250 Series Operator Manual Rev F

GE Healthcare

Corometrics™ 250cx Series Monitor Operator’s Manual

Corometrics 250cx Series Monitor English 2036946-001 F (paper) © 2009 General Electric Company. All Rights Reserved.

GUARANTEE All equipment sold by GE Medical Systems Information Technologies, is fully guaranteed as to materials and workmanship for a period of 1 year. GE Medical Systems Information Technologies reserves the right to perform guarantee service operations in its own factory, at an authorized repair station, or in the customer’s installation. Our obligation under this guarantee is limited to repairing, or, at our option, replacing any defective parts of our equipment, except fuses or batteries, without charge, if such defects occur in normal service. Claims for damage in shipment should be filed promptly with the transportation company. All correspondence covering the instrument should specify the model and serial numbers. GE MEDICAL SYSTEMS Information Technologies A GE Healthcare Company

GE Medical Systems Information Technologies will make available on request such circuit diagrams, component diagrams, component parts lists, descriptions, calibration instructions, or other information which will assist the users or appropriately qualified technical personnel to repair those parts of the equipment which are classified by GE Medical Systems Information Technologies as repairable. Refer to the 250/250cx Series Service Manual for further information. NOTE: In addition to software version 4.50, the information in this manual also applies to previous software revisions of Corometrics 250cx Series Monitor. There are no user-apparent differences among these software versions. Due to continuing product innovation, specifications in this manual are subject to change without notice. NOTE: For technical documentation purposes, the abbreviation GE is used for the legal entity name, GE Medical Systems Information Technologies Ohmeda Oximetry and other trademarks (OxyTip+®, PIr™, TruSat™, TruSignal™, TruTrak+®, SuperSTAT™) are the property of GE Medical Systems Information Technologies, a division of General Electric Corporation. All other product and company names are the property of their respective owners. MASIMO SET® is a trademark of Masimo Corporation. Possession or purchase of this device does not convey any express or implied license to use the device with replacement parts which would, alone, or in combination with this device, fall within the scope of one or more of the patents relating to the device. NELLCOR®, OxiMax®, C-LOCK® and SatSeconds™ are trademarks of Nellcor Puritan Bennett.  TAT-5000™, Exergen® and TemporalScanner™ are trademarks of Exergen Corporation. CAUTION: In the United States of America, Federal Law restricts this device to sale by or on the order of a physician.

Corometrics and Marquette are registered trademarks of GE Medical Systems Information Technologies. GE is a registered trademark of General Electric Company. All other product and brand names are trademarks or registered trademarks of their respective companies. ©2005, 2006, 2007, 2009 GE Medical Systems Information Technologies. All rights reserved. No part of this manual may be reproduced without the permission of GE Medical Systems Information Technologies.

T-2

Corometrics 250cx Series Monitor 2036946-001

Revision F 28 Apr 2009

CE Marking Information

CE Marking Information 0459

Compliance A GE brand Corometrics 250cx Series Monitor bears CE mark CE-0459 indicating its conformity with the provisions of the Council Directive 93/ 42/EEC concerning medical devices and fulfills the essential requirements of Annex I of this directive. The device is manufactured in India; the CE mark is applied under the authority of Notified Body GMED (0459). The country of manufacture and appropriate Notified Body can be found on the equipment labeling. The product complies with the requirements of standard EN 60601-1-2 “Electromagnetic Compatibility-Medical Electrical Equipment” and standard EN 60601-1 “General Requirements for Safety.”

Components of the Certified Systems The IEC electromagnetic compatibility (EN) standards require individual equipment (components and accessories) to be configured as a system for evaluation. For systems that include a number of different equipments that perform a number of functions, one of each type of equipment shall be included in the evaluation. The equipment listed below is representative of all possible combinations. For individual equipment certification, refer to the appropriate declarations of conformity. Component Description:                

Revision F

250cx Series Maternal/Fetal Monitor Model 146 Fetal Acoustic Stimulator Intrauterine Pressure Transducer TOCO Transducer FECG Cable/Legplate Ultrasound Transducers (x2) Blood Pressure Hose and Cuff MSpO2 Interconnect Cable and Sensor MECG Cable FECG/MECG Adapter Cable Remote Event Marker RS-232C Interconnect Cables (x3) Central Nurses Station Interconnect Cable Model 2116B Keyboard and Interconnect Cable Model 1563AAO Telemetry Cable Exergen TemporalScannerTM TAT-5000 Assembly 2036641-001

250cx Series Maternal/Fetal Monitor 2036946-001

CE-1

CE Marking Information

Exceptions The Monitor System EMC: Immunity Performance None Be aware that adding accessories or components, or modifying the medical device or system may degrade the EMI performance. Consult with qualified personnel regarding changes to the system configuration.

CE-2

250cx Series Maternal/Fetal Monitor 2036946-001

Revision F

Contents

1

Safety... 1-1 General Information... 1-3 General Use... 1-3 Responsibility of the Manufacturer... 1-3 Responsibility of the User... 1-3 Definitions of Terminology... 1-4 Fetal Monitoring Indications for Use... 1- 5 Surveillance... 1-5 Maternal Monitoring Indications for Use... 1- 5 Blood Pressure... 1-5 Pulse Oximetry... 1-5 Heart/Pulse Rate... 1-5 Monitor Contraindications, Warnings, and Precautions... 1- 6 Cautions... 1-9 Electromagnetic Interference... 1-10 Equipment Symbols... 1-11

2

Introduction... 2-1 About the Manual... 2-3 Purpose... 2-3 Intended Audience... 2-3 Illustrations... 2-3 Series Overview... 2-3 The 250cx Series Monitor Features... 2-4 System Parameters (256cx and 259cx)... 2-4 Fetal Parameters... 2-5 Maternal Parameters (259cx only)... 2-5 Adding Fetal Movement Detection and/or Spectra Alerts... 2-6

3 Revision F

Controls, Indicators, and Connectors... 3-1 Front Panel Description... 3-3

250cx Series Maternal/Fetal Monitor 2036946-001

i

Front Panel Displays... 3-6 Display Example... 3-7 Primary Labor Parameters... 3-8 FHR Display... 3-8 UA Display... 3-9 Additional Parameters... 3-10 Maternal NIBP... 3-10 MHR/P Area... 3-11 MSpO2 Area... 3-12 Waveform Area... 3-12 Time and Waveform Message Area... 3-12 Battery-Backed RAM Status... 3-13 Softkeys... 3-13 Mode Title Softkeys... 3-13 Waveform Softkeys... 3-13 Dedicated Softkey Area... 3-14 Rear Panel Description... 3-16

4

Setup Procedures... 4-1 Loading Strip Chart Recorder Paper... 4-3 Power... 4-6 Interruption of Power... 4-6 Self-Test Routine... 4-7 Setup Screens... 4-7 Using the Trim Knob Control... 4-8 General Setup Screen... 4-9 Play Song... 4-9 Song Volume... 4-9 Temp Done Volume... 4-9 Brightness... 4-9 Paper Speed... 4-10 Date... 4-10 Time... 4-10 MSpO2 Print Interval... 4-10 FSpO2 Print Interval... 4-10 FSpO2 Trace... 4-10 Service... 4-10 Preparing the Monitor for Patient Use... 4-11

ii

250cx Series Maternal/Fetal Monitor 2036946-001

Revision F

5

Fetal Heart Rate Monitoring... 5-1 Ultrasound (External Method)... 5-3 Methodology... 5-3 US/US2 Setup Screen... 5-3 Volume... 5-3 Alert... 5-4 Alarm Volume... 5-4 FECG (Internal Method)... 5-4 Methodology... 5-4 Artifact Elimination... 5-4 FECG Setup Screen... 5-5 Volume... 5-5 Alarms... 5-5 Audio Alarms... 5-5 Alarm Volume... 5-5 Fetal Heart Rate Alarms... 5-6 FHR Threshold Alarms... 5-6 FHR High Alarm... 5-7 Sample Clinical Exceptions... 5-8 Active Signal Quality Alarm... 5-8 Resolved Signal Quality Alarm... 5-8 100% Signal Loss... 5-9 Silencing an Audio Alarm... 5-9 Summary... 5-10 Single Fetal Heart Rate Monitoring... 5-10 Dual Fetal Heart Rate Monitoring... 5-10 Heartbeat Coincidence... 5-11 Fetal Heart Rate Offset... 5-11 Activating the Fetal Heart Rate Offset Feature... 5-11 De-Activating the Fetal Heart Rate Offset Feature... 5-12

6

Uterine Activity Monitoring... 6-1 Tocotransducer (External Method)... 6-3 Methodology... 6-3 Establishing a Baseline... 6-3 Initial Referencing... 6-3  Accounting for Belt Tension... 6-4 More About Referencing... 6-4 Out of Range Condition... 6-4 Manually Setting the Baseline at the Default Value... 6-4 Manually Overriding the Baseline Default Value... 6-4 Automatic Baseline “Zeroing”... 6-4 Internal Method - Intrauterine Pressure (IUP)... 6-5

Revision F

250cx Series Maternal/Fetal Monitor 2036946-001

iii

Methodology... 6-5 Why You Must Zero the System... 6-5

7

Maternal Heart/Pulse Rate Monitoring... 7-1 MHR/P Source... 7-3 MHR/P Setup Screen... 7-4 Source... 7-4 HR/PR Trace... 7-5 Volume... 7-5 Alarms... 7-5 Alarm Volume... 7-5 MECG Lead... 7-5 MECG Pacer... 7-6 Maternal ECG Monitoring... 7-7 Theory and Methodology... 7-7 Pacemaker Safety Information... 7-7 MECG Waveform... 7-8

8

Maternal Non-Invasive Blood Pressure Monitoring... 8-1 Blood Pressure Safety Precautions... 8-3 Warnings... 8-4 NIBP Determination... 8-5 SuperSTAT NIBP Determination... 8-5 Accelerated Determination... 8-6 Systolic Search... 8-6 NIBP Setup Screen... 8-7 Mode... 8-7 Target... 8-7 NIBP Done Volume... 8-8 Alarms... 8-8 Alarm Volume... 8-8 NIBP Monitoring... 8-8 Checklist... 8-8 Patient Preparation... 8-8 Blood Pressure Methodology... 8-9 Hydrostatic Effect... 8-10 Manual Mode... 8-10 Automatic Mode... 8-10 Taking a Manual Reading Between Auto Determinations... 8-11 Venous Return in Auto Mode... 8-11 Adjusting the Interval Time Between Automatic Determinations... 8-11 NIBP Interval Button Shortcut... 8-12

iv

250cx Series Maternal/Fetal Monitor 2036946-001

Revision F

Terminating a Determination in Progress... 8-13 Smart BP Feature... 8-13 Enabling/Disabling Smart BP... 8-13 Methodology... 8-13

9

Maternal Pulse Oximetry Monitoring... 9-1 MSpO2 Technology... 9-3 Which Module is Installed?... 9-3 Theory of Operation... 9-4 Ohmeda TruSignal™ Oximetry... 9-4 TruSignal™ Enhanced SpO2... 9-4 Signal processing... 9-4 Masimo SET®... 9-4 Signal Processing... 9-4 Nellcor OxiMax®... 9-5 Automatic Calibration... 9-6 SatSeconds™... 9-6 SatSeconds “Safety Net”... 9-8 Using SatSeconds... 9-8 MSpO2 Setup Screen... 9-9 Response Time (Nellcor 506 Technology Only)... 9-9 Response Time (Nellcor NELL-3 Technology Only)... 9-9 Sensitivity (Masimo Technology Only)... 9-9 Averaging Time (Masimo Technology Only)... 9-10 Print Interval... 9-10 %O2 Trace... 9-10 Alarms... 9-10 Alarm Volume... 9-10 MSpO2 Methodology... 9-10 MSpO2 Pulse Beat Audio... 9-11 The MSpO2 Waveform... 9-11 Module and Probe Compatibility... 9-11 Modules and Sensors... 9-12 No Implied License... 9-12 Sensors... 9-12

10

Alarms... 10-1 Introduction... 10-3 Alarm Setup... 10-3 Master Alarm Setup Screen... 10-3 Alarms... 10-3 Alarm Volume... 10-4 Alarm Silence... 10-4

Revision F

250cx Series Maternal/Fetal Monitor 2036946-001

v

Alarm Setting Indicators... 10-5 Maternal Alarm Occurring During Setup... 10-5 Alarm Behavior... 10-5 Fetal Heart Rate Alarms... 10-6 FHR Patient Alarms... 10-6 Active Patient Alarm... 10-6 Resolved Patient Alarm... 10-6 FHR Signal Quality Alarms... 10-6 Active Signal Quality Alarm... 10-6 Resolved Signal Quality Alarm... 10-7 Silencing an FHR Audio Alarm... 10-7 Maternal Alarms... 10-7 Maternal Patient Alarms... 10-7 Active Patient Alarm... 10-7 Resolved Patient Alarm... 10-7 Signal Quality Alarms... 10-7 Active Signal Quality Alarm... 10-8 Resolved Signal Quality Alarm... 10-8 Silencing a Maternal Audio Alarm... 10-8 Alarms Summary... 10-9

11

Recorder Modes... 11-1 Modes... 11-3 Off Mode... 11-3 On Mode... 11-3 Maternal-Only Mode... 11-3 What is the Maternal-Only Mode?... 11-3 Printing Style... 11-3 Changing Recorder Modes... 11-4 Functionality with a QS System... 11-5 Paper Versus Electronic Strip Charts... 11-5 Fetal Heart Rate Alarms... 11-6 Trends... 11-6 Multiple Trends... 11-6 SpO2 Scale... 11-7 Annotations... 11-7 Standard Annotations... 11-8 Blood Pressure Annotations... 11-8 Maternal Pulse Oximetry Annotations... 11-9 Annotations from a Central Information System... 11-9 Multiple Annotations... 11-9

vi

250cx Series Maternal/Fetal Monitor 2036946-001

Revision F

Summary of Annotations... 11-10 Adjustable Recorder Font Size... 11-13 Chart Style Vital Signs Printing... 11-14 Enabling/Disabling Chart-Style Printing... 11-14 Examples of Printing Styles... 11-15 Chart-Style Printing Examples... 11-15 Real-Time Printing Example... 11-15 Chart-Style 7-Minute Exception for NIBP... 11-15 Strip Chart Paper... 11-16 Paper-Low, Paper-Out, and Paper-LoadING Error Conditions... 11-18

12

Maternal Vital Signs History... 12-1 What is the Maternal Vital Signs History Screen?... 12-3 Using the Maternal Vital Signs History Screen... 12-4 Displaying the Screen... 12-4 Selecting the HX Interval... 12-4 Printing the Maternal Vital Signs History Screen... 12-5 Printing the Entire Vital Signs History... 12-5 Printing a Page of the Vital Signs History... 12-5 Stopping the Printing of Maternal Vital Signs History... 12-5

13

Heartbeat Coincidence... 13-1 Heartbeat Coincidence Theory... 13-3 Using the Heartbeat Coincidence Feature... 13-3 Enabling/Disabling Heartbeat Coincidence Detection... 13-3 Display Indicator... 13-3 Strip Chart Annotation... 13-5

14

Waveforms... 14-1 Waveform Area... 14-3 Selecting the Waveform... 14-3 Waveform Speed... 14-3 ECG Size... 14-3 MECG Lead Select... 14-3 MECG Pacer Label... 14-3 Moving Gap... 14-4 Freezing Waveforms... 14-4 Printing a Waveform Snapshot... 14-5 Recorder On... 14-5

Revision F

250cx Series Maternal/Fetal Monitor 2036946-001

vii

Recorder in Maternal-Only Mode... 14-6 Recorder Off... 14-6 Stopping a Print Command... 14-6

15

Maintenance... 15-1 Cleaning... 15-3 Monitor Exterior... 15-3 Display... 15-4 Tocotransducer and Ultrasound Transducer... 15-4 Leg Plates and MECG Cables... 15-4 Maternal NIBP Cuffs and Hoses... 15-5 General... 15-5 Materials... 15-5 Procedure... 15-5 SpO2 Sensors... 15-6 Maternal SpO2 Calibration... 15-6 NIBP Maintenance... 15-6 Disposal of Product Waste... 15-7 Patient Applied Parts... 15-7 Packaging Material... 15-7 Monitor... 15-7

16

Troubleshooting... 16-1 General Troubleshooting... 16-3 Ultrasound Troubleshooting... 16-4 FECG Troubleshooting... 16-5 External Uterine Activity Troubleshooting... 16-5 Internal UA Troubleshooting... 16-6 MECG Troubleshooting... 16-7 Blood Pressure Troubleshooting... 16-7 Maternal Pulse Oximetry Troubleshooting... 16-8

17

Technical Specifications... 17-1 General Monitor... 17-3 Operating Modes... 17-4 Strip Chart Recorder... 17-11

viii

250cx Series Maternal/Fetal Monitor 2036946-001

Revision F

18

Supplies & Accessories... 18-1 General Add-Ons Ordering Information... 18-3 Paper Supplies Ordering Information... 18-3 Ultrasound Ordering Information... 18-3 FECG Ordering Information... 18-4 Tocotransducer Ordering Information... 18-4 IUPC Ordering Information... 18-4 MECG Ordering Information... 18-5 NIBP Ordering Information... 18-5 MSpO2 Ordering Information... 18-6 Peripheral Device Ordering Information... 18-6

A

Factory Defaults...A-1 Table of Defaults... A-3

B

Fetal Movement Detection...B-1 Introduction... B-3 Availability...B-3 Methodology...B-3 Using Fetal Movement Detection While Monitoring... B-3 Enabling/Disabling Fetal Movement Detection...B-3 Display Indicator...B-4 Strip Chart Annotation...B-4 Using the FM Remote Marker to Complement the Patient Record...B-4

C

Spectra Alerts...C-1 Important Safety Information... C-3 Using the Spectra Alert Option... C-4

Revision F

250cx Series Maternal/Fetal Monitor 2036946-001

ix

Enabling/Disabling Spectra Alerts...C-4 Methodology...C-4 Alert Indications... C-6 Active Alerts...C-6 Silencing Alerts...C-6 Resolved Alerts...C-7 Alert Suspension Feature...C-7 Enabling/Disabling the Alert Suspension Feature...C-7 Suspending Audio Alerts (and the Nurse Call Interface)...C-7 Restoring Audio Alerts (and the Nurse Call Interface)...C-7 Alert Parameters Summary... C-9 Resetting Alerts... C-12 False Pattern Recognition...C-12 Mode Switching...C-12 Trend Screen... C-13 Uterine Contraction Frequency... C-13 Enabling/Disabling UC Frequency Display...C-14 UC Frequency in UA Display Area...C-14 UC Frequency Histogram...C-15 Enabling/Disabling UC Chime...C-15 Nurse Call Interface... C-16 Alert Parameters... C-17

D

Frequently Asked Questions D-1 FAQs...D-3

x

250cx Series Maternal/Fetal Monitor 2036946-001

Revision F

1

Revision F

Safety

250cx Series Maternal/Fetal Monitor 2036946-001

1-1

Safety:

For your notes

1-2

250cx Series Maternal/Fetal Monitor 2036946-001

Revision F

Safety: General Information

General Information General Use If the monitor is cold to the touch or below ambient temperature, allow it to stabilize before use. To ensure patient safety, use only parts and accessories manufactured or recommended by GE Medical Systems Information Technologies. Parts and accessories used shall meet the requirements of EN60601-1-1. Disposable devices are intended for single use only. They should not be reused. Test all functions periodically and whenever the integrity of the monitor is in doubt. Refer to the “Maternal/Fetal Monitoring, Clinical Applications Manual” for information concerning the limitations of internal and external fetal heart rate monitoring techniques.

Responsibility of the Manufacturer GE Medical Systems Information Technologies is responsible for the effects on safety, reliability, and performance if: 

assembly operations, extensions, readjustments, modifications, or repairs are carried out by persons authorized by GE Medical Systems Information Technologies;



the electrical installation of the relevant room complies with the requirements of appropriate regulations; and



the monitor is used in accordance with the instructions of use.

Responsibility of the User This device is intended for use by clinical professionals who are expected to know the medical procedures, practices, and terminology required to monitor obstetrical patients. This manual documents all possible parameters available in the 250cx Series monitor. It is the responsibility of each hospital to ensure that the Labor and Delivery staff is trained in all aspects of the selected model. The 250cx Series monitor is only one clinical indicator of fetal status during labor. The monitor is designed to assist the perinatal staff in assessing the status of a patient. The monitor does not replace observation and evaluation of the mother and fetus at regular intervals by a qualified care provider, who will make diagnoses and decide on treatments or interventions. Visual assessment of the monitor display and strip chart must be combined with knowledge of patient history and risk factors to properly care for the mother and fetus.

Revision F

250cx Series Maternal/Fetal Monitor 2036946-001

1-3

Safety: Definitions of Terminology

Definitions of Terminology Six types of special notices are used throughout this manual. They are: Danger, Warning, Caution, Contraindication, Important, and Note. The warnings and cautions in this Safety section relate to the equipment in general and apply to all aspects of the monitor. Be sure to read the other chapters because there are additional warnings and cautions which relate to specific features of the monitor. When grouped, warnings and cautions are listed alphabetically and do not imply any order of importance.

Definitions of Terminology

1-4

Danger

A DANGER notice indicates an imminently hazardous situation which, if not avoided, will result in death or serious injury.

Warning

A WARNING indicates a potentially hazardous situation which, if not avoided, could result in death or serious injury.

Caution

A CAUTION indicates a potentially hazardous situation which, if not avoided, may result in minor or moderate injury. Cautions are also used to avoid damage to equipment.

Contraindication

A CONTRAINDICATION describes any special symptom or circumstance that renders the use of a remedy or the carrying out of a procedure inadvisable, usually because of a risk.

Important

An IMPORTANT notice indicates an emphasized note. It is something you should be particularly aware of; something not readily apparent.

Note

A NOTE indicates a particular point of information; something on which to focus your attention.

250cx Series Maternal/Fetal Monitor 2036946-001

Revision F

Safety: Fetal Monitoring Indications for Use

Fetal Monitoring Indications for Use A Corometrics 250cx Series Fetal Monitor is used for fetal surveillance.

Surveillance A Corometrics 250cx Series monitor can be used for routine non-invasive and invasive fetal monitoring throughout labor and delivery.

Maternal Monitoring Indications for Use A Corometrics 250cx Series Maternal/Fetal Monitor is intended for monitoring maternal vital signs to help assess maternal well-being. The vital signs which can be measured are summarized below. NOTE: Maternal vital signs provided by the monitor should only be used as an adjunct to patient assessment and must be used in conjunction with clinical signs and symptoms.

Blood Pressure The monitor is intended for use only in the non-invasive monitoring of maternal blood pressure (NIBP). This monitor is not intended for use in neonatal or pediatric blood pressure monitoring.

Pulse Oximetry The monitor is intended for use in the non-invasive monitoring of the functional oxygen saturation of maternal arterial blood (MSpO2).

Heart/Pulse Rate The monitor is intended for use in the non-invasive monitoring of the maternal heart/pulse rate (MHR/P). NOTE: The Corometrics 250cx Series provides both maternal heart rate and maternal pulse rate data; the heart rate data is derived from the MECG section of the monitor while the pulse rate data is derived from the NIBP or MSpO2 sections of the monitor.

Revision F

250cx Series Maternal/Fetal Monitor 2036946-001

1-5