Quick-Start Guide
16 Pages
Preview
Page 1
Smartdop 30EX Quick-Start Guide
INDEX
3
MAIN FEATURES & CONTROLS
4
INITIAL SET-UP
5
OBTAINING DOPPLER WAVEFORMS USING THE 8MHZ PROBE
6
DOPPLER WAVEFORM INTERPRETATION
7-9
OBTAINING ABI & TBI PRESSURES
10
SEGMENTAL PRESSURES
11
VENOUS REFLUX STUDIES
12
PULSE VOLUME RECORDING
13
VIDEO DEMONSTRATION
© Copyright Briggate Medical Company 2018 - No parts of this document either written or images may be reproduced without permission.
3
MAIN FEATURES & CONTROLS
1 2
ARM/LEG
TOE
1 MODE
4
ARM
2 PRINT
3 7
MENU
5
6
LEG/TOE
INF/ DUMP
2
1
Smartdop 30EX
8
6
9 11
10
1 2
ARM/LEG TOE
MODE
MENU
ARM
LEG/TOE
INF/ DUMP
2
1
Smartdop 30EX
12
16
13
14
15
17
18
For a more detailed explanation on the Features and Controls for the Smartdop 30EX, please refer to the Manufacturers Operating Manual supplied with the device.
1.
Mode Button
10. Speaker Volume Control
2.
Print Button
11. Printer
3. Menu Button
12. Paper Roll Shaft
4.
13. Headphone Inlet
Arm Button
This document will offer instructions on how to obtain T.B.I’s on the Smartdop 30EX. In order to perform these tests the following accessories are required:
5. Leg/Toe Button
14. Probe Connection Port 1
- Arm and Toe Cuffs
6.
Inflate/Dump Button
15. On/Off Switch
- PPG Probe (sold separately)
7.
Probe Selector Button
16. Probe Connection Port 2
8.
8MHz Probe
17. AC Power Inlet
9. Speaker
18. Doppler/Computer USB Port
- PPG Toe Clip (sold separately) or Tape to attach PPG Probe to Toe
4
INITIAL SET-UP The Smartdop 30EX has numerous functions in non invasive vascular assessment: • • • • • • •
Qualitative interpretation of Doppler waveforms Ankle Brachial Index Toe Brachial Index Absolute Toe Pressures Qualitative interpretation of Pulsed Volume waveforms Segmental Pressure Studies Venous Reflux Studies
Probe Connection 1
To prepare for performing vascular studies: •
Insert the 8 MHZ probe by lining up the round mark on the connection end of the probe to the 12 o’clock position and gently push into the Probe Connection 1 located on the right side of the Doppler.
•
Insert the PPG probe into the probe connection 2 at the back of the Doppler (PPG Probe is sold seperately).
!
Probe Connection 2
BATTERY To check the battery level press the MENU button. This will show the battery level in 4 stages:
High
Medium
Low
Empty
Charge ONLY when the battery level is low. 1.
2.
To charge plug the AC adaptor into the rear of the unit.
!
AC Power Inlet
4.
3.
When charging the MODE LED lights will begin to illuminate sequentially.
When charge is complete the MODE LED lights will stop flashing.
1
1
2 ARM/LEG TOE
2 ARM/LEG MENUTOE
MODE
Remove AC adapter before beginning any studies.
ARM
INF/ DUMP
LEG/TOE
2
MODE 1
ARM
LEG/TOE
M
INF
Smartd LOADING THE PRINTER 1.
Remove the paper roll shaft.
2.
3.
Insert and hold the edge of the paper into the paper entry slot located under the printer.
Apply slight pressure to the paper and press the PRINT button.
1 2 ARM/LEG TOE
MODE
MENU
INF/
5
INITIAL SET-UP LOADING THE PRINTER (cont.) 4.
As the paper catches it will feed through the printer.
5.
6.
Place the paper roll shaft into the paper roll and snap the shaft and the paper roll into the roller guide.
When a sufficient amount of paper has been fed through press the PRINT button again to stop the printer. Tear off the excess paper.
1 2 ARM/LEG TOE
MENU
OBTAINING DOPPLER WAVEFORMS USING THE 8MHZ ARMPROBE LEG/TOE
INF/ DUM
1.
Switch on the Smartdop 30EX. Press the MODE button until the Mode 1 LED is selected.
MODE
On/Off Switch 1 2 ARM/LEG TOE
2.
MODE
ARM
LEG/TOE
90º
Apply ultrasound gel to the skin. Place the probe on the artery against the flow at a 60 degree angle and adjust the probe to locate the best sound (Note: if the probe is positioned perpendicular to the vessel the resulting sound and waveform will appear monophasic incorrectly suggesting a severely occluded vessel).
60º
1
3.
4.
5.
6.
2 ARM/LEG TOE
Watch the waveforms on the LCD screen. When it becomes steady, wait 5 seconds or more without moving the probe and then press the probe button or the INF/DUMP to freeze the waveform.
1 2
ARM/LEG TOE
MODE
LEG/TOE
ARM
LEG/TOE
ARM
2
2
1
1
Smartdop 3
INF/ DUMP
2
LEG/TOE
MENU
INF/ DUMP
MENU
If you would like to store the waveform in the Doppler memory press the MENU button to 1 go to the menu screen, use the arrow buttons to scroll to memory, press2 enter to1display INF/ the sub menu, select store from the menu options and press enter to highlight the DUMP 2 ARM LEG/TOE ARM/LEG MODE PRINT MENU ARM/LEG TOEScroll memory number. The next available memory number will be selected. up or 2 1 MODE PRINT MENU TOE down to change or press enter to select. Press INF/DUMP button to exit the menu and return to the monitoring screen.
MENU ARM
ARM
Press the PRINT button to print the waveform. The printer will stop automatically 1 or you can press the PRINT button again to stop it after the required number of 2 scanned waveforms have been printed. It is advised that the print out is copied or ARM/LEG as the thermal paper will fade with time. MODE TOE
MODE
2
1
S
1
INF/ DUMP INF/ LEG/TOE
DUMP
Smartdop
Sm
6
DOPPLER WAVEFORMS - INTERPRETATION
TRIPHASIC (Normal) • • • •
Triphasic sounds indicate bi-directionality and a compliant artery at the point of probe contact. The first long sound is the systolic forward component. The second short sound is the reversal component and is seen below the baseline of the waveform print out. It is thought to occur upon closure of the aortic valve. The third sound indicates wall motion characteristic of a compliant artery.
BIPHASIC (Normal to Mild PAD) • •
Biphasic sounds indicate bidirectional flow velocity having both forward systolic and reverse diastolic component but no third component. While they are considered normal, the lack of the third component may indicate minor to moderate blood flow impairment or simply improper probe angle this is why it is important to carefully adjust the probe to obtain the best sounds.
MONOPHASIC (Severe PAD) •
Monophasic sounds are low frequency sounds having a single cycle. They are low in intensity and indicate severe disease.
ABI Ankle Brachial Indexes provide quantitative measurements of peripheral circulation. However, elevated readings >1.3 are common with patients with diabetes due to calcification of the vessels which results in an invalid reading.
Peripheral arterial disease (PAD)
<0.9
Mild PAD 0.7-0.9 Moderate PAD 0.4-0.69 Severe PAD <0.4
ABI =
ankle systolic blood pressure
brachial systolic blood pressure
TBI Toe Brachial Indexes are now commonly used as the chance of an invalid reading due to calcification of the vessels is less likely when compared with ankle pressures.
Normal 0.65-1 Severe/Critical PAD
TBI =
toe systolic blood pressure
brachial systolic blood pressure
Absolute Toe Pressures Absolute toe pressures are also used to indicate wound healing potential. Absolute toe pressures >30mmHg indicate there is an increased chance of healing. These quantitative measurements can assist in establishing a baseline to track a patient’s progress over time, as well as being an excellent screening tool to identify potential foot health risk. Reference: International Working Group on the diabetic foot, 2011
<0.2
7
OBTAINING ANKLE BRACHIAL INDEX (ABI) & TOE BRACHIAL INDEX (TBI) PRESSURES
STAGE 1 – BRACHIAL PRESSURE 1.
1 place the pressure cuff comfortably With the patient in the supine position snug around the arm. 2 ARM/LEG TOE
2.
MODE
ARM
3.
4.
5.
6.
7.
8.
MENU
Make sure probe 1 is selected, if not press the probe selector button to change.
LEG/TOE
2
1
INF/ DUMP
Smartdop 30EX
Couple the standard arm cuff to the inflation inlet at the front of the Doppler using the extender tubing.
1
2 ARM/LEG TOE
MODE
MENU
ARM
LEG/TOE
INF/ DUMP
2
1
Smartdop 30EX
1
Press the MODE button until the Arm/Leg LED light is selected.
2 ARM/LEG TOE
Palpate the brachial or radial artery and apply ultrasound gel to the skin.
MODE
MENU 2
ARM
LEG/TOE
1
INF/ DUMP
Smartdo
Place the probe on the artery at a 45-60 degree angle against flow and adjust to locate the best sounds.
1 2 ARM/LEG TOE
When the waveform on the LCD screen becomes steady and the light on the INF/DUMP button starts to flash, press the INF/DUMP button or the probe button to activate the automatic cuff inflator.
MODE
MENU 2
1 2
ARM/LEG TOE
MODE
ARM
ARM
LEG/TOE
MENU
LEG/TOE
INF/ DUMP
2
INF/ DUMP
1
1
Smartdop 30
The Smartdop 30EX will automatically inflate 20mmHg above sound cessation and then slowly deflate the cuff until the Doppler sounds return. 1
9.
2 When finished the SmartDop 30EX will freeze and display the systolic ARM/LEG pressure automatically. TOE 1
10. Press the ARM button to save the pressure.
2 ARM/LEG TOE
MODE
MENU 2
MODE ARM
11. Press the INF/DUMP button to return to the monitoring screen and repeat the test on the other arm.
PRINT INF/ MENU DUMP LEG/TOE 1 2
ARM 12. Use the highest arm systolic pressure to calculate the ABI. Therefore if the systolic pressure of the 2nd arm is higher press the ARM button again 1to save the new pressure. This deletes the first pressure previously saved. 2 If the second arm is lower do not press the ARM button. This will keep the ARM/LEG 1st pressure saved in the memory. TOE
MODE
LEG/TOE ARM/LEG TOE
1
2
Sma
INF/ DUMP MODE
MENU
ARM
LEG/TOE
INF/ DUMP
MENU 2
13. Press the INF/DUMP button to return to the monitoring screen.
ARM
LEG/TOE
1
INF/ DUMP
1
8
OBTAINING ANKLE BRACHIAL INDEX (ABI) & TOE BRACHIAL INDEX (TBI) PRESSURES (CONT...) STAGE 2 – ANKLE PRESSURE 1.
Place the pressure cuff comfortably snug around the ankle.
2.
Press the MODE button until the Arm/Leg LED light is selected.
1 2 ARM/LEG TOE
MODE
MENU 2
3. Apply a generous amount of ultrasound gel on the posterior tibial or dorsalis pedis artery sites. Place the probe on the site against flow and adjust to locate the best sounds.
1 2 ARM/LEG TOE
ARM
INF/ DUMP
LEG/TOE
MODE
Sma
MENU 2
1 2 ARM/LEG TOE
4.
1
When the waveform on the LCD screen becomes steady and the LED light on the INF/DUMP button begins to flash press the INF/DUMP button or the probe button to activate the automatic cuff inflator.
ARM
MODE
MENU
ARM
LEG/TOE
INF/ DUMP
INF/ DUMP
LEG/TOE
2
1
1
Smartdop 30EX
1 5.
2 When finished the Smartdop 30EX will display the systolic pressure. ARM/LEG TOE
6.
MODE
MENU 2
Press LEG/TOE button to save the ankle pressure. ARM
LEG/TOE
1
INF/ DUMP
Smartdop 7.
The Smartdop 30EX will automatically calculate the ABI by dividing the ankle pressure into the previously saved arm pressure.
1 8.
9.
Press PRINT to print the ABI.
2 ARM/LEG TOE
To store the waveform to the Doppler memory press the MENU1button. Press enter and the next available memory number will be selected, 2 1 scroll up or down to change or press enter to select. ARM/LEG TOE 2MODE ARM/LEG TOE ARM
MODE
LEG/TOE
ARM
Normal
<0.90
PAD
>1.3
Non compressible vessels
1
INF/ DUMP
MENU
PRINT INF/ DUMP
10. When complete press the INF/DUMP button to return to the monitoring screen.
0.91 - 1.3
LEG/TOE 2
MODE
MENU 2
ARM PRINT
LEG/TOE
1
MENU 2
INF/ DUMP
1
Smartdop 30EX
Smar
9
OBTAINING ANKLE BRACHIAL INDEX (ABI) & TOE BRACHIAL INDEX (TBI) PRESSURES (CONT...) STAGE 3 – TOE PRESSURE Toe pressure and TBI’s use a PPG probe to assess the condition of the small vessels distal to the ankle. These tests are especially useful in those patients who have non compressible larger vessel as a result of diabetes and who have an ABI greater than 1.3. Show patient in supine position with toe cuff in place connected to Doppler with PPG probe taped.
1 2
ARM/LEG TOE
1.
Prepare the patient with the foot at the same level as the heart.
2.
Use extender tubing to connect the digital cuff to the automatic cuff inflator on the front of the Doppler.
3.
Position the PPG Probe, ensuring complete contact between the sensor and the skin. Hold in place with either tape or the PPG Clip. The orientation of the sensor is not relevant. Keep the PPG Probe cable clear of interference by taping it to the dorsum
4.
of the foot. Press the MODE button until the Toe LED light is selected. 1 PLEASE NOTE: DO NOT APPLY ULTRASOUND GEL 2 ARM/LEG MODE TOE When the waveform on the LCD becomes steady and the light on the INF/DUMP button is lit press the INF/DUMP or probe button to activate the auto cuff inflator. The Smartdop 30EX will automatically inflate the cuff 20mmHg past the point where the waveform ceases then slowly ARM deflates the cuff until the waveform motion returns.
MODE
MENU
ARM
LEG/TOE
INF/ DUMP
2
1
Smartdop 30EX
1 2 ARM/LEG TOE
MODE
MENU
ARM
LEG/TOE
INF/ DUMP
2
1
2 ARM/LEG TOE
5.
When finished the Smartdop 30EX will freeze and display the systolic pressure.
6.
Press the LEG/TOE button to save the toe pressure.
7.
The Smartdop 30EX automatically calculates the TBI by dividing the toe pressure by the previously saved arm pressure.
MODE
MENU
ARM
LEG/TOE
INF/ DUMP
MENU 2
1 LEG/TOE 2 ARM/LEG TOE
1
2
Smartdop 30E 1
Smartdop 30EX
1
INF/ DUMP MODE
MENU
Smartdo 2
ARM
LEG/TOE
INF/ DUMP
MENU
1 8.
9.
2 ARM/LEG TOE
If you would like to print the results press the PRINT button.
To store the results to the Doppler memory press the MENU button. 1 Press enter and the next available memory number will be selected, 2 ARM/LEG scroll up or down to change or press enter to select.
1 MODE 2
TOE
ARM/LEG TOE
10. Press the INF/DUMP button to return to the monitoring screen and repeat the test on the other foot.
ARM
MODE
2
ARM PRINT
MENU 2
MODE LEG/TOE
ARM
INF/ DUMP
LEG/TOE
2
INF/ DUMP LEG/TOE
1
MENU
INF/ DUMP
1
Smartdop 3
Sma
10 SEGMENTAL PRESSURES Segmental pressure studies are used to measure systolic pressures at different levels in the legs to evaluate blood flow and identify the location of blockages of the arteries in the leg.
1.
Prepare the patient by placing them in a supine position and wrap the pressure cuff around the required area (above the knee, below the knee or ankle).
2.
Turn the Smartdop 30EX on and press the MODE button until Mode 1 light is selected.
1
3.
Apply ultrasound gel to the skin. Place the probe on the artery at a 45-60 degree angle against flow and adjust to locate the best sound.
MODE
MENU
ARM
LEG/TOE
INF/ DUMP
1 2 ARM/LEG TOE
4.
2 ARM/LEG TOE
MODE
Watch the waveform on the LCD and when it becomes steady wait 5 seconds or more without moving the probe then press the probe button or INF/DUMP button to inflate the cuff. ARM
MENU 2
LEG/TOE
5.
Repeat this at another segment.
6.
Pressure differences of less than 20mmHg between adjacent cuff sites on the same legs are considered normal.
INF/ DUMP
1
11 VENOUS REFLUX STUDIES Venous Reflux Studies are used to assess valvular competency. Normal refill time will exceed 20 seconds. However, if the refill time is between 18-21 seconds it is questionable and this test should be repeated. If the refill time is < 18 seconds a venous reflux condition may exist and further testing is indicated. 1.
Place the patient in a sitting position with feet off the floor.
2.
1 Before beginning the test show the patient how to dorsiflex the foot using the calf muscle as a pump. 2
3.
Turn the Smartdop 30EX on.
4.
ARM/LEG MODE TOE Ensure the PROBE 2 selector button is selected. If not, press the probe selector button to change.
2
ARM 5.
6.
MENU
INF/ DUMP
LEG/TOE
1
Then press the MODE button and select venous mode 2.
To change the number of times the patient should dorsi flex the foot, scroll using the ARROW buttons on the menu control panel until the count is highlighted.
9.
MODE
ME
ARM
LEG/TOE
INF/ DU
1 2 ARM/LEG TOE
2 ARM/LEG TOE
MODE
Press the PROBE SELECTOR button to change the number. The recommended number of times is 5.
When finished press the MENU button to confirm and begin the test.
MODE
MENU
ARM
LEG/TOE
INF/ DUMP
1
Smartdop 30E
1
LEG/TOE
INF/ DUMP
21 ARM/LEG2 TOE ARM/LEG
MODE
MENU
TOE
MODE
MENU
To start the test press the probe button or the INF/DUMP button to activate the timer.
2
MENU 2
ARM 1
8.
Smartdop 3
2 ARM/LEG TOE
1
7.
1
ARM ARM
LEG/TOE LEG/TOE
Smartdop 30EX 2
1
2
1
INF/ DUMP INF/ DUMP
Smart Smartd
10. Ask the patient to dorsi flex the foot the specified number of times following the foot displayed on the screen. 11. Then have the patient rest the foot. 12. Observe the waveform on the LCD screen which will show a steady motion upward to the baseline. 13. When the test is complete the Smartdop 30EX will freeze the results and calculate the recovery time. 1
14. To save the result press the MENU button to go to the menu screen 2 scroll to memory and press enter (or scroll to change memory number). ARM/LEG TOE
MODE
MENU 2
1
15. Press the PRINT button to print.
ARM
2 LEG/TOE ARM/LEG TOE
1
INF/ DUMP
Smartdop 30 2 1 EX
MODE
MENU
ARM
LEG/TOE
INF/ DUMP
12 PULSE VOLUME RECORDING (PVR) PVR’s use pneumophlthysmography to identify changes in leg blood volume through waveform pattern analysis. 1.
Place the patient in a supine position with the leg and hip rotated outward.
2.
Wrap the blood pressure cuff appropriately around the patients leg in the appropriate location (ankle or toe).
3.
Use extender tubing to connect the cuff to the automatic cuff inflator on the 1 front of the Doppler. 2
ARM/LEG MODE
TOE
4.
5.
Turn the Smartdop 30EX on and press the probe selector button on the front of the device until both probe LED lights are lit.
MENU 2
2 ARM/LEG ARM TOE
Press INF/DUMP to activate the automatic cuff inflator. The Smartdop 30EX will automatically inflate the cuff to 60 mmHg.
INF/ DUMP
LEG/TOE MODE
MENU 2
ARM
1
2 ARM/LEG TOE
6.
1
1
LEG/TOE
1 Smartdop 30E
INF/ DUMP
MODE
Smar
MENU 2
Watch the Pulse Volume Waveform on the LCD screen. When it becomes steady press the INF/DUMP button to freeze the waveform. ARM
LEG/TOE
1
INF/ DUMP
1
7.
8.
9.
2 ARM/LEG TOE
Press the PRINT button to print the waveform.
MODE
MENU 2
1
To store the waveform to the Doppler memory press the MENU button. 2 Press enter and the next available memory number will be selected, ARM/LEG scroll up or down to change or press enter to select. TOE
Repeat at other sites if required.
ARM MODE
LEG/TOE
LEG/TOE
INF/ DUMP
MENU 2
ARM
1
1
INF/ DUMP
Smartdop 30
13 VIDEO - HOW TO OBTAIN ABI/TBI READINGS
In conjunction with this manual, we have produced a video that demonstrates how to perform ABI and TBI studies using the Smartdop 30EX. Head to the the “Product Videos” section at www.briggatemedical.com (located at the top left of our home page) and scroll down to the video titled “Smartdop 30EX - Obtaining ABI & TBI Readings”. If you have any questions, feel free to contact us on: Ph: Ph:
(03) 8586 7800 1800 33 4142
(Melbourne Metro) (Interstate Freecall)
14
ALSO AVAILABLE:
Smart-V-Link Software for use with Smartdop 30EX/Smartdop45/ES100V3 Allows for creation of detailed patient reports in pdf format - ideal for referrals Fully auto-gain controlled waveform by computer ABI, TBI and arterial blood flow velocity Real-time vascular waveform display Data storage for future reference Standardised testing modules for easy operation and documentation Includes specially designed USB interface cable to link Doppler to PC Requires Windows 7/8.1/10 CODE: DOP/SMLINK
Contact Briggate Medical for pricing
ABI Main Screen Report
Date: 2007/08/23 Time: 11:21:27 ID: HADECO00001 Name: Hadeco Taro Facility: Kawasaki Hospital Ordering Physician: hadeco User2
Sex: MALE Age: 37
Right
Left
Posterior Tibial cm/s
205
2.5 10
2.5 10
0
0
8M Compound
8M Compound
21.4 cm/s
Peak Velocity :
Dorsalis Pedis cm/s
17.8 cm/s
Dorsalis Pedis HR : 59 BPM
HR : 68 BPM
cm/s
205
205
2.5 10
2.5 10
0
0
8M Compound
8M Compound
Peak Velocity :
HR : 61 BPM
cm/s
205
Peak Velocity :
1sec/div.
Posterior Tibial HR : 62 BPM
28.5 cm/s
Peak Velocity :
Right
Pressures(mmHg) Site
Left
112 136 155
Arm Ankle Great Toe
111 152 149
1.21 1.38
ABI TBI
1.36 1.33
19.4 cm/s
Notes: Notes for symptoms & diagnosis
Smart-V-Link(R) Hadeco
15
ALSO AVAILABLE: Additional Cuffs, Probes and Accessories are also available. Contact Briggate Medical for further details.
23-25 Lakewood Blvd Braeside Vic 3195 Australia Ph: (03) 8586 7800 Fax: (03) 8586 7888 [email protected] www.briggatemedical.com