CNAP MONITOR 500 HD QUICK GUIDE. This Quick Guide DOES NOT REPLACE the user manual!

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1 CNAP MONITOR 500 HD QUICK GUIDE This Quick Guide DOES NOT REPLACE the user manual! Version 07/2016 V1.5.5 EN

2 2 CONTENT SET UP MEASUREMENT NAVIGATION FAQs FUNCTIONS: FAST ACCESS

3 Hemodynamic Parameters...5 Set Up Checklist for fast Set Up...6 Power Up CNAP Monitor... 7 Prepare CNAP Monitor for Measurement - Components...8 Prepare CNAP Monitor for Measurement - Connections...9 Connecting to a Patient Monitor...10 Zeroing of CNAP and patient monitor...11 Overview CNAP Monitor Patient Set Up...12 Choose correct CNAP finger sensor size...13 Place CNAP finger sensor and CNAP Controller...14 Place NBP Cuff...15 Measurement Select Measurement Mode / Start Measurement...16 Started Measurement: Perfusion Index / Signal Quality...17 Choose Patient Category / Enter Biometric Data...18 Stop / Resume Measurement...19 Navigation Navigation Frames...20 Function of Navigation Frames

4 4 Functions - Fast Access CONTENT Main Keys and Status Indicators The SETUP Key...25 Calibration Modes: Function / Benefits Triggering A Manual NBP - Fast Access...27 When is it recommended to trigger a manual NBP?...28 Change Finger manually...29 FAQs: 1. How can I change alarm settings for current measurement? How can I change alarm settings permanently? Enabling hemodynamic parameters for a measurement? How can I improve measurement quality? How can I adjust trend, signal and time settings? The battery? Service intervals for the CNAP Monitor? What to do if CNAP needs service? SERVICE HOTLINE? Where can I get additional information? How can I contact CNSystems directly?...41

5 HEMODYNAMIC PARAMETERS CNAP Monitor Measurement Type BP BP + PPV BP + HD CNAP NBP continuous noninvasive arterial pressure, sys, dia, mean noninvasive oscillometric blood pressure sys, dia x x x x x x Pulse pulse rate x x x PPV pulse pressure variation x x SVV stroke volume variation x CO continuous noninvasive cardiac output x CI cardiac index x SV stroke volume x SVI stroke volume index x SVR systemic vascular resistance x SVRI systemic vascular resistance index x 5

6 SET UP 6 SET UP CHECKLIST CHECKLIST STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 STEP 6 STEP 7 Start the device and connect the CNAP Controller Cable (orange connectors) to CNAP Monitor and CNAP Controller (see also p.7,9) Use the indicator on the CNAP Controller to find the correct CNAP finger sensor size for the patient. (see p. 13) Slide the finger sensor over two neighbouring fingers, and fix the CNAP Controller on the forearm using the Velcro fixation cuff. (see p. 14) Be sure that the CNAP Controller is in the center of the forearm cuff so that the patient can freely bend his / her wrist. (see p.14) Select the right NBP cuff size for the patient using the indicator on the inside of the NBP cuff and connect the black hose to the CNAP Monitor. (see p.15) Fit the NBP cuff on the patient s upper arm. The NBP cuff can be placed ipsilaterally or contralaterally to the CNAP finger sensor. (see p.15) Start measurement by clicking Start New Measurement. Choose patient category Adult or Pediatric. (see p.16, 18)! ATTENTION During CNAP initialisation the patient needs to be in a stable position. During general anesthesia start CNAP before or after the induction phase!

7 POWER UP CNAP MONITOR 1 Press POWER ON / OFF button 2 When alarm sounds, confirm by pressing the yellow alarm button. SET UP 7

8 SET UP 8 PREPARE CNAP MONITOR FOR MEASUREMENT COMPONENTS 1 CNAP Monitor 1 2 CNAP Controller Cable 3 CNAP Controller CNAP Finger sensor NBP Cuff 4 6 NBP Air hose

9 PREPARE CNAP MONITOR FOR MEASUREMENT CONNECTIONS 1 Connect the controller cable to the orange connector of the CNAP Controller. 3 Connect NBP air hose to NBP Cuff 4 2 Connect finger sensor to black connection of CNAP Controller.! ATTENTION Plug in straight, not tilted! Connect the NBP air hose and the CNAP Controller cable to the CNAP Monitor. SET UP 9

SET UP 10 CONNECTING TO A PATIENT MONITOR Interface

connect it to the arterial port of your patient

2 Transducer Cable Select right color from list in

10 SET UP 10 CONNECTING TO A PATIENT MONITOR Interface cable 1 Prepare patient monitor Interface Cable and connect it to the arterial port of your patient monitor. 2 Transducer Cable Select right color from list in user manual (Chapter 4-5-2) and connect it to the BP wave out port on the CNAP Monitor. 3 connect to Connect Transducer cable and patient monitor interface cable.! ATTENTION Zeroing neccessary! (see next page) BP Wave Out port

ZEROING OF CNAP AND PATIENT MONITOR 1 Go to parameter frame on CNAP

transducer on patient monitor *click* *click* Zeroing of patient monitor

CNAP Zeroing is automatically active when the CNAP Monitor is on and

11 ZEROING OF CNAP AND PATIENT MONITOR 1 Go to parameter frame on CNAP Monitor: *click* 2 Select IBP: Zeroing Start - *click* then zero transducer on patient monitor *click* *click* Zeroing of patient monitor *click* 3 Stop Zeroing on CNAP : Select IBP: Zeroing Stop - *click* TIP CNAP Zeroing is automatically active when the CNAP Monitor is on and connected to the patient monitor but no measurement has been started so far. SET UP 11

12 SET UP 12 OVERVIEW: PATIENT SET UP Connections NBP Cuff CNAP Controller CNAP Finger sensor

the sensor size indicated on the shortest bar which is still visible.

13 STEP 1. CHOOSE CORRECT CNAP FINGER SENSOR SIZE AVAILABLE SIZES: small, medium or large 1 B2 Choose the sensor size indicated on the shortest bar which is still visible. Put proximal phalanx of index finger on indicator of CNAP Controller align with the grey line on the left. 2! ATTENTION Always choose the larger sensor if you are in doubt about the size! SET UP 13

SET UP 14 STEP 2. PLACE CNAP FINGER SENSOR AND CNAP CONTROLLER! ATTENTION 1 Slide the finger sensor over two neighbouring fingers, make sure that it is not placed on the finger joints!

14 SET UP 14 STEP 2. PLACE CNAP FINGER SENSOR AND CNAP CONTROLLER! ATTENTION 1 Slide the finger sensor over two neighbouring fingers, make sure that it is not placed on the finger joints! 2 slide back fully! Make sure that the CNAP Controller is placed in central position of the slide and fix the strap. NOTE 12 hours before lifetime expiration of the finger sensor a message appears. It automatically disappears and does not affect measurements. Please make sure to contact your local distributor in time for a new sensor. See also: Operators Manual chapter 16.1

from 4 different sizes by using the size

See also: Operators Manual chapters 3.2.

15 STEP 3. PLACE NBP CUFF 1 Choose the right NBP cuff from 4 different sizes by using the size indicator on the inside of the cuff. See also: Operators Manual chapters and Fasten NBP cuff on the upper arm (ipsilaterally or contralaterally to arm with fingersensor). Align marker (white arrow) with the brachial artery in the crook of the arm. 3 SET UP 15

MEASUREMENT 16 SELECT MEASUREMENT MODE / START MEASUREMENT 1 2 Once the patient set up is completed, select the measurement mode in the pop-up menu from three options: > BP only > BP + PPV > BP + HD

16 MEASUREMENT 16 SELECT MEASUREMENT MODE / START MEASUREMENT 1 2 Once the patient set up is completed, select the measurement mode in the pop-up menu from three options: > BP only > BP + PPV > BP + HD (full hemodynamics) Confirm by clicking the wheel. *click* 3 To start the measurement, select Start New Measurement and confirm with the click wheel. NOTE BP + PPV and BP + HD must be enabled to be selectable. Contact your distributor for a licence key if you cannot select these options.

17 STARTED MEASUREMENT 1 Once measurement has started, finger sensor checks perfusion index (PI): TIP no signal good perfusion If perfusion is poor (=red), try pushing the finger sensor to the back of the finger, warming the hand (use exam glove or towel), changing finger sensor size, or changing hands. 2 At the same time menu window opens for choosing patient category and for entering biometric data (see next page). Calibration to NBP reference value also takes place.! ATTENTION Keep patient still, do not move hand! No changes in body posture! MEASUREMENT 17

MEASUREMENT 18 CHOOSE PATIENT CATEGORY AND ENTER BIOMETRIC DATA 1 2 3 Choose patient category (Adult or Pediatric) in the pop-up menu and enter biometric patient data (for full hemodynamics).

18 MEASUREMENT 18 CHOOSE PATIENT CATEGORY AND ENTER BIOMETRIC DATA Choose patient category (Adult or Pediatric) in the pop-up menu and enter biometric patient data (for full hemodynamics). NOTE This is important as alarm ranges and NBP inflation pressure are different! Confirm with ok by clicking the wheel. Calculation of hemodynamic parameters starts; display after a few seconds. *click* Before starting any! ATTENTION interventions, make sure that the calibration has been completed: numerical values should not have gray background anymore! *click*

19 STOP / RESUME MEASUREMENT 1 Press the Start/Stop Button to STOP measurement (e.g. when finished or to readjust set-up).! ATTENTION Do not remove the CNAP finger sensor when measurement is still in progress! STOP MEASUREMENT FIRST! 2 RESUME a measurement with the Start/Stop Button (e.g. after readjusting set-up, patient transfer, etc.) Patient data remain displayed! MEASUREMENT 19

20 NAVIGATION 20 NAVIGATION FRAMES The monitor has a clickwheel and 5 different frames on the screen to access all menus / functions. Alarm frame Signal & Trend frame *turn* Signal and Trend View selector frame *click* clickwheel Parameter frame (= default) Hemodynamic frame

21 FUNCTION OF NAVIGATION FRAMES Parameter frame Signal & Trend frame Alarm & Status frame This is the default frame! > manual NBP triggering > manual finger change > finger change interval setting > alarm settings > zeroing of IBP port > NBP measurement type > intervention setting > change of trend view (graphic numeric) > scaling of trend curve > selection of trending parameters (up to 2 additional) > change of time range > display of alarm and status messages > direct access to alarm settings as long as alarm message is visible > display of battery status, date, next finger change, next NBP measurement NAVIGATION 21

NAVIGATION 22 FUNCTION OF NAVIGATION FRAMES Signal & Trend View Selector Hemodynamic frame > switch between signal view and parameter trends > activating/ deactivating HD > manual entry or change of

22 NAVIGATION 22 FUNCTION OF NAVIGATION FRAMES Signal & Trend View Selector Hemodynamic frame > switch between signal view and parameter trends > activating/ deactivating HD > manual entry or change of patient data > discharging of patient (data of current measurement are deleted for measurement with new patient) > changes between absolute and indexed values > manual entry of external CO value for calibration > selection Fluid Parameter PPV or SVV > manual entry of CVP

23 FAST ACCESS KEYS and STATUS INDICATORS MAIN KEYS FOR FAST ACCESS MAIN SCREEN: return to main screen from any submenu POWER ON / OFF: hold for 2 seconds to power on/off. power on indicator: > green: switched on > orange: system error SETUP: access to configuration menu FUNCTIONS 23

FUNCTIONS 24 MAIN KEYS FOR FAST ACCESS ALARM PAUSE/ OFF: alarm functions control: > Press once: alarm acknowledgement > Press twice: set alarm to pause / off > Press three times: re-activate alarm

24 FUNCTIONS 24 MAIN KEYS FOR FAST ACCESS ALARM PAUSE/ OFF: alarm functions control: > Press once: alarm acknowledgement > Press twice: set alarm to pause / off > Press three times: re-activate alarm function PRINTING START/ STOP: > press once: print blood pressure curve > press and hold for one second: print trend view START/ STOP: > stop and resume measurement Battery charge status: > green = ok > orange = less than 25% > red = less than15 minutes left!

Measurement Settings > NBP Mode: select calibration mode (see next page) > NBP Interval > CNAP Calibr.

25 1. Monitor Settings THE SET UP KEY > Change Language / Time / Date > En-/ disable device features: PPV, HD, Record, Analog Out, enter licence keys, etc. > Recording on/off (if activated) > Switch between Metric / US customary units > Access PPU measurement statistics 3. Service Settings For service purposes only! 2. Measurement Settings > NBP Mode: select calibration mode (see next page) > NBP Interval > CNAP Calibr. Interval > Hemodynamic (on/off, change settings) > Display Options: Interventions, Views, Scales,etc. > Trend Parameters: select parameters to be displayed in the trend view > Print options > Parameter averaging > Patient category FUNCTIONS 25

26 FUNCTIONS 26 CALIBRATION MODES Function AUTOMATIC NBP CALIBRATION: INTERNAL (= DEFAULT) Calibration to automatic NBP measurements triggered by the integrated NBP module in adjustable intervals between 5-60 minutes. Can be stopped any time by pressing Start/Stop Button. Benefit This is the default mode delivering absolute values automatically as long as no other blood pressure reference value (NBP or IBP) is entered manually (see also: external calibration mode). Function Function Calibration to a manually entered NBP, IBP or height offset reference value from external devices. Automatic calibration to a heart level value based on an emipric database for bridging the short time until CNAP is calibrated to a measured or externally entered NBP value. MANUAL BP CALIBRATION: EXTERNAL Benefit TRENDING MODE: EMPIRIC CALIBATION Benefit CNAP can be operated without internal NBP measurement calibrating to a manually entered value for absolute BP information. Useful for special applications. Blood pressure curve is displayed only 10 secs after start-up for a quick trending prior to calibration to the directly measured reference value.

27 TRIGGERING A MANUAL NBP NOTE Triggering a manual NBP is possible at ANY TIME in any mode! 1 Go to parameter frame: 2 Choose NBP: Start - *click* *click* *click* FUNCTIONS 27

28 FUNCTIONS 28 WHEN IS IT RECOMMENDED TO TRIGGER A MANUAL NBP? 1. Upon hand movement or patient repositioning Trigger a manual NBP after moving or repositioning the patient or the patient s hand or whenever hydrostratic change/ offset happens.! ATTENTION 2. In situations that quickly require updated calibration After an intervention or whenever you feel that an update to the NBP reading may be beneficial.

29 CHANGE FINGER MANUALLY NOTE Switching a measurement to the other finger is possible at ANY TIME except during a NBP measurement! 1 Go to parameter frame: 2 Choose CNAP: Change Finger - *click* *click* TIP FAST ACCESS: Parameter frame is the default frame. If not changed, just click wheel 2 times to change finger! *click* FUNCTIONS 29

30 FAQs 30 FREQUENTLY ASKED QUESTIONS FAQs: 1. How can I change alarm settings for current measurement? How can I change alarm settings permanently? Enabling hemodynamic parameters for a measurement? How can I improve measurement quality? How can I adjust trend, signal and time settings? The battery? Service intervals for the CNAP Monitor? What to do if CNAP needs service? SERVICE HOTLINE? Where can I get additional information? How can I contact CNSystems directly?...41

limits and turn values to Off or change limits TIP *click* Whenever a physiological

31 1. HOW TO CHANGE ALARM SETTINGS: CURRENT MEASUREMENT ALARMS OFF/ON AND CHANGE LIMITS 1 Go to parameter frame with click-wheel and *click* *click* 2 Select Adult alarm limits and turn values to Off or change limits TIP *click* Whenever a physiological alarm is active, the settings can be directly changed by clicking on the alarm frame. FAQs 31

32 2. HOW TO CHANGE ALARM SETTINGS: PERMANENTLY ALARMS OFF/ON AND CHANGE LIMITS FAQs 32 1 Press Setup key. 2 Change the alarm default settings in the submenu Service Alarm Defaults (Password: 8737)

! NOTE TIP ATTENTION *click* Hemodynamic parameters visible now!

33 3. ENABLING HEMODYNAMIC PARAMETERS FOR A MEASUREMENT 1 If HD is not enabled, hemodynamic frame shows question marks: select with click-wheel - *click* 2 Choose Measurement Mode: BP+HD and confirm with ok. If BP + HD is active, BP + PPV is automatically enabled.! NOTE TIP ATTENTION *click* Hemodynamic parameters visible now! Hemodynamic parameters can also be set permanently in Set Up Measurement Hemodynamic If it is not possible to enable the Hemodynamic parameters, please request a license key from CNSystems or your distributor. See also: Operators Manual chapters 4.4 and 12.2 FAQs 33

34 FAQs HOW TO IMPROVE MEASUREMENT QUALITY RED: no signal can be detected Reasons / limitations: > poor peripheral perfusion (shock, severe Raynaud s, hypothermia, vasoconstriction) > edema TIP for improving signal quality: > Check position of CNAP finger sensor: Do not place on finger joints! > Check if CNAP finger sensor size is correct > Warm up fingers to improve blood flow (use disposable exam glove or towel) > Try to measure on the other hand GREEN: measurement starts automatically. See also: Operators Manual chapter 3.7 no signal good perfusion

5. HOW TO ADJUST TREND SETTINGS, SIGNAL AND TIME SCALES 1 Go to Signal & Trend frame with click-wheel and *click*

2 Trend Menu: Trend adjustments TREND PARAMETERS > Parameter 1+2: You can choose up to 2 additional parameters

> Adjust MEAN and AMPLITUDE NOTE of BP and Pulse in case trends are not visible within scale range.

35 5. HOW TO ADJUST TREND SETTINGS, SIGNAL AND TIME SCALES 1 Go to Signal & Trend frame with click-wheel and *click* *click* TREND DISPLAY For switching > graphical, > numerical, > alarm history, > Intervention views. 2 Trend Menu: Trend adjustments TREND PARAMETERS > Parameter 1+2: You can choose up to 2 additional parameters shown in Trend view (SVV, PPV, CO, SV, SVR). > Adjust MEAN and AMPLITUDE NOTE of BP and Pulse in case trends are not visible within scale range. NOTE TIME SCALE / TIME SHIFT > Adjust displayed time range according to your needs. > Trend navigation in time back and forth with arrows. Switching parameters here also causes changes in the Hemodynamic frame! FAQs 35

FAQs 36 6. THE BATTERY HOW LONG CAN I MEASURE RUNNING ON BATTERY POWER? up to 120 minutes Battery charge status is indicated with Battery-status-LED.

36 FAQs THE BATTERY HOW LONG CAN I MEASURE RUNNING ON BATTERY POWER? up to 120 minutes Battery charge status is indicated with Battery-status-LED. Battery charge status is also shown in right edge of alarm & status frame in steps of 25%. HOW CAN I IMPROVE THE LIFECYCLE OF THE BATTERY? green = ok orange = 25% left red = 15 minutes left!! ATTENTION Never completely discharge the battery! Immediately connect to power supply if battery charge status is below 25%! Send device to CNSystems for maintenance every 24 months. See also: Operators Manual chapter 3.3.2

37 7. CNAP MONITOR SERVICE INTERVALS WHAT ARE THE DEFINED SERVICE INTERVALS? EVERY 12 months SAFETY CONTROL: is usually done according to medical directives. Please contact your biomedical department. See Service Manual for Users for more details. EVERY 24 months CALIBRATION/ METROLOGICAL CONTROL: must be done by CNSystems or an authorized service partner. MAINTENANCE: must be done by CNSystems or an authorized service partner. See also: Operators Manual chapter 17.4 FAQs 37

38 FAQs WHAT TO DO IF CNAP MONITOR NEEDS SERVICE! ATTENTION Metrological control or repair work must be performed by CNSystems or an authorized service partner! 1 For all service requests let us know serial number and software version (displayed on start-up screen). 2 Contact CNSystems via Website: support/service-order service@cnsystems.com Online service order QR-Code:

9. SERVICE HOTLINE SERVICE HOTLINE: +43 316 723456 33 Service hotline QR-Code: NOTE Service

39 9. SERVICE HOTLINE SERVICE HOTLINE: Service hotline QR-Code: NOTE Service work is usually finished within five working days. Express-Service is possible on request! FAQs 39

40 FAQs WHERE TO GET ADDITIONAL INFORMATION CNSYSTEMS INFO LIBRARY CNAP Monitor - Operators Manual - Comes in hard copy with every CNAP Monitor - Available as PDF-file by CNSystems Website - Applications - Downloads Website - Newsletter - Regular news about our products - Register online: Website - Description of the technology - Still didn t find what you are looking for? Contact us directly! support/contact office@cnsystems.com

11. HOW TO CONTACT CNSystems DIRECTLY i GENERAL REQUESTS Contact form: http://www.

41 11. HOW TO CONTACT CNSystems DIRECTLY i GENERAL REQUESTS Contact form: office@cnsystems.com Phone: Fax: REGISTER FOR OUR NEWSLETTER Online: news-events/newsletter feedback@cnsystems.com Newsletter registration FAQs 41

42 42

43 CNAP Monitor 500 HD Quickguide CNSystems Medizintechnik AG, 2016 Version: 07/2016, V1.5.5 EN 43

44 Backcover: Currently using your CNAP Monitor for blood pressure monitoring only? Upgrade to the full set of hemodynamic parameters: BP I PR I CO I SV I SVR I PPV I SVV with Software Upgrade V5.2: Full hemodynamics available after 90 secs upon startup Noninvasive HD for all low & intermediate risk surgeries as an addition to arterial line Perfect match with all other monitoring equipment Improved accuracy through calibration to manual CVP & CO/CI

according to the European standard for medical devices 93/42/EWG, annex IX as amended by 2007/47/EC

The CNAP Monitor 500 meets the requirements of -mark 0408 according to the European standard for medical devices 93/42/EWG, annex IX as amended by 2007/47/EC The product starting with the serial number