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Welch Allyn Acuity Central Monitors
Acuity LT and Mobile LT Wireless Central Monitoring System - Directions for Use Sw Ver 6.4x
Directions for Use
138 Pages
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Acuity® LT and Mobile Acuity® LT Wireless Central Monitoring System
Directions for Use Acuity® System software version 6.4x, compatible with: Propaq® CS software versions 3.6x and higher Propaq® LTR software versions 1.0x and higher Micropaq® software versions 1.3x and higher
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Welch Allyn Acuity LT Wireless Central Monitoring System
Copyright 2005, Welch Allyn®. All rights are reserved. No one is permitted to reproduce or duplicate, in any form, this manual or any part thereof without permission from Welch Allyn. Welch Allyn assumes no responsibility for any injury to anyone, or for any illegal or improper use of the product, that may result from failure to use this product in accordance with the instructions, cautions, warnings, or statement of intended use published in this manual. Welch Allyn®, Propaq®, Acuity®, Micropaq® Smartcuf® and Flexible Monitoring® and FlexNet® are registered trademarks of Welch Allyn. ParamSet™ is a trademark of Welch Allyn. C-LOCK® and Nellcor® are registered trademarks of Nellcor Puritan Bennett. Masimo® and SET® are registered trademarks of Masimo Corporation. Software in this product is Copyright 2005 by Welch Allyn or its vendors. All rights are reserved. The software is protected by United States of America copyright laws and international treaty provisions applicable worldwide. Under such laws, the licensee is entitled to use the copy of the software incorporated with this instrument as intended in the operation of the product in which it is embedded. The software may not be copied, decompiled, reverse-engineered, disassembled or otherwise reduced to human-perceivable form. This is not a sale of the software or any copy of the software; all right, title and ownership of the software remains with Welch Allyn or its vendors. For information about any Welch Allyn product, call Welch Allyn Technical Support: USA 1 800 535 6663 +1 315 685 4560
Australia +61 2 9638 3000 1 800 074 793
Canada 1 800 561 8797
China +86 216 327 9631
European Call Center +353 46 906 7790
France +33 1 55 69 58 49
Germany +49 7477 9271 86
Japan +81 3 3219 0071
Latin America +1 305 669 9003
Netherlands +31 157 505 000
Singapore +65 6419 8100
South Africa +27 11 777 7555
United Kingdom +44 207 365 6780
Sweden +46 85 853 6551
Reorder Part Number 810-1603-XX Manual Part Number 810-1600-03 Rev A, 12/2005 Welch Allyn 8500 SW Creekside Place Beaverton, Oregon 97008-7107 www.monitoring.welchallyn.com Printed in USA
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Contents 1 - General Information... 1 About this Manual... 1 Intended Use... 1 Conventions Used in this Manual... 3 Warnings and Cautions... 4 Acuity Compliance with Safety Standards... 6
2 - Acuity LT Wireless System Overview... 7 Acuity System Components... 7 Wireless Devices... 9 Acuity Central Station Screen... 10 Screen Views... 10 Central Station Map and Status Icons... 12 Patient Monitor Representations at Acuity... 13 System Image-Buttons - Lower Left Corner... 15
3 - Admit and Begin Monitoring... 17 Preadmit a Patient to Acuity Monitoring... 17 Readmit a Discharged Patient... 18 Start Communication Between a Wireless Monitor and Acuity... 19 Important Considerations When Connecting a Monitor to Acuity... 19 The Micropaq Monitor... 21 The Propaq LTR Monitor... 23 The Wireless Propaq CS Monitor... 25 Enter or Confirm Patient ID or Room... 26
4 - Set or Edit Monitoring Settings... 29 Set Up Typical Monitoring... 29 Set Alarm Limits for a Patient... 32 Set Printing Choices for a Patient... 34 Set Waveform Displays for a Patient... 35 Select Waveforms in an On-Screen Monitor... 35 Select Waveforms in a Waveform Window... 35 Set Arrhythmia Alarm Choices for a Patient... 36 The Arrhythmia Alarms Setup Window... 36 Arrhythmia Terms... 39 Arrhythmia Event Definitions... 40 Edit Patient Information... 41 Edit Any Information Except a Patient ID... 41
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Welch Allyn Acuity LT Wireless Central Monitoring System
Add or Remove a Note in a Patient’s Waveform Window... 42 Edit a Patient ID by Adding an Amended (Revised) Patient ID... 43
5 - Respond to Alarms and Alerts... 45 Central Station Alarm and Alert Indications... 45 Suspend an Alarm or Alert Tone for 90 Seconds... 46 Suspend From a Waveform Window... 47 Suspend From an On-Screen Monitor... 47 Remove a Latched Arrhythmia Alarm Indication... 48 Respond to Specific Alarms and Alerts... 49 Respond to a Dropout Alert... 49 Dismiss a “Check Patient HR/PR Alert”... 50 Dismiss an Arrhythmia Alarm Message... 51 Respond to a Relearn Alert... 52 Respond to a Check Leads Alert... 53 Respond to an Arrhythmia Noise Alert... 53 A Summary of Alarm and Alert Levels at Acuity... 54
6 - Review or Print Patient Data... 55 Review Patient Data... 55 Locate Patient Data... 55 Review Trends... 56 Review Waveforms... 57 Review Arrhythmia Events... 58 Review OxyCRG Information... 59 Print or Review Printouts... 60 Print a Snapshot... 60 Print a Review Printout... 61 Review an Alarm Printout... 62 Coordinate Print Jobs... 63
7 - Move a Monitored Patient... 65 Move the Patient and Monitor to a New Location... 65 From the Acuity Central Station... 65 From a Micropaq Monitor... 65 From a Propaq LTR Monitor... 66 From a Wireless Propaq CS Monitor... 66 Move a Patient to a Different Monitor... 67 Move a Micropaq Patient to a Different Monitor... 67 Move a Propaq LTR Patient to a Different Monitor... 67 Move a Wireless Propaq CS Patient to a Different Monitor... 67
8 - Discontinue Acuity Monitoring... 69 Stop Monitoring a Patient... 69 Temporarily Interrupt Monitoring a Patient... 69 Permanently Stop Monitoring a Patient... 70 Discharge a Patient from Acuity Monitoring... 71
Directions for Use
Contents
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9 - Image Buttons & Status Icons... 73 Image-Buttons... 73 Status Icons... 76
10 - Troubleshooting and Maintenance... 81 Troubleshooting... 81 Connection and Disconnection... 81 ECG, SpO2 and CO2... 82 NIBP... 83 Alarms and Alerts... 84 Printing... 85 Maintenance... 86 Set the Clock... 86 Set Localization Parameters... 87 Power Outages... 88 Periodically Check Equipment for Safety... 89 Equipment Disposal... 89
11 - Specifications... 91 General Acuity LT Monitoring... 91 Acuity LT System Heart Rate... 92 Acuity System Pacemaker Detection... 93 Acuity System Alarm and Alert Indications... 94 Electromagnetic Standards Compliance... 99 Acuity Factory Defaults and Specifications... 103 Setup Windows... 105 Review Windows... 107
A - New Features in Acuity Version 6.2... 111 Rapidly Enter Patient ID for Pre-Admitted Patients... 112 Edit a Patient ID by Adding an Amended (Revised) Patient ID... 113
B - New Features in Acuity Version 6.3... 115 Add or Remove a Note in a Patient’s Waveform Window... 116 New Arrhythmia Features... 117 Paced Patients and Arrhythmia... 117 New Alerts Related to Arrhythmia... 118
C - New Features in Acuity Version 6.4... 121 New Life-Threatening Arrhythmia Alarm Tone... 122 Quick Access to the Arrhythmia Events Review Window... 122 New Latching Arrhythmia Alarm Behaviors... 123 The Propaq LTR Patient Monitor... 124
Warranty... 125 Index... 127
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Contents
Welch Allyn Acuity LT Wireless Central Monitoring System
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1 General Information About this Manual This manual describes how to operate the Acuity® LT wireless system and the Mobile Acuity® LT wireless system. Except where explicitly stated otherwise, all operating features described in this manual for the Acuity LT wireless system also apply to the Mobile Acuity LT wireless system.
Intended Use The Acuity® Central Monitoring Station is intended to be used by clinicians for the central monitoring of neonatal, pediatric, and adult patients in health care facilities. In addition to the central monitoring of patient data, waveforms, alarms and alerts, the Acuity software can include optional modules to provide extended recording of patient data (Full Disclosure) and arrhythmia monitoring. •
Full Disclosure stores patient data for up to 24 hours.
•
Arrhythmia monitoring module provides real-time monitoring and alarms for specific changes in cardiac rhythms. The clinician is responsible for determining the clinical significance of each detected arrhythmia event or alarm. The arrhythmia module is not intended for use with neonatal patients.
The Acuity LT System with wireless technology is Welch Allyn’s Central Monitoring solution. It consists of the Acuity Central Monitoring Station, the Acuity software and a collection of other commercially available networking hardware products. The system connects to a network of patient monitors to record and analyze the data being acquired by those devices. This solution offers a proven technology with the options and features needed to support a distributed network of connected devices while providing arrhythmia detection and alarms for adult and pediatric patients. The Acuity System supports patient information management, patient alert and alarm management, patient data review, system administration and product installation and service. It leverages various networking and connectivity options to obtain and distribute information where and when needed. Acuity is available in multiple product configurations. Acuity Systems can be ordered offthe-shelf or custom configured to meet a customer’s unique needs based on hospital policy, healthcare facility size, patient census and floor layout. In all cases, the user must carefully review the features and functionality of both the distributed devices and the Acuity Central Station to ensure that clinical needs are met.
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Welch Allyn Acuity LT Wireless Central Monitoring System
The Acuity Central Monitoring Station is not directly connected to patients. It is designed to be used as a central monitoring system for a set of patient monitors supporting both continuously and intermittently acquired data. The monitors supported include, but are not limited to, the following Welch Allyn devices: Propaq CS, Propaq LTR and Micropaq as configured to interface with Acuity. Acuity Systems monitor patient data supplied by a bedside monitor and do further processing of that data by software at the Acuity Central Monitoring Station. Acuity Systems with the Arrhythmia option calculate heart rate using multiple ECG leads and arrhythmia analysis algorithms, where the bedside monitor uses a heart rate algorithm based on data from a single ECG lead. The overall performance of the networked system is based upon trending and data management techniques consistent with industry practice and applicable standards. It is important to note that some Acuity software options and/or devices will support adult and pediatric patients but are not intended for neonatal patients. The following Acuity software options are intended only for adult and pediatric patients. They are NOT intended for neonatal patients. •
Arrhythmia Analysis Software Option
Acuity Central Monitoring Stations and distributed monitoring devices are prescription devices to be used as authorized by health care professionals and/or by institutional standard procedures and good clinical practice guidelines for monitoring of specific patients. Staff trained in the operation of Acuity and the patient monitoring devices connected to it is essential for optimal use. System users should be skilled at the level of a technician, nurse, physician, healthcare provider or medical specialist.
Directions for Use
Chapter 1 General Information
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Conventions Used in this Manual WARNING Indicates conditions or practices that could lead to illness, injury or death. Caution In this manual, indicates conditions or practices that could damage the equipment or other property. On the product, means “Consult accompanying documentation.”
Note
Provides additional important information.
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Warnings and Cautions Although this guide might suggest some medical monitoring techniques, Welch Allyn expects those who use the Acuity LT System are trained clinicians with the knowledge and experience to acquire and interpret patients’ vital signs. Clinicians using the Acuity LT System should be familiar with the operation of the Acuity LT System as described in this manual, including an understanding of all warnings and cautions throughout this manual. WARNING U. S. Federal law restricts this device to sale by or on the order of a physician or licensed health care professional. WARNING For best product performance and measurement accuracy, use only accessories supplied by Welch Allyn or recommended in the Welch Allyn Products and Accessories booklet. Use accessories according to your facility’s standards and the manufacturer’s recommendations. Always refer to the manufacturer’s directions for use. WARNING The Acuity LT wireless system (or Mobile Acuity LT wireless system) must be installed according to the system’s cabling and power requirements described in the Acuity LT Wireless System Installation Guide, Part Number 810-1601-XX (or Mobile Acuity LT Wireless System Installation Guide, Part Number 810-1624-XX). Altering the cabling or connecting the Acuity LT system to another type of power source could damage the equipment, cause system restarts or hazardous conditions on the Acuity LT system network, or result in inaccurate patient information at the Central Station. WARNING Acuity LT system components should only be changed according to instructions in the Acuity LT Installation Guide. Changes could degrade system performance and affect patient monitoring. After any changes, make sure that system performance is validated by qualified personnel according to instructions in the Acuity LT Installation Guide. WARNING Devices connected to Acuity should be certified for overall system compliance according to the European Norm 60 601-1 and 60 950 safety standards. The interconnection of any device with Acuity must comply with IEC 601-1-1. Devices listed in the Acuity LT Installation Guide comply with these standards. If in doubt about network jacks or devices, please consult your facility’s Biomedical Engineering Department, Information Technology Department, or Welch Allyn Technical Support.
Directions for Use
Chapter 1 General Information
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WARNING Do not attempt to monitor neonatal patients’ ECGs using Micropaq monitors. WARNING Make sure Acuity patients are kept under close surveillance, especially patients prone to arrhythmias. Use Acuity only in conjunction with close surveillance by trained clinicians. WARNING The Acuity LT Central Station does not always detect and report to the operator when a problem occurs with the printer (such as out of paper or paper jam). If a printer problem occurs and is not corrected by the operator, the printer will not print, including any alarm prints that are configured to automatically print when an alarm occurs. To avoid this, periodically check the printer to make sure it has paper, toner, and is working properly. WARNING Although the printer is optional with the Acuity LT system, be aware that there is no physical record available for Acuity events such as alarms without a printed paper copy. WARNING When using a Propaq CS monitor that has both hardwired and wireless Acuity capability, be aware that when the monitor is unplugged from an Acuity hardwired system, it will automatically attempt to make a wireless connection with any nearby wireless system. To prevent the monitor from making this wireless connection, make sure that the monitor network name does not match the network name of any nearby Acuity wireless system. WARNING When setting the network Name for a wireless monitor, make sure that the monitor network name matches the CPU for your Acuity LT wireless system. If a different network name is set, the monitor could connect to a different nearby Acuity LT wireless system that has that network name resulting in confusion about patient monitoring and the location of patient data. For more information, refer to the Acuity LT Wireless Installation Guide.
Caution Acuity Engineering Menus are large, gray menus with only a password entry line enabled: they appear along the left side of the Acuity screen. These menus are meant for use only by trained, authorized Welch Allyn service personnel. Unauthorized use of these menus can result in unsafe alteration of the Acuity System, including shut-down of the system. Should you inadvertently open a menu that you do not understand and that’s not explained in this manual, disregard the menu and clear it from the screen by pointing anywhere outside the menu and clicking on the left mouse or trackball key.
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Acuity Compliance with Safety Standards 0123
The CE Mark and Notified Body Registration Number signify that the Acuity System meets all essential requirements of European Medical Device Directive 93/42/EEC.
Acuity Component
Product Category
Standard
Propaq CS, Propaq LTR, Micropaq monitors
Medical Equipment
EN 60 601-1:1990 A1:1992, A2:1995
All components operating together as a system
Electromagnetic compatibility for Medical Equipment
IEC 60 601-1-2:2001
All components operating together as a system
Medical Systems
IEC 60 601-1-1:1995
All information systems components
Information Technology Equipment
EN 60 950:1994
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2 Acuity LT Wireless System Overview Acuity System Components The Acuity LT wireless system displays vital signs from patient monitoring devices on the Acuity LT Central Station. Network components enable connections to wireless patient monitoring devices and a laser printer. The system also stores patient data through the Full Disclosure feature. This feature automatically stores all trend information for all patients for up to 24 hours Figure 1. Acuity LT Wireless System
Propaq LTR wireless monitors communicate through access points.
Access points provide connection between the Ethernet network and wireless devices.
Micropaq wireless wearable patient monitors communicate through access points.
Wireless Propaq CS portable monitors communicate through access points. Switch connects the multiple access points and the CPU.
Laser printer provides printouts of stored patient data and alarms. Uninterruptible power supplies (UPSs) provide temporary power during power outages. Acuity Central Station is composed of the Display and CPU that monitors all connected patients.
External modem connects to the CPU to facilitate remote technical support.
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Welch Allyn Acuity LT Wireless Central Monitoring System
Figure 2. Mobile Acuity LT Wireless System Access Point provides connection between the Acuity Central Station and wireless devices.
Propaq LTR wireless monitors communicate through access point.
Micropaq wireless wearable patient monitors communicate through access point.
Wireless Propaq CS portable monitors communicate through access point.
Acuity Central Station is a laptop portable computer that monitors all connected patients.
For more information, refer to the following documents: Acuity LT wireless system network
See the Acuity LT Wireless System Installation Guide (810-1603-XX.)
Mobile Acuity LT wireless system network
See the Mobile Acuity LT Wireless System Installation Guide (810-1624-XX).
Micropaq patient monitor
See the Micropaq Directions for Use (810-1464-XX).
Propaq LTR patient monitor
See the Propaq LTR Directions for Use (810-1828-XX).
Propaq CS Wireless patient monitor
See the Propaq CS Directions for Use (810-1441-XX).
Directions for Use
Chapter 2 Acuity LT Wireless System Overview
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Wireless Devices Figure 3. Wireless Devices
Micropaq
Propaq LTR
Wireless Propaq CS
This manual uses the term “wireless” to mean the two-way transmission of data between the monitor and the Acuity Central Station by radio, forming a local area network. A loss of bi-directional communication between a wireless monitor and Acuity can occur; this state is called “Dropout.” (See “Respond to a Dropout Alert” on page 49.) The following table shows Acuity wireless products and the standards to which they adhere. Monitor
Regulations
Micropaq, Propaq LTR and Wireless Propaq CS
IEEE 802.11, Industrial Scientific Medical (ISM) band, 2.4 GHz; two-way communications
WARNING All wireless systems are prone to intermittent signal dropout, so use this wireless monitor only on patients whose conditions tolerate intermittent monitoring interruptions. During signal dropout periods, arrhythmia analysis cannot be performed, and Acuity will not show alarms, alerts or Nurse Call requests.
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Welch Allyn Acuity LT Wireless Central Monitoring System
Acuity Central Station Screen There are two Acuity screen views available for viewing patient data: the 12-waveforms view and the half screen review view.
Screen Views Figure 4. 12-Waveforms View The message window at the top of the screen shows the location of alarms and alerts.
The color of the Waveform Window border and status icon indicate alerts (yellow) or alarms (red).
Alternate between the 12waveforms and the half screen review views.
The Waveform Window is an abbreviated On-Screen Monitor. From this window, you can Suspend alarms, initiate snapshot prints or open the On-Screen Monitor.
Click the Patient List button to preadmit, readmit or discharge patients or view and print waveforms and trends of patients discharged from Acuity up to 24 hour ago. Click the Sort Windows button to sort the order of displayed rooms. (See “System Image-Buttons - Lower Left Corner” on page 15.)
The Acuity LT map shows status icons that indicate patient and monitor status. (See “Central Station Map and Status Icons” on page 12.)
Directions for Use
Chapter 2 Acuity LT Wireless System Overview
Figure 5. Half-Screen View Alternate between the 12waveforms and the half screen review views with these buttons.
The upper area is available for display and reviewing of patient data.
The On-Screen Monitor displays the patient’s vital signs, alarms and alerts. The patient shown is in alarm.
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Central Station Map and Status Icons The Central Station Map provides status information for the monitors and printer. Figure 6. Central Station Map and Status Icons
This patient is being monitored and is assigned to Room 122.
This patient is being monitored, but the patient ID has not been entered.
Click to open the Central Station Printer Window.
This patient is being monitored, but the room has not been assigned. This monitor is identified by “+1224,” which is the last 4 digits of the monitor serial number. The “+1224” is replaced by the room number after the room number is assigned.
Patient and monitor status icons appear at locations with active monitors. Click the map icon once to open the Waveform Window or twice to open the On-Screen Monitor.
Here are some of the most common status icons. (See “Status Icons” on page 76 for a complete list. Inactive Acuity port
An alert has occurred and has been suspended
Patient monitoring is OK Some alarms are off Patient alarm is occurring
Patient ID has not been entered
A patient alarm has occurred and has been suspended
Room number has not been assigned Patient has been intentionally disconnected
Directions for Use
Chapter 2 Acuity LT Wireless System Overview
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Patient Monitor Representations at Acuity Figure 7. Waveform Window
ECG Lead Indicator
Alarm and alert messages replace Patient Mode indicator. Color indicates status: red, alarm; yellow, alert; green, patient vital signs within limits and normal equipment operation; blue, intentional disconnection.
From the Patient ID Window, you can enter a temporary note to appear here (see “Add or Remove a Note in a Patient’s Waveform Window” on page 42).
Alarm limit settings
Click the patient and equipment status icon to open the On-Screen Monitor
Click in waveform area to print a snapshot print at the printer.
Vital signs in alarm are shown by numbers in a red field. Click in this area to suspend or resume an alarm tone.
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Figure 8. On-Screen Monitor Up to three waveform display areas
ECG lead indicator
Border color indicates status: red, alarm; yellow, alert; green, patient vital signs within limits and normal equipment operation; blue, intentional disconnection Solid bell symbol indicates all of this vital sign’s alarm limits are set. Up to eight labeled numeric displays
Prints a snapshot at the Central Station printer. Buttons are visible when the pointer is within the window. Suspends an alarm tone for 90 seconds. Click to open Review Windows for Graphical Trends, Waveforms, Arrhythmia Events and OxyCRG.
Alarm and alert messages replace Patient Mode indicator.
Click to open Setup Windows for Patient ID, Alarms, Printouts, Waveform Window and Arrhythmia Alarms. Patient and monitor status icon; alarm is occurring
The Acuity On-Screen Monitor represents a patient’s monitor and the information obtained from the monitor. The appearance and button sequences of an On-Screen Monitor can differ somewhat from an actual patient’s monitor, and units of measure and labeling vary depending upon the country of use. Options or monitor functions that are not available or active are shown in faint gray type.