User`s Manual
Contents
1. information to correctly determine the blood pressure Increasing the high range will center the waveform providing a correct blood pressure measurement ier ae a in F r z 7 r r z z 1 l iT i m e P E EEP a i at aL sai HG Til j M I Ate A E Pree sure mrig J J In this example the system does not have enough low range information to correctly determine the blood pressure Decreasing the low range will center the waveform providing a correct blood pressure measurement Excessive Patient Movement Like other blood pressure devices the DynaPulse Pathway unit is sensitive to motion Although the DynaPulse Pathway uses signal conditioning and artifact rejection algorithms if the patient moves or talks during the measurement the DynaPulse may not be able to determine the correct blood pressure Have the patient avoid moving and talking while taking the measurement Air Release Not Set Correctly If you receive an error message air release too fast check for cuff leaks or hose and connector leaks As the device is 60 inflating the cuff during measurement there should be no hissing sounds until the air is released If the cuff connection is good check the release valve setting The release valve is the wheel dial located on the right side of the DynaPulse Pathway unit labeled with up and down arrows The air release setting should be around 20 to 30 seconds using the default pressure rang2. 100 1D o 10 10 20 40 D 60 70 amp 90 100 Auscultatory Method mm Hg Auscultatory Method mm Hg Pulse Dynamics vs Auscultatory Method Summary Systolic Diastolic Mean Difference Ausc PD Standard Deviation Standard Error of Estimation Correlation Coefficient Experimental Conditions 1 Total Subjects 132 3 Heart Rate Range 45 115 BPM 2 Age Groups 11 24 28 25 44 38 4 Data represents a three measurement 45 64 28 65 85 38 average The correlation coefficient 1s a measure of comparison A coefficient of 1 corresponds to a perfect correlation As a general rule coefficients above 0 80 are considered good correlations The line on each graph has been fitted to the data Pulse Dynamics vs Intra Arterial Catheterization UCSD Medical Center Systolic Pressure Diastolic Pressure 220 110 oN 200 oN 100 am am 180 f a o 6 80 amp 140 fae fae q ras 70 gt 120 gt Q G a g 100 2 80 50 60 40 6 8 100 120 140 160 180 200 220 40 50 60 70 80 90 100 110 Intra Arterial Catheter mm Hg Intra Arterial Catheter mm Hg Mean Arterial Pressure Pulse Dynamic mm Hg o 70 9 10 110 10 10 Intra Arterial Catheter mm Hg Pulse Dynamics vs Intra Arterial Catheterization Summary Systolic Diastolic Mean Arterial Mean Difference Cath PD 2 Standard Deviation 9 Standard Error of Estimation 9 Correlation Coefficient 0 94 Experim
3. 1f the patient has been previously registered on the DAC server a Register Patient To register patient s on the DAC select patient s and click on the Profile button A Patient Profile window will appear as shown below Patient Profile e Tere Prahle pran ell Serer _Updete Server seal Display Local Patient Profile _Update Local Patient Hame John Doe Birth Date 1160 E Weight h20 Pounds Height 5 Feet fia Inches Seg Mae Ethnicity Unspecitied Cuff Size Medium Indicates required fields DynaPulse Unit ID Po Comments P Lagin Po Password 0 Confirm pooo The Patient Profile screen will display your local patient profile if you have never registered the patient Otherwise the Patient Profile screen will display your patient profile from the DAC server Verify or edit information for each field Then click the Update Local button to update the patient s profile on your hard drive Next click on Update Server to update the patient s profile on the DAC server this will also register the patient on the DAC server Hit the close button to exit the patient profile screen 53 Note You will only be able to upload data for registered patients Measurement Data Upload Select the registered patient s for upload and click on the Upload Data button on the DAC patient list Your patient s data should now be uploaded to the DAC server To view uploaded patient
4. DynaPulse Unit D 3 Verify or edit information for each field Select OK to save updated patient information before you exit the dialog Note Patient Profile needs to be completed for DAC upload DYNAPULSE ANALYSIS CENTER DAC DAC stands for DynaPulse Analysis Center a Pulse Metric website for hemodynamic analysis based on the measured waveform Access to the DAC website 1s available by subscription only If you have a DAC subscription use the following procedure to use the DAC analysis service Access the DAC Service Select Analysis from the DAC BAC menu The Login screen will Amalysig o appear Internet Explorer Netscape 51 Login To DynaPulse Analysis Center DAC Analisis Center i offered only to subscribing physicians and ther designated users Host Mame eDAC PulseMetric com Username fjohndoe Cancel Faszsword Ea Select a host name cDAC eDAC or one explicitly provided by Pulse Metric Inc Enter your username and password Then click the Login button Your local patient list will appear Patient List Name ID Fegstered Profe e Mana Suarez Robert E Lee O01 Mo Upload Wata George Washington 004 No Benjamin west 0gs Mo Close Johnathan Smith 00E No Mark Franklin U0 Mo Sammy Jenkins O05 Ho Mark Jones O10 Heo Shirley Bonvera O11 No Newsom Aogers ue Mo Miron Vinny O15 No John Doe Gordon Levy The registered column in the Patient List shows
5. Gave iris ent new directory function by selecting the Current destination directory patient s that you c dppathwa would like to move dpp y If you want to Enter or select a new move all of the destination directory patients use the Select All feature in the Patient menu Choose Move to New Directory from the Patient menu The screen to the right appears asking where you want the data to be moved You can select an existing directory or create a new o one p Cancel 44 BACKUP ARCHIVE AND RESTORE PATIENT DATA The DynaPulse Pathway software provides utilities to help you protect patient data files from accidental loss due to hardware or storage media failure A In general never move Pathway data files by software other than Pathway software features provided in menu item Patient Pathway data files must be either 1 created within Pathway by adding Patients taking measurements and editing Patient s profile or 2 Restored to active use by Pathway from folders currently not used within Pathway Data files Restored to active use by Pathway may have in the past been 1 Archived using Pathway software to folders for safe keeping and deleted from use by Pathway 2 Backed up using Pathway software to folders for safe keeping and still in use by Pathway or 3 with caution files that have been copied to other folders or media using non Pathway software such as Windows E
6. aN t unit Pressure Cuff Hose and Connector Install the Batteries or Plug in the DC Adapter The DynaPulse Pathway unit either operates on four AA batteries or it draws power from a DC adapter The battery compartment is located below the LCD screen 10 Connect the Communication Cable Connect the communication cable to both the unit and computer You will find a cable in your DynaPulse Pathway package with a nine pin serial connector on one end and a circular connector on the other The nine pin connector plugs into a serial port on your computer and the circular connector plugs into the left side of the DynaPulse Pathway unit Should your computer have a twenty five pin serial port you will need to purchase a nine to twenty five pin adapter from your computer dealer This should be an inexpensive item Note If your computer does not have an empty serial port most computers come with at least two serial ports you will need to install an additional serial port This should be relatively inexpensive The alternative is to use an A B switch box which allows you to alternate between serial devices for example the Pathway and an external modem Plug the Cuff Assembly into the DynaPulse Pathway Unit The cuff assembly plugs into the right side of the DynaPulse Pathway unit Large and small cuffs are interchangeable with the medium adult cuff assembly INSTALL THE DYNAPULSE PATHWAY SOFTWARE We strongly recommend that yo
7. artifacts are introduced What happens if your measurements are taken with air release times outside this range Shorter air release times produce individual heartbeats that are spread farther apart With a longer release time heartbeats will be close together This holds true for heart rate as well With a slow heart rate the heartbeats will be spread farther apart With a fast heart rate the heartbeats will be closer together With practice you can become familiar with how a good measurement should appear You will discover how the differences in air release rate will cause differences in the appearance of the DynaPulse pressure waveform The following waveform examples illustrate how pressure waveforms might differ from one patient to the next In this example blood pressure measurements were taken on the same individual Even with the blood pressures and heart rate being similar the difference in air release time caused the waveforms to appear quite different Retrieving the Measurement Display Measurement data can be quickly recalled from the Trend screen by either double clicking on the cursor at the 28 measurement point or choosing the measurement and pressing the Enter key You can also retrieve a Measurement Display by selecting the measurement and choosing Measurement from the Trend menu 29 TRENDING AND STATISTICAL ANALYSIS The Trend window Disease management requires that the patient be managed over
8. as seen below w 1 Patent List 35 fl Patient List Shirley Bo a Ea Ml Measurement 06 156 fl Central BP Trend SyS 134 Dia 75 Mee Patient Name Sh mmHg Tii Date Time 06 15 2001 10 4 Choosing the Cascade option causes each window to overlap so only title bars are visible The Window menu also lists the open displays Choosing any listed display from the screen or menu list brings that display to the foreground Arrange Icons and Close All windows You may also clean up the display screen and still have several measurements available for your review by using the Arrange Icons option from the Window menu el DynaPulse Pathway File Edit Patient Measure Waveform Trend DAC Optio Activated Patent George Washingtar cidppathwas Ea 4 Central BP ejoj ed Any Measurement Trend Measurement Table or Patient List may be minimized and arranged by selecting this feature 36 Choosing the Close All option will clear off all measurement screens and reduce the Patient List and Trend windows if open to icons The icons will indicate the time and date of the measurement associated with the icon PRINTING Print Header Set up and Print with Report You can customize your File reports to display a stored Save ihe header Unless you wish to a a on Print Ctrl P change the header you need a i hon Prat onrent Page o enter it only once E E Click on File You
9. cuff over your arm with the air hose pointing toward your hand Position the cuff slightly above your elbow with the air hose aligned with the inside of your elbow Tighten the cuff so it is snug but does not cut off circulation and attach the Velcro Place the cuff with the air hose positioned over the brachial artery Ideally the cuff should be placed on the bare arm If there is a constricting garment such as a tight long sleeve blouse or shirt it is preferable to place the cuff over the top of the garment rather than to restrict circulation by rolling up the sleeve 4 Click OK to continue 16 5 A mercury type column will appear 6 The Measuring Measure message appears while the measurement is taken You will see the heart beating just as Relax you would with a standard mercury column Keep the patient from talking or moving while the Measuring message 1s displayed fe Once the cuff pressure reaches the post diastolic point the Quit Pathway will release the remaining air pressure When the measurement ends the results will appear on the screen and LCD of the DynaPulse Pathway unit along with other data Pocotlavarloraeldactobrovadbioavcbererderoederaedan Note If you experience problems taking a measurement see the Troubleshooting section For maximum accuracy adjust the air release valve such that the measurement time is between 20 and 30 seconds 17 Blood Pressure Arteri
10. o p hd Delete selected patient s Cancel Note Do not backup archive patient data files to the root directory use a directory similar to C dpbackup or on a floppy disk A dpbackup Patient Restore The restore function restores patient s from secondary storage to the Patient List this operation will not influence the original copy of your patient data files in secondary storage Note The DynaPulse Pathway identifies patients by ID 47 To restore backup archived EESTI data choose Restore from the Patient menu Current source director The Restore dialog shown to C dppathway Enter of select a new source directory the right will appear on your screen Select the directory path with the backup archived patient data files The next screen shown below will tell you how many patients are in that directory path Uncheck the Restore patient s to box if you want to leave the data in the backup archived directory If you want to transfer particular patient s click the second box to be prompted for each patient 13 patients found W Restore patientis to CDpPahway Prompt to restore each patient Cancel Note If you want to restore patient s from backup spanned among multiple floppy disks you must first copy all the floppy disks to one directory in your hard drive Then restore from that directory 48 CONTROL VIA THE DYNAPULSE PATHWAY UNIT Using
11. s reports see your DAC Manual 54 V OPERATION REFERENCES THE MAIN MENU el DynaPulse Pathway lof x File Edit Window Help Patient Measure Waveform Trend DAC Options Eile Save Print Print Current Page Print with Report Set Printing Header Quit Edit Undo Cut Copy Faste Delete Ctrl Ctrl Ctrl C Ctrl Del Chrl 5 Ctrl F Ctrl L Save measurement result pg 17 Prints the active window pg 36 Print the current page of the measurement table pg 36 Print with a report pg 36 Set personalized header for report pg 36 Exit the program Cancel the previous edit operation Remove to buffer Copy to buffer Recall from buffer Erase selected text 55 Patient Activate Enter Guest Find Sort Add Edit Profile Delete Select All Ctrl Set Default Directory Move to New Directory Backup Archive Restore Measure Start Chrl M Cycle Setting High Range d Low Range d Cuff Size Waveform Pressure Trend Measurement Mask Measurement Table Export S ave as ASCII Statistics DAC Analysis Internet Explorer Netscape 56 ctivates a patient pg 14 nter guest mode pg 38 ind a patient by ID ort patient list by patient ID or name dd a new patient to the patient list pg 12 dit an activated patient profile pg 49 emove a patient from the patient list elect all listed patients pg 43 et
12. to Central End BP Mode click on BP Mode from the Options menu Then choose Central End BP If you would like to switch back to Auscultatory eq BP follow the instructions above and make sure that Auscultatory eq BP is checked If you switch from one BP mode to the other all windows with blood pressure information will be changed accordingly These windows include the Trend window Measurement window Statistics Measurement Table etc 38 Note DynaPulse will automatically save the BP Mode setting that you choose GUEST MODE Guest Mode allows you to take a patient s blood pressure measurement s without having to add a patient Note You will not be able to save measurements that are taken in Guest mode To switch to Guest mode click on Guest from the Patient menu Notice that the Activated Patient now says Guest fl DynaPulse Pathway Patient List Guest File Edit Patient Measure Waveform Trend DAC Options Activated Patient Guest George Washington Benjamin West ohnathan Smith THE MEASUREMENT TABLE The Measurement Table lets you view trend data such as systolic and diastolic blood pressures in tabular form Use the following procedure to open a patient s Measurement Table 1 Activate a patient on the patient list by double clicking on the name of the patient 2 Select Measurement Table from the Trend menu This will display the dialog shown below 39 Central BP Measure
13. BP and diastolic DBP points of individual heartbeats as well as specific cardiovascular events such as pressures corresponding to the opening and closing of the aortic valve This display is often used for educational purposes 25 Bias Point Djastolic point oji me e Millimeters of 8 Mercury mmHg 01 second intervals ym g 11 Aortic ane a Aortic Valve closes Figure 1 Accuracy Validation and Irregular Heartbeats The arterial pressure waveform can be used for validating measurement accuracy and detecting irregular heartbeats Features of the waveform that are used for accuracy validation are e Waveform Quality e Pressure Icon Position Waveform Quality Examine the characteristic shape of the arterial waveform Ti a p 5 l a Idd T t l d fi ao 7 oo 50 Cul Pioawe fete Figure 2 An ideal waveform has the following characteristics The waveform is 20 30 seconds in length The waveform is symmetrical and has a waxing and waning pattern Pressure limits are set correctly 26 No motion artifact is present Arrhythmias are minimal Any disruption of the pressure wave caused by irregular heartbeats or by patient movement arm movement talking coughing etc can potentially compromise the accuracy of the measurement These disruptions in the pressure wave are typically referred to as artifact In a normal waveform display
14. CD screen except for the Safety Time out Check PC Message Saving the Measurement Result The procedure for saving a measurement can change depending on whether the measurement was initiated from the DynaPulse Pathway unit or the mouse and keyboard The following chart describes the differences Initiate Successful Unsuccessful from measurement measurement DP Unit Auto save Auto discard no further prompt Mouse or Always prompt If waveform is displayed keyboard to save user is prompted to save PATIENT PROFILE The Patient Profile dialog allows you to view or edit personal information for an activated patient This dialog has sections for entering or viewing such information as patient name birth date weight height etc Use the following procedure to open and use the Patient Profile dialog for a patient 1 Activate a patient on the patient list by double clicking on the name of the patient 2 Select Edit Profile from the Patient menu This will display the dialog shown below If you need to enter a comment use the Measurement Table Prompt comes up when another patient is activated or when another measurement is initiated from either the mouse and keyboard or the DP unit 50 Patient Profile Patient Name Johnathan Smith Birth Date 8 377 24 yrs Cancel Weight hzo Pounds Height B Feet e Inches DEX Male gt Ethnicity Unspecified Cuff Size Medium
15. COM port used by the DynaPulse Pathway unit choose Com Port from the Options menu and select the appropriate port If the port settings are correct make sure the cables are connected properly You will also get a communication error if the batteries are dead improperly installed or if the DC adapter is connected improperly If everything checks out the communications cable connecting the DynaPulse Pathway unit to your PC may be faulty or your system may have a unique configuration Please check both the DynaPulse Installation Communication Guide and DynaPulse Pathway FAQs High or Low Measuring Range Not Set Correctly If the cuff was not inflated above the patient s systolic pressure you will get the message Increase High Measuring Range Likewise if the cuff did not inflate below diastolic you will get the message Decrease Low Measuring Range If this occurs you will need to adjust the appropriate range from the Measure menu Measure Start Ctrl Cycle Setting High Range Low Hange Cuff Size Click on either High Range or Low Range Default ranges are 160mmHg for High Range and 50mmHg for Low Range 59 To adjust the range click on a different value Once you adjust the range for a particular patient the information is stored in the patient file and will remain at the adjusted values for that patient Aly ir Wi Cet Peet rel pac In this example the system does not have enough high range
16. Close window after auto save When you finish select OK If the Cycle function automeasure on the Measure menu 1s checked turned on all measurement results will be auto saved Follow the normal procedures for taking the patient s pulse as described in the section Getting Started with the DynaPulse Pathway but have the patient remain seated with the arm band in place until the cycle completes and all the measurements have been taken 42 THE TOOL WINDOW Selecting Show Tool Window from the Options menu is a convenient way to operate the DynaPulse system The Tool window contains controls that you use the most Once selected the Tool window will remain in the display area for easy access You may remove the Tools window by clicking the button marked X at the upper right corner of the Tool Window Activate a patient Starts the measurement sequence Stores patient measurement data Displays the trend window Displays the measurement table Prints the current selected display Quits the DynaPulse program Tools Activate Patient Measure KMeasurement Table 43 MANAGE YOUR PATIENT DATA INTO DIFFERENT DIRECTORIES When your patient list grows larger sometimes it is better to arrange your patients in different directories such as gender The DynaPulse Pathway provides you with a function Move to New Directory that will help you to achieve this goal Patient Move to New Directory Start the move to PEARL
17. Copyright 1992 2007 by Pulse Metric Incorporated All rights reserved All Pulse Metric products are covered by patents and or pending patents from the United States and other governments Trademarks Pulse Metric is a registered trademark of Pulse Metric Inc General notice Other product names used herein are for identification purposes only and may be trademarks of their respective companies 2100 Hawley Drive Vista CA 92084 USA Phone 760 842 8278 Fax 760 758 9425 Email teksupport dynapulse com Website www DynaPulse com April 2007 Table of Contents Pathway Software Guide Ue C8 8 0 Gal a l Facts About Hypertension eeeeeseeeeeeeeeeeeeeeeeeerenrerrrrrrereennen Z How is Blood Pressure Measured ccececescesessceeess 2 II GETTING STARTED WITH THE DYNAPULSE PAED ALY a 13 Add a New Patient ee ee ee ees eee anne ee 13 Take a Test Measurement cccccsseccsesesscessesscussesseussens 15 Take and Save Several Measurements 18 Guidelines for Blood Pressure Measurement 19 Position th Patient Correcitiy oncwinssoiiniinenniiies 19 Use the Correct Cuff unsensensrenrenrensrenrenrerese 20 Le nC eee ee EE ee eee any mens RE TEN PAI INTRODUCTION The DynaPulse Pathway is a non invasive blood pressure system based on a unique oscillometric technique known as Pulse Dynamics This technology allows you to obtain clin
18. DpData The drive or directory can be on a hard drive Diskette is not recommended because of limited space Once you have added a patient the name will appear on the patient list and the patient will be automatically activated A Trend window will then appear on top of this window A No Trend data available box should appear like the one below 14 el DynaPulse Pathway File Edit Patent Measure Waveform Trend DAL Activated Patient John Doe cidspathwary el Central BP Trend OI No trend data available You are now ready to take measurements and store them in your own patient data file TAKE A TEST MEASUREMENT l Activate a patient on the patient list by double clicking on the name of a patient The activated patient name will appear in the Patient List title bar WA Patient List Maria Suarez Maria Suarez cldppathway Robert E Lee c dppathway George Yrashington c dppathway c dppathway c dppathway c dppathway c dppathway c dppathway c dppathway shirley Bonvera c dppathway Newsom Rogers c dppathway Myron Yimby c dppathway 2 Select Start from Measure the stark Ctrl h Cycle Measure menu Setting High Range d Low Range d Cuff Size 15 You will be prompted to place the cuff on your arm Measure Ea Put the medium cuff on patient Benjamin West Cancel Note You can set the cuff size by clicking on Cuff Size under the Measure menu 3 Slide the
19. ING Most errors occur during measurements early on when the patient is unfamiliar with the DynaPulse or the first time a measurement is taken for a new patient The following information should help you solve most problems To get help for recurring errors or problems that refuse to go away please check the online help section titled Troubleshooting Communication Error Communications Error 1000 0 E to ensure it s functioning properly Prou may run Com Check from Options to find which COM port i used or refer to Help User s Manual for further information AN Communication Error Please check DynaPulse unit This message indicates the DynaPulse software was not able to keep the communication channel open between the DynaPulse Pathway unit and your computer If you have a communication problem you will not be able to take a measurement You will receive this error before you get a chance to inflate the cuff Itis usually caused by improper serial port configuration If you have taken measurements before with the current system settings and are now receiving this error install a fresh set of batteries or check the DC adapter connection and try again If you are using the DynaPulse for the first time run Com Check from the Options menu This utility will check your system to determine which COM port is connected to your DynaPulse Pathway unit On screen instructions will show you how to proceed 58 If you know the
20. PMI was incorporated in 1990 to develop and market instrumentation and software for the diagnosis and management of hypertension and to develop technology and instrumentation for arterial pressure and waveform analysis PMI s non invasive blood pressure waveform technology Pulse Dynamics is patented in the United States and worldwide Several different DynaPulse products are available including systems for clinical hypertension management home blood pressure monitoring and ambulatory monitoring If you have any questions or require additional information you can reach us between 10 00AM and 4 00PM Pacific Time Address Pulse Metric Inc 2100 Hawley Drive Vista CA 92084 U S A Order Lines Phone 760 842 8278 Fax 760 758 9425 Web order sales dynapulse com or orders dynapulse com Facsimile 760 758 9425 Web Site http www dynapulse com Technical Support Voice 760 842 8224 E Mail teksupport dynapulse com 71
21. al pulse display Systolic Diastolic Heart Rate Tig p 13 jbl UL y Nii yy ye T Cull FiSaure fon Systolic Cursor position Mean Diastoly c Cuff pressure icon icon icon at cursor position Measurement Timeline 20 30 sec TAKE AND SAVE SEVERAL MEASUREMENTS Activate a patient before taking a measurement At this point take several measurements and save them to your hard drive by clicking on Save from the File menu This will build your patient data file to the point where you can use the patient management features of the software effectively When you save a measurement you will be prompted to add comments such as patient position seated standing etc medication or anything else you feel is pertinent 18 Please enter comments for this measurement Your comments will be saved with the measurement The comment will appear on the Measurement Table and on the Trend window when the cursor is placed on the measurement Once you have saved a number of measurements you are ready to begin using software features such as the Trend Display and the Statistical Analysis GUIDELINES FOR BLOOD PRESSURE MEASUREMENT Position the Patient Correctly Gravity and body position both affect blood pressure Standard measurement protocols suggest that The patient should be seated comfortably and relaxed for 5 10 minutes before taking measurements The idea is to get a measurement that is most representa
22. e DynaPulse software 23 Measurement Display The Arterial Waveform Central BP End Sys End Dia MAF 109 73 84 mmHg HF 72 bpm PP 36 mmHg oll praana a a Bem E a Lc Tr C lod ldo es lod eo 30 Cull Poa Hg Cursor The arterial waveform represents the pressure signal produced by the interaction between the restrictive cuff and the pressures generated by the cardiac cycle A pressure sensor in the DynaPulse unit measures this signal at the brachial artery There are two scales for the arterial waveform The bottom scale is cuff pressure in mmHg The upper scale measures time in seconds The amplitude height of each individual spike or pulse indicates the arterial pressure of a particular pulse relative to the cuff pressure and blood flow Each spike is equivalent to a heart beat The box at the extreme right of the waveform displays the cuff pressure at the current cursor position to give you an idea of the pressures related to that waveform and at that time during the blood pressure measurement Starting from the left blood flow is restricted by the cuff As cuff pressure falls the blood s counter pressure is detected at the edge of the cuff and displayed as a rise in amplitude As 24 the cuff pressure declines renewed blood flow allows each pulse to strike the entire width of the cuff causing the pulse amplitude to increase until it reaches its maximum height on the waveform Beyond
23. e settings of 160mmHg to 50mmHg In other words the measurement period should last about 25 seconds before the device is set to release To slow the air release and increase the length of the measurement period turn the release valve dial towards up arrow To decrease the measurement time turn the dial towards the down arrow for a faster release time If the pumping action takes longer than 55 seconds you will receive a safety time out error message In that case you may need to increase the air release rate which decreases air release time Measurement Error The most common reason for this type of error 1s excessive cuff movement Excessive arm or cuff movement can cause pressure changes on the cuff and faulty blood pressure readings The unit interprets the movement as part of a heartbeat pressure wave and cannot correctly determine the blood pressure For the best results rest the patient s arm on a table or similar surface keeping the cuff and hose free from obstructions that might cause the air pressure to change unexpectedly The pressure cuff is normally placed on the left arm on the same side as the heart 61 VII APPENDICES CHECKING CALIBRATION To check the calibration of the DynaPulse Pathway unit in reference to a standard sphygmomanometer you will need to connect a sphygmomanometer recommend vertical mercury type T connector with the Pathway and the cuff Wrap the cuff loosely around a bottle t
24. echnical Support at 760 842 8224 or E mail teksupport dynapulse com 64 DYNAPULSE PATHWAY AND MULTIMEDIA The DynaPulse Pathway software incorporates a unique switchless design which allows the unit to turn itself on and off via the operating software Multitasking capabilities may not be utilized when running the DynaPulse Pathway in a Windows environment The substitution of MOD WAV or any other type of sound playback file for a standard system sound may cause the DynaPulse Pathway to terminate operation To ensure that no WAV files are in use do the following 1 From the Program Manager open Main 2 From Main open the Control Panel and choose the Sound icon 3 There are two dialogue boxes one titled Events and the other Files From the Events list highlight System Default sometimes called System Default Beep 4 Look in the Files dialogue box and confirm that the file highlighted is none If it is not select none from the files list and click OK If you are using a third party sound event organizer please refer to the program documentation that came with the software 65 SPECIFICATIONS Measurement accuracy 2 mmHg or 2 whichever is greater Measurement Range Blood pressure 20 to 300 mmHg Pulse 30 to 200 bpm Deflation method Air release valve Inflation method automatic Power Consumption 60mW when measuring Operating temperature 0 C to 45 C 32 F to 113 F Power Su
25. ental Conditions 1 Total Subjects 36 3 Data represents a three measurement 2 Invasive Pressure Site Descending Thoracic Aorta average Copies of abstracts and other clinical research information may be obtained by contacting Pulse Metric for a copy of the Pulse Dynamic Clinical Research Guide I INSTALLATION System Requirements Installing the DynaPulse Pathway Unit Installing the DynaPulse Pathway Software Setting Up the DynaPulse Pathway Software SYSTEM REQUIREMENTS To install the DynaPulse Pathway you will need the following equipment IBM PC or compatible computer with at least 486x 66 processor 16 Mb of RAM a hard drive and a floppy disk drive Windows 98 ME NT 2000 XP An RS 232 serial communications port independent of ports incorporated by other serial devices like mouse pointer or serial printers see Appendix The DynaPulse Pathway package The DynaPulse Pathway package comprises the following l The DynaPulse Pathway unit 2 Standard Large Medium Small Adult Cuffs a Communication cable 4 DC adapter DynaPulse Pathway software INSTALLING THE DYNAPULSE PATHWAY HARDWARE Install your DynaPulse Pathway unit in just a few steps e Install the Batteries or Plug in the DC adapter e Connect the Communication Cable to both the unit and computer e Plug the cuff assembly into the DynaPulse Pathway unit EQUIPMENT LAYOUT rg rh Pathway measuremen
26. essure One benefit of this method is the direct relationship of the technique to the blood flow Blood pressure variations in the artery create the Korotkoff sounds Many other techniques obtain blood pressure by mathematical calculations that are not directly observable The auscultatory method does have several drawbacks Extensive training is required to ensure accuracy The human ear may effectively respond to frequencies between 20 and 20 000 Hz but the ear hears best between the range of 200 and 4000 Hz The Korotkoff sounds heard through an acoustic stethoscope range from 18 to 26 Hz at systolic cuff pressures and 40 to 60 Hz at diastolic pressures These frequencies are not in the range at which humans are most sensitive Measurements taken by different people on the same patient can vary due to differences in hearing ability even if the measurements are taken at the same time This method also encounters difficulty with patient conditions such as hypotension mute or dampens the Korotkoff sounds Other automated blood pressure monitors are designed to solve the hearing variability problem by using microphones with sound based algorithms to estimate systolic and diastolic blood pressure Unfortunately by removing the human element these devices lose the advantage of professional validation They have problems estimating blood pressure in patients with muted Korotkoff sounds A noisy environment will also influence the determi
27. few measurements you need to click on Last and then type in the number of measurements that you wish to use When you click on OK you will be asked how you want to store this new data text file Suggestion Save the file directly to the spreadsheet file folder and name it as simply as possible The next step is to open your spreadsheet program and open the file that you just saved You will find that the DynaPulse has given you the Date Time Systolic Diastolic Mean Pressure Heart Rate and Comments if selected 4 AUTOMEASURE CYCLE The DynaPulse Pathway software has a continuous interval monitoring feature that allows the DynaPulse Pathway unit to take a fixed number of measurements at set intervals To enable the cycle function click Cycle on the Measure menu When Automeasure Cycle is turned on any measurements after the first measurement will be taken automatically To turn off Cycle click the Cycle option again When you use the cycling automeasure function you should set the Time between measurements and the Number of measurements per cycle pled ai z from the Measure menu Time between measurements H min to open the dialog tothe No Measurements per cycle 3 right Close window after auto save Cancel Enter your desired time between measurements and the number of measurements per cycle in the text boxes The Measurement window can be automatically closed if you check the box for
28. hat approximates an arm size non crushable Before you continue be aware that you should not open the Pathway to adjust the calibration of the unit or you will void all warranty Also only perform this procedure if you think the Pathway is off by more than 3mmHg OO Watch the mercury DynaPulse bar onthe screen 7 Pathway Sofware ik tN Cuff wrapped loosely around can Steps to check calibration Rg 232 cable l Once sphygmomanometer is connected in line with the Pathway and cuff run the DynaPulse software 2 Go to Measure and set the high range to 220mmHg and leave the low range at default of 50mmHg 62 Set the top of the speed knob on the Pathway to This is the slowest bleed rate possible Go to Measure and Start Select three measurement points such as 200 160 80 mmHg to compare the sphygmomanometer with what you see on screen Once the measurement begins record the values you get from the sphygmomanometer and the computer screen as the air slowly leaks from the system If there is greater than 3 mmHg difference between the values contact Pulse Metric to schedule a calibration of your Pathway Again do not try to calibrate the Pathway yourself 63 COM PORT CONFIGURATION WINDOWS 98 ME NT 2000 XP For technical problems with the COM port configuration please refer first to the online help section titled Troubleshooting If you still have problems call T
29. ically accurate measurements quickly and easily The DynaPulse customer support team is committed to ensuring your continued satisfaction You are welcome to call us with questions or comments at 760 842 8224 A Indicator Used in this Manual F y to call your attention to an important feature FACTS ABOUT HYPERTENSION Hypertension 1s elevated blood pressure that persistently exceeds a safety threshold The Sixth Report of the Joint National Committee on Prevention Detection Evaluation and Treatment of High Blood Pressure estimates that the blood pressure of 50 million Americans consistently equals or exceeds 140 90 mmHg Hypertension increases the risk of developing cardiovascular diseases and stroke and about three quarters of those who have hypertension are not controlling it well HOW IS BLOOD PRESSURE MEASURED There are many ways to measure blood pressure To achieve the most accurate measurement a doctor must insert an intra arterial catheter Less invasive indirect methods were devised to allow safe quick measurements Still the accuracy of non invasive methods is judged against the standard of catheter based measurements The auscultatory method is now the most common method used to measure blood pressure After inflating a cuff around the patient s arm the health practitioner places a stethoscope against the arm and as the cuff is deflated listens for Korotkoff sounds to determine systolic and diastolic pr
30. itations or exclusion may not apply to you This warranty gives you specific legal rights and you may have other rights which vary from state to state Technical Support and Service Phone 760 842 8224 Fax 760 758 9425 E mail teksupport dynapulse com Technical support representatives are available between 10 00 a m to 4 00 p m Pacific Time Monday through Friday 67 All products returned to Pulse Metric Inc must be accompanied by a Return Material Authorization RMA Number and the original or a copy of the dated sales slip as proof of warranty An RMA Number can be obtained by calling Technical Support at 760 842 8224 Packages sent without an RMA Number marked on the outside of the shipping container will be refused Please also include a letter with your name address telephone number and brief description of the problem s 68 SOFTWARE LICENSING AGREEMENT This is a legal Agreement between you the end user being either an individual or legal entity such as a corporation and Pulse Metric Inc PMI By clicking the Accept button that appears after you see this Agreement when you install your software you are agreeing to be bound by the terms of this software agreement If you do not agree to the terms of this Agreement immediately remove all traces of the PMI software product from your computer and disk archives and promptly return the disk package and the accompanying items manuals DynaPulse
31. m Check 3 Com Check will automatically detect and record the communications port used by the DynaPulse Pathway unit 12 Hl GETTING STARTED WITH THE DYNAPULSE PATHWAY The best way to get started is to add a new patient you and take a few measurements As you use the DynaPulse Pathway unit repeatedly you will find that efficient operations quickly become second nature The following steps will get you started Add a New Patient Take a Test Measurement Take and Save Multiple Measurements ADD A NEW PATIENT l Select DynaPulse Pathway Add from the Patient File Edit Patient Measure Wavefi menu You will be Activate Activate Bate prompted to enter an Guest identification number Find ID Maria S Sort Robert George Benjam Edit Prone Inhnath Delete Using medical record or social security numbers is often helpful 2 Enter the Enter ID patient s ID and select OK This will open a text Doo box where you can enter additional details Cancel 3 Enter the patient s name and if the default 13 location or path where the patient s data will be stored is missing or incorrect enter the directory and select a drive Name ID 465555555 Current path c dppathway New Directory Last Modified 01 21 2002 15 29 OK Cancel Note Do not store measurement information in the root directory Use the default subdirectory C Dppathway or an alternative subdirectory such as C
32. ment Table Patient Name Johnathan smith Date Time Systolic Diastolic Mean HR 06 14 2001 10 59 123 fa 69 G1 add comments here 0D6N 4 2001 10 58 117 fe 68 fq re 06 4 2001 10 57 126 D x The Measurement Table also allows you to add edit comments You can use the mouse to move the cursor to the comment box of each measurement and edit the comment Press the ENTER key to confirm the changes Using the Edit menu you may cut or copy comments into other Window applications When measurement data is saved the systolic mean arterial and diastolic pressures along with heart rate are automatically entered into the Measurement Table Any comments you add in the text boxes will be displayed with the measurement data Choosing the Print option from the File menu allows you to print either the entire Measurement Table or the current page 40 EXPORT DATA IN ASCIT FORMAT This feature allows you to copy the measurement table into an external spreadsheet program to produce your own graphs To use this feature Trend activate the patient Measurement whose data you want Mask choose Export Save Measurement Table as ASCII from the Export S ave as ASCII Trend menu Statistics Deselect the Include RESTS x comment box if you All Measurements wish Additionally Export act fio you can choose to use A Include Comments all of the measurements or just a portion of them To Cancel select the last
33. nation of blood pressure These difficulties prompted the development of the Oscillometric technique Instead of listening for characteristic sounds the Oscillometric technique uses a cuff and a pressure sensor These devices estimate blood pressure by examining the pressures generated by the cuff and the arterial pulsation The estimations are based on large amounts of data and are usually accurate but they are still estimations The algorithms are not based on arterial flow or pressure These devices determine mean arterial pressure and then estimate systolic and diastolic pressures The Next Step What is needed is a technology that combines the best of the auscultatory and oscillometric techniques e A technique that like the auscultatory method 1s based on blood flow properties e A technique that also offers validation capabilities like the manual auscultatory method e A technique that like the oscillometric method works on a broad range of patients including those whose cardiovascular problems may make their blood pressure difficult to measure Above all the technique must be accurate The DynaPulse blood pressure monitor meets all of these criteria Pulse Dynamics the patented technology used with the DynaPulse Pathway also measures the pressures generated by the cuff and the arterial pulsation However it is the only oscillometric method to measure blood pressure based on physical phenomena much like the ausc
34. nometer measurements For measurement of end systolic and end diastolic blood pressures more closely related to invasive hemodynamics of the central arterial system use the central blood pressure measurement mode The power of using the Pulse Dynamics central blood pressure measurement techniques are described in the following sections Accuracy of the Pathway Systems To obtain FDA 510K registration for the DynaPulse Pulse Metric PMI validated Pulse Dynamics accuracy relative to both auscultatory and invasive catheter measurements A 132 patient study compared the monitor to the auscul tatory method in accordance with Association for the Advancement of Medical Instrumentation AAMI 10 1987 guidelines The DynaPulse achieved correlations of 0 96 and 0 89 for systolic and diastolic pressures respectively When the DynaPulse was compared to invasive intra arterial measurements a 36 subject study correlations of 0 94 0 91 and 0 95 were found for systolic diastolic and mean arterial pressures respectively Summaries of these two validation studies are presented on the following pages Interpreting the Results In all cases the graphs compare Pulse Dynamics to either invasive measurements using a catheter or auscultatory measurements Pulse Dynamics vs Auscultatory Method ANSI AAMI SP10 1987 Systolic Pressure Diastolic Pressure S 8 8B B 5 Pulse Dynamics mm Hg Pulse Dynamics mm Hg 8
35. ppathway The Patient List is the first screen to appear when you open the DynaPulse Pathway program It normally remains open in the background when other screens are open but you can use the Tile function to view it while other screens are open or reduce it to an icon at the bottom of the screen 21 HI BASIC OPERATION Measurement Result Trending and Statistical Analysis Managing the Displays Printing MEASUREMENT RESULT Blood Pressure Estimation The DynaPulse Pathway can estimate either systolic SBP or diastolic DBP blood pressure values from accurate measurements of Mean Blood Pressure MAP and either SBP or DBP An asterisk after the blood pressure indicates estimated value Although these measurements can be useful they are not as reliable as a direct measurement without estimation Central BP End Sys End Dia MAF 162 96 1 15 mmHg HR 59 bpm PP 66 mmHg Estimated value Systolic Estimation An asterisk indicates estimated value 22 Central BF End Sys End Dia MAF 150 61 91 mmHg HR T0 bpm PP 67 mmHg Ico Ida Diastolic Estimation The arterial waveform display will be skewed to one side when estimation occurs Systolic estimation is to the left and right for diastolic estimation The pressure icon may not be present for the estimated value Estimation occurs when the normal resting pressures of the patient are outside of what is set for the high low range of th
36. pply Four 4 1 5 Volts AA batteries or DC adapter 66 WARRANTY INFORMATION Pulse Metric Inc warrants that the DynaPulse Pathway system unit will be free from defects in workmanship and materials for a period of one year from the date of purchase This one year warranty extends only to the original purchaser All other accessories pressure cuff communications cable etc will be warranted for 90 days Pulse Metric Inc will repair or replace at its option any defective parts or product when shipped to the initial purchaser This limited warranty DOES NOT cover damages or losses due to improper environment temperature extremes or other misuse or negligence such as adjustment or repair by personnel not authorized by Pulse Metric Inc improper installation failure to follow the installation instructions or shipment to or from the distributor or customer Pulse Metric Inc s liability shall not exceed the price of the defective product itself which is the basis of the claim Tampering with the unit voids this warranty In no event shall Pulse Metric Inc be liable for any loss of profits loss of use of facilities loss of other equipment or any incidental or consequential damages even if Pulse Metric Inc has been advised of the possibility of such damages Some states do not allow the exclusion or limitation of incidental or consequential damages or allow limitations on how long an implied warranty lasts so the above lim
37. s eee Tra 12 24 06 05 AL a6 06 14 2001 Click to select measurement Analysis results for selected Scale in parameters you want displayed measurement data mmHg a2 The average value is the arithmetic average of the analyzed measurements The standard deviation is a range around the average value within which 67 of the measurements will fall The larger the standard deviation the wider the range This is visually represented by the histograms Editing the Trend Display to Validate Results When reviewing measurement data you can remove suspect measurements from the Trend by selecting the measurement on the Trend Graph and choosing Mask from the Trend menu SS ti Mask measurement at cursor Cancel C Unmask measurement at cursor This procedure should be performed by an authorized physician only The Mask dialog box appears It allows you to mask the suspect measurement so it is ignored by the Trend and Statistics features Click on Mask measurement at cursor to mask the measurement The Mask feature is a validation tool that allows you to obtain data that is more representative of your patient s condition The measurement is not deleted The measurement still appears in the Measurement Table and may be distinguished from unmasked measurements by the presence of ERR for each column Although the measurement points disappear from the Trend you can still scroll to the measurement location and retrieve
38. stributions The Statistics feature may be used to compare the analysis data from before and after changes in therapy A concise report can be printed that gives an excellent overall view of the patient s condition You can run a statistical analysis on all measurements recorded for the individual patient or on a series of measurements selected by date and time The date and time indicator for each measurement is bolded on the upper right corner of the Trend window Note the current date and time are in the top right hand area of the DynaPulse Pathway screen To select a specific series of measurements for statistics l Press and hold your left mouse button on the first measurement and drag to the last measurement If you do not select a series of measurements the default is an analysis of all of the individual patient s data 31 fl D ynaPulse Pathway Central EP Trend Iof x File Edit Patient Measure Waveform Trend DAC Options Window Help a x Activated Patient Geo cAdopathway 01 16 200 ng Sys 128 End Dia 72 Mean HR 84 2 Select Trend then Statistics 3 Select any combination of the blood pressure measurement parameters you would like displayed and they will be plotted on a histogram Pulse rate can be plotted independently Number of samples of a Number and date Systolic diastolic and particular value occurring in range of mean blood pressure distribution measurements distributions net we
39. that point the amplitude declines Pressure icons markers located below the pressure waveform indicate the points where the cuff pressure equaled the patient s systolic mean and diastolic blood pressures The point where blood flow is initially detected is noted by the left most pointer and referred to as systolic blood pressure SPB The period of maximum amplitude noted by the middle pointer is called mean arterial pressure MAP The third pointer indicates the diastolic blood pressure DBP point Note that the systolic and diastolic points in the Pulse display Figure 1 and Figure 2 refer respectively to the top and bottom of the wave The DynaPulse measurement process relies on pattern recognition to detect changes in the shape of the pressure wave as it moves from systolic to diastolic pressure It is not dependent on the pulse amplitude or strength The Arterial Pulse Display The Arterial Pulse Display is the smaller graph at the top left corner of the Measurement Display It shows a magnified single heartbeat marked by the cursor in the waveform below As you move the cursor from one heartbeat to the next the Arterial Pulse Display changes to show the heartbeat to the left of the cursor position The pressure wave shown in this display corresponds to the heartbeat marked by the cursor on the arterial waveform The pulse wave is displayed in units of mmHg and one hundredths of a second You can identify the systolic S
40. the Buttons On the DynaPulse Pathway Unit Four buttons are located on the DynaPulse Pathway unit They have the following functions ON OFF 2 turns the DynaPulse Pathway unit on or off START STOP amp starts taking a measurement Up arrow scrolls up the patient list Down arrow Y scrolls down the patient list Use these buttons before taking measurements During a measurement pushing ED A or V aborts the measurement and displays an Abort by user message on the DynaPulse unit LCD screen If the button is pushed while taking a measurement the DynaPulse Pathway unit turns off and a Communication Error message pops up After you take a measurement the DynaPulse Pathway unit LCD screen displays the measurement result If the measurement is not successful it displays warning or messages You can scroll through the warning error message by pushing any of the buttons other than the H button After you have advanced to the patient name ID screen you are ready to take another measurement To take another measurement push the button Comparing DynaPulse Pathway Unit Buttons to Mouse and Keyboard Error and Warning Message Displays If you start a measurement using the mouse and keyboard all error and warning messages will be displayed on both 49 the LCD screen and the computer monitor If a measurement is taken using the START STOP button all error and warning messages will appear only on the L
41. the arterial waveform 33 nd cys ERR End Dia ERR Mean ER R When a masked measurement is highlighted on the Trend measurement values will appear as ERR Da Central BF Measurement Table i O x ah Patient Name Amet Godfrey Date Time Systolic Diastolic Mean HR 07 24 2001 09 50 ERR ERR ERR ERR Of f2472001 09 49 146 05 106 72 mana 09 34 ERR ERR ERR Masked measurements also appear as ERR in the Measurement Table Measurements should not be masked without due cause Masking decreases the amount of data available for statistics A pressure waveform does not have to be perfect to yield clinically sound data To ensure that all the data is evaluated uniformly we suggest that you create your own criteria for masking a measurement The measurement may be unmasked at any time 34 1 Move the cursor to the masked measurement on the trend screen 2 Select Trend and Mask to open the Mask dialog box shown above 3 Select Unmask measurement at cursor to unmask the measurement MANAGING THE DISPLAYS Cascade and Tile The DynaPulse Pathway allows you to display multiple measurements on the screen This feature is useful if you wish to compare data from different measurements Features like the Cascade window and Tile options accessed Cascade Shift F5 from the Window menu Shift F4 help organize open Arrange cons windows Selecting the Tile Close All option produces a display
42. the default directory for patient ata files ove selected patient data to another directory pg 43 ackup selected patient data files pg 45 estore patients to the patient list pg 46 Begin measuring using current settings pg 14 Turn on cycle function pg 41 Set the cycle parameters pg 41 Set high range pg 58 Set low range pg 58 Select cuff size for patient pg 19 Toggle the display of specific pressure at selected point in the pulse cycle pgs 25 26 Retrieves measurement display pg 27 Mask measurement 32 Displays table of BP measurements pg 38 Export and save trend data to a text file pg 40 Run trend statistical analysis pg 30 Login to the DynaPulse analysis center pg 50 Open Internet Explorer Open Netscape Options BP Mode Select a BP Mode pg 37 Select a COM port pg 59 Check COM ports to find the Pathway device pg 58 Display hide the Trend window pg 29 Display hide the Tool window pg 42 Com Port Com Check Show Trend Window Show Tool Window window Cascade SHift F 5 Overlap all open windows pg 34 Tile Shifter Fit all open windows on screen Arrange cans pg 34 Close All Arrange displayed icons pg 35 Close all open windows pg 35 w 1 Patent List T ict af active window Help Help F1 On Line help DynaPulse Pathway Software Version About DynaPulse Pathway 57 VI TROUBLESHOOT
43. the heartbeats will occur at regular intervals and will have uniform width and shape Poor quality measurements often have jagged and unevenly spaced heartbeats Pressure Icon Position The position of the pressure icons relative to the position of the artifact will indicate whether the measurement has been compromised If an irregularity in the pulse waveform occurs close to one of the blood pressure icons or 1f there is significant patient movement at one of the blood pressure indicators you may have a poor quality measurement As you use the DynaPulse you will notice that individual patients will display characteristic waveform patterns Some patients will have a shorter fatter waveform some a thinner more elongated waveform Some waveforms will have a high amplitude some a low amplitude with differences in the air release time Waveform patterns may vary due to various physiological differences specifically in the composition of patient arms For example an individual with a muscular arm has little in the way of fat tissue to impede the pressure signal acquired by the DynaPulse An obese arm has significant amounts of fat tissue which will tend to damp the pressure signal These physiological differences will be reflected in the appearance of the pressure waveform 2 Let us assume that you keep the air release time within the normal limits of 20 30 seconds then measurements should be always obtainable assuming no movement
44. the lifetime of the disease state With hypertension this often requires blood pressure information to be accumulated and analyzed over the remaining lifetime of a patient DynaPulse trending allows you to save the patient s blood pressure information in an attractive graphical format Line graphs of the blood pressure and pulse measurements will indicate in an intuitive manner the patient s response to the treatment regimen Measurement results uidelines of BP Threshold at Cursor position 140 90 il Central BFP Trend M OI x Fly Sye 128 End Ole 72 Mean HF mmHg 110 0 120 100 Blood pressure Neart rate in Measurement comment in mmHg beats per minute at cursor position Isolated measurements have a limited benefit However a series of measurements over time fulfills the purpose of 30 blood pressure monitoring by providing you with a representative average of your patient s blood pressure Your DynaPulse Pathway allows you to track an unlimited number of patients in this manner When you activate a patient from the Patient List the Trend Display will appear You can access the Trend feature by clicking on Options and Show Trend Window Statistical Analysis DynaPulse software offers a built in statistical analysis feature that provides a complete statistical report including maximum minimum average and standard deviation for each of the measured parameters and a histogram showing the measurement di
45. tive of the patient s resting blood pressure By sitting the patient is more relaxed and movement can be kept to a minimum Both feet should be flat on the floor with the legs uncrossed The upper arm should be resting at the level of the heart Keeping the arm at heart level minimizes the gravitational effect on blood pressure as the blood travels from the heart to the arm 19 Measurements may also be taken in the standing position with the arm elevated and rested at heart level Use the Correct Cuff Cuffs come in three sizes Small medium and large Before taking a measurement determine the correct cuff size for the patient American Heart Association AHA guidelines recommend that the rubber bladder inside the cuff should encircle 80 of the arm in adults and 100 of the arm in children less than 13 years of age Correct Cuff for Various Arm Circumferences Measured in Inches at the Bicep Small cuff for children Standard medium Large cuff for and small adults cuff for adults adults 7 to 10 5 10 to 13 75 13 to 18 5 If you cannot decide between the cuffs use the medium cuff To setup cuff size click on Cuff Size from the Measure menu 20 PATIENT LIST Patient List Maria Suarez shirley Bonvera Newsom Rogers Myron Wimby cidppathway c dppathway c dppathway c dppathway c dppathway c dppathway c dppathway c dppathway c dppathway c dppathway c dppathway c d
46. u make a backup of the DynaPulse Pathway software diskette and use the backup to install the program if the software package is provided with a floppy disk Please refer to the Windows User s Guide for instructions on copying diskettes If you have a previous version of DynaPulse product Pathway or 200M or 2000A installed on your hard disk and want to maintain the same patient data files created with that version enter the drive and directory path where the original 11 program files are stored when the installation utility asks for the installation path Do not delete the previous files In Windows click on Start then Run and type in A setup Once the software ve is installed you will see the DynaPulse Gaal Pathway icon on the screen oreo After installation is complete start the DynaPulse Pathway software by double clicking on the DynaPulse Pathway icon If your DynaPulse Pathway package comes with a CD just insert the CD into your CD ROM drive and windows will guide you through the installation steps SETTING UP THE SOFTWARE The first time you execute the DynaPulse Pathway software it will run an automatic communications port checker to find which port the DynaPulse Pathway unit is attached to To run the communications port checker manually follow the procedure below l Connect the DynaPulse Pathway unit to the COM port of the computer via the communications cable 2 From the Options menu select Co
47. ultatory method Instead of estimating blood pressure Pulse Dynamics uses pattern recognition to determine systolic diastolic and mean arterial pressure each of which is measured independently from the Pulse Dynamic pressure wavetorm This pattern recognition technique is possible due to the effect that blood flow has on the measured pressures at the brachial artery Pulse Dynamics measurements have been found to agree extremely well with catheter based measurements Measurement values based on these standard oscillometric techniques have been provided in the DynaPulse software for your convenience Several clinical studies have shown that these values for systolic and diastolic pressures based on the presence of Korotkoff sounds K1 systolic K4 diastolic tend to underestimate the true intra arterial systolic blood pressure and overestimate the diastolic blood pressure The diastolic blood pressures based on K5 sounds are often difficult to hear while more closely resembling end diastolic 4 blood pressures However due to popular usage and publication of hypertension guidelines based on these auscultatory techniques measurement of blood pressure by auscultation has been the standard for clinical practice in the health care community As a guideline for use of the DynaPulse for measurements of blood pressure based on use of the auscultatory equivalent algorithms to provide a reasonable comparison with auscultated mercury sphygmoma
48. unit and all accessories to the place you obtained them for a full refund Part I Grant of License PMI grants you the right to use one copy of the enclosed DynaPulse software program SOFTWARE on a single computer at a time You may not rent or lease the SOFTWARE but you may transfer the SOFTWARE and accompanying written material provided you do not retain copies and the recipient agrees to the term of this Agreement You may not reverse engineer recompile or disassemble the SOFTWARE The agreement is effective from the day you open the sealed package until terminated You may terminate this Agreement by returning to PMI the original disks and any backup copies If you breach this Agreement PMI can terminate this license upon written notification to you Part II Copyright The SOFTWARE is owned by PMI and is protected by United States copyright laws and international treaty provisions Therefore you must treat the SOFTWARE like any other copyrighted material except that you may either 69 a make one copy of the SOFTWARE solely for backup or archival purposes Or b transfer the SOFTWARE to a single hard disk provided you keep the original solely for backup purposes You may not copy the written material accompanying the SOFTWARE Part II Controlling Law This Agreement shall be governed by and construed in accordance with the laws of the State of California 70 COMPANY INFORMATION Pulse Metric Inc
49. will notice that there is a Print command and a Print with Report command The Print command prints the active DynaPulse screen with the customized header on top The Print with Report feature gives you the header active screen and last few measurements from the Measurement Table Set Printing Header Ctrl Ll Measurement Trend and Measurement Table displays may be printed by selecting File and then Print Remember that only the current selected display is printed For example if several selections are on the screen at the same time only the highlighted screen is printed This is also true for selections arranged using the Cascade or Tile feature Print quality is directly related to the printer used and the printer driver selected Jl IV ADVANCED OPERATIONS BP Mode Move to a New Directory Guest Mode Backup Archive Restore The Measurement Table Pathway Unit Control Export Data Patient Profile Automeasure Cycle DynaPulse Analysis Center The Tool Window BLOOD PRESSURE BP MODE For convenience of physicians DynaPulse Pathway also provides auscultatory equivalent blood pressure readings K 1 and K4 in addition to the central end blood pressure To understand the difference between the two methods please refer to the Introduction see pages 4 5 The default BP Mode is set to Auscultatory eq BP Mode The DynaPulse Pathway provides you the option of switching from Auscultatory eq BP to Central End BP To switch
50. xplorer or some Backup facility Never use non Pathway software such as Windows Explorer or some Backup Restore facility to move or copy data files directly into currently used Pathway data file folders You must first move or copy the data files to a folder not currently in use by Pathway and then use Pathway s Restore feature 45 Patient Backup Archive Backup makes a copy of the selected patient data files to a secondary storage such as a diskette or another directory Archive will move the selected patient data files to secondary storage and remove the selected patient s from the Patient List To backup archive patient data files first select patient s which you want to backup from the patient list Choose Backup Archive from the Patient menu 46 Patient Activate Enter Guest Find Sort H Add Edit Profile Delete Select All Chrl 4 Set Default Directory Move to New Directory Backup Archive Restore Backup Archive The screen to the right appears asking where you Current destination directory want the data to be c idppathway copied archived You can select an Enter or select a new existing directory destination directory or create a new directory under the current destination directory by typing the new directory name in the text box Check the Delete selected patient s box if you want to archive patient s remove the selected patient s to secondary storage
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