Propaq Encore Vital Signs Monitor 202, 204 and 206EL SW 2.4X Reference Guide

Contents General Information... 9 Safety Summary... 9 Symbols... 11 Propaq Encore Documentation... 13 The Documentation Set... 13 About This Reference Guide... 13 Statement of Expectations of the Reader... 13

Getting Started... 15 Introducing the Propaq Encore... 15 Intended Use... 15 Propaq Encore Models and Options... 15 Expansion Module... 16 Propaq Encore Pulse Oximetry Option (SpO2)... 16 Capnography (CO2) Options... 16 Impedance Pneumography (RESP) Option... 17 Printer Option... 17 Propaq-to-Acuity Option... 17 Modem-Propaq Option... 17 HP-compatible Side Panel Option... 17 Using the Propaq Encore... 18 System Controls (Right Side Panel)... 18 Alarm Lights... 19 Power-up Screen... 20 Patient Connections... 22 Propaq Encore Display... 24 Propaq Encore Buttons... 25 Propaq Encore Menus... 26 Monitor Setup... 29 Selecting Waveforms for Display... 31 Setting the Time and Date... 31 Changing the Date Format, Filter, and Units... 32 Setting the Current, Custom, and Powerup Modes... 33 Printer Functions... 35 Learning the Propaq Encore... 37 Using In-Service Mode... 37 Welch Allyn

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What You Can Do With In-Service Mode...37 What You Cannot Do With In-Service Mode...38

Patient Monitoring... 39 ECG/RESP... 39 Intended Use–Impedance Pneumography (RESP)...39 Intended Use–ECG...40 ECG Connector and Applicable Accessories...41 Preparation...42 How ECG/RESP is Displayed...45 Using the Propaq Encore With Pacemaker Patients...47 Using the Filter to Better Display a Waveform...48 ECG Messages...48 RESP Messages...49 Invasive Pressure...50 Intended Use...50 Invasive Pressure Connectors and Transducers...50 Preparation...51 Rezeroing a Transducer...52 How Invasive Pressure is Displayed...53 Invasive Pressure Messages...54 NIBP...56 Intended Use...56 Improve NIBP Accuracy with Smartcuf™...57 NIBP Connector and Cuffs...58 Preparation...59 Important Information About Automatic Measurements...62 NIBP Messages...62 Temperature...66 Intended Use...66 Temperature Connectors and Probes...66 Preparation...66 How Temperature is Displayed...66 Temperature Messages...67 Pulse Oximetry (SpO2)...68 Perform SpO2 Monitoring with Masimo Option...69 Perform SpO2 Monitoring with Nellcor Option...70 Perform SpO2 “Spot-Check” Monitoring...73 Capnography (CO2)...75 Intended Use...75 Propaq Encore Reference Guide

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CO2 Measurements and Display... 76 CO2 Display Menus and Status Window... 78 Mainstream CO2 Monitoring... 80 How to Set Up the CO2 Channel and Alarm Limits... 81 Sidestream CO2 Monitoring... 83 CO2 Messages... 86

Alarms and Limits... 91 Alarms Window and Menu... 91 Alarm Status Window... 91 Alarms Menu... 91 Adjusting the Alarm Tone Volume... 91 Types of Propaq Alarms... 93 Patient Alarms: Definitions and Indications... 93 Life-Threatening Alarms... 94 Temporary Alarms... 94 Responding to Patient Alarms... 95 Responding to Life-Threatening Alarms... 96 Alarm Prints... 96 Alarm Holdoffs... 97 Propaq Audio and Visual Alarm Holdoffs... 97 Propaq Audio Alarm Holdoff with Acuity... 97 Setting Alarm Limits... 98 Adjust Limits with STAT SET... 98 Turning On and Off All Limits... 99 Changing Individual Limits... 99 Customizing Propaq Encore Alarm Limits... 100 Equipment Alerts... 101 Definitions and Indications... 101 Responding to Equipment Alerts... 101 Power-up Equipment Alert: Program Fault, Settings Lost... 102

Trends... 103 The Trend Status Window and Menu... 103 How Trends are Accumulated... 104 NIBP Trends... 104 Displaying Trends... 104 Selecting a Trend (NXT TRND)... 105

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Printing... 107 Printing Patient Data... 107 Printing Waveforms...107 Printing NIBP Measurements...109 Printing the Apnea Ticket...110 Printing When a Patient Alarm Occurs...111 OxyCRG...112 Printing Trends...113 Printing a Single Trend...113 Printing Several Trends...113 Automatic Trend Prints...114

Acuity Central Monitoring System... 115 Intended Use... 115 Connecting to the Acuity System... 115 Key-press Route to Acuity Menu...117 Press NET OFF to Disconnect from Acuity... 117 Printing at Acuity... 118 Network Alert Message... 118

Power Sources... 119 Power Adapter Intended Use... 119 Verifying Proper Power Adapter Configuration...120 Replacing the Power Adapter Fuses...120 Battery Care...123 Recharging Time...123 Monitor Functions Resumed...123 Operating Times Using Battery Power...123 Monitor Functions Based on Battery Voltage...124 Checking Battery Voltage...124 Replacing the Fuse...124

Care and Maintenance... 125 Inspect and Clean the Monitor and Accessories... 125 Maintenance... 126 Service Interval Recommendations...126 Product Recycling...127 Monitor Care... 127 Environmental Operating and Storage Limits...127 Propaq Encore Reference Guide

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Extended Storage Precautions... 127 Printer Maintenance... 128 Loading Paper... 128 Customer Services... 130 Ordering and Customer Service... 130 Technical Service... 130 Repacking... 130

Defibrillator Synchronization... 131 Defib Sync Connector and Cables... 131 Installing the Defib Sync Interface to the LIFEPAK 5... 131 Removing the Defib Sync Interface from the LIFEPAK 5... 132 Synchronized Cardioversion Using the LIFEPAK 5... 133 Synchronized Cardioversion Using the LIFEPAK 6s... 134 Defib Sync Message... 136

Specifications... 137 ECG... 137 Real-Time ECG Analog/Defib Sync... 139 Impedance Pneumography (RESP)... 140 Invasive Pressure... 141 NIBP... 142 Temperature... 143 Pulse Oximetry (SpO2)... 144 Capnography (CO2)... 146 Alarms... 150 Trends... 151 Display... 151 Monitor (Environmental)... 152 Monitor (Physical)... 153 Printer... 154 Power... 155 Power Adapters... 156 Factory Default Settings... 158 In-Service Simulated Values... 160

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Glossary... 161 Index... 171

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General Information Safety Summary This Safety Summary should be read by all Propaq Encore users. Specific warnings and cautions will be found throughout the Propaq Encore documentation where they apply. Caution Caution: Federal (U.S.A.) law restricts this device to sale, distribution, or use by or on the order of a licensed medical practitioner.

Warning This monitor is to be operated by qualified personnel only. The operator of this monitor should read this entire manual, the monitor Reference Guide or Directions For Use, and all accessory Directions For Use before operating the monitor. Place the Propaq monitor and accessories in locations where they cannot harm the patient if they fall from their shelf or mount. Lift the monitor only by its handle; do not lift it by any attached cables. Do not connect more than one patient to a monitor. Do not connect more than one monitor to a patient. Do not use the Propaq Encore in an MRI suite or a hyperbaric chamber. Do not autoclave the Propaq. Autoclave accessories only if the manufacturer's instructions clearly approve it. Many accessories can be severely damaged by autoclaving. Inspect the power adapter cord periodically for fraying or other damage, and replace the adapter as needed. Do not operate the apparatus from mains power with a damaged power adapter cord or plug. When using a power adapter with this monitor, be sure to connect the power adapter to a three-wire, grounded, hospital-grade receptacle. Do not under any circumstances attempt to remove the grounding conductor from the power plug of the power adapter. Do not plug the power adapter into an extension cord. If there is any doubt about the integrity of the protective earth ground of the receptacle for the power adapter, do not plug in the power adapter; operate the monitor only on battery power. Contact your biomedical engineering department for assistance in identifying the proper power receptacle and making appropriate power connections.

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Safety Summary

Warning Make frequent electrical and visual checks on cables and electrode wires. Avoid electrosurgery burns at monitoring sites by ensuring proper connection of the electrosurgery return circuit so that the return paths cannot be made through monitoring electrodes and probes. During defibrillation, keep the discharge paddles away from ECG and other electrodes, as well as other conductive parts in contact with the patient. Avoid contact with any accessories connected to the Propaq’s left side panel. To ensure patient safety, the conductive parts of the ECG electrodes (including associated connectors) and other patient-applied parts should not contact other conductive parts, including earth ground, at any time. Do not operate this product in the presence of flammable anesthetics or other flammable substance in combination with air, oxygen-enriched environments, or nitrous oxide; explosion can result. Within certain governmental jurisdictions, all interconnected accessory equipment must be labeled by an approved testing laboratory. After interconnection with accessory equipment, risk (leakage) current and grounding requirements must be maintained. To ensure conformance to risk (leakage) current requirements when operating from an ac mains power source, use only a Welch Allyn 503-0054 series power adapter. This monitor should only be repaired by qualified service personnel. The operator should not attempt to open the monitor case or perform any maintenance on the monitor except for procedures explicitly described in this manual that can be performed by operators such as inspection and cleaning. To ensure patient safety, use only accessories recommended or supplied by Welch Allyn. For a list of those accessories, see the Welch Allyn Products and Accessories book that accompanied this manual (P/N 810-0409-XX). Accessories must be used according to your hospital’s standards and the manufacturer’s recommendations. Always refer to the manufacturer’s Directions for Use.

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Safety Summary

Warning Safe interconnection between the Propaq monitor and other devices must comply with applicable medical systems safety standards such as IEC 60601-1-1. Within certain governmental jurisdictions, all interconnected accessory equipment must be labeled by an approved testing laboratory. After interconnection with accessory equipment, risk (leakage) current and grounding requirements must be maintained. As with all medical equipment, carefully route the patient cabling to reduce the possibility of patient entanglement or strangulation. A product that has been dropped or severely abused should be checked by qualified service personnel to verify proper operation and acceptable risk (leakage) current values. The pulse oximetry channel should NOT be used as an apnea monitor. If the monitor detects an unrecoverable problem, an error message window appears containing an error number and a short message. Report such errors to Welch Allyn.

The Propaq Encore should be serviced only by a Welch Allyn service technician while under warranty. The Propaq Encore Service Manual (P/N 810-0696-XX) is available from Welch Allyn to assist the biomedical engineer during post-warranty period service.

Symbols The following symbols may appear on the Propaq Encore monitor or accessories or documentation. These internationally recognized symbols are defined by the International Electrotechnical Commission, IEC 878 and IEC 417A. Notes identify useful tips or points about operation.

Caution Caution statements identify conditions or practices that could result in damage to the equipment or other property.

Warning Warning statements identify conditions or practices that could result in personal injury.

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Safety Summary

Off (Standby)

Patient connections are Type CF, isolated for direct cardiac application, and protected against defibrillation.

Transformer meets requirements of a short-circuit-proof safety-isolating power transformer.

On

Alternating current

For continued fire protection, use only the specified fuse.

Patient connections are Type BF, and protected against defibrillation.

For indoor use only (on power adapter only)

Direct current

Patient connections are Type B.

Caution: Refer to Reference Guide and accompanying documentation.

Enclosure Protection Drip proof: Classification IPX1 per IEC Publication 529

The CE Mark signifies the device has met all essential requirements of European Medical Device Directive 93/42/EEC for a Class 1 product. (This symbol is on the Universal Power Adapter.)

Battery charging when green indicator illuminated 0123

The CE Mark and Notified Body Registration Number signify the device has met all essential requirements of European Medical Device Directive 93/42/EEC.

IPX1

NRTL/C Evaluated to CSA 601-1 and UL2601-1

Two way communication port

The Canadian StandardsAssociation has evaluated this device according to CSA 601-1 and Underwriters Laboratory Standard UL 2601-1. (This symbol is on the Universal Power Adapter.) Input port Output port

Temperature sensor input

2

Single-use only (not reusable). Apply the NIBP cuff as shown.

NIBP cuff sizes: Thigh Large adult Adult Small adult Child Infant

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Propaq Encore Documentation

Propaq Encore Documentation The Documentation Set The Propaq Encore documentation set consists of documents for the clinician, the biomedical technician, and the department head or purchaser of accessories for the Propaq Encore monitors. This Propaq Encore Reference Guide contains important safety and operating information for the clinician. The Propaq Encore Service Manual (P/N 810-0696-XX) contains information on how to properly maintain the Propaq Encore through routine calibration, inspection, and maintenance. The Welch Allyn Products & Accessories booklet (P/N 810-0409-XX) provides a comprehensive list of accessories recommended for Propaq Encore monitors and options.

About This Reference Guide This Reference Guide provides descriptions and operating information for the Propaq Encore models 202EL, 204EL, and 206EL, including all available options at the time of this manual's printing.

Statement of Expectations of the Reader This Reference Guide was written for the clinician. Although this guide may describe some monitoring techniques, Welch Allyn expects that you are a trained clinician who knows how to take and interpret a patient’s vital signs. The Propaq Encore has been designed as a quality monitor; however, inherent limitations require that good clinical judgment always prevails.

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Getting Started Introducing the Propaq Encore Intended Use Before using the Propaq Encore on a patient, be sure you understand the Safety Summary at the front of this book. It provides important information about safely using the Propaq Encore. The Propaq Encore monitor is intended to be used by skilled clinicians for multiparameter vital signs monitoring of neonatal, pediatric, and adult patients in health care facility bedside applications; as well as for intra- and interfacility transport.

Propaq Encore Models and Options Three models of Propaq Encore monitors are available. Features common to all models

ECG, 3-lead or 5-lead configurations, 0.05-40/0.5-40 Hz NIBP, with neonatal, pediatric and adult modes Temperature, 2 channels: YSI™ 400 and 700 series-compatible connectors Defibrillator Synchronization Real-time Analog output of ECG Electrocautery noise suppression on all channels except Impedance Pneumography

206EL

Two Invasive Pressure Channels

204EL

One Invasive Pressure Channel

202EL

No Invasive Pressure

Options available for each model

Pulse Oximetry (SpO2) Capnography (CO2) (available only with SpO2): Mainstream Capnography (MCO2) Sidestream Capnography (SCO2) Dualstream Capnography (Both MCO2 and SCO2) Impedance Pneumography (RESP) (available only with SpO2) Printer HP-compatible side panel

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Introducing the Propaq Encore

Expansion Module The Propaq Encore Expansion Module attaches to the monitor and houses additional capabilities. The Expansion Module can be fitted with the SpO2, CO2, and Printer options. ALARM(S) OFF Light ALARM Light

SpO2 Option

Expansion Module

Mainstream CO2 Option

Printer Option Sidestream CO2 Option

Propaq Encore Pulse Oximetry Option (SpO2) The Propaq Encore Pulse Oximetry option (SpO2) can be installed in the Expansion Module or in a smaller unit that attaches to the rear of the monitor: Masimo® Pulse Oximetry option (motion tolerant). Nellcor® Pulse Oximetry option (motion tolerant). Nellcor® Pulse Oximetry option (without motion tolerance).

Capnography (CO2) Options The Propaq Encore CO2 options allow carbon-dioxide monitoring. The Mainstream CO2 option and Sidestream CO2 option allow CO2 monitoring directly in the breathing circuit of a ventilator. The Sidestream CO2 option also allows CO2 monitoring of non-intubated patients through a cannula. The CO2 options can be installed separately, or together as Dualstream CO2 in the Expansion Module. These options require the Pulse Oximetry (SpO2) option.

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Impedance Pneumography (RESP) Option The RESP option detects the rate or absence of respiratory effort, and is configured with the Pulse Oximetry option.

Printer Option The Expansion Module with Printer (EMP) provides a lightweight 3-channel recorder.

Propaq-to-Acuity Option This option allows communication between the Propaq Encore and the Acuity Central Monitoring System by means of an ethernet network system installed in your facility. The Acuity System operator can view the patient data and control most of the bedside Propaq functions. The Propaq Encore connects to the Acuity System through an Acuity network cable that plugs into the Propaq right side panel.

Modem-Propaq Option This option allows telecommunication between a Propaq Encore and the Acuity System by means of external modems. This option is configured with the Propaq-to-Acuity option. For more information refer to the Modem-Propaq Reference Guide.

HP-compatible Side Panel Option The HP connector-compatible option makes the Propaq Encore compatible with many Hewlett-Packard sensors and accessories used with the Hewlett Packard Component Monitoring System. This option replaces the standard Propaq Encore left side panel.

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Using the Propaq Encore

Using the Propaq Encore System Controls (Right Side Panel) MONITOR

On/Off Switch

DEFIB SYNCHRO

Defib Sync Connector

! Real-time ECG Output Connector Speaker

Input Fuse 3A 2AG

EKG x 1000

! Power Input Connector

!

Battery Charging Light Connector for Acuity or Modem-Propaq

12-28V, 3A

Warning Safe interconnection between the Propaq Encore and other devices must comply with applicable medical systems safety standards such as IEC 601-1-1.

On/Off Switch This switch turns the monitor on and off. The switch is recessed to prevent accidentally turning off the monitor, which would result in losing patient data.

Input Fuse The input fuse, which protects the Propaq Encore against power surges, is a 3 Ampere fuse, externally replaceable by qualified service personnel. See page 124 for fuse replacement instructions.

Power Input Connector This receptacle accepts the Welch Allyn ac power adapter, which must be used for ac mains operation and battery charging. The Propaq Encore is also designed to operate with other 1228 volt, dc-only power sources, such as a vehicle battery system.

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Defib Sync Connector This connector allows connection with a LIFEPAK 5 or LIFEPAK 6s defibrillator for synchronized cardioversion. See page 131 for more information.

Real-Time ECG Output Connector This connector provides a real-time analog ECG signal output.

Battery Charging Light This green light turns on when a power source (ac power adapter or external dc source) is connected and the battery is charging. Although the monitor may be turned off, battery charging continues when an external power source is connected.

Connector for Acuity or Modem-Propaq This connector allows either direct connection to an Acuity System, or connection to an external modem for telecommunication to an Acuity System. For more information about the Acuity System, see page 115. For more information about the Modem-Propaq, refer to the Modem-Propaq Reference Guide.

Alarm Lights Alarms and limits are described in detail beginning on page 91.

ALARM Light When an alarm limit is violated, the red ALARM light turns on.

ALARM(S) OFF Light When any alarm limit is turned off, the yellow ALARM(S) OFF light turns on.

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Using the Propaq Encore

Power-up Screen PROTOCOL SYSTEMS INC. MODEL PROPAQ 204 DIAGNOSTICS IN PROGRESS

When you first turn on the monitor, the power-up screen displays information about the Propaq Encore and the monitor runs diagnostic tests to ensure proper functioning.

BATTERY: 8.3 VOLTS SOFTWARE VERSION 2.00.00 (c) PROTOCOL SYSTEMS INC. 1988-1998

A few seconds later, the top two lines of the screen are replaced with text indicating the current patient mode (adult, pediatric, or neonatal).

PEDIATRIC MODE DIAGNOSTICS IN PROGRESS BATTERY: 8.3 VOLTS SOFTWARE VERSION 2.00.00 (c) PROTOCOL SYSTEMS INC. 1988-1998

Warning Before you use a Propaq on a new patient, always turn off the Propaq for a few seconds, then turn it on again. This clears the prior patient’s trend values, alarm limit settings, and NIBP cuff inflation target. 1. If the Propaq Encore has been used for a previous patient, switch the monitor off, then on again. The monitor will turn on in the powerup patient mode with the associated settings. Verify that the powerup tone is produced. If the monitor has SpO2, verify two tones are produced to make sure that both speakers are working. 2. Verify the monitor is in the correct patient mode according to the patient’s age. If the patient mode is not correct, change it (see page 29 to change the patient mode). Warning Always check the patient mode when monitoring a new patient. The patient mode determines default alarm limits, maximum cuff inflation pressure, and internal algorithm settings. 3. Verify the battery voltage is sufficient for monitoring. If it is less than 7.4 V, connect to a power adapter (see page 119 for information about the power adapter).

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Using the Propaq Encore

Powerup Equipment Alert: Program Fault, Settings Lost If a PROGRAM FAULT: SETTINGS LOST, TIME/DAY RESET equipment alert appears when you turn on the monitor, the monitor cannot recall the programmed custom settings and current time and date. This can occur if the battery is drained or after new software has been installed. If this occurs, the monitor provides a special sequence of display windows to help you regain use of your monitor as quickly as possible. Do the following: 1. Connect an ac power adapter to recharge the battery (if the battery is drained). 2. Press any button below the equipment alert screen to acknowledge the alert. The monitor will display the Mode Setup window (shown on page 33). 3. Press these buttons to select one of the Factory patient modes for use: Factory Adult mode

POWERUP*, YES.

Factory Pediatric mode

NEXT, POWERUP*, YES.

Factory Neonatal mode

NEXT, NEXT, POWERUP*, YES.

After you press YES, the monitor will display the Time/Day window. 4. Press NEXT, UP, and DOWN as needed to set the time and date. Then press ENTER to store the new time and date. These display screens are only displayed in this order if the PROGRAM FAULT equipment alert occurs. 5. Turn off the monitor, then turn it on again so the settings will take effect. The monitor is ready for use. If you want to store some customized patient mode program settings, refer to page 33. If you follow these steps and the equipment alert reappears at powerup, the monitor may need to be serviced and the battery replaced. Contact a qualified service person.

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Using the Propaq Encore

Patient Connections The left side panels differ depending on the Propaq Encore model. All models have ECG, NIBP, and two temperature connectors. The Propaq Encore 204 left side panel includes one invasive-pressure connector, and the Propaq Encore 206 includes two invasive-pressure connectors.

ECG / EKG RESP

INV. BP

P1

ECG / EKG RESP

INV. BP

P1

ECG / EKG RESP

! NIBP PSNI

T1

NIBP PSNI !

T1

NIBP PSNI !

T2

T2

T2 INV. BP

Propaq Encore 202 EL

ECG / EKG RESP

T1

P2

Propaq Encore 204 EL

Propaq Encore 206 EL

INV. BP

INV. BP

P1 ECG / EKG RESP

P1 ECG / EKG RESP

! COMPATIBLE HP

! COMPATIBLE HP

P S N I

! COMPATIBLE HP

P S N I NIBP

NIBP

202 HP

P S N I INV. BP

204 HP

P2

NIBP

206 HP

On Propaqs with the Hewlett-Packard connector option, all models have only one temperature connector, the YSI 400 connector.

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