Panorama Patient Monitoring Network Operating Instructions Rev 5.0 Dec 2016

Operating Instructions

Panorama® C E N T R A L S TAT I O N PAT I E N T M O N I TO R I N G N E T W O R K

0070-02-0656-01_revD.indd 1

9/30/11 10:29 AM

DPM™ is a trademark of Mindray DS USA, Inc. Masimo SET® is a U.S. registered trademark of Masimo Corp. Mindray® is a trademark or registered trademark of Shenzhen Mindray Bio-Medical Electronics Co., Ltd. Nellcor® is U.S. registered trademark of Tyco International Ltd. Panorama® is a U.S. registered trademark of Mindray DS USA, Inc. Passport® is a U.S. registered trademark of Mindray DS USA, Inc. Spectrum® is a U.S.registered trademark of Mindray DS USA, Inc. Symbol® is a U.S. registered trademark of Symbol Technologies, Inc. Vigilance® is a U.S. registered trademark of Edwards Lifesciences Corporation. View 12™ is a trademark of Mindray DS USA, Inc. PureLight® is a U.S. registered trademark of the Nonin Medical, Inc.

Copyright © Mindray DS USA, Inc., 2009-2016. All rights reserved. Contents of this publication may not be reproduced in any form without permission of Mindray DS USA, Inc.

Panorama® Operating Instructions

Company Contact Manufacturer:

Shenzhen Mindray Bio-Medical Electronics Co., Ltd.

Address:

Mindray Building,Keji 12th Road South, High-tech industrial park, Nanshan, Shenzhen 518057, P.R.China

Website:

www.mindray.com

E-mail Address:

[email protected]

Tel:

+86 755 81888998

Fax:

+86 755 26582680

Technical Support:

Mindray DS USA, Inc.

Address:

800 MacArthur Boulevard, Mahwah, NJ 07430, USA

Website:

www.mindray.com

Tel:

800.288.2.121(US) 201.995.8000 (International)

Fax:

+1.201.995.8680

Panorama® Operating Instructions

Table of Contents

Company Contact... 2 ... 2 Foreword ... x Warnings, Cautions, and Notes ... x Indications for Use ... xix Unpacking Information ... xix Symbols and Descriptions ... xx Technical Support ... xxii

System Overview ... 1 - 1 Licensing Key ... 1 - 2 Supported Devices ... 1 - 3 Panorama Central Station... 1 - 3 Panorama ViewStation and WorkStation ... 1 - 3 Panorama Telemetry Server ... 1 - 4 Panorama Wireless Transceiver... 1 - 4 Panorama Gateway... 1 - 5 Panorama Web Viewer... 1 - 5 Passport 2 Bedside Monitor ... 1 - 6 Passport V Bedside Monitor ... 1 - 8 Spectrum Bedside Monitor ... 1 - 10 Spectrum OR Bedside Monitor ... 1 - 12 DPM 6 and DPM 7 Bedside Monitors... 1 - 14 Passport 12M/Passport 17M Bedside Monitors... 1 - 16 Passport 8/Passport 12 Bedside Monitors ... 1 - 18 T1 Monitor ... 1 - 19 V 12/V 21 Monitors... 1 - 21 Panorama Telepack ... 1 - 23 Network Printer ... 1 - 25 Wireless Network ... 1 - 25 Requirements for Setting up the Wireless Network ... 1 - 25 Wireless Network Related Problems... 1 - 27 Antivirus ... 1 - 28 Troubleshooting ... 1 - 29

Getting Started ... 2 - 1 The Panorama Central Station ... 2 - 2 The ViewStation and the WorkStation ... 2 - 4 The Main Screen ... 2 - 7 Patient Tiles... 2 - 7 Menu Bar ... 2 - 10 Tabs ... 2 - 14 Sidebar Buttons ... 2 - 15 Common Controls and Elements ... 2 - 16 Quick Reference Guide ... 2 - 21 Auto-Admitting a Patient ... 2 - 21 Standby ... 2 - 21 Discharge ... 2 - 22 Display... 2 - 23 Patient Alarms ... 2 - 24 Viewing List Trends ... 2 - 26 Viewing Events... 2 - 26 Viewing Disclosure Data... 2 - 26 Troubleshooting ... 2 - 28

Alarm Behavior ... 3 - 1 General Alarm Behavior ... 3 - 2

Panorama® Operating Instructions

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Table of Contents

Physiological Alarms ... 3 - 2 Alarm Behaviors ... 3 - 2 Alarm Options ... 3 - 3 Physiological Alarm Responses... 3 - 4 Technical Alarms ... 3 - 6 Alarm Behaviors ... 3 - 6 Alarm Options ... 3 - 6 Alarm Responses ... 3 - 6 System Alarms ... 3 - 6 Alarm Behaviors ... 3 - 6

Arrhythmia and ST Analysis... 4 - 1 Lead Placement Procedures ... 4 - 2 Skin Preparation... 4 - 2 Electrode Patches... 4 - 2 Lead Placement Methods: AHA and IEC ... 4 - 3 Arrhythmia Algorithm ... 4 - 11 ST Segment Analysis ... 4 - 14 Arrhythmia Alarms ... 4 - 15 Lethal Arrhythmia Alarms... 4 - 16 Non-Lethal Arrhythmia Alarms... 4 - 17 Extreme Bradycardia/Extreme Tachycardia... 4 - 22 Troubleshooting ... 4 - 24

Patient Setup Functions ... 5 - 1 Demographics Tab... 5 - 2 Communications with the Panorama Gateway ... 5 - 2 Accessing the Demographics Tab ... 5 - 3 Entering Data in the Demographics Tab ... 5 - 4 Sidebar Buttons ... 5 - 24 Troubleshooting... 5 - 25 Transfer Tab ... 5 - 27 Accessing the Transfer Tab ... 5 - 27 Room To Room Transfer Without Device ... 5 - 27 Room To Room Transfer With Device ... 5 - 29 Central To Central Transfer Without Device ... 5 - 31 Sidebar Buttons ... 5 - 35 Troubleshooting... 5 - 38 Discharge Tab ... 5 - 43 Accessing the Discharge Tab ... 5 - 43 Discharging a Patient from the Central Station and the Bedside Monitor ... 5 - 43 Discharging a Patient from the Central Station... 5 - 44 Discharging a Patient from a Telepack Device... 5 - 45 Sidebar Button - Normal Screen ... 5 - 45 Troubleshooting... 5 - 45 Display Tab... 5 - 47 Accessing the Display Tab ... 5 - 47 Components of the Display Tab ... 5 - 48 Configuring the Display Tab ... 5 - 52 Sidebar Buttons ... 5 - 55 Troubleshooting... 5 - 55 Standby Tab ... 5 - 56 Accessing the Standby Tab ... 5 - 56 Placing a Patient in Standby Mode ... 5 - 56 Removing a Patient from Standby Mode ... 5 - 57 Sidebar Button - Normal Screen ... 5 - 57

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Panorama® Operating Instructions

Table of Contents

Troubleshooting... 5 - 58 Wave Gain Tab (Patient) ... 5 - 59 Accessing the Wave Gain Tab (Patient)... 5 - 59 Changing a Patient’s Wave Gain Settings ... 5 - 60 Sidebar Buttons ... 5 - 61 Troubleshooting... 5 - 61 Print Setup Tab (Patient) ... 5 - 62 Accessing the Print Setup Tab... 5 - 62 Changing a Patient’s Print Setup... 5 - 63 Sidebar Buttons ... 5 - 63 Troubleshooting... 5 - 64

Patient Alarm Functions ... 6 - 1 Patient Alarm Setup Tab (Optional) ... 6 - 2 Accessing the Patient Alarm Setup Tab ... 6 - 2 Entering a Password ... 6 - 2 Sidebar Buttons ... 6 - 3 Troubleshooting... 6 - 3 Alarm Limits Tab (Patient) ... 6 - 4 Accessing the Alarm Limits Tab... 6 - 4 Configuring Patient Alarm Limits ... 6 - 5 Simultaneous Alarm Limit Editing ... 6 - 7 Sidebar Buttons ... 6 - 8 Generating a Patient Alarm Report ... 6 - 10 Testing Alarm Limits ... 6 - 10 Troubleshooting... 6 - 10 Alarm Responses Tab (Patient) ... 6 - 13 Accessing the Alarm Responses Tab... 6 - 13 Configuring Alarm Responses ... 6 - 15 Sidebar Buttons ... 6 - 16 Troubleshooting... 6 - 19

Views ... 7 - 1 Bedside Tab ... 7 - 2 Accessing the Bedside Tab ... 7 - 2 Bedside Tab (All Waveforms View)... 7 - 3 Generating an All Strips Report ... 7 - 8 Bedside Tab (All ECG View) ... 7 - 8 Trends Tab ... 7 - 14 Accessing the Trends Tab ... 7 - 14 Trends Tab (List View) ... 7 - 15 Trends Tab (Graphic View) ... 7 - 20 Generating a Graphic Trend Report... 7 - 23 Events Tab ... 7 - 25 Accessing the Events Tab... 7 - 25 Events Tab (List View) ... 7 - 26 Event Filtering ... 7 - 29 Events Tab (Waveforms View) ... 7 - 35 Accessing the Waveforms View... 7 - 35 Disclosure Tab ... 7 - 43 Accessing the Disclosure Tab ... 7 - 43 Disclosure Tab (Waveforms View) ... 7 - 49 ST Tab... 7 - 58 Accessing the ST Tab ... 7 - 58 Generating an ST Report ... 7 - 63 Troubleshooting... 7 - 63

Panorama® Operating Instructions

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Table of Contents

Report Functions ... 8 - 1 Patient Reports Tab ... 8 - 2 Accessing the Patient Reports Tab ... 8 - 2 All Strips Report... 8 - 2 Full Disclosure Report ... 8 - 6 ST Report... 8 - 14 Trend List Report ... 8 - 17 Event List Report ... 8 - 21 Patient Alarm Report ... 8 - 25 Troubleshooting... 8 - 29 System Reports Tab ... 8 - 31 Accessing the System Reports Tab ... 8 - 31 All Strips (All Patients) Report ... 8 - 32 Equipment Report ... 8 - 36 Paging Report ... 8 - 37 Print Status Tab... 8 - 40 Print Status Tab List Box ... 8 - 40 Removing Print Jobs from the Print Queue ... 8 - 40 Sidebar Buttons ... 8 - 41 Troubleshooting... 8 - 41 Additional Reports ... 8 - 43 Accessing Additional Reports ... 8 - 43 Event Zoom In Report ... 8 - 43 Full Disclosure Zoom In Report... 8 - 46 Printing a Full Disclosure Zoom In Report ... 8 - 49 Graphic Trend Report ... 8 - 51 12-lead Report ... 8 - 55 Telepack Error Log Report... 8 - 57 System Alarm Report... 8 - 59 Troubleshooting... 8 - 64

System Setup Functions... 9 - 1 Parameter Color Tab ... 9 - 2 Accessing the Parameter Color Tab ... 9 - 2 Selecting a Color for Parameter Data ... 9 - 2 Sidebar Button - Normal Screen ... 9 - 2 Troubleshooting... 9 - 3 Touch Screen Tab ... 9 - 4 Accessing the Touch Screen Tab... 9 - 4 Sidebar Button - Normal Screen ... 9 - 6 Troubleshooting... 9 - 6 Installation Setup Tab ... 9 - 7 Accessing the Installation Setup Tab... 9 - 7 Entering a Password ... 9 - 7 Sidebar Button - Normal Screen ... 9 - 8 Troubleshooting... 9 - 8 Care Group Tab ... 9 - 9 Accessing the Care Group Tab ... 9 - 9 Editing Care Group Labels... 9 - 9 Assigning a Patient Tile to a Care Group... 9 - 10 Sidebar Button - Normal Screen ... 9 - 10 Troubleshooting... 9 - 10 Volume Tab... 9 - 11 Accessing the Volume Tab ... 9 - 11

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Panorama® Operating Instructions

Table of Contents

Sidebar Button - Normal Screen ... 9 - 13 Troubleshooting... 9 - 13 System Alarms Tab... 9 - 14 System Alarms (Options) Tab ... 9 - 14 System Event Filtering... 9 - 19 System Alarms (Alarm Limits) Tab ... 9 - 24 System Alarms (Alarm Responses) Tab... 9 - 26 Passwords Tab ... 9 - 29 Accessing the Installation Setup Tab... 9 - 29 Modifying a Default Password... 9 - 30 Sidebar Button - Normal Screen ... 9 - 31 Troubleshooting... 9 - 31 Equipment Setup Tab... 9 - 33 Accessing the Equipment Setup Tab ... 9 - 33 Entering New Equipment ... 9 - 34 Modifying Equipment Included in the Equipment List ... 9 - 35 Deleting Equipment in the Equipment List ... 9 - 36 Sidebar Buttons ... 9 - 36 Troubleshooting... 9 - 36 More Tab... 9 - 39 Accessing Additional (More) Tabs ... 9 - 39 Previous Tab ... 9 - 40 Accessing Previous Tabs... 9 - 40 Date/Time Tab ... 9 - 41 Accessing the Date/Time Tab... 9 - 41 Set Date/Time... 9 - 42 Sidebar Button - Normal Screen ... 9 - 44 Troubleshooting... 9 - 44 Print Setup Tab (System)... 9 - 45 Accessing the Print Setup Tab (Central Station) ... 9 - 45 Accessing the Print Setup Tab (ViewStation and WorkStation) ... 9 - 46 Setting the System Default Print Setup ... 9 - 46 Troubleshooting... 9 - 46 Unit Priorities Tab... 9 - 47 Accessing the Unit Priorities Tab ... 9 - 47 Setting a Default Order in the Unit Priorities Tab... 9 - 47 Sidebar Buttons ... 9 - 48 Troubleshooting... 9 - 49 Unit Choices Tab ... 9 - 50 Accessing the Unit Choices Tab (Central Station) ... 9 - 50 Accessing the Unit Choices Tab (ViewStation and WorkStation) ... 9 - 50 Setting the Unit Choices (Central Station)... 9 - 51 Setting the Unit Choices (ViewStation and WorkStation) ... 9 - 54 Arrhythmia Setup (Telepack) ... 9 - 54 ST Settings (Telepack)... 9 - 56 Pacer ... 9 - 57 Configuring Default Report Waveform Parameters ... 9 - 58 Sidebar Buttons ... 9 - 59 Troubleshooting... 9 - 60 Wave Gain Tab (System)... 9 - 61 Accessing the Wave Gain Tab... 9 - 61 Changing the System Default Wave Gain Settings ... 9 - 61 Sidebar Button - Normal Screen ... 9 - 62 Troubleshooting... 9 - 63

Panorama® Operating Instructions

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Table of Contents

Wireless Tab ... 9 - 64 Accessing the Wireless Tab ... 9 - 64 Entering Wireless Settings (Telepack) ... 9 - 64 Sidebar Buttons ... 9 - 67 Error Log Sidebar Button... 9 - 68 Device ID... 9 - 68 Connect Field... 9 - 69 Troubleshooting... 9 - 71

Telepack (Optional)... 10 - 1 Introduction ... 10 - 2 Applied Parts ... 10 - 2 Button Indicators ... 10 - 3 Nurse Call Button ... 10 - 3 Attendant Present Buttons ... 10 - 3 LEAD SELECT Button ... 10 - 3 CHECK Button ... 10 - 4 RECORD Button ... 10 - 4 Indicator Lights ... 10 - 4 ECG Lead Diagram LED Indicator Lights ... 10 - 4 Link Status LED Indicator Light... 10 - 6 Battery Status LED Indicator Light ... 10 - 6 Operating Instructions ... 10 - 7 Initial Setup of Telepack ... 10 - 7 Securing the Telepack Device... 10 - 9 Telepack with Nonin SpO2 Module (Optional) ... 10 - 10 Introduction... 10 - 10 Installing the SpO2 Module on the Telepack... 10 - 10 Removing the SpO2 Module from the Telepack ... 10 - 11 Installing the Patient Cable... 10 - 12 Attaching the Finger Clip Sensor ... 10 - 13 Removing the Patient Cable ... 10 - 14 Approved Telepack Accessories ... 10 - 15 Troubleshooting ... 10 - 17

User Maintenance ... 11 - 1 Touch Screen User Maintenance ... 11 - 2 Care and Cleaning of the Touch Screen ... 11 - 2 Telepack User Maintenance ... 11 - 3 Storing the Telepack ... 11 - 3 Cleaning the Telepack Device ... 11 - 3 Disinfecting the Telepack Device... 11 - 6 Disposal of the Telepack Device ... 11 - 7 Disposing of Batteries... 11 - 8

Parameter Specifications... 12 - 1 Parameter Specifications... 12 - 2 Heart Rate: HR ... 12 - 2 Respiration: Resp... 12 - 3 NIBP ... 12 - 3 SpO2 ...12 - 4 Nonin SpO2...12 - 5 IBP: mmHg... 12 - 5 CO2...12 - 6 O2...12 - 6 N2O ... 12 - 7 Anesthetic Agents: Iso, Enf, Des, Sev, Hal, Agent ... 12 - 7

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Panorama® Operating Instructions

Table of Contents

Premature Ventricular Contraction (PVC)... 12 - 8 QT/QTc ... 12 - 8 Pause per Minute (Pause/min)... 12 - 8 Temp: T1,T2, T3, Delta T, and T Blood ... 12 - 9 ST... 12 - 10 Cardiac Output ... 12 - 10 Cardiac Index ... 12 - 10 Continuous Cardiac Output (CCO) ... 12 - 11 Continuous Cardiac Output STAT (CCO STAT)... 12 - 11 Continuous Cardiac Index (CCI) ... 12 - 11 Continuous Cardiac Index STAT (CCI STAT)... 12 - 11 System Vascular Resistance (SVR) ... 12 - 12 System Vascular Resistance Index (SVRI) ... 12 - 12 Mixed Venous Saturation (SvO2) ... 12 - 12 Central Venous Oxygen Saturation (ScvO2) ... 12 - 12 Pulmonary Artery Wedge Pressure (PAWP)... 12 - 13 Bispectral Index (BIS/BIS L/BIS R) ... 12 - 13 Battery Percentage... 12 - 13 Invalid Data Display... 12 - 14

Alarms and Events ... 13 - 1 Physiological Alarms and Events ... 13 - 2 Alarm Limit Settings... 13 - 2 Physiological Alarm Event Messages... 13 - 14 Physiological Alarms and Events: Arrhythmias ... 13 - 17 Technical Alarms and Events ... 13 - 19 System Event Messages and Error Codes ... 13 - 25 Operator Position... 13 - 26 Alarm Verification ... 13 - 26

Network Tab (Optional) ... 14 - 1 Network Tab ... 14 - 2 Accessing the Network Tab ... 14 - 2 Sorting the Contents of the Network Tab List Box ... 14 - 2 Assigning Patient Tiles in the Network Tab... 14 - 2 Removing a Patient Tile Assignment in the Network Tab ... 14 - 4 Removing All Patient Tile Assignments in the Network Tab ... 14 - 4 Refreshing the Network Tab List Box ... 14 - 4 Troubleshooting... 14 - 5

Paging Tab (Optional)... 15 - 1 Paging Password Tab ... 15 - 2 Accessing the Paging Tab... 15 - 2 Entering a Password ... 15 - 2 Sidebar Buttons ... 15 - 3 Troubleshooting... 15 - 3 Paging Tab ... 15 - 4 Accessing the Paging Tab... 15 - 4 Adding a Pager ... 15 - 4 Assigning a Patient Tile ... 15 - 5 Adding All Patient Tiles to a Pager... 15 - 6 Removing a Patient Tile Assignment ... 15 - 6 Removing All Patient Tiles from a Pager... 15 - 6 Editing a Pager ... 15 - 7 Removing a Pager ... 15 - 7 Resending a Failed Page ... 15 - 8

Panorama® Operating Instructions

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Table of Contents

Generating a Paging Report ... 15 - 9 Troubleshooting... 15 - 9

Performance Specifications ... 16 - 1 Parameter Performance... 16 - 2 ECG Performance Requirements ... 16 - 2 ECG Derived Heart Rate Meter Performance Requirements ... 16 - 4 ST Segment Analysis ... 16 - 5 Arrhythmia Analysis ... 16 - 6 NIBP Performance Characteristics ... 16 - 6 Pulse Rate ... 16 - 7 IBP... 16 - 7 Temperature Performance Requirements ... 16 - 7 ECG Respiration Performance Requirements... 16 - 7 SpO2 ...16 - 7 CO2 Performance Requirements ... 16 - 8 BIS Performance Requirements ... 16 - 8 Panorama Central Station and Panorama Telemetry Server ... 16 - 9 Real Time Clock ... 16 - 9 Power Supply... 16 - 10 Operating Temperature ... 16 - 10 Operating Humidity ... 16 - 10 Operating Altitude... 16 - 10 Storage Temperature... 16 - 10 Storage Humidity... 16 - 10 Storage Altitude ... 16 - 10 Standards... 16 - 11 Information Display and Control ... 16 - 12 Electromagnetic Compatibility ... 16 - 13 Wireless Essential Performance ... 16 - 16 Physical Characteristics ... 16 - 17 Keyboard ... 16 - 17 Mouse ... 16 - 17 Displays... 16 - 17 21" CRT Display ... 16 - 17 20" CRT Display ... 16 - 18 19" Flat Panel ... 16 - 18 18.1" Flat Panel ... 16 - 18 Touch Screen ... 16 - 19 Network Printer ... 16 - 19 Requirements ... 16 - 19 Wireless Communication ... 16 - 20 Panorama Wireless Transceiver/Splitters/Antennas/Cable Repeaters ... 16 - 21 Panorama Wireless Transceiver... 16 - 21 Panorama Antenna ... 16 - 22 Cable Repeater ... 16 - 22 Splitter ... 16 - 22 Environmental Characteristics for the Panorama Wireless Transceiver/Splitters/Antennas... 16 - 23 Telepack Specifications ... 16 - 24 Safety Designations ... 16 - 24 Panorama Server Analysis ... 16 - 24 Environmental Characteristics... 16 - 25 Electromagnetic Compatibility ... 16 - 25 FCC Labeling ... 16 - 30 Compliance ... 16 - 30

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Panorama® Operating Instructions

Table of Contents

Specific Absorption Rate ... 16 - 31 Nonin SpO2 Module Specifications ... 16 - 32 Environmental Characteristics... 16 - 32 Measurement Specifications... 16 - 32 Electromagnetic Compatibility ... 16 - 33 Panorama Instrument Radio-608 ... 16 - 37 Approved Accessory ... 16 - 37 FCC Label ... 16 - 37

Glossary... 17 - 1 Terms, Acronyms, and Abbreviations ... 17 - 2

Anomalies ... 18 - 1 Anomalies Description ... 18 - 2

Panorama® Operating Instructions

ix

Foreword

Introduction

Foreword The Panorama Operating Instructions are intended to provide the information required to operate the Panorama Patient Monitoring Network. For additional information and technical assistance, please contact an area or regional Representative. A general understanding of the features and functions of the Panorama Patient Monitoring Network and its components is a prerequisite for the proper use of this equipment. Therefore, do not operate this equipment before reading these instructions thoroughly, including all appropriate warnings and cautions. CAUTION:

US Federal law restricts the sale of this device to, by or on the order of a physician.

NOTE:

Figures in this manual are provided for reference purposes only. Screens will likely differ based on the monitoring device configuration, licenses available, parameters selected and patient configuration of the Panorama Patient Monitoring Network.

Warnings, Cautions, and Notes Please read and adhere to all of the warnings and cautions listed throughout this manual. A WARNING is provided to alert the user to potentially serious outcomes (death, injury or serious adverse events) to the patient or the user. A CAUTION is provided to alert the user that special care should be taken for the safe and effective use of the device. They will include actions to be taken to avoid effects on patients or users that will not be potentially life threatening or result in serious injury, but about which the user should be aware. A NOTE is provided when additional general information is available.

Panorama® Operating Instructions

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Introduction

Warnings, Cautions, and Notes

Warnings WARNING: Only qualified and trained personnel or Service Personnel should attempt to service the equipment. Service is defined as any activity requiring the cover to be removed for internal adjustments, parts replacements, repairs or software upgrades of any kind to insure compatibility. WARNING: To insure compatibility with the operating system and applications software, use only approved components to repair any part of the Panorama Patient Monitoring Network. Use of unauthorized software, devices, accessories, or cables may render the application unsuitable for medical patient monitoring. It may also result in increased electromagnetic emissions or decreased Immunity of the system. WARNING: Route cables neatly. Ensure cables are not in the way of patient or hospital personnel. WARNING: Do not incinerate batteries, possible explosion may occur. WARNING: Some of the equipment on the Panorama Patient Monitoring Network must utilize the hospital emergency power system. Failure to do so will result in loss of monitoring during extended periods of power failure. The back-up power time period, for the Panorama Patient Monitoring Network, is limited. WARNING: The 18.1" flat panel may tip over, if the display head is inclined to an angle greater than 45° backward tilt. If the user elects to have the display head inclined to an angle greater than 45° backward tilt, the flat panel must be attached to a secure mounting surface via three screw locations on the bottom of the base. WARNING: Do not put MPSO (Multiple Portable Socket Outlets, i.e., multiple outlet extension cords) used with the Panorama Patient Monitoring Network equipment on the floor. Connect only approved accessories and components to the same MPSO as the Panorama Patient Monitoring Network equipment. Do not overload MPSOs. Use only MPSOs that comply with the requirements of IEC 60601-1-1. WARNING: Incorrect setting or silencing of patient alarms can jeopardize patient safety. WARNING: Operator should check that the current alarm presets are appropriate prior to use on each patient. WARNING: A hazard can exist if different alarm presets are used for the same or similar equipment in any single area. WARNING: When the All Non-High Alarms Pause/Off sidebar button is enabled, the Panorama Central Station will not monitor any priority 2 and priority 3 physiological alarms, and will not display numeric physiological or technical alarms for the selected patient tile.

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Panorama® Operating Instructions

Warnings, Cautions, and Notes

Introduction

WARNING: When the All Alarms Pause/Off sidebar button is enabled, the Panorama Central Station will not monitor any lethal or non-lethal arrhythmias and will not display numeric physiological or technical alarms for the selected patient tile. WARNING: The Telepack should not be used adjacent to or stacked with other equipment. If adjacent or stacked use is necessary, the Telepack should be observed to verify normal operation in the configuration in which it will be used. WARNING: The Telepack with Nonin SpO2 module should only be used with Nonin-manufactured PureLight® pulse oximeter sensors. Using other manufacturers’ sensors can result in inaccurate pulse oximeter performance. WARNING: Do not use the Telepack with Nonin SpO2 module in an explosive atmosphere or in the presence of flammable anesthetics or gases. WARNING: Loss of SpO2 monitoring when using the Telepack with Nonin SpO2 module can result if any objects hinder the pulse measurement. Ensure that no blood flow restrictions (e.g. blood pressure cuff) hinder pulse measurements. WARNING: The Telepack with Nonin SpO2 module does not meet defibrillation-proof requirement per IEC 60601-1. WARNING: Operation of the Telepack with Nonin SpO2 module below the minimum amplitude of 0.3% modulation may cause inaccurate SpO2 results. WARNING: The Panorama Telepack is NOT intended for use in a magnetic resonance imaging (MRI) environment. The Telepack must be physically removed if a patient enters the MRI environment; induced currents may potentially cause burns. WARNING: The Panorama Patient Monitoring Network, including all related system components, is NOT intended for use in a magnetic resonance imaging (MRI) environment. WARNING: Do not use a damaged SpO2 sensor. WARNING: Using unapproved accessories, sensors, and cables may result in increased emission and/or decreased immunity of this device. WARNING: As with all medical equipment, carefully route cables and connections to reduce the possibility of entanglement or strangulation. WARNING: PACEMAKER PATIENTS - Indication of the heart-rate may be adversely affected by cardiac pacemaker pulses or by cardiac arrhythmias. Keep pacemaker patients under close surveillance. Refer to ‘‘ECG Performance Requirements’’ on page 16-2 for disclosure of the pacer rejection capability. WARNING: PACEMAKER PATIENTS - Rate meters may continue to count the pacemaker rate during occurrences of cardiac arrest or some arrhythmias. Do not rely entirely upon rate meter alarms. Keep pacemaker patients under close surveillance.

Panorama® Operating Instructions

xii

Introduction

Warnings, Cautions, and Notes

WARNING: PACEMAKER PATIENTS – On ventricular paced patients, episodes of Ventricular Tachycardia may not always be detected. Do not rely entirely upon the system’s automated arrhythmia detection algorithm. Keep pacemaker patients under close surveillance. WARNING: Changing the patient alarm limits at the WorkStation will automatically change the patient alarm limits at the Panorama Central Station AND the bedside monitor (if applicable) for the selected patient tile. WARNING: Electrode polarization: some electrodes may be subject to large offset potentials due to polarization. Use only electrodes as recommended by Mindray. Recovery time after application of defibrillator pulses may be especially compromised. Squeeze bulb electrodes commonly used for diagnostic ECG recording may be particularly vulnerable to this effect. Electrodes of dissimilar metals should not be used unless the amplifier can handle polarization potentials as high as 1 volt (V). WARNING: To reduce the hazard of burns in the high-frequency surgical neutral electrode connection, the electrodes should not be located between the surgical site and the electro-surgical unit return electrode.

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Panorama® Operating Instructions

Warnings, Cautions, and Notes

Introduction

Cautions CAUTION:

For proper operation do not obstruct the fan air holes.

CAUTION:

For proper operation use only hospital grade power cords.

CAUTION:

For proper operation, do not use the Panorama Patient Monitoring Network equipment with a frayed or damaged power cord.

CAUTION:

For proper operation never place fluids on top of this equipment. In case of accidental spillage, wipe clean immediately and have the system serviced to ensure no hazard exists.

CAUTION:

Do not block the speakers. Set the volume levels so that alarms can be heard at all times, as described in this Operation Manual.

CAUTION:

Dispose of single use items in accordance with hospital policy.

CAUTION:

The bedside device should be disconnected from the Panorama Central Station when changing the CO2 units of measurement.

CAUTION:

For proper monitoring of patient information, do not block the operators' clear view of the Panorama Patient Monitoring Network data display(s).

CAUTION:

If passwords are changed from the factory defaults, users MUST ensure that they document new passwords in the space provided in this manual. For additional information refer to ‘‘Passwords Tab’’ on page 9-29. Failure to recall user defined passwords will render the system UNUSABLE.

CAUTION:

The Panorama Telepack and Instrument Radio are wireless devices and may be subject to intermittent signal dropout. Panorama wireless devices are designed to perform with a maximum cumulative signal dropout of one minute in a 24-hour period under ideal conditions. A crowded wireless environment or interference from other medical or nonmedical devices, either intentional (e.g., VOIP phones, pagers, asset tracking systems, etc.) or unintentional (e.g., AC motors, microwave ovens, paper shredders, etc.), may result in a significantly increased amount of signal dropout experienced by any one or multiple wireless device(s).

CAUTION:

Operation of the wireless product requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service.

CAUTION:

Changes or modifications not expressly approved by Mindray DS USA, Inc. could void the user's authority to operate the equipment.

CAUTION:

The Telepack and the Telepack with Nonin SpO2 module should not be used when the Electro Surgical Unit (ESU) is active.

CAUTION:

To avoid potential system issues, deactivate the touch screen before cleaning.

Panorama® Operating Instructions

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Introduction

xv

Warnings, Cautions, and Notes

CAUTION:

DO NOT spray glass cleaner directly on a display as it could possibly leak inside a non-sealed unit and cause damage.

CAUTION:

Follow your hospital protocol for handling of blood and body fluids.

CAUTION:

The use of the Telepack may affect the functioning of other medical electrical equipment operating in the same frequency band.

CAUTION:

Conductive parts of electrodes and associated connectors for applied parts and neutral electrode should not contact other conductive parts and earth.

CAUTION:

The Telepack may not function properly, if it was subjected to extreme mechanical forces.

CAUTION:

The Telepack may not function if the batteries installed in the device are corroded. Use only approved batteries (P/N 0146-00-0077-01) in the Telepack and observe proper polarity. Installing batteries with the incorrect polarity may cause the batteries to become excessively warm.

CAUTION:

The Telepack should not be attached to the patient when the device is being programmed into the system.

CAUTION:

Ensure that the ECG lead cable is plugged into the port firmly, the end cap of the battery is firmly secured and the serial port is also secured with the protective plug to prevent fluids from entering into the Telepack.

CAUTION:

When disconnecting ECG leads from the patient, do not pull on the leadsets. This will decrease the life of the leadsets. Grasp the connectors on the leadset and pull gently.

CAUTION:

Ensure that the lead wires are not inadvertently caught in the bed rails. If this happens, the insulation may get cut or the leadset may break.

CAUTION:

Using more than one type of electrode on the same patient should be avoided because of variations in electrical resistance.

CAUTION:

The LEDs on the Telepack may not be clearly visible under brightly lit conditions. The lighting should be adjusted to ensure that all LED indicators are clearly visible.

CAUTION:

The user should monitor the Panorama Central Station for messages from the Telepack that indicate a low battery condition.

CAUTION:

Periodically press the CHECK button on the Telepack to verify the battery condition.

CAUTION:

Some pacemakers may contain a respiratory sensor that may produce artifact on an ECG waveform.

CAUTION:

Prior to sterilization, lead sets must be removed from the Telepack. The Telepack and/or the Telepack with Nonin SpO2 must not be sterilized.

CAUTION:

Visually inspect the battery compartment for any foreign object prior to use.

Panorama® Operating Instructions

Warnings, Cautions, and Notes

Introduction

CAUTION:

Ensure that the batteries are removed when the Telepack is being stored.

CAUTION:

Tissue damage or inaccurate SpO2 measurements may be caused by incorrect sensor application or use, such as wrapping too tightly, applying supplemental tape, failing to inspect the sensor site periodically, or failing to position appropriately. Carefully read the sensor directions for use, the Panorama Operating Instructions, and all precautionary information before use.

CAUTION:

The accuracy of the SpO2 measurement may be affected if the total cable length (including extension cables) is greater than 3.28 yards (3 meters).

CAUTION:

Inaccurate SpO2 measurements may be caused by: •

Incorrect sensor application or use

•

Significant levels of dysfunctional hemoglobins, (e.g., carboxyhemoglobin or methemoglobin)

•

Intra-vascular dyes such as indocyanine green or methylene blue

•

Exposure to excessive illumination such as surgical lamps (especially ones with a xenon light source), bilirubin lamps, fluorescent lights, infrared heating lamps, or excessive ambient light. In such cases, cover the sensor site with opaque material.

•

Excessive patient movement

•

Venous pulsations

•

Electro-surgical interference

•

Placement of a sensor on an extremity that has a blood pressure cuff, arterial catheter, or intra-vascular line.

•

Cold extremities due to reduced circulation.

•

Nail polish or fungus

CAUTION:

In certain situations in which perfusion and signal strength are low, such as in patients with thick or pigmented skin, inaccurately low SpO2 readings will result. Verification of oxygenation should be made, especially in patients with chronic lung disease, before instituting any therapy or intervention.

CAUTION:

Many patients suffer from poor peripheral perfusion due to hypothermia, hypovolemia, severe vasoconstriction, reduced cardiac output, etc. These symptoms may cause a loss in vital sign readings.

CAUTION:

Prolonged and continuous monitoring may increase the risk of skin erosion and pressure necrosis at the site of the sensor. Check the SpO2 sensor site frequently to ensure proper positioning, alignment and skin integrity at least every eight (8) hours; with the Adult and Pediatric re-usable finger sensor, check every four (4) hours; for patients of poor perfusion or with skin sensitive to light, check every 2 - 3 hours; more frequent examinations may be required for different patients. Change the sensor site if signs of circulatory compromise occur.

Panorama® Operating Instructions

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