MAC 5000 Operators Manual Rev D

Trademarks - Revision History

Trademarked names appear throughout this document. Rather than list the names and entities that own the trademarks or insert a trademark symbol with each mention of the trademarked name, the publisher states that it is using the names only for editorial purposes and to the benefit of the trademark owner with no intention of improperly using the trademark. 900 SC, ACCUSKETCH, AccuVision, APEX , AQUA-KNOT, ARCHIVIST, Autoseq, BABY MAC, C Qwik Connect, CardioServ, CardioSmart, CardioSoft, CardioSys, CardioWindow, CASE, CD TELEMETRY, CENTRA, CHART GUARD, CINE 35, COROLAN, CORO, COROMETRICS, Corometrics Sensor Tip, CRG PLUS, DASH, Digistore, Digital DATAQ, E for M, EAGLE, Event-Link, FMS 101B, FMS 111, HELLIGE, IMAGE STORE, INTELLIMOTION, IQA, LASER SXP, MAC, MAC-LAB, MACTRODE, MANAGED USE, MARQUETTE, MARQUETTE MAC, MARQUETTE MEDICAL SYSTEMS, MARQUETTE UNITY NETWORK, MARS, MAX, MEDITEL, MEI, MEI in the circle logo, MEMOPORT, MEMOPORT C, MINISTORE, MINNOWS, Monarch 8000, MULTI-LINK, MULTISCRIPTOR, MUSE, MUSE CV, NeoTrak, NEUROSCRIPT, OnlineABG, OXYMONITOR, Pres-R-Cuff, PRESSURE-SCRIBE, QMI, QS, Quantitative Medicine, Quantitative Sentinel, RAC, RAMS, RSVP, SAM, SEER, SILVERTRACE, SOLAR, SOLARVIEW, Spectra 400, Spectra-Overview, Spectra-Tel, SpiroSoft, ST GUARD, TRAM, TRAM-NET, TRAM-RAC, TRAMSCOPE, TRIM KNOB, Trimline, UNION STATION, UNITY logo, UNITY NETWORK, Vari-X, Vari-X Cardiomatic, VariCath, VARIDEX, VAS, and Vision Care Filter are trademarks of GE Medical Systems Information Technologies, Inc., registered in the United States Patent and Trademark Office. 12SL, 15SL, Access, AccuSpeak, ADVANTAGE, BAM, BODYTRODE, Cardiomatic, CardioSpeak, CD TELEMETRY®LAN, CENTRALSCOPE, Corolation, EDIC, EK-Pro, Event-Link Cumulus, Event-Link Cirrus, Event-Link Nimbus, HI-RES, ICMMS, IMAGE VAULT, IMPACT.wf, INTER-LEAD, IQA, LIFEWATCH, Managed Use, MARQUETTE PRISM, MARQUETTE® RESPONDER, MENTOR, MicroSmart, MMS, MRT, MUSE CardioWindow, NST PRO, NAUTILUS, OCTANET, O2 SENSOR, OMRS, PHi-Res, Premium, Prism, QUIK CONNECT V, QUICK CONNECT, QT Guard, SMARTLOOK, SMART-PAC, Spiral Lok, Sweetheart, UNITY, Universal, Waterfall, and Walkmom are trademarks of GE Medical Systems Information Technologies, Inc.

GE Medical Systems Information Technologies, Inc. 8200 West Tower Avenue Milwaukee, WI 53223 USA Tel: +1.414.355.5000 800.558.5120 (USA only) Fax: +1.414.355.3790

GE Medical Systems Information Technologies GmbH Munzinger Str. 3 D-79111 Freiburg, Germany Tel: +49.761.45.43.0 Fax: +49.761.45.43.233

© 2000, 2001, 2004 General Electric Company. All rights reserved. Revision History This manual is subject to the GE Medical Systems Information Technologies change order service. The revision code, a letter that follows the document part number, changes with every update of the manual. Part No./ Revision

Date

Comment

2003361-004-A

2000-04

Initial Release / ECO 064 204

2003361-004-B

2001-06

ECO 067 433

2003361-004-C

2004-02

ECO 076 135

2003361-004-D

2004-05

ECO 077 187

2

MAC® 500

2003361-004-D

General Information

General Information • The product MAC 500 bears the CE marking

GE Medical Systems

CE-0459 (notified body GMED) indicating its con-

Information Technologies, Inc.

formity with the provisions of the Council Directive 93/42/EEC concerning medical devices and fulfills the

8200 West Tower Avenue Milwaukee, WI 53223 USA

essential requirements of Annex I of this directive.

Tel: +1.414.355.5000 800.558.5120 (USA only) Fax: +1.414.355.3790

• Standards compliance: IEC60601-1-2/EN 60601-1-2 "Electromagnetic Compatibility - Medical Electrical Equipment"

The authorized representative for GE Medical Systems Information Technologies Inc. in Europe is:

CISPR11 / EN 55011 "Radio interference emission" IEC 60601, protection class I

GE Medical Systems Information Technologies GmbH

MDD class IIb

Munzinger Str. 3

• The symbol means: Consult accompanying documents. It indicates points which are of particular

D-79111 Freiburg, Germany Tel:+49.761.45.43.0 Fax: +49.761.45.43.233

importance in the operation of the device. • The warranty does not cover damage resulting from the use of unsuitable accessories and consumables from other manufacturers. • On request GE Medical Systems Information Technologies will provide a service manual. • The GE Medical Systems Information Technologies quality management system complies with the standards EN ISO 9001 and EN 46001. • The country of manufacture appears on the device label.

2003361-004-D

MAC® 500

3

For your notes

For your notes

4

MAC® 500

2003361-004-D

Contents

®

1

INTRODUCTION TO THE MAC 500 SYSTEM... 7

2

CONTROLS AND INDICATORS... 8

3

SAFETY INFORMATION, STARTUP AND PERFORMANCE TEST... 10

4

PREPARATIONS FOR ECG RECORDING ... 18

5

12 LEAD MODE... 21

6

3 LEAD MODE... 30

7

AUTO RHYTHM MODE ... 33

8

HEART-RATE CONTROL... 37

9

ECG RECORDING DURING DEFIBRILLATION / ECGS OF PACEMAKER PATIENTS... 38

10 LOADING WRITER PAPER ... 39 11 THE SETUP MENU... 41 12 CLEANING, DISINFECTION AND MAINTENANCE ... 44 13 TROUBLESHOOTING ... 45 14 TECHNICAL SPECIFICATIONS ... 46

2003361-004-D

MAC® 500

5

For your notes

For your notes

6

MAC® 500

2003361-004-D

®

Introduction to the MAC 500 System

1 Introduction to the MAC® 500 System The MAC® 500 is a compact 3-channel electrocardiograph for battery and line-power operation. The MAC® 500 has three operating modes: 12 Lead, 3 Lead and Auto Rhythm, and meets all demands on modern electrocardiographs. In the 12 Lead Mode the MAC® 500 simultaneously acquires 12 leads of ECG for a period of 10 seconds and then prints them out. You can choose between simultaneous and sequential recordings. In simultaneous recordings all leads represent the same period of time (either 10 seconds = long format, or 3 seconds = short format).

1.5 times the RR interval averaged over the 4 preceding QRS complexes. The MAC® 500 continues recording until the triggering event ceases. The first 30 seconds are recorded at the selected speed, then the recorder switches to a paper speed of 5 mm/s. Numerous device settings can be customized to meet each user's special requirements. The device is not intended for intracardial use. The device is not intended for use as a vital-signs physiological monitor.

For sequential recordings the 10-second signal acquisition period is divided into 4 segments of 2.5 seconds each. The first 3 recorded leads represent the first segment (0-2.5 seconds), the second group of 3 leads represents the second segment (2.5 to 5 seconds), etc.

Caution Patient Hazard  Medical technical equipment such as the MAC® 500 must only be used by qualified and trained personnel.

You can choose between the standard lead sequence and the CABRERA sequence for the recording. One version of the MAC® 500 comes with an ECG measurement program which, in the 12 Lead Mode, provides a patient data sheet with ECG measurement results (Figure 5-3).

powe on/of r f sta

sto

stan db y bat te lowry

rt

copy

p

pro g

setup

With the Interpretation option activated, this version of the MAC® 500 will also print the interpretative statements after the measurement results (Figure 58). In the 3 Lead Mode the MAC® 500 records 3 leads of continuous ECG data (or 1 lead, if the default setting is changed in the setup menu).

mm /s

12

mm /m

50

3

Hz V Hz

20 25

HR ∆

10

5

20/35 filter

5

Figure 1-1. The MAC® 500 system

In the Auto Rhythm Mode the MAC® 500 will analyze the ECG and automatically starts recording − when the heart rate exceeds the set upper or lower limit − when QRS complexes are detected whose RR interval is shorter than 0.8 times or greater than

2003361-004-D

MAC® 500

7

Controls and Indicators

2 Controls and Indicators 1

2

3

pow on/o er ff star

t

stop

copy

pro

g

setu

mm

12

p

Hz

/s mm /m V

50

3

Hz 20 25

HR ∆

20 filte/35 r

10

5

4

5

5

6

7 Hz

standby battery low

prog

power on/off

mm/s

mm/mV

Hz

50

20

20/35 filter

3

25

10

HR∆

5

5

10

9

12

copy

setup

8

start

stop

19 18

17 16 15

14

13 12 11

Figure 2-1. Controls and Indicators

8

MAC® 500

2003361-004-D

Controls and Indicators

1

Cover of paper compartment

2

Spring lock to open the paper compartment

3

Power connector

Observe the operator's manual

4

Patient cable connector (type CF, highly insulated, defibrillation-proof)

Type CF signal input, highly insulated,

5

"battery low" indicator (yellow): when it lights up, the battery needs to be charged

6

Explanation of the signs and symbols used on the device

defibrillation-proof Start

"standby" indicator (green): when it lights up, the MAC® 500 is connected to the mains and operates on line power

ECG lead

7

2-line character display

Lead-fail indicator

8

Enables/disables muscle filter (20/35 Hz)

9

Gain selection keys - 5, 10, 20 mm/mV

10

Paper speed selection keys - 5, 25, 50 mm/s (5 mm/s only in 3 Lead and Auto Rhythm Modes)

Stop

heart rate (BPM)

11

Mode selection keys

12

Prints additional report copies (e.g. after change of lead sequence) and the 10-second ECG in Auto Rhythm Mode

13

Displays the setup menu

14

ECG lead selection in 3 Lead and Auto Rhythm Modes, cursor control keys for navigating in the setup menu

15

Enables/disables QRS beep, silences audio signals

16

Power switch (ON/OFF)

17

Starts and stops the recorder in the selected mode

18

Yellow indicator is lit when selected mode is disabled

19

Green indicator is lit when selected mode is enabled

2003361-004-D

QRS beep/audio signals Cursor control, lead selection 12

12 Lead Mode

3

3 Lead Mode

HR∆

Auto Rhythm Mode

MAC® 500

9

Safety Information, Startup and Performance Test

3 Safety Information, Startup and Performance Test 3.1 Safety Information • This manual is an integral part of the device. It should always be kept near the device. Close observance of the information given in the manual is a prerequisite for proper device performance and correct operation and ensures patient and operator safety. Please note that information pertinent to several chapters is given only once. Therefore, carefully read the manual once in its entirety.

Caution indicates a potentially hazardous situation which, if not avoided, may result in minor or moderate injury or product/property damage.

• GE Medical Systems Information Technologies is responsible for the effects on safety, reliability, and performance of the device, only if − assembly operations, extensions, readjustments, modifications, or repairs are carried out by persons authorized by GE Medical Systems Information Technologies,

• To ensure patient safety, the specified measuring accuracy, and interference-free operation, we recommend using only original GE Medical Systems Information Technologies components. The user is responsible for application of unsuitable accessories from other manufacturers. • This manual is in conformity with the device specifications and standards on safety of electromedical equipment valid at the time of printing. All rights are reserved for devices, circuits, techniques, software programs, and names appearing in this manual. • The terms danger, warning, and caution are used throughout this manual to point out hazards and to designate a degree or level of seriousness. Hazard is defined as a source of potential injury to a person. Danger indicates an imminently hazardous situation which,

− the electrical installation of the relevant room complies with the requirements of the appropriate regulations, and − the device is used in accordance with the instructions for use. The safety statements presented in this chapter refer to the equipment in general and, in most cases, apply to all aspects of the device. There are additional safety statements in the other chapters which are specific to the topic described. The order in which safety statements are presented in no way implies order of importance. DANGERS EXPLOSION HAZARD - Do not use this equipment in the presence of flammable anesthetics, vapors or liquids.

if not avoided WILL result in death or serious injury.

Warning indicates a potentially hazardous situation which, if not avoided, COULD result in death or serious injury.

10

MAC® 500

2003361-004-D

Safety Information, Startup and Performance Test

WARNINGS ACCESSORIES (SUPPLIES) - Use only the original GE Medical Systems Information Technologies cables. Do not connect other signal sources to the cables. The user is responsible for the use of accessories from other manufacturers. 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. BEFORE USE - Before putting the system into operation visually inspect all connecting cables for signs of damage. Damaged cables and connectors must be replaced immediately. BEFORE USE - Before using the device, the operator must verify that it is in correct working order and operating condition. For instructions, refer to section 3.3 “Testing the Performance” in this chapter. CONDUCTIVE CONNECTIONS - Do not allow electrodes to come into contact with conductive parts. The neutral electrode, in particular, must not be connected to earth.

MPSO-The use of a multiple portable socket outlet (MPSO) for a system will result in an enclosure leakage current equal to the sum of all individual earth leakage currents of the system if there is an interruption of the MPSO protective earth conductor. Do not use an additional extension cable with the MPSO as it will increase the chance of the single protective earth conductor interruption. OPERATOR - The user must have received adequate training in the use of the MAC® 500 and must be capable of applying it properly. POWER SUPPLY - The device must be connected to a properly installed power outlet with protective earth contacts only. If the installation does not provide for a protective earth conductor, disconnect the monitor from the power line and operate it on battery power, if possible. If the installation of this equipment in the USA will use 240V rather than 120V, the source must be a center-tapped, 240V, single phase circuit.

DISCONNECTION FROM MAINS - When disconnecting the system from the power line, remove the plug from the wall outlet first. Then you may disconnect the power cord from the device. MOISTURE CONDENSATION - Devices intended for emergency application must not be stored or transported at temperatures which cause moisture condensation at the application site. Wait until all moisture condensation has evaporated before using the device.

2003361-004-D

MAC® 500

11

Safety Information, Startup and Performance Test

CAUTIONS MAINTENANCE - Regular preventive maintenance should be carried out annually, inspections of equipment with measuring functions should be done every two years (refer to chapter 12 “Cleaning, Disinfection and Maintenance”). PERFORMANCE CHECKS - Check the device performance once a month, strictly following the instructions outlined in section 3.3 “Testing the Performance”. POWER REQUIREMENTS - Before connecting the device to the power line, check that the voltage and frequency ratings of the power line are the same as those indicated on the unit’s label. If this is not the case, do not connect the system to the power line until you adjust the unit to match the power source. VENTILATION REQUIREMENTS - Set up the device in a location which affords sufficient ventilation. The ventilation openings of the device must not be obstructed. The ambient conditions specified in the technical specifications must be ensured at all times.

EMC - Magnetic and electrical fields are capable of interfering with the proper performance of the device. For this reason make sure that all external devices operated in the vicinity of the monitor comply with the relevant EMC requirements. X-ray equipment or MRI devices are a possible source of interference as they may emit higher levels of electromagnetic radiation. INTERFACING OTHER EQUIPMENT - Devices may only be interconnected with each other or to parts of the system when it has been determined by qualified biomedical engineering personnel that there is no danger to the patient, the operator, or the environment as a result. In those instances where there is any element of doubt concerning the safety of connected devices, the user must contact the manufacturers concerned (or other informed experts) for proper use. In all cases, safe and proper operation should be verified with the applicable manufacturer’s instructions for use, and system standards IEC 60601-1-1/EN 60601-1-1 must be complied with.

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. Proper placement of defibrillator paddles in relation to the electrodes is required to ensure successful defibrillation. DISPOSAL - Dispose of the packaging material, observing the applicable waste control regulations and keeping it out of children’s reach. 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 in. is recommended.

12

MAC® 500

2003361-004-D

Safety Information, Startup and Performance Test

NOTES

Literature

- The MAC® 500 is designed to comply with IEC 60601/ EN 60601 requirements. It is Class I equipment/equipment with a built-in rechargeable electrical power source. The device is not suitable for intracardiac use. The device is suitable for continuous operation. - Choose a location which affords an unobstructed view of the monitor’s screen and easy access to the operating controls. - The MAC® 500 has no additional protection against ingress of water. - Medical technical equipment such as the MAC® 500 must only be used by persons who have received adequate training in the use of such equipment and who are capable of applying it properly.

Medical Device Directive 93/42/EEC EN 60601-1/1990 + A1: 1993 + A2: 1995: Medical electrical equipment. General requirements for safety EN 60601-1-1/9.1994 + A1 12.95: General requirements for safety. Requirements for the safety of medical electrical systems. Requirements for the safety of medical electrical systems. EN 60601-2-25/1993: Medical electrical equipment. Part 2: Special requirements for the safety of electrocardiographs. IEC Publication 513/1994: Fundamental aspects of safety standards for medical equipment.

- At the end of its service life; the MAC® 500 and its accessories must be disposed of in compliance with the special waste control regulations for electronic parts. If you have any questions in this matter, please contact GE Medical Systems Information Technologies.

2003361-004-D

MAC® 500

13

Safety Information, Startup and Performance Test

®

3.2 Starting Up the MAC 500

5

6 Power Supply Hz

standby battery low

prog

copy

setup

mm/s

mm/mV

Hz

50

20

20/35 filter

3

25

10

HR∆

5

5

12

− The MAC® 500 operates on line power or on power from the rechargeable battery. − The battery is automatically charged when the device is connected to the power line (indicator 6 (Figure 3-1) is lit when the battery is charging). It is not necessary to turn the device on for charging. In order to have the battery fully charged at all times, leave the MAC® 500 connected to the power line. A depleted battery needs 6 hours to recharge. − Indicator (5) lights up when the battery needs charging. − A new, fully charged battery provides power to record at least 50 12 Lead ECGs. Have the battery replaced by a service technician when the capacity drops to about 25 recordings.

Figure 3-1. Indicators

Starting Up and Connecting the MAC® 500 − The MAC® 500 must not be used or stored in moist and/or dusty rooms. Further, it must not be exposed to direct sunlight or other sources of heat. − Figure 3-2 shows a practical arrangement between patient and recorder. For interferencefree operation, it is important that the patient cable and the power cord do not run parallel. Figure 3-2. Arranging the MAC® 500 and examination couch

• Use the power cord to connect the recorder to the power line (Figure 3-3). Use only the original power cord or an equivalent cable. The MAC® 500 is shipped with a fully charged battery. Please note that the battery needs to be charged when the battery indicator (5) lights up.

• Insert writer paper as described in chapter 10.

Figure 3-3. Power input

14

MAC® 500

2003361-004-D

Safety Information, Startup and Performance Test

3.3 Testing the Performance

• Using the power switch (16), turn on the MAC® 500. The yellow indicator (18) lights up.

standby

18 16

battery low

power on/off

copy

On power up the device runs an automatic self-test. It defaults to the 12 Lead Mode (Figure 3-5), unless a malfunction is identified. If a malfunction is detected, the system will display an error message. Contact GE Medical Systems Information Technologies Service for further information.

setup start

When a patient cable is not connected, two ^^ symbols appear on the display in place of the leadfail indicator. Also, the MAC® 500 will emit an audio signal to inform you that the cable is missing.

stop

The ^^ symbols on the display disappear as soon as Figure 3-4. Operating controls and indicators

you connect the cable. At the same time the lead-fail detection function is enabled. The MAC® 500 will again emit an audio signal and alert you to one of the missing electrodes, until a patient is connected. The audio signal can be silenced with

Hz

.

After application of all required electrodes, the MAC® 500 automatically enables the HR indication function (chapter 8 "Heart-Rate Control"). prog

mm/s

mm/mV

Hz

Figure 3-5. Display after successful MAC® 500 selftest

2003361-004-D

MAC® 500

15

Safety Information, Startup and Performance Test

3.4 Selecting the Language, Customizing the Recorder Selecting the Language

standby

For the displayed texts and reports you can choose among various languages.

battery low

• Press

12

copy

to display the language selection menu:

Figure 3-7 will appear.

prog

power on/off

setup

• Use the cursor keys

to select the

language and confirm your selection with .

3

setup start

• Exit the menu with

setup

.

HR∆ stop

Figure 3-6. Controls required for language selection Hz

prog

mm/s

mm/mV

Hz

Figure 3-7. Selected language

16

MAC® 500

2003361-004-D

Safety Information, Startup and Performance Test

Customizing the Device Settings Parameter

Default

Options

Language

[English]

further languages

Notation

[AAMI]

IEC

Leads

[Standard]

Cabrera

Report format

[Sequential]

Simultaneous

- when choosing "sequential" Rhythm lead - when choosing "simultaneous"

[Yes]

No

[Short]

Long

Override Mode

[On]

Off

Patient Data sheet*

[No]

Yes

Leads

[3]

1

Speed

[25]

50

Sensitivity

[10]

5, 20

AC Filter

[60]

50, off

Muscle Filter

[On]

Off

The MAC® 500 allows you to customize numerous settings to suit your personal needs and preferences. The MAC® 500 will save these settings as the user defaults and will activate them each time it is turned on. Figure 3-8 lists all settings that can be customized, the middle column shows the factory defaults. Please refer to chapter 11 "The Setup Menu" for a detailed explanation of how to customize the device settings.

Muscle Filter

[35]

20

ADS (cubic spline)

[On]

Off

HR Control

[On]

Off

HR-Control

[45], [130]

30 to 120, 80 to 240

Cut-off Frequency

[0.08]

0.04; 0.16

Contrast QRS Beep

< reduce, > increase [2] (medium)

0 (off), 1 (low), 3 (loud)

Date Time Option no.**

for "Interpretation" option

Factory Defaults

[No]

Yes

Print

[No]

Yes (printout of all settings)

Figure 3-8. The MAC® 500 setup menu (on the display the active selections are shown in angular brackets [ ])

*

not part of MAC® 500 with measurement program

**

only for MAC® 500 with measurement program

2003361-004-D

MAC® 500

17

Preparations for ECG Recording

4 Preparations for ECG Recording 4.1 Connecting the Patient Cable The 10-lead cable is used for acquisition of the standard ECG leads (Standard, Augmented, Chest).

• Connect the patient cable to the ECG signal input Warning

(4, Figure 4-1).

Shock Hazard  For reasons of safety, use only the original GE Medical Systems Information Technologies patient cables. Do not connect other signal sources to the cable.

When a patient cable is not connected, two ^^ symbols appear on the display in place of the leadfail indicator. Also, the MAC® 500 will emit an audio signal to inform you of the missing cable. The ^^ symbols disappear as soon as you connect

Note

the cable. At the same time the lead-fail detection

The signal input is highly insulated and defibrilla-

function is enabled. The MAC® 500 will again emit

tion-proof (only if the original GE Medical Systems

an audio signal and alert you to one of the missing

Information Technologies patient cables are used). These patient cables ensure patient safety and

electrode, until a patient is connected. The audio

protect the device during defibrillation and electro-

all required electrodes, the MAC® 500 automatically

surgery.

signal can be silenced with

. After application of

enables the HR indication function (chapter 8 "Heart-Rate Control").

4 Figure 4-1. ECG signal input (type CF, highly insulated, defibrillation proof)

18

MAC® 500

2003361-004-D

Preparations for ECG Recording

4.2 Applying the Electrodes Note

Applying Electrodes (Limb Leads)

Use silver-silver chloride electrodes when recording the ECG of a patient who may have to be defibrillated. (Refer to chapter 9 "ECG Recording During

Careful application of the electrodes is the key to an interference-free ECG.

Defibrillation" for details.)

Refer to the illustration shown in Figure 4-2. RA (white) LA (black) LL (red) RL (green)

V RA

electrode on right arm electrode on left arm electrode on left leg electrode on right leg

Applying Suction Electrodes (Thorax)

LA

• Shave and clean application points, if necessary. RL

LL

Application Points for Standard Leads (I, II, III, aVR, aVL, aVF, V1 to V6)

Figure 4-2. Applying limb-lead electrodes

V1

V2 V3

V5 V4

Four limb and six chest electrodes must be applied for the acquisition of the standard leads. Attach the limb electrodes above the wrists and ankles. Figure 4-3 shows the chest lead application points. V1 in the 4th intercostal space at the right sternal edge

V6

V2 in the 4th intercostal space at the left sternal edge V6

V1 V2 V3 V4

V3 on the level of the 5th rib midway between between V2 and V4

V5

Figure 4-3. Chest electrode application points

RL green RA white

V4 in the 5th intercostal space on the left midclavicular line V5 on the left anterior axillary line between V4 and V6

right leg right arm

V1 brown V1

V2 brown V3 brown

V2 V3

V5

V6 on the mid-axillary line at the level of V4 V6

V4

Connect the 10-wire patient cable as shown in Figure 4-4.

V4 brown V5 brown V6 brown LA black left arm LL red

V6

V1 V2 V3 V4

V5

Figure 4-4. Connecting the patient cable (10-lead cable, standard leads)

2003361-004-D

Warning Shock Hazard  Avoid contact between electrodes

left leg

MAC® 500

and conductive parts The neutral electrode, in particular, must not come into contact with ground.

19

Preparations for ECG Recording

Artifact Due to Poor Electrode Application This device is equipped with state-of-the-art electronic utilities to insure artifact-free recording. Among these are the automatic baseline adjustment and the anti-drift system (ADS). At the beginning of the recording the automatic baseline adjustment verifies the incoming signal and adjusts the baseline position accordingly. During recording the anti-drift system continuously checks the baseline position and returns the baseline to its normal level if it wanders (Figure 4-5). When electrodes are not properly applied, these measures may not fully compensate for artifact. High polarization voltages induced by electrodes applied without conductive gel may cause the amplifier to overrange, so that a straight line will be recorded instead of the ECG (see Figure 4-5). ADS will return this line to its normal position, and a baseline ensues for approx. 1 second. Blocking can be initiated manually by disconnecting the RA electrode.

Remedy

• Apply the electrodes according to instructions. • Do not apply the electrodes on top of clothing. • Use a contact agent (moist electrode paper, electrode cream, spray, etc.).

• Wait approx. 10 seconds before initiating a recording. After the 10-second period the polarization voltages have stabilized, provided the electrodes are properly applied. If this is not the case, the electrode concerned is indicated on the display (RL, RA, LA, LL, V1 to V6).

• If it becomes necessary to verify the raw ECG signal, switch off the ADS function and all filters (35 Hz/20 Hz muscle filter, AC filter).

approx.1 s

Figure 4-5. Sample recording

20

MAC® 500

2003361-004-D