Operators Manual
592 Pages
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Solar® 8000M Patient Monitor Operator’s Manual Software Version 4 2000701-143
Revision C
NOTE: The information in this manual only applies to Solar 8000M Patient Monitor software version 4. It does not apply to earlier software versions. Due to continuing product innovation, specifications in this manual are 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.
© General Electric Company, 2002-2004. All rights reserved.
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CE Marking Information
CE Marking Information Compliance The Solar 8000M bears CE mark CE-0459 indicating its conformity with the provisions of the Council Directive 93/42/EEC concerning medical devices and fulfills the essential requirements of Annex I of this directive. The product is in radio-interference protection class A in accordance with EN 55011. The country of manufacture can be found on the equipment labeling. The product complies with the requirements of standard EN 60601-1-2 “Electromagnetic Compatibility - Medical Electrical Equipment”.
Exceptions The Solar 8000M system EMC: Immunity Performance - IEC 60601-1-2 Medical Electrical Equipment, Part 1: General Requirements for Safety, 2. Collateral Standard: Electromagnetic compatibility- Requirements and tests. Section 36.202.a-Radiated electromagnetic fields states: For Patient Coupled Equipment and/or systems applicable IMMUNITY levels are under consideration. The 3 volts per meter IMMUNITY level may be inappropriate because the physiological signals measured can be substantially below those induced by a field strength of 3 volts per meter. The Tram module respiration parameter numeric and waveform data may be affected at levels of 3 volts per meter or greater over the frequency range of 115 to 125 MHz. Noise may be induced on the CO2 waveform from the CO2 Capnostat modules when the system is used in the presence of an electromagnetic field strength of 3 volts per meter or greater. Measurement accuracy is maintained at a field strength of 3 volts per meter or less. Users should be aware of known RF sources, such as radio or TV stations and hand-held or mobile two-way radios, and consider them when installing a medical device or system. Be aware that adding accessories or components, or modifying the medical device or system may degrade the immunity performance. Consult with qualified personnel regarding changes to the system configuration.
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CE Marking Information
General Information
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This manual is an integral part of the product and describes its intended use. It should always be kept close to the equipment. Observance of the manual is a prerequisite for proper product performance and correct operation and ensures patient and operator safety.
The symbol documents.
Information which refers only to certain versions of the product is accompanied by the model number(s) of the product(s) concerned. The model number is given on the nameplate of the product.
The warranty does not cover damages resulting from the use of accessories and consumables from other manufacturers.
GE Medical Systems Information Technologies is responsible for the effects on safety, reliability, and performance of the product, only if:
means ATTENTION: Consult accompanying
assembly operations, extensions, readjustments, modifications, or repairs are carried out by persons authorized by GE Medical Systems Information Technologies;
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.
All publications conform with the product specifications and applicable IEC publications on safety and essential performance of electromedical equipment as well as with applicable UL and CSA requirements and AHA recommendations valid at the time of printing.
The GE Medical Systems Information Technologies quality management system complies with the international standards EN ISO 9001 and EN 46001, and the Council Directive on Medical Devices 93/42/EEC Annex II.
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Contents
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The Basics... 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 Product References... 1-4 Definitions... 1-4 Illustrations and Names... 1-4 Menus... 1-7 Main Display... 1-7 Menu Timeout... 1-7 More Menus... 1-8 Popup Menus... 1-9 Scrolling Popup Menu... 1-10 Pointer Popup Menu... 1-10 Numeric Popup Menu... 1-11 Subordinate Menus... 1-12 Windows... 1-14 Parameter Windows... 1-14 Common Operations... 1-18 Using the Trim Knob Control... 1-18 Using the Touchscreen Display... 1-19 Using the Touchscreen with Popup Menus and Information Windows... 1-20 Entering Alphanumeric Characters... 1-22 Setting Alarm Limits... 1-24 Selecting Options from Scroll Lists... 1-26 Language-Specific Information... 1-28 Chinese and Japanese Language Information... 1-28 French Language Information... 1-28 Hungarian, Polish and Russian Language Information... 1-28
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Equipment Overview... 2-1 Components... 2-3
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Solar 8000M Patient Monitoring System... 2-3 Solar 8000M Processing Unit... 2-4 Solar 8000M Display Unit... 2-6 Tram Modules... 2-7 Tram x51 Series Modules... 2-8 Tram Module Y-Adapter Cable... 2-9 Other Tram Module Series... 2-10 Tram Module Front Panel Connectors... 2-11 Single-Parameter Modules... 2-12 Single-Parameter ECG/Resp Module... 2-12 Tram-rac Housing... 2-14 Multiple Housings... 2-14 Housing Connectors... 2-15 Features of the Housing... 2-17 Installing and Removing Modules... 2-18 Optional Writers and Printers... 2-19 Optional Remote Display... 2-19 Optional Connectivity Devices... 2-19 Controls... 2-20 Keypad... 2-20 Trim Knob Control... 2-21 Buttons... 2-21 Putting the Monitor Into Operation... 2-24 Monitor Installation and Connection... 2-24 Turning Power On... 2-25 Performance Check... 2-26
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Safety... 3-1 For Your Safety... 3-3 Intended Use... 3-3 Terminology... 3-3 Monitor Safety... 3-3 Dangers... 3-4 Warnings... 3-4 Cautions... 3-8 Notes... 3-12 Reference Literature... 3-12 Classification... 3-13 Underwriters Laboratories, Inc... 3-14 Equipment Symbols... 3-14
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Maintenance... 4-1 Biocompatibility... 4-3 Inspection... 4-4 General Cleaning... 4-5 Cleaning the Touchscreen... 4-6 Cleaning Applied Parts... 4-7 Cables and Leadwires... 4-7 Other... 4-7 Internal Lithium Battery... 4-8 Technical Maintenance... 4-9 Technical Specifications... 4-9
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Monitor Setup... 5-1 Monitor Setup Menu... 5-3 Waveforms On/Off... 5-4 Individual Display Mode... 5-4 Full Display Mode... 5-5 CRG Plus Display Mode... 5-5 Display... 5-6 Individual 6 Waveform Display... 5-6 Individual 3 Waveform Display... 5-6 Full Display... 5-6 Full Grid Display... 5-6 CRG Full Display... 5-7 CRG Individual Display... 5-7 EEG Spectra Display... 5-7 BIS Spectra Display... 5-7 Parameters On/Off... 5-9 Graph Setup... 5-10 ECG 1, Waveform 2, Waveform 3, Waveform 4... 5-10 Alarm Graph... 5-12 Speed... 5-13 Timed Graph... 5-13 CRG Plus Options... 5-13 Graph BP Invasive... 5-13 Setup Default Arrhythmia Alarm Levels... 5-15 Setup Default Parameter Alarm Levels... 5-16 Setup Default Limits... 5-17
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Setup Default Display... 5-18 Setup Default Parameter Priority... 5-18 Recall Default... 5-20 Custom Defaults... 5-20 Monitor Defaults Password... 5-22 Recall Defaults... 5-22 Change Defaults... 5-23 Print CRG Plus... 5-23 Touchscreen Volume... 5-23 Learn the Monitor... 5-24 Software Compatibility... 5-25 Patient-Monitor Type... 5-27 Menu Setup... 5-27
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Admit/View A Patient... 6-1 About Admitting... 6-3 Monitor Applications... 6-3 Guidelines for Combination Monitoring... 6-4 For Which Application is the Monitor Set?... 6-5 Admit Menus... 6-6 Standard Admit Menu... 6-7 Combo Admit Menu... 6-9 Rover Combo Admit Menu... 6-10 Admit Menu Options... 6-11 Change Admit Info... 6-11 Admit Information Storage... 6-12 Multiple Patient IDs... 6-13 Request Admit Information... 6-14 View Manual Admit Information... 6-14 Recall Default... 6-14 ECG Source... 6-15 Graph Location... 6-15 Set Unit Name... 6-16 Set Bed Number... 6-16 Units of Measure... 6-16 Options for Admitting a Patient... 6-17 Admit Patient... 6-17 New Case... 6-17 Admit Help... 6-17 Quick Admit... 6-17 About Discharging... 6-18 Discharge Patient - Standard and Rover Applications... 6-18 Discharge Patient - Combo and Rover Combo Applications... 6-19 New Case... 6-19
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Viewing Other Patients... 6-20 Automatic View On Alarm Feature... 6-21 Functionality Comparison... 6-22 Viewing Bed Characteristics... 6-23 Viewed Patient Display... 6-24 Monitor Setup for Viewing Other Patients... 6-26 Default Settings... 6-26 View On Alarm Setting... 6-27 VOA Broadcast Setting... 6-27 VOA Alert Tone Setting... 6-27 AVOA Alarm Level Setting... 6-28 Remote Silence Setting... 6-28 AVOA Silence Setting... 6-28 View On Alarm Options Menu Settings... 6-29 View Other Patients Menu... 6-30 View Alarm... 6-31 View On Alarm Options... 6-32 View Other Beds on Alarm: ON... 6-32 View Other Beds on Alarm: AUTO... 6-34 Alarm Silencing... 6-34 Send Auto Views... 6-35 Alert Tone... 6-35 Configure Auto View On Alarm... 6-36 Current Configuration... 6-37 Select a Bed to View... 6-37 Turn the View Off... 6-37 Select Another Care Unit... 6-37 Graph Viewed Bed... 6-38 Viewed Patient Data... 6-38 Full Patient View... 6-39
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Printing... 7-1 Writers and Printers... 7-3 PRN 50 and PRN 50-M Digital Writers... 7-3 M-Port and AutoPort PRN 50 Digital Writers... 7-4 Changing the PRN 50 and PRN 50-M Digital Writer Paper... 7-5 Laser Printer... 7-6 Graphing... 7-7 Manual Graphs... 7-7 Exclusive Graph Control... 7-7 Alarm Graphs... 7-8 Invasive BP Only... 7-8 Pressure Scales... 7-8
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Graphing Messages... 7-9 Graph Header... 7-9
8
Alarm Control... 8-1 Smart Alarms... 8-3 Alarm Structure... 8-4 Patient Status Alarms... 8-4 Remote Alarm Terminal... 8-5 System Status Alarms... 8-6 On-screen Alarm Help... 8-6 Controlling Audio Alarms... 8-7 Silencing Alarms... 8-7 Pausing Alarms... 8-8 Alarm Pause Breakthrough... 8-9 Remote Silencing... 8-9 Turning Alarm Volume Off Permanently... 8-9 Alarm Window... 8-10 Clear Alarms... 8-10 Alarm Histories... 8-11 Alarm Control Menu... 8-12 All Limits... 8-13 Changing a Limit... 8-13 Arrhythmia Alarm Level... 8-14 Parameter Alarm Level... 8-15 Alarm Volume... 8-15 Minimum Alarm Volume... 8-16 Alarm Volume Off... 8-16 Alarm Help... 8-17 Display Off/Alarm Pause... 8-18 Clear Alarms... 8-18 Alarm History... 8-18 CRG Trends... 8-19 Alarm Pause... 8-19
9
CRG Plus Display... 9-1 Parameters Displayed... 9-3 CRG Plus Full Display... 9-4 CRG Plus Individual Display... 9-5 Turning on the CRG Plus Display... 9-6 Selecting Parameters for the CRG Plus Display... 9-6
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Printing CRG Plus Parameters... 9-7 Print CRG Plus... 9-7 CRG Plus Printing Options... 9-7 Choose Parameters... 9-7 Print CRG Plus Every Two Minutes... 9-8 Print CRG Plus on Alarm... 9-9 Other Printing Information... 9-9 CRG Trends... 9-10 CRG Trends Display... 9-10 CRG Trends Event Directory... 9-12 CRG Trends Menu Options... 9-13 Locate Cursor... 9-13 Zoom In/Out... 9-13 View Older/View Newer... 9-13 Select Parameters... 9-14 Select Event... 9-14 Delete Event... 9-14 Print Events... 9-14 Document CRG Events... 9-15 Troubleshooting... 9-17
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Patient Data... 10-1 Patient Data Menu... 10-3 Alarm History... 10-4 Select Alarm... 10-5 Vital Signs... 10-7 View Older/View Newer... 10-8 Time Interval... 10-8 Specific Time... 10-8 Sort Data... 10-9 Page Up/Page Down... 10-9 Graphic Trends... 10-10 Select Parameters... 10-11 Preset Trends... 10-12 View Older/View Newer... 10-12 Time Period... 10-12 Cardiac Calcs... 10-13 Change Value... 10-14 Save Calc... 10-15 Review Calcs... 10-15 Weight and Height... 10-16 Pulmonary Calcs... 10-17 Monitored/Measured Parameters... 10-17
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Derived Pulmonary Calculations... 10-18 Change Value... 10-20 Save Calc... 10-20 Review Calcs... 10-21 Weight and Height... 10-21 Calculate... 10-21 Store Estimated Calcs... 10-21 Dose Calcs... 10-23 Change Value... 10-26 Save Calc... 10-28 Recall Saved Calc... 10-28 Delete Calc... 10-28 Titration Table... 10-29 Weight... 10-29 Drug Units... 10-30 Drug Quantity Range... 10-30 Resuscitation Medications... 10-30 CRG Trends... 10-30 Lab Data... 10-31
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ECG... 11-1 Introduction... 11-3 “NO ECG” Comm Alarm... 11-4 Checklist... 11-5 Skin Preparation... 11-6 Electrode Placement... 11-7 5-Leadwire Electrode Placement... 11-8 3-Leadwire Electrode Placement... 11-9 3-Leadwire Configuration... 11-10 Electrode Placement for Neonates... 11-11 Electrode Placement for Pacemaker Patients... 11-12 10-Leadwire Electrode Configuration for 12SL Monitoring... 11-13 Maintaining Quality ECG Signal... 11-15 Surgical Considerations for Electrode Placement (Adults)... 11-15 ESU ECG Filters... 11-16 Electrosurgical Unit (ESU) Cable... 11-16 ECG Monitoring Features... 11-17 ECG Display... 11-17 ECG Menu... 11-18 Getting to the ECG Menu... 11-18 Display Lead... 11-19
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Synchronized Cardioversion... 11-19 Smart-Lead Fail... 11-20 Leads Fail Patient Condition... 11-20 ECG Size... 11-21 Detect Pace... 11-22 Safety Considerations... 11-22 Monitoring Pacemaker Patients... 11-24 Pace Help... 11-27 ECG Limits... 11-28 PVCs Per Minute... 11-28 Artifact Alarm... 11-28 View All ECG... 11-29 Print All ECG... 11-29 Clear V2-V6 Fail... 11-29 Arrhythmia... 11-30 Turning Arrhythmia On and Off... 11-31 Minimum Arrhythmia... 11-32 Lethal Arrhythmia... 11-32 Full Arrhythmia... 11-32 Arrhythmia Conditions... 11-33 Relearn... 11-36 ST Analysis... 11-37 Numerics... 11-37 Trends and Complexes... 11-38 Turn ST On and Off... 11-40 ST Analysis Menu... 11-40 Print ST... 11-41 Store New References... 11-41 ST Limits... 11-42 Identify V Lead... 11-44 Trend Scale... 11-45 ST Display... 11-45 Initiate 12 Lead on ST History... 11-46 Adjust ST Point... 11-46 ECG Filter... 11-47 12 Lead ECG Analysis... 11-48 Manual Method... 11-50 Automatic Method... 11-51 Lead Analysis... 11-52 Multi-Lead Analysis... 11-52 Single Lead Analysis... 11-53 Changing Lead Analysis... 11-53 More ECG... 11-53 QRS Volume... 11-54 QRS Width... 11-55 Speed... 11-55 Troubleshooting... 11-56 Pacemaker Troubleshooting... 11-58
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12
Pressures... 12-1 Introduction... 12-3 Assigned BP Names... 12-4 Zero Reference... 12-6 Checklist... 12-7 Pressure Monitoring... 12-8 Pressure Information... 12-8 CPP Pressure... 12-9 Getting to the Pressure Menu... 12-9 Pressure Menu Options... 12-10 Scales... 12-10 Full Scales... 12-10 Cursor... 12-11 Clear Cursor... 12-11 Change Name... 12-12 Zero... 12-13 BP Filter... 12-13 Calibrate Transducer... 12-14 Speed... 12-14 Special Features... 12-15 IABP... 12-15 Triggering... 12-15 Using the IABP Feature... 12-17 Starting the IABP Program... 12-17 Displayed Values... 12-17 Smart BP... 12-20 Pulse Rate... 12-21 Disconnect Alarm... 12-21 PA Wedge... 12-22 PA Wedge Menu Option... 12-22 PA Insert Wedge Menu Option... 12-24 Move Wedge Cursor... 12-27 Auto Mode... 12-28 Manual Mode... 12-29 Full Scales... 12-30 Speed... 12-30 Graph BP Invasive... 12-30 General Troubleshooting... 12-31 Wedge Troubleshooting... 12-32
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NBP... 13-1 Introduction... 13-3 NBP Connectors... 13-4 Safety... 13-5 Checklist... 13-6 Patient Preparation... 13-7 NBP Monitoring Features... 13-9 NBP Information... 13-9 Mean Arterial Pressure... 13-10 Systolic Search... 13-10 NBP Go/Stop Button... 13-11 Display On/Off Button... 13-11 Getting to the NBP Menu... 13-11 NBP Menu Options... 13-12 NBP Auto... 13-12 NBP Auto Timing... 13-12 NBP Stat... 13-14 Early Systolic Measurement... 13-15 Review NBPs... 13-15 NBP Limits... 13-16 Cuff Size... 13-16 Clear NBP Reading... 13-16 Initial Inflation Pressure... 13-17 Troubleshooting... 13-18 NBP Status Messages... 13-18
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SPO2... 14-1 Introduction... 14-3 Safety... 14-5 Measurements... 14-6 Neonates and Infants... 14-7 Checklist... 14-8 Patient Preparation... 14-9 Signal and Data Validity... 14-10
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Signal Strength Indicator... 14-10 Quality of SPO2 Waveform... 14-10 Stability of SPO2 Values... 14-11 Masimo SET Modules and Probes... 14-12 No Implied License... 14-12 Probes... 14-12 Masimo SET Module PWR Indicator Light... 14-13 SPO2 Monitoring Features... 14-14 SPO2 Information... 14-14 Two SPO2 Sites... 14-15 Getting to the SPO2 Menu... 14-16 SPO2 Menu Options... 14-17 Size... 14-17 Rate... 14-17 Rate Volume... 14-18 SPO2 Limits... 14-18 Persistent... 14-19 Speed... 14-19 Sensitivity... 14-20 Averaging... 14-20 Sat-Seconds... 14-20 Sat-Seconds Alarm Management... 14-21 Probe Off Patient Condition... 14-24 Pulse Search Condition... 14-25 Troubleshooting... 14-26 SPO2 Messages... 14-26 Clinical Questions... 14-28
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Cardiac Output... 15-1 Introduction... 15-3 Cardiac Output Washout Curve... 15-4 Influencing Factors... 15-5 Technique... 15-5 Suggested Cardiac Output Procedure... 15-6 Checklist... 15-8 Bath Probe Setup... 15-9 In-Line Setup... 15-10
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Cardiac Output Monitoring Features... 15-11 Cardiac Output Information... 15-11 Cardiac Output Trials... 15-12 Getting to the Cardiac Output Menu... 15-14 Cardiac Output Menu Options... 15-15 Delete CO Trials... 15-15 Cardiac Calcs... 15-15 Cardiac Output Now... 15-16 BT Limits... 15-16 Units... 15-16 Print CO Curve... 15-17 Auto Mode... 15-17 Use: PAW (PAD, LA)... 15-17 Catheter... 15-18 Injectate Temperature... 15-18 Injectate Volume... 15-19 Computation Constant... 15-20 Cardiac Output Help... 15-20 Cardiac Calculations... 15-21 Introduction... 15-21 Monitored Parameters... 15-21 Calculated Parameters... 15-22 Cardiac Calcs... 15-23 Change Value... 15-24 Save Calc... 15-25 Weight... 15-25 Height... 15-25 Troubleshooting... 15-26 Procedural Prompts and Messages... 15-26
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Respiration... 16-1 Introduction... 16-3 General Information... 16-4 Checklist... 16-7 Respiration Monitoring Features... 16-8 Respiration Information... 16-8 Getting to the Respiration Menu... 16-9 Respiration Menu Options... 16-10 Lead... 16-10 Relearn Respiration... 16-10 Sensitivity... 16-11 Respiration Limits... 16-11
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Auto Size... 16-11 Manual Size... 16-12 Cardiac Artifact Alarm... 16-12 Speed... 16-13 Troubleshooting... 16-14 Respiratory Waveform... 16-14 Cardiac Artifact... 16-14 Messages... 16-16
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Temperature... 17-1 Introduction... 17-3 Checklist... 17-4 Temperature Monitoring Features... 17-5 Temperature Information... 17-5 Getting to the Temperature Menu... 17-6 Temperature Menu Options... 17-7 T1... 17-7 T2... 17-7 Units... 17-7 Temperature Limits... 17-7 Troubleshooting... 17-8 Messages... 17-8
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SvO2... 18-1 Introduction... 18-3 Checklist... 18-5 Signal and Data Validity... 18-6 Signal Strength Indicator... 18-6 SVO2 Monitoring Features... 18-7 SVO2 Information... 18-7 Getting to the SVO2 Menu... 18-8 SVO2 Menu Options... 18-9 SVO2 Limits... 18-9 SVO2 Help... 18-9 Preinsertion Calibration... 18-9 Light Intensity Calibration... 18-9
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SVO2 Cal History... 18-10 Calibration... 18-11 Preinsertion Calibration... 18-11 Light Intensity Calibration... 18-13 Calibrate to Venous Blood Gas... 18-14 SVO2 Cal History... 18-16 Troubleshooting... 18-18
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CO2... 19-1 Introduction... 19-3 CO2 Monitoring Features... 19-4 CO2 Information... 19-4 Capnostat Modules... 19-6 General Information... 19-6 Mainstream Setup... 19-8 Sidestream Setup (Dual Module)... 19-10 Non-Intubated Patients... 19-12 Intubated Patients... 19-13 Gas Exhaust... 19-14 CO2 Menu Options (Capnostat Modules)... 19-15 Getting to the CO2 Menu... 19-15 Pump... 19-16 Units... 19-16 CO2 Scale... 19-16 N2O Compensation... 19-17 O2 Compensation... 19-17 CO2 Averaging... 19-18 Cal Sensor to Zero Cell... 19-18 Calibrate Adapter... 19-18 Speed... 19-18 Zero the Capnostat Sensor... 19-19 Calibrate the Capnostat Adapter... 19-20 Capnostat Sensor and Adapter Cleaning... 19-21 Cleaning the Capnostat Sensor... 19-21 Cleaning the Reusable Capnostat Adapters... 19-21 Capnostat Sensor Troubleshooting... 19-22 Capnostat Sensor Check... 19-22 Messages... 19-24
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Sidestream Modules... 19-27 Sidestream Module Setup... 19-28 Pump Control... 19-29 Gas Exhaust... 19-29 CO2 Menu Options (Non-Capnostat Modules)... 19-30 Getting to the CO2 Menu... 19-30 Units... 19-30 CO2 Scale... 19-31 CO2 Limits... 19-31 N2O Compensation... 19-32 Speed... 19-32
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Interfaces... 20-1 Introduction... 20-3 Connectivity Devices... 20-7 Safety... 20-8 Interconnection... 20-10 Serial Port Indicator Lights... 20-11 Tram-net Interface Adapter... 20-12 Displayed Data... 20-14 Parameters... 20-15 Parameter Windows and Menus... 20-15 Pulse Oximeters... 20-15 Transcutaneous Monitors... 20-16 Ventilators... 20-17 Gas Analyzers... 20-18 Continuous Cardiac Output... 20-19 IV Pumps... 20-20 Urometers... 20-20 Anesthesia Machines... 20-20 BIS Monitor... 20-20 NICO Monitor... 20-21 POC Blood Gas Monitor... 20-22 Software Compatibility... 20-23 Device-Specific Information... 20-24 Notification of Equipment Upgrade... 20-26
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