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1. TIME 22 42 32 DATE 01 17 200 GAIN 1mwcm HR 72 t t SP02 em c02 aL AN A A AJLLA Ph A pt A A A A ALa i TEMP NIBP mmHg 52 4 6 Troubleshooting 1 ECG and Temperature Problems Possible Causes Recommended Actions After inserting an esophageal probe the ECG is erratic Not all metal rings have established a good contact with the esophagus The probe is inserted too shallow or deep 1 Make sure an appropriate sized probe is used 2 Adjust the position depth of the probe After inserting an esophageal probe LEAD OFF is still displayed Wire s inside the probe may be damaged Try another probe After inserting an esophageal probe no temperature is registered Wire s inside the probe may be damaged Try another probe When using the ECG leads with flat clips ECG is erratic or having a lot of interference Good electrode to tissue contacts are not established Make sure that all three clips are applied to the patient properly and all three contact sites are soaked with saline LEAD OFF is still displayed after applying all three leads on the patient A lead wire in2. GAIN Imwern HR yz EX 98 P A A A IN A a A a H od kd i NIBP mmHg SAP 119 DAP 84 MAP 95 PR 72 ra 1 y Fi 1 1s 6s To turn pages click the arrow buttons as shown below 46 You can delete any screen captures which you do not want to keep To delete a screen capture click the red Del button as shown below B Print screen captures Click the button with a printer symbol as shown below or click File menu and select Print In the Print window select the printer you want to use and then click OK File View m amp Printer Name Canon Bubble Jet BJC 85 v Properties Status Ready Type Canon Bubble Jet BJC 85 Where LPT1 Comment Printto file Print range Copies All Number of copies E z C Pages from 1 to Cancel You can preview the printout before you print by simply clicking File menu and selecting Print Preview 47 C View and print trends To view the trends page click the Tr button as shown below BP Tr Ww The trends page opens up To print the trends page click the Print button Z WAVEOO VS7 VetSpecs_VSM7_Program uw amp Pic Del I BP Tr Ww Z gt 110 HR bprn 01 17 2008 21 38 100 90 4 80 j 70 3 60 3 50i 100 SPO2 6 1 2 hour 95 4 90 3
3. 85 4 eo J 25 RR brpm 2hour 20 4 153 10 3 1 100 4 TEMP TF 2 hour sg CO2 mmHg 2 hour 2 hour D View and print BP readings To view recorded BP readings click the BP button as shown below I BP Tr hs ID Pet s Name Owner Breed Sex Age Weight Ibs The BP readings table opens up as shown below To print out click the Print button 48 d WAVEO0 VS7 VetSpecs_VSM7_Program File View zx amp Pic Del I BP Tr Ww a gt Averages 122 81 94 82 DATE 01 417 2008 No Time SAP DAP MAP PR No Time SAP DAP MAP PR ed TUN ot 21 38 124 86 38 86 MM 02 21 42 126 86 99 80 Brood 03 21 45 128 89 102 82 Sax 04 21 48 133 gt 105 84 Age 05 21 51 128 94 105 80 Weight Ibs 06 21 54 124 78 34 82 07 2 57 116 74 88 84 08 22 0 123 81 95 86 09 22 3 129 94 105 88 10 22 6 121 79 93 86 ti 22 9 121 86 97 82 12 22 12 119 69 85 30 13 22 15 118 78 32 70 14 22 18 129 82 E 76 15 22 21 124 87 38 78 18 22 24 118 74 88 70 17 22 27 129 79 95 82 18 22 30 118 n 86 82 18 22 33 118 68 85 80 20 22 38 118 84 95 84 Click the W button to go back to viewing screen captures E Input patient data To input patient information click the button as shown below Del I BP 49 The Pet s Information window
4. 190 mmHg should also be considered hypertensive particular in cats 14 years old In the absence of clinical findings of hypertension cats with a systolic pressure between 160 190 mmHg should have measurements repeated many times over the course of a day In general dogs with a systolic pressure over 180 mmHg are considered hypertensive Care has to be taken in diagnosing hypertension as marked breed differences occur These are not absolute limits just a guideline for each individual case Repeated measurement helps clarify whether the elevation in pressure is sustained or stress induced Results always need to be interpreted carefully in light of the animal s condition and measurement environment If the same patient is to be measured at different times cuff size and position should be matched as close as possible 3 BP measurements in hypotensive patients In order for the sensor band to pick up valid arterial pulsations in hypotensive patients place the sensor band at a site with better circulation position the sensor band right above a main artery and wrap the sensor band firmly If necessary clip the hair underneath the sensor band If the sensor band cannot pick up valid arterial pulsations try another location The sensor band may not be able to pick up valid arterial pulsations when the circulation underneath is too weak Failure to pick up arterial pulsations by the sensor band at multiple locations is an indication of se
5. The NIBP module keeps inflating the cuff 1 There is a leakage on the cuff 2 There is a leakage on the tubing 1 Try different cuffs The cuffs are semi disposable and need to be replaced after using for a period of time 2 Check the tubing The bar graph is erratic and no PR is registered 1 There are repetitive motions 2 The sensor band is not working properly 1 Calm down the patient or eliminate motions being induced to the patient 2 Test the sensor band on your finger as instructed on page 15 BP SENSOR OFF is still displayed after the sensor band is applied to the patient The sensor band may be worn out Tap on the sensor band If BP SENSOR OFF does not go away the sensor band needs to be replaced The bar graph is barely moving and BP SENSOR OFF is displayed 1 The perfusion at the sensor site is too weak 2 The sensor band is not 1 Check the patient status 2 Place the sensor band above a main artery and intermittently placed correctly wrap it firmly 3 The sensor band is not 3 Test the sensor band on working normally your finger The bar graph is pulsating in synch with the heartbeats However no PR can be registered The NIBP module is malfunctioning Test on your finger If still the same the NIBP module needs to be serviced MODULE OFF is displayed when the NIBP module is connected to the monitor The NIBP modul
6. 33 Turn the JOG DIAL to change the speed and then push it to set B NIBP With the NIBP module connected to the monitor Turn the JOG DIAL to select PAGE 1 1 and then push the JOG DIAL The first page of stored BP readings will be displayed on the screen Turn the JOG DIAL to change page numbers Push the JOG DIAL to return to waveforms display C TREND Turn the JOG DIAL to select TREND 1h and then push the JOG DIAL The trends of the last one hour 1 hour trends will be displayed on the screen Turn the JOG DIAL to change between the 1 hour trends and the 4 hour trends Push the JOG DIAL to return to waveforms display NIBP With the NIBP module connected to the monitor select NIBP and push the JOG DIAL to enter NIBP submenu as below 1 Interval 3min 2 Alarm OFF 3 SAP HI 180 LO 60 4 DAPHI 120 LO 40 5 MAP HI 150 LO 50 6 RETURN 7 ESC A INTERVAL To change the interval setting for automatic BP measurements default 3 minutes Select 3 min and then push the JOG DIAL to highlight in red 34 Turn the JOG DIAL to change the setting and then push the JOG DIAL to set B ALARM The default setting for BP alarm is OFF To turn on BP alarm e Select Alarm OFF and push the JOG DIAL to highlight in red Turn the JOG DIAL to change to ON and then push the JOG DIAL to set C CHANGE BP ALARM LIMITS Select the item to be changed push the JOG DIAL to highlight in red Turn
7. ESC To change alarm limits Select the item to be changed push the JOG DIAL to highlight in red Turn the JOG DIAL to change the number and push the JOG DIAL to set SETUP Select SETUP in main menu and push JOG DIAL to enter as below 1 Dete m d y 36 2 Time h m s 3 RETURN 4 ESC To change the date and time Select the item to be changed and push the JOG DIAL to highlight in red Turn the JOG DIAL to change setting and push the JOG DIAL to set 4 3 Recall Data 1 Recall BP readings The VSMSB stores in its internal memory registered BP readings for up to 58 measurements Push TREND key to display the BP readings Turn the JOG DIAL to change pages The VSM8 automatically calculates averages of the registered BP readings and displays them at the top of the BP readings table Turning off the monitor or disconnecting the NIBP module from the monitor will erase all BP readings stored in the internal memory However the data already saved in the flash drive will not be deleted 2 Recall trends The VSM6B stores in its internal memory up to four hours of trends HR SpO2 Temp RR and CO2 and can display these trends in one hour or four hour formats Push TREND key to display the trends Turn the JOG DIAL to switch between displaying the trends of the last one hour and displaying the trends of the last four hours 4 4 Save Information Plug the flash drive directly or through the USB extension cable
8. If you see OCCLUSION FAILED is displayed verify the cuff placement and size Make sure that 1 the cuff is applied correctly 2 the cuff is placed at an appropriate site and 3 the cuff size is appropriate for the site The VSM8 will keep flashing OCCLUSION FAILED until READY is displayed again It is highly recommended to manually start the first measurement and watch the entire measurement process closely Set the VSM8 to automatically perform BP measurements only after you have confirmed that the cuff can successfully occlude the arterial flow 5 Mainstream Capnography optional A The concept Capnography is measurement and waveform display of CO2 concentration at the 17 patients airway It monitors various components of patient and anesthesia circuit equipment as well as the critical connection between the two A capnogram is the graphical waveform depicting CO2 concentration throughout respiration End tidal CO2 ETCO2 which can be expressed as mmHg or percentage refers to the measurement of CO2 concentration at the end of exhalation The normal range of ETCO2 for most mammals is 30 45 mmHg or 4 0 5 5 It is considered to be abnormal when the ETCO2 is higher than 50 mmHg or 6 5 or lower than 20 mmHg or 2 596 The diagram below shows the shape of a normal capnogram mm Hg Phase A near zero baseline Exhalation of CO2 free gas contained in dead space Phase Il Rapid sharp rise Exhalation o
9. If the bar graph is jumping up and down erratically the sensor band is picking up motions rather than valid arterial pulsations In order to perform BP measurements a valid pulse rate has to be registered first The VSM8 will continue to display WAIT until a valid pulse rate is displayed When the sensor band is picking up valid arterial pulsations a valid pulse rate will be displayed in seconds and at the same time READY will be displayed indicating it is ready for BP measurements No BP measurements can be started before READY is displayed If the bar graph is erratic not in synch with the heartbeats there may be repetitive motions induced to the patient or the sensor band is not working properly Test the sensor band on your finger For the short sensor band wrap it firmly on your index finger For the long sensor band wrap it firmly on your index and middle fingers together If the bar graph pulsates vigorously and in synch with your heartbeats the sensor band is good Try it again on the patient If the bar graph is also erratic the sensor band needs to be replaced When the NIBP module registers no signals the VSM8 will flash BP SENSOR OFF indicating one of the three situations 1 no sensor band is connected to the NIBP module 2 the sensor band is not applied to the patient or 3 the sensor band was worn out If the monitor flashes BP SENSOR OFF while the sensor band is applied on the patient tap the sensor band with y
10. machine The following are examples of abnormal capnograms 1 Low readings mm Hg 40 If ETCO2 readings are consistently below 20 mmHg or 2 5 look for the following causes e Increased respiratory rate e Excessive mechanical ventilation minute volume ventilation too high e Reduced cardiac output failure to deliver CO2 to the lungs e Ifthe animal is intubated check there are no leaks around the tube dilution e Decreased metabolic activity e g hypothermia 2 High readings 19 mm Hg oC 40 If ETCO2 readings are consistently above 50 mmHg or 6 5 look for the following causes e Decreased respiratory rate e Insufficient mechanical ventilation minute volume ventilation too low e Increased metabolic activity shivering hyperthermia 3 Rise in base line caused by increased levels of inspired CO2 mm Hg 40 Possible causes e Insufficient fresh gas flow in non rebreathing circuit e Excessive dead space in anesthetic circuit e Exhausted soda lime in rebreathing circuit Note that at the same time the ETCO2 value will also start to rise 4 Increase in the slope of phase Il and phase lll 20 mm Hg CO 4 595 Possible causes Reduced ability to expire e g e Block ET tube e Bronchial disease asthma e Upper airway obstruction e Faulty expiratory valve 5 Abrupt fall in ETCO2 level mm Hg 40 Possible causes any effect leading to sudden
11. o occi Seo RE Ee uide tenias 52 4 6 Iroubleshoollng iier perio iaa arta Seen oni ho Yep e spen eren 53 Va Ma int nanG et 56 VL ACCOSSOLPIGS iniaa a deas duntua roo dva cus dans 57 MIL Technical SupDOLLb i oor e ceo tetto iet 59 Limited Warranty rrr ro I prae e Eras ERR ELE EUR EINE ea anaana 60 l Introduction The VetSpecs VSMSB vital signs monitor the flagship model of VetSpecs monitors is developed specifically for vital signs monitoring during anesthesia ECG testing and blood pressure measurements in cats dogs and other similar sized veterinary patients VetSpecs VSM8 1 Upgradeable Digital Platform VSM8 A VSM8 B VSM8 C VSM8 D VSM8 E ECG with esophageal probes S S S S S Core body Temperature S S S S S Pulse Oximetry S S S S S Airway direct Respiration S S Mainstream Capnography O O S S S Noninvasive Blood Pressure O S O S S Invasive direct Blood Pressure O O O O S S Standard O Optional external module which can be added on without returning the monitor to VetSpecs The VSM8 incorporates VetSpecs state of the art digital modular platform with five configurations to choose from see the table above You can purchase a system which is best suited for your monitoring needs and upgrade the monitor later to meet your growing clinical needs The digital mainstream capnography CO2 function noninvasive blood pressure NIBP function and invasive direct blood pressure IBP function ea
12. patient s condition is normal the pulse waveforms and ECG are in synch with each other However if registered pulse waveforms and ECG are not in synch with each other a red flashing question mark will be displayed near the heart rate Check both the pulse waveforms and the ECG If one or both are erratic verify the patient status and adjust the placement of the SpO2 sensor and or the esophageal probe The red flashing question mark will stay on until the two are in synch with each other again This feature ensures that both the ECG and the SpO2 function are working properly during the monitoring 11 3 Airway direct Respiration VSM8 A and VSM8 B The VetSpecs proprietary airway direct respiration technology provides real time respiratory waveforms a respiratory rate RR and a respiratory sound The monitor comes with two airway sensors The one labeled Dog Airway Sensor is for medium to large dogs The one labeled Cat Small Dog Airway Sensor is for cats and small dogs The monitor flashes SENSOR OFF when no airway sensor is connected to the monitor Connect an airway sensor to the Module SENSOR OFF goes away and the monitor displays 00 or 01 at the RR After the patient has been intubated insert the airway sensor between the endotracheal tube and the breathing circuit Respiratory waveforms white and a RR are displayed The airway direct respiration also offers a digital respiratory sound which allows you to cont
13. sensors and airway sensors Make sure to disconnect the sensors from the Module prior to cleaning Clean the sensors with a paper towel damped with some water or liquid detergent Do not wash the sensors or submerge them in liquid Airway sensors are semi disposable items BP sensor bands and cuffs Make sure to disconnect the sensor bands and cuffs from the NIBP module prior to cleaning Use a toothbrush to remove hairs from the Velcro strip on the sensor bands if necessary Clean the cuffs with a paper towel wet with some water or liquid detergent Do not wash the sensor bands or cuffs or submerge them in liquid BP sensor bands and cuffs are semi disposable items CO2 sensor and its airway adapter Make sure to disconnect the sensor from the Module prior to cleaning After each use wipe the sensor and the airway adapter dry with a towel or paper towel Do not detach the airway adapter from the sensor for cleaning Do not try to clean the inside of the sensor and the airway adapter as it may damage the special optical film Never use alcohol or any detergent to clean the CO2 sensor or the airway adapter Do not wash the sensor and the airway adapter or submerge them in liquid The airway adapter is semi disposable which needs to be replaced frequently in order to ensure a normal performance of the CO2 sensor 56 Modules and accessories Never modify any modules or accessories or use them on any other monitors which are not VetSpecs
14. the JOG DIAL to change the number and push the JOG DIAL to set ECG Select ECG in main menu and push the JOG DIAL to enter ECG submenu as below 1 HI 400 2 LO 50 3 Gain AUTO 4 Alarm ON 5 RETURN 6 ESC A CHANGE HR ALARM LIMITS Select the item to be changed push the JOG DIAL to highlight in red Turn the JOG DIAL to change the number and push the JOG DIAL to set The new setting will be saved as default B GAIN AUTO The ECG amplifier features automatic sensitivity adjustment GAIN AUTO indicates that the ECG amplifier will automatically adjust its sensitivities gain among six levels X75 X1 X2 X4 X8 and X16 to display ECG in an optimal size as large as possible without saturation The red bar 10 mm high displayed in the ECG channel provides a scale mV for measuring the amplitude of the ECG on the screen To suspend the automatic sensitivity adjustment change GAIN AUTO to GAIN CAL the gain of the ECG amplifier will be fixed at X1 35 SPO2 Select SPO2 in main menu and then push the JOG DIAL to enter as below 1 HE 100 2 LO 90 3 Alarm ON 4 RETURN 5 ESC To change SpO2 alarm limits Select the item to be changed push the JOG DIAL to highlight in red Turn the JOG DIAL to change the number and push the JOG DIAL to set Temp Select Temp in main menu and then push the JOG DIAL to enter as below 1 Units F 2 HI 105 3 LO 95 4 Alarm ON 5 RETURN 6
15. to the USB port on the monitor The VSM8 can not save information without the flash drive The monitor displays DISK None when no flash drive is plugged in 37 A new folder will automatically be created on the flash drive upon entering a new patient name The monitor will not save information on the flash drive until a name is entered 1 Save information in monitoring mode In monitoring mode the monitor will save the information on the screen i e make a screen capture along with registered trends and BP readings automatically every five minutes or when you push the SAVE key For example for a one hour monitoring at least 12 screen captures along with a trends page and a BP readings page will be saved in the folder of the patient on the flash drive The number of saved screen captures is displayed at the bottom of the screen 2 Save information in ECG mode In ECG mode the monitor automatically and continuously saves ECG on the flash drive The monitor will automatically start saving ECG screen captures upon registering valid ECG and automatically stop saving when ECG is no longer registered Up to 99 screen captures can be saved continuously The number of saved screen captures is displayed at the bottom of the screen 3 Save information in BP mode In BP mode the monitor automatically saves on the flash drive readings registered in each measurement Readings for up to 58 measurements along with the averages of al
16. up as shown below t ak VetSpecs_ SM _Program Untitled VetSpecs_VSM_Program File View ux amp Pic Del I BP Tr W a gt R ID Pet s Name Owner Breed Sex Age Weight Ibs Click the File button as shown above or click File menu and select Open Go to the data folder you want to open on the flash drive or hard drive You can also directly go to the data folder you want to open on the flash drive or hard drive without the need to open the program first See the next section 45 4 View and print monitoring records A View screen captures To view saved monitoring records directly go to the data folder on the flash drive or the hard drive without the need to open the program first In the data folder you will see screen captures WAVEOO VSM WAVE01 VSM WAVEO2 VSM WAVEOS3 VSM trends page TREND VSM and BP readings BP DATA VSM Double click any one of the screen captures as shown below s e s s s e e e e a BP DATA VSM PetInfo SM TREND VSM WAVEOO VSM WAVEO1 VSM WAVYEOZ VSM WAVEOS VSM WAVEO4 VSM WAVEOS VSM LWAVEOO VS7 VetSpecs VSM7 Program zm 3 Pic Del I BP Tr Ww ES gt ID i Pet s Name ul A J5 jil A ry A N JA A A Owner F ia Breed Sex Age Weight Ibs TIME 22 39 49 1398079570 DATE 01 17 2008
17. CONTENTS I IntrOQU CHO ide cea ctore ioa de Ratatat et eatin 2 Ma mstallati n 4 Il Clinical Instructions td oorr ng nere reus 7 3 1 Monitoring During Anesthesia 7 1 ECG and Core body Temperature ssussusse 8 2 Pulse OXIMEUY aaea vae bd EE nca d SR RES D 9 3 Airway direct Respiration VSM8 A and VSM8 B 12 4 Blood Pressure Monitoring optional 13 5 Mainstream Capnography optional 17 3 2 ECG Testihg 53e ioca doucgos edeuacdas aa Venet once ea sais E 25 3 3 BP Measurements optional 27 IV Operational Instructions ees 28 AS Control Panel iioi aeaaea n etes 30 4 2 Menu System uie coe oeste ode rote ceo sai eeu eo decer dadaran 31 4 3 Recall Dade i eod siena ipod bc a ox orco oe deos bra desea iore 37 4 4 Save Information 5 eec sse eect eee cece 37 4 5 Review Saved Information 38 1 Install the software on computer suus 38 2 Transfer data and organize files ssuusse 43 3 gt Open tie progra cese cicuta es ieu en IEEE Esos ea even eser iE NAE 45 4 View and print monitoring records sesususss 46 9 VIEW dbd DEINE EGG
18. Never use any cables leads probes sensors or cuffs which are not provided by VetSpecs on the VSM8 monitor Never have the monitor or its modules and accessories serviced by any unauthorized person Warranty for the monitor and its modules and accessories are voided if any of the above occurred VI Accessories VSMB8 A One multi parameter module one Large Dog Esophageal Probe one Small Dog Esophageal Probe one Cat Esophageal Probe one set of ECG Flat Clips one SpO2 Lingual Sensor one SpO2 Leg toe Sensor one Dog Airway Sensor one Cat Small Dog Airway Sensor one USB flash drive one USB extension cable one power cord one software CD and one VSM8 User s Manual VSM8 B One multi parameter module one Large Dog Esophageal Probe one Small Dog Esophageal Probe one Cat Esophageal Probe one set of ECG Flat Clips one SpO2 Lingual Sensor one SpO2 Leg toe Sensor one Dog Airway Sensor one Cat Small Dog Airway Sensor one NIBP module with tubing one Short BP Sensor Band one Long BP Sensor Band and six BP cuffs of different sizes one USB flash drive one USB extension cable one power cord one software CD and one VSM8 User s Manual VSM8 C One multi parameter module one Large Dog Esophageal Probe one Small Dog Esophageal Probe one Cat Esophageal Probe one set of ECG Flat Clips one SpO2 Lingual Sensor one SpO2 Leg toe Sensor one Mainstream CO2 Sensor attached with one clear airway adapter one USB flash drive one
19. O2 sensor to the Module Airway adapter The CO2 sensor will automatically start to calibrate as soon as it is powered on The VSM8 displays CO2 CALIBRATION and CAL Upon completing the calibration both CO2 CALIBRATION and CAL go away The calibration process takes two minutes To ensure the CO2 sensor to be calibrated correctly attach the airway adapter to the CO2 sensor as shown above before the sensor is being powered on and do not connect the CO2 sensor to the endotracheal tube before the calibration process has been completed 2 CO2 monitoring 23 The CO2 waveforms indicate the real time airflow in and out the patient If the CO2 waveforms are erratic check the patient status and the placement of the endotracheal tube Adjust the endotracheal tube and or bag the patient if necessary If the patient has stopped breathing longer than the apnea interval set by the user an alarm will be sounded To push the ALARM key only suspends the apnea alarm for one minute After a monitoring disconnect the CO2 sensor from both the endotracheal tube and the breathing circuit D Respiratory sound The CO2 function offers a digital respiratory sound which allows you to continuously assess the patient s respiratory status without constantly watching the screen The respiratory sound can be set ON or OFF in the menus and the setting will be saved as default The volume of the sound can be adjusted with the VOLUME Dial E The air
20. To continue click Next If vou would like to select a different folder click Browse VESTENIENITET Bronce C Don t create a Start Menu folder lt Back J Wee N Check the box Create a desktop icon as below 40 1 s Setup VetSpecs_VSM_Program Select Additional Tasks Which additional tasks should be performed Select the additional tasks you would like Setup to perform while installing VetSpecs VSM Program then click Next Additional icons Create a desktop icon C Create a Quick Launch icon METTUS VetSpecs VSM Program Ready to Install Setup is now ready to begin installing VetSpecs VSM Program on your computer Click Install to continue with the installation or click Back if you want to review or change any settings Destination location C Program Files VetSpecs VSM Program Start Menu folder VetSpecs VSM Program Additional tasks Additional icons Create a desktop icon 41 s Setup VetSpecs_VSM_Program m ux Completing the VetSpecs VSM Program Setup Wizard Setup has finished installing VetSpecs VSM Program on your computer The application may be launched by selecting the installed icons Click Finish to exit Setup Launch VetSpecs VSM Program Finch N The window below pops up indicating the program is opened up To close the program click the Close box as indicated by the cursor below i Untitled VetSpe
21. USB extension cable one power cord one software CD and one VSM8 User s Manual 57 VSM8 D One multi parameter module one Large Dog Esophageal Probe one Small Dog Esophageal Probe one Cat Esophageal Probe one set of ECG Flat Clips one SpO2 Lingual Sensor one SpO2 Leg toe Sensor one Mainstream CO2 Sensor attached with one clear airway adapter one NIBP module with tubing one Short BP Sensor Band one Long BP Sensor Band and six BP cuffs of different sizes one USB flash drive one USB extension cable one power cord one software CD and one VSM8 User s Manual 58 VII Technical Support Medical For customer or technical support or ordering accessories after purchasing the monitor please call 44 0208 763 9777 For more information please visit www YDTlimited com or write to info ydtlimited com 92 Hartley Down Purley Surrey CR8 4EB UK 59 Limited Warranty VetSpecs Inc VetSpecs warrants the main unit of the VetSpecs VSMB8 Vital Signs Monitor hereinafter the VSM8 Main Unit to be free from defects in materials and workmanship when stored under appropriate conditions and given normal proper and intended usage for two 2 years from the date of delivery of the VSM8 Main Unit to the original end user purchaser Buyer VetSpecs agrees during the applicable warranty period to repair or replace defective monitor without cost to Buyer VetSpecs shall not have any obligat
22. ch comes as a separate external module If your VSM8 did not come with CO2 NIBP and or IBP functions you can add them at any time by purchasing the needed modules Then all you need to do is to simply connect the modules to the monitor There will be no need to return your VSM8 to VetSpecs for the upgrade 2 Comprehensive Monitoring The VSM8 provides comprehensive monitoring for your patients under anesthesia With the VSM8 you monitor the patient s ventilation with mainstream capnography or airway direct respiration its circulation with noninvasive or invasive direct blood pressure its oxygenation with pulse oximetry and its ECG and core body temperature with an esophageal probe 3 Digital Documentation Go Paperless The VSM8 automatically saves monitoring records waveforms readings and trends ECG tracings and blood pressure readings on a USB flash drive for easy transfer of saved information to computers You can then review the information print out through any office laser or ink jet printers with 8 5 X11 plain papers and integrate the data to the patient s file using your existing veterinary practice management software Il Installation 1 Multi parameter module Connect the multi parameter module hereinafter the Module to the port labeled CO2 SPO2 ECG Resp Temp on the right side of the monitor The monitor displays MODULE OFF in the areas for HR green SPO2 red and RR yellow when the Modul
23. cs_VSM_Program File View ux amp Pic Del I BP Tr WwW a gt ID Pet s Name Owner Breed Sex Age Weight Ibs 42 2 Transfer data and organize files A Create a master folder on the hard drive It is highly recommended to establish a new folder on the hard drive of your computer to be the master folder for storing all patient data recorded by the VSM8 before you ever start to transfer data to the computer You can give any name to the master folder For example you can name it My VetSpecs Data LJ My YetSpecs Data B Create a patient folder inside the master folder Each patient should have a separate folder inside the master folder You can literally create thousands of folders inside the master folder if necessary Before you transfer any data of a new patient you should crease a new folder inside the master folder for the new patient You should name all your patient folders in a way which allows you to identify them easily For example you may name a patient s folder with the patient s name and ID number as below LJ 100001 Champ LJ 100002 Max C Copy data files to the computer Remove the flash drive from the VSM8 and insert it to a USB port on the computer The flash drive should be recognized by the computer automatically and indicated as Removable Disk under My Computer If you can not find the flash drive under My Computer window try another USB port on the computer If all USB po
24. cture sale supplying or use of the VSM8 VetSpecs liability arising out of the manufacture sale or supplying of the VSM8 or its use or disposition whether based upon warranty contract tort or otherwise shall not exceed the actual purchase price paid by Buyer for the VSM8 In no event shall VetSpecs be liable to Buyer or any other person or entity for special incidental or consequential damages including but not limited to loss of profits damages to properties and injuries to the patient and or the user arising out of the manufacture sale supplying or use of the VSM8 The foregoing Limited Warranty extends to Buyer only and shall not be applicable to any other person or entity including without limitation customers of Buyer 60
25. d half of an inch distal to the cuff Do not place the cuff above or on the hock The rear leg placement may not be suitable for patients with short hind legs Place the cuff and the sensor band between the elbow and the carpus with the sensor band about one inch distal to the cuff see sketch 6 Lay the patient in lateral 14 recumbence to minimize the effect of gravity Conscious cats usually do not tolerate well the foreleg placement Do not place the cuff on or above the hock or elbow The cuff will not be able to occlude the arterial flow if placed too high on a limb Sketch 5 Place the cuff at the base of the tail and the sensor band half of an inch below the cuff Position the sensor band over the median coccygeal artery Sketch 6 Place the cuff and the sensor band between the elbow and the carpus with the sensor band one inch distal to the cuff Lay the patient in lateral recumbence to minimize the effect of gravity E Watch the bar graph The VSM68 displays a systolic arterial pressure S diastolic arterial pressure D mean 15 arterial pressure M real time pulse rate PR Measurement interval INT is also displayed on the screen The arterial pulsations registered by the sensor band are displayed as a pulsating bar graph blue After applying the cuff and the sensor band watch the bar graph The bar graph pulsates in synch with the heartbeats when the sensor band is picking up valid arterial pulsations
26. e is malfunctioning The NIBP module needs to be returned to manufacturer for service 5 Capnography 54 Problems Possible Causes Recommended Actions CAL and CO2 calibration are not displayed after connecting the CO2 sensor to the monitor The CO2 sensor is malfunctioning The CO2 sensor needs to be returned to manufacturer for service After the CO2 sensor is inserted CO2 waveforms stay a flat line The CO2 sensor is malfunctioning or not calibrated properly Re calibrate the CO2 sensor and then test it on yourself by breathing through it If still the same the CO2 sensor needs to be serviced The CO2 function is not working properly The waveforms are erratic The airway adapter is dirty inside or damaged The airway adapter can not be cleaned Insert another airway adapter and then re calibrate the CO2 sensor The airway adapter is semi disposable and needs to be replaced frequently 55 V Maintenance The monitor Keep the monitor away from heat sources liquid flammable or corrosive materials and direct sunshine Avoid dusty humid or wet places Always place the monitor on a stable and secure place Do not block the ventilation vent Esophageal probes and ECG leads Make sure to disconnect them from the Module prior to cleaning Clean the esophageal probes and ECG leads with a paper towel wet with alcohol after each use SpO2
27. e is not connected to the monitor Upon connecting the Module MODULE OFF in all three areas go away It is suggested to hang the Module onto the anesthesia machine with the attached string or affix the Module to a proper place with the attached Velcro strip 2 Esophageal probes The VSM8 comes standard with a set of three esophageal probes The one labeled CAT is for kittens cats and very small dogs The one labeled Small Dog is for small to medium dogs The one labeled Large Dog is for medium to large dogs The esophageal probes are to be connected to the Module 3 ECG leads with flat clips The VSM8 comes standard with one set of ECG leads green red and white with flat clips The ECG leads are to be connected to the Module 4 SpO2 sensors The VSM8 comes standard with one SpO2 lingual sensor Gray clip and one SpO2 leg toe sensor Blue clip The SpO2 sensors are to be connected to the Module Upon connecting a SpO2 sensor PROBE OFF goes away 5 Airway Sensors VSM8 A and VSM8 B The monitor comes with two airway sensors The one labeled Dog Airway Sensor is for use in medium to large dogs while the one labeled Cat Small Dog Airway Sensor is for use in kittens cats puppies and small dogs The airway sensors are to be connected to the Module Upon connecting an airway sensor SENSOR OFF goes away 6 NIBP module and accessories optional The optional NIBP function consists of a NIBP module a BP tube attac
28. e the short sensor band is for cats and small dogs When applying a sensor band to a site on the patient the sensor band must allow it to be wrapped tightly around the site Otherwise the sensor band is too large to work properly for the site Apply the short sensor band or try a site with a larger circumference D Apply the cuff and sensor band The cuff and the sensor band must be applied onto the same limb or tail It is not necessary to clip the hair Apply the cuff and then the sensor band The sensor band must be placed distal to below the cuff Place the sensor band over a main artery with the side labeled VetSpecs facing out Pull the Velcro strip to wrap the sensor band firmly but not too tight The sensitivity of the sensor band will be reduced if the sensor band is not wrapped firmly or positioned correctly In order for the cuff to successfully occlude the arterial flow when inflated the cuff must be placed at an appropriate site as instructed below Place the cuff at the base of the tail and the sensor band half of an inch below the cuff Position the sensor band over the median coccygeal artery see sketch 5 Pull the Velcro strip to wrap the sensor band firmly The tail placement is highly recommended for patients with short legs and for conscious patients especially cats Cats tolerate much better the tail placement e For cats or dogs with long hind legs the cuff may be placed below the hock and the sensor ban
29. ement Push it again before a measurement has completed aborts the measurement ALARM Push this key to turn on or off an audible alarm However apnea alarm can be suspended for only 60 seconds JOG DIAL Push the JOG DIAL to display main menu Turn the JOG DIAL to select items in main menu or submenus VOLUME Turn this dial to increase or decrease the volume of the speaker 30 4 2 Menu System Main menu Push the JOG DIAL to display main menu as shown below Turn the JOG DIAL to select a submenu and then push the JOG DIAL to enter To exit from main menu select ESC and push the JOG DIAL 1 Name CO2 amp Resp SCREEN NIBP ECG SPO2 Temp SETUP ESC Me ope ANC GER SOncdu sep qi Name The VSM8 will prompt you to enter a patient name upon turning on the power with at least one module connected to the monitor The monitor will beep for 10 seconds and keep flashing NAME until a name is entered You can enter a name only when DISK Ready is displayed and NAME is flashing The name on the screen will be canceled when the monitor switches work modes for example from ECG mode or BP mode to monitoring mode Therefore for monitoring do not enter a name until the monitor is in monitoring mode To enter a patient name push the JOG DIAL to select NAME and then Push the JOG DIAL again to generate a red cursor rotate the JOG DIAL to input the first letter A to Z or digit 0 9 and then push the JOG DIAL
30. en push the JOG DIAL to set If the patient has stopped breathing for longer than the apnea time set by the user an alarm will be sounded The default apnea time is 30 S To change it highlight in red and then turn the JOG DIAL 32 The end tidal CO2 can be expressed as mmHg or percentage 96 The user can select one of the two units and set it as default To change the unit Select units mmHg and push the JOG DIAL to highlight in red Turn the JOG DIAL to change the unit and then push the JOG DIAL to set To change end tidal CO2 alarm limits Select the item to be changed push the JOG DIAL to highlight in red Turn the JOG DIAL to change the number and push the JOG DIAL to set The default alarm setting for end tidal CO2 is ON To change the alarm setting to OFF Select Alarm ON and push the JOG DIAL to highlight in red Turn the JOG DIAL to change to OFF and then push the JOG DIAL to set The CO2 waveforms have two speeds Fast and Slow To change waveform speed Select Speed Slow and push the JOG DIAL to highlight in red Turn the JOG DIAL to change to Fast and then push the JOG DIAL to set SCREEN e Select SCREEN and push the JOG DIAL to enter SCREEN submenu as below 1 WAVE SPEED 50 mm s 2 NIBP PAGE 1 1 3 TREND 1h 4 RETURN 5 ESC A WAVE The ECG and pulse waveforms have three speeds 25 50 default and 100 mm s e Select SPEED 50 mm s and then push the JOG DIAL to highlight in red
31. f mixed dead space and alveolar gas Phase Ill Alveolar plateau Exhalation of mostly alveolar gas At the end of exhalation CO2 concentration reaches the peak end tidal CO2 value Phase 0 Rapid sharp down stroke Inhalation Mainstream capnography provides real time CO2 waveforms an ETCO2 reading a RR and a respiratory sound Unlike side stream or micro stream capnography mainstream capnography performs CO2 measurements directly inside the airway withdrawing no gas away from the airway B Clinical implications Normal ETCO2 readings together with a normal capnogram indicate normal function of the patients metabolism circulation and ventilation and of the anesthetic machine Increases in ETCO2 may be due to anesthetic induced respiratory depression 18 increased metabolism or the addition of CO2 to the circulatory system as a result of re breathing CO2 Re breathing CO2 can be due to soda lime exhaustion or incompetent expiratory valve on the anesthetic machine allowing exhaled CO2 to be re inhaled Decreased or abolished end tidal CO2 may be due to hyperventilation low cardiac output respiratory arrest or cardiac arrest Capnogram also provides vital information regarding the patient s airway potency A depressed or absent capnogram may be due to a dislodged misplaced or obstructed endotracheal tube or airway a leak around endotracheal tube cuff or disconnection of the endotracheal tube from the anesthetic
32. hed to the NIBP module two BP sensor bands one short and one long and six cuffs of different sizes VetSpecs VetSpecs BP Sensor Bands Connect the NIBP module to the BP port on the right side of the monitor The monitor displays MODULE OFF in the NIBP area blue when the NIBP module is not connected to the monitor Upon connecting the NIBP module MODULE OFF goes away The BP sensor bands are to be connected to the NIBP module Upon connecting a BP sensor band a blue bar graph appears in the NIBP area When the BP sensor band is not applied to the patient the monitor may be flashing BP SENSOR OFF The cuffs are to be connected to the BP tube on the NIBP module 7 CO2 module and its airway adapter optional The optional mainstream capnography function consists of a CO2 module labeled VetSpecs Mainstream CO2 Sensor and a clear airway adapter inserted on the CO2 module sensor The CO2 sensor is to be connected to the Module The monitor displays MODULE OFF in the CO2 area yellow when the CO2 sensor is not connected to the monitor Upon connecting the CO2 sensor the monitor displays CAL and CO2 CALIBRATION 8 USB flash drive and its extension cable The VSM8 monitor comes with a USB flash drive and a USB extension cable connected to the flash drive Connect the extension cable with the flash drive to the USB port on the back of the monitor The monitor displays at the bottom of the screen DISK None whe
33. inuously assess the patient s respiratory status without constantly watching the screen The respiratory sound can be set ON or OFF in the menus and the setting will be saved as default If the patient has stopped breathing for longer than the apnea time set by the user an alarm will be sounded To push the ALARM key only suspends the apnea alarm for one minute After a monitoring disconnect the airway sensor from both the endotracheal tube and the breathing circuit 12 4 Blood Pressure Monitoring optional A The concept Blood pressure BP is the lateral force per unit area exerted on a vessel wall The pressure generated is pulsatile and creates a wave of vascular distention This forward moving pressure wave has maximum systolic arterial pressure and minimum diastolic arterial pressure values oscillating around a mean value mean arterial pressure which is the average pressure throughout the cardiac cycle that pushes blood through the vascular network Since systole is normally shorter than diastole mean arterial pressure MAP is not simply the midpoint between systolic arterial pressure SAP and diastolic arterial pressure DAP but is estimated as MAP DAP SAP DAP 3 The VSMB offers a breakthrough noninvasive blood pressure technology called the Volume Plethysmographic Method VPM which shares the same principle as the Doppler Method The VPM employs an inflatable cuff to occlude arterial flow and a senso
34. ion under this Limited Warranty to make replacements which result in whole or in part from catastrophe fault or negligence of Buyer or anyone claiming through or on behalf of Buyer or from improper use of the VSM8 Main Unit or use of the VSM8 Main Unit in a manner for which it was not designed or by cause external to the VSM8 Main Unit The multi parameter module NIBP module mainstream CO2 sensor USB flash drive and USB extension cable are covered by a 12 month limited warranty The esophageal probes ECG leads with flat clips and SpO2 sensors are covered by a 6 month limited warranty The airway sensors BP sensor bands cuffs and airway adapter are semi disposable items and have no warranty The PC software is covered by a life time replacement warranty Buyer shall notify VetSpecs of any product which it believes to be defective during the warranty period Such product shall be returned by Buyer transportation and insurance prepaid to VetSpecs for examination and testing VetSpecs shall repair or replace any such product found to be so defective and return such product to Buyer transportation and insurance prepaid The provisions of the foregoing Limited Warranty are exclusive and are expressly in lieu of any other warranty whether express or implied written or oral VetSpecs neither assumes nor authorizes any employee agent distributor or other person or entity to assume for it any other liability in connection with the manufa
35. it to anywhere you want To open the bitmap picture simply double click the file The picture is opened up as shown below 1s 51 ID Pet s Name Owner Breed Sex Age TIME 22 38 49 DATE 01 17 2008 GAIN 1mwcm HR 72 5P02 98 CO2 48 RR 16 TEMP 99 0 NIBP mmHq SAP 119 DAP 84 MAP 95 PR 72 5 View and print ECG To review saved ECG directly go to the data folder Double click any one of the screen captures to open it up as shown below To print follow the same steps as above WAVEO2 VS7 VetSpecs_VSM7_Program File view u amp Pic Del I BP Tr W a e ID Th Pet s Name A AN SES IA A A A ra A Owner r cs A 3 al e Breed Sex Age Weight Ibs TIME 22 42 32 DATE 01 17 2008 GAIN 1mw cm HR 72 SP02 co2 N A A ran f Se Ste H HASANA AA At RR TEMP NIBP mmHg o D R ur ME To save as an independent bitmap picture follow the same steps as above ID Pet s Name A A A A A A 1A N fy LA INA LA A Owner Breed Sex Age Weight Ibs
36. l measurements will automatically be saved in the folder of the patient on the flash drive 4 5 Review Saved Information 1 Install the software on computer The VetSpecs program is compatible with all computers using Microsoft amp Windows amp XP operating system Insert the software CD into a CD drive on the computer and then open the CD Double click the file VetSpecs exe and then follow the steps below 38 d VetSpecs exe Select Setup Language bd Select the language to use during the installation C EN NW N 77N Setup VetSpecs_VSM_Program Welcome to the VetSpecs VSM Program Setup Wizard This will install YetSpecs_V SM_Program 1 5 on your computer It is recommended that you close all other applications before continuing Click Next to continue or Cancel to exit Setup 39 s Setup VetSpecs VSM Program Select Destination Location Where should VetSpecs VSM Program be installed LJ Setup will install VetSpecs VSM Program into the following folder To continue click Next If you would like to select a different folder click Browse C Program Files VetSpecs VSM Program At least 1 1 MB of free disk space is required lt Back J Ner 3 s Setup VetSpecs VSM Program Select Start Menu Folder Where should Setup place the program s shortcuts rz 1 P j Setup will create the program s shortcuts in the following Start Menu folder
37. n no flash drive is plugged in and DISK Ready when a flash drive is connected 9 Connecting the power Plug the power cord into the power port on the back of the VSM8 and then into a 3 line power outlet For maximum safety only connect the VSM8 to a power outlet with three lines Ill Clinical Instructions 3 1 Monitoring During Anesthesia The VSM8 features three work modes monitoring mode ECG mode and blood pressure BP mode The VSMB8 automatically switches to monitoring mode when an esophageal probe is inserted into the patient i e a temperature is registered an airway sensor is connected to the monitor or the CO2 sensor is connected to the monitor In monitoring mode the VSM8 displays cascaded two lines of ECG green one line of pulse waveforms red and one line of respiratory waveforms white or one line of CO2 waveforms light yellow GRIN RUTO 12 SPEED S5Omm s fs CO2 s BEAT DISK None PRH None NAME Monitoring mode 1 ECG and Core body Temperature The VSM8 registers ECG heart rate HR and core body temperature in anesthetized patients with an esophageal probe A Choose an appropriate sized esophageal probe The esophageal probe labeled Large Dog is for medium to large dogs The esophageal probe labeled Small Dog is for small to medium dogs The esophageal probe labeled CAT is for kittens cats and very small dogs The esophageal probe labeled Exotics optional i
38. o the patient for a few seconds the VSM8 will display a line of pulse waveforms red and a pulsating bar graph red as well as a SpO2 reading Both the waveforms and the bar graph are pulsating in synch with the heartbeats when the sensor is picking up valid arterial pulsations The SpO2 reading is accurate only when the waveforms and the bar graph are pulsating in synch with the heartbeats After applying the lingual sensor if the waveforms are erratic the tissue underneath may be in a low perfusion condition Verify the patient status and try another site on the tongue If the waveforms or bar graph become erratic during the monitoring verify the patient status and move the sensor to another spot on the tongue After the sensor has been placed on one spot for an extended period of time the effect of the pressure could build up to cause vasoconstriction in the tissue When using the leg toe sensor always place the sensor at a site with light skin if possible To apply to a site with pigmented tissue the hair on both sides must be clipped Watch the waveforms If the waveforms are a flat line or pulsating intermittently the bar graph is barely moving the site is too pigmented to permit adequate light transmission Try another site It is highly recommended to simultaneously use both the ECG function and the SpO2 function when monitoring during anesthesia When both the SpO2 channel and the ECG channel are working properly and the
39. on page 14 as cats usually tolerate much better the tail placement Apply the cuff and the sensor band and then calm down the patient After the patient is calmed down connect the cuff and the sensor band to the NIBP module which should be placed close to the patient The patient must be calmed down before starting a measurement Do not start a measurement when the patient is constantly struggling panting trembling or shivering No technologies can measure BP effectively when there are repetitive motions on the patient Furthermore it makes no sense to measure BP when the patient is obviously under stress Watch the bar graph If the bar graph is pulsating erratically i e it is not in synch with the heartbeats the patient is not relaxed Even when there are no visible body motions the muscles underneath the sensor band may still be too tense producing minute muscle movements Continue to calm the patient After the patient is calmed down the bar graph will pulsate in synch with the heartbeats As soon as READY is displayed you can push the START STOP key to start a measurement 27 For BP screening it is recommended to set the measurement interval at 1 minute or to manually start each measurement 2 Systemic hypertension The diagnosis of systemic hypertension may be made in a cat of any age with a systolic pressure over 190 mmHg Cats with clinical findings compatible with hypertension and systolic pressures between 160
40. our finger If BP SENSOR OFF does not go away the sensor band needs to be replaced F Start a measurement BP measurements can be started manually or automatically at a user set interval To manually start a measurement push START STOP key while READY is displayed 16 The VSM8 rapidly inflates the cuff to around 280 mmHg and then deflates gradually The real time cuff pressure count down is displayed in the NIBP area The deflation process takes only a few seconds The bar graph will resume pulsating when the pressure inside the cuff equals the systolic arterial pressure indicating the return of arterial flow Upon completing the measurement systolic diastolic and mean arterial pressures are displayed The time at which the measurement was completed is also displayed Between measurements if motions are induced to the patient the VSM8 may display WAIT until the sensor band is again picking up valid arterial pulsations If pushing START STOP key while WAIT is still displayed a measurement will not be started until READY is again displayed To abort a measurement push START STOP key The bar graph should stop pulsating immediately after the cuff inflation indicating an occlusion of the arterial flow If the bar graph keeps pulsating immediately after the cuff inflation indicating a failure to occlude the arterial flow no BP readings will be registered for the measurement and OCCLUSION FAILED will be flashing on the screen
41. pops up as shown below Type in patient information and or comments and then click OK You can update information at any time you want Pet s Information Patient ID Pet s name Owner Weight Ibs Breed Comments Cancel When printing the patient information will be printed on the top of each printout To review and print diagnostic comments double click to open the file below L PetInfo SM F Save as an independent picture You can save screen captures trends page and BP readings page as independent pictures in bitmap bmp format These pictures can then be opened on any computer without using the VetSpecs program For example you can email these pictures to anyone and he or she will be able to open these pictures 50 More importantly this capability allows the data monitoring records ECG and BP readings to be integrated to existing patient files in your veterinary practice management program software All you need to do is to cut and paste these pictures in bitmap format to the patient s file folder under your practice management program such as AVImark and Cornerstone To save as an independent picture in bitmap format click the Pic button and click OK Del VetSpecs VSM7 Program A Picture saved to WAYEOO 57 bmp As default the bitmap picture is saved in the same original data folder as shown below WAVEOO VSM bmp 1148 x Bitmap Image You can then move
42. r band to sense arterial pulsations It provides systolic diastolic and mean arterial pressures and a continuous real time pulse rate B Choose an appropriately sized cuff The VSM8 comes with six cuffs of different sizes All six cuffs are marked to aid in proper cuff selection When a cuff is wrapped around a site its index edge should be within the range indicated on the cuff The cuff is too small or too large if the index edge is outside the range The following should be used only as general guidelines for cuff selections because the circumference and shape of the cuff site not the size of the patient matter most Size 1 circumference 4 3 6 4 cm is for kittens and very small dogs Size 2 circumference 5 9 8 7 cm is for kittens cats and small dogs Size 3 circumference 7 2 10 7 cm is for cats and small dogs e Size 4 circumference 8 5 12 7 cm is for small to medium dogs Size 5 circumference 9 0 15 0 cm is for medium to large dogs Size 6 circumference 15 0 21 5 cm is for large dogs 13 Cuff size can have a significant influence on the accuracy of a measurement A cuff that is too narrow will produce artificially elevated readings while a cuff that is too wide will produce spuriously low values C Choose an appropriately sized sensor band The VSM8 comes with one long sensor band and one short sensor band Generally speaking the long sensor band is for medium and large dogs whil
43. reduced cardiac output e Pulmonary artery compression e Pulmonary artery embolism e Sudden hemorrhage e Acute cardiac tamponade e Cardiac compression 6 Differential emptying 21 mm Hg 40 mm Hs CO 40 The above capnograms can result from the following e Positioning of the ET tube at or beyond the carina so that one side of the lung has impaired emptying This makes the retained gas higher in CO2 and later to empty than from the normal lung The spike can occur anywhere in the plateau phase e Any functional blockage of a major airway below the carina foreign body mucous compressed airway etc 7 Cardiogenic oscillations mm Hg 40 Cardiogenic oscillations are ripples superimposed on the expiratory plateau and the descending limb of the capnogram which are caused by small gas movements inside 22 the airway Although cardiogenic oscillations can occur in any animal where the pulsations of the aorta and heart cause areas of lungs to be compressed and thereby emptied and filled they are typically seen in large dogs with a slow RR The guide to the fact that this is happening is that the oscillations are in synch with the heartbeats The displayed respiratory rate can be much higher than the actual respiratory rate when cardiogenic oscillations occur C Operational instructions 1 Apply the CO2 sensor Attach the airway adapter onto the CO2 sensor as shown below and then connect the C
44. rinary patients because Lead ll offers the largest ECG tracings Placements of leads clips for registering different Leads are listed as below LEAD II ECG GREEN lead attaches to RIGHT REAR LEG RED lead attaches to LEFT REAR LEG WHITE lead attaches to RIGHT FORELEG LEAD I ECG GREEN lead attaches to RIGHT REAR LEG RED lead attaches to LEFT FORELEG WHITE lead attaches to RIGHT FORELEG LEAD III ECG GREEN lead attaches to RIGHT REAR LEG RED lead attaches to LEFT REAR LEG WHITE lead attaches to LEFT FORELEG The patient should be laid on its side usually on a towel or rubber mat and relaxed Trembling and panting may produce motion artifacts on ECG For more information on ECG refer to pages 37 51 and 52 26 3 3 BP Measurements optional For more instructions refer to pages 12 16 36 37 47 48 and 53 The VSM8 automatically enters into BP mode when only the NIBP module is connected to the monitor In BP mode the VSM8 displays cascaded four lines of pulse waveforms blue registered by the BP sensor band 1 Screening for hypertension Screening for hypertension must be performed in a quiet environment under a stress free condition If possible have two people to perform the procedure One holds and calms the patient while the other places the cuff and the sensor band and then performs the measurements For cats it is highly recommended to place the cuff and sensor band on the tail see sketch 5
45. rts are not working try another computer The USB flash drive is universally compatible with all computers with functional USB port s It is suggested that you copy all folders on the flash drive to the computer as soon as possible and then delete all folders on the flash drive Otherwise you may get confused as the time and the number of folders on the flash drive increase D Rename data files 43 Immediately after these data folders are copied to the computer you should move them into the folders of each patient involved and then rename these data folders in a way that they can be identified easily For example the data folder of a surgical monitoring on July 1 2005 is named as SM 07 01 05 the data folder of an ECG testing on July 1 2005 is named as ECG 07 01 05 and the data folder of a BP screening on July 1 2005 is named as BP 07 01 05 as shown below LJ 5M 07 01 05 LJ ECG 07 01 05 a BP 07 01 05 E Organize patient files All files for the same patient should be placed inside the patient s folder For example for patient Max with a patient ID number of 100002 all its files should be placed inside the folder 100002 Max as shown below LJ 100002 Max w ww ww ww B B p SM 07 01 05 ECG 07 01 05 BP 07 01 05 ECG 07 01 06 BP 07 01 06 ECG 07 01 07 BP 07 01 07 44 3 Open the program Double click the shortcut icon VetSpecs VSM Program on the desktop to open the program A window titled VetSpecs Program pops
46. s for lizards and snakes In order for the probe to register ECG all three metal rings must establish good contacts with the esophagus If the probe is too small for the patient it will not be able to establish good contacts with the esophagus Applying the CAT probe in medium or large dogs may produce erratic ECG and inaccurate HR B Apply the esophageal probe After the patient has been anesthetized and intubated estimate how deep to insert by laying the probe on the patient The distal ring and middle ring should be positioned across the heart after inserted Mark the probe at the mouth level with your hand slide the probe into the esophagus to the estimated depth and then watch the screen If ECG is erratic adjust the depth of the probe until stable ECG is registered Motions induced to the patient or the probe may produce motion artifacts on the ECG Tie the esophageal probe to the endotracheal tube to minimize motions if necessary Never insert a probe into a patient not anesthetized and intubated Do not use a probe which is defective or damaged externally When using the esophageal probes in electrosurgery the patient must be properly grounded as instructed in the User s Manual for the electrosurgical unit being used 2 Pulse Oximetry A Connecting the SpO2 sensor The monitor flashes PROBE OFF when no SpO2 sensor is connected to the monitor Connect a SpO2 sensor to the Module PROBE OFF goes away B Applying a SpO2
47. sensor 1 SpO2 Lingual Sensor Gray clip The lingual sensor is intended for use only on the tongue Place the sensor at the center of the tongue with the light emitting side on top of the tongue The lingual sensor may not work effectively at any other locations on the patient 2 SpO2 Leg toe Sensor Blue clip Use the leg toe sensor only when the lingual sensor is not suitable for the procedure For cats place the leg toe sensor on e A leg between the carpal pad and the metacarpal pad with the light going through the leg from front to back see Sketch 1 If the sensor site is covered with dark hair clip the hair on both sides of the leg A paw with the light emitting side on top of the paw and the other side of the sensor on top of the metacarpal pad see Sketch 2 For dogs place the leg toe sensor on e Alegatthe Achilles tendon see Sketch 3 Atoe side to side see Sketch 4 If possible apply the sensor to a toe with light skin If the toe is covered with dark hair clip the hair on both sides Aleg front to back between the carpal pad and metacarpal pad see Sketch 1 Never place the leg toe sensor on the tongue Applying the leg toe sensor to the tongue will cause vasoconstriction Sketch 2 The leg toe sensor on a cat s paw Sketch 3 The leg toe sensor on the Achilles tendon of dogs Sketch 4 The leg toe sensor on a toe of dogs 10 C Watch the waveforms After the sensor has been applied ont
48. side was damaged Use another set of leads MODULE OFF is displayed when the Module is connected to the monitor The Module is malfunctioning The Module needs to be returned to manufacturer for service 2 Pulse Oximetry Problems Possible Causes Recommended Actions PROBE OFF is displayed when a SpO2 sensor is connected to the Module A wire inside the SpO2 sensor was damaged Use another SpO2 sensor After applying the leg toe sensor to the patient the pulse waveforms are erratic or just a flat line No adequate light transmission due to dark hair pigmented skin and or thick tissue 1 Clip the hair on both sides 2 Apply the sensor to a site with light skin After applying the lingual sensor the pulse waveforms are erratic 1 Low perfusion at the sensor site 2 The sensor is malfunctioning 1 Check the patient status 2 Try the sensor on your finger If the sensor works normally try it again on the patient 3 Airway direct Respiration 53 Problems Possible Causes Recommended Actions After inserting the airway sensor the respiratory waveforms are a flat line Wire s inside the airway sensor may be damaged Test the airway sensor on yourself by breathing through it If still no waveforms the sensor needs to be replaced 4 NIBP Problems Possible Causes Recommended Actions
49. to enter e Rotate the JOG DIAL to input the second letter or digit and then push the JOG DIAL to enter A total of eight letters and or digits can be entered e After entering the name push the JOG DIAL until the red cursor disappears 31 The name is displayed at the bottom of the screen and a new folder under the name is created on the flash drive No new folder will be created on the flash drive until a new name is entered Upon entering a new name BP readings and trends data already stored in the internal memory of the VSM8 will be erased making the monitor ready for the new patient The information already saved on the flash drive will not be deleted If a folder with the same name has already existed on the flash drive the word EXISTED will be displayed briefly upon entering Enter a different name or go to a computer to delete the folder with the same name from the flash drive If you do not want to save any information for a procedure just do not enter a name CO2 amp Resp n main menu select CO2 amp Resp and then push the JOG DIAL to enter 1 Sound OFF 2 Apnea 30S 3 Unit mmHg 4 HE 50 5 LO 20 6 Alarm ON 7 Speed Slow 8 RETURN 9 ESC The VSMB8 offers a digital respiratory sound The respiratory sound can be set OFF or ON as default To turn on or off the respiratory sound Select SOUND OFF and push the JOG DIAL to highlight in red Turn the JOG DIAL to change to ON and th
50. vere hypotension IV Operational Instructions 28 Push the purple POWER button on the back of the monitor to turn on or off the VSM8 Sleep Mode To extend the life of the screen the VSM8 will automatically turn off the screen sleep mode after the monitor has been idle for more than 30 minutes In sleep mode the screen is turned off but the green power light at the lower left corner is flashing To exit sleep mode turn the screen back on simply push the Wake Up key yellow on the front panel rather than push the POWER button on the back To turn the screen back on exit sleep mode push the yellow Wake Up key not the POWER button If you mistakenly pushed the power button when the monitor was in sleep mode you would need to wait 10 seconds with the power button at the UP position before pushing down the power button to turn on the monitor 29 4 1 Control Panel Wake Up Push this key to exit sleep mode turn the screen back on TREND Push this key to display stored BP readings and trends and back to waveforms display TREND and Wake Up share the same key yellow SAVE In monitoring mode push this key to make a screen capture saving the information on the screen to the flash drive V BEAT Push this key to turn off or on the heartbeats sound FREEZE Push this key to freeze a line of ECG on the screen Push it again to release the line START STOP Push this key to manually start a BP measur
51. way adapter The airway adapter is a semi deposable item After using for a period of time it must be replaced due to the residuals accumulated inside the airway adapter Do not try to clean the airway adapter as it may damage the special optical film on the two circular windows Generally speaking if the CO2 function does not work properly replace the airway adapter It is recommended to replace the airway adapter at least twice once a month 24 3 2 ECG Testing The VSM8 comes with a set of ECG leads with flat clips designed specifically for ECG testing in cats dogs and other similar sized animals The VSM8 automatically enters into ECG mode when the ECG leads are applied to the patient and no CO2 sensor or airway sensor is connected to the Module In ECG mode the VSM8 displays cascaded four lines of ECG on one screen GAIN AUTO 120 ECG mode Attach the foreleg lead s to the appropriate foreleg just above the elbow and the rear leg lead s to the appropriate rear leg immediately proximal to the stifle It is not necessary to clip hair Wet all three contact sites thoroughly with conductive agent such as saline In order to register interference free ECG adequate amount of 25 conductive agent must be applied to all three contact sites With the ECG leads the VSM8 can register Lead l Lead ll or Lead lll ECG but one Lead at a time Lead ll is the Lead of choice for ECG monitoring testing and screening in vete
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