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Operating Instructions

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1. Faxing Reports NOTE To use the Fax option you must have a modem and fax software installed For additional information see the Vision Series Setup Guide 1 Print as you would to a normal printer see Printing the Report on pg 13 1 and Taking Pictures of the Display on pg 13 2 2 When the Print window is displayed select Microsoft Fax as the name of the printer 3 Click OK Vision Premier Operating Instructions 13 3 Chapter 13 Printing and Sending Files 13 4 Sending Reports Sending HL7 Reports NOTE This feature is optional on Vision Premier If the HL7 communication option has been installed on Vision Premier users can send data to compatible management systems such as PYRAMIS ECG management system When an HL7 report is sent the following information is included cover page VE tabular SVE tabular pacer tabular narrative and ST summary To send a report in HL7 format 1 Highlight the desired record in the Report Manager window NOTE To select more than one report hold down the Control key 2 Select Procedure from the menu bar 3 From the pull down menu select Send and then HL 7 Report The report is sent to the IP address and port ID listed in the System Settings window see HL7 Communication on pg 12 8 Sending Summary Reports Using E Mail Users can e mail summary reports to recipients using the host site s e mail application for more infor
2. 164 211 9834 116 o j j j j 138 226 8076 136 113 250 6590 249 75 200 4484 149 ojojoj 151 226 8867 268 187 250 11151 28 73 125 4382 149 197 250 11597 206 103 226 6084 249 69 125 4162 149 196 250 11456 266 145 226 8575 167 oj j j j j e sa os 3405 1 121 O V H H ala alal m alal a m e2 wlm ol o 4497 72 75 81 23 103 250 290909 1 4 lt 1 of 7 a0 fy 5386 19 a Modified by user For Help press F1 NUM Zi The Tabular Summary pages provide an hourly summary of the results Variations in heart rate or frequency of arrhythmias during periods of activity or sleep can be easily identified 1 Use the arrow keys to move through the columns and rows of each table You may edit any areas that can be highlighted by the cursor however if you change the quantity in the Total QRS column even inadvertently the system requires that it be changed to 0 You can do this if you disagree with the calculated value and wish to have nothing printed on the Final Report To edit these values to something besides zero you should edit forms and arrhythmias so that the Vision Premier system recalculates the results After reviewing the Ventricular Tabular summary advance to the Supraventricular Tabular screen This screen is similar to the Ve
3. Vision Premier Operating Instructions 7 5 Chapter 7 Reviewing amp Editing Arrhythmias 7 6 In the histogram section at the top right of the display click the column of the episode you wish to review or edit The column becomes highlighted The Diagnostic Strip Form display and 30 second Full Disclosure strip change to display the data for the selected episode Click Review Edit Events The Diary Patient Event List window is displayed To create a new episode enter a new time in the Diary Time edit field and click Add NOTE DO NOT try to enter the day of the week this will be filled in automatically based on the date and time You can delete a patient event by highlighting it in the Event List and clicking Remove When all the desired changes have been made click Close to return to the Pattern Strip window Vision Premier Operating Instructions Chapter 8 Viewing the ECG The Vision Premier system allows you to review and verify every beat recorded during the monitoring period You may edit the classifications made by the system during analysis The Vision Premier system provides you with two methods of viewing the recorder ECG data Full Disclosure a page by page view Superimposition a beat by beat view Full Disclosure This method of reviewing the recorded ECG data is page by page Each screen displays from 20 seconds of ECG data to up to 10 minutes depending on
4. Acquisition Wizard x Manual Tape Gain Review 5 0mv gain 1 0 z Calibrate Interval 1002 Msec Recorder Gain ZoomECG CH1 CH2 CH3 8 8 mm 9 3 mm 7 9 mm x10 x1 0 mei Vv d Vv Calibrate Amplifier Scaling Factor Analysis Channel Next gt Cancel Help iene Vision Premier Operating Instructions 3 3 Chapter 3 Acquiring amp Analyzing Patient Data Figure 3 5 Acquisition Wizard Enter Patient Information 8 10 Acquisition Wizard x Set the Recorder Gain to the setting that was selected on the recorder during the recording process Select the desired Scaling Factor for each channel The data shown in the ECG window is the uncalibrated data from the first hour of the recording Use this to determine the appropriate scaling factors When the tape gain settings are as you wish them click Next The Enter Patient Information screen is displayed NOTE If patient information was entered during PC Card initialization then this information will appear automatically in the Enter Patient Information window Continue to step 18 on page 3 5 Enter Patient Information Patient ID Hookup Date and Time Optional 12345678 10715799 12 00 00 AM Last Name iones Diary Events Eirst Name John Second Last Name or Middle Name optional Clinical Limi
5. Pacer Operating Instructions for more information Click Initialize PC Card to begin initialization The Enter Patient Information window is presented NOTE The Enter Patient Information window will not appear if this feature has been disabled If the window does not appear proceed directly to step 7 Enter the patient s information into the window When you are finished click OK For more information see The Enter Patient Information Window on pg 2 3 When initialization is complete a confirmation dialog box is displayed Vision Premier g i Card Recorder successfully initialized for i Sample Rate 200 Channels 3 Duration 24 hours Pacer Sensitivity Disabled 2 2 Vision Premier Operating Instructions Initializing the PC Card Figure 2 4 Enter Patient Information 8 Click OK NOTE Ifyou are using an internal PC Card to acquire patient records you must deactivate the PC Card drive before removing the PC Card from the computer See Removing the PC Card on pg 1 2 for more information The Enter Patient Information Window Enter Patient Information Lx Patient ID Hookup Date and Time 12717702 z 1 05 54PM__ Last Name MM First Name e Second Last Name or Middle Name MLA Data Recorder Serial Number NOTE Patient information entry is optional during initialization You will also have the opportunity to enter patient information during recor
6. Time HRV System Display Settings Full Disclosure Superimposition M CH2 F CH3 25 secs line ha ECG Channel Gain Adjust ECG Channel Invert CHI x25 Cx5 xl Cx2 x4 ap ee we OM we we F CHI F CH2 F CH3 CH3 x25 CxS xl C x2 C x4 Cancel Display Settings Full Disclosure Select which channels are displayed and the number Superimposition of seconds of data are displayed on each line 10 15 25 or 30 seconds per line NOTE No data is excluded from analysis NOTE The display will be larger if there are fewer seconds displayed per line ECG Channel Gain Adjust _ If the patient s data is consistently weak or strong in one or more channels adjust the displayed amplitude for those channels ECG Channel Invert Invert the display for one or more channels NOTE There is no visual indication on the screen or printouts that this inversion has been made Vision Premier Operating Instructions 12 3 Chapter 12 System Setup Clinical Limits nee System Settings ee PRE Display Print Clinical Limits Auto Strips User Strips Freq HRV Time HRV System Clinical Limits Settings pley ps ele lesn Clinical Limits Group Standard Pause Duration gt 2 seconds ST Duration 2 feo seconds 1 0 5 0 seconds 1 300 seconds ST Reset gt 60 seconds 1 300 seconds Bradycardia Rate lt 50 BPM ST Elevation 3a F 20 119 BPM 0 2
7. magenta indicates the high and low rate for each 1 minute interval Vision Premier Operating Instructions ST Summary ST Summary Figure 5 7 ST Channel Summary Figure 5 8 ST Episode Summary This page provides a detailed summary of all ST episodes that satisfy the clinical criteria for amplitude duration and separation It is divided into two sections NOTE The printout of the ST Episode Summary will include a subset of all ST episodes displayed ST Channel Summary Vision Premier 3 Channel ECG Report f The ST Channel Summary provides The number of episodes of depression or elevation The duration of all episodes The time and maximum depression elevation of the episodes for each channel of data ST Episode Summary RE 02 48 46 PM Mon 56 46 PM Mon 3 28 42 PM Mon 03 48 47 PM Mon 04 28 46 PM Mon 07 38 33 PM Mon 07 44 32 PM Mon 07 50 31 PM Mon 07 58 32 PM Mon 08 06 32 PM Mon 08 14 32 PM Mon Vision Premier Operating Instructions 5 9 Chapter 5 Reviewing the Report 5 10 The ST Episode Summary provides the following information for each significant episode Onset time and date Peak ST change identified as elevation or depression Slope downsloping upsloping or horizontal Duration Channel Heart rate at onset Heart rate at maximum ST change Each entry listed may be edited inserted into the Report Strips or deleted 1 Click the episode you
8. 1 Report Editing Enhancements Insert Beat Figure 11 1 Insert Beat This function is available from most ECG displays and allows you to label a designated beat in a patient ECG To insert a beat Marker at a designated location left click the mouse while holding the H key down The single Marker notes where Beat Insert will take place The Marker can be moved by using the keyboard or by clicking on the new location The following keyboard controls can be used to move the Marker The f amp and F keys will move the Marker left or right in 100 msec intervals Press and hold the key while using the f and f keys to move the Marker left or right in 5 msec intervals The display below is a Tachogram Review showing the Insert Beat I beam marker Vision Premier Afib Report BENE Z Review Edit View Edit Print Close ReportSettings Window Help xj HH Ee Se or gt Hage 2000 Meee mae R M 5 1000 e c 0 1000 R 1 Msec Form18 x 64 4 SSS For Help press F1 I NUM NOTE When inside the Calipers view two color Markers may be present inside the ECG window To remove the inactive Marker left click your mouse on the ECG day and time text above the ECG strip Vision Premier Operating Instructions 11 1 Chapter 11 Report Editing Enhancements 11 2 Once you have aligned the Marker with the b
9. 7 Chapter 13 Printing and Sending Files Select a program to open the file The data can be opened using word processing programs such as Microsoft Word text viewing programs such as Notepad or Wordpad and spreadsheets such as Microsoft Excel 13 8 Vision Premier Operating Instructions Chapter 14 Maintenance amp Troubleshooting No calibration is needed for your Vision Premier system For maintenance and cleaning procedures consult the documentation that came with your computer Contact an authorized service agent immediately if Vv Vv Vv Vv Vv The equipment is dropped or subjected to some other mechanical stress Liquid is spilled on the equipment The equipment is not functioning as described in this manual Parts of the enclosure are cracked or missing Any connector shows signs of deterioration such as cracking All functions of the Vision Premier system are designed to be user friendly and easy to understand If a questions arise or you would like additional information contact your local representative or Burdick Technical Support Department at 800 333 7770 or 608 764 1919 Computer to Recorder Interface Error Codes NOTE Please consult the operating instructions that accompanied your recorder for additional information The following error codes are displayed on the computer during the PC Card or Tape initialization sequence Type of Code
10. 97 08 36 AM Wed Full Not Confirmed 3 Channel ECG Report 123 45 6789 R5829245 07 08 97 10 14 AM Tue Full Not Confirmed Pacer Report 234 56 7890 R6839457 05 19 97 11 00 AM Mon Full Not Confirmed For Help press F1 NUM 2 Select Acquire from the menu bar or click on the Acquire New Report icon The Acquisition Wizard is presented to guide you through the steps necessary to acquire the patient record from the recording media Vision Premier Operating Instructions 3 1 Chapter 3 Acquiring amp Analyzing Patient Data NOTE The steps presented in the acquisition wizard are automatically determined by the recorder hardware you have installed Some of the steps discussed in this manual may not appear on your system You may skip those steps The wizard will guide you through the steps that are necessary for your system 3 The ECG Data Source screen is displayed Figure 3 2 Acquisition Wizard ECG Data Source Acquisition Wizard NOTE The Select ECG Data Source dialog will not be seen by users that have a PC Card system only All Tape and Tape PC Card combination systems will see the Select ECG Data Source dialog box 4 Select which type of recorder you have used to record the patient s data by clicking the appropriate radio button 5 Click Next to continue If you selected a tape recorder in step 4 the Select Data Channel screen is displayed If you selected a PC Card recorder skip to ste
11. Changing Reports to be Displayed 00 0 00 eee eee 4 2 Tracking Open Windows 660 c cece eee nee 4 3 Backup and Restore of Reports 00 eee 4 3 Summarizing Reports 6 eens 4 6 Chapter 5 Reviewing the Report s sscscsccrcsscsscsscsscressesseseeees D 1 Beat Classification se irse ten nient I e a e 5 1 Viewing and Eqiting gri ii ene anG RA RER cece ER RE EEA 5 2 C yvet Pape sparia eaaa pete A a an ated D ee wheats 5 3 Narrative Summary i a e a een eens 5 6 Tabular Summary 0 666 5 7 Graphie Summary ei esar pan E aot a a a ee A EE 5 8 Dd OUMIMN Aly csktterteen nhs suste sate shine At ehh E A 5 9 RepOrt StS fg aie y Sew elon oa ee cote ele aah nee BW Slee RCE aS 5 11 Vision Premier Operating Instructions Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Reviewing amp Editing FOrmMs sssssscsseesesscsscssesseeees 6 1 Reviewing Forms 6 66 ccc ccc cece ence eens 6 2 Editing Forms reoi reterii donate telat dna Suited ls ca E a i 6 5 Editing Beats 220i sags aA ae aide E ee OE E E aed 6 7 Reviewing amp Editing Arrhythmias cucscrcrserseeees 7 1 Reviewing Arrhythmias einer visu cy weet weten waaay 7 1 Editing Arrhythmias 22 20 saae te ales es cages ee eae ae 7 3 Editing Min Max Heart Rate 2 4 6 s0 sacsbesuseeuds be clean 7 5 Editing Diary Events sisne cerni ena aie a aE 7 5 Viewing
12. Possible Cause adit 1 Wrong number of parameters passed by the host software application 2 Data file error software 3 Info file error software 4 Pacer file error software 5 Timeout during disk transfer hardware 6 Disk did not respond to power up test and or disk erase hardware procedure failed 7 No disk detected hardware 8 RTC NVM write error hardware Vision Premier Operating Instructions 14 1 Chapter 14 Maintenance amp Troubleshooting p Type of Code Possible Cause Problem 9 Drive power down error hardware 10 Excessive errors during disk read hardware 11 Unable to read cylinder index from drive hardware 12 Failure to read time from UPLD DAT info file hardware or software 13 Unable to build header file software 14 Unable to build event file software 15 Initialization failure hardware or software 16 Initialization failure pacer data area hardware or software 17 Initialization failure time mode verification failure hardware or software 18 Mode information has been corrupted check hardware connections Batteries were removed and reinstalled during recording 20 Recorder does not contain data for procedure requested 23 Requested 2 channel data recorder contains 3 channel data 24 Invalid data request 30 Recorder type is not capable of combined mode operation 41 Did not detect recorder hardware 48 Did not find disk interface board hardwar
13. S A Telephone 49 511 62628630 800 777 1777 608 764 1919 Fax 49 511 62628633 Table of Contents Intended Use gurie snl ens tase teen ase a4 E TA esa ea iii Software Version 66 eee AEA iv Electronic Manuals 0 666 e cnc eens iv Warnings Cautions amp Notices 6 6 c eee ee ne v Chapter 1 Introduction to Vision Premier ssec 1 1 Inspection Upon Delivery s sesrses eis Ene eens 1 1 System Requirements 0 enere trnr arrora ees 1 1 Starting Cert e Beatie ach oN oh ead hah a ela Oe ad ah ee 1 2 Fxiting the Program sat oak ote ay hee ae a eee ae 1 2 Removine the PC Card oige paagi ake nri So ne a a sey A eh 1 2 Search by TIME syes tepsa pe eo a E EE EEEE A A 1 2 Running Vision Premier Remotely 0000 e ee eees 1 3 Using the Mouser ihc siete Senn tice h eee eyelets 1 3 Getting Around ccc 1 4 Chapter 2 PC Card Recording Preparation cucsscrcrserserseeees 2 1 Initializing the PC Card G50 sak sani nee ete alia Me attend tee eds 2 1 Hookup Wizard Digital Recorder unnan ranr 2 5 Hookup Wizard Tape Recorder 6 0 00 cece eee 2 10 Chapter 3 Acquiring amp Analyzing Patient Data eee 3 1 Chapter 4 Managing Reports issssisssicecersssssicesvesvecseosbssesstoosssenoeae4 L Sharing Records over the Network 00 e cece eee eee 4 1 Sorting Patient Reports 0 eee nee 4 2 Analyzing Patient Records 6 c cece cee 4 2
14. System for the purpose of screening for ECG rhythm disturbances It should be used by or under the supervision of those knowledgeable in all aspects of ECG morphology rhythm and arrhythmia This device is intended to be used under the supervision of a qualified physician The Vision Premier Holter analysis system may be used in conjunction with standard 12 lead ECG analysis as an additional means for identifying heart disease The extended recording period for Holter data provides a great deal more data than the standard 10 second ECG recording A Holter recording captures abnormalities which may be infrequent or provoked by specific activities Suggested indications for conducting Holter analysis include Arrhythmias Chest pain Unexplained syncope Shortness of breath Palpitations Evaluation of a pacemaker Regulation of antiarrhythmic drugs Evaluation of a patient after myocardial infarction Family history of heart disease ARARAS The Vision Premier system uses a sophisticated algorithm to detect measure and classify QRS complexes Each beat is classified and grouped into classifications called forms After the Vision Premier system has performed its analysis of the data you may then review and change the system s classification When editing has been completed the Vision Premier system automatically recompiles the report and incorporates your changes into the final results All aspects of the report are affect
15. Wizard Tape Recorder Figure 2 13 Hookup Wizard Final Recorder Setup Hookup Wizard 8 Follow the on screen instructions for final recorder setup and click Finish Vision Premier Operating Instructions 2 11 Chapter 2 PC Card Recording Preparation 2 12 Vision Premier Operating Instructions Chapter 3 Acquiring amp Analyzing Patient Data Figure 3 1 Report Manager After you have recorded data from a patient you must copy the data to your computer for analysis If you are using a PC Card recorder remove the PC Card from the recorder and insert it into the PC Card bay on your computer When you acquire this data make sure that the correct PC Card recorder is selected for ECG Data Source If you are using a cassette tape recorder remove the tape from the recorder and insert it into the tape reader connected to your computer When you acquire this data make sure that the correct tape recorder is selected for ECG Data Source To acquire and analyze data NOTE If at any time you are unable to proceed to the next step refer to Maintenance amp Troubleshooting on pg 14 1 1 Start the Vision Premier program The Report Manager window is displayed Vision Premier Report Manager a Procedure Acquire Print System Settings View Initialize PC Card Window Help xj a Se r oO mw amp E Patient ID Report iD Status Afib Report 012 34 5678 R5829223 03 12
16. all the necessary steps Vv detailed instructions in for each step text and or graphics VY ondemand movies containing detailed instructions for each step The Hookup Wizard guides you through all of the steps necessary to ensure accurate recording results The wizard also initializes the PC Card for you As the wizard guides you through the appropriate steps you may press Back at anytime to review the previous steps and any choices you have made If you have installed the optional media player and video files each screen will contain a Show Me icon amp Click on this icon anytime to view a short movie containing detailed instructions for performing the current step 1 Start the Vision Premier program The Report Manager window is displayed 2 Insert a PC Card into the PC Card slot in the computer 3 Click on the Hookup Wizard icon K in the toolbar The Hookup Wizard is presented Hookup Wizard Electrode Placement 1 White 1 2 Red 1 3 Brown 2 4 Black 2 5 Blue 30 6 Orange 3 Reterence Green Acquisition Device Tape Recorder Digital Recorder i Coret en 4 Ifyou have a Tape Reader installed in your system you are given the option of selecting Tape Recorder or Digital Recorder Ensure Digital Recorder is selected 5 Click on the appropriate radio button for either a 2 channel or a 3 channel hookup 6 Attach the electrodes on
17. always displayed in a group of two or more mutually exclusive buttons Like check boxes radio buttons are either selected or unselected A selected radio button is indicated by a filled in dot Unlike check boxes selecting one radio button in a group causes any other radio button in that group to become unselected Click on the radio button to select the desired item ECG Channel Gain Adjust CHT C x25 xh xl Cx Cod cHe C x25 xh xl xe Cod CH3 f x25 Cx5 foal Cxe Cyd Vision Premier Operating Instructions 1 9 Chapter 1 Introduction to Vision Premier Figure 1 9 Tabs Figure 1 10 Dialog Box Tabs Some windows have more information in them than can be displayed at one time The problem of displaying all the information is handled by using tabs Windows with tabs have multiple pages that are overlapping A tab from each page is visible at all times You can click on the tab to display the corresponding page System Settings M x M M x M Confirmation Boxes A confirmation box is a small window with just one or two buttons usually OK alone or both OK and Cancel together These boxes provide you with information or ask you to verify an action They disappear after you select a button An example of a confirmation box is displayed if you try to delete a record in the Report Manager window Yision Premier You must respond to a confirmation box in order to continue working In the abo
18. by dragging or clicking the scroll bars and can resize each window by clicking and dragging the borders and corners Click and drag the title bar to move the window itself about To reduce the active window to an icon select Minimize from the control menu box or the Minimize button To have the window fill the screen click on the Maximize button Report windows are always maximized when they are first opened The program will display multiple independent windows so you can have several different reports open at once Each report will have its own window and can be separately moved resized opened and closed and printed To make a window active just click on it or press fTF f 48 to cycle through the open windows Objects are special items displayed on the screen You can use these items to interact with the system Menu Bars Toolbars Context Menus Dialog Boxes Confirmation Boxes NOTE When an object appears lighter than the rest or grayed out this means that the object is not available An object may be unavailable if v Vision Premier is not in the appropriate mode to utilize that object v Your version of Vision Premier does not support the object s function Vision Premier Operating Instructions Getting Around Figure 1 1 Menu Bar Menu Bars Menu bars may be used to select an item such as a new window or to select a function such as acquiring a new record from the Holter recorder V
19. column that includes the most severe episodes is automatically highlighted when this window is opened The top left portion of this window displays the total number of episodes for the current subcategory of arrhythmia and which of these episodes is currently displayed For the Min Max Heart Rate window the top portion of the window has the following features A 24 or 48 hour graph of the heart rate displayed in beats per minute BPM Ablue rectangular box that encloses 20 minutes of data on the 24 or 48 hour graph Vision Premier Operating Instructions Editing Arrhythmias The 20 minutes of data defined by the blue box is displayed at a larger scale on the right side of the screen The Diagnostic Strip and Form Display The right side of this section contains a 7 second diagnostic strip The onset of the current episode is centered in this box Above the 7 second strip is information about the episode such as a description of the subcategory and the heart rate Also displayed is more detailed information when applicable For example a Pause episode will have the pause duration displayed here The left side of this section displays the form that is currently highlighted in the 7 second diagnostic strip The Contextual View Display At the bottom of the Pattern Strip window is a 30 second full disclosure strip for viewing the selected beat in context with the surrounding beats The onset of the current epis
20. duration and separation from prior episodes are identified as ST episodes Prior to printing the report the classification of all arrhythmia and ischemic episodes can be reviewed and edited NOTE The Vision Premier system locks out the first five minutes of ECG data which is used for calibration These beats are labeled U Uneditable in graphic displays Vision Premier Operating Instructions 5 1 Chapter 5 Reviewing the Report 5 2 Viewing and Editing There are several ways to advance through the pages of the final report use the method that is most comfortable for you Y Select View in the Menu bar From the pull down menu select the page you wish to view Vv Press FN E v Click on the Next Previous page icons to move forward or back through the pages The Holter data and or analysis information contained in some of the report pages is editable If the information on such a page has been edited then the lower left corner of the window will show Modified by user Refer to the graphic under Narrative Summary on pg 5 6 for an example NOTE The Modified by user message appears only on the page that has been edited and is limited to the following pages only Narrative Summary Ventricular Tabular Supraventricular Tabular Pacer Tabular and ST Tabular Following is a description of the pages that can be selectively included in the report Vision Premier Operating Instructions Cove
21. from the list The beat is automatically moved to the prime form of the correct category and the label is changed 6 10 Vision Premier Operating Instructions Chapter 7 Reviewing amp Editing Arrhythmias The Vision Premier system detects arrhythmias and annotates events indicated each time the patient presses the Event button on the recorder These episodes are then separated into seven classifications v Pause Episodes Ventricular Episodes Supraventricular Episodes Tachycardia Bradycardia Episodes Minimum Maximum Heart Rate ST Episodes XS SNS 8 8 8 Diary Patient Episodes Reviewing Arrhythmias 1 Start from the Report Manager window 2 Double click the record you wish to review or edit The Patient Information window is displayed 3 Verify that the information displayed in the window is correct Click the Arrhythmias icon in the toolbar The Pattern Strip window is displayed Figure 7 1 i Vision Premier 3 Channel ECG Report RE Pattern Strip Z Review Edit View Edit Print Close ReporSettings Window Help la x Esm ea 8 Ea eea Ventricular Episodes Pattern Strip 1 of 2 10 27 15 AM Tue Y Couplet I Strip Included In Report HR 94 Fomi2 iv a SS SO aa a For Help press F1 I I I NUM Vision Premier Operating Instructions 7 1 Chapter 7 Reviewing amp Editing Arrhythmia
22. i e 05 T i i i 0 1000 2000 R 1 Msec Form 3 S 3730 j Oy EER y peiie i aioe if ye a PSP AA ia aia a mye Pepo i ao A 1 J j oe ad AM wl re AAEN i A V ee L Seo N Nnr AAI se es ee ee HALL ULL Add ddeblebebelebebeledadlalalandalel gj Ls Ei Insert an Atrial Fibrillation Flutter Episode NUM Vision Premier Operating Instructions Insert Atrial Fib Flutter Figure 11 3 Add Edit Atrial Fib Flutter List Once you have aligned th the Markers with the segment you wish to label click on the Insert Afib icon A f in the tool bar or click the right mouse button and select Insert Afib from the context menu to open the Add Edit Atrial Fib Flutter List window Mision E Afh FITE 15 x Review Edit t port Settings gt erie Sin an 2000 M 1000 M B Add Edit Atrial Fib Flutter List M 000 PA Analyze Start Time Analyze End Time s e 3 12 97 8 41 00 AM 3 13 97 7 51 28 AM c a We Atrial Fib Flutter Start Time Atrial Fib Flutter Stop Time 0 3 12 97 3 712797 e a TA E 4219 AM a 8 42 23AM Fom 3 s 3730 Start Time End Time T pA tg TATRA IIT ee eveeennnnee Abd lid edabel adele nl a abana z 4 y For Help press F1 NUM The Analyze Start Time designates the position of the first Marker The Analyze Stop Time designates the position of the second Marker The duration of the Atrial Fib Flutter epi
23. information is also included For clarity of presentation the arrhythmia of interest is centered in the strip or as in the case of runs tachycardia bradycardia bigeminy or pauses the onset of the arrhythmia is centered The ECG strips will vary from report to report depending upon system configuration and the data being analyzed The strips are presented either by time or by category depending on the report configuration If they are grouped by time the strips are printed in chronological order starting at the beginning of the recording If they are grouped by category all strips of the same type isolated couplets runs etc are printed together To review the remaining report strips press or click in the scroll bar located on the right side of the window The strips are displayed one after another until the last strip The Report Strips may be edited and deleted 1 To edit a Report Strip click on the strip to highlight it and press A window similar to a diagnostic strip is displayed WN Vision Premier Operating Instructions 5 11 Chapter 5 Reviewing the Report Figure 5 10 H Vision Premier Yang Gretchen Report Strip editing ee rera EEE KEE saneeseannses baia 2 You may edit any of the fields which can be highlighted by the cursor You can also select a strip label from the drop down menu 3 When you have finished editing the report strip press To delete a Rep
24. one that can be edited To edit a form designation and the designation of all the beats in that form 1 Highlight the desired form 2 Click Edit in the menu bar or click on the form with the right mouse button and select the desired form label from the list The form is automatically moved to the correct category and the label is changed All the beats included in the form are relabeled Vision Premier Operating Instructions 6 5 Chapter 6 Reviewing amp Editing Forms 6 6 Merging Forms If there are two or more forms containing the same type of beats they may be merged to create one larger form Merging does not affect data analysis To merge two forms 1 Highlight the forms you wish to merge by holding down while clicking on each form Figure 6 5 Select Forms to Merge 2 Select Merge Selected from the Edit menu A message box appears asking you to confirm that you want to merge the highlighted forms 3 Click Yes to continue The form display reflects the merge All the beats from the selected forms are now grouped into a single form This is the form that originally had the most beats Vision Premier Operating Instructions Editing Beats Figure 6 6 dk Vision Premier 3 Channel ECG Report x N N N N N Ni Merged Forms NOTE In the example shown above the number of beats in Form 4 has changed to 175 which is the sum of the original form 5 and 13 After and edit or m
25. the ECG sssssisnsirierrisisisnirirsrrsrinosisss 8 1 Pull Disclosures asosda e aeaea a oa R AAE EEAS 8 1 SUPEMPO SION tsy t se a E E ied E ARON 8 7 Reviewing the TAchOgram ucscscsscssssseseeseescsscrserseeees 9 1 The Histogram Distribution and Poincare Plot 9 2 The Diagnostic Strip and Form Display 084 9 2 Including the Strip in the Final Report 00005 9 3 The Contextual View Display 23 4 ss0censteeas oedatcs daa 9 3 Calipers sciccecvsectasiesestsessssetnsnsetetoinesipenrsriestaheniacssaoade 10 1 Report Editing Enhancements ssssssssersrerereserereeeese 11 1 Insert BOA bys roy ci eee aE e E a Manns dade a aE E a ea a d Me 11 1 Insert Atrial Fib Flutter n unanunua nananana 11 2 System Setup caivsssosctesisiassasns savdevestansaantistyeiencasatesatonss 12 1 Printing and Sending Files scssscscccssesserscrsceceess 13 1 Printi g th Rep rt 4 0eeitacewend Senate ended RE 13 1 Taking Pictures of the Display crak et laa eats Os on Rt 13 2 Faxing Reports aeoea te Ee alg ae ee ea 13 3 Sending Reports creo Tirpi cece eee ene 13 4 Exporting Reports AE E eects 13 6 Maintenance amp Troublesnooting csesscsscrssrseeeees 14 1 Computer to Recorder Interface Error Codes 14 1 Printing Problems vo e a ea ae Sita eae 14 2 Vision Premier Operating Instructions Intended Use NOTICE This device is intended to be used as a Holter Monitor Analysis
26. the patient as indicated on the screen Vision Premier Operating Instructions 2 5 Chapter 2 PC Card Recording Preparation 2 6 Hookup Wizard ECG Verification Setup NOTE Welch cups may be used at this point to eliminate waste of sensors during signal verification The Welch cup will leave a red mark on the chest to aid in final placement of the sensor When you are satisfied that the electrodes are properly placed on the patient click Next The ECG Verification Setup screen is presented Hookup Wizard NOTE Audio ECG Verification is only available for the Burdick 6722 6732 92512 and 92513 model recorders If you are using any other recorder you should evaluate the signal quality using the procedures presented in the operating instructions for that recorder Click Next as necessary to skip the ECG Signal Verification section of the wizard Follow the on screen instructions for preparing the system for audio signal verification Click Next when you are ready to verify the ECG signal The Show ECG screen is presented Vision Premier Operating Instructions Hookup Wizard Digital Recorder Figure 2 8 Hookup Wizard Hookup Wizard Show ECG 1 Press the event button to view each channel Stet stop 2 Verify that the amplitude of each channel top to bottom exceeds two boxes 10 11 NOTE The Show ECG screen is not a calibrated display It is intended as a basi
27. vy the time entered during initialization or v the current time Use the patient diary to verify this information Change the time if necessary To add comments to the patient event list or to insert patient diary time and comments see Diary Event Entry on pg 3 8 Click Next The Enter Patient Demographic Information screen is displayed Vision Premier Operating Instructions 3 5 Chapter 3 Acquiring amp Analyzing Patient Data Figure 3 6 Acquisition Wizard Enter Patient Demographic Information Acquisition Wizard Enter Patient Demographic Information Gender Age Race fa Years x Unknown x Unknown x Weight Height fo kilograms x fo Centimeters z Medications Indications vj lt v lt j 20 21 22 23 24 25 26 3 6 NOTE All of the fields in this screen are optional You may skip to step 26 if you do not wish to include any of this information in the patient s report Enter the patient s Age and select the proper age units from the drop down menu Select the patient s Race from the pull down menu Select the patient s Gender from the pull down menu Enter the patient s Height and Weight and select the appropriate units from the pull down menus NOTE The lists that appear in the Medications and Indications fields may be edited Click on the expand button E and you are presented with a new window where you can add de
28. wish to review or edit The episode becomes highlighted To edit an episode click Edit at the bottom of the screen The ST Episode Edit window is displayed When all changes have been made click OK to return to the ST Summary window To insert an episode into the Report Strips click Insert at the bottom of the screen The ST Episode Edit window is displayed Verify that all the information is correct and click OK To delete an episode click Delete The episode is removed from the list Vision Premier Operating Instructions Report Strips Report Strips Figure 5 9 Report Strips vk Vision Premier Yang Gretchen BE x Xl Review Edit View Edit Print Close Report Settings Window Help laj x or A hn mn gt im ce of OF Ah RH cd ee he ee E Prev Next Close Setting Diay Afb Beat HRY Preview Print 03 16 28 PM Tue HR 58 J an a Sa hp 03 46 45 PM Tue HR 85 Ho 03 53 46 PM Tue 05 05 00 PM Tue iodi 05 10 41 PM Tue HR 49 HR 67 HR 71 VRm Beats 138 Rate 88 By J haan ee A a ee J pp MAA a a COS SECRET Ry For Help press F1 The final report pages show some of the strips selected by the system to represent the arrhythmias noted in the report Each ECG strip shows the designation of the strip the time and the heart rate For some arrhythmias such as runs pauses and bigeminy additional
29. 3 ventricular ectopics which represented 2 of the total beat count were noted The highest ventricular ectopic frequency occurred from 03 00 AM to 04 00 AM Thu During this time 270 VE s occurred Ventricular ectopics were observed as 90 isolated beat s as 7 couplet s and as 149 run s Some of the ventricular beats occurred in bigeminal cycles 3198 supraventricular ectopics which represented 1 of the total beat count were noted The highest supraventricular ectopic frequency occurred from 05 00 PM to 06 00 PM Tue During this time 503 SVE s occurred No episodes of ST depression defined as 1 0 mm or more VP were noted in channel 1 No episodes of ST depression defined as 1 0 mm or more were noted in channel 2 M Ss as This page presents a concise statement of the results in an easy to read narrative style It can be used as a preliminary guide for the physician s review of the report or be included in the report as the physician s interpretation 5 6 Vision Premier Operating Instructions Tabular Summary Tabular Summary Figure 5 5 Ventricular Tabular Summary I Review Edit View Edit Print Close Report Settings Window Help alaj x mae sl yl Forms Arrhyth Tacho Super FullDisc Pacer HRV Ventricular Tabular Total Ventricular Ave QRS Runs Isolated 4121 211 5915 81 146 4852 58 83 3473 62 250 3655 234 57 85 3406 3
30. 5 0 mm Tachycardia Rate gt 120 BPM ST Depression lt 1 80 250 BPM 0 2 5 0 mm Ai SVE Prematuriy gt 25 early 10 100 SVE ATach Rate gt 85 BPM 30 150 BPM Clinical Limit Settings Clinical Limits Group Standard Paced Pediatrics Custom 1 or Custom 2 Select which set of clinical limits should be applied to the patient data You can configure all 5 categories to suit your needs Pause Duration The amount of time in seconds that must elapse with no ECG detected before a pause is declared Bradycardia Rate The rate the heart rate must fall below before a bradycardia event is declared Tachycardia Rate The rate the heart rate must exceed before a tachycardia event is declared SVE Prematurity The percentage that a normal morphology beat must be premature before an SVE event is declared SVE ATach Rate The rate a beat RR must exceed before an SVT is declared Supports more accurate detection for bradycardiac patients or patients with an underlying low heart rate ST Duration The time in seconds an ST episode must exceed the threshold limits before being declared an event 12 4 Vision Premier Operating Instructions Clinical Limit Settings ST Reset The time in seconds an ST episode must not exceed the threshold limits to end the declared event ST Elevation The amplitude threshold in millimeters the ST segment must exceed above the base
31. A list box is a box with a list of available choices An example of a list box is shown for the Full Disclosure option in the Print tab of the System Settings window E 60 secs line 10 secs line 30 ete 1 8 Vision Premier Operating Instructions Getting Around Figure 1 7 Check Boxes Figure 1 8 Radio Buttons List boxes are not fully displayed until activated by clicking the expand button To select an item from a list position the pointer over the item and click Click outside the list to deactivate it You can create or add to some of the lists that are available on the Vision Premier system Most of these user editable lists are found in the Patient Demographic Information and the Miscellaneous Data windows These lists are identified by a special expand button lt lt Click this button to access the window where the list can be edited Check Boxes A check box is a small square object Check boxes are either selected or unselected A selected check box is indicated by a check mark Click in the check box to select or deselect that item Any number of check boxes may be selected Pages to Print M Cover Page M Normal Abnormal Histogram EEA M Narrative l Forms Summary V Tabular l Time HR Report SelectAll M ST Summary l Freq HRV Report T Pacer Summary M ECG Strips M Graphic l Full Disclosure Radio Buttons A radio button is a small round object that is
32. Operating AStrUCTIONS i Vision Premier 3 Channel ECG Report Review Edit View Edit Print Close ReportSettings Window Help gt esd ann Me GS oe Spy Strip 1 of 25 10 19 03 AM Tue Baseline 10 23 25 AM Tue V Isolated 10 24 58 AM Tue V Isolated HR 73 z B4 HR 83 Jl Jl 10 27 15 AM Tue Maximum Heart Rate 10 27 15 AM Tue V Couplet 10 30 22 AM Tue V Couplet HR 98 HR 34 HR 88 Ty f yH H ed 10 43 07 AM Tue ST Depression 10 45 11 AM Tue V Isolated 10 59 22 AM Tue SV Isolated HR 82 Ch1 2 9 mm HP 77 HP 75 For Help press F1 Vision Premier Holter Analysis System Software Version 3 3 Operating Instructions Part No 086558 Revision 0103 DISCLAIMER BURDICK INC MAKES NO REPRESENTATIONS OR WARRANTIES WITH RESPECT TO THE CONTENTS OR USE OF THIS MANUAL OR WITH RESPECT TO ANY BURDICK INC HARDWARE OR SOFTWARE AND EXPRESSLY DISCLAIMS ANY EXPRESS OR IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE Copyright 2003 Burdick Inc All rights reserved Authorized EC Representative Printed in the United States of America Medical Device Safety Service GmbH No part of this publication may be reproduced photocopied or Burckhardtstr 1 transmitted without the express written consent of the publisher D 30163 Hannover GERMANY oe k Contact Ludger Moeller MEISS Arway E mail Imoeller mdss com Deerfield Wisconsin 53531 U
33. To cancel any actions in the View Activity Log window and return to the Backup Wizard window click the Cancel button Vision Premier Operating Instructions Backup and Restore of Reports Figure 4 5 Restore Restore Reports This option allows you to restore a report from a local network optical CDR or CDRW drive 1 Select the Restore option and the Restore window is displayed Patient ID Report ID Status 3 Channel ECG Report 123 45 6789 R5829245 07 08 97 10 14 AM Tue Full Not Confirmed 4 Print Patient Print List Report Entire List Restore Folder Browse Full Disclosure Selected List C My Documents Holter a C Specific Pages Print Print Refresh List Restore Cancel 2 Enter the Restore Folder where you want to get the report from If you want to change the Restore Folder click the Browse button to locate and select the new drive or folder you wish to use The records available in the location you have selected will be listed 3 Ifa folder is manually selected click the Refresh List button to update the list according to what reports are available for restoring Select the report to be restored by clicking once on it and tagging it The Print Patient group box and the Print List group box options are now available To select more than one report press and hold the key while clicking on the reports The Print Patient group box allows you to print specific componen
34. We will refer to this button as the left mouse button and the one to the right as the right mouse button If your mouse has three buttons the center one is not used by the Vision Premier system Click To click press and release the left mouse button You should feel and hear the button click Right Click Most operations require the left mouse button but some special operations can be done with the right mouse button see Context Menus on pg 1 7 Vision Premier Operating Instructions 1 3 Chapter 1 Introduction to Vision Premier 1 4 In this manual using the right mouse button will be referred to as right clicking To right click press and release the right mouse button You should feel and hear the button click Double Click To double click press and release the left button twice without pausing Do this quickly Double clicking takes less than one second Getting Around The Vision Premier system follows Microsoft Windows conventions for manipulating files and issuing commands When you start the program two windows are displayed one for the application and one for the report manager The application window includes the title and menu bars toolbar control menu box minimize and maximize restore buttons and when necessary vertical and horizontal scroll bars The Report Manager window has only its own title bar and window controls You can move around within each window
35. X BPM Msec Delta Y mm For Help press F1 NUM Select the checkbox for each channel that you wish to enable Select the desired vertical scale and horizontal time base The zoom controls allow the vertical scaling to be set to x4 x2 x1 x 5 and x 25 The vertical scaling will only effect the channel that is active A green inverted T marker notes the active channel Horizontal time base can be set to 7 0 4 0 3 0 2 0 1 0 or 0 5 seconds The horizontal time base setting applies to all channels that are currently displayed The Marker can be moved by using the keyboard or by clicking with left mouse button The following keyboard controls are available and f will advance the marker up or down to other channels and gt 1 will move the marker left or right by 10 of screen size combined with f and will advance the marker left or right at a 5 msec interval Press enter to lock the first marker The first marker will turn red and a second a green marker will appear Move this marker to the desired location and press again to lock it into place iN Vision Premier Operating Instructions 10 1 Chapter 10 Calipers Figure 10 2 Set Calipers 10 2 To unlock or reset the calipers press the f key or un check the Set A check box Vision Premier 3 Channel ECG Report Review Edit View Edit Print Close ReportSettings W
36. allows you to manually delete data from analysis Data can be deleted in amounts as small as seven seconds or as large as the entire procedure The deleted data is not removed from the system it is marked and the system ignores the data when building a report The deleted data appears blue to indicate that it will not be used in analysis when the report is recompiled To delete data use the above procedure to select the data you wish to delete and press the key on the keyboard or right click the mouse and select Delete ECG Data Vision Premier Operating Instructions 8 3 Chapter 8 Viewing the ECG Figure 8 2 Delete ECG Data Inserting a Report Strip Data may be manually inserted into the Final Report see Report Strips on pg 5 11 1 Select the desired data see Selecting Data to Edit or Delete on pg 8 3 2 Right click the mouse and select Insert Strip from the context menu The Insert Edit Strip window is displayed Figure 8 3 Insert Edit Strip x Insert Strip 8 4 Vision Premier Operating Instructions Full Disclosure The Time field is automatically filled in with the time of the center of the strip The Strip Label field is automatically set to ECG but may be changed by selecting a different label from the pull down menu The Heart Rate field is automatically filled in with the rate from the time of the beat closest to the center of the strip The Strip Size field is set in s
37. ar summary page NOTE The number of isolated ventricular beats indicated in the Summary section of the cover page is different from that indicated in the Review Arrhythmias display This is because on the cover page every ventricular ectopic on the record is counted however in the Review Arrhythmias display the last ventricular ectopic of every bigeminal cycle is not displayed 5 4 Vision Premier Operating Instructions Cover Page Interpretation Figure 5 3 ul Vision Premier Yang Gretchen Interpretation Page This section provides a place for the reviewing physician to type in the interpretation Blank lines are omitted in order to save space on the printouts If you enter a name or select one from the drop down menu in the Transcribed By and Overreading Physician fields the record report status will be changed to Confirmed When the Cover Page is printed there is a place for the reviewing physician to sign and date the interpretation Vision Premier Operating Instructions 5 5 Chapter 5 Reviewing the Report Narrative Summary Figure 5 4 R Vision Premier Yang Gretchen Narrative Summary The patient s average heart rate was 103 BPM Heart rates greater than 120 BPM were noted 30 ofthe time Heart rates less than 50 BPM were noted 18 ofthe time 3929 pauses exceeding 2 0 seconds were noted The longest pause of 6 6 seconds occurred at 02 56 22 PM Tue 538
38. c representation of the ECG signal to aid in the placement of the electrodes Turn on the power to the microphone Click Start Press the Event button on the recorder to advance to the next channel The recorder will beep to indicate the ECG channel that is about to be frequency modulated through the speaker Channel 1 1 beep Channel 2 2 beeps Channel 3 3 beeps Verify that the amplitude of the signal for each channel is optimal The best recordings are produced if the amplitude of the ECG signal is a minimum of two boxes and a maximum of four boxes on this display Vv To increase the amplitude in Holter channel 1 move the red sensor down and left of the sternum vY To increase the amplitude in Holter channel 2 move the black sensor right toward the sternum Y To increase the amplitude in Holter channel 3 move the orange sensor right toward the sternum When you are satisfied with the ECG signal quality click Stop then click Next The Initialize PC Card screen is presented Vision Premier Operating Instructions Cancel Help 2 7 Chapter 2 PC Card Recording Preparation 2 8 Figure 2 9 Hookup Wizard Initialize PC Card Figure 2 10 PC Card Initialization Confirmation Hookup Wizard 12 13 14 15 NOTE Your Vision Premier system automatically recognizes the size of the PC Card being initialized and will grey out options not available to that specific ca
39. ct the appropriate Hookup Technician from the pull down menu or if the technician is not listed type the technician s name in the text entry field Select the appropriate Scan Technician from the pull down menu or if the technician is not listed type the technician s name in the text entry field Select the Data Recorder Serial Number from the pull down menu or if the recorder is not listed type the recorder number in the text entry field NOTE Ifthe recorder serial number was entered during recorder initialization then this information will appear automatically in the Optional Test Related Information window Vision Premier Operating Instructions 3 7 Chapter 3 Acquiring amp Analyzing Patient Data 32 Click Next when you are finished editing the information in this screen The record is copied to your computer and analysis is performed 33 The new record is listed in the Report Manager window The complete unedited report and full disclosure is now ready for you to review edit and print Diary Event Entry To add comments to the patient event list or to insert patient diary time and comments click Diary Events in the Enter Patient Information window The Diary Patient Event List window is displayed Diary Patient Event List ix Event List Figure 3 8 Acquisition Wizard Diary Patient Event List Procedure Start Time Procedure End Time 572700 1 00 00 PM pv4700 3 09 00 PM Dia
40. d 3 Select Initialize PC Card from the Menu bar NOTE Ifa PC Card is not inserted into PC Card drive a dialog will appear requesting you to insert a PC Card This dialog will also allow you to browse for the PC Card in case it is located in a different drive Put PC Card in Drive EG Drive P Cancel The Initialize Holter PC Card window is displayed Vision Premier Operating Instructions 2 1 Chapter 2 PC Card Recording Preparation Figure 2 2 PC Card Initialization Options Figure 2 3 PC Card Initialization Confirmation NOTE Ifthe research license is installed then the Select PC Card Acquisition Parameters window is displayed For more information refer to Research Mode on pg 2 4 Initialize Holter PC Card Recorder Data Channels Pacer Detection Sensitivity C 2 Channel 24 hour Disable Detection C Standard Sensitivity C High Sensitivity C 2 Channel 48 hour C Maximum Sensitivity C 3 Channel 48 hour Initialize PC Card Cancel hs NOTE Your Vision Premier system automatically recognizes the size of the PC Card being initialized and will grey out options not available to that specific card Select the appropriate number of recorder data channels and time duration to record by clicking the corresponding radio button If you have the optional Pacer software installed on your system select the appropriate detection sensitivity Refer to the
41. d acquisition If you prefer to enter patient information at a later time click Cancel Use the keyboard to enter information 1 Enter the Patient ID identification number NOTE Ifyou do not enter a patient ID Vision Premier automatically generates a patient ID that begins with STAT Patient ID as well as other patient information fields can also be edited when acquiring the patient record from the PC Card Click in the Last Name field and enter the patient s Last Name 3 Click in the First Name field and enter the patient s First Name Click in the Second Last name or Middle Name field and enter the patient s second last name or middle name 5 Click in the Data Recorder Serial Number field and enter the recorder serial number this is located on the back or inside of the recorder 6 The Hookup Date and Hookup Time are automatically filled in with the current date and time Change this information if necessaty Vision Premier Operating Instructions 2 3 Chapter 2 PC Card Recording Preparation 7 When you are finished entering information click OK Research Mode CAUTION Vision Series research mode is available for use with the 6632 and 92510 digital recorders only Attempts to use any other Burdick recorders in research mode will result in erroneous data NOTE Research mode requires 256 MB or 512 MB PC Card NOTE You always must select Initialize PC Card from the menu bar in order to utili
42. ding Preparation Hookup Wizard Tape Recorder The Hookup Wizard guides you through all of the steps necessary to ensure accurate recording results As the wizard guides you through the appropriate steps you may press Back at anytime to review the previous steps and any choices you have made If you have installed the optional media player and video files each screen will contain a Show Me icon amp Click on this icon anytime to view a short movie containing detailed instructions for performing the current step 1 Start the Vision Premier program The Report Manager window is displayed 2 Insert anew Holter Cassette Tape into the Tape Reader in the computer 3 Click on the Hookup Wizard icon s1 in the toolbar The Hookup Wizard is presented Figure 2 12 Hookup Wizard Hookup Wizard i Electrode Placement Electrode Placement C 2 Channel J Channel 1 White 19 2 Red 1 3 Brown 2 4 Black 2 5 Blue 3 6 Orange 3 Reference Green C Digital Recorder AEE cancel __Help Ensure Tape Recorder is selected 5 Click on the appropriate radio button for either a 2 channel or a 3 channel hookup Attach the electrodes on the patient as indicated on the screen When you are satisfied that the electrodes are properly placed on the patient click Next The Final Recorder Setup screen is presented 2 10 Vision Premier Operating Instructions Hookup
43. display record types 4 2 restore 4 5 sort 4 2 summarize 4 6 remote use 1 3 report manager 4 1 report strips 5 11 report summary 5 4 reports export 13 6 fax 13 3 print 13 1 send e mail 13 4 send HL7 13 4 text format 13 7 requirements 1 1 research mode 2 4 restore records 4 5 S search 1 2 send reports 13 4 setup 12 1 sharing records via network 4 1 software version iv sort records 4 2 ST limits 12 4 ST summary 5 9 start program 1 2 strip settings 12 5 summarize records 4 6 superimposed data 8 7 superimposition display 6 9 SVE beats 6 4 SVE limits 12 4 system requirements 1 1 system settings 12 7 system setup 12 1 T tabs window pages 1 10 tabular summary 5 7 tachogram 9 1 tachycardia rate limits 12 4 tape gain 3 3 text format reports 13 7 time search 1 2 toolbars 1 6 U uneditable beats 5 1 8 2 user strips 12 6 V ventricular forms 6 1 W warnings V window tabs 1 10 In 2 Vision Premier Operating Instructions Burdick Inc 500 Burdick Parkway Deerfield WI 53531 U S A 608 764 1919
44. displayed 3 Verify that the information displayed in the window is correct Click the Tachogram Review icon r in the toolbar The Pattern Strip window is displayed Figure 9 1 Vision Premier 3 Channel ECG Report Review Edit View Edit Print Close ReportSetings Window Help BEE 18 x Tachogram Review gt w ESA Pr H E an ES PUETE x For Help press F1 NOTE Some frequently used functions can be accessed quickly by right clicking within this window This will activate a context menu see Context Menus on pg 1 7 This screen is divided into three sections Vv The Histogram Distribution and Poincare Plot displays vY The Diagnostic Strip and Form displays Y The Contextual View display Vision Premier Operating Instructions 9 1 Chapter 9 Reviewing the Tachogram 9 2 The Histogram Distribution and Poincare Plot The top section contains a procedure graph which displays all of the raw RR values There is a box cursor within this graph which spans one hour of data Below the graph is a higher resolution graph showing an enlarged display of 64 minutes of raw RR values With 2 additional minutes on either side this box represents the 60 minutes of data covered by the cursor in the graph above it There is a cursor in this box which represents the center of the 7
45. e 255 Poor or no data on recorder 1368 Copy protection violation 1369 Copy protection violation Printing Problems Most printing problems will result in a message displayed on the screen Consult the operating instructions for your printer to troubleshoot these problems 14 2 Vision Premier Operating Instructions Index A acquire data 3 1 acquisition wizard 3 1 analyze records 4 2 annotations 12 2 arrhythmias 7 1 arrhythmias edit 7 3 artifact data delete 8 3 artifact forms 6 1 Atrial Fib insert 11 2 audio ECG verification 2 6 auto strips 12 5 backup activity log 4 4 backup records 4 3 beat classification edit 9 2 beat insert 11 1 beats classify 5 1 beats color 8 2 beats edit 6 7 bigeminals 5 4 bradycardia rate limits 12 4 C calipers 10 1 cautions V channel gain adjust 12 3 channel invert 12 3 check boxes 1 9 click 1 3 clinical limits settings 12 4 confirmation boxes 1 10 context menus 1 7 D delete artifact data 8 3 diagnostic strip 7 3 8 6 diagnostic strip display 6 10 dialog boxes 1 7 diary event entry 3 8 diary events edit 7 5 display settings 12 3 double click 1 4 E ECG verification 2 6 edit arrhythmias 7 3 edit fields 1 7 edit full disclosure 8 3 electronic manuals iv error codes 14 1 exit program 1 2 export reports 13 6 F facility identification 12 3 fax reports 13 3
46. e this screen to create up to 16 labels for ECG strips that may be incorporated into the Final Report 12 6 Vision Premier Operating Instructions Figure 12 6 System Settings System System System Settings Xx Display Print Clinical Limits Auto Strips User Strips Freq HRV Time HRV System Select Product Maximum Summary Reports 500 Vision Premier Maximum FD Reports 16 C Vision Select Language english 7 PC Card Info m HL 7 Communication r Enter Custom Information Institution x Medications 1 PRO Department x Indications e o 0 x Overreading Physician Gierinanl Reticss Scan Technician 164 90 57 160 x Referring Physician Port ID 61002 x Hookup Technician Reference file share x Data Recorder Serial Number Maximum Reports Use the Maximum Summary Reports and Maximum FD Reports fields to set a limit on the number of reports that can be saved in Vision Premier Once the limit is reached old reports must be deleted before a new report can be acquired When setting these values make sure that you have enough free space on your computer s hard drive to hold the indicated number of reports As a general rule one FD full disclosure report requires between 20 and 30 Mb of space depending on whether the recording was 2 channel or 3 channel One 48 hour FD report will use up to twice these amounts Summary Reports usually require between 200K a
47. eat you wish to label click on the Insert Beat icon HH in the tool bar or click the right mouse button and select Insert Beat from context menu Select the beat classification for the beat you designated Insert Atrial Fib Flutter Figure 11 2 Insert Afib Flutter This function is available from most ECG displays and allows you to label a designated period of Afib Flutter in a patient ECG To insert a Marker left click the mouse while holding the key down The single Marker notes the start of the designated Afib flutter episode The Marker can be moved by using the keyboard or by clicking on the new location The following keyboard controls can be used to move the Marker The f amp and keys will move the Marker left or right in 100 msec intervals Press and hold the key while using the f and keys to move the Marker left or right in 5 msec intervals To insert a second Marker left click the mouse while holding the key down This second Marker notes the end of the designated Afib flutter episode The second Marker can be moved in the same way as the first The display below shows the two Afib flutter I beam markers designating the episode I Vision Premier Afib Report Review Edit View Edit Print Close ReportSetings Window Help 8 xj gt om Pe of PE ca eel ES jae 2000 R J M 1000 m e a
48. ed hourly totals and beat totals NOTICE Computer assisted analysis is a valuable tool when used properly However no automated analysis is completely reliable and the results should be reviewed by a qualified physician before treatment or non treatment of any patient Vision Premier Operating Instructions iti Software Version This manual contains instructions for using Version 3 3 of the Vision Premier software To check the version of the software you have installed on your system perform the following steps 1 From the Windows desktop double click the program icon This will start the program 2 Under Help on the menu bar select About Vision Premier The software version is indicated in the window that appears Electronic Manuals Vision Premier software includes electronic manuals if this optional feature has been installed To access electronic manuals including the Vision Series Setup Guide Vision Premier Operating Instructions and Holter recorder Operating Instructions perform the following steps 1 From the Windows desktop double click the program icon This will start the program 2 Under Help on the menu bar select Setup Guide or one of the other manuals that are listed NOTE The Operating Instructions is listed as Main Manual iv Vision Premier Operating Instructions Warnings Cautions amp Notices Warnings WARNING Most waveform displays are not diagnostic qual
49. eports consists of a cover page VE tabular SVE tabular pacer tabular narrative graphic summary ST summary and strips Summary reports require very little space compared to full reports and therefore potentially can be saved longer than full reports for more information see Maximum Reports on pg 12 7 To convert a full disclosure report to a summary report 1 Highlight the desired record in the Report Manager window NOTE To select more than one report hold down the Control key Select Procedure from the menu bar 3 From the pull down menu select Summarize The following message box appears Figure G Summarize warning Warning Converting reportis to a summary format will delete all full disclosure ECG data Select es to perform backup and then summarize the repos Select No to proceed directly to summarizing the reportis No Cancel To backup the full report before proceeding select Yes The Backup Wizard window is displayed Enter the destination folder and select Finish To proceed without backing up select No NOTE Full disclosure data will be lost if the full report is not backed up prior to summarizing To exit without performing any action select Cancel Once a report has been converted a summary report the Type as shown in the Report Manager window changes to Summary 4 6 Vision Premier Operating Instructions Chapter 5 Reviewing the Report The Vi
50. erge process the numbering of the form which is based on number of beats in the form may change as occurred in the above example Editing Beats When viewing forms you may edit not only the form designation but you may also review and edit individual beats Vision Premier Operating Instructions 6 7 Chapter 6 Reviewing amp Editing Forms The Multi Beat Display 1 Click on the desired form and select Multi Beat from the View menu The multi beat view of the form is displayed Figure 6 7 ll Vision Premier 3 Channel ECG Report BEE Multi Beat Display Review Edit View Edit Print Close ReportSettings Window Help 18 xj gt wt Fe of if exe Eo me oo Se BE a a Form 6 beat 1 of 99 Epa P For Help press F1 elot ra Faia ESS ed a i Fei Reis Mii Sa Rea i Wa a a a ASG E i OBE Ri Ri TEREE 5 ii Aa Ke ER Ha EB EEEE Z Every beat that is incorporated into the form is displayed in a series of screens with up to 60 beats per screen NOTE Some frequently used functions can be accessed quickly by right clicking within this window This will activate a context menu see Context Menus on pg 1 7 Press and to move through each screen or click in the scroll bar located on the right side of the window 2 To vie
51. erties a Dialog Boxes Dialog boxes are used to enter information by typing in edit fields picking from pull down menus or selecting check boxes or radio buttons Dialog boxes also include buttons for indicating you are finished and want the program to accept the new settings or to escape without making any changes Dialog boxes may include any or all of the following objects Edit Fields List Boxes Check Boxes Radio Buttons Tabs Edit Fields An edit field is a box where you can enter text from the keyboard To view a window with edit fields click on the System Settings icon in the toolbar of the Report Manager window Vision Premier Operating Instructions 1 7 Chapter 1 Introduction to Vision Premier Figure 1 5 Edit Field Figure 1 6 List Box System Settings M x M M E M The Facility Identification field is an Edit field Move the mouse pointer into this field and click to activate the field Notice that the pointer turns into an I beam il in these fields Edit fields accept text from the keyboard when they are active This is indicated by a blinking cursor at the insertion point Start typing and the characters you type are placed into the box Space in edit fields is limited Each edit field accepts a specific type of information For example some accept only numbers within a preset range If you type invalid information a dialog box will inform you of the problem List Boxes
52. even second increments up to 56 seconds This field will be filled in automatically if you first select the data as described in Selecting Data to Edit or Delete on pg 8 3 You will usually want to include enough data prior to the arrhythmia to aid in evaluating the arrhythmia The Comment field allows you to enter a brief note to indicate the reason you have inserted this strip into the final report Fill in and edit the information in this window as needed then click OK Vision Premier Operating Instructions 8 5 Chapter 8 Viewing the ECG Displaying a Diagnostic Strip For a more detailed view of a beat right click on the selected data in the full disclosure view and select Diagnostic Strip from the context menu Figure 8 4 Diagnostic Strip AAAAAARAAAARARARAT ARNI This screen shows a larger display of the contextual viewing box The waveform in line with the highlighted label is the selected beat Along the bottom of the screen is a 30 second Full Disclosure strip with the contextual viewing box centered over the same data as that displayed in the 7 second Diagnostic Strip 8 6 Vision Premier Operating Instructions Superimposition Superimposition In this mode normal beats are displayed one on top of another superimposed The display advances automatically You may freeze the screen at any time by clicking Stop 1 Start from the Report Manager window 2 Double c
53. final report add strips 7 4 8 4 9 3 delete strips 7 4 flutter insert 11 2 form classification edit 9 2 forms 5 1 6 1 forms classify 5 1 forms edit 6 5 forms merge 6 6 full disclosure display 8 1 full disclosure edit 8 3 G graphic summary 5 8 grouping beats 5 1 H heart rate edit events 7 5 histogram distribution 7 2 9 2 HL7 communication 12 8 hookup wizard digital recorder 2 5 See also initialize tape recorder 2 10 hot keys 1 5 l initialize 2 1 See also hookup wizard insert Afib Flutter 11 2 insert beat 11 1 inspection 1 1 intended use iii interpretation 5 5 L list boxes 1 8 lists configurable 12 7 log backup activity 4 4 maximum reports 12 7 menu bars 1 5 miscellaneous settings 12 7 mouse 1 3 1 5 multi beat display 6 8 N narrative summary 5 6 network operation 4 1 normal forms 6 1 6 3 notices vi O other forms 6 1 P paced forms 6 1 Vision Premier Operating Instructions n 1 patient information entry 2 3 3 4 3 6 3 7 patient information entry enable 12 7 patient information review 5 3 pattern strip 7 1 pause duration limits 12 4 PC card initialize 2 1 2 5 2 10 PC card remove 1 2 pcAnywhere 1 3 Poincare plot 9 2 prime forms 6 4 print reports 13 1 print screen 13 2 print settings 12 2 printing problems 14 2 R radio buttons 1 9 records analyze 4 2 backup 4 3
54. hat this is the prime form The prime forms are also indicated by a small tic mark next to the form designation N The beats grouped in the prime form do not fit any other form At least five beats that share the same morphology are required to create a form If there are not enough beats to create a form the beats are placed in the prime form for that category Displayed Channels A form that does not display a waveform for channel 1 or channel 2 indicates that those beats within that group may have had a low amplitude signal in the other channel or artifact Typically the unused channel contains data with too much artifact or with a wandering baseline SVE Only The SVE Only checkbox appears on the Normal Forms display When this box is checked if there are any SVE beats within the currently highlighted form a representative SVE beat and the count of SVE beats within that form are displayed Using the SVE Only option provides a more detailed view of the SVE morphology It provides a useful tool to edit false positives i e artifact from the report SVE false positives are typically recorded as single channel forms Vision Premier Operating Instructions Editing Forms Figure 6 4 Normal Forms SVE Only Editing Forms While reviewing forms the first form is highlighted The highlight cursor can be moved with the arrow keys or by clicking once on the desired form The highlighted form is the
55. he program Burdick Holter System 3 The Vision Premier program is started and the Report Manager window is displayed Exiting the Program To exit click on Procedure then select Exit in the Vision Premier Report Manager window The Windows desktop is displayed Removing the PC Card If you are using an internal PC Card to acquire patient records you must deactivate the PC Card drive before removing the PC Card from the computer NOTE The following procedure applies for internal PC Card drives only Disregard the following if you are using an external PC Card drive 1 To deactivate the PC Card drive click on the PC Card symbol in the lower right corner of the desktop Click on the Stop PCMCIA Card option When the PC Card is deactivated Windows will display a confirmation message Click OK and remove the PC Card from the computer Search by Time You can search for specific times in the Holter report using the graphic summary view Time is indicated near the bottom of the window Locate the desired time and double click to view the beats For additional information see Graphic Summary on pg 5 8 and Displaying the Full Disclosure on pg 8 1 1 2 Vision Premier Operating Instructions Running Vision Premier Remotely Running Vision Premier Remotely Vision Series software supports the use of remote Windows operation using third party software such as Symantec pcAnywhere Fo
56. he name you select there will determine which customized System Settings are used to analyze and print that patient s report Pages to Print Select which report pages will print when Print Report is selected ECG Strips Selection All Strips or User Inserted Format Mini Strip or Diagnostic Mini Strip is a paper conserving small print format and Diagnostic is a larger diagnostic quality print format Sort By Time or Category When sorted by Time the strips are printed in chronological order When sorted by Category like strips are printed together Annotations Include beat annotations above each strip in the printout 12 2 Vision Premier Operating Instructions Print Settings Full Disclosure Select which channels to print and what resolution to use when printing the full disclosure 10 30 or 60 seconds per line ECG Channel Gain Adjust the amplitude for one or more channels only if the Adjust patient s signal is consistently weak or strong ECG Channel Invert Invert the signal from one or more channels Facility Identification Type the name and address information as desired for your facility This information will appear on the cover page of report printouts The first line that you type in this field will appear at the top of every printed page of the report Display Figure 12 2 Sys tem Settings Display Print Clinical Limits Auto Strips User Strips Freq HRV
57. in the toolbar The Normal Category forms window is displayed Figure 6 3 JE Vision Premier 3 Channel ECG Report Normal Forms NOTE There are several ways to advance through the various sets of forms 1 Click on the icon for the classification of forms you wish to view 2 Select View in the Menu bar From the pull down menu select the classification of forms you wish to view 3 Press F1 F or click on the Next Previous page icons to move forward or back through the pages Use the method that is most comfortable for you NOTE If there are more than 21 forms in the category more than one screen may be displayed for that category and you will need to press P to move to the next set of forms mm Vision Premier Operating Instructions 6 3 Chapter 6 Reviewing amp Editing Forms 6 4 The Form Display The forms are displayed in groups of up to 21 per screen Each screen gives the following information Y Category v Number of forms in the category v Each form s number and population Y Letter used to designate the form for example N for Normal Form Numbers Form numbers are assigned based on the number of beats in the form and does not depend on the beat category Form 1 always has the largest number of beats Prime Forms While reviewing forms you may notice that one form in a category does not display any waveform in the viewing window This indicates t
58. indow Help xj S E f Eea reg M cd re Hd Be i 8 Zoom Caliper View Galact Channel 10 22 40 AM Tue Hr 89 pest M Chi M Ch2 M Ch3 Ni N M Nj Zoom Controls Vertical Scale Horizontal Secs xl rc oo Walk Caliper By C Next Beat amp Interval Measurements Ch2 SetA M E DeltaX 68 BPM 885 Msec DeltaY 1 4 mm 0 137 mV For Help press F1 NUM The data for the active channel is indicated in the left side of display under measurements DELTA X measurements are the absolute difference between the two markers calculated in BPM and msec DELTA Y measurements are the difference between the markers calculated in mm and mV The sign is referenced to the first caliper locked Measurements are displayed after the first caliper is locked NOTE SetB values under Measurements are not functional at this time After both calipers are locked you may walk the calipers Press the f or key to move the calipers to either the Next Beat or the preset Interval With Next Beat the first marker s position relative to the closest beat is used as well as the distance to the second marker You may edit the beat classification by right clicking on the beat label above the desired beat and selecting the appropriate classification for the beat from the context menu The bottom part of the display shows a contextual view of the currently selected beat Vision Premier Operating Instructions Chapter 1
59. ipment Please inspect all components upon delivery for any damage which may have occurred in transit If you notice any damage please contact your shipping agent If items are missing contact your local representative or call Burdick Customer Service at 800 284 4362 or 608 764 2396 NOTE Your Vision Premier system is intended for use with approved supplies its reliability and performance are directly affected by the supplies you use All functions of the Vision Premier system are designed to be user friendly and easy to understand If questions arise or you would like additional information contact your local representative or Burdick Technical Support Department at 800 333 7770 or 608 764 1919 C TE Meets or exceeds Council Directive 93 42 EEC MDD Class Ila Complies with the EMC Radiocommunications requirements set out by the Australian Communication Authority under Radiocommunications Act 1992 System Requirements In order to run the Vision Premier program your computer system will need to meet minimum requirements For more information refer to Chapter 1 of the Vision Series Setup Guide Vision Premier Operating Instructions 1 1 Chapter 1 Introduction to Vision Premier Starting the Program NOTE Reference your PC peripheral manual for hardware installation Starting from the Icon on the Desktop 1 Turn on your computer 2 Double click on the Spacelabs Holter System icon to start t
60. ision Premier Report Manager QR Procedure Print System Settings View Jnitialize PCCard Window Help 16 x Open Ctr O F a 5 Fe H Delete CiD yint Archive Setting PB Petit 1 Report iD Hookup Time Type Status it Besiaials 012 34 5678 5829223 03 12 97 08 36 AM Wed Full Not Confirmed z Backup 123 45 6789 5 0 Summary Not Confirmed eee 23456 7890 R683945 05 18 97 11 00 AM Mon Summary Not Confirmed Summarize Send Export Exit Menu bars contain two basic types of commands Executing commands carry out tasks immediately when selected and Dialog box commands followed by an ellipsis bring up dialog boxes You can use either the mouse or the keyboard to activate and use menu commands Using the Mouse 1 Position the pointer over the menu bar item and click More choices become available 2 Click on one of these items to select it or click anywhere outside the menu bar to cancel Using the Keyboard 1 To activate a menu bar item hold down the key and press the appropriate hot key A hot key is a key on the keyboard which is temporarily specialized to perform a function To indicate which key will perform this function a letter is underlined For example fF is the hot key which activates the Procedure menu bar item 2 To select an item from the pull down menu that appears press the appropriate hot key fA is not needed once the pull do
61. ity Due to monitor video resolution waveforms displayed on the monitor are for viewing purposes only To view data that is diagnostic quality use the report strip view or print the record WARNING Remove all Holter sensors from the patient before defibrillation There is a risk of defibrillation failure burns and equipment damage if defibrillator paddles contact sensors or cables In the special case where the patient has a defibrillator at home family members and in home caregivers who could be responsible for attempting defibrillation must be advised of this hazard WARNING Explosion hazard Do NOT use in the presence of flammable anesthetics Cautions CAUTION Vision Series research mode is available for use with the 6632 and 92510 digital recorders only Attempts to use any other Burdick recorders in research mode will result in erroneous data CAUTION Edits made directly to Holter report e mail attachments cannot be saved To edit Holter reports received via e mail first save the attached report to a secure file location requires an rps file extension CAUTION Do NOT use acetone ether freon petroleum derivatives or other solvents to clean the recorder CAUTION Holter data acquired on cassette tapes is directly affected by the condition of the cassette tape the tape recorder and the tape playback unit To ensure that a reliable analysis is made regularly clean the recorder and playback unit and always use Burdick Ho
62. kup Time Hour 48 48HOUR 2002 09 30 00 00 00 fastl 2003 01 09 1 3 Channel ECG Report 123 45 6789 1997 07 08 10 14 00 Primary_Drive 2003 01 07 11 Pacer Report 234 56 7890 1997 05 19 11 00 00 Primary_Drive 2003 01 07 11 Pacer Report 234 56 7890 1997 05 19 11 00 00 Primary_Drive 2003 01 07 1 i View r Print List All Backup Activities Entire List Failed Backups Selected List C Successful Backups Print This window automatically sorts reports according to the time of backup the last report backed up is at the top of the list The list can also be sorted into ascending or descending order by column title such as Patient ID In the View Activity Log window two additional group boxes are shown the View group box and the Print List group box Selecting a radio button in the View group box will automatically display the corresponding backup reports for the view selected Selecting a radio button in the Print List group box will select the Entire List of reports or the Selected List of highlighted reports for printing Click on a report to highlight it To select more than one report press and hold the key while clicking on the reports NOTE The Selected List option becomes active after a report is highlighted After making your selections from the View and Print List group boxes click the Print button in the Print List group box to print your selection s from the View Activity Log window to your printer
63. lete or edit the available selections Select any Medications that the patient is taking from the pull down menu or if the medications are not listed type them in the text entry field Select any Indications that the patient exhibits from the pull down menu or if the indications are not listed type them in the text entry field Click Next The Optional Test Related Information screen is displayed Vision Premier Operating Instructions Figure 3 7 Acquisition Wizard Optional Test Related Information Acquisition Wizard x Optional Test Related Information Referring Physician pals Overreading Physician aE HookupTechnician zE ScanTechnician BA Data Recorder Serial Number 27 28 29 30 31 NOTE All of the fields in this screen are optional You may skip to step 32 if you do not wish to include any of this information on the patient s report NOTE All of the lists that appear in this window may be edited Click on the expand button lt lt and you are presented with a new window where you can add delete or edit the available selections Select the Referring Physician from the pull down menu or if the physician is not listed type the physician s name in the text entry field Select the Overreading Physician from the pull down menu or if the physician is not listed type the physician s name in the text entry field Sele
64. lick on the record you wish to review to open it 3 Click the Superimposition Review icon in the toolbar Superimposed data is displayed Figure 8 5 uk Vision Premier Yang Gretchen i spe I Review Edit View Edit Print Close Report Settings Window Help Superimposition SS ee J e gt af Fe of PGE col Be ES et g HE Next Close Setting Diay Afib Beat Forms Arhyth Tacho Super FullDise Pacer HEY Preview Print Superimposition A ak ee 30X 60X 120X 180X 240 For Help press F1 A superimposed ECG B 30 second full disclosure data C RR plot displays up to 400 consecutive RRs color coded to match standard beat classification see Full Disclosure on pg 8 1 Use this screen to view superimposed beats Vv Click Start to begin viewing the superimposition scans VY Click Stop to stop the scan Vv Click 30X 60X 120X 180X or 240X to select the speed of the scan 30X is approximately 30 times the actual speed of the recording Vision Premier Operating Instructions 8 7 Chapter 8 Viewing the ECG 8 8 Vision Premier Operating Instructions Chapter 9 Reviewing the Tachogram Tachogram Review allows you to view and correct all of the RRs for the entire Holter procedure To review the Tachogram 1 Start from the Report Manager window 2 Double click the record you wish to review or edit The Patient Information window is
65. like to view The Diagnostic Strip and Contextual View displays change to display the data for the corresponding time period To assign a different time as the Minimum Heart Rate event or the Maximum Heart Rate event 1 Click within the 24 or 48 hour graph to place the cursor at the appropriate time period 2 Select the Minimum Heart Rate or the Maximum Heart Rate radio button 3 Select the Used As Minimum Maximum HR check box Editing Diary Events Figure 7 3 Patient Events window The Vision Premier system will automatically insert an episode for every time that the patient pressed the EVENT button on the recorder You can add additional events based on what is written in the patient diary from the Pattern Strip window 1 While in Arrhythmia Review mode click on the Diary Patient Episodes icon HH The Pattern Strip window for the patient events is displayed a Vision Premier 3 Channel ECG Report E Review Edit View Edit Print Close ReportSettings Window Help eed bo ett I etal OS Se fee Slee ee Sac Episodes a1 x 18 x T m Diary Patient Episodes Pattern Strip 1 of 1 Review Edit Erone voan 10 Diary and Patient Events per Hour Patient Event Form 1 N 80348 N N l IN N N iN l iN Ba Strip Included In Report 4 For Help press F1 J I I NUM
66. line before being declared ST Depression The amplitude threshold in millimeters the ST segment must exceed below the baseline before being declared Auto Strips Figure 12 4 System Settings Auto Strip Settings System Settings Lx Display Print Clinical Limits Auto Strips User Strips Freq HRV Time HRV System Physician Standard Report Format d V Isolated 4 Pause 6 V Couplet a V Run 6 ST Depression 4 V Bigeminy 2 ST Elevation 4 SV Isolated jf SV Couplet 4 Minimum HR SV Run 6 Maximum HR M S Bradycardia B Baseline Vv S Tachycardia B Periodic Every fa zl hours Use this screen to tell the system how many strips of each category you want included in the Final Report Any combination of these strips may be selected for a maximum of 255 total strips Select a Physician from the list This is the name of the person who will be using the customized System Settings The Physician list is editable in the Acquisition Wizard see Acquiring amp Analyzing Patient Data on pg 3 1 When acquiring a new record you are given the option of selecting the name of the Overreading Physician The name you select there will determine which customized System Settings are used to analyze and print that patient s report Vision Premier Operating Instructions 12 5 Chapter 12 System Setup User Strips Figure 12 5 System Settings System Settings User Strips Us
67. lter cassette tapes NEVER reuse cassette tapes Vision Premier Operating Instructions W vi CAUTION Although Burdick Inc recorders are designed to meet IEC 601 1 2 EMC immunity requirements the presence of strong EMI fields generated by electronic surgical or diathermy instruments in close proximity to the unit may cause trace noise or input overload conditions CAUTION To avoid operator injury refer to you PC owners manual for proper ergometric use Notices NOTICE U S Federal law restricts this device to use by or on the order of a physician NOTICE Computer assisted analysis is a valuable tool when used properly However no automated analysis is completely reliable and results should be reviewed by a qualified physician before treatment or non treatment of any patient NOTICE Because the Holter system offers different lead configurations always ensure that the appropriate sensor placement is employed for the lead configuration selected NOTICE This device is intended to be used as a Holter Monitor Analysis System for the purpose of screening for ECG rhythm disturbances It should be used by or under the supervision of those knowledgeable in all aspects of ECG morphology rhythm and arrhythmia Vision Premier Operating Instructions Chapter 1 Introduction to Vision Premier Inspection Upon Delivery Your new Vision Premier Holter Analysis system was carefully inspected before sh
68. mation on summary reports see Summarizing Reports on pg 4 6 Summary reports are included as an attachment on e mails and can be viewed on systems installed with the Vision Series Holter Report Viewer for more information see the Vision Series Holter Report Viewer Installation Instructions and Operating Instructions To e mail a summary report NOTE Vision Premier automatically generates a summary report if one does not already exist for a record The summary report is then deleted once the e mail is sent 1 Double click the record to open it Select Report Settings from the menu bar to view the print settings for the report 3 Make changes as necessary Click OK NOTE In order for the e mail recipient to print each page in the summary report each active checkbox in Pages to Print must be selected 4 Close the report Vision Premier Operating Instructions Sending Reports 5 With the report highlighted in the Report Manager window select Procedure from the menu bar NOTE To select more than one report hold down the Control key 6 From the pull down menu select Send and then Mail Recipient The e mail form is displayed NOTE The information provided here includes details that are specific to Outlook Express This is for illustration purposes only various e mail applications can be used Figure 13 2 New Message Microsoft Outlook E Mail form in Outlook File Edit Inse
69. nd 500 K bytes or more of space depending on the total number of report strips and the size of each strip PC Card Info Use this checkbox to enable or disable patient information entry during PC Card initialization When the feature is enabled the user has the option to enter patient demographic as a part of initialization Any patient information entered during initialization is automatically saved to the record Disable this feature if you do not want the Enter Patient Information window to appear during initialization Enter Custom Information Use this area to add delete or modify the lists for medications indications overreading physician scan technician referring physician hookup technician and data recorder serial number 12 7 Vision Premier Operating Instructions Chapter 12 System Setup Click on the arrows lt next to the selection to view the list for the selection For example to view the list of medications click on the arrows next to Medications The Medications List window is displayed Figure 12 7 Medications List E The Medications List Insert Before Update Remove Close To add a new item to the list type in the desired information and select Add If you want the item to appear in a specific location in the list highlight the item that will appear just after the new item type the desired information for the new item and select Insert Before To delete an item from
70. nd strip display and select the appropriate classification for the beat from the context menu Editing the Form Classification Right click on the form label above the form displayed at the left center of the screen and select the appropriate classification for the form from the context menu Including the Strip in the Final Report 1 Select the Strip Included in Report check box located above the 7 second strip display The Insert Edit Strip window is displayed 2 Fill in the information as needed Figure 7 2 ae Insert Edit Strip esenfean Strip x Strip Label Heart Rate Misc Info 71 f Beats 5 Rate 76 Comment m Strip Size 7a Corco 3 Click OK to save your changes and insert the strip Deleting a Strip 1 When the strip you wish to delete is showing in the diagnostic strip section press the key or right click the mouse and select Delete ECG Data from the context menu All of the beats in that strip will turn blue to indicate that they will not be used when the report is recompiled NOTE The data is not actually deleted If you re analyze the report the data will be returned to it s original state 7 4 Vision Premier Operating Instructions Editing Min Max Heart Rate Editing Min Max Heart Rate The Minimum Heart Rate and the Maximum Heart Rate events are both automatically included in the Final Report Click within the 24or 48 hour graph at the time period you would
71. ntricular Tabular screen Vision Premier Operating Instructions 5 7 Chapter 5 Reviewing the Report 5 8 Graphic Summary Figure 5 6 Graphic Summary vl Vision Premier Yang Gretchen Laois I Review Edit View Edit Print Close Report Settings Window Help laj xj cd ie ej Ae Prev Next Close Setting Diay Afb Beat Forms Arrhyth Tacho Super FullDisc Pacer HAV 9 Preview Print Graphic Summary For Help press F1 This display shows trends in ST level heart rate and ventricular frequency for a 24 hour period Average ST level is graphed for each channel with 1 minute resolution Breaks in the graph indicate that ST measurements were interrupted because of ectopics wide QRSs or excessive noise artifacts Maximum average and minimum heart rates are graphed with 1 minute resolution Note that the time and rate of maximum and minimum heart rates are also on the report cover page and are included automatically in the selected ECG strips Frequency of ventricular beats is graphed with 1 minute resolution Tic marks denoting the times at which the patient pressed the event button on the recorder are printed below the ectopic ventricular trends The colors on the graphic summary ST level display allow for easy location of information ST elevations are in green depressions are in magenta The HR graph is divided into two colors green indicates the average
72. o marks is the currently highlighted beat As in the Multi Beat display you can edit the designation of an individual beat Right click on the beat and select the desired label from the list The beat is automatically moved to the prime form of the correct category and the label is changed NOTE Tagged beat selections are not preserved from page to page Vision Premier Operating Instructions 6 9 Chapter 6 Reviewing amp Editing Forms The Diagnostic Strip Display Double click on a specific beat to view the beat in more detail The Diagnostic Strip is displayed Figure 6 9 Vision Premier 3 Channel ECG Report 5 Z Review Edit View Edit Print Close ReportSettings Window Help l8 xj Diagnostic Strip Display as on See SS e a a eel SR SS S 7 Be ae 28 8a Se 10 25 40 AM Tue Hr 86 Go To Next Page This screen shows a 7 second diagnostic strip There are six tic marks in this box three at the top and three at the bottom The waveform in line with the two center marks is the currently selected beat Along the bottom of the screen is a 30 second Full Disclosure strip with the contextual viewing box centered over the same data as that displayed in the 7 second Diagnostic Strip To edit the beats in this screen right click on the beat label and select the desired label
73. ode is centered in this box Editing Arrhythmias Selecting Arrhythmias to Edit The Vision Premier includes a certain number of representative arrhythmia strips in the Final Report The number of strips included is determined by the System Settings See System Setup on pg 12 1 The Vision Premier selects what it considers to be the worst case examples of each type of arrhythmia You may however wish to edit or include additional strips that you feel are representative or delete those that you believe are not significant 1 Click on the column of the subcategory you wish to review in order to view the Diagnostic Strip and Contextual View displays 2 To view the next Pattern Strip for the current arrhythmia subcategory press 64 Press to go to the previous Pattern Strip at any time 3 To view another arrhythmia category click the icon in the toolbar that corresponds to the category you wish to review such as SVE Episodes Editing an Episode NOTE Beats labeled as SVE may be reclassified as Normal if beats within the SVE run are manually edited It takes two beats in a row to trigger the labelling of an SVE run Relabelling one of these beats results in a different call by the Vision Premier software Vision Premier Operating Instructions 7 3 Chapter 7 Reviewing amp Editing Arrhythmias Editing the Beat Classification Right click on the beat label above the desired beat in the 7 seco
74. on Premier system allows you to backup or store your patient records to any digital storage device that is accessible to your computer You can then restore those reports to your hard drive if you need to review or print them Click on the Archive icon ce in the toolbar Select Backup or Restore from the options presented NOTE The Full Disclosure Final Report and summary reports may be archived Backup Reports This option allows you to backup a report to a local network optical CDR or CDRW drive 1 Select the Backup option and the Backup Wizard window is displayed IT x Where Destination Folder Browse JA a m When M Imme f F Automa n report confirmation plete F Automa n the maximum number of reports ts reached View Activity Log Cancel Vision Premier Operating Instructions 4 3 Chapter 4 Managing Reports Figure 4 4 View Activity Log 4 4 2 Under Where enter the destination folder where you want the backup file to go If you want to change the destination folder click the Browse button to locate and select the new drive or folder you wish to use Click the Finish button to start the backup process If an error occurs during the backup process a message is displayed in the Report Manager Status column You may also select the View Activity Log button on the Backup Wizard window to display the View Activity Log window x Volume Label Bac
75. ort Strip click on the strip in the Report Strip view to highlight it and press the key Wr 5 12 Vision Premier Operating Instructions Chapter 6 Reviewing amp Editing Forms The Vision Premier system uses a sophisticated algorithm to detect measure and classify QRS complexes as types of forms A form is a group of beats that have similar characteristics Forms are broken down into five different categories Normal Ventricular Other Paced and Artifact trt Normal forms N contain normal beats and SVE beats ux Ventricular forms V contain ventricular fusion escape and idioventricular beats x The Other forms contain questionable normal beats that the system could not identify with 100 confidence They are placed here for review and editing by you t Paced forms P contain beats that were generated by a pacemaker detected only when the pacer analysis software option is installed or when manually labelled by you vce Artifact forms X contain all detected events that were determined to be noise or artifact T waves P waves and noise are examples of Artifact forms and beats The Vision Premier system offers many powerful editing capabilities that allow you to change the system s original classification These editing capabilities allow you to override the form or beat classification assigned by the system When form editing has been completed the Vision Premier system automaticall
76. ove the form displayed at the left center of the screen and select the appropriate classification for the form from the context menu Vision Premier Operating Instructions Including the Strip in the Final Report Including the Strip in the Final Report 1 Press the Insert key on the keyboard The Insert Edit Strip window is displayed 2 Fillin the information as needed Figure 9 2 Insert Edit Strip Insert Edit Strip 3 Click OK to save your changes and insert the strip The Contextual View Display The bottom section is a 30 second full disclosure strip for contextual viewing The onset of the current episode is centered in this box Vision Premier Operating Instructions 9 3 Chapter 9 Reviewing the Tachogram 9 4 Vision Premier Operating Instructions Chapter 10 Calipers This function is available from any ECG display to allow the user to make precise measurements on screen Select Calipers from the View menu The Calipers window is displayed Figure 10 1 Vision Premier 3 Channel ECG Report Calipers Display Z Beview Edit View Edit Print Close ReportSettings Window Help le x gt mt ce of Oe Yt ee ee Zoom Caliper View h 10 22 40 AM Tue Hr 89 Select Channel M Chi M Ch2 F Ch3 Zoom Controls Vertical Scale Horizontal Secs Walk Caliper By C Next Beat amp Interval Measurements Ch2 SetA g x E Delta
77. p 10 If you have not yet inserted the cassette or PC Card you will be prompted to do so at this point 3 2 Vision Premier Operating Instructions Figure 3 3 Acquisition Wizard Select Data Channel Figure 3 4 Acquisition Wizard Manual Tape Gain Review Acquisition Wizard x l Select Data Channel Select Data Channel 1 Place tape cassette in playback unit 2 Select number of recorder data channels 3 Press Next button to start transfer or Cancel button to abort transfer Recorder Data Channels C 2 Channel I Enable Manual Tape Gain lt Back 6 Select the number of data channels you wish to acquire either 2 or 3 channel At this point you have the option of letting the system determine the optimum tape gain settings or setting them yourself If you wish to allow the system to determine the tape gain settings ensure that the Enable Manual Tape Gain check box is unchecked and click Next The Tape Calibration Data Transfer screen is displayed and the system automatically transfers the calibration data from the tape Proceed to step 10 7 If you wish to set the tape gain manually click in the Enable Manual Tape Gain check box and click Next The Tape Calibration Data Transfer screen is displayed and the system automatically transfers the calibration data from the tape The Manual Tape Gain Review window is displayed T Manual Tape Gain
78. r Page Cover Page Figure 5 1 Patient Information Start from the Report Manager window Double click the record you wish to review or edit The Patient Information window is displayed This is the first page of the Final Report Cover Page Patient Information vl Vision Premier Yang Gretchen Female 55 inches Digoxin pe reas g foo Dizzy piss Coucesicn E This window includes the patient demographics medications and clinical indications Enter the appropriate information using the keyboard NOTE The entries for hookup time recording duration and channels analyzed are entered during acquisition You should verify that this information is correct Vision Premier Operating Instructions 5 3 Chapter 5 Reviewing the Report Holter Report Summary Figure 5 2 vk Vision Premier Yang Gretchen ol Holter Report Summary S i MEIN Jat ee GEE E ea l ETE Pouca A ES o ii 2 eeng e gt EESAN a ee Pe E o ee Prev Next Close Setting Diay Afb Beat Forms Arhyth Tacho Super FullDisc Pacer HRY Preview Print Holter Report Summary Total QRS Complexes E Heart Rate VETE EEES 5 2 min l 29 bpm at 09 13 39 PM Tue max 250 237 Supraventricular Ectopics 3198 1 250 bpm ot 05 37 17 PM Tue 10116 ak a PaBselaeciss Rate gt 120 bpm for 14 10 26 Rate lt 50 bpm for 08 45 11 Pauses 3929 gt 2 0 secs Longest 6 6 seconds a
79. r information on installing and configuring pcAnywhere refer to the Vision Series Setup Guide Using the Mouse Although many operations on the Vision Premier system may be carried out using the keyboard the mouse is usually more convenient Before using Vision Premier you may want to familiarize yourself with how the mouse works Moving When moving the mouse you might simply think of it as a holder for the small ball which can be seen on the underside of the mouse The best arrangement for the mouse is ball side down on a flat mouse pad with the cord pointing away from you In this position the ball rolls along the pad whenever you move the mouse When Vision Premier is on the screen always displays a pointer which moves as the mouse ball rolls If you move the mouse off the mouse pad simply pick up the mouse and place it back on the pad Lifting the mouse stops the ball from rolling and keeps it from moving the pointer This pointer is usually a small arrowhead ff which is positioned over objects when selecting them Sometimes it is an I beam which is used to position the cursor for typing in edit fields Clicking Locate the mouse under the palm of your hand with the cord pointing away from you The Left and Right Mouse Buttons Notice that the mouse has either two or three buttons When the mouse is positioned with the cord pointing away from you the button to the left is the most commonly used button
80. rd Select the appropriate number of recorder data channels and time duration to record by clicking the corresponding radio button If you have the optional Pacer software installed on your system select the appropriate detection sensitivity Click Next The Enter Patient Information window is presented NOTE The Enter Patient Information window will not appear if this feature has been disabled If the window does not appear proceed directly to step 15 Enter the patient s information into the window When you are finished click OK For more information see The Enter Patient Information Window on pg 2 3 When initialization is complete a confirmation dialog box is displayed Vision Premier G Vision Premier Operating Instructions Hookup Wizard Digital Recorder NOTE Ifyou are using an internal PC Card to acquire patient records you must deactivate the PC Card drive before removing the PC Card from the computer See Removing the PC Card on pg 1 2 for more information 16 Remove the PC Card and click OK to continue The Final Recorder Setup screen is displayed Figure 2 11 Hookup Wizard Hookup Wizard Final Recorder Setup 17 Follow the on screen instructions for final recorder setup and click Finish NOTE The recorder is not ready until the green LED is steady on i e on but not flashing Vision Premier Operating Instructions 2 9 Chapter 2 PC Card Recor
81. rt Format Tools Help Express arial zj o 7 B 7 0 3 EE R5629245 RPS 8 Enter e mail addresses as desired 9 Press the send key x to e mail the report CAUTION Edits made directly to Holter report e mail attachments cannot be saved To edit Holter reports received via e mail first save the attached report to a secure file location requires an rps file extension Outlook Express is a registered trademark of Microsoft corporation Vision Premier Operating Instructions 13 5 Chapter 13 Printing and Sending Files Exporting Reports Holter report data can be converted into text format for additional analysis and reporting Conversion occurs through the process of exporting data Exported data can be imported into spreadsheets To convert Holter report data to text 1 Highlight the desired record in the Report Manager window NOTE To select more than one message hold down the Control key Select Procedure from the menu bar From the pull down menu select Export The Export Wizard window will appear to guide you through the steps necessary to setup the export function Figure 13 3 i Export Wizard The Export Wizard amen 2 CABURDICKVALTAIRWNDATA 5 Select which information you would like to export under What To change the destination folder select an item from under Setup Click the Browse button to locate and select the new drive or folder you wish to
82. ry Time 57 2700 gt 1050m Diary Comment Using the patient s diary enter information as necessary If you want the diary entries included as a report strip in the final report ensure this option is checked To enter a diary event enter the date and time under Diary Time Use the keyboard to enter information under Diary Comment Click Add to add the entry to the Event List Repeat these steps as necessary to enter all of the diary events To update an entry select the entry in the Event List Make changes as necessary in the Diary Time and Diary Comment boxes Click Update To remove an entry select the entry in the Event List and click Remove When you are finished editing press Close You are returned to the Acquisition Wizard Patient Information window 3 8 Vision Premier Operating Instructions Chapter 4 Managing Reports When you first start the Vision Premier program the first thing that is displayed is the Report Manager window Figure 4 1 4 Vision Premier Report Manager BEE Report Manager Procedure PETAI Ei System Seringe View Initialize PC Card Window Help le x oO mw Ww Status Afib Report 012 34 5678 R5829223 03 12 97 08 36 AM Wed Full Not Confirmed 3 Channel ECG Report 123 45 6789 R5829245 07 08 97 10 14 AM Tue Full Not Confirmed Pacer Report 234 56 7890 R6839457 05 19 97 11 00 AM Mon Full Not Confirmed For Help press F1 NUM Thi
83. s 7 2 NOTE Some frequently used functions can be accessed quickly by right clicking within this window This will activate a context menu see Context Menus on pg 1 7 Most of the arrhythmia windows are very similar These windows are all divided into three sections Vv The Histogram Distribution display Y The Diagnostic Strip and Form displays vY The Contextual View display The Histogram Distribution Display With the exception of the Min Max Heart Rate window the top right portion displays the histogram distribution for the category with the following features Each column represents a subcategory for the arrhythmia The first column represents the number of single beats containing the arrhythmia The second column represents the number of instances with 2 consecutive beats containing the arrhythmia This pattern continues to the far right column which represents the number of instances with 10 consecutive beats containing the arrhythmia The height of each column represents the number of episodes that are included for each subcategory This number also appears at the top of each column The columns are proportional in height The maximum height for specific episodes is as follows Isolated Ventricular and Supraventricular 500 Ventricular and Supraventricular Couplets 400 Ventricular and Supraventricular Runs 400 Ventricular Bigeminy 200 Pauses 400 Tachycardia and Bradycardia 200 The
84. s that are labeled x X t or p are the same color as the previous beat 4 To view the data at different times use the scroll bar to the right of the screen NOTE The first five minutes of the ECG data is blue This indicates that this data was not used to generate the report The Vision Premier system locks out the first five minutes of ECG data which is used for calibration These beats are labeled U Uneditable in other graphic displays 8 2 Vision Premier Operating Instructions Full Disclosure Selecting Data to Edit or Delete To select Full Disclosure data you can position the cursor box over the data you wish to edit or delete or you can use two I beam shaped cursors to mark off specific regions To position the Cursor box move your mouse cursor over the data you want to select and left click your mouse To use the I beam cursors 1 Hold down the key 2 Click at the beginning of the section you wish to select 3 Continue to hold the key and click again at the end of the Wi data you wish to select You can view and edit the selected data more closely by right clicking within the area you have selected and choosing Diagnostic Strip from the context menu Most noise is removed automatically by the system during analysis however you may encounter recordings that contain excessive amounts of artifact that you don t want considered when analyzing a report To handle these occurrences the system
85. s window is your starting point for accessing and organizing all of your patient records Sharing Records over the Network NOTE Network sharing features are available only on Vision Premier NOTE In order to share records over the network with other users you must install multiple licenses of Vision Premier Additionally you must configure the system for network use for more information see the Vision Series Setup Guide If another user on the network opens a record then Vision Premier locks the record to everyone but the user until the user closes the record The record is unavailable to other users and shows a status of Opened Review Edit in the Report Manager window Vision Premier Operating Instructions 4 1 Chapter 4 Managing Reports Sorting Patient Reports At the top of the Report Manager window below the toolbar is a special kind of menu This menu displays titles for the columns of information which are displayed for each report such as Patient ID Click on a title in this menu to sort all the displayed records according to the information in that column into descending or ascending order Analyzing Patient Records Figure 4 2 Select Channels to Analyze To eliminate any editing that may have been done on a patient s report and generate a new report based on the original data you may re analyze the report To re analyze a patient s record highlight the record and click on Procedure in the menu bar
86. second strip displayed in the Diagnostic Strip The 1 hour Poincare plot to the left of this section displays the plot of the last RR value to the next RR This data is the same data that is covered by the cursor in the graph You can click anywhere within the two graphs to move the cursors Clicking within the Poincare plot has no effect on cursor movement For more precise cursor movement make sure this section has focus appears highlighted and use the f or key to move the 1 hour cursor box 1 minutes to the left or right respectively For even more precise movement hold down the key while using the arrow keys to move the cursor 2 seconds to the left or right The Diagnostic Strip and Form Display The Diagnostic Strip and Form display is below the Histogram and Poincare Plot To the right of this section is a 7 second strip The onset of the current episode is centered in this box To the left of this section the Form is displayed for the currently highlighted beat see Reviewing amp Editing Forms on pg 6 1 You can edit tachogram data in two ways Vv Beat classification VY Form classification Editing is done exactly as it is done while reviewing Forms Editing the Beat Classification Right click on the beat label above the desired beat in the 7 second strip display and select the appropriate classification for the beat from the context menu Editing the Form Classification Right click on the form label ab
87. sion Premier system provides a comprehensive and detailed report of a patient s ambulatory cardiac procedure NOTICE Computer assisted interpretation is a valuable tool when used properly However no automated interpretation is completely reliable and interpretations should be reviewed by a qualified physician before treatment or non treatment of any patient Beat Classification During analysis the Vision Premier Holter analysis system uses a technique known as feature extraction to group based on their features the individual ORS complexes into forms These formal and heuristic features include QRS morphology QRS width QRS absolute area QRS offset QRS peak to peak amplitude and prematurity After the individual QRS complexes have been consolidated into forms the forms are classified into one of the following categories Normal N Ventricular V Paced P Other or Artifact A Paced beats are identified only if you are using the optional pacer software Identification of ventricular and supraventricular arrhythmias takes place These are then classified as runs couplets isolated or SV episodes Rate dependent arrhythmias tachycardia and bradycardia are calculated on the basis of the RR intervals measured in an eight beat sliding window Pauses are identified when an RR interval exceeds preset criteria ST changes both negative depression and positive elevation that satisfy the criteria for amplitude
88. sode is the time between the two Markers You can edit the start and stop times to modify the duration To Add an Atrial Fib Flutter episode to the list click the Add button overlapping episodes will be merged To Update an existing Atrial Fib Flutter episode click the Update button overlapping episodes will be merged To Remove an existing Atrial Fib Flutter episode click the Remove button When all the desired modifications to the list have been made click the Close button to save your modifications or click the Cancel button to abort your modifications Vision Premier Operating Instructions 11 3 Chapter 11 Report Editing Enhancements 11 4 Vision Premier Operating Instructions Chapter 12 System Setup Before using your Vision Premier system you may wish to spend a few minutes to configure the system to suit your individual needs Use the Windows Control Panel to set the formats for time and date All other setup is performed from within the Vision Premier application as described in this chapter The Vision Premier System Settings option allows you to set various parameters of the system setup and report configurations To access the System Settings 1 Start from the Report Manager window 2 Click on the System Settings icon 7 in the toolbar The System Settings window is displayed There are 8 pages in this window Display Print Clinical Limits Auto S
89. t 02 56 22 PM Tue m Ventricular Events Supraventricular Events Isolateds Isolateds In Bigeminal Cycles 12 Couplets Couplets o 20 Runs 149 Runs Longest 138 beats 88 bpm at 05 10 41 PM Tue Longest 500 beats 250 bpm at 05 37 16 PM Tue Fastest 21 beats 107 bpm at 04 15 47 PM Tue Fastest l 500 beats 250 bpm at 05 37 16 PM Tue Slowest 60 beats 60 bpm at 02 03 01 AM Wed Slowest 25 beats 85 bpm at 06 43 48 PM Tue For Help press F1 This section draws the physician s attention to highest and lowest heart rate total number of QRS ventricular and supraventricular beats severity of pauses and the time of occurrence duration and rate of the longest fastest and slowest runs both ventricular and supraventricular Any area that can be highlighted with the cursor can be edited Before editing however you should be aware of the following This is the only place that Bigeminals are reported Heart Rate minimum and maximum values must be between 0 and 250 The only change that you can make to the rest of the values displayed in this window is to change a value to zero You can do this if you disagree with the calculated value and wish to have nothing printed on the Final Report To edit these values to something besides zero you should edit forms and arrhythmias so that the Vision Premier system recalculates the results NOTE Paced beats can be edited on the pace tabul
90. the number of channels displayed and the number of seconds displayed per line The display format for this window may be edited in the System Settings window see Display on pg 12 3 To change the display format for the current report only click the Report Settings icon amp in the toolbar Displaying the Full Disclosure 1 Start from the Report Manager window 2 Double click on the record you wish to review to open it 3 Click the Full Disclosure Review icon 22 in the toolbar Full Disclosure data is displayed Vision Premier Operating Instructions 8 1 Chapter 8 Viewing the ECG Figure 8 1 i Vision Premier 3 Channel ECG Report Full Disclosure Review Edit View Edit Print Close ReportSettings Window Help 8 x O F 4 08 5 pect B lao Screen Start Time 10 19 00 AMTue Strip Box Time 10 20 28 AM HR 73 Ch12 E PER E eed ee a ete ed ly S Go To Next Page NUM NOTE Some frequently used functions can be accessed quickly by right clicking within this window This will activate a context menu see Context Menus on pg 1 7 This window shows all hours of the recording Abnormal beats are shown in a different color so you can quickly pick out the abnormal beats VY Normal beats are black Ventricular beats are red SVEs are green Paced beats are magenta CNN 8 Artifact beats that are labelled asterisk or period are blue Artifact beat
91. the list highlight the item and select Remove To change an existing item highlight the item type in the changes and select Update NOTE All changes are saved automatically To exit the window select Close HL7 Communication HL7 parameters must be configured in order for Vision Premier to communicate with the PYRAMIS ECG Management System see Sending HL7 Reports on pg 13 4 Y Enter the IP address of the PYRAMIS machine which will be receiving the exported data Y Enter the network location Reference file share for holding summary reports that have been sent as part of HL7 communication All other values are automatically entered with default values NOTE The Institution and Department numbers are derived from similar values on PYRAMIS The Port ID number is the number for communication between Vision and PYRAMIS 12 8 Vision Premier Operating Instructions Chapter 1 3 Printing and Sending Files Printing the Report From the Report Manager window there are 5 options for printing patient data y Print Report Y Print Forms VY Print Full Disclosure Vv Print User Inserted Strip Y Print Specific Pages To print patient data 1 Highlight the desired record in the Report Manager window 2 Click on Print in the Menu bar 3 From the pull down menu select the desired print option Figure 13 1 Vision Premier Report Manager Print Options A Procedure Acquire Print System Se
92. then select Analyze from the pull down menu The Select Channels to Analyze window is displayed Select Channels to Analyze 3 Channel ECG Report Ea Analysis Channels M CHI M CH2 M CH3 T Analysis Channels Cancel M CHI M CH2 M CH3 Select each of the channels you wish to re analyze and click OK Changing Reports to be Displayed You may determine which types of reports are displayed in the Report Manager window The options are Yy All Reports y Full Disclosure Reports only Y Summary Reports only Y Nonconfirmed Reports only Y Confirmed Reports only These options make it easier for you to select the reports you wish to work with during a particular session Click on View in the menu bar and select the type of reports you wish to see displayed The Refresh option updates the screen 4 2 Vision Premier Operating Instructions Tracking Open Windows Tracking Open Windows Another item in the Report Manager menu bar is the Window option Select from the pull down menu under Window to manage how you want to view open windows The Cascade option allows windows to appear over one another while the Tile option makes every window fit so that no window is obscured by any other Each open window is listed at the bottom of the pull down menu The window which is currently active is indicated by a check mark Backup and Restore of Reports Figure 4 3 Backup Wizard The Visi
93. tions are active when they have a check mark next to the name If you make any changes to these options your selections will become active after the program has been restarted a Vision Premier 3 Channel ECG Report E x O Review Edit View Edit Print Close ReportSettings Window Help la x gee 88 25 T SVE only Normal Forms 11 Forms E TAE Form 1 N 80348 Form 2 N 8973 Form 3 N 5915 Form 5 N 143 Form 6 399 Form13 N 32 Fc v Forms s v Arrhythmia v HRV V Pace v Status Bar Vision Premier Operating Instructions Getting Around Figure 1 4 Context Menu Context Menus A context menu is a list of functions available to you in context to whatever you are pointing the mouse at when you activate the menu You can activate a context menu by right clicking within a window Not all windows have context menus J Vision Premier 3 Channel ECG Report Review Edit View Edit Print Close ReportSettings Window Help laj xj Op f 1 A A ee Patient Information First Name Last Name over Le Satenisoeaiea 3 Channel ECG Report naras Report Summary Tabular Intrepretation Graphic Summary Gender Height ST Summary y Report Strips Unknown bd Inches fa z J Multiple Report Strips B Individual Report Strips Age Weight g Years a Pounds zl Referred By Race x Unknown zl Prop
94. tions under Pages to Print will be grayed out Taking Pictures of the Display With the Vision Premier system you can obtain pictures of the image shown on the display This option has many uses For example if you are experiencing difficulties with your system having a picture of the display is useful when consulting with Technical Support personnel There are several options available with the Print Screen feature Obtain a picture of the entire screen display Obtain a picture of the active window only Obtain a printout from the printer Obtain a picture that can be pasted into a document such as a WordPad document or a graphic program document Follow the instructions below to take pictures of the display for printing or pasting into a document Vision Premier Operating Instructions Faxing Reports To take a picture of the display Y Press the lt Print Scrn gt key to take a picture of the entire screen or VY Click within the window that you want to capture The window becomes active Y Hold down the key and simultaneously press the WS lt Print Scrn gt key Windows 95 98 The Print window is displayed v To print the picture select the desired printer V Click OK or Vv To paste the picture into a document click Cancel v Open the document v Paste the picture into the document Windows 2000 Professional XP Professional Y Open Wordpad Vv Paste the picture into the document
95. trips User Strips Freq HRV Time HRV System TSN N NL SN To switch to a different page click on the appropriate tab The Print page is displayed when this window is first opened NOTE The two tabs Frequency HRV and Time HRV are described in your HRV option operating instructions if you have purchased the HRV option Vision Premier Operating Instructions 12 1 Chapter 12 System Setup Print Figure 12 1 SE x System Settings Display Print Clinical Limits Auto Strips Freq HRV Time HRV System Print Settings Pages to Print V Cover Page IM Normal Abnormal Histogram Clear All T Narrative I Forms Summary M Tabular I Time HRV Report SelectAll M ST Summary I Freq HRV Report I Pacer Summary ECG Strips Graphic I Full Disclosure ECG Strips Full Disclosure Selection All Strips b C CHI F CH2 F CH3 Format Mini Strip Se 60 secs line X Sort By Time X M Annotations ECG Channel Gain Adjust CHI x25 CxS amp xl Cx2 x4 CH2 x25 CO x5 xl C x2 x4 Facility Identification CH3 C x25 x5 xl Cx Cx ECG Channel Invert M CH1 M CH2 F CH3 Print Settings Physician This is the name of the person who will be using the customized settings This list is editable in the Acquire Wizard see Acquiring amp Analyzing Patient Data on pg 3 1 When acquiring a new record you are given the option of selecting the name of the Overreading Physician T
96. ts Configuration Standard 11 12 13 NOTE Although it is possible to enter a total of 50 characters in each name field Vision Premier will display only the first 52 characters of the combined name fields in the Report Manager window The name and patient ID may also be truncated to fit on the printouts Enter the Patient ID identification number 32 characters maximum Click in the Last Name field and enter the patient s Last Name 64 characters maximum Click in the First Name field and enter the patient s First Name 64 characters maximum 3 4 Vision Premier Operating Instructions 14 15 16 17 18 19 NOTE These are the only fields which are required in order to acquire the record from the PC Card or tape You may skip to step 19 if desired Click in the Second Last name or Middle Name field and enter the patient s second last name or middle name 64 characters maximum To apply preset clinical limits to the patient data select one of the five options from the Clinical Limits Configuration pull down menu See Clinical Limits on pg 12 4 for information on the Clinical Limits settings The Hookup Date is automatically filled in with Y the date entered during initialization or Y the business day prior to the current date Use the patient diary to verify this information Change the date if necessary The Hookup Time is automatically filled in with
97. ts of an individual report without actually opening or restoring the report Select the Report option to print the entire Final Report at the time the report was active in the system Select the Full Disclosure option to print the entire procedure or portions of patient data as defined in the System Settings window see Print on pg 12 2 Select the Specific Pages option to print only the Final Report pages that you select A window similar to the System Settings window see Print on pg 12 2 is displayed allowing you to make selections that affect only the current printout The Print List group box allows you to print the Entire List of restorable reports or the Selected List of tagged reports as shown in the Restore window Printing this list would be recommended in order to have a printed copy of a patient reports backed up on this logical drive Vision Premier Operating Instructions 4 5 Chapter 4 Managing Reports 4 Click the Restore button to start the restore process or click the Cancel button if you do not want to restore a report at this time Summarizing Reports Once a Holter report has been reviewed by a doctor and further actions have been taken if necessary full disclosure data may not need to be saved on Vision Premier any longer Full disclosure reports can be converted to summary reports using the Summarize procedure When a report is summarized full disclosure data is discarded The summary r
98. ttings View Initialize PCCard Window Help l xj O a Pin Screen Print Forms Afib Report Print Full Disclosure 9 Not Confirmed f3 Channel ECG Repo Print User Inserted Strip 329245 07 0 M Tue u Not Confirmed Pacer Report Print Specific Pages b Not Confirmed Print Selected Report NUM Print Report Select this option to print the entire Final Report as defined in the System Settings window see Print on pg 12 2 Vision Premier Operating Instructions 13 1 Chapter 13 Printing and Sending Files 13 2 Print Forms Select this option to print all the forms as they are displayed for form review see Reviewing Forms on pg 6 2 Print Full Disclosure Select this option to print the entire 24 hours of patient data The format for this printout is determined in the System Settings window see Print on pg 12 2 Print User Inserted Strip Select this option to print all the strips that have been inserted manually The format for this printout is determined in the System Settings window see Print on pg 12 2 Print Specific Pages Select this option to print only the Final Report pages that you select A window similar to the System Settings window see Print on pg 12 2 for a description of this window is displayed where you can make selections that affect only the current printout NOTE Ifthe highlighted record is a summary report then several of the op
99. use 13 6 Vision Premier Operating Instructions Exporting Reports NOTE You must change the destination for each item individually 7 Once all information has been configured as desired click on the Finish button Accessing Exported Data One file is created for each item that is selected under What in the Export Wizard window items include for example cover page VE SVE tabular page etc Each exported item has a different file extension for example the file extension for a Cover Page is txc All files however can be opened as text To open exported files 1 Open the location where the exported data was saved the location given for Destination Folder in the Export Wizard window 2 Click on the file you wish to open Use the table below to identify each file File Extension Item Data Format txec Cover Page tab delimited txt VE SVE tabular page tab delimited txm Minute HR information comma delimited xs ST episode information comma delimited txh HRV page tab delimited txb BEAT information comma delimited 3 The following window will appear Open With EES Click the program you wantto use to open the file R5829223 TXB Ifthe program you wantis notin the list click Other Description of TXB files _ Choose the program you wantto use M Aways use this program to open this file Cancel Other Vision Premier Operating Instructions 13
100. ve example you must click OK or Cancel to acknowledge the message 1 10 Vision Premier Operating Instructions Chapter 2 PC Card Recording Preparation To prepare for a patient recording you must prepare the recorder and connect the recorder to the patient Please refer to the Operating Instructions that came with your recorder for further information If you are using a PC Card recorder the PC Card must be initialized prior to being inserted into the recorder The Vision Premier system provides two methods for initializing the PC Card If you are experienced with patient hookup and PC Card initialization follow the instructions given in Initializing the PC Card below The Vision Premier system also offers a Hookup Wizard to guide you through all of the steps necessary to ensure accurate recording results For more information see Hookup Wizard Digital Recorder on pg 2 5 or Hookup Wizard Tape Recorder on pg 2 10 Initializing the PC Card Figure 2 1 Insert PC Card Dialog Box To record data from a patient you must first prepare the PC Card This process is called Initialization NOTE If at any time you are unable to proceed to the next step refer to Maintenance amp Troubleshooting on pg 14 1 1 Remove the PC Card from the recorder and place it in the PC Card slot in your computer 2 Start the Vision Premier program The Report Manager window is displaye
101. w a beat within the context of Full Disclosure data click on the beat to highlight it and then select Full Disclosure from the View menu 3 To edit the beat label right click on the beat and select the desired label from the list The beat is automatically moved to the prime form of the correct category and the label is changed 6 8 Vision Premier Operating Instructions Editing Beats Figure 6 8 Multi Beat with Superimposition Display The Multi Beat with Superimposition Display If during the beat review you need to see more detail of the selected beat select Multi Beat with Superimposition from the View menu h Vision Premier 3 Channel ECG Report Z Beview Edit View Edit Print Close ReportSettings Window Help la x 10 19 14 AM Tue Form 3 iN o 8 8 5 tf F Fat For Help press F1 I NUM This screen displays up to 40 beats rather than 60 In the lower left of the screen is a waveform that represents the basic appearance of the beats in the form Next to this is a composite picture of the displayed beats superimposed on one another In the lower right corner of the screen is a diagnostic strip There are two tic marks one at the top and one at the bottom of this box The beat in line with these tw
102. wn menu is activated Instead of hot keys you may use the ff and f keys on the right side of the keyboard With these keys highlight the desired item and press to select it 3 You may deactivate pull down menus by pressing or moving to other menus with the f or P key on the right side of the keyboard Vision Premier Operating Instructions 1 5 Chapter 1 Introduction to Vision Premier 1 6 Figure 1 2 Toolbar Figure 1 3 Toolbar Options Toolbars Toolbars are a row or rows of icons located just below the menu bar Toolbar icons are provided to allow you to initiate a function or to advance to another window with just a single click of the mouse All of the icons have a corresponding menu bar and or drop down menu which will perform the same function dk Vision Premier 3 Channel ECG Report Beview Edit View Edit Print Close ReportSettings Window Help 18 x Noe Ae ERR BR Se ce PY ce RSS 88 A OES SSS el The icons presented in the Vision Premier system toolbar change according to what is shown in the active window For example if you are currently reviewing forms you are presented with additional icons to enable you to quickly switch to another type of form You have the option of choosing which toolbars are displayed and whether or not the text labels are on or off To change these options point the mouse anywhere in the toolbar area and right click A context menu will appear Op
103. y recompiles the report and incorporates your changes into the final results All aspects of the report are affected hourly totals and beat totals Even strips selected for the report may be changed Vision Premier Operating Instructions 6 1 Chapter 6 Reviewing amp Editing Forms 6 2 Reviewing Forms 1 Start from the Report Manager window Figure 6 1 Report Manager 07487092 Not Confirmed 16784923 Schidke Mark 876 9807 4848 10 28 98 08 55 AM Wed Not Confirmed WengerJason 697785 R4024441 127 17 02 12 00 AM Tue Not Analyzed Walters Vivan 12894655 R5747282 08 12 02 09 12 AM Mon Not Confirmed Walters Dorris 057 85 364 R5829223 06 23 01 10 36 AM Sat Not Confirmed Johnson Mary 498 02 6855 R5829245 077 08 97 10 14 AM Tue Confirmed Smithson walter 1287 35 645 R6839457 05 19 97 11 00 AM Mon Not Confirmed Johnson Jill 164 745 9852 R8444037 07702702 03 14 PM Tue Not Confirmed Jenkins Eleanor 8477923 R8444275 027 28 02 04 37 PM Thu Not Confirmed 2 Double click the record you wish to review or edit The Patient Information window is displayed Figure 6 2 ision Premier Yang Gretchen Patient Information joretchen O n pa Freos i fico owas ps O d fee Dizzy fs200 froo 2 Jefi Walters E Dan Smin H Vision Premier Operating Instructions Reviewing Forms 3 Verify that the information displayed in the window is correct 4 Click the Forms icon
104. ze research mode features If you use the Hookup Wizard select Initialize PC Card after the Hookup Wizard window closes Research mode on Vision Premier allows you to initialize the digital recorder at a higher sample rate than is regularly used During initialization the Select PC Card Acquisition Parameters window appears instead of the Initialize Holter PC Card window Figure 2 5 Select PC Card Acquisition Parameters E x Select PC Card Acquisition 2 4 Holter PC Card Drive G H Parameters rm 48 Hour 200SPS 8 bit 5m A D Range 16 bit 10m A D Range eena C 2005PS 3 Channel C 400 SPS Pacer Detection Sensitivity 800 SPS Disable Detection 1000 SPS C Standard Sensitivity C High Sensitivity Maximum Sensitivity Initialize PC card Cancel 1 Select sample rate acquisition parameters v Select a sample rate from the left side of the window or VY Select the appropriate number of channels at 200SPS etc from the top right side of the window 2 If you have the optional Pacer software installed on your system select the appropriate detection sensitivity Refer to the Pacer Operating Instructions for more information Continue with step 6 on page 2 2 Vision Premier Operating Instructions Hookup Wizard Digital Recorder Hookup Wizard Digital Recorder Figure 2 6 Hookup Wizard Electrode Placement The Hookup Wizard includes three tiers of information VY an outline of

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