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Portable Bedside Capnograph/Pulse Oximeter

1. sssssssssseeeeeene nennen 64 Table 19 Monitor Parameters ccccccccceeceeeceeeeeeeeeeaeeeaeeeaeeeaeeeaeeeaeeeaeeeaeeeaeeeaeeeaaeeaeeeaeeeaeeeaaeeeeeeess 67 Table 20 Printed Reports Parameters ssssesssssssssseeeeeeeee nennen ener nnne 70 Table 21 Data Transfer Types cccccceceeeeeeeneaeeeceeeeeeeeeeaeeeeeeeececeeeaaeeeeeeeesescessaeeceeeeesesesesieeetees 75 Table 22 Select Data Output Type sssssssssssssseeeeeeneee enne enne nnne ne nennen ener nens 7T Table 23 File Naming Conventions sssssssssssssseeneeeenene em eee enne n e nennen nens 78 Table 24 D A Signal Vales dtc teet ree etn E ERE De Wun Se RA FERA RBS EET RR ERROR a Du ped 81 Table 25 D A Cable color codes sss eene nemen nennen nnne een EEEE EEEE ener 82 Table 26 Nurse Call Specs cede eO aba Ee ERE A EE ER ue VERRE Vena aa OR exa CEPR eve ES aue ds 83 Table 27 Nurse Call Indicators essssssssssssseeeeee a eene a aoa aaa Dea 84 Table 28 Factory Default Alarm Limits ueeeseeeseseesssseseee nennen enne nnne nnn nnn nnns 98 Table 29 Factory Default and Optional Trend Settings sessssssseeseeeeee 99 Portable Bedside Capnograph Pulse Oximeter Safety Information Warnings Definitions To use the Capnostream 20 monitor henceforth referred to as Capnostream correctly and safely carefully read this ope
2. 108 8 Portable Bedside Capnograph Pulse Oximeter List of Figures List of Figures Figure 1 Installing the Battery Pack rn eee nen 19 Figure 2 Battery Pack Close up ssssssssssssssssssseeeene eene eene nennen nennen trt E nenne rennen 19 Figure 3 Menu Bar with Battery Charge Level sssssssssseeeemeneeeeen eene 20 Figure 4 Monitor Bottom View sesseeenn mmm em emnmennmnnnnnnnnnn nnns nnns nnns nennen sss n nsns 22 Figure 5 Capnostream Front View sss eene nennen enn nrr nnns nenne rennen 24 Figure 6 Front Panel Control Buttons ssssssssssssssssseeeeeeeee nennen ennemi 25 Figure 7 Capnostream Rear View sssssessssssssssseesee eene nennen nnne nennen nennen nenne nennen 26 Figure 8 Capnostream Left View ssesssssssssssssssssesese eene emen ne nnne nenne retr nnn nnns nenne rennen nein 27 Fig re 9 Salutation Screen cie teer inesset bt er dde ERR X Xr aa e EE CREE Xu Da ia ee RR Ed 28 Figure 10 Typical Home Screen ssssssssssssssseseseeeenenee nennen nennen nnemerrr nnn nenne nennen enin 29 Figure 11 Header Area niei eR Het HP EP RE EH e LET EAEE E PPP RET e TERRE e eaa dS 29 Figure 12 System Setup Screen sessssssssssssseseeseeee eene nennen nennen inen en nennen nennen 32 Figure 13 M6nU Bo Iz En 39 Figure 14 Alarm Volume Selection ssssssssssssssssseee
3. eussesssessesssessee nennen nennen nennen nnn nnn rine ninh rine rina rine rens ns 27 Table 7 Header Section rper emend enge tee tta de tedgendeeneanaie anaa ei aiu aana 30 Table 8 Event Markings et Erde isset ense ErbeRga s e Venu TRE CUL e eve QR OE FEDT EEA 38 Table 9 Adjustable CO Parameters ssssessseseseseeeeeeeenenee nennen nennen nnn nnn nnn nnn nnn nnn anna nas 46 Table 10 Adjustable SpOz Parameters ccccccccccccceceeeseeeeeeeeeeaeeeseeeseeeaeeeseeeaeeeaeeeaeeeaeeeaeeeaueeaaeeaas 51 Table 11 Alarm Indications sesa Tei cans sien aee e re arose to au Qe YER gaza cece eye Desechoteed eyedandendawessacseeunds 52 Table 12 High Priority Alarms acie srt teen teda aes a EXER E E d DE pes ERE aaa DR Re 54 Table 13 Low Priority Alarms c ccseeceeee eee ance aces cece sees cece anes ease aaee cece anes nnne nne rn ne nnne nnne nnne rns nnns nnns 55 Table 14 Advisory Alarms 2 i eter teet uses ede cesser t kene peo cox o eue PEL rune GrP DROPPED aa EEEE 55 Table 15 Silent Advisory Alarms ccccccecceeeecee cece ceeeeeeeceneaeeeeeeeetecensaaeeeeeeeesecenceneeseeeeeeesesueeetees 56 Table 16 Non Message Area Advisories ssssssssseseseseseneeeneeenenene nennen nnne nnne nnns 56 Table 17 Tabular Display Example eeeeeeeeeeeeeeeeeeeeesseeseeee enne nenne nennen nene nnn nennen 64 Table 18 Detailed Tabular Display Example
4. determined PERFORMING AUTOZERO The monitor automatically performs a zeropoint calibration Portable Bedside Capnograph Pulse Oximeter 55 Alarms and Messages NO USB DEVICE FOUND USB FLASH FULL USB TIME OUT LOW SPO SIGNAL STRENGTH SPO2 INTERFERENCE SPO2 INTERFERENCE FROM LIGHT SPO2 LOW SIGNAL IQ DEFECTIVE SPO2 SENSOR UNRECOGNIZED SPO SENSOR Silent Advisories A valid flash memory device is not connected to the USB port No room on the USB flash memory device USB communication stopped due to lack of response from the USB device SpO module detects signal strength or interference problems with the SpO2 sensor SpO module detects an unrecognized or defective sensor Table 15 Silent Advisory Alarms CO2 WARM UP CO module is preparing for operation CO2 READY CALIBRATION REQUIRED MAINTENANCE REQUIRED DATA TRANSFER IN PROCESS REPORT TRANSFER COMPLETE CO2 MONITORING HAS BEEN OFF FOR HH MM DEMO MODE PRERECORDED DATA Non Message Area Advisories Before the first measurement of CO after the FilterLine is connected and before patient breath is detected CO READY replaces the CO WARM UP message CO calibration is overdue CO maintenance is overdue Data communication in progress Data communication is complete Displays the hours and minutes the pump has been turned off during PUMP OFF mode Displayed during demo mode when no other message is displayed The following
5. e Real time EtCO and FiCO values along with selected unit see Institutional Defaults on page 96 for details regarding the available units e Real time FiCO values along with selected unit see Institutional Defaults on page 96 for details regarding the available units e Respiration rate RR in breaths per minute e CO Waveform EtCOz FiCO2 CO Waveform F EtCO2 mmHg and Respiration 7 Rate values Figure 18 CO Data on the Capnostream Monitor Additionally the monitor can display CO data in trend form showing time date EtCO RR alarms events and a CASE START marker For more information about trend display see Chapter 8 Using Trends on page 59 When the monitored parameter limits are exceeded the affected numeric will flash to alert the attending health care professional to the specific parameter that is affected Adjustable CO Parameters The Capnostream monitor provides the option of adjusting some parameter settings used for CO measurement to suit your patients your institution s requirements or other needs To change these settings on a temporary basis until the device is turned off follow the procedure below To set changes as institutional defaults so that the settings will remain in effect even after the monitor is turned off see CO2 Parameters on page 101 gt TO CHANGE CO PARAMETER SETTINGS 1 On the Home screen move the control knob to the CO section of the screen so that it is outlined in
6. um em d i A p 3 9 20 00 AM 39 15 71 6 100 0 100 9 22 00 AM 39 16 71 je 4 9 23 30AM 39 15 71 9 25 00AM 39 15 71 TURNED 9 26 30AM 41 14 68 9 28 00AM 4 16 68 9 29 30AM 4l 15 68 9 31 00AM 4 15 68 9 32 30AM 41 15 71 9 34 00AM 39 16 71 9 35 30AM_ 39 16 71 9 37 00AM 39 15 71 9 38 30AM 39 15 73 SNORING 9 40 00 AM 40 15 3 9 41 30AM 40 15 72 9 43 00AM 39 15 72 9 44 30AM 39 15 3 9 46 00 AM 39 15 3 9 47 30AM 40 15 72 9 49 00 AM 39 15 72 9 50 30AM 39 17 3 9 52 00 AM 39 16 3 9 53 30AM 40 16 72 9 55 00AM 39 15 72 Figure 28 Printed Trend Reports 74 Portable Bedside Capnograph Pulse Oximeter Downloading Patient Data Introduction Data Transfer via the USB Data Port Data Transfer via the RS 232 Port Using Analog Data Output Digital Analog Signal Values Nurse Call Operation Operation with Hospital Patient Data Systems Introduction Chapter 10 Capnostream can export stored and current data to external devices by the following methods Data transfer to a USB flash memory device for later transfer to a computer Direct connection to a computer via the RS 232 port e 7 channel analog output The occurrence of an alarm condition can also be indicated to an external system via the Nurse Call feature Data Transfer via the USB Data Port There are six types of reports that can be transferred to a USB flash memory device as described in the table below Four report types are in text form
7. 30 seconds 1 5 minutes 3 minutes 15 minutes 60 minutes Graphical presentation of levels of EtCOz and SpOz with a data point every 50 milliseconds Tabular presentation of EtCO RR and PR with a data line every 2 seconds Equipment Advisory Message Occurrences CO2 NOT AVAILABLE SpO2 NOT AVAILABLE BATTERY LOW Events EVENT 1 EVENT 2 EVENT 3 Patient Readings at start of recording period EtCOz RR SpO2z PR Graphs of levels of two of the following parameters according to the parameters chosen in the PRINT FORMAT screen see To print a report on page 69 at interval set for trend increment display EtCOz2 RR SpO and PR Patient Readings at start of recording period EtCO2 FiCO2 RR SpOz PR Graphs of levels of EtCO2 and SpO2 Patient Readings at start of recording period EtCO2 FiCO2 RR SpOz PR Patient readings at 2 second intervals EtCO2 RR and PR From the time sensor is first connected to the device following the erasure of trend memory until current time once trend is erased data is not available Real time data from time START PRINTER is pressed to time STOP PRINTER is pressed Real time data from time START PRINTER is pressed to time STOP PRINTER is pressed Please note that in all cases EtCO2 and FiCO are displayed in selected units SpO2 in percentages and RR and PR in bpm beats per minute 72 Portable Bedside Capnograph Pulse Oximeter Sampl
8. Data Cable Part Number 010492 to the back of the monitor and connect the other end of the cable to an analog system such as a polysomnograph as required Check that all cables are connected and tightened Setup analog data output on the monitor as described in Using Analog Data Output on page 80 Verify that data transfer between the monitor and the system is taking place Oo 14 Set Up Bernoulli System Interface if applicable central monitoring system and accessories must be purchased separately Connect the Client Bridge to the RS 232 port at the back of the monitor Make sure that all connections are in place and sufficiently tightened Verify that the Client Bridge is mounted safely Verify communication between the Capnostream monitor the client bridge and the Bernoulli central station See Operation with Hospital Patient Data Systems on page 85 for more details Oo 15 Set Up Data Transfer via USB USB flash drive must be purchased separately Connect the USB Flash drive to the back of the monitor Choose the desired type of patient report and press the Start USB button on the screen Refer to Data Transfer via the USB Data Port on page 75 for detailed information 34 Portable Bedside Capnograph Pulse Oximeter Chapter 4 Using the Capnostream Monitor Preparing the Monitor for a Patient Using Patient Cases and Patient ID Entering Patient Events Changing the Alarm and Pulse Volumes Use of Scaven
9. Line 5 Column headings Line 6 Column headings second line 76 Portable Bedside Capnograph Pulse Oximeter Data Transfer via the USB Data Port Capnostream recognizes flash memory drive devices manufactured by Sandisk Lexar and PNY Technologies A typical flash memory device is shown below Figure 29 Typical Flash Memory Device TORECORD CAPNOSTREAM DATA ON A USB DEVICE 1 Insert a USB Flash Memory drive into the USB port on the back side of the Capnostream 2 When the Flash Memory drive is detected the USB icon will appear in the top right hand corner of the display beside the alarm symbol Depending on the type of drive this may take a few seconds 12 00AM 25 MAY 06 USB port icon NEONATAL HOME Figure 30 USB Icon Note The USB port on the Capnostream monitor is for use with a Flash Memory device only It is not a full service USB port Do not attempt to connect the monitor to a computer via the USB port 3 After the USB icon appears the monitor is ready to begin outputting data to the USB flash memory device 4 From the Home screen select the SYSTEM button on the menu bar to open the System screen and then select DATA OUTPUT 5 Use the control knob to select the desired report from the DATA OUTPUT table as shown below Please note that the Tabular Case and Tabular Trend options are only available while a case is active If the current case is closed the case and trend memory are deleted and this
10. Portable Bedside Capnograph Pulse Oximeter 67 Using Trends Event Marking Mode Detailed when the Event button is pushed you can enter a specific description of the event from a table of 30 user definable values see the section Entering Patient Events on page 38 Quick marks that an event occurred when the Event button is pushed but does not give any details If the monitor is set to Detailed event marking mode but you don t have time to enter the detailed event a quick event mark can be entered by pushing the Event button twice Trend Graphical Display Trend Graphical Display options are 2 6 and 12 hours The factory default is 6 hours Trend Increment Display Trend Increment Display options for the Tabular Trend Display are MINIMUM 1 5 3 15 or 60 minutes The factory default is 1 5 minutes The MINIMUM setting is defined as the trend recording resolution and can be 5 10 or 30 seconds see Appendix 1 Institutional Settings on page 96 for instructions on how to change the recording resolution 68 Portable Bedside Capnograph Pulse Oximeter Chapter 9 Printing Reports Introduction Printing Reports Sample Reports Introduction Capnostream can be purchased with a built in thermal strip printer The report printing menu in Capnostream is for use with the optional printer To print a report on an external printer the recommended procedure is to transfer the data to a computer using a USB flash memory devi
11. Use the control knob to select the speaker icon at the right hand side of the menu Portable Bedside Capnograph Pulse Oximeter Use of Scavenging System N SYS POENI PRINT o TREND SYSTEM TYPE Volume icon Figure 13 Menu Bar 2 Click the control knob once to select the alarm volume control 3 Turn the control knob to raise or lower the volume The selected alarm volume level will be audible as you turn the knob Click the knob twice to set the new volume level Figure 14 Alarm Volume Selection Note The alarm volume cannot be set to zero using the alarm volume control The audible alarm can only be disabled in the Institutional Default settings Pulse Tone Volume The monitor can be set to sound an audible beep for each pulse beat The monitor is shipped from the factory with the pulse tone turned off Setting the Pulse Tone Volume To make the pulse tone louder or softer use the control knob to select the speaker icon and click twice to select the Pulse Tone volume setting Figure 15 Pulse Tone Volume Selection The pulse tone volume can be set to zero Turning the Pulse Tone On Off gt TO TURN THE PULSE TONE VOLUME ON 1 Use the control knob to select the SpO display area Click the control knob to go to the SpO Setup screen 2 Turn the control knob to highlight the PULSE TONE setting click the knob to select the option turn the knob once to change the setting to ON and push the knob again to set the op
12. Zero display appears for oxygen saturation and pulse rate Inaccurate SpO2 measurements appear Printer Sensor not properly connected to monitor or extension cable Sensor is improperly applied to patient Patient s perfusion may be too poor Sensor or sensor extension cable may be damaged Excessive patient motion or electrosurgical interference Excessive illumination Sensor placement on an extremity that has a blood pressure cuff arterial catheter or intravascular line or nail polish Patient s condition Excessive patient movement Check that the sensor and extension cable if used are properly connected to the monitor Check sensor application Check the condition of the patient Replace sensor or sensor extension cable If possible keep patient still Check whether the sensor is secure and properly placed Replace if necessary move the sensor to a new site or use a sensor that tolerates more motion Check sensor placement or cover sensor with a dark or opaque material Check sensor placement Check patient If possible keep patient still and use a sensor that tolerates more motion Printer does not print Red Alarm light on the printer is flashing Printer cover is open Portable Bedside Capnograph Pulse Oximeter Open the plastic printer cover fully ensure that a short length of printer paper is outside the monitor and then close the cover s
13. always check that the orange AC power indicator light is on during monitor use This will ensure the battery is charged during use and the monitor is prepared in case of a power outage or a patient transfer If a patient has to be transferred to another location the unit can be unplugged and transferred with the patient Care should be taken to reconnect the monitor to the AC mains following the transfer Handling the Battery Pack CAUTION Do not immerse the battery pack in water it may malfunction CAUTION Only recharge the battery pack in the monitor to avoid possible heating burning or rupture of the battery pack Storing the Battery There are differing requirements depending on how long you store the battery without use Portable Bedside Capnograph Pulse Oximeter Installing the Battery Pack e Short term storage one month or less The battery pack has an automatic discharge feature You must periodically check the charge level of the battery pack Long term storage 6 months or more The battery pack must be stored in a cold dry area Its charge decreases over time To restore the battery pack to full power recharge the battery before use CAUTION Storage or transport of the monitor under environmental conditions beyond those mentioned in the specification will affect monitor performance and damage the monitor Disposing of the Battery CAUTION Do not dispose of the battery pack in fire it may explode Follow local g
14. ensure that the sensor is properly applied and cover the sensor site with opaque material CAUTION Failure to cover the sensor site with opaque material in high ambient light conditions may result in inaccurate measurements Portable Bedside Capnograph Pulse Oximeter Connecting an SpO2 Sensor to the Monitor If patient movement presents a problem try one or more of the following remedies Verify that the sensor is properly and securely applied Move the sensor to a less active site Use an adhesive sensor that tolerates some patient motion Use a new sensor with fresh adhesive backing The device may be used during defibrillation but the readings may be inaccurate for a short time Connecting an SpO Sensor to the Monitor Before monitoring a patient with pulse oximetry the appropriate SpO sensor must be connected to the monitor and to the patient gt To CONNECT THE SPO SENSOR l Connect the SpO extension cord firmly to the monitor SpO gt sensor port and then connect the appropriate Masimo SpO sensor to the extension cord Connect the Masimo SpO sensor to the patient as described in its Directions for Use When the SpO sensor is plugged into the extension cable and connected to the monitor the monitor will immediately begin to search for a pulse It will indicate NO PULSE FOUND and SpO2 SENSOR NOT ON PATIENT until the time that the sensor is placed on the patient This is classified as a Low Priority Al
15. medication physical activity by the patient and interventions These events can be marked in the monitor s memory to assist in tracking patient care and appear in the trend displays and data output To USE DETAILED EVENTS 1 Press the 4 amp event button on the front display panel of the monitor 2 Thetable below will appear on the display Use the control knob to click on an event 3 Click the control knob again to store the event and return to the HOME screen The table below shows the factory default settings The event names can be changed using the institutional defaults as described in Appendix 1 Institutional Settings on page 96 Table 8 Event Markings MEDICATION PATIENT INTERVENED FENTANYL EATING OXYGEN VERSED DRINKING SUCTION MIDAZOLAM COUGHING ADJ AIRWAY MORPHINE AMBULATING NARCAN DEMEROL CHEST PT ROMAZICON PROPOFOL TURNED NEB TX OTHER SNORING STIMULATED OTHER OTHER If the monitor is set to record detailed events but you do not wish to designate a specific event name pressing the s event button twice will record an unlabeled event similar to a quick event mark This is useful when there is no time to designate details Changing the Alarm and Pulse Volumes The alarm volume can be made louder or softer for patient alarms and pulse tone The pulse tone can also be turned off using the SpO menu By default the pulse tone is turned off Alarm Volume gt TO MAKE THE ALARM VOLUME LOUDER OR SOFTER 38 1
16. 25 Trend Memory Message below Click YES to erase the trend memory If you intend to continue measurement of the same patient as previously you may want to retain the trend memory In that case click NO If you record patient data as part of a case trend memory will always be erased when you close the case Portable Bedside Capnograph Pulse Oximeter Configuring Trends SHOULD THE MONITOR BE PREPARED FOR A NEW PATIENT BY CLEARING THE MEMORY YES NO e Figure 25 Trend Memory Message Configuring Trends To change the parameters for trend displays go to the Home screen and select SYSTEM to see the System Setup screen The table below shows the options as they appear on the System Setup screen Table 19 Monitor Parameters DATE MAY 25 2006 TIME 11 27 32 AM LANGUAGE ENGLISH EVENT MARKING MODE DETAILED TREND GRAPHICAL DISPLAY hour 6 hour TREND INCREMENT DISPLAY min 1 5 min NURSE CALL DISABLED The Trend Data parameters are Event Marking Mode Trend Graphical Display and Trend Increment Display The Trend Display settings refer to how the screen will be initially be displayed when you enter the Trend mode Once you are on the Trend screen these views can be easily changed using the Zoom feature These settings will remain until the monitor is powered off Changing the resolution of how often data is stored can be done in the Institutional Defaults screen only See Appendix 1 Institutional Settings on page 96
17. CAL MONITOR CAL CHECK CO2 BACK SPO2 BACK Y Y START CONTINUE BACK i START BACK Y ADULT NEONATAL ALARM LIMITS Y CAUTION ENABLE DISABLE DEFAULT RESET HOME FACTORY DEFAULTS BACK MED PAT INT FACTORY DEFAULTS BACK D A FACTORY DEFAULTS BACK FACTORY DEFAULTS BACK FACTORY DEFAULTS BACK v PRINT Y START STOP PRINTER PRINT FORMAT HOME BACK FACTORY DEFAULTS BACK FACTORY DEFAULTS BACK FACTORY DEFAULTS BACK FACTORY DEFAULTS BACK Figure 17 Screen Menu Reference Chart Portable Bedside Capnograph Pulse Oximeter 42 Chapter 5 Capnography with the Capnostream Monitor Microstream EtCO2 Consumables Connecting a FilterLine CO Data Displayed by the Capnostream Monitor Adjustable CO2 Parameters Monitoring CO2 during MRI Scanning Microstream EtCO Consumables CAUTION CAUTION CAUTION CAUTION WARNING WARNING WARNING Basic Principles Before use carefully read the Microstream EtCO consumables Directions for Use Only use Microstream EtCO consumables to ensure the monitor functions properly Microstream EtCO consumables are designed for single patient use and are not to be reprocessed Do not attempt to clean disinfect or blow out the FilterLine as the monitor can be damaged Dispose of Microstream EtCO consumables according to standard operating procedures or local regulations for the disposal of con
18. Capnography with the Capnostream Monitor 44 Microstream EtCO2 Consumables The following products comprise the Microstream EtCO consumables Part Number Product Description and Suggested Application for box of 25 FilterLine Set FilterLine set for intubated patients for non humid XS04620 environments FilterLine H Set FilterLine set for intubated patients for humid XS04624 environments Smart CapnoLine O2 Oral Nasal FilterLine for non intubated patients 007267 requiring oxygen during procedural sedation Smart CapnoLine Plus Oral Nasal FilterLine for non intubated patients 009818 during procedural sedation Smart CapnoLine Plus O2 Oral Nasal FilterLine for non intubated patients 009822 requiring oxygen during procedural sedation Smart CapnoLine H O2 Oral Nasal FilterLine for non intubated patients 010478 requiring oxygen for post op pain management for long term use Smart CapnoLine H Plus Oral Nasal FilterLine for non intubated patients 010433 O2 requiring oxygen for post op pain management for long term use CapnoLine H Nasal FilterLine for non intubated patients receiving 008177 hi flow oxygen by mask on long term CPAP or Bi PAP or post op pain management for long term use NIV Line Nasal FilterLine for non intubated patients under 008174 oxygen CPAP Bi PAP or NPPV mask Smart BiteBloc Non intubated patients for use during u
19. Chapter 6 47 Pulse Oximetry with the Capnostream Monitor 47 Masimo SPOS SEM SONS T 47 Selecting Masimo SpO SeENSOlrs ccecccceceeeeeeeeeeeeeeeceeeeeeeceeeaaeeeeeeeeseseeccueeeeeeseeesesneeneaeeess 47 Performance Considerations cccccccccccsecceeeceeeceeeceeeceeeseeeceeeeeeeseeeeeeeceeeeeeeseeeeesaueeaueeseesaeenas 48 Connecting an SpO Sensor to the Monitor esses 49 SpO Data Displayed by the Capnostream Monitor ssssssseseeeeeee 49 Perfusion Mde e E 50 Signal IG Wavefotrtm etre e ettet hier pe edi da tes reu pna te esr Aaaa erai E 50 Adjustable SPOs arii i c 50 Chapter 7 52 Alarms and Messages 52 PTO OV MCCC c cc 52 Message deg EE 53 PUTS ENDE NEUE 53 igh Prony Alaf MSsir 54 Low Priority Alarms eeeseseseseeeeeeeeee enne EEEE EEEE EEEE EEEE EEEE nnne sehn nnn nne nn sehn sen n sens EEEE neant 55 FACVISOLIOS PENIS EEEE OE dts vias avecese nace dududedacsecedns EA KENEEN avedebimacetududeaaesecedaaedeundwnets 55 silent telo RETRO eet GA ne A oe ee 56 Non Message Area Advisories ccccccececeeeeeeeceeeaeeeaeeeaeeeaeeeaeeeaeeeaeeeaeeeaeeeaeeesesaeeeaaeeaaeeaaenaes 56 P Fe 1g gg Mest ol 5 0 PP MH I ORCI OUTRE eee tae ROT ene INRERERIE 57 Changng AIG FE TET C 57 Testing Capnography Alarm Setlings iuis cascada nta cine iei
20. and the Pump Off screen is displayed The countdown timer is shown in the CO waveform area Note While the pump is off CO2 is not monitored and no breath waveform EtCO FiCO or respiration rate number values are displayed SpO and pulse rate monitoring continues 2 Pump Off mode can be ended by pressing the Pump Off button again 3 Pump Off mode can be extended by using the control knob to select the EXTEND TIMER menu option When the monitor is in Pump Off mode a timer appears in the message area at the top of the screen and shows the total hours and minutes that the CO monitoring has been turned off When the timer finishes or you manually exit Pump Off by pressing the Pump Off button again the pump will turn on and CO monitoring will resume The monitor automatically returns to the Home screen Note The Pump Off button does not function while scrolling in Graphical and Tabular Trend screens Demo Mode The Capnostream monitor provides the possibility of viewing pre recorded standard data to display an example of the monitor s appearance under standard measurement conditions The Demo Mode permits clinicians and 40 Portable Bedside Capnograph Pulse Oximeter Monitor Screen Menu Reference Chart technicians to understand what the screen will show when monitoring patients and is useful to them as a guide before attaching the monitor to real patients TOUSE THE DEMO MODE 1 To enter the Demo Mode click SYSTEM
21. are settable in the monitor To change the parameters select SpO gt in the Institutional Defaults screen Portable Bedside Capnograph Pulse Oximeter 101 Institutional Settings Pulse Tone On Off Off SpO Sensitivity Normal Maximum APOD Maximum Averaging Time sec 2 4 4 6 8 10 12 14 16 8 SpOz Scale for Trend Display 0 100 50 100 50 100 PR Scale for Trend Display 150 300 150 Sweep Speed Adult mm sec 3 6 3 12 5 25 25 Sweep Speed Neonatal mm sec 3 6 3 12 5 25 25 Digital to Analog Channel Settings To change the default channel assignments for the analog output from the Institutional Defaults screen select MONITOR and then select D A Follow the instructions as described in Digital Analog Signal Values on page 81 102 Portable Bedside Capnograph Pulse Oximeter Specifications Power Supply Battery Controls Display Microstream Capnography Masimo Pulse Oximetry Alarms Outputs Internal Thermal Printer optional General Characteristics Equipment Classification Compliance Power Supply Appendix 2 EE CENE Value Input Voltage Fuses Input Power Battery 100 240VAC 50 60Hz Two F3 15A 250 Volt 90 VA PT EM Value Battery Type Battery Operation Battery Charging Time Controls 14 8V 4Ah Lithium lon 2 5h without thermal recorder 100 in 12h PE tem Value Front Panel Back Panel Portable Bedside Capnograph Pulse Oximeter 1 Switch for monitor On Off control 4 specific
22. change will remain in effect until the patient type is changed The monitor has independent alarm limit settings for Adult and Neonatal Patients which can be configured according to the physiology observed in the particular age groups See the relevant information in the Message Priorities on page 53 Using Patient Cases and Patient ID Numbers 36 It is strongly recommended that you associate all data stored in the monitor with a patient ID that will identify its origin with a particular patient This allows stored trend data to be associated with a patient ID and avoids the possibility of confusing data from several patients in one trend printout or download TO BEGIN A NEW CASE 1 Once the patient is already connected to the monitor press the Patient Admit Discharge button on the front panel of the monitor The PATIENT ID field appears on the screen and an automatically generated 14 digit ID number will appear in the ID field PATIENT ID 20061209072645 2 This automatically generated ID indicates the start date and time of the case session format YYYYMMDDhhmmss indicating year month day hour minute and second of the session start To use the automatically generated ID number use the control knob to select START CASE and click the START CASE button to begin the case 3 To change the ID number if desired turn the control knob to highlight PATIENT ID in blue on the screen and click the control knob Use the control knob
23. earth conductor arrangement operate the device on internal battery power until the AC power supply protective conductor is fully functional Do not connect to an electrical outlet controlled by a wall switch or a dimmer Portable Bedside Capnograph Pulse Oximeter Definitions WARNING Measure the device s leakage current whenever an external device is connected to the serial port Leakage current must not exceed 100 microamperes CAUTION Blectrical installation of the room or the building in which the monitor is to be used must comply with regulations specified by the country in which the equipment is to be used Electro magnetic Interference This device has been tested and found to comply with the requirements for medical devices according to the standard EN60601 1 2 2001 This standard is designed to provide reasonable protection against harmful interference in a typical medical installation However because of the proliferation of radio frequency transmitting equipment and other sources of electrical noise in healthcare environments for example cellular phones mobile two way radios electrical appliances it is possible that high levels of such interference due to close proximity or strength of a source may result in disruption of performance of this device WARNING Operating high frequency electrosurgical equipment in the vicinity of the monitor can produce interference in the monitor and cause incorrect measurements WARN
24. factory defaults use the control knob and select FACTORY DEFAULTS Intervention Events Allows the institution to enter a set of 10 event labels which the operator can use to mark events where a physical or other intervention occurred during the time of monitoring The default Intervention Events are OXYGEN SUCTION ADJ AIRWAY NARCAN ROMAZICON NEB TX STIMULATED and OTHER The last two settings are blank All settings are changeable To reset the Intervention Events to the factory defaults use the control knob and select FACTORY DEFAULTS How to Change Event Defaults From the Service screen select the INST DEFAULTS screen and then the TREND screen In the Menu Bar of the Institutional Settings Trend screen are the options to select MED to change medication events settings PAT to change patient events settings and NT to change intervention events settings To change an event scroll to a particular event label and click it so as to clear the field and enter another event name Monitor Settings From the Institutional Defaults screen select MONITOR 11 OOAM JAN 01 05 INSTITUTIONAL DEFAULTS MONITOR DATE FORMAT mmm dd yy TIME FORMAT 12 hour LANGUAGE ENGL ISH n AUDIO ALARM SILENCE DISABLED EVENT MARKING MODE DETAILED AUTO NURSE CALL DISABLED FACTORY DEFAULTS Figure 38 Institutional Defaults Monitor 100 Portable Bedside Capnograph Pulse Oximeter The Institutional Defaults that can be set for th
25. function keys 1 optical encoder with switch 1 Mains ON OFF Switch 103 Specifications Display Doom ilem Ve Microstream Capnography 104 Screen Trace Speed Waveform sampling rate Trend Storage Trend Display 162mm 6 4in Color TFT Display Pixel Pitch 0 204 H x 0 204 V mm 0 008in Active Display Area 130 56 H x 97 92 V mm 5 14in x 3 86in Resolution 640 x 480 pixels Viewing angle vertical 110 Viewing angle horizontal 140 3 0 6 3 12 5 amp 25 mm sec 75 7 samples sec for SpO fixed 20 samples sec for Capnography fixed 8640 point storage 12h at 5s resolution 24h at 10s resolution 72h at 30s resolution Graphical Display 2h 6h 12h views Tabular Display 60 min 15 min 3 min 1 5 min and minimum resolution minimum resolution settable to 5 10 or 30 seconds n EM Value CO Units CO EtCOz2 FiCOz Range CO2 Waveform Resolution EtCOz FiCO Resolution CO2 Accuracy Respiration Rate Range Respiration Rate Accuracy Flow Rate Waveform Sampling Response Time mmHg or kPa or Vol 0 99 mmHg 0 1 mmHg 1 mmHg 0 38 mmHg 2 mmHg 39 99 mmHg 5 of reading 0 08 for every 1 mmHg above 38 mmHg 0 150 bpm 0 70 bpm 1 bpm 71 120 bpm 2 bpm 121 150 bpm 3 bpm 50 42 5 s flow lt 65 ml min flow measured by volume 20 samples s 2 95 s typical Portable Bedside Capnograph Pulse Oximeter Masimo Pulse Oximetry Initialization Time 40 s
26. information will no longer be available Table 22 Select Data Output Type TABULAR CASE TABULAR TREND REALTIME CONTINUOUS WAVEFORM REALTIME CONTINUOUS TABULAR FULL BINARY CONTINUOUS TRANSFER FULL BINARY TREND TRANSFER 6 An asterisk will appear to the left of the selected report name If no case is active the text NO CASES will appear to the right of the Tabular Case option when that option is selected 7 Turn the control knob to select START USB on the Menu Bar and click to begin data transfer Data output can be aborted by clicking again to select STOP USB CAUTION If the Flash Memory disk drive is removed from the Capnostream when data transfer is in progress the data may not be readable Before removing the Flash Memory drive data transfer should be completed or stopped by selecting STOP USB on the Menu Bar Portable Bedside Capnograph Pulse Oximeter 77 Downloading Patient Data 78 Note If the Capnostream does not detect the Flash Memory drive remove and re insert the Flash Memory drive If the Flash Memory drive is still not detected check that drive being used is from a supported manufacturer If free disk space on the Flash Memory drive is less than 100 kb writing to the USB disk drive is not allowed Under this condition if data transfer is already in progress it will be aborted Any new data transfer CANNOT be initiated under the low disk space condition The maximum amount of data that can be transferred in a
27. n e LESRXR aki tegen Ea 77 Figure 31 Digital to Analog Setup Screen sssssssssssssssseeeeeeeenee en eene nennen 81 Figure 32 Stereo Phono Plug for Nurse Call ssssssssssseseeeeeeeen eene 83 Figure 33 Connection Point for Nurse Call ssssssssssssssseeeeeneeenene eene nne 84 Figure 34 Service Sereen cette bite eee reir aae e Hen Ree ded edad ike kata Deb dado pu e RE ER EE S EKE EEEa ESEESE 87 Figure 35 Insert Paper Roll into printer sesseseeeeeenem mmn 90 Figure 36 Institutional Defaults Screen ssssssssssssssssssseeeeenee eene 97 Figure 37 Institutional Defaults Alarm Limits Screen ssssssssseem 98 Figure 38 Institutional Defaults Monitor enne 100 Portable Bedside Capnograph Pulse Oximeter 9 List of Tables List of Tables Table 1 Symbols that Appear on the Monitor sese ener 15 Table 2 Capnostream Accessories ssesessssssssesseeseee ene nnn nnn nnn nnne rine rine rine rares 22 Table 3 Printer Paper Specifications sssssssssssssssseeeneee nennen enne 24 Table 4 Capnostream Front View cccccccccccccececeeeeeeeceeeeeeeceeeeeeeseesceeseeeaeeeaeeeaeeeseeeaueeaaeeaseeaaeeaaeeess 25 Table 5 Capnostream Rear VieW cccccccccscccsecceeeeeeeceeeeeeeceeeseeeseeeseeseeeaueeseeeaeeeaseeaueesaeeaueeaaeeaaeeess 26 Table 6 Capnostream Left View
28. power cable improperly attached or disconnected or cable has faulty electrical connection Internal battery is totally discharged and main power switch not turned on AC wall outlet has no power and internal battery is not charged Blown fuses AC mains power and Battery pack not plugged in to monitor monitor on indicator lights are on but unit will not operate on battery power when the AC mains power cable is disconnected Monitor is plugged in AC power not getting to the monitor but does not appear to charge the battery Portable Bedside Capnograph Pulse Oximeter Check power cable connection and check that on off switch is on Turn on the main power switch located on the back of the monitor just below the electrical supply cord Check connections and correct problem When AC power is restored ensure that the main power switch on the back of the monitor stays on so that the internal battery pack will charge Replace the fuses Contact your representative to determine the reason for the electrical problem Open the battery housing and check that the battery pack cable is firmly connected to the battery Socket See Installing the Battery Pack on page 19 Check if the yellow power indicator light is on If not check that the AC power cord is properly plugged in to a live AC 91 Maintenance and Troubleshooting mains socket and that the power switch on the back of the moni
29. single file is 65 536 rows this corresponds to the maximum sheet size for an Excel file If the data exceeds 65 536 rows a new file is automatically opened and the data continues to transfer into the new file In this situation the new file name is indexed as described below in Table 23 File Naming Conventions The following are estimates of the approximate sizes of the files that can be expected to be generated For patient cases where events and alarms are recorded extensively the file sizes will be larger Tabular Case 1 hour 30s resolution 10kB Tabular Trend 1 hour 30s resolution 10kB Real time Continuous Waveform hour 50ms resolution 2 4MB Real time Continuous Tabular 1 hour 2s resolution 150kB Full Binary Continuous Transfer 1 hour 50ms resolution 720kB Full Binary Trend Transfer 1 hours 2 30s resolution 2 5kB entire trend memory dump is 175kB USB File Naming Convention For the different report types the following file naming convention is used REPORT TYPE REPORT DATE gt REPORT TIME SER NO gt ext Where e REPORT TYPE three letter report type identifier see Table 23 File Naming Conventions e REPORT DATE Start date on which the report was made in yymmdd format e REPORT TIME Start time at which the report was made in hhmmss format e SER NO arunning serial number that indicates 1f the data was split into multiple files e File extension ext is csv Comma Separated Value file
30. the individual settings described below for the SpO and CO parameters Table 29 Factory Default and Optional Trend Settings Factory Default Trend Recording 5 seconds at 12 hours 30 seconds at 72 hours Resolution 10 seconds at 24 hours 30 seconds at 72 hours Tabular Increment MINIMUM 1 5 3 15 or 60 minutes 1 5 Minutes Display Default Graphical View Default 2 6 or 12 hours 6 hours The default Trend Recording Resolution determines how many hours of patient information can be recorded The Tabular Increment Display enables the default to be set to the values in the table The Graphical View Default can be changed so that the Trend window will show a different time period of data Note Changing the Trend resolution will clear the Trend memory erasing any patient data that was in the monitor To make changes to the Trend Defaults click SERVICE gt INST DEFAULTS gt TREND on the menu bar Use the control knob to navigate to the parameters described above and click to view options Chose an option using the control knob and click again to record that option as the default Event labels used in Trend recording can also be changed from the Institutional Defaults Trend screen using the menu bar A detailed explanation appears in Events below Events Up to 10 event names in each of three categories can be stored in Capnostream This allows the attending health care professional to describe the event that is inputted to the moni
31. time and accurate CO readings even at high respiration rates The Micro Beam IR source illuminates the micro sample cell and the reference cell This proprietary IR light source generates only the specific wavelengths characteristic of the CO absorption spectrum Therefore no compensations are required when different concentrations of N20 O2 anesthetic agents and water vapor are present in the inhaled and exhaled breath The IR that passes through the micro sample cell and the IR that passes through the reference cell are measured by the IR detectors The microprocessor in the monitor calculates the CO concentration by comparing the signals from both detectors What is Pulse Oximetry Pulse oximetry is based on the following The difference in the absorption of red and infrared light spectrophotometry by oxyhemoglobin and deoxyhemoglobin e Changes in the volume of arterial blood in tissue during the pulse cycle plethysmography and hence light absorption by that blood A pulse oximeter determines Spot Oxygen Saturation SpO2 by passing red and infrared light into an arteriolar bed and measures changes in light absorption during the pulsatile cycle Red and infrared low power light emitting diodes LEDs in the oximetry sensor serve as light sources a photodiode serves as the photo detector Because oxyhemoglobin and deoxyhemoglobin differ in light absorption the amount of red and infrared light absorbed by blood is related
32. to regularly download patient data using the USB interface as described in Chapter 10 Downloading Patient Data on page 75 The Trend Display Screens Trend data is displayed in two different formats graphical and tabular The Graphical Trend screen allows you to view the patient data over a longer time scale 2 6 or 12 hours at a time and scroll through the data looking for patterns specific events or alarms Portable Bedside Capnograph Pulse Oximeter 59 Using Trends Once you have located the data of interest you can zoom in to the specific event or examine the messages and data using the Tabular Trend screen Tabular Trend presents the data in an easy to read table format Graphical Trend Display Screen TO VIEW THE GRAPHICAL TREND DISPLAY SCREEN 1 From the Home screen use the control knob to select TREND from the soft buttons in the menu bar at the bottom of the screen The Graphical Trend screen seen in Figure 22 Graphical Trend Display below is shown 6 41AM JAN 03 05 Time and date ADULT of cursor TNR TITO Yellow cursor location BIETITSRTEEIGIE NIS 6 HR DISPLAY Ln Um Oe ee er RR mmHg line 6 39AM JAN 03 05 m Zoom level EtCO2 i 3 8 Tz RR FicO2 Alarm Real time patient data occurrence indicator Patient data at cursor location Event indicator SCROLL TABULAR LIMITS Figure 22 Graphical Trend Display 2 Please note that the Trend screens display both Trend informatio
33. type or bin binary file type The Patient ID field in the monitor contains the character which is not a valid character for file names It is replaced with a hyphen for file names The character is used by the monitor to indicate multiple files with the same Patient ID e g Smith 1 Smith 2 Smith 3 File Name Examples For different reports taken on 2nd March 2006 at 20 30 57 for the patient with Patient ID PATIENT02 1 the file names would be Table 23 File Naming Conventions Report type D mmLilename Cd Tabular Case Report TCR PATIENTO2 1 060302 203057 1 csv Tabular Trend Report TTR 060302 203057 1 csv Real time Continuous Waveform RCW 060302 203057 1 csv Real time Continuous Tabular RCT 060302 203057 1 csv Full Binary Continuous Transfer FCT 060302 203057 1 bin Full Binary Trend Transfer FTT 060302 203057 1 bin Portable Bedside Capnograph Pulse Oximeter Data Transfer via the RS 232 Port Examples Taking the same example described above multiple files for the same Real time Continuous Tabular report would look like this Reporttype File name Real time Continuous Tabular RCT 060302 203057 1 csv RCT 060302 203057 2 csv RCT 060302 203057 3 csv RCT 060302 203057 4 csv RCT 060302 203057 10 csv RCT 060302 203057 100 csv RCT 060302 203057 1000 csv Note Binary files are never split into multiple files because they do not have the length limitation imp
34. typical Calibration Interval Initially calibrate after 1 200 operating hours then once a year or after 4 000 operating hours whichever comes first Masimo Pulse Oximetry EE CENE Value SpO Measurement Range 1 100 SpO Accuracy Adult Mode SpO range 70 100 t 2 digits SpO range 0 69 Unspecified Neonate Mode SpO range 70 100 t 3 digits SpO range 0 69 Unspecified Pulse Rate Range 25 240 bpm Pulse Rate Accuracy During No t 3 digits Motion Conditions Pulse Rate Accuracy During Motion 5 digits Conditions Perfusion Index range 0 0296 2096 Alarms Adjustable Alarm Limits SpOz high SpOz low Pulse Rate high Pulse Rate low Alarms EE HN High Priority Patient Warning Flashing Red LED Alarms Flashing Red Numeric High Priority Alarm beep pattern Alarm Indication on Screen Nurse Call Patient Caution Alarms Flashing Yellow LED Flashing Yellow Numeric Low Priority Alarm Lit Yellow LED Beep once every minute Alarm Indication on Screen Nurse Call Advisories Beep once Advisory Indication on Screen Silent Advisories Advisory Indication on Screen Alarm Volume Control 5 steps Temporary Alarm Silence All audible alarms silenced for 2 minutes Portable Bedside Capnograph Pulse Oximeter 105 Specifications Outputs Analog Output 15 pin female D type connector Pinout 8 1 15 9 Pin Assignment Pin 1 Ground 9 Ground 2 Ch 1 Signal 10 Ground 3 Ground 11 Ch 5 Signal 4 Ch 2 Signal 12 Groun
35. updated date and time are saved in the monitor memory when you exit the screen and will not need to be re adjusted after the monitor is turned off To change the language of the display use the control knob to change the language The new language will remain in effect until the monitor is turned off To permanently change the display language and other settings see the information in Changing Institutional Defaults on page 96 6 27AM JAN 03 05 ADULT SYSTEM SETUP CAL SERVICE DATA CHECK OUTPUT Figure 12 System Setup Screen Screen Timeouts 32 Screen Timeouts All setup and system screens will timeout after 60 seconds of no activity with the control knob and revert back to the previous screen you came from This will continue every 60 seconds until you reach the Home or Trend screen depending on the screen from which the Setup process was started Portable Bedside Capnograph Pulse Oximeter Capnostream 20 Operational Check Sheet Capnostream 20 Operational Check Sheet To get the Capnostream monitor up and running quickly and smoothly follow the list of instructions below Oo 1 Unpack the monitor Remove the Capnostream monitor and the accessories from the box Check that the items on the enclosed packing list are included Check that paper is in printer o 2 Install the battery pack Refer to Installing the Battery Pack on page 19 for installation instructions Oo 3 Turn on the monitor Plug
36. 58 Alarm Limits Factory Defaults cento dept Hp ES MEpUE MMpten Mp pM IE MENU 58 Portable Bedside Capnograph Pulse Oximeter 5 Table of Contents Chapter 8 59 Using Trends 59 Introduction MT E 59 The ro d Boocigoc Q cd m 59 Graphical Trend Display Screen sates hd tolit id bio plo ie d ER ass bc ala 60 Graphical Trend Display eor iter eer terree ento knee ken IEEE ede ko ER YE EL AR Le RES E Rer a duds 60 Using SCROLL and ZOOM ete ctt nt kno n ee np Ee Rare EE Eu se eun ke x XE dE ra MAR EE RR ERR dads 61 Tabular Trend Display SOPSSIl utecibuerinastuetndanbgekasabuckksanbuek n kie ubntonbule tinfetiue Kbulcitbulitul titu 63 Specific Events as seen in Trend Dalagsisemceddesdisubiseenseddsdddxeddkadesddradaeddiu de o diredde 65 Using the Graphical Trend Screen for Monitoring Patients seeeesssussss 65 Printing The Trend Data es tase ees site nice ene ere xta aas utis ule ao ene ease ibus n EE TE QUAD Qs 65 Clearing Trend Memon Tm 66 Configuring TCM eco pee ouE edP RIED MER MOREM MEE NEN ERU EM ME MRNA D UU LE 67 Event Marking Moda nee eh eto tea b x a CERRAR Feux uc nu a enun uua gd 68 Trend Graphical Display iran ie i Ex rear Pr detecting aee dd oe ea ER dedecus Gees 68 Trend increment Display eerte ta rere ire Det rdv esee o dex edad e Posee ete 68 Chapter 9 69 Printing Reports 69 Introduction em 69 Printing TROON NIE RERO DRIN DO
37. 69 Sample Report S AM RR 73 Sample Case Reports rre iere a eee es aa EEEE Ea e EEEE A a E a aa 73 Sample Trend Reports osrin irrien ain die eaaa E aa EKE a E a radarra SNE enne AEST nennen 74 Chapter 10 75 Downloading Patient Data 75 Introd UD a oc mi dp MM M ME 75 Data Iranster via ihe USB Data POFL etn tttm ett mb c bs b ER Ete pa bna eia 75 USB File Naming Convention ssessseseseeneeneeenenm eene enn nnemerrr enhn nennen 78 I2 i s cpee C 79 USB Error erm 79 Reading Patient Data from Saved Capnostream Files eceecceceeeeceeeeeeeeeeeeeeeeeeeeeenneeeeees 79 Data Iraonstervia the RS 232 Poff irsinin soca aise cesta cid an ocean UNA 79 Using Analog Data COUDDUL sistas naa eka eae hind S 80 Using Capnostream with a Polysomnograph sse 80 Digital Analog Signal Values P 81 D A Cable Color Coding siisccecessnegtescaeenctancennielogseeabasnenivatanaedethebdbadestuntececerndeeauaeeeagearmieae unten 82 6 Portable Bedside Capnograph Pulse Oximeter Table of Contents N rs Call Operati E 82 Types of Nurse Call SySIOIfibsesediaiosendicudd ediraid oddiem oci Uid acd ordre d ereere eeen ue s 82 The Nurse Call Cable 2 re nette a itat seks e he o ede dt E eg ce 83 Activating Nurse Call ssssssssssssssseeeeeeeen eem eene nnne nennen nenn
38. ANCE N Connect the other end of the Calibration Line to the gas canister and then select CONTINUE 4 The screen displays the message OPEN GAS SUPPLY FROM CYLINDER Open the gas canister and select CONTINUE At this time the module performs a calibration check While doing so it displays a message CALIBRATION CHECK IN PROGRESS If the CO Module is still warming up the monitor displays the message NOT READY TO CALIBRATE Wait until module is ready and then select CONTINUE 5 When the module has completed the calibration check measurements and is processing data it displays the message CALCULATING RESULTS GAS SUPPLY MAY BE CLOSED Portable Bedside Capnograph Pulse Oximeter Maintenance 6 Close the calibration check gas supply If you have to stop the calibration check before it is complete use the control knob to select STOP 7 The screen displays the message DISCONNECT CALIBRATION GAS AND FILTERLINE and CONTINUE The module then displays CALIBRATION CHECK COMPLETE MEASURED CO X X ACCURACY SPECIFICATION FOR A 5 GAS IS 4 7 5 396 Select BACK to return to the Home screen or START to perform the calibration check again 8 If the calibration check result indicates that the monitor is out of calibration the message MEASURED CO2 NOT WITHIN SPECIFICATIONS CALIBRATION RECOMMENDED is displayed In this case the Calibration Procedure must be performed Refer to the Service Manual or to authorized Oridion Service perso
39. Capnostream 20 Portable Bedside Capnograph Pulse Oximeter Operator s Manual PN 011414A Notice Purchase of this product confers no express or implied license under any Oridion Medical 1987 Ltd patent to use the instrument with any accessory that is not manufactured or licensed by Oridion Medical 1987 Ltd Possession or purchase of this device does not convey an express or implied license to use the device with unauthorized sensors or cables which would alone or in combination with this device fall within the scope of one or more of the patents relating to this device The capnography component of this product is covered by one or more of the following United States patents 6 437 316 5 300 859 6 428 483 6 997 880 and their foreign equivalents Additional patent applications pending E FilterLine Smart CapnoLine CapnoLine Smart BiteBloc NIV Line Capnostream Microcap Microcap Plus and VitalCap are trademarks or registered trademarks of Oridion Medical 1987 Ltd Oridion Microstream The pulse oximetry component of this product is covered under one or more of the following U S A patents 5 758 644 5 823 950 6 011 986 6 157 850 6 263 222 6 501 975 and other applicable patents listed at www masimo com patents htm Masimo Masimo SET LNOP LNCS and LNOPv are trademarks or registered trademarks of Masimo Corporation Exemptions Oridion Medical 1987 Ltd s liability un
40. Check the audible alarm silence duration before temporarily silencing the audible alarms When using the monitor with anesthetics nitrous oxide or high concentrations of oxygen connect the gas outlets to a scavenger system The monitor is not suitable for use in the presence of flammable anesthetic mixture with air oxygen or nitrous oxide The FilterLine may ignite in the presence of O2 when directly exposed to laser ESU devices or high heat When performing head and neck procedures involving laser electrosurgical devices or high heat use with caution to prevent flammability of the FilterLine or surrounding surgical drapes To protect against electric shock hazard the monitor s cover is to be removed only by qualified service personnel There are no user serviceable parts inside To ensure patient electrical isolation connect only to other equipment with circuits that are electrically isolated Connect the device only to a three wire grounded hospital grade receptacle The three conductor plug must be inserted into a properly wired three wire receptacle if a three wire receptacle is not available a qualified electrician must install one in accordance with the governing electrical code Do not under any circumstances remove the grounding connector from the power plug Do not use extension cords or adapters of any type The power cord and plug must be intact and undamaged If there is any doubt about the integrity of the protective
41. D CO2 HOURS OF USE 927 SpO2 HOURS OF USE NA CO2 HOURS REMAINING BEFORE SERVICE 19073 CO2 HOURS REMAINING BEFORE CALIBRATION 273 CO2 SERIAL NUMBER PC0539002680 HARDWARE REVISION C 02 00 SOFTWARE REVISION Spoz SERIAL NUMBER NA HARDWARE REVISION 1 4 0 0 SOFTWARE REVISION 03 08 04 MONITOR SERIAL NUMBER HARDWARE REVISION SOFTWARE REVISION 2 3 FOR ASSISTANCE CONTACT technicalsupport oridion com Figure 34 Service Screen When the monitor reaches 20 000 hours of use send it to an authorized service center Contact your local representative for shipping instructions CO Calibration Note The unit is calibrated when it leaves the factory The monitor should be calibrated by qualified service personnel after the first 1 200 operating hours of use or 12 months whichever comes first After that calibration should be performed every 12 months or after 4 000 operating hours whichever comes first To help you plan in advance for the upcoming calibration process the monitor stores both the number of operating hours before calibration is due and the date of the last calibration When calibration is due the monitor will display the advisory message CALIBRATION REQUIRED in the message area The number of operating hours remaining before calibration appears on the salutation screen every time the monitor is turned on see Figure 9 Salutation Screen on page 28 After the operating hour limit has been exceeded the message will cha
42. Hospital Patient Data Systems Operation with Hospital Patient Data Systems The Capnostream monitor provides connectivity with hospital patient data systems Bernoulli and Oxinet III produced and or marketed by Cardiopulmonary Corporation CPC This option permits regular real time transfer of data from the monitor to hospital patient data systems Eight bed or 12 bed configurations are available Before beginning the connection process ensure that the following equipment is available e Bernoulli or Oxinet III system installed in the hospital e Bernoulli MSM or Oxinet Client Bridge terminated with a 9 pin D connector cable e Capnostream monitor Connect the system as described in the DFU supplied with the Bernoulli MSM or Oxinet Client Bridge Once the connection between the devices is made as described above data in binary format will be transferred automatically from the Capnostream monitor to the Bernoulli Oxinet III system No additional setting of the monitor is required The following measurement data is transferred e Instantaneous CO e EtCO e FiCO e Resp rate e SpO e Pulse In addition information regarding patient type alarm data and device settings alarm limits etc are transferred For more information regarding the Bernoulli Oxinet III system or for troubleshooting the setup procedure contact your local distributor Portable Bedside Capnograph Pulse Oximeter 85 Chapter 11 Maintenance a
43. ING Do not use the monitor with nuclear spin tomography MRT NMR NMT as the function of the monitor may be disturbed Definitions Note A Note is inserted to point out procedures or conditions which may otherwise be misinterpreted or overlooked and to clarify apparently contradictory or confusing situations Caution A Caution is inserted to call attention to a procedure which if not followed exactly can lead to damage or destruction of the equipment Warning A Warning is inserted to call attention to dangerous or hazardous conditions inherent to the operation cleaning and maintenance of the equipment which may result in personal injury or death of the operator or patient Portable Bedside Capnograph Pulse Oximeter 13 Chapter 1 About this Manual Overview Who Should Read This Manual Contacting Technical Support Symbols Overview This manual provides directions for setting up and operating the Capnostream monitor The Capnostream is a portable bedside monitor that continuously monitors a patient s End tidal carbon dioxide EtCO level of carbon dioxide in exhaled breath Respiratory rate RR Fractional inspired carbon dioxide FiCOz level of carbon dioxide present during inhalation Oxygen saturation SpO Pulse rate PR The Capnostream combined capnograph pulse oximeter monitor is intended to provide professionally trained health care providers the continuous non invasive measurement and monitori
44. Nurse Call Port used for the Mains power attaching to Nurse supply to the monitor Call system 2 Mains fuse holder Two 3 15A fast blow 7 Analog output 15 pin female D fuses type connector for 7 channel analog output 3 Mains plug Connection for AC 8 Equipotential For external power ground grounding 4 USB port For flash memory 9 Manufacturer stick labels 5 RS 232 9 pin female D type 10 Carrying handle connector for RS 232 communication 26 Portable Bedside Capnograph Pulse Oximeter Turning on the Monitor Monitor Left View The left side of the monitor contains the battery housing and the connection points to the patient interface s d Micmetreanr oW 39 5s mn M 3 WWW pat 4 nit yj os ta Figure 8 Capnostream Left View Table 6 describes the functions of the features on the left side of the monitor Table 6 Capnostream Left View eLabel o Function F Ceesscription ed 1 FilterLine Input connector To connect the FilterLine to the monitor Provided with an automatic door close 2 Gas outlet To connect to a scavenger system when the monitor is used in the presence of anesthetic gases The gas output is a barbed style connector intended for 3 32 inch ID tubing 3 SpO2 To connect SpOz sensor to the monitor with an extension cable 4 Battery housing Where the battery pack is installed Barcode label Barcode of the Serial Number and Model Number of monitor
45. OM button to select a Zoom option i e to go to lower zoom level 6 or 2 hours and scroll again until you have found your specific area of interest To exit from Zoom change mode click the control knob 4 To exit from Scroll mode click the control knob To view more information about the displayed patient use the control knob to select the TABULAR trend display on the Menu Bar and see the instructions below in the section Tabular Trend Display Screen on page 63 Tabular Trend Display Screen To VIEW THE TABULAR TREND DISPLAY SCREEN 1 In the graphical trend mode use the control knob to select TABULAR from the Menu Bar The Tabular Trend display screen will appear To enter the Tabular Trend mode from the Home screen click TREND on the Menu bar and then TABULAR on the Menu bar 6 47AM JAN 03 05 ADULT TABULAR TREND TENS TT Im f 1 mmHg 40 gt AR cabot fica SCROLL GRAPHICAL HOME LIMITS TREND Figure 24 Tabular Trend Display 2 Note that the real time patient data is displayed on the right hand side of the screen while the left side of the screen displays the Tabular Trend with detailed historic patient data 3 Click ZOOM on the Menu bar to change the time resolution from the current display to 60 15 3 or 1 5 minutes or the MINIMUM setting The MINIMUM setting is defined as the trend recording resolution and can be 5 10 or 30 seconds see Appendix 1 Institutional Settings on page 96 for instruction
46. There is no need for the user to make any changes to the BTPS setting Monitoring CO during MRI Scanning 46 WARNING Do not use the FilterLine H Set Infant Neonatal during magnetic resonance imaging MRI scanning Using the FilterLine H Set Infant Neonatal during MRI scanning could harm the patient CAUTION During MRI scanning the monitor must be placed outside the MRI suite When the monitor is used outside the MRI suite EtCO monitoring can be implemented by attaching the FilterLine XL to provide extended length Non invasive EtCO monitoring during magnetic resonance imaging MRI can be accomplished with the monitor and a FilterLine XL The maximum magnetic field gauss line in which EtCO monitoring can take place is 3 A m 0 0375 Gauss TO USE THE MONITOR DURING MRI SCANNING 1 Place the monitor outside the MRI suite There must be a hole in the wall of the suite approximately 10 cm diameter 2 Connect the FilterLine XL to the monitor and guide the FilterLine XL through the hole in the wall of the MRI suite 3 Attach the FilterLine XL to the patient Note A small hole at the base of the wall does not affect the integrity of the MRI shielding shielding of a 1 5 Tesla magnet Note Due to the extended length of the FilterLine XL there may be a slower response and a decreased frequency response time To purchase the FilterLine XL contact your local representative Portable Bedside Capnograph Pulse Oxime
47. Turning on the Monitor This section explains how to turn on the monitor CAUTION The monitor is intended only as an adjunct in patient assessment It must be used in conjunction with clinical signs and symptoms CAUTION Use only Microstream EtCO consumables and Masimo SpO sensors to ensure that the monitor functions properly Portable Bedside Capnograph Pulse Oximeter 27 The Capnostream Monitor CAUTION Do not connect anything other than an SpO sensor to the sensor port for example do not attempt to connect a PC to the monitor at the sensor port gt TO TURN ON THE MONITOR 1 Plug the electrical cord into the mains plug in the rear of the monitor see Figure 7 on page 26 2 Plug the electrical cord into the mains AC supply 3 Turn on the power switch on the back of the unit The orange power indicator on the front panel will light up CAUTION If the orange light is not on the monitor is running on battery power only and will stop operating when the AG is discharged 4 Press the Power ON OFF button on the front panel to turn on the monitor The following happens The green power on indicator lights up showing that the monitor is turned on An hourglass figure appears on the screen for a few seconds followed by the blue monitor salutation screen for about 5 seconds as the monitor performs a self test The red alarm and yellow alarm lights will briefly light up and the speaker will beep CAUTION If
48. UTION The calibration check must be performed with a manufacturer authorized Calibration Kit containing a gas mixture of 5 CO 21 O and Bal N and the authorized connecting means T piece A manufacturer approved Calibration Kit can be purchased from Scott Medical part number 0304653ORFBD It includes e Calibration Gas containing 5 CO 21 O5 Bal N e Tubing Adapter T Piece e Calibration Line Calibration FilterLine Note If this process is performed while a battery powers the monitor make sure that the battery is fully charged Prior to checking the calibration verify that the Calibration Line supplied with the Calibration Kit is firmly attached Calibration Check Procedure Note At any stage in the Calibration Check procedure you can go back to the first screen by clicking the BACK button TO PERFORM CALIBRATION CHECK 1 Use the control knob to navigate to the CO CALIBRATION CHECK screen From the Home screen select the SYSTEM button on the menu and then select CAL CHECK Or from the Service screen select CO2 CAL and then select CAL CHECK The CO CALIBRATION CHECK screen is displayed On screen instructions will guide you through a number of Calibration Check steps 2 The screen displays the message CONNECT FILTERLINE TO MONITOR Connect the Calibration Line to the monitor and select START to start the calibration check 3 The screen displays the message CONNECT CALIBRATION GAS 596 CO 21 O BAL
49. W Equipment Advisory Message Occurrences CO2 NOT AVAILABLE SpO NOT AVAILABLE BATTERY LOW Events EVENT 1 EVENT 2 EVENT 3 Patient Readings at start and end of From start of case until recording period EtCO 2 RR SpO PR current time once case is Graphs of levels of two of the following stopped data is not available parameters according to the parameters chosen in the PRINT FORMAT screen see To print a report on page 69 at 30 second intervals EtCO2 mmHg RR bpm SpO 96 and PR bpm DATE TIME From the time sensor is first Patient Readings at start of recording connected to the device period EtCOz FiCO RR SpO PR following the erasure of trend memory until current time Patient readings at intervals set for trend once trend is erased data is increment display Three of the following not available five parameters according to parameters chosen in the PRINT FORMAT screen see To print a report on page 69 EtCO FiCOz RR SpO PR Patient Urgent Alarm Occurrences EtCO2 HIGH EtCO2 LOW RR HIGH RR LOW NO BREATH SpO HIGH SpO2 LOW PR HIGH PR LOW 71 Printing Reports Report Name Fields Included Time Frame of Report Graphical Trend Report Real Time Continuous Waveform Real Time Continuous Tabular Patient readings of trend memory in graphical format The time between data entries is the resolution set for trend increment display MINIMUM
50. able gives the equivalent value that corresponds to the maximum voltage reading for each analog output data channel Table 24 D A Signal Values Parameter EE NNI EtCO2 End of breath indication EtCO2 value when the 100 mmHg 0 9 V end of breath is signaled OV otherwise EtCO2 100 mmHg 0 9 V FiCO2 100 mmHg 0 9 V RR 150 BPM 0 9 V CO2 Wave 100 mmHg 0 9 V CO Measurement Valid 0 Vzyes 1 V no SpOz Saturation 100 Sat 0 9 V Pulse Rate 250 BPM 0 9 V Portable Bedside Capnograph Pulse Oximeter 81 Downloading Patient Data SpO2 Wave pleth waveform 255Pleth 0 9 V Square wave at 1 Hz 50 duty cycle OV 1V p p No signal always high 1V No signal always low OV D A Cable Color Coding The following table lists the cable colors and channels for the D A cable Table 25 D A Cable color codes Data Channel CH1 RED m CH2 WHITE CH3 GREEN E CH4 BLUE EI CH5 YELLOW CH6 BROWN yy CH7 ORANGE E Nurse Call Operation The Capnostream monitor allows connection to an external Nurse Call system When connected the monitor sends information to the institutional nurse call system that an alarm condition has occurred alerting medical personnel that the patient requires medical care The nurse call alarm output becomes active simultaneously with the occurrence of an alarm on the monitor and remains active while the alarm condition is present When the alarm condition is no longer present that is when the
51. alarm on the monitor ceases the Nurse Call alarm output also becomes inactive A Nurse Call cable 3 5 m can be purchased from Oridion part number 011149 One end of the Nurse Call Cable attaches to the Capnostream monitor The cable is supplied un terminated so it can be built to fit your nurse call system Types of Nurse Call Systems 82 From an alarm activation deactivation perspective Nurse Call Systems can usually be configured in two ways latching and non latching Latching systems the nurse call light alarm will remain active until the connected device ceases to alarm and until the nurse cancels the alarm by pressing the nurse call system s CANCEL ALARM button Non latching systems the nurse call light alarm remains active until the connected device ceases to alarm User intervention is NOT required if the alarm condition clears This means that if the alarm condition corrects itself the nurse call light and tone will automatically cease When interfacing between Capnostream and a Nurse Call system a non latching configuration should be used Please note that both types of Nurse Call Systems will not permit a Nurse Call alarm to be silenced while there is an active alarm from a connected device such as the Capnostream monitor Portable Bedside Capnograph Pulse Oximeter Types of Nurse Call Systems The Nurse Call Cable The monitor has a built in relay that can be connected to a hospital nurse call system using the nur
52. and then SERVICE on the menu bar at the bottom of the screen Enter the Service password see Changing Institutional Defaults on page 96 to enter the Service screen 2 On the Service screen click the DEMO MODE button on the menu bar The monitor will now enter Demo Mode and will display pre recorded CO and SpO data As an indicator of operation under Demo mode the header will indicate DEMO MODE PRERECORDED DATA Service options and the Calibration Check feature are not available to the user while the device is in Demo mode 3 To exit the Demo Mode you must turn off the monitor using the ON OFF button at the front of the monitor When the monitor 1s turned on again it will have returned to its standard operating status Monitor Screen Menu Reference Chart The chart below shows the menu flow paths for navigating through the different screens of the Capnostream Portable Bedside Capnograph Pulse Oximeter 41 Using the Capnostream Monitor ALARM LIMITS PRINT TREND ZOOM SCROLL TABULAR GRAPHICAL HOME z CAUTION ENABLE DEFAULT RESET HOME Y CO2 DIRECT MONITOR SOFTWARE BACK PATIENT SYSTEM TYPE v CLEAR TREND DIA SETUP CAL CHECK SERVICE DATA OUTPUT HOME Y START Y DISABLE ENABLE e DEFAULT RESET CAL HIGH CAL LOW CAL RESET HOME Y ISTART USB HOME Password Required v DEMO MODE INST DEFAULTS SERVICE DATA SOFTWARE SUPPORT CO2 CAL HOME v ALARM LIMITS Y TREND
53. any questions regarding service and periodic maintenance Replacing the Fuses The monitor is protected from electrical surges by two fuses If the fuses blow the monitor will not turn on and the battery pack will not charge To replace the fuses turn the monitor off disconnect the power cord from the monitor and turn off the main power switch on the back of the monitor Portable Bedside Capnograph Pulse Oximeter 89 Maintenance and Troubleshooting The fuses are located in the back of the monitor between the ON OFF power switch and the electrical cord connection Use a flat screwdriver to pry out the fuse housing cover and replace the fuses with fuses of the same rating only F3 15A 250 Volt Push the fuse housing cover closed then reconnect the power cord and turn the monitor on Note Blown fuses indicate that an abnormal electrical condition occurred If the cause is not known contact your representative to determine if servicing is required Replacing the Printer Paper Roll If the printer runs out of paper replace it with a roll of thermal printer paper Oridion part 010516 or similar paper which meets the specifications outlined in the Specifications in Internal Thermal Printer optional on page 107 TOREPLACE THE PRINTER PAPER Open the plastic cover on the printer 2 Remove the empty spindle inside the paper compartment 3 Insert a new roll of paper in the direction shown in the figure below so that the loo
54. arm and will generate a beep once a minute To avoid the alarm message and beeping connect the extension cable to the monitor but do not connect the SpO sensor to the extension cable until it is time to connect the patient to the monitor SpO Data Displayed by the Capnostream Monitor The Capnostream monitor Home screen displays real time SpO data The displayed data includes Waveform Signal IQ Waveform SpO Numeric Pulse Rate Perfusion Index see Perfusion Index on page 50 Plethysmograph SpO waveform Signal IQ Waveform see Signal IQ Waveform on page 50 SpOz Perfusion Index and Pulse Rate values Figure 19 SpO Data on the Capnostream Monitor Additionally the monitor can display SpO data in trend form showing time date SpOz pulse rate PR alarms events For more information about trend display see Chapter 8 Using Trends on page 59 When the monitored parameter limits are exceeded the affected reading will flash to alert the attending health care professional to the specific reading that is affected Portable Bedside Capnograph Pulse Oximeter 49 Pulse Oximetry with the Capnostream Monitor Perfusion Index The Perfusion Index is a relative assessment of the pulse strength at the monitoring site expressed as a numerical value that ranges from 0 02 to 20 where the lower values indicate weak pulse strength and the higher values indicate strong pulse strength This index represents the ratio of p
55. as shown in Figure 22 Graphical Trend Display on page 60 Alarm indicator wide vertical red lines that may appear in the four graphs showing where in time an alarm occurred For EtCO SpO2 RR and PR alarms the red line is drawn through the respective graph of the waveform for that parameter In the case of NO BREATH alarms the red line extends though both the EtCO and RR graphs The actual alarm details can be viewed in the Tabular Trend Display Screen seen on page 63 Event indicator the small vertical pink line along the bottom of the graph shows when an event was registered The actual event can be viewed in the Tabular trend display screen described in Tabular Trend Display Screen on page 63 The following controls for viewing graphical trend are selected from the Menu Bar TABULAR switches the display from Graphical to Tabular display in the Tabular trend display this control changes the display to Graphical See Tabular Trend Display Screen on page 63 for an explanation of the tabular trend display e SCROLL allows you to scroll through the patient data The date and time of the cursor location are indicated under CURSOR LOCATION e ZOOM allows you to increase or decrease the time segment being looked at PRINT TREND provides a printout of the trend display currently seen on the screen e ALARM LIMITS displays the Alarm Limits screen allowing you to see what the settings are and modify them if necessary Us
56. at and are suitable for use in applications such as Microsoft Excel The two binary data report types are for advanced programming applications Table 21 Data Transfer Types Report Name Fields Included Tabular Case Report Comma separated value csv file Reports the data stored in trend memory that is assigned to the selected case The time between data entries is the resolution set for trend storage 5 10 or 30 seconds Tabular Trend Report Comma separated value csv file Reports all the data stored in trend memory The time between data entries is the resolution set for trend storage 5 10 or 30 Portable Bedside Capnograph Pulse Oximeter DATE TIME Patient Readings EtCO 2 RR SpOz PR Patient Urgent Alarm Occurrences EtCO2 HIGH EtCO2 LOW RR HIGH RR LOW NO BREATH SpO2 HIGH SpO2 LOW PR HIGH PR LOW Equipment Advisory Message Occurrences CO2 NOT AVAILABLE SpO2 NOT AVAILABLE BATTERY LOW Events EVENT 1 EVENT 2 EVENT 3 DATE TIME Patient Readings EtCO 2 RR SpO PR Patient Urgent Alarm Occurrences EtCO2 HIGH EtCO2 LOW RR HIGH RR LOW NO BREATH SpO2 HIGH SpO2 LOW PR HIGH PR LOW 75 Downloading Patient Data Report Name Fields Included Real Time Continuous Waveform Real Time Continuous Tabular Full Binary Continuous Transfer Full Binary Trend Transfer seconds csv file with data entries every 50 milliseconds csv file similar to the Tabular T
57. atient Stopping a case will erase the Trend Memory and a warning that indicates STOPPING THE CASE WILL ERASE TREND MEMORY PRESS STOP CASE AGAIN TO CONFIRM will appear on the screen when STOP CASE is pressed If you want to transfer or print case or trend data this must be done before the case is stopped If you do not want to stop the case simply turn the knob to remove the question from the screen and continue the case If you do want to stop the case click the control knob again 7 If STOP CASE is not pressed when the user finishes monitoring and powers off the monitor the case will continue when the monitor is turned off and then on again However when the monitor is powered up again in such a case a warning will suggest that the user clear trend data and close the case to clear patient ID before beginning a new monitoring session This screen is seen in Figure 25 Trend Memory Message on page 67 Oridion strongly suggests that you do so in order to avoid mis identification of patient data However if you intend to continue monitoring the same patient as previously you may want to retain the trend and case data Clicking YES and CONFIRM in the screen seen in Figure 25 Trend Memory Message on page 67 will clear the trend memory and close the current case thus erasing all data in the monitor regarding that case WARNING The monitor can store only one case at a time The trend memory includes only data for the current case and whe
58. ay result in increased emission and or decreased immunity of the equipment and or system WARNING CO readings respiratory rate pulse oximetry readings and pulse signals can be affected by sensor application errors certain ambient environmental conditions and certain patient conditions WARNING The monitor is a prescription device and is to be operated by qualified healthcare personnel only Portable Bedside Capnograph Pulse Oximeter 11 Safety Information MRI Scanning WARNING CAUTION Alarms WARNING WARNING WARNING WARNING Fire Hazard WARNING WARNING WARNING Electrical WARNING WARNING WARNING WARNING WARNING Do not use oximetry sensors during magnetic resonance imaging MRI scanning Conducted current could cause burns The sensors may affect the MRI image and the MRI unit may affect the accuracy of oximetry measurements During MRI scanning the monitor must be placed outside the MRI suite When the monitor is used outside the MRI suite EtCO monitoring can be implemented using the FilterLine XL Refer to Monitoring CO2 during MRI Scanning on page 46 Do not silence the audible alarm if patient safety may be compromised Always respond immediately to a system alarm since the patient may not be monitored during certain alarm conditions Before each use verify that the alarm limits are appropriate for the patient being monitored
59. blue Click the control knob 2 The CO Setup screen will appear Move the control knob to the parameter that you wish to change and click to select that parameter Move the control knob to select the desired setting and click to select the setting A list of the settings that can be changed appears in Table 9 Adjustable CO2 Parameters below Portable Bedside Capnograph Pulse Oximeter 45 Capnography with the Capnostream Monitor 3 Move the control knob to the HOME button and click to select The screen will also revert to the Home screen after a few seconds if no additional actions are taken on that screen but if the screen timed out and reverted back to the HOME screen in this manner changes will not be saved 4 The changes in the parameters will remain in effect until the device is turned off Table 9 Adjustable CO Parameters Factory Default BTPS On Off On FiCO Display On Off On Pump Off Timeout minutes 5 10 15 or 30 15 CO2 Waveform Scale mmHg 50 100 Auto Auto EtCO2 Scale for Trend Display 50 100 50 RR Scale for Trend Display 50 100 150 50 Sweep Speed mm sec 3 6 3 12 5 25 6 3 for current patient type BTPS denotes the standard correction used during measurement for body temperature pressure and saturation BTPS should be set to ON during all measurement procedures The device automatically turns off the BTPS correction during calibration procedures and turns it on again following these procedures
60. calibration but salutation screen shows there is still time before next calibration Returning the Monitor If it is necessary to return the monitor for repairs contact your local representative for shipping instructions To repack the monitor disconnect the accessories from the monitor Pack the monitor in the original shipping carton If the original carton is unavailable use a suitable box filled with the appropriate amount of packing material It is not necessary to return the sensors Microstream EtCO2 consumables or power cords If the monitor malfunctions carefully pack the consumable used at the time of malfunction with the monitor and return it with the monitor for inspection Technical Assistance For technical information contact your local representative or write to technicalsupport oridion com The Service Manual includes information that is required by qualified personnel to service the monitor See also the Technical Service area in the Capnography section of our website www oridion com If it is necessary to return the monitor for repairs contact your local representative for shipping instructions Portable Bedside Capnograph Pulse Oximeter 95 Appendix 1 Institutional Settings Institutional Defaults Changing Institutional Defaults Resetting to Factory Defaults Changing Monitor Settings Institutional Defaults Capnostream is shipped from the factory with all changeable settings configured acc
61. ce see Data Transfer via the USB Data Port on page 75 The report can then be formatted and printed using the computer The following printed reports are available Tabular Case Report Graphical Case Report Tabular Trend Report Graphical Trend Report Real Time Continuous Waveform Real Time Continuous Tabular The data printed for the trend reports is the data that was last displayed on the Trend screen at the time PRINT TREND was selected The resolution of the case report is always the minimum resolution maximum detail Real Time Continuous Tabular data is printed at the same interval that the numerics on the screen are updated The Real Time Continuous Waveform graph is printed as it is displayed on the screen Please note that all Trend and Case reports must be printed before the case is ended Once a case is ended the case and trend data is deleted from the memory and printing is no longer possible Printing Reports The Print screen is accessed from the Home screen The Print screen allows you to choose what report to print and also to start and stop the printing of a report gt TO PRINT A REPORT 1 From the Home screen select PRINT to display the Print screen seen in Figure 26 Print Screen below 2 Use the control knob to select the type of report to print Only one type of report can be selected at a time An asterisk will indicate the report that has been selected If you choose a case report and no ca
62. chnology Overview 16 egens Pet 16 2 101 MeL 16 Technology Ov rvi Rm 16 Whats Capnography eite etes an e at hop Ra Fco da pa ERR E NaN ENES ERE Ce Rea eaa DU 16 What is Pulse OXIM t0ry fem P HM 17 Chapter 3 18 The Capnostream Monitor 18 Unpacking and Inspection es oscunsthetazekbd na ER QUIS AM UMH ROBUR IRA RR APER UR IU RM M PA RON MMC RN RE 18 Installing the Battery Paoli ioi id e i re ra DER o EIE HY EE ELE e Ex ERE e Hire oce pA Y eMe ire unus 19 Testing the Battery and AC Connections sessssssssssseeeeeeenneeeee nennen 20 Handling the Battery Pack sessssssseseseseseeeeene nenne ener nennen nnne nnn nnn nn nnn nnns 20 Portable Bedside Capnograph Pulse Oximeter 3 Table of Contents Storing the Battery etr ee race ee ense t deren eee eee esae uad as 20 Disposing of the Battery ener nennen nennen tnn nn nenne rens 21 Battery and Power Usage eee ite eei ende ae Eu E ee esa x HY EY X Rod dax ER YR EAE da 21 M u n ti g the MOTION A 22 ACCOSSOO c NEP asa ase ewe ee E E E 22 Available AGCGSSOTIGS iioii eee amen Genera ia leu n aaa Y SERRA V ENERETT SEEE YR ERR ERU NERA EE EEANN ARAA 22 Monitor Mounting Plate sisis i eder tede ded esaet be e EAE En S aa EET EAEL iant 23 Digital to Analog Data Transfer Cable ssssssssssssssemeeeeeeen enne nnne 23 P
63. creen on page 29 shows data and waveforms for a patient connected with a FilterLine and SpO sensor 30 Portable Bedside Capnograph Pulse Oximeter Screen Navigation Screen Navigation Select options and set values using the control knob The control knob works in a manner similar to that of a regular computer mouse It is also used as a keyboard for entering letters and numbers TOMOVE AROUND THE SCREEN 1 Turn the control knob to the right or left to move to the next area on the screen which is highlighted by the frame changing to blue 2 To make a selection push the control knob in until it clicks gt TOENTER LETTERS AND NUMBERS 1 When required to enter alphanumeric data turn the control knob for navigation and then click on the input data block on the screen The content of the data block is cleared and the 4 Enter symbol appears in the place of the first character in the empty block 2 As you turn the control knob to the right or left you will see the complete alphabet and numbers 0 9 the backspace symbol a blank space and the Enter symbol 3 When the desired character is displayed press on the control knob until it clicks Pressing the control knob when the blank space is displayed will insert a blank space if you want to use a patient name for the Case ID number for example The cursor then highlights the next character to be entered and shows the Enter symbol 4 Turn the control knob again to begin a ne
64. d 5 Ground 13 Ch 6 Signal 6 Ch 3 Signal 14 Ground 7 Ground 15 Ch 7 Signal 8 Ch 4 Signal Nurse Call Normally Open Normally Closed Relay Rated Carrying current 2A Max Allowable Current 2A Max Allowable Voltage 24V DC Contact Capacity 2A 24V DC 1 8 stereo phono jack Pin out of mating stereo phono plug N1 N NS N1 N2 Normally Closed relay N1 N3 Normally Open relay RS 232 9 pin female D type connector Pinout 106 Portable Bedside Capnograph Pulse Oximeter Internal Thermal Printer optional rm i Assignment 1 2 PC_RX 3 PC_TX 4 2 5 Isolated Ground 6 7 mies 8 9 USB USB Type A Host connector female For use only with flash memory drives Pinout re id Sig nment 1 2 3 4 VBUS Data Data Ground Internal Thermal Printer optional EM Value Type Two Channel Printing Method Thermal Recording Dot Density 203 dpi Paper Width 58mm 2 in Paper Roll Diameter maximum 40mm 1 1 2 in Paper Length maximum Speed 15 2 meters 50 ft 25mm s General Characteristics EE CENE Value Unit Dimensions Unit Weight Operating Temperature 167mm h x 220mm w x 192mm d 6 6in h x 8 7in w x 7 6in d 3 5kg 7 721b 0 C to 40 C 32 F to 104 F Portable Bedside Capnograph Pulse Oximeter 107 Specifications EE EM Value Operating Pressure and Altitude Operating Humidity Storage amp Transport Temperat
65. der this warranty does not include any transportation damage or other charges or liability for direct indirect or consequential damages or delay resulting from improper use or application of the product or the substitution upon it of parts or accessories not approved by Oridion Medical 1987 Ltd All information in this manual is believed to be correct Oridion Medical 1987 Ltd shall not be liable for errors contained herein with the performance or use of this manual Copyright 2007 Oridion Medical 1987 Ltd All rights reserved Table of Contents Table of Contents Table of Contents 3 List of Figures 9 List of Tables 10 Safety Information 11 Warming PERTENECER een ens eee eee 11 i e x 11 ls iere inin Ipto EL 12 A aFms e ctetu toe mrt ree estes tur A e etus Se dennis iow Sever see Ren ceu inq A aeta Sa dine ndr ae ras 12 FM AAZANG eere 12 leup e ewan tune 12 Electro magnetic Interference ssssssssssssssssssssseseen eee neenere nennen nennen nnn 13 R MUS 13 Chapter 1 14 About this Manual 14 OVOVISW erara E IDE 14 Who Should Read This Manual a0aaaa0nannnennannnnnannnnnnnnnnnnnnnnrnnnnnnrnnnnnrrnnnnnrrnnnnrrnnnnnnne 14 Contacting Technical Support L sadescvessseszuvaz excrescxusCwrenkxvs ckussVescw ux ix ead aes s cr pa SUR ER UE Ka Gu 14 vip 15 Chapter 2 16 Te
66. ding wire pair of the D A cable There are 12 different settings available for the data channel outputs The current settings and the available options are shown when you enter the Digital to Analog setup screen as shown below in Figure 31 Digital to Analog Setup Screen on page 81 gt TO SET UP D A DATA OUTPUT 1 From the Home screen select SYSTEM from the menu bar and then select D A SETUP from the menu bar The seven data channels provided are listed on the left hand side of the screen seen in Figure 31 Digital to Analog Setup Screen on page 81 The signals available to assign to the channels are listed on the right hand side 2 Use the control knob to select the channel to which you want to assign a signal by pressing the control knob when that channel is highlighted Then turn the control knob to select the signal to be assigned to that channel Press the control knob to select the signal Repeat the process for each channel to which you want to assign or re assign signals 3 Any signal can be assigned to any channel Also the same signal can be assigned to multiple channels If you want these settings to be permanently stored in the monitor you must make these changes in the Institutional Defaults screen while in Service mode See Appendix 1 Institutional Settings on page 96 Using Capnostream with a Polysomnograph gt TO RECORD DATA FROM CAPNOSTREAM TO A POLYSOMNOGRAPH 1 Calibrate the signal output with your data collect
67. duction Message Priorities Alarms Alarm Silence Changing Alarm Limits Testing Capnography Alarm Settings Alarm Limits Factory Defaults Introduction 52 Chapter 7 Capnostream triggers alarms related to patient condition as well as equipment errors Alarms alert the health care provider that the patient s condition is beyond predefined limits or indicate a malfunction or operating condition of the monitor hardware The monitor contains four levels of alarms and advisories each defined by a set of audible and or visual indications High Priority Alarms Low Priority Alarms Advisories Silent Advisories High Priority Alarms are provided with the option of setting two levels of alarms red urgent and yellow caution for each alarm issue if desired in order to permit the clinician to follow developing alarm situations The following table describes how the alarms are indicated Table 11 Alarm Indications Alarm Type High Priority Repeated Beep Patient Alarms Pattern Red Urgent High Priority None Patient Alarms Yellow Caution Low Priority Repeated triple beep Advisories Single Beep Silent Advisories None Flashing Red except NO BREATH Flashing Yellow N A N A N A Audible Messages Indicator Light Message area NO BREATH in waveform area Flashing Red None Flashing Yellow Message area Solid Yellow Message area N A Message area N A Portable Bedside Ca
68. e CO Numeric Data and real time SpO Numeric Data sections The continuous display of the real time CO and SpO Numeric Data allows continuous patient monitoring even when changing system settings or observing patient history on the trend screens Header Area The Header section is always displayed along the top of the screen and contains the information listed in the table below 4 1 5 11 32 AM JAN 18 07 SpO2 ERRORS DUE TO MOTION 2 ADULT JOHN SMITH 6 HOME 3 Figure 11 Header Area Portable Bedside Capnograph Pulse Oximeter 29 The Capnostream Monitor Table 7 describes the elements of the header area Table 7 Header Section Item Function Description a 1 Time Date Displays the Time and Date in selected formats 2 Patient Type Indicates patient mode ADULT for adults and pediatrics and NEONATAL for neonatal patients Screen name Displays the current screen name 4 Message area Messages explaining alarms and equipment status appear in this area 5 Patient ID If a patient ID has been entered for the current case the patient ID will appear 6 Alarm status indicator Indicates whether the audio alarms are enabled temporarily disabled or permanently disabled Menu Bar The menu bar of available options and functions is located along the bottom of the monitor display screen At the left hand side is the battery charge level indicator At the right hand side is the speaker volume control The menu bar w
69. e Reports Sample Reports Sample Case Reports The following are examples of tabular and graphical case reports as described above CASE REPORT CASE REPORT CASE ID ANN SMITH CASE ID ANN SMITH ADULT ADULT START 9 29 55 AM JAN 04 07 START 9 29 55 AM JAN 04 07 EtCO2 RR CO2 mmHg bpm mila Copen 5 E 39 15 S902 PR SpO2 PR pm o bpm E 98 73 DATE EtCO2 RR PR A x TIME mmHg bpm bpm EtCO2 SpO2 mmHg o 9 30 00 AM 39 15 71 9 3200AM 39 16 71 i md Bd 9 33 30AM 39 15 71 9 35 00 AM 39 15 71 TURNED 9 36 30AM 4 14 68 9 38 00AM 41 16 68 9 39 30AM 41 15 68 9 41 00 AM 4l 15 68 9 42 304M 4l 15 71 9 44 00AM 39 16 71 9 45 30AM 39 16 71 9 47 00 AM 39 15 71 9 48 30AM 39 15 73 SNORING 9 50 00AM 40 15 73 9 51 30AM 40 15 72 9 53 00 AM 39 15 72 9 54 30AM 39 15 3 9 56 00 AM 39 15 3 END 9 56 01AM JAN 04 07 END 9 56 01 AM JAN 04 07 EtCO2 RR EtCO2 RR mmHg bpm mmHg bpm 39 15 39 15 n0 SpO2 PR CE 98 73 98 73 Figure 27 Sample Case Reports Printout Portable Bedside Capnograph Pulse Oximeter 73 Printing Reports Sample Trend Reports The following are examples of tabular and graphical Trend reports as described above TREND REPORT TREND REPORT CASE ID ANN SMITH CASE ID ANN SMITH ADULT ADULT START 9 19 55 AM JAN 04 07 START 929 55 AM JAN 04 07 EtCO2 RR acoz mmia bp ui iig Copa p 39 15 rs bia Spo PR Yo m 2 202 TET T TIME maig
70. e monitor are as follows Factory Default Changing Monitor Settings Date Format dd mmm yy mmm dd yy mmm dd yy Time Format 12 or 24 hour 12 hour Language English Spanish French English German Additional languages may be available in later software versions Audio Alarm Silence ENABLED DISABLED DISABLED Event Marking Mode Quick Detailed DETAILED RS 232 Baud Rate AUTO AUTO 9600 19 2K 57 6K 115 2K Nurse Call ENABLED DISABLED DISABLED CO Parameters Institutional Defaults can be set for all CO parameters that are settable in the monitor To change the parameters select CO in the Institutional Defaults screen Factory Default CO Units mmHg kPa Vol mmHg BTPS On Off On FiCO Display On Off On Pump Off Timeout minutes 5 10 15 or 30 15 CO Waveform Scale mmHg 50 100 Auto Auto EtCO2 Scale for Trend Display 50 100 50 RR Scale for Trend Display 50 100 150 50 Sweep Speed Adult mm sec 3 6 3 12 5 25 6 3 Sweep Speed Neonatal mm sec 3 6 3 12 5 25 6 3 BTPS denotes the standard correction used during measurement for body temperature pressure and saturation BTPS should be set to ON during all measurement procedures The device automatically turns off the BTPS correction during calibration procedures and turns it on again following these procedures There is no need for the user to make any changes to the BTPS setting SpO Parameters Institutional Defaults can be set for all SpO2 parameters that
71. e section Changing Alarm Limits on page 57 By default the Caution alarms are disabled and in the Alarm Limits screen the numbers for the Caution alarm settings appear in grey Select CAUTION ENABLE if you want to enable the Caution alarms When the Caution alarms are enabled the numbers for the Caution alarm settings change to white from grey Portable Bedside Capnograph Pulse Oximeter 97 Institutional Settings 10 31AM JUN 06 06 INSTITUTIONAL DEFAULTS ALARM LIMITS ADULT UTION ALARM CAUTION FACTORY DISABLE DEFAULTS Figure 37 Institutional Defaults Alarm Limits Screen The factory default settings for Adult and Neonatal alarm limits are given below Table 28 Factory Default Alarm Limits Parameter Adult Red Adult Neonatal Neonatal Alarm Range Urgent Yellow Red Urgent Yellow Caution Caution EtCO High 60 55 60 55 5 99 mmHg EtCO2 Low 8 10 8 10 0 94 mmHg FiCOz High 8 8 8 8 2 98 mmHg RR High 50 40 80 70 5 150 bpm RR Low 3 6 12 15 0 145 bpm No Breath 30 30 20 20 10 60 sec Detected SpO High 100 100 98 98 90 100 saturation SpO Low 85 90 85 90 85 95 saturation Pulse Rate High 140 140 200 200 30 240 bpm Pulse Rate Low 50 50 100 100 25 235 bpm 98 Portable Bedside Capnograph Pulse Oximeter Changing Monitor Settings Trend Settings Institutional Defaults can be set to change the Trend stored in the monitor and how it is displayed on the screen For the specific trend settings for SpO and CO see
72. eeeeeene nennen nnne nnne nnn 39 Figure 15 Pulse Tone Volume Selection essssssssssssssseeeeeenee nennen 39 Figure 16 Scavenger System Connection Point 40 Figure 17 Screen Menu Reference Chart sssssssssssssssssssssssee eene nnne 42 Figure 18 CO Data on the Capnostream Monitor essssesssseseeeeennnenee nnn 45 Figure 19 SpO Data on the Capnostream Monitor enn 49 Figure 20 Example Showing Alarms ssssssssssssseeeeeeeee eene ener enn nennen nenne 54 Figure 21 Alarm Limits Screen iine etre Fait Er ebd eun Fran EE ERR ERR Rae EE Ce pas ERR ER 57 Figure 22 Graphical Trend Display ssssssssssseeese enne nennen nennen nennen rennen 60 Figure 23 Scroll mode in the Graphical Trend ssssssssssseeeeeeeeeee eene 62 Fig re 24 Tabular Trend Display mea Pe hec eto c d ER t Ee da P a dn 63 Figure 25 Trend Memory Message sssssesee eene nnns nnns nnns nnns nnns nnns nnns nnns 67 Fig re 26 Print SCcreen uro e Ee I eise E UP Ere aestas PRU E deehenks naa UE CUP Fb aeg I T E PE a 70 Figure 27 Sample Case Reports Printout sesssssssssssssseeeeeeeeeee eee 73 Figure 28 Printed Trend Reports reti er rti eee orina e are eun a 74 Figure 29 Typical Flash Memory Device seeen nenene Hmmm nanne enaner nennen nnne nae 77 Fig re 30 USB ICOM accessed ccr trece rne seek eia seek eren a na e RR En kd ua
73. en nennen nnn nennen 84 UT defe BU e 1 107 m 84 Operation with Hospital Patient Data Systems essssssssseeeennnne 85 Chapter 11 86 Maintenance and Troubleshooting 86 ja igera t eio a ERR En 86 Determining Monitor Service HOS dis vsu rir panic abet sai inde si bd ura 86 EC OTRO ia ee reve cement RU E tapa FEM M RU eCUUMDE MM UE 87 CO C libration Chock serris riaa 88 Calibration Check Procedure esses ener nennen nennen 88 PEA oeae nM MB NUT EaMd uM M Ota S a IUS DM a A A een ANM NUI MUN DUM QM 89 Replacing NG US CS CC 89 Replacing the Printer Paper FROM sites siesta eite tabi een nla bd UR dn uti onda 90 i is PTCTETC 90 Reeve cie 91 ea M DE 91 COs Problemo ccrte ot eret erede ces bs ch neces ode we ecm ene 92 POs SENSON m EET 93 xl EE 93 N rse Call 94 D A CONNEC OM RN 94 CO Calibration seeeseee nmm nenn tkan rutean nnn nenn ERAR neni a eese nnne sa arn nena EEn nn 95 Re t rning the MAGI m M 95 Wu ngu 95 Appendix 1 96 Institutional Settings 96 in s tutional Defaults TC S7 96 Changing Institutional TOTALS ususuuecamcdoexisx uineis tad ixabivide aca p nim owl tui aM adden d UEM UNE 96 Resetting to Factory RAINS mte Mnt 96 Changing Monitor Settings sacs E OE o T S OTT 97 Alarm SII ves vu
74. ent Admit Discharge O eo N Pump Off RC Temporarily silence alarms L Type BF Defibrillator Proof Protection Gas inlet L EJ Bs Gas outlet Equipotential ground h 4 USB flash memory connection port Portable Bedside Capnograph Pulse Oximeter Symbols 15 Chapter 2 Technology Overview Introduction Features Technology Overview Introduction The Capnostream bedside monitor provides accurate continuous capnography and pulse oximetry monitoring for intubated and non intubated patients from neonate to adult Using Microstream technology patented FilterLine EtCO consumables and pulse oximetry technology the Capnostream allows for simultaneous hassle free EtCO and SpO monitoring Features Dual parameter monitor that supports the current standard of care providing CO and SpO measurements Simple user interface with color screen Routine functions are accessed with 2 clicks 72 hour trends to review patient history Event marking to compare events and medication administration to changes in patient status Case recording to help organize patient files Nurse call Optional internal printer USB output to transfer patient data to USB flash memory devices Analog output for use in sleep labs and other laboratory environments e RS 232 port for data transfer Technology Overview This section provides a basic overview of Capnography and Pu
75. f the Capnography pump for a preset time in order to protect the monitor during suctioning procedures Front Panel Control Buttons 7 12 Temporary alarm silence button Red alarm indicator Yellow alarm indicator Control knob Display screen Carrying handle Front Panel Control Buttons Temporarily disables the Audio Alarm for two minutes Indicator that flashes during High Priority alarms see Chapter 7 Alarms and Messages on page 52 Indicator that lights or flashes according to the alarm status see Chapter 7 Alarms and Messages on page 52 Rotary knob used to navigate the screen and select a function when pressed Screen displaying the patient data menu bar patient mode date time and any information or error messages Allows the monitor to be carried The figure below is a close up of the controls shown in Figure 5 Capnostream Front View on page 24 and described in Table 4 Capnostream Front View above Figure 6 Front Panel Control Buttons Portable Bedside Capnograph Pulse Oximeter 25 The Capnostream Monitor Monitor Rear Panel The rear panel of the monitor contains power and communications connections Figure 7 Capnostream Rear View 8 Table 5 describes the functions of the rear monitor connections Table 5 Capnostream Rear View Label Function Description Label Function Description 1 Mains power switch To switch ON or OFF 6
76. ging System Turning the Pump Off for Suction or Lavage Demo Mode Monitor Screen Menu Reference Chart Preparing the Monitor for a Patient CAUTION If any monitor response does not seem appropriate do not use the monitor Instead contact your local representative The following steps describe the procedure for preparing the monitor for a patient gt TO PREPARE THE MONITOR FOR A PATIENT 36 1 Turn on the monitor by pushing the on off switch amp on the front panel 2 The complete power on sequence is described in Turning on the Monitor on page 27 3 Confirm that the green power on indicator and the orange AC power indicator light are both on CAUTION If the orange light is not on the monitor is running on battery power only and will stop operating when the battery is discharged See Turning on the Monitor on page 27 4 The red alarm and yellow alarm lights will briefly light up and the speaker will beep CAUTION If the red and yellow alarm lights do not light up or there is no sound from the speaker the monitor should not be used and should be sent for servicing 5 Connect one or both sensors to the monitor following the instructions in this manual To connect the sensors please see Chapter 5 Capnography with the Capnostream Monitor on page 43 and Chapter 6 Pulse Oximetry with the Capnostream Monitor on page 47 Once either or both sensors are connected to the monitor it is ready for operation If a FilterLine is
77. icate that an event was marked 5 The monitor will hold up to 72 hours of patient data If there is more data than you can see on the screen then scrolling up will change to display earlier data if you scroll up or later data if you scroll down Specific Events as seen in Trend Data gt TO SEARCH FOR SPECIFIC EVENTS IN TREND DATA 1 Use the cursor in the graphical trend screen to locate an area of interest 2 Use ZOOM to get as close as possible to the specific area 3 Switch to the Tabular trend display 4 Use SCROLL to find the area of interest 5 Zoom to minimum resolution to see detailed alarm and event information Using the Graphical Trend Screen for Monitoring Patients It is possible to use the Graphical Trend screen as the main monitoring screen rather than the Home screen Instead of seeing the real time waveforms the Graphical Trend gives you the ability to easily track changes in the patient s condition The real time numeric data is shown on the right hand side of the screen for both the Trend and Home screens When using the Graphical Trend screen as the main monitoring screen it is important to ensure that the graphs are updated with the latest data This will happen automatically as long as the Scroll function has not been used since you entered the Graphical Trend screen While in automatic update mode the screen will automatically Portable Bedside Capnograph Pulse Oximeter 65 Using Trends 66 update
78. icated by an asterisk The number beside each indicates how many alarms or events occurred during that time period 4 To see the specific events and alarms change the ZOOM setting to the MINIMUM value which changes the zoom level to the lowest time interval Specific events and alarms will now appear in the table and you can use the Scroll option to scroll up and down the table The table below gives a sample of the tabular display at the MINIMUM resolution in this case the minimum resolution is set at 5 seconds Portable Bedside Capnograph Pulse Oximeter Specific Events as seen in Trend Data Table 18 Detailed Tabular Display Example TIME EtCO2 RR SpO2 PR EVENTS mmHg bpm bpm May 23 06 38 85 97 76 3 45 20 PM 34 88 97 72 OXYGEN 3 45 25 PM 30 90t 98 71 3 45 30 PM 30 90 t 99 73 3 45 35 PM 32 90 t 98 73 3 45 40 PM 32 911 98 72 3 45 45 PM 33 90 t 97 71 3 45 50 PM 34 89 97 73 3 45 55 PM 34 88 97 72 3 46 00 PM 34 88 98 71 3 46 05 PM 29 89 97 72 In the above example oxygen was given to the patient during the period between 3 45 20 and 3 45 25 PM followed by a rise in respiration rate to a level that triggered the high value alarm This is indicated by the red up arrow Similarly a low respiration rate alarm would have a red down arrow If the Event Marking Mode is set to QUICK no text information is available at the lowest zoom level but a triangle will still appear to ind
79. if AC power is lost for any reason the monitor will not work Note that with no battery pack the battery charge level indicator will mistakenly indicate the presence of a fully charged battery Note If the battery is not fully charged the battery icon will indicate the charge level of the battery Testing the Battery and AC Connections The battery pack charge level and AC power connections should be confirmed before each use TOTEST THE BATTERY Battery Charge Level Indicator 20 1 Press the ON OFF button to turn on the monitor 2 Observe the battery icon level in the bottom left hand corner of the screen PATIENT ALARM REND SYS PRINT TRENI SYSTEM TYPE LIMITS Rit Figure 3 Menu Bar with Battery Charge Level 3 If you have previously fully charged the battery the battery icon should indicate that the battery is full Note As part of the monitor power up the battery charge level indicator will show full for about 15 seconds after the monitor is turned on The monitor will then update the battery charge level indicator to show the true battery level Recharge the battery pack when the advisory message BATTERY LOW appears on the display screen To recharge the battery make sure that the monitor is plugged into the AC mains and the power switch on the rear E of the monitor is turned to the ON position The orange AC power indicator on the front panel of the monitor will light up For normal operation
80. ill change depending on which options and functions are available for a specific screen In some screens there are additional selectable options in the screen specific area Real Time CO Data This area of the screen displays the real time EtCO and FiCO values along with selected units and the respiration rate RR in breaths per minute For more details regarding the displayed information see Chapter 5 Capnography with the Capnostream Monitor on page 43 When the monitored parameter limits are exceeded the affected numeric will flash to alert the attending health care professional to the specific parameter that is affected This area of the screen can be selected as if it were a menu option Selecting this area gives access to the setup screen for changing the CO parameter values Real Time SpO Data This area of the screen displays real time SpO data For more details about the displayed SpO gt data see Chapter 6 Pulse Oximetry with the Capnostream Monitor on page 47 When the monitored parameter limits are exceeded the affected reading will flash to alert the attending health care professional to the specific reading that is affected This area of the screen can be selected as if it were a menu option Selecting this area gives access to the setup screen for changing the SpO parameter values including the option to turn the pulse beat tone on or off Home Screen The typical home screen shown in Figure 10 Typical Home S
81. ing SCROLL and ZOOM There are many ways in which the Trend screens can be used to examine patient data The following is a brief overview of a general method of searching for and displaying specific events in the graphical Trend screen gt TO VIEW TREND DATA IN SCROLL MODE 1 In the graphical trend mode use the control knob to select SCROLL from the Menu Bar The box around the word SCROLL in the Menu Bar and the time date heading both turn yellow indicating that you are in scrolling mode Portable Bedside Capnograph Pulse Oximeter 61 Using Trends 62 6 42AM JAN 03 05 ADULT GRAPHICAL TREND CURSOR LOCATION 6 HR DISPLAY Figure 23 Scroll mode in the Graphical Trend 2 When you scroll to the end of the screen and continue to scroll the screen will change to add the next or previous 1 2 time period to the display for example if you are viewing a 2 hour display from 4 PM to 6 PM and you scroll backward to reach 4 PM the yellow line will return to the middle of the screen and you will see 3 PM to 5 PM instead on the screen Scrolling all the way to the right and getting a beep means you are at the current time Scrolling all the way to the left and getting a beep means that you are at the beginning of the recorded data To see a longer or shorter time period on the display select ZOOM on the Menu Bar and turn the control knob to change the resolution to 2 6 or 12 hours The box on the Menu Bar around ZOOM turns yell
82. inter Paper Specifications EN RN Value Paper Width 58mm 2 in Paper Roll Diameter maximum 40mm 1 1 2 in Paper Length maximum 15 2 meters 50 ft Note Some manufacturers use a different thickness of paper so that a 15 2 meter roll from a different manufacturer may exceed the maximum diameter limit and will not fit in the monitor Replacement paper rolls that meet the specifications can be obtained from Oridion part number 010516 for a package of 6 rolls or in North America from www thermalpaperdirect com Model number 22550 Buttons Indicators and Connections Following are the front rear and side views of the monitor showing the display controls and external comnection points Monitor Front View The front panel of the monitor contains the display screen action buttons and the control knob CUT 391081121730 Oridion 10 Figure 5 Capnostream Front View Table 4 lists the numbered labels 24 Portable Bedside Capnograph Pulse Oximeter 1 Monitor power ON OFF AC power indicator Monitor power on indicator Event button Patient Admit Discharge button Pump Off button Table 4 Capnostream Front View Label Name Description Label Name Description Button switch Orange light Green light Starts the process of placing either a Quick or Detailed Event marker in the trend data Allows Starting and Stopping a case and entering patient ID Shuts of
83. ion equipment before using the analog output of the monitor for data collection 2 Turn on the Capnostream monitor 3 Insert the Digital to Analog cable in the 15 pin output socket on the back of the monitor 4 From the Home screen select SYSTEM from the menu bar and then select D A SETUP from the menu bar 80 Portable Bedside Capnograph Pulse Oximeter Digital Analog Signal Values 6 56AM JAN 03 05 Available ADULT settings D A SETUP Current Ses EtCO 1 2 mmHg settings EtCO2 END OF BREATH PT EtCO END OF BREATH FiCOz ga RESPIRATION RATE RE SPIRATION RATE me CO2 WAVEFORM CO WAVEFORM ERI Spo SATURATION coz VALID PULSE RATE SpO2 SATURATION CH6 SPO WAVEFORM PULSE RATE BW iHz SQUARE WAVE SpO2 WAVEFORM Hz SQUARE WAVE ALWAYS HIGH ALWAYS LOW DEFAULT RESET DISABLE Figure 31 Digital to Analog Setup Screen 5 For zero calibration use the control knob to select the CAL LOW setting All channels will be set to ALWAYS LOW Connect each channel cable to your lab equipment to confirm the output is zero For gain calibration use the control knob to select the CAL HIGH setting All channels will be set to ALWAYS HIGH Connect each channel cable to your lab equipment to confirm the output is 1 volt corresponding to the highest output of the channel 6 Use the control knob to select CAL RESET AII channels will be reset to their original settings Digital Analog Signal Values The following t
84. ion of the Service mode as follows TO ACTIVATE NURSE CALL Turn on the monitor and wait for the Home screen to appear Use the control knob to select the SYSTEM button to open the System screen then select SERVICE and enter the service password see Changing Institutional Defaults on page 96 for instructions on doing so From the SERVICE screen select INST DEFAULTS Institutional Defaults and then select MONITOR Use the control knob to select NURSE CALL and change the option to ENABLED Select BACK BACK and HOME to exit the Service mode The new setting is now stored nA A U N Test the Nurse Call system as described in Testing Nurse Call below Testing Nurse Call Verify that the system is functioning by forcing a test alarm occurrence such as breathing into the FilterLine for a few seconds then stop breathing into it to create a NO BREATH alarm Confirm that the expected result was received according to the standard for the institution s nurse call system This may be a warning light turned on or an audio signal generated when the alarm event occurs The following table describes which alarms are indicated by the Nurse Call output Table 27 Nurse Call Indicators Alarm Type Activates Nurse Call High Priority Red Urgent Patient Alarms YES High Priority Yellow Caution Patient Alarms NO Low Priority Alarms YES Advisories NO Silent Advisories NO Portable Bedside Capnograph Pulse Oximeter Operation with
85. k of the monitor For detailed information on the use of this feature please refer to the document Capnostream Data Transfer Protocols available on the Operator s Manual CD The data transfer rate for the RS 232 interface is set in the Institutional Defaults Monitor screen The factory default is automatic detection of the data transfer speed See Appendix 1 Institutional Settings on page 96 for information on how to change the data transfer rate Note The RS 232 port has electrical isolation according to IEC 601 1 1 Non medical devices such as PCs and printers may be connected to this port without additional electrical isolation These devices must be placed at least 1 5 meters from the patient environment Portable Bedside Capnograph Pulse Oximeter 79 Downloading Patient Data Using Analog Data Output Capnostream can output seven analog signals corresponding to various parameters that it monitors This makes the monitor an ideal tool to provide input to a Polysomnograph in a sleep laboratory Each data channel gives an output of 0 1 volt 1 volt full scale with a sink current of at least 12 mA Each channel is also protected against shorting of outputs The analog data output requires the Oridion D A Digital Analog Data Cable Part Number 010492 Each data channel shown on the D A Setup screen on the monitor corresponds to the wire colors of the D A cable The channels are color coded to match the insulation covering of correspon
86. lse Oximeter Alarms Corrective Action SPO2 LOW ALARM The SpOz is below the upper Patient requires immediate lower limit medical attention PULSE RATE HIGH ALARM The pulse rate is above the Patient requires immediate upper alarm limit medical attention PULSE RATE LOW ALARM The pulse rate is below the Patient requires immediate lower alarm limit medical attention FiCO2 RATE HIGH ALARM The FiCO rate is above the Patient requires immediate upper alarm limit medical attention Low Priority Alarms Table 13 Low Priority Alarms Message e CO2 ERROR Failure has occurred which prohibits the Contact Oridion operation of the CO function authorized personnel SPO2 ERROR Failure has occurred which prohibits the Contact Oridion operation of the SpO function authorized personnel PULSE NOT FOUND No detectable pulse Patient requires immediate medical attention Reposition sensor on patient SPO2 SENSOR NOT ON Sensor is off patient Place sensor properly PATIENT on patient FILTERLINE BLOCKAGE FilterLine is kinked or clogged Disconnect and reconnect the FilterLine Check the airway adapter and if necessary replace the FilterLine BATTERY LOW Battery charge level is low and monitor will Connect monitor to shutdown soon AC power Advisories Table 14 Advisory Alarms CLEARING FILTERLINE FilterLine kinked or clogged with water Appears during clearing time until FilterLine is unclogged or a blockage state is
87. lse Oximetry What is Capnography Capnography is a non invasive method for monitoring the level of carbon dioxide in exhaled breath EtCO2 to assess a patient s ventilatory status Capnostream uses Microstream non dispersive infrared NDIR spectroscopy to continuously measure the amount of CO during every breath the amount of CO present at the end of exhalation EtCO the amount of CO present during inhalation FiCO and the Respiratory Rate Infrared spectroscopy is used to measure the concentration of molecules that absorb infrared light Because the absorption is proportional to the concentration of the absorbing molecule the concentration can be determined by comparing its absorption to that of a known standard Portable Bedside Capnograph Pulse Oximeter E Technology Overview The Microstream EtCO consumables deliver a sample of the inhaled and exhaled gases from the ventilator consumable or directly from the patient via an oral nasal cannula into the monitor for CO measurement Moisture and patient secretions are extracted from the sample while maintaining the shape of the CO waveform The 50 ml min sampling flow rate reduces liquid and secretion accumulation decreasing the risk of obstruction in the sample pathway in humid ICU environments Once inside the Microstream CO sensor the gas sample goes through a micro sample cell 15 microliters This extremely small volume is quickly flushed allowing for fast rise
88. messages appear in the waveform area of the display Table 16 Non Message Area Advisories Message Description Corrective Action FILTERLINE DISCONNECTED SPOz SENSOR DISCONNECTED 56 Connect a FilterLine to the monitor Connect an SpO sensor to the monitor Portable Bedside Capnograph Pulse Oximeter Alarm Silence Alarm Silence To temporarily silence disable an alarm press the alarm silence button A When the alarm silence button is pressed all audible alarms are silenced for 2 minutes This includes both alarms that were already sounding and also alarms that may occur during the 2 minute period The 2 minute alarm silence can be cancelled by a second press of the alarm silence button Visual alarms are still present While the alarm silence period is active a bell with crossed dashed lines through it E is displayed on the screen A crossed bell with solid lines symbol E3 is shown if audio alarms are permanently disabled in the institutional settings Changing Alarm Limits Alarm limits can be changed for Urgent and Caution alarms on the Alarm Limits screen The Alarm Limits screen is accessed from the Home Screen Graphical Trend screen or Tabular Trend screen On the Alarm Limits screen the Caution alarms can be enabled or disabled If Caution Alarms are disabled the values in the Caution Alarm column will be grayed out The limits can also be reset to Institutional Default settings using the DEFAULT RESET butt
89. n described below and real time patient numerics which are displayed on the right hand side of the screen The Trend data displayed is historic data from the trend memory When the screen is first opened it shows the cursor line in the middle of the graphical display which is the middle point of the displayed data Data regarding the patient at the point in time indicated by the cursor is displayed at left Details regarding the graphical trend display appear in the next section Graphical Trend Display In the center of the screen are the graphic trend displays The upper two graphs show historic trend capnography data EtCO in white and respiration rate values in blue Similarly the two lower graphs show the patient s historic trend pulse oximetry data SpO data in pink and pulse rate values in green On the left hand side of the screen is the historic patient data at the date and time where the cursor is located The exact recorded date and time of the cursor location are displayed Zoom level Can be set to 2 6 or 12 hours using the ZOOM key Yellow cursor line The vertical yellow line extends through all four graphs and is movable with the control knob when the SCROLL option is selected The cursor line shows the current location in the trend data with the exact date and time listed under the CURSOR LOCATION 60 Portable Bedside Capnograph Pulse Oximeter Graphical Trend Display Screen heading near the top left of the screen
90. n the case is stopped the trend memory is erased The monitor automatically stores patient data and records the date and time for all events whether or not the patient case option is used As long as the trend memory is not erased this data remains stored in the monitor until the trend memory is full and the beginning of the trend data is overwritten by new data See Using Trends on page 59 for more information on trend capacity However case printouts will only include data recorded after the current case was started even if the trend memory also includes data previous to the current case On the other hand displayed trend data and trend printouts will include all data stored in the trend memory Portable Bedside Capnograph Pulse Oximeter 37 Using the Capnostream Monitor Entering Patient Events When scanning patient history in the monitor it is often useful to have a record of patient events that could have influenced the recorded readings The monitor has the ability to record a wide variety of patient events There are two options Quick Events and Detailed Events If the monitor is set to record Quick events pressing the event button h places a mark in the trend memory showing that an event took place at the date and time the button was pushed See Table 17 Tabular Display Example for an example of a quick event mark Detailed events allow the clinician to record more detail There are three categories of events administering
91. nd Troubleshooting Introduction Determining Monitor Service Hours CO Calibration CO Calibration Check Maintenance Replacing the Fuses Replacing the Printer Paper Roll Cleaning Troubleshooting Returning the Monitor Technical Assistance Introduction The monitor requires no routine service other than any performance testing mandated by the operator s institution The monitor requires servicing by qualified service personnel only once every 20 000 operating hours The monitor s CO detection mechanism should be periodically calibrated as detailed below in CO2 Calibration on page 87 CO calibration can be checked at any time to ensure the calibration is within proper operating limits Troubleshooting on page 91 discusses potential difficulties possible causes and suggestions for resolving them Note Contact your local distributor or refer to the Service Manual for service instructions and performance tests and checks Determining Monitor Service Hours 86 The information on the Service screen gives the number of hours remaining until servicing or calibration is required To access the Service screen select SYSTEM from the Menu bar at the bottom of the Home screen and then select SERVICE No password is required to see the number of hours before servicing is required The main service screen is shown below Portable Bedside Capnograph Pulse Oximeter CO2 Calibration 10 56AM JAN 01 05 ADULT SERVICE ENTER PASSWOR
92. nents before performing any further procedures TOUNPACK AND INSPECT THE MONITOR 1 Carefully remove the Capnostream monitor and the accessories from the box 2 Check that the items on the enclosed packing list are included Capnostream Monitor Operating Manual Two3 15 Amp Type F fuses FilterLine Starter Kit Mains Electrical Power Cord SpO Sensor Pack SpO Extension Cable Printer Paper Roll one installed and one extra roll Battery Pack CD with additional documentation RS 232 Capnostream Data Transfer Protocols the Patient Data Transfer Application Note and this manual in additional languages 3 Inspect each component If any component is damaged or missing contact your local representative 8 Portable Bedside Capnograph Pulse Oximeter Installing the Battery Pack Installing the Battery Pack WARNING The unit should always be operated with the battery installed in order to provide back up power in the event of a momentary or temporary power outage The monitor operates on AC power or on a battery It is equipped with a rechargeable Lithium Ion battery pack To install the battery pack open the battery cover on the side of the monitor as shown below Battery Restraining lever Connection Socket Battery Compartment Door Figure 1 Installing the Battery Pack TOINSTALL THE BATTERY PACK 1 Slide the two release latches outward and open the battery compartment door 2 While holdi
93. new data to the right of the yellow cursor line When the area to the right of the cursor is filled the graphs will shift allowing more data points to be plotted If you use the Scroll feature and then want to return to using the Graphical Trend to monitor the patient simply go to the Home screen and then select TREND again Printing the Trend Data If the optional printer is installed you can obtain a printout of the trend data that is displayed on the screen by selecting PRINT TREND in the Menu Bar Clearing Trend Memory It is recommended to erase trend memory when the monitor is switched to a new patient in order to avoid mistaking the earlier data for the present patient s data If you are working with cases and the current case is ended the trend memory is automatically cleared TOERASE TREND MEMORY l To erase the trend data from the monitor memory use the control knob to go to the Home screen and select SYSTEM on the menu On the System screen select CLEAR TREND The word CONFIRM will appear just above the Menu Bar If you are certain that you want to erase the trend memory click the control knob If you do not want to erase the trend memory turn the knob to the left or right to cancel When the machine is turned on a message appears suggesting that you erase the trend memory in order to start a new patient without information from previous patients in the trend memory This screen appears in Figure
94. ng of carbon dioxide concentration of the expired and inspired breath and respiration rate and for the continuous non invasive monitoring of functional oxygen saturation of arterial hemoglobin SpO and pulse rate It is intended for use with neonatal pediatric and adult patients in hospitals hospital type facilities intra hospital moves and home environments Who Should Read This Manual This manual should be read by Health Care Professionals who will be using Capnostream Equipment managers responsible for ensuring that equipment conforms to institutional policies Researchers or laboratory personnel who will be downloading patient data Technical experts who will be connecting Capnostream to a computer via the RS 232 interface CAUTION In the United States federal law restricts this device to sale by or on the order of a physician Contacting Technical Support For any technical issue involving the Capnostream monitor please contact Oridion Technical Support North America Tel 1 888 ORIDION 674 3466 Fax 781 453 2722 Outside North America Tel 972 2 589 9104 Fax 972 2 582 8868 E mail technicalsupport oridion com 14 Portable Bedside Capnograph Pulse Oximeter Symbols The following symbols appear on the body of the monitor Table 1 Symbols that Appear on the Monitor Monitor ON OFF button AC power ON indicator UNIT ON indicator Event selection p Om R Pati
95. ng the battery pack with the wires on the right rotate the restraining lever up to the horizontal position and place the battery pack in the monitor 3 Push the battery pack all the way in 4 Hold the battery pressed in and lock it in position by returning the restraining lever to the vertical position 5 Plug the battery cable into the battery connection socket Push the wires back into the monitor Restraining lever Battery Connection Socket Figure 2 Battery Pack Close up 6 Align the flaps on the battery compartment door with the slots in the monitor casing slide the two release latches inward and close the door Ensure that the battery pack is fully charged before using the monitor without AC power A fully charged battery pack provides 2 5 hours of operation without printer usage When the monitor is connected to the AC Portable Bedside Capnograph Pulse Oximeter 19 The Capnostream Monitor mains with the main power switch at the back of the monitor ON even if the monitor is turned off the battery pack charges automatically It takes approximately 12 hours to fully charge an empty battery pack When you start using the monitor verify that the battery icon at the bottom left of the monitor screen is full Refer to Testing the Battery and AC Connections below for details WARNING It is recommended to always have a battery installed If the battery is not installed the unit will operate properly on AC power but
96. nge to CALIBRATION OVERDUE The number of operating hours before calibration can also be viewed on the service screen and this will also change to CALIBRATION OVERDUE in the same manner as the salutation screen if the limit has been reached The data on the service screen is updated when the monitor is turned on and also each time the password is entered to enter Service Mode Note It is recommended that you calibrate the monitor within two weeks of the CALIBRATION REQUIRED message appearing on the monitor Portable Bedside Capnograph Pulse Oximeter 87 Maintenance and Troubleshooting To display the date of the last calibration enter the service mode and go to the Calibration Screen From the Home screen select the SYSTEM button to open the System screen and then select the SERVICE button to open the Service screen Enter the service password and then select CO2 CAL This screen shows the number of hours left before service is due the date of the last calibration performed and the date on which the next calibration should take place one year after the most recent calibration Use of the password required to enter Service Mode is needed to view this screen CO Calibration Check 88 Depending on institutional policy and procedure the monitor can be checked at any time to determine if CO2 detection is within the accepted limits The Calibration Check Procedure below gives the step by step instructions to perform a Calibration Check CA
97. nnasstenod ASPAS ONA E AEE SO Ei 97 Trend Settings iese aE aA aE OO 99 EVOHIIS 2o A E S E E E E E E EN E ta MEME ores 99 How to Change Event Defaults ssssssssssssssssssseeenee eene 100 Portable Bedside Capnograph Pulse Oximeter 7 Table of Contents Monitor Settings asss 100 CO Parameters essssssse eene nenenne nnn enne nnn nasse aes r sane sena sane NANKANA EENAA ia 101 SpOs Paratmetetrs oat erudi ms Dresses un eet seva Wie rares s idler oder ied e rta das E 101 Digital to Analog Channel Settings ssssssssssssssseee eene nnne 102 Appendix 2 103 Specifications 103 Powe r SUPDIV EH 103 27 y cee ee 103 Porc dp e E E E E A ee ee A ee es 103 picos HN E E eee 104 Microstream Capnograph jT ee eee ECE ere eee eet See eee er eee E 104 Masimo ad c Ee qui qc ea eRe eee eRe ESE oe 105 Alar ra Sates ie 105 QUID MMMCNOMICEPC Jem 106 Af alog OUt PU M 106 MUIXG l 106 per MEL 106 US ce 107 Internal Thermal Printer optional oen tee Ere tran ara nion Pia En eH ava ub xao dns 107 ETT Be 107 Equipment imeem 9 108 TAI NG M
98. nnel 9 Ifthe monitor is unable to complete the calibration check a CALIBRATION FAILED message appears with one of the following error messages FILTERLINE NOT CONNECTED CALIBRATION FAILED NO GAS WRONG GAS CONCENTRATION OR UNSTABLE GAS MEASUREMENT ERROR CHECK ALL CONNECTIONS AND TRY AGAIN CALIBRATION ABORTED BY USER CO2 MODULE INTERNAL SELF TEST FAILED Maintenance The monitor requires no routine service other than any performance testing mandated by the operator s institution The Troubleshooting section on page 91 below discusses potential difficulties their possible causes and suggestions for resolving them Periodic maintenance is recommended according to operating hours e The CO Pump should be replaced every 20 000 operating hours e Acalibration should be performed after the initial 1 200 hours of use and following that calibration once a year or every 4 000 operating hours whichever comes first see CO2 Calibration on page 87 e The monitor s number of hours remaining until the 20 000 hour operating limit before service is required is displayed each time when the unit is powered on This can also be viewed in the Service Screen e Battery back up time of the Li ion battery may degrade over a period of time To avoid degradation of battery capacity it is recommended that the battery pack be replaced every two years Note Contact your local representative to order spare parts calibration kits or to get answers to
99. not connected there is no CO waveform and the message FILTERLINE DISCONNECTED will appear If an SpO sensor is not connected there is no SpO waveform and the message SoO2 SENSOR DISCONNECTED will appear It is possible to use either the Capnography function EtCO or the Pulse Oximetry function SpO2 without using the other function If you only want to operate one function connect ONLY the sensor for that function and the monitor will operate normally Portable Bedside Capnograph Pulse Oximeter 35 Using the Capnostream Monitor Setting the Patient Type There are two patient types recognized by the monitor Adult and Neonatal The adult setting is used for both adult and pediatric patients The patient type is displayed at the top left hand corner of the screen Setting the patient type is compulsory CAUTION The characteristics of a breath are calculated differently for adult and neonates Setting the correct patient type is therefore very important Incorrect setting will result in inaccurate monitoring of the patient s respiration rate TO CHANGE THE PATIENT TYPE 1 Ifthe patient type that appears on the screen is correct for the current patient there is no need to make any change to the patient type If you want to make a change use the control knob to select the PATIENT TYPE function on the menu bar of the Home screen 2 Rotate the control knob to change the type and press the control knob to register the change This
100. nstallation Nurse Call Cable 011149 Cable length 3 5 meters Cable is supplied un terminated so it can be built to fit system Refer to Nurse Call Operation on page 82 for set up instructions Digital Analog D A Cable 010492 Used for transfer of data from Capnostream to an analog device such as a polysomnograph Refer to Using Analog Data Output on page 80 for set up instructions Y Power Cable CS08707 Used with a Bernoulli Oxinet hospital system Refer to Operation with Hospital Patient Data Systems on page 85 for details Fuse 2 each 3 15 amp 250 Volts 010543 Refer to Replacing the Fuses on page 89 for instructions on how to replace fuses US Power Cord PE03833 European Power Cord PE00208 Monitor Mounting Plate Accessories The mounting kit contains a VESA Mounting Adapter 100 x 100mm to 75 x 75mm which can be affixed to the bottom of the monitor as described above This allows the monitor to be mounted on a wide range of GCX stands and mounts including the GCX model RS 0006 64C Roll Stand Assembly Please contact GCX www gcx com for more information on their available solutions for mounting the monitor Digital to Analog Data Transfer Cable The Digital to Analog interface requires the Oridion D A Data Cable Oridion part number 010492 Printer Paper The monitor uses thermal printer paper with the following specifications Portable Bedside Capnograph Pulse Oximeter 23 The Capnostream Monitor Table 3 Pr
101. nt and yellow Caution alarms appear on the monitor Portable Bedside Capnograph Pulse Oximeter 53 Alarms and Messages 6 31AM JAN 03 05 ADULT SYSTEM RR HIGH ALARM PATIENT TYPE ALARM PRINT LIMITS Figure 20 Example Showing Alarms In the above example RR has exceeded the RR HIGH alarm limit The RR reading will flash red the red arrow pointing up indicates that the upper limit has been exceeded and the message RR HIGH appears in the message area at the top of the screen The yellow alarm on the SpO value together with the yellow arrow pointing down indicates that the SpO LOW caution alarm level has been exceeded High Priority Alarms Table 12 High Priority Alarms Corrective Action NO BREATH XXX SECONDS ETCO HIGH ALARM ETCO LOW ALARM RR HIGH ALARM RR LOW ALARM SPO2 HIGH ALARM 54 No valid breath has been detected for xxx seconds The EtCOz is above the upper alarm limit The EtCOz is below the lower alarm limit The RR is above the upper alarm limit The RR is below the lower alarm limit The SpOz is above the upper alarm limit Patient requires immediate medical attention Patient requires immediate medical attention Patient requires immediate medical attention Patient requires immediate medical attention Patient requires immediate medical attention Patient requires immediate medical attention Portable Bedside Capnograph Pu
102. o that it clicks into place 93 Maintenance and Troubleshooting Printer paper is either not threaded properly Open the plastic printer cover over plastic cover or caught in the plastic and pull the paper so that a cover short length is outside the monitor Hold the paper so that the short length of printer paper remains outside the monitor and then close the cover so that it clicks into place Printer is out of paper Open the plastic cover and insert a new roll of paper Printer works but Paper roll is placed backwards in the printer Open the plastic cover turn output paper is blank compartment of the monitor the roll of paper the other way and replace the plastic cover taking care to leave a short length of paper outside the monitor Nurse Call Nurse Call output does Nurse Call not enabled Enable the Nurse Call function not work from the system setup screen or from the Institutional Defaults screen in Service Mode Wiring problem on phono plug Check the wiring of the cable and phono plug connected to the Nurse Call socket on the back of the monitor D A Connection D A output does not D A output not enabled Go to the D A setup screen work and enable D A output 94 Portable Bedside Capnograph Pulse Oximeter Returning the Monitor CO Calibration CALIBRATION It has been more than one year since the Perform a CO calibration REQUIRED message appears on the monitor last CO
103. on on the screen 6 3BAM JAN 03 05 ADULT ALARM LIMITS ADULT EtCO2 mmHg NO BREATH SpO2 HIGH SpO2 LOW PRHIGH PR LOW CAUTION DEFAULT ENABLE RESET Figure 21 Alarm Limits Screen gt TO CHANGE ALARM LIMITS 1 Open the Alarm Limits screen by selecting the ALARM LIMITS button on the Menu bar at the bottom of the screen from the Home screen Graphical Trend screen or Tabular Trend screen 2 To modify a setting scroll to the individual limit setting using the control knob Click the control knob to select that setting and then turn the control knob to select a new value Click the control knob again to set the new value Portable Bedside Capnograph Pulse Oximeter 57 3 To enable Caution Alarms click the CAUTION ENABLE button on the screen using the control knob The Caution Alarm limit values will now become active and can be changed on this screen in the same manner as Urgent Alarm limits can be changed The CAUTION ENABLE button will show CAUTION DISABLE when the Caution Alarms are enabled and clicking the CAUTION DISABLE button will disable the Caution Alarms 4 Use the control knob to select HOME and click the control knob again to return to the Home screen Changing the high alarm limit towards the low alarm limit will force the low alarm limit down if necessary in order to maintain a difference of at least 5 units between high and low alarm limits This type of adjustment cause
104. or it is ready for operation o 9 Check Alarm Limits Check the alarm limits default and make any permanent changes in the institutional defaults Referto Alarms and Messages on page 52 for more details about alarms Portable Bedside Capnograph Pulse Oximeter 33 The Capnostream Monitor Oo 10 Open a Patient Case To record patient data so that it is easy to track and retrieve opening a patient case is recommended Opening a patient case is required when recording a Tabular Case Report Refer to Using Patient Cases and Patient ID Numbers on page 36 for instructions o 11 Print Patient Data Choose the desired type of patient report and press the Print button on the screen Refer to Printing Reports on page 69 for detailed information o 12 Set Up Nurse Call Operation if applicable Nurse Call connectivity accessories must be purchased separately Plug the Nurse Call cable into the Nurse Call socket on the back of the monitor and connect the other end of the cable to the institution s system as determined by the institution s requirements Check that all cables are connected and tightened Enable Nurse Call on the monitor as described in Nurse Call Operation on page 82 Verify communication between the monitor and the Nurse Call system Oo 13 Set Up Analog Data Output Operation if applicable analog system connectivity accessories must be purchased separately Connect the Oridion D A Digital Analog
105. ording to the tables in the section Changing Monitor Settings on page 97 These are called the Factory Default Settings If the specific environment of use indicates that other settings are preferable or required or Institutional policy requires different values than the Factory Defaults then the default settings can be changed so that they are in effect every time the monitor is turned on This is more reliable than expecting staff members to change the settings before each use Default settings can be changed manually by an authorized technician biomedical engineer to produce institutional defaults Default settings are set from the Institutional Defaults screen which is reached from the Service screen The Service Screen is password protected The procedure is described in Changing Institutional Defaults below Changing Institutional Defaults From the Home screen use the control knob to select the SYSTEM button and then select the SERVICE button on the menu to open the Service screen The enter password box appears near the top of the screen ENTER PASSWORD As described in Screen Navigation on page 31 use the control knob to select ENTER PASSWORD Using the control knob enter the password SERVICE and click the control knob again after the last letter Use the control knob to select INST DEFAULTS You have the option of changing the default settings for ALARM LIMITS TRENDS MONITOR CO and SpO WARNING Changing
106. ore it is critical If the Caution Alarms are enabled a limit which is between the red urgent alarm limit and the normal level is provided for each alarm situation By default Caution Alarms are disabled To enable them see Changing Alarm Limits on page 57 The associated numeric on the display will blink yellow if the numeric has reached the Caution Alarm limit or red if it has reached the Urgent Alarm limit Also the red alarm and yellow caution indicators will light appropriately If a user does not wish to use this early caution system on any particular alarm he can set both the Urgent and Caution Alarms to the same limits see Changing Alarm Limits on page 57 Then only the red Urgent Alarm will occur You can also revert to a single level system by pressing the button for Caution Disable All recording and digital reporting of patient alarms involves only the red Urgent Alarms In addition to the two levels of high priority alarms low priority alarms which alert the clinician to device issues as opposed to patient issues which are covered by high priority alarms are also provided Note In high altitude environments EtCO values may be lower than values observed at sea level as described by Dalton s law of partial pressures When using the monitor in high altitude environments it is advisable to consider adjusting EtCO alarm settings accordingly The following is an example for illustration purposes only showing how the red Urge
107. osed by MS Excel USB Error Messages The following messages may appear in the message area of the monitor NO USB DEVICE FOUND Advisory displayed if a USB operation is tried in the absence of a USB device USB DEVICE FAILED Displayed when the USB device has been detected but the data transfer operation cannot be successfully completed USB FLASH FULL Advisory displayed when data can no longer be downloaded into a USB memory stick due to the memory being full USB TIME OUT Advisory displayed when monitor is unable to establish communication with USB device Reading Patient Data from Saved Capnostream Files The four USB report types that have a csv comma separated value file type are text files This makes them easy to read in most spreadsheet and database software applications The csv format type means that there is a comma in between each piece of data in every line of the file The Patient Data Transfer Application Note explaining the utilization of the transferred data can be found on the Operator s Manual CD The two USB report types that have a bin file type are binary files These files are intended for use by programmers who are creating application programs for use with the Capnostream The binary file formats are described in the document Capnostream Data Transfer Protocols that can be found on the Operator s Manual CD Data Transfer via the RS 232 Port Capnostream is equipped with a 9 pin RS 232 connection on the bac
108. otentially erroneous data In such a case a reassessment of sensor placement and patient condition is recommended Adjustable SpO Parameters The Capnostream monitor provides the option of adjusting some parameter settings used for SpO2 measurement to suit your patients your institution s requirements or other needs To change these settings on a temporary basis until the device is turned off follow the procedure below To set changes as institutional defaults so that the settings will remain in effect even after the monitor is turned off see SpO2 Parameters on page 101 TOCHANGE SPO PARAMETER SETTINGS 1 On the Home screen move the control knob to the SpO section of the screen so that it is outlined in blue Click the control knob 2 The SpO Setup screen will appear Move the control knob to the parameter that you wish to change and click to select that parameter Move the control knob to select the desired setting and click to select the setting A list of the settings that can be changed appears in Table 10 Adjustable SpO2 Parameters on page Sl 3 Move the control knob to the HOME button and click to select The screen will also revert to the Home screen after a few seconds if no additional actions are taken on that screen 4 The changes in the parameters will remain in effect until the device is turned off 50 Portable Bedside Capnograph Pulse Oximeter Adjustable SpO2 Parameters Table 10 Adjustable SpO Paramete
109. overning ordinances and recycling instructions regarding disposal or recycling of batteries Battery and Power Usage If power is lost when the monitor is operating from AC power it automatically switches to the internal battery pack for power The orange AC power indicator light is on when the monitor operates from an external power source with no relation to the status of the battery pack If the orange light is not on check that the AC power switch on the back panel is set to ON The green power on indicator is on when the monitor is switched on If the orange AC power indicator light is off and the green power on indicator is on the monitor is operating from the battery pack The battery icon will show the battery pack s approximate charge level An advisory message BATTERY LOW appears when approximately 15 minutes of battery charge remains Portable Bedside Capnograph Pulse Oximeter 21 The Capnostream Monitor Mounting the Monitor The bottom of the Capnostream device is designed to fit GCX model FLP 0002 17C Mounting Adaptor with 100mm VESA Standard Mounting can be ordered from Oridion part number is 010713 The adaptor fits the GCX model RS 0006 64C Roll Stand Assembly Please refer to the appropriate Directions for Use for these products Rubber feet 4 Mounting Holes 4 Figure 4 Monitor Bottom View CAUTION Do not remove the rubber feet from the bottom of the monitor The mounting adaptor includes space
110. ow to indicate that you are changing the zoom level Click the control knob again to exit the Zoom function You can then return to Scroll mode to continue inspecting the patient s recorded data To see the greatest amounts of patient data change the resolution to 12 hours To do this use the control knob to select and click on ZOOM on the Menu Bar The box around ZOOM will turn from blue to yellow and the title area showing the display resolution will also turn yellow Turn the control knob to select 72 HR DISPLAY and then click the control knob Now use the control knob to select and click on SCROLL on the Menu Bar The box around SCROLL will turn from blue to yellow and the time and date heading under CURSOR LOCATION will also turn yellow Turn the control knob to move the cursor to the left or right As you turn the control knob the time changes and the patient data on the left hand side of the screen also changes to show the readings at that point in time To find an event or alarm occurrence scroll the graphic display to look for event and alarm markers as shown above in on page 60 Place the yellow cursor line on the red alarm marker then exit the scroll mode by clicking the control knob When you zoom to a different time display the cursor will appear in the middle of the graphical screen at the appropriate time that it marked on the previous screen Portable Bedside Capnograph Pulse Oximeter Tabular Trend Display Screen Use the ZO
111. pnograph Pulse Oximeter Message Priorities Message Priorities Messages are displayed on the monitor in order of priority When there is an alarm only the alarm messages will appear in the message area and advisory messages will not appear until the alarm condition is cleared For example if there is a RR HIGH ALARM the advisory message SPO WEAK REPOSITION SENSOR does not appear even though the condition exists to generate this message If more than one alarm condition exists the monitor will display each alarm message for about 4 seconds and continue to repeat the messages in turn until the alarm conditions are cleared For example the RR HIGH ALARM and SpO LOW ALARM messages will alternate in the message area If no alarm condition exists but more than one advisory message condition exists the advisory messages will each appear for four seconds as described above The advisory messages will continue to appear until the condition clears or an alarm condition occurs and the alarm message is displayed instead of the advisory message Alarms There are two levels of high priority patient alarms Red Urgent Alarms and Yellow Caution Alarms Urgent Alarms indicate that the particular parameter has exceeded the Urgent limit A default urgent limit is provided for each alarm situation Urgent alarm limits can be changed to fit the particular institution if desired Caution Alarms allow the clinician to address a developing situation bef
112. pper 010037 endoscopy procedures Smart BiteBloc O2 Non intubated patients requiring oxygen for use 010131 during upper endoscopy procedures FilterLine XL FilterLine for use during MRI scanning see 006325 Monitoring CO2 during MRI Scanning on page 46 Note Smart products provide oral and nasal sampling H products are for long term use Note consumables This listing describes the main products available For more information about Oridion FilterLines or additional sizing and packaging options for these products see www oridion com Portable Bedside Capnograph Pulse Oximeter The generic term FilterLine used in this manual is interchangeable with any of the Microstream EtCO Connecting a FilterLine Connecting a FilterLine Before monitoring a patient with capnography the appropriate FilterLine must be connected to the monitor and to the patient gt TO MAKE THE CONNECTIONS 1 Slide open the FilterLine input connector shutter and connect the appropriate FilterLine 2 Connect the FilterLine to the patient as described in the Directions for Use supplied with the FilterLine When the FilterLine is connected the monitor will immediately begin to search for breaths but it will not indicate a No Breath condition before any valid breaths have occurred CO Data Displayed by the Capnostream Monitor The Capnostream monitor Home screen displays real time CO data The displayed data includes
113. ra te axe eee dra e nes rera I d Eae e eeu EP Ends 36 Using Patient Cases and Patient ID Numbers ssssssssseseeee nennen 36 Entering Patient Ta VIS citant ooi s bra RM RAE EU DRELAR DAR RERO CR QN anaubanenaueman andes 38 Changing the Alarm and Pulse VOlUIMOS 2 ss 0sss sceesssesseesseessessvsessesssevssessssssveseeees 38 Alam VOUM E AREE METER E TL EM 38 Pulse Tone Volume eeii eene enne nnn nennen nn enirn nne a asi rn nnne n nnne nnn renis 39 Use of Scavenging System s idcdiioedes doute died ipbisu i etras add subisiolsuddss ad wis dis eddidi nudi side 39 4 Portable Bedside Capnograph Pulse Oximeter Table of Contents Turning the Pump Off for Suction or Lavage eere reos ee tiit e reatu i arare 40 Demo MOOS asec taconite cccad deo a dad esu o robdrod e MERE ERU I E MM 40 Monitor Screen Menu Reference Charrt eese eene nnn 41 Chapter 5 43 Capnography with the Capnostream Monitor 43 Microstream EtCO Consumables eerta 43 Basic Pririciples z aii utt rer EE vu EE Ev edades bu pe p bove ave div Aided eee 43 Microstream EtCO2 Consumables eet tnter tnt 44 Connecting a Filter iNe eT M 45 CO Data Displayed by the Capnostream Monitor ussssessssssseseeeeeeeenennne 45 Adjustable CO 2 Parameters A E 45 Monitoring CO during MRI Scanning iiec n aae atto ta enean sana tno nares en aa uu diam Eas 46
114. rameters Report Name Fields Included Time Frame of Report All reports Name of Report TREND REPORT CASE REPORT or REAL TIME REPORT Patient Type ADULT or NEONATAL Case ID 70 Portable Bedside Capnograph Pulse Oximeter Printing Reports Report Name Fields Included Time Frame of Report Tabular Case Patient readings of Report recorded case in tabular format The time between data entries is the lowest resolution available for trend increment display 30 seconds Graphical Case Patient readings of Report recorded case in graphical format The time between data entries is the lowest resolution available for trend increment display 30 seconds Tabular Trend Report Patient readings of trend memory in tabular format The time between data entries is the resolution set for trend increment display MINIMUM 30 seconds 1 5 minutes 3 minutes 15 minutes 60 minutes Portable Bedside Capnograph Pulse Oximeter DATE TIME Patient Readings at start and end of From start of case until recording period EtCOz2 FiCO2 RR SpO PR current time once case is stopped data is not available Patient Readings Three of the following five parameters according to parameters chosen in the PRINT FORMAT screen see To print a report on page 69 EtCO FiCOz2 RR SpOz PR Patient Urgent Alarm Occurrences EtCO2 HIGH EtCO2 LOW RR HIGH RR LOW NO BREATH SpO HIGH SpOz LOW PR HIGH PR LO
115. rator s manual and the Directions for Use that accompany Microstream EtCO consumables FilterLines henceforth referred to as FilterLines and the SpO sensors Use of the monitor requires full understanding and strict observance of these instructions the precautionary information in boldface type and the specifications Warnings General WARNING If uncertain about the accuracy of any measurement first check the patient s vital signs by alternate means and then make sure the monitor is functioning correctly WARNING The device should not be used as an apnea monitor WARNING The device should be considered an early warning device As a trend towards patient deoxygenation is indicated blood samples should be analyzed by a laboratory co oximeter to completely understand the patient s condition WARNING To ensure patient safety do not place the monitor in any position that might cause it to fall on the patient WARNING Carefully route patient cabling SpO sensor and FilterLine to reduce the possibility of patient entanglement or strangulation WARNING Do not lift the monitor by the SpO sensor cable or FilterLine as they could disconnect from the monitor causing the monitor to fall on the patient WARNING To ensure accurate performance and prevent device failure do not expose the monitor to extreme moisture such as rain WARNING The use of accessories transducers sensors and cables other than those specified m
116. rend report but transmitted line by line in real time Equipment Advisory Message Occurrences CO2 NOT AVAILABLE SpO2 NOT AVAILABLE BATTERY LOW Events EVENT 1 EVENT 2 EVENT 3 DATE TIME Patient Readings EtCO2 SpO2 DATE TIME Patient Readings EtCO FiCO RR SpO PR Patient Urgent Alarm Occurrences EtCO2 HIGH EtCO2 LOW RR HIGH RR LOW NO BREATH SpO2 HIGH SpO2 LOW PR HIGH PR LOW Equipment Advisory Message Occurrences CO2 NOT AVAILABLE SpO2 NOT AVAILABLE BATTERY LOW Events EVENT 1 EVENT 2 EVENT 3 See the document Capnostream Data Transfer Protocols See the document Capnostream Data Transfer Protocols CO in mm Hg millimeters of mercury The SpO2 waveform plethysmograph values provided in the Real Time Continuous Waveform download do not indicate the percentage of oxygen saturation in the patient s blood These values which range from 0 255 are provided for purposes of building the SpO2 waveform only Health care practitioners used the shape of the waveform to help analyze patient health To see SpO2 percentage values for a patient download data using the Tabular Case Tabular Trend or Real Time Continuous Tabular report formats Note that in the csv files the first six lines of data are as follows Line 1 The name of the report type Line 2 Blank or Patient ID if the report is a case report Line 3 Patient type either ADULT or NEONATAL Line 4 Blank
117. rinter Paper spertis 23 Buttons Indicators and Connections eese nennen nnn nnne nnn nnn nnn 24 Monitor Front VOW ERE 24 Front Panel Control BHTODSS ient tatioe station tip din tds esopn denti e tdratben dte ind bM atu nl a HUE 25 Monitor Rear Panelo AEEA TAE nnne nnn n nnn nnn nre n nen nn nnn nnns 26 Monit r Left View asics iie ri ehe eee o tiep e te dee ena EE Re tede kem decina 27 T rning on TC MONItOr C E U 27 Standard Sections of the Display Screen ssssssssssssssssssseeeene nnns 28 Header Alea rc 29 UBI pm REA 30 Real Time CO Data n Eee t ta EE iR eE Rte nter Erde etn 30 Real Time SpOs Data tette tia ea tede ecco c t a eo a da ot 30 Fome SC OON rss sis Seo wae hs ase asses a 30 Screen NAVIGQUON PTT 31 Configuration Changes ssssssssssssssssseeene seen emeenn nennen rnnt EEEE Ehi rns nsn sre nnne 31 Setting the Date Time and Langue essen onam taa rana eaput ek ke UE ute a Fx pna 32 Screen TIGL S ciate C 32 Screen nre m 32 Capnostream 20 Operational Check Sheet 33 Chapter 4 35 Using the Capnostream Monitor 35 Preparing the Monitor for a Patient ueesieescci tania rodeada aes iro URB ed 35 Setting the Patient Type rere ere tues task tene
118. rs Factory Default Pulse Tone On Off Off SpO Sensitivity Normal Maximum APOD Normal Averaging Time sec 2 4 4 6 8 10 12 14 16 8 SpO Scale for Trend Display 0 100 50 100 50 100 PR Scale for Trend Display 150 300 150 Sweep Speed mm sec 3 6 3 12 5 25 25 for current patient type The SpO parameters include the following Sensitivity Sensitivity is the level of response the SpO results will show under conditions of fluctuations in SpO signals The monitor will display signals based on the information from the patient and the chosen level of sensitivity e Normal sensitivity provides the best combination of sensitivity and probe off detection recommended for the majority of patients e Maximum sensitivity interprets and displays data even for weak signals recommended for patients with low perfusion for whom obtaining a pulse oximetry reading is most difficult Also recommended for situations in which contact between patient and clinician is continuous e APOD sensitivity provides information about whether the pulse oximetry probe is on or off the patient useful in situations where the sensor may become detached including step down or ward care nursing homes remote monitoring or patients for whom the sensor is likely to become detached generally due to excessive movement often with pediatric or combative patients Averaging time The pulse oximetry function of Capnostream provides averaging algorithms which
119. rs that allow the monitor to be mounted with the feet in place ensuring that the air vents on the bottom of the monitor are not covered so that the monitor does not overheat Accessories Available Accessories See the list of available accessories for Capnostream below Table 2 Capnostream Accessories Accessory Oridion Part Number Paper 6 rolls 010516 Paper fits Capnostream s integrated printer Monitor is shipped with one paper roll and one spare paper roll Refer to Replacing the Printer Paper Roll on page 90 for paper installation Mounting Adaptor Plate Vesa 010713 Used for mounting Capnostream to GCX roll stands and other mounting assemblies GCX equivalent part number FLP 0002 17C Refer to Mounting the Monitor on page 22 for mounting instructions C 22 Portable Bedside Capnograph Pulse Oximeter Pole Clamp 010962 Clamp fits pole mount pole diameter 0 75in 19mm to 1 5in 38mm or rail mount rail size 10mm 0 39in x 25mm 0 98in Mounting adapter plate is included Roll Stand with Basket Not stocked by Oridion GCX Part Number RS 0006 64C Roll Stand Kit 38 post with 5 Slide in type mounting plate including 21 base 4 casters 10lb Counterweight handle and 6 basket Mounting plate is required to use Roll Stand Battery Pack 010520 Refer to Installing the Battery Pack on page 19 for battery i
120. s on how to change the recording resolution The controls for viewing tabular data are e GRAPHICAL switches the display from to Graphical from Tabular display in the Graphical trend display this changes to Tabular Portable Bedside Capnograph Pulse Oximeter 63 Using Trends 64 SCROLL allows you to scroll through the table of patient data ZOOM allows you to increase or decrease how much time is averaged into each data point shown in the table At the lowest setting the zoom allows you to examine detailed alarms and events PRINT TREND provides a printout of the trend display currently seen on the screen e ALARM LIMITS displays the Alarm Limits screen to allow you to see what the settings are and change them if necessary The table below gives a sample of the tabular display at a resolution of 1 5 minutes TIME May 23 06 3 45 00 PM 3 46 30 PM 3 48 00 PM 3 49 30 PM 3 51 00 PM 3 52 30 PM 3 54 00 PM 3 55 30 PM 3 57 00 PM 3 58 30 PM EtCO2 mmHg 38 34 30 30 32 32 33 34 34 34 29 RR bpm 38 34 30 32 34 32 33 34 32 31 33 97 97 98 99 98 98 97 97 97 98 97 PR bpm 66 62 61 63 63 62 61 63 62 61 62 Table 17 Tabular Display Example SpO2 EVENTS 16 14 24 1A Events are indicated by a triangle similar to the event button located on the front panel of the monitor and alarms are ind
121. s the low alarm limit to also change in color to make it obvious that it 1s active Similarly if you change the low alarm limit towards the high alarm limit the high alarm limit is forced up if necessary in order to maintain a difference of at least 5 units between high and low alarm limits This type of adjustment causes the high alarm limit to also change in color to make it obvious that it is active The alarm will go off if it exceeds the High Limit value or goes below the Low Limit not if it only reaches the value Alarm limits will reset to their factory default when the power is turned off To make the changes permanent use the Service Mode to change the Institutional Settings for the alarm limits see Appendix 1 Institutional Settings on page 96 Testing Capnography Alarm Settings In order to test the No Breath alarm establish a display of normal breathing on the device Once normal breathing is displayed remove the sampling line from the patient s mouth to create a no breath situation The device should then display a No Breath alarm Alarm Limits Factory Defaults 58 The factory defaults for the Adult and Neonatal alarm limits are given in Table 28 Factory Default Alarm Limits on page 98 Caution Alarms are disabled by default Portable Bedside Capnograph Pulse Oximeter Chapter 8 Using Trends Introduction The Trend Display Screens Graphical Trend Display Screen Tabular Trend Display Screen Specific E
122. se call cable Details about the Nurse Call cable appear below Table 26 Nurse Call Specs Parameter Value Rated Carrying Current 2A Max Allowable Current 2A Max Allowable Voltage 24V DC Stereo Phono Jack 1 8 3 5 mm N1 N NS Figure 32 Stereo Phono Plug for Nurse Call A diagram of pin out of mating stereo phono plug appears in Figure 32 Stereo Phono Plug for Nurse Call above Please note the following e NI COMMON N2 NORMALLY CLOSED Normally Closed relay configuration e NI COMMON N3 NORMALLY OPEN Normally Open relay configuration gt TO SET UP NURSE CALL DATA TRANSFER 1 To use the Nurse Call function plug the Nurse Call cable into the Nurse Call socket on the back of the monitor as shown below 2 Connect the other end of the cable to the institution s system as determined by the institution s requirements 3 Enable the Nurse Call connection as described in Activating Nurse Call below Portable Bedside Capnograph Pulse Oximeter 83 Downloading Patient Data Nurse Call Connection 84 Figure 33 Connection Point for Nurse Call Activating Nurse Call The factory default setting for Nurse Call is disabled and to operate the feature it must be enabled This can be done using the System Setup screen however it will reset to disabled again when the monitor is turned off To permanently enable the Nurse Call feature enable it using the monitor screen in the Institutional Defaults sect
123. se end of the paper comes out at the top of the plastic cover as shown Feed Button Figure 35 Insert Paper Roll into printer 4 Close the door so that it clicks shut Briefly press the Feed button to verify that the paper is aligned properly and is not caught on the edge of the cover Cleaning To clean the monitor s surfaces lightly dampen a cloth with a 7096 alcohol solution and wipe all surfaces Alcohol wipes may also be used Frequency of the cleaning procedure should be in keeping with hospital policy To clean the screen use a damp lint free cloth WARNING Do not autoclave or sterilize this device 90 Portable Bedside Capnograph Pulse Oximeter Troubleshooting CAUTION Do not spray or pour any liquid directly on the monitor accessories or consumables CAUTION Do not use caustic or abrasive cleaners or harsh solvents including petroleum based or acetone solutions to clean the device CAUTION Microstream EtCO consumables are designed for single patient use and are not to be reprocessed Do not attempt to clean disinfect or blow out the FilterLine as the monitor can be damaged Troubleshooting This section lists potential problems you may experience while using the monitor and suggestions for resolving them If you are unable to correct the problem contact qualified service personnel or your local representative Electrical Monitor does not turn Internal battery is totally discharged and on
124. se is currently active the field to the right of the report name will read NO CASES Portable Bedside Capnograph Pulse Oximeter 69 Printing Reports 6 52AM JAN 03 065 ADULT PRINT Lx AR CASE GRAPHICAL CASE TABULAR TREND GRAPHICAL TREND REALTIME CONTINUOUS WAVEFORM I REALTIME CONTINUOUS TABULAR START PRINTER Figure 26 Print Screen 3 Choose data to be printed Select the PRINT FORMAT option from the Print screen On the Print Format screen select the parameters that you want to print on the report Three columns of data appear in one printed report in the tabular formats and two graphs appear in one printed report in the graphical formats The print format selected applies to all reports to be printed Note For tabular trend or graphical trend report if FiCO2 is selected the column is left blank because FiCO data is not stored in trend memory For tabular reports EtCO2 FiCO2 RR SpO2 PR and blank are available for selection For graphical reports EtCO2 RR SpO PR and blank are available for selection Selecting blank means that nothing will be printed in that column 4 Click BACK on the Menu bar at the bottom of the screen to return to the Print screen 5 Click START PRINTER on the Print screen to begin printing To stop printing in order to stop continuous printing or abort other reports that have not completed click the STOP PRINTER button on the screen Table 20 Printed Reports Pa
125. smooth out the SpO numeric result during rapid desaturations and resaturations to show the average saturation level over each short period making it easier to track trends of desaturation or resaturation Averaging helps clinicians avoid a situation in which irrelevant or minor changes might obscure the big picture of the patient s oxygen saturation level The averaging algorithms in the Capnostream device use the FastSat technology in the lowest averaging time ranges this technology takes the signal quality of each saturation result into account in calculating the average minimizing the averaging where required based on signal strength This procedure results in a numeric that is more representative of the patient s actual oxygenation level than numerics produced with other averaging algorithms Averaging with FastSat is used clinically to enable rapid tracking of arterial oxygen saturation changes Clinical indications include the following e Lower averaging levels using FastSat 2 4 4 6 are recommended during procedures in which detecting rapid changes in oxygen saturation is crucial including induction therapy intubation and sleep studies e Higher averaging levels 8 and higher are recommended for patients for whom a general picture of oxygen saturation is required the same patients for whom the SpO gt Sensitivity level should be Normal as described above Portable Bedside Capnograph Pulse Oximeter 51 Alarms and Messages Intro
126. taminated medical waste Loose or damaged connections may compromise ventilation or cause an inaccurate measurement of respiratory gases Securely connect all components and check connections for leaks according to standard clinical procedures If too much moisture enters the FilterLine ie from ambient humidity or breathing of unusually humid air the message Clearing FilterLine will appear in the Capnostream message area If the FilterLine cannot be cleared the message FilterLine Blockage will appear in the Capnostream message area Replace the FilterLine once the FilterLine Blockage message appears The FilterLine may ignite in the presence of O2 when directly exposed to laser ESU devices or high heat When performing head and neck procedures involving laser electrosurgical devices or high heat use with caution to prevent combustion of the FilterLine or surrounding surgical drapes When choosing Microstream EtCO consumables the following should be considered Whether the patient is intubated or non intubated Whether the patient is on mechanical ventilation Duration of use Patient s size and weight For further information please contact your local representative Select the appropriate FilterLine and connect it to the monitor before attaching it to the patient s airway Be sure to follow Microstream EtCO Consumables Directions for Use for proper connection Portable Bedside Capnograph Pulse Oximeter 43
127. ter Chapter 6 Pulse Oximetry with the Capnostream Monitor Masimo SpO Sensors Connecting an SpO Sensor to the Monitor SpO Data Displayed by the Capnostream Monitor Adjustable SpO Parameters Masimo SpO Sensors WARNING Before use carefully read the sensor Directions for Use including all warnings cautions and instructions WARNING Do not use a damaged sensor Do not use a sensor with exposed optical components Do not immerse the sensor in water solvents or cleaning solutions the sensor and connectors are not waterproof Do not sterilize by irradiation steam or ethylene oxide See the cleaning instructions in the directions for use for reusable pulse oximetry sensors WARNING Use only Masimo oximetry sensors for SpO measurements Other sensors may cause improper monitor performance WARNING Do not use oximetry sensors during magnetic resonance imaging MRI scanning Conducted current could cause burns The sensors may affect the MRI image and the MRI unit may affect the accuracy of oximetry measurements WARNING Tissue damage can be caused by incorrect application or use of a pulse oximetry sensor for example by wrapping the sensor too tightly Inspect the sensor site as directed in the sensor Directions for Use to ensure skin integrity and correct positioning and adhesion of the sensor WARNING Do not use damaged patient cables Do not immerse the patient cables in water solvents or cleaning solutions
128. the patient cable connectors are not waterproof Do not sterilize by irradiation steam or ethylene oxide See the cleaning instructions in the Directions for Use for reusable patient cables Note The oxygen transducers sensors used in this device can be categorized as surface devices contacting skin for a limited duration of time The sensors have passed the recommended biocompatibility testing and are therefore in compliance with ISO 10993 1 Selecting Masimo SpO Sensors When selecting a sensor consider the patient s weight and activity the adequacy of perfusion the available sensor sites and the anticipated duration of monitoring The sensor models are listed below For further information please contact your local representative Portable Bedside Capnograph Pulse Oximeter 47 Pulse Oximetry with the Capnostream Monitor 48 Masimo sensor models include e LNOP Reusable Sensors e LNOP Adhesive Sensors e LNCS Reusable Sensors e LNCS Adhesive Sensors e LNOPv Adhesive Sensors Performance Considerations WARNING Pulse oximetry readings and pulse signal can be affected by certain ambient environmental conditions sensor application errors and patient conditions WARNING Tissue damage can be caused by incorrect application or inappropriate duration of use of an SpO sensor Inspect the sensor site as directed in the sensor Directions for Use WARNING Use only Masimo approved sensors and pulse oximetr
129. the power cord into the mains plug in the rear of the monitor Plug the power cord into the mains AC supply Turn on the power switch on the back of the unit The battery power indicator orange light at the front of the monitor will turn on Press the Power ON OFF button on the front panel to turn on the monitor The power on indicator green light will light up showing that the monitor is turned on Note that both the battery power indicator orange light and the power on indicator green light should both be on during operation of the monitor o 4 Change the date time or language Use the control knob to select SYSTEM in the Menu Bar Change each setting on that screen if desired o 5 Set the Patient Type Use the control knob to select the PATIENT TYPE function on the menu bar of the Home screen Select Adult for an adult or pediatric patient or Neonatal for a neonatal patient go 6 Connect a FilterLine Slide open the FilterLine input connector shutter and connect the appropriate FilterLine Connect the FilterLine to the patient as described in the Directions for Use supplied with the FilterLine o 7 Connect an SpO Sensor Connect the SpO extension cord firmly to the monitor SpO sensor port and then connect the appropriate SpO sensor to the extension cord Connect the SpO sensor to the patient as described in its Directions for Use o 8 Once either or both sensors are connected to the monit
130. the red and yellow alarm lights do not light up or there is no sound from the speaker the monitor should not be used and should be sent for servicing e You will hear the pump briefly turn on for a few seconds and then turn itself off However if a FilterLine is connected to the monitor the pump will remain on Microstream CAPNOGRAPHY SOLUTION TIME TO SERVICE 19061 hours TIME TO CALIBRATION 862 hours MONITOR SOFTWARE VERSION 2 2 Figure 9 Salutation Screen Standard Sections of the Display Screen After the blue Salutation screen a screen requesting that you clear the trend memory will appear For an explanation of that screen see Using Patient Cases and Patient ID on page 36 Following that screen the Home screen will appear The Home screen displays the CO and SpO waveforms along with other information that is standard on most other screens This section explains the main parts of the screen 28 Portable Bedside Capnograph Pulse Oximeter Standard Sections of the Display Screen JAN 03 05 Header Area EtCO2 Real Time CO Numeric Data Screen Specific Information Real Time SpO2 Numeric Data PATIENT ALARM SYSTEM Menu Bar TYPE LIMITS Figure 10 Typical Home Screen Most of the screens contain the following sections on page on page on page ui on page In most cases as you move from screen to screen the monitor will always display the Header Menu Bar real tim
131. the settings might adversely affect the monitoring of patients Changes to the Institutional settings must only be made by authorized personnel Resetting to Factory Defaults Each section of settings described below allows you to reset to the factory settings for that specific section You can also do a global reset of all settings in all sections to their factory defaults To do this select RESET when you first select the Institutional Defaults screen 96 Portable Bedside Capnograph Pulse Oximeter Changing Monitor Settings 11 13AM JUN 06 06 INSTITUTIONAL DEFAULTS THESE SETTINGS WILL REMAIN AFTER THE MONITOR HAS BEEN TURNED OFF PRESS RESET TO REVERT ALL PARAMETERS TO FACTORY DEFAULT SETTINGS RESET ON RESET TREND WILL BE CLEARED ALARM TREND MONITOR Spoz LIMITS Figure 36 Institutional Defaults Screen Changing Monitor Settings Alarm Limits There are two sets of alarm limits that are stored in the monitor for Adult and for Neonatal patient types The factory default settings for Adult and Neonatal alarm limits are given above in Table 28 Factory Default Alarm Limits on page 98 To change the alarm limits for each type of patient open the Institutional Defaults screen Select ALARM LIMITS and then use the control knob to set either NEONATAL or ADULT as the default patient type You will then be presented with the Institutional Defaults Alarm Limits Adult or Neonatal screen Change the settings as described in th
132. tion 3 A beep now sounds once for each pulse beat To turn the pulse tone off repeat the procedure and select PULSE TONE off Use of Scavenging System When the patient is being sedated with a gaseous anesthetic a scavenging system can be attached to the monitor The gas output connection is a barbed style connector intended for 3 32 inch ID tubing Using any appropriate tubing connect the scavenging system to the gas outlet located between the FilterLine and SpO connections as shown below in Figure 16 below Disposal of sampled gases should be carried out according to according to standard operating procedures or local regulations for the disposal of gases Portable Bedside Capnograph Pulse Oximeter 39 Using the Capnostream Monitor Figure 16 Scavenger System Connection Point Turning the Pump Off for Suction or Lavage Use the Pump Off mode whenever performing suction or lavage During Pump Off mode pump activity is suspended to protect the monitor from drawing in liquids which could cause a malfunction In the Pump Off mode the CO module pump is switched OFF for a preset time to prevent liquids from entering the monitor WARNING If at any time the device displays the FILTERLINE BLOCKAGE message replace the FilterLine gt TO CHANGE THE PUMP MODE 1 Before performing lavage or suction press the Pump Off button located on the front of the monitor The CO module pump turns off the countdown timer begins
133. to enter a new alphanumeric Patient ID by rotating and pressing the control knob to select letters and numbers If you wish to enter a space turn the knob until you see an empty square instead of a letter or numeral and click to enter a space The maximum permitted length for the Patient ID is 20 characters Select the Enter symbol to finish See the section Screen Navigation on page 31 for instructions on how to enter letters and numbers 4 If you want to change the patient type for this patient you may do so from this screen using the control knob to select and change the patient type 5 Use the control knob to select START CASE Note Once the START CASE button is pressed the case has begun and that button now becomes STOP CASE A new case cannot begin until the previous case has been stopped with the STOP CASE button If you are not sure whether the monitor is currently monitoring a case click the Patient Admit Discharge T key to display the screen in which the START CASE button appears The status of the START CASE Portable Bedside Capnograph Pulse Oximeter Using Patient Cases and Patient ID Numbers button can provide an indication of current status when there is no case started it will show START CASE and in the middle of a case it will show STOP CASE 6 To end a case when monitoring the patient is finished press the Patient Admit Discharge h key and then select STOP CASE This marks the end of the data for that p
134. to hemoglobin oxygen saturation To identify the oxygen saturation of arterial hemoglobin the monitor uses the pulsatile nature of arterial flow During systole a new pulse of arterial blood enters the vascular bed and blood volume and light absorption increase During diastole blood volume and light absorption reach their lowest point The monitor bases its SpO measurements on the difference between maximum and minimum absorption measurements at systole and diastole The focus of light absorption by pulsatile arterial blood eliminates the effects of nonpulsatile absorbers such as tissue bone and venous blood Portable Bedside Capnograph Pulse Oximeter 17 EN The Capnostream Monitor Unpacking and Inspection Installing the Battery Pack Mounting the Monitor Accessories Buttons Indicators and Connections Front Panel Control Buttons Turning on the Monitor Standard Sections of the Display Screen Home Screen Screen Navigation Setting the Date Time and Language Screen Timeouts This chapter describes the physical components of the monitor and how to set up the monitor so it is ready for use The Capnostream 20 Operational Check Sheet is provided at the end of this chapter to simplify the installation setup and getting started processes Photocopy the Check Sheet from the manual and check off the steps on the Check Sheet as you set up the monitor Unpacking and Inspection Unpack the monitor and check all the compo
135. tor is switched to the on position CO Problems NO BREATH message Physiological cause Check patient appears constantly and Clogged or blocked FilterLine Check FilterLine and replace if red alarm indicator blocked flashes FilterLine caught in something or tube is Check the FilterLine from the kinked monitor all the way to the patient to see if line is kinked twisted closed or caught in bed or equipment FilterLine connected FilterLine not plugged in properly Check that the FilterLine plug but pump is not working is screwed into the monitor and no COz EtCO20r Gold ring worn or dirty Check that the gold ring on RR readings are the end of the FilterLine shown connector is present and not damaged or covered with dirt Wipe off any dirt or replace FilterLine as necessary EtCO values read Mechanically ventilated patient who No action needed erratically breathes spontaneously A leak in the airway Check for connection and line leaks to patient and correct if necessary EtCO values are Improper calibration Check calibration See CO2 consistently higher or Calibration Check on page 88 lower than expected BTPS setting turned off Check BTPS setting in the institutional settings See CO2 Parameters on page 101 for details 92 Portable Bedside Capnograph Pulse Oximeter SpO Sensor Troubleshooting No SpOz signal Zero display appears for oxygen saturation and pulse rate Loss of pulse or SpO2 signal
136. tor s memory The three categories are medication patient actions and clinician intervention actions Most event names are provided as factory defaults with several left blank in each of the three categories However all 30 event names can be edited to provide the most appropriate descriptions for the environment that the monitor will be used in Each event name can be up to 11 alphanumeric characters If an event name is left blank a selection of that event will be stored in trend memory as a Quick event see Entering Patient Events on page 38 for information on using Events Medication Events Allows the institution to enter a set of 10 event labels which the operator can use to mark the administration of medicine at the time of monitoring The default medicines are FENTANYL VERSED MIDAZOLAM MORPHINE DEMEROL PROPOFOL and OTHER The last three settings are blank All settings are changeable To reset the Medication Events to the factory settings use the control knob and select FACTORY DEFAULTS Portable Bedside Capnograph Pulse Oximeter 99 Institutional Settings Patient Events Allows the institution to enter a set of 10 event labels which the operator can use to mark events that happen to the patient at the time of monitoring The default Patient Events are EATING DRINKING COUGHING AMBULATING CHEST PT TURNED SNORING and OTHER The last two settings are blank All settings are changeable To reset the Patient Events to the
137. ulsatile to non pulsatile components of the blood at a particular site with a higher number indicating a higher proportion of pulsatile blood The PI is used to assess the relative effectiveness of different application sites and to alert the clinician to changes in the physiological condition of the patient Clinically it is often used to help choose the best body site for pulse oximetry assessment with clinicians choosing the site in which the Perfusion Index and thus pulse strength is highest Signal IQ Waveform The Signal IQ wave is a visual indicator of the confidence associated with the saturation measurement and the timing of the pulse relative to the plethysmosgraph In the Signal IQ waveform a tall vertical line indicates a high quality signal while a small vertical line indicates a low quality signal The Signal IQ waveform is plotted synchronously with the plethysmograph and the lines on the waveform will correspond to the patient s arterial pulse Thus a normal Signal IQ waveform will indicate regular high peaks while an abnormal Signal IQ waveform will indicated low peaks peaks of differing heights or irregularly appearing peaks When a normal Signal IQ waveform is displayed on the Capnostream monitor this information serves to increase the clinician s confidence that the plethysmograph is displaying reliable information When the Signal IQ waveform indicates an abnormal pattern that information can be taken as a warning of p
138. ure Storage amp Transport Pressure and Altitude Storage amp Transport Humidity Packaged Dimensions Packaged Weight Equipment Classification Pressure 430 mmHg to 795 mmHg Altitude 381m to 4572m 1 250 feet to 15 000 feet 1096 to 9596 non condensing Until lower limit of 35 C 31 F Up to upper limit of 70 C 158 F Pressure 430 mmHg to 795 mmHg Altitude 381m to 4572m 1 250 feet to 15 000 feet 1096 9596 non condensing 315mm h x 340mm w x 285mm d 12 4in h x 13 4in w x 11 2in d 5 5kg Po item Value Types of Protection against Electric Shock Degree of Protection against Electric Shock Mode of Operation Degree of Protection against Ingress of liquids Compliance Class 1 Defibrillator Protected Type BF Continuous IEC 60601 1 sub clause 44 6 for class IPX1 Drip proof equipment This product is designed to conform to the following standards IEC EN60601 1 UL 60601 1 CSA C22 2 No 601 1 M90 IEC EN60601 1 2 2001 Class A Radiated and Conducted Emission IEC 60601 1 8 Audible and Visual Alarms ISO 21647 Capnography ISO 9919 Pulse Oximetry IEC 60601 2 49 Particular requirements for the safety of multifunction patient monitoring equipment 108 Portable Bedside Capnograph Pulse Oximeter
139. vents as seen in Trend Data Using the Graphical Trend Screen for Monitoring Patients Printing the Trend Data Clearing Trend Memory Configuring Trends Introduction Capnostream stores patient data that provides detailed information on the history of the patient during monitoring The trend displays allow you to look at the patient history as part of the medical analysis to aid in patient assessment The institution can define the trend storage to be 12 hours of data at 5 seconds resolution 24 hours of data at 10 seconds resolution or 72 hours of data at a resolution of 30 seconds The trend data stores the following parameters Time Date EtCO2 RR SpO PR High priority patient alarms only red urgent alarms Equipment caused events such as LOW BATTERY or other monitor related messages Event markers input by the user along with any event label CASE START marker to indicate start of case Changing the resolution of how often data is stored can be done in the Institutional Defaults screen only See Appendix 1 Institutional Settings on page 96 Note Changing the resolution setting will clear the trend data previously stored in memory The trend data can be viewed on the monitor printed and downloaded via an RS 232 connection or a USB flash memory device for transfer to a computer for further analysis If the patient will be monitored for a longer period than can be stored in the monitor memory it is recommended
140. w character selection 5 To end alphanumeric entry press the control knob twice after entering the final letter or symbol gt TO CHANGE SETTINGS 1 When you are on a screen with settings that can be changed turn the control knob until the desired setting is highlighted by the frame changing to blue To select the setting push the control knob in until it clicks Turn the control knob until the new setting 1s reached To set the setting push the control knob in until it clicks nA A W N Continue to select settings or turn the control knob to select BACK or HOME Configuration Changes On most selection screens when you make a change to one or more system parameters the new settings will only become effective when you exit the screen by selecting HOME or BACK If the selection screen is exited by pressing one of the front panel control buttons located below the screen or if you wait more than one minute and the screen times out and resets the changed settings will not be saved Portable Bedside Capnograph Pulse Oximeter 31 The Capnostream Monitor Setting the Date Time and Language v After you first turn on the monitor check the top left hand corner of the header to ensure that the date and time are correct TO CHANGE THE DATE TIME OR LANGUAGE From the Home screen use the control knob to select SYSTEM in the Menu Bar To adjust the date and time use the control knob to select and change each setting The
141. y cables Other sensors or oximetry cables may cause improper monitor performance Inaccurate measurements can be caused by incorrect application of the sensor placement of the sensor on an extremity with a blood pressure cuff arterial catheter or intravascular line ambient light prolonged and or excessive patient movement intravascular dyes or externally applied coloring such as nail polish or pigmented cream failure to cover the sensor site with opaque material in high ambient light conditions Significant levels of dysfunctional hemoglobins HbCO or MetHb venous pulsations Loss of pulse signal can occur for the following reasons the sensor is applied too tightly a blood pressure cuff is inflated on the same extremity as the one with the sensor attached there is arterial occlusion proximal to the sensor poor peripheral perfusion Clean and remove any substances such as nail polish from the application site Periodically check to ensure that the sensor remains properly positioned on the patient Select an appropriate sensor apply it as directed and observe all warnings and cautions presented in the directions for use accompanying the sensor High ambient light sources such as surgical lights especially those with a xenon light source bilirubin lamps fluorescent lights infrared heating lamps and direct sunlight can interfere with the performance of an SpO sensor To prevent interference from ambient light

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