Dash Clincal Reference and Troubleshooting Guide Rev A Jan 2005

127(Due to continuing product innovation, information in this manual is subject to change without notice.

Listed below are GE Medical Systems Information Technologies trademarks used in this document. All other trademarks contained herein are the property of their respective owners. CD TELEMETRY, CRG PLUS, MUSE, QS, RAC, RAMS, SAM, SOLAR, ST GUARD, TRAM, TRAM-NET, TRAM-RAC, TRIM KNOB, and UNITY NETWORK are trademarks of GE Medical Systems Information Technologies registered in the United States Patent and Trademark Office. 12SL, ApexPro, CD TELEMETRY®-LAN, CENTRALSCOPE, EK-Pro, IMPACT.wf, MENTOR, Octanet, PRN 50, PRN 50-M, and UNITY are trademarks of GE Medical Systems Information Technologies. © 2005 General Electric Company. All rights reserved.

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Contents

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Introduction... 1-1 About This Manual... 1-3 Manual Purpose... 1-3 Intended Audience... 1-3 Revision History... 1-3 Ordering Manuals... 1-3 Manual Conventions... 1-4 Text Conventions... 1-4 Illustrations and Names... 1-4 Safety Information... 1-5 Complete Safety Information... 1-5 Terminology... 1-5 Dangers... 1-5 Warnings... 1-6 Cautions... 1-8

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Calculation Programs... 2-1 Introduction... 2-3 Cardiac Calculations... 2-4 Monitored Parameters... 2-4 Calculated Parameters... 2-5 Pulmonary Calculations... 2-6 Monitored/Measured Parameters... 2-6 Derived Pulmonary Calculations... 2-7 Estimated Pulmonary Calculations... 2-9 Dose Calculations... 2-10

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ECG... 3-1 Introduction... 3-3 Skin Preparation... 3-4 Electrode Placement... 3-5

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3-Leadwire Electrode Placement... 3-6 5-Leadwire Electrode Placement... 3-8 6-Leadwire Electrode Configuration... 3-9 10-Leadwire Electrode Configuration for 12SL Monitoring... 3-10 Electrode Placement for Neonates... 3-12 Electrode Placement for Pacemaker Patients... 3-13 Maintaining Quality ECG Signal... 3-14 Electrosurgical Unit (ESU) Cable... 3-14 Pacemaker Detection... 3-15 Safety Considerations... 3-15 Monitoring Pacemaker Patients... 3-17 Arrhythmia Analysis... 3-19 Lethal Arrhythmia Analysis... 3-19 Full Arrhythmia Analysis... 3-20 Arrhythmia Conditions... 3-20 Troubleshooting... 3-24 Pacemaker Troubleshooting... 3-26

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Invasive Blood Pressures... 4-1 Introduction... 4-3 Assigned Pressure Names... 4-4 IABP... 4-6 Triggering... 4-6 Smart BP... 4-10 Disconnect Alarm... 4-11 Troubleshooting... 4-12 Wedge Troubleshooting... 4-13

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Noninvasive Blood Pressure... 5-1 Introduction... 5-3 Safety... 5-4 Warnings... 5-4 Cautions... 5-4 Notes... 5-5 Patient Preparation... 5-6

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NBP Monitoring Features... 5-8 Mean Arterial Pressure... 5-8 Systolic Search... 5-8 NBP Auto Timing... 5-8 Troubleshooting... 5-11

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SpO2... 6-1 Introduction... 6-3 SpO2 Sensor Compatibility... 6-3 Safety... 6-5 Warnings... 6-5 Neonates and Infants... 6-6 Patient Preparation... 6-7 Signal and Data Validity... 6-8 Signal Strength Indicator... 6-8 Quality of SpO2 Waveform... 6-8 Stability of SpO2 Waveforms... 6-9 Masimo SET Technology and Sensors... 6-10 No Implied License... 6-10 Sensors... 6-10 Nellcor Sat-Seconds Alarm Management... 6-11 Troubleshooting... 6-15

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Cardiac Output... 7-1 Introduction... 7-3 Cardiac Output Washout Curve... 7-3 Bath Probe Setup... 7-4 In-Line Setup... 7-5 Cardiac Calculations... 7-6 Troubleshooting... 7-7

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Respiration... 8-1 General Information... 8-3 Monitoring Respiration on Pacemaker Patients... 8-5 Troubleshooting... 8-6 Respiratory Waveform... 8-6

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Respiratory Mechanics... 9-1 Introduction... 9-3 Respiratory Mechanics Parameters... 9-3 Patient Connection... 9-5 RM Waveforms... 9-8 Sample RM Waveforms... 9-8

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SvO2... 10-1 Introduction... 10-3 Signal Strength Indicator... 10-5 Troubleshooting... 10-6

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End-Tidal CO2... 11-1 Introduction... 11-3 Safety... 11-4 Cautions... 11-4 Setup... 11-6 Capnostat Mainstream Setup... 11-6 Capnostat Sidestream Setup (Dual CO2 Module)... 11-7 Sidestream CO2 Module Setup... 11-13 CapnoFlex LF Sidestream CO2 Module Setup... 11-14 Troubleshooting... 11-15 Capnostat Sensor Check... 11-15

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Anesthetic Agent Analysis... 12-1 Introduction... 12-3 Two Models... 12-3 Safety... 12-4 Cautions... 12-4 Notes... 12-5 Connections... 12-6 Gas Exhaust... 12-7 Room Air Calibration... 12-8

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Transcutaneous pO2/pCO2... 13-1 Introduction... 13-3 Safety... 13-4 Warnings... 13-4 Cautions... 13-4 Measurement Requirements... 13-5 Recommended Sites... 13-5 Recommended Temperatures... 13-6 Applying a Sensor Membrane... 13-7 Removing the O-Rings... 13-7 Cleaning the Sensor Surface... 13-8 Applying the Electrolyte Solution... 13-9 Applying the New Membrane... 13-10 Applying the Sensor... 13-11 Applying the Fixation Ring... 13-12 Adding the Contact Fluid... 13-12 Inserting the Sensor... 13-13 Waiting for a Stabilized Reading... 13-13 Barometric Pressure... 13-14 O2 Calibration Values... 13-14 CO2 Calibration Values... 13-15 Correction for the Effects of Heat Applied to the Skin... 13-16 Sensor Troubleshooting... 13-17 Reduction in O2 and CO2 Sensitivity... 13-17

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ICG... 14-1 Introduction... 14-3 Safety... 14-4 Warnings... 14-4 Cautions... 14-4 Notes... 14-5 Monitoring ICG on Pacemaker Patients... 14-5 ICG Parameters... 14-6 ICG Formulas... 14-7 Definitions of Terms... 14-9 Patient Preparation... 14-10 Skin Preparation... 14-10 Sensor Placement... 14-11 Connecting the ICG Cable to the Patient... 14-12 ICG Reference Literature... 14-13 ICG Parameter Normal Range... 14-13 ICG Technology... 14-13

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EEG Monitoring... 15-1 Introduction... 15-3 Definitions of Terms... 15-3 EEG Electrodes... 15-5 EEG Electrode Placement... 15-6 International 10-20 Electrode Placement System... 15-6 Regional Lead Placements... 15-8 Generic “X” Lead Placement... 15-9 Commonly Used Electrode Montages... 15-9 Skin Preparation... 15-11 Applying Electrodes... 15-12 Connecting the Electrodes to the EEG DSC... 15-13 EEG Reference Literature... 15-14

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BIS Monitoring... 16-1 Introduction... 16-3 Considerations for Using BIS... 16-3

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Safety... 16-4 Warning... 16-4 Cautions... 16-4 BIS Sensor Placement... 16-5 Three-Electrode Sensor Placement... 16-5 Four-Electrode Sensor Placement... 16-6 BIS Range Guidelines... 16-7 BIS Spectral Displays... 16-8 BIS Reference Literature... 16-9

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For your notes

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Introduction

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Introduction: About This Manual

About This Manual Manual Purpose This document is intended to serve as a guide to clinical professionals in a hospital setting. It provides patient application instructions for GE Medical Systems Information Technologies patient monitors. This manual must be used in conjunction with the operator’s manual specific to your GE Medical Systems Information Technologies patient monitor.

Intended Audience This manual is geared for clinical professionals. Clinical professionals are expected to have a working knowledge of medical procedures, practices, and terminology, as required for monitoring of critically ill patients.

Revision History Each page of the document has the document part number and revision letter at the bottom of the page. The revision letter changes whenever the document is updated. Revision A

Comments Initial release of this manual.

Ordering Manuals To order additional copies of this manual, call Accessories and Supplies and request part number 2024578-001. Refer to the How to Reach Us page for Accessories and Supplies contact information.

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Introduction: Manual Conventions

Manual Conventions This section describes terminology, standards, and other conventions that are used throughout this manual.

Text Conventions In this manual, bold text indicates keys on a keyboard, text to be entered by the user, or labeling on equipment, such as the names of buttons and switches. Italic text indicates software terms that may identify menu items, buttons, options, or messages that appear on the monitor display.

Illustrations and Names All illustrations in this manual are provided as examples only. They may not necessarily reflect your monitoring setup or data displayed on your monitor. In this manual, all names appearing in examples and illustrations are fictitious. The use of any real person’s name is purely coincidental.

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Introduction: Safety Information

Safety Information The order in which safety statements are presented in no way implies order of importance.

Complete Safety Information You MUST refer to your monitor and/or device operator’s manual(s), as well as the other chapters in this document, for complete safety information.

Terminology The terms danger, warning, and caution are used throughout this document to point out hazards and to designate a degree or level of seriousness. Familiarize yourself with their definitions and significance. Hazard is defined as a source of potential injury to a person. DANGER indicates an imminent hazard which, if not avoided, will result in death or serious injury. WARNING indicates a potential hazard or unsafe practice which, if not avoided, could result in death or serious injury. CAUTION indicates a potential hazard or unsafe practice which, if not avoided, could result in minor personal injury or product/property damage. NOTE provides application tips or other useful information to assure that you get the most from your equipment.

Dangers There are no dangers that refer to the equipment in general. Specific “Danger” statements may be given in the respective sections of this document or your monitor and/or device operator’s manual(s).

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Introduction: Safety Information

Warnings „

ACCIDENTAL SPILLS - To avoid electric shock or device malfunction, liquids must not be allowed to enter the device. If liquids have entered a device, take it out of service and have it checked by a service technician before it is used again.

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ACCURACY - If the accuracy of any values displayed on the monitor, central station, or printed on a graph strip is questionable, determine the patient’s vital signs by alternative means. Verify that all equipment is working correctly.

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ALARMS - Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm volume to a low level or off during patient monitoring may result in a hazard to the patient. Remember that the most reliable method of patient monitoring combines close personal surveillance with correct operation of monitoring equipment. After connecting the monitor to a central station, remote alarm system, and/or network, verify the function of the alarm system. The functions of the alarm system for monitoring the patient must be verified at regular intervals.

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CABLES - Route all cables away from the patient’s throat to avoid possible strangulation.

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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 could cancel the protection provided by the isolated input. In particular, there must be no contact of the neutral electrode and ground.

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DEFIBRILLATION - Do not come into contact with patients during defibrillation. Serious injury or death could result.

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EXPLOSION HAZARD - Do not use this equipment in the presence of flammable anesthetics, vapors, or liquids.

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Introduction: Safety Information

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INTRACARDIAC APPLICATION - When applying devices intracardially, electrically conductive parts in contact with the heart (pressure transducers, metal tube connections and stopcocks, guide wires, etc.) must be avoided in all cases. To prevent electrical contact, we recommend the following:

‹ Always wear isolating rubber gloves. ‹ Keep parts that are connected to the heart isolated from ground. ‹ If possible, do not use tube fittings or stopcocks made of metal. During intracardiac application of a device, a defibrillator and pacemaker whose proper functioning has been verified must be kept at hand.

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RATE METERS - Keep pacemaker patients under close observation. Rate meters may continue to count the pacemaker rate during cardiac arrest and some arrhythmias. Therefore, do not rely entirely on rate meter alarms.

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Introduction: Safety Information

Cautions

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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.

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DISPOSABLES - Disposable devices are intended for single use only. They should not be reused as performance could degrade or contamination could occur.

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ELECTROCAUTERY PRECAUTIONS - To prevent unwanted skin burns, apply electrocautery electrodes as far as possible from all other electrodes. A distance of at least 15 cm (6 inches) is recommended.

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ELECTRODES - Whenever patient defibrillation is a possibility, use non-polarizing (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.

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INSTRUCTIONS FOR USE - For continued safe use of equipment, it is necessary that the listed instructions are followed. However, instructions listed in this document in no way supersede established medical practices concerning patient care.

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SINGLE PATIENT USE - This equipment is designed for use on one patient at a time. Using this equipment to monitor different parameters on different patients at the same time compromises the accuracy of data acquired.

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Calculation Programs

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