MAC 2000 Quick Reference Guide Rev F

Notice The materials contained in this document are intended for educational purposes only. This document does not establish specifications, operating procedures or maintenance methods for any of the products referenced. Always refer to the official written materials (labeling) provided with the product for specifications, operating procedures and maintenance requirements.

Contents Skin Preparation and Resting 12-lead Placement... 1 Skin Preparation and Stress ECG Lead Placement... 2 Patient Data (ADT) ... 4 Patient Data (Simple Orders)... 5 Patient Data (Advanced Order Manager) ... 6 Acquire an ECG ... 8 Print Continuous Rhythm ... 9 RR Analysis ... 10 Acquire an Arrhythmia... 11 Acquire a Stress ECG Test... 12 File Manager... 20 Exporting to SD Card... 23

1. Ensure that skin is dry, clean and remove excessive hair.

10

2. Mark each electrode site with a felt tip pen.

7

1

3. Degrease each site with a skin preparation cream.

2

4. Use a mild abrasion to remove the mark left by the felt tip pen.

3 4

6

5

5. Apply the electrodes to the prepared sites. 9

Lead AHA Label IEC Label C1 red

6. Look at the hook-up advisor and on-screen messages for indication of lead problems.

8

Description

1

V1 red

Fourth intercostal space at the right sternal border

2

V2 yellow C2 yellow Fourth intercostal space at the left sternal border

3

V3 green

C3 green

4

V4 blue

C4 brown Mid-clavicular line in the fifth intercostal space

5

V5 orange C5 black

6

V6 purple C6 purple Mid-axillary line on the same horizontal level as 4 and 5

7

LA black

L yellow

Left wrist

8

LL

F green

Above left ankle (Alternate placement, upper leg as close to torso as possible)

9

RL green

N black

Above right ankle (Alternate placement, upper leg as close to torso as possible)

10

RA white

R red

Right wrist

Skin Preparation and Resting 12-lead Placement

The quality of your ECG tracing is a direct result of skin prep and lead placement.

Skin Preparation and Resting 12-lead Placement

Midway between location 2 and 4

Anterior axillary line on the same horizontal level as 4

1

Skin Preparation and Stress ECG Lead Placement

10

7

1

2 3 4

6

5

9

8

Skin Preparation and Stress ECG Lead Placement Preparing the patient correctly of their ECG is a critical part of making sure that the reading is accurate and free of noise. Here is what is suggested for a proper patient prep.

2

1. Ensure that skin is dry, clean and remove excessive hair.

5. Apply the electrodes to the prepared sites.

2. Mark each electrode site with a felt tip pen.

6. Look at the hook-up advisor and on-screen messages for indication of lead problems.

3. Degrease each site with a skin preparation cream. 4. Use a mild abrasion to remove the mark left by the felt tip pen.

Electrode Placement

1

Fourth intercostal space at the right sternal border

2

Fourth intercostal space at the left sternal border

3

Midway between 2 and 4

4

Mid-clavicular line in the fifth intercostal space

5

Anterior axillary line on the same horizontal level as 4

6

Mid-axillary line on the same horizontal level as 4 and 5

10

Recommend placing in the soft fleshy area just below the right clavicle

7

Recommend placing in the soft fleshy area just below the left clavicle

9

Recommend placing on the corresponding right side of the thorax at the lower edge of the rib cage, or at the lower level of umbilicus at the right mid-clavicular line.

8

Recommend placing on the corresponding left side of the thorax at the lower edge of the rib cage, or at the lower level of umbilicus at the left mid-clavicular line.

Skin Preparation and Stress ECG Lead Placement

Lead

3

Patient Data (ADT)

Resting ECG

Arrhythmia

Stress ECG

File Manager

System Configuration

More

25 mm/s

10 mm/mV

150 Hz

Pace Enhance Off

More

1 Patient Data

2

Patient Data (ADT) The MAC 2000 allows you to download patient demographics via an ADT interface. You can download patient demographics using internal or external keyboard, or barcode reader. Use the following procedures to query the database and select patient demographic for each.

Database Query Using Barcode Reader 1. Select Resting ECG. 2. Select the Patient Data. 3. Scan the patient barcode using the barcode reader. A dialog box opens with the scanned Patient ID.

Database Query Using Internal or External Keyboard 1. Select Resting ECG. 2. Select the Patient Data. A dialog box opens instructing you to enter the Patient ID.

4. Click OK to accept the selection.

3. Enter the Patient ID using the internal keypad or external keyboard. A dialog box opens 5. The patient demographic with the Patient ID you entered. data is populated. Modify any fields as necessary. 4. Click OK to accept the selection. 6. Select Save.

4

5. The patient demographic data populated. Modify any fields as necessary. 6. Select Save.

Arrhythmia

Stress ECG

File Manager

System Configuration

More

25 mm/s

10 mm/mV

150 Hz

Pace Enhance Off

More

Main Menu

More

1 Patient Data

Printer Leads Rhythm 6

ADS On

Cancel

Orders

2

3 Page Up

Page Down

Patient Data (Simple Orders)

Resting ECG

Load

5 Patient List

Page Down

Cancel

Save

6 Simple Orders Simple Orders provides an interface to quickly download and execute one order at a time. Use the following steps to execute a simple order. 1. Select Resting ECG 2. Select More. 3. Select Orders.

Note! If Auto Execute Single Order setting is enabled in Resting ECG Setup and only one open order for that given location is present the system will automatically download that single order and populate the Patient Information screen.

4. Select an order from the list. 5. Select Load. 6. The order will download and populate the Patient Data screen. Modify as patient data as necessary. 7. Select Save.

5

Patient Data (Advanced Order Manager)

Resting ECG

Arrhythmia

Order Manager

RR Analysis

Select

Load Orders

2

File Manager

System Configuration

More

1 More

Delete Orders

Sort Orders

Main Menu

Print

3

Advanced Order Manager Advanced Order Manager provides an interface to download and store multiple orders on the system and execute them later. Use the following procedure to execute an advanced order.

4

6

Stress ECG

1. From the Main Menu, select More. 2. Select Order Manager. 3. Select Load Orders. 4. Enter the location(s).

Note! To query multiple locations, add a comma between each location number e.g. 1,2,5,7. 5. Select Ok.

Page Up

Page Down

Load Orders

7 Select

Load Orders

Delete Orders

Sort Orders

Print

Main Menu

Cancel

OK

8

10 Patient List

Page Down

Cancel

Save

13

6. Select the order(s) from the list. 7. Select Load Orders. 8. Select Select. 9. Select an order.

10. Select Ok to confirm the order selection.

Patient Data (Advanced Order Manager)

Cancel

11. Select Patient Data to open with the patient information screen which will be populated from the selected order. 12. Modify the patient and test data as necessary. 13. Select Save.

7

Acquire an! ECG @ 1

#

2

1. Prepare the patient.

$

3

2. Open the Resting ECG Q of two Wways:E function in one • Power on the unit or

A select S • From Main Menu Resting ECG. 3. Verify waveform Shift quality by:

Z

%

5

^

6

&

7

*

8

(

5. Select Patient Data to enter the patient information.

Y 6.R SelectTPage Down toUaccessI other Test Information windows.

D

F

G

H

J

7. Select Save to save and close the Patient Data window.

X

• Checking Hook-up Esc Advisor. Green indicates a good quality waveform. • Cycle through the lead groups to visually verify lead quality by selecting the Leads key on the keyboard. 4. Use the appropriate keys to make adjustments to (if necessary): • Speed • Gain • Filter

8

4

B key on N the M 8. CSelectVthe ECG keyboard to record and print an ECG. Space 9. If you have your system set to Preview before Analysis, select Continue to proceed to analyze and print an ECG or Cancel to cancel the analysis. 10. If finished, continue with step 11, or continue with these options: • Select Print to print another copy • Select Save if the unit is not set to save the ECG automatically.

9

)

+

• Select- Transmit to transmit that single | ? the default record to O P /

transmit location.

0

=

“

Leads

Stop

Rhythm

ECG

L start: a; new patient or

• Select Next Patient to

K

<,

‘

Acquire an ECG

ECG Leads

Select the ECG key to take ECG on the > . anotherEnter same patient.

11. When finished, do one of Alt two things: • Proceed to File Manager to transmit records. (See Transmit Stored Records.) • Turn the unit off and plug it into AC power. Note! Steps 1, 5 and 8 are the minimal basic steps for acquiring an ECG. All other steps are only used as required depending on options and features turned on.

!

@

1

#

2

Q

W A

S

%

4

E

Z

Shift

$

3

R D

X

Esc

^

5 T

F C

&

6

V

Rhythm

Stop

*

7

Y G

Stop

U H

B

(

8 I J

N

)

9 O K

M

?

P

:;

L

<,

Space

+

-

0

>.

= |

/

“

ECG

Leads

Rhythm

‘

Leads

Print Continuous Rhythm

Power

Enter

Alt

Print Continuous Rhythm 1. Prepare the Patient. 2. Open the Resting ECG function in one of two ways: • If the select default power on option is Resting ECG, simply power on the unit or • From Main Menu select Resting ECG 3. Verify waveform quality by: • Checking Hook-up Advisor. Green indicates a good quality waveform.

• Cycle through the lead groups to visually verify lead quality by selecting the Leads key on the Keyboard. 4. Use the keys to make adjustments to (if necessary): • Speed • Gain • Filter 5. Select Patient Data to enter patient information.

6. Select Page Down to access other Test Information windows 7. Select Save to save and close the Patient Data window. 8. Select the Rhythm key on the keyboard to print a continuous rhythm. 9. Select the Stop button to stop printing. Note! Rhythm reports are not stored to File Manager.

9

RR Analysis

Resting ECG

Order Manager

Arrhythmia

Stress ECG

File Manager

System Configuration

RR Analysis

More

2 More

3 Start Test

Patient Data

RR Analysis Setup

6

4

5

Print

PDF Export

Main Menu

Main Menu

Return

7 Printing an RR Analysis Report (not sold in all countries) RR table) as necessary by selecting RR Analysis Setup.

Use the following steps to generate an RR Analysis report. 1. Prepare the patient. 2. From the Main Menu select More.

6. Select Start Test to start the test. When the target is achieved, a preview of the summary results, histogram, and trendgram are shown on the display.

3. Select RR Analysis. You can also access RR Analysis from the Resting ECG mode after an ECG has been acquired. 4. Select Patient Data and enter the patient data.

10

5. Adjust the setup options (target, record lead, gain, speed, filter, pacemaker detection, rhythm record, and

7.

• To discard the reading and begin over, select Return. and repeat from Step 5. • To discard the reading and return to the Main Menu, select Main Menu. • To accept the reading and print the report on the thermal printer, select Print

Note! You may select Stop Test to stop the test prior to the reaching the target.

• To accept the reading and export the results as a PDF file, select PDF Export.

While reviewing the preview, do any of the following:

Note! Steps 1, 4 and 6 are the minimal basic steps for acquiring RR Analysis.

12.5 mm/s 5 mm/s

Start Recording

8

10 mm/mV

150 Hz

ECG

Rhythm

Leads

More

Acquire an Arrhythmia

Start recording button

Stop

Leads button @

#

$

2 3 Acquire an 1Arrhythmia 1. Prepare the Patient.

Q

W

E

2. Open the Arrhythmia function in one of two ways:

4

%

5

^

6

&

7

*

8

(

5. Select Save to save and close R the Patient T Y U I Data window. 6. Verify waveform quality by:

)

9

+

-

0

=

8. Select Start Recording. | ?

O

P

/

9. Select Stop Recording.

“

!

10. Select Confirm Stop to : ;recording or Continue F• Checking G H JAdvisor. K Lstop the • If the select A defaultSpowerD Hook-up on option is Arrhythmia, Green indicates a good Recording to continue to simply power on the unit quality waveform. < , collect > . information. Z X C V B N M Enter or Shift • Cycle through the lead 11. After the recording is • From Main Menu select groups to visually verify stopped, select the type of Space Alt you wish ArrhythmiaEsc lead quality by selecting Arrhythmia report the Leads key on the the printout to include: 3. The Patient Data window Keyboard. Summary Report, Table automatically opens. Enter Report, or Episode Report. 7. Make adjustments to the desired information. (if necessary): 12. Select Main Menu. 4. Select Page Down to access • Speed Note! Steps 1, 3 and 8 are other Test Information • Gain the minimal basic steps windows. • Filter for acquiring an ECG.

‘

11

Acquire a Stress ECG Test

Leads 1

3

Pretest

Exercise

Recovery

Test End

Recall

12 ld

Medians

Comment

2

!

1

5

4

@

Stress ECG Testing Keyboard

#

2

7

6

$

3

8

%

4

^

5

7. Test End: Ends the current test. When a confirmation message appears on the screen, select the desired function key.

4. 12 Ld: Prints a 12 lead report.

8. Comment: Allows you to enter comments about the test. Comments are printed on the Tabular Summary Report. You can enter up to 100 characters.

Q

1. Pretest: Advanced the test to the Pretest Phase or while in the Pretest Phase if selected will advance to the next stage in that phase.

5. Recovery: Advances to the Recovery phase or while in the Recovery Phase if selected will advance to the next stage.

W

A

E

S

Z a medianX Shift 6. Medians: Prints

report. Set the type of median report you wish to print in the Stress Setup window under In-test Reports.

Esc

R

D

T

F

C

&

6

3. Exercise: Advanced the test to the Exercise Phase or while in the Exercise Phase if selected will advance to the next stage in that phase.

The Stress ECG test keys are located at the top of the stress test keyboard. These keys are used to control the functions of the stress test as well as the connected stress device.

2. Recall: Prints a one-page rhythm strip report using the previous 10 secs of data from the point from which you select the Recall key

12

ECG

Y

G

V

B

Stop

Rhythm

Hold Stage

Speed W+

Grade

Tmil

Enter BP

Speed W-

Grade

Tmil

*

7

(

8

)

9

_

14

+

-

0

=

9. Hold Stage: Maintains the current test stage and doesn’t allow the protocol to go to next stage. Select again to remove the stage hold and to go back to programmed protocol staging.

12. Speed W- : Decreases treadmill speed or ergometer load. Selecting this button will ? result in the system no longer following the selected protocol and places the system in manual mode.

manually or triggers a reading for a supported external device.

will result in the system no longer following the selected protocol and places the system in manual mode.

I

O

P

: 13. Grade : Increase treadmill BP: Allows you to enter H 10. Enter J K L ; incline. Selecting this button a Blood Pressure reading N

M

<,

11. Speed W+: Increase treadmill speed or ergometer load. Selecting this button will result in the system no longer following the selected protocol and places the system in manual mode.

Space

>.

15. Tmil >: Starts the Treadmill 16. Tmil•: Stops the Treadmill

|

/

“

U

16

‘

12

Acquire a Stress ECG Test

15

11

10

&

13

9

Enter

14 Grade : Decrease treadmill incline. Selecting this button will result in the system no longer following the selected protocol and places the system in manual mode.

Alt 13

Acquire a Stress ECG Test

Resting ECG

Arrhythmia

Stress ECG

File Manager

1 Patient Data

25 mm’s

10 mm/mV

2 Pace Enhance Off

Printer Leads 12

Select Protocol

Report Format

System Configuration

More

FRF On

More

Target HR

More

3

4

Accessing Stress ECG Mode The Stress ECG mode is a purchasable option and allows you to conduct a Stress ECG test with a direct connection to treadmill or ergometer. Regardless of the devices the basic procedure for conducting a Stress ECG test is the same. Now let’s access the Stress ECG menu. 1. Select Stress ECG from the Main Menu. 2. Select Patient Data and enter the appropriate data.

14

3. Select More.

5. You can also turn Pace Enhance On or Off, select the Printer Leads, select Report Formats or change the Target HR.

4. Select Protocol to choose desired protocol. The default protocol will be chosen, however you can select another protocol from the list. If you do select a new protocol, select Save.

Note! In setups you can automatically set the Target HR % that you wish to achieve. This number is calculated against the patient’s age.

4

5

Leads

ECG

Rhythm

Stop

6

Pretest

Exercise

Recovery

Test End

Hold Stage

Speed W+

Grade

Tmil

Recall

12 ld

Medians

Comment

Enter BP

Speed W-

Grade

Tmil

Q Pretest Phase

# 2 3 3

W

$

4

E

A Stress ECG protocol typically is composed of 4 A phases.SThese D include Pretest, Exercise Recovery and Test End. Shift

Z

%

X

Pretest allows the user to take ECG and bloodEsc pressure measurements in a variety of patient positions. Depending on the protocol, it is also a phase that could be used to allow the patient to warm-up before the Exercise portion of the Stress ECG test.

R

^

5 T

&

6 Y

* 7 2 8

U

(

)

9

I

1. Select the Pretest button on F the keyboard G Hto enterJ the K Pretest Phase.

C 2. Select V theBBP button N on the M

keyboard and enter patient’s blood pressure. Space

O

_

+

-

0 P

?

= |

/

4. Select the Pretest button to : ;through the Ladvance Standing and Hypervent 12-lead as < , stages > . a BP andEnter required.

“

1

@

‘

!

Acquire a Stress ECG Test

1

5. Select the Pretest button to Alt advance to Warm-up. 6. Select the Tmil> button to start the treadmill.

3. Select the 12 ld button on the keyboard to take a 12-lead ECG

7. Have the patient start to walk at speed based on the selected protocol.

15

Leads

Rhythm

Stop

2

Pretest

Exercise

Recovery

Test End

Hold Stage

Speed W+

Grade

Tmil

Recall

12 ld

Medians

Comment

Enter BP

Speed W-

Grade

Tmil

51

@

Q

#

2

Exercise Phase

W

44

$

3 E

%

R

6^ 6

5 T

&

Y

7

3* 8 U

(

I

manually control the treadmill or ergometer’s workload. G H J K

Once the patient is comfortable A S or D F walking on the treadmill peddling on the ergometer, select 2. Select the Hold Stage button the Exercise key onZthe keyboard in the stage X C willV result B N being M Shift to start the Exercise Phase. The held at that workload for as phase will now indicate Exercise long as the stage is held. Esc Space and the stage time and workload Select Hold Stage a second will be dictated by the protocol. time to release the stage to

Note! Selecting the Speed or Grade controls for the treadmill or ergometer will result in the system dropping out of the protocol. At this point the user must

)

9

follow the selected protocol.

O

_

+

-

0

= |

?

P

/ 3. A blood pressure willbe automatically prompted for : ; the protocol or you Lbased on can select the Enter BP button < on the > keyboard to enter a BP.

“

!

1. Select the Exercise button on the keyboard. The system will now enter the exercise phase and follow the selected protocol. Select the Exercise button a second time will advance the protocol to the next stage.

16

ECG

,

.

‘

Acquire a Stress ECG Test

1

Enter

4. A 12 lead will be automatically taken by the system based on Alt the protocol or you can select the 12 ld button on the keyboard to take a 12 lead. You may also take a median report at any time by selecting Medians. 5. Select the Recall button to capture the previous 10 sec of ECG that just pasted on the screen.

Note! The stage time will turn red when the stage is in hold.

6. Select Comment on the keyboard to enter a patient related comment.

ECG

Rhythm

Stop

Pretest

Exercise

Recovery

Test End

Hold Stage

Speed W+

Grade

Tmil

Recall

12 ld

Medians

Comment

Enter BP

Speed W-

Grade

Tmil

@

1 Q

#

2

Recovery Phase

W

$

3 E

%

4 R

^

5 T

&

6 Y

*

7 U

(

8 I

)

9 O

_

+

-

0 P

?

6

= |

/

“

!

Once it is determined that the key on be A S D 1.F SelectGthe Recovery H J K 4. LBP will :automatically ; Exercise portion of the stress test the function keyboard when prompted based on the has been completed, you will the patient has reached peak protocol. <, >. Z X C exercise, V B when N Enter Shift now select the Recovery button or you areM 5. Enter comments or take extra and enter into the recovery ready to advance to the 12 leads or medians as phase. The Recovery phase is Recovery Phase. Esc Space Alt needed. opportunity to continue to 2. On supported treadmills the 6. Select Tmil• on the keyboard monitor the patient to make sure speed and grade of the to stop the belt. If using an their blood pressure, heart rate, treadmill will gradually ergometer, have the patient symptoms and ECG return to decrease according to the stop peddling. their pre- test values. The length protocol. of the Recovery Phase will 3. The system will automatically depend on your clinician print a peak 12-lead or protocol. median report according to the protocol.

Acquire a Stress ECG Test

1 Leads

‘

17

Rhythm

Stop

Pretest

Exercise

Recovery

Test End

Hold Stage

Speed W+

Grade

Tmil

Recall

12 ld

Medians

Comment

Enter BP

Speed W-

Grade

Tmil

@

1

2

Confirm Test End

Q

Test End

Shift

2# 3

$

Continue Test

W

E S

Z

%

4

R D

X

Once the Recovery phase is completed you can select Test Esc End on the keyboard and disconnect the leads from the patient. 1. Select the Test End key on the keyboard when ready to end the test.

^

5 T

F C

&

6 Y

G V

*

7 U

H B

(

8 I J

N

)

9 O K

M

2. Confirmation of ending the test appears. Select Space Confirm Test End to end test or select Continue Test to continue collecting data for the current patient.

_

?

P

:;

L

<,

+

-

0

>.

= |

/

“

!

‘

Acquire a Stress ECG Test

Leads

A

18

ECG

1

Enter

3. Once you have selected Confirm Test End Alt the following menu selections appear.