CARDlOVlT AT-6 OPERATING MANUAL

Terms of Warranty The CARDlOVlT AT-6 is warranted against defects in material and manufacture for the duration of one year (as from date of purchase). Excluded from this guarantee is damage caused by an accident or as a result of improper handling. The warranty entitles to free replacement of the defective part. Any liability for subsequent damage is excluded. The warranty is void ii unauthorized or unqualified persons attempt to make repairs. In case of defect, send the apparatus post-paidto your dealer or directly to the manufacturer.

The manufacturercan only be held responsible for the safety, reliability, and performance of the apparatus if:

-

assembly operations, extensions, re-adjustments, modifications, or repairs are carried out by persons authorized by him, and

-

the electrical installation of the relevant room complies with IEC requirements, and

- the CARDlOVlT AT-6 is used in accordance with the operating instructions.

CARDlOVlT AT-6

Operating Manual CONTENTS

SAFETY CHAPTER 1: GETTING STARTED 1.

INTRODUCTION

2.

INSTALLATION

3.

SWITCHING ON AND OFF

4.

MAIN ELEMENTS OF THE CARDlOVlT AT-6

5.

MENU ACCESS

6.

USER IDENT1FlCATlON

7.

MTA IDENTIFlCATlON

8.

INPUT OF PATIENT DATA

9.

ACOUSTIC QRS INDICATION

10.

CONNECTING THE PATIENT CABLE

CHAPTER 2: RECORDING RESTING ECGS 1.

INTRODUCTION

2.

SELECTING DISPLAY CONFIGURATION

3.

AUTOMATIC ECG RECORDING

4.

MANUAL ECG RECORDING

5.

RECORDING OF LONG-TERM RHYTHM ECGS

6.

CALIBRATION

7.

BASE SETTING

i

CHAPTER 3: RECORDING EXERCISE ECGs 1.

INTRODUCTION

2.

PREPARATION

3.

SElTlNGS AND ADJUSTMENTS BEFORE THE TEST

4.

STARTING EXERCISE TESTING

5.

SETTINGS AND ADJUSTMENTS DURING THE TEST

6.

INTERRUPTING EXERCISE TESTING

7.

PRINTOUT OF FINAL REPORT

8.

QUITTING EXERCISE TESTING

CHAPTER 4: FURTHER SETTINGS AND PROGRAMMES 1.

LONG-TERM MEMORY

2.

VARIOUS SETTINGS

3.

ADJUSTING CLOCK AND CALENDAR

CHAPTER 5: CARE AND MAINTENANCE 1.

CARE OF YOUR CARDlOVlT AT-6

2.

SELF-TEST

3.

TESTING THE ELECTRODE CABLES

4.

MAINTENANCE

5.

REPLACING THE RECORDING PAPER

CHAPTER 6: OPTIONS OPTION 1 - SCHILLER ECG MEASUREMENT PROGRAM OPTION 2 - SCHILLER ECG INTERPRETATION PROGRAM OPTION 3 - RHYTHM AND HEART RATE MONITORING OPTION 4

- RS-232 COMPUTER INTERFACE

OPTION 5 - EXEC ANALYSIS PROGRAM FOR EXERCISE ECGS OPTION 6 - VIDEO MONITOR

ii

CHAPTER 7: TECHNICAL DATA AND AVAILABLE CONFIGURATIONS 1.

TECHNICAL DATA

2.

CONNECTOR PANEL

3.

RS-232 (V24) SERIAL INTERFACE

4.

VIDEO MONITOR

5.

AVAILABLE CONFIGURATIONS

CHAPTER 8: TECHNICAL SAFETY CHECK TECHNICAL SAFETY CHECK TEST RESULTS

iii

SAFETY This unit is classified CF (iMt).This means that the patient connection is fully isolated and defibrillation protected and that the unit is also suitable for intracardiac application. Protection against defibrillation voltages is only ensured, however, if the original Schiller patient cable is used. For ECG recordings it must be ensured that neither the patient nor the conducting parts of the patient connection nor the electrodes (including the neutral electrode) come into contact with other persons or conducting objects (even if these are earthed). The original Schiller patient cable is provided with special safety devices to offer protection against burns from HF surgical equipment. Incorporated protective resistors prevent or reduce the passage of defibrillation or HF currents through the electrode leads. special care must be exercised when using high frequency surgical equipment together with an electrocardiograph:the active surgical electrode should always be placed at least 15 cm from the nearest electrode. For a defibrillation,the protection against overvoltages fitted in the patient cable is indeed sufficient, but here too, the necessary caution must be observed. If possible, the patient should be disconnected temporarily from the ECG unit during defibrillation. There is no danger when using the ECG unit for a pacemaker patient or with simultaneous use of other electrical stimulation equipment, however, the stimulation units should only be used at a sufficient distance from the electrodes. In case of doubt, the patient should be disconnected from the ECG recording unit. If several units are coupled, there is a danger of summation of the lead currents. It must be determined in each case before coupling (e.g. by consulting the manufacturer)whether the units are suitable for this purpose.

iv

Chapter 1 GETTING STARTED

CONTENTS

1.

INTRODUCTION

1-3

2. 2.1 2.2 2.3 2.4

INSTALLATION Location Potential Equalisation Interference Power Supply

1-3 1-3 1-3 1-3 1-4

3.

SWITCHING ON AND OFF

1-4

4. 4.1 4.2 4.3 4.4 4.5

MAIN ELEMENTS OF THE CARDlOVlT AT-6 Functional Description Alphanumeric Keyboard Connector Panel Liquid Crystal Display Freeze Screen

1-5 1-5 1-6 1-7 1-8 1-8

5.

MENU ACCESS

1-9

6.

USER IDENTIFICATION

1-10

7.

MTA IDENTIFICATION

1-10

8.

INPUT OF PATIENT DATA

1-11

9.

ACOUSTIC QRS INDICATION

1-11

CONNECTING THE PATIENT CABLE 10. 10.1 Connecting the Electrodes 10.1.1 Standard Leads 10.1.2 Leads V3r, V4r, V5r 10.1.3 Leads V7, V8, V9 10.1.4 Frank Leads 10.1.5 Nehb Leads 10.1.6 Bipolar Leads

1-12 1-12 1-12 1-13 1-13 1-13 1-14 1-14

1-1

1.

INTRODUCTION

The CARDlOVlT AT-6 is equipped with a highly sophisticated technology enabling it to be used as a simple electrocardiograph or as a complex unit for many different applications. The CARDlOVlT AT-6 is easy to operate, for despite its versatility the automatic programs are started by pressing a single key. The options and programs allow the performance of the CARDIOVIT AT-6 to be adapted exactly to your particular needs. With the CARDIOVIT AT-6 you can record resting ECGs and print them in many different formats. There is also an exercise test program for the recording of exercise ECGs and several printing formats for longterm rhythm recordings are at your disposal.

2.

INSTALLATION

2.1 Location Do not keep or operate the apparatus in a wet, moist, or dusty environment. Also, avoid exposure to direct sunlight or heat from other sources. Do not allow the unit to come into contact with acidic vapours or liquids as such contact may cause irreparable damage. Furthermore,the unit should not be placed near X-ray or diathermy units, large transformers or motors. WARNING: This apparatus should not be operated in areas with danger of explosion.

2.2 Potential Equalisation The yellow/green ground lead can be connected to the potential equalisation and then to the connection marked on the rear of the CARDIOVIT AT-6.

2.3 Interference Due to the digital processing of the ECG signals, the influence of disturbances and artefacts are reduced to a minimum. 50 Hz interferences are suppressed by the AC interference filter, an adaptive digital filter, without attenuating or distorting the ECG. When using the unit, make sure that no sources of interference (such as electrotherapy units, X-ray appliances, strong lamps or current conductors) are nearby.

1-3

2.4

Power Supply

The CARDlOVlT AT-6 can be operated either from the mains supply or from the built-in rechargeable battery. For mains operation and recharging of the battery, connect the AT-6 to the mains supply and switched it on with the green O/I power switch located on the front of the unit. The power switch is illuminated when in the on position. In battery operation, the unit is powered by the rechargeable 12V accumulator. This mode of operation is indicated by the control lamp to the right of the ON key. As soon as the battery voltage drops below a certain minimum (25% of total charge), the battery control lamp starts to blink. After this indication first appears, there is still enough capacity left to record ECGs for another half an hour. To recharge the battery, the CARDlOVlT AT-6 is connected to the mains supply (power switch on!). A totally discharged battery is completely recharged after 12 hours. After approx. 3 hours, however, 80% of the battery charge will be regenerated. The CARDlOVlT AT-6 can be permanently connected to the mains supply without any danger of damage to either the battery or the unit.

3.

SWITCHING ON AND OFF

In mains operation, the CARDlOVlT AT-6 is switched on by pressing the green O/I power switch (8) on the front of the unit. The switch is illuminated when in the on position. To bring the unit into the active operating condition, press the green ON key (6) on the keyboard. In battery operation, it is only necessary to press the green ON key on the keyboard. The CARDlOVlT AT-6 is now in Automatic mode. To switch the unit off, press the red OFF key (5)on the keyboard. To switch off the mains supply, press the green O/I switch on the front of the unit and the lamp will no longer be illuminated. This switch can however remain in the on position and the battery will automatically be recharged as necessary.

14

4.

MAIN ELEMENTS OF THE CARDlOVlT AT-6

SCHILLER Swltzerland

4.1

Functional DescriDtion STOP: interrupts the printout.

(8)

Power switch: Switched on for mains operation and for recharging the battery.

START: Lead selector keys: lead group selected with keys D< and Fs, single lead selected with key C.

Autornm mode: The last 10s of the ECG are stored, analysed and printed in the selected format. Manual m a : ECG printout is started.

Chart speed selector keys: The last key (+lo) divides the values of the other keys by 10.

COPY: For copies of the ECG in automatic mode or to switch from manual to automatic mode.

Keys for selecting the sensitivity. FILT: switches myogramm filter on and off. Control lamp illuminated when switched on.

Key for selecting the number of printed leads.

OFF: switches unit off.

Key for selecting the number of leads on the screen.

ON: switches unit on.

Calibration key.

Battery control: Illuminated: battery operation Extinguished: mains operation Blinking: battery is low (connect unit to mains supply!)

Mains connection. Connection for ground lead.

1-5

Alphanumeric Keyboard

4.2

The main keyboard functions are as follows:

Key -

Function

A

Format for automatic mode

C

Selection of a single lead

D

Selection of a lead group

E

Exercise test program

F

Selection of a lead group

G

Storage of base setting

H

List of functions

I

MTA identification (temporary)

J

User identification (permanent)

L

User-programmablelead group

M

Switch to manual mode

N

Rhythm and heart rate monitoring (Option)

0

Pulmonary function testing (Option)

P

Entering patient data

Q

Switching owoff acoustic QRS indication

R

Format for rhythm mode

S

Store ECG in memory (not available if EXEC option installed)

T

Self-test

U

Adjusting clock and calendar

V

Various machine settings

X

RS-232 control (Option)

Y

Stop ECG-monitor (freeze)

z

Memory mode (not available if EXEC option installed)

FNCT

Switching to ECG monitor (monitor mode) or releasing the screen after "freeze" (key Y)

RETURN

Moving to next line or to next page, confirm entry

DEL

Delete characters

-36

Channel selector for printout, 3 or 6 channels

1

-3

Channel selector for display, 1 or 3 channels 1-6

4.3

Connector Panel (right-hand side of unit)

0

PATIENT

@

Q

@

0

0

0

Socket for patient cable CF rated: fully floating and isolated, defibrillation protected, suitable for intracardiac application. Caution: Defibrillationprotected only if used with the original patient cable.

(2)

Test socket for electrode leads with control light

(3)

'STRESS' or 'ERGO' Exercise Test Interface

(4)

Scope output

(5)

LCD Knob for adjusting the contrast of the Screen

(6)

DC1, DC2 DC inputs 0.5 V/cm

(7)

ACC for connection of footswitch, QRS trigger

NOTE:

0

When the optional RS-232 serial interface is installed, the RS-232 connection is located on this panel, to the right of the ACC and experimental input connections. The optional video connection is located on the rear of the unit.

1-7

4.4

Liquid Crystal Display

The liquid crystal display (LCD) performs both as an ECG monitor and as an alphanumeric display for menu selection, data input and the provision of important information. To obtain good visibility of the Screen contents, adjust the contrast by means of the LCD knob on the right-hand side of the unit. The screen is best visible if fully illuminated. As soon as the patient is connected to the patient cable and the unit is switched on, the ECG is recorded and presented on the screen as follows (if no patient is connected, the same display appears but without ECG traces):

. HR: 63(67)/mln

EL C4 loose 5mm/mU

.

Th 27.0ct.86

25mm/s

1 1 :23:45

U l -U6

6

-

(1):

Heart rate: mean value of 8 heart beats, in brackets beat-to-beat measurement; day of the week, date, time

(2):

Line for system messages: Here for example, poor or no contact of electrode C4

(3): Sensitivity, recording speed, number of printed leads, selected lead group, function status Together with the ECG tracings, heart rate (mean value of 8 heart beats and beat-to-beat measurement), day of the week, date and time are listed on the top line of the screen. At the bottom, sensitivity and recording speed as well as the number of leads selected for printing, the lead group selected and function status (ie "R" will be given here when in the Rhythm mode) are indicated. The displayed leads are identified on the left-hand side. If any disturbances (e.g. loose electrodes, empty paper compartment) occur, they are signalled on the second lowest line. These disturbances have to be removed before ECG recording can take place.

4.5

Freeze Screen

The ECG shown on the screen can be frozen by pressing key Y. To release it again, press FNCT.By this manipulation, the ECG on the screen can be examined more closely. The recording of the ECG continues while the screen is frozen. It is not possible to print directly the contents of the screen. There is, however, enough time (10 seconds) to retain and print out the event of interest by pressing the START key.

1-8

5.

MENU ACCESS

To call up a particular menu, simply press the correspondingkey on the keyboard for the function you require. Until you are familiar with all the functions, the best way to proceed is to press key H on the keyboard and the first page of a list of functions is displayed as follows:

Press RETURN to move on to the second page:

Press RETURN to move on to the third page:

By pressing the indicated character on the alphanumeric keyboard, the function to be performed is called up or the command given is executed. NOTE:

Functions S and Z are not operable when the EXEC exercise testing option is installed.

To return to the Monitor mode, press FNCT. 1-9

6.

USER IDENTIFICATION

This menu is used to enter the name of the physician, clinic or department which will then be printed on each ECG. The input is stored permanently, i.e. it is not deleted when the unit is switched off. Press letter J and the following appears on the display:

Using the keyboard, enter the desired user identification. The maximum length of the entry is 30 characters. Press RETURN to store the new identification and confirmation is given on the display. A change is made by simply typing over the existing entry and pressing RETURN. Press FNCT to return to the Monitor mode.

7.

MTA IDENTIFICATION

In order to mark the ECG with the name or identification of the person in charge of the recording, you can make a temporary input by means of this menu. The entry is stored until the unit is switched off or a new entry is made. Press letter I and enter the name or any other identification (up to 22 characters).

Press FNCT to return to the Monitor mode.

1-10

8.

INPUT OF PATIENT DATA

Each ECG is printed with the name and other information concerning the patient. Before beginning an ECG recording, the patient data should be entered. On the keyboard, press letter P in order to call up the menu for patient data input as follows:

Patient name: maximum length 22 characters Patient number: maximum length 22 characters The date of birth has to be entered in figures in the order day, month, year. For example, for 3rd november, 1936 enter: "3.1 1.36 or "03.1 1.36 The age is calculated by the CARDlOVlT AT-6 on the basis of the date of birth (up to 2 years: number of months; up to 6 years: number of years and months; over 6 years: number of years) Sex: maximum length 13 characters Height in cm (3 figures) Weight in kg (3 figures) Blood pressure in mmHg (7 figures) Medication: maximum 16 characters Line for remarks: maximum length 22 characters The cursor is located on the first parameter "Pat-Name". Enter the patient name and press RETURN. The cursor now moves automatically to the next line for the entry of the patient number. All entries are made in a similar way and each one must be confirmed by pressing RETURN. Wrongly typed characters can be deleted with the DEL key. Whole lines can be typed over. The old contents of the line is deleted as soon as the first character is entered. NOTE:

If a new patient name is entered, all the other patient data and any ECG recording stored in the memory are automatically deleted.

Once all patient data has been entered and confirmed by pressing RETURN, press FNCT to return to the Monitor mode. NOTE:

9.

When the Pulmonary Function option is installed, the patient data entered here will be retained when switching to the Pulmonary Function mode.

ACOUSTIC QRS INDICATION

The heart rate is indicated on the display as the average value of eight heart beats and in brackets as beat-to-beat extrapolation. By pressing key Q, the acoustic heart rate indication can be switched on and off.

1-11

10. CONNECTING THE PATIENT CABLE The accessories kit of the electrocardiograph includes a 10-lead patient cable. This cable is plugged into the patient cable socket on the right-hand side of the unit and secured with the two screws.

The apparatus is CF (4mt)rated. The patient connection Is fully Isolated and defibrillation protected. The unit can be used for intracardiac application. The protection against defibrlliation voltage is only ensured, however, if the original Schiller patient cable is used.

10.1 Connecting the Electrodes The lower the resistance between skin surface and electrodes, the better the quality of the ECG recording. The skin areas have first to be cleaned with alcohol and thick hair has to be removed. The standard accessories include four stainless steel limb electrodes and 6 precordial suction electrodes. The extremity electrodes are first spread with electrode gel and then fixed to the arm and foot pick-up points. Please make sure that the rubber bands are only tightened to such an extent as to prevent any movement of the electrode without constricting the blood circulation. The precordial suction electrodes are also first moistened with gel and attached in their respective positions.

10.1.1

Standard leads I, II, I l l , aVR, aVL, aVF, V,, V, V, V, V, V,

f-

right leg right arm

left m left leg

1-12

10.1.2

Leads V3r, V4r, V5r

m

The electrodes have to be connected as follows: Plug C3 green to electrode C3r Plug C4 brown to electrode C4r Plug C5 black to electrode C5r

10.1.3

Leads V7, V8, V9

The electrodes have to be connected as follows: Plug C1 red to electrode C7 Plug C2 yellow to electrode C8 Plug C3 green to electrode C9

10.1.4

Frank leads X, Y, 2

N black RF rightleg

RA rightm I

right x4llatylini X

E frontmidian prestemal

C 45*ventral from A A

left dlsryline

M rearmidianow spinal cord

H

k?%

neck

LA left wm LF left leg

1-13

10.1.5

Nehb leads

The electrodes have to be connected as follows: Plug R red to electrode on N, Plug L yellow to electrode on N, Plug F green to electrode on N Plug N black to electrode on

rist

10.1.6

leg

-

Bipolar leads CF, CF,

These leads are measured between one extremity electrode (F green) and the precordial electrodes C, C,. The electrode F green is usually placed on the left leg. In this way, the semithoracic leads CF, - CF, are derived. The F electrode can also be placed in other positions: If it is placed on the manubrium of the sternum, you will derive CM leads.

right leg

f

I

1 left leg

1-14

Chapter 2 RECORDING RESTING ECGs

CONTENTS

1.

INTRODUCTION

2-3

2. 2.1 2.2 2.3

SELECTING DISPLAY CONFIGURATION Lead Selection Sensitivity Selection Speed Selection

2-3 2-3 2-4 2-4

3. 3.1 3.2 3.3 3.4

AUTOMATIC ECG RECORDING Printout Format in Automatic Mode Selecting the User Programmable Leads Sensitivity in Automatic Mode Copies of ECGs in Automatic Mode

2-5 2-5 2-7 2-7 2-8

4. MANUAL ECG RECORDING 4.1 Printout Format in Manual Mode 4.1.1 Lead Selection 4.1.2 Selecting Chart Speed 4.1.3 Sensitivity Selection 4.2 Copies of ECGs in Manual Mode

2-8 2-8 2-8 2-9 2-9 2-9

5.2 5.3

RECORDING OF LONG-TERM RHYTHM ECGS Selecting the Rhythm Leads Selecting the Printout Format Starting Rhythm Recording

2-10 2-10 2-10 2-11

6.

CALIBRATION

2-12

7.

BASE SEll'lNG

2-12

5. 5.1

2-1