Hill Rom
Welch Allyn Acuity Central Monitors
Acuity Central Monitoring System Directions for Use Sw Ver 6.4x
Directions for Use
156 Pages
Preview
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Acuity® Central Monitoring System
Directions for Use Acuity® System software version 6.4x, compatible with: Propaq® CS software versions 3.6x and higher Propaq® Encore software versions 2.5x and higher Propaq® 100 Series software versions 7.x and higher Propaq® LTR software versions 1.0x and higher Micropaq® software versions 1.5x and higher
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Welch Allyn Acuity Central Monitoring System
Copyright 2005, Welch Allyn®. All rights are reserved. No one is permitted to reproduce or duplicate, in any form, this manual or any part thereof without permission from Welch Allyn. Welch Allyn assumes no responsibility for any injury to anyone, or for any illegal or improper use of the product, that might result from failure to use this product in accordance with the instructions, cautions, warnings, or statement of intended use published in this manual. Welch Allyn®, Propaq®, Acuity®, Micropaq®, Flexible Monitoring® and FlexNet® are registered trademarks of Welch Allyn. ParamSet™ is a trademark of Welch Allyn. C-LOCK® and Nellcor® are registered trademarks of Nellcor Puritan Bennett. Masimo® and SET® are registered trademarks of Masimo Corporation. Software in this product is Copyright 2005 by Welch Allyn or its vendors. All rights are reserved. The software is protected by United States of America copyright laws and international treaty provisions applicable worldwide. Under such laws, the licensee is entitled to use the copy of the software incorporated with this instrument as intended in the operation of the product in which it is embedded. The software may not be copied, decompiled, reverse-engineered, disassembled or otherwise reduced to human-perceivable form. This is not a sale of the software or any copy of the software; all right, title and ownership of the software remains with Welch Allyn or its vendors. For information about any Welch Allyn product, call Welch Allyn Technical Support: USA
1 800 535 6663 +1 315 685 4560
Australia
+61 2 9638 3000 1 800 074 793
Canada
1 800 561 8797
China
+86 216 327 9631
European Call Center
+353 46 906 7790
France
+33 1 55 69 58 49
Germany
+49 7477 9271 86
Japan
+81 3 3219 0071
Latin America
+1 305 669 9003
Netherlands
+31 157 505 000
Singapore
+65 6419 8100
South Africa
+27 11 777 7555
United Kingdom
+44 207 365 6780
Sweden
+46 85 853 6551
Reorder Part Number 810-1605-XX Manual Part Number 810-1598-03 Rev A, 12/2005 Welch Allyn 8500 SW Creekside Place Beaverton, Oregon 97008-7107 www.monitoring.welchallyn.com Printed in USA
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Contents 1 - General Information... 1 Intended Use... 1 Conventions Used in this Manual... 3 Warnings and Cautions... 4 Acuity Compliance with Safety Standards... 6
2 - Acuity System Overview... 7 Acuity System Components... 7 System Configurations... 8 Acuity Central Station Screen... 11 Screen Views... 12 Central Station Map and Status Icons... 13 Waveform Window... 13 The On-Screen Monitor... 14 System Image-Buttons... 15
3 - Admit and Begin Monitoring... 17 Preadmit a Patient to Acuity Monitoring... 17 Readmit a Discharged Patient... 18 Important Considerations while Connecting a Monitor to Acuity... 18 All Types of Monitors... 18 Hardwired Monitors... 19 Wireless Monitors... 19 Connect a Hardwired Monitor to Acuity... 20 Start Communication between a Wireless Monitor and Acuity... 21 The Micropaq Monitor... 21 The Propaq LTR Monitor... 22 The Wireless Propaq CS Monitor... 23 Enter and Confirm Patient ID or Room... 25
4 - Set or Edit Monitoring Settings... 27 Set Up Typical Monitoring... 27 Set Alarm Limits for a Patient... 30 Set Printing Choices for a Patient... 32 Set Waveform Displays for a Patient... 33 Select Waveforms in an On-Screen Monitor... 33 Select Waveforms in a Waveform Window... 33 Set Arrhythmia Alarm Choices for a Patient... 34 The Arrhythmia Alarms Setup Window... 34
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Arrhythmia Terms... 38 Arrhythmia Event Definitions... 39 Set ST Analysis Choices for a Patient... 42 Edit Patient Information... 44 Edit Any Information Except a Patient ID... 44 Add or Remove a Note in a Patient’s Waveform Window... 45 Edit a Patient ID by Adding an Amended (Revised) Patient ID... 46
5 - Respond to Alarms and Alerts... 47 Central Station Alarm and Alert Indications... 47 Suspend an Alarm or Alert Tone for 90 Seconds... 48 Suspend from a Waveform Window... 49 Suspend from an On-Screen Monitor... 49 Remove a Latched Arrhythmia Alarm Indication... 50 Respond to Specific Alarms and Alerts... 51 Respond to a Dropout Alert... 51 Dismiss a “Check Patient HR/PR” Alert... 52 Dismiss an Arrhythmia or ST Alarm Message... 53 Respond to a Relearn Alert... 54 Respond to a Check Leads Alert... 55 Respond to an Arrhythmia Noise Alert... 55 A Summary of Alarm and Alert Levels at Acuity... 56
6 - Review or Print Patient Data... 57 Review Patient Data... 57 Locate Patient Data... 57 Review Trends... 58 Review Waveforms... 59 Review Arrhythmia Events... 60 Review OxyCRG Information... 62 Print or Review Printouts... 63 Print a Snapshot... 63 Print a Review Printout... 64 Review an Alarm Printout... 66 Coordinate Print Jobs and Printers... 67
7 - Move a Monitored Patient... 69 Move the Patient and Monitor to a New Location... 69 Move Patients and Their Hardwired Monitors... 69 Move Patients and Their Wireless Monitors... 70 Move the Patient to a Different Monitor... 72 Move Hardwired Patients to a Different Monitor... 72 Move Wireless Patients to a Different Monitor... 72
8 - Discontinue Acuity Monitoring... 75 Stop Monitoring a Patient... 75 Temporarily Interrupt Monitoring a Patient... 75 Permanently Stop Monitoring a Patient... 75 Discharge a Patient from Acuity Monitoring... 76
Directions for Use
Contents
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9 - Image Buttons & Status Icons... 77 Image-Buttons... 77 Status Icons... 80
10 - Troubleshooting and Maintenance... 87 Troubleshooting... 87 Connection and Disconnection... 88 ECG, SpO2 and CO2... 89 NIBP... 90 Alarms and Alerts... 91 ST Analysis... 92 Printing... 92 Maintenance... 93 Power Outages... 93 Periodically Check Equipment for Safety... 94 Equipment Disposal... 95
11 - Specifications... 97 Monitor/Acuity Compatibility... 97 General Acuity Monitoring Capabilities... 97 Acuity System Heart Rate... 99 Acuity System Pacemaker Detection... 100 Acuity System Alarm and Alert Indications... 101 Electromagnetic Standards Compliance... 107 Acuity Factory Defaults and Specifications... 111 Setup Windows... 113 Review Windows... 117
A - New Features in Acuity Version 6.2... 121 Connectivity Server Icons... 121 Rapidly Enter Patient ID for Pre-Admitted Patients... 122 Edit a Patient ID by Adding an Amended (Revised) Patient ID... 123
B - New Features in Acuity Version 6.3... 125 Add or Remove a Note in a Patient’s Waveform Window... 126 New Arrhythmia Features... 127 Monitoring for Three New Arrhythmia Events... 127 Paced Patients and Arrhythmia... 128 New Alerts Related to Arrhythmia... 129 Choose Leads for ST Analysis... 132 Latched Medium-Level Arrhythmia and ST Alarms... 133 High Availability (HA) Pair System Indicators... 134
C - New Features in Acuity Version 6.4... 135 New Life-Threatening Arrhythmia Alarm Tone... 136 Quick Access to the Arrhythmia Events Review Window... 136 New Latching Arrhythmia Alarm Behaviors... 137 Delete Arrhythmia Event Listings from Review Windows and Printouts... 138
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The Propaq LTR Patient Monitor... 140
Warranty... 141 Index... 143
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1 General Information Intended Use The Acuity® Central Monitoring Station is intended to be used by clinicians for the central monitoring of neonatal, pediatric, and adult patients in health care facilities. In addition to the central monitoring of patient data, waveforms, alarms and alerts, the Acuity software can include optional modules to provide extended recording of patient data (Full Disclosure), arrhythmia monitoring and ST analysis. •
Full Disclosure stores patient data for up to 96 hours.
•
Arrhythmia monitoring module provides real-time monitoring and alarms for specific changes in cardiac rhythms. The clinician is responsible for determining the clinical significance of each detected arrhythmia event or alarm. The arrhythmia module is not intended for use with neonatal patients.
•
ST analysis module provides real-time monitoring and alarms for ST segment deviations, from a reference beat, for patients with suspected heart disease and anomalies. The clinician is responsible for determining the clinical significance of each selected ST segment deviation or alarm. The ST analysis module is not intended for use with neonatal patients.
The Acuity System is Welch Allyn’s Central Monitoring solution. It consists of the Acuity Central Monitoring Station, the Acuity software and a collection of other commercially available networking hardware products. The system connects to a network of patient monitors to record and analyze the data being acquired by those devices. This solution offers a proven technology with the options and features needed to support a distributed network of connected devices while providing arrhythmia detection, alarms and ST Analysis for adult and pediatric patients. The Acuity System supports patient information management, patient alert and alarm management, patient data review, system administration and product installation and service. It leverages various networking and connectivity options to obtain and distribute information where and when needed. Acuity is available in multiple product configurations. Acuity Systems can be ordered offthe-shelf or custom configured to meet a customer’s unique needs based on hospital policy, healthcare facility size, patient census and floor layout. In all cases, the user must carefully review the features and functionality of both the distributed devices and the Acuity Central Station to ensure that clinical needs are met.
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The Acuity Central Monitoring Station is not directly connected to patients. It is designed to be used as a central monitoring system for a set of patient monitors supporting both continuously and intermittently acquired data. The monitors supported include, but are not limited to, the following Welch Allyn devices: Propaq 100 Series, Propaq Encore, Propaq CS, Propaq LTR and Micropaq as configured to interface with Acuity. Acuity Systems monitor patient data supplied by a patient monitor and do further processing of that data by software at the Acuity Central Monitoring Station. Acuity Systems with the Arrhythmia option calculate heart rate using multiple ECG leads and arrhythmia analysis algorithms, where the patient monitor uses a heart rate algorithm based on data from a single ECG lead. The overall performance of the networked system is based upon trending and data management techniques consistent with industry practice and applicable standards. It is important to note that some Acuity software options and/or devices will support adult and pediatric patients but are not intended for neonatal patients. The following Acuity software options are intended only for adult and pediatric patients. They are NOT intended for neonatal patients. •
ST Analysis Software Option
•
Arrhythmia Analysis Software Option
Acuity Central Monitoring Stations and distributed monitoring devices are prescription devices to be used as authorized by health care professionals and/or by institutional standard procedures and good clinical practice guidelines for monitoring of specific patients. Staff trained in the operation of Acuity and the patient monitoring devices connected to it is essential for optimal use. System users should be skilled at the level of a technician, nurse, physician, healthcare provider or medical specialist.
Directions for Use
Chapter 1 General Information
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Conventions Used in this Manual WARNING Indicates conditions or practices that could lead to illness, injury, or death. Caution In this manual, indicates conditions or practices that could damage the equipment or other property. On the product, means “Consult accompanying documentation.”
Note
Provides additional important information.
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Warnings and Cautions Although this guide might suggest some medical monitoring techniques, Welch Allyn expects those who use the Acuity System are trained clinicians with the knowledge and experience to acquire and interpret patients’ vital signs. Clinicians using the Acuity System should be familiar with the operation of the Acuity System as described in this manual, including an understanding of all warnings and cautions throughout this manual. WARNING U. S. Federal law restricts this device to sale by or on the order of a physician or licensed health care professional. WARNING For best product performance and measurement accuracy, use only accessories supplied by Welch Allyn or recommended in the Welch Allyn Products and Accessories booklet. Use accessories according to your facility’s standards and the manufacturer’s recommendations. Always refer to the manufacturer’s directions for use. WARNING Welch Allyn installed this Acuity System according to the system’s cabling and power requirements. Altering the cabling or connecting the Acuity System to another type of power source could damage the equipment, cause system restarts or hazardous conditions on the network, or result in inaccurate patient information at the Central Monitor. WARNING Do not change the Acuity system components or configuration (such as removing or adding a printer or substituting hardware) without approval by Welch Allyn. Such changes could degrade system performance and affect patient monitoring. WARNING Devices connected to Acuity should be certified for overall system compliance according to the European Norm 60 601-1 and 60 950 safety standards. The interconnection of any device with Acuity must comply with IEC 601-1-1. Devices listed in the Acuity System Installation Planning Guide comply with these standards. If in doubt about network jacks or devices, please consult your facility’s Biomedical Engineering Department or Welch Allyn Technical Support. WARNING Do not attempt to monitor neonatal patients’ ECGs using Micropaq monitors. WARNING Monitoring a patient remotely is not a substitute for monitoring a patient at the primary Acuity System. If you are viewing a monitor remotely and its primary Acuity System fails, you will lose all access to the remote monitor. WARNING Make sure Acuity patients are kept under close surveillance, especially patients prone to arrhythmias. Use Acuity only in conjunction with close surveillance by trained clinicians. WARNING It is possible for Acuity alarms, alerts or other events to go unnoticed if clinical personnel are not present at the Acuity Central Station, or if interruptions occur in power or system operations. To help reduce this possible occurrence, it is strongly recommended that the Acuity System be installed with redundant power supplies and redundant means of operator surveillance such as secondary Central Stations and hallway message panels.
Directions for Use
Chapter 1 General Information
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Caution Acuity Engineering Menus are large, gray menus with only a password entry line enabled: they appear along the left side of the Acuity screen. These menus are meant for use only by trained, authorized Welch Allyn service personnel. Unauthorized use of these menus can result in unsafe alteration of the Acuity System, including shut-down of the system. Should you inadvertently open a menu you do not understand that’s not explained in this manual, please disregard the menu and clear it from the screen by pointing anywhere outside the menu and clicking on the left mouse or trackball key.
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Acuity Compliance with Safety Standards 0123
The CE Mark and Notified Body Registration Number signify that the Acuity System meets all essential requirements of European Medical Device Directive 93/42/EEC.
Table 1. Acuity Compliance with Safety Standards Acuity Component(s)
Product Category
Organization and Standard
Propaq 100 Series, Propaq Encore, Propaq CS, Medical Equipment Propaq LTR and Micropaq monitors
EN 60 601-1:1990 A1:1992, A2:1995
All components operating together as a system
Electromagnetic compatibility for Medical IEC 60 601-1-2:2001 Equipment
All components operating together as a system
Medical Systems
IEC 60 601-1-1:1995
All information systems components
Information Technology Equipment
EN 60 950:1994
Acuity cordless receiver cabinet
Electromagnetic compatibility
FCC Class Aa
a.
When the equipment is operated in a commercial environment, Class A limits provide reasonable protection against harmful interference. The equipment generates, uses and can radiate radio frequency energy; if it is not used in accordance with this reference guide, or if it is modified from original installation, it might cause harmful interference to radio communications. Operation of this equipment in a residential area is likely to cause harmful interference, in which case the user is required to correct the interference at his own expense.
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2 Acuity System Overview Acuity System Components Hallway message panel
Micropaqs
Propaq LTR
Ethernet access point
Networked Acuity Station
Propaq CS
Hospital information system
Laser printer Propaq Encore
Uninterruptible power supply Acuity Central Station
Acuity Central Station
Monitors all connected patients, stores patient information, and displays alarms and alerts.
Micropaq
Small wireless monitors that measure ECG and SpO2 and are useful for ambulatory patients
Propaq LTR
Small wireless monitors that measure ECG/Resp, SpO2 and NIBP and are capable of displaying large numerics.
Propaq CS
Wireless or hardwired full-featured vital-signs monitors with large displays
Propaq Encore
Hardwired, portable, full-featured vital-signs monitors
Ethernet access point
The wireless connection to wireless monitors
Laser printer
Optional laser printers give you printouts of various types of patient information.
Hallway message panel
Optional panels, located throughout a unit, visually indicate alarms and some alerts.
Networked Acuity Station One or more Acuity Stations can be networked to an Acuity Central Station. For details, see Table 20 on page 98.
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Welch Allyn Acuity Central Monitoring System
Hospital information system
Vital signs information collected by Acuity can be communicated to other hospital information systems.
Uninterruptible power supply
The UPS supplies power to Acuity for a few minutes during power outages, until back-up generators come on line.
System Configurations The Acuity System centralizes vital signs from patient monitoring devices for display on a computer workstation (the Acuity Central Station). Network components included with the system enable connections to hardwired and wireless monitoring devices, optional laser printers and hallway message panels, other Acuity Systems, and other hospital information systems. From the Acuity Central Station, a Full Disclosure option is available to automatically store all waveforms and trend information for all patients for up to 96 hours. For patients with Full Disclosure, options for arrhythmia analysis and ST analysis are also available. The FlexNet concept allows several Acuity Systems to centrally monitor groups of patients resident on local Acuity Systems within a hospital or on networked Acuity Systems in smaller clinics or hospitals. Transfers from system to system and remote viewing of real-time and historical Full Disclosure data is available for consultation from any of the Acuity Systems.
Directions for Use
Chapter 2 Acuity System Overview
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High Availability (HA) Paired Systems Acuity Systems that support at least 29 patients take advantage of a High Availability (HA) central processing unit (CPU), which is a redundant CPU for an Acuity System. Systems with 28 or less patients can also include the HA Paired System feature. An HA CPU ensures minimal loss of central station patient monitoring by assuming control in the event of a CPU interruption. Displays in an HA Paired System are able to show information from either CPU. To switch a display to the other CPU, press the INPUT button on the flat screen display. If a display is switched to the HA CPU, a yellow indicator appears in the top right corner of its screen. Note
Make sure all the displays in an HA Paired Acuity System either show the yellow indicator or do not show the indicator. This ensures all displays are showing information from the same CPU, and that alarms and alerts will appear on all displays. If displays go blank, switch them to the other CPU, and contact Welch Allyn Technical Services. (See “Troubleshooting and Maintenance” on page 87.)
Figure 1. High Availability Paired Acuity System This yellow indicator along the top of the Acuity screens shows that these displays are connected to the High Availability CPU.
Since this CPU doesn’t match the others because it has no yellow indicator, press the INPUT button to switch it to the other CPU (or switch the other two to match this one).
INPUT button CPU for the Acuity Central Station. CPU for High Availability (HA).
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Welch Allyn Acuity Central Monitoring System
Wireless Devices
Micropaq
Propaq LTR
Wireless Propaq CS
The term “wireless” as used in this manual means the two-way transmission of data between a wireless monitor and the Acuity Central Station by radio, forming a local area network. A loss of bi-directional communication between a wireless monitor and Acuity can occur, and this state is called “Dropout.” (See “Respond to a Dropout Alert” on page 51.) The following table shows Acuity wireless products and the standards to which they adhere. Table 2. Wireless Products Monitor
Standards
Micropaq, Propaq LTR and Wireless Propaq CS
IEEE 802.11, Industrial Scientific Medical (ISM) band, 2.4 GHz; two-way communications
WARNING All wireless systems are prone to intermittent signal dropout, so use this wireless monitor only on patients whose conditions tolerate intermittent monitoring interruptions. During signal dropout periods, arrhythmia and ST analysis cannot be performed, and Acuity will not show alarms, alerts or nurse call requests.
Directions for Use
Chapter 2 Acuity System Overview
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Acuity Central Station Screen The message window at the top of the screen displays the date and time or the location of alarms and alerts.
Utility space may display Setup, Patient List, Review, or Printer Windows.
Select the overall Acuity screen view with these image-buttons. These vary in appearance according to your system configuration. (See “Screen Views” on page 12.)
The On-Screen Monitor displays the patient’s vital signs, alarms and alerts. This patient is in alarm.
The Acuity System map shows the location and status of patients and displays status icons for system equipment. (See “Central Station Map and Status Icons” on page 13.)
Click system image-buttons to select the patient list, to view wireless patients, for system administration or to sort the order of displayed rooms. (See “System Image-Buttons” on page 15.)
The Waveform Window is an abbreviated On-Screen Monitor. It shows the patient name, location and alarm limits, and from it you can suspend alarms, initiate snapshot prints or open the On-Screen Monitor. A message pane in the border of the window shows alarms and alerts. (See “Waveform Window” on page 13.)
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Screen Views Table 3. Screen Views Image-Button
Description
Map View
4-Waveforms View
2-Utilities View
Expands the map to cover most of the Acuity Screen; shows room locations and status icons of all monitored patients. One On-Screen Monitor and review window cover part of the map. If your system has multiple screens, the additional screens show Waveform Windows. The 4-waveforms view shows four Waveform Windows, two utility windows and one On-Screen Monitor. If your Acuity System includes the Multiple Screens Option, this view shows two utility windows and one On-Screen Monitor; a utility window can cover the map.
The 8-waveforms view shows eight Waveform Windows and one On-Screen Monitor; a utility window can cover the map.
8-Waveforms View The 12-waveforms view shows 12 Waveform Windows; an On-Screen Monitor can cover the map and can be replaced by a utility window.
12-Waveforms View The top half of this view shows a review window and the bottom right quarter of the screen shows four Waveform Windows. The map in the bottom left quarter might be covered by an On-Screen Monitor or utility window. The Multi-Screen Option replaces the Waveform Windows with an On-Screen Monitor. Half Screen Review View This view shows one review window for one patient.
Full-Screen Review View Simultaneously shows three On-Screen Monitors and one utility window that can cover the map; shows no Waveform Windows.
All Monitors View
Directions for Use
Chapter 2 Acuity System Overview
Central Station Map and Status Icons These status icons represent networked Acuity Systems, and they indicate the state of communications with the networked systems.
A room number has been assigned to this patient connected to a wireless monitoring device.
No room number has been assigned to this patient connected to a wireless monitor. The number is the device ID number.
Inactive Acuity port
Patient and monitor status icons appear at locations with active monitors. Click on the map icon once to open the Waveform Window or twice to open the On-Screen Monitor.
This indicates the Acuity Central Station location and status. Click to open the Central Station Printers Window.
Waveform Window
Alarm and alert messages replace the patient mode indicator. Color indicates status: red, alarm; yellow, alert; green, patient vital signs within limits and normal equipment operation; and blue, intentional disconnection. From the Patient ID Window, you can enter a temporary note to appear here. (“Add or Remove a Note in a Patient’s Waveform Window” on page 45.)
Alarm limit settings
ECG lead indicator
Click on the Patient/ Equipment Status icon to open the On-Screen Monitor.
Click in waveform area to print a snapshot print at the central printer.
Vital signs in alarm are shown by numbers in a red field. Click in this area to suspend or resume an alarm tone.
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The On-Screen Monitor
ECG lead indicator. To see waveforms from all leads, click Review (see below) to view the Waveforms Review Window.
Color indicates status: red, alarm; yellow, alert; green, patient vital signs within limits and normal equipment operation; and blue, intentional disconnection.
MCO2 indicates Mainstream CO2; SCO2 indicates Sidestream CO2 measurements. Solid bell symbol indicates all of this vital sign’s alarm limits are set. This symbol indicates some of this vital sign’s alarm limits are set. Missing bell symbol indicates none of this vital sign’s alarm limits are set. Up to eight labeled numeric displays Buttons are visible when the pointer is within the window.
Prints a snapshot at the Central Station printer. Click to open Setup Windows for: Patient ID, Alarms, Printouts, Waveform Window, Arrhythmia Alarms, and ST Analysis. Patient/Monitor Status icon. (See “Status Icons” on page 80).
Suspends an alarm tone for 90 seconds. Alarm and alert messages replace patient mode indicator. Click to open Review Windows for: Graphical Trends, Waveforms, Arrhythmia Events, and OxyCRG.
Up to three waveform display areas
The Acuity On-Screen Monitor represents a patient’s monitor and the information obtained from the monitor. The appearance and button sequences of an On-Screen Monitor can differ somewhat from an actual patient’s monitor, and units of measure and labeling vary depending upon the country of use. Note
Options or monitor functions that are not available or active are shown in faint gray type.