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Cardiacoutput

274CARESCAPEModularMonitors2062971-001

Table of Contents

1 About this manual39
- Intended use of this manual39
  - Intended markets of this manual39
- Intended audience of this manual39
- Training requirements39
- Manual conventions39
  - Monitor naming conventions40
  - Acquisition module naming conventions40
- Illustrations and names41
- Related documents41
- Ordering manuals41
- Trademarks42
  - Third party trademarks42
- Manufacturer responsibility42
2 Safety43
- Safety message signal words43
- System safety43
- System warning safety messages43
- System caution safety messages46
- Notice safety messages47
- Safety symbols47
- Indications for use48
- Indications for use safety precautions50
  - Indications for use warnings50
  - Indications for use cautions50
- Training requirements50
- Electromagnetic compatibility51
3 System introduction53
- Monitor and module compatibility limitations53
- System safety precautions53
  - System warnings53
  - System caution54
- B850 system components55
  - B850 processing unit front view56
  - B850 processing unit back view56
  - B850 module frames F7 and F557
  - B850 Tram-Rac frames 2A and 4A58
- B650 system components58
  - B650 monitor front panel59
  - B650 monitor side views60
  - B650 monitor back panel60
  - B650 pivoting module frame61
- B450 system components62
  - B450 monitor front panel64
  - B450 monitor side views64
  - B450 monitor back panel65
- Monitor battery65
  - Inserting and removing the B650 monitor battery66
  - Inserting and removing the B450 monitor battery67
  - Checking the battery charge with monitor software67
  - Monitor battery charge symbols on screen68
  - Battery test button68
- Alarm light69
- Displays69
- Acquisition modules70
  - PSMP front view70
  - PDM front view71
  - TRAM module front view72
  - Single-parameter Tram-Rac front view72
  - Modules and parameters73
- Barcode reader77
- Keyboard77
- Mouse77
- Remote control and keypad78
- Recorders and laser printers78
- About the Unity Network Interface Device (ID)78
- CIC Pro Clinical Information Center79
- CARESCAPE Central Station79
- iCentral80
- Remote alarm box (nurse call)80
- iPanel software application81
- Equipment symbols81
- User interface symbols89
4 Monitoring basics93
- Module compatibility limitations93
- Identical modules93
- Connecting and removing modules: B85094
- Connecting and removing modules: B65096
- Connecting and removing modules: B45097
- Main keys98
- Main screen layout101
  - An example of a menu102
- Menu options102
- Data field entries103
  - Entering data with the on-screen keyboard103
  - Entering data with a keyboard103
- Putting the monitor into operation104
  - Operation warnings104
  - Operation caution104
- Monitor installation points to note104
- Turning on the monitor105
- Performance check105
- Message about PDM service105
- Pre-monitoring checklist105
- Supply mains interruption106
- Power failure alarm106
5 Setting up the monitor before use107
- Normal screen and other pages107
  - Selecting the normal screen (main page)107
  - Selecting pages107
- Adjusting sound volumes108
- Brightness settings108
- Screen setup modifications109
- Setting up printing options112
- Checking the PDM battery status113
- Checking the monitor battery status113
- Setting the touchscreen off113
- B850 with several screens113
- Other setup changes113
6 Starting and ending monitoring115
- Monitor and module compatibility115
- Software packages and terminology115
- About the user default settings115
- Invasive pressure labels and PDM or TRAM115
- Starting monitoring116
- About the combination monitoring mode117
- Entering patient data118
  - Entering patient data with the monitor118
  - Entering patient data with a barcode reader119
- About the roving functionality119
- Entering administrative information121
- Loading patient information from the CARESCAPE Network (ADT serv121
- Loading patient data and trend data from the S/5 Network121
- About standby122
  - Starting standby122
  - End of standby123
- About continuing monitoring123
  - How to continue monitoring when a case is not active/patient is123
  - How to continue monitoring when a case is active/patient is admi124
- About case reset/patient discharge125
7 Alarms127
- Alarm warnings127
- Alarm cautions129
- Alarm overview129
  - Alarm types129
  - Alarm conditions129
  - Alarm priority levels130
  - Alarm priority escalation130
  - Physiological alarms’ activation criteria130
  - Broadcast only alarms131
  - Checking alarm function133
- Alarm indications133
  - Alarm icons on the screen133
  - Description of alarm and information messages134
  - Setting the alarm light brightness135
  - Audible alarm signals135
  - Audible and visual alarm signals136
  - Auditory information signals136
  - Audible alarms off behavior136
- Pause audio behaviors137
  - Pausing alarms for 5 minutes138
  - Activating all audible alarms138
- Technical alarms’ deactivation with the pause audio key139
- Apnea alarms’ deactivation with the pause audio key139
- Pause audio with combination monitoring139
- Breakthrough alarms139
- Latched alarms140
- Setting parameter alarm limits140
  - Alarm locks140
  - Alarm guard limits140
- Setting arrhythmia alarms141
- Selecting parameter alarm priority levels141
- Setting alarm limits automatically142
  - Default auto alarm limits143
- Returning the default alarm limits143
- Turning off all local alarm indicators (sleep mode)144
- Remote management of alarms144
- Alarm settings after a power loss144
- Alarm data stored in Clinical logs145
- Stored alarm data during a power cycle or power loss145
8 ECG147
- ECG compatibility limitations147
- ECG safety precautions147
  - ECG warnings147
  - ECG cautions149
- ECG measurement limitations149
- ECG points to note149
- ECG measurement setup150
- About the ECG analog output signal154
- About the combination monitoring mode155
  - Selecting the ECG source156
- Using the ECG measurement156
- ECG measurement practicalities165
- ECG troubleshooting166
- 12 lead analysis166
- Pacemaker detection172
- Arrhythmia monitoring175
- ST detection182
9 Impedance respiration191
- Impedance respiration compatibility limitations191
- Respiration safety precautions191
  - Respiration warnings191
  - Respiration cautions192
- Respiration measurement limitations192
- Respiration points to note192
- Respiration measurement setup193
- Respiration measurement on the monitor screen196
- Using the respiration measurement196
- Respiration measurement description199
  - Respiration measurement with PSM199
  - Respiration measurement with PDM and TRAM199
- How to interpret the respiration values199
- Respiration troubleshooting199
10 Pulse oximetry201
- SpO2 compatibility limitations201
- SpO₂ safety precautions201
  - SpO2 warnings201
  - SpO2 cautions204
- SpO2 measurement limitations204
- SpO2 points to note204
- SpO₂ measurement guidelines205
- SpO₂ measurement setup207
- Using the SpO₂ measurement208
- How to interpret the SpO₂ values214
- SpO2 wavelengths and optical output power215
- SpO2 measurement and interference215
- SpO2 troubleshooting216
11 Non-invasive blood pressure219
- NIBP compatibility limitations219
- NIBP safety precautions219
  - NIBP warnings219
  - NIBP cautions220
- NIBP measurement limitations221
- NIBP points to note221
- NIBP measurement setup222
- NIBP measurement on screen223
- Manual NIBP measurements223
- Automatic NIBP measurements224
- NIBP cuffs226
- NIBP volume and display settings227
  - Adjusting the NIBP measurement completion tone volume227
  - Setting the NIBP display format228
- NIBP alarms228
- NIBP measurement description228
- NIBP calibration232
- NIBP troubleshooting233
12 Invasive pressures235
- Invasive pressures compatibility limitations235
- Invasive pressure safety precautions235
  - Invasive pressure warnings235
- Invasive pressure measurement limitations235
- Invasive pressure points to note235
- Invasive pressure measurement setup236
- Using the invasive pressure measurement238
- Setting an arterial invasive pressure disconnection alarm244
- Setting invasive pressure alarm limits244
- Invasive pressures alarm priorities245
- Systolic pressure variation and pulse pressure variation245
  - Changing the SPV source245
  - Measuring SPV manually245
- PA catheter insertion246
  - Selecting the PA catheter insertion mode246
- Pulmonary capillary wedge pressure (PCWP) measurement246
- Calibrating the invasive pressure measurement with PDM and TRAM248
- Invasive pressure calibration with E-modules249
- Invasive pressure practicalities249
  - Invasive pressure parameters249
  - Intra-aortic balloon pump249
- Invasive pressure troubleshooting252
13 Temperature255
- Temperature compatibility limitations255
- Temperature safety precautions255
  - Temperature warnings255
- Temperature measurement limitations255
- Temperature points to note255
- Temperature measurement setup256
- Temperature measurement on the monitor screen257
- Using the temperature measurement257
- Temperature practicalities259
- Temperature troubleshooting259
14 Cardiac output261
- C.O. safety precautions261
  - C.O. warnings261
  - C.O./CCO cautions261
- C.O. measurement limitations261
- C.O. points to note261
- C.O. measurement setup262
- Using the C.O. measurement264
- C.O. practicalities269
  - Cardiac output washout curve269
  - How to improve the C.O. accuracy269
- C.O. troubleshooting270
15 Mixed venous oxygen saturation (SvO₂)275
- SvO2 compatibility limitations275
- SvO₂ safety precautions275
  - SvO2 warnings275
- SvO2 measurement limitations275
- SvO2 points to note276
- SvO₂ measurement setup276
- Using the SvO₂ measurement277
- SvO2 measurement description279
- SvO2 troubleshooting279
16 Airway gases281
- Airway gases compatibility limitations281
- Airway gases safety precautions281
  - Airway gases warnings281
  - Airway gases cautions283
- Airway gases measurement limitations283
- Airway gases points to note283
- Airway gases measurement setup284
  - Airway gases equipment to patient connections with CARESCAPE res284
  - Airway gases equipment to patient connections with compact airwa285
  - Airway gases equipment to patient connections with compact airwa285
  - Airway gases equipment to patient connections with E-miniC, crit286
  - Airway gases measurement setup286
  - CARESCAPE respiratory module connectors287
  - Compact airway module connectors287
  - E-miniC module connectors288
  - E-miniC indications for use288
  - Airway gases alternative patient connections288
  - Checking the airway gases measurement289
  - Airway gases parameters290
- Using the E-modules for CO₂ measurement292
  - Available menu selections292
  - Selecting the CO2 scale292
  - Selecting the CO2 sweep speed292
  - Setting CO2 limit alarms292
  - Deactivating the apnea alarm292
  - Apnea alarms’ deactivation with the pause audio key293
  - Selecting what to show with EtCO2293
  - Selecting the FiO2 level293
  - Selecting the N2O level293
- Using the CARESCAPE respiratory modules and compact airway modul294
  - Selecting the O2 scale294
  - Selecting the O2 sweep speed294
  - Setting O2 alarms294
- Using the CARESCAPE respiratory modules and compact airway modul294
  - Selecting the agent scale294
  - Selecting the agent sweep speed294
  - Setting agent limit alarms295
- Gases alarm priorities295
- Preventing operating room pollution295
  - Scavenging through the ventilator reservoir295
  - Scavenging through the anesthesia gas scavenging system295
  - Connecting directly to the scavenging system295
- Stopping the airway gases measurement296
- Calibrating airway gases296
- Basics of airway gases measurement297
  - Airway gases measurement description, CARESCAPE respiratory modu297
  - Airway gases measurement description, E-miniC297
  - Sidestream gas sampling298
- Minimum Alveolar Concentration (MAC)298
  - MAC and MACage298
  - References used for MAC and MACage values299
  - MAC values of different anesthetics in oxygen299
  - MAC values of different anesthetics in 65% N2O300
- ET balance gas, CARESCAPE respiratory modules and compact airway300
- Automatic agent identification with E-sCAiO, E-sCAiOV, E-CAiO, E301
- Basics of CO₂ measurement301
  - Normal CO2 waveform301
  - The origin of the CO2 waveform301
  - Dips in capnogram302
- Oxygen measurement interpretation, CARESCAPE respiratory modules303
- Airway gases practicalities303
  - Ventilation management303
  - Prevention of the breathing system contamination304
  - How to prevent effects of humidity304
  - Oxygen delivery, CARESCAPE respiratory modules and compact airwa304
  - Level of anesthesia: E-sCAiO, E-sCAiOV, E-CAiO, E-CAiOV, E-CAiOV305
- Airway gases troubleshooting305
17 CO2 with CAPNOSTAT Mainstream, CapnoFlex LF, and Dual CO2 mod307
- CO2 compatibility limitations307
- CO₂ safety precautions307
  - CO2 warnings307
  - CO2 cautions309
- CO2 points to note309
- CO₂ measurement setup309
- Using the CO₂ measurement315
- Preventing operating room pollution with CAPNOSTAT Mainstream, D317
  - Scavenging to scavenging systems317
- Stopping the CO2 measurement317
- Basics of CO₂ measurement317
- CO₂ measurement practicalities319
- CO2 troubleshooting320
18 Patient Spirometry323
- Patient Spirometry compatibility323
- Patient Spirometry safety precautions323
  - Patient Spirometry warnings323
  - Patient Spirometry cautions323
- Patient Spirometry limitations323
- Patient Spirometry points to note324
- Patient Spirometry measurement setup324
- Using the Patient Spirometry measurement325
- Patient Spirometry measurement basics328
- Patient Spirometry practicalities336
- Patient Spirometry troubleshooting337
19 Gas exchange339
- Gas exchange compatibility limitations339
- Gas exchange safety precautions339
  - Gas exchange warnings339
  - Gas exchange cautions340
- Gas exchange measurement limitations340
- Gas exchange points to note340
- Gas exchange measurement setup341
  - Gas exchange equipment to patient connection341
  - Checking the gas exchange measurement342
- Using the gas exchange measurement342
- Gas exchange measurement basics343
  - Gas exchange measurement description343
  - How to interpret the gas exchange values343
- Gas exchange practicalities346
- Gas exchange troubleshooting347
20 Entropy349
- Entropy compatibility349
- Entropy safety precautions349
  - Entropy warnings349
  - Entropy cautions350
- Entropy indications for use350
- Entropy measurement limitations350
- Entropy points to note351
- Entropy measurement setup351
- Using the Entropy measurement353
- Entropy measurement basics355
- Entropy practicalities357
- Entropy troubleshooting358
- Entropy reference studies359
21 Neuromuscular transmission361
- NMT compatibility361
- NMT safety precautions361
  - NMT warnings361
  - NMT cautions362
- NMT measurement limitations362
- NMT points to note362
- Checking the NMT measurement362
- NMT measurement setup363
- NMT graphical trends on the monitor screen365
- Using the NMT measurement365
- NMT alternative uses367
  - Local nerve and plexus localization367
- NMT measurement basics368
  - NMT measurement description368
  - How to interpret the NMT values369
- NMT practicalities370
- NMT troubleshooting370
22 EEG and auditory evoked potentials373
- EEG compatibility373
- EEG safety precautions373
  - EEG warnings373
  - EEG cautions373
- EEG indications for use374
- EEG measurement limitations374
- EEG points to note374
- EEG measurement setup375
- EEG measurement on the monitor screen378
- Using the EEG measurement379
- EEG practicalities382
- EEG troubleshooting386
- Measuring auditory evoked potentials (AEP)387
  - Preparing the patient for AEP measurement387
  - AEP montage388
- Using the AEP measurement388
- AEP practicalities391
- AEP troubleshooting392
23 Bispectral index393
- BIS compatibility393
- BIS safety precautions393
  - BIS warnings393
  - BIS cautions394
- BIS indications for use395
- BIS measurement limitations395
- BIS points to note395
- BIS measurement setup396
- BIS measurement on the monitor screen397
- Using the BIS measurement397
- How to interpret the BIS values399
- BIS troubleshooting399
24 Laboratory data401
- About laboratory values401
25 Calculations405
- About calculations405
- Viewing calculation values405
- Source data for calculations405
  - Selecting source data for oxygenation calculations406
  - Selecting source data for ventilation calculations406
- Estimated values in oxygenation calculations406
- Estimated values in hemodynamic calculations406
  - Selecting the PCWP source407
- Indexing parameters for hemodynamic and oxygenation calculations407
- Editing calculation input values407
- Saving calculation values408
- Viewing saved calculations408
- Printing hemodynamic, oxygenation, or ventilation calculations408
- Printing all calculation trends409
26 Drug calculations411
- About drug calculations411
- Calculations menu description412
- Drug calculator413
- Titration table414
  - Calculating drug titrations414
  - Printing the titration table414
- Resuscitation medications415
  - Calculating resuscitation medication doses415
  - Printing resuscitation medication doses415
27 Trends417
- Monitor and module compatibility417
- Trend views417
- Graphic trends417
- Numeric trends419
- Invasive pressure trends420
- Heart rate (HR) trends420
- Gas consumption421
  - Viewing gas consumption data421
  - Printing gas consumption data421
- Minitrend split screen421
- Time change during a patient case423
28 Snapshots and events425
- Description of snapshots425
  - Snapshot configuration425
- Manually created snapshots425
- Creating automatic snapshots425
- Viewing snapshots426
- Changing the snapshot time scale426
- Changing snapshot trend scales427
- Printing snapshot pages427
  - Selecting snapshots to print automatically427
  - Selecting spirometry loops to print with snapshots427
- Erasing snapshots and trends427
- Snapshots and alarm history428
- Snapshot transfer to PDM428
- ST snapshots428
- Events429
29 Printing433
- Printing options433
- Laser printers433
- Recorders434
  - PRN 50–M recorder (B850 only)434
  - XE-50 recorder (B650 and B450 only)435
- Printing device selections435
  - Changing printer435
  - Checking the print status436
- Printing waveforms436
- Printing trends439
- Printing reports439
- Printing calculations440
  - Printing Hemo, Oxy, or Vent calculations440
  - Printing Hemo, Oxy, or Vent calculation trends441
- Printing drug calculations441
  - Printing drug calculator441
  - Printing titration table441
- Printing laboratory data and parameter printouts441
  - Printing laboratory data441
  - Parameter printouts441
- Print header information442
  - Laser printer print header442
  - Recorder print header442
30 Viewing other monitored patients443
- About viewing other monitored patients443
- Automatic view of remote beds in alarm444
- Next alarming remote bed to screen445
- Viewing remote patient beds445
- Audio pause for a remote patient bed alarms446
- Manual printing of remote bed waveforms446
31 Interfacing with peripheral devices447
- Interfacing safety precautions447
  - Interfacing warnings447
  - Interfacing cautions447
- Compatible peripheral devices448
- Unity Network Interface Device (ID)448
32 Cleaning and care453
- Cleaning and care safety precautions453
  - Cleaning and care warnings453
  - Cleaning and care cautions454
- Disposal safety precautions454
  - Disposal warnings454
  - Disposal cautions454
- Cleaning and care schedules454
- Regular calibration checks455
- Cleaning and care points to note456
- Permitted detergents456
- Permitted disinfectants456
- Cleaning and care instructions456
- How to store PDM and PSM458
- Monitor battery care459
  - Replacing the monitor battery459
  - Battery recycling459
- PDM battery care459
- About the internal lithium battery460
33 Messages463
- Messages related to ECG measurement463
- Messages related to impedance respiration measurement468
- Messages related to SpO2 measurement469
- Messages related to NIBP measurement472
- Messages related to invasive pressures measurement475
- Messages related to temperature measurement481
- Messages related to cardiac output measurement482
- Messages related to SvO2 measurement485
- Messages related to gases measurement488
- Messages related to spirometry measurement493
- Messages related to gas exchange measurement495
- Messages related to Entropy measurement496
- Messages related to NMT measurement498
- Messages related to EEG and AEP measurements500
- Messages related to BIS measurement501
- Messages related to TC measurement503
- Messages related to trends, snapshots, and laboratory data504
- Messages related to various situations505
34 Abbreviations513
- List of abbreviations513
A Skills checklist529
- System introduction529
- Starting and ending530
- Monitoring basics530
- Alarms531
- Trends532
- Snapshots and events532
- ECG533
- Impedance respiration534
- Pulse oximetry (SpO2)535
- Non-invasive blood pressure536
- Invasive pressures537
- Temperature538
- Cardiac output538
- Mixed venous oxygen saturation (SvO2)539
- Airway gases539
- CO2 with CAPNOSTAT Mainstream, CapnoFlex LF, and Dual CO2 module540
- Patient Spirometry541
- Gas exchange541
- Entropy542
- Neuromuscular transmission543
- EEG and AEP543
- BIS544

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