Guide Quick Reference
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Page 1
Pediatric Use Guide - Quick Reference Refer to the FORE-SIGHT ELITE® User Manual and Sensor Directions for Use for complete instructions, warnings, and cautions.
The Numeric Area (Figure 1) a. S ensor Location: identifies the sensor location being monitored. Touch the location icon to change the setting. b. StO2 Reading: displays the current %StO2 level in the location being monitored. c. Channel High/Low Alarm Limits: displays the upper and lower StO2 limits outside which an alarm will be activated. d. StO2 Reference Value: this value appears 30 seconds after the start of monitoring and can be updated through the Data Menu. e. TPI Indicator: displays the Tissue Perfusion Index (TPI), an indicator of hemoglobin concentration under the sensor. f. Message Area: displays any alarm or system messages specific to that channel. Begin Monitoring a Patient 1. Turn the monitor ON. 2. Connect the preamp cable(s) into the port. 3. Select the appropriate sensor (see page 2) and apply it to the patient. 4. Select the corresponding Patient Mode 5. Verify the correct body location is enabled on each channel. 6. Connect the sensor to the preamp cable.
C onfigure the Sensor Body Location and Alarms
1 c
90 50
d
Ref
A
72
68
b e f
Stool Interference High
Figure 1
Setup Ch
Loc
Alarm Limits
1
High
Low
2
High
Low
3
High
Low
4
High
Low
90%
50%
90%
R
Right
Left
50%
90%
50%
90%
50%
Ch 1 High _
_
(55 - 98)
1 2 3 4 5 6 7 8 9 0
Figure 2
1. Touch the StO2 reading in the numeric area (Figure 1) to access the Patient Setup screen. 2. Touch the Body icon or High/Low limit to make your selection (Figure 2).
How to Select the Patient Mode T ouch the Patient Mode icon (Figure 3) at the top of the display area to select the appropriate patient mode.
a
Figure 3
FORE-SIGHT ELITE • Pediatric Use Guide - 1 of 4
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Selecting the Appropriate Sensor When selecting a sensor, stay within the Indications for Use for the corresponding patient weight. Small: cerebral - pediatric patients < 8 kg; non-cerebral - pediatric patients < 5 kg
Non Adhesive Small: cerebral - pediatric patients < 8 kg; non-cerebral - pediatric patients < 5 kg
Medium: cerebral and non-cerebral - pediatric patients ≥ 3 kg
Large: cerebral and non-cerebral - adults and transitional adolescents ≥ 40 kg
ote: The monitor will prompt the user to switch the patient mode if a sensor is connected that N conflicts with the current patient mode.
Special Focus Pediatric and neonatal sensor selection for 3 – 8 kg pediatric patients
For Cerebral Use T he selection of the sensor size for patients between 3 kg and 8 kg is determined by the available forehead space. • If there is enough space on the forehead, two medium sensors should be used. • If there is not enough space to accommodate two medium sensors, use two small sensors. - In some cases, such as severe edema, it may be preferable to use one medium sensor to take advantage of the greater depth of penetration. • If there is not enough space to accommodate two small sensors, use one medium sensor. • Patients between 5 kg and 8 kg should always use medium sensors. • Patients between 3 kg and 5 kg should use medium sensors. Small sensors can be used if the medium sensors are too large for the desired anatomic location. FORE-SIGHT ELITE • Pediatric Use Guide - 2 of 4
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For Non-Cerebral Use
small
um
Skin Check Assessment 1. L ift the sensor to assess the skin under the sensor at least every 12 hours, or more often as required by the institution’s protocol. 2. Move the sensor to a different site if there is a circulatory condition or the skin integrity has deteriorated. 3. Replace the sensor if the adhesion small is inadequate. 4. F or patients with low blood pressure and/or very immature or fragile skin: • Perform first skin check in 4 hours; if skin remains intact under sensor, then extend to 6 hours or more as needed.
The monitor displays a message to remind the user to verify the skin integrity under the sensor (Figure 4). The reminder can be set to appear every 2, 4, 6, 8, and 12 hours. Attention Inspect sensor site to verify skin integrity relocate sensor if necessary
Figure 4 ote: Do not attach the sensor to skin with N unapproved devices, such as head bands, hats, < 8 kg wraps, etc. Avoid putting pressure over sensor. small small
Applying the Sensors to the Patient 1. Remove the sensor from the package. kg <<88kg Carefully inspect the sensor for damage. Discard and replace if damage is found. 2. Select appropriate sensor location on the medium small Figure 5 Figure 6 monitor. small 3. Clean and dry the sensor site (Figure 5). Small Sensor Medium Sensor 4. Remove the protective liner from the kg < 8 kg <≥53kg sensor (Figure 6). [Not applicable for small< 5 kg <8 kg < 8 kg < 5 kg < 8 kg < 5 kg non-adhesive sensor]. 5. Apply the sensor to the patient: cerebral use medium medium (Figure 7) and non-cerebral use (Figure 8)*. Figure 7 Do not apply the sensor over hair, air Small Sensor sinuses, hematomas, birthmarks, places with < 8broken kg < 5 kg externally applied coloring, or skin. kg ≥≥33kg Note: You may use Tegaderm™ or Mepitel Film®
< 8 between kg 5 kgskin in patients with the sensor<and
delicate skin. Using when edema is present may result in poor signal quality and error messages. medium
na small
medium 6. Insert the sensor straight into the preamp Medium Sensor connector until it snaps into place (Figure ≥ 3 kg ≥ 3 kg ≥ 3 kg 9). Use the bedsheet clip on the preamp 3 kg ≥ 3 kg ≥cable 3 kg and prevent cable to secure≥the ≥ 3 kg pulling on the sensor. medium 7. If needed, fold the sensor’s flat cable to nasmall small na route the sensor connector in the desired direction (Figure 9 arrows). ≥ 3 kg 8. Lift the sensor to assess≥ the skin under Figure 8 ≥ 3 kg3 kg ≥ 3 kg the sensor at least every 12 hours, or more often as required by the institution’s protocol. Move the sensor to a different site if circulatory condition or the skin Figure 9 integrity has deteriorated. all
na small
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*Refer to the non-adhesive small sensor Directions for Use for additional instructions, warnings, and cautions.
FORE-SIGHT ELITE • Pediatric Use Guide - 3 of 4
≥ 3 kg
Recommended Sensor Placement for Cerebral Monitoring
Providing there is sufficient space on the forehead, it is recommended to use two of the largest sensors, within the Indications for Use, for the corresponding patient weight, symmetrically placed on the left and right side of the forehead (using the midline as a reference), as close to the hairline as possible.
Optimal Sensor Placements for Non-Cerebral Monitoring
Abdomen: Horizontally (perpendicular to the spine) Most commonly placed just below the belly button when used to monitor the oxygenation of the tissue over the intestines. This position allows the user to avoid the liver (right upper abdomen) and bladder (immediate suprapubic) area. Flank: Either horizontally or vertically (at clinician’s discretion) Most commonly used to detect the oxygenation of tissue near the kidneys. Neither the light source nor the far detector should be higher than the lowest rib, as air from the lungs could impair the readings. a. O ption 1: Horizontal (perpendicular to spine) – placed on either side of the spine. This placement offers some ease of use for cable management and patient comfort. b. Option 2: Vertical (parallel to spine) – placed on either side of the spine. This placement follows the vertical orientation of the kidneys. The left back is preferred to avoid monitoring over the liver region. Route the lead and connector beyond the side of the patient to avoid pressure-induced skin injury.
Message
Condition
Recommended Action
High Ambient Light
External high intensity light is interfering with the sensor’s detection.
Verify sensor is well-adhered to the patient’s skin. If present, move external light source away from sensor site. Cover the sensor with opaque material.
Sensor over Temp
Internal sensor temperature is > 45ºC; the sensor will deactivate, so StO2 is not displayed.
Determine source of extraneous heat. If present, move external heat source away from sensor site.
Tissue under sensor may have birth marks, edema, hematoma, scar tissue, low perfusion. TPI symbol may show one or no bar.
Verify sensor is well-adhered to the patient’s skin. Move sensor to a location where TPI is 3 or 4 bars. Remove sensor until tissue condition (edema) returns to normal.
Stool Interference High
The sensor is interrogating primarily stool.
This condition may be transient while stool moves through the bowel. If persistent, move the sensor to a new location.
Incorrect Sensor Size
The sensor is incompatible with the body location or patient mode.
Change either the body location, patient mode or sensor size.
Signal out of Range Check under Sensor
FORE-SIGHT ELITE and are registered trademarks and The confidence of knowing is a trademark of CAS Medical Systems, Inc. Mepitel Film and Tegaderm are registered mark and trademark of their respective companies.
FORE-SIGHT ELITE • Pediatric Use Guide - 4 of 4
44 East Industrial Rd., Branford, CT 06405 USA 203.488.6056 • 800.227.4414 • fore-sight.com
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System Messages