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IQecg® - Midmark

1. L HAAA A E E E l m a RR Mer ES e Ld A te S ena e e a Me LL L4 View 2x Ent ERR DD qe avl i TEES EE EE EE E B EE mT L Hert Ke E A d TT I tl d SES T p p Gain 1X l P E peorm n ELE LG AICTE A v2 Edit Comments l rn err ab T epo te bc Eon EH FERE L Ha HE EE ES assess L Heo EE EE Latest an IBS Modified 12 Lead V3R V1 V2 V5 V6 V7 Click View 2X in the ECG Report Review Details screen to magnify the 12 lead ECG tracings on the left to 2x zoom Click the same button again and ECG tracings are displayed with 4x magnification Click Calipers to select between Simple Calipers or P QRS T Calipers These electronic calipers allow you to measure the amplitude mv and duration ms of any part of the ECG waveform making it easy to over read ECG tests online without printing them 48 IQecg Operation Manual onner 0000000701 Measurement Matrix de EJ qd ave avi avr vi v2 va v4 3 j 120 106 120 102 108 1 T pe D N 0 107 0 04 0 20 0 05 0 165 Rer 110 106 102 Le d Mod 0 231 0 151 0 041 Hl 15 19 46 20 eal 0 03 0 07 0 36 0 05 ave CL va 44 19 46 44 18 28 47 Hz 0 08 0 302 1 44 0 05 0 04 SR E I Calipers S szavas a 4 SC Sd 26 28 29 45 26 28 46 27 26 Sa 0 161 0 25 0 092 1 747 0 03
2. H 2 CONTENTS CHECKLIST 5 55655 e inre nre eee eo aane en ao Ln EP ENNER ENNEN Ee coe 3 l GENERAL INFORMATI ON 5 eso nean nono enn Rn eoa ine sono bao na ER wo eoe gore a EE Ra eoe ne eeh Se ee 4 A INTROBDUCTIONJ 12 3 522 2 cae utres eedem een tere baee iso i dee Tene tea mito ente e Or aata a Drag sep teta 4 B NECESSARY COMPUTER SKILLS g 5 esee re Eed 5 E CONFIGURATIONS 22 5 sepes ce EE eh aS ee epo Re Eee eoe ba Antea EE AER 5 Typical PC Configurotion ceeeeses esses rn nnne a tans snas enn 5 Thin Client Configurations eeessssss eese rnnt nnns nnn 5 Thin Client Using the IQpath Software Solution 6 Thin Client Using COM Port Mopping nennen enne 7 D SYSTEM SPECIFICATIONS 22 2 Ae Mega ane Fe Pee eode Enn eo pa Cera dee de fau 9 Modulating Effects eee tete pe tee iet ee leet ui ee reete Meds 9 I SYSTEM INSTALLATION 5 5 eoe se ean oa nan nero aoa oer a Ron R ano In EE REENEN EEN roa R o ES 10 A MINIMUM COMPUTER REQUIREMENTS censere eene nnne enne nn nnns nsns inserere enn 10 B SOFTWARE INSTALLATION bis 22252 eaae eu Eed reg E ee Edel 11 Windows Taskbar uc cccccecececscsceceseeeeeeseseeeececscececeescecsceescetesesesesesesesesesesesesesescescececs 12 Screen SOVET s ce os eerte ERR ee Pepe oli wes AR e RP Ex ERST NR eo Tous bie oie 0h oou bs 12 Installation Steps for IQmanager csssessssscccecesessssscecececscssecssaeseseesseetentsaseeses 12 C CONNECTING TH
3. e Similar to the original QTc information the system does not allow the user to change the new QTc data directly However changing the heart rate or QT value will automatically update the new QTc data according to the specific formula 64 IQecg Operation Manual D Appendix D Troubleshooting Guide This Troubleshooting Guide provides a list of solutions or recommendations to situations that may be encountered with IQecg Before calling Midmark Technical Service please refer to the following table for help Error messages may be displayed at the center or at the bottom right corner of the screen A NOTE For errors that occur during the analysis or management of ECG files please refer to Troubleshooting section in the JQmanager Operation Manual Troubleshooting Guide Error Message Problem Recommendation Possible Solution A format error has occurred in the ECG data collected e This error message can be cleared by clicking on Settings then Cancel e Verify that the Low Battery LED on the ECG Module is not DATA FORMAT ERROR blinking If it is install new batteries e Switch to 4 leads display format Refer to section on Live ECG for Display setting change instructions e Turn off Waveform Smoothing Refer to section on Live ECG and Default Interpretation and Acquisition Display settings If an error message appears consistently at the beginning of a new ECG verify that the ECG module is connected to the cor
4. 0 17 1 18 0 05 0 131 2 SECTEUR SC v2 Mil HT a ADER E Td 210 210 210 210 240 210 2 v3 Ta 0 19 0 30 0 11 0 217 0 052 0 175 KO ona an E A V4 ze a ampl in mv d dur in msec v5 N dE E Le The Simple Calipers are shown on the following screen shot To move the pair of Simple Calipers together with a fixed interval place the mouse on one of the calipers hold down the Ctrl Control key and drag to a desired location Selecting the P QRS T Calipers will prompt the reviewer to select a specific beat from the 10 seconds of ECG Click on the QRS complex of the desire beat and a screen similar to the following will display E Measurement Matrix BEE v p Durations msec Intervals msec 64 70 64 68 Wal s P fm 0 041 0 095 0043 on mea Em EH P6 pend ace zm 20 14 0 046 0 034 33 39 31 26 ques Seting 5_ 0097 0634 0 200 0 4 C POnset C QRSUmet C T Onset 1 P Offset C QRS Offset T Oifset 6 None 25 34 44 Close 9 0 048 0 732 11 S a i S d Sa Td 162 164 150 168 164 188 164 Ta 0214 0297 0 085 0 075 0190 0085 02 DR E i a ampl in mv View 2X Calipers 2 d dur in msec Show Ref Points
5. Figure 3 7 Select ECG Reports Report Selection ECG Reports 1 05 25 12 15 01 23 m Oldest And Newest 2 05 25 12 15 58 59 3 05 25 12 11 01 36 m 4 05 24 12 15 08 19 5 05 24 12 15 07 48 m disset B 05 24 12 14 20 46 m 7 05 24 12 12 22 1 Sp 8 05 24 12 12 21 30 m Select From List 3 05 24 12 10 50 45 m 05 24 12 10 50 27 m 05 24 12 10 50 01 View Report 05 24 12 10 33 15 v Print Report Ot Figure 3 8 53 IQecg Operation Manual If the selected ECG reports have both Standard 12 L V1 V2 V3 V4 V5 V6 and Modified 12 L V3R V1 V2 V5 V6 V7 the OK button is disabled see Figure 3 8 The following sample Serial Comparison screen shows four ECG reports simultaneously Summaries of each ECG report are displayed at the top right section Each report is given a report number shown to the left of the date ECG tracings are color coded to identify different reports as indicated at the lower left corner Clearing a report check box turns off the median beats for that report displayed on the left side of the screen Median beats are superimposed so that subtle differences can be viewed easily Rhythm strips from each report are displayed in the lower right section together with the report number and lead label Different rhythm leads can be viewed by clicking the down arrow button next to the Rhythm Lead indicator If Standard 12 Lead V1 V2 V3 V4 V5 V6 is selected
6. If working in a thin client environment install the software on the Terminal Server and operate the IQecg through a thin client terminal IQmanager supports two thin client configurations Qpath Software Solution and Thin Client using COM port mapping IQpath works with either USB or serial port versions of the IQecg in high latency limited bandwidth network configurations with Windows based PC clients For non Windows thin client terminals on low latency high speed networks use the serial port versions of the IQecg and connect to client devices via COM port mapping IQecg Operation Manual Setting up any application in a network environment typically requires special access rights and knowledge of the network Please have the system administrator install and configure IOmanager to the office environment Thin Client Using the IQpath Software Solution IQpath utilizes a dedicated flow control scheme to provide the following advantages over COM port mapping e Improved operation over high latency low bandwidth high loss networks o Microsoft Terminal Services Improvement is approximately 10 to 1 in latency tolerance o Citrix ICA protocol Improvement is approximately 40 to 1 in latency tolerance e No COM port mapping is required e The USB version of the ECG module is compatible e Improved device auto configuration and diagnostics ANOTE lQpath has specific requirements for computer hardware software and
7. OPERATION MANUAL Version 8 6 1 MIIDIMIAIRIK IQecg Operation Manual Notice The information in this manual is subject to change without notice Midmark Corporation shall not be liable for technical or editorial omissions made herein nor for incidental or consequential damages resulting from the furnishing performance or use of this guide This document may contain proprietary information protected by copyright No part of this document may be photocopied or reproduced in any form without prior written consent from Midmark Corporation IQecg IQholter IQspiro IQvitals IQstress IQmanager and IQpath are trademarks of Midmark Corporation Microsoft and Windows are registered trademarks of Microsoft Corporation in the United States and other countries Intel and Intel Core are trademarks of Intel Corporation in the United States and other countries Citrix ICA and XenApp are trademarks of Citrix Systems Inc and or one or more of its subsidiaries and may be registered in the United States Patent and Trademark Office and in other countries Cidex is a registered trademark of Advanced Sterilization Products Division of Ethicon Inc a Johnson amp Johnson company Sani Cloth is a registered trademark of PDI Part Number 3 100 1115 Rev C IQecg Operation Manual TABLE OF CONTENTS RELATED DOCUMENTS iie iins s e ue aa nnn ere o ee aao ERR Fe dE ENEE NENNEN Ce 1 PRECAUTIONS pem
8. 8096 e Glutaraldehyde 2 pH 7 5 8 e g Cidex e Quaternary ammonium compounds e g Sani Cloth HB wipes Remove the disinfectant immediately after the recommended contact time by wiping the cable with a cloth moistened with water 4 CAUTION e The ECG patient cable is not suitable for autoclave or UV sterilization e Never immerse or soak the cable e Prolonged alcohol exposure can negatively affect the mechanical properties of the cable jacket e N propyl alcohol or sodium hypochlorite bleach should be avoided for the disinfection of the cables G Appendix G Radio and Television Interference This equipment generates and uses radio frequency energy If not installed and used properly in strict accordance with the manufacturer s instructions it may cause interference to radio and television reception This equipment has been tested and proved to be in compliance with the standards for medical devices and in accordance with the IEC 601 1 rules which are designed to provide reasonable protection against such interference in a medical or hospital environment H Appendix H EMC Requirements for the IQecg Medical electrical equipment needs special precautions regarding EMC and needs to be installed and put into service according to the EMC information provided in this section Portable and mobile RF communications equipment can affect the operation of medical electrical equipment The IQecg is medical electrical e
9. Atrial fibrillation ventricular rate 7 Atrial flutter with 2 1 conduction ratio Arate Vate Atrial flutter with predom 3 1 conduction ratio Arate 7 Vate 77 Atrial flutter with predom 4 1 conduction ratio Arate V rate Atrial flutter with varying conduction ratio Arate V rate Anterior infarct acute Anterior infarct old Anterior infarct age indeterminate panera aaa 19 IQecg Operation Manual e To repopulate statements into this screen the user may either o Add new diagnostic statements or o Choose from the two lists available through Load Default Statements General List Management ECG Statements User Names Statement Category Al v Edt Categories Double click on an abbreviation to edit the statement Abbr Statement C AAMI SCP ECG Cancel Help The IQmark Default List is the default list installed with IQmanager 20 IQecg Operation Manual User Names tab Add modify or delete the list of physicians and technicians that appears when a new test is started Names can be assigned to one or both lists Type in a user s name and define the user as a physician technician or both General List Management ECG Stafement Double click on an item s text to edit that item User Name 1 Click Add and the following dialog box will appear E ZS a e UserName Abigail Smith RN Physician Appears In
10. Edit Comments General Meas Show Medians Edit Diagnosis Axis Meas Nl Gain 1X Print OK Help id A NOTE These measurements do not represent any editing made to the General Measurements or interpretation Click and drag any of the calipers will update the P QRS T Calipers box accordingly 49 IQecg Operation Manual A NOTE The QTc 1 and QTc 2 information on the P QRS T Calipers box reflects the current ECG settings which may be different from the saved data A NOTE Any changes made in this screen which reference an individual beat will NOT be saved Edit Comments displays a text box for entering and editing report comments that are printed at the top of the ECG report General Meas displays a dialog box showing the general measurements which are also displayed on the previous ECG Review screen and on the ECG report if printed General Measurements 81 BPM 164 msec 368 msec 427 msec 90 msec 36 deg 47 deg 37 deg See Section III E Reviewing Patient Reports for information on how to change these values Axis Meas displays a dialog box showing the axes frontal horizontal and sagittal for the P QRS and T waves Axis Measurements in degrees x Frontal I aF Horizontal I V1 Sagital V1 aVF 21 66 43 132 22 66 Show Medians switches the ECG display between the median beats representative beats or the 10 second ECG tracings While displaying the Show Medians beats
11. Electrodes Check to ensure the electrodes are fresh and sticky The technician s fingers must be clean and free of lotion when handling electrodes e Adhere electrodes to the patient e Attach the ECG clips from the patient cable to the electrodes according to color coding Limb Lead Placement RA White Right Arm electrode is placed on a distal portion the right lateral side of the upper arm below the shoulder LA Black Left Arm electrode is placed on a distal portion of left lateral side of the upper arm below the shoulder RL Green Right Leg electrode is placed on the inside calf midway between knee and ankle LL Red Left Leg electrode is placed on the inside calf midway between knee and ankle Standard 12 Lead Placement Precordial V1 Red 4 intercostal right margin of the sternum V2 Yellow 4 intercostal left margin of the sternum V3 Green Midway between V2 and V4 on top of the 5 rib V4 Blue 5 intercostal left midclavicular line V5 Orange Horizontal level of V4 at the anterior axillary line V6 Purple Horizontal level of V4 at the midaxillary line Standard 12 Lead ECG Hookup S CAUTION Follow standard 12 Lead ECG Placement when performing a STAT ECG The automated ECG analysis algorithm assumes standard 12 lead ECG placement Any deviation from the standard 12 lead ECG placements may affect the accuracy of the automated interpretation 32 IQe
12. If a report was collected using the Start RR function and IQmanager Software Version 8 6 or later the ECG data is displayed on the Report Review screen as shown below see Figure 3 12 Reports Ter a a 10 aaa DOH 01 01 1960 Sex Male ECG RR Variability Holter Spirometry Stress Vitals 2 05 07 12 10 43 30 Report 2 of 13 Technician Beats E Duration 9 Number of RR Interval 32 Mean HR 76 BPM Mean RR 789 msec Max RR 988 msec Dy Blood Pressure Premature Reviewed By PACs Review Date l Settings Comments EE Gain1X Show Graphs 0 10 Sec MEE SEE LL KOR KE EECH Figure 3 12 RR Variability Report Created with IQmanager Version 8 6 or Later The diagnostic results for the RR Variability analysis are displayed in text boxes on the upper right portion of the screen and cannot be edited There are three rhythm leads which are selectable from RR Variability Settings View the patient s ECG tracing from the entire data collection period 30 360 seconds by clicking the lt lt lt gt gt gt arrows above the traces Each click on the arrows shifts the ECG tracings left or right by 10 seconds Click on the ECG tracings view to let the view get the focus Press Left or Right button on the keyboard to move the ECG tracings left or right by 1 second Click Gain 1X if the amplitude of the ECG is too tall or too short clicking the same button circulates throu
13. Legacy Mode e Enhanced Mode Legacy Mode shows about 2 seconds of each lead in 3x4 lead format plus ten seconds of a selected rhythm lead and the background is white in live review and print modes Enhanced Mode shows about 2 5 seconds of each lead in a 3x4 lead format plus ten seconds of a selected rhythm lead in enhanced display quality in live and review modes the background is black and grid lines appear in print mode the background is white A NOTE Changes to the Display Mode setting are reflected on the next new test 25 IQecg Operation Manual Default Interpretation And Acquisition Display Settings Item Settings Comments QTc 1 default is Hodges QTcH QTc 2 default is None These settings determine what QTc equation s to include in the report Bazett QTcB QT VRR where RR is in seconds Framingham e None QTcFh QT 0 154 1000 RR where RR is in e Bazett QTcB milliseconds QTc1 Framingham QTcFh QTc2 e Fridericia QTcFd Fridericia Hodges QTcH QTcFd QT YRR where RR is in seconds Hodges QTcH QT 1 75 HR 60 Where RR is the R R interval and HR is the averaged heart rate in beats per min QTc is expressed in milliseconds A NOTE Any changes to QTc 1 and QTc 2 settings will apply to the ECG report if the report is edited Default is Standard 12 Lead Select one of the two choices to be the default e Standard 12 Lead resting ECG lead gro
14. V5 V6 V5 V6 V7 Rhythm Lead Group Default setting is I Il Ill Applies to 12 lead with 3 lead rhythm format above V5 V6 V7 has a similar definition The Rhythm Lead Group V1 V2 V3 V3R V1 V2 specifies V1 V2 V3 if Standard 12 Lead is selected it specifies V3R V1 V2 if Modified 12 Lead is selected The Rhythm Lead Group V4 V V Default setting is Off cleared TE When On the resting ECG report is l Analysis On Off automatically printed following analysis ANOTE For speed set to Off and print manually Default setting is Off cleared Print On Off When On the detailed measurement matrix Measurements report is printed automatically with the ECG report l On off Default setting i En EEN Grid Black Red or Greer When on the grid is printed in the selected color if a color printer is used 28 IQecg Operation Manual RR Variability Setting Click RR Variability Settings tab of the ECG Settings dialog box to preset the default test duration and report format Rhythm Leads provides choices for the three rhythm leads from all available leads s h zv Jh d RR Duration C 30sec C 120sec C 210sec C 60sec C 150sec 240sec B sec C 180sec C 360sec RR Print Speed C 5mm sec C 10mm sec 25mm sec Print After Analysis Print Graphics Report Rhythm Leads e RR Variability Settings Settings Comments 30
15. clicking Show Ref Points displays the reference points for onsets and offsets of the P QRS T component waves of the median representative beats A NOTE These reference points do not represent any editing made to the General Measurements or interpretation 50 IQecg Operation Manual John Smith 850000001 Measurement Matrix Il H aVR aVL aVF Mi vs 70 70 68 64 70 64 68 0 112 0 143 0 048 0041 0095 0043 00 70 0 126 21 18 20 14 0 080 0 070 0 046 0 034 36 43 19 33 39 31 26 162 0 214 0 902 0366 0075 0 097 0 6634 0200 04 0 061 24 23 38 25 34 44 0 073 0 036 0 719 0 048 0 732 1 1 164 150 168 164 188 164 0 297 0 085 0 075 0 190 0 085 02 in a ampl in mv Calpers d dur in msec Hide Ref Points Edit Comments General Meas Show ECG Edit Diagnosis Axis Meas d Gain 1X Print OK Help e Ka Make adjustments when necessary using the P QRS T Calipers to obtain new measurement values while on the Show Medians beats screen as follows A NOTE The reference points for P QRS T Calipers do not represent any editing made to the General Measurements or interpretation 1 Click View 2X button twice to magnify median beats 2 Click Calipers button and select P QRS T Calipers 3 To move the P Onset point click on the P Onset
16. ff pesante Default settings are MYO Off AC On Drift On Filters AC On Off e Drift On Off See Note following this table Rhythm Lead Select any lead LILIL aVR aVL aVF V1 V2 V3 V3R V4 V7 V5 V6 Default setting is Lead Il This setting applies to both the 3x4 and 4 lead display formats and to the RR Variability analysis rhythm lead The Rhythm Lead V3 V3R specifies lead V3 if Standard 12 Lead V1 V2 V3 V4 V5 V6 is selected when a new ECG test is started it specifies lead V3R if Modified 12 Lead V3R V1 V2 V5 V6 V7 is selected V4 V7 has a similar definition Lead Group e II Il aVR aVL aVF e V1 V2 V3 V3R V1 V2 e V4 V5 V6 V5 V6 V7 Default setting is I Il Ill This setting applies to the 4 lead display format definition The Lead Group V1 V2 V3 V3R V1 V2 specifies V1 V2 V3 if Standard 12 L is selected it specifies V3R V1 V2 if Modified 12 L is selected The Lead Group V4 V5 V6 V5 V6 V7 has a similar Display Format e 3x4 leads plus rhythm 4 leads Default setting is 3x4 plus rhythm lead 12 leads Default setting is On checked Display Real If this setting is Off cleared the live ECG screen time ECG On Off will not display real time tracings while acquiring Tracings ECG data Set it to Off only if the computer has problems displaying real time ECG Default setting is On checked Controls how the ECG waveforms
17. 41 42 40 Ra 0 27 0 087 0 18 0 60C 0 20 0 42 Dan 1 132 1 03 0 74 LA A Rid 18 aVL R a 0 072 eee SR ME AT ALME Ret eid de R a Sd 25 43 19 35 32 28 23 18 19 Sa Inner 0 78 0 10 0 531 0 91 0 70 0 334 0 151 0 094 A HE t m sl BESSE zig x eel tg MS v2 7 Sa A d Td 192 188 194 192 188 190 190 194 v3 E Ta 0 06 0 117 0 085 0 162 0 06 0 22 0 17 0 136 T 488 d jc e Ki View 2x Calipers a ampl in mv Show Medians Gain 1X Pim os Heb Measurement Matrix LE x Meas IIl avR avL avF var vi v2 v5 ve v7 CEET Pd 88 80 80 78 78 88 78 80 Ii i ae A Se 0 04 0 082 0 114 0 072 0 07 0 114 O 08C 0 117 Pd 78 ab zu TEF ERU RIED E Vl SE St Pal 0 09C li Qd 17 20 18 14 23 21 21 Qa 0 02 0 05 0 061 0 02 0 12 0 09 0 097 aVR snas sep BIS ch Rd 40 21 65 40 35 35 31 42 41 39 Ra 0 27 0 08 0 18 0 597 0 902 0 207 0 434 1 037 0 751 1 12 ie HS Rd 20 aVL Ra 0 07 M insusuunanurenur Ares aVF ER 2 sd 22 42 20 28 34 32 20 21 24 End Ido Al pa Tage 0 77 0 097 0 69 0 5341 0 907 0 14 0 09C 0 33 V3R EI Sa Sa i S d v E
18. C Operation of IQecg with IQmanager Starting the Program The software application for operating the IQecg is called Qmanager and is located on the computer desktop as a shortcut icon Double click on this icon to start IQmanager KS Midmark IQmanager A NOTE For a detailed description of diagnostic functions available through IQmanager refer to the Qmanager Operation Manual Opening Screen When starting IQmanager the opening screen appears Q manager E e New Patient Patient List STAT ECG STAT VITALS nm Je 34 IQecg Operation Manual Opening Screen Buttons a Register a New Patient Refer to the product s Operation Manual for a description of the patient details required for specific tests New Patient View a list of patients previously entered into the database selecting a patient from the list allows access to edit add and delete data from that patient s records and view data from Patient List previous tests STAT ECG Acquire an ECG before entering patient demographics or mm selecting a patient Enables users to select which database to use and configure the program to meet their needs See Section II E Configuring IQecg for more information Online assistance regarding the use operation and troubleshooting of IQmanager and other products Calibrate the Midmark lOspiro device Exit the program and returns to the Window
19. Cable Installation Attach the patient cable to the 15 pin connector on the ECG acquisition module Figure 2 2 13 IQecg Operation Manual Connecting the USB Type IQecg Module If using a USB type IQecg module connect it to any available USB port on the computer after IQmanager is installed As with other USB devices Windows will attempt to identify the IQecg module the first time it connects to it This may take a few seconds The USB type IQecg does not require batteries as it receives its power from the computer D Configuring IQecg IQmanager and the IQecg can be customized by using the configuration settings Access the Configuration Settings by one of the following ways IQmanager Double click the shortcut installed on the desktop Configuration or Click on the SETTINGS button in the upper right side of the Qmanager opening screen l The Qmanager Configuration Settings dialog box appears remanent Sting e ke Institution Name Institution Address Units Date Format 3 3 Serial Port English C DD MM YY C Metric G MM DD YY Database Settings C YY MM DD List Management Time Format Line Frequency ECG Settings 24 Hour Clock 60Hz Holter Settings C 12 Hour Clock C 50Hz Spirometry Settings Stress Settings Default Help Select ES Default Fax Printer If the practice name and details were entered during the registration installation process for
20. Diagnosis The Edit Diagnostic Statements dialog box appears see Section III E Reviewing Patient Reports Editing Diagnostic Statements for details Edit Diagnostic Statements x Edit Statements Sinus Rhythm WITHIN NORMAL LIMITS Add Clear All Add teen m 52 IQecg Operation Manual Serial Comparison This feature provides access to compare up to four ECGs from the same patient If the patient has more than one ECG report click Serial Comparison on the Report Review screen and the Select ECG Reports dialog box appears Choose the desired test selections and click OK Modified 12 L V3R V1 V2 V5 V6 V7 ECG reports are marked with m on the right Select ECG Reports i Report Selection ECG Reports O Most Recent 4 O Select From List View Report Mi O Print Report Ur Only ECG reports with the same lead group can be compared Figure 3 7 shows that four Modified 12 Lead ECG reports are selected and the serial comparison is enabled Select ECG Reports Report Selection ECG Reports i 1 05 25 12 16 01 23 m Al C Oldest And Newest 2 05 25 12 15 58 59 3 3 05 25 12 11 01 35 m 4 05 24 12 15 08 19 5 05 24 12 15 07 48 m O Most Recent 4 B 05 24 12 14 20 46 ml 7 05 24 12 12 22 17 8 05 24 12 12 21 30 m Select From List a 05 24 12 10 50 45 m 10 05 24 12 10 50 27 m 11 05 24 12 10 50 01 View Report 12 05 24 12 10 33 15 vi O Print Report
21. E E ea Lech r E A A HEHH 2 Li d A j LN d TOT TA ed r p VBR abe qe 1 T is c Si H ERepoti amp Repot3 ___ Rhythm Lead V3 V3R Gain1x Preview Settings Report 2 Report4 ShowAl Prnt __ Print Setup Hep o Figure 3 10 Modified 12 Lead Click inside the median beat or the rhythm strip area to zoom in on the ECG tracings Click again and ECG views return to the previous scale RR Variability Report Review If a report was collected using the Start RR function and IQmanager Software Version 8 5 or earlier the ECG data is displayed on the Report Review as shown below see Figure 3 11 El Reports For Jonathan Conner 1D 0000000201 DOB 02 02 1995 Sex Male ECG RR Variability Holter Spirometry Stress Vitals y 1 04 07 10 16 44 34 Report of 1 Technician Rosemarie Beats 38 Duration 41 sec a Normal 35 Number of RR Interval 38 Blood Pressure Premature D Mean HR 60 BPM VECs 0 Mean RR 986 msec Reviewed By PACs D Max RR 988 msec Min RR oan mean Review Date Settings Comments lt lt lt gt gt gt Gain 1x Show Graphs 0 30 Sec D I a TRES FERRI PH JR Ea New Patient Patient List Patient Data New Test Figure 3 11 RR Variability Report Created with IQmanager Version 8 5 or Earlier 55 IQecg Operation Manual
22. MYO filter on for pacemaker patients Wait for the ECG tracings to pass the screen twice about 20 seconds to verify that the signal quality is good and the baselines are stable To acquire a test report click either Analyze or Start RR on the menu bar e Analyze instructs the program to acquire analyze and store a resting ECG test e Start RR instructs the program to acquire a preset duration of the rhythm strip and prepare a RR Variability report Reports are automatically saved and can be viewed upon exiting the ECG screen by the Review button Reports on the Report Review screen are in chronological order for the patient being tested and are displayed on the ECG or RR Variability tabs Review reports from other patients by clicking Patient List 60 IQecg Operation Manual B Appendix B Operations at a Glance Modified 12 lead ECG A condensed guide to using the IQecg to acquire a modified 12 lead ECG A NOTE The modified 12 lead ECG provides the clinician the tool to acquire V3R and V7 using 1 2 3 4 the IQecg device and its 10 lead patient cable in a way that supplements the standard 12 lead ECG We recommend performing a standard 12 lead ECG on the patient prior to performing a modified 12 lead ECG Perform and acquire a standard 12 lead ECG test Refer to Appendix A for information on performing a standard 12 lead ECG test While in the Report Review screen prepare the patient for
23. Technology 1 25Volt micropower shunt reference regulator provides precision 1 25Volt reference voltage Isolation is provided for signals entering the ECG module and can withstand up to 1000Volts 80 IQecg Operation Manual C System Maintenance and Obtaining Service The IQecg is a portable device and requires little maintenance To ensure the best performance of the device the following procedures are recommended e Keep the patient cable clean e Do not unplug the patient cable from the IQecg hardware e When the device LED turns red or the computer screen displays low battery 45 Series RS232 version only replace the batteries inside the unit before continuing The IQmark and IQecg Digital ECG acquisition modules contain no user adjustable or serviceable parts and are designed to operate without adjustment for the lifetime of the product However electronic equipment can be subject to wear and damage that can cause malfunctions A certification policy is the responsibility of the end user and is subject to the end users business practices which may require it Certification provides peace of mind that the device continues to work within factory specifications Certifications can be purchased directly from Midmark Please contact Technical Service at 800 624 8950 option 2 with questions or to make arrangements for the certification of an Qmark Digital ECG or IQecg Digital ECG device A NOTE Return authorization
24. Thin Client using IQpath or COM port mapping IQecg Operation Manual D System Specifications The following are the physical and performance specifications for the IQecg IQecg Performance Specifications Category Specification To provide standard 12 lead resting electrocardiogram recordings e 3 5 88mm x 5 7 145mm x 1 2 30mm W x Lx H e 10 202 USB type ECG module without batteries Physical Characteristics e 11202 serial type ECG module with batteries e Two 1 5V AA alkaline batteries serial type ECG module only 25 hours of ON time serial type ECG module Intended Use Anatomical Sites e Noninvasive device 12 lead electrocardiogram Safety Parameters e Patient electrically isolated from main current supply e Patient leakage current not to exceed 10 uA e Ground leakage current not to exceed 50 uA ECG Acquisition e 12 leads simultaneous e Input impedance gt 100 MegaOhm e Frequency response 0 05 150 Hz 3 dB e Sensitivity 5 10 20 mm mV 596 e Dynamic range 10 mV e ADC resolution 13 bits at 2 44 uV bit Acceptable electrode offset 300 mV per AAMI and EC 11 specifications e A D 500 samples sec Patient Connection e 10 lead patient cable with RFI filter defibrillator protection and patient isolation Monitor e Varies by computer system minimum 1024 x 768 resolution ECG Analysis amp Measurement e Midmark 12 Lead Resting El
25. are drawn in the real time display screen Selecting On Waveform produces smoother waveforms In contrast Smoothing ER selecting Off cleared may produce waveforms that appear jagged A NOTE If using a slow PC or having delayed ECG tracing set to Off 24 IQecg Operation Manual Default Interpretation And Acquisition Display Settings Item Settings Comments Disable Interpretation On Off Default is Off cleared If On checked the ECG will not produce any diagnostic statements and the interpretation portion of the report ECG Review and Edit screen will be blank A NOTE Modified 12 Lead ECG lead group does not provide automatic interpretation statements Disable Quick Edit On Off Default is Off cleared If On checked the software defaults to free text entry method for adding any diagnostic statements instead of the Quick Edit feature of the Add a Statement dialog box See Editing Diagnostic Statements Disable QTc Formula Warning On Off Default is Off cleared If On checked the software will not display a warning message that the QTc formula on the report will be changed based on new QTc1 and QTc2 settings when the report is edited and saved Hide Measurement Matrix On Off Default is Off cleared If On checked the Details screen will display longer duration of ECG tracings without the Measurement Matrix Display Mode
26. authorization are followed We highly recommend following all guidelines for the shipment of medical products set forth by the shipping company you choose to use If a question should arise regarding the appropriate method of shipment please feel free to ask when calling for your RMA number It is the responsibility of the customer when shipping a product to ensure that all packages and their contents get to Midmark safely Midmark will not assume responsibility for damage due to improper packaging shipment or product use Such actions will void all applicable warranties Midmark Corporation 690 Knox Street Suite 100 Torrance California 90502 Tel 310 516 6050 USA 800 624 8950 option 2 Fax 310 516 6517 82 IQecg Operation Manual VIII Contact Information Midmark Corporation 690 Knox Street Suite 100 Torrance California 90502 Phone 310 516 6050 USA 800 624 8950 option 2 Fax 310 516 6517 Email techsupport midmark com Website midmark com Knowledge base kb midmark com hm AR Midmark Corporation 2014 Because we care 83
27. before each use Plug the metal post of each lead of the patient cable into an ECG clip Make sure each ECG clip is pushed all the way in If experiencing signal disturbance distortion or interruptions stop the procedure and localize the source of the problem and correct before continuing At the end of the procedure gently disconnect the ECG clips from the electrodes o Do not remove the patient cable from the ECG module All cables should be stored in big loops Tight coiling must be avoided Also avoid heat sources and direct sunlight Cleaning Cables are supplied non sterile and are reusable For cleaning and disinfection the following substances and procedures must be used Disconnect cable Wipe plastic parts with a cloth moistened in lukewarm water with alcohol free neutral soap Always wipe towards the patient connectors ECG clips Proceed carefully as to not damage the cable through excessive stretching bending or kinking of the wires Remove the cleaning agent by wiping the cable with a cloth moistened in water Wipe or air dry before use Remove adhesive residues only with the alcohols listed below Never use other organic solvents acetone or toluol will damage the cable jacket Disinfection Clean cables before each disinfection as described above Perform wipe disinfection using products with the following substances as active ingredients 70 IQecg Operation Manual e Ethyl or Isopropyl alcohol 70
28. e Edit the diagnostic statements accordingly See Section III E Reviewing Patient Reports ECG Report Review e seim mt Incorrect diagnostic interpretation No error message and no ECG Refer to ECG MODULE NOT RESPONDING above trace on Live ECG screen Refer to SERIAL PORT ERROR above Depending on the computer print jobs may be slower if the ECG module is still actively collecting live ECG data e Click Freeze before printing the ECG tracing displayed on the screen Refer to Section III E Live ECG e Verify that Print after Analysis is not checked Refer to ECG Settings Section II D Configuring IQecg Printer Settings and RR Variability Settings e Uncheck Grid setting Printing ECG reports without the grid will expedite the print jobs Prints slowly when printing live ECG tracing or printing automatically after analysis 67 IQecg Operation Manual Error Message Problem ECG signal quality problems such as a low amplitude wandering baseline noisy signal etc Troubleshooting Guide Recommendation Possible Solution For a good signal quality the patient must be properly prepped the lead placements correct and the electrodes and lead wires firmly secured See Section III B Patient Preparation for best practices For the Valentine ECG Verify that the Low Battery LED on the ECG module is not blinking if it is install new batteries For the IQecg Verify that the LED is not red
29. in use 80mA DC VOLTAGE SERIAL CONNECTION DEVICES This device uses 3 Volt power and consumes 80mA when in use f Seize BATTERY ORIENTATION SERIAL CONNECTION DEVICES This device uses 2 AA alkaline batteries The icon indicates the orientation of Ae D batteries to be installed IEC 601 Defibrillator proof Type CF equipment 1 I Equipment displaying this symbol contains an F type isolated floating applied part that provides a high degree of protection against electrical shock and is suitable for use during defibrillation ETL Listing Mark T Equipment displaying this symbol has been tested and complies with the ONE Ur US following safety standards Intertek e Conforms to UL Std 60601 1 Sie e Certified to CAN CSA Std C22 2 No 601 1 DISPOSAL Do not dispose of this product as unsorted municipal waste Dispose this product in accordance with national requirements per EC Directive 2002 96 pm 76 IQecg Operation Manual VI IQecg Service Manual A Introduction The Midmark IQecg is a PC based diagnostic instrument that converts any Windows based personal computer to a 12 lead electrocardiograph with interpretative and data storage capabilities A complete IQecg system consists of the ECG data acquisition module the PC system including a monitor and printer Microsoft Windows operating systems Windows 8 or 7 and lIQmanager software program This manual is provided to assistance primaril
30. is required prior to the return of the device Midmark Technical Service will issue a Return Materials Authorization RMA number prior to shipment 81 IQecg Operation Manual VII Customer Support and Warranty Information For immediate help diagnosing problems with this product refer to the online Help or Appendix C Troubleshooting Guide For help diagnosing problems by phone with this product contact Midmark Technical Service at 800 624 8950 option 2 between 6 00 AM to 4 00 PM Pacific Standard Time To contact Midmark Technical Service via email techsupport 9 midmark com Self help knowledge base and live chat can be accessed at kb midmark com Warranty Midmark warrants IQecg to be free from manufacturing and material defects for 12 months from the date of purchase Accessories and patient cables for IQecg are warranted for 90 days Any misuse or abuse of a Midmark product voids all applicable warranties Please refer to midmark com for the full and current Warranty Terms and Conditions Return Materials Authorization To return any product for repair a Return Materials Authorization RMA number must be obtained from Midmark Technical Service This RMA number should be referenced on the package s containing the items to be returned and in any correspondence regarding the return Shipping Before shipping any unit to Midmark be certain that an RMA number has been issued and that all guidelines regarding this
31. lQmanager the information will appear here If the practice name and details were not entered during the registration installation process for Qmanager enter the information here Complete the Institution Name and Institution Address boxes with information about the medical practice This information will also be displayed on printed reports Enter a name that describes the practice location to enable other medical personnel to recognize the origin of the reports 14 IQecg Operation Manual From the Configuration Settings the following options can be selected 1 Metric and English units of measurement 2 AC power source frequencies of 50 Hz or 60 Hz o The IQecg uses the information to filter out background noise introduced by the power source through its AC filter In the United States this frequency is 60 Hz If using this product outside of the United States please consult with the local power utility company to determine the appropriate frequency Configuring for Serial Type IQecg Module If using a serial type IQecg select the serial port for the ECG module in the Configuration Settings screen Click Serial Port to open the following dialog box pu pel ECG COM Pot Spirometry COM Port Vital Signs aw 9 o e l acd T Auto Detect Auto Detect Thin Client Channel Weight Scale com Port Mapping Ie Enable Scale Cancel Help amp NOTE The default serial com
32. nor the Low Battery message displayed If it is install new batteries Verify that the electrodes are fresh moist and sticky not dry or hard Check electrode expiration date on package Verify that the patient lead wires and cables are not damaged or worn out Inspect connections between the electrodes clips lead wires lead cable and the ECG module The exam room should not be too cold patient may shiver causing a noisy signal If any I II Ill aVR aVL and aVF leads on the screen are noisy or flat lined check the limb lead electrodes for proper contact in this order RL LL RA and LA If a precordial lead is noisy or flat lined check the limb lead electrodes first and then check the corresponding chest lead electrode for proper contact Once identified discard and replace the used electrode Prepare the problem site again or try a new electrode site in close proximity to the original site Note any site variance on test report Test the filter settings on the ECG screen Turn AC filter ON if you see 50 60Hz noise Turn MYO filter ON if patient produces muscle tremor Turn Drift filter ON if the ECG baseline is drifting While these digital filters can improve signal quality they cannot correct hookup problems ANOTE As with any ECG measuring device turning on the MYO filter may alter measurements which may affect the diagnostic statements Do NOT turn on the MYO filter for pacemaker patients Click INST to reset the bas
33. on the right chest and V4 lead on the V7 location on the back 37 IQecg Operation Manual Click OK to open the live ECG screen The ECG module will turn on automatically and the green LED on the module will light The laptop computer s AC adapter may introduce electrical interference For best ECG result do not use the AC adapter while running a live ECG Midmark Diagnostics Group Figure 3 1 Standard 12 Lead Place V3 lead on V3R V4 lead on V7 Figure 3 2 Modified 12 Lead The live ECG screen displays the results of the 12 channel ECG in the three by four 3x4 leads display format This format can be changed by using the Settings function 38 IQecg Operation Manual If Modified 12 Lead V3R V1 V2 V5 V6 V7 is selected e The live ECG screen displays a message Place V3 lead on V3R V4 lead on V7 at the top center for about 10 seconds see Figure 3 2 Once the message disappears the facility s name is displayed e The chest leads on the live ECG screen are arranged in the order of V3R V1 V2 V5 V6 V7 S CAUTION Follow standard 12 lead ECG placement when performing a STAT ECG The automated ECG analysis algorithm assumes standard 12 lead ECG placement Any deviation from the standard 12 lead ECG placements may affect the accuracy of the automated interpretation A NOTE Modified 12 Lead ECG lead group does not generate automatic interpretations The facility s name date time and the patient s he
34. sec 60 sec 90 sec Default setting is 90 sec e 120 sec RR Duration e 150 sec This setting defaults the length of the rhythm strip e 180 sec acquired through Start RR test The rhythm strip is e 210 sec defined in the ECG Settings e 240 sec 360 sec 1 5 mm sec Default setting is 25 mm sec RR Print Speed 2 10 mm sec This setting defines the print scale of the ECG tracings 3 25 mm sec for RR test Print After Analysis On Off Default setting is Off cleared When set to On checked the RR test report is printed automatically following successful completion of RR test analysis ANOTE For speed set to Off and print manually 29 IQecg Operation Manual RR Variability Settings Settings Comments Default setting is Off cleared Print Graphics On Off When set to On checked the graphic report which Report includes the RR Trend and RR Histogram is printed automatically with the RR rhythm strip report Select any three pans Default settings are Il V2 and V5 Rhythm Lead II lll aVR aVL aVF V1 V2 V3 V3R VA V7 V5 V6 ECG Configuration Setting Click the Configuration tab of the ECG Settings dialog box to access the ECG Configuration settings Default Interpretation And Acquisition DjsffSy Settings Printer Format Settings R R Variability Selling Configuration Units Date Form Com Port DD MM YY low lt Auto Detec
35. the chest leads are arranged in the order of V1 V2 V3 V4 V5 V6 see Figure 3 9 If Modified 12 Lead V3R V1 V2 V5 V6 V7 is selected when acquiring a new ECG report the chest leads of ECG tracings on the left of the screen are arranged in the order of V3R V1 V2 V5 V6 V7 see Figure 3 10 No Date Interpretation Reviewed BP l HR PR QT ex QTel ere C 05 08 12 Sinus Rhythm With rate variation 76 156 346 QTcH 374 orl WITHIN NORMAL LIMITS 05 07 12 Sinus Rhythm With rate variation 79 156 348 QTcH cv 7 16 WITHIN NORMAL LIMITS 2 Sinus Rhythm 158 388 QTH WITHIN NORMAL LIMITS 358 5 02 12 Sinus Rhythm a 1 160 358 Oto v2 f E WITHIN NORMAL LIMITS 358 d V 4 d J d Aa A a HTAA H E Po SR Se USE Ree db Vell IMS ofa s IP ERR i Dod H amp Report 1 B Report 3 Rhythm Lead V3 V3R Gain1X Preview Settings 2 Report 2 Report 4 Show All Print Print Setup Help J OK Figure 3 9 Standard 12 Lead 54 IQecg Operation Manual 1 No Date Interpretation Reviewed BP HR PR QT gre QTcl QTc2 C 05 08 12 gt 79 154 38 QKH t EEH 05 08 12 H T 162 346 H QTcH 375 2 05 07 12 H 75 164 36 ore 4 372 05 04 12 76 156 346 gra E 1 bob
36. 3 V4 V5 V6 is selected when a new ECG test is started it specifies Lead V3R if Modified 12 Lead V3R V1 V2 V5 V6 V7 is selected V4 V7 has a similar definition The Rhythm Lead Group V1 V2 V3 V3R V1 V2 specifies V1 V2 V3 if Standard 12 Lead is selected it specifies V3R V1 V2 if Modified 12 Lead is selected The Rhythm Lead Group V4 V5 V6 V5 V6 V7 has a similar definition 27 IQecg Operation Manual ECG Report Printer Format Settings Settings Comments 6x2 format 12 lead with 3 lead rhythm format 3x4 3 12 lead format 12x1 12 lead plus single rhythm format 3x4 1 e 2 Page Format Printer Format Settings Default setting is 12 lead plus single rhythm format 2 Page Format prints leads I II Ill aVR aVL and aVF on the first page and V1 V6 V3R V7 on the second page Select the print scale of 25 mm sec or 50 mm sec when printing in 2 page format Other formats will always print at 25mm sec scale Select any lead L II IIl aVR aVL aVF V1 V2 V3 V3R VA V7 V5 V6 Rhythm Lead Default setting is II Applies to 12 lead plus single rhythm format 3x4 1 above selected V4 V7 has a similar definition The Rhythm Lead V3 V3R specifies Lead V3 if Standard 12 Lead V1 V2 V3 V4 V5 V6 is selected when a new ECG test is started it specifies Lead V3R if Modified 12 Lead V3R V1 V2 V5 V6 V7 is e II il aVR aVL aVF e V1 V2 V3 V3R V1 V2 e V4
37. E IQECG Moput eren nemen nennen nennt nnn nnns 12 Connecting the Serial Type IQecg Module esses 12 Connecting the USB Type IQecg Module 14 D CONFIGURING IOECGS EE BEES 14 Configuring for Serial Type IQecg Module esses 15 Configuring for USB Type IQecg Module 15 Thin Client Channel Setting 16 Database Settihgs oid beoe e 16 Ee eeler 16 EGG StatemehtstQD ate edi beu eo io tbv ETE ERE PERPE Calo ra P eg ao ds 18 User Namestab 4 tite teer eee laser e beo vv labete Polo ape ei ea reed labepee doas 21 ECG Setting EE 22 ECG Lead GFroup EE 23 Printer Settings uie e ree ca seek uec uade eaa pia e nua e eua E ado ene na Far ad eden anota 27 RR Variability Setting 29 ECG Configuration Setting idee et Dei ie 30 IL OPERATION e 31 A INTRODUCTORY NOTES EE 31 B PATIENT PREPARATION eege NES rre e ape Fre EELER dE Eege Ee Een EN Patient POSITION m D 31 Prepare Patient SKin st atas ewe ERES 32 IQecg Operation Manual moo lt ae ER Limb Lead Placement eee esee eee ta ahhh hana stan 32 Standard 12 Lead Placement Precordial eene 32 Modified 12 Lead Placement Precordial amp Dosterior csscccceessssesessseseceenaes 33 OPERATION OF IQECG WITH IQMANAGER sse enne eee enne enne 34 Starting the Progradmz e tete n e nee EE E E THEE 34 Re Eeler EE 34 STATE CG Ion v t iba ode Petr VERE T 35 TESTING ANEW PATIENT 6 dn n
38. MUST BE AT LEAST 2 REPORTS FOR SERIAL COMPARISON TRENDING Message appears after clicking the Serial Comparison button Serial Comparison in ECG requires at least 2 ECG reports completed under the same patient e Click OK Perform additional test if needed SERIAL PORT ERROR EXIT Message appears after starting a new ECG No ECG trace is displayed on the screen The ECG module cannot communicate with the ECG Acquisition module it is either connected to the wrong serial port or the configuration is incorrect ANOTE For Touchscreen Display users If using the same COM or USB port for the ECG module and the touchscreen display close or disable the touchscreen driver before running IQmanager e Refer to Sections II B and II D for COM port selection and setup Use Auto Detect to find the correct COM port 66 IQecg Operation Manual Troubleshooting Guide Error Message Problem Recommendation Possible Solution 1 Exit lQmanager Start MS DOS Prompt Details button does not work Change directory to c windows system if Windows NT in the ECG Report Review c winnt system32 screen Type regsvr32 msflxgrd ocx and press Enter Type regsvr32 oleaut32 dll and press Enter Exit MS DOS Prompt and restart the IQecg application pou Refer to ECG signal quality problems above Patient s Date of Birth Sex and Medications must be accurately entered Refer to Section III E Testing a New Patient
39. Midmark devices and software please contact Midmark Technical Service before doing so lQecg Minimum Computer Requirements Requirement Operating Systems Windows 8 Professional and Enterprise 32 bit and 64 bit Windows 7 Professional and Enterprise 32 bit and 64 bit Hardware Requirements Windows compatible personal computer CPU Intel Core 2 Duo Processor E4300 2M Cache 1 80 GHz 800 MHz FSB x86 or 64 bit x64 processor or faster Disk 2GB of free disk space or greater Memory Minimum 2GB of system memory Input Output Ports One 1 USB port or one 1 serial port e One Universal Serial Bus USB port if using USB version of the IQ product Or e One RS 232 Serial Port if using serial port version of IQ product The above computer port is required for new test acquisitions It is not required to review and or edit a test Additional USB ports as needed for keyboard mouse printer etc Pointing Device Windows compatible mouse 10 IQecg Operation Manual Keyboard Windows compatible keyboard Display 1024x768 or higher resolutions for the real time acquisition screen 16 bit color Wide screen 1680x1050 is highly recommended Printer Microsoft Windows compatible inkjet or laser printer Surge Protector One 1 hospital grade power surge protector for the computer system A NOTE The above is the minimum computer requirement specification fo
40. ODUCTION P 77 THEORY OF OPERATION NENNEN EEN 77 10 Leadwire Patient Cable eee eee eene nnn 78 ECG Buffer Amplifiers ce er tee E X OH RENE ee SE 78 Instrumentation Amplifiers cesis esses esee enne nn nnns entra a ranas 78 Filters and Gain Amplifiers c cesses esses eene eene nnne nh nnns 79 Analog to Digital Conversion EE 79 Microcontroller aae di t eoe creer a araa r ree tere Pe ke aao Co dodo 79 Isolated Serial Interface S noirir iri eiia E nh E eE 80 IQecg Operation Manual VII VIII Lead Off Deene 80 Pacemaker Detector eese eene nennt A esent esse ses i esse ssa ates ease 80 DC DC Powetr gel E 80 SYSTEM MAINTENANCE AND OBTAINING SERVICE eene nennen nnne nen 81 CUSTOMER SUPPORT AND WARRANTY INFORMATION ccscscscscscececes 82 lu GIOIA 325 acces LE 82 CONTACT INFORMATION cccccccseseecsesceccsceeccseccccesccesesccesesssesseccsseecesseees 83 IQecg Operation Manual Physician s Responsibility The interpretations provided by the Midmark IQecg are for the exclusive use of licensed physicians or personnel under their direct supervision Not all ECG abnormalities can be detected by computerized automated ECG analysis algorithm The suggested interpretation including numerical and graphical results should be examined with respect to the patient s overall clinical condition It is the responsibility of the physician to en
41. Physician Lists Cancel Help 2 Enter a User Name 3 Check the box es indicating on which list s the name should appear and click OK The names will appear in the New Test and Review windows 21 IQecg Operation Manual General List Management ECG Statements User Names Double click on an item s text to edit that item ECG Settings Set the default settings to use for ECG tests by clicking ECG Settings from the Qmanager Configuration Settings dialog box Institution Name English C Metric Time Format e 24 Hour Clock C 12 Hour Clock Units m Institution Address Serial Port Database Settings E p ECG ECG Settings D Date Format r Line Frequency 60Hz C 50Hz C DD MM YY MM DD YY C YY MM DD Default Fax Printer 22 Spirometry Settings Stress Settings Default D mI Cancel IQecg Operation Manual The ECG Settings dialog box appears Printer Format Settings R R Variability Settings Configuration Gain r Filters C 5mm mV Iw AC Filter Ze 10mm mV Muscle Filter C 20mm mV JM Drift Filter Lead Group r Display Format sl jura v 34 Leads E Display Realtime ECG Tracing 4 Leads Waveform Smoothing 12 Leads Disable Interpretation r Display Mode Disable Quick Edit Legacy Disable QTc Formula Waming Hide Measurement Matrix QTc 1 Q
42. Settings Stress Settings Default Help 2 Select either the local or network database and click Manage Lists This will open the List Management dialog box to add edit and delete the lists that appear throughout the program Database Selection General List Management Tab DK eem rz List Management vom I Select a database then click on Manage Lists Customize the Medications History Statements ECG Holter Indications and Race Categories Select the desired item from the pull down list to modify Click Add Edit or Delete 17 IQecg Operation Manual Amiodarone Digoxin Diltiazem Disopyramide Ethmozine Flecainide Inderal Isordil Metoprolol Mexiletine Phenytoin Pindolol Procainamide Propafenone bes lt i e Add Add an item to the list A pop up box will appear that allows you to enter in the new information e Edit Edit an existing item Highlight the statement with the cursor and then click Edit e Delete Delete an existing item Highlight the statement with the cursor and then click Delete ECG Statements tab Customize the ECG Statements list in order to quickly edit when interpreting an ECG Add Edit and Delete work the same way as in the General List Management tab These statements will Double click on an abbreviation to edit the statement Abbr Statement First degree AV block Second degree AV block Axate Vote Third degr
43. Tc2 Hedges pr x None 2 one ECG Lead Group Standard 12 Lead V1 V2 V3 V4 V5 V6 hd C Enhanced ECG Lead Group When acquiring an ECG report lQmanager Version 8 6 and later offers two options e Standard 12 Lead ECG lead group and e Modified 12 Lead ECG lead group Refer to Section II D Testing A New Patient Live ECG for more information on these options Printer Format Settings R R Variability Settings Configuration Default Interpretation And Acquisition Display Settings r Sweep Speed r Gain r Filters C 10mm sec C 5mm mV V AC Filter 25mm sec Ze 10mm mV Muscle Filter C 50mm sec C 20mm mV WM Drift Filter Rhythm Lead Lead Group r Display Format zl un v 34 Leads JW Display Realtime ECG Tracing 4 Leads Waveform Smoothing 12 Leads Disable Interpretation Display Mode Disable Quick Edit Legacy I Disable QTc Formula Waming Hide Measurement Matrix C Enhanced 23 IQecg Operation Manual Default Interpretation And Acquisition Display Settings Item Settings Comments e 10 mm sec Default setting is 25 mm sec Sweep Speed setting only applies to real time ECG e 25 mm sec Sweep Speed si display The ECG report only prints at 25mm sec ses scale except if a 2 Page Format is selected See Printer Format Settings e 5 mm mv gain Gain 10 mm mv Standard gain default setting e 20 mm mv 2X gain Muscle
44. Trode ECG Electrodes Mouse Pad Training DVD Operation Manual CD Quick Reference Guide Warranty Card Carrying Case k ltaltaltait lt ltaitalt it IQecg Operation Manual l General Information A Introduction The information in this Operation Manual is provided for users of ECG models Midmark IQecg and IOmark Digital ECG Future references of IQecg in this document may include the following part numbers Model Connection Device Part Number Kit Part Number USB 1 100 1325 4 000 0061 i Mop IERE Serial 1 100 1305 4 000 0060 USB 1 100 1320 4 000 0057 e Digital E Oark Digital ECG Serial 1 100 1300 4 000 0005 No longer in production A NOTE This manual is intended for lIQmanager Diagnostic Workstation software users If using the IQecg through an EMR please contact Midmark Technical Service for assistance with installation setup and operation The IQecg is a portable device that converts a supported Microsoft Windows based personal computer PC be it desktop laptop notebook or pen based to an electrocardiograph with interpretive capabilities The device is electronically isolated from the PC and connects to it directly through the USB port or serial port Together with IQmanager Diagnostic Workstation software the lQecg makes it easy to record 12 lead ECG interpret them archive the reports for future reference and share the
45. a network database the default can be set either to the local or network by clicking Database Settings on the Qmanager Configuration screen Select a network database as the default by checking the Enable Network Database box then clicking Network Refer to the Qmanager Operation Manual for more details E Database Settings Enable Network Database Default Database Holter ECG File Storage Path Brentwood Database Holter Browse 64089 MBytes available DK Cancel Default Help If using a Midmark IQholter system a different location can be selected to store the Holter ECG files List Management The List Management configuration option customizes the lists used in Qmanager including e Medications e History Statements e ECG Holter Indications e Race Categories e ECG Statements and e User Names The names of doctors and technicians can be entered here 16 IQecg Operation Manual Modifying these lists saves time when using them in the appropriate testing screens 1 To access List Management open the Configuration setting and click List Management EIE Institution Address Units Date Format English C DD MM YY C Metric MM DD YY C YY MMNDD Time Format e 24 Hour Clock 12 Hour Clock Line Frequency 60Hz C 50Hz Default Fax Printer Select List Management D Serial Port Holter Settings Spirometry
46. acquisition by clicking New Test on the menu bar on the Patient Data screen File Print New Patient Patient List New Test Exit amp E if I5 ALJ S GT The New Test dialog box appears Select the test type to run Click the ECG icon in the left hand portion of the dialog box Technician Requesting Physician Indication ECG Lead Group Modified 12Lead V3RNIN2VEVEN7 OK Cancel Help Enter the name of the technician conducting the test and the requesting physician Enter the diagnostic reason for performing the ECG in the ndication field This information is optional If using a customized list configured through List Management for the practice select these entries from the lists Click on the drop down arrow for the appropriate field and click on the desired selection The ECG Lead Group drop down menu provides two options e Standard 12 Lead and e Modified 12 Lead Both options have the same limb leads I II Ill aVR aVL aVF e Standard 12 Lead has a conventional and standard chest lead placement e Modified 12 Lead uses V3 as V3R and V4 as V7 A NOTE Modified 12 Lead ECG lead group does not generate automatic interpretations The user can choose Standard 12 Lead V1 V2 V3 V4 V5 V6 for adult patients and Modified 12 Lead V3R V1 V2 V5 V6 V7 for pediatric patients if needed If performing an ECG using Modified 12 Lead option place the V3 lead on the V3R location
47. art rate appear at the top of the screen The names of the three rhythm leads for the RR Variability test are displayed to the right of RR Variability in the bottom right corner The ECG tracings are in the center of the screen moving from left to right The sweep speed gain and filter settings are below the moving tracings Click the appropriate button to modify its setting Changes to these settings made from this screen are temporary and only apply for as long as the test is active Make changes and set them as the default settings for all new ECG tests by clicking Settings Clicking on INST resets the ECG module and stabilizes the ECG baselines Print Analyze Freeze Start RR Settings Help Exit Ka LH fl oo TONE In the lower right corner of the screen are the status indicators for ECG Report and RR Variability An empty status indicator means that the user has not acquired the specific report since entering the screen Once a report is created the indicator next to the test type appears solid This indicator is not affected by tests that were previously stored or reviewed in the database The menu bar at the bottom of this screen provides different options available The available options change according to the settings and the process established The blue Settings button on the live ECG screen provides a way to change the ECG lead group after the new test is started 39 IQecg Operation Manual Print vu Analyze
48. cH 388 msec Reviewed By QRSD 90 msec P Axis 49 e 1 Review Date Details ea ph GainiX Settings Add Clear Amada KU ht I PRA EA CET AL LA E Ae geg geg L A ST WI TU Vi I 1 a Pte cer ECOLE ALL ULL SRRS Caer XE f Se i SA LA Spt Se E E an l f AA LB ME LS ET M l d l Ade EL L KX eee e o ECG RR Variability Holter Spirometry Stress Vitals Report 6 of 56 Serial Comparison Technician Rate 81 BPM PR 156 msec BP ne ar 350 msec zm QTcH 386 msec Reviewed By k QRSD 90 msec P Axis 53 Review Date 06 01 12 Saa QRS Axis 4i Details T Axis 45 Gain 1X Settings Add Clearawadd IS J ER See IRS BET EE E SEI Pen Pes D EE EE EE i LT GecH d Aer j H EE Li URES RRR eee ee CC d u i Mi We KE ilL 4L JL LE A LIA eee ge k r i S Wl It T T a I e e d al eR New Patient Patient List Patient Data Figure 3 4 Modified 12 Lead Reports collected using the Analyze function will be displayed on the Report Review screen with ECG data traces from each of the patient leads Click on any part of the ECG tracings to 43 IQecg Operation Manual zoom in to view in 2X magnification Click again on the ECG tracings to return to the normal view In normal and magnified views mo
49. cg Operation Manual Modified 12 Lead Placement Precordial amp Posterior V3R Green corresponds to V3 on the Right side V1 Red 4 intercostal right margin of the sternum V2 Yellow 4 intercostal left margin of the sternum V5 Orange Horizontal level of V4 at the anterior axillary line V6 Purple Horizontal level of V4 at the midaxillary line V7 Blue Horizontal level of V4 at the posterior axillary line Modified 12 Lead ECG Hookup E A Precordial Posterior ANOTE The live ECG acquisition screen will show the signal tracings after all limb leads have been connected When the right leg RL lead becomes detached the system behaves as if all electrodes were disconnected A NOTE Lead placement does affect the ECG waveform When the limb leads are placed on the torso waveform changes might be seen in the QRS amplitude axis shift occurs Q waves can be seen and T waves might appear flipped or flattened These changes are clinically significant in that they are associated with cardiac ischemia If a non standard lead placement is used note the variation in the ECG comment field S CAUTION Do not use Modified 12 Lead ECG Placement when performing a STAT ECG The automated ECG analysis algorithm assumes standard 12 lead ECG placement Any deviation from the standard 12 lead ECG placements may affect the accuracy of the automated interpretation 33 IQecg Operation Manual
50. complete connect the IQecg module to the computer with the steps outlined in the following section C Connecting the IQecg Module Connecting the Serial Type IQecg Module If using a serial type IQecg module attach the female end of the 9 pin communication cable to any available serial port on the PC see Figure 2 2 below Secure the connections with the thumbscrews Do not over tighten If using a USB port with the serial type IQecg module install the USB to serial port adapter before connecting the IQecg module to the adapter Secure the connections with the thumbscrews Do not over tighten 12 IQecg Operation Manual A NOTE Almost all USB to serial port adapters come with specific software drivers that must be installed prior to use Before connecting the IQecg module to any adapter ensure that all software drivers have been installed according to the manufacturer s instructions Battery Installation for Serial Type IQecg For the serial type IQecg module slide out and remove the battery door underneath the module and install 2 AA batteries see Figure 2 1 below Follow the battery positions indicated Replace the battery compartment door Follow the battery i EE Si P The battery compartment door flips closed Insert outer edge first then push down the inner edge Figure 2 1 ANOTE For the USB type IQecg no batteries are required Patient
51. e Edit Measurement Rate BPM Enter without quotes to indicated not measured or not valid A NOTE If Rate or QT value is edited the QTc 1 and QTc 2 data will automatically recalculate using the new value and the specific QTc formula For additional information see Section II D Configuring IQecg 9 ECG Settings Editing Diagnostic Statements Some patients have specific physiological profiles that can affect the IQecg interpretation of their test results If the physician believes there are any discrepancies in the diagnostic statements the statements can and should be edited To modify diagnostic statements either edit the statements directly in the text box or click Add enter new diagnostic statements or Clear Add clear all statements and add new ones from a pre established list clicking either will open the Add a Statement dialog box 45 IQecg Operation Manual Add a Statement X RIA Repolarization abnorm suggests ischemia anterior leads Repotaization abnorm suggests ischemia anterior leads Cancel In the top box begin typing the abbreviation of a statement and the statement itself e g RBBB Right bundle branch block or select a statement from the list by clicking the down arrow the statement appears in the box below where it can be edited A NOTE Ifthe statement list is empty no default ECG statement list is selected in List Management Refer to Section II D Confi
52. e MYO filter on for pacemaker patients Wait for the ECG tracings to pass the screen twice about 20 seconds to verify that the signal quality is good and the baselines are stable To acquire a test report click either Analyze or Start RR on the menu bar e Analyze instructs the program to acquire analyze and store a resting ECG test e Start RR instructs the program to acquire a preset duration of the rhythm strip and prepare a RR Variability report Reports are automatically saved and can be viewed upon exiting the ECG screen by the Review button 10 Reports on the Report Review screen are in chronological order for the patient being tested and are displayed on the ECG or RR Variability tabs 11 Review reports from other patients by clicking Patient List 62 IQecg Operation Manual C Appendix C Upgrading IQmanager software version 8 5 and earlier The following describes the changes to the original QTc data in the ECG reports with previous versions of Qmanager software after this upgrade e Information on the old ECG reports will remain the same as long as no changes are made to the report e The original QTc information will no longer be editable This value will be fixed e Add up to two of the four available QTc data to include in the ECG report See Section II D Configuring IQecg ECG Settings e Changes made to the ECG report that have the original QTc information may remove it from the report The ge
53. ectrocardiogram Analysis Program Printer e Windows supported ink jet or laser printer Paper e Plain 8 5 x 11 Letter size Modulating Effects The digital sampling techniques used by this device and the ashychronism between sample rate and signal rate may produce a noticeable modulating effect from one cycle to the next This variation may be particularly noticeable in pediatric recordings This phenomenon is not entirely physiologic IQecg Operation Manual ll System Installation A NOTE Contact Midmark Technical Service before installing and setting up the IQecg Computers today are more complex with more software and hardware options than before making each computer almost unique Midmark wants to make sure that your IQecg device is installed and configured as quickly and easily as possible Midmark Technical Service can be reached at 1 800 624 8950 option 2 A Minimum Computer Requirements This section describes the minimum computer resources and hardware components needed when using new Midmark devices and software As is the nature of technology to change often these requirements will be evaluated and modified periodically We suggest always referring to the most recent Minimum Computer Requirements document at www midmark com or contact Midmark Technical Service at 1 800 624 8950 option 2 for additional information ANOTE If updating existing computer systems currently being used with older
54. ee AV block V rate 77 SR with APCs in bigeminal pattem mean ventricular rate 7 Aberantly conducted atrial premature complexes Atrial fibrillation ventricular rate 7 Atrial flutter with 2 1 conduction ratio Arate Vase Atrial flutter with predom 3 1 conduction ratio Aate Vate Atrial flutter with predom 4 1 conduction ratio Arate 77 Vote Atrial flutter with varying conduction ratio Arate Vate Anterior infarct acute Anterior infarct old Arten ai 18 IQecg Operation Manual e Add Add a statement to the list A pop up box will appear to enter the new information Statement Category Abbreviation Statement Text Cancel Help e Edit Edit an existing statement Highlight the statement with the cursor and then click Edit Statement Category Abbreviation Statement Text linterior infarct acute Cancel Help e Delete Delete an existing statement Highlight the statement with the cursor and then click Delete A NOTE Delete All will delete all the ECG statements General List Management ECG Statements User Names Satenert Categoy Eat Gtoote Double click on an abbreviation to edit the statement First degree AV block Second degree AV block Aate 7 Vase Third degree AV block V rate 7 SR with APCs in bigeminal pattem mean ventricular rate 7 Aberrantly conducted atrial premature complexes
55. elines or manually restart the ECG module Verify patient s bed is properly grounded Verify patient or examination room is not susceptible to energy interference such as electromagnetic fields from high power equipment like X ray machines power generators power compressors etc All other operational problems Click Help found on all screens for the online help Additional troubleshooting covering ECG diagnostics is available in the Qmanager Operation Manual Contact Midmark Technical Service at 1 800 624 8950 option 2 or see the Contact Information at the end of this manual 68 IQecg Operation Manual E Appendix E Maintenance and Storage of the ECG Module Preventative Inspection A preventative inspection should occur prior to each use of the ECG module to verify that there is no visible damage to the unit that may cause it to malfunction Visual inspection should include the ECG module and all cables for signs of damage and deterioration including but not limited to cracks cuts discoloration or oxidation If a cable or other accessory exhibits any of these symptoms replace it prior to using the ECG module Cleaning Clean the outside of the ECG module with a mild solution of detergent and water using a soft cloth Avoid using excessive amounts of solution which may infiltrate the connectors battery compartments or ECG module If necessary use a mild sterilizing detergent with low alcohol con
56. epotes Ee dag EXER EAR EIE QE un ENEE ENEE 36 Li Ve EGGS vinta ba tetti ee e lun nita 37 REVIEWING BaTENrRrpop s eene snnn sse nnns s seres sa reser essais 43 EGG Report REVIEW e rii etit nee I Fe ee YE TRA REESEN dU Rega DAR DA Tu la ee 43 Editing Diagnostic Statements isses sseeeeeseee eee nh nnne natans 45 ECG Report Details REVIOWus ihe p v tV Dein e ease RE a etn 47 Setial COmpGatisOn E 53 RR Variability Report Review 55 ACCESSORIES FOR IQECG ERR ETEA 58 APPENDICES aen a eet ee A aS 59 APPENDIX A OPERATIONS AT A GLANCE STANDARD 12 LEAD ECG 59 APPENDIX B OPERATIONS AT A GLANCE MODIFIED 12 LEAD ECG ss 61 APPENDIX C UPGRADING IQMANAGER SOFTWARE VERSION 8 5 AND EARLIER 63 APPENDIX D TROUBLESHOOTING DUIDE seen 65 APPENDIX E MAINTENANCE AND STORAGE OF THE ECG Mon 69 Preventative Inspection 69 Cleaning ee ee Pt e E 69 Eil e 69 APPENDIX F MAINTENANCE AND STORAGE OF 10 LEAD RESTING ECG PATIENT CABLE 70 Instructions for blse siste e dr S dx e rhe e eee needs 70 Cleaning sect re E Rt set e DU paie 70 DISINFECTION mm 70 APPENDIX G RADIO AND TELEVISION INTERFERENCE eene enne nnne 71 APPENDIX H EMC REQUIREMENTS FOR THE IOC 71 APPENDIX SAFETY AND INTERNATIONAL SYMBOLS 0ssceccesesceeceeseseeceaeeseeseeeeseeeeees 76 IQECG SERVICE MANUAL cccssssccsssscccsscccesssccesseccessecccsteccesceccssececeseeens 77 INTR
57. f data has been collected Otherwise the program will automatically analyze the data and store the report Print RR Variability reports by clicking Exit and selecting Print or select Print After Analysis in the RR Variability Settings to print reports automatically Setting Opens a four tab dialog box for changing the Default Interpretation And Acquisition Display settings Printer Format settings RR Variability settings and Configuration which are similar to those described in Section II E Configuring the IQecg e I D Uo Displays the online Help screen Exit Indicates an ECG or RR Variability Report has not been collected Click this button to return to the Patient Data screen and terminate ECG acquisition Review Indicates at least an ECG or RR Variability test has been performed Click to display the most recent report in the Review Reports screen A NOTE Verify clean waveform before pressing Analyze or Start RR button The IQecg collects and stores a test report when Analyze or Start RR is clicked on from the Live ECG screen Selecting Analyze instructs the program to acquire analyze and store a resting ECG Report If the patient s right and left arm leads are swapped the software will then display the warning message as shown below 41 IQecg Operation Manual Midmark eng NEAN 4 Suspected Arm Lead Reversal Please verify the arm lead placement Do you want to con
58. g analysis on the last 10 seconds of data and stores this analysis as an ECG Report which can be printed from the Report Review screen or by selecting Print After Analysis in the Printer Format Settings nmi Freeze Freezes the display and copies the last 10 seconds of ECG data into a memory buffer If there are less than 10 seconds of ECG data collected the freeze function is delayed until the 10 second buffer is filled Click this button a second time to unfreeze the display and clear the memory buffer When the display is frozen click Print or Analyze 40 IQecg Operation Manual Button Icon Patient Data Screen Buttons Function s This option is only available if the Display Real time ECG Tracing setting is disabled Click on this button to display the ECG tracing acquired in the last 10 seconds Tracings are displayed in static form and are not stored Click on the Analyze button to analyze and save the ECG displayed This option is only available if the Display Real time ECG Tracing setting is disabled Click on this button to start new acquisition of ECG data A message Acquiring ECG will display on the screen o g c S t Collects ECG data for RR Variability analysis A preset duration between 30 and 360 seconds of ECG data may be collected in 30 second increments Stop data collection by clicking Start RR again No RR Variability analysis is performed if less than 30 seconds o
59. gh 2X 20mm mv 1 2X 5mm mv and 1X 10mm mv amplitudes RR Variability reports created with IQmanager Software Version 8 5 or earlier have only one rhythm lead see Figure 3 11 Each click on the arrows shifts the ECG tracings left or right by 30 seconds The data collected can also be reviewed during the RR Variability analysis in RR Trend and RR Histogram formats by clicking the Show Graphs button 56 IQecg Operation Manual lity Holter Spirometry Stress Vitals 1 04 07 10 16 44 34 Report 1 of 1 Technician Rosemarie Beats 39 Normal 35 Premature 0 Duration 41 sec Number of RR Interval 38 Mean HR 60 BPM Mean RR 986 msec Max RR 988 msec Min RR oe mear Blood Pressure PACs H Reviewed By Review Date Settings Show ECG Comments Patient List On both the resting ECG and RR Variability Report Review screens there are fields labeled Technician and Reviewed By Ensure that the name of the technician doing the ECG is entered in the Technician field and that the name of the doctor performing the ECG review and confirmation in entered in the Reviewed By field These names are important as they serve to document the ECG collection process and will assist people reviewing these reports in the future Click the Print button to print the report displayed on the screen When finished reviewing the patient s reports exit the Report Review screen by cl
60. guring IQecg List Management for how to load the default statements through List Management A NOTE If Disable Quick Edit is checked on the Default Interpretation and Acquisition Display Settings dialog box the cursor is placed in the lower edit box by default for free text entry Diagnostic statements can also be edited through the Details screen A NOTE If Disable Interpretation is checked on the Default Interpretation and Acquisition Display Settings dialog box no interpretive statement appears in the ECG Report Review screen and the top center box is blank The top right box however still displays the measurements A NOTE If a stat ECG was run STAT ECG is displayed in the ECG window above Lead I 46 IQecg Operation Manual ECG Report Details Review Click Details to display a detailed measurement screen like the one shown below Measurement Matrix d dur in msec Edit Comments l General Meas Edit Diagnosis Axis Meas Mess m avr ave ave vi v2 vi v4 vs ve TIPREUBUEE Cent Pee Pd 74 80 78 78 80 80 80 76 n Pa 0 05 0 09 0 072 0 075 0 117 0 117 0 117 omg Pd 80 LA P EN ie REI A LE P a 0 092 M Qd 16 18 15 19 20 22 23 Qa 0 03 0 05 0 031 0 061 0 102 0 131 0 104 ave TI me as a Ona ll all Rd 39 21 54 43 34 31 35
61. ician interpretation All ECG must be examined with respect to the patient s overall clinical condition The measurement box may display up to two QTc i e QT intervals corrected for heart rate based on QTc 1 and QTc 2 settings See Section II D Configuring IQecg ECG Settings When an ECG report is opened for review the QTc 1 and QTc 2 data saved last will be displayed If changes are made to the report the QTc 1 and QTc 2 information will be updated based on the current selections in the QTc 1 and QTc 2 settings 44 IQecg Operation Manual When editing a report is first started a New QTc Formula Update warning message will appear to notify the user of the changes in QTc data The change must be accepted in order to edit the report To skip future warning messages regarding QTc formula updates check the Do not show any New QTc Formula Update message again A NOTE If IQmanager has been updated from a version prior to 8 5 see section Appendix B Upgrading an IQmanager software version 8 5 and earlier to understand the impact to older ECG reports Computerized calculation of QTc is not a substitute for physician interpretation of the ECG It is the responsibility of a qualified physician to review the ECG to determine the accuracy of QTc calculation before using QTc to make a diagnosis To edit the data in the measurements box other than QTc double click on its title e g Rate for heart rat
62. icking the appropriate button on the bottom of the screen If the diagnostic statements have been edited or filled in blank fields the system will prompt to save the changes prior to exiting the screen The system will proceed to the next appropriate screen regardless of whether changes have been saved or not 57 IQecg Operation Manual IV Accessories for lQecg The following table shows the accessories approved by Midmark for use with the lQecg S WARNING Use only approved accessories with the IQecg Substitution of a component different from that supplied might result in measurement error tem Part Number Universal ECG Clips 3mmm amp 4mm 10 pack 3 047 0001 Clear ECG Clips 3 mm 4mm amp Snap 10 pack 3 047 0005 Patient Cable Standard lQecg 3 100 0199 Disposable EZ Trode ECG Electrodes box of 500 2 100 0205 Disposable EZ Trode ECG Electrodes case 10 boxes 2 100 0206 58 IQecg Operation Manual V Appendices A Appendix A Operations at a Glance Standard 12 lead ECG A condensed guide to using the IQecg to acquire a standard 12 lead ECG 1 2 3 4 5 Start IQmanager Select New Patient from the opening screen For returning patient select Patient List and search by patient s last name or ID Complete the fields on the Patient Data screen as accurately as possible Enter a name or ID number to perform a test Enter the date of birth and
63. ielded lead wires There is a 1Kohm 1096 resistor embedded inside each lead wire Together with the voltage clamping circuit built into the ECG front end the IQecg provides the built in defibrillation protection capability required by AAMI EC 11 and IEC 60601 ECG Buffer Amplifiers The patient ECG signals are first fed to the 8 ECG buffer amplifiers These buffer amplifiers provide high input resistance for the patient interface with low output resistance to the instrumentation amplifiers Instrumentation Amplifiers There are eight differential instrumentation amplifiers used in the IQecg providing eight output signals from CHO to CH7 Each differential amplifier has two inputs one positive and one negative 78 IQecg Operation Manual The following table lists the positive and negative inputs for each channel Channel Number Positive Input Negative Input CHO LA RA LL RA V6 Wilson Center CH3 V5 Wilson Center V4 Wilson Center CH5 V3 Wilson Center V2 Wilson Center CH7 V1 Wilson Center The Wilson Center is a reference point combined with the three limb leads The purpose of the instrumentation amplifier is to provide a high Common Mode Rejection Ration CMRR rejecting common mode signals such as 60 Hz line noise Filters and Gain Amplifiers After the instrumentation amplifiers the 8 channel ECG signals are passed into two stages of filters The first stage consists of eight first order high pass filters with a cu
64. imum safety for the patient the Qecg hardware and the PC are isolated with an optical coupler and or isolated DC to DC converters The serial signal sent out by the PIC microcontroller is coupled optically to the PC system either through the RS232 or USB interface There is no electrical connection between the patient and the PC system The isolation circuit can withstand up to 1000Volts Lead Off Detector The IQecg has a built in lead off detection circuit The lead off circuit senses the lead off condition and reports to the PIC microcontroller The PIC microcontroller sends out the lead off condition to the PC through the serial interface Pacemaker Detector The pacemaker detection circuit in the IQecg ensures the device s capability of printing the ECG signal in the presence of pacemaker pulses with amplitudes between 2 and 250 mV duration between 0 1 and 2 0 ms recommended by AAMI EC 11 DC DC Power Converter The Serial RS232 model of the IQecg uses two AA batteries to supply its power The USB model of the IQecg devices does not require the use of batteries The USB port of the host computer provides the operating power A step up DC DC converter is used to provide a 4 5Volt power source Two 3 3Volt regulators are used to provide two 3 3Volts power source for the analog circuits and digital circuit for the unit There is also a negative voltage converter used to generate a 3 3Volt power source for the analog circuit A Linear
65. m with colleagues via networks or email As simple to use as a traditional office ECG device it features fully integrated PC technology and a host of advanced diagnostic features 4 IQecg Operation Manual ANOTE There are two types of IQecg modules a serial COM port type and a USB port type both are designed for use with a Windows based computer The serial type ECG module requires two AA batteries and the USB type ECG module does not This manual is written for both types of modules B Necessary Computer Skills This manual is intended for a user capable of using Microsoft Windows applications has some understanding of PC operations and is familiar with the basic operations of Windows This Operation Manual is designed as a comprehensive guide designed to educate the user on the operation and functions of the IQecg device The information in this manual includes options currently available with IQecg C Configurations Typical PC Configuration The block diagram below illustrates the standard configuration of the IQecg system The primary components are a Windows based PC a printer and the IQecg acquisition module A portable computer is recommended if mobility is a consideration Please refer to this diagram when setting up your IQecg system Patient Cable 10 lead patient IQecg Windows based connection module computer Figure 1 2 Block Diagram for the IQecg system Thin Client Configurations
66. mei The user can select Standard 12 Lead or Modified 12 Lead group from the ECG Lead Group drop down menu at the bottom of the Default Interpretation And Acquisition Display Settings page If the ECG lead group is changed and OK button is clicked the lead group change takes effect immediately Button Icon r ECG SETTINGS NN Printer Format Settings RR Variability Settings Configuration Default Interpretation And Acquisition Display Settings Gain Filters C 5mm mV JW AC Filter 10mm mV Muscle Filter C 20mm mV v Drift Filter Rhythm Lead Lead Group Display Format ji x uw v 34 Leads IV Display Realtime ECG Tracing 4 Leads Waveform Smoothing 12 Leads Disable Interpretation Display Mode Disable Quick Edit Legacy Disable QTc Formula Waming C Enhanced Hide Measurement Matrix QTc 1 QTc2 Ho EI Hp ECG Lead Group Standard 12 Lead V1 V2 V3 V4 V5 V6 EN cel Patient Data Screen Buttons Function s Prints the last 10 seconds of ECG data being collected This report contains no measurements or diagnostic statements If data is not actively being collected this function prints out the last 10 seconds of data in memory A NOTE Clicking Print more than once before the report is printed produces multiple printouts Exit is disabled until the report is printed To speed up printing click Freeze before clicking Print Analyze Performs restin
67. munications port is COM 1 Click Auto Detect to find the port that the IQecg is connected to The IQecg module must be connected to an available serial port on the computer Confirm that a fresh set of batteries is installed in the ECG module and click Auto Detect for ECG COM ports Configuring for USB Type IQecg Module If using a USB type IQecg and it is already connected to the computer the ECG COM Port setting will be disabled once it is detected Serial Communications Port Setup ECG COM Port Spirometry COM Port Vital Signs E zl r USB Detected Auto Detect Thin Client Channel Weight Scale Enable Scale EEN COM Port Mapping Cancel Help 15 IQecg Operation Manual Thin Client Channel Setting The Thin Client Channel setting applies only when using IQmanager in a thin client environment This setting is ignored when the software is not running in a thin client environment The drop down list contains the following selections e COM port mapping default e Microsoft RDP e Citrix Select COM port mapping if using Qmanager in a thin client environment and are not using lIQpath If using IQpath select Microsoft RDP or Citrix depending on what the clients and servers are using Refer to the document Setup Manual Midmark Products over Thin Client using IQpath or COM port mapping for more information Database Settings IQmanager uses the local database by default If using
68. neral rules of thumb are 1 Changing the interpretation statement or general measurement values other than heart rate or OT will retain the original QTc data This is to preserve the original QTc value to support the physician s interpretation Additional QTc information will be added to the report based on the current selections in QTc 1 and QTc 2 settings 2 Changing the heart rate or QT value will remove the original QTc data and replace it by the current selection in QTc 1 and QTc 2 settings The original QTc value is redundant in this case since QTc will be recalculated based on the new heart rate or QT values 3 If the report already has the QTc 1 and or QTc 2 data any changes to the report will update the QTc 1 and QTc 2 information based on the current selection in these settings e Awarning message will appear to inform the user of the changes in QTc data when you begin to edit the report Accept the change in order to edit the report e Optional Check Do not show any New QTc Formula Update message again to disable the warning message e The original QTc data in the Measurement Matrix will be removed and replaced by the new QTc 1 and QTc 2 information e Accessing the P QRS T Calipers will display the QTc information based on the current QTc 1 and QTc 2 settings Moving the calipers that measure the QT interval will automatically update the new QTc values according to the specific formula 63 IQecg Operation Manual
69. network performance System administrators should read Setup Manual Midmark Products over Thin Client using IQpath or COM port mapping before installing configuring and using this software in a thin client environment The following block diagram describes IQpath In this thin client environment the client computers must be running Windows 8 or 7 Terminal server Windows based clients Network Windows based client 10 lead SES patient IQecg USB or connection module serial To use IQpath load Qmanager on the terminal server and install one of the following software components on each client PC to be used for data acquisition e iQpath for Microsoft Terminal Services If using Microsoft Terminal Services Microsoft RDP Patient Cable Figure 1 3 IQecg Operation Manual e Opath for Citrix ICA If using Citrix software on the clients and servers These software products are provided separately and may be obtained by contacting Midmark Technical Service at 800 624 8950 option 2 Once the software is installed on the client server network and computers Qmanager must be configured for thin client operation as described in Section Il C Connecting the IQecg Module and Section II D Configuring IQecg or refer to the IQmanager Operation Manual Section VI F Configuring Client Server Networks Thin Client Using COM Port Mapping COM port mapping refers to a configuration in which
70. o run as a full screen program For best results the Windows Taskbar should not be displayed in order to provide maximum display area Place the mouse pointer on the blank portion of the Taskbar on the bottom of the screen then right click and select Properties Check the Auto hide the taskbar box to hide the taskbar when it is not in use to display the taskbar when it is hidden move the cursor over the area where the taskbar is normally set and it will reappear Screen Saver If a screen saver or any energy saving feature is enabled on the computer make sure that it does not activate and interfere with data acquisition during patient care Refer to your computer or software manual for these settings Installation Steps for IQmanager A NOTE Close all Windows programs before running this software installation Do not interrupt the installation program while it is running The installation should take less than five minutes 1 Unplug all IQ devices from the computer before running the software installation 2 Insert the Qmanager Installation CD into the CD ROM or DVD ROM drive The installation starts automatically If the installation does not start automatically double click My Computer on the desktop and double click the CD ROM icon to start 3 Follow the instructions on the screen For detailed installation setup and detailed operation instructions please refer to the Qmanager Operation Manual 4 Once installation is
71. of a typical location in a typical magnetic field IEC 61000 4 8 commercial or hospital environment ANOTE Ur is the A C mains voltage prior to application of the test level 73 IQecg Operation Manual Guidance and manufacturer s declaration electromagnetic immunity The IQecg is intended for use in the electromagnetic environment specified below The customer or the user of the IQecg should assure that it is used in such an environment Immunity test IEC 60601 test level Compliance Electromagnetic environment guidance level Portable and mobile RF Communications equipment Gef should be used no closer to any part of the IQecg A including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Recommended separation distance Conducted RF 3 Vrms 3 Vrms d 1 2vP IEC 61000 4 6 150 kHz to 80 MHz Radiated RF 3 V m 3 V m d 1 2 V P 80 MHz to 800 MHz IEC 61000 4 3 80 MHz to 2 5 d 1 2 V P 800 MHz to 2 5 GHz GHz where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer and d is the recommended separation distance in meters m Field strengths from the fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range j Interference may occur in the vicinity of equipmen
72. quipment The following is a list of the Midmark cables and other accessories that are used as part of the IQecg that comply with sections 36 201 and 36 202 of the EMC Standard IEC60601 1 2 E e ECG Model s IQecg e Patient cables Approved Midmark cables with 4mm banana connectors or pinch leads Use of cables cable extensions or accessories other than those specified with the exception of cables and accessories sold by the manufacturer of the IQecg as replacement parts for 71 IQecg Operation Manual internal components may result in increased EMISSIONS or decreased IMMUNITY of the IQecg Guidance and manufacturer s declaration electromagnetic emissions The IQecg is intended for use in the electromagnetic environment specified below The customer or the user of the IQecg should assure that it is used in such an environment Emissions Test Compliance Electromagnetic environment guidance RF emissions Group 1 The IQecg uses RF energy only for its CISPR 11 internal function Therefore its RF emissions are very low and are not likely to cause any interference in nearby electronic environment RF emissions Class B The IQecg is suitable for use in all CISPR 11 establishments including domestic establishments and those directly connected to the public low voltage power supply network that supplies buildings used for domestic purposes Harmonic Emissions N A Battery operated device
73. r operating the IQecg through I Qmanager A faster CPU and or more Memory may be required if planning to operate the IQecg through an EMR or install additional software A NOTE USB ports contacts can become worn with repeated use The IQecg test may not function with a worn USB port B Software Installation A NOTE The following software installation information refers to lQmanager only If using an IQecg through an EMR please contact Midmark Technical Service for assistance with installation and setup The medical diagnostic application IQecg uses lIQmanager to manage patient records When installing or upgrading the IQecg IQmanager is automatically installed or upgraded accordingly Refer to the Qmanager Operation Manual for further information Other Midmark products can also be accessed from IQmanager such as IQholter IQspiro lOstress IQvitals IQvitals PC and Weight Scale Interfaces Contact the Midmark Sales Department for the latest information on available Midmark products or visit midmark com A NOTE If IQmanager is already installed on the computer and are now either upgrading or adding a new Midmark product please skip this section and refer to the IQmanager Operation Manual for installation information Before installing IQmanager on a computer it is important to understand and carry out the following tasks 11 IQecg Operation Manual Windows Taskbar IQmanager is designed t
74. radio button then simply move the mouse to a desire location and click 4 Repeat with the rest of the measurement points 51 IQecg Operation Manual zi Measurement Matrix COR REECH p Durations beer Intervals msec 64 70 64 68 oi 298 Si per 0041 0 095 0 043 op QRSd E DI 362 eomm 20 14 0 046 0 034 I 33 39 31 26 Now Setting 5 0097 0 6634 0200 04 G P nsel C QRS Onset T Onset C P Offset C ORS Offset C T Otfset C None 25 34 44 Cancel 9 0 048 0 732 11 162 164 150 168 164 188 164 0214 0297 0 085 0 075 0190 0085 02 E View 1X Calipers a ampl in mv d 7 dur in msec Show Ref Points Edit Comments General Meas Show ECG Edit Diagnosis Axis Meas Gain 1X Print OK Help A NOTE When moving the calipers the relevant values in the P QRS T Calipers box will change The QTc data will automatically update based on the specific equation s heart rate or RR and QT as described in Section III E Reviewing Patient Reports ECG Report Review xi e j Do you wish to save the new PR QRSd QT and QTcH WR measurements No Clicking Yes above will update the PR QRSd QT QTc 1 and QTc 2 measurements in the General Measurements box and ECG Report Review screen View and edit the diagnostic statements from the ECG Report Review Details screen by clicking Edit
75. rect serial port Refer to Sections II B and ID A The graphics display adapter in the computer is too slow displaying the live ECG for the current display settings B The computer might also be too slow or too busy running other programs in the background C If running live ECG in a thin client environment the bandwidth Message appears after starting a new ECG DISPLAY DIAGNOSTICS maybe too low Delays in the ECG display e Click Help and follow the recommendations on the Help screen have been detected Click e Verify that the Waveform Smoothing option is off and set to Help to diagnose this display in 4 leads display format This is found under Default problem Interpretation and Acquisition Display Settings tab on Settings Message appears while function running an ECG e Verify no other tasks or programs running Exit IQmanager and close all running programs Restart Qmanager without restarting the computer e If the above fails to correct the problem disable the Display Real time ECG Tracing under Default Interpretation and Acquisition Display Settings tab on Settings function 65 IQecg Operation Manual Error Message Problem ECG MODULE NOT RESPONDING Message appears after starting a new ECG test No ECG tracing is displayed on the screen Troubleshooting Guide Recommendation Possible Solution The program cannot communicate with the ECG module because it is not on not connected
76. rn FEET E de Si LC Ee ATA Td 194 194 188 194 194 192 190 188 v2 Ta 0 05 0 114 0 265 0 062 0 165 0 162 0 13 0 22 m 488 xe A S v5 SC GEES SCH zt View 2x Calipers RIS hia n tn d dur in msec L1 Sa S Bibi Edit Comments J General Meas EXE PIE Show Medians l Edit Diagnosis Axis Meas v Peer ee eck Ge Ganix Print Il ok JI Hee gt Figure 3 6 Modified 12 Lead If Standard 12 Lead V1 V2 V3 V4 V5 V6 is selected the chest leads and measurement columns are arranged in the order of V1 V2 V3 V4 V5 V6 see Figure 3 5 If Modified 12 Lead V3R V1 V2 V5 V6 V7 is selected when acquiring a new ECG report the chest leads of ECG tracings and measurement columns are arranged in the order of V3R V1 V2 V5 V6 V7 see Figure 3 6 47 IQecg Operation Manual If Hide Measurement Matrix is checked on the Default Interpretation and Acquisition Display Settings dialog box the Details screen will display longer ECG strips L IEEE HERES HR ERE ERE MET Ped Pant Bit E E E EE L ECHTER Ps le ESATA ATTA ALTA A ee Bus LB UH LESE BB E m EISE Keeper eg D S xr E bob i Bae CRESS ESSE I7 L WE EE onan ENBEI BRE FEES aeee nU EE LEE Standard 12 Lead V1 V2 V3 V4 V5 V6
77. s desktop Connect to the Midmark website These links only work if connected to the Internet STAT ECG 4 WARNING Follow standard 12 lead ECG placement when performing a STAT ECG The automated ECG analysis algorithm assumes standard 12 lead ECG placement Any deviation from the standard 12 lead ECG placements may affect the accuracy of the automated interpretation In the event that a stat ECG is required hook up the patient using a STANDARD 12 lead hook up to the IQecg and click STAT ECG to immediately access the live ECG test screen without having to enter the patient information A live ECG report can be printed without saving the 35 IQecg Operation Manual patient test or click Analyze to have the computer analyze and save the report The system will prompt the user to enter the patient information when exiting the Report Review screen A NOTE The green LED on the ECG module will light when the module is on D Testing a New Patient To create a new patient file click the New Patient icon on the Opening screen This opens the Patient Data Entry screen to enter the patient s specific data ANOTE If changes are made to any of the Vital Signs tabs after clicking New Patient from the Opening screen a patient record must be created in order to exit the screen Last Name Smith Date Of Birth mm dd yyyy First Name John M R Sex View Data ID SMITH10000 Race mm Smoking Hi
78. serial version module IEC 61000 3 2 only Voltage fluctuations N A Battery operated device serial version module flicker emissions only IEC 61000 3 3 72 IQecg Operation Manual Guidance and manufacturer s declaration electromagnetic immunity The IQecg is intended for use in the electromagnetic environment specified below The customer or the user of the IQecg should assure that it is used in such an environment Immunity test IEC 60601 test level Compliance level Electromagnetic environment guidance Electrostatic discharge ESD 6 kV contact 6 kV contact Floors should be wood concrete or ceramic tile If floors are 8 kV air 8 kV air covered with synthetic materials IEC 61000 4 2 the relative humidity should be at least 3096 Electrical fast 2 kV for power N A Battery operated device transient burst supply lines IEC 61000 4 4 1 kV for 1 kV for input output lines input output lines Surge 1 kV differential N A Battery operated device mode IEC 61000 4 5 Voltage dips 596 Ur N A Battery operated device short 9596 dip in U interruptions for 0 5 cycle and voltage variations on 4096 Ux power supply 6096 dip in Ux input lines for 5 cycles IEC 61000 4 11 70 U 30 dip in Ux for 25 cycles 596 Ur 9596 dip in U for 5 sec Power Power frequency magnetic fields frequency should be at levels characteristic 50 60 Hz 3 A m 3 A m
79. sex of the patient Enter the patient s vital signs If the patient has a cardiac history or is taking prescription medications make sure to enter them on the appropriate tabs When the Patient Data screen is complete prepare the patient for the resting ECG test Refer to the Quick Reference User s Guide included with the IQecg kit for a standard 12 lead hookup or refer to Section IIl B Patient Preparation of this operation manual The green LED on the module will light when the ECG module is on Select New Test on the menu bar select the ECG test type and enter relevant information New el K List Geer Data New Test 7 The following window will appear E EC Test Type Technician Sarah May RN ECG Requesting Physician Dr Grand S Indication Shortness of breath Y Holter ECG Lead Group 3 D Spirometry D Gs c a Make sure ECG is selected for Test Type b Select or enter the Technician Requesting Physician and Indication information c Select Standard 12 lead from the ECG Lead Group drop down menu 59 IQecg Operation Manual 8 9 10 11 12 13 14 Click OK when the patient is prepared and comfortable Adjust the sweep speed and gain as necessary If artifacts or noise occur in the ECG signal please refer to ECG signal quality problems in the Troubleshooting Guide for corrective actions Do NOT turn the
80. splashing water e Do not install the instrument where humidity ventilation direct sunlight or air containing dust salt sulfur etc might affect it e Protect the instrument from shock and vibration while transporting it e Do not install the instrument in a chemical storage area or where gas is generated 2 Preparation of the instrument prior to operation e Verify proper instrument operation e Check that all cable connections are safe and secured e When in use with additional equipment such as a computer request the assistance of personnel familiar with the additional equipment if needed 3 Observe the patient and instrument closely during use If any abnormality is observed immediate proper action such as stopping the operation of the instrument should be taken for the safety of the patient 4 Keepthe instrument clean to ensure trouble free operation for the next use 5 n case of a malfunction contact Midmark Technical Service at 800 624 8950 option 2 and describe the problem precisely 6 Inspect the instrument and accessories regularly 7 Donot make any modifications to the instrument 8 Environmental operating limits Operation e 59 to 95 F 15 to 35 C e 30 to 75 humidity non condensing e 760mm Hg 20 Storage Shipping batteries removed e Ato 120 F 15 to 50 C e 30 to 95 humidity non condensing e 760mm Hg 20 IQecg Operation Manual amp DANGER There is a possible e
81. story Contact Info Risk Factors Diagnostic Repo rts gns Medications History Vital Signs Type Date Reviewed Reviewed By Comments Format Weight Ibs E Temp deg F Height inches SpO2 BMI Resp Rate RPM BP H Pulse BPM Pain Score L ___New Vital Signs _ Review Vital Signs _ A NOTE A patient name or ID must be entered to start a new test It is highly recommended to enter all information available including an ID Click in any text box or press the Tab key to enter information This information may not be essential for the acquisition of an ECG however it is important to complete each of the fields as accurately as possible particularly Date of Birth Sex and Medications which are used by the Midmark 12 Lead Resting ECG Analysis Program to produce diagnostic statements The blood pressure values entered will be displayed and printed on the ECG report The Midmark analysis program is capable of interpreting ECG from infant to adult age by using age dependent criteria It automatically calculates the age of the patient based on the date of birth entered on the Patient Data screen and the current date of the computer Please make sure that the date and time on your computer is current 36 IQecg Operation Manual Refer to the Qmanager Operation Manual for additional information on the Patient Data screen Live ECG When the patient is properly prepared calm and is comfortable initiate the ECG data
82. sure proper administration of the test making a diagnosis obtaining expert opinions on the results and instituting the correct treatment X CAUTION Federal Law restricts this device to sale by or on the order of a physician X CAUTION The automated ECG analysis algorithm assumes standard 12 lead ECG placement Any deviation from the standard 12 lead ECG placements may affect the accuracy of the automated interpretation S CAUTION Follow standard 12 lead ECG placement when performing a STAT ECG Related Documents The following documents may be needed in order to operate Midmark diagnostic devices and software products with the IQecg Digital ECG e Qecg Quick Reference User s Guide Performing a 12 lead Resting ECG Test Part number 3 100 1116 e Qmanager Software Operation Manual Part number 4 100 1200 e Setup Manual Midmark Products over Thin Client using IQpath or COM port mapping Part number 3 100 1126 All documents referenced above are located on the Midmark Operation Manuals CD part number 3 100 1000 included with every device All product Operation Manuals can also be downloaded from midmark com For additional information contact Midmark Technical Service at 1 800 624 8950 option 2 IQecg Operation Manual W Precautions Read the following precautions to ensure proper operation of the IQecg 1 Installation and maintenance of the instrument e Install and keep the instrument away from
83. t Thin Client Channel COM Port Mapping M Lone Most of the settings on this screen are controlled by the Qmanager Configuration Settings and therefore cannot be changed except for the line frequency and COM port auto detection for the IQecg Changes to these settings can be made from either screen Click OK on the ECG Settings dialog box to save any changes made The system will return to the Qmanager Configuration Settings dialog box Once the configuration settings are set appropriately click OK on the Qmanager Configuration Settings dialog box to store the settings These settings will become effective the next time IQmanager is started Click Cancel if configuration changes are not to be saved 30 IQecg Operation Manual Click Default to restore the IQmanager configuration settings except Institution Name Address and List Management to their default values Ill Operation WARNING The IGecg module has been designed and tested to meet IEC 60601 2 25 and AAMI EC11 defibrillation protection standards In the event of defibrillation follow the instructions on your defibrillator and adhere to all warnings and cautions A Introductory Notes This manual describes how to use the various IQecg features and the operational sequence most users will follow This does not mean that a user is restricted to following this particular sequence There are certain sequences that must alwa
84. t marked with the following symbol ANOTE 1 At 80 MHz and 800 MHz the higher frequency range applies DNOTE 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the lQecg is used exceeds the applicable RF Compliance level above the IQecg should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as re orientating or relocating the IQecg Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m 74 IQecg Operation Manual Recommended separation distances between portable and mobile RF communications equipment and the IQecg The IQecg is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled The customer or the user of the IQecg can help prevent electromagnetic interferences by maintaining a minimum distance between portable and mobile RF communica
85. tent such as those generally used in hospitals Verify that all equipment including accessories is completely dry before using Z4 CAUTION Do not use aromatic hydrocarbons rubbing alcohol or chlorinated solvents for cleaning the ECG module Storage Avoid extreme humidity and heat during storage If applicable To prevent damage to the IQecg module due to battery leakage or oxidation remove all batteries if the module will not to be used for a long period of time 4 CAUTION To prevent possible damage do not hang the IQecg module by the interface cable or the patient cable The module is constructed with a study built in hanger to accommodate safe storage when not kept in the carrying case 4 CAUTION Electronic devices can be damaged by exposure to liquids Do not use or store the IQecg near any type of liquids 69 IQecg Operation Manual F Appendix F Maintenance and Storage of 10 Lead Resting ECG Patient Cable Instructions for Use Check the cable integrity before each use In case of damage of any kind do not use and do not attempt to repair cable Contact Midmark Technical Service for a replacement cable If cable is found to be contaminated clean and disinfect it according to instructions below before reusing Plug the 10 Lead Resting ECG Patient Cable to the IQecg module as described in Section II of this Qecg Operation Manual Figure 2 2 Make sure the connection is tight Check the connection
86. the ECG device connects to a serial port of the client and the server is configured so that logical COM ports on the terminal server are mapped to the physical COM ports of the client If using a non Windows based thin client terminal device on a low latency high speed network use the serial port versions of the ECG device and configure the thin client server for COM port mapping A NOTE In order to use the COM port mapping solution in a thin client environment the computer hardware and software as well as the network must meet stringent performance requirements System administrators must read the document Setup Manual Midmark Products over Thin Client using IQpath or COM port mapping before installing configuring and using this software in a thin client environment using COM port mapping A NOTE If using wireless in a Thin Client Environment check waveform to ensure data integrity IQecg Operation Manual The following block diagram illustrates the use of the ECG device in a thin client environment using COM port mapping Terminal server Patient Cable 10 lead patient lQecg connection module Figure 1 4 To use the ECG device in this configuration install IQmanager on the terminal server and configure the server to map to the COM port on the client terminal System administrators should configure the terminal server for COM port mapping as described in the document entitled Setup Manual Midmark Products over
87. the modified 12 lead resting ECG test as follows a Prepare V3R and V7 electrode sites according to best practice b Apply new electrodes on V3R and V7 sites c Remove V3 lead and attach to V3R electrode d Remove V4 lead and attach to V7 electrode Refer to Section IIl B Patient Preparation of this operation manual for additional information Select New Test on the menu bar File Print New Patient Patient List Patient Data New Test E en Y amp The following window will appear TT es n Test Type Technician Abigail Smith RN p eme a ECG Requesting Physician Dr Kramer m C RU Indication Dizziness Holter a ECG Lead Group Modified 12 Lead V3A VIN2V5VEV7 v dm C Spirometry Cy Stress Cancel J e Make sure ECG is selected for Test Type e Select or enter the Technician Requesting Physician and Indication information Select Modified 12 lead from the ECG Lead Group drop down menu A NOTE Modified 12 Lead ECG lead group does not generate automatic interpretations 5 Click OK when the patient is prepared and comfortable 61 IQecg Operation Manual 6 7 8 9 Click on the Settings button at the bottom of the screen to adjust the sweep speed and gain as necessary e fartifacts or noise occur in the ECG signal please refer to ECG signal quality problems in the Troubleshooting Guide for corrective actions Do NOT turn th
88. tinue with saving this report Select Yes to save the report Select No to discard this test correct the arm leads and re test the patient Selecting Start RR instructs the program to begin acquisition for an RR Variability Report When a minimum of 30 seconds of ECG data has been acquired the program proceeds to analyze the data and will store an RR Variability report in the Qmanager database There is no limit to the number of reports collected for a given patient using the Analyze and Start RR functions Resting ECG and RR Variability reports are stored in the designated database for future reference whether locally on the hard drive or remotely in a central database IQmanager provides many record management features that make it easy to retrieve and review this information later 42 IQecg Operation Manual E Reviewing Patient Reports After a report has been collected through Analyze or Start RR click Review on the Live ECG screen to access the Report Review screen Data from the latest report collected will be displayed with the format reflecting the method of collection i e Analyze or Start RR ECG Report Review Measurements x ECG RR Variability Holter Spirometry Stress Vitals Diagnostic 1 05 24 12 15 08 19 EZR Report 1 of 50 Seel Comparison Statements Marked sinus Bradycardia Rate 81 BPM Nonspecific QRS widening PR 154 msec BP 1 Si QT 352 msec m BORDERLINE QT
89. tions equipment transmitters and the IQecg as recommended below according to the maximum output power of the communications equipment Rated maximum output power of transmitter Separation distance according to frequency of transmitter m Ww 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2 5 GHz d 12VP Erde ME 0 01 0 12 0 12 0 23 0 1 0 38 0 38 0 73 1 1 2 1 2 2 3 10 3 8 3 8 7 3 100 12 12 23 For transmitters rated at a maximum output power not listed above the recommended separation distance d in meters m can be estimated using the equation applicable to the frequency of the transmitter where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer ANOTE 1 At 80 MHz to 800 MHz the separation distance for the higher frequency range applies ANOTE 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people 75 IQecg Operation Manual I Appendix I Safety and International Symbols The following symbols are used on Midmark products These symbols appear on products when applicable Refer to this directory for details concerning the symbols used on equipment Description 5 Follow instructions for use Year manufactured 80mA DC VOLTAGE USB CONNECTION DEVICES This device uses 5 Volt power and consumes 80mA when
90. to the computer or is connected to the wrong port ANOTE For Touchscreen Display users If using the same COM or USB port for the ECG module and the touchscreen display close or disable the touchscreen driver before running the IQecg program e Verify that the ECG module is connected to the correct serial port Refer to Sections II B and II D e For Valentine ECG module Verify that the ON LED on the ECG module is lit If not push the power button For Valentine ECG verify that the Low Battery LED is not blinking If it is install new batteries e For IQecg module Verify that the LED on the top cover is green If the LED is red install new batteries If there is a Q symbol on the module it may be necessary to press it to turn the power on ECG SECURITY KEY NOT FOUND Message appears after clicking Analyze This message only appears when using the Valentine PC ECG module and not with the IGecg module IQmanager cannot find the Security Key for the Valentine PC ECG because it is either not installed or there is a conflict with the parallel port e Verify that the Security Key is installed directly on the parallel printer port of the computer and that the printer cable is connected to the back of the Security Key Ensure that the printer is on and ready or online e Print from Windows Notepad or any text file to verify the parallel port is working properly with the Security Key installed ERROR THERE
91. toff frequency of 0 048Hz The second stage consists of eight low pass filters with a cutoff frequency of 159Hz The ECG signals are also amplified to match the AD converter input dynamic range of 0 2 5V There are eight test points provided on the PCB board The test points are labeled as CHO CH1 CH2 CH3 CH4 CH5 CH6 and CH7 The signals measured on these test points are amplified with a gain of 125 and DC offset to 1 25Volt Analog to Digital Conversion The AD converter used is ADC12138 from National Semiconductor The AD converter is 12 bit plus sign serial UO A D converter with MUX and Sample Hold The amplified and filtered 8 channel ECG signals are passed to the 8 channel inputs of the AD converter The sampling rate for each channel is 500Hz The digitized ECG data are sent to the microcontroller through the serial interface Microcontroller The microcontroller is a PIC16LC67 chip from Microchip Technology This chip has 8Kx14 OTP 33 I O lines and built in serial interfaces for A D converter and RS232 The microcontroller receives the digitized ECG data from the AD converter and encodes the data with packets and sends out to the PC through serial interface circuitry The setting for the RS232 is 8 bit data 1 bit stop no parity and 115 000 baud rate and is usually handled automatically Settings for USB are automatic and are not user selectable 79 IQecg Operation Manual Isolated Serial Interfaces To provide the max
92. up V1 V2 V3 VA V5 V6 ECG Lead Group E dified 12 Lead A NOTE This setting does not affect STAT ECG oaie Pain STAT ECG assumes standard 12 lead ECG V3R V1 V2 V5 V6 V7 placement amp NOTE Modified 12 Lead ECG lead group does not generate automatic interpretations A NOTE For all pacemaker patients it is strongly recommended that the ECG be performed with all filters turned off particularly the MYO filter Any artifacts in the ECG should be corrected at the source i e making sure the electrode sites are clean of lotion or body hair the electrodes are fresh and sticky and are adhering properly on the skin Patient should be supine relax and not talking Refer to ECG Signal Quality Problems in the Troubleshooting Guide for more details 26 IQecg Operation Manual Printer Settings Click the Printer Format Settings tab of the ECG Settings dialog box to select the default ECG report format Default Interp Printer Format Settings Printer Format Settipat tion And Acquisition Display Settings R Variability Settings Configuration C Six By Two Twelve Lead Format C Twelve Lead With Three Lead Rhythm Format c 2 Page Format 25mm sec 50mm sec KS Print After Analysis M Grid 2 Black M Print Measurements C m Rhythm Lead Group The Rhythm Lead V3 V3R specifies Lead V3 if Standard 12 Lead V1 V2 V
93. ve or pan the ECG tracings to view the other leads by holding down the Shift key and dragging with the mouse The Sign checkbox is used for signing off the report If the Sign checkbox is unchecked it indicates the report has not been signed by a physician and can still be edited If the Reviewed By box is filled in with a physician s name and the Sign checkbox is checked and saved when the review screen is exited the report becomes read only If the user tries to check the Sign checkbox without first typing the reviewer s name in the Reviewed By box a warning message will pop up as follows IQmanager A Reviewed By name must be completed before report can be signed If Standard 12 Lead V1 V2 V3 V4 V5 V6 is selected the chest leads are arranged in the order of V1 V2 V3 V4 V5 V6 see Figure 3 3 If Modified 12 Lead V3R V1 V2 V5 V6 V7 is selected the chest leads are arranged in the order of V3R V1 V2 V5 V6 V7 see Figure 3 4 A NOTE Modified 12 Lead ECG lead group does not generate automatic interpretations If the ECG amplitude is too tall or too short for viewing click Gain 1X to increase the amplitude gain to 2X 20mm mv or decrease to 1 2X bmm mv The analysis results are displayed in the two text boxes on the upper right portion of the Report Review screen The attending physician must review and evaluate the diagnostic interpretation and the measurements The computerized interpretation is not a substitute for phys
94. xplosion hazard if used in the presence of flammable anesthetics 9 The lQmanager Diagnostic Workstation software and the IQecg have been tested for proper function with the Off The Shelf OTS Operating Systems OS specified in this manual Do not operate the lOmanager Diagnostic Workstation and the IQecg with an operating system other than the OTS OS specified Future releases of currently approved operating systems should not be used until Midmark has had an opportunity to test the IQecg with them Before updating your operating system contact Midmark Technical Service for the latest OTS operating systems information S CAUTION Replace the patient cable with Midmark patient cables equipped with built in defibrillation protection Contact Midmark Technical Service for cable replacement 4 CAUTION Electronic devices can be damaged by exposure to liquids Do not use or store the IQecg near any type of liquids 4 CAUTION Contact Midmark Technical Service for any servicing questions Contents Checklist The IQecg kit contains the items listed below Open the package and account for each item Inspect them for any signs of damage such as dents cracks tears or scratches If an item is missing or damaged contact Midmark Technical Service at 1 800 624 8950 option 2 for replacement Quantity Each Description IQecg Device data acquisition module 10 Lead Patient Cable 10 pack Clear ECG Clips 100 pack Disposable EZ
95. y with service of the IQecg data acquisition module For information regarding the operation of the IQecg please consult the Qecg Operation Manual for information about the service and operation of the PC system please consult your PC s documentation B Theory of Operation The IQecg data acquisition module is an improved version of previous hardware modules Some features for the IQecg data acquisition module include e Built in defibrillation protection circuit e Hardware lead off detection circuit e Hardware pacemaker detection circuit e Analog bandwidth from 0 05Hz to 150 Hz e Digital sample rate of 500 Hz e USB computer interface or RS 232 Serial COM port interface 77 IQecg Operation Manual Pacemaker DC DC Power Detector Circuit Lead Off Detector 10 Leadwire Patient Cable ECG Buffer e Instrumentation Filters and Gain with Defib Amplifiers Amplifiers amplifiers Protection Patient 8 Channel A D Isolated Serial Microcontroller 9 PC System Converter Interface Figure 6 1 System Block Diagram 10 Leadwire Patient Cable The IQecg uses the special Midmark 10 Leadwire patient cable for its 12 lead ECG data acquisition The patient cable has 10 conductor sh
96. ys be followed such as entering a patient s medical data prior to acquiring an ECG However this program is designed to be both user friendly and flexible Many of the features are interconnected and can be accessed from more than one screen The menu bar buttons or tabs on each screen lead the user to a different screen or feature To enter any of these screens click once on the appropriate selection For user convenience we have included a condensed guide to the operation of the IQecg with new patients in Appendix A Operations at a Glance B Patient Preparation Careful preparation of the patient s electrode sites is important for obtaining an interference free ECG and accurate result The skin is naturally a poor conductor of electricity and frequently creates artifact that distorts the ECG signal due to dry or dead epidermal cells oils sweat and dirt Well managed skin preparation will reduce the resistive barrier that causes muscle noise and baseline wander ensuring high quality signal and test data Instructions for Performing ECG Acquisition Patient Position The patient should be placed comfortably in a supine position Any variation should be noted on the ECG report 31 IQecg Operation Manual Prepare Patient Skin e Shave hair from electrode sites if necessary Reference diagrams below e Abrade these areas with fine sandpaper or an abrasive pad e Rub skin with alcohol wipes Allow the skin to air dry

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