ABP Monitor 90207 and 90217 Operations Manual Rev F

Copyright 2002 Spacelabs Medical, Inc. All rights reserved. Contents of this publication may not be reproduced in any form without the written permission of Spacelabs Medical, Inc. Products of Spacelabs Medical are covered by U.S. and foreign patents and/or pending patents. Printed in U.S.A. Specifications and price change privileges are reserved. Spacelabs Medical considers itself responsible for the effects on safety, reliability and performance of the equipment only if: • • •

assembly operations, re-adjustments, modifications or repairs are carried out by persons authorized by Spacelabs Medical, and the electrical installation of the relevant room complies with the requirements of the standard in force, and the equipment is used in accordance with the operations manual.

Spacelabs Medical will make available, on request, such circuit diagrams, component part lists, descriptions, calibration instructions or other information which will assist appropriately qualified technical personnel to repair those parts of the equipment which are classified by Spacelabs Medical as field repairable. CORPORATE OFFICES Spacelabs Medical, Inc. 15220 N.E. 40th Street P.O. Box 97013 Redmond, WA 98073-9713 U.S.A.

Spacelabs Medical Instruments (Tianjin) Co. Ltd. 6th Floor, Wang Jing Building 9 Wang Jing Zhong Huan South Road Chaoyang District, Beijing 100015

Telephone: 425-882-3700 Fax: 425-885-4877 Telex: 4740085 SPL UI

CHINA

Spacelabs Medical Products Pty. Ltd. Macquarie View Estates Unit 1, 112-118 Talavera Road North Ryde, N.S.W. 2113

Authorized EC Representative:

AUSTRALIA Telephone: 61-2-9878-6644 Fax: 61-2-9878-4820 Spacelabs Medical Products GmbH Jochen Rindt Straße 25 1230 Vienna AUSTRIA Telephone: 43-1-616 52 37 Fax: 43-1-616 52 37-11 Spacelabs Medical B.V. Airport Boulevard Office Park Bessenveldstraat 25A 1831 Diegem BELGIUM Telephone: 32 2 7164026 Fax: 32 2 7164114 Spacelabs Medical Products, Ltd. 151 Superior Boulevard, Unit 1 Mississauga, Ontario L5T 2L1 CANADA Telephone: 905-670-5880 Fax: 905-670-5883 Spacelabs Produits Medicaux Ltée 6030 rue Vanden Abeele St. Laurent, Quebec H4S 1R9

Telephone: 86-10-6438 1705 Fax: 86-10-6438 1707

Spacelabs Medical Sarl 6, Allée des Saules Europarc 94042 Créteil Cedex FRANCE Telephone: 33 (0) 1 45.13.22.44 Fax: 33 (0) 1 45.13.22.00 Spacelabs Medical GmbH Justus-Liebig-Straße 3 41564 Kaarst GERMANY Telephone: 49-(0)2131-92670 Fax: 49-(0)2131-926721 Spacelabs Medical Limited Suite 901 Tower 1 China Hong Kong City 33 Canton Road, Tsimshatsui Kowloon

Spacelabs Medical S.r.l. Via Montecatini, 13 20144 Milano ITALY Telephone: 39-(0)-2/48958203 Fax: 39-(0)-2/48958204 Spacelabs Medical Ltd. 2F-3, No. 161. Sung Te Road Taipei, Taiwan R.O.C. TAIWAN Telephone: 8862-2759-7228 Fax: 8862-2759-9060 Spacelabs Medical B.V. Ringveste 9 A 3992 DD Houten THE NETHERLANDS Telephone: 31-(0)-30-638 5050 Fax: 31-(0)-30-638 5059 Spacelabs Medical Ltd. Eskdale Road Winnersh Triangle, Wokingham Berkshire RG41 5TS UNITED KINGDOM Telephone: 44-1189-448411 Fax: 44-1189-448006

HONG KONG Telephone: 852-2376-1370 Fax: 852-2376-2502 Spacelabs Medical, Inc. C/O Impulse Business Club F-22 South Extension Part 1 New Delhi 110049 INDIA Telephone: 911 1464 5002 Fax: 911 1464 5007

CANADA Telephone: 514-335-2669 Fax: 514-335-1042

CAUTION: • US Federal law restricts the devices documented herein to sale by, or on the order of, a physician.

1

Chapter

Contents Page

Contents Operation Overview... 1-1 Preparing the Patient and Precautions for Use... 1-8 Data Transfer and Reports... 1-12 Event Codes... 1-14

Accuracy Checking Accuracy...2-1

Troubleshooting Problem Solving Checklist...3-1 Servicing... 3-2

Symbols

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Spacelabs Medical is committed to providing comprehensive customer support beginning with your initial inquiry through purchase, training, and service for the life of your Spacelabs Medical equipment. If you need our help along the way, we offer these guidelines for fast, efficient response.

Acquiring Equipment Sales Representative 800-522-7025 (U.S.A.) or call your local office

To discuss your monitoring or clinical information needs, to schedule product demonstrations, to order equipment, or to schedule in-service education

Delivery Information 800-251-9910 (U.S.A.) or call your local office

To find out when you can expect delivery of your Spacelabs Medical equipment

Supplies Products 800-223-6467 (U.S.A.) or call your local office

To order compatible supplies and accessories for your equipment

Getting Started Sales Representative 800-522-7025 (U.S.A.) or call your local office

To arrange in-service education sessions

Answering Other Needs Clinical Applications 800-522-7025 (U.S.A.) or 425-882-3700 or call your local office

To answer specific questions on arrhythmia products and clinically related issues

First Call™ National Dispatch Center 800-522-7025 (U.S.A.) 800-942-7968 (Canada)

To call for service or to contact your assigned customer service representative

Technical Support - Monitoring/Anesthesia 800-522-7025 (U.S.A.) or 425-882-3700 or call your local office

For technical support of all Ultraview® Care Network™ monitoring products and anesthesia products

Technical Support - Intesys Clinical Information Systems 800-210-0247 (U.S.A.) or 425-882-3700 or call your local office

For technical support of BirthNet®, Caremaster®, Chartmaster®, QuIC, and WinDNA® products

Service Parts Department 800-547-8805 (U.S.A.) or 425-867-2039 or call your local office

For parts ordering and pricing information

Service Training Department 800-251-9910 (U.S.A.) or call your local office Regional Service Manager 800-522-7025 (U.S.A.) 800-942-7968 (Canada) or call your local office

To arrange training of hospital biomedical and anesthesia personnel To obtain answers to general questions concerning service issues and service contracts

Contacting Your Local Offices Outside the U.S. Mississauga, Ontario Canada 905-670-5880

Mönchengladbach Germany 49-2161-8209-0

Kowloon Hong Kong 852-2376-1370

Taipei Taiwan 8862-2759-7228

Créteil France 33 (0)1 45.13.22.44

Vienna Austria 43-1-616 52 37

Milano Italy 39-0-2/48958203

Beijing China 86-10-6438-1705

Wokingham Berkshire, U.K. 44-1189-448411

New Delhi India 911 1464 5002

Diegem Belgium 32 2 7164026

Operation Contents Overview...1 Replacing the Batteries...2 Initializing the Monitor...3 Preparing the Patient and Precautions for Use...8 Patient Instructions...11 Data Transfer and Reports...12 Cleaning...12 Event Codes...14

Overview The Spacelabs Medical Models 90207 and 90217 Ambulatory Blood Pressure (ABP) monitors are small, lightweight battery-powered units designed to take blood pressure and heart rate measurements for 24 or 48 hours, or for longer periods of time. These measurements are recorded in the monitors and may be transferred to an ABP Analysis System (FT1000A/FT2000A or equivalent), the PC Interface, the Base Station, or a Report Generator for data analysis, report printing, and archiving. Each monitor and a base station can operate in a direct connect mode (when both units are in the same location) or in a remote connection mode (using modems).

ABP Monitor The monitors have the following features: • • • • • •

4-digit LCD display Battery powered Serial communications port Power ON/OFF switch Reading START/STOP button Blood pressure cuff

The monitors are carried in pouches that are strapped and/or belted to the side of the patient. Blood pressure and heart rate measurements are taken using a blood pressure cuff attached to the patient's arm. This information is recorded in the monitors and can be transferred over a modem link or by direct connection between the monitors and one of the ABP analysis systems. The monitors can be programmed to either activate or deactivate the following features: • • • •

Display the cuff pressure at each bleed step Display the systole, diastole, and heart rate at the end of each measurement Bleed to 40 mmHg rather than stopping at the diastolic value Beep before and after each reading

1-1

90207/90217 ABP Monitors

Front Panel The 90207 and 90217 front panels include the LCD display, cuff hose connector, and a START/STOP switch. Rear Panel The rear panels of both monitors contain program input and data output communication ports. On the 90207 the power ON/OFF switch is also located on the rear panel. On the 90217 the ON/OFF switch is located on the top panel.

Replacing the Batteries “AA” batteries provide the main power source for the monitors. The 90207 uses four batteries, and the 90217 uses three. These batteries should be replaced or recharged before the start of each patient monitoring. Use either alkaline or NiCad batteries. In the 90207, a lithium battery (P/N 146-0008-XX) is used to back up the monitor memory and should be replaced periodically. The 90217 backup battery should not require replacement.

Main Battery Replacement

!

•

if the main “AA” batteries must be replaced during patient monitoring, this replacement must be accomplished within one minute to ensure successful resumption of the test (90207 only).

1.

Turn the monitor off, and remove the door over the battery compartment.

2.

Replace the AA alkaline or NiCad batteries, being careful to observe polarities. CAUTION: • The monitor will not operate if the alkaline, nickel cadmium, or lithium batteries are incorrectly installed. If the monitor is going to be stored for an extended period of time, remove the batteries to prevent the possibility of leakage or discharge. •

Spacelabs Medical is not responsible for product damage incurred as a result of AA battery leakage. In the event your unit has been damaged by a leaking battery, contact the battery manufacturer for any recoverable repair or replacement costs. Spacelabs Medical will assist you in determining those costs

3.

Gently replace the battery cover and secure the latch.

4.

Turn the monitor power switch on. Check that the LCD display is on. If there is no display, turn the monitor off and review the problem-solving checklist in Troubleshooting in Chapter 3.

1-2

Operation

Lithium Battery Replacement (90207 only) The lithium battery is located in the battery compartment under a pry-off cover to the right of the AA batteries. 1.

Turn the monitor off, and remove the door over the battery compartment.

2.

Remove the pry-off cover, and note the polarity of the battery and socket indicators.

3.

Remove the old lithium battery by carefully prying it out (curved forceps are recommended).

4.

Install the new lithium battery and replace the pry-off cover. The underside of this cover is divided into two unequal-sized compartments. Install the cover with the smaller compartment oriented over the lithium battery.

5.

Gently replace the battery compartment cover and secure the latch.

!

•

Once the lithium battery has been completely discharged, it is considered nonhazardous and can be safely discarded.

Initializing the Monitor The ABP monitors must be initialized prior to the start of patient monitoring. Initialization specifies the monitoring period, patient information, time format, measurement interval, monitor tone on/off during selected periods, event code display, and whether or not to display pressure values. To initialize the monitor, connect it to one of the following analysis systems.

Connecting Directly to a Local Report Generator For a direct connection to the 90207 or 90217 monitor, place the monitor into the chute on the Report Generator (Model 90239A or equivalent) as shown below.

LOCAL REPORT CONFIGURATION

1-3

90207/90217 ABP Monitors

Connecting Directly to the PC Interface For a direct connection to a PC-compatible computer via a Model 90121, 90219-02, or 90219-03: Connect the ABP interface cable to the serial port on the 90219 or 90121 system and to the monitor. Refer to the 90121 ABP Report Management System Operations Manual for more information on the report management system.

PC INTERFACE DIRECT CONNECT CONFIGURATION

90219 or 90121 System ABP Monitor

cable to serial port

Connecting to the Base Station via Modem For a modem connection to a remote IBM XT/AT/PS2 (or equivalent) base station, refer to the following figure. MODEM CONNECTION CONFIGURATION

TO BASE STATION MODEM

PUBLIC TELEPHONE NETWORK

cable to serial port ABP Monitor

MODEM

PHONE

!

1-4

•

The actual initialization procedure is discussed in the 90219 ABP PC Interface/Base Station Operations Manual (P/N 070-0238-XX).

Operation

Modem Speed and Compatibility Issues The 90207 and 90217 operate Hayes-compatible modems only. You can identify your model type by plugging the communications cable into your 90207/90217 unit and looking at the numbers on the display. The acceptable modem types and maximum speeds of 90207/90217 units are summarized below: MODEL TYPE

MAX SPEED

MODEMS ACCEPTED

DISPLAY

Older 90207

1200

1200 only

9999

Newer 90207

1200

Any Hayes

1999/9999

Older 90217

up to 9600

up to 9600

2999/9999

Newer 90217

9600

Any Hayes

0999/9999

Connection Procedure 1.

If you are using an older 90207 with a 1200 modem, set the switches on the modem as follows: SETTING AT MONITOR SITE

SWITCH # 1 2 3 4 5 6 7 8 9 10 2.

down up down down down up up down up up

Connect the serial port cable (P/N 012-0096-00) between the monitor and the modem.

!

•

If call waiting or call forwarding are options on a telephone used to transfer data, ensure that both are deactivated or modem communications may be interrupted. In addition, telephone systems such as CBX or PBX can cause interference with the modem or the modem can cause interference with the switching system.

To initialize the monitor for remote connection: 1.

Contact the base station by telephone (for remote operation only).

2.

Ask the base station operator to initialize the monitor. Give the following information to the operator: • Patient's name • Patient ID number • Whether monitor display is to be active or not • Time of day (12- or 24-hour format) • Whether to display measurement (systolic/diastolic and heart rate)

1-5

90207/90217 ABP Monitors

• Multiple or single cycle times. If using a single cycle for the 24-hour monitoring period, indicate the cycle interval and whether the tone is on or off. For multiple cycle time, specify each cycle interval and whether the tone is on or off for each cycle. • Any other information the base station operator may request. 3.

The base station operator enters the patient information in the computer.

4.

Prepare the monitor to receive the patient data from the base station. • Turn on the modem. • When instructed by the base station operator, turn the ABP monitor on. •

! 5.

The modem link must be established within 10 to 20 seconds for the 90207, and 45 seconds for the 90217. If this does not occur, turn the monitor off and then on again to retry.

When the transfer of information is complete, the ABP monitor will beep. Voice communication is restored after the monitor beeps. • Turn off the monitor. Disconnect the monitor from the modem. • If direct connection between the monitor and the base station is used, turn the monitor off and disconnect it from the ABP data interface unit.

To transfer readings from the monitor to the base station: 1.

Contact the base station by telephone (for remote operation only).

2.

Ask the base station operator to read the monitor. Give the following information to the operator: • Patient's name • Patient ID number • Any other information the base station operator may request.

3.

The base station operator enters the patient information in the computer. (If the monitor is in a remote location, the operator turns the base station modem on.)

4.

Prepare the monitor to transfer data to the base station. • Turn on the modem • When instructed by the base station operator, turn the ABP monitor on (for remote operation only).

! 5.

•

The modem link must be established within 10 to 15 seconds for the 90207, and 45 seconds for the 90217. If this does not occur, turn the monitor off and return to step 1.

When the transfer of information is complete, the ABP monitor will beep. Voice communication is restored after the monitor beeps. Turn off the monitor. Disconnect the monitor from the modem.

Modem Indicator Lights Modem indicators at the local modem are lit, flashing or unlit depending on the stage of operation. When the monitor is turned on, the RD (Receive Data) and SD (Send Data) lights will flash for several seconds. The OH (On Hook) indicator becomes lit when the monitor starts communicating with the remote modem. When the modems connect, the CD (Carrier Detect) is lit. The SD and RD lights flash as data is being transferred.

1-6

Operation

After the transmission is complete and the monitor is turned off, the HS, TR and MR indicators will always remain lit at the local modem.Setup Test

!

•

Verify that cable connections are secure.

Turn on the ABP monitor. It will display "9999." When the monitor is being read or initialized, the digits will change to indicate that communication is taking place between the monitor and the analysis system. When communication is complete, the digits will stop changing.

Office Check Mode The monitor automatically enters an office check mode for the first five measurements immediately following initialization. This allows you to verify the performance of the monitor on an individual patient without the need for re-initialization to reset the display features. While in the office check mode, the monitor will operate as follows: • • •

Display the cuff pressure on each bleed step Display systole, diastole, and heart rate at the end of the measurement Bleed one step below the diastolic value as determined by the monitor

Terminating Office Check Mode For the 90207 (versions earlier than 2.14), press the START/STOP key twice to cancel each of the remaining readings. The office check mode is terminated when the sum of the canceled and successful measurements equals five. For the 90217 and 90207 (version 2.14 and later), press the START/STOP key twice to cancel a single blood pressure reading. The office check mode is terminated when a blood pressure reading is cancelled. Any event that prevents a successful blood pressure measurement (other than a manual cancel) is not counted as one of the five office check mode readings. Reinstating Office Check Mode The office check mode can be reinstated in the 90217, and in versions 2.14 and later of the 90207. To reinstate the office check mode without initialization of the monitor follow the steps below. 1.

Turn the power on to the monitor.

2.

When the version is displayed on the LCD press and hold the START/STOP key.

3.

Release the START/STOP key when EC03 is displayed on the LCD.

An EC13 will be logged to indicate the time at which the office check mode was reinstated. The office check mode will be enabled for five additional successful measurements.

1-7

90207/90217 ABP Monitors

Preparing the Patient and Precautions for Use

!

•

Blood pressure measurements determined with this device are equivalent to those obtained by a trained observer using the cuff/stethoscope auscultation method, within the limits prescribed by the American National Standard, Electronic or automated sphygmomanometers.

The fifth Korotkoff sound was used to determine overall efficiency. •

As in manual auscultatory methods, accurate readings might not always be achieved under some conditions. Patient movement, the position of the cuff relative to the level of the heart, extreme heart rates and blood pressures, various arrhythmias, and the subject’s physiological condition and other factors can hinder an accurate reading. Vibration, such as that in a moving automobile, is an environmental problem that can affect readings.

•

When some of the above factors prevent an accurate reading, an event code is provided to indicate the reason for the missed blood pressure reading. When only a single blood pressure parameter (systole, diastole, or mean arterial pressure) is obscured and the other two parameters are measured, the obscured parameter can be replaced with a computed value.

•

If such a value is computed in the 90217, it appears on the report in angle brackets, e.g. < value >. On the monitor display, dashes are displayed instead of the estimated value. The ratio used in the formula is determined by the previous successful measurements of the pressure, rather than a fixed ratio.

•

Consult a physician for interpretation of pressure measurements.

CAUTION: • The ABP unit is not for use with defibrillators. Please remove the ABP unit prior to use with a defibrillator. •

For patients in shock, indirect methods of measuring pressure (auscultatory, oscillometric, Doppler) may not be reliable due to peripheral vascular changes. In some cases peripheral pulses or Korotkoff sounds may be diminished or disappear in spite of adequate blood pressure. Direct blood pressure measurements (invasive) should be considered in patients with signs of shock or for any patient who becomes unstable for unknown reasons.

•

The ABP unit might not perform to specifications if stored or used outside the following ranges: Operating: temperature between 0o and 40o C, and relative humidity between 10% and 95%. Storage: temperature between -30o and 65o C, and relative humidity between 10% and 95%.

After the monitor has been initialized, prepare the patient for monitoring as follows: 1.

Turn on the monitor (wait for the monitor to perform self-tests). When the LCD displays the current time, the monitor is ready for operation.

2.

Strap the monitor to the patient on the hip opposite the side on which the cuff is worn. Secure the monitor using the patient’s own belt or the ABP pouch strapped over the opposite shoulder. When using the shoulder strap, use the belt supplied with the monitor or the patient’s belt to provide additional security.

1-8

Operation

3.

4.

Proper cuff selection and application is essential in ensuring the accuracy of blood pressure measurements. To select the proper cuff, first measure the circumference of the limb at the point where the cuff is to be applied. Match the limb measurement to the range of appropriate circumferences (in centimeters) specified on each cuff (refer to the table below).

CUFF SIZE

LIMB CIRCUMFERENCE

Pediatric

13 to 20 cm

Small Adult

17 to 26 cm

Average Adult

24 to 32 cm

Large Adult

32 to 42 cm

Extra-large Adult

38 to 50 cm

Position the cuff so that the center of the inflatable bladder is directly over the brachial artery. The center of the bladder location is marked on the outside of the cuff. Once the proper position is determined, the cuff must be tightened to ensure that it is equally snug at the top and bottom edges and that it is not kinked. This is especially important on larger arms. Insert a finger between the cuff and the limb to ensure it is not too tight. It may be necessary to wrap the cuff with its tail at an angle to achieve uniform tightness. If the cuff is not equally snug at the top and bottom edges, the number of readings available will be limited and the monitor may indicate that the cuff is improperly applied.

!

•

Use only Spacelabs Medical cuffs with this monitor. Using other manufacturer’s cuffs may result in inaccurate readings even if the manufacturer’s recommended size is observed.

•

If the cuff is too small, pressure readings may be falsely high; a cuff that is too large produces a falsely low reading. The bladder can be positioned in the cuff for either the left or right arm.

CAUTION: • Avoid compression or restriction of pressure in the NIBP patient connector tubes. Check that operation of the equipment does not result in prolonged impairment of circulation.

5.

•

Do not apply cuff to areas of breached or injured skin.

•

Cuff hose connections use luer fittings. Be careful not to connect the ABP monitor into an intravenous fluid line when working close to them.

•

This product contains natural latex rubber components to which some people may be allergic. These components include the bladder and the first four inches of tubing extending from the cuff.

Once cuff is applied, the arm should be relaxed at the patient’s side. To avoid reading errors due to hydrostatic pressure differences, the level of the cuff on the arm should be near the level of the heart.

1-9

90207/90217 ABP Monitors

6.

Lead the hose up the arm with the cuff and place it across the back of the patient. Drape the hose so it does not cause the patient discomfort and is not pinched shut by too tight a radius. The following figure shows the most common positions for the cuff hose. ALTERNATIVE #1

ALTERNATIVE #2

7.

Connect the hose to the monitor.

8.

To verify proper monitor operation, take one or more blood pressure readings. Push the START/STOP key to begin a measurement. Spacelabs Medical recommends taking three readings in the office so that the patient becomes comfortable with operation of the monitor and the measurement process.

9.

Show the patient how to enter information in the patient diary. Make sure the patient knows what to do if the cuff becomes very uncomfortable during a measurement, slips out of place, or event codes are displayed on the monitor screen (refer to Patient Instructions on page -11). In addition, ensure the patient knows how to care for the monitor.

10. When you are satisfied the monitor is operating properly, the remaining measurements in the check mode can be canceled. Refer to Office Check Mode on page -7.

Using Cuff Support

!

•

Keeping the blood pressure cuff in place is very important both for patient comfort and for accuracy of the readings. This becomes particularly challenging when the arm has considerable taper, as is often the case with obese patients.

1.

Once the cuff is successfully applied to the patient, put the large loop of the support around the opposite arm. Adjust the length so the junction of the straps fits well back on the shoulder towards the neck.

2.

Fasten the rear short strap to the rear of the arm pit. Be careful to clip to the material only and not to the bladder.

3.

Fasten the front strap to the top layer of the cuff material at the location where the hose exits the cuff. Adjust the length of these straps to apply a minor amount of tension to hold the cuff in position.

1-10

Operation

Correlating with Manual Readings The monitor bleeds pressure in discrete steps (not continuously) using the oscillometric method of blood pressure determination. If manual pressure readings are taken simultaneously with the monitor readings, interpolation is required to accurately correlate monitor systolic and diastolic pressure values with the manual auscultatory pressures. •

•

For systole, record the first pressure at which a Korotkoff sound is heard. Actual systolic pressure is somewhere between the pressure when the sound is heard and the previous (higher) pressure where no sound was heard. The interval of uncertainty can be reduced by half by adding one half of the bleed step size (4 mmHg) to the manual systolic pressure. For diastole, record the cuff pressure at which the last Korotkoff sound was heard. Actual diastolic pressure is somewhere between that pressure and the next lower pressure. Thus, you must subtract one half of the bleed step size (4 mmHg) from the manual diastolic pressure.

Patient Instructions If the cuff becomes uncomfortable during a reading, make certain the patient knows how to terminate the readings by pressing the STOP key on the front of the monitor. If the cuff slips out of place, make certain the patient understands correct repositioning of the cuff for successful readings. If the cuff is not properly positioned, event codes may appear on the monitor.

!

•

The patient should make every effort to keep the monitor dry. However, there is no hazard if the monitor does get wet. If this occurs, turn the monitor off and return it to Spacelabs Medical for service.

1-11

90207/90217 ABP Monitors

Data Transfer and Reports After monitoring is complete, connect the monitor to either a PC Direct or Base Station interface to transmit patient data and generate blood pressure reports. Refer to 90121 ABP Report Management, 90219-02/03 ABP PC Interface/Base Station, or 90239 ABP Report Generator Operations Manuals for more details.

!

•

Any pulse rate obtained from the ABP cuff should be used only as a guideline for the heart rate.

Cleaning Visually inspect the monitor, air hose, and pressure cuff for dirt, debris, frayed or worn areas, etc. prior to patient use.

Cleaning the Monitor Use a soft, damp cloth and mild detergent mixed with water to wipe the exterior of the monitor. Clean the air hose with isopropyl alcohol.

Cleaning the Cuff and Carrying Pouch Small soiled or stained areas may be cleaned by gentle scrubbing with a sponge or cloth soaked in a mild soap and water solution. The cuff wrap (with the air bladder removed) and the pouch are machine washable on “delicate” cycle only. Do not wash in large commercial-type washers or with bed linens or gowns. Ensure that the carrying pouch is dry before re-use.

Removing/Installing the Bladder To remove the bladder, follow the steps listed below. 1.

Using fingers only, fold or roll up the bladder inside the cuff. Do not use pencils, pens, or other hard objects as these may damage the bladder.

2.

Remove the bladder through the hose exit opening.

Once the bladder has been removed, mate together the hook and loop surfaces of the velcro attachment before washing.

1-12

Operation

Re-install the bladder into the cuff wrap in reverse order. Make certain that all folds in the bladder have been removed, and that the long end of the bladder fits into the long end of the cuff (see the figure below). OPENING FOR RIGHT ARM

OPENING FOR LEFT ARM

BLADDER (shown inserted into cuff wrap for left arm application) ARTERY

!

•

The cuff hose can exit from either opening in the cuff, depending on whether you plan a right arm or left arm application.

1-13

90207/90217 ABP Monitors

Event Codes The monitor will display an event code whenever an event prevents the unit from successfully completing a blood pressure measurement. The two numerical digits of the event code indicate the reason the measurement was aborted. The table below lists event codes that are displayed on the monitor, as well as event codes that appear on the Event Code Report. Monitor

Report

Condition

EC10

Excess movement artifact. Frequent EC10 messages may indicate an air leak.

EC20

A) A very large number of movement artifacts B) Heart rate arrhythmia

EC30

A) Movement artifact at mean arterial pressure B) Heart rate arrhythmia

EC40

A) Movement artifact at asystole B) Heart rate arrhythmia

EC50

A) Movement artifact at diastole B) Heart rate arrhythmia

EC60

A) Movement artifact B) Heart rate arrhythmia

EC70

Systole was found to be above the highest cuff pressure. However, this result appears to be an error caused by motion artifact. Therefore, the cuff will not be inflated to a higher pressure on the next measurement attempt.

EC80

A) Movement artifact B) Heart rate arrhythmia

EC90

A) Movement artifact B) Heart rate arrhythmia

EC11

Did not pump above the mean arterial level

EC21

Did not pump above systolic pressure

EC91

Systole appears higher than the selected maximum cuff pressure limit

EC12

Did not reach initial cuff pressure. The cuff may have been improperly applied or there may be an air leak.

EC22

Overpressure

EC32

Overpressure

EC42

No cuff attached

EC52

Kinked hose

EC62

Cuff applied too loosely

EC00

EC01

EC02

1-14

Operation

Monitor

Report

Condition

EC82

Kinked hose.

EC03

Patient canceled reading by pressing STOP key. No retry attempt is made following an EC03 code.

EC13

The Office Check Mode has been reinstated. No retry attempt is made following an EC13 code.

EC04

Blood pressure measurement not completed in the maximum time allowed. Occasional EC04 messages may result from excessive patient movement. Frequent EC04 messages would indicate an improperly applied cuff or a monitor malfunction which requires service.

ECn4

(where n = 1 to 9) Indicates that one or more of the blood pressure results have been corrupted and subsequently recovered. Frequent occurrence of this message would indicate a malfunction which requires service.

EC05

The individual blood pressure result has been corrupted and cannot be recovered.

EC03

EC04

EC15

Equipment malfunction. Return to Spacelabs Medical for service.

EC25

Unit failed to initialize. Please initialize. 90207 At least one of the blood pressures or time readings obtained before the event code is erroneous. Interpret all readings with caution. 90217 The monitor needs to be reinitialized.

EC35

EC05 EC05 & EC45

EC45

Invalid bleed size. The monitor automatically has changed the bleed size to 8 mmHg.

EC05 & EC55

EC55

An unexpected loss of power possibly caused by a) removal of the batteries during a blood pressure measurement, b) hardware overpressure, or c) a hardware time-out. Frequent EC55 messages would indicate a malfunction which requires service.

EC05 & EC65

EC65

90207 Equipment malfunction. Return to Spacelabs Medical for service. 90217 Extremely large artifact.

EC05 & EC75

EC75

Equipment malfunction. Return to Spacelabs Medical for service.

EC05 & EC85

EC85

Equipment malfunction. Return to Spacelabs Medical for service.

EC05 & EC95

EC95

Cuff pressure baseline out of bounds. The monitor should correct the baseline automatically within 10 minutes; or it can be set by initialization of the monitor. If initialization does not correct the condition the monitor must be returned to Spacelabs Medical for calibration.

1-15

90207/90217 ABP Monitors

Monitor

Report

Condition

EC78

Clogged luer filter

EC18

Too few data entries to accurately determine blood pressure. The message may indicate that the cuff is not being worn by the patient (taken off but left connected to the monitor). The message may also indicate that motion artifacts cause the majority of the incomplete data.

EC28

Diastole above 200 mmHg

EC38

Pulse pressure less than 16 mmHg

EC48

A) Movement artifact at mean arterial pressure B) Heart rate arrhythmia

EC58

A) Movement artifact at diastole B) Heart rate arrhythmia

EC68

Division by zero

EC19

Contradictory instructions sent to hardware (e.g., “pump on and valve open”)

EC29

Diastolic pressure value cannot be obtained from the data available.

EC39

90207 Systolic pressure cannot be obtained from the data available. 90217 Algorithm could not process input data quickly enough resulting in an input queue overflow.

EC49

90207 Mean arterial pressure cannot be obtained from the data available. 90217 This monitor must be initialized.

EC59

Heart rate value cannot be obtained from the data available.

EC69

Heart rate value cannot be obtained from the data available.

EC79

Bleed steps were too small. This may be caused by a partially obstructed air hose. All blood pressure attempts following this message are inhibited. Attempts can be enabled by turning the power switch off then on.

EC99

Unexpected or contradictory data (such as a negative cuff pressure).

EC16

Low battery detected prior to start of measurement.

EC26

Low battery detected after measurement started. Usually caused by the pump drawing enough current to lower the battery voltage.

EC07

EC08

EC09

LLL

Lbb

The report does not print an event code for this condition, which is a low backup battery. Contact Spacelabs Medical for replacement of the battery.

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