWLRQV 'R :$51,1* QRW SXQFWXUH GLVDVVHPEOH RU LQFLQHUDWH EDWWHULHV :KHUH WKH LQWHJULW\ RI WKH H[WHUQDO SURWHFWLYH HDUWK FRQGXFWRU LV LQ GRXEW WKH...

  • Page 189: Electromagnetic Compatibility

    Electromagnetic Compatibility Electromagnetic Compatibility When using the M4735A Heartstream XL Defibrillator/Monitor, electromagnetic compatibility with surrounding devices should be assessed. A medical device can either generate or receive electromagnetic interference. Testing for electromagnetic compatibility EMC with and without the appropriate accessories has been performed according to the international standard for EMC for medical devices (IEC 60601-1-2).

  • Page 190: Reducing Electromagnetic Interference

    Electromagnetic Compatibility Reducing Electromagnetic Interference The M4735A Heartstream XL Defibrillator/Monitor and associated accessories are susceptible to interference from other RF energy sources and continuous, repetitive, power line bursts. Examples of other sources of RF interference are medical devices, cellular products, information technology equipment and radio/television transmission.

  • Page 191: Restrictions For Use

    The criteria used for degradation is not specified by the standard and may vary with the manufacturer. 127( For additional information about compliance with the EMC standards lease see the Declaration of Conformity Statement available at: http://www.healthcare.agilent.com/mpg-reginfo/conformity.html. M4735A Heartstream XL Defibrillator/Monitor 13-27...
  • Page 192 Electromagnetic Compatibility 13-28 Specifications & Safety...
  • Page 193 Index Alarms heart rate 4-6, 8-2 Accessories Batteries 1-3, 2-9 interruption of power arranging 10-5 charging 11-7 checking 11-4 checking 11-5 SpO2 monitoring 5-8 ordering 11-17, 13 inserting and symbols 11 AED Mode 3-1 removing 2-9 Analysis 3-8 configuring 3-4, 10-9 maintenance 11-7 AED Mode 3-8 CPR 3-12...
  • Page 194 Index Configuration 10-6 accessing menu 10-6 Cables Data Card 2-11 AED Mode 3-4 checking 11-4 downloading and Automatic Re- cleaning 11-13 erasing analysis 3-4 connecting 2-2, 3-6 information 9-1 default 10-14 ECG 10-3 inserting and Device Initiated ordering 11-18 removing 2-11 Analysis 3-4 Pads 3-6, 10-2 ordering 11-19...
  • Page 195 Index Display ECG monitoring 4-1 European Protocol 10-11 AED Mode 2-7 controls 2-3 Event Summary 9-1 controls 2-2 electrodes 4-2, 10-9 events recorded 9-3 layout 2-5 events recorded 9-3 information included Manual Mode 2-8 heart rate alarm 4-6 specifications 13-5 leads 4-5 interruption of power troubleshooting 12-7...
  • Page 196 Index Heartstream XL 1-2 Manual Mode 6-1 assessment of 1-4 controls 2-2, 2-4 Key Inactive message 3- cleaning 11-11 current charge 6-4 18, 8-7, 12-6 configuring 10-6 defibrillation process controls 2-2 Leads operational checks 11- delivering shock 6-5 formation 4-3 2, 11-3 display 2-5, 2-8 Lead Select setting...
  • Page 197 Index Monitoring electrodes. Pacemakers Pads Cable Off message See Electrodes AED therapy 1-5 3-18, 12-3 Monitoring Rhythm. See heart rate alarm 4-6 Pads cables Rhythm Monitoring Pacing 8-1 cleaning 11-13 Multifunction defib defibrillation 8-6 connecting 10-2 electrode pads. See defined 1-6, 8-1 ordering 11-18 Pads demand v.
  • Page 198 Index Precautions 13 Printer paper RF interference 16 asystole 1-6 loading 11-9 Rhythm Monitoring 3-4, batteries 11-8 ordering 11-17 3-14 defibrillation current specifications 13-9 AED Mode 3-8 (shock) 3-10 troubleshooting 12-5 configuring 3-14, 10- ECG analysis 3-9 Printing electrodes 4-2 controls 2-3 events recorded 9-3 electromagnetic...
  • Page 199 Index Shock SpO2 Light Interf Supplies AED Mode 3-9 message 5-11 checking 11-4 events recorded 9-3 SpO2 Low Signal ordering 11-17 settings 10-10 message 5-10 Symbols, list of 10 troubleshooting 3-18, SpO2 monitoring 5-1 Sync After Shock setting 12-5 cable connection 5-6 10-12 Shock Series Timer 10-10 controls 2-3...
  • Page 200 Index Training materials 1-8 Training required 1-4, 13 Troubleshooting 12-1 AED Mode 3-18 Data Card 12-6 display 12-7 ECG monitoring 4-7 pacing 8-5, 8-7, 12-3, 12-6 SpO2 monitoring 5- 10, 12-4 time and date 12-7 User messages 2-7 Ventricular fibrillation manual defibrillation pacing 1-7 Ventricular tachycardia 1-...
  • Page 202 &RS\ULJKW ‹  (GLWLRQ  $JLOHQW 7HFKQRORJLHV ,QF 0 3ULQWHG LQ WKH 86$ 6HSWHPEHU ...

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