Instructions for Use Vista 120

Transcription

1 Instructions for Use Vista 120 To properly use this medical device, read and comply with these Instructions for Use. Patient Monitor Software 1.n Release date April

2 Screen images Schematic renderings of screen images are used, which may differ in appearance or in configuration from the actual screen images. Definition of Safety Information This guide is designed to give key concepts on safety precautions. A statement provides important information about a potentially hazardous situation which, if not avoided, could result in death or serious injury. CAUTION A CAUTION statement provides important information about a potentially hazardous situation which, if not avoided, may result in minor or moderate injury to the user or patient or in damage to the medical device or other property. NOTE: A NOTE provides additional information intended to avoid inconvenience during operation. Abbreviations and Symbols For explanations refer to sections Abbreviations and Symbols in chapter Overview.

3 Table of Contents For Your Safety and that of Your Patients... 1 General safety information...1 Strictly follow these Instructions for Use...1 Maintenance...1 Accessories...1 Connected devices...2 Not for use in areas of explosion hazard...2 Safe connection with other electrical equipment...2 Patient safety...2 Information on Electromagnetic Compatibility...3 Sterile accessories...3 Installing accessories...3 Product-specific safety information...3 Application... 6 Intended use...6 Restrictions for use...6 Overview... 7 Front view...8 Side view...10 Back view...11 Abbreviations...12 Symbols...14 Vista 120 configuration...15 Getting started...16 Initial inspection...16 Installing the monitor...16 Installing the monitor on a flat surface...16 Installing the monitor on a wall...16 Installing the monitor on a roll stand/trolley...16 Connecting the power cord...16 Checking the monitor...16 Checking the strip recorder...17 Setting the date and time...17 System Configuration Opening User Maintain Menu...18 Entering Demo Mode...18 Selecting Lead Placement...18 I

4 Operation Using keys...20 Changing monitor settings...21 Adjusting screen brightness...21 Changing date and time...22 Adjusting volume...22 Adjusting key volume...22 Adjusting alarm volume...22 Adjusting beat volume...22 Checking the monitor version...22 Setting languages...22 Understanding screens...23 Calibrating screens...23 Alarms Alarm category...24 Physiological alarms...24 Technical alarms...24 Prompts...24 Alarm levels...24 Controlling alarm...25 Switching the individual alarm off...25 Temporary alarm mute...25 Alarm mute...25 Setting alarm limits...25 Latching alarms...26 Testing alarms...26 Alarm information Physiological alarm information...27 Technical alarm information...30 Prompts...35 Adjustable range of alarm limits...37 Managing patients Admitting a patient...39 Patient category and paced status...39 Quick admit...40 Editing patient information...40 Update a patient...40 User interface...41 Setting interface style...41 Selecting display parameters...41 Changing waveform position...41 Changing interface layout...41 Viewing short trend screen...41 Viewing OxyCRG screen...41 Viewing large font screen...42 II

5 Monitoring ECG Overview...43 ECG safety information...43 ECG display...44 Changing the size of the ECG waveform...44 Changing the ECG filter settings...45 Using ECG alarms...45 Selecting calculation lead...45 Monitoring procedure...46 Preparation...46 Connecting ECG cables...46 Selecting lead type...46 Installing electrodes...46 Electrode placement for 3-lead...47 Electrode placement for 5-lead...47 Recommended ECG lead placement for surgical patients...49 ECG menu setup...50 Setting alarm source...50 Smart lead off...50 Setting beat volume...50 ECG display...50 Setting pace status...51 ECG calibration...51 ECG waveform settings...51 ST segment monitoring...51 Setting ST analysis...52 ST display...52 ST analysis alarm setting...52 About ST measurement points...52 Adjusting ST and ISO measurement points...53 Arrhythmia monitoring...53 Arrhythmia analysis...53 ARR ANALYSIS menu...55 Monitoring RESP Overview...56 RESP safety information...56 Resp display...56 Electrode placement for monitoring resp...56 Cardiac overlay...57 Chest expansion...57 Abdominal breathing...57 Selecting resp lead...57 Changing hold type...58 Changing the size of the respiration waveform...58 Using Resp alarms...58 Changing the apnea time...58 III

6 Monitoring SpO Overview...59 SpO 2 safety information...59 Measuring SpO Measurement procedure...60 Understanding SpO 2 alarms...61 Adjusting alarm limits...61 Setting SpO 2 as pulse source...61 Setting pitch tone...61 Setting sensitivity...61 Monitoring PR Overview...62 Setting PR volume...62 Using pulse alarms...62 Selecting the active alarm source...62 Monitoring NIBP Overview...63 NIBP safety information...63 Measurement limitations...64 Measurement methods...64 Measurement procedures...65 Operation prompts...66 Correcting the measurement if limb is not at heart Level...66 NIBP alarm...66 Resetting NIBP...66 Calibrating NIBP...67 Leak test...67 Procedure for leak testing...67 Monitoring TEMP Overview...68 TEMP safety information...68 TEMP monitoring setup...68 Calculating temp difference...68 Monitoring IBP (optional) Overview...69 IBP safety information...69 Monitoring procedures...69 Selecting a pressure for monitoring...70 Zeroing the pressure transducer...70 Troubleshooting the pressure zeroing (taking art for example)...71 IBP pressure calibration...71 Troubleshooting the pressure calibration...72 IBP alarm...73 IV

7 Monitoring CO 2 (optional) Overview...74 CO 2 safety information...74 Monitoring procedures...75 Zeroing the sensor...75 C5 CO 2 module...75 Setting CO 2 waveform setup...77 Setting CO 2 corrections...77 Changing CO 2 alarms...77 Changing apnea alarm...78 Freeze Overview...79 Entering/exiting freeze status...79 Entering freeze status...79 Exiting freeze status...79 Reviewing frozen waveform...80 Review Trend graph review...81 Selecting trend graph of specific parameter...81 Setting resolution...81 Scrolling the screen...81 Switching to the trend table...82 Record...82 Trend table review...82 Setting resolution...82 Scrolling the screen...82 Switching to trend graph...82 Recording...83 NIBP review...83 Scrolling the screen...83 Recording...83 Alarm review...83 Scrolling the screen...83 Selecting alarm event of specific parameter...83 Setting time index...83 Recording...84 Arr review...84 Selecting specific arrhythmia event...84 Scrolling the screen...84 Deleting arrhythmia events...84 Recording...84 Calculation and titration table Drug calculation...85 Calculation procedures...85 Calculation unit...86 Titration table...86 V

8 Strip recording General information...87 Performance of the recorder...87 Recording type...87 Starting and stopping strip recording...88 Recorder operations and status messages...89 Record paper requirement...89 Proper operation...89 Paper out...89 Installling paper...89 Removing paper jam...91 Other Functions Nurse call...92 Using battery...93 Battery power indicator...93 Battery status on the main screen...93 Checking battery performance...93 Replacing the battery...94 Recycling the battery...95 Care and cleaning General points...96 Cleaning...96 Cleaning the monitor...96 Cleaning the accessories...97 Sterilization...98 Disinfection...98 Maintenance Inspecting...99 Maintenance task and test schedule...99 Replacing fuse Disposal Service policy Accessories ECG accessories SpO 2 accessories NIBP accessories Temp accessories IBP accessories CO 2 accessories Device accessories Spare parts VI

9 Technical Data Classification Device specifications Ambient conditions Leakage current Power supply Display Recorder Review ECG , 5-lead monitoring RESP NIBP SpO TEMP IBP CO EMC Declaration General information Electromagnetic emissions Electromagnetic environment Electromagnetic immunity Recommended separation distances to portable and mobile RF telecommunication devices Default settings Patient information default settings Alarm default settings ECG default settings RESP SpO PR NIBP TEMP IBP CO Passwords VII

10 For Your Safety and that of Your Patients General safety information The following and CAUTION statements apply to general operation of the medical device. and CAUTION statements specific to subsystems or particular features of the medical device appear in the respective sections of these Instructions for Use or in the Instructions for Use of another product being used with this device. Strictly follow these Instructions for Use Any use of the medical device requires full understanding and strict observation of all sections of these Instructions for Use. The medical device must only be used for the purpose specified under "Intended Use". Strictly observe all and CAUTION statements throughout these Instructions for Use and all statements on medical device labels. Failure to observe these safety information statements constitutes a use of the medical device that is inconsistent with its intended use. Maintenance The medical device must be inspected and serviced regularly by professionals who possess the required qualifications due to their training and their experience. Repair of the medical device must also be performed by trained personnel with additional product-specific DrägerService training. Dräger recommends that a service contract is obtained with DrägerService and that all repairs are performed by DrägerService. Dräger further recommends that only authentic Dräger repair parts are used for maintenance. If the above are not complied with, the correct functioning of the medical device may be compromised. See chapter "Maintenance". Accessories Only the accessories indicated on the chapter Accessories have been tested and approved for use with the medical device. Therefore, it is strongly recommended that only these accessories are used in conjunction with the medical device. Otherwise, the correct functioning of the medical device may be compromised

11 Connected devices Risk of electric shock and of device malfunction. Any connected devices or device combinations not complying with the requirements mentioned in these Instructions for Use may compromise the correct functioning of the medical device. Before operating any combination of devices, refer to and strictly comply with the Instructions for Use for all connected devices and device combinations. Not for use in areas of explosion hazard Not for use in areas of explosion hazard This medical device is neither approved nor certified for use in areas where combustible or explosive gas mixtures are likely to occur. Safe connection with other electrical equipment CAUTION Risk of patient injury Electrical connections to equipment not listed in these Instructions for Use or these Assembly Instructions must only be made when approved by each respective manufacturer. Patient safety The design of the medical device, the accompanying documentation, and the labeling on the medical device are based on the assumption that the purchase and the use of the medical device are restricted to professionals, and that certain inherent characteristics of the medical device are known to the user. Instructions and and CAUTION statements are therefore largely limited to the specifics of the Dräger medical device. These Instructions for Use do not contain references to various hazards which are obvious to professionals who operate this medical device as well as references to the consequences of medical device misuse, and to potentially adverse effects in patients with different underlying diseases. Medical device modification or misuse can be dangerous. CAUTION Risk of patient injury Do not make therapeutic decisions based solely on individual measured values and monitoring parameters

12 Information on Electromagnetic Compatibility General information on electromagnetic compatibility (EMC) according to international EMC standard IEC : Medical electrical equipment is subject to special precautionary measures concerning electromagnetic compatibility (EMC) and must be installed and put into operation in accordance with the EMC information provided in this Instructions for Use. Portable and mobile RF communications equipment can affect medical electrical equipment. Do not connect connectors with an ESD warning symbol and do not touch the pins of such connectors without implementing ESD protective measures. Such protective measures may include antistatic clothing and shoes, touching a ground stud before and during connection of the pins, or using electrically insulating and antistatic gloves. All relevant personnel must be instructed in these ESD protective measures. Sterile accessories CAUTION Do not use sterile-packaged accessories if the packaging has been opened, is damaged or there are other signs of non-sterility. Disposable articles must not be reprocessed and resterilized. Reuse, reprocessing, or resterilization can lead to a failure of the medical device and cause injury to the patient. Installing accessories CAUTION Install accessories to the basic device in accordance with the Instructions for Use of the basic device. Make sure that there is a safe connection to the basic device system. Strictly observe Assembly Instructions and Instructions for Use. Product-specific safety information Before using Vista 120, patient cables, electrodes etc. should be checked. Replacement should be taken if there is any evident defect or signs of aging which may impair the safety or performance. The power receptacle must be a three-wire grounded outlet. A hospital grade outlet is required. Never adapt the three-prong plug from the monitor to fit a two-slot outlet

13 Route all cables away from patient s throat to avoid possible strangulation. Do not rely exclusively on the audible alarm system for patient monitoring. Adjustment of alarm volume to a low level or off during patient monitoring may result in a hazard to the patient. Remember that the most reliable method of patient monitoring combines close personal surveillance with correct operation of monitoring equipment. When interfacing with other equipment, a test for leakage current must be performed by qualified hospital technical personnel before using with patients. During monitoring, if the power supply is off and there is no battery for standby, the monitor will be off. After reconnecting the power supply, the user should turn on the monitor for monitoring. Keep away from fire immediately when leakage or foul odor is detected. The device and accessories are to be disposed of according to local regulations after their useful lives. Alternatively, they can be returned to the dealer or the manufacturer for recycling or proper disposal. Batteries are hazardous waste. Do NOT dispose them together with house-hold garbage. At the end of their life hand the batteries over to the applicable collection points for the recycling of waste batteries. For more detailed information about recycling of this product or battery, contact your local Dräger sales representative. This equipment is not intended for home usage. Devices connected to the equipment must meet the requirements of the applicable IEC standards (e.g., IEC Safety standards for information technology equipment and IEC Safety standards for medical electrical equipment ) The system configuration must meet the requirements of the IEC Medical electrical systems standard. Any personnel who connect devices to the equipment s signal input/output port is responsible for providing evidence that the safety certification of the devices has been performed in accordance to the IEC CAUTION Do not immerse transducers in liquid. When using solutions, use sterile wipes to avoid pouring fluids directly on the transducer

14 CAUTION Do not use autoclave or gas to sterilize the monitor, recorder or any accessories. CAUTION Disposable devices are intended for single use only. They should not be reused as performance could degrade or contamination could occur. CAUTION Remove a battery whose life cycle has expired from the monitor immediately. CAUTION Avoid liquid splash on the device. The temperature must be kept between 5 and 40 C while working. And it should be kept between -20 and +55 C during transportation and storage. NOTE Position the device in a location where the operator can easily see the screen and access the operating controls. The monitor can only be used on one patient at a time. If the monitor gets damp, put it in dry circumstance to dry it until it can work normally. If liquid pours on the monitor, contact DrägerService. Do not use this monitor for diagnostic purposes. When the monitor is shut off, only the patient information and alarm settings can be saved. The pictures and dialog boxes in these Instructions for Use are for reference only. Regular preventive maintenance should be carried every two years. The user is responsible for any requirements specific to their country

15 Application Intended use Instructions for Use Vista 120 Patient Monitor The Vista 120 monitors parameters such as ECG (3-lead or 5-lead selectable), respiration (RESP), functional arterial oxygen saturation (SpO 2 ), invasive or non-invasive blood pressure (dual-ibp, NIBP), temperature (dual-temp), and expired CO 2. Vista 120 is intended to be used only under regular supervision of clinical personnel. It is applicable to adult, pediatric, and neonatal usage in a hospital environment and during patient transport inside a healthcare facility. Restrictions for use CAUTION Device for use in health care facilities only and exclusively by persons with specific training and experience in its use

16 Overview Vista 120 is optimized for surgical, cardiac, medical and neonatal care environments, and can store data for both trends and events. The user can also view and record graphical and tabular trends (vital signs). Vista 120 has a 15-inch TFT color flat panel display. Up to 11 waveforms can be displayed on the screen

17 Front view A B C D E F G H J I A Alarm indicator When an alarm occurs, the alarm indicator will light or flash. The alarm level is color coded. B Alarm Mute Press this button to pause the alarm. All audio alarms stop and the Temporary Alarm Mute **s and the symbol are displayed in the information area. If the user presses the button again or if the pause time ends, the system will resume normal monitoring status and the Temporary Alarm Pause **s and icon will clear. The symbol is displayed in the information area. Pressing or holding the button again resumes the alarm. C NIBP measurement Press to inflate the cuff and perform NIBP measurement. Press again to stop the measurement and deflate the cuff. D Trend Press this button to enter trend table review dialog box. E Freeze In normal mode, press this button to freeze all the waveforms on the screen. In Freeze mode, press this button to restore the waveform refreshing. F Recording Press this button to start a real-time recording. Press again to stop recording. G Menu Press to return to the main dialog box. H Rotary Knob The user can turn the rotary knob clockwise or counter-clockwise to - 8 -

18 highlight the desired item. Press the rotary knob to select the item. I Mains/Battery Refer to chapter Battery power indicator for details. indicator J On/Off When connected to the AC power supply, press the key to turn the monitor on. Press the key again to turn the monitor off. Further Alarm Mute information can be found in the chapter Audio Off

19 Side view A B C D I E F G H J A B C D E F G H I J NIBP port ECG port etco 2 port SpO 2 port T1 port T2 port IBP 1 port IBP 2 port Recorder Battery compartment door

20 Back view L K J I A B C H G F E D A B C D E F G H I J K L Fan Speaker Equipotential grounding terminal. If the monitor is used with other devices, connect this terminal to eliminate potential ground differences between devices. Security lock. Used to prevent the power cord from detaching. Ventilation grid Anti-theft lock USB interface. This port is used to connect the USB device. RJ45 network interface RS232 interface VGA output Analog output. Vista 120 outputs the waveform through the auxiliary output port. Nurse Call port. This port may be connected to an external nurse call system, not provided by Dräger

21 Abbreviations Instructions for Use Vista 120 Patient Monitor Abbr. Explanation Abbr. Explanation AC Alternating current Adu Adult AHA American Heart Association Art Arterial avf Left foot augmented lead avl Left arm augmented lead avr Right arm augmented lead awrr Airway respiration rate BP Blood pressure BTPS Body temperature and pressure, saturated CISPR International Special Committee on Radio Interference CO 2 Carbon dioxide COHb Carboxyhemoglobin CVP Central venous pressure DC Direct current Dia Diastolic ECG Electrocardiogram EEC European Economic Community EMC Electromagnetic compatibility EMI Electromagnetic interference ESU Electrosurgical unit et End-tidal etco 2 End-tidal carbon dioxide FCC Federal Communication Commission FiCO 2 Fraction of inspired carbon dioxide Hb Hemoglobin Hb-CO Carboxyhemoglobin HR Heart rate IBP Invasive blood pressure ICP Intracranial pressure ICU Intensive care unit ID Identification IEC International Electrotechnical Commission IEEE Institute of Electrical and Electronic Engineers LA Left arm LAP Left arterial pressure LCD Liquid crystal display LED Light emitting diode LL Left leg MAP Mean arterial pressure MDD Medical Device Directive MetHb Methemoglobin N/A Not applicable Neo Neonate NIBP Non-invasive blood pressure O 2 Oxygen oxycrg Oxygen cardio-respirogram PA Pulmonary artery PAWP Pulmonary artery wedge pressure Ped Pediatric Pleth Plethysmogram PR Pulse rate PVC Premature ventricular complex R Right

22 Abbr. Explanation Abbr. Explanation RA Right arm RAP Right arterial pressure Resp Respiration RHb Reduced hemoglobin RL Right leg RR Respiration Rate SYS Systolic pressure TD Temperature difference USB Universal serial bus TEMP Temperature

23 Symbols Alarm Pause USB port NIBP measurement RS232 port Trend graph VGA output, External Monitor Freeze Signal output port Recording Signal output port Menu Locked position Battery indicator Mains indicator Nurse call port Protection class type CF (defibrillation-protected) Defibrillation-proof type BF applied part Alternating current Power supply switch Serial number Equipotential bonding Disposal instructions Caution Recycle Network port Manufacturer Date of manufacture GOST label Part number Conformitè Europèenne Directive 93/42/EEC concerning medical products China RoHS (Restriction of Hazardous Substances) label Consult Instructions for Use

24 Vista 120 configuration Instructions for Use Vista 120 Patient Monitor Size (L W H) Shape Function Configuration 408 mm 157 mm 316 mm Square ECG, RESP, SpO 2, NIBP, TEMP, IBP, CO

25 Getting started Initial inspection Instructions for Use Vista 120 Patient Monitor Before unpacking, check the packaging and check that there are no signs of mishandling or damage. If the shipping cartons are damaged, contact your local supplier for assistance. Open the package carefully and remove the monitor and accessories. Check that all correct options and accessories are included. If you have any question, contact your local supplier. Installing the monitor Installing the monitor on a flat surface Place the monitor on a flat surface. Make sure the surface does not vibrate and is free of corrosive medicine and dust. Installing the monitor on a wall Refer to Wall-Mounting Bracket Assembly Instruction. Installing the monitor on a roll stand/trolley An Assembling Instruction will be delivered with the roll stand/trolley. Refer to that Assembly Instruction for details of installing the monitor on a roll stand/trolley. Connecting the power cord 1. Make sure the AC power supply complies with the following specifications: 100 V to 240 V~, 50 Hz/60 Hz. 2. Connect the power cord provided with the monitor to the power input of the monitor. Connect the other end of the power cord to a grounded 3-phase power output. Checking the monitor Make sure there is no damage to the measurement accessories and cables. Turn on the monitor and verify that the monitor starts normally. Make sure all alarm lamps light up and the alarm sound is heard when turning on the monitor. Do not use the device if you detect any damage or if the monitor displays error messages. Contact your hospital technical personnel or Customer Service Center immediately

26 NOTE Check that all monitor functions are operating correctly. If rechargeable batteries were provided, charge them each time before using the device to ensure adequate power. If you power the monitor off, wait at least 60 seconds before powering it on again. Checking the strip recorder If your monitor is equipped with a strip recorder, verify that paper is properly installed in the strip recorder by opening the strip recorder s door. Refer to the chapter Recording for details regarding installing paper. Setting the date and time To set the date and time: 1. Select Menu > System Setup > Date Time Setup. 2. Adjust the date display format as desired. 3. Set the correct time of Year, Month, Day, Hour, Min and Sec from the pop-up menu and press Exit

27 System Configuration Instructions for Use Vista 120 Patient Monitor The user can not change the system configuration of the monitor. After the monitor is installed and checked properly, a service engineer needs to change the system configuration. Opening User Maintain Menu 1. Select the Menu item on the main interface. 2. Select Maintenance > User Maintain 3. Type the password into the displayed dialog box and press OK to enter the User Maintain menu. Entering Demo Mode The Demo Mode is for demonstration purposes only. You must not change to Demo Mode during patient monitoring. In Demo Mode, all stored trend information is deleted from the monitor s memory. To change from operating mode to demo mode: 1. Select Menu > Common Function > Demo Mode from the pop-up dialog box. 2. Type the password into the displayed dialog box. After entering the Demo Mode, the monitor will perform the following: Stops detecting alarms and generating alarm signals. Stops storing data and clears previously stored data from memory. All real-time data and historical data are simulated rather than actual patient data. To exit the Demo Mode, select Menu > Common Function > Demo Mode Selecting Lead Placement ECG lead names have two styles: American standard (AHA) and European standard (EURO). To set the correct style: 1. Select User Maintain > Lead Placement 2. Select AHA or EURO from the list and press the knob to confirm the selection

28 Operation Instructions for Use Vista 120 Patient Monitor Everything the user needs to operate the monitor is displayed on its screen. Nearly every element on the screen is interactive. Screen elements include measurement numerics, waveforms, screen keys, information fields, alarms fields and menus. The monitor can be configured in a number of different ways. For example, the user can access an item through the on-screen setup menu, via a hard key, or via a shortcut key. This Instructions for Use describes how to access items via an on-screen menu Department 10 Date and time 2 Bed number 11 Battery status symbol 3 Patient name 12 AC power supply symbol 4 Patient type 13 Shortcut key area 5 Alarm status area 14 Scroll left to display more shortcut keys 6 Alarm off 15 Mute key 7 Measurement value 16 Parameter waveform 8 Menu 9 Scroll right to display more shortcut keys

29 Using keys The monitor has four different types of keys: Permanent keys Instructions for Use Vista 120 Patient Monitor A permanent key is a graphical key that is permanently located at the bottom of the main screen allowing fast, direct access to functions. Menu Display the main setup menu Mute Permanently silences auditory alarm signals Shortcut keys A shortcut key is a configurable graphical key located at the bottom of the main screen. It gives the user direct access to functions. The selection of shortcut keys available on the monitor depends on the monitor configuration and options purchased. The following functions are available: Admission Trend Graph Trend Table AlarmReview NIBP Review Admit a patient Access the trend graph review dialog box Access the trend table review dialog box Access the alarm event review dialog box Access the NIBP review dialog box ARR Review Access the ARR review dialog box Standard TrendScreen OxyCRG Large Font ModulSwitch Key Volume Access the standard dialog box Access the Trend Screen dialog box Access the OxyCRG dialog box Access the Large Font dialog box Access the module switch dialog box Change the key volume

30 Brightness Touch Calib IBP Zero Alarm Setup Adjust the screen brightness Calibrate the touch screen Zero the IBP sensor Access the alarm setup dialog box Beat Volume Menu Mute Standby Change the beat volume Enter the menu Mute the alarm Standby mode Hardkeys Hardkeys are the physical keys on the front panel of the monitor. The Vista 120 has the following hardkeys: Mute, NIBP, Trend, Freeze, Recording, and Menu. Refer also to the chapter Front view. Pop-up keys Pop-up keys are task-related graphical keys that appear automatically on the screen when required. For example, the confirmation pop-up key appears only when the user need to confirm a change. Changing monitor settings Adjusting screen brightness To change the screen brightness: 1. Press the Brightness key on the screen directly or. 2. Select Menu > Common Function > Brightness, and select the appropriate setting for the screen brightness. 10 is the brightest, 1 is the least bright. The monitor can be configured with lower brightness in standby mode and also for transport to conserve battery power

31 Changing date and time Instructions for Use Vista 120 Patient Monitor To change the date and time, refer to chapter Setting the date and time. Changing date and time will affect the storage of trend data. Adjusting volume Adjusting key volume The key volume is audible when the user selects any field on the monitor screen or when the user turns the knob. To adjust the key volume: 1. Select the Key Volume key on the screen directly or 2. Select Menu > System Setup > Key Volume, then select the appropriate setting: Five is the loudest and Zero is the quietest. Adjusting alarm volume The monitor provides five levels of alarm volume: 1, 2, 3, 4 and 5. To change the alarm volume: 1. Select Menu > Alarm Setup > Alarm Volume, and select the desired setting from the pop-up dialog box. Adjusting beat volume To change the beat volume, press the Beat Volume key on the screen directly or refer to chapter Adjusting beat volume. Checking the monitor version To check the monitor version, select Menu > Common Function > About to check the monitor revision menu. Setting languages To change the language: 1. Select Menu > Maintenance > User Maintain, then type the maintenance password into the displayed dialog box. 2. Select the Language option on the pop-up dialog box to display the language list. 3. Select the desired language from the list. To make the change permanent, restart the monitor

32 Understanding screens Instructions for Use Vista 120 Patient Monitor The monitor has a set of preconfigured screens, which are optimized for common monitoring scenarios such as OR adult or ICU neonatal. A screen defines the overall selection, size and position of waveforms, numerics and shortcut keys displayed when the user starts the monitor. The user can switch between different screens during monitoring. Screens do not affect alarm settings, patient category etc. If the user changes from a complex to a less complex screen layout, some measurements may not be visible but are still monitored in the background. For detailed information, refer to chapter User Interface. Calibrating screens To calibrate the screen: 1. Select the Touch Calib shortcut key on the screen directly or select Menu > Maintenance > User Maintain, then type the maintenance password into the displayed dialog box, then select TouchScr Calibration from the pop-up dialog box. 2. The symbol appears on the screen. 3. Click the center of the symbol. 4. After calibration, the message Screen Calibration completed appears on the screen. Select Exit to finish the calibration

33 Alarms Instructions for Use Vista 120 Patient Monitor The following alarm information is applicable for all measurements. Refer to chapters on specific alarms for more information. A potential hazard can exist if different alarm presets are used for the same or similar equipment in different areas, e.g., an intensive care unit or an cardiac operating room. Alarm category The monitor has physiological, technical, and prompt alarms. Physiological alarms If one or more physiological parameters monitoring the patient exceed the predefined alarm limit (for example: APNEA and SpO 2 value exceed the alarm limit), the monitor alarms. For more information, refer to chapter Physiological alarm information. Technical alarms If, for example, the device has a low battery or defective lead the monitor will initiate a technical alarm. Technical alarms cannot be disabled. For more information, refer to chapter Technical Alarm Information. Prompts The device monitors processes and other functions, such as: ARR Relearning. For more information, refer to chapter Prompts. Alarm levels There are three alarm levels consisting of high, medium, and low. 1. High level alarms A life threatening situation exists and emergency treatment is required. 2. Medium level alarms The patient s vital signs or system status is abnormal. Response is required. 3. Low level alarms The patient s vital signs or system status is abnormal. Attention is required

34 Alarm sound Instructions for Use Vista 120 Patient Monitor The high/medium/low-level alarms have the following audible characteristics: Alarm level High Medium Prompt Mode is DO-DO-DO------DO-DO, DO-DO-DO------DO-DO, which is triggered once every 5 seconds. The alarm indicator flashes in red, with a frequency of 1.4Hz~2.8Hz. Mode is DO-DO-DO, which is triggered once every 25 seconds. The alarm indicator flashes in yellow, with a frequency of 0.4Hz~0.8Hz. Low Mode is DO-, which is triggered once every 30 seconds. The sound pressure range for audible alarm signals is from 45 db to 85 db. Controlling alarm Switching the individual alarm off To switch the alarm off, select XX Setup > Alarm Setup (XX stands for parameter name) and set the alarm from the pop-up list. Temporary alarm mute If the monitor is in temporary alarm mute status, the monitor will: Not generate an auditory alarm signal. Visually display alarm information. The temporary alarm mute symbol a red colored background. is displayed and the remaining pause time is displayed on The user can set the audio pause to 60 s, 120 s, or 180 s. Alarm mute To mute the alarm, select Menu > Maintenance > User Maintain > Alarm Setup, and set Mute to On. Press the key on the front panel for more than three seconds or the shortcut key Mute on the screen to mute the alarm. Setting alarm limits Prior to monitoring, make sure that the alarm limit settings are appropriate for your patient

35 Setting alarm limits to extreme values may cause the alarm system to become ineffective. To change individual measurement alarm limits: 1. Select the HR Parameter area. 2. Select HR Setup > Alarm Setup. Then set the alarm limit to the desired value from the pop-up dialog box. See the following figure: Upper arrow or lower arrow to increase or decrease the alarm limit High Alarm Limit Setting value of high alarm limit Setting value of low alarm limit Low Alarm Limit Latching alarms To set the alarm latch function, select Menu > Maintenance > User Maintain > Alarm Setup and set Alarm Latch from the pull-down list. If set to On, when an alarm occurs, the monitor will display the alarm message of the parameter in the alarm status area. If several parameters latch alarms, each message is displayed in two second intervals. To deselect the alarm latch, set Alarm Latch to Off. When Alarm Latch is set to Off, the latch function is invalid. Testing alarms When the user switches the monitor on, a self test is started. Verify that the alarm indicator lights and emits a single tone. The self test verifies that the visible and audible alarm indicators are functioning correctly. For further testing of individual measurement alarms, perform the measurement on a subject or use a simulator. If necessary, adjust the alarm limits and check that the system is operating correctly

36 Alarm information Physiological alarm information Instructions for Use Vista 120 Patient Monitor Message Cause Alarm level ECG Too Weak Cannot detect the signal in designated time period. High ST-X high ST-X low ST value is above the upper alarm limit. (X stands for I, II, III, avr, avl, avf, V) ST value is below the lower alarm limit. (X stands for I, II, III, avr, avl, avf, V) User-selectable User-selectable ASYSTOLE No QRS is detected for 4 consecutive seconds User-selectable VFIB/VTAC Ventricular tachycardia: The fibrillation waveform lasts for 4 consecutive seconds; or the number of continuous Vent beats is larger than the upper limit of cluster Vent beats (>5). The RR interval is less than 600 ms. User-selectable VT>2 3< the number of cluster PVCs < 5 User-selectable COUPLET 2 consecutive PVCs User-selectable BIGEMINY Vent bigeminy User-selectable TRIGEMINY Vent trigeminy User-selectable R ON T PVC TACHY BRADY MISSED BEATS IRR A type of single PVC under the condition that HR<100, R-R interval is less than 1/3 the average interval, followed by a compensating pause of 1.25X the average R-R interval (the next R wave advances onto the previous T wave). Single PVCs not belonging to the type of above mentioned PVCs. 5 consecutive QRS complex, RR interval is less than 0.5 s. 5 consecutive QRS complex, RR interval is longer than 1.5 s. When HR is less than 100 beats/min., no heart beat is detected during the period 1.75 times of the average RR interval; or When HR is higher than 100beat/min, no beat is detected within 1 second. IRREGULAR RHYTHM: The patient has irregular heart rate, check patient s condition, electrodes, cables and leads. User-selectable User-selectable User-selectable User-selectable User-selectable User-selectable

37 Message Cause Alarm level PNC PNP VBRADY VENT PACE NOT CAPTURE: After the pacemaker is paced, QRS complex can not be detected during 300 ms. PACER NOT PACED: After the QRS complex, no pace is detected during 1.75 times of RR interval. VENTRICULAR BRADYCARDIA: The patient has irregular HR, and his average HR is less than 60 bpm. Check his condition, electrodes, cables and leads. VENTRICULAR RHYTHM: The patient has irregular heart rate, check patient s condition, electrodes, cables and leads. RESP APNEA RESP cannot be measured within specific time interval. High User-selectable User-selectable User-selectable User-selectable RR High RESP value is above upper alarm limit. User-selectable RR Low RESP value is below lower alarm limit. User-selectable HR High HR value is above the upper alarm limit. User-selectable HR Low HR value is below the lower alarm limit. User-selectable SpO 2 High SpO 2 value is above upper alarm limit. User-selectable SpO 2 Low SpO 2 value is below lower alarm limit. User-selectable SpO 2 No Pulse The signal of the measurement site is too weak, so the monitor can not detect the pulse signal. High PR High PR value is above upper alarm limit. User-selectable PR Low PR value is below lower alarm limit. User-selectable T1 High Value of T1 channel is above upper alarm limit. User-selectable T1 low Value of T1 channel is below lower alarm limit. User-selectable T2 High Value of T2 channel is above upper alarm limit. User-selectable T2 Low Value of T2 channel is below lower alarm limit. User-selectable TD High Value of TD channel is above upper alarm limit. User-selectable TEMP High Value of TEMP is above upper alarm limit. User-selectable TEMP Low Value of TEMP is below lower alarm limit. User-selectable SYS High SYS value is above upper alarm limit. User-selectable SYS Low SYS value is below lower alarm limit. User-selectable DIA High DIA value is above upper alarm limit. User-selectable DIA Low DIA value is below lower alarm limit. User-selectable MAP High MAP value is above upper alarm limit. User-selectable

38 Message Cause Alarm level MAP Low MAP value is below lower alarm limit. User-selectable Art SYS High Art SYS value is above upper alarm limit. User-selectable Art SYS Low Art SYS value is below lower alarm limit. User-selectable Art DIA High Art DIA value is above upper alarm limit. User-selectable Art DIA Low Art DIA value is below lower alarm limit. User-selectable Art MAP High Art MAP value is above upper alarm limit. User-selectable Art MAP Low Art MAP value is below lower alarm limit. User-selectable PA SYS High PA SYS value is above upper alarm limit. User-selectable PA SYS Low PA SYS value is below lower alarm limit. User-selectable PA DIA High PA DIA value is above upper alarm limit. User-selectable PA DIA Low PA DIA value is below lower alarm limit. User-selectable PA MAP High PA MAP value is above upper alarm limit. User-selectable PA MAP Low PA MAP value is below lower alarm limit. User-selectable CVP MAP High CVP MAP value is above upper alarm limit. User-selectable CVP MAP Low CVP MAP value is below lower alarm limit. User-selectable ICP MAP High ICP MAP value is above upper alarm limit. User-selectable ICP MAP Low ICP MAP value is below lower alarm limit. User-selectable LAP MAP High LAP MAP value is above upper alarm limit. User-selectable LAP MAP Low LAP MAP value is below lower alarm limit. User-selectable RAP MAP High RAP MAP value is above upper alarm limit. User-selectable RAP MAP Low RAP MAP value is below lower alarm limit. User-selectable P1 SYS High P1 SYS value is above upper alarm limit. User-selectable P1 SYS Low P1 SYS value is below lower alarm limit. User-selectable P1 DIA High P1 DIA value is above upper alarm limit. User-selectable P1 DIA Low P1 DIA value is below lower alarm limit. User-selectable P1 MAP High P1 MAP value is above upper alarm limit. User-selectable P1 MAP Low P1 MAP value is below lower alarm limit. User-selectable P2 SYS High P2 SYS value is above upper alarm limit. User-selectable P2 SYS Low P2 SYS value is below lower alarm limit. User-selectable P2 DIA High P2 DIA value is above upper alarm limit. User-selectable P2 DIA Low P2 DIA value is below lower alarm limit. User-selectable

39 Message Cause Alarm level P2 MAP High P2 MAP value is above upper alarm limit. User-selectable P2 MAP Low P2 MAP value is below lower alarm limit. User-selectable EtCO 2 High EtCO 2 value is above upper alarm limit. User-selectable EtCO 2 Low EtCO 2 value is below lower alarm limit. User-selectable FiCO 2 High FiCO 2 value is above alarm limits. User-selectable AWRR High AwRR value is above upper alarm limit. User-selectable AWRR Low AwRR value is below lower alarm limit. User-selectable CO 2 APNEA In a specific time interval, no RESP were detected by the CO 2 module. High Technical alarm information NOTE The lead names in the table below use the AHA (American Heart Association) denomination. For the corresponding IEC lead names, refer to chapter Installing Electrodes. Message Cause Alarm Level Action Taken ECG Lead Off More than one ECG electrode is off the skin or ECG cable is disconnected from the monitor. Low Make sure that all electrodes, lead wires and patient cables are properly connected. ECG V Lead Off ECG electrode V is off the skin or that lead wire is disconnected. Low ECG LL Lead Off ECG electrode LL is off the skin or that lead wire is disconnected. Low ECG LA Lead Off ECG electrode LA is off the skin or that lead wire is disconnected. Low ECG RL Lead Off ECG electrode RL is off the skin or that lead wire is disconnected. Low ECG RA Lead Off ECG electrode RA is off the skin or that lead wire is disconnected. Low

40 Message Cause Alarm Level Action Taken ECG Signal Exceed ECG value is beyond measuring range. High Check lead connection and patient condition ECG Comm Fail ECG module failure or communication failure High Stop monitoring ECG and notify hospital technical personnel or customer support. ECG Noise ECG signal is too noisy. Low Check lead connection and patient condition ECG Signal Overflow The amplitude of ECG is too tall. Low Modify the ECG gain. RESP Comm Fail SpO 2 Sensor Off RESP module failure or communication failure SpO 2 sensor may be disconnected from the patient or the monitor. High Low Stop monitoring RESP, and notify hospital technical personnel or customer support. Ensure the sensor is properly connected to the patient s body. SpO 2 No Sensor SpO 2 Low Perfusion SpO 2 sensor was not connected well or connected to the monitor, or the connection is loose. The pulse signal is too weak or the perfusion of the measurement site is too low. Low Ensure the monitor and sensor are properly connected. Reconnect the sensor. Low Reconnect the SpO 2 sensor and change the measurement site. If the problem continues, notify hospital technical personnel or customer support. SpO 2 Comm Fail NIBP Comm Fail SpO 2 module failure or communication failure NIBP module failure or communication failure High Stop monitoring SpO 2 and notify hospital technical personnel or customer support High Stop monitoring NIBP and notify hospital technical personnel or customer support

41 Message Cause Alarm Level Action Taken NIBP Loose Cuff NIBP Weak Signal NIBP Excessive Motion NIBP Excessive Pressure NIBP Signal Saturated NIBP Init Pressure High Cuff is no properly wrapped or no cuff exists Cuff is too loose or patient pulse is too weak. Due to arm motion, signal noise is too large or pulse rate is not regular Pressure has exceeded the specified upper safety limit Low Low Low Low Rewrap the cuff Use a different method to measure blood pressure. Ensure that the patient being monitored is still. Measure again, if failure persists, stop monitoring NIBP and notify hospital technical personnel or customer support. Signal amplitude too strong Low Stop the patient from moving. The initial pressure is too high during measuring High Measure again, if failure persists, stop monitoring NIBP and notify hospital technical personnel or customer support. NIBP Invalid Reset The hardware pressure is too high Low Measure again, if failure persists, stop monitoring NIBP and notify hospital technical personnel or customer support. NIBP Time Out Measuring time has exceeded 120 seconds (adult/pediatric) or 90 seconds (neonatal). Low Measure again or use other measuring method. NIBP Tube Leak NIBP cuff or pump has a leakage Low Check the NIBP cuff and pump for leakages NIBP Cuff type Error The cuff type used is inconsistent with the patient type Low Confirm the patient type and change the cuff

42 Message Cause Alarm Level Action Taken Air Pressure Error Environment atmospheric pressure abnormal or system pressure abnormal NIBP Self Test Error Sensor or other hardware errors Low High Check whether the airway is occluded or pressure sensor works properly in pressure meter mode. If the problem still exists, contact your service personnel. Contact your service personnel. NIBP Pneumatic Leak NIBP cuff or pump has a leakge Low Check the NIBP cuff and pump for leakages NIBP System Failure Hardware abnormal High Contact your service personnel. NIBP Cuff Leak NIBP Leak Test Error NIBP Range Exceeded NIBP Air Leak Cuff, pumnp or airway has a leakage Low NIBP cuff is not properly connected, or there is a leak in the airway. Hardware abnormal High Check whether the airway is occluded or pressure sensor works properly in pressure meter mode. If the problem still exists, contact your service personnel. The patient s blood pressure is beyond the measurement range The cuff pressure cannot reach the set value within 60 sec. or 20 sec. Neo mode Low Low The patient s blood pressure is beyond the measurement range Check the connections and the wrapped cuff to see whether they are all well prepared

43 Message Cause Alarm Level Action Taken NIBP Pressure Low NIBP Pulse Abnormal NIBP Pulse Signal Weak TEMP T1 Sensor Off The module is unable to detect the SYSTOLIC. Measure the pressure again. Abnormal oscillometric waveform Low Low Inflate gain and retry three times. Check whether the patient has an overly high blood pressure or it is interfered by movement. Retry twice. Check for hyperkinesia or arrhythmia. Pulse is too low to measure Low Check the patient s condition or the wrapped cuff. Temperature cable of TEMP channel 1 may be disconnected. Low Make sure that the cable is properly connected TEMP T2 Sensor Off Temperature cable of TEMP channel 2 may be disconnected. Low Make sure that the cable is properly connected. Excessive T1 Excessive T2 TEMP Comm Fail YY Sensor Off (YY stands for the IBP label name) YY Comm Fail (YY stands for the label name) CO 2 Out Of Range TEMP1 measuring value is beyond measuring range. TEMP2 measuring value is beyond measuring range. TEMP module failure or communication failure High High High Check sensor connection and patient condition Check sensor connection and patient condition Stop monitoring TEMP and notify hospital technical personnel or customer support. IBP sensor falls off monitor. Low Make sure that cable is properly connected. IBP module failure or communication failure The CO 2 concentration exceeds the accuracy range of the gas module High Stop monitoring IBP and notify hospital technical personnel or customer support. High Reduce CO 2 concentration

44 Message Cause Alarm Level Action Taken CO 2 Sensor Faulty CO 2 Sensor Over Temp CO 2 Comm Fail CO 2 module failure CO 2 module failure or communication failure High High CO 2 Ram Error CO 2 module failure High Stop monitoring CO 2 and notify hospital technical personnel or customer support. CO 2 Rom Error CO 2 module failure High CO 2 Zero Required Zero calibration failure Low CO 2 Check Adapter The cannula is off or disconnected Battery Low Battery low High Change the battery or recharge it Low Recorder Out Of Paper Recorder out of paper Low Insert new paper Recorder setup needed The user presses the RECORD button when the monitor is not installed with a recorder. Low Notify hospital technical personnel or customer support to install and set the recorder. Prompts Message ECG Arr Learning SpO 2 Search Pulse Manual Measuring Continual Measuring Auto Measuring Cause The QRS template building required for Arr. Analysis is in process. When the sensor is connected to the patient, the SpO 2 is analyzing the patient signal and searching for the pulse to compute the saturation. In manual measuring mode In continuous measuring mode In automatic measuring mode

45 Message Measure Abort Calibrating Calibrate Abort Leak Testing Leak Test Ok Leak Test Abort Resetting Please Start Done Continual Measuring Stat Measuring Please Switch To Maintain Mode Please Switch To Normal Mode CO 2 Standby CO 2 Sensor Warm Up Cause Measurement over During calibrating Calibration over During pneumatic test NIBP module has passed leak test Pneumatic test over NIBP module in resetting NIBP module is in idle status NIBP measurement successfully done NIBP module performs continuous measuring NIBP module performs STAT measurement NIBP module is in normal mode, the user can not start leak test and pressure calibration. Enter User Maintain > NIBP Maintain and switch to Maintain Mode to perform leak test or pressure calibration. NIBP module is in maintain mode, the user can not start blood pressure measurement. Enter User Maintain > NIBP Maintain and switch to Normal Mode to perform blood pressure measurement. Changing from measuring to standby mode places the module in energy-saving status. The CO 2 module is in warm-up state

46 Adjustable range of alarm limits Instructions for Use Vista 120 Patient Monitor ECG alarm limits are listed as follows (unit bpm): Patient Type ALM HI ALM LO HR ADU PED NEO ST analysis alarm limits are listed as follows (unit mv): ALM HI ALM LO ST PVCs alarm upper limits are listed as follows: PVCs 10 ALM HI ALM LO RESP alarm limits are listed as follows (unit rpm): Patient Type ALM HI ALM LO ADU PED NEO SpO 2 alarm limits are listed as follows (unit %): ALM HI ALM LO SpO PR alarm limit is listed as follows (unit bpm): ALM HI ALM LO PR NIBP alarm limits are listed as follows (unit mmhg): Patient Type ALM HI ALM LO ADU SYS DIA

47 MAP PED SYS DIA MAP NEO SYS DIA MAP TEMP alarm limits are listed as follows: ALM HI ALM LO T1 50 C (122 F) 0 C (32 F) T2 50 C (122 F) 0 C (32 F) TD 50 C (90 F) 0 C (0 F) IBP alarm limits are listed as follows (unit mmhg): ALM HI ALM LO Art CVP ICP LAP P P PA RAP CO 2 alarm limits are listed as follows: ALM HI ALM LO EtCO mmhg 0 FiCO 2 50 mmhg 3 mmhg AwRR 150 rpm 2 rpm

48 Managing patients Admitting a patient Instructions for Use Vista 120 Patient Monitor The monitor displays patient physiological data and records the information in trends. This allows the user to monitor unadmitted patients. It is recommended, however, that the user admit patients to record their information in reports. During admission, the patient category setting determines the algorithm that the monitor uses to process and calculate measurements. These include safety limits that are applied for specific measurements and alarm limit ranges. To admit a patient: 1. Select the Admission shortcut key on the screen or 2. Select Menu > Patient Setup > New Patient, then a message is displayed to ask the user to confirm to update patient. 3. Click No to cancel this operation; click Yes, the Patient Info window is displayed. 4. Enter the patient information: Serial No: Enter the patient s medical record number (MRN), for example Last name: Enter the patient s last name (family name), for example Smith. First name: Enter the patient s first name, for example Joseph. Gender: Choose Male or Female. Type: Choose the patient type, either Adult, Pediat, or Neonat. BloodType: Choose the patient type N/A, A, B, AB, or O. Pace: Choose On or Off (The user must use On if the patient has a pacemaker). Date of Birth: Enter the patient s date of birth. Date of Admission: Enter the patient s date of admission. Height: Enter the patient s height. Weight: Enter the patient s weight. Doctor: Enter any extra information about the patient or treatment. 5. Select Exit to save the changes and exit this screen. Patient category and paced status The patient category setting determines which algorithm the monitor uses for specific measurements, the safety limits that are applied for specific measurements, and the alarm limit range. The paced setting determines whether the monitor shows pacemaker pulses. When Pace is set to Off, pace pulses are filtered and do not show in the ECG waveform. Refer to chapter Setting Pace Status

49 Changing the patient category may change the arrhythmia and NIBP alarm limits. Always check alarm limits to make sure that they are appropriate for your patient. For paced patients, you must set Pace to On. If it is incorrectly set to Off, the monitor could mistake a pace pulse for a QRS and fail to alarm during asystole. Quick admit If the user does not have the time or information to fully admit a patient, fill in the rest of the patient information later. The user can quickly admit a patient as follows: 1. Select Menu > Patient Setup > Quick Admit, a message is displayed requesting that the user confirm the patient update. 2. Click No to cancel this operation; click Yes to continue and the Patient Info window is displayed, choose Type and Pace and set them to the correct mode. 3. Select Exit to save the changes and exit this screen. Editing patient information To edit the patient information after a patient has been admitted, select Menu > Patient Setup > Patient Info, and make the desired changes through the pop-up dialog box. Update a patient The user should always perform an update before starting monitoring for a new patient. To update a patient: Select Menu > Patient Setup > New Patient or Menu > Patient Setup > Quick Admit, a menu is displayed. If the user selects Yes, the monitor will update the patient information. If the user selects No, the monitor won t update the patient information and returns to patient setup dialog box. NOTE Discharging a patient will clear all associated data in the monitor

50 User interface Setting interface style Instructions for Use Vista 120 Patient Monitor The user can set the interface style. The following options are available: Waveform sweep Monitored parameters Only authorized personnel should set the interface style. Selecting display parameters The user can select the display parameters based on specific monitoring and measurement requirements. To select the parameter: 1. Select Menu > System Setup > Module Switch. 2. Select the parameters from the pop-up dialog box. 3. Press Exit to exit the menu. The screen will adjust the parameters automatically. Changing waveform position The user can exchange the waveform positions of parameter A and parameter B as follows: 1. Select waveform A and display the setup menu of waveform A. 2. Select Change from the pop-up menu and select the desired label name of waveform B from the pull-down list. Changing interface layout To change the interface layout: 1. Select Menu > Display Setting. 2. Select one dialog box from the pop-up menu. 3. The user can implement one kind of function screen based on the requirements. If the user selects the Large Font option, there is no function screen to be selected. Viewing short trend screen To view the short trend screen, press the Trend Screen key on the screen directly or select Menu > Display Setting > View Selection > TrendScreen. Viewing OxyCRG screen To view the oxycrg screen, press the OxyCRG key on the screen or select Menu > Display Setting > View Selection > OxyCRG

51 This is a NICU only feature. Monitoring of SpO 2, HR and Resp is different for neonates than for adults. Viewing large font screen To display the large font screen: 1. Select the Large Font key on the screen directly or. 2. Select Menu > Display Setting > View Selection > Large Font to select this display mode. To view the large font dialog box of specific parameter, select the parameter pull-down dialog on the dialog box (the red rectangle shown in the following figure)

52 Monitoring ECG Overview Instructions for Use Vista 120 Patient Monitor The electrocardiogram (ECG) measures electrical activity in the heart and displays it both numerically and as a waveform. This chapter also describes arrhythmia and ST segment monitoring. ECG safety information Do not touch the patient, table, or the monitor during defibrillation. Use only compatible ECG cables for monitoring. When connecting the cables and electrodes, make sure no conductive part is in contact with the ground. Verify that all ECG electrodes, including the neutral electrode, are securely attached to the patient but not a conductive part or ground. Check every day whether there is skin irritation resulted from the ECG electrodes. If yes, replace electrodes every 24 hours or change their sites. Place the electrode carefully and ensure a good contact. Check if the lead connection is correct before monitoring. If you unplug the ECG cable from the socket, the screen will display the error message ECG LEAD OFF and an audible alarm sounds. When using the monitor with the defibrillator or other high-frequency equipment, use defibrillator-proof ECG leads to avoid burns. When using electrosurgery (ES) equipment, do not place an electrode near the grounding plate of the electrosurgery device: otherwise, more interference will be evident on the ECG waveform. For paced patients, you must set Pace to On. If it is incorrectly set to Off, the monitor could mistake a pace pulse for a QRS and fail to alarm during asystole. The simultaneous use of cardiac pacemaker and other patient-connected equipment may cause a safety hazard

53 CAUTION If patients may be defibrillated, be sure to use defibrillation-proof ECG cables, otherwise, the ECG cables will be damaged. NOTE Interference from a non-grounded instrument near the patient and ESU interference can cause inaccuracy of the waveform. IEC/EN (protection against radiation is 3 V/m) specifies that the electrical field density exceeding 1V/m may cause measurement error in various frequencies. It is accordingly suggested to not use equipment generating electrical radiation near ECG/RESP monitoring devices. In the default settings of the monitor, the ECG waveforms are the first two waveforms from the top in the waveform area. For measurements in or near the heart connect the monitor to the potential equalization system. For protecting the environment, the used electrodes must be recycled or disposed of properly. ECG display The figure below is for reference only. The symbol 1 indicates the lead name of the displayed waveform; refer to chapter Selecting calculation lead. The symbol 2 indicates waveform gain; refer to chapter Changing the size of the ECG waveform. The symbol 3 indicates Filter setting; refer to chapter Changing the ECG filter setting. Changing the size of the ECG waveform If any of the displayed ECG waveforms are too small or clipped, the size can be changed. Select ECG Waveform Setup > ECG Gain, then select an appropriate factor from the pop-up box to adjust the ECG waveform. X0.125 to make strength of ECG signal waveform of 1 mv become 1.25 mm;

54 X0.25 to make strength of ECG signal waveform of 1 mv become 2.5 mm; X0.5 to make strength of ECG signal waveform of 1 mv become 5 mm; X1 to make strength of ECG signal waveform of 1 mv become 10 mm; X2 to make strength of ECG signal waveform of 1 mv become 20 mm; Auto let the monitor choose the optimal adjustment factor for all the ECG waveforms. Changing the ECG filter settings The ECG filter setting defines how ECG waveforms are smoothed. An abbreviation indicating the filter type is shown under the lead label on the monitor display. Filter settings do not affect ST measurement. To change the filter setting in the ECG Setup menu, select Filter and then select the appropriate setting. Monitor: Use this mode under normal measurement conditions. Surgery: The filter reduces interference to the signal. It should be used if the signal is distorted by high- or low-frequency interference. High frequency interference usually results in large amplitude spikes making the ECG signal look irregular. Low-frequency interference usually leads to a wandering or rough baseline. In the operating room, the Filter reduces artifacts and interference from HF surgical equipment. Under normal measurement conditions, selecting Surgery may distort the QRS complexes too much and thus interfere with the clinical evaluation of the ECG displayed on the monitor. Diagnos: Use when diagnostic quality is required. The unfiltered ECG waveform is displayed so that changes such as R-wave notching or discrete elevation or depression of the ST segments are visible. Using ECG alarms ECG alarms can be switched on and off. Changes to high and low alarm limits can be made using the same methods used in other measurement alarms. Refer to chapter Alarms for more information. Only ECG special alarm features are described in this chapter. Selecting calculation lead On the Normal dialog box, the user can select either 3 LEADS or 5 LEADS for this item. Normal QRS complex is defined as: The normal QRS should be either completely above or below the baseline and it should not be biphasic. For paced patients, the QRS complexes should be at least twice the height of pace pulses. The QRS should be tall and narrow. The P-waves and the T-waves should be less than 0.2 mv

55 Monitoring procedure Preparation Skin is a poor conductor of electricity. Prepare the patient's skin to facilitate good electrode conductivity. Select sites with intact skin, without impairment of any kind. Shave hair from sites, if necessary. Wash sites thoroughly with soap and water. (Never use ether or pure alcohol, because this increases skin impedance). Rub the skin briskly to increase capillary blood flow in the tissues and remove skin scurf and grease. Connecting ECG cables 1. Attach a clip or snap to the electrodes prior to placement. 2. Place the electrodes on the patient. Before attaching, apply some conductive jelly on the electrodes if the electrodes are not electrolyte self-supplied. 3. Connect the electrode lead to the patient's cable. Selecting lead type To change the lead type: 1. Select the ECG parameter area, display the ECG Setup menu; 2. Set Lead Type to 3 Leads or 5 Leads based on the lead used. Installing electrodes NOTE The following table gives the corresponding lead names according to IEC (used in Europe) and the AHA (USA) respectively. AHA (American Standard) Electrode Labels IEC (Europe Standard) Color Electrode Labels Color RA White R Red LA Black L Yellow LL Red F Green RL Green N Black V Brown C White

56 Electrode placement for 3-lead For the AHA standard for example, see the following figure: RA: directly below the clavicle and near the right shoulder. LA: directly below the clavicle and near the left shoulder. LL: on the left hypogastrium. Electrode Placement for 3-lead Electrode placement for 5-lead For the AHA standard for example, see the following figure: RA: directly below the clavicle and near the right shoulder. LA: directly below the clavicle and near the left shoulder. RL: on the right hypogastrium. LL: on the left hypogastrium. V: on the chest, the position depends on the desired lead selection

57 Electrode Placement for 5-lead NOTE To ensure safety, all leads must be attached to the patient. For 5-lead, attach the V electrode to one of the indicated positions as below: V1 On the 4th intercostal space at the right sterna margin. V2 On the 4th intercostal space at the left sterna margin. V3 Midway between V2 and V4 electrodes. V4 On the 5th intercostal space at the left clavicular line. V5 On the left anterior axillary line, horizontal with V4 electrode. V6 On the left middle axillary line, horizontal with V4 electrode. V3R-V6R On the right side of the chest in positions corresponding to those on the left. VE Over the xiphoid position. V7 On the 5th intercostal space at the left posterior axillary line of back. V7R On the 5th intercostal space at the right posterior axillary line of back

58 V-Electrode Placement for 5-lead Recommended ECG lead placement for surgical patients When using HF surgical equipment, leads should be placed in a position in equal distance from the cautery knife and the electrosurgery grounding plate to avoid burning the patient. HF surgical equipment wires and ECG cable must not be tangled up. ECG leads are used mainly for monitoring patient vital signs. When using the patient monitor with other HF surgical equipment, use defibrillator-proof ECG leads. The placement of the ECG leads depends on the type of surgery. For example, during open heart surgery the electrodes can be placed laterally on the chest or back. In the operating room, artifacts may affect the ECG waveform due to the use of ES (electrosurgery) equipment. To help reduce this interference, the electrodes can be placed on the right and left shoulders, the right and left sides near the abdomen and the chest lead on the left side at mid-chest. Avoid placing the electrodes on the upper arms, which might result in a small waveform. NOTE If an ECG waveform is not accurate (with electrodes are tightly attached), change the lead. Interference from a non-grounded instrument near the patient can cause inaccurate waveforms

59 ECG menu setup Setting alarm source Instructions for Use Vista 120 Patient Monitor To change the alarm source, select ECG Setup > Alarm Source. Select from the following options: HR: HR is HR/PR alarm source; PR: PR is HR/PR alarm source; AUTO: If the Alarm Source is set to Auto, the monitor will use the heart rate from the ECG measurement as the alarm source whenever the ECG measurement is switched on. At least one ECG lead can be measured. The monitor will automatically switch to Pulse for the alarm source if: a valid ECG lead can no longer be measured and a Pulse source is switched on and available. The monitor uses the pulse rate from the currently active measurement as system pulse. While Pulse is the alarm source, all arrhythmia and ECG HR alarms are switched off. If an ECG lead becomes available again, the monitor automatically uses HR as alarm source. Smart lead off In 5 LEADS mode, if CH1 and CH2 are disabled due to lead off for example, the system selects other modes to collect an ECG waveform. To change the smart lead off setting, select ECG Setup > Smart Leadoff. Select options from the pop-up menu. Setting beat volume Beat volume is derived from HR or PR, depending on the HR alarm setting. To change the beat volume, select ECG Setup > Beat Volume, and select the desired volume from the pop-up menu. Six selections are available: 0, 1, 2, 3, 4, 5. 5 is maximum volume. 0 is mute. ECG display The ECG display varies with the Lead Type. When Lead Type is set to 3 Leads, Display can be set to Normal, and displays one ECG waveform on the main screen. When Lead Type is set to 5 Leads, Display can be set to Normal, Full-Scr and Half-Scr. Select Normal to display two ECG waveforms on the main screen. Select Full-Scr to display seven ECG waveforms. Half-Scr displays seven ECG waveforms on the screen in an area of four waveforms. NOTE If 3 Leads is selected in the ECG Setup menu, only Normal can be selected for Display in the sub-menu

60 Setting pace status Set the paced status correctly when starting ECG monitoring. To change the paced status in the Setup ECG menu, select Pace to toggle between On or Off. When Pace is set to On: - Pace Pulse Rejection is switched on. This means that pacemaker pulses are not counted as extra QRS complexes. - Paced symbol is displayed as on the main screen. NOTE When monitoring a patient with a pacemaker, set Pace to On. If monitoring a patient without a pacemaker, set Pace to Off. If Pace is set to On, the system will not perform some types of ARR analysis. Some pace pulses can be difficult to reject. When this happens, the pulses are counted as a QRS complex, and could result in an incorrect HR and failure to detect cardiac arrest or some arrhythmias. Keep pacemaker patients under close observation. ECG calibration Selecting this item from the ECG Setup menu inserts a square wave into the ECG waveform that can be used to estimate the amplitude accuracy of that waveform. Select the item again to turn off the square wave. NOTE The patient is not monitored while this square wave is displayed. ECG waveform settings To change the speed, select ECG Wave Setup > Sweep, then select from the pop-up list. The bigger the value, the wider the waveform. ST segment monitoring The monitor performs ST segment analysis on normal and atrially paced beats and calculates ST segment elevations and depressions. This information can be displayed in the form of ST numerics and snippets on the monitor. ST segment monitoring function is shut off by default. It can be switched to On when necessary. When using the ST analysis function, the result is displayed on the main screen. Refer to the following figure

61 Setting ST analysis Instructions for Use Vista 120 Patient Monitor To change ST analysis, select ECG Setup > ST Setup > ST Analysis, then select On or Off from the pop-up list. ST display The screen may look different from the illustrations. ST I II 0.08 avr V avl 0.03 III 0.02 avf 0.06 NOTE ST Analysis can be used only in Adu mode. If ST Analysis is on, the monitor must be in Diagnos mode. ECG monitoring must be in Diagnos mode. ST analysis alarm setting The user can select Alarm > ST Alarm Setup > ST Setup to set the upper and lower alarm limit. ALM HI can be set to 0.2 to 2.0 mv, and ALM LO to -2.0 to +0.2 mv. ALM HI must be higher than ALM LO. About ST measurement points The ST value for each beat complex is the vertical difference between the isoelectric (ISO) point and the ST point, as shown in the diagram below. The ISO point provides the baseline, and the ST point is at the midpoint of the ST segment. The J point is where the QRS complex changes its slope. It is a fixed distance away from the ST point and can be useful during positioning. DEF POINT

62 The ST and ISO measurement points need to be adjusted when monitoring is started, and if the patient's heart rate or ECG morphology changes significantly. Always ensure that ST measurement points are appropriate for the patient. Abnormal QRS complexes are not considered in ST segment analysis. Adjusting ST and ISO measurement points Depending on the monitor s configuration, the ST point can be positioned as well. These two points can be adjusted by turning the knob. When adjusting ST measurement point, the system shows the ST measurement point window. The system displays the QRS complex template in the window and can be adjusted using the highlight bar. The user can select ISO or ST by switching the knob left or right to move the cursor line. When the cursor is at the desired position, the base point or the measurement point can be selected. Arrhythmia monitoring Arrhythmia analysis The arrhythmia algorithm is used to monitor clinical neonatal and adult ECG. It also detects heart rate and ventricular rhythm changes, arrhythmia events, and generates alarm information. The arrhythmia algorithm can monitor paced and non-paced patients. Qualified personnel can use arrhythmia analysis to evaluate patient condition (such as heart rate, PVCs frequency, rhythm and ectopic beat). The arrhythmia algorithm can also monitor patients and generate arrhythmia specific alarms. The monitor can support up to 16 different arrhythmia analyses. ARR Types ASYSTOLE VFIB/VTAC No QRS is detected for 4 seconds Occurring Condition Ventricular tachycardia: The fibrillation waveform lasts for 4 consecutive seconds; or the number of continuous Vent beats is larger than the upper limit of cluster Vent beats (>5). The RR interval is less than 600 ms. VT>2 3< the number of cluster PVCs < 5 COUPLET BIGEMINY TRIGEMINY 2 consecutive PVCs Vent bigeminy Vent trigeminy R ON T PVC A type of single PVC when HR<100,R-R interval is less than 1/3 the average interval, followed by a compensating pause of 1.25X the average R-R interval (the next R wave encroaches on the previous T wave). All other single PVCs

63 TACHY 5 consecutive QRS complex, RR interval is less than 0.5 s. BRADY 5 consecutive QRS complex, RR interval is longer than 1.5 s. MISSED BEATS IRR PNC PNP VBRADY VENT When HR is less than 100 beats/min. no heart beat is detected during the period 1.75 times of the average RR interval; or When HR is higher than 100 beats/min. no beat is detected within 1 second. The patient has an irregular heart rate. Check patient condition, electrodes, cables and leads. After the pacemaker fires, QRS complex was not be detected for 300 ms. After the QRS complex, no pacemaker activity is detected during 1.75 times of RR interval. The patient has an irregular HR, and his average HR is less than 60 bpm. Check patient condition, electrodes, cables and leads. The patient has an irregular heart rate. Check patient condition, electrodes, cables and leads

64 ARR ANALYSIS menu Instructions for Use Vista 120 Patient Monitor Switching ARR analysis on and off To switch ARR Analysis on or off: From the ARR Analysis Setup menu, select ARR Analysis and toggle between On and Off. PVCs alarm Select On in the menu to enable the prompt message when an alarm occurs. Select Off to disable the alarm function. The symbol appears. When the PVCs Alarm is set to OFF, the monitor won t give an alarm prompt even if an alarm occurs. In order to avoid endangering the patient s life, the user should use this function cautiously. ARR relearning Select this item to start a learning procedure. ECG ARR LEARNING is displayed on the screen. The ECG ARR LEARNING will start automatically the following: Changing lead type; Connecting leads; Updating the patient category; Starting ARR learning manually; After the ARR analysis is switched on; The module is set to on; Calibration mode is changed to normal measurement mode; Exiting the Demo mode; Exiting the standby mode; ARR alarm The user can switch on or off all arrhythmia alarms by selecting ECG Setup > ARR Analysis > ARR Setup > ARR Alarm. Individual arrhythmia alarms can be turned on or off. These are: ASYSTOLE, VFIB/VTAC, R-ON-T, VT>2, COUPLET, PVC, BIGEMINY, TRIGEMINY, TACHY, BRADY, MISSED BEATS, IRR, PNC, PNP, VBRADY and VENT. To switch individual alarms on or off, select ECG Setup > ARR Analysis > ARR Setup > ARR Alarm

65 Monitoring RESP Overview Instructions for Use Vista 120 Patient Monitor The monitor measures respiration from the amount of thoracic impedance between two ECG electrodes. The change of impedance between the two electrodes, (due to the thoracic movement), produces a respiratory waveform on the screen. RESP safety information If you do not set the detection level for the respiration correctly in manual detection mode, it may not be possible for the monitor to detect apnea. If you set the detection level too low, the monitor is more likely to detect cardiac overlay, and to falsely interpret cardiac overlay as respiratory activity in the case of apnea. The respiration measurement does not recognize obstructive and mixed apneas - it only initiates an alarm when a pre-adjusted time has elapsed since the last detected breath. If operating under conditions according to the EMC Standard EN (Radiated Immunity 3 V/m), field strengths above 1 V/m may cause erroneous measurements at various frequencies. Therefore it is recommended to avoid the use of electrically radiating equipment in close proximity to the respiration measurement unit. NOTE The RESP monitoring is not recommended to be used on patients who are very active, as this can cause false alarms. Resp display Resp Electrode placement for monitoring resp Correct patient skin preparation for electrode placement is important for Resp measurement. Refer to the chapter on ECG for more information

66 The Resp signal is always measured between two of the ECG electrodes. There are two standard ECG leads for selection: I lead (RA and LA) and II lead (RA and LL). Electrodes Placement for 5-lead Cardiac overlay Cardiac activity that affects the Resp waveform is called cardiac overlay. This occurs when Resp electrodes detect impedance changes caused by rhythmic blood flow. Correct electrode placement can reduce cardiac overlay. Chest expansion Some patients, especially neonates, expand their chests laterally. In this case, place the two respiratory electrodes in the right midaxillary and left lateral chest areas at the maximum expansion point. This placement optimizes respiratory waveform results. Abdominal breathing Some patients with restricted chest movement breathe mainly abdominally. In this case, place the LL electrode on the left abdomen at the point of maximum abdominal expansion. This placement optimizes respiratory waveform results. NOTE Place the red and green electrodes diagonally to optimize the respiration waveform. Do not position electrodes over the liver or the heart s ventricles. This is an especially important safety procedure for neonates. Selecting resp lead To change Resp lead: From the Resp Setup menu, select Resp Lead, then choose the appropriate lead from the pop-up list

67 Changing hold type Instructions for Use Vista 120 Patient Monitor To change the calculation mode: From the Resp Setup menu, set Hold Type to Manual or Auto. When set to AUTO mode, Hold High and Hold Low are unavailable, and the monitor calculates the respiration rate automatically. When set to Manual mode, the broken lines in RESP area can be adjusted by using Hold High and Hold Low. Changing the size of the respiration waveform Select the Resp waveform area to display the Resp waveform menu: Select AMP and select the desired value. Larger values increase the waveform amplitude. Select Sweep: Select an appropriate setting from the pop-up list. Using Resp alarms The User can turn Resp alarms on and off and set high and low alarm limits using the same procedures as described in the chapter Alarms. Changing the apnea time The apnea alarm is a high priority red alarm. The apnea alarm delay time is the period between no detected respiratory activity and alarm activation. 1. In the Resp Setup menu, select RESP APNEA. 2. Select the desired setting from the pop-up list

68 Monitoring SpO 2 Overview The SpO 2 value is derived from the absorption of pulse blood oxygen by red and infrared light using a finger sensor and a SpO 2 measuring unit. SpO 2 Plethysmogram measurement is employed to determine the oxygen saturation of hemoglobin in the arterial blood. If, for example, 97 % of the hemoglobin molecules in the red blood cells of the arterial blood combine with oxygen, then the blood has a SpO 2 oxygen saturation of 97 %. The SpO 2 numeric on the monitor will read 97 %. The SpO 2 numeric shows the percentage of hemoglobin molecules which have combined with oxygen molecules to form oxyhemoglobin. The SpO 2 /PLETH parameter can also provide a pulse rate signal and a plethysmogram waveform. SpO 2 safety information If the SpO 2 sensor does not work properly, reconnect the sensor or use a new one. Do not use sterile supplied SpO 2 sensors if the packaging or the sensor is damaged. Prolonged and continuous monitoring may increase the risk of unexpected change of dermal condition such as abnormal sensitivity, rubescence, vesicle, repressive putrescence, and so on. It is especially important to check the sensor placement of neonatal patients and patients with poor perfusion or immature dermogram by light collimation and proper attaching strictly according to changes of the skin. More frequent examinations may be required for different patients. Tissue damage may be caused by incorrect application or prolonged measurement duration using the sensor (more than 4 hours). Inspect the sensor periodically according to the sensor user manual. Neonate SpO 2 sensor can only be used when required, no more than 20 min at a time. Use only Dräger permitted sensors and extension cables with the oximeter. Other sensors or extension cables may cause improper monitor performance and/or minor personal injury. NOTE Make sure the fingernail covers the light window. The wire should be placed on the backside of the hand. The amplitude of the SpO 2 waveform is not proportional to the pulse volume

69 Avoid placing the sensor on extremities with an arterial catheter, or intravascular venous infusion line. Do not use a functional tester to access the SpO 2 accuracy. The function of SpO 2 measurement does not require calibration. The materials with which the patient or any other person can come into contact must be conforming to standard ISO Measuring SpO 2 1. Select the correct patient category setting (adult/pediatric and neonatal). This is used to optimize the calculation of the SpO 2 and pulse numerics. 2. During measurement, ensure that the application site: - has a pulsatile flow, ideally with a good circulation perfusion. - has not changed in its thickness, causing an improper fit of the sensor. Measurement procedure 1. Switch on the monitor. 2. Attach the sensor to the appropriate site of the patient finger. 3. Plug the sensor extension cable connector into the SpO 2 socket on the SpO 2 module. Mounting of the Sensor Inspect the application site every two to three hours to ensure skin quality and correct optical alignment. If the skin quality changes, move the sensor to another site. Change the application site at least every four hours. NOTE Injected dyes such as methylene blue or intravascular dyshemoglobins such as methemoglobin and carboxyhemoglobin may lead to inaccurate measurements

70 Interference can be caused by: Instructions for Use Vista 120 Patient Monitor High levels of ambient light or strobe lights or flashing lights (such as fire alarm lamps). (Hint: cover application site with opaque material.) Electromagnetic interference. Excessive patient movement and vibration. Understanding SpO 2 alarms This chapter describes SpO 2 specific alarms. See the chapter Alarms for general alarm information. SpO 2 alarms are adjustable and have high and low limits. Adjusting alarm limits In SpO 2 Setup menu: Select the SpO 2 High Alarm Limit and chose the desired high alarm limit. Select the SpO 2 Low Alarm Limit and chose the desired low alarm limit. High oxygen levels may predispose a premature infant to retrolental fibroplasia. If this is a consideration do not set the high alarm limit to 100 %, which is equivalent to switching the alarm off. Setting SpO 2 as pulse source 1. In the PR Setup menu, select PR Source; 2. Select SpO 2 from the pop-up list. Setting pitch tone If tone modulation is on, the PR sound lowers when the SpO 2 level drops. In SpO 2 Setup menu, select pitch tone to toggle between On and Off. Setting sensitivity Sensitivity allows the user to set the refresh frequency. High is the highest SpO 2 refresh frequency value. To change the sensitivity: 1. Select the SpO 2 Setup menu; 2. Select Sensitivity and set the desired sensitivity from the pop-up list

71 Monitoring PR Overview Instructions for Use Vista 120 Patient Monitor The pulse numeric counts the arterial pulsations that result from heart mechanical activity in beats per minute (bpm) from the measured SpO 2 signal. Setting PR volume Six selections are available: 0, 1, 2, 3, 4, and 5. 5 is the maximum volume. 0 is mute. PR Volume can be changed in the PR Setup menu. Using pulse alarms The user can change pulse rate alarm limits in the PR Setup menu by selecting PR Alarm Limit. Pulse alarms are only generated when the active alarm source is set to Pulse. The pulse source is set as system pulse and pulse alarms are switched on. Selecting the active alarm source In most cases, the HR and Pulse numerics are identical. To avoid simultaneous alarms on HR and Pulse, the monitor uses either ECG or Pulse as its active alarm source. To change the alarm source, select Alarm Source in the ECG/Pulse Alarms menu, then select HR: If HR should be the alarm source for HR/Pulse. PR: If Pulse is selected as the active alarm source, the monitor will prompt the user to confirm his choice. If Pulse is selected as the alarm source, all arrhythmia and ECG HR alarms are switched off. AUTO: If the Alarm Source is set to Auto, the monitor will use the heart rate from the ECG measurement as the alarm source whenever the ECG measurement is switched on and at least one ECG lead can be measured without a technical alarm condition. The monitor will automatically switch to Pulse as the alarm source

72 Monitoring NIBP Overview Instructions for Use Vista 120 Patient Monitor This monitor uses the oscillometric method for measuring NIBP. It can be used for adult, pediatric and neonatal patients. Oscillometric devices measure the amplitude of pressure changes in the occluding cuff as the cuff deflates from above systolic pressure. The amplitude suddenly increases as the pulse breaks through the occlusion in the artery. As the cuff pressure decreases further, the pulsations increase in amplitude, reach a maximum (which approximates to the mean pressure), and then diminish. In adult and pediatric mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP ) in relation to mean error and standard deviation, when compared to auscultatory measurements in a representative patient population. For the auscultatory reference, the fifth Korotkoff sound was used to determine the diastolic pressure. In neonatal mode, the blood pressure measurements determined with this device comply with the American National Standard for Electronic or Automated Sphygmomanometers (ANSI/AAMI SP ) in relation to mean error and standard deviation, when compared to intra-arterial measurements in a representative patient population. NIBP safety information The monitor and peripheral devices are protected against high-frequency interference from defibrillators and electrosurgical units and against 50- and 60-Hz power line interference. Do not measure NIBP on patients with sickle-cell disease or any condition where skin damage has occurred or is expected. Use clinical judgment to decide whether to perform frequent unattended blood pressure measurements on patients with severe blood clotting disorders because of the risk of hematoma in the limb fitted with the cuff. Before starting a measurement, verify that you have selected a setting appropriate for your patient (adult, child, or neonate). An incorrect setting may be dangerous for children, because of higher measurement pressures. Do not apply the cuff to a limb that has an intravenous infusion or catheter in place. This could cause tissue damage around the catheter when infusion is slowed or blocked during cuff inflation

73 Make sure that the air tubing connecting the blood pressure cuff and the monitor is neither blocked nor tangled. NOTE Do not start NIBP measurements during low battery conditions (the monitor may turn off automatically). If an alarm occurs or measurement fails, discontinue the measurement. If you spill liquid onto the equipment or accessories, particularly if there is a chance that it can get inside the tubing or the measurement device, contact your service personnel. Continuous use of the automatic measuring mode for short intervals may lead to the discomfort of the patient. Measurement limitations Measurements are impossible with heart rate extremes of less than 40 bpm or greater than 240 bpm, or if the patient is on a heart-lung machine. The measurement may be inaccurate or impossible in the following situations: A regular arterial pressure pulse is hard to detect. Patients with cardiac arrhythmias. Patients with excessive and continuous movement such as shivering or convulsions. Patients with rapid blood pressure changes. Patients with severe shock or hypothermia that reduces blood flow to the periphery. Obese patients, where a thick layer of fat surrounding a limb dampens the oscillations coming from the artery. Patients with an edematous extremity. Measurement methods There are three methods of measuring NIBP: Manual - measurement on demand. Auto - continually repeated measurements (between 1 and 480 minute adjustable interval). Continual - NIBP measurements run consecutively in five minutes, and then the monitor switches to manual mode

74 Prolonged non-invasive blood pressure measurements in Auto mode may be associated with purport, ischemia and neuropathy in the limb wearing the cuff. When monitoring a patient, examine the extremities of the limb frequently for normal color, warmth and sensitivity. If any abnormality is observed, stop the blood pressure measurements. Measurement procedures 1. Connect the air hose and switch on the monitor. 2. Attach the blood pressure cuff to the patient's arm or leg and follow the following instructions. Ensure that the cuff is completely deflated. Attach the appropriate size cuff to the patient (For information about cuff size selection, refer to the chapter NIBP accessories ), and ensure the symbol "Φ" is over the artery. Ensure that the cuff is not wrapped too tightly around the limb. Excessive tightness can cause discoloration and ischemia of the extremity. NOTE The width of the cuff should be either 40 % of the limb circumference (50 % for neonates) or 2/3 of the upper arm length. The inflatable part of the cuff should be long enough to encircle % of the limb. The wrong size of cuff can cause erroneous readings. If you are unsure what size to use, consult a physician or use a large size cuff. 3. Connect the cuff to the air tubing. Cuff Usage 4. Check if the patient mode is appropriate. Access the Patient Setup menu from Menu and select Type. Turn the knob to select the desired patient Type. 5. Select a measurement mode in the NIBP Setup menu. Refer to chapter Operation Prompts for information. 6. Press the button on the front panel to start a measurement

75 Operation prompts 1. Manual measurement - Access the NIBP Setup menu and set the Measure Mode item to Manual. Press the button on the front panel to start a manual measurement. - During the idle period between AUTO measurements, press the button on the front panel at any time to start a manual measurement. Press the button again to stop the manual measurement. This allows the system to continue to take AUTO measurements according to the selected time interval. 2. Automatic Measurement Access the NIBP Setup menu and set the Measure Mode item to Auto. Press the button on the front panel to start the AUTO measurement according to the selected time interval. 3. Continuous measurement Access the NIBP Setup menu and select the Continual item to start a continuous measurement. The continuous measurement will last 5 minutes. 4. Stopping continuous measurement During continuous measurement, press the stop. button on the front panel at any time to Correcting the measurement if limb is not at heart Level The following measurement corrections should be applied if the limb is not at heart level: Add 0.75 mmhg (0.10 kpa) for each cm higher or Add 1.9 mmhg (0.25 kpa) for each inch higher NIBP alarm Subtract 0.75 mmhg (0.10 kpa) for each cm lower or Subtract 1.9 mmhg (0.25 kpa) for each inch lower When NIBP Alarm is On, the physological alarm occurs if any measurement value of Systolic pressure, Mean pressure, Diastolic pressure is outside the alarm limits. The user can adjust the alarm limit by accessing NIBP Setup > Alarm Setup > Sys Alarm/Mean Alarm/Dia Alarm. Resetting NIBP When NIBP does not work properly and the system does not generate an error message, select Reset in the NIBP Setup menu to activate the self-test procedure. This function restores the system.

76 Calibrating NIBP Instructions for Use Vista 120 Patient Monitor NIBP is not user-calibrated. Cuff-pressure transducers must be verified and calibrated, if necessary, at least once every two years by a qualified service professional. See the Service Guide for details. Leak test This item is used for the leak test. Turn the knob to select the Leak Test item in the User Maintain > NIBP Maintain menu to start the air leakage test. When the item is selected, it will change to Stop. If this item is selected again, the system will stop air leakage test and the item returns to Leak Test. This pneumatic test, other than being specified in the EN standard, is to be used by the user to simply determine whether there are air leaks in the NIBP airway. If, at the end of the test, the system gives the prompt that the NIBP airway has air leaks, contact the manufacturer for repair. Procedure for leak testing 1. Connect the cuff securely with the socket for NIBP air hole. 2. Wrap the cuff around the cylinder of an appropriate size. 3. Access User Maintain > NIBP Maintain 4. Turn the knob to the Leak Test item and press the item. Then the prompt of Leak Testing will appear indicating that the system has started performing the leak test. 5. The system will automatically inflate the pneumatic system to about 180 mmhg. 6. After 20 seconds, the system will automatically open the deflating valve, which marks the completion of a pneumatic measurement. If the prompt of Leak Test OK appears, it indicates that the airway is in good condition and no air leaks exist. However if the alarm information of NIBP Cuff Leak appears, it indicates that the airway might have air leaks. In this case, the user should check for loose connections. After confirming secure connections, the user should re-perform the pneumatic test. If the failure prompt still appears, contact DrägerService. Diagram of NIBP Air Leakage Test

77 Monitoring TEMP Overview Instructions for Use Vista 120 Patient Monitor Body temperature is measured using a thermistor probe (a semiconductor whose resistance changes with temperature) placed appropriately on the patient. Two TEMP probes can be used simultaneously to measure two TEMP values. The monitor automatically calculates the temperature difference. The default configuration is axilla sensor for adult. TEMP safety information Verify probe cables fault detection before using the probe to monitor the patient. If you unplug the temperature probe cable of channel 1 from the socket, the screen will display the error message TEMP1 SENSOR OFF and the audible alarm is activated. It is the same for the other channel. Handle the TEMP probe and cable carefully. When they are not in use, you should coil the probe and cable into a loose circle. Pulling the wire inside the cable may mechanically damage the probe and the cable. NOTE Disposable TEMP probe can only be used once per patient. TEMP monitoring setup If disposable TEMP probes are used, connect the TEMP cable to the monitor and then connect the probe to the cable. With a reusable TEMP probe the probe can be connected directly to the monitor. Apply the TEMP probes securely to the patient. Switch on the monitor It takes 2 to 3 min for the body temperature to stabilize. Calculating temp difference The monitor can calculate and display the difference between two temperature values by subtracting the second value from the first. The difference is labeled TD

78 Monitoring IBP (optional) Overview Instructions for Use Vista 120 Patient Monitor IBP is measured by means of a catheter inserted into the circulatory system. A pressure transducer connected to the catheter converts the mechanical force exerted by the blood into an electrical signal. This is displayed graphically as pressure versus time and as numerics on the monitor screen. The monitor measures direct blood pressure of one selected blood vessel through two channels and displays waveforms and numerics for the measured direct blood pressure (SYS, DIA and MAP). For further information on the IBP Kit, refer to the accompanying Instructions for Use of the manufacturer. IBP safety information The operator should avoid contact with the conductive parts of the device when it is connected to the patient. When the monitor is used with HF surgical equipment, avoid conductive connections of the transducer and the cables to the HF surgical equipment. This is to protect against burns to the patient. Disposable IBP transducer or domes should not be reused. If any kind of liquid, other than solution to be infused in pressure line or transducer, is splashed on the equipment or its accessories, or enters the transducer or the monitor, contact your service personnel immediately. NOTE Use only the pressure transducer listed in the IBP accessories Monitoring procedures Preparatory steps for IBP measurement: 1. Connect the pressure cable to the corresponding socket and switch on the monitor. 2. Flush the system with a normal saline solution. Ensure that the system is free of air bubbles. 3. Connect the patient s catheter to the pressure line. Ensure there is no air present in the catheter or pressure line. 4. Position the transducer so that it is at the same level as the patient s heart, approximately mid-axillary line

79 5. For the label name selection, refer to chapter Selecting a Pressure for Monitoring. 6. To zero the transducer, refer to chapter Zeroing the Pressure Transducer. If there are air bubbles in the pressure line or the transducer, flush the system with the infused solution. Selecting a pressure for monitoring The user can assign a pressure label to uniquely identify each pressure. The monitor then uses that label s stored settings (i.e., for color, scale and alarm settings) and selects which algorithm is used to process the pressure signal. An incorrect label can lead to incorrect pressure values. To select the label, refer to the following table: Label ART PA CVP ICP LAP RAP P1-P2 Description Arterial blood pressure Pulmonary artery pressure Central venous pressure Intracranial pressure Left atrial pressure Right atrial pressure Alternative non-specific pressure labels Zeroing the pressure transducer To avoid inaccurate pressure readings, the monitor requires a valid zero. Zero the transducer in accordance with your hospital s policy (at least once per day). Zeroing must be performed: When a new transducer or tubing is used; Every time the transducer cable is reconnected to the monitor; If the monitor s pressure readings seem to be incorrect. When using a pressure module, the zero information is stored in the module. To zero a pressure measurement: 1. Turn off the stopcock to the patient. 2. Vent the transducer to atmospheric pressure. This compensates for the static and atmospheric pressure exerted on the transducer. 3. In the setup menu for pressure, select Zero <Press>. 4. When the message <Press> zero done is displayed, close the stopcock to atmospheric pressure and open the stopcock to the patient

80 Troubleshooting the pressure zeroing (taking art for example) The status message lists the probable cause of an unsuccessful calibration. Message Art ZERO FAIL Art SENSOR OFF, FAIL IN DEMO, FAIL PRESSURE OVER RANGE, FAIL PULSATILE PRESSURE ZERO FAIL IBP pressure calibration Corrective Action Make sure that the transducer is not attached to the patient Make sure that transducer is not off, and then proceed zeroing Make sure that the monitor is not in DEMO mode. Contact service technician if necessary Make sure that the stopcock is vented to atmosphere. If the problem persists, contact service technician Make sure that the transducer is vented to air, not connected to a patient, and try again. Mercury calibration should be performed by the hospital technical personnel either whenever a new transducer is used, or as frequently as dictated by your hospital s policy. The purpose of the calibration is to ensure that the system gives accurate measurements. Before starting a mercury calibration, a zero procedure must be performed. If the user needs to perform this procedure himself, he will need the following equipment: standard sphygmomanometer 3-way stopcock tubing (approx. 25 cm long). The Calibration Procedure: 1. Close the stopcock that was open to atmospheric pressure for the zero calibration. 2. Attach the tubing to the sphygmomanometer. 3. Ensure that connection to patient is off. 4. Connect the 3-way connector to the 3-way stopcock that is not connected to the patient catheter. 5. Open the port of the 3-way stopcock to the sphygmomanometer. 6. Select the channel to be calibrated in the menu and select the pressure value to which the IBP is to be adjusted

81 7. Inflate to make the mercury bar rise to the setup pressure value. 8. Adjust repeatedly until the value in the menu is equal to the pressure value shown by the mercury calibration. 9. Press the Start button, the device will begin calibrating. 10. Wait for the calibrated result. Corresponding measures should be taken based on the prompt information. 11. After calibration, disassemble the blood pressure tubing and the attached 3-way valve : Hydrargyrum pressure meter; 2: 3-way connector; 3: 3-way stopcock; 4: Pressure transducer; 5: Pressure transducer interface cable; 6: Monitor 6 IBP Calibration Troubleshooting the pressure calibration The status line lists the probable cause of an unsuccessful calibration. Message Art SENSOR OFF, FAIL IN DEMO, FAIL PRESSURE OVER RANGE, FAIL Pulsatile Pressure Calibration Fail Corrective Action Make sure that sensor is not off, and then start the calibration. Contact service technician if necessary. Make sure that the monitor is not in DEMO mode. Contact service technician if necessary. Make sure that transducer value has been selected in IBP CAL, and then start the calibration. Contact service technician if necessary. Make sure that pressure value shown by hydrargyrum pressure meter is changeless. Contact service technician if necessary

82 IBP alarm Instructions for Use Vista 120 Patient Monitor When Alarm Switch is On, the physological alarm occurs if any measurement value of Systolic pressure, Mean pressure, or Diastolic pressure is outside the alarm limits. The alarm limit can be adjusted by accessing XX Options (XX stands for the label name) > Setup > SYS Alarm > MEAN Alarm > DIA Alarm

83 Monitoring CO 2 (optional) Overview Instructions for Use Vista 120 Patient Monitor The monitor uses a Capnostat 5 CO 2 module (c5) as the means for MainStream method CO 2 monitoring. MainStream measurement uses a CO 2 sensor attached to an airway adapter that is directly inserted into the patient s breathing system. The principle of CO 2 measurement is primarily based on the fact that CO 2 molecules absorb 4.3μm infrared rays. Absorption intensity is proportional to the CO 2 concentration of the patient sample. CO 2 safety information Do not use the device in the environment with flammable anesthetic gas. The device should be used by trained and qualified medical personnel. Nitrous oxide, elevated levels of oxygen, helium, xenon, halogenated hydrocarbons, and barometric pressure can influence the CO 2 measurement. The monitor will be damaged if any tube from the CO 2 module is disconnected, or the air tube/the air inlet/the air outlet are plugged by water or other materials. The accuracy of the CO 2 measurement will be affected by the following reasons: the airway was highly obstructed; a leaky airway connection or quick variation of environment temperature. Follow precautions for electrostatic discharge (ESD) and electromagnetic interference (EMI) to and from other equipment. In the presence of electromagnetic devices (e.g., electrocautery), patient monitoring may be interrupted due to electromagnetic interference. Electromagnetic fields up to 20V/m will not adversely affect module performance. Do not place the sensor cables or tubing in a way that may cause tangling or strangulation. Do not store the CO 2 Module at temperatures less than -40 ºC or greater than +70 ºC. Do not operate the CO 2 Module at temperatures less than 0 ºC or greater than 40 ºC

84 NOTE After the low battery alarm appears, do not start the CO 2 measurement. The monitor may turn off from lack of battery power. Monitoring procedures Zeroing the sensor Zeroing must be performed according to the following procedure when using a new airway adapter: 1. Expose the sensor to room air, but not to any source of CO 2. This includes the ventilator, patient, and operator. 2. Select CO 2 Setup, and change Work Mode from Standby to Measure. 3. In the CO 2 Setup menu, select Zero Calibration. 4. If the system briefly displays Zeroing, the process is successful. After the zeroing calibration is finished, you can start CO 2 Monitoring. If the system displays Breath detected or Zero required, zeroing has failed. Zero calibration must be performed again. C5 CO 2 module NOTE You must perform a zero calibration as described in this procedure each time you use a new airway adapter. Measurement steps C5 CO 2 module 1. Attach the sensor connector to the CO 2 connector on the monitor. 2. Wait two minutes, allowing the sensor to reach its operating temperature and a stable thermal condition. 3. Choose the appropriate airway adapter and connect it to the sensor head. The airway adapter clicks into place when seated correctly

85 Connecting Sensor 4. To zero the sensor, refer to zeroing the sensor; 5. Install the airway adapter at the proximal end of the circuit between the elbow and the ventilator Y-section. Connecting Airway Adapter Accuracy is affected by temperature and barometric pressure. Installing or removing the CO 2 module when the monitor is working may make the monitor unstable. If you do it inadvertently, turn off the module in menu immediately. The module enters STANDBY mode if you reconnect it to monitor which it is powered on. If the readings are inaccurate, you should do calibration. NOTE Replace the airway adapter if excessive moisture or secretions are observed in the tubing or if the CO 2 waveform changes unexpectedly without a change in patient status

86 To avoid infection, use only sterilized, disinfected, or disposable airway adapters. Inspect the airway adapters prior to use. Do not use if airway adapter appears to have been damaged or broken. Observe airway adapter color coding for patient population. Periodically check the flow sensor and tubing for excessive moisture or secretion buildup. Removing exhaust gases from the system Anesthetics: when using the CO 2 measurement on patients who are receiving or have recently received anesthetics connect the outlet to a scavenging system, to avoid exposing medical staff to anesthetics. Use an exhaust tube to remove the sample gas to a scavenging system. Attach the tube to the mainstream sensor at the outlet connector. Setting CO 2 waveform setup Select the CO 2 waveform area to display the CO 2 waveform menu: 1. Set Mode to Curve or Filled as desired. 2. Set Sweep to an appropriate value from the pop-up list. The larger the value, the faster the speed. Setting CO 2 corrections Temperature, water vapor in the patient s breath, barometric pressure, and the proportions of O 2, N 2 O and Helium in the mixture all influence CO 2 absorption. If values seem inaccurately high or low, check that the monitor is using the appropriate corrections. Baro Press, O 2 Compens, Balance Gas and Anes Agent can be selected. Changing CO 2 alarms This chapter describes specific CO 2 alarms. See the chapter Alarms for general alarm information. To change the alarm, refer to the following steps: 1. Select the CO 2 Setup menu to display that menu. 2. Select etco 2 Alarm Setup, FiCO 2 Alarm Setup or AwRR Alarm Setup to adjust the alarm limit

87 Changing apnea alarm Instructions for Use Vista 120 Patient Monitor This function allows the user to set an apnea alarm that monitors a time limit if a patient ceases breathing. 1. Select the CO 2 Setup menu. 2. Select Apnea Alm. 3. Choose the apnea alarm time from the pop-up list. Safety and effectiveness of the respiration measurement method in the detection of apnea, particularly the apnea of prematurity and apnea of infancy, has not been established

88 Freeze Overview Instructions for Use Vista 120 Patient Monitor When monitoring a patient, the user can freeze waveforms and examine them. Generally, the user should not view frozen waveforms for longer than 60 seconds. The Freeze function has the following features: Freeze status can be activated on any operating screen. Upon freezing, the system exits all other operating menus. The system freezes all waveforms in the Waveform area of the Basic Screen, the Full Lead ECG waveforms and extra waveforms on the Full Lead ECG interface (if any). The Parameter area refreshes normally. The frozen waveforms can be reviewed and recorded. Entering/exiting freeze status Entering freeze status In the non-freeze status, press the hardkey on the monitor control panel to exit the current menu. Freeze status is entered and the pop-up Freeze menu is displayed. In Freeze status, all waveforms are frozen and will not be refreshed. Exiting freeze status Executing any of the following operations will exit Freeze status: 1. Select Exit option in/from the Freeze menu; 2. Press hardkey on the control panel again; 3. Execute any operation that triggers the adjustment of the screen or displays a new menu. After exiting Freeze status, the system will clear screen waveforms and resume displaying real-time waveforms. In the Screen Refresh mode, the system will sweep the waveforms from left to right in the Waveform Area. Press the hardkey on the control panel, and the Freeze menu will appear on the bottom part of the screen. At the same time, the system freezes the waveforms. REC WAVE: can be set to any waveform of 8 s, such as IBP1, CO 2, PLETH etc. It can also be set to OFF. Review: Used to review frozen waveforms. Exit: The system closes the Frozen menu and exits Freeze status. NOTE Pressing the hardkey repeatedly over a short period of time may result in discontinuous waveforms on the screen

89 Reviewing frozen waveform Instructions for Use Vista 120 Patient Monitor By moving the waveform, the user can review 120 seconds of the waveform before it was frozen. For a waveform of less than 60 seconds, the remaining part is displayed as a straight line. The rotary knob on the control panel can be used to move the cursor to the Review option in the Freeze menu. Press the knob. By turning the knob left or right, frozen waveforms on the screen will move left or right correspondingly. There is an arrow indicating upward on the right side of the last waveform

90 Review The monitor provides 120-hour trend data of all parameters, storage of 1200 NIBP measurement results and 60 alarm events. This chapter gives detailed instruction for review of all data. Trend graph review The latest 1-hour trend displays data taken every 1 or 5 seconds. The latest 120-hour trend displays data taken every 1, 5 or 10 minutes. To review the Trend Graph, press the Trend hardkey on the front panel or select Menu > Review > Trend Graph. In the trend graph, the y-axis is the measurement value and x-axis represents time. Selecting trend graph of specific parameter The monitor can display trend graphs of different parameters. To select a different parameter s trend, select Menu > Review > Trend Graph and select the desired parameter name from the pop-up list (as shown in red text on the above figure). Setting resolution To set an appropriate resolution, select Menu > Review > Trend Graph. Choose Resolution to display the list and select a resolution ranging from 1 sec, 5 sec, 1 min, 5 min and 10 min. Scrolling the screen Not all trend graphs are displayed on the current screen. To see other trend graphs, press the symbols and displayed on the trend graph

91 Switching to the trend table Instructions for Use Vista 120 Patient Monitor To switch to the trend table, select Trend Table. Record The monitor can print the data in the current trend window. For more information, refer to chapter Strip recording. Trend table review To review the trend table, press the Trend Table shortcut key on the screen or select Menu > Review > Trend Table. Setting resolution To set an appropriate resolution, select Menu > Review > Trend Table. Choose Resolution to display the list and select a resolution ranging from 1 sec, 5 sec, 1 min, 5 min and 10 min, 30 min and 60 min. Scrolling the screen Not all trend tables can be displayed on the current screen. To see other measurement trend tables, press the symbols,, and displayed on the trend graph. Switching to trend graph The user can switch to the trend graph on the Trend Table dialog box. Select Menu > Review > Trend Graph and select the Trend Graph option from the pop-up dialog box

92 Recording The monitor can make a tabular trend recording of the data in the current trend graph window. The report uses the current trend interval settings. For more information, refer to chapter Recording. NIBP review To review the NIBP measurement data, select the NIBP Review key on the screen or select Menu > Review > NIBP Review. The NIBP Review window is displayed. Scrolling the screen Not all measurement data is displayed on the current screen. To see other measurement data, press the symbols and displayed on the NIBP Review dialog box. Recording The monitor can record the measurement data in the NIBP review window. For more information, refer to chapter Recording. Alarm review The monitor can store up to 60 alarm events and displays the last 10 alarm events. To review the alarm event, select the Alarm Review key on the screen or select Menu > Review > Alarm Review. The Alarm Review dialog box is displayed. Scrolling the screen Not all alarm events are displayed on the current screen. To see other alarm events, press the symbols and displayed on the Alarm Review dialog box. Selecting alarm event of specific parameter The monitor can review an alarm event of a specific parameter. To view the alarm event of the specific parameter, select Menu > Review > Alarm Event and choose Event Type to select the desired parameter name from the pop-up list. Setting time index The user can set End time of alarm review by selecting the Time Index option displayed on the Alarm Event Review dialog box. If the user selects Current Time on the pop-up dialog box, the alarm events occurring before the current time are displayed on the alarm event review dialog box

93 If the user selects User Define, he can define the review time by setting Year, Month, Day, Hour, Min and Sec. The alarm events occur before the User Define option is displayed on the alarm event review dialog box. Recording The monitor can record the alarm event in the alarm event review window. For more information, refer to chapter Recording. Arr review Select ECG Setup > Arr Analysis> Arr Review or Menu > Review > Arr Review to display the Arr Review dialog box. The dialog box displays the latest arrhythmia events. Selecting specific arrhythmia event The monitor can review a specific arrhythmia event. To view the specific arrhythmia event, select Menu > Review > Arrhythmia Review > Rename and choose the desired name from the pop-up list. Scrolling the screen Not all arrhythmia events can be displayed on the current screen. To see the other arrhythmia events, press the symbol and displayed on the Arrhythmia Review dialog box. Deleting arrhythmia events The user can delete the arrhythmia events displayed on the current screen by selecting Delete on the Arrhythmia Review dialog box. Recording The monitor can record the waveforms of the arrhythmia events displayed on the current screen. For more information, refer to chapter Recording

94 Calculation and titration table The monitor provides a calculation function and titration table. Calculations are patient data that are not directly measured but calculated by the monitor. The monitor can perform drug calculations. Hemodynamic calculations are not described in this Instructions for Use. To perform a calculation, select Menu > Common Function > Drug Cal. NOTE The drug calculation function acts only as a calculator. The patient weights in Drug Calculation menu and in Patient Information menu are independent of each other. Therefore changing the Weight in Drug Calculation menu will not change the weight in the Patient Information menu. Drug calculation Calculation procedures 1. The drug calculation window is displayed by selecting Menu > Common Function > Drug Calc. 2. Select the right pull-down Drug Name option and select the desired drug name among the 15 drugs which are listed as follows. The names of drug Drug A, Drug B, Drug C, Drug D and Drug E can be defined by the user. Drug A, Drug B, Drug C, Drug D and Drug E AMINOPHYLLINE DOBUTAMINE DOPAMINE EPINEPHRINE HEPARIN ISUPREL LIDOCAINE NIPRIDE NITROGLYCERIN PITOCIN 3. The system generates default values that cannot be treated as calculation results. The user must input the correct parameter values. 4. Input the patient s weight. 5. Input the correct parameter value. 6. Confirm if the calculation result is correct

95 Calculation unit Instructions for Use Vista 120 Patient Monitor Each drug has the fixed unit or unit series that is used for it. Within the same unit series, the numeric value is automatically scaled up or down as needed. The calculation units of the drugs are as follows: Drug DRUG A, DRUG B, DRUG C, AMINOPHYLLINE, DOBUTAMINE, DOPAMINE, EPINEPHRINE, ISUPREL, LIDOCAINE, NIPRIDE, NITROGLYCERIN DRUG D, PITOCIN, HEPARIN DRUG E Unit g, mg, mcg Ku, mu, Unit When defining a drug, select Drug A, Drug B, Drug C, Drug D, and Drug E based on the unit series. meq NOTE The drug calculation is displayed as invalid prior to data entry. Drip Rate and Drop Size are invalid in neonatal mode. Titration table After completing the drug calculation, the user can display the Titration on the Drug Calc dialog box. The user can change the following items in the titration table: Basic Step Dose Type The data in the trend table will vary with the changes above. The user can perform the following: Scroll up and down the screen by selecting the symbol and displayed on the trend graph. Record the data displayed in the current dialog box by selecting the button Record

96 Strip recording General information Instructions for Use Vista 120 Patient Monitor A thermal dot matrix recorder is used for the monitor and can support a number of recording types and output patient information, measurement data, and review data waveforms Start/Stop key. Press this key to start or stop recording task. 2 Recorder door 3 Paper outlet 4 Recording indicator Performance of the recorder Waveform record printed at the rate of 25 mm/s or 50 mm/s. 48 mm wide printout paper. Record up to three waveforms. User-selectable real-time recording time and waveform. Auto recording interval is set by the user and the waveform displays in real time. NOTE You should not use the strip recorder with a low battery as recorder usage will more quickly deplete the battery. Recording type The monitor provides several types of strip recordings: Continuous real-time recording

97 Time recording Alarm recording Trend graph, trend table recording Arrhythmia review recording Drug calculation titration recording NIBP review recording Alarm review recording Starting and stopping strip recording The strip recording can be started and stopped in the following ways: Continuous real-time recording Auto recording Alarm recording Trend graph recording Trend table recording Arrhythmia review recording Alarm review recording NIBP review recording Titration table recording Press the Start/Stop hardkey on the printer or the Recording hardkey on the monitor to start the strip recording, and repress it to stop the strip recording. Record the three waveforms selected in the Record menu for the duration defined in the Record menu. The strip recording automatically stops in 8 seconds. When alarm recording is ON, it automatically starts when alarm occurs. Display the Trend Graph menu, and then press the Record button in the dialog box to start strip recording. Display the Trend Table menu, then press the Record button in the dialog box to start strip recording. Display the ECG Setup menu via shortcut key, select ARR Analysis > ARR Review, and then press the Record button in the dialog box to start strip recording. Display the Alarm Review menu, then press the Record button in the dialog box to start strip recording. Display the NIBP Review menu, then press the Record button in the dialog box to start recording. Display the Drug Calc menu from the Menu. Pick the Titration button in the menu to access the Titration window. Press the Record button to print out the currently displayed titration table

98 The recorder will stop recording in the following situations: The strip recording task is finished. When the Start/Stop button on the front panel of the printer is pressed while the printer is printing. No paper in the recorder. Because of malfunction. Recorder operations and status messages Record paper requirement CAUTION Only use standard thermo-sensitive record paper. If non-standard record paper is used, the recorder might not function, the recording quality may be poor, and the thermo-sensitive printhead could be damaged. Proper operation When the strip recorder is operating, do not pull the paper. Do not operate the strip recorder without record paper. Paper out When the Recorder Out Of Paper alarm is displayed, the strip recorder will not start. Installling paper 1. Pull out the upper arc of the strip recorder casing as shown in the following figure

99 2. Insert a new roll of paper into the paper cassette, printing side facing upwards. 3. Position the paper correctly. 4. Pull 2 cm of paper out and close the strip recorder casing. NOTE Be careful when inserting paper. Avoid damaging the thermo-sensitive print head. Do not leave the strip recorder door open except to insert paper or troubleshoot printing problems

100 Removing paper jam Instructions for Use Vista 120 Patient Monitor When the strip recorder malfunctions, open the strip recorder door to check for a paper jam. Remove the paper jam in the following way: Cut the record paper from the feeding edge. Open the strip recorder door. Re-install the paper. NOTE If the monitor is not installed with a strip recorder, it will indicate RECORDER SETUP NEEDED after pressing the Record button in the dialog box. Do not touch the thermo-sensitive print head when performing continuous recording

101 Other Functions Nurse call Instructions for Use Vista 120 Patient Monitor The monitor provides a dedicated nurse call port which can be connected to the hospital s nurse call system

102 Using battery Battery power indicator Instructions for Use Vista 120 Patient Monitor The indicator labeled Battery on the front panel of the monitor illuminates green when the monitor is battery powered and yellow when being charged. The indicator is not illuminated when the monitor is not powered or when using AC power. Battery status on the main screen The Battery Status shows the status of each battery detected and the combined battery power remaining. It also includes an estimate of the monitoring time remaining. Icon is shown when the battery is being charged. The yellow section represents the battery charge level. When fully charged, the section turns green. Icon is shown when the monitor is not equipped with a battery. Icon is shown is there is insufficient power. When the monitor is battery powered, the monitor switches off automatically if there is no power. Checking battery performance NOTE Remove the battery from the monitor when the monitor is not used for a long periods of time. The performance of rechargeable batteries may deteriorate over time. The battery should be conditioned regularly as follows: 1. Disconnect the patient from the monitor and stop all monitoring and measurement. 2. Switch the monitor power on and charge the battery for more than 6 hours continuously. 3. Disconnect the monitor and let it run until there is no battery power remaining and the monitor shuts off. 4. Reconnect the monitor to mains. This should improve the battery running time. If the running time is less than listed in the specification, change the battery or contact the customer service. Before using the rechargeable lithium-ion battery (hereinafter called battery), be sure to read these Instructions for Use and follow all safety precautions. Do not destroy, disassemble or modify the battery in any way. Do not short circuit the battery, or its terminals, to a metal object

103 Do not unplug the battery while the monitor is monitoring a patient. Do not heat or throw battery into a fire. Do not store the battery at temperatures above 60 C. Do not immerse, throw, or wet battery in water/seawater. Use the battery only in the monitor. Do not connect battery directly to an electric outlet or cigarette lighter charger. If liquid leaking from the battery gets into your eyes, do not rub your eyes. Wash them well with clean water and go to see a doctor immediately. If liquid leaks of the battery splash onto your skin or clothes, wash well with fresh water immediately. Keep away from fire immediately when leakage or foul odor is detected. Stop using the battery if abnormal heat, odor, discoloration, damage, deformation, or abnormal condition is detected during use, charge, or storage. Keep it away from the monitor. Replacing the battery To install or replace the battery: Battery door 1. Pull the battery door downwards to open it. 2. Pull the metal retainer until the battery can be removed

104 3. Insert the new battery into the battery compartment. 4. Pull the metal retainer downward to fix the battery and close the battery door. Recycling the battery When the battery no longer holds a charge, it should be replaced. Remove the old battery from the monitor and recycle it properly. NOTE To prolong the life of rechargeable battery, charge it at least once every six months for a charging time of about five hours

105 Care and cleaning Instructions for Use Vista 120 Patient Monitor Use only the Dräger-approved substances and methods listed in this chapter to clean or disinfect the equipment. The warranty does not cover damage caused by using unapproved substances or methods. Dräger makes no claims regarding the efficacy of the listed chemicals or methods as a means for controlling infection. Contact infectious disease experts in your hospital for details. General points Before cleaning, sterilizing, or disinfecting the monitor or any accessory, make sure that the equipment is switched off and disconnected from the power line. Keep the monitor, cables, and accessories free of dust and dirt. CAUTION To prevent the device from damage, follow this procedure: Always dilute cleaning, sterilizing, or disinfecting agents according to the manufacturer s instructions or use the lowest possible concentration. Do not immerse any part of the equipment or any accessory in liquid or pour liquid onto them. Never use bleach. Do not allow liquid to enter the case. Never use abrasive material (such as steel wool or silver polish). CAUTION If you spill liquid on the equipment, battery, or accessories, or they are accidentally immersed in liquid, contact your service personnel or DrägerService. Cleaning Cleaning the monitor Regular cleaning of the monitor shell and the screen are strongly recommended. Use only non-caustic detergents such as soap and warm water (40 C maximum) to clean the monitor shell. Do not use strong solvents such as acetone or trichloroethylene. Exercise caution when cleaning the monitor screen. Do not permit liquids to enter the monitor case. Do not allow water or cleaning solution to enter the measurement connectors. Examples of disinfectants that can be used on the instrument casing are as follows: Tenside; Diluted Ammonia Water < 3%;

106 Diluted Sodium Hypochlorite (Bleaching agent); Diluted Formaldehyde 35 to 37 %; Hydrogen Peroxide 3 %; Alcohol; Isopropanol. NOTE The diluted sodium hypochlorite from 500 ppm (1:100 diluted bleaching agent) to 5000 ppm (1:10 bleaching agents) is very effective. The concentration of the diluted sodium hypochlorite depends on how many organisms (blood, mucus) on the surface of the chassis to be cleaned. The monitor and sensor surface can be cleaned with hospital-grade ethanol and allowed to air dry or dried using a clean cloth. Cleaning the accessories Cleaning the Cables and Lead Wires CAUTION Do not use acetone or ketone solvents for cleaning; do not use an autoclave or steam cleaner. CAUTION The decision to sterilize must be made per your hospital s policy with an awareness of the effect on the integrity of the cable and leadwire. Cables and leadwires can be cleaned with a warm, damp cloth and mild soap, or isopropyl alcohol wipes. Refer to the previous page for safe cleaning techniques. Cleaning the blood pressure cuff Use a soft brush to wash the cuff surface and clean as follows: NOTE Do not immerse the rubber tube or allow liquid to enter either the cuff or the tube when washing it. Do not scrub or knead the cuff. Cleaning the CO 2 sensor Clean the sensor surface with a damp cloth. Ensure the sensor windows are clean and dry. Do not immerse the sensor. Do not attempt to sterilize the sensor

107 An adapter can be cleaned by rinsing in a warm soapy solution, followed by soaking in a liquid disinfectant, pasteurized, or cold sterilized (glutaraldehyde). It should then be rinsed with sterile water and dried. Before reusing any adapter, ensure the windows are clean and free of any residue. For other applied parts, the manufacturer must be consulted for cleaning, sterilization, or disinfecting methods. Other accessories For cleaning other accessories, contact the manufacturers for details. Sterilization To avoid extended damage to the equipment, sterilization is only recommended when stipulated as necessary in the hospital s policy. Sterilization facilities should be cleaned first. Recommended sterilization material: Ethylate and Acetaldehyde. Appropriate sterilization materials for ECG lead and blood pressure cuff are described in those chapters. Sterilize and disinfect as needed to prevent cross infection between patients. CAUTION Use a moistened cloth to wipe up any agent remaining on the monitor. Disinfection Mixing bleach and ammonia (or other disinfecting solutions) may produce hazardous gases. To avoid extended damage to the equipment, disinfection is only recommended when stipulated as necessary in the hospital s policy. Disinfection facilities should be cleaned first. Appropriate disinfection materials for ECG leads, SpO 2 sensor, blood pressure cuff, TEMP probe, IBP sensor are described in those chapters. Recommended types of disinfecting agents are: Alcohol Aldehyde CAUTION Do not use eto gas or formaldehyde to disinfect the monitor

108 Maintenance Failure on the part of the responsible institution to implement a satisfactory maintenance schedule may cause undue equipment failure and possible health hazards. If the monitor is mechanically damaged, or if it is not working properly, do not use it. Contact your technical personnel. If you discover a problem with any of the equipment, contact your service personnel or your authorized supplier. Inspecting The overall check of the monitor, including the safety check, should be performed by qualified personnel every 24 months, and following repair. The following items should be checked: If the environmental condition and power supply meet requirements. If the power supply cord is damaged and the insulation is not cut. If the device and accessories are damaged. Specified accessories. If the alarm system works properly. If the recorder works properly and there is sufficient paper. Battery performance If all monitoring functions are in good condition. If grounding resistance and leakage function properly. If any damage or abnormality is found, do not use the monitor and contact customer support. Maintenance task and test schedule The following maintenance tasks are for Dräger-qualified service professionals only. Contact a Dräger-qualified service provider if the monitor needs a safety or performance test. Clean and disinfect equipment before testing or maintaining it. Maintenance and Test Schedule Safety checks. Selected tests on the basis of IEC Frequency At least once every two years, or as needed, following any repairs where the power supply is removed or replaced, or if the monitor has been dropped

109 Maintenance and Test Schedule Check ECG synchronization of the monitor NIBP leakage inspection and calibrations CO 2 calibration and performance test Frequency At least once every two years, or as needed. At least once every two years, or as specified by local laws. At least once every two years, or if you suspect the measurement values are incorrect. Replacing fuse To replace the blown fuse: 1. Switch off the monitor and unplug the power cable. 2. Carefully place the monitor upside down on a flat surface covered with cloth or other protecting pad. 3. Pull ot the fuse box from the groove and you will see the fuse. 4. Remove the old fuse. Take out a new fuse with the following specifications: Ф 5 mm x 20 mm: Model: T1.6AL 250 V. 5. Place the new fuse in the fuse socket and push the box back into position