Schiller CARDIOVIT AT3 Operating Manual Issue 28 1990

CONTENTS INTRODUCTION

1

About this manual

2

Safety

CHAPTER 1 Brief Operating Instructions

5

Automatic ECG Recording Manual ECG Recording Long-term Rhythm Recording Replacing the Recording Paper Keyboard Functions Connector Panel

6 6 6 7 8 10

CHAPTER 2 Getting Started Setting Up the Apparatus Power Supply Mains AdapteKharger Unit MA-3 Mains AdapterEharger Unit MA-4 Potential Equalisation Switching On and Off Replacing the Recording Paper

11

__

12 12 13 13 13 13 14

CHAPTER3 Working with the CARDlOVlT AT-3 ECG Recording Liquid Crystal Display LC Display as ECG Monitor Printing the ECG shown on the screen LC Display as Alphanumeric Screen Operating instructions on the screen Selecting Number of Leads Selecting the Lead Groups Connecting the Patient Cable Connecting the electrodes Input of Patient Data Chart Speed Sensitivity Heart Rate Indication Automatic ECG Recording EGG acquisition and printout Copies of the ECG Selection of sensitivity in automatic mode Manual Recording of ECGs Copies of manual ECGs Recording of Long-term Rhythm ECGs Transfer to/from CARDlOVlT CS-6/12 Basic Settings Further Settings and Programs

17 18 18 18 19

20 20 21 21 22 22 23 24 24 24 25 25 25 25 26 26 27 28 29 29

CHAPTER 4 Care and Maintenance

31

Disturbances Self-test Testing the Electrode Cables Care and Maintenance Terms of Warranty

32 32 32 33 34

CHAPTER 5 Technical Data and Equipment Configurations

35

Technical Data Available Configurations

36 38

CHAPTER 6 Reference Information

39

Adjusting Date and Time Format for Automatic Mode Leads (freely programmable) Lead Systems Attaching the electrodes Pacemaker Measurement User Identification Various Settings Baseline and myogram filters Interpretation settings

40 41 43 44

44 46 46 47

48 49

CHAPTER 7 Options SCHILLER ECG Analysis Program (Versions M 81C) Heart rate (HR) Intervals Electrical axes Detailed measurementsfor each lead

51 52

52 52 52 53

Schiller ECG Interpretation Program (Version C) Explanation of findings Rhythm Electrical axis Atrial activity ECG Voltages Blocks QRS abnormalities Myocardial infarctions ST-T morphology QT- interval Hypertrophy Miscellaneousstatements Low sensitivity statements

55 55 58 58 59 59 60 61 62 65 65 66 67

Long-term Memory

69

Emergency Tripod Electrode

71

Rhythm and Heart Rate Monitoring Selecting monitor mode

73

55

73

Starting and termination of monitoring Heart rate trend

74 74

RS-232 Computer Interface Setting up Mode setting Select transmission mode Selecting the ECG data to be transmitted Input ECG from RS-232 Ouput ECG to RS-232 Output all ECGs to RS-232 Error messages Test procedures for the RS-232 Technical data RS-232 (V24) serial interface

75 75 76 76 77 78 78 78 78 79 79

Pulsoximetry (SaO,) Connecting the finger sensor Selecting the settings Starting SaO, recording Trend curves Interrupting SaO, recording Acoustic beeper Error messages Technical data

81 81 81 82 83 83 83 84 84

TECHNICAL SAFETY CHECK

85

Test Results

86

INTRODUCTION

CARDlOVlT AT-3, the intelligent miniature ECG unit from Schiller, is ready for use at any time and anywhere: It is handy, battery powered and equipped with all the knowhow of the large ECG recorders. You can program it so that you will be able to recordand print an ECG in exactly the way you need by pressing only one key.

With the CARDlOVlTAT-3 you can record resting ECGs and print them in many different formats. Also, there are several printingformats for long-term rhythm recordings at your disposal. If you read the following pages you will very quickly be able to use your new electrocardiograph optimally.

‘The manufacturer can only be held responsible for the safety, reliability, and performance of the apparatus when:

- assembly operations, extensions, readjustments, modifications, or repairs are carried out by persons authorized by him, and

- the electrical installation of the relevant room complies with the IEC requirements, and

- the CARDlOVlT AT-3 is used in accordance with the operating instructions.

Page 2

About this manual

This manual introduces you to the operation of the CARDIOVIT AT-3. We recommend that the instructions be read first in order to obtain the necessary basis for working with the unit. The manual can later be used for reference. The operating manual is divided into three main parts: The Brief Operating instructions describe in a few sentences the most important procedures (automatic and manual ECG recordings, rhythm recording, replacing the paper). When you are used to working with the unit, these brief hints will serve as an aide-memoire. In the second part Working with the CARDlOVlT AT-3 you will be introduced in detail to the different applications. In the Reference part you find all the settings, programs and inputs described in detail.

The last chapters contain further information. The general parts of the operating manual apply to the CARDlOVlT AT-3 standard model. Nevertheless, some of the options are included, especially if they are necessary for a particular mode of operation. The other options are described in Chapter 7 . The most important part is "Working with the CARDlOVlT AT-3". There you learn all the important applications. In order to use you new electrocardiograph optimally we recommend that the whole manual be read carefully.

Page 3

Safety

4ml).

This unit is classified CF ( This means that the patient connection is fully isolated and defibrillation protected and that the unit is also suitable for intracardiac application. Protection against defibrillation voltages is only ensured, however, if the original Schiller patient cable is used. For ECG recordings it must be ensured that neither the patient nor the conducting parts of the patient connection nor the electrodes (including the neutral electrode) come into contact with other persons or conducting objects (even if these are earthed). The original Schiller patient cable is provided with special safety precautions to offer protection against burns from HF surgical equipment. Incorporated protective resistors prevent or reduce the passage of defibrillation or HF currents through the electrode leads. When using hiah freauencv suraical equipment together with an electrocardiograph, special care must be exercised in all cases: the active surgical electrode should always be placed at least 15 cm from the nearest electrode.

For a defibrillation, the protection against overvoltages fitted in the patient cable is indeed sufficient, but here too, the necessary caution must be observed. If possible, the patient should be disconnected temporarily from the ECG unit during defibrillation. There is no danger when using the ECG unit for a pacemaker patient or with simultaneous use of other electrical stimulation equipment. A certain caution should however be observed here: the stimulation units should only be used at a sufficient distance from the electrodes. In case of doubt, the patient should be disconnected from the ECG recording unit. If several units are coupled, there is a danger of summation of the leakage currents. It must be determined in each case before coupling (e.g. by consulting the manufacturer) whether the units are suitable for this purpose. The CARDlOVlT AT-3 should only be operated togethei with mains adapter unit MA-3 or MA-4.

CHAPTER 1

Brief Operating Instructions In this first chapter, the applications are briefly described. Once you are used to working with the CARDlOVlT AT-3, these descriptions will serve as an aide-memoire. Apart from the short lists of operating. instructions for automatic and manual ECG recording and long-term rhythm recording, the procedure for replacing the paper is also shown. On a further page, the function keys are listed.

Automatic ECG Recording

Manual ECG Recording

Long-term Rhythm Recording

1.

Place electrodes in standard positions on patient

1.

Place electrodes in standard positions on patient

1.

Place electrodes in standard positions on patient

2.

Switch on the CARDlOVlT AT-3 with green key ON + check recording on screen

2.

Switch on the CARDlOVlT AT-3 with green key ON + check recording on screen

2.

Switch on the CARDlOVlT AT-3 with green key ON + check recording on screen

3.

Enter patient data: press FNCT and 1 and input according to table

3.

Select lead group, sensitivity, and paper speed

3.

Enter patient data: press key FNCT and 1 and input according to table

4. 4.

Press AUTOETART -I EGG is printed in the preset format

Enter patient date: press key FNCT and 1 and input according to table

4.

Press FNCT and 2: Select recording format

Press MANETART

5.

5.

Copies: press COPY

6.

Switch off electrocardiograph, free patient from electrodes

5.

+ ECG is printed

6.

During the recording, you can change lead group, sensitivity, paper speed at any time

7.

Stop recording with the STOP key

8.

Switch off unit, free patient from electrodes

Press 7 to start the recording + The rhythm leads are printed

in the preset format after 4 to 12 minutes.

6.

To stop the recording, press 8 + The remainder of the rhythm leads is printed.

7.

Switch off electrocardiograph, free patient from electrodes

Page 7

Replacing the Recording Paper The recording paper should be replaced as soon as the end of the paper is indicated on the lower edge. After the indication first appears, there are about eight pages left.

Push paper compartment release and pull out paper drawer.

'ut the new paper package into iaper compartment. Pull up ieginning of paper and place it iver guide roller.

Put in the paper drawer and press firmly until it clicks into place. Check for correct paper alignment.

I

Keyboard Functions

Kev

Function

Kev

Function

FNCT

switching to operating help or ECG monitor on the screen

STOP

stop printout

DEL

delete characters

FNCT + 1 FNCT + 2 FNCT + 3 FNCT + 4 FNCT + 5 FNCT + 6 FNCT + 7 FNCT + 8 FNCT + 9 FNCT + RETURN + 1 FNCT + RETURN + 2 FNCT + RETURN + 3 FNCT + RETURN + 4

entering patient data format for rhythm mode storage mode format for automatic mode on/off acoustic QRS indication self-test adjusting clock and calendar program of additional lead group measurement of pacemaker storing base setting various machine settings user identification ECG transmission

3-1

ECG monitor: switching from 1channel to 3-channel representation and vice versa.

OFF

switch off

5/25150mm/s

chart speed selector

ON

switch on

2,5/5/10/20mm/mV

sensitivity selector

COPY

copies of ECGs

1 mV

key for manual calibration

AUTOISTART

start automatic printout

MANISTART

start manual printout

&-

FILT

switch on/off myogram filter (muscle tremor filter)

4

lead group selector (backward)

b

lead group selector (forward)

0

1

moving to next line or to next page

SCHILLER Switzerland

page 10

Connector Panel (right-hand side of unit)

Patient

ipJt

Socket for patient cable CF rated: fully floating and isolated, defibrillation protected, suitable for intracardiac application Caution: Defibrillation protected only if used with the original patient cable.

Test

Test socket for electrode leads with control light

DC1

Experimental input (differential input) sensitivity: 0,5 V input impedance: > 100 kOhm

LCD

Knob for adjusting the contrast of the screen

DATA 110

socket for : - input and output of data - connecting the footswitch - transferring a QRS trigger signal

2

, 4 J ( 6 3 7

Pin 2

footswitch (contact to GND = START) GND

Pin 3

QRS trigger

Pin 1

5

ov

CHAPTER 2

Getting Started Once you receive your CARDlOVlT AT-3, it is important to set it up properly and to learn the basic manipulations such as switching on and off, changing the paper etc. When you have read this second chapter, you will be able to start working with the CARDlOVlT AT-3.

page 12

Setting Up the Apparatus

Power Supply

Do not keep or operate the apparatus in a wet, moist, or dusty environment. Also, avoid exposure to direct sunlight or heat from other sources. Do not allow the unit to come into contact with acidic vapours or liquids, as such contact may cause irreparable damage.

The unit can either be operated with the in-built rechargeable battery, or by connection to the mains supply by means of the supplied power adapter.

Furthermore, the unit should not be placed near X-ray or diathermy units, .large transformers or motors. ution: This apparatus should not be operated in areas with danger of explosion.

On the lower right of the screen the indication ' B A T shows the condition of the battery. As soon as the battery voltage reaches a minimum (25%), the indication starts to blink. For recharging the battery, connect the apparatus to the mains supply by means of the supplied power adapter. A totally discharged battery needs 24 hours to be recharged with the MA-3, or 1 1/2 hours with the MA-4. A fully charged battery will last for approx. 1 1/4 hours of ECG recording and printing. When used for monitoring and long-term rhythm recording, the battery will last for at least 2 112 hours. The stored ECGs will be retained in the memory even if the battery voltage is too low to operate the unit.

In order to conserve battery power, an automatic switch-off will occur if the unit is inactive for a period of 5 minutes. The unit can remain connected to the mains supply all the time without any danger of damage to the battery or the unit.

page 13

Mains AdapterKharger Unit MA-3

Potential Equalisation

Use the connector cable to connect the MA-3 to the CARDIOVIT AT-3, and connect the mains cable to the mains supply. When connectedto the MA-3, the AT-3 will be supplied directly from the mains. During battery charging, the green indicator lamp is lit. This lamp is extinguished as soon as the battery is recharged (approx. 24 hours).

The yellow/green ground lead can be connected to the potential equalisation and then to the ( ) connection either on the rear of the CARDIOVITAT-3 or on the left-hand side of the MA-4.

.&

Switching On and Off Mains AdapterEharger Unit MA-4 The mains adaptedcharger unit MA-4 is a fast-charging unit enabling the accumulator in the AT-3 to be fully recharged in a short time. The MA-4 is connected to the AT-3 either by plugging directly into the socket on the rear of the unit or via the connecting cable supplied. (When connecting directly, first unscrew and remove the potential equalisation connection ( ) on the rear of the AT-3.) Connect the MA-4 to the mains supply with the power cable (by means of a special cable, it is also possible to operate the MA-4 from a 12 V battery). Switch the MA-4 on and the green “power on” light is illuminated. The yellow light illuminates indicating that the battery is being charged and is extinguished as soon as the battery is fully recharged. A totally discharged battery can be fully recharged within a maximum of 1 1/2 hours.

&

ution: The MA-4 mains adapterkharger can only be used with AT-3 units which are equipped with a fast charging accumulator.

The CARDlOVlT AT-3 is switched on by means of the green ON key and off by means of the red OFF key. You can program the CARDlOVlT AT-3 in order to have it in the right setting when switching on. (+Basic setting).

i

1

Please make sure that, during ECG recording, neither the patient nor the conducting parts of the patient connection or the electrodes (including the neutral electrode) come into contact with other persons or conducting objects (even if these are earthed).

page 14

Replacing the Recording Paper The recording Paper must be replaced as Soon as the end of the paper is indicated on the lower edge. After the indication first appears, there are about 8 pages left. However, we recommend that the paper be replaced immediately. If no paper is left, the printing process is interrupted. On the screen, a corresponding remark appears. After the paper has been replaced, the printout is started again by pressing COPY.

can only guarantee an excellent printout, Schiller original chart paper or a chart paper of the same quality is used.

1. Push paper compartment release and pull out paper drawer.

page 15

2.

Remove the remaining paper by turning the drawer upside-down. Place a new paper pack into the drawer. Check that the printed (grid) side is facing upwards, and place the beginning of the paper over the guide roller.

‘4@

Q ... ... ... ... ... ... ... ...

3.

Reinsert the paper drawer and press firmly until it clicks into place.

CHAPTER 3

Working with the CARDlOVlT AT-3 If you have never worked with a SCHILLER unit, it is important to read this chapter carefully. First, the basic functions such as selecting the lead group, entering patient data etc. are described. Further you learn how to record ECGs, which formats are available in automatic mode and what further possibilities the CARDlOVlT AT-3 offers.

page 18

ECG Recording

Liquid Crystal Display

The CARDIOVIT AT-3 always receives all ECG signals simultaneously. Thus, 12 synchronous standard leads are available for measurement and interpretation. The recorded ECG signals are stored for 10 seconds in the input memory. For the further processing of the signals (i.e. formation of average complexes, interpretation) 10 seconds ECG signals are stored in the working memory. The ECG stored in the working memory.can be printed as many times as required and in any format. This ECG remains stored until a new ECG is recorded, even if the unit is switched off.

As soon as the apparatus is switched on and the patient is connected, three leads are shown on the display together with information about the recording. The LC display is used on the one hand as an ECG monitor and on the other hand as an alphanumeric display for operating help, change of format, input of patient data etc. To obtain good screen visibility, the contrast can be adjusted by means of knob LCD on the right-hand side of the unit.

Accordingly, the CARDIOVIT AT-3 has two different memories: 1. The input memory, where the real-time signals are

LC Display as ECG Monitor

stored for 10s and continually renewed.

2. The working memory for processing and printing of the ECG leads as described in section "Automatic ECG recording". As an option, the CARDIOVIT AT-3 can be equipped with a long-term memory for up to 15 ECGs. (see Option "Longterm memow)

On the screen, either one or three leads can be represented. By pressing the key you can change from 1channel to 3-channel mode.