BR-102 plus User Guide rev e

Sales and Service Information The SCHILLER sales and service centre network is world-wide. For the address of your local distributor, contact your nearest SCHILLER subsidiary. In case of difficulty a complete list of all distributors and subsidiaries is provided on our internet site: www.schiller.ch Sales information can also be obtained from: [email protected]

Address Headquarters SCHILLER AG Altgasse 68 CH-6341 Baar Switzerland

Article No: 2.510576 rev.: e Issue date: 29.03.06

Tel: +41 (0) 41 766 42 42 Fax: +41 (0) 41 761 08 80

BR-102 plus

User Guide

Contents 1

Safety Notes ... 7

1.1

Intended Use ... 7

1.2

Responsibility of the User ... 7

1.3

Organisational Measures ... 7

1.4

Safety-conscious Operation ... 8

1.5

Safety Facilities ... 8

1.6

Operation with other Devices ... 8

1.7

Maintenance ... 8

1.8

Safety Symbols and Pictograms ... 9

1.8.1 1.8.2

Symbols used in this document ... 9 Symbols used on the device ... 10

1.9

Terms of Warranty ... 11

2

Introduction ... 12

2.1

The BR-102 plus Unit ... 12

2.2

The MT-300 Program ... 12

2.3

Main Components of the BR-102 plus ... 13

2.4

Initial Operation ... 14

2.4.1 2.4.2 2.4.3 2.4.4

Unpacking ... 14 Installation of the MT-300 Program... 15 Inserting/changing the accumulators ... 16 Connecting the pressure hose and microphone ... 16

3

The BR-102 plus Unit ... 17 Operating and Display Elements ... 17

3.1.1 3.1.2 3.1.3 3.1.4

Switching on... 17 Switching off / stopping a recording ... 17 Accumulator display ... 17 Time display ... 17

3.2

BR-102 plus Menu Structure ... 18

Art. no.: 2.510576 rev.: e

3.1

Page 3

BR-102 plus

Page 4

Taking a BP Recording ...20

4.1

Applying the Cuff... 20

4.1.1 4.1.2

Fixing the microphone directly on the upper arm... 22 Securing the cuff with the fixation pad ... 22

4.2

Commencing a Recording from the BR-102 plus ... 23

4.2.1

Procedure ... 23

4.3

Stopping the Recording ... 24

4.4

Patient Information ... 25

4.4.1 4.4.2 4.4.3 4.4.4

General ... 25 Taking an extra measurement during the recording ... 25 Interrupting a measurement during the recording... 25 Changing the accumulators during a recording (48 hour)... 26

4.5

Displaying a Recording on the BR-102 plus ... 26

4.6

Taking a Single Measurement ... 27

4.7

Switching off the BR-102 plus ... 27

5

MT-300 Program ...28

5.1

Introduction... 28

5.2

Transferring Data to the MT-300 Program... 29

5.2.1 5.2.2

Transferring data from the BR-102 plus... 29 Transferring data from a mini SD card (Option)... 29

5.3

Starting a Recording from the MT-300... 30

5.4

Stopping a Recording from the MT-300... 31

5.5

MT-300 Toolbar Icons... 32

5.6

Accessing and Opening Files... 33

5.7

Viewing and Editing a Recording... 34

5.7.1 5.7.2 5.7.3 5.7.4 5.7.5 5.7.6 5.7.7

Trend view ... 34 Defining the active and resting periods and limits... 35 Histogram (bar graph view)... 36 Measurement table ... 37 Results screen ... 38 Comparison screen... 40 Patient Screen, Assignment and Diagnosis... 41

5.8

Miscellaneous Functions ... 42

5.8.1 5.8.2 5.8.3 5.8.4 5.8.5 5.8.6 5.8.7

PDF Functions ... 42 Editing PDF files ... 42 Saving a Recording... 42 Sending a recording by e-mail ... 43 Importing recordings ... 43 Exporting recordings ... 43 Printing... 43

5.9

System Settings and Options... 44

5.9.1 5.9.2 5.9.3 5.9.4 5.9.5

Default analyse and display options ... 44 Default Print Options... 44 System Settings ... 45 Acronyms ... 47 Toolbar... 47

Art. no.: 2.510576 rev.: e

4

User Guide

6

Definitions ... 48

6.1

Mean Arterial Pressure ... 48

6.2

Body Mass Index ... 48

6.3

Blood Pressure Classification... 49

6.3.1 6.3.2

Classification of Blood Pressure Levels in Adults ... 49 Classification of Hypertension in Children and Adolescents ... 49

7

Maintenance and Cleaning ... 50

7.1

Visual Inspection ... 50

7.2

Calibration ... 51

7.3

Accumulator Maintenance ... 51

7.3.1 7.3.2

Charging the accumulators ... 51 Accumulator disposal ... 51

7.4

Cleaning ... 52

7.4.1 7.4.2

Cleaning the unit ... 52 Cleaning the cuff ... 52

7.5

BR-102 Error Messages ... 54

7.5.1

Error Message Table... 54

7.6

Transmission Problems ... 56

7.6.1

Checking the connection... 56

8

Technical Data ... 57

8.1

BR-102 plus ... 57

9

Accessories ... 58

9.1

Table of Accessories... 58

10

Patient Diary ... 59

10.1

Patient Diary Example ... 59

11

Charger Instructions ... 61

11.1

Copy of Charger Instructions ... 61

12

Index ... 63

Art. no.: 2.510576 rev.: e

BR-102 plus

Page 5

Art. no.: 2.510576 rev.: e

BR-102 plus

Page 6

BR-102 plus

User Guide

Safety Notes Intended Use

1 1.1

1 Safety Notes 1.1

Intended Use V

V

1.2

Responsibility of the User V V

V V V V

1.3

The BR-102 plus is a non-invasive ambulatory blood pressure monitor. It uses auscultatoric and oscilliometric signals, or purely oscilliometric signals, to measure the blood pressure of human beings. Systolic, diastolic, mean arterial pressure and heart rate are measured. The BR-102 plus is intended as an aid to diagnosis and treatment when it is necessary to measure an adult or adolescent patient’s blood pressure over an extended period of time (up to 48 hours). The BR-102 plus can be used for patients of both sexes and all races. The BR-102 plus should not be used with neonates.

This BP Recorder and PC program is provided for the exclusive use of qualified physicians or trained personnel under their direct supervision. The numerical and graphical results as well as any interpretation suggested by the device must be examined with respect to the patient's overall clinical condition and the quality of the recorded data. The responsibilities of the personnel for the operation and maintenance of the device must be specified. Ensure that personnel have read and understood these operating instructions. In particular this section safety notes must be read and understood. Damaged or missing components must be replaced immediately. The operator is responsible for compliance with all applicable accident prevention regulations and safety regulations.

Organisational Measures V

V

Art. no.: 2.510576 rev.: e

V V

Before using the unit, ensure that an introduction regarding the unit functions and the safety precautions has been provided by a medical product representative. Keep these operating instructions in an accessible place for reference when required. Make sure that they are always complete and legible. Observe the operating instructions and maintenance instructions. These operating instructions do not override any statutory or local regulations, or procedures for the prevention of accidents and environmental protection.

Page 7

1 1.4

Safety Notes Safety-conscious Operation

1.4

BR-102 plus

Safety-conscious Operation V Make sure that the staff have read and understood the operating instructions particularly this Safety Notes section. V Immediately report any changes that impair safety (including operating behaviour) to the person responsible.

1.5

Safety Facilities V Operating the device with defective cables may constitute a danger to life. Therefore: – Do not operate the PC when connected to the BR-102 plus, if the earth connection is suspect or if the mains lead is damaged or suspected of being damaged. – Damaged cable connections and connectors must be replaced immediately.

1.6

Operation with other Devices V Only use accessories and other parts recommended or supplied by SCHILLER AG. The use of other than recommended or supplied parts may result in injury, inaccurate information and/or damage to the device. V Accessory equipment must be certified according to the respective IEC standards (e.g. IEC/EN 60950 for data processing equipment and IEC/EN 60601-1 for medical equipment). Furthermore, all configurations shall comply with the valid version of the system standard IEC/EN 60601-1-1. Everyone who connects additional equipment to the signal input part or signal output part configures a medical system, and is therefore responsible that the system complies with the requirements of the valid version of the system standard IEC/EN 60601-1-1. If in doubt, consult the technical service department or your local representative. V The unit is safe during defibrillation. However, as a safety precaution remove the USB connector from the BR-102 plus and the PC before defibrillation. V The unit complies with EMC regulations for medical products which afford protection against emissions and immunity. However, the possibility exists that high frequency disturbance from other devices can affect the unit‘s operation.

Maintenance V Do not use high temperature sterilisation processes (such as autoclaving). Do not use e-beam or gamma radiation sterilisation. V Do not use aggressive or abrasive cleaners. V Do not, under any circumstances, immerse the device or cable assemblies in liquid.

Page 8

Art. no.: 2.510576 rev.: e

1.7

BR-102 plus

User Guide

Safety Notes Safety Symbols and Pictograms

1.8

Safety Symbols and Pictograms

1.8.1

Symbols used in this document

1 1.8

The safety level is classified according ANSI Z535.4. The following overview shows the safety symbols and pictograms used in this manual. For a direct danger which could lead to severe personal injury or to death.

For a possibly dangerous situation, which could lead to serious bodily injury or to death.

For a possibly dangerous situation which could lead to personal injury. This symbol is also used to indicate possible damage to property.

For general safety notes as listed in this chapter.

Note For possibly dangerous situations, which could lead to damages to property or system failure. Important or helpful user information.

Art. no.: 2.510576 rev.: e

Reference to other guidelines.

Page 9

1 1.8

Safety Notes Safety Symbols and Pictograms

1.8.2

BR-102 plus

Symbols used on the device The unit/component can be recycled.

Notified body of the CE certification (TÜV P.S.).

Attention: Consult accompanying documents.

Type BF equipment, safe for external applications.

Symbol for the recognition of electrical and electronic equipment

Art. no.: 2.510576 rev.: e

Equipment/components and accessories no longer required must be disposed of in a municipally approved collection point or recycling centre. Alternatively, you can return the equipment to your supplier or SCHILLER AG for disposal. Improper disposal can harm the environment and human health.

Page 10

BR-102 plus

User Guide

1.9

Safety Notes Terms of Warranty

1 1.9

Terms of Warranty The SCHILLER BR-102 plus is warranted against defects in material and manufacture for the duration of one year (as from date of purchase). Excluded from this guarantee is damage caused by an accident or as a result of improper handling. The warranty entitles free replacement of the defective part. Any liability for subsequent damage is excluded. The warranty is void if unauthorised or unqualified persons attempt to make repairs. In case of a defect, send the apparatus to your dealer or directly to the manufacturer. The manufacturer can only be held responsible for the safety, reliability, and performance of the apparatus if: • assembly operations, extensions, readjustments, modifications, or repairs are carried out by persons authorized by him, and • the SCHILLER BR-102 plus and approved attached equipment is used in accordance with the manufacturers instructions.

Art. no.: 2.510576 rev.: e

There are no express or implied warranties which extend beyond the warranties hereinabove set forth. SCHILLER makes no warranty of merchantability or fitness for a particular purpose with respect to the product or parts thereof.

Page 11

2 2.1

Introduction The BR-102 plus Unit

BR-102 plus

2 Introduction The SCHILLER long term blood pressure system comprises the BR-102 plus Ambulatory Blood Pressure Recorder and the MT-300 PC program.

2.1

The BR-102 plus is a menu-guided, user-programmable unit enabling long-term blood pressure measurements to be taken at preset intervals around the clock. The unit can take up to 200 (400) measurements over a 24 hour (48 hour) period with all recorded data stored in an internal memory. Individual measurements can also be taken at any time. The BR-102 plus can be used as a standalone unit or with the MT300 program. Two versions of the BR-102 plus are available, based on the measurement method:

08.38 RECORD START DISPLAY RESULTS SINGLE MEASUR. SYSTEM SETUP NEXT

The BR-102 plus Unit

OK

• Version 1 employs the auscultatory (Riva-Rocci, Korotkoff) method of measurement, with an oscilliometric method as back-up. This means that when a clear measurement cannot be obtained with the auscultatory method, the oscilliometric value is used. If a clear measurement cannot be obtained with either method the the BP measurement retaken. It is not possible to define oscilliometric as the primary measurement method. • Version 2 employs the oscilliometric method only. Note that with this unit no microphone is provided with the cuff. Details of the operation and user interface of the BR-102 plus is the same for both units and are detailed on the following pages.

2.2

The MT-300 Program The MT-300 is a PC based program. It is used to display, save, edit, analyse and print recordings made with the BR-102 plus. It can also be used to define measurement interval programs and other settings for the BR-102 plus and to start a long term recording on the BR-102 plus.

The MT-300 program can also be opened from the SCHILLER data and management system SEMA-200 if installed on the PC.

Page 12

Art. no.: 2.510576 rev.: e

Details of the MT-300 program are given later in this book (see page 28).

BR-102 plus

User Guide

2.3 1

2 3

4

OK

8

Main Components of the BR-102 plus (1) Microphone for recording patient identification. (2) USB-cable connection. (3) LCD display. (4) Loudspeaker. (5) Microphone connector jack plug. (6) Patient cuff connection. (7) Programming function key and On/off key. (8) Mini SD memory card (Option) used to store (raw) data for clinical trials and for software updates. (9) Programming function key.

08.38

7

2 2.3

Front

5 6

RECORD START DISPLAY RESULTS SINGLE MEASUR. SYSTEM SETUP NEXT

Introduction Main Components of the BR-102 plus

9

Back (10) Accumulator housing.

Art. no.: 2.510576 rev.: e

10

Data transmission Data transfer to the PC is realised directly via standard USB connection (2).

Page 13

2 2.4

Introduction Initial Operation

BR-102 plus

2.4

Initial Operation

2.4.1

Unpacking Check that all items are present and free of shipping damage. Immediately report any damage to SCHILLER AG.

Standard • • • • • • • • • •

BR-102 plus unit Two sets of rechargeable NiMH 2300 mAh accumulators (four in total) Accumulator charger unit Cuff size ‘M’ (medium) adult, and pressure hose with microphone (no microphone when unit has only oscilliometric method of measurement) Velcro fixing pad to secure cuff (single use, pack of 10) Adhesive pad to fix the microphone (single use, pack of 10) Securing pouch with belt SCHILLER CD with MT-300 software USB cable User guide and user guide short form

Optional Accessories • Cuff size ‘S’ (small) small adult, child • Cuff size ‘L’ (large) adult • Mini SD Card (16MB)

Special procedure for oscilliometric measurement only units If the oscilliometric only version of the BR-102 plus has been ordered, the cuff is different and must be prepared prior to use. To do this proceed as follows:

2.

11 -12 cm

Page 14

Using a pair of scissors, cut the cuff pressure hose approximately 11 -12 cm from the cuff. Discard the cut hose and connector. Carefully insert the plastic pressure hose until the lip is reached.

Art. no.: 2.510576 rev.: e

1.

BR-102 plus

User Guide

2.4.2

Introduction Initial Operation

2 2.4

Installation of the MT-300 Program Requirements Read the Software License Agreement enclosed in the package. By breaking the seal of the package you are agreeing to be bound by the terms of the agreement.

To install the MT-300 program you must have the following: • Pentium processor PC compatible computer (>500MHz, >256MB RAM) with approximately 1Gbyte or more of free disk space. • Windows operating system (Windows 2000 or XP). • SCHILLER program installation disk.

Procedure To install the program, proceed as follows: 1. 2. 3. 4. 5.

Insert the CD into the relevant drive of your computer. Access the drive and double click on the MT-300 folder and then the `Install.exe` file. (The drive can also be accessed via the RUN option (in the Start menu)). After a few moments the installation program starts and the welcome screen is displayed. Follow the screen Instructions and enter selections as required. Confirm installation and restart your computer.

• When the computer reopens, the MT-300 Program icon appears on the desktop and in the Windows™ `Start` menu.

Installation of the USB driver for the BR-102 plus 1.

Art. no.: 2.510576 rev.: e

2.

Using the USB cable provided, connect the BR-102 plus to a USB port of the computer. Follow the screen instructions and at the prompt for the driver, select USB driver from the SCHILLER CD.

Page 15

2 2.4

Introduction Initial Operation

BR-102 plus

2.4.3

Inserting/changing the accumulators The accumulators supplied are rechargeable NiMH 2300 mAh. Only use rechargeable accumulators supplied or recommend by SCHILLER. If other battery types are used, the capacity may not be sufficient for a 24 hour recording. V Ensure that accumulators are fully charged when replacing. Accumulators must be charged for approximately 3 hours (see page 51). V The full capacity of new accumulators is only reached after three charge/discharge cycles. V We recommend that the accumulators are replaced every 500 charge / discharge cycles. V Charged accumulators lose their charge when removed from the charger unit. Therefore to ensure full capacity at the beginning of a recording we recommend that: – The accumulators are left in the charger unit when not in use. – Accumulators are only removed from the charger unit immediately before commencing a recording. V

- (Neg) + (Pos)

Open the accumulator compartment and insert the two accumulators supplied. Observe the polarity.

On closing the accumulator cover, pay attention that the two lugs are inserted correctly. Always ensure that the lugs are inserted before closing the cover. Press the cover down until it clicks in place.

Switch on the device and check the accumulator charge capacity. The accumulator symbol must be fully black. This corresponds to a recording time of 24 hours (see following page). An audible and visual indication is given during recording when accumulator capacity is limited. When the alarm is given and a recording is to be continued, we recommend that the accumulators are replaced at the first opportunity.

2.4.4

Connecting the pressure hose and microphone 1.

2 1

2.

Position the pressure hose connector (1) and attach to the BR-102 plus by gently pressing until the connector ‘clicks ‘ in place. If the version is with a microphone, insert the microphone plug (2) into the BR102 plus socket at the same time.

Removing the pressure hose Lift the securing slider (1) and remove the hose connector (and microphone jack plug) from the BR-102 plus.

Page 16

Art. no.: 2.510576 rev.: e

When recording is stopped because of low accumulator capacity, and the accumulators are replaced within 5 hours of the unit switching off, the recording will continue (see page 26).

BR-102 plus

The BR-102 plus Unit Operating and Display Elements

User Guide

3 3.1

3 The BR-102 plus Unit 3.1

Operating and Display Elements Menu option selection and control of the BR-102 plus is with two function keys:

Left Green Key Functions:

Right Blue Key Functions:

On/off. Next (next menu item).

08.38 RECORD START DISPLAY RESULTS SINGLE MEASUR. SYSTEM SETUP NEXT

No (do not confirm selection). Meas: initiate a measurement (during the recording). Holding the key stops the recording.

OK

OK (confirm menu selection). Change (toggle through options). Yes (confirm selection). Meas: initiate a measurement (during the recording).

Break: Halts an ongoing measurement.

3.1.1

Switching on Press the green on/off key. The display shows the name and version number of the device before the main menu is displayed. If an unformatted mini SD card is installed, you are prompted to format the card when the unit is switched on, and again when a recording is started (also see page 23).

3.1.2 08.38 RECORD START DISPLAY RESULTS SINGLE MEASUR. SYSTEM SETUP

Art. no.: 2.510576 rev.: e

NEXT

OK

Switching off / stopping a recording With the main menu displayed and the cursor at any position, keep the green button pressed for 4 seconds. When the button is released, the device is switched off. If a recording is running, first stop it by following the same procedure and confirming that the recording is to be stopped. Any recorded data is saved when the unit is switched off. When no recording is running (and no function key is pressed), the device is switched off automatically after five minutes.

3.1.3 Full Half full Empty

3.1.4

Accumulator display The accumulator symbol indicates the capacity status. When the accumulator is full, the symbol is solid.

Time display The current time is displayed in the top right corner. The format of the time display can be set to 24 hour or 12 hour display (Am/Pm displayed) - this setting is defined in System setup (see next page).

Page 17

3 3.2

The BR-102 plus Unit BR-102 plus Menu Structure

BR-102 plus

3.2

BR-102 plus Menu Structure The menus are selected with the green function key (Next). A selected menu is opened with the blue button (OK) and values selected with the blue button (Change). Depending on the selected menu, the button functions may change .

Main Menu

Sub-Menu 1

RECORD START

Patient ID

Value/Info >

Sub-Menu 2

Sub-Menu 3

Value/Info

Record Voice

>

Value/Info

Start

Start Voice Recording

Stop

Stop Voice Recording

Stop

Stop Playing Voice

Play Voice

Plays recorded patient identification

Program

A, B, C, D

Select one of four individual recording programs - the programs are defined in Program Setup below.

Start

Press either of the two function keys for approxiDo you want Yes / No - Confirm Record- BP Recordmately a second to take an to start a BP ing start ing Started extra measurement during Recording? the recording.

Record Setup

Pat Group

Adult / Child. Maximum initial pressure for adult is 300mmHg and for a child 210mmHg

Page 18

Deflation Speed

Auto, 2, 3, 4, 5, 6, 7, 8, 9 mmHg/s

Program Setup

A, B, C, D - Four individual Change / BP measurement proNext grams (A, B, C and D) can be defined. Each individual program has: • up to 8 separate start times • defined BP measurement interval for each start time.

1. Define the start time by pressing change. The time counts up in 10 minute intervals. 2. When the desired start time is shown press next. The measurement interval is highlighted. 3. Press change to select a BP measurement interval of: –10, 15, 20, 30, 60, or 120 minutes. 4. Press next to define the next start time. 5. Continue until all desired start times (with measurement interval) are defined for the selected program. When less that 8 starts are required pressing next twice returns to the previous menu. A minimum of 2 start times must be defined.

Art. no.: 2.510576 rev.: e

Record Du24/48 Hours ration

BR-102 plus

The BR-102 plus Unit BR-102 plus Menu Structure

User Guide

Main Menu

Sub-Menu 1

DISPLAY RESULTS

Measurements

Displays results of stored recording

Patient ID

Play voice ID. Note: If started from a PC the patient Stop data is displayed.

Value/Info

Sub-Menu 2

Value/Info

Sub-Menu 3

3 3.2

Value/Info

Stop voice recording

Date and time, patient group, deflation speed, Record Data record duration, number of measurements. SINGLE MEASUREMENT

SYSTEM SETUP

Patient Group

Adult/Child See Record Setup before

Deflation Speed

Auto, 2, 3, 4, 5, 6, 7, 8, 9 mmHg/s

PulseBeep

Audible beep with detected On / Off heart rate

Start

Measurement starts and displayed

Contrast

1, 2, 3, 4, 5, 6, 7, 8

Language

ENG, DEU, FRA, ITA, SPA, POR, SWE, RUS

Date /Time

Break

Interrupt Measurement

Date

• • • • • •

Time

12, 24 hour

dd.mm.yyyy mm/dd/yyyy yyyymmmdd ddmmmyyyy yyyy-mm-dd yyyymmdd

Set date

Set time

Art. no.: 2.510576 rev.: e

Serial number, Hardware, System Info software version, SD card capacity (if inserted)

Page 19

4 4.1

Taking a BP Recording Applying the Cuff

BR-102 plus

4 Taking a BP Recording V To prevent excessive pressure, it is important to choose the correct cuff size and to check that the correct setting is used in the menu setup (Record Setup > Patient Group > Adult / Child). V During long term monitoring, the area where the cuff is attached must be checked regularly for signs of ischaemia, purpuras and/or neuropathy. V To prevent incorrect measurement results, ensure that the tube is not pinched or compressed. V The unit is safe during defibrillation. However, as a safety precaution, when possible remove the cuff and microphone before defibrillation and, if connected remove the USB connector from the BR-102 plus and the PC. V Do not touch the unit casing during defibrillation. V If the unit gets wet accidentally, switch off and dry with a cloth. V If the unit is accidentally immersed in liquid, remove the batteries and return to SCHILLER for checking.

A list of BR-102 plus error messages is given in the Maintenance section (see page 55).

4.1

Applying the Cuff 1.

Select the appropriate cuff size according to the patient's upper arm.

Three cuff sizes are available as follows: To fit arm size Midpoint Arm Circumference (cm)

Cuff Designation

18 - 26 S (Small Adult, Child) 25 - 35 M (Adult) 35 - 45 L (Large Adult) Note: Too small a cuff for the patient may give over measurement. Similarly, too big a cuff may give under measurement. Note: Cuffs S and L are available as optional accessories.

2cm

Page 20

Uncover the left upper arm of the patient. (The cuff is especially designed to fit the left upper arm). 3. Locate the brachial artery above the elbow bend inside the upper arm. 4. Position the microphone (marked Micro) over the brachial artery and secure cuff. – Wrap the cuff around the upper arm in such a way that the patient can still bend arm (the bottom edge of the cuff should be 2 cm away from the elbow bend). – Tighten the cuff and close it with the fixation wrap. The cuff must be tightened to such an extent that it fits properly on the upper arm and is prevented from moving. – To avoid a venous congestion don't tighten the cuff too firmly. – The pressure hose and microphone cable must point to the patient's shoulder.

Art. no.: 2.510576 rev.: e

2.