Clinical Reference Manual
210 Pages
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GE Healthcare
CARESCAPE Monitor B650 Clinical Reference Manual
CARESCAPE Monitor B650 International English M1207464 (CD) M1119627 (paper) 2nd edition © 2010 General Electric Company All rights reserved.
NOTE: Due to continuing product innovation, information in this manual is subject to change without notice.
Trademarks DINAMAP, IntelliRate, MUSE, TRAM, Tram-Net, Tram-Rac, Trim Knob, Aqua-Knot, Quantitative Sentinel, Unity Network, Multi-Link, 12RL, 12SL, CIC Pro, and EK-Pro are trademarks of GE Medical Systems Information Technologies, Inc. S/5, D-lite, D-lite+, Pedi-lite, Pedi-lite+, D-fend, D-fend+, Mini D-fend, Entropy, Patient O2, and Patient Spirometry are trademarks of GE Healthcare Finland Oy. Datex, Ohmeda, and OxyTip+ are trademarks of GE Healthcare Finland Oy and Datex-Ohmeda, Inc. iPanel is a trademark of GE Healthcare Finland Oy and GE Medical Systems Information Technologies, Inc. CARESCAPE is a trademark of General Electric Company.
Third party trademarks Masimo SET is a trademark of Masimo Corporation. Nellcor is a trademark of Nellcor Puritan Bennett, Inc.
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Contents 1
Introduction...1- 1 About this manual... 1-2 Intended use of this manual... 1-2 Conventions used in this manual... 1-2 Module naming conventions... 1-3 Printed copies of this manual... 1-3 Related documents... 1-4 Revision history... 1-4 About this device... 1-4 Training requirements... 1-4 Safety precautions... 1-5 Safety message signal words... 1-5
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Electrocardiography (ECG)...2- 1 ECG safety precautions... 2-2 ECG warnings... 2-2 Arrhythmia detection warnings... 2-3 Pacemaker detection warnings... 2-4 ECG cautions... 2-4 ECG measurement limitations... 2-5 ECG measurement limitations... 2-5 Arrhythmia measurement limitations... 2-5 ST detection measurement limitations... 2-5 QT/QTc measurement limitations... 2-5 Intended use... 2-6 Intended use of 12RL Interpolated 12 lead ECG analysis... 2-6 Intended use of 12SL analysis program... 2-6 Intended use of ACI-TIPI... 2-7 ECG clinical implications... 2-7 Basics of ECG measurement... 2-7 ECG measurement description... 2-7 Arrhythmia detection... 2-7 Arrhythmia alarm messages... 2-8 ST detection... 2-10 Ischemic burden... 2-10 ECG parameters... 2-11 ECG practicalities... 2-11 Selecting an alternate pulse rate source... 2-11
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PDM modules... 2-11 E-modules... 2-11 Using the 12 lead ECG analysis program... 2-12 Using the 12RL analysis program... 2-14 Points to note... 2-15 ECG points to note... 2-15 Pacemaker detection points to note... 2-16 ST detection points to note... 2-16 12 lead ECG analysis points to note... 2-16 Advanced ECG troubleshooting... 2-17
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Impedance respiration...3- 1 Respiration safety precautions... 3-2 Respiration warnings... 3-2 Respiration cautions... 3-2 Respiration measurement limitations... 3-3 Basics of respiration measurement... 3-3 Respiration measurement description... 3-3 How to interpret the respiration values... 3-3 Respiration practicalities... 3-4 Respiration lead placement... 3-4 Cardiac artifact alarm... 3-5 Apnea alarm... 3-5 Respiration relearning... 3-5 Managing sources of respiration interference... 3-6 Respiration points to note... 3-6 Advanced respiration troubleshooting... 3-7
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Pulse oximetry (SpO2) monitoring...4- 1 SpO2 warnings... 4-2 SpO2 measurement limitations... 4-4 SpO2 measurement guidelines... 4-4 Masimo SET technology and sensor measurement guidelines... 4-4 Nellcor OxiMax technology and sensor measurement guidelines... 4-5 GE Ohmeda technology and sensor measurement guidelines... 4-6 SpO2 measurement description... 4-6 How to interpret the SpO2 values... 4-7 Signal strength... 4-7 Waveform quality... 4-7
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Waveform stability... 4-7 SpO2 points to note... 4-8 SpO2 calculations... 4-8 Nellcor OxiMax Sat-Seconds alarm management... 4-8 Hemoglobin saturation calculation... 4-10 Additional information... 4-10 Displayed saturation values... 4-10 Interference... 4-10 Data update and averaging... 4-11 Nellcor OxiMax data averaging and updating... 4-11 Masimo SET data averaging and updating... 4-11 SpO2 functional testers... 4-12 Advanced SpO2 troubleshooting... 4-12
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Non-invasive blood pressure (NIBP)...5- 1 NIBP safety precautions... 5-2 NIBP warnings... 5-2 NIBP cautions... 5-3 NIBP measurement limitations... 5-3 NIBP clinical implications... 5-3 NIBP measurement description... 5-3 NIBP practicalities... 5-5 Selecting and placing NIBP cuffs... 5-5 NIBP measurement technologies... 5-5 PDM modules... 5-7 E-modules... 5-8 Automatic cycling measurement modes... 5-9 Time progress bar... 5-9 NIBP Auto mode... 5-9 STAT mode... 5-9 Venous Stasis mode... 5-9 Clock sync timing... 5-10 NIBP points to note... 5-10 Checking NIBP calibration... 5-10 Advanced NIBP troubleshooting... 5-11
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Invasive blood pressures...6- 1 Invasive blood pressures safety precautions... 6-2 Invasive blood pressures warnings... 6-2 Invasive blood pressures measurement limitations... 6-2
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Invasive blood pressures clinical implications... 6-2 Invasive blood pressures parameters... 6-2 Invasive blood pressures practicalities... 6-3 Zeroing invasive blood pressure transducers... 6-3 Invasive blood pressure waveform cursor... 6-4 Smart BP algorithm... 6-4 Arterial invasive blood pressure disconnect alarm... 6-4 PA catheter insertion... 6-4 Pulmonary capillary wedge pressure (PCWP) measurement... 6-4 Intra-aortic balloon pump (IABP)... 6-5 Triggering IABPs... 6-5 Effects of IABP on displayed values... 6-6 Invasive blood pressures points to note... 6-8 Invasive blood pressures calibration...6-8 Invasive blood pressures calculations... 6-8 Advanced invasive blood pressures troubleshooting... 6-9
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Temperature...7- 1 Temperature safety precautions... 7-2 Temperature warning... 7-2 Temperature caution... 7-2 Temperature clinical implications... 7-2 Temperature measurement limitations... 7-2 Temperature measurement description... 7-2 Temperature practicalities... 7-3 Temperature points to note... 7-3
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Cardiac output (C.O.)...8- 1 C.O. safety precautions... 8-2 C.O. warnings... 8-2 C.O. caution... 8-2 C.O. measurement limitations... 8-2 Basics of C.O. measurement... 8-2 Performing C.O. trials... 8-2 Cardiac output washout curve... 8-2 C.O. practicalities... 8-3 Improving C.O. accuracy... 8-3 C.O. points to note... 8-4
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C.O. calculations... 8-4 Advanced C.O. troubleshooting... 8-5
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Mixed venous oxygen saturation (SvO2)...9- 1 SvO2 safety precautions... 9-2 SvO2 warnings... 9-2 SvO2 measurement limitations... 9-2 SvO2 clinical implications... 9-2 SvO2 measurement description... 9-3 How to interpret the SvO2 values... 9-3 SvO2 points to note... 9-3
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Airway gases...10- 1 Airway gases measurement with compact airway modules... 10-2 Airway gases safety precautions... 10-2 Airway gases warnings... 10-2 Airway gases cautions... 10-2 Airway gases measurement limitations... 10-3 Airway gases clinical implications... 10-3 Basics of airway gases measurement... 10-3 Airway gases measurement description... 10-3 Sidestream gas sampling... 10-4 Airway gases parameters... 10-4 MAC values... 10-5 ET balance gas... 10-7 Automatic agent identification with E-CAiO, E-CAiOV and E-CAiOVX modules 10-7 Airway gases calculations... 10-8 How to interpret the airway gases values... 10-8 Interpreting capnogram... 10-8 Interpreting oxygen measurement... 10-10 Airway gases practicalities... 10-11 Ventilation management... 10-11 Preventing breathing system contamination... 10-11 Preventing effects of humidity... 10-11 Oxygen delivery... 10-12 Level of anesthesia... 10-12 Airway gases points to note... 10-13 Airway gases calibration... 10-13 CO2 unit conversions... 10-14 Advanced airway gases troubleshooting... 10-14 CO2 measurement with E-miniC... 10-15 CO2 safety precautions... 10-15
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CO2 warnings... 10-15 CO2 cautions... 10-15 CO2 measurement limitations... 10-15 CO2 clinical implications... 10-16 Basics of CO2 measurement... 10-16 CO2 measurement description... 10-16 Sidestream gas sampling... 10-16 E-miniC parameters... 10-17 How to interpret the CO2 values... 10-18 Interpreting capnogram... 10-18 CO2 practicalities... 10-20 Ventilation management... 10-20 Preventing breathing system contamination... 10-20 Preventing effects of humidity... 10-20 CO2 points to note... 10-21 CO2 calibration... 10-21 CO2 unit conversions... 10-21 Advanced CO2 troubleshooting... 10-22
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Patient Spirometry...11- 1 Patient Spirometry safety precautions... 11-2 Patient Spirometry warnings... 11-2 Patient Spirometry cautions... 11-2 Patient Spirometry measurement limitations... 11-2 Patient Spirometry clinical implications... 11-2 Basics of Patient Spirometry measurement... 11-3 Patient Spirometry measurement description... 11-3 D-lite(+)/Pedi-lite(+) flow sensor... 11-3 Patient Spirometry parameters... 11-4 Airway pressures... 11-5 I:E ratio... 11-7 Compliance... 11-8 Airway resistance (Raw)... 11-9 Patient Spirometry loops and waveforms... 11-9 Paw-Vol loop phases... 11-9 Flow-Vol loop phases... 11-10 How to interpret the Patient Spirometry values... 11-10 Normal Paw-Vol loop... 11-11 Typical pediatric loop... 11-11 Normal Flow-Vol loop... 11-12 Patient Spirometry practicalities... 11-12 Patient Spirometry points to note... 11-12 Patient Spirometry calculations... 11-13 Airway pressures... 11-13 Airway flow... 11-13 Compliance... 11-13 Airway resistance... 11-14
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Advanced Patient Spirometry troubleshooting... 11-14
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Gas exchange...12- 1 Gas exchange safety precautions... 12-2 Gas exchange warnings... 12-2 Gas exchange measurement limitations... 12-2 Gas exchange clinical implications... 12-3 Basics of gas exchange measurement... 12-3 Gas exchange measurement description... 12-3 How to interpret the gas exchange values... 12-4 Oxygen consumption (VO2)... 12-4 Carbon dioxide production (VCO2)... 12-5 Respiratory quotient... 12-5 Energy expenditure... 12-6 Gas exchange practicalities... 12-6 Gas exchange points to note... 12-8 Gas exchange calculations... 12-8 Advanced gas exchange troubleshooting... 12-10
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Entropy...13- 1 Entropy safety precautions... 13-2 Entropy warnings... 13-2 Entropy cautions... 13-2 Entropy measurement limitations... 13-2 Entropy clinical implications... 13-3 Basics of Entropy measurement... 13-4 Entropy indications for use... 13-4 Entropy measurement description... 13-4 Entropy parameters... 13-4 Frequency and display ranges... 13-5 How to interpret the Entropy values... 13-5 Relation of Entropy values to EEG and patient status... 13-6 Entropy range guidelines... 13-6 Entropy in typical general anesthesia... 13-7 Burst suppression ratio (BSR)... 13-7 Entropy practicalities... 13-7 Entropy points to note... 13-8
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Entropy calculations... 13-8 Entropy reference studies... 13-8 Advanced Entropy troubleshooting... 13-10
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Neuromuscular transmission (NMT)...14- 1 NMT safety precautions... 14-2 NMT warnings... 14-2 NMT cautions... 14-2 NMT measurement limitations... 14-2 NMT clinical implications... 14-3 Basics of NMT measurement... 14-3 NMT measurement description... 14-3 NMT sensors... 14-4 MechanoSensor and kinemyography (KMG)... 14-4 ElectroSensor and electromyography (EMG)... 14-4 Stimulation modes... 14-4 How to interpret the NMT values... 14-4 Train of four (TOF) mode... 14-4 Double burst stimulation (DBS) mode... 14-5 Post tetanic count (PTC) mode... 14-5 Single twitch (ST) mode... 14-5 Alternative uses... 14-6 Regional block... 14-6 NMT practicalities... 14-7 NMT points to note... 14-7 Advanced NMT troubleshooting... 14-8
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EEG and auditory evoked potentials...15- 1 EEG safety precautions... 15-2 EEG warnings... 15-2 EEG cautions... 15-2 EEG measurement limitations... 15-2 EEG clinical implications... 15-2 Basics of EEG measurement... 15-3 EEG measurement description... 15-3 EEG frequency bands... 15-4 Compressed spectral array (CSA)... 15-5 How to interpret the EEG values... 15-5
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What to look for in EEG... 15-6 Normal EEG frequencies... 15-6 Abnormal EEG characteristics... 15-6 EEG reactivity... 15-6 Examples of typical EEG patterns... 15-6 Technical artifact and EEG... 15-7 Monitoring auditory evoked potentials (AEP)... 15-10 Main peak categories... 15-10 Examples of typical AEP patterns... 15-11 Frontal EMG measurement... 15-11 EEG practicalities... 15-12 EEG points to note... 15-12 Advanced EEG troubleshooting... 15-12
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Bispectral Index (BIS)...16- 1 BIS safety precautions... 16-2 BIS warnings... 16-2 BIS cautions... 16-2 BIS measurement limitations... 16-3 BIS indications for use... 16-3 Basics of BIS measurement... 16-3 BIS measurement description... 16-3 How to interpret the BIS values... 16-4 BIS practicalities... 16-5 BIS points to note... 16-5 BIS calculations... 16-5 Advanced BIS troubleshooting... 16-5
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Calculations and laboratory data...17- 1 Drug calculations... 17-2 Resuscitation medications... 17-3 Laboratory data... 17-4 Calculations... 17-4 Hemodynamic calculations... 17-4 Input parameters... 17-4 Calculated parameters... 17-5 Oxygenation calculations... 17-6
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Input parameters... 17-6 Calculated parameters... 17-8 Ventilation calculations... 17-9 Input parameters... 17-10 Calculated parameters... 17-10
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Abbreviations... A-1 Abbreviations...A-2
B
Glossary... B-1 Glossary...B-2
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Introduction
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About this manual Intended use of this manual This manual is intended for clinical professionals. Clinical professionals are expected to have a working knowledge of medical procedures, practices and terminology, as required for the monitoring of all patients. This manual must be used in conjunction with the user’s manual for important safety information and detailed instructions for clinical use of this product.
Conventions used in this manual Within this manual, special styles and formats are used to distinguish between terms viewed on screen, a button you must press, or a list of menu commands you must select:
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For technical documentation purposes, the abbreviation GE is used for the legal entity names, GE Medical Systems Information Technologies, Inc. and GE Healthcare Finland Oy.
Menu items are written in bold italic typeface: ECG.
Menu options or control settings selected consecutively are separated by the > symbol: ECG > Alarms.
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Module naming conventions In this manual, the following naming conventions are used to refer to different modules and module categories:
PDM: CARESCAPE Patient Data Module
PSM: Patient Side Module: E-PSM and E-PSMP
E-modules: all modules with prefix 'E-'
M-modules: all modules with prefix 'M-'
Hemodynamic E-modules: E-PRESTN, E-PRETN, E-RESTN
Cardiac Output and SvO2 E-modules: E-COP, E-COPSv
Pressure E-modules: E-P, E-PP, E-PT
Compact airway modules: E-CO, E-COV, E-COVX, E-CAiO, E-CAiOV, E-CAiOVX
Single-width airway module: E-miniC
Specialty E-modules: E-NMT, E-EEG, E-BIS and E-ENTROPY
SpO2 E-modules: E-NSATX, E-MASIMO
For more information, see the user’s manual or compatible devices document.
Printed copies of this manual Further paper copies of this manual will be provided upon request. Contact your local GE representative and request the part number on the first page of the manual.
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Related documents This manual is intended to be used in conjunction with the following manuals:
CARESCAPE Monitor B650 User's Manual
CARESCAPE Monitor B650 Technical Manual
Module Frames and Modules Technical Manual
CARESCAPE Monitor B650 Supplemental Information Manual
CARESCAPE Monitor B650 Supplies and Accessories
CARESCAPE Monitor B650 Skills Checklist
Marquette 12SL ECG Analysis Program Physician's Guide
Mounting Reference Guide
Displays User’s Manual. See this manual for additional safety, compliance classifications, technical specifications, and installation information for the D15K and D19T displays.
Unity Network Interfacing Device (ID) Operator's Manual
iCentral and iCentral Client User's Reference Manual
CIC Pro Clinical Information Center Operator’s Manual
Revision history Revision
Comments
1st edition
Initial release of this manual.
2nd edition
Updates before release.
About this device Refer to the user’s manual for important information about this device, including intended use of this device, important safety information and detailed instructions for clinical use of this product.
Training requirements No product-specific training is required for the use of this monitor.
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Safety precautions Refer to the user’s manual for important system safety messages. Safety messages specific to parts of the system are found in the relevant section. Read all the safety information before using the monitor for the first time.
Safety message signal words Safety message signal words designate the severity of a potential hazard. Danger: Indicates a hazardous situation that, if not avoided, will result in death or serious injury. Warning: Indicates a hazardous situation that, if not avoided, could result in death or serious injury. Caution: Indicates a hazardous situation that, if not avoided, could result in minor or moderate injury. Notice: Indicates a hazardous situation not related to personal injury that, if not avoided, could result in property damage.
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Electrocardiography (ECG)
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ECG safety precautions ECG warnings
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Make sure that the leadwire set clips or snaps do not touch any electrically conductive material including earth.
The Maximum filter may alter the displayed ECG morphology. Do not make measurements from the displayed or printed ECG when this filter is selected. Displayed ST values are calculated before applying the Maximum filtering and may differ from values measured from the displayed or printed ECG.
This device uses a computerized 12-lead ECG analysis program, which can be used as a tool in generating ECG records that provide ECG measurements and interpretative statements from the ECG recordings. The interpretive statements are only significant when used in conjunction with clinical findings. All ECG records should be overread by a qualified physician. To ensure accuracy, use only the ECG records for physician interpretation.
When transitioning from a 10-lead cable to a 5-lead cable with the PDM, select the Update Lead Set option to clear the ‘Leads off’ message from the display.
CONDUCTIVE CONNECTIONS - Extreme care must be exercised when applying medical electrical equipment. Many parts of the human/machine circuit are conductive, such as the patient, connectors, electrodes, transducers. It is very important that these conductive parts do not come into contact with other grounded, conductive parts when connected to the isolated patient input of the device. Such contact would bridge the patient’s isolation and cancel the protection provided by the isolated input.
ELECTRODES - Whenever patient defibrillation is a possibility, use nonpolarizing (silver/silver chloride construction) electrodes for ECG monitoring. Polarizing electrodes (stainless steel or silver constructed) may cause the electrodes to retain a residual charge after defibrillation. A residual charge will block acquisition of the ECG signal.
DEFIBRILLATOR PRECAUTIONS - Patient signal inputs labeled with the CF and BF symbols with paddles are protected against damage resulting from defibrillation voltages. To ensure proper defibrillator protection, use only the recommended cables and leadwires.
HEART RATE ALARM INTERFERENCE - Poor cable positioning or improper electrode preparation may cause line isolation monitor transients to resemble actual cardiac waveforms and thus inhibit heart rate alarms. To minimize this problem, follow proper electrode placement and cable positioning guidelines provided with this product.
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