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CARESCAPE Monitors B850, B650, B450 User's Manual Software version 2
CARESCAPE Monitors B850, B650, B450 English 2nd edition 2106297-001 © 2018 General Electric Company. All rights reserved.
The information in this manual applies to the software version listed on the first page of the manual. Due to continuing product innovation, specifications in this manual are subject to change without notice. For technical documentation purposes, the abbreviation GE is used for the legal entity names, GE Medical Systems Information Technologies, Inc. and GE Healthcare Finland Oy.
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CARESCAPE Monitors B850, B650, B450
2105822-001 2018-04-11
Contents 1
About this manual ...35 Intended use of this manual... 35 Intended markets of this manual ... 37 Intended audience of this manual ... 37 Training requirements ... 37 Manual conventions ... 37 Monitor naming conventions ... 37 Acquisition module naming conventions ... 38 Illustrations and names ... 39 Related documents... 39 Ordering manuals ... 39 Trademarks ... 39 Third party trademarks ... 39 Manufacturer responsibility ... 39
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Safety ...41 Safety message signal words... 41 Safety symbols ... 41 System safety... 42 System warning safety messages ... 42 Accessories warnings ... 42 Cables warnings... 43 Defibrillation warnings... 43 Electrical warnings ... 43 Equipment warnings ... 45 Site requirement warnings ... 45 System caution safety messages ... 45 Loss of data ... 46 Electrical caution... 46 Site requirement cautions ... 46 Notice safety messages ... 46 Indications for use... 46
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B850 indications for use ... 46 B650 indications for use ... 47 B450 indications for use ... 47 Indications for use safety precautions ... 48 Indications for use warnings ... 48 Indications for use cautions ... 49 Training requirements ... 49 Electromagnetic compatibility ... 49 EMC warnings... 49 EMC cautions ... 50 ESD safety precautions ... 50 3
System introduction ...51 System safety precautions ... 51 System warnings... 51 System caution... 53 Operation warnings ... 53 Monitor installation points to note... 54 Short description of the equipment ... 54 B850 system components... 55 B850 processing unit front view... 57 B850 processing unit back view... 57 B850 module frames F7 and F5 ... 58 B650 system components... 58 B650 monitor front panel ... 60 B650 monitor side views... 60 B650 monitor back panel ... 61 B650 pivoting module frame ... 61 B450 system components... 62 B450 monitor front panel ... 64 B450 monitor side views... 64 B450 monitor back panel ... 65 Monitor battery ... 65 Inserting and removing the B650 monitor battery ... 66 Inserting and removing the B450 monitor battery ... 67
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Checking the battery charge with monitor software... 67 Monitor battery charge symbols on screen... 68 Battery test button ... 68 Alarm light ... 68 Acquisition modules... 69 Identical modules... 69 PSMP front view... 70 PDM front view ... 70 Connecting a PDM or PSM to a frame... 71 Removing a PDM or PSM from a frame ... 71 Connecting other E-modules than the PSM to a frame ... 71 Removing other E-modules than PSM from a frame ... 72 Connecting a PSM or PDM to the B650... 72 Removing a PSM or PDM from the B650... 72 Connecting other E-modules than PSM to the B650 ... 72 Removing other E-modules than PSM from the B650 ... 73 Connecting a PDM or PSM to the B450... 73 Removing a PDM or PSM from the B450... 73 Connecting other E-modules than PSM to the B450 ... 74 Removing other E-modules than PSM from the B450 ... 74 PSM and PDM parameters... 74 E-COP and E-COPSv parameters... 75 E-PP and E-PT parameters... 75 E-module gas parameters... 75 E-MASIMO and E-NSATX parameters... 76 Specialty E-module parameters... 76 Displays... 76 Other system components ... 77 iPanel software application ... 79 InSite with RSvP... 79 Equipment markings... 79 Unique Device Identifier (UDI)... 86 4
Monitoring basics ...87 Main screen layout... 87
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Main keys... 88 An example of a menu... 89 Menu options... 90 Selecting menu options with a touchscreen ... 90 Selecting menu options with the Trim Knob control... 91 Selecting menu options with a mouse... 91 Data field entries ... 91 Entering data ... 91 About the user default settings... 91 About profiles ... 91 Selecting a profile... 92 Supply mains interruption ... 92 User interface indicators ... 92 5
Setting up the monitor before use...97 Normal screen and other pages ... 97 Selecting the normal screen (main page) ... 97 Selecting pages ... 97 Adjusting sound volumes ... 98 Brightness settings ... 98 B850 display brightness... 98 Adjusting the display brightness automatically ... 98 Adjusting the display brightness manually... 98 Adjusting the alarm light brightness... 99 Setting the keyboard light to turn on automatically ... 99 Turning the keyboard light on manually... 99 Screen setup modifications... 99 Parameter windows ... 99 Selecting parameters to the screen... 100 Waveform field safety precautions... 101 Selecting the display mode for IP waveforms ... 101 Setting up a split screen... 101 Locked alarm and parameter settings ... 102 Color selections ... 102 Parameter configurations... 102
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Setting up printing options ... 102 Checking the PDM battery status ... 103 Checking the monitor battery status... 103 B850 with several screens... 103 Other setup changes ... 103 6
Starting and ending monitoring ...105 Software packages and terminology... 105 Turning on the monitor... 105 Turning off the monitor... 105 Invasive pressure labels and PDM ... 106 Starting monitoring... 107 Pre-monitoring checklist... 107 Performance check... 108 Entering patient data... 108 Entering patient data with the monitor ... 108 Entering patient data with a barcode reader... 108 Loading patient information from the CARESCAPE Network (ADT server) ... 109 Entering administrative information... 109 About case reset/patient discharge ... 109 Pending software or setting activation... 110 Residual physiological data... 110 Resetting a case/discharging a patient... 110 Resetting a case/discharging a patient in combination monitoring mode ... 110 About continuing monitoring ... 111 How to continue monitoring when a case is not active/patient is discharged ... 111 How to continue monitoring when a case is active/patient is admitted ... 112 About standby... 113 Starting standby... 113 End of standby... 113 About the combination monitoring mode... 113 About the roving functionality... 115
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Roving between units... 115 Roving between beds... 115 Adding new units and beds (manual roving) ... 116 7
Alarms ...117 Alarm warnings ... 117 Alarm cautions ... 120 Alarm overview ... 120 Alarm types... 120 Alarm conditions ... 120 Broadcast only alarms... 120 Broadcasted limit alarms... 122 Arrhythmia alarm mapping ... 123 Checking alarm function... 123 Visual alarm indications ... 124 Alarm icons on the screen ... 124 Description of alarm and information messages... 124 Visual alarm signals and priority levels... 125 Setting the alarm light brightness... 125 Audible alarm indications... 125 Audible alarm signals... 125 Audible alarm signals and priority levels ... 126 Auditory information signals ... 127 Parameter alarms ... 127 Alarm locks ... 127 Absolute alarm limits ... 127 Setting parameter alarm limits ... 127 Setting alarm limits automatically ... 128 Returning the default alarm limits ... 129 Configurable alarm delays ... 129 Alarm priorities and escalation ... 129 Alarm priority levels... 129 Alarm priority escalation... 130 Selecting parameter alarm priority levels... 130 Setting arrhythmia alarms... 131
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Pausing and silencing alarms ... 132 Audible alarms off behavior ... 132 Pause audio behaviors ... 133 Pausing alarms for 5 minutes... 133 Activating all audible alarms ... 134 Technical alarms’ deactivation with the pause audio key... 134 Apnea alarms’ deactivation with the pause audio key... 134 Pause audio with combination monitoring ... 134 Breakthrough alarms ... 134 Latched alarms ... 135 Turning off all local alarm indicators (sleep mode) ... 135 Remote management of alarms... 135 Alarm settings after a power loss ... 136 Alarm data stored in Clinical logs ... 136 Stored alarm data during a power cycle or power loss ... 136 8
ECG ...137 ECG compatibility limitations... 137 ECG safety precautions ... 137 ECG warnings ... 137 ECG cautions ... 139 ECG measurement limitations... 139 ECG points to note ... 139 ECG measurement setup... 140 ECG equipment to patient connection... 140 Preparing the patient’s electrode sites ... 140 Applying the electrodes to the patient... 140 3– lead or 5–lead ECG electrode placement ... 141 6–lead ECG electrode placement ... 141 10–lead ECG electrode placement for cardiac monitoring ... 142 Standard resting 10–lead ECG electrode placement ... 143 Checking the ECG measurement ... 144 About the ECG analog output signal... 144 About the combination monitoring mode... 145 About V Tach criteria and combination monitoring... 146
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About enhanced Asystole detection and combination monitoring ... 146 Selecting the ECG source... 147 Using the ECG measurement ... 147 The first three displayed ECG leads... 147 Selecting the Va ECG lead... 148 Selecting the Vb ECG lead... 148 Changing to an ECG cable with fewer leadwires ... 148 Deactivating the ECG leads off alarm ... 149 Selecting the beat source ... 149 Setting the beat volume... 149 Setting the beep tone during bradycardia and HR low alarms... 149 Variable beat tone... 150 Aspect ratio and different display sizes ... 150 Selecting the ECG waveform size ... 150 Selecting the hemodynamic waveform sweep speed... 150 Printing all ECG waveforms ... 151 Selecting the ECG waveform filter... 151 Setting the QRS width ... 151 Selecting the leads for ECG analysis ... 152 Relearning the patient’s QRS pattern... 152 Setting the primary HR source ... 153 Showing a second HR value in the HR parameter window ... 153 Showing ST in the HR parameter window ... 153 Showing PVC in the HR parameter window ... 153 Showing QT in the HR parameter window... 154 Displaying the ECG grid... 154 ECG alarm limits ... 154 Selecting the HR alarm range ... 155 Configurable PR alarm delays ... 156 ECG alarm priorities ... 156 Checking alarm delays and priorities information... 156 ECG measurement practicalities... 157 Alternate pulse rate source ... 157
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PDM IntelliRate algorithm ... 157 E-modules, and telemetry transmitters Auto algorithm... 157 ECG troubleshooting ... 157 12 lead analysis... 158 Intended use of 12RLTM Interpolated 12 lead ECG analysis... 158 Intended use of 12SL ECG analysis ... 158 Intended use of ACI-TIPI... 158 About 12SL analysis ... 159 12 lead ECG analysis points to note... 159 Entering data for a 12 lead ECG analysis ... 159 Entering data for an ACI-TIPI 12 lead ECG analysis ... 160 Enabling and disabling the 12SL ACS... 160 Entering the Location ID for 12SL... 160 Setting automatic 12 lead ECG analysis measurements... 160 Setting the 12 lead ECG analysis display format... 161 Selecting the 12 lead waveform filter ... 161 Selecting the 12SL baseline stabilization... 161 Including or excluding 12SL statements in printed reports... 162 Generating a 12 lead ECG analysis report during an ST alarm condition ... 162 Performing a 12 lead ECG analysis ... 162 A 12 lead report and the MUSE database ... 162 Sending a 12 lead ECG report to the MUSE database ... 162 Viewing or printing saved 12 lead ECG reports ... 163 About the 12 lead ECG analysis program ... 163 About the 12RLTM ECG analysis program... 164 12 lead ECG analysis troubleshooting ... 165 Pacemaker detection... 165 Pacemaker detection warnings ... 165 Pacemaker detection points to note... 166 Selecting the pacemaker detection ... 166 Pacemaker detection troubleshooting ... 167 Arrhythmia monitoring ... 168 Arrhythmia monitoring warnings... 168
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Arrhythmia measurement limitations... 169 Arrhythmia alarm mapping ... 169 Setting the arrhythmia category to alarm... 170 Setting arrhythmia alarms... 170 Setting the alarm pause interval... 171 Selecting V Tach criteria ... 171 Setting minimum HR for V Tach ... 172 Setting V Tach event duration ... 172 Setting the SVT length... 172 Setting HR for SVT ... 172 Arrhythmia alarm messages ... 173 About the arrhythmia detection... 175 Arrhythmia troubleshooting ... 176 ST detection... 177 About the ST analysis... 177 ST detection measurement limitations ... 177 ST detection points to note... 177 Starting the ST detection ... 177 Selecting leads to the ST window... 178 Changing the displayed ST leads ... 178 Adjusting the ST point manually... 178 Adjusting the isoelectric measurement (ISO) point ... 178 Adjusting the J point ... 179 About the realtime QRS/ST complexes ... 179 About the reference QRS ... 179 Saving a reference QRS manually... 179 Automatic saving of reference QRS complexes ... 179 Selecting a saved reference QRS complex for display... 180 Erasing a reference QRS ... 180 Printing a realtime QRS/ST report ... 180 Viewing QRS and ST in a split screen ... 180 Selecting the ST time scale ... 180 ST trend display ... 181 Displaying QRS complexes and ST trends for other leads ... 181
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Reviewing ST trends ... 181 Printing an ST trend report ... 181 Ischemic burden... 182 ST alarm limits ... 182 QT detection ... 183 9
Impedance respiration...185 Impedance respiration compatibility limitations ... 185 Respiration safety precautions ... 185 Respiration warnings ... 185 Respiration cautions ... 186 Respiration measurement limitations... 186 Respiration points to note ... 186 Respiration measurement setup... 187 Respiration equipment to patient connection... 187 Preparing the patient’s respiration electrode sites ... 187 Respiration lead and breath detection ... 187 Respiration lead I electrode placement ... 188 Respiration lead II electrode placement ... 189 Respiration lead RL-LL electrode placement... 189 Respiration measurement checks... 190 Respiration measurement on the monitor screen... 190 Using the respiration measurement ... 190 Turning on the respiration measurement... 190 Selecting the respiration lead... 190 Selecting the respiration waveform size manually ... 190 Selecting the respiration waveform size automatically... 190 Selecting the waveform speed... 191 Selecting the waveform sensitivity ... 191 Enabling respiration smoothing ... 191 Relearning the respiration pattern... 191 Turning on or off the respiration rate alarm... 192 Setting the respiration alarm limits... 192 Setting the apnea alarm delay ... 192 Configurable respiration alarm delays ... 192
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Enabling the respiration cardiac artifact alarm ... 192 Respiration alarm priorities ... 193 Checking alarm delays and priorities information... 193 Turning off the respiration measurement ... 193 Respiration measurement description ... 193 Respiration measurement with PSM... 193 Respiration measurement with PDM ... 194 How to interpret the respiration values... 194 Respiration troubleshooting ... 194 10 Pulse oximetry...197 SpO2 compatibility limitations ... 197 SpO₂ safety precautions ... 197 SpO2 warnings... 197 SpO2 cautions ... 200 SpO2 measurement limitations ... 200 SpO2 points to note ... 200 Masimo safety precautions ... 201 Masimo warnings... 201 Masimo cautions ... 203 Masimo points to note ... 205 SpO₂ measurement guidelines... 205 GE Ohmeda technology and sensor measurement guidelines... 205 Masimo SET technology and sensor measurement guidelines... 206 Nellcor OxiMax technology and sensor measurement guidelines... 206 SpO₂ measurement setup ... 207 SpO2 equipment to patient connection ... 207 Preparing the SpO2 connection... 207 Checking the SpO2 measurement ... 208 Using the SpO₂ measurement... 208 Primary and secondary SpO2 measurement sources... 208 Changing the SpO2 waveform size... 208 Changing the SpO2 waveform scale ... 208 Selecting the SpO2 hemodynamic sweep speed... 209
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Selecting the SpO2 as the primary heart rate source ... 209 Showing the SpO2 pulse rate... 209 Adjusting the SpO2 pulse beep tone volume ... 209 Variable beat tone... 210 Masimo SET data averaging and updating ... 210 Selecting the SpO2 averaging time ... 210 Selecting the Masimo SpO2 sensor sensitivity level ... 210 Nellcor OxiMax data averaging and updating ... 210 Selecting the SpO2 response time ... 211 Nellcor OxiMax Saturation Seconds alarm management ... 211 Setting the SpO2 alarms and alarm limits... 213 Deactivating the SpO2 probe off alarm ... 213 Configurable SpO2 alarm delays ... 213 Configurable PR alarm delays ... 214 SpO2 alarm priorities ... 214 Checking alarm delays and priorities information... 214 Stopping the SpO2 measurement ... 214 How to interpret the SpO₂ values... 215 SpO2 signal strength ... 215 SpO2 waveform quality ... 215 SpO2 waveform stability ... 215 SpO2 wavelengths and optical output power ... 215 SpO2 measurement and interference... 216 SpO2 troubleshooting... 216 11 Non-invasive blood pressure...219 NIBP compatibility limitations ... 219 NIBP safety precautions ... 219 NIBP warnings ... 219 NIBP cautions ... 221 NIBP measurement limitations ... 221 NIBP points to note ... 221 NIBP measurement setup... 222 NIBP equipment to patient connection... 222 NIBP module keys... 223
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Preparing the NIBP patient connection ... 223 Checking the NIBP measurement ... 223 NIBP measurement on screen ... 223 Manual NIBP measurements... 224 Starting or stopping a single NIBP measurement from the main menu ... 224 Starting or stopping a single NIBP measurement from the NIBP Setup menu ... 224 Starting or stopping a single NIBP measurement with the PSM module key ... 224 Automatic NIBP measurements... 224 NIBP Auto mode ... 224 Setting the cycle time between NIBP measurements... 225 Automatic NIBP measurements and monitor clock synchronization ... 225 STAT mode ... 225 Venous stasis... 226 NIBP cuffs ... 226 NIBP cuff selection and placement ... 226 Selecting NIBP cuff size... 227 Initial NIBP cuff inflation pressure ... 227 Selecting the cuff inflation limits ... 228 NIBP volume and display settings... 228 Adjusting the NIBP measurement completion tone volume ... 228 Setting the NIBP display format ... 228 NIBP alarms... 228 Setting NIBP alarms ... 228 Silenced NIBP alarms ... 229 NIBP recheck after alarm violation (control measurement) ... 229 NIBP measurement description ... 229 NIBP measurement technologies ... 230 PDM modules’ NIBP technology ... 231 PSM modules’ NIBP technology... 232 NIBP calibration... 232 NIBP troubleshooting... 233
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12 Invasive pressures ...235 Invasive pressures compatibility limitations ... 235 Invasive pressure safety precautions ... 235 Invasive pressure warnings ... 235 Invasive pressure measurement limitations ... 235 Invasive pressure points to note ... 236 Invasive pressure measurement setup ... 237 Invasive pressure equipment to patient connection ... 237 Invasive pressure module keys ... 237 Connecting the invasive pressure transducer and cable ... 237 Checking the invasive pressure measurement ... 238 Invasive pressure measurement on the monitor screen... 238 Selecting the display mode for IP waveforms ... 238 Using the invasive pressure measurement ... 239 Invasive pressure measurement mapping ... 239 Invasive pressure analog output... 239 About zeroing the invasive pressure transducers... 239 Zeroing the invasive pressure transducers ... 240 Selecting an invasive pressure channel label... 240 Selecting the size of the invasive pressure waveform ... 240 Optimizing the invasive pressure waveform scale... 241 Selecting the hemodynamic waveform sweep speed... 241 Selecting the invasive pressure noise reduction filter... 241 Selecting the displayed invasive pressure format... 241 Selecting invasive pressure as the primary heart rate source ... 242 Variable beat tone... 242 Selecting the ventilation mode... 242 Showing the pulse rate in the invasive pressure parameter window ... 242 Showing the CPP value in the ICP parameter window... 243 Selecting Smart BP... 243 Compensating for intra-aortic balloon pump (IABP) waveform irregularities... 243 Selecting the invasive pressure response time ... 244
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Using the IP channel standby... 244 Using the invasive pressure waveform cursor ... 244 Setting an arterial invasive pressure disconnection alarm ... 244 Setting invasive pressure alarm limits ... 244 Configurable PR alarm delays ... 245 Invasive pressures alarm priorities ... 245 Checking alarm delays and priorities information... 245 Systolic pressure variation and pulse pressure variation... 245 Changing the SPV source ... 246 Measuring SPV manually ... 246 PA catheter insertion ... 246 Selecting the PA catheter insertion mode ... 246 Pulmonary capillary wedge pressure (PCWP) measurement... 247 Showing the PCWP value in the PA window ... 247 Taking a manual PA wedge measurement... 247 Taking an automated PA wedge measurement... 248 Starting a new PA wedge measurement ... 248 Other selections in the Wedge menu... 249 Calibrating the invasive pressure measurement with PDM ... 249 Invasive pressure calibration with E-modules ... 249 Invasive pressure practicalities ... 249 Invasive pressure parameters... 249 Intra-aortic balloon pump ... 250 Invasive pressure troubleshooting... 252 13 Temperature...257 Temperature compatibility limitations... 257 Temperature safety precautions... 257 Temperature warnings ... 257 Temperature measurement limitations... 257 Temperature points to note... 258 Temperature measurement setup... 258 Temperature equipment to patient connection... 258 Preparing the patient for temperature measurement... 259 Checking the temperature measurement ... 259
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Temperature measurement on screen... 259 Using the temperature measurement... 259 Temperature mappings ... 259 Starting the temperature measurement ... 260 Changing the temperature site label ... 260 Displaying the delta value between two temperature channels ... 260 Setting temperature alarms ... 260 Stopping the temperature measurement... 260 Temperature practicalities ... 260 Temperature troubleshooting ... 261 14 Cardiac output ...263 Cardiac output compatibility limitations ... 263 C.O. safety precautions ... 263 C.O. warnings... 263 C.O. cautions ... 264 C.O. measurement limitations ... 264 C.O. points to note ... 264 C.O. measurement setup ... 264 C.O. equipment to patient connection with an in-line probe... 264 C.O. equipment to patient connection with a bath probe ... 266 C.O. module key ... 266 Preparing the C.O. measurement ... 266 Checking the C.O. measurement... 267 Using the C.O. measurement... 267 Entering patient data for the C.I. value ... 267 C.O. measurement modes ... 267 C.O. trial measurements... 269 Editing the C.O. average... 269 Canceling a C.O. measurement ... 269 C.O. catheter selections ... 270 Selecting the C.O. injectate probe type ... 270 Setting a C.O. right ventricular ejection fraction (REF) measurement ... 270 Selecting the C.O. scale ... 271
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Selecting what to show with C.O. ... 271 Setting the Tblood alarm ... 271 Adjusting the SvO2 from the cardiac output menu ... 271 Editing calculations ... 271 Adjusting the wedge from the cardiac output menu... 272 C.O. practicalities... 272 Cardiac output thermodilution curve ... 272 How to improve the C.O. accuracy... 272 C.O. troubleshooting... 273 15 Venous oxygenation (SvO₂)...277 SvO2 compatibility limitations ... 277 SvO₂ safety precautions ... 277 SvO2 warnings ... 277 SvO2 measurement limitations ... 277 SvO2 points to note ... 278 SvO₂ measurement setup ... 278 SvO2 equipment to patient connection... 278 Checking the SvO2 measurement ... 278 SvO2 measurement on screen... 279 Using the SvO₂ measurement ... 279 SvO2 calibration in vitro ... 279 Calibrating a new SvO2 catheter in vitro... 279 Recalling a previous in vitro calibration... 280 Calibrating SvO2 in vivo... 280 Updating the Hb value for SvO2 measurement... 280 Setting the SvO2 alarms ... 280 Stopping the SvO2 measurement... 281 SvO2 measurement description ... 281 SvO2 troubleshooting... 281 16 Airway gases ...283 Airway gases compatibility limitations ... 283 Airway gases safety precautions ... 283 Airway gases warnings... 283 Airway gases cautions ... 285
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