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14 Monitoring Carbon Dioxide

254

Table of Contents

Introduction13
- Safety Information14
  - Electrical Hazards and Interference14
  - Use Environment14
  - Alarms15
  - Accessories15
- Security Information15
  - Protecting Personal Information15
  - About HIPAA Rules16
  - About the EU Directives16
  - Philips Product Security Policy Statement16
  - Manufacturer Disclosure Statement for Medical Device Security – MDS216
- Introducing the Monitor16
  - Major Parts and Keys17
- Devices for Acquiring Measurements18
  - Flexible Module Rack (M8048A)19
  - 4-Slot Flexible Module Rack (FMS-4)19
  - Measurement Modules20
    - Example Module (SpO2)21
  - X1 Multi-Measurement Module (M3001A)21
    - X1 Connectors and Symbols22
  - X2 Multi-Measurement Module (M3002A)22
  - MMS Extensions25
    - M3014A, M3015A, M3015B and M3016A Capnography MMS Extensions25
    - M3012A Hemodynamic MMS Extension27
  - Using MMSs in a Mixed Software Environment27
- Operating and Navigating27
  - Selecting Screen Elements30
  - Using the Touchscreen30
  - Disabling Touchscreen Operation30
  - Using a Mouse or Trackball30
  - Moving Windows30
  - Using Keys30
  - Using the Remote Control34
    - Using the SmartKeys Key35
  - Using the On-Screen Keyboard35
  - Using the On-Screen Calculator35
- Operating Modes36
  - Standby Mode36
- Understanding Screens37
  - Switching to a Different Screen37
  - Changing a Screen's Content37
- Connecting Additional Displays to the Monitor38
  - Independent Displays38
- Using the XDS Remote Display39
- Using the Visitor Screen39
- Understanding Profiles39
  - Swapping a Complete Profile40
  - Swapping a Settings Block40
  - Default Profile40
  - Locked Profiles40
- Understanding Settings41
  - Changing Measurement Settings41
  - Switching a Measurement On and Off41
  - Switching Numerics On and Off42
  - Adjusting a Measurement Wave42
- Changing Wave Speeds42
  - Changing the Wave Group Speed42
  - Changing Wave Speed for a Channel42
- Freezing Waves42
  - Freezing An Individual Wave43
  - Freezing All Waves43
  - Measuring Frozen Waves43
  - Changing The Wave Speed43
  - Updating The Frozen Wave43
  - Releasing Frozen Waves44
- Using Labels44
  - Changing Measurement Labels (e.g. Pressure)44
  - About Label Sets44
  - Resolving Label Conflicts44
  - Label Compatibility46
- Entering Measurements Manually46
  - Switching Manually Entered Measurements On and Off47
- Changing Monitor Settings47
  - Adjusting the Screen Brightness47
  - Setting the Date and Time47
- Checking Your Monitor Revision48
- Getting Started48
  - Inspecting the Monitor48
  - Setting up the Modules48
  - Switching On48
    - Power On/Power Off Behavior49
  - Starting Monitoring49
- Disconnecting from Power49
  - Monitoring After a Power Failure49
- Networked Monitoring50
- Using the Integrated PC50
  - Starting the iPC51
  - Viewing the iPC Desktop on the Monitor Display51
  - Adjusting the iPC Audio Volume51
  - Using Input Devices with the iPC and Monitor51
  - Shutting the iPC Down52
    - Special Situations at Shutdown52
- Using Your Monitor with a Monitor in Companion Mode52
What's New?55
- What's New in Release K.1 (for MX400/450/500/550 only)55
- What's New in Release K.055
  - MX400/MX45055
- What's New in Release J.056
Alarms59
- Visual Alarm Indicators60
- Audible Alarm Indicators61
- Acknowledging Alarms63
  - Acknowledging Disconnect INOPs64
  - Alarm Reminder64
- Pausing or Switching Off Alarms64
- Alarm Limits67
- Reviewing Alarms71
  - Alarm Messages Window71
  - Review Alarms Window71
- Latching Alarms72
  - Viewing the Alarm Latching Settings72
  - Alarm Latching Behavior72
- Testing Alarms73
- Alarm Behavior at Power On73
- Alarm Recordings73
Patient Alarms and INOPs75
- Patient Alarm Messages75
- Technical Alarm Messages (INOPs)81
Managing Patients and Equipment105
- Patient Concepts105
- Equipment Concepts105
- Managing Patients106
- Managing Equipment119
- Care Groups126
- Information Center Compatibility132
ECG, Arrhythmia, ST and QT Monitoring133
- Skin Preparation for Electrode Placement133
- Connecting ECG Cables133
- Selecting the Primary and Secondary ECG Leads134
- Checking Paced Mode134
- Understanding the ECG Display134
- Monitoring Paced Patients135
  - Setting the Paced Mode (Pace Pulse Rejection)136
  - Avoiding Pace Pulse Repolarization Tails136
- Changing the Size of the ECG Wave136
  - To Change the Size of an Individual ECG Wave137
  - To Change the Size of all the ECG Waves137
- Changing the Volume of the QRS Tone137
- Changing the ECG Filter Settings137
- Selecting Positions of Va and Vb Chest Leads (for 6-lead placement)138
- Choosing EASI or Standard Lead Placement138
- About ECG Leads138
  - ECG Leads Monitored139
  - Changing Lead Sets139
- ECG Lead Fallback139
- ECG Lead Placements139
  - Standard 3-Lead Placement140
  - Standard 5-Lead Placement141
  - 6-Lead Placement141
  - Chest Electrode Placement142
  - 10-Lead Placement142
  - Conventional 12-Lead ECG143
    - Modified 12-Lead ECG144
  - Choosing Standard or Modified Electrode Placement144
- EASI ECG Lead Placement145
  - EASI Electrode Placement145
- Capture 12-Lead146
  - Viewing the Realtime 12-Lead ECG146
  - Capturing the 12-Lead ECG146
  - Changing Settings for a Captured 12-Lead ECG147
  - Storing and Sending the 12-Lead ECG147
  - Printing the 12-Lead ECG148
  - Downloading Analysis Results (PIIC iX only)148
  - Reviewing Previewed or Stored 12-Lead Captures148
  - Information Center Remote Export (PIIC iX only)148
  - Information Center Remote Lock/Unlock (PIIC iX only)148
  - Capture 12-Lead Pop-up Keys148
  - Setting Up the 12-Lead ECG149
- ECG and Arrhythmia Alarm Overview149
- Using ECG Alarms151
  - Extreme Alarm Limits for Heart Rate151
  - ECG Alarms Off Disabled152
  - HR Alarms When Arrhythmia Analysis is Switched Off152
  - Enhanced Asystole Detection152
- ECG Safety Information152
- About Arrhythmia Monitoring154
  - Arrhythmia Options154
  - Where Can I Find More Information?154
- Switching Arrhythmia Analysis On and Off154
- Choosing an ECG Lead for Arrhythmia Monitoring155
- Atrial Fibrillation Alarm155
- Aberrantly-Conducted Beats156
- Intermittent Bundle Branch Block156
- Understanding the Arrhythmia Display156
  - Viewing Arrhythmia Waves156
  - Arrhythmia Beat Labels157
  - Arrhythmia Status Messages157
    - Rhythm Status Messages157
    - Ectopic Status Messages158
- Arrhythmia Relearning159
  - Initiating Arrhythmia Relearning Manually159
  - Automatic Arrhythmia Relearn159
    - Arrhythmia Relearn and Lead Fallback160
- Arrhythmia Alarms160
  - Yellow Arrhythmia Alarms160
  - Arrhythmia Alarms and Latching161
  - Switching Individual Arrhythmia Alarms On and Off161
  - Switching All Yellow Arrhythmia Alarms On or Off161
  - Adjusting the Arrhythmia Alarm Limits161
  - Arrhythmia Alarm Timeout Periods161
    - What is a Timeout Period?161
    - Resetting the Timeout Period162
  - How are Yellow Arrhythmia Alarms Indicated?162
    - Arrhythmia Alarm Chaining162
  - Understanding PVC-Related Alarms164
- About ST Monitoring164
- Switching ST or STE On and Off165
  - Selecting Leads for ST Analysis165
- Understanding the ST Display166
- Updating ST Baseline Snippets168
- Recording ST Segments168
- About the ST Measurement Points168
  - Setting ISO and J-Point Detection Mode169
  - Adjusting ST Measurement Points169
- ST Alarms171
  - Changing ST Alarm Limits171
- STE Alarms171
- Viewing ST Maps172
  - Current View172
  - Trend View173
  - Viewing an ST Map174
  - Working in the ST Map Task Window174
- About QT/QTc Interval Monitoring175
  - QT Measurement Algorithm175
    - Where Can I Find More Information?176
  - Indications For Use Of QT Interval Monitoring176
  - Limitations For Use Of QT Interval Monitoring176
  - Selecting The QT Leads176
  - QT View177
- QT Alarms178
  - Switching Individual QTc Alarms On and Off179
  - Changing QTc Alarm Limits179
- Switching QT Monitoring On and Off179
Monitoring Pulse Rate181
- Entering the Setup Pulse Menu181
- System Pulse Source181
- Switching Pulse On and Off182
- Using Pulse Alarms182
Monitoring Respiration Rate (Resp)185
- Lead Placement for Monitoring Resp185
- Understanding the Resp Display186
- Changing Resp Detection Modes186
- Changing the Size of the Respiration Wave187
- Changing the Speed of the Respiration Wave188
- Using Resp Alarms188
- Changing the Apnea Alarm Delay188
- Resp Safety Information188
Monitoring SpO2191
- SpO2 Sensors191
- Applying the Sensor191
- Connecting SpO2 Cables192
- Measuring SpO2192
- SpO2 Signal Quality Indicator (FAST SpO2 only)193
- Assessing a Suspicious SpO2 Reading194
- Changing the Averaging Time194
- Understanding SpO2 Alarms194
- Pleth Wave200
- Perfusion Numeric200
- Perfusion Change Indicator200
- Setting SpO2/Pleth as Pulse Source200
- Setting Up Tone Modulation201
- Setting the QRS Volume201
- Calculating SpO2 Difference201
Monitoring NBP203
- Introducing the Oscillometric NBP Measurement203
- Preparing to Measure NBP205
- Starting and Stopping Measurements207
- Enabling Automatic Mode and Setting Repetition Time208
- Enabling Sequence Mode and Setting Up The Sequence208
- Choosing the NBP Alarm Source209
- Switching Pulse from NBP On/Off209
- Assisting Venous Puncture210
- Calibrating NBP210
Monitoring Temperature211
- Making a Temp Measurement211
  - Selecting a Temperature for Monitoring211
  - Extended Temperature Label Set212
- Calculating Temp Difference212
Monitoring Invasive Pressure213
- Setting up the Pressure Measurement213
  - Selecting a Pressure for Monitoring214
  - Extended Pressure Label Set214
- Zeroing the Pressure Transducer215
- Adjusting the Calibration Factor217
- Displaying a Mean Pressure Value Only217
- Changing the Pressure Wave Scale217
- Optimizing the Waveform217
- Using the Wave Cursor217
- Non-Physiological Artifact Suppression218
- Choosing the Pressure Alarm Source218
  - Extreme Alarm Limits for Pressure218
- Calibrating Reusable Transducer CPJ840J6219
  - Making the Pressure Calibration219
  - Troubleshooting the Pressure Calibration220
- Calculating Cerebral Perfusion Pressure221
- Calculating Pulse Pressure Variation221
- Measuring IAP222
  - Manual Entry222
  - Using a Pressure Waveform222
- Measuring Pulmonary Artery Wedge Pressure222
- Editing the Wedge223
- Identifying the Pressure Analog Output Connector224
Monitoring Cardiac Output225
- Hemodynamic Parameters226
- Using the C.O. Procedure Window226
- Accessing the Setup C.O. and Setup CCO Menus228
- Entering the HemoCalc Window228
- Measuring C. O. Using the PiCCO Method228
- Measuring C.O. Using the Right Heart Thermodilution Method233
- Documenting C.O. Measurements235
- C.O. Injectate Guidelines235
- C.O./CCO Curve Alert Messages236
- C.O./CCO Prompt Messages238
- C.O./CCO Warning Messages238
- C.O./CCO Safety Information239
Monitoring Carbon Dioxide241
- Measurement Principles242
- Measuring CO2 using M3014A or X2242
  - Preparing to Measure Mainstream CO2243
  - Preparing to Measure Sidestream CO2244
    - Using the Sidestream Sensor Holder246
    - Removing Exhaust Gases from the System246
- Measuring Mainstream CO2 using M3016A246
- Measuring Microstream CO2 using M3015A/B248
- Setting up all CO2 Measurements250
- Understanding the IPI Numeric252
Monitoring Airway Flow, Volume and Pressure255
- Attaching the Flow Sensor256
- Zero Calibration258
- Automatic Purging258
  - Adult Mode259
  - Neonatal and Pediatric Modes259
- Manual Purging259
- Gas Compensation259
- Setting up Spirometry260
Monitoring tcGas263
- Identifying tcGas Module Components263
- Setting the tcGas Sensor Temperature264
- Using the tcGas Site Timer264
- Setting the tcGas Barometric Pressure265
- Remembraning the tcGas Transducer265
  - New/Dried Out Transducers265
  - Storing tcGas Transducers265
- Calibrating the tcGas Transducer265
  - Calibration Failure267
  - Troubleshooting tcGas Calibration267
- Applying the tcGas Transducer267
  - Selecting the tcGas HeatPowerDisplay Mode268
- Finishing tcGas Monitoring268
- Zeroing the tcGas Relative Heat Power268
- TcGas Corrections268
  - Temperature Correction for tcpCO2268
  - Metabolism Correction for tcpCO2269
Monitoring Intravascular Oxygen Saturation271
- Selecting a Measurement Label272
- Preparing to Monitor with the M1021A Wide Module272
- Preparing to Monitor with the M1011A Narrow Module275
- Further Information for Both Modules277
  - Checking Suspicious Values277
  - Calculating Oxygen Extraction277
Monitoring EEG279
- EEG Monitoring Setup279
- Using the EEG Impedance/Montage Window280
- About Compressed Spectral Arrays (CSA)282
  - Changing CSA Settings282
- Changing EEG Settings283
- EEG Reports284
- EEG Safety Information284
- EEG and Electrical Interference284
Monitoring BIS285
- BIS Monitoring Setup286
- BIS Continuous Impedance Check288
- BIS Cyclic Impedance Check288
  - Starting a Cyclic Impedance Check288
  - Stopping a Cyclic Impedance Check288
- BIS Window289
  - BIS Impedance Indicators289
- Changing the BIS Smoothing Rate290
- Switching BIS and Individual Numerics On and Off290
- Changing the Scale of the EEG Wave290
- Switching BIS Filters On or Off290
- BIS Safety Information291
Monitoring NMT293
- Stimulation Modes294
- Preparing to Measure NMT295
- Taking NMT Measurements296
  - Calibrating the NMT Measurement296
    - Starting Calibration296
    - Clearing a Reference Twitch297
  - Starting/Stopping NMT Measurements297
- Changing the NMT Measurement Settings298
- Alarms299
  - TOFcnt High Limit Alarm299
  - NMT Alarm Suppress299
- Understanding NMT Numerics299
Guardian Early Warning Scoring301
- Performing the Scoring Procedure301
- Understanding Guardian Early Warning Scoring303
  - Which Type of Scoring is Being Used?304
- Viewing EWS Trend Data304
  - Symbols Used in the Trend Views305
  - Making Recordings305
- Using Different Types of Scoring305
Using a Telemetry Device and a Monitor (PIIC only)307
- How Can You Combine Devices?307
- Use Models With Telemetry309
Trends311
- Viewing Trends311
- Setting Up Trends315
- Documenting Trends319
- Trends Databases319
  - Aperiodic Trends Database320
  - Trending Multiple-Value Measurements320
- Screen Trends320
Calculations325
- Viewing Calculations326
  - Calculations Windows326
  - Calculations Pop-Up Keys326
- Reviewing Calculations327
- Performing Calculations327
- Entering Values for Calculations328
- Documenting Calculations329
High Resolution Trend Waves331
- Changing the Hi-Res Trend Waves Displayed331
- Hi-Res Trend Wave Scales331
- Hi-Res Trend Waves and OxyCRG331
- Printing Hi-Res Trend Wave Reports332
- Hi-Res Trend Wave Recordings332
Event Surveillance333
- Levels of Event Surveillance333
- Event Groups334
- Event Episodes334
- Events Pop-Up Keys335
- Event Triggers336
- The Events Database339
- Viewing Events340
- Annotating Events342
- Documenting Events342
ProtocolWatch349
- SSC Sepsis Protocol349
Recording357
- Paper-Strip Recording357
- Electronic Recording365
  - Capturing Alarm Events365
  - Alarm-Triggered Realtime Reports366
    - More Information About the Print Database366
Printing Patient Reports369
- Starting Report Printouts369
  - Printout Location369
  - Starting the Different Types of Report370
- Stopping Reports Printouts371
- Setting Up Reports371
- Setting Up Individual Print Jobs372
- Checking Printer Settings373
- Printing a Test Report374
- Switching Printers On or Off for Reports374
- Dashed Lines on Reports374
- Unavailable Printer: Re-routing Reports374
- Checking Report Status and Printing Manually375
  - Printing Manually375
- Printer Status Messages375
- Sample Report Printouts376
Using the Drug Calculator381
- Accessing the Drug Calculator382
- Performing Drug Calculations382
- Charting Infusion Progress385
- Using the Titration Table385
- Documenting Drug Calculations386
VueLink Modules387
- Connecting an External Device388
- Changing VueLink Waves and Numerics Displayed388
- Viewing the VueLink Device Data Window389
- Using VueLink Screens389
- Switching VueLink On and Off389
- Alarms/INOPs From External Devices389
- Language Conflict with External Device Drivers390
IntelliBridge EC10391
- Connecting an External Device391
- Changing Waves and Numerics Displayed392
- Viewing the IntelliBridge Device Data Window392
- Using Screens with External Device Data393
- Alarms/INOPs from External Devices393
  - INOPs from the IntelliBridge Module/Interface Board393
Using Timers395
- Viewing Timers395
  - Timer Types395
- Timer Setup Pop-up Keys396
- Setting Up Timers396
- Displaying a Timer On The Main Screen397
  - Main Screen Timer Pop-up Keys398
- Displaying A Clock On The Main Screen398
Respiratory Loops399
- Viewing Loops399
- Capturing and Deleting Loops400
- Showing/Hiding Loops400
- Changing Loops Display Size400
- Using the Loops Cursor400
- Changing Loops Type401
- Setting Up Source Device401
- Documenting Loops401
Laboratory Data403
- Viewing Received Data403
Using Batteries405
- Battery Power Indicators405
- Checking Battery Charge407
- When Battery Lifetime is Expired407
- Replacing a Battery407
- Optimizing Battery Performance408
- Battery Safety Information409
Care and Cleaning411
- General Points411
- Cleaning the Equipment412
- Disinfecting the Equipment412
- Sterilizing the Equipment413
- Cleaning, Sterilizing and Disinfecting Monitoring Accessories413
- Cleaning the SO2 Optical Module413
- Cleaning the Recorder Printhead (M1116B only)413
- Cleaning Batteries and the Battery Compartment414
Maintenance and Troubleshooting415
- Inspecting the Equipment and Accessories415
- Inspecting the Cables and Cords416
- Maintenance Task and Test Schedule416
- Troubleshooting417
- Returning Equipment for Repair417
- Disposing of the Monitor417
- Disposing of Empty Calibration Gas Cylinders418
Accessories419
- ECG/Resp Accessories419
  - Recommended Cables419
  - Supported Cables422
- NBP Accessories423
  - Adult/Pediatric Reusable Comfort Care Cuffs423
  - Adult/Pediatric Reusable Comfort Care Cuff Kits423
  - Adult/Pediatric Reusable Easy Care Cuffs424
  - Adult/Pediatric Reusable Easy Care Cuff Kits424
  - Adult/Pediatric Multi Care Cuffs424
  - Adult/Pediatric Single Patient, Gentle Care Cuffs425
  - Adult/Pediatric Single Care Cuffs425
  - Adult/Pediatric Value Care Cuffs425
  - Neonatal/Infant Single Patient Cuffs426
  - Neonatal/Infant Single Patient, Soft Cuffs426
  - Neonatal/Infant Cuff Kits426
- Invasive Pressure Accessories426
- Transpac 4 Disposable Pressure Transducer Pressure Monitoring Kits427
- SpO2 Accessories429
  - Philips Reusable Sensors430
  - Philips Disposable Sensors431
  - Nellcor Sensors431
  - Extension Cables and Adapter Cables for Philips and Nellcor Sensors432
  - MASIMO LNOP Reusable Sensors433
  - MASIMO LNCS Reusable Sensors433
  - MASIMO LNOP Disposable Adhesive Sensors433
  - MASIMO LNCS Disposable Adhesive Sensors434
  - Adapter Cable for MASIMO Sensors434
- Temperature Accessories435
- Cardiac Output (C.O.) Accessories436
- Mainstream CO2 Accessories437
- Sidestream CO2 Accessories437
- Mainstream CO2 Accessories (for M3016A)438
- Microstream CO2 Accessories438
- Spirometry Accessories439
  - Measurement of CO2 and Spirometry with Neonates439
- tcGas Accessories439
- EEG Accessories440
- BIS Accessories440
- SO2 Accessories for M1021A440
- SO2 Accessories for M1011A441
- NMT Accessories441
  - Symbols on the Accessory Packaging441
- Recorder Accessories442
- Battery Accessories442
Specifications443
- Indications for Use443
- Restricted Availability444
- Use Environment444
  - Physical Security and Limited Access to the Monitor444
- Manufacturer's Information444
  - BIS Manufacturer's Information444
  - Trademark and License Acknowledgment445
- Symbols445
- Installation Safety Information447
  - Connectors447
- Monitor Mounting Precautions455
  - Repositioning a Monitor on the Mounting Arm456
- Altitude Setting456
- Monitor Safety Specifications456
- Physical Specifications457
- Environmental Specifications458
- EMC and Radio Regulatory Compliance462
- Monitor Performance Specifications464
- Interface Specifications470
- Display Specifications474
  - Compatible Devices475
- M4605A Battery Specifications475
- Measurement Specifications475
- Safety and Performance Tests495
Default Settings Appendix501
- Country-Specific Default Settings501
- Alarm and Measurement Default Settings508
- Alarm Default Settings508
- ECG, Arrhythmia, ST and QT Default Settings509
  - Arrhythmia Default Settings510
  - ST and QT Default Settings511
- Pulse Default Settings512
- Respiration Default Settings513
- SpO2 Default Settings513
- NBP Default Settings514
- Temperature Default Settings514
- Invasive Pressure Default Settings515
- Cardiac Output Default Settings517
- CO2 Default Settings518
- Spirometry Default Settings518
- tcGas Default Settings519
- Intravascular Oxygen Saturation Default Settings519
- SvO2 Default Settings520
- ScvO2 Default Settings520
- EEG Default Settings520
- BIS Default Settings521
- NMT Default Settings521
- VueLink Default Settings522
  - #523
  - A523
  - B524
  - C524
  - D525
  - E525
  - F526
  - G526
  - H526
  - I526
  - J527
  - K527
  - L527
  - M527
  - N527
  - O528
  - P528
  - Q528
  - R528
  - S529
  - T530
  - U531
  - V531
  - W531
  - Z531

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