Cardiocap 5 Manual Usuario
Cardiocap 5 Manual Usuario
Software S-XANE
CAUTION: US Federal law restricts this device to sale by or on the order of a licensed medical
practitioner. Outside the USA, check local laws for any restrictions that may apply.
Classifications
IEC 60601-1:
• Type of protection against electric shock: Class I equipment.
• Degree of protection against electric shock (indicated by a symbol on the monitor beside
each connector): Type BF applied part or Type CF applied part.
• The equipment is not suitable for use in the presence of a flammable anesthetic mixture
with air or with oxygen or nitrous oxide.
• Mode of operation: Continuous.
IEC 60529 (degree of protection against harmful ingress of water): IPX1
EU Medical Device Directive: IIb
Trademarks
Datex®, Ohmeda®, and other trademarks (Cardiocap/5, AS/3, CS/3, S/5, S/5 Light, D-lite,
Pedi-lite, D-fend, D-fend+, MemCard, ComWheel, EarSat, FlexSat, OxyTip, PatientO2, and
Patient Spirometry) are the property of Instrumentarium Corp. or its subsidiaries.
Nellcor® is a registered trademark of Mallinckrodt Inc. Durasensor®, Dura-Y® Oxiband®,
OxiCliq®, and Oxisensor® are registered trademarks of Nellcor Puritan Bennett.
All other product and company names are the property of their respective owners.
© 2002 Datex-Ohmeda, Inc. All rights reserved.
Cardiocap/5 User’s Reference Manual—Anesthesia
Specifications................................................................... 1-11
General.......................................................................................................................................................... 1-11
Power supply ............................................................................................................................... 1-11
Back-up battery........................................................................................................................... 1-11
Environmental conditions ................................................................................................... 1-11
ECG ................................................................................................................................................................. 1-11
ST segment analysis ................................................................................................................ 1-11
Heart rate .......................................................................................................................................1-11
Impedance respiration........................................................................................................... 1-11
NIBP................................................................................................................................................................ 1-12
Cardiocap/5 User’s Reference Manual—Anesthesia
Table of Figures
Figure 1-1. Cardiocap/5 monitor (F-MXG) ................................................................................................1-3
Figure 1-2. Patient connectors (F-MXG)......................................................................................................1-4
Figure 1-3. Cardiocap/5 rear panel (F-MXG) ...........................................................................................1-5
Monitor Description
1. MONITOR DESCRIPTION
Introduction
This User’s Reference Manual contains detailed information about the features of the
Datex-Ohmeda Cardiocap/5 monitor with Anesthesia software (S-XANE) installed.
Additional information
The Cardiocap/5 User’s Guide—Anesthesia ships with the monitor. It contains basic
information for using the Cardiocap/5.
The Cardiocap/5 Technical Reference Manual describes installation, maintenance,
service, and repair procedures to be performed by authorized service personnel only.
For information about other devices closely related to the Cardiocap/5, see the
Datex-Ohmeda S/5 Network and Central, User’s Reference Manual
Licensed accessories are listed in the Datex-Ohmeda Supplies and Accessories Catalog.
Clinical application
This manual contains specific information about clinical and technical aspects of the
Cardiocap/5. In addition, Datex-Ohmeda produces application guides that contain
detailed information about clinical applications, such as patient spirometry, CO2
monitoring, ST segment analysis, impedance respiration, etc.
Configuration
This manual describes most configurable features of the Cardiocap/5. Due to the
possibility of different factory configurations, some menus, displays, and functions
described in this manual may not be available in the monitor you are using.
When your monitor was delivered, it was configured with the default settings and
ready to use. Instructions for changing settings to make your own permanent
configuration are located within the appropriate chapters in this manual.
Configuration passwords
Some features can be configured only from the Install/Service menu. A password is
required to access the Install/Service options. The default password is 16–4–34.
To enter the Install/Service menu:
1. Press the ComWheel and select Monitor Setup from the Main Menu.
2. Select Install/Service.
3. Turn the ComWheel until the first number (16) appears in the adjustment window,
then press the ComWheel to select the number. Select the other password numbers
(4, then 34) in the same way. When you finish, the Install/Service menu opens.
Most modifications are temporary unless you save them in the Save Modes menu, a
password-protected submenu of the Install/Service menu. The default password for
entering the Save Modes menu is 13–20–31.
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Cardiocap/5 User’s Reference Manual—Anesthesia
The F-MXG can also be equipped with each of these built-in options:
N-XP Two invasive pressure channels and second temperature (T2)
N-XV Patient Spirometry (N-XCO or N-XCAiO option required)
N-XREC Recorder
In addition, the F-MXG can be equipped with one of the following built-in options:
N-XOSAT Datex-Ohmeda enhanced pulse oximetry (SpO2)
N-XNSAT Nellcor® compatible pulse oximetry (SpO2)
N-XNMT NeuroMuscular Transmission (NMT) for relaxation measurement and
plexus stimulation (N-XCAiO option required)
1-2
Monitor Description
12
11
10 6
9
7
8
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Cardiocap/5 User’s Reference Manual—Anesthesia
Spirometry NMT P2 T2
10 9 8 7 6 5
SpO2
SpO2
(8) ECG
(9) NIBP
(10) D-fend housing
1-4
Monitor Description
Rear panel
1
2
13
3
4
12
11 10 9 8 7 6 5
• Place the monitor on a flat surface that can hold at least 10 kg (22 lb.).
• Use only the power cord provided to connect the monitor to the wall outlet.
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Cardiocap/5 User’s Reference Manual—Anesthesia
Symbols
Attention! Read accompanying instructions, including all warnings and
cautions, before using this device.
This symbol has the following meanings when it appears on the screen:
• When displayed beside the O2 value, indicates that the FiO2 low-alarm
limit is set below 21%.
• When displayed next to the HR value, indicates that there is a risk
that the monitor counts pacemaker spikes (pacer is set ON R) or the
monitor counts T-waves (a wide QRS is selected).
Alarm silence indicator. When displayed at the upper left corner of the
screen, indicates that all alarms are silenced. When in a menu or digit
field, indicates that the alarm source has been turned off.
Main Menu. Located beside the ComWheel to indicate you can open the
Main Menu by pressing the ComWheel when no other menu is displayed.
Submenu. Appears in a menu to indicate the selection will open a new
menu. A submenu contains functions that are used less frequently.
The monitor is connected to the Datex-Ohmeda Network.
Flashes next to the heart rate value or pulse rate value to indicate the
beats detected.
Appears next to the respiration rate value to indicate that the respiration
rate is calculated from the impedance respiration measurement.
Battery operation and remaining capacity.
Ethernet connectors.
Fuse.
Power On/Standby.
1-6
Monitor Description
Back-up battery
If mains power is lost during monitoring, the Cardiocap/5 can run on power from the
internal battery. The capacity of a fully charged internal battery is 15 minutes
minimum.
NOTE: The monitor can be started only when connected to mains power.
Battery time
A symbol on the display indicates the remaining operating time of the battery. It is
displayed only when the monitor is not connected to mains power.
Charge
The symbol is removed from the display when the battery is fully charged.
During battery charging, the standby LED is flashing in standby mode.
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Cardiocap/5 User’s Reference Manual—Anesthesia
Safety precautions
This section lists the warnings and cautions you should know before using the monitor.
Warnings
A WARNING indicates a situation in which the user or the patient may be in danger of injury
or death.
Failure of operation
It is possible for any device to malfunction; therefore, always verify unusual data by
performing a formal patient assessment.
Explosion hazard
To avoid an explosion hazard, do not use the monitor in the presence of flammable
anesthetics. The monitor measures only non-flammable anesthetics.
NMT
Always stop NMT measurement before handling stimulation electrodes.
Do not place the NMT stimulation electrodes on the patient’s chest.
Cleaning
Before cleaning, disconnect the monitor from the electrical outlet.
After cleaning, or if liquid has accidentally entered the interior of the monitor, make
sure that every part of the monitor is dry before reconnecting it to the power supply.
Patient safety
All invasive procedures involve risks to the patient. Use aseptic technique. Follow the
instructions provided by the catheter manufacturer.
The output signals are not floating and they must not be connected directly to a patient.
Connect only one patient to one monitor at a time.
Constant attention by a qualified professional is needed whenever a patient is under
anesthesia or connected to a ventilator. Some equipment malfunctions may pass
unnoticed in spite of the monitor alarm.
Do not use antistatic or electrically-conductive breathing tubes. They may increase the
risk of burns when an electrosurgery unit is used.
Do not use the Cardiocap/5 during magnetic resonance imaging (MRI).
1-8
Monitor Description
Impedance respiration
In obstructive apnea, respiration movements and impedance variations may continue.
NIBP
The monitor sets the inflation pressure automatically according to the first
measurement. Reset the case to reset the inflation limit before measuring a new patient.
Gases
MAC values are empirical, not absolute. Cardiocap/5 MAC values correspond to those
of healthy adults and cannot be applied to children. Age and other individual factors
influencing the effect of volatile agents are not taken into account.
Pulse oximetry
A damaged sensor or a sensor soaked in liquid may cause burns during electrosurgery.
Use clean and dry sensors and cables only. Moisture and debris on connectors may
affect measurement accuracy.
Patient conditions (such as reddening, blistering, skin discoloration, ischemic skin
necrosis, and skin erosion) may warrant changing the sensor site frequently or using a
different style of sensor. For details, refer to the instructions supplied with the sensor.
Conditions that may cause inaccurate readings and impact alarms include interfering
substances, excessive ambient light, electrical interference, ventricular septal defects
(VSD), excessive motion, low perfusion, low signal strength, incorrect sensor
placement, poor sensor fit, and/or movement of the sensor on the patient.
To prevent erroneous readings, do not use an inflated blood pressure cuff or arterial
blood pressure measurement device on the same limb as the oximeter sensor.
Temperature
To prevent patient injury, use Datex-Ohmeda temperature probes only.
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Cardiocap/5 User’s Reference Manual—Anesthesia
Alarms
Make sure that necessary alarm limits are set and alarms are on when you start
monitoring a patient.
When alarms are suppressed, observe the patient frequently.
Cautions
A CAUTION indicates a situation that may cause damage to the unit or devices connected to it..
US Federal law restricts this device to sale by or on the order of a licensed medical
practitioner.
The system is intended for use by qualified medical personnel only.
Do not apply pressurized air to any outlet or tubing connected to the monitor. Pressure
may destroy sensitive elements.
Do not store the monitor outside the specified temperature range (-10 to + 50 °C /
14 to 122 °F).
Do not subject memory cards to excessive heat, bending, or magnetic fields.
Leave space for circulation of air to prevent the monitor from overheating.
Turn off the power before making any rear panel connections.
Use only cables and accessories approved by Datex-Ohmeda. Other cables and
accessories may damage the system or interfere with measurement. Single-use
accessories are not designed to be reused.
Vibrations during transport may disturb SpO2, ECG, impedance respiration, and NIBP
measurements.
Cleaning
Do not disinfect or open the water trap cartridge. To avoid damage, do not touch or try
to clean the water trap hydrophobic membrane (other than to rinse it with water).
Do not sterilize any part of the monitor with steam autoclave or ethylene oxide.
Do not immerse any part of the device in liquids or allow liquid to enter the interior.
Do not use hypochlorite, acetone-based, phenol-based, or ammonia-based cleaners.
Disposal
Dispose of the whole device and its parts in accordance with local environmental and
waste disposal regulations.
1-10
Monitor Description
Specifications
All specifications are subject to change without notice.
General
Power supply
Rated voltages and frequencies: 100-240 V 60/50 Hz
Allowed voltage fluctuations: ± 10%
Maximum power consumption: 80 VA
Fuses (2): T2AH/250V
Back-up battery
Type: 12V 2.6AH lead acid
Back-up battery time: at least 15 minutes when fully charged
Charging time (typical): 5 hours
Charging indicator: Green LED On: full charge, battery on the holding voltage
Green LED flashing: charging
Environmental conditions
Operating temperature: +10 to +40°C (50 to 104°F)
Storage and transport temperature: –10 to +50°C (14 to 122°F)
Relative humidity: 0 to 85% noncondensing; in airway 0 to 100% condensing
Atmospheric pressure: 660 to 1060 hPa (500 to 800 mmHg)
ECG
Waveform display (with 50 Hz power supply frequency):
Monitoring filter 0.5 to 30 Hz
ST filter 0.05 to 30 Hz
Diagnostic filter 0.05 to 100 Hz
Waveform display (with 60 Hz power supply frequency):
Monitoring filter 0.5 to 40 Hz
ST filter 0.05 to 40 Hz
Diagnostic filter 0.05 to 100 Hz
ST segment analysis
Measured and displayed simultaneously for up to three ECG leads
ST level range: –6 to +6 mm (–0.6 to +0.6 mV)
Display resolution: 0.1 mm (0.01 mV)
Averaging: Calculated from 16 QRS complexes
Display update interval: 5 seconds
Heart rate
Measurement range: 30 to 250 bpm
Measurement accuracy: ± 5% or ± 5 bpm
Pacemaker pulse detection level: 2 to 500 mV
Pacemaker pulse duration: 0.5 to 2 ms
Impedance respiration
Respiration range: 4 to 120 resp/minute
Accuracy: ± 5% or ± 5 resp/minute
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Cardiocap/5 User’s Reference Manual—Anesthesia
NIBP
Measurement range:
Adult 25 to 260 mmHg; Child 25 to 195 mmHg; Infant 15 to 145 mmHg
Pulse rate range accepted: 30 to 250 bpm
Typical measuring time: Adult 23 seconds; Infant 20 seconds
Pulse rate
Measurement range: 30 to 250 bpm
Accuracy: ± 5% or ± 5 bpm
Temperature
Measurement range: 10 to 45°C (50 to 113°F)
Measurement accuracy:
25 to 45.0 °C ± 0.1 °C (77 to 113 °F ± 0.2 °F)
10 to 24.9 °C ± 0.2 °C (50 to 76.8 °F ± 0.4 °F)
Probe type: Datex-Ohmeda only
SpO2
Calibration range: 50 to 100%
Calibrated against functional saturation
Measurement range: 40 to 100%
Measurement accuracy (% SpO2 ± 1SD):
80 to 100% ± 2 digits;
50 to 80% ± 3 digits;
Below 50% unspecified
NOTE: SpO2 measurement accuracy is based on deep hypoxia studies using Datex-
Ohmeda FingerSat sensors on volunteers. Arterial blood samples were analyzed by a
Radiometer OSM CO-oximeter. Refer to the sensor instructions for specific accuracy
data.
Pulse rate
Measurement range: 30 to 250 bpm
Measurement accuracy: ± 5% or ± 5 bpm
1-12
Monitor Description
SpO2
Calibration range: 70 to 100%
Calibrated against functional saturation
Measurement range: 1 to 100%
Measurement accuracy (± 1SD):
70 to 100% ± 2 digits
70 to 100% ± 3 digits during conditions of clinical patient motion
Below 70% unspecified
NOTE: SpO2 measurement accuracy is statistically derived and correlated to
simultaneous arterial blood gases measured on a Radiometer OSM3 CO-oximeter.
Refer to the sensor instructions for specific accuracy data.
Pulse rate
Measurement range: 30 to 250 bpm
Measurement accuracy: ± 2% or ± 2 bpm (whichever is greater)
SpO2
Calibrated against functional saturation
Measurement range: 1 to 100%
Measurement accuracy (% SpO2 ±1SD):
70 to 100% (± 2 digits to ± 3.5 digits, depending on the sensor)
Below 70% unspecified
See the Pulse Oximetry chapter for a list of approved sensors and accuracy details.
NOTE: SpO2 measurement accuracy is based on testing healthy adult volunteers in
induced hypoxia studies.
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Cardiocap/5 User’s Reference Manual—Anesthesia
Pulse rate
Measurement range: 30 to 250 bpm
Measurement accuracy: ± 3 digits
Airway gases
Sampling rate (typical value): 200 ml/minute
Sampling delay: 2.5 seconds typical with a 3 meter sampling line
Total system response time: 2.9 seconds typical with a 3 meter sampling line, including
sampling delay and rise time
Warm-up time: 2 to 5 minutes, 30 minutes for full spec.
Default alarm limits:
NOTE: Limits are adjustable within the measurement range. Alarm limits and
their adjustment range may vary depending on the mode used.
EtCO2 high 8%, low 3% FiEnf high 5.1%, low Off
FiCO2 high 3%, low Off EtEnf high 3.4%, low Off
EtO2 high Off, low 10% FiIso high 3.4%, low Off
FiO2 high Off, low 18% EtIso high 2.3%, low Off
FiN2O high 82% FiDes high 18%, low Off
FiHal high 2.2%, low Off EtDes high 12%,low Off
EtHal high 1.5%, low Off FiSev high 5.1%, low Off
EtSev high 3.4%, low Off
Non-disturbing gases:
Ethanol C2H5OH (< 0.3%) Acetone (< 0.1%)
Methane CH4 (< 0.2%) Nitrogen N2
Carbon monoxide CO Nitric oxide NO (< 200 ppm)
Water vapor
Maximum effect on readings
CO2: < 0.2 vol%
O2, N2O: < 2 vol%
Anesthetic agents: < 0.15 vol%
Effect of helium: Decreases CO2 readings < 0.6 vol% typically
Agent identification
Identification threshold (typical value): 0.15 vol%
1-14
Monitor Description
Patient Spirometry
Detection through D-lite™ or Pedi-lite™ flow sensor and gas sampler:
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Cardiocap/5 User’s Reference Manual—Anesthesia
NMT
Stimulation modes:
Train of four (TOF)
Double burst (3.3) (DBS)
Single twitch (ST)
50 Hz tetanic + post-tetanic count (PTC)
Measurement intervals:
TOF and DBS: Manual; 10 seconds, 12 seconds, 15 seconds, 20 seconds, 1 minute,
5 minutes, 15 minutes
ST: Manual; 1 second, 10 seconds, 20 seconds
Stimulator
Stimulus pulse: Square wave, constant current
Pulse width: 100, 200 or 300 µs
Stimulus current range (supramax and manual): 10 to 70 mA with 5 mA steps
Stimulus current accuracy: 10% or ± 3mA (whichever is greater)
Max load: 3 kΩ
Max voltage: 300 V
Recorder
Principle: thermal array
Print resolution:
Vertical: 8 dots/mm (200 dots/inch)
Horizontal: 32 dots/mm (800 dots/inch) at speed of 25 mm/second and slower
Paper width: 50 mm; printing width 48 mm
Traces: selectable; 1, 2, or 3 traces
Print speed: 1, 6.25, 12.5, 25 mm/second
1-16
Contents
Table of Figures
Figure 2-1. Cardiocap/5 keys and controls ...............................................................................................2-1
Figure 2-2. Remote Control ................................................................................................................................2-3
Figure 2-3. Parts of a menu.................................................................................................................................2-4
Figure 2-4. Main Menu..........................................................................................................................................2-4
Monitoring Basics
2. MONITORING BASICS
Introduction
You can control Cardiocap/5 monitoring with the ComWheel, the direct access keys, or
the optional Remote Control.
• The ComWheel provides access to all monitor functions.
• The direct access keys provide direct access to frequently-used functions that are
also available through the Main Menu.
• The Remote Control Menu key lets you enter all monitoring functions. Each
Remote Control direct access key lets you enter a common function.
See Main Menu map and Direct access key maps later in this chapter for the menus you
can access from the Main Menu and by pressing the direct access keys.
2
Silence
Alarms
3
Trends
4
Invasive
Pressures
5
ECG
NIBP 6
NIBP
Start/Cancel 7
Normal
Screen
8
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Cardiocap/5 User’s Reference Manual—Anesthesia
Key functions
Power On/Standby key.
NOTE: The monitor will start only when connected to mains power.
Silence Silences an active alarm or pre-silences all alarms for two minutes
Alarms
(press the key once) or five minutes (press the key for three seconds).
Pressing the key once again clears the alarm message field of all alarm
messages and enables new alarms. A lighted yellow LED indicates a
yellow alarm; a lighted red LED indicates a red alarm.
Trends
Displays trends (numerical and graphical) and snapshots. Press the
Normal Screen key to return to monitoring mode.
The next oval-shaped key can be Pulse Oximetry, Invasive Pressures, or NMT, depending on
which built-in options your monitor contains.
The ComWheel is the main tool for all menu functions. You turn and/or
press it to access, navigate, and choose all menu options.
Recorder keys
See the Recording and Printing chapter for descriptions of the keys on the optional
recorder.
2-2
Monitoring Basics
Remote control
The optional Remote Control (K-CREMCO) contains keys that help you in most
common situations and tasks. You can use these direct access keys to start or end a
function.
Silence
Alarms Record
Take
Snapshot Wave
Zero ALL
Pressures Other
Special Patients
Start
Start Wedge Start
C.O. NIBP
Freeze Normal
Menu Screen
Menu Opens the Main Menu from which you can access all menus and
functions of the monitor.
Silence Silences an active alarm or pre-silences all alarms for two or five
Alarms minutes.
Zero ALL Zeroes all invasive pressure channels.
Pressures
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Cardiocap/5 User’s Reference Manual—Anesthesia
Using menus
A menu is a list of functions or commands displayed on the screen.
1 2 3 14 33
ECG
aVR
NIBP Pacer 1 mV H Arrh.
Start Cycling
Cycle Time 3 min 1
hidden R
58 /min OFF
mm
Start STAT 2.5 1 mV S aVR 1.0
I
Start Manual 3 T I -1.5
-1.5
II 0.5
4 Start Ven. Stasis 5
Pleth
NIBP Setup 10 S %
P
NIBP Alarm
Parameters Menu
15
30
0
2 97
60 02 21 %
5 O ET
16 FI 21
2
16
FI-ET 5.0
Change interval between
6 automatic cuff inflations.
C02 5 C
%
O ET
2
5.0 FI 0.0
RR 15 /min
0
NIBP T1 Paw TV Gases O2:
mmHg Sys Dia C cmH2O Adult O2% N2O% Des%
Mean
128/81
(93) Manual
T1
38.8 Ppeak
PEEP
25
7
TVexp ml
790
ET
FI
16 77 2.3
21 77 3.0
2-4
Monitoring Basics
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Cardiocap/5 User’s Reference Manual—Anesthesia
Monitoring a patient
Use only supplies and accessories approved by Datex-Ohmeda for use with the
Cardiocap/5. See the Datex-Ohmeda Supplies and Accessories Catalog.
Preparations
1. Check that the monitor and patient accessories are clean and intact.
2. Press the Power On/Standby key to turn on the monitor.
NOTE: The monitor will start only when connected to mains power.
3. Tilt the monitor to the optimal viewing angle:
• Press the center of the foot and adjust.
• Make sure both feet are at the same angle.
NOTE: If wall mounting is used, make sure the monitor’s front and back
attachment bars fit tightly to the edges of the mounting plate and the locking bolt in
the back of the monitor locks into place.
4. If necessary, change the operating mode:
• Press the ComWheel and select Monitor Setup from the Main Menu.
• Select Select Mode.
The operating mode defines what is displayed on the screen and in the trends.
Note that changing the mode also changes, for example, the alarm limits.
Starting monitoring
1. Prepare the patient connections. Refer to the applicable measurement parameter
chapter(s) later in this manual.
2. Alarms are operative and the parameter default settings are active when the patient
is connected to the monitor. To review alarm limits, press the ComWheel and
select Alarms Setup from the Main Menu.
You can also select Alarms Setup through the corresponding parameter menu.
3. Check that you have the desired waveforms and digits in the fields.
To adjust them:
• Press the ComWheel and select Monitor Setup from the Main Menu.
• Select Screen Setup.
• Select Waveform Fields or Digit Fields.
2-6
Monitoring Basics
During monitoring
If you need to suppress alarms, press the Silence Alarms key.
• To silence the alarms for two minutes, press the key once.
• To silence the alarms for five minutes, press the key for more than three seconds.
If you accidentally press the Power On/Standby key during monitoring, the “Switching to
standby mode in X seconds” message is displayed. If the Power On/Standby key is not
pressed again within eight seconds, the monitor will switch to standby mode.
To return to monitoring, press the Power On/Standby key again within eight seconds.
Ending monitoring
1. Press the ComWheel to open the Main Menu.
Main Menu
Parameters
Alarms Setup
Record/Print
Patient Data
Reset Case
Monitor Setup
Trends
Normal Screen
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Cardiocap/5 User’s Reference Manual—Anesthesia
ECG Setup
NMT Setup
* Menu is displayed when the NMT Regional Block Adapter is connected to monitor.
2-8
Monitoring Basics
Alarm Volume
Audio ON/OFF
Record Trends
Print Graphical
Reset Case
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Cardiocap/5 User’s Reference Manual—Anesthesia
Digit Fields
O2 Setup
Sweep Speeds
Select Mode
Snapshot
Gases
More Parameters
Alarms Options
Printer
Analog Outputs
Monitor Settings
Service
2-10
Monitoring Basics
or
or
P2 “CVP’ Setup P2 ‘CVP’ Alarm Adjust Limits
NMT Setup
ECG ST Analysis
ECG Setup
ST Alarms
* Menu is displayed when the NMT Regional Block Adapter is connected to monitor.
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Cardiocap/5 User’s Reference Manual—Anesthesia
Abbreviations
The abbreviations that appear on the monitor screen and/or in this manual are listed
below.
AA anesthetic agent
ABP arterial blood pressure
AirW airway temperature
APN apnea
Art arterial
Asy asystole
ATMP atmospheric pressure
ATPD ambient temperature and pressure, dry gas
AVF augmented voltage foot—usually left (ECG)
AVL augmented voltage left (ECG)
AVR augmented voltage right (ECG)
Axil axillary temperature
°C degrees Celsius
Casc. cascaded (ECG)
CO2 carbon dioxide
Compl compliance
Cont. continuous recording
Contrl controlled ventilation
Core central temperature
CVP central venous pressure
E expiratory
ECG electrocardiography
ECG1 first ECG waveform (top)
ECG1/r real time ECG
ECG2 second ECG waveform
ECG3 third ECG waveform
EMG electromyography (NMT)
Enf enflurane
Eso esophageal temperature
ET, Et end tidal concentration
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Monitoring Basics
Exp expired
°F degrees Fahrenheit
FI, Fi fraction of inspired gas
FiO2 fraction of inspired oxygen
Flow airway gas flow
FVloop flow volume loop
Graph. graphical
Hemo hemodynamic
Hal halothane
Hgb hemoglobin
HR heart rate
I inspiratory
ICP intra cranial pressure
ID identification
Imped. impedance
indep. independent
Inv. invasive
Iso isoflurane
O2 oxygen
Oxy oxygen
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Cardiocap/5 User’s Reference Manual—Anesthesia
S/D systolic/diastolic
SaO2 arterial oxygen saturation
Sev sevoflurane
Skin skin temperature
Snaps. snapshot
Spiro spirometry
SpO2 oxygen saturation measured by pulse oximeter
Spont spontaneous breathing
ST single twitch stimulation (NMT)
ST ST segment of ECG
ST inf. ST segment on inferior leads (II, III, aVF)
ST lat. ST segment on lateral leads (I, aVL, V5)
STAT continuous NIBP cuff inflation for 5 minute
Stfilt ST filter (ECG)
STPD standard temperature and pressure, dry gas
Surf skin temperature
Sw software
Sys systolic pressure
T1, T2 temperature
T1% first stimulus as a percentage of the reference value (NMT)
Tab. tabular trends
Temp temperature
TOF train of four stimulation(NMT)
TOF% ratio of the fourth response to the first response (NMT)
TV tidal volume
Tymp tympanic temperature
2-14
Contents
Table of Figures
Figure 3-1. Parts of the display.........................................................................................................................3-2
Figure 3-2. Display fields .....................................................................................................................................3-3
Figure 3-3. Waveform field.................................................................................................................................3-4
Figure 3-4. Digit fields............................................................................................................................................3-5
Figure 3-5. Split screen view..............................................................................................................................3-6
Monitor Setup
3. MONITOR SETUP
Overview
The Cardiocap/5 has setup options for display, parameters, alarms, etc. You can change
the settings to suit your specific needs. General monitor settings can be changed in the
Monitor Setup menu. Other settings are changed in setup menus for each parameter.
Modifications remain in effect until the case is ended, a user mode is changed, or for
15 minutes after the monitor is turned off. Replacing the CPU Board also returns
settings to their defaults.
NOTE: You can load or reload the settings using the Datex-Ohmeda Network.
GENERAL Mode for basic general anesthesia and for low- and medium-risk adult
patients.
REGIONAL Mode for all types of regional anesthesia and anesthesia care.
PEDIATRIC Mode for basic general anesthesia and for low- and medium-risk
pediatric patients.
The monitor always starts in startup mode. Startup mode is one of your user modes,
chosen during configuration. You can change mode settings during monitoring.
To change the startup mode to another mode:
Activate mode.
All preconfigured stettings
are loaded into monitor.
Changes made separately are maintained when returning to the previous mode.
3-1
Cardiocap/5 User’s Reference Manual—Anesthesia
aVR ECG
Pacer 1 mV
H
hidden
R
58 /min
02 21
%
O ET
2 16 FI 21
4
FI-ET 5.0
16
Art200
mmHg
A
100 r
t 130/82
(93)
0
Pleth
S%
p
O
2 97
T1 NIBP CO2 Gases O2:
C mmHg Sys Dia O2% N2O% Des
5
T1
38.8 128/81 ET 5.0 RR ET 16 77 2.3
Mean (93) Manual FI 0.0 15/min FI 21 77 3.0
3-2
Monitor Setup
Display setup
At startup, the display is arranged according to the startup mode definitions. Unused
parameters are not displayed and no space is reserved for them.
NOTE: Choosing to display the same parameter in the waveform field and the digit
field makes the previously chosen field disappear so that the same information is not
displayed in two fields at the same time.
3-3
Cardiocap/5 User’s Reference Manual—Anesthesia
aVR
ECG
1 mV H
R
58
/min
Up to six waveforms can be displayed at a time. When fewer than six waveforms are
displayed, the remaining waveforms are enlarged to fill the entire waveform area.
Changing the waveform also changes the numerical field on the right of the waveform.
It may also change the digit fields. If you choose the same measurement in the
waveform field that is currently in the digit field, the digit field will disappear so that
the same information will not be displayed in two fields at the same time.
To set the parameters for the waveform fields:
The invasive pressure waveforms are displayed only when the transducer is connected
to the monitor.
Selecting Combine Pressures in the Waveform Fields menu displays invasive pressures in
the same waveform field with individual scales.
When you use a 5-lead set in the ECG measurement, up to three different ECG leads
can be displayed simultaneously in different fields.
3-4
Monitor Setup
The digit fields are numbered from left to right in the Digit Fields menu (Lower Field 1
is the left-most field; Lower Field 4 is the right-most field).
Changing the digit field may also change the waveform field setup. If you choose the
same measurement in the digit field that is currently in the waveform field, the
measurement waveform field will disappear so that the same information will not be
displayed in two fields at the same time.
To modify digit fields:
3-5
Cardiocap/5 User’s Reference Manual—Anesthesia
I
R
mm
58 /min
0
Paw
cmH20
40
1 mV S aVR
T I
1.0
OFF
aVR
) II OFF 1.0
Art 200 mmHg
A
100
0
r
t 130/82
(93)
Adult cmH20 TVinsp ml CVP 20
C
mmHg Contrl
Ppeak 25 800 10
0
V
P (12)
14/9
Pplat 21 TVexp ml Pleth
S %
P
PEEPtot
Compl
6 790
55 ml/cmH20
0
2
%
97
CO2 5 C
O ET
2
5.0 FI 0.0
0 RR 15 /min
T1 NIBP O2
C mmHg Sys Dia Mean %
T1
38.8 128/81 (93) Manual
ET
FI
16
21
FI-ET
5.0
3-6
Monitor Setup
Minitrend view
You can choose to view the Minitrend data from the last five minutes or the last
30-minute period next to the waveform field for the parameter. 5-minute minitrend is
updated every 10 seconds, 30-minute minitrend is updated once every minute.
To modify the trend split screen view:
1. Press the ComWheel and select Monitor Setup from the Main Menu.
2. Select Screen Setup.
3. Select Minitrend Length and choose 5 min or 30 min.
Set hour.
3-7
Cardiocap/5 User’s Reference Manual—Anesthesia
Display brightness
To adjust display brightness according to environmental conditions:
1. Press the ComWheel and select Monitor
Setup from the Main Menu.
2. Select Display Brightness.
3. Choose the desired adjustment
(30% to 100%).
3-8
Monitor Setup
3-9
Cardiocap/5 User’s Reference Manual—Anesthesia
Install/Service Installation
Installation Units
Units Height cm
Alarms Options Weight kg
Printer Parameters
Analog Outputs Previous Menu
Monitor Settings
Previous Menu
3-10
Contents
Chapter 4. Alarms
Overview ............................................................................ 4-1
Alarm categories ................................................................. 4-1
ISO pattern alarms ....................................................................................................................................4-2
ISO2 pattern alarms .................................................................................................................................4-2
General pattern alarms...........................................................................................................................4-2
Table of Figures
Figure 4-1. View of alarms ..................................................................................................................................4-1
Figure 4-2. Alarms Setup menu and limits screen ...............................................................................4-3
Alarms
4. ALARMS
Overview
When an alarm for the monitored parameter becomes active, an audible tone sounds
and the screen changes as shown and described below:
1 2 3
HR 16.09
low
ECG
aVR 1 mV H
R
58
I Learning
1 mV
S aVR 2.8
T I -2.8 I
IIR 2.8
-2.8
WARNING: Patient safety. Make sure that necessary alarm limits are set and alarms are on
when you start monitoring a patient.
WARNING: Patient safety. When alarms are suppressed, observe the patient frequently.
Alarm categories
Alarms are classified into three categories according to their priority: RED ALARM
(highest priority), YELLOW ALARM, and NOTE (white color).
The alarm type depends primarily on the physiological significance and the duration
(generally a minimum of 20 seconds) of the alarm. Thus, for example, asystole
advances rapidly to a red priority, whereas apnea is allowed a slightly longer duration.
The monitor has three choices of alarm tones and patterns: ISO, ISO2 (the default), and
General.
NOTE: There is also a sound for catastrophic situations. A continuous beep sounds if
the FiO2 is less than 18% and EtO2 less than 10%, FiN2O is high, or Ppeak is high.
To change the alarm pattern, contact the person responsible for the configuration.
4-1
Cardiocap/5 User’s Reference Manual—Anesthesia
4-2
Alarms
Alarm activation
To make the alarms operative, connect the patient cables. Alarms are operative even
when the measurement is not selected on the display (except for the respiration
measurement), unless the alarm source is selected Off.
Individual alarms have their own specific requirements before they become active:
• Apnea requires five breaths to be activated.
• Invasive pressures are required to be within alarm limits for 20 seconds after
zeroing.
Displaying alarms
Patient alarm limits can be viewed and adjusted in the Alarms Setup menu.
To display the Alarms Setup menu, press the ComWheel and select Alarms Setup from
the Main Menu.
Cancel Changes
1 3
Alarm Volume
Audio ON/OFF
Alarm History 40 80 80 0 90 0.0 3.0
Main Menu
Push ComWheel
to adjust alarm 18 0.0 4 –20 0 34.0
limits manually O2 Des Resp P MV Temp Next
FI ET Rate peak exp T1 Page
4-3
Cardiocap/5 User’s Reference Manual—Anesthesia
Alarms Setup
Adjust Limits Exit Alarm Volume 5
Auto Limits HR NIBP Art CVP SpO2 CO2 O2
Sys Sys Sys FI ET
Default Limits
72 170 172 22 100 3.0 100
Cancel Changes
Alarm Volume
Audio ON/OFF
Alarm History
43 86 87 5 92 0.0 10
Remove Menu
Main Menu 12.0 20 35 14 39.8
4-4
Alarms
Adjust Limits 1. Press the ComWheel and select Alarms Setup from
the Main Menu.
100 8.0 3.0 100
2. Select Adjust Limits.
3. Turn the ComWheel to highlight the
measurement you wish.
4. Press the ComWheel to display an adjustment
90 3.0 0.0 18
window.
SpO2 CO2 CO2 O2 Next
ET FI FI Page
Canceling changes
Before you exit the Alarms Setup menu, select Cancel Changes to return all limits to those
that were in effect before you entered the Alarms Setup menu.
4-5
Cardiocap/5 User’s Reference Manual—Anesthesia
4-6
Alarms
Adjust Limits
Sys Alarm OFF
P2
Dia Alarm ON Dia
Mean Alarm OFF 300
High 20
Alarms Setup
Previous Menu Low 5
–40
mmHg
Push ComWheel to
turn alarm
ON/OFF.
4-7
Cardiocap/5 User’s Reference Manual—Anesthesia
Suppressing alarms
APN. When alarms are suppressed, this warning symbol is displayed.
ASY.
NOTE: If alarms are suppressed and a power interruption occurs, or if the monitor is
turned off for up to 15 minutes, check the alarm status before you resume monitoring
or begin monitoring a new patient.
Warning: Patient Safety. When alarms are suppressed, observe the patient frequently.
Exit
Audio ON/OFF
P SpO2 CO2 O2
Activate Alarms Sys Sys Sys FI ET
Silence Apnea \ 22 100 3.0 100
Silence ECG
Silence Apn&ECG
Silence ALL
43
Previous Menu 86 87 5 92 0.0 10
12.0 20 35 14 39.8
Silence audible0.0
apnea, 9CO2, 15 10 37.7
RR, spirometry and ECG alarms
permanently. MV Temp
exp T1
If an active alarm is suppressed, a reminder beep sounds every two minutes. You can
adjust the volume of the reminder beep in the Audio ON/OFF menu.
Reactivating alarms
Select Activate Alarms to turn audible alarms on.
4-8
Alarms
This symbol is displayed in the digit field for each alarm you suppress.
or
Select the parameter alarm to be reactivated from the menu and press the
ComWheel to turn the selection ON.
4-9
Cardiocap/5 User’s Reference Manual—Anesthesia
Transferring alarms
All alarms can be transferred to the Datex-Ohmeda S/5 Network and Central or to
another monitor that is connected to the Datex-Ohmeda monitor network.
1. Press the ComWheel and select Patient Data from the Main Menu.
2. Select Other Patients.
3. Select Receive Alarms.
4. Select one of the sites on the list that is displayed.
4-10
Alarms
Displaying limits
Alarm limits can be displayed next to the numerical parameter value as shown below.
4-11
Cardiocap/5 User’s Reference Manual—Anesthesia
Latching alarms
Latching alarms enables unattended monitoring. If Latching Alarms is active, alarm
messages continue to be displayed even if the initial alarm condition has ceased. A
reminder beep sounds every 10 seconds.
• To clear all inactive alarm messages and the beep, press the Silence Alarms key once.
• To clear all inactive and active alarm messages, enabling only new upcoming
alarm messages, press the Silence Alarms key twice.
To select latching alarms:
Installation 1. Press the ComWheel and select Monitor Setup
Alarms Options from the Main Menu.
4-12
Contents
Snapshots.......................................................................... 5-9
Viewing snapshots..................................................................................................................................5-10
Creating snapshots.................................................................................................................................5-11
Marking an event ...................................................................................................................... 5-11
Erasing snapshots ...................................................................................................................................5-11
Table of Figures
Figure 5-1. Graphical trend view.....................................................................................................................5-4
Figure 5-2. Minitrend view..................................................................................................................................5-6
Figure 5-3. Numerical trend page ...................................................................................................................5-8
Figure 5-4. Waveform snapshot page ...........................................................................................................5-9
Figure 5-5. Waveform snapshot ....................................................................................................................5-10
Figure 5-6. Snapshot fields...............................................................................................................................5-10
Figure 5-7. Marking numerical trends ......................................................................................................5-11
Trends and Snapshots
Overview
A trend is a collection of the measured patient data. The monitor displays two types of
trend information: graphical and numerical. You can create snapshots (frozen frames
saved to memory) of this information.
The monitor collects graphical and numerical trend data automatically from the
trended parameters. You can select between 20 minutes and 24 hours of trend time.
You can view the trends in the Trends menu, or you can continuously display graphical
“minitrends” next to the waveform fields. A minitrend is a view of collected trend data
from the last 5-minute period or 30-minute period, depending on which period of time
you chose.
Trended parameters
The trend parameters are listed below
• Electrocardiograph (HR)
• ST analysis
• Invasive pressure
• Noninvasive blood pressure
• Oxygen saturation (Pleth, SpO2)
• Gases (CO2, O2, N2O, AA, MAC, Resp)
• Respiration rate (RR)
• Temperature
• Airway pressure
• Airway flow
• Derived values from airway pressure and flow
• NMT
Trend data is stored in memory for 15 minutes after the power is turned to Standby.
5-1
Cardiocap/5 User’s Reference Manual—Anesthesia
5-2
Trends and Snapshots
5-3
Cardiocap/5 User’s Reference Manual—Anesthesia
1 2 3 4
9 37
+
aVR
Trends Pacer 1 mV
hidden
Take Snapshot
Next Page HR 240 56 100 Sp02 aVR
97 S aVR 1.0 1.0
Print Page 120 90 T I OFF
II OFF
Cursor 0 80
Time Scale 2 h Art 200 128/81 20 CVP A mmHg
Graphical
NIBP
100
(12)
10 r
t 130/82
(93)
Snapshot 0 0 Contrl
mmHg
C02 6 5.0/0.0 20 Des C
Numerical
Trend Scales
4
2
3.0/2.3
5
V
P (12)
14/9
0 0
Remove Menu S %
02 100 21/16 100 N20 P
Main Menu 50
0
77/77
50
0
0
2
%
97
Show graphical C FI
trends. Mark Trend O 5.0 0.0
Event 8:25 8:30 8:35 8: 8:43 1/4 2 RR 15 /min
HR NIBP Gases O2: T1
Lead aVR mmHg Sys Dia O2% N2O% Des% C
58 /min Mean
128/81
(93) Manual
ET
FI
16 77 2.3
21 77 3.0
T1
38.8
7 6 5
5-4
Trends and Snapshots
Trend bar, parameter scale to the right. The gap shows the mean value (except
in the Paw field where it indicates Pplat).
A dotted vertical line across the trend field indicates a change, such as a
change of ECG lead, anesthetic agent, or zeroing the invasive blood pressure
channel.
A blue, white, or red line above the marker field indicates the following:
• Blue line: the left end of the line is the point at which gathering of trend data
started. The right end shows the last moment data was gathered.
• White line: the proportion of data shown on the screen. If the line is on the
left, leaving space on the right, there is more data to see after the current
view. If the line is on the right, there is more data before the current view.
If the line is in the middle, there is more data at the beginning and end of
the case.
• Red line: the time period during which a 20-minute trend was gathered.
5-5
Cardiocap/5 User’s Reference Manual—Anesthesia
Minitrend view
17:00
240 5 min aVR ECG
Pacer 1 mV H
120
0
100 5 min
hidden
Pleth
R
S %
88 /min
90
80
6 5 min
P
0
2
C
%
97
C02 5
4
2 O ET
2
5.0 FI 0.0
0 0 RR 15 /min
100 5 min 02 21 %!
50 O ET
2 16 FI 21
0 16 FI-ET 5.0
3 2 min %
AA 2.5
2
1 1.0
A ET
A
2.3 FI 3.0
0 0 MAC ---
60 5 min Imped. R CO2
40 e
20
0
NIBP T1 Paw TV
s
p
Gases
15 /min
Mean
--- ---
(---) Manual
T1
38.8 Ppeak
PEEP tot
25
7
TVexp ml
790
ET
FI
16
21
77 2.3
77 3.0
You can split the Normal Screen display so that one fourth of the display (on the left)
shows continuous graphical minitrends. Minitrends show the measurements selected
for the waveform fields.
NOTE: The split screen option is possible only with displays that have waveforms on
the Normal Screen.
5-6
Trends and Snapshots
Adding a minitrend
To split the screen and show minitrends:
Removing a minitrend
To remove the minitrend from the display:
1. Press the ComWheel and select Monitor Setup from the Main Menu.
2. Select Screen Setup.
3. Select Split Screen and choose None.
5-7
Cardiocap/5 User’s Reference Manual—Anesthesia
1 2 3 4
9 14
aVR ECG
Trends Pacer 1 mV H Arrh.
Take Snapshot
hidden
Main Menu
8:55
9:00
9:05
9:10 58 97 128/ 81 130/ 82 ( 12) 5.0 21 3.0
0
2
%
97
Show numerical
trends. 9:11 58 97 128/ 81 130/ 82 ( 12) 5.0 21 3.0 C ET 5.0 FI 0.0
9:12 58 97 128/ 81 130/ 82 ( 12 ) 5.0 21 3.0 O
9:13 58 97 128/ 81 130/ 82 ( 12) 5.0 21 3.0 2 RR 15 /min
Gases O2: NIBP Comp Raw Resp
O2% N2O% Des% mmHg Sys Dia ml/cmH2O cmH2O/l/s CO2
ET
FI
16 77 2.3
21 77 3.0 Mean
128/81
(93) Manual
55 8
15 /min
5-8
Trends and Snapshots
Snapshots
A snapshot is a frozen frame that is saved to the monitor memory. A snapshot captures
the contents of the frozen frame chosen during configuration, not the image you are
currently viewing when you take the snapshot. A snapshot can contain waveforms,
numerical trends, and graphical trends.
1 2 3 4 GENERAL 9 45
+
Trends aVR
Pacer 1 mV
hidden
Take Snapshot
Waveform saved: 9:44:17
Next Page aVR mm
1 mV S
T aVR 1.0 aVR
Print Page I OFF
II 1.0
Next Snapshot OFF
ST 5 1.0/
–1.5/ A mmHg
Time Scale 0 r
Graphical -5
0.5
t 130/82(93)
Snapshot Art 200 128/81 20 CVP
NIBP C mmHg Contrl
100 (12) 10 V
Numerical
Trend Scales 0 0
P (12)
Waveform saved: 9:44:17 S %
Remove Menu
Main Menu
CO2 5%
0
p
O
2
97
%
Show snapshots. C
Snaps.
Mark s O
2
ET 5.0 FI 0.0
Event 9:30 9:35 9:40 9:44 1/1 RR 15/min
T1 NIBP HR Gases O2:
C mmHg Sys Dia Lead aVR O2% N2O% Des
16 77 2.3
T1
38.8 Mean
128/81
(93) Manual 58 /min
ET
FI 21 77 3.0
9 8 7 6 5
5-9
Cardiocap/5 User’s Reference Manual—Anesthesia
Viewing snapshots
A snapshot includes 15 seconds of a waveform and/or graphical trend from the time
period that corresponds to the time scale selected for the graphical trend and/or the
numerical trend.
1 2
122
122
0
ST 5 2.8/
0 -2.7/
2.8
-5
Art 200 128/81 240 HR
NIBP 100 58 120
0 0
Mark s‘ s‘ s‘ Snaps.
Event 15:30 16:00 16:42 17:00 1/1
To view snapshots:
1. Press the Trends key and select Snapshot from the Trends menu.
2. Select Next Snapshot.
3. Turn the ComWheel to move the cursor in the time and marker field.
4. When the cursor reaches the saving time of a snapshot (marked with an “S” in the
time axis), the snapshots that were saved at that time appear.
5. Press the ComWheel to return to the menu.
5-10
Trends and Snapshots
Creating snapshots
To create a snapshot, press the Trends key and select Take Snapshot.
The waveforms and trends that are currently selected to the Snapshot page will be
saved. You can take up to 16 snapshots, depending on the data load and the amount of
fields chosen to contain information on the snapshot page.
Marking an event
At the time Take Snapshot is selected, a number is inserted in the numerical trends
beside the trend information. This number marks the event at which a snapshot was
created.
Also, NIBP measurement marks a trend line. If there are several measurements during
one minute, a one-minute average appears instead of individual measurements.
Page 4 0f 4 T1 T2 SpO2
Mark Time T1 T2
12:25
12:30
12:35
1 12:39 38.8 20.0
12:40 38.8 20.0
2 12:43 38.8 20.0
12:45 38.8 20.0
Erasing snapshots
The snapshots will be erased when you reset the case or reset the trends. They are also
erased after 24 hours automatically.
To erase snapshots:
1. Press the ComWheel and select Reset Case from the Main Menu.
2. Select Reset Trends or Reset ALL, and choose YES.
As memory fills up, older snapshots are overwritten automatically.
5-11
Cardiocap/5 User’s Reference Manual—Anesthesia
Trends & Snapshot 1. Press the ComWheel and select Monitor Setup
from the Main Menu.
Snapshot
Field 1 ECG1/r 2. Select Install/Service and enter the password.
Field 2 ECG1 NO 3. Select Trends & Snapshot.
Field 3 ECG2 YES
4. Select Snapshot.
Field 4 P2
Field 5 P1+HR
5. Select Create on Alarms and choose YES.
Field 6 Num 1
Print Loops NO
Create on Alarms YES
Automatic Print NO
Previous Menu
Select YES to create a snapshot
automatically when Brady, Tachy
or ART High/Low alarm occurs.
5-12
Trends and Snapshots
5-13
Cardiocap/5 User’s Reference Manual—Anesthesia
5-14
Contents
Table of Figures
Figure 6-1. Inserting and removing a memory card............................................................................6-3
Figure 6-2. Marked events in trends .............................................................................................................6-6
Figure 6-3. Data from another site .................................................................................................................6-7
Patient Data Management
Overview
The Cardiocap/5 monitor continuously collects and saves patient data, such as trends.
Saving is activated when the monitor receives vital signs. With a single, stand-alone
monitor, you can add patient demographics and place markers on the trends.
The data management capabilities can be expanded if your monitor is connected to the
Datex-Ohmeda S/5 Network and Central or if you use memory cards to store and
transfer data.
Network options
The monitor can be equipped with the following options to enhance network and data
continuity capabilities in Datex-Ohmeda information systems:
N-XNET Network
N-XDNET Data card and Network
• The N-XNET option allows real-time information sharing between your
Cardiocap/5 and monitors that are connected to the same Datex-Ohmeda monitor
network (the Datex-Ohmeda S/5 Network and Central). When the monitor is
connected to the network, patient information is saved to the network computer.
The network offers the possibility of viewing real-time patient information, such as
alarms, from another monitoring site.
• The N-XDNET option offers the same capabilities as the N-XNET option and, in
addition, it allows you to load trend data from a Data card. With this option, you
can assure the continuity of patient data by gathering all previously-collected
information for a patient, then adding new information to the same patient file.
6-1
Cardiocap/5 User’s Reference Manual—Anesthesia
CAUTION: Do not subject memory cards to excessive heat, bending, or magnetic fields.
6-2
Patient Data Management
Insert the end of the card with the small connectors first. Push the card firmly into
place. The release button will come up. To remove the card, press the release button,
then pull the card out of its slot.
This symbol appears on the display to indicate that a memory card is
inserted. The “Data card inserted” or “Menu card inserted” message
appears in the message field of the display.
6-3
Cardiocap/5 User’s Reference Manual—Anesthesia
Resetting a case
At the beginning of a new procedure, you should erase the screen layout, trend data,
and all alarm and parameter settings of the previous case.
To reset a case:
Reset Case 1. Press the ComWheel and select Reset Case from
the Main Menu.
Reset Trends
2. Select Reset ALL and choose YES.
Reset ALL
Main Menu
Adding demographics
To add demographics:
1. Press the ComWheel and select Patient Data
Patient Data from the Main Menu.
Demographics
2. Select Demographics.
Height
3. Enter the patient’s height and weight.
Weight
BSA
Previous Menu
6-4
Patient Data Management
6-5
Cardiocap/5 User’s Reference Manual—Anesthesia
Marking events
During monitoring, you can place numbers beside the numerical trend to mark the
event.
To mark events:
1. Press the Trends key.
2. Select Take Snapshot.
The events are numbered from 1 to 16, depending on the data load. A number is
displayed beside the numerical trend information that was recorded at the time Take
Snapshot was selected.
Page 4 0f 4 T1 T2 SpO2
Mark Time T1 T2
12:25
12:30
12:35
1 12:39 38.8 20.0
12:40 38.8 20.0
2 12:43 38.8 20.0
12:45 38.8 20.0
6-6
Patient Data Management
9:18
aVR ECG
Show Signs Pacer 1 mV H Arrh.
More Waveforms
Black Room
hidden R
58 /min OFF
TCP 20 ICP mmHg mm
Blue Room (IU) 10 / S aVR 1.0
Eye OR1 0 ( ) T I -1.5
II 0.5 -1.5
Eye OR3 HR SpO2 NIBP Art CVP CO2 O2 AA
Mark Time sys/dia ET FI FI
Green Room 9:03 A mmHg
9:04
Gyn OR1
Gyn OR3
9:05
9:06
r
t 130/82
(93)
9:07
Heart OR1 9:08 S %
9:09 P
More Monitors 9:10
Previous Menu
Push ComWheel
9:11
9:12
9:13
0
2
%
97
9:14 C
to activate 9:15 O ET 5.0 FI 0.0
trend cursor. 9:16 2 RR
9:17 15 /min
Gases O2: NIBP Compl Raw Resp
O2% N2O% Des% mmHg Sys Dia ml/cmH2O cmH2O/l/s CO2
ET
FI
16 77 2.3
21 77 3.0 Mean
128/81
(93) Manual
55 8
15 /min
6-7
Cardiocap/5 User’s Reference Manual—Anesthesia
The sites from where the alarms are forwarded to your monitor are marked by a bell
next to the site name.
6-8
Contents
Table of Figures
Figure 7-1. Built-in recorder...............................................................................................................................7-1
Figure 7-2. Sample recording............................................................................................................................7-2
Figure 7-3. Numerical trend printout ...........................................................................................................7-6
Figure 7-4. Recorder paper replacement....................................................................................................7-8
Recording and Printing
Overview
You can record waveforms, values, and loops and print them to a laser printer that is
either connected to the monitor or accessible over the Datex-Ohmeda monitor network.
Recording and printing options are located in the Record/Print menu and its submenus.
• You can record or print just one loop or one view of trends from within the
corresponding measurement menu.
• You can record or print several pages, several parameters, or all gathered
information from the Record/Print menu.
3
5 4
NOTE: The two-button recorder (shown) is for Cardiocap/5 monitors using software
version 3.0 or higher. A one-button recorder was available previously.
(1) Record Waveform/Stop key. Press to start or stop recording selected real-time
waveforms. This key functions like the Record Start/Stop key on a one-button recorder.
(2) Record Trend/Stop key. Press to start or stop recording selected numerical or
graphical trend data. Since this key is not available on a one-button recorder, use
the Record/Print menu options to print trend data.
(3) Key to release and open the recorder paper compartment.
(4) Recorder paper.
(5) Recorder paper compartment.
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Cardiocap/5 User’s Reference Manual—Anesthesia
Recording waveforms
Date Time
Selected 3Apr01 10:24
ECG aVR
waveform 0.5mV/div
Recorder CO2 %
speed Speed: 12.5mm/s
Waveform 1 ECG1 1 3. Select Paper Speed and choose the speed you
prefer (1, 6.25, 12.5, or 25 mm/second).
Waveform 2 OFF 6.25
Waveform 3 OFF 12.5
Start on Alarms NO 25
Delay 12 s
Paper Speed 25 mm/s
Length 30 s
Previous Menu
7-2
Recording and Printing
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Cardiocap/5 User’s Reference Manual—Anesthesia
NOTE: When recording is activated by alarms, the recording time is always 30 seconds.
7-4
Recording and Printing
7-5
Cardiocap/5 User’s Reference Manual—Anesthesia
Recording trends
Adjust the parameter and time scales to record the desired level of trend detail.
3 Apr 2001
Either Sys/Dia or mean pressures are recorded, depending on the digit format selected
in the pressure setups.
7-6
Recording and Printing
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Cardiocap/5 User’s Reference Manual—Anesthesia
7-8
Recording and Printing
7-9
Cardiocap/5 User’s Reference Manual—Anesthesia
7-10
Contents
Chapter 8. Troubleshooting
Checklist ........................................................................... 8-1
General.............................................................................................................................................................8-1
ECG ....................................................................................................................................................................8-1
Impedance respiration............................................................................................................................8-1
Pulse oximetry .............................................................................................................................................8-2
Non-invasive blood pressure (NIBP) ..............................................................................................8-2
Invasive blood pressure .........................................................................................................................8-2
Temperature..................................................................................................................................................8-3
Airway gases .................................................................................................................................................8-3
Patient spirometry .....................................................................................................................................8-3
NeuroMuscular Transmission (NMT)...........................................................................................8-3
8. TROUBLESHOOTING
This chapter consists of three parts that should help you solve common monitoring
problems: Checklist, Messages, and Other situations.
Checklist
Check the following items to ensure you remember to make all essential preparations
before monitoring. They also help if problems occur during monitoring.
General
Check that
• The monitor has no visual defects, such as cracks or loose parts.
• The power cord is connected to an electrical wall outlet and to the monitor.
• The D-fend water trap is empty and properly pushed into its place (with F-MXG).
• The sampling line is connected to the monitor (with F-MXG).
• Patient connection cables are attached to the connectors so that the color coding on
the plug matches the color coding on the connector.
• Trends of the previous patient are erased.
• Alarm limits are suitable for the patient.
ECG
Check that
• Electrodes are positioned correctly, electrode gel is moist, and skin contact is good.
• Correct lead-wire set is selected (3-lead or 5-lead) and correct lead-wire type is
selected in the ECG Setup menu.
• Lead-wire set is properly connected to the ECG extension cable.
• ECG extension cable is plugged into the blue connector.
• Pacemaker selection in the ECG Setup menu is Show when a pacemaker is used.
• ECG is selected for display (Main Menu – Monitor Setup – Screen Setup).
Impedance respiration
Check that
• Electrodes are positioned correctly, electrode gel is moist, and skin contact is good.
• Correct lead-wire set is selected (either 3 or 5 lead) and correct lead-wire type is
selected in the ECG Setup menu.
• Lead-wire set is properly connected to the extension cable.
• ECG extension cable is plugged into the blue connector.
• Resp is selected for display (Main Menu – Monitor Setup – Screen Setup).
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Cardiocap/5 User’s Reference Manual—Anesthesia
Pulse oximetry
Check that
• Correct sensor is selected for the size of the patient and sensor is positioned correctly
on the patient.
• The sensor is completely dry after cleaning.
• Sensor cable is plugged into the gray connector and is properly connected to an
extension cable or sensor, as applicable.
• SpO2 is selected for display (Main Menu – Monitor Setup – Screen Setup).
8-2
Troubleshooting
Temperature
Check that
• You are using a Datex-Ohmeda temperature probe.
• Temperature probe is positioned correctly.
• Temperature probe is inserted properly into the appropriate temperature connector.
• Temperature is selected for display (Main Menu – Monitor Setup – Screen Setup).
Airway gases
Check that
• D-fend water trap is properly placed in the monitor.
• Water trap container is empty.
• A new sampling line is used after each patient.
• Sampling line is connected to the water trap and to the airway adapter.
• Monitor is turned on and self-check is performed with the sampling line attached.
• Humidification and/or bacteria filter is placed correctly.
• Breathing circuit or accessories are free of residuals from alcohol-based disinfectants.
• Desired gas parameter is selected for display (Main Menu – Monitor Setup – Screen Setup).
Patient spirometry
Check that
• Correct flow sensor is used (D-lite for adults and Pedi-lite for pediatrics).
• Correct flow sensor type is selected
(Main Menu – Parameters – Airway Gas – Spirometry Setup).
• Straight luer connectors of the spirometry tube are attached to the connector on the
monitor and the angled luer connectors are attached to the sensor.
• Spirometry tube is not kinked or squeezed.
• D-lite and spirometry tube are free of water drops.
• Humidification and/or bacteria filter is placed correctly.
• Desired spirometry parameter is selected for display
(Main Menu – Monitor Setup – Screen Setup).
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Cardiocap/5 User’s Reference Manual—Anesthesia
Messages
Message Explanation and/or Corrective Action
Acknowl. alarms silenced Acknowledged alarms are silenced. (Silence Alarms key pressed
during silencing period).
Air leakage Air leakage in NIBP cuff or hose. Check all connections and test
the cuff tightness using venous stasis.
Apnea No change detected in CO2 during the last 20 seconds.
(Impedance respiration) No change detected in impedance
respiration waveform for 20 seconds.
Apnea deactivated Apnea alarm is silenced until reactivation after five breaths.
Artifact(s) Unsuccessful NIBP measurement. Patient is moving, shivering, or
breathing deeply; also marked arrhythmia or irregular beats. Calm
the patient and start a new measurement.
Asystole Asystole, no QRS detected in ECG.
NOTE: This does not depend on the heart rate source.
Back-up batt. failure Backup battery is discharged or faulty. Use mains power for
4 hours, then switch to battery power. If the message reappears,
contact authorized service personnel.
Cable off NMT or regional block cable is not connected.
Calibrate Agent ID Agent identification error. Perform gas calibration.
Calibration not protected (NIBP) Contact authorized service personnel.
Calibration switch ON (NIBP) Calibration protection switch at the bottom of the monitor
is turned to the right. Contact authorized service personnel.
Call service: Error X NIBP hardware error. Note the error number (X) and contact
authorized service personnel.
Check D-fend Check that the water trap is properly attached.
Check SpO2 probe Pulse search active for 20 seconds but no acceptable pulse is
found. Either there is no detectable SpO2 signal, the sensor is
faulty, or it is detached from the patient.
Check stim. electrodes NMT stimulus current could not be delivered due to poor
stimulus electrode connection or damaged cable.
Control measurement NIBP alarm limit was exceeded and a new measurement was
started automatically.
Cuff loose NIBP cuff is loose or not attached to the patient. Hose is not
connected to the monitor.
Cuff occlusion Check NIBP cuff hose and tubes; restart measurement. If the
problem persists, contact qualified service personnel.
Cuff over-pressure NIBP cuff is squeezed during measurement and pressure safety
limits are exceeded.
EEPROM Error Faulty EEPROM circuit on the CPU board. Contact authorized
service personnel.
8-4
Troubleshooting
8-5
Cardiocap/5 User’s Reference Manual—Anesthesia
8-6
Troubleshooting
8-7
Cardiocap/5 User’s Reference Manual—Anesthesia
Other situations
Other problem situations which may occur during monitoring, with possible
explanations and instructions, are listed below.
8-8
Troubleshooting
8-9
Cardiocap/5 User’s Reference Manual—Anesthesia
8-10
Contents
Cleaning............................................................................ 9-3
Monitor ............................................................................................................................................................9-3
ECG cables .....................................................................................................................................................9-4
Pulse oximetry sensors ...........................................................................................................................9-4
NIBP cuff hose.............................................................................................................................................9-4
NIBP cuff.........................................................................................................................................................9-4
Cables for invasive pressure................................................................................................................9-4
Temperature probes .................................................................................................................................9-4
NMT sensor cable, sensors, and regional block adapter ...................................................9-5
Reusable D-lite sensor .............................................................................................................................9-5
Airway adapter............................................................................................................................................9-5
Sampling line................................................................................................................................................9-5
D-fend water trap .......................................................................................................................................9-5
Removing the water trap .........................................................................................................9-6
Other accessories .......................................................................................................................................9-6
Table of Figures
Figure 9-1. Emptying the water trap container ......................................................................................9-6
Maintenance and Cleaning
Introduction
For safe, reliable function and operation of the monitor, regular care has to be carried
out according to the instructions in this manual and the Planned Maintenance
procedures described in the Cardiocap/5 Technical Reference Manual.
If the monitor does not function as it should, and information in the Troubleshooting
chapter does not provide help, contact your sales representative. Do not perform
cleaning or maintenance procedures other than those described in the Cardiocap/5
manuals.
Preventive maintenance
Daily tasks
Check that all accessories, cables and monitor parts are clean and intact.
Clean the device as described in Cleaning later in this chapter.
Check the parameter items as directed below:
Pulse oximetry
Sensor functions when properly connected to the patient.
NIBP
Cuff hose detection (Adult/Infant) works properly.
Pump is not restarting in Venous Stasis mode. If it starts, there may be a leak in the cuff.
InvBP
The monitor recognizes the cable connection (activates the display) for all the pressure
channels used.
Zeroing of all transducers is working correctly.
Temperature
Measurement starts when a temperature probe is connected.
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Cardiocap/5 User’s Reference Manual—Anesthesia
Every month
Cooling fan dust filter
Check the fan filter on the rear panel of the monitor. Replace the filter if it is damaged.
Clean the fan filter every month or whenever needed:
1. Pull the filter out.
2. Wash in detergent solution.
3. Allow to dry before reinserting. Do not use pressurized air.
Every 12 months
Planned Maintenance check
The Planned Maintenance check detailed in the Technical Reference Manual requires
trained service person and appropriate testing tools and equipment.
9-2
Maintenance and Cleaning
Cleaning
The appropriate cleaning procedure depends on where and how the part or accessory
is used, and on the condition of the patient.
WARNING: Electrical Shock Hazard. Before cleaning, disconnect the monitor from the
electrical outlet.
WARNING: Electrical Shock Hazard. After cleaning, or if liquid has accidentally entered the
interior of the monitor, make sure that every part of the monitor is dry before reconnecting it
to the power supply.
CAUTION: Do not sterilize any part of the monitor with steam autoclave or ethylene oxide.
CAUTION: Do not immerse any part of the monitor in liquids or allow liquid to enter the interior.
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Cardiocap/5 User’s Reference Manual—Anesthesia
Monitor
To clean the monitor:
1. When the display surface becomes dusty, wipe it gently with absorbent cotton,
chamois or other soft material. The display may also be cleaned using a small
amount of normal hexane. Do not use acetone, toluene or alcohol because they
cause chemical damage to the polarizer.
2. Wipe the monitor with a mild detergent solution such as the Datex-Ohmeda
Cleaning Fluid. Do not leave liquid spills on any metal part.
3. Let dry completely before connecting to power source.
The internal sampling system does not need to be cleaned nor sterilized. The D-fend
water trap functions as a bacteria filter and there is no reverse flow to the patient.
ECG cables
Wipe the cables with a mild detergent solution. Disinfect when necessary.
Disposable sensors are for single-patient use only. Do not attempt to clean them.
For cleaning instructions and recommended cleaning agents for a reusable sensor,
consult the instructions for using that sensor.
Consider possible patient allergies when selecting the cleaning agent.
In general, to clean any reusable sensor or sensor cable, detach it from the patient and
the monitor. Wipe it with a pad moistened with a mild cleaning solution, such as 70%
isopropyl alcohol. Allow the sensor and/or cable to dry completely before use.
NIBP cuff
Clean only when necessary. Remove the bladder from the cuff. Wash the bladder and
the cuff in mild detergent solution. Do NOT use alcohol.
Temperature probes
Clean with a mild detergent solution and rinse with water. Disinfect or sterilize when
necessary.
9-4
Maintenance and Cleaning
Airway adapter
Replace the single-use adapter after each patient.
A reusable adapter can be disinfected with glutaraldehyde or alcohol. A reusable steel
adapter may be autoclaved.
If you want to clean the adapter before use, submerge it in 70% alcohol solution for 30
seconds and rinse carefully with water.
Rinse away all traces of alcohol or detergent. Dry the adapter before connecting to the
patient.
Sampling line
Do not reuse the sampling line. Attempting to clean and reuse a sampling line may
affect measurement results.
CAUTION: Do not disinfect or open the water trap cartridge. To avoid damage, do not touch or try
to clean the water trap hydrophobic membrane (other than to rinse it with water).
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Cardiocap/5 User’s Reference Manual—Anesthesia
Other accessories
See the accessory packages for checkout and cleaning instructions. Do not reuse
disposable accessories.
9-6
Contents
Table of Figures
Figure 10-1. ECG and HR display ................................................................................................................10-1
Figure 10-2. Standard electrode positioning with 3-lead set........................................................10-2
Figure 10-3. Modified electrode positioning, CB5, with 3-lead set..........................................10-2
Figure 10-4. Standard electrode positioning with 5-lead set........................................................10-3
Figure 10-5. ECG setup.......................................................................................................................................10-3
Figure 10-6. ST analysis view ......................................................................................................................10-10
Figure 10-7. ST number field .......................................................................................................................10-10
ECG
10. ECG
Overview
The electrocardiograph, ECG, reflects the electrical activity generated by the heart
muscle. ECG monitoring is used for heart rate measurement and to detect arrhythmias,
pacemaker function, and myocardial ischemia.
When you use a 5-lead set, you may monitor the waveforms of up to three different
ECG leads. When you use a 3-lead set, the monitor displays one ECG lead.
When monitoring ECG, the monitor simultaneously analyzes ST segment changes.
Changes of up to three different ECG leads are analyzed depending on your lead set.
16:48
aVR ECG 9
1 mV H
1
I
R
58
1 mV S aVR 2.8 II
2 T I –2.8
2.8 10
II 2.8
II 1 mV
3
13 12 11
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Cardiocap/5 User’s Reference Manual—Anesthesia
Patient connections
Patient preparation
Good signal quality requires good skin contact with the electrodes. Excessive body hair
or skin oil can affect the contact. Pre-gelled electrodes are recommended. Check that
the electrodes are moist and have not dried out during storage.
WARNING: Make sure the lead set clips or snaps do not touch any electrically conductive
material including earth.
Placing electrodes
When placing the electrodes, avoid bones close to the skin, obvious layers of fat, and
major muscles.
LEAD III
LEAD 2
GREEN (IEC) *
RED (AAMI)
* The color might be BLACK in some older cables.
You can use a CB5-lead when you want the 3-lead set connection to resemble the 5-lead
set V5 connection. The red (IEC standard) or white (AAMI standard) electrode, which
is shaded, is on the back.
RED (IEC)
WHITE (AAMI)
LEAD I
YELLOW (IEC)
BLACK (AAMI)
GREEN (IEC) *
RED (AAMI)
10-2
ECG
When you use routine positioning with a 5-lead set, place the chest electrode on one of
the six places indicated in the picture. If the lead set follows the IEC standard, the chest
electrode is white; if the set follows the AAMI standard, the chest electrode is brown.
1 2
3
4 5 6
Cable set
RED (IEC) YELLOW (IEC) RED (IEC) RED (IEC) YELLOW (IEC)
WHITE (AAMI) BLACK (AAMI) WHITE (AAMI) WHITE (AAMI) BLACK (AAMI)
LEAD I
LEAD III
1 2
LE LE 3
4 5 6
AD AD
II
I
GREEN (IEC) GREEN (IEC) YELLOW (IEC) BLACK (IEC) GREEN (IEC)
RED (AAMI) RED (AAMI) BLACK (AAMI) GREEN (AAMI) RED (AAMI)
WARNING: Patient Safety. Ensure proper contact of the return electrode of the
electrosurgery unit to your patient to avoid possible burns on the patient via ECG electrodes
and probes.
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Cardiocap/5 User’s Reference Manual—Anesthesia
10-4
ECG
ECG
ECG ECG Setup
ECG1 Lead II HR Source AUTO
ECG2 Lead I Display with HR None
ECG3 Lead I Filter STfilt
ECG Size 1.0 5-lead Cable 5elect
ST Analysis ECG Grid OFF
Beat Sound Volume 3 Pacemaker Hide
ECG Setup QRS Type Normal
ECG Alarms Previous Menu
Parameters Menu
HR Source Selects the heart rate source. When ECG is selected, the HR source is
always calculated from ECG 1. If the ECG signal is affected by too
much noise for a reliable heart rate calculation, heart rate can be
calculated from pressure (Art and ABP) or the plethysmographic pulse
waveform.
The selected heart rate source is shown above the numerical heart rate
display. The heart rate color is the same as the source parameter.
The AUTO selection priorities for heart rate calculation are: ECG,
Pressure (Art or ABP), and Plethysmographic pulse waveform. The
first heart rate source available is selected.
Display with HR Select PR to display combined Heart Rate and Pulse Rate next to the
ECG waveform. The current HR source is displayed in a larger font
size and the QRS symbol flashes next to the reading.
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Cardiocap/5 User’s Reference Manual—Anesthesia
Filter Filters the ECG signal high frequency noise and slow respiratory
artifacts. The selections are Monit, Diagn, and STfilt.
• Monit (monitor) filter is used in routine monitoring. It effectively
filters the high frequency artifacts caused by the electrosurgery
unit and respiration, for example.
• Diagn (diagnostic) filter is used if more accurate information of the
waveform is needed (e.g., of P-wave or AV block). The diagnostic
filter is more susceptible to both high frequencies and baseline
wander than the monitor filter.
• STfilt (ST filter) permits more accurate of ST segment information.
It filters the high frequency artifacts caused by an electrosurgery
unit but catches the slow changes in ST segment. The ST filter is
more susceptible to baseline wander than the monitor filter.
5-lead Cable This selection is visible only when a 5-lead trunk cable is connected to
the monitor. Select 5elect if you are using 5 electrodes or 3elect if you
are using 3 electrodes with the 5-lead trunk cable.
ECG Grid Selects a background to be shown on the ECG waveforms, making it
easier to evaluate the waveform. The grid scale is 0.5 mV.
Pacemaker Selects how the pacing pulse of a cardiac pacemaker is displayed. The
selections are Show, Hide, ON R and Sensit.
• Show—the pacer pulse is filtered away from ECG data but the pulse
is displayed as a constant height marker.
• Hide—the pacer pulse is filtered away from ECG data.
• ON R—pacer pulses are not filtered away from ECG data. This
improves ECG monitoring with A-V pacemaker patients, as QRS
complexes are counted even if the pacer pulse hits the QRS
complex. However, during asystole the monitor may count pacer
pulses as heart beats.
• Sensit—uses a more sensitive pacemaker detection. A pacemaker
spike is displayed on ECG.
QRS Type QRS detection and HR calculation may be affected by the shape of the
QRS complex. Normal QRS type detects a heart beat between 40 and
120 ms. Wide QRS type detects a beat between 40 and 220 ms.
10-6
ECG
Selecting a lead
The following lead selections are possible:
• With 3-lead set: I, II, III
• With 5-lead set: I, II, III, aVR, aVL, aVF and V5
To select the ECG1 lead:
1. Press the ECG key.
ECG
2. Select ECG1 Lead.
ECG1 Lead aVR
ECG2 Lead Casc. I You can select all the leads (ECG1, ECG2 and
ECG3) in the ECG menu.
ECG3 Lead Casc. II
ECG Size 1.0 III
ST Analysis aVL
Beat Sound Volume 3 aVF
ECG Setup aVR
ECG Alarms V
Parameters Menu
The label of the lead is displayed in the ECG field and above the numeric HR.
NOTE: It is possible to connect a 3-lead set to a 5-lead trunk cable. The combination
functions as a 3-lead set.
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Cardiocap/5 User’s Reference Manual—Anesthesia
10-8
ECG
ST segment analysis
The ST value illustrates the electrical activity difference between ISO points and
ST points. The points are based on R-wave detection.
Myocardial ischemia manifests itself in the ECG by causing the ST segment to deviate
from the isoelectric line (ISO point). The ST segment generally rises above the PQ
isoelectric line in the presence of transmural ischemia and is pressed below the
isoelectric line in the subendocardial ischemia. Ischemic heart disease may result in
myocardial infraction, fatal arrhythmias, or acute coronary insufficiency.
ST segment changes may also be affected by other factors than myocardial ischemia.
These factors can be, for example, drugs, or metabolic or conduction disturbances.
10-9
Cardiocap/5 User’s Reference Manual—Anesthesia
When the ST analysis view is accessed, the display shows three measured ECG leads
and an averaged QRS complex for each ECG lead. In addition, a graphic trend display
for each ECG lead is shown. Changing the lead causes a new learning of the ST
segment. The learning period is shown as a line in the trend display.
1 2 3
ECG
II
5
0.7
(1) ST view showing QRS complex average for each lead with ST and ISO point cursors
(2) Lead label, ST values
(3) ECG waveform area showing 3 ECG leads
(4) A trend of ST values of each selected lead
(5) Current ST values displayed continuously
1
(1) Message field
mm Learning
(2) The lead that has the largest absolute ST value
S II 0.9 II 2
T V5 0.0 (3) ST values of ECG1, ECG2, and ECG3
aVL 0.0 0.9
(4) Lead label
4 3
To do this:
1. Press the ComWheel and select Monitor Setup from the Main Menu.
2. Select Screen Setup.
3. Select Digit Fields.
10-10
ECG
aVR
2. Select ST Analysis.
2.8
3. Select Set ST point.
4. Set the ST point by turning the ComWheel. To confirm the
setting, press the ComWheel.
I
-2.8
II
2.8
Set ST point.
Push ComWheel
to confirm.
aVR
2. Select ST Analysis.
2.8
3. Select Set Set ISO point.
4. Set the ISO-point by turning the ComWheel. Confirm the
setting by pressing the ComWheel.
I
-2.8
II
2.8
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Cardiocap/5 User’s Reference Manual—Anesthesia
Pacemaker markers
The monitor detects and rejects pacemaker pulses (see the Pacemaker selection in the
ECG Setup menu). Sometimes this may lead to unnecessary asystole alarms.
NOTE: The pacemaker may change the shape of the QRS complex so much that QRS
detection may be affected.
WARNING: Patients with Pacemakers or Arrhythmias. The monitor may count pacemaker
pulses as heart beats during cardiac arrest, some arrhythmias, and with certain types of
pacemakers particularly in ON R mode. Do not rely entirely upon rate meter alarms. Keep
patients with pacemakers and arrhythmias under close surveillance.
10-12
ECG
1. Press the ComWheel and select Monitor Setup from the Main Menu.
2. Select Install/Service and enter the password.
3. Select Installation.
4. Select Analog Outputs.
For more information, refer to the Technical Reference Manual.
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Cardiocap/5 User’s Reference Manual—Anesthesia
10-14
Contents
Table of Figures
Figure 11-1. Respiration rate source indication for impedance and CO2 .......................... 11-1
Figure 11-2. Monitor display with impedance respiration measurement........................... 11-2
Figure 11-3. Impedance respiration waveform and respiration rate numeric value....11-2
Figure 11-4. Impedance respiration setup.............................................................................................. 11-3
Impedance Respiration
Overview
Impedance respiration is measured across the thorax. When the patient is breathing or
is ventilated, the volume of air changes in the lungs, resulting in impedance changes
between the electrodes. A respiration rate is calculated from these impedance changes,
and a respiration waveform is displayed on the monitor screen.
Respiration detection
The respiration rate is the sum of respirations that exceed the detection limit.
Imped.
The dotted lines are the zero line and the detection limit.
. . . . . . . The signal strength produced by a respiration should thus
% . . . . . . . exceed this minimum limit to be included in the respiration
rate calculation. Peaks within the grids are not calculated.
If AUTO detection mode is chosen, the grid lines are the minimum limits but the limits in
use may be larger. The RR value can include fewer respirations than indicated by the
gridline.
Imped. CO2
R R
e
s
p 20 /min
e
s
p 18 /min
Figure 11-1. Respiration rate source indication for impedance and CO2
The impedance respiration waveform is also displayed next to the RR value when the
RR value is calculated from CO2.
11-1
Cardiocap/5 User’s Reference Manual—Anesthesia
mm
58 /min
Casc.
1 mV S
T aVR 2.8
I -2.8
II 2.8 -2.8
Art244 mmHg
A
122
0
r
t 130/82
(93)
Pleth S %
p
O
2
97
Imped.
R CO2
e
s
p
15 /min
%
CO2 5 C
O ET
2
5.0 RR
0 FI 0.0 15/min
Gases NIBP T1 P2
O2% N2O% Des% mmHg Sys Dia C mmHg Contrl
ET 16 77 2.3
128/81 T1 38.8 (50)
FI 21 77 3.0 Mean (93) Manual 60/45
Figure 11-3. Impedance respiration waveform and respiration rate numeric value
11-2
Impedance Respiration
Patient connections
The setup for impedance respiration is the same as for ECG measurement. If you do
not have the ECG setup, see Patient connections in the ECG chapter.
You can use 3-lead or 5-lead ECG sets.
LEAD I
LEAD III
1 2
LE LE 3
4 5 6
AD AD
II
I
GREEN (IEC) GREEN (IEC) YELLOW (IEC) BLACK (IEC) GREEN (IEC)
RED (AAMI) RED (AAMI) BLACK (AAMI) GREEN (AAMI) RED (AAMI)
WARNING: Patient Safety. Ensure proper contact of the return electrode of the
electrosurgery unit to avoid possible burns at sensor sites.
WARNING: Make sure that the lead set clips or snaps do not touch any electrically
conductive material including earth.
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Cardiocap/5 User’s Reference Manual—Anesthesia
Select ON to enable
impedance respiration
measurement.
11-4
Impedance Respiration
1 mm
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Cardiocap/5 User’s Reference Manual—Anesthesia
Measurement limitations
Movement artifacts
Changing the patient position, moving the head or the arms, or shaking will result in
movement artifacts. Also, the heart may cause noticeable movement and sometimes
this may interfere with the respiration measurement.
Electrical interference
Electrical devices that emit electromagnetic disturbance, such as electrosurgery units
and infrared heaters, will result in artifacts or may disable the respiration measurement.
Pacemaker patients
WARNING: Pacemaker Patients. The impedance respiration measurement may cause rate
changes in Minute Ventilation Rate Responsive Pacemakers. Set the pacemaker rate
responsive mode off or turn the impedance respiration measurement off on the monitor.
11-6
Contents
Table of Figures
Figure 12-1. Display of SpO2 value and Pleth waveform ............................................................. 12-2
Pulse Oximetry
Overview
Oxygen saturation (SpO2) is the percentage of saturated hemoglobin compared to total
hemoglobin as measured by a two-wavelength pulse oximeter (also called functional or
in vivo oxygen saturation).
SpO2 is measured with light absorption techniques: red and infrared light are emitted
from the emitter side of the sensor. The light is partly absorbed when it passes through
the monitored tissue. The amount of transmitted light is detected in the detector side of
the sensor. When the pulsative part of the light signal is examined, the amount of light
absorbed by arterial hemoglobin is discovered and the saturation level is calculated.
The plethysmographic pulse wave is derived from variations of the intensity of the
transmitted light. It reflects the blood pulsation at the measuring site. Thus, the
amplitude of the waveform reflects the perfusion.
NOTE: See the pulse oximetry product specifications in chapter 1 for more details.
Nellcor® sensors
Use the sensors listed below with the N-XNSAT option (* indicates latex-free).
Oxygen Transducer Name Patient Type Order Number SpO2 Accuracy (± 1 SD)
Oxisensor® II Adult D-25 * / D-25L *
Pediatric D-20 * 70-100% ± 2 digits
Infant I-20 / I-20LF *
Adult Nasal R-15 80-100% ± 3.5 digits
OxiCliq® Adult A*
Pediatric P* 70-100% ± 2.5 digits
Infant I
Durasensor® II Adult DS-100A *
Dura-Y® II Multisite Adult, Pediatric, Infant D-YS 70-100% ± 3 digits
Oxiband® II Pediatric, Infant OXI-P/I *
12-1
Cardiocap/5 User’s Reference Manual—Anesthesia
2 Pleth 5 S %
p
O
2
97 3
12-2
Pulse Oximetry
Menu selections
Pleth Scale The scale of the plethysmographic waveform display is set
automatically during “Pulse search.” To adjust it further,
select 2, 5, 10, 20, 50, or AUTO.
NOTE: This selection is not available for the N-XNSAT or N-XOSAT
options, both of which are preset to AUTO.
When AUTO scaling is used, the scale changes automatically if the
amplitude of the pleth waveform exceeds the current scale or falls
below the maximum value of the next lower scale by 10% for
30 seconds or more. When the scale changes, the “Scale changed”
message is displayed.
The scale indicator number appears at the left of the waveform.
SpO2 Response Selects the SpO2 averaging time: b-to-b (beat to beat), Normal
(10 seconds), or Slow: (20 seconds, the default setting).
NOTE: This selection is not available for the N-XNSAT option,
which is preset to 5–7 seconds, or for the N-XOSAT option, which is
preset to 12 seconds.
Beat Sound Volume Adjusts the SpO2 beat volume. This adjustment also affects the ECG
beat volume.
When SpO2 is monitored, the tone of the pulse beep rises as oxygen
saturation increases and falls as it decreases.
HR Source Selects the heart rate source. If the ECG signal is affected by too
much noise for a reliable heart rate calculation, the heart rate can
also be calculated from the invasive pressure (Art) or from the
plethysmographic pulse waveform (Pleth).
The selected heart rate source is shown above the numerical display
of the heart rate. The color of the heart rate is the same as the source
parameter.
If AUTO is selected, the heart rate calculation priorities are:
ECG (the lead with the highest R-wave), invasive pressure (Art), then
Plethysmographic pulse waveform (Pleth).
SpO2 Alarm Select to adjust the SpO2 alarm limits as described in the Alarms
chapter.
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Cardiocap/5 User’s Reference Manual—Anesthesia
Patient connections
Selecting the sensor
Choose a sensor that is appropriate for the patient and the monitoring requirements.
Sensors are categorized as reusable (durable) or disposable (single-patient use).
Examples of both types are shown and described below.
O O
Adhesive sensor with integrated cable; wraps
around a finger or toe.
Adhesive sensor with integrated cable. The sensor
is positioned inside tape that is wrapped around
the site to hold the sensor in place. This sensor is
used on fingers, toes, and the fleshy part of a hand
or foot, depending on the patient.
A finger sensor is usually appropriate for short-term patient monitoring. For long-term
monitoring, a single-patient, disposable sensor or a wrap-type sensor is commonly used.
WARNING: Patient safety. Use clean and dry sensors and cables only. Moisture and debris
on connectors may affect measurement accuracy.
Choosing a site
Site selection depends on the type of sensor and the weight of the patient. When
choosing a site for a sensor, refer to the instructions for that sensor.
Choose a well-perfused site on a nondominant hand or foot, or the fleshy upper or
lower part of the ear when using an ear sensor.
• Clean the application site you choose, if necessary.
• Finger or toe—remove nail polish and artificial fingernails; clip long fingernails.
• Ear—remove earrings.
12-4
Pulse Oximetry
1. Connect the sensor (or sensor extension cable) to the SpO2 connector on the monitor.
Monitor Connections
Datex-Ohmeda standard
pulse oximetry
Datex-Ohmeda enhanced
pulse oximetry
(N-XOSAT)
Cable Connections
3. Position the sensor and attach it to the patient. For proper sensor positioning and
application, consult the instructions that accompany the sensor.
4. To minimize movement, attach the sensor cable to the wrist or bed clothes.
The “Pulse search” message appears. After the pulse search is completed, the
plethysmographic pulse waveform and the SpO2 reading appear on the screen.
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Cardiocap/5 User’s Reference Manual—Anesthesia
During monitoring
WARNING: Patient safety. Do not use a pulse oximeter with magnetic resonance imaging
(MRI).
WARNING: Patient safety. A damaged sensor or a sensor soaked in liquid may cause burns
during electrosurgery.
Patient condition or prolonged use may require changing the sensor site periodically.
Check skin integrity, circulatory status, and correct alignment.
For patients with poor peripheral blood circulation, change the site at intervals of 30
minutes to one hour. To confirm the circulatory status, observe the size of the
plethysmographic waveform with a fixed pleth scale.
Be especially careful when monitoring infants.
Measurement limitations
Use Cardiocap/5 pulse oximetry only for patients weighing 5 kg (11 lb.) or more, even
if the SpO2 sensor can be used for patients weighing less than 5 kg.
Interfering substances
WARNING: Data validity. Conditions that may cause inaccurate readings and impact alarms
include interfering substances, excessive ambient light, electrical interference, ventricular
septal defects (VSD), excessive motion, low perfusion, low signal strength, incorrect sensor
placement, poor sensor fit, and/or movement of the sensor on the patient.
12-6
Contents
Table of Figures
Figure 13-1. NIBP digit field display.......................................................................................................... 13-1
Figure 13-2. Cuff positioning.......................................................................................................................... 13-2
Non-Invasive Blood Pressure (NIBP)
Overview
The non-invasive blood pressure (NIBP) measurement uses the oscillometric measuring
principle. The cuff is inflated with a pressure slightly higher than the presumed systolic
pressure, then slowly deflated at a speed based on the patient’s heart rate, collecting
data from the oscillations produced by the pulsating artery. Based on this data, the unit
calculates values for systolic, mean and diastolic pressures.
The measurement can be used for adults, children and infants. The monitor
automatically recognizes the type of cuff hose (black hose for adults and children,
white hose for infants) used for each patient type at the beginning of each
measurement.
It is possible to set an automatic cycling mode to make measurements at desired time
intervals. It is also possible to measure NIBP continuously for five minutes in STAT
mode or take separate single measurements.
NIBP display
NIBP can be displayed in the digit field:
1 NIBP
mmHg Sys Dia
2
Mean
128/81(91) 0 5 min
3 4 5
(1) Label
(2) Systolic and diastolic pressure value of non-invasive blood pressure
(3) Mean pressure value of NIBP
(4) Time since the last autocycle measurement
(5) NIBP autocycle time indicator
13-1
Cardiocap/5 User’s Reference Manual—Anesthesia
Patient connections
13-2
Non-Invasive Blood Pressure (NIBP)
Ready Prompt Gives an audible tone when the NIBP measurement is ready. Adjust
the volume of the beep tone from 1 (silent) to 10 (loud), or to 0 (OFF).
Inflation Limits The selections are: Infant, Child, Adult, and AUTO.
When the selection is AUTO (default), the monitor automatically
identifies the cuff hose and selects the right inflation pressure and
alarm limits. The Child selection decreases the maximum inflation
pressure to 200 mmHg when using adult hoses/cuffs.
NOTE:
• When using infant cuffs, the white infant cuff hose must be used.
The Child selection increases the maximum inflation pressure to
200 mmHg when using infant hoses/cuffs.
• When using very large adult cuffs, use Adult limits to prevent a
“Cuff loose” message from appearing.
Calibration Check Enables a calibration check using an external manometer (see below).
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Cardiocap/5 User’s Reference Manual—Anesthesia
In the beginning of the measurement, the sys and dia labels are replaced with the
inflation limit indication (adult, child, infant) for five seconds. The cuff pressure will be
displayed in the mean pressure value field.
If motion artifacts are detected, the monitor automatically holds deflation until the
motion stops (maximum of 30 seconds). If the artifacts prevent proper measurement, a
new measurement is automatically started.
When the measurement is ready, a short beep appears and result numbers flash.
WARNING: The monitor sets the inflation pressure automatically according to the first
measurement. Reset the case to reset the inflation limit before measuring a new patient.
During measurement
Observe the cuffed limb frequently. Measurement may impair blood circulation.
Make sure that the tubing is not bent, pressed or stretched. Otherwise, measurement
may be impaired.
Canceling a measurement
To cancel any measurement, press the NIBP Start/Cancel key.
13-4
Non-Invasive Blood Pressure (NIBP)
Autocycling
It is possible to set automatic NIBP measurement On and Off at selected intervals.
Autocycling is synchronized to real time. For example, if the first measurement is at
12:02 with a 5-minute cycle time, the next measurement will be at 12:05 and again at
12:10, 12:15, etc.
Starting/stopping autocycling
• To start autocycling, press the NIBP key and select Start Cycling.
The bar at the bottom of the NIBP display shows the
remaining time until the next measurement.
• To stop autocycling:
Press the NIBP key and select Stop Cycling.
or
If you wish to cancel the present measurement but start a new one after the
selected interval time, press the NIBP Start/Cancel key.
13-5
Cardiocap/5 User’s Reference Manual—Anesthesia
The pressurization time is displayed in the NIBP field and STASIS flashes during the
last 15 seconds.
• To release the pressure before two minutes has expired, press the NIBP Start/Cancel
key before two minutes has expired.
13-6
Contents
Table of Figures
Figure 14-1. Top: Separated waveforms
Bottom: Waveforms combined in several fields ................................................... 14-1
Figure 14-2. Invasive blood pressure setup............................................................................................ 14-2
Figure 14-3. Position of Swan-Ganz catheter in pulmonary artery and
Pressure waveforms from balloon-tipped pulmonary
catheter during insertion...................................................................................................... 14-7
Invasive Blood Pressure
Overview
The Cardiocap 5 monitor with the Invasive Pressures option (N-XP) enables you to
measure and monitor two invasive blood pressures at the same time.
During the invasive blood pressure measurement, the transducer converts the pressure
variations into electrical signals. The electrical signals are amplified and displayed as
numeric pressure values and waveforms.
WARNING: All invasive procedures involve risks to the patient. Use aseptic technique. Follow
catheter manufacturer’s instructions.
2 3
Art 240
4 5
CVP 50
mmHg
A
r
t
130/82
(93)
1 120 25
mmHg
C
0
V
P
(14)
0 25/12
2 3
4 5
Art 240 CVP 50
mmHg
A
r
t
130/82
(93)
1 120 25
mmHg
C
0
V
P
(14)
0 25/12
(1) Invasive blood pressure waveforms with zero and reference lines
(2) Selected pressure label
(3) Selected pressure scale
(4) Field for messages and alarm limit settings
(5) Systolic, diastolic and mean pressure values of invasive blood pressures
14-1
Cardiocap/5 User’s Reference Manual—Anesthesia
1
Disposable
3
Disposable
Reusable
WARNING: Mechanical shock to invasive blood pressure transducer may cause severe shifts
in zero balance and calibration, and cause erroneous readings.
WARNING: Patient Safety: Ensure proper contact of the return electrode of the
electrosurgery unit to your patient to avoid possible burns at sensor sites.
WARNING: Make sure that no part of the patient connections touches any electrically
conductive material including earth.
14-2
Invasive Blood Pressure
Patient connections
Do the connections as follows:
1. Connect the pressure transducer to the transducer cable and the cable to the
monitor’s red connector.
2. Prepare the transducer kit according to the manufacturer’s instructions. Mount the
kit with the transducer zeroing port at mid-heart level.
3. Ensure that there is no air in the transducer dome or in the catheter line. Refer to
transducer manufacturer’s instructions on how to remove trapped air from the
transducer.
4. Connect the patient catheter to the pressure line.
5. Open the dome stopcock to room air.
6. Zero the transducer. See Starting with accurate values later in this chapter.
7. Open the dome stopcock to pressure catheter and check the quality of the
waveform.
Zero P2 ‘CVP’
Wedge Pressure
P1 ‘Art’ Setup
P2 ‘CVP’ Setup
Ventilation Mode Contrl
Parameters Menu
Wedge Pressure Used for Pulmonary Capillary Wedge Pressure Measurement (PCWP).
See Measuring Pulmonary Capillary Wedge Pressure later in this chapter.
P 1 ‘Art’ Setup and P2 ‘CVP’ Setup
Used to set the label, scale, and other attributes of the P1 or P2 channel.
See Invasive line setup.
Ventilation Mode Respiration causes artifacts in invasive pressures. The artifact is
smallest at the end of expiration. You can select Spont for spontaneous
respiration or Contrl for controlled ventilation.
14-3
Cardiocap/5 User’s Reference Manual—Anesthesia
14-4
Invasive Blood Pressure
LABEL P1, Art, ABP P2, CVP RAP, LAP ICP PA RVP
Scale 200 20 20 20 60 60
Digit Format Sys/Dia Mean Mean CPP Sys/Dia Sys/Dia
Filter 22 9 9 9 9 9
Alarm source Sys off off off off off
Color Red Blue White White Yellow White
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Cardiocap/5 User’s Reference Manual—Anesthesia
The “Zeroing” message is displayed during the zeroing process. After the transducer
has been zeroed, the “Zeroed” message appears in the digit field.
After each channel has been zeroed, the time when zeroing occurred appears in the
menu.
NOTE: Check the zero level after power interruptions.
14-6
Invasive Blood Pressure
PA
PCWP
20
RA
RV 0
The speed of the waveforms in the Wedge Pressure menu is 12.5 mm/s.
NOTE: During wedge pressure measurement, PA values are not trended and PA alarms
are disabled.
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Cardiocap/5 User’s Reference Manual—Anesthesia
6. Inflate the catheter balloon when the “Inflate the balloon” message is displayed in
the PA waveform field.
The monitor searches the end expiratory mean pressure value. The pressure is
displayed in the waveform field and menu. After 20 seconds, the waveform is
automatically frozen and the “Deflate the balloon” message is displayed.
7. Deflate the balloon when the “Deflate the balloon” message is displayed in the PA
waveform field.
The pressure waveform will stay frozen until you accept the PCWP level.
8. Adjust the PCWP level by turning the ComWheel. Press the ComWheel to accept
the PCWP level that represents the true PCWP level.
After accepting the PCWP level, normal pressure monitoring continues.
14-8
Invasive Blood Pressure
NOTE: You can also manually freeze the waveform before 20 seconds has elapsed by
selecting Freeze/Adjust.
Adjusting PCWP
To manually adjust the PCWP pressure level:
1. In the Wedge menu, select Freeze/Adjust.
2. Turn the ComWheel to move the cursor to a point on the waveform that represents
the true PCWP level.
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Cardiocap/5 User’s Reference Manual—Anesthesia
14-10
Contents
Table of Figures
Figure 15-1. Temperature digit display .................................................................................................... 15-1
Figure 15-2. Temperature setup.................................................................................................................... 15-1
Temperature
15. TEMPERATURE
Overview
You can use Datex-Ohmeda temperature probes to measure esophageal,
nasopharyngeal, rectal, and skin temperature, for example.
Monitoring perioperative body temperature is recommended when inducing
hypothermia or if unexpected temperature changes occur.
WARNING: Patient Safety. To prevent patient injury, use only Datex-Ohmeda temperature
probes.
Temperature display
1 2
T1
ºC
T1
38.8
Figure 15-1. Temperature digit display
(1) Label
(2) Temperature measurement value
Patient connections
15-1
Cardiocap/5 User’s Reference Manual—Anesthesia
Temperature menu
You can change the label of the temperature measurement site, the temperature units,
and set temperature alarms in the Temp Setup menu.
NOTE; The Temp Alarms selection in the Temp Setup menu opens a menu in which you
can adjust the temperature alarm limits. For instructions, see the Alarms chapter.
Temp Setup
T1 Label Naso
T2 Label T2 T1
Unit °C Eso
Temp Alarms Naso
Parameters Menu Tymp
Rect
Blad
Axil
Skin
-More-
4. Select the label you wish to use for the temperature measurement site:
Eso Esophageal temperature Skin Skin temperature
Naso Nasopharyngeal temperature AirW Airway temperature
Tymp Tympanic temperature Room Room temperature
Rect Rectal temperature Myo Myocardial temperature
Blad Bladder temperature Core Core temperature
Axil Axillary temperature Surf Surface temperature
15-2
Contents
Table of Figures
Figure 16-1. Airway gas waveform display............................................................................................16-1
Figure 16-2. Lower digit field for gases ....................................................................................................16-1
Figure 16-3. Airway gases setup....................................................................................................................16-2
Figure 16-4. Normal endotracheal intubation......................................................................................16-3
Figure 16-5. Tracheostomy...............................................................................................................................16-3
Figure 16-6. Mask ventilation.........................................................................................................................16-4
Figure 16-7. Endotracheal intubation of pediatric patients .........................................................16-4
Figure 16-8. Gas return to patient circuit through ventilator reservoir.................................16-5
Figure 16-9. Gas return to patient circuit in AS/3 ADU .................................................................16-5
Figure 16-10. Connection directly to a scavenging system...........................................................16-6
Figure 16-11. Attaching the regulator to the gas container .......................................................16-13
Figure 16-12. Connecting a sampling line to the gas valve and feeding gas...................16-14
Airway Gases
Overview
With the Datex-Ohmeda Cardiocap/5, you can measure and monitor the gases delivered
to an anesthetized patient and exhaled by the patient through the anesthesia circuit.
Respiratory rate is the frequency of peak (end tidal) CO2 measurements per minute. A
breath is defined as a change in the CO2 signal that exceeds 1% (8 mmHg). All
concentrations are measured and displayed breath by breath.
Display of gases
2 3 4 5 6
CO2 5 C %
O ET 5.0 FI 0.0
7
2
0 RR 15/min
O2 21 O %
2 ET 16 FI 21
1 16 FI-ET 5.0
Enf 5.0 E % 3
n ET 2.3 FI 3.0
f
2.0 MAC 0.8 8
0
Gases
O2% N2O% Enf%
ET 16 77 2.3
FI 21 77 3.0
Agent mixture
During an agent mixture situation, the “Agent mixture” message appears in the lower
digit field for gases. The labels of both agents and their concentrations are displayed.
16-1
Cardiocap/5 User’s Reference Manual—Anesthesia
Patient connections
CAUTION: Keep the monitor horizontal. Tilting the monitor may cause erroneous results in the
readings and damage the monitor.
CAUTION: Use only cables and accessories approved by Datex-Ohmeda. Other cables and
accessories may damage the system or interfere with measurement. Single-use accessories are
not designed to be reused.
1
4
(1) Gas sampling line (3) Airway adapter with sampling line connector
(2) Y-piece (4) Heat and moisture exchanger with filter HMEF
6. Connect the sampling line to the patient’s airway adapter. Position the adapter’s
sampling port upwards to prevent condensed water from entering the sampling line.
16-2
Airway Gases
NOTE: If you are administering medication using a nebulizer, disconnect the HMEF
and airway adapter while the nebulizer is in use.
CAUTION: Remove the airway sampling line from the patient airway while nebulized medications
are being delivered.
16-3
Cardiocap/5 User’s Reference Manual—Anesthesia
(1) Mask
(2) Bacteria filter
(3) Airway adapter
16-4
Airway Gases
If you use the Datex-Ohmeda AS/3 Anesthesia Delivery Unit (ADU), connect an
optional adapter (881644, 5/pkg) to the patient breathing tubes.
16-5
Cardiocap/5 User’s Reference Manual—Anesthesia
CAUTION: Strong scavenging suction may change the operating pressure of the monitor and
cause inaccurate readings or internal damage.
16-6
Airway Gases
CO2 setup
1. Press the ComWheel and select Parameters from the Main Menu.
2. Select Airway Gas.
3. Select CO2 Setup.
Airway Gas
CO2 Setup
Scale 6%
Resp Rate Source AUTO 6%
CO2 Alarm 10%
Resp Rate Alarm 15%
Previous Menu 20%
16-7
Cardiocap/5 User’s Reference Manual—Anesthesia
O2 setup
To open the O2 Setup menu:
1. Press the ComWheel and select Parameters from the Main Menu.
2. Select Airway Gas.
3. Select O2 Setup.
Airway Gas
O2 Setup
Scale DIFF6
Measurement ON DIFF6
O2 Alarm DIFF10
Previous Menu DIFF15
DIFF30
10-60%
100%
16-8
Airway Gases
N2O setup
NOTE: N2O and Agent adjustments are made in the same menu. To adjust for agent
measurement, see Agent setup later in this chapter.
To open the Agent/N2O setup menu:
1. Press the ComWheel and select Parameters from the Main Menu.
2. Select Airway Gas.
3. Select Agent/N2O Setup.
4. Select N2O Measurement and choose ON or OFF.
Airway Gas
Agent/N2O Setup
Agent Scale 10 %
Agent Measurement ON ON
N2O Measurement ON OFF
Agent Alarm
Previous Menu
If OFF is selected, this symbol is displayed in the digit field and the
“Measurement OFF” message is displayed in the N2O waveform field.
16-9
Cardiocap/5 User’s Reference Manual—Anesthesia
Agent setup
NOTE: Agent and N2O adjustments are made in the same menu. To adjust for N2O
measurement, see N2O setup earlier in this chapter.
To open the Agent/N2O Setup menu:
1. Press the ComWheel and select Parameters from the Main Menu.
2. Select Airway Gas.
3. Select Agent/N2O Setup.
Airway Gas
Agent/N2O Setup
Agent Scale 5%
Agent Measurement ON 1.2%
N2O Measurement ON 2.5%
Agent Alarm 5%
Previous Menu 10%
20%
4. To select the anesthetic agent waveform scale, select Agent Scale and choose
0 - 1.2%, 0 - 2.5%, 0 - 5%, 0 - 10% or 0 - 20%.
Scale 0 - 1.2% is used with concentrations < 1%. Scales 0 - 2.5% and 0 - 5% are
normal scales, 0 - 5% being used in induction, for example. The maximum scale is
0 - 20%.
5. Select Agent Measurement and choose ON or OFF.
You can turn off agent measurement when no agent alarms or digit information is
desired.
If OFF is selected, this symbol is displayed in the digit field and the
“Measurement OFF” message is displayed in the agent waveform field.
6. Select Agent Alarm to open the Agent Alarms Adjustment menu where you can
change agent alarms.
16-10
Airway Gases
MAC values
To display the MAC value on the screen:
1. Press the ComWheel and select Monitor Setup from the Main Menu.
2. Select Screen Setup.
3. Select Digit Fields.
4. Select one of the lower digit fields and choose MAC.
1 MAC (Minimum Alveolar Concentration) is the alveolar concentration (end-tidal) of
the agent at which 50% of individuals fail to move in response to a noxious stimulus,
such as a surgical incision.
WARNING: MAC values are empirical, not absolute. Cardiocap/5 MAC values correspond to
those of healthy adults and cannot be applied to children. Age and other individual factors
influencing the effect of volatile agents are not taken into account.
%(EtAA) %EtN 2O
MAC( AA) = +
x( AA) 100
where x(AA) is Hal=0.75%, Enf=1.7%, Iso=1.15%, Sev=2.05%, Des=6.0%
1) Quasha AL. Eger EI II, Tinker JH. Determination and application of MAC.
Anesthesiology 1980; 53: 315.
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Cardiocap/5 User’s Reference Manual—Anesthesia
Agent mixtures
The agent identification warns you if a mixture of anesthetic agents is detected. The
mixture warning is activated at the latest when the concentration of the minor agent is
greater than 0.3 vol% and more than 15% of the total anesthetic agent concentration.
When a mixed agent is detected, the “Agent mixture” message is displayed and an
audible alarm sounds. The message remains active as long as the situation persists.
When there is an agent mixture, the anesthetic agent concentrations and labels of two
anesthetic agents are displayed.
When changing the anesthetic agent, the monitor will detect an agent mixture until the
first agent is washed out of the patient and the circuit. When the second agent begins to
dominate, the measurement is based on the new agent. The “Agent mixture” message
disappears when the concentration of the first agent becomes insignificant. When this
event occurs, the exact limits depend on the mixture of agents.
16-12
Airway Gases
Gas calibration
Perform a gas calibration every six months or whenever there are indications of errors
in the gas readings. The time of the last calibration is shown at the bottom of the Gas
Calibration menu.
Calibration is not available during the first five minutes of monitoring and during a gas
sampling warning.
NOTE:
• During gas calibration, % units are always used for CO2 regardless of selected
measuring units.
• Anesthetic agent is always calibrated with Desflurane.
Equipment and use
• Use only Datex-Ohmeda calibration gas to calibrate the gas measurement.
Otherwise, the calibration will not succeed.
• The calibration gas container may be used until the pressure indicator reaches the
red zone.
• If separate gas containers are used, each gas must be calibrated separately.
• If you use an older brass regulator, the feeding pressure should be adjusted
between 5 and 7 psi. The use of an old regulator with the new aerosol containers
requires an adapter available from Datex-Ohmeda. For ordering details see the
Datex-Ohmeda Supplies and Accessories Catalog.
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Cardiocap/5 User’s Reference Manual—Anesthesia
3. Attach a new sampling line to the water trap. Connect the loose end of the
sampling line to the regulator on the gas container.
Figure 16-12. Connecting a sampling line to the gas valve and feeding gas
4. Press the ComWheel and select Parameters from the Main Menu.
5. Select Airway Gas.
The Gas Calibration selection remains gray (inactive) until the “Calibrating gas
sensor” message is no longer displayed.
6. Select Gas Calibration.
Airway Gas
Airway Gas Gas Calibration
7. Wait until the “Zero ok” and then “Feed gas” messages appear on the screen after
each gas.
If the “Zero error” message is displayed, press the Normal Screen key and repeat the
calibration procedure. If the problem persists, contact authorized service
personnel.
16-14
Airway Gases
8. Open the regulator and feed the calibration gas until “Adjust” appears, then close
the valve.
NOTE: When the monitor is in automatic agent ID mode and it detects a calibration
gas and no anesthetic agent (from Datex-Ohmeda Quick Cal calibration gas, for
example), the “Cal gas found” message appears. If the identification sensor fails,
the “Agent id inop” message will be displayed.
9. Check that the displayed gas values match the values on the calibration gas
container.
Calibration adjustments
Calibration adjustments may be required if the gas values displayed during calibration
do not match the values on the calibration gas container.
If adjustments are required:
Last calibration:
––– 0
—
Adjust values to match
calibration gas.
Autozeroing intervals
Autozeroing intervals after startup are: 5 minutes, 5 minutes, 5 minutes, 15 minutes,
15 minutes, 15 minutes, and every hour thereafter. Autozeroing may also occur after
agent selection.
Interfering gases
Known effects of gases NOT MEASURED by the monitor:
Helium (He) Affects the CO2 measurement, decreases the CO2 readings.
For example:
5% CO2, 30% O2, balance He: CO2 reading decreases 8.5% relative.
Nitrogen (N2) The monitor compensates for the effect of nitrogen in the gas
measurement. Nitrogen is used as the balance gas in gas measurement.
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Cardiocap/5 User’s Reference Manual—Anesthesia
Unit conversions
Relationship between gas concentration and its partial pressure:
Reading in mmHg (dry gas) =
(ambient pressure in mmHg * gas concentration in %) / 100.
Reading in mmHg (water vapor saturated gas) =
[(ambient pressure in mmHg – 47 mmHg) * gas concentration in %] / 100.
Reading in kPa (dry gas) =
(ambient pressure in mmHg * gas concentration in % ) / 750.
Reading in kPa (water vapor saturated gas) =
[(ambient pressure in mmHg – 47 mmHg) * gas concentration in %] / 750.
NOTE: 47 mmHg is the partial pressure of the saturated water vapor at 37oC.
Changing units
To change the CO2 measurement unit:
1. Press the ComWheel and select Monitor Setup from the Main Menu.
2. Select Install/Service and enter the password.
3. Select Installation.
4. Select Units.
5. Select Parameters.
6. Select CO2 and choose the unit (%, kPa, or mmHg).
To change a color:
1. Press the ComWheel and select Monitor Setup from the Main Menu.
2. Select Install/Service and enter the password.
3. Select Colors.
4. Select Gases and choose the color.
16-16
Contents
Table of Figures
Figure 17-1. Patient spirometry waveform display........................................................................... 17-2
Figure 17-2. Digit fields for Paw, Paw + TV, Flow, and Compl. + Raw................................. 17-3
Figure 17-3. Spiro1 (left) and Spiro2 (right) split screen options.............................................. 17-3
Figure 17-4. Patient spirometry setup ....................................................................................................... 17-4
Figure 17-5. Connector positioning............................................................................................................ 17-4
Figure 17-6. D-lite sensor ..................................................................................................................................17-5
Figure 17-7. Pedi-lite sensor............................................................................................................................17-5
Figure 17-8. Vol Scale, Paw Scale, and Flow Scale options.......................................................17-10
Patient Spirometry
Overview
The Patient Spirometry option (N-XV) enables monitoring of the patient’s airway
pressures, volumes, lung mechanics, and the ventilator operation.
In Patient Spirometry measurement, the airway pressures are measured as close to the
patient as possible (between patient circuit and intubation tube), using the D-lite and
Pedi-lite sensors. The same sensors are used for gas sampling.
The D-lite and Pedi-lite sensors measure kinetic pressure by a two-sided Pitot tube.
Pressure is transferred to the monitor through a spirometry tube and measured by a
pressure transducer. The pressure difference across a flow restrictor, together with the
gas concentration information, is used to calculate flow. The volume information is
obtained by integrating the flow signal.
Measured parameters
• Expiratory and inspiratory tidal volumes (TVinsp/exp)
• Expiratory and inspiratory minute volumes during controlled mechanical
ventilation and during spontaneous breathing (MVinsp/exp)
• Airway pressures:
Peak pressure (Ppeak)
Plateau pressure (Pplat, plateau)
Mean pressure (Pmean)
Real-time pressure waveform (Paw)
• End expiratory pressure (PEEP)
• Flow real-time waveform (Flow)
• Compliance (Compl)
• Airway resistance (Raw)
• Ratio of the inspiratory and expiratory time (I:E)
• Pressure-volume loop (Paw-Vol. loop)
• Flow-volume loop (Flow-Vol. loop)
NOTE: Airway resistance and PEEP are not measured with spontaneous breaths
compliance or with pressure-supported breaths.
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Measurement principles
Pplat is the pressure at the reversal point of the flow, at the end of the inspiration phase,
after the inspiratory pause.
Ppeak is the maximum pressure during one breath.
PEEP is the pressure in the lungs at the end of the expiration, measured at the moment
when the expiratory phase changes to inspiratory flow.
Compliance (Compl) tells how big a pressure difference is needed to deliver a certain
volume of gas into the patient. Compliance is calculated for each breath from the
following equation:
TVexp
Compl =
Pplat − PEEP
Raw, the airway resistance, is calculated from an equation that describes the kinetics of
the gas flow between the lungs and the flow sensor. The pressure at the sensor can be
derived at any moment of the breath cycle from the following equation:
17-2
Patient Spirometry
Figure 17-2. Digit fields for Paw, Paw + TV, Flow, and Compl. + Raw
You can choose to display tidal volume (TV) or minute volume (MV) in the Spirometry
Setup menu. This selection also affects the Spiro1 split screen display (see below).
1200 1200
Vol Vol
ml ml
Paw Paw 2
cmH2O cmH2O
0 40 0 40 1
Adult cmH2O TVinsp ml Adult cmH2O ml
Ppeak 25 TV insp 800
Ppeak 25 800
Pplat 21 TVexp 790
Pplat 21 TVexp ml Pmean 11 l/min
PEEPtot 7 MVinsp 12.0
PEEPtot 7 790
MVexp 12.0
Compl 55 ml/cmH20 I:E 1 : 2.0 4
Raw 8 cmH2O/l/s
Compl 55 ml/cmH2O
Figure 17-3. Spiro1 (left) and Spiro2 (right) split screen options
Spiro1, the basic spirometry view, shows Ppeak, Pplat, PEEP, Compliance, TVinsp,
Tvexp, MVinsp, and MVexp.
Spiro2 shows the same parameters as the basic view plus Pmean, I:E, and Raw.
For both views, TVinsp/exp and MVinsp/exp values are displayed according to the
spirometry setup selections.
To select the spirometry values for the split screen display:
1. Press the ComWheel and select Monitor Setup from the Main Menu.
2. Select Screen Setup.
3. Select Split Screen and choose from the options.
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Patient connections
To make the connections:
1. Connect a new spirometry tube to the flow sensor by inserting the angle
connectors into the sensor connectors.
2. Connect the other end of the spirometry tube to the pressure connectors on the
monitor.
3. Connect a gas sampling line to the luer connector on the other side of the flow
sensor.
4. Connect the other end of the gas sampling line to the sampling line connector on
the D-fend water trap. Confirm that the connections are secure.
5. Select the type of sensor you use, D-lite (the factory default) or Pedi-lite:
Press the ComWheel and select Parameters. Then, select Airway Gases and Spirometry
Setup. Select Sensor Type and choose the sensor.
6. Complete the other patient connections as shown below.
Patient tubes
1 2 3 4
Sampling line
connector
5
Spirometry
connectors
(1) Y-piece
(2) Spirometry tube
(3) D-lite sensor
(4) Bacterial filter
(5) Gas sampling line
To prevent condensed water from
entering the lines, position the gas
sampling line and the spirometry tube
connections so that they head upward
from the patient.
The gas sampling line can be aligned along the groove of the spirometry tube for a
more serviceable setup.
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Patient Spirometry
NOTE: If you are using a nebulizer to administer medication, disconnect the HME-F
filter and the flow sensor while the nebulizer is in use.
NOTE: When using a Bain circuit, the inspiratory volumes are erroneously high. This
can be corrected by using a filter.
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Spirometry setup
To open the Spirometry Setup menu:
1. Press the ComWheel and select Parameters from the Main Menu.
2. Select Airway Gas.
3. Select Spirometry Setup.
Airway Gas
Spirometry Setup
Scaling
Sensor Type Adult Adult
TV or MV TV Pedi
Paw Alarms
MVexp Alarm
Previous Menu
NOTE: For detailed information about the Scaling selection, refer to Scaling of
loops and waveforms later in this chapter.
4. Select Sensor Type and choose Adult (the factory default) or Pedi (pediatric) according
to the flow sensor in use.
5. Select TV or MV and choose tidal volume (TV) or minute volume (MV) for display in
the digit field. Your selection also affects the Spiro1 Split Screen.
6. Select Paw Alarms to open the Paw Alarms Adjustment menu. You can adjust Ppeak
and PEEP alarms in the same menu.
7. Select MVexp Alarm to open the MVexp Alarms Adjustment menu.
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Patient Spirometry
Spirometry loops
Spirometry parameters are viewed in the Spirometry display.
• If CO2 is detected and the respiration rate is below 15/minute, the loops are
updated every breath.
• If no CO2 is detected or the respiration rate is 15/minute or higher, the loops are
updated every other breath.
The values are always updated breath by breath.
To open this menu:
1. Press the ComWheel and select Parameters from the Main Menu.
2. Select Airway Gas.
3. Select Spirometry Loops.
Spirometry selections
Print Saved Prints the saved loops.
You can also print all saved loops by pressing the ComWheel and
selecting Record/Print from the Main Menu. Then select Print Loops.
Paw-Vol Loop Displays the pressure-volume loop. A 45° angle is equal to a compliance
of 30 ml/cmH2O for adults and 10 ml/cmH2O for pediatrics.
With pediatric measurement, the ratio of the loop axis is changed to
maintain the normalized 45° loop slope also in pediatric measurement.
Flow-Vol Loop Displays the flow-volume loop.
Scaling Changes the size of the Paw-Vol and Flow-Vol loops. See Scaling of
loops and waveforms later in this chapter.
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Save Loop Saves up to six pairs of reference loops in memory. Both loops are
saved at the same time. When more than six pairs are saved, the most
recent one is erased from the memory and the “Saving next will
override last loop” message is displayed.
The time the saved loop pair is saved appears at the upper right of the
spirometry view. A frame around the time of saving indicates which
loop is currently displayed.
Reference Loop Recalls a selected reference loop from memory. One real-time loop and
one reference loop are displayed simultaneously.
To recall, highlight the stamp of the loop with the ComWheel and press
the ComWheel. The real-time loop is drawn with a blue line, the
reference loop is drawn with a white, dotted line.
Reference Off If you do not want the reference loop to be displayed, choose this
option.
Erase Loop Erases the selected reference loop from memory.
To erase, turn the ComWheel to highlight the number of the loop. The
loop is drawn with a blue line. Press the ComWheel to erase.
To return to the menu without erasing a loop, select Exit instead of the
number of the loop.
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Patient Spirometry
Scaling AUTO (the factory default) automatically adjusts the scaling of parameters
to suit the situation. Complete loops and waveforms are always
displayed.
Vol results in interdependent scales. A change to one scale affects the
others so that the ratio between pressure and volume and flow and
volume scales remains constant.
Indep. allows independent and separate changes to the volume, pressure,
and flow scales. A change in one scale does not affect the scaling of
other scales. This selection may be needed, for example, with pediatric
or ARDS patients whose airway pressure is high but the tidal volume
low.
Scaling Speed Changes the speed at which loops and waveforms are rescaled during
AUTO scaling.
Slow rescales to a higher scale after two breaths are above the selected
scale. Rescaling to a lower scale occurs after four breaths are within the
limits of the lower scale.
Fast rescales to a higher scale after one breath is above the selected scale.
Rescaling to a lower scale occurs after two breaths are within the limits
of the lower scale. For example, select Fast as the scaling speed for
manual ventilation.
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Figure 17-8. Vol Scale, Paw Scale, and Flow Scale options
Calibrating
The flow measurement should be calibrated once a year, or when there is a permanent
difference between inspiratory and expiratory volume.
Calibration should be performed by trained service personnel using a special
spirometry tester designed by Datex-Ohmeda. For more information, see the Technical
Reference Manual.
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Patient Spirometry
TV measuring conditions
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Contents
Table of Figures
Figure 18-1. Ulnar nerve and the corresponding muscles............................................................18-2
Figure 18-2. Stimulating electrodes ............................................................................................................18-3
Figure 18-3. Grounding electrode of EMG measurement .............................................................18-3
Figure 18-4. Measurement from the adductor pollicis muscle...................................................18-4
Figure 18-5. NMT setup with ElectroSensor .........................................................................................18-4
Figure 18-6. MechanoSensor attachment ...............................................................................................18-5
Figure 18-7. NMT setup with MechanoSensor...................................................................................18-5
Figure 18-8. Perioperative stimulus response.......................................................................................18-9
Figure 18-9. Sensor cable, regional block adapter, and needle with syringe................18-13
NeuroMuscular Transmission (NMT)
Overview
The Cardiocap/5 monitor with the N-XNMT option delivers stimulating electrical
pulses to a motor nerve and measures the muscle response to these stimulations.
Two electrodes are needed for electrical stimulation of a peripheral nerve. The
resulting response can be measured with a MechanoSensor or an ElectroSensor.
• The MechanoSensor is attached between the thumb and index finger. It is easier to
use and more suitable for routine clinical use. It measures movements with a
piezoelectric wafer.
• The ElectroSensor uses three recording electrodes for electromyography (EMG)
and is mainly intended for research purposes.
Displaying NMT
You can choose three different NMT views on the display: current numeric values,
waveforms illustrating the progression of the stimulation responses during measuring,
and graphical trends.
NOTE: When waveforms are selected for the display, the digit field with the NMT
measurement disappears automatically.
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Patient connections
Before connecting the electrodes, clean the application site of oil or dirt. Avoid
placement over excessive body hair or lesions. Pay attention to the condition and
placement of the electrodes. Good signal quality requires good skin contact with the
electrodes. Only Datex-Ohmeda NMT electrodes are recommended.
Stimulating electrodes
To stimulate the motor nerve correctly on standard conditions, the stimulating
electrodes (white and brown) are recommended to be placed along the ulnar nerve on
a site where the nerve is as near to the skin as possible.
To locate the nerve, locate the ulnar artery which runs side by side with the ulnar
nerve. The wrist area is the easiest site for locating the artery, and thus the nerve. The
wrist area is a site where the nerve is near the skin. Fat or muscle does not hinder
detection at this site.
m.adductor pollicis
n.ulnaris
medial epicondyle
WARNING: Electrical Shock Hazard. Do not place the NMT stimulation electrodes on the
patient’s chest.
WARNING: Electrical Shock Hazard. Always stop the NMT measurement before handling the
stimulation electrodes.
WARNING: Patient Safety. Ensure proper contact of the return electrode of the
electrosurgery unit to your patient to avoid possible burns at sensor sites.
WARNING: Patient Safety. Make sure that the lead set clips do not touch any electrically
conductive material including earth.
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NeuroMuscular Transmission (NMT)
Brown
White
ElectroSensor setup
Grounding electrode
For measuring EMG response, the grounding electrode (black) may be placed where
convenient, but placing it between the stimulation and recording electrodes at the
palmar groove may reduce stimulation artifact.
Brown
White
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Recording electrodes
Place one green recording electrode on the adductor pollicis. Place a second recording
electrode on the muscle's tendon or insertion site. The hand should be immobilized.
Red
Green
Black
Brown
White
The adductor pollicis muscle is customarily used for the measurement. When the
thenar is preferred, electrode placement becomes crucial. The adductor pollicis and
flexor pollicis brevis muscles lie next to each other and may be recorded on the radial
surface of the palm between the first and second metacarpals. Interference due to
median nerve stimulation is more likely than on the hypothenar side.
Cable set
White
Brown
1 Black Green
Red
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NeuroMuscular Transmission (NMT)
MechanoSensor setup
The MechanoSensor is attached between the thumb and index finger with a piece of
tape. Make sure that the thumb can move freely.
Cable set
White
1 Brown
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Starting measurement
NMT monitoring should be started before a muscle relaxant drug is administered. It is,
however, advisable to begin after the induction of sleep to prevent voluntary muscle
contraction and tension from interfering with the reference search.
If the patient is already relaxed, the reference level is not usually found, however,
monitoring can proceed without a reference level. In some cases, the reference level
may be found but may be erroneous.
To start a measurement:
1. Press the NMT key.
2. Select Start-Up.
NMT
Supramax search
TOF%
Count
30mA
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NeuroMuscular Transmission (NMT)
NMT
Setting reference
TOF%
Count
52mA
If the patient is paralyzed at the time of start-up, it does not make the measurement
impossible or the results useless. When nondepolarizing blocking agents are used, the
responses will fade and the reference value is rejected, however, values other than T1%
are available.
If the block is depolarizing at start-up, T1% should not be used because the reference
level is incorrect.
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NeuroMuscular Transmission (NMT)
When no TOF% is available, the degree of neuromuscular block is estimated from the
number of responses, or Counts. The Count tells how many responses have been
detected to the 4 stimuli. The fewer responses detected, the deeper the relaxation.
Perioperatively, this can be seen in the trends where the bars represent the TOF%.
Adequate clinical recovery from competitive block is normally reached when the
TOF% is over 70.
NMT
DBS% 31
Count 2
0 20 sec T1% 56
NMT
SINGLE TW.
Count 1
T1% 34
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NeuroMuscular Transmission (NMT)
Activation principle
Activation of the note depends on the Count number set as the recovery note and the
cycle time.
When the cycle time is less than one minute, the monitor requires that the Count is
below the Count limit in two successive measurements before the Recovery Note is
enabled. Then, to give the note, the monitor requires that the number of Counts
exceeds the limit, or is the same as the limit, twice in one minute. The note disappears
when two measurements are below the limit again.
If the cycle time is one minute or more, or if the measurement is done manually, the
monitor requires that at least one Count is below the chosen limit before the note is
enabled. Then, to give the note, the monitor requires one Count to exceed or to be the
same as the Count limit. The note disappears when one measurement is below the limit
again.
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Relaxation Meter
100 TOF% 20 4 Count 0 10 PTC 0
Light Deep
When stimulation pulses no longer give any stimulation response, the Count is not
available either. To monitor the relaxation level, you can start tetanic stimulation and
estimate the relaxation level from the Post Tetanic Count (PTC).
Tetanic stimulation is a continuous, 5-second stimulation. The stimulation makes the
muscle more responsive. After the tetanic stimulation, single-twitch stimulations are
generated. The number of detected responses to the stimulations is counted and
expressed as PTC. The fewer responses detected, the deeper the relaxation.
For example, when the patient is relaxed with pancuronium, the TOF response will
return in about 5 minutes when PTC is 8, and in 15 minutes when PTC is 5. These
values are general guidelines and may differ from case to case.
NMT
Measurement OFF
TOF% PTC 6
Count
T1%
If the responses do not fade away, a maximum of 20 responses are counted and >20 is
displayed.
After tetanic stimulation, NMT measurements are stopped for one minute. After this
the monitor continues with the previously selected cycle automatically.
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NeuroMuscular Transmission (NMT)
Figure 18-9. Sensor cable, regional block adapter, and needle with syringe
NMT
Regional Block
Current
2.0 mA
Note that the pulse width is 40 µs and somewhat higher currents may be needed
when compared to other similar systems. However, shorter pulse width is less
painful to the patient.
7. To stop the stimulation, select Stop in the Regional Block menu.
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Movement artifact
All movements of the hand are measured as a response to the stimulation. Therefore,
moving or touching the patient during a measurement may cause incorrect results. If
possible, immobilize the hand during NMT measurements.
Electrosurgery
The measurement results may be incorrect during electrosurgery.
Verifying reliability
The reliability of the response can be estimated by looking at the bar graph or the NMT
trend.
The bars of the graph should be in a smoothly descending order from left to right, and
the NMT trend should indicate that the T1% has remained steady. If this is not the
case, the newest response is unreliable. Relaxation level does not usually decrease
greatly in one minute even with short-acting relaxants.
To verify the observations, start a new measurement manually right after completing
the previous measurement. Sometimes the selected cycle time has been so long (five
minutes, for example) that the relaxation level has changed considerably between the
measurements.
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