Pero-System
Models 400 NT, NTL and T - 100 NT and M - 350 NT and S Manual Revised Oct 2014
Manual
53 Pages

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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S TABLE OF CONTENTS
1
OPENING INSTALLATION REMARKS AND SECURITY ADVICES
4
2
MOUNTING AND DISMOUNTING PEROMETER 400 NT/NTL/T
5
2.1
Model 400 NT/NTL
5
2.2
Mounting and Dismounting model 400 T
7
2.3
Security advices model 400 NT/NTL/T
9
3
MOUNTING AND DISMOUNTING PEROMETER 350 NT AND S
10
4
MOUNTING PEROMETER MODEL 1000 NT AND 1000 M
11
5
SWITCHING ON THE SYSTEM
13
6
DATABASE
13
6.1
Entering personal data
14
6.2
Entering new data
15
7
PERFORMING A MEASUREMENT
15
7.1 Scanning legs and trunk 7.1.1 Model 400 NT, NTL, T and 1000 NT and M: How to scan legs 7.1.2 Model 400 NTL: How to scan a trunk 7.1.3 Model 350 NT: How to scan legs
15 17 18 18
7.2 Measurement of the feet for compression stockings 7.2.1 Model 350 NT 7.2.2 Model 400 NT/NTL, 1000 NT
19 19 20
7.3 Measurement of arms 7.3.1 Model 400 NT/NTL 7.3.2 Model 350 NT, 1000 NT
21 21 21
8
22
8.1
FITTING COMPRESSION STOCKINGS Locating girth measurements
23
8.2 Girth data form 8.2.1 Editing the girth data form
24 24
8.3
Size charts
25
8.4
Stocking data form
27
8.5
Analyzing the Data Form
28
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S 9
ANALYZING OEDEMA
29
9.1
Comparing circumference profiles
29
9.2
Analyzing Leg Volume vs. Time
30
9.3
Analyzing oedema
31
10
DELETE DATA
32
11
DATA BACKUP
32
12
TECHNICAL DETAILS OF MEASUREMENT
32
13
TEST OF CORRECT FUNCTIONALITY
33
13.1
Testing Frame Movement
33
13.2
Testing light switches
33
14
THEORY OF MEASUREMENT
34
14.1
Comparing Perometer and Tape Measurements
36
15
MAINTENANCE
37
16
WARNING NOTICE
38
17
DECLARATION ACCORDING TO IEC 60601-2
39
18
MECHANICAL AND ELECTRICAL DATA
43
19
MAINTENANCE INTERVALS FOR PEROMETERS
46
20
BALANCER-MANUAL MODEL 400 NT/NTL
47
21
BALANCER-MANUAL MODEL 400 T
50
22
POWER SUPPLY (ALL MODELS)
52
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S
1 Opening installation remarks and security advices
supply system with protective earth. More safety instructions are found in sect. 2 and in particular, 2.3 and 19 and in other appropriate sections of this manual. All security advices given in this manual must be strictly adhered to. In an emergency situation or in general hazardous situations the Perometer must be disconnected from the mains. Pull the mains plug of the power supply connected to the Perometer frame. Make sure, this mains plug is always easily accessible. In the evening and outside office hours the Perometer must be disconnected from the mains. For correct operation the Perometer must be connected to a computer with windows operating system and to a printer. The computer must comply to the general requirements for safety of Information Technology Equipment (IEC60950) at least.
Fig. 1: Perometer measurement frame of model 400 NT Before setting up the Perometer, the Perometer manual has to be read. Always refer to the latest version of the manual, which can be downloaded from http://www.pero-system.de/downloads/manual The user of the Perometer must be competent and must be able to understand and apply these instructions. In Europe the Perometer is approved as a medical device class I (with measurement function). Outside Europe the Perometer is intended for use only in non-medical applications (e.g. for custom fit clothing, for monitoring the shape of extremities or – in case of model 400 NTL - the trunk. The Perometer is intended only for measuring human parts of the body. In this manual the person to be measured is often called “the patient”, though in non-medical applications the person is often not ill at all. Replace “the patient” by “the person to be measured” in these cases. The Perometer may only be used in dry areas, on flat ground and with a power
It must be placed outside the environment of the person to be measured, so that it cannot be touched by this person. The operator of the Perometer is not allowed to touch the computer and the person to be measured simultaneously, not intentionally nor unintentionally. If you use your own computer, be sure to meet the requirements for medical electrical equipments according to § 16 IEC 60601-1. Set up the Perometer system in a place which is not too close to a window. Avoid strong lighting, sunlight or spot lamps. Similar to a camera too much direct light on the channels in the inner black covers overexposes the pictures and they will not properly show the actual leg contours. The light transmitters and sensors which scan body extremities are placed at the bottom of the channels in the black inner covers of the frame. When touching these sensors (e.g. during cleaning) be very careful to avoid bending or damaging them. Make sure all channels are clean (e.g. of paper,
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S packing material or other small pieces), otherwise the sensors might be obstructed and the system cannot function properly. The Perometer frame carries two sensors between the four wheels of the frame carriage. They look like two squares of about 0.5 cm width. Make sure they are clean (e.g. of paper, fluffs or packing material) when mounting the frame and during operation. If you need to transport or store the Perometer again after set-up, use the original packaging. The following text describes details, which relate to Perometer model 400 NT, 400 NTL, 350 NT, 1000 NT, 400 T, 350 S and 1000 M. Skip those sections that do not belong to your model.
10. USB adapter cable 11. Screw driver, wrench, etc. to mount the parts 12. Support for the hand including grip to measure arms (if ordered) 13. Computer (if ordered) First put the assembling board to the ground (black metal upwards), where you are going to operate the machine. Open the rear of the Perometer tower using the Pillips screwdriver and remove the transport packing of the (yellow or red) balancer housing. Fit the rail tower to the base board using the four Allen wrench screws. Make sure it is firmly bolted to the plate. The back of the tower will then coincide with the back end of the assembling board.
2 Mounting and Dismounting Perometer 400 NT/NTL/T 2.1 Model 400 NT/NTL Your Perometer comes in several pieces. The parts included are: 1. Assembling board used to mount all parts 2. Perometer tower with rail and balancer system to balance the weight of the Perometer frame 3. Four Allen wrench bolts to connect assembling board and Perometer tower 4. Large frame grip for measurement frame 5. Perometer measurement frame on a carriage with bolt and nut to fix the grip 6. Metal security screw to stop frame sliding from the rail at the upper end 7. Foot adapter to measure feet (only if software PEROFIT has been ordered) 8. Power supply (accessory) with power cord 9. Perometer-computer connection cable
Fig. 2: Mounting the measurement frame of model 400 NT/NTL. Fit the L-shaped metal of the carriage into the slit at the left of the Perometer rail (see also Fig. 3) Attach the large frame grip to the measurement frame (see Fig. 1). First remove nut and washer from the countersunk screw placed between the wheels of the carriage (use wrench and Allen wrench). Leave the pipe (25 mm in length) covering the screw. Turn the large frame grip so that you can slide it over the pipe and the two bolts next to the screw. Fix the grip carefully with washer and nut using wrench and Allen wrench. Cover the nut with a white plastic cap. Turn the Perometer frame until the channel within the inner black covers and the grip is positioned upside and the label on the frame can be read. Fit the L-shaped metal into the top end of the slit next to the rail until the red marking matches the slit (see Fig. 2 and
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S Fig. 3). Move the carriage of the frame from above onto the rail. Make sure the frame carriage is not tilted relatively to the rail to allow an easy sliding. Carefully move the frame down the rail until it touches the ground. Caution: As long as the weight of the frame is not balanced by the red (or yellow) balancer within the rail tower, it may hurt you when falling down!
Make sure the balancer housing hangs free at its fixation during the movement of the frame from top to bottom end of the rail. Make sure the rope remains vertical (or nearly vertical) during this movement. Make sure the balancer housing remains free from the sponge rubber upholstery inside the tower. Don't remove the security chain! A balancer delivered from factory is adjusted. It will balance the frame or allow it to move down slowly. It must not move upwards unintentionally, as the patient may stumble over the frame when moving into the correct position for measurement. To adjust the balancer (could be necessary after a longer period of operation) contact the Perometer hotline ([email protected]) for advises. Finally fix the rear cover of the Perometer tower using the bolts attached.
Fig. 3: The carriage of the measurement frame moves on the Perometer rail. The L-shaped metal reaches into the slit at the left of the rail. Inside the tower it is fixed to the balancer rope. Use the balancer system to balance the weight of the frame. Main parts of the balancer placed inside the rail tower are the yellow or red housing and the metal rope. CAUTION: Never try to draw manually the rope out of the balancer. It develops a force of about 50 N. The rope may hurt you when it moves back suddenly in case you cannot hold it! An assistant lifts the device until the hole in the L-shaped metal (which moves inside the tower) matches the spring hook at the end of the balancer rope (see Fig. 4). Make sure not to move the frame from the rail. A second person at the rear of the rail tower connects carefully ring and L-shaped metal by the spring hook attached to the ring. Make sure the hook is closed. Release the frame slowly until it hovers hanging at the balancer rope (see Fig. 4). Fix the metal security screw at the right of the rail near the top end of the rail. It stops the frame before it moves from the rail without intention.
Fig. 4: The L-shaped metal of the carriage is fixed to the spring hook In some cases (e.g. if no measurement is possible because of fluffs or pieces between Perometer frame and black/white stripes on the Perometer rail) you must remove the frame. Also, you could be advised to do so in case of a severe electronic break down to send back the frame to the factory. To remove the frame from the Perometer tower first remove the
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S security bolt next to the top end of the rail. Open the rear of the tower. Often it is sufficient to open the inspection door. Lift the frame until the rope of the balancer is pulled completely back and until it is no longer tightened. The black rubber bowl/cylinder MUST touch the balancer housing. Hold the frame by your hand. A second person opens the spring hook and removes it from the Lshaped metal of the Perometer frame. CAUTION: Never handle or manipulate a balancer, whose rope is not pulled back completely (i.e. the rubber bowl/cylinder does not touch the balancer housing) without the weight of the frame. The rope could be clamped somewhere. The energy of the spring inside the housing could be unintentionally released pulling back the rope suddenly. Thus, it could harm you severely. Contact the producer or distributor if the rope seems to be clamped ([email protected]) or phone +49202-31713-222. CAUTION: When the spring hook between balancer ring and Perometer frame is removed the frame suddenly gains weight due to its mass of nearly 5 kilograms! Don't let it slip from your hands. Lift the frame (see Fig. 2) and move it from the rail. For transportation the large frame grip may be removed using a wrench. Close the rear of the Perometer tower again. If the movement of the frame is blocked, refer to sect. 2.3
2.2 Mounting and Dismounting model 400 T Your Perometer comes in 11 pieces. In addition, the computer/printer is necessary for operation. The parts included are: 1. Wooden assembling board used to mount all parts 2. Perometer tower with rail/patient's grip/balancer system to balance the
Perometer frame/6 allen wrench bolts and appropriate wrench 3. Patient's stand, rectangular 4. Patient's stand, square shaped 5. Perometer frame 6. Large frame grip/attachment bolts 7. Metal security plate to stop frame sliding from the rail at the upper end 8. Foot adapter to measure feet
Fig. 5: Sliding the frame onto the rail. The L-shaped metal is gently pushed into the slit. 9. Power supply (accessory with power cord 10. Perometer-computer connection cable 11. USB adapter cable First put the wooden assembling board to the ground, where you are going to operate the machine. Assemble the rail tower by fitting the wooden pegs into the base board. Use 6 bolts and the allen wrench to fix the rail tower to the board. The back of the tower will then coincide with the back end of the assembling board. The platforms can be placed according to their shape to the base plate. Rotate the rectangular platform in such a way
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S that the black marking for the foot is as far away as possible from the rail. Put the patient's stands onto the assembling board according to their shape (square or rectangular). Use the fittings attached to the ground board to fix the position of the stands. Turn the rectangular stand, if necessary, so that the distance of its black foot marking from the frame is far off the frame. Now attach the frame. Always carry the frame by two persons, to provide a secure mounting (see Fig. 5). Do not touch moving parts of the balancer system to avoid clamping. Turn the square Perometer frame until the channel within the inner black covers is positioned upside (i.e. it is turned away from the feet of the standing patient). Mounting the frame as described allows you to fix it to the balancer system correctly as the L-shaped metal at the frame carriage is on top of the frame (see Fig. 5). The position allows to measure the patient's leg as far as possible up to the body. The Perometer frame carries two sensors between the four wheels of the frame carriage. They look like two squares of about 0.5 cm width. Make sure they are clean when mounting the frame.
must be removed from the rail. Removing the frame is described at the end of this chapter. Fit the L-shaped metal into the top end of the slit next to the rail (see Fig. 5). Move the carriage of the frame onto the rail. Make sure the frame carriage is not tilted relatively to the rail to allow an easy sliding. Carefully move the frame down the rail until it touches the ground. Caution: As long as the weight of the frame is not balanced by the red balancer within the rail tower, it may hurt you when falling down! Attach the large frame grip (see first picture) to the frame carriage using the wrench. Cover the bolts with white plastic caps. Use the balancer system to balance the weight of the frame. Main parts of the balancer placed inside the rail tower are the red housing and the metal rope. CAUTION: Never try to draw manually the rope out of the balancer. It develops a force of about 150 N. The rope may hurt you when it moves back suddenly in case you cannot hold it! One person lifts the frame until the hole in the L-shaped metal (which moves inside the tower) can be fixed by a second person to the spring hook at the end of the balancer rope (if there is no spring hook, refer to the remarks at the end of this chapter!). Make sure not to move the frame from the rail. Release the frame slowly until it hovers with spring hook and rope in a straight line, while it is hanging at the balancer rope (see Fig. 6). Fix the metal security plate inside the tower near the top end of the rail. It prevents the frame to move from the rail without intention. Use the holes drilled into the tower and two bolts. Cover the bolts with plastic caps outside the tower.
Fig. 6: Measurement frame of model 400 T fixed to the balancer rope ATTENTION: Regular cleaning of the sensors is necessary to avoid system errors. To clean the sensors the frame
Make sure the balancer housing hangs free at its fixation at each position of the frame during its move from top to bottom end of the rail. Move it to the right or left until the rope is (nearly)
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S vertical at each position of the frame. Make sure it remains free from the spongerubber upholstery inside the tower. Don't remove the security chain! A balancer delivered from factory is adjusted. It will balance the frame or allow it to move down slowly. It must not move upwards unintentionally, as the patient may stumble over the frame when moving into the correct position for measurement. To adjust the balancer (could be necessary after a longer period of operation) contact the Perometer hotline ([email protected]).
Dismounting the frame In some cases (e.g. if no measurement is possible because of dust or other pieces between Perometer frame and black/white stripes on the Perometer rail) you must remove the frame. Also, you could be advised to do so in case of a severe electronic break down to send back the frame to factory. To remove the frame, refer also to sect. 2.3. First remove the security metal plate inside the Perometer tower using the wrench. Lift the measurement frame until the rope of the balancer is pulled completely back and until it is no longer tightened. The black rubber bowl MUST touch the balancer housing in this case! The balancer rope may be attached to the L-shaped metal of the measurement frame by a bolt or by a spring hook (see Fig. 6). A second person removes the bolt or the spring hook, respectively. NOTE: Balancers being attached to the measurement frame by a bolt are worn out. They MUST be replaced by a new balancer (contact [email protected] for a new one). If the balancer is not replaced in this case, the Perometer must be put out of operation! CAUTION: Never handle or manipulate a balancer, whose black rubber bowl at the end of the rope does not touch the balancer housing. The rope could be clamped somewhere. The energy of the spring inside the housing could be unintentionally released pulling back the rope suddenly. Thus, it could harm you. Contact the producer or distributor in a
case like this. If the movement of the frame is blocked refer to sect. 2.3. CAUTION: When the bolt between balancer ring and Perometer frame is removed the frame suddenly gains weight due to its mass of nearly 15 kilograms! Don't let it slip from your hands. If necessary, two persons have to lift the frame and move it from the rail. For transportation the large frame grip may be removed using a wrench.
2.3 Security advices model 400 NT/NTL/T . This section covers special security advices referring only to model 400 NT/NTL, 400 T and 550 T. In addition security advices and warnings must be observed, which are common to all Perometer models and which are given in other sections of this manual. A) Monitoring of the suspension of the measurement frame: Always leave the frame in its lowest position except for measurement. Do not put any items on the frame. Make sure that you have moved the frame always to its lowest position as soon as the person to be measured steps into or out of the frame during measurement. Neither the operator nor the person to be measured of any other person is allowed to put any parts of the body under the frame as long as it is lifted from its lowest position. This is especially important, if (in very rare cases) the movement of the frame is blocked. It could happen due to a break of the balancer spring. If the frame crashes down, it could cause serious injuries. Safety instructions say, the balancer and the balancer rope have to be checked for signs of wear following the regulations of the producer (see and section 20 for Mod. 400 NT/NTL and sect. 21 for model 400 T). To allow an easy checking in the case of model 400 NT/NTL, an inspection door is placed at the side of the tower. In the case of
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S model 400 T the rear of the tower is open. Therefore, the rear of the Perometer tower of model 400 T must face a wall being not more then 20 cm apart from the tower. For all Perometer models the maintenance steps according sect. 19 have to be performed carefully. During inspection and maintenance it is not allowed to measure patients. Unauthorized persons are not permitted to access the rear area of the Perometer. During inspection of the balancer no measurements are allowed and all persons have to leave the rear area of the Perometer. After 5 years of operation the balancer has to be replaced in order to avoid a fatigue of the metal spring holding the measurement frame. If the replacement is missed, the Perometer must be taken out of service. Call the hotline ([email protected]) for advices. B) Procedure if the movement of the measurement frame is blocked during operation. If the movement of the measurement frame is blocked, the balancer rope could be obstructed or the metal spring inside the balancer could be broken. In the latter case a spring safety device is activated, which holds the measurement frame. DO NOT ATTEMPT TO MOVE THE FRAME WITH VIOLENCE! THE FRAME COULD CRASH DOWN AND HURT THE PERSON TO BE MEASURED AS WELL AS THE OPERATOR. If during a leg measurement the frame is blocked, when it is near the groin of the person to be measured, make sure the person does NOT leave the foot markings. An assistant lifts the frame a bit, holds it and prevents it from crashing. If necessary, ask two assistants. Only then use a step ladder and/or appropriate stools and now allow the person inside the frame to climb out of the frame. Always keep ladder and/or stools ready and practice the correct
procedure prior to the event. If the trunk is measured (model 400 NTL) and the frame is blocked, lift the frame and ask the person to bend down and move away. Individuals being too frail to behave correctly in the event of blocking of the frame, must be excluded from the measurement. As soon as the person to be measured left the frame, support the frame permanently from crashing down and make sure, nobody can put any parts of the body below the frame. Contact the Perometer hotline ([email protected]) for further advices.
3 Mounting and Dismounting Perometer 350 NT and S Your Perometer comes in the following different pieces: 1. Power supply (accessory) with power cord 2. Perometer rail 3. Two wooden end stands, each with two Allen wrench bolts for attachment to the rail 4. Foot rest 5. Perometer frame 6. Perometer-computer connection cable 7. USB adapter cable 8. Patient's seat (if ordered) 9. Computer (if ordered) CAUTION: Do not lift the rail, before having removed the foot rest and the frame from the rail. First turn the Perometer rail until you can see the black and white stripes. If you are going to measure legs, put it on
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S the ground. For the measurement of arms put it on a table. Turn the rail, until the type plate attached to the wooden part of the rail is placed at the side where the foot of the sitting person to be measured will be. Next mount the first of the wooden rail stands. Note the two stands are different. One of them has two additional vertical holes for attaching the Perometer seat (if ordered). Attach the first mount (without the vertical holes) to the rail at the side of the type plate. Use two screws and the Allen wrench to secure the stand. Before mounting the foot/arm rest make sure the brake handle is turned counterclockwise. Thus, the plastic end of the brake (between the wheels of the carriage) is not damaged, when you allow the foot/arm rest to slide onto the rail. Move the carriage until it is near the type plate. Turn the square Perometer frame until the channel within the inner black covers is positioned next to the person to be measured (i.e. it is turned away from the foot rest). Only if the frame is oriented as described, the Perometer will function properly.
movement will be interpreted in a false direction. Between the wheels of the measurement carriage there are two square sensors which scan the grid strips during the movement of the frame. When mounting the measurement frame make sure that no fluff or small pieces remain on the sensors or the grid strip. Sensors being obstructed may lead to a termination of the measurement. Dismount the measurement frame from time to time and clean the sensors using a soft brush or just your fingers. After having mounted the frame attach the second wooden stand to the rail using the screws and Allen wrench. Secure the frame and foot rest in position. Avoid tilting the rail or moving the parts unintentionally. Having installed the Perometer rail and frame then continue mounting the Perometer seat (if applicable). Make sure the brake of the seat is working properly. Place the seat so that the rail below is midway between the front legs of the seat. Connect seat and Perometer rail by fitting the two screws into the holes between the legs of the seat and into the holes of the rail stand. If you use your own seat make sure the measurement frame can be moved up to the crotch of the Person to be measured. The measurement frame is detached from its rail following the above advices in reverse order.
4 Mounting Perometer model 1000 NT and 1000 M Fig. 7: Mounting two base plates of Perometer model 1000 NT and the measurement frame. ATTENTION: If the frame is mounted with the channel away from the person to be measured the direction of frame
Your Perometer comes in several pieces. In addition, the computer /printer are necessary for operation. The parts included are: 1. Perometer frame, to which a small 4 wheel carriage is attached
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S 2. Two base plates, which are the assembling board. One of them has mounting holes 3. Perometer rail and device to fix it to the base plate. 4. Power supply 5. Perometer-computer connection cable; COM-USB adapter. 6. Foot adapter to measure feet (if ordered) 7. Arm adapter (if ordered) 8. Computer (if ordered) Caution: The grip for lifting up the frame during measurement is attached to a spiral spring. If the grip is not fixed to the clip at the Perometer frame, it could snap upwards, when you open the cover of the transport case. This could hurt you.
Fig. 8: Mounting the Perometer rail of model 1000 NT. Make sure the rail slides smoothly into the space between the wheels of the carriage. The Perometer should be placed so that the patient may hold a grip attached to the wall or may use for example a stationary piece of furniture as a support. First put the wooden assembling board having holes to that place, where you are going to operate the machine. The foot markings will have to be turned upwards (see Fig. 7). Remove the frame from its case as shown in the picture, remove the spiral spring from its clip and put the frame on the assembling board. The label "Perometer" must be on top. The frame grip fixed to the spiral spring must point upwards.
As the next step, fit the rail carefully to the carriage of the frame as shown in Fig. 6. The rail is guided by two upper and two lower wheels. Take care that the rail also slides between the lower wheels. Don't do this forcibly. It is possible as soon as you hold the rail in vertical direction. Attention: The space between the wheels of the carriage fits precisely to the rail. If you use too much force, when the rail slides down, the carriage wheels will be pressed apart and must be realigned. Move frame and rail on the base plate until the holes in the board will match the holes of the device holding the rail. Fix it by the two screws delivered with the base plate and place the second plate in front of the frame. If you are out-house, you may have only a transport case, which does not comprise the two base plates. In this case, mount the Perometer frame on a flat floor to operate it without the assembling board. Fig. 16 shows how to fix the rail by your foot during the measurement. To detach the frame from the base plate first open the screws holding the base plate, then remove the rail and put back the frame to its case. Be careful not to clamp the cables, when closing the case. The plastic hook at the side of the frame is for fixing the grip in the case of storing the frame e.g. in a shelf. Remove the grip from the plastic hook when you set up the Perometer for measurement again. CAUTION: Never leave the laptop switched on or in stand-by mode when you are going to close the transport case. The inner parts of the case might heat too much. This will destroy the electronics of the device. Also, parts may start burning! Take care, when closing the case after measurement, not to clamp cables or other parts. Check all cables for damage regularly.
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S
5 Switching on the system
cannot reach its ground position for measurement in this case.
After having set up the Perometer mechanics, the computer and printer have to be installed. Use the manuals given by the producers of these devices.
All models: The status "ready" is indicated by the green LED next to the two connectors of the measurement frame. Switch on the Perometer, the printer,
Fig.9: Screen before entering personal data and the computer. Connect the computer and the Perometer measurement frame. Use the USB-adapter cable to fit the cable supplied to the USB-port of the computer. Load the driver CD. In case the computer has a serial RS232 port you may also connect the cable directly to that port. Connect the power supply box with the measurement frame. Connect the power supply to the mains. From now on the Perometer is switched on and switched off by plugging or unplugging the power cord. Model 400 NT/L: Clip the two cables running to the Perometer frame into the hook at the side of the Perometer tower. Make sure the cables are not below the frame during its movement. The frame
Install the Perometer program delivered by CD, if you use the computer with the Perometer for the first time. Use the Windows command RUN after having clicked the START button in the lower left corner of the screen. Run the installation program “setup.exe” on the CD and follow the instructions given by the Install shield. You need administrator access rights for the installation. Start the program by clicking the peroplus icon. The computer displays a message if the Perometer in not yet switched on at that moment.
6 Database
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S The Perometer is used in two main applications for which two different software packages are needed. Persons are measured for the fit of compression stockings with the help of the software PeroFit. The program PeroScan allows the measurement of extremities for monitoring leg/arm volumes or oedema. If ordered, both programs are implemented in one software package. The shape of the trunk (often for non-medical applications) can be analyzed using PeroScan in connection with Perometer model 400 NTL. This manual describes all of these options. In the following pages we will indicate what parts of this manual you may skip when you are interested in only one of the possible applications.
not yet highlighted in blue, click on desired name found in the SEARCH WINDOW below or use the arrow keys of the keybord (up/down arrow). Press the ESC key to quickly access the measurements of an individual, which you have selected. The screen then appearing we will call the LIST OF MEASUREMENTS screen from now on. Press ESC again to return to PERSONAL DATA screen. This function quickly enables you to review
6.1 Entering personal data Fig.10: Screen for comments to personal data Let's assume if an individual named Peter Testman, who has already previously been measured, is going to be scanned with the Perometer again. After having started the Perometer program the screen shown in Fig.9 is displayed. Enter the first several letters of Mr Testman’s last name into the space provided below ENTER NEW SET OF DATA. Press ENTER key to bring up the data on this individual patient. The search box turns from white to grey and the information is then registered in the data bank. Click this grey square to reopen the patient's data bank. Letters may then be removed or additional letters may be entered. Please notice: to enter letters into this box it must be white. If the box is grey it must be clicked on. In the large white box (from now on referred to as SEARCH WINDOW) the names of all patients who have already been entered, are displayed corresponding to the letters you have entered in the small box. To find Mr. Testman enter the letter T (or t), then press ENTER. Box is then displayed in grey. If patient's name is
past information about Mr. Testman. By using the arrow keys (up/down) you instantly know all details on his data (e.g. stockings that he already has been received). Personal remarks may have been entered under the CUSTOMER INFO index heading (Fig.10). A dot in the circle below indicates information has been entered. Click on the flap above the dot in order to display the information.
In situations where a large number of patient's names begin with the same letter or letters, it is also possible to scroll up and scroll down to locate an individual patient not shown in the white box. The scroll is found to the right of the names. It is also possible to locate the patient more directly by entering additional letters of the name into the white box located above the SEARCH WINDOW.
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S 6.2 Entering new data
"photographing" legs/arms (and feet, when necessary) as well as trunk (in the case of model 400 NTL). This is done
Fig. 11: Screen after having pressed the button „PEROMETER START“ Personal data may be changed, for example, when patients have a change of address. To do this at any time click the CORRECT DATA button to the right of the SEARCH WINDOW. Fill in the desired corrections on the right of the window and finish your input by CANCEL or SAVE. In cases where you want to enter new patient's information, you must click the NEW PATIENT button located above the SEARCH WINDOW. Similar to the information already discussed concerning corrections, a blank new patient form appears on the screen. Partial or complete patient data may be entered as you like. The patient is registered into the data base as soon as you click the button labelled SAVE INPUT.
7 Performing a measurement Your next step is now to begin actually measuring an individual by
by activating the box on the upper left hand screen symbolized by a camera. As a result, a diagram appears with the buttons LEFT LEG, RIGHT LEG, LEFT FOOT, RIGHT FOOT (Fig. 11). For arm measurements press the radio button at the bottom of the screen shown in Fig.10. If measurements have already been taken corresponding buttons will display red check marks. When measurements must be repeated simply click the corresponding buttons once more.
7.1 Scanning legs and trunk The first step when measuring the leg starts with the frame in position below the foot rest (model 350 NT) or when the frame is in its lowest position (model 400 NT/NTL and 1000 NT). When the frame is slid into its starting position you will hear a beep and the command START POSITION
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S REACHED will appear on the computer screen. Now move the frame as far as you need it. If possible, scan a larger part of the extremity. ATTENTION: Move the frame forward and again back to its start position. Only then the measurement can be finished. Analyze the shape of an extremity (or of the trunk) and its change versus time only afterwards. The computer will select the same part from all the images having been taken. For more information see section 9 “ANALYZING OEDEMA”. If you intend to fit compression stockings, scan either a part of the leg (e.g. for A-D-stockings) or all of it (A-Gstockings). Keep in mind to cover the full extent of the leg up to the body (crotch - groin) area, when the patient receives an A-G stocking. If not, the length of the stocking will be falsely determined. In special cases, when patients feel very uncomfortable, you
light rays and will falsely influence the measurements. ATTENTION: The frame must be moved continuously in one direction only. It may be stopped. However, as soon as it moves backward, the computer will stop photographing the leg in that specific direction (i.e. forward) and will wait until the frame returns to its original position below the foot rest again (During that movement an opposite direction measurement is performed). If you returned the frame too early, you get pictures which are too short. Thus, if the picture is incomplete, repeat the measurement process from the initial starting position and make sure that the frame moves in one continuous direction only. Computer data is fed into the computer and appears in the upper right box as a
Fig.12: Computer screen after having successfully scanned a leg. The contours of the leg are shown from the side and from above. may allow the patient to pull the frame by themselves the last part of the way (not in the case of model 1000 NT and M). In this case the patient must be instructed to touch only the outer white part of the frame, not the inner black covering: Hands, clothing or other objects could interrupt the measuring
side view and in the lower box as a top view of the leg (see Fig.12). Careful attention should be given to the pictures to make sure they look correct (i.e., no objects other than the leg should be seen, leg contours should not appear masked by anything else). If so, repeat the measurement once more by clicking
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S on the LEFT LEG (or corresponding box). It may be necessary, particularly in the g-region to avoid measuring the person's clothing or stomach. Likewise direct lighting on the Perometer sensors could produce changes on the leg contour. In unusual cases, when "realistic" contours in the side view and in the top view cannot be achieved although the procedure given above was followed directly, an electronic break down could have occurred. Contact the hotline ([email protected]) for help. If a "realistic" contour appears (see Fig.12) the measurement is complete. LEFT LEG button in discussion will appear with a red check. Usually (but not necessarily) the measurement of the left foot will now be taken. ATTENTION: If you do not wish to measure the foot, the corresponding box should not be activated.
7.1.1 Model 400 NT, NTL, T and 1000 NT and M: How to scan legs
ATTENTION: Make sure the person to be measured does not touch the frame by his feet or trip over the frame. Make sure the person approaching the Perometer for measurement cannot stumble over the cables running to the computer/power supply. If necessary, hold the hand of the person to be measured. For correct leg measurement the patient should stand with one leg inside and one leg outside the frame on the foot markings. If necessary instruct the patient to move the legs wider apart from each other. Start with left leg inside. For secure standing during measurement of the left leg the left hand must hold the patient's grip (model 400 NT/NTL) at the top of the tower or another support (in the case of model 1000 NT). During measurement of the right leg (being inside the frame) the right hand must hold the grip/support. CAUTION: Make sure the patient does not leave the correct positions of the feet (or hands) during measurement. Neither the person to be measured nor the operator is allowed to put their feet below the frame. The extremities could be pinned between frame and floor in case they moved away too far from their correct position. This is especially important, if the balancer spring (model 400 NT, NTL and T) breaks during measurement and if at the same moment the spring safety device fails. The frame cannot crush any part of the body, if it is not below the frame. Perometer model 1000 NT: The frame might fall down, e.g. because the grip, by which you hold it, slides from your hand! It could cause severe injuries, if the frame falls on the feet of an individual. Make sure that feet of the person to be measured and your feet are never below the frame.
Fig. 13: Measuring a leg with Perometer model 1000 NT. Base plates are omitted for this measurement
In case you are out-house you may not use the assembling board. Run measurements only on a flat floor. Clamp the metal stand of the Perometer rail by your foot as shown in
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S Fig. 13. As soon as the patient is in correct position, you may move the frame by the grip. At the same time always hold the rail at its top end using the other hand (Fig.12).
To open a database for trunk scans, press OPTIONS in the top menu bar and then ALLOW CREATING MASTER DATA FOR TRUNK MEASUREMENTS. You are asked “Do you want to do trunk measurements with these master data”. Answer YES (JA). Now proceed as usual. During trunk measurements the person to be measured stands with both feet inside the measurement frame and faces the Perometer tower. The feet are put together as close as possible. The toes touch the black plastic bar (see Fig. 14).
Fig. 14 The position legs and feet during a trunk measurement. The toes touch the black bar.
7.1.2
Model 400 NTL: How to scan a trunk
Often trunk scans are performed when a person wants to monitor the body’s
ATTENTION: As described in sect. 14, the Perometer measures two diameters for any given cross section of an object. If you place both legs inside the frame their cross sections are approximated by only one ellipse (not by two!). Thus, in a trunk measurement, the volume and circumference given for the two legs may differ strongly from the correct values! Analyze the trunk only, not the legs in a series of trunk measurements!
Fig. 15 Sample of scans of a person having lost a volume of 2000 ml during a 3-weeks diet. shape, e.g. when doing sports or undergoing a diet. In most countries these are non-medical activities. Therefore, the database is separated from all other databases.
7.1.3 Model 350 NT: How to scan legs
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S Let us assume you want to measure the left leg of an individual first. The adjustable Perometer seat is fixed into the right side position. The seatback may be adjusted to any desired position. Move the seatback forward or backward according to the body structure of the person to be measured. Be sure the full extent of the leg is scanned when the patient is measured for an A-G stocking. In those cases, the frame must be drawn over the entire length of the leg (not necessary for A-D stockings). The seat arm rests give the patient additional stability. Special attention must be given when a patient attempts to slide forward in the seat. Avoid letting the patient slip out of the seat when sliding forward.
7.2 Measurement of the feet for compression stockings
7.2.1 Model 350 NT Normal procedure continues by "photographing" each foot in order to obtain the measurements of the a- and the h-position.
ATTENTION: Patients who are too frail cannot be measured by Perometer and must be measured by hand. The patient is now instructed to push his left leg through the frame and his foot on the foot rest. To correctly place the foot of the patient for correct results, release the brake of the foot rest by turning the black handle of the brake counterclockwise. Hold the patient's foot in one hand and by your other hand slide the foot rest forward to the bottom heel of the patient's foot. The patient's leg should be in a stretched position. Tighten the foot/arm rest to a snug fit. Overtightening will damage the unit. ATTENTION: The Perometer measures the length of a scan starting exactly at the point of the vertical plate of the foot/arm rest. It is very important for the heel to be in a resting position against the foot/arm rest. The heel must touch the vertical plate, otherwise false length measurements will result!
Fig. 16: Perometer model 350 NT: How to position a foot for the measurement of the a- and h-circumference. First clamp the toe adapter onto the foot rest. It has a black triangular toe holder. The patient places the foot on the triangle at the point where the toe bends. Pay attention; the foot and leg should be roughly at a 90 degree angle. The bottom of the foot should be at a 45 degree angle to the floor (see Fig. 16). When necessary move the foot rest closer to the patient. At this point you may begin measuring as described above. Move the frame to the starting position below the foot rest, then over the heel up to the shinbone and move
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S the frame back again. At all times avoid touching the patient's leg with the
Fig.17: Computer screen after having successfully scanned a foot. The contours are shown from the side and from above. frame. If necessary repeat the foot measurement (e.g.if the scan has no „realistic“ contours (see Fig.17).
7.2.2 Model 400 NT/NTL, 1000 NT Put the foot adapter carrying a black cuboid on the foot marking of the square patient's stand. Instruct the patient to hold the Perometer grip of the tower (model 400 NT/NTL) or use an appropriate support (model 1000 NT) Measuring the right foot
ball of the foot (where to measure the aposition) is lower than the foot adapter itself and thus cannot be scanned correctly. If necessary, repeat the foot measurement.
Fig. 19: Same as Fig. 16, except measuring a frail person Scanning the foot means to move the frame at the starting position below the foot over the heel up to the shinbone and back again.
After being sure the picture of the foot is correct on your computer screen (see diagram 15), continue with measurements of the opposite foot and the opposite leg, when necessary.
Fig. 18: Perometer model 400 NT/NTL, 1000 NT: How to position a foot for the measurement of an a- and hcircumference use the right hand, measuring the left foot use the left hand. Put the patient's toes on the black cuboid as shown in the Fig. 18 for a right foot. The foot should not be moved lower as shown in Fig. 19. Otherwise the
Fig. 20: Perometer model 400 NT/NTL: Posture of the Arm and the hand for measurement of the upper extremity
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PEROMETER 400 NT/NTL AND T – 1000 NT AND M – 350 NT AND S 7.3 Measurement of arms The Perometer calculates volumes slice by slice. For volume vs. time plots the volumes derived from different scans are plotted. As a consequence, slices of equal distance from the starting point of the measurements are compared. Therefore, make sure that the hand is held so that eg the knuckles in all images have the same distance from the bottom plate. Details are described below measurement of the upper extremity .
7.3.1 Model 400 NT/NTL For the measurement of an arm the person to be measured sits next to the frame on a chair at the side opposite to the cable connectors. The hand adapter stands on the foot marking and the hand holds the grip (see Fehler! Verweisquelle konnte nicht gefunden werden.). Lift or lower the seat of the chair if necessary for short or tall patients until the arm is stretched out. As shown in the picture you should now be able to move the frame with its measurement area as far as possible up to the armpit (g-position).
Fig. 21: Perometer model 1000 NT: Posture of the Arm and the hand for measurement of the upper extremity
7.3.2 Model 350 NT, 1000 NT
respectively, the unit is placed on a table. For security reasons, detach the rail stand of model 350 NT, the measurement frame and the foot rest first. Place the parts on the table and mount them again. Using model 1000 NT release the brake at the carriage of the arm adapter (it is a black bowl, which you can turn) and mount the adapter. Position the hand (palm in horizontal direction) as shown in Fig. 21. Advise the person to be measured to stretch out the arm and hand. Move the arm adapter (the foot/arm stand for model 350 NT, respectively) until the fingertips touch the vertical plates of the adapter (Fig. 21). Tighten the brake. Choose the "Arms" selection circle and button (see Fig. 11) on the computer screen. Set the zero point of the scan by moving the frame until it touches the carriage of the arm support. Only then start the measurement by moving the frame forward across the arm and then backward until it touches the carriage of the arm support again. You may find it difficult in the case of arm measurements to determine the correct measurement position for the c-, e-, f- and g-circumferences by just using the side view pictures. To prevent incorrect positioning stick markers onto the arm. You can detect them later on in the side view picture. The stickers should be next to the correct position to allow the Perometer to measure the circumference properly without being disturbed by the sticker itself. A set of suitable stickers is provided together with the perometer. More stickers are available from the supplier. The subsequent measurement process is similar to the measurement of legs. For those measurement positions you have marked by stickers move the cursors next to the stickers otherwise they will induce an error to the reading of the circumference. For the fitting of compression stockings proceed to the printer data form, to the size chart form and to the ordering form as described in sect. 8. Where necessary the forms will be different to the leg forms.
For arm measurements using model 350 NT and model 1000 NT,
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