Datex-Ohmeda Cardiocap /5 For Critical Care: User's Reference Manual
Datex-Ohmeda Cardiocap /5 For Critical Care: User's Reference Manual
Datex-Ohmeda Cardiocap /5 For Critical Care: User's Reference Manual
053 7
CAUTION: U.S. 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 restriction that may apply.
All specifications subject to change without notice.
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
CISPR 11: Group 1, class A
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.
© 2004 General Electric Company. All rights reserved.
Cardiocap/5 User’s Reference Manual—Critical Care
Cardiocap/5 models and options for Critical Care software ............ 1-2
Hemodynamic model (F-MX).......................................................................................1-2
Hemodynamic model with airway gas measurement (F-MXG) ...........................1-2
Data collection and management options (for F-MX and F-MXG) ......................1-2
Specifications ............................................................................1-14
General .......................................................................................................................... 1-14
Power supply ..................................................................................................... 1-14
Back-up battery ................................................................................................. 1-14
Environmental conditions .............................................................................. 1-14
Cardiocap/5 for Critical Care User’s Reference Manual—
ECG................................................................................................................................. 1-14
ST segment analysis......................................................................................... 1-14
Heart rate............................................................................................................ 1-15
Impedance respiration .................................................................................... 1-15
NIBP ............................................................................................................................... 1-16
Invasive blood pressure.............................................................................................. 1-16
Pulse rate ............................................................................................................ 1-16
Temperature ................................................................................................................. 1-16
Pulse oximetry, standard............................................................................................ 1-16
SpO2 .................................................................................................................... 1-16
Pulse rate ............................................................................................................ 1-17
Default alarm limits ......................................................................................... 1-17
Sensor emitter wavelength ranges................................................................ 1-17
Pulse oximetry, Datex-Ohmeda enhanced (N-XOSAT option) .......................... 1-17
SpO2 .................................................................................................................... 1-17
Pulse rate ............................................................................................................ 1-17
Default alarm limits ......................................................................................... 1-17
Sensor emitter wavelength ranges................................................................ 1-17
Pulse oximetry, Nellcor compatible (N-XNSAT option)...................................... 1-18
SpO2 .................................................................................................................... 1-18
Pulse rate ............................................................................................................ 1-18
Default alarm limits ......................................................................................... 1-18
Sensor emitter wavelength ranges................................................................ 1-18
Airway gases................................................................................................................. 1-18
Respiration rate (RR) ....................................................................................... 1-19
Carbon Dioxide (CO2) and Oxygen (O2) ..................................................... 1-19
Patient Spirometry ...................................................................................................... 1-19
Recorder ........................................................................................................................ 1-19
Table of Figures
Figure 1-1. Cardiocap/5 monitor (F-MXG)............................................................................1-4
Figure 1-2. Patient connectors (F-MX) ...................................................................................1-5
Figure 1-3. Patient connectors (F-MXG) ................................................................................1-5
Figure 1-4. Cardiocap/5 rear panel (F-MXG)........................................................................1-6
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 Critical Care software (S-XCCA01) installed.
Additional information
The Cardiocap/5 User’s Guide—Critical Care 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 iCentral, User’s Reference Manual
Licensed accessories are listed in the 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.
1-1
Cardiocap/5 for Critical Care User’s Reference Manual—
In addition, the F-MX model 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)
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 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)
1-2
Monitor Description
Order codes
Items and corresponding order codes are given in the table below:
Abbreviation Description Order code
F-MX Cardiocap/5 Hemodynamic 6050-0005-614
Frame
F-MXG Cardiocap/5 Hemodynamic 6050-0005-617
Frame with gas measurement
S-XANE01 Cardiocap/5 Anesthesia 6050-0005-615
Software
N-XC Airway Gas Option (CO2) 6050-0005-611
N-XCO Airway Gas Option (CO2, O2 6050-0005-612
and N2O)
N-XCAIO Airway Gas Option (CO2, O2, 6050-0005-613
N2O and anesthesia agents
with automatic identification)
N-XV Patient Spirometry Option 6050-0005-620
N-XP Invasive Pressure Option with 6050-0005-940 or 6050-
second temperature channel 0005-939
N-XREC Recorder Option 6050-0005-941
N-XNET Network Option 6050-0005-622
N-XDNET DataCard and Network Option 6050-0005-700, 6050-
0005-735 or 6050-0005-
736
N-XNMT NeuroMuscular Transmission 6050-0005-914
(NMT) Option
N-NSAT Nellcor Compatible SpO2 6050-0005-916
Option
N-XOSAT Enhanced Datex-Ohmeda 6050-0005-917
SpO2
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Cardiocap/5 for Critical Care User’s Reference Manual—
1-4
Monitor Description
1 2 3 4 5 6 7
Spirometry P2 T2
9 8 7 6 5 4
1-5
Cardiocap/5 for Critical Care User’s Reference Manual—
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.
1-6
Monitor Description
Symbols
Attention! Read accompanying instructions, including all warnings and
cautions, before using this device.
This symbol has the following meanings:
• On the front panel indicates that protection against cardiac
defibrillator discharge is due in part to the accessories for pulse
oximetry (SpO2), temperature (T) and invasive pressure (P)
measurement.
• 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.
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.
Battery charging.
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Cardiocap/5 for Critical Care User’s Reference Manual—
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.
The symbol is removed from the display when the battery is fully charged.
During battery charging, the standby LED is flashing in standby mode.
1-8
Monitor Description
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.
The monitor or its components should not be used adjacent to or stacked with other
equipment. If adjacent or stacked use is necessary, the monitor and its components
should be observed to verify normal operation in the configuration in which it will be
used.
Explosion hazard
To avoid an explosion hazard, do not use the monitor in the presence of flammable
anesthetics.
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Cardiocap/5 for Critical Care User’s Reference Manual—
Cleaning
Before cleaning, disconnect the monitor from the electrical outlet.
If liquid has accidentally entered the equipment, disconnect the power cord from the
power supply and have the equipment serviced by authorized service personnel.
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
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).
Use only approved accessories, mounts and defibrillator-proof cables and invasive
pressure transducers. For a list of approved supplies and accessories, see the "Supplies
and Accessories" catalog. Other cables, transducers and accessories may cause a safety
hazard, damage the equipment or system, result in increased emissions or decreased
immunity of the equipment or system or interfere with the measurement. Protection
against cardiac defibrillator discharge is due in part to the accessories for pulse
oximetry (SpO2), temperature (T) and invasive pressure (P) measurement.
Single-use accessories are not designed to be re-used. Re-use may cause a risk of
contamination and affect the measurement accuracy.
To prevent erroneous readings, do not use physically damaged sensors or sensor
cables. Discard a damaged sensor or sensor cable immediately. Never repair a damaged
sensor or cable; never use a sensor or cable repaired by others. A damaged sensor or a
sensor soaked in liquid may cause burns during electrosurgery.
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. Discharge the patient to reset the inflation limit before measuring a new
patient.
1-10
Monitor Description
Pulse oximetry
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.
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.
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Cardiocap/5 for Critical Care User’s Reference Manual—
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.
Points to note
Medical electrical equipment needs special precautions regarding electromagnetic
compatibility and needs to be installed and put into service according to the
electromagnetic compatibility information provided in the "Technical Reference
Manual" by qualified personnel.
Portable and mobile RF communications equipment can affect the medical electrical
equipment.
The allowed cables, transducers and accessories for the system are listed in the
“Supplies and Accessories” catalog.
The equipment is suitable for use in the presence of electrosurgery. Please notice the
possible limitations in the parameter sections and in the "Safety precautions” section.
Service and reparations are allowed for authorized service personnel only.
CISPR 11 classifications:
• Group 1 contains all ISM (Industrial, scientific and medical) equipment in which
there is intentionally generated and/or used conductively coupled radio-frequency
energy which is necessary for the internal functioning of the equipment itself.
• Class A equipment is suitable for use in all establishments other than domestic and
those directly connected to the public low-voltage power supply network that
supplies buildings used for domestic purposes.
ESD precautionary procedures
To avoid electrostatic charges to build up, it is recommended to store, maintain and use
the components at a relative humidity of 30% or greater. Floors should be covered by
ESD dissipative carpets or similar. Non-synthetic clothing should be used when
working with the component.
To prevent applying a possible electrostatic discharge to the ESD sensitive parts of
the component, one should touch the metallic frame of the component or to a large
metal object located close to the component. When working with the component
and specifically when the ESD sensitive parts of the component may be touched, a
1-12
Monitor Description
grounded wrist strap intended for use with ESD sensitive equipment should be
worn. Refer documentation provided with the wrist straps for details of proper use
ESD precautionary procedure training
It is recommended that all potential users receive an explanation of the ESD
warning symbol and training in ESD precautionary procedures.
The minimum content of an ESD precautionary procedure training should include
an introduction to the physics of electrostatic charge, the voltage levels that can
occur in normal practice and the damage that can be done to electronic
components if they are touched by and operator who is electrostatically charged.
Further, an explanation should be given of methods to prevent build-up of
electrostatic charge and how and why to discharge one’s body to earth or to the
frame of the equipment or bond oneself by means of a wrist strap to the equipment
or the earth prior to making a connection.
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Cardiocap/5 for Critical Care User’s Reference Manual—
Specifications
All specifications are subject to change without notice.
WARNING: Operation of the monitor outside the specified values may cause inaccurate
results.
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
Minimizing the effects of the line isolation monitor transients: Crystal controlled
oscillator is used as the operating frequency source of the patient isolation power
supply.
Offset voltage range: ±0.4 V
WARNING. The ±0.4 V offset voltage range of the ECG measurement may be insufficient to
handle the offset potentials when using ECG electrodes of dissimilar metals
The isolation barrier capacitance has been minimized to reduce the hazard of burns in
the event of a defect in the ESU return electrode connection.
Direct current for leads-off detection through any patient electrode : ≤50 nA
The normalized respiration sensing current : ≤3.0 µA
Frequency of respiration sensing current: 31.25 kHz
Maximum Tall T wave amplitude that does not disturb the heart rate calculation time
(according to ANSI/AAMI EC13 4.1.2.1): 10 mV
1-14
Monitor Description
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
Test result of ST segment measurement algorithm testing.
The algorithm testing has been performed by using The European Society of
Cardiology ST-T Database
Average results from ischemic ST detection
Episode sensitivity: 77
Episode positive predictive accuracy: 67
Duration sensitivity: 74
Duration positive predictive accuracy: 61
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
Display averaging time: 10 seconds
Display update time: 5 seconds
The heart rate calculation operates with irregular rhythms of ANSI/AAMI EC13 4.1.2.1
(e) as follows: a): 40 bpm b): 87 bpm c): 60 bpm d): 117 bpm
Average heart rate response time and time range of response time (according to
ANSI/AAMI EC13 4.1.2.1 (f)):
Response time 80 to 120 bpm: 5.0s (3.7 to 6.2 s)
Response time 80 to 40 bpm: 6.5s (4.1 to 9.2 s)
The average time and time range ( ) to alarm for tachycardia are as follows ANSI/AAMI
EC13 4.1.2.1 (g)):
Figure 4a halved amplitude: 5.5 s (4.8 to 5.9 s)
Figure 4a normal amplitude: 6.6 s (4.8 to 7.2 s)
Figure 4a doubled amplitude: 7.2 s (5.3 to 9.4 s)
Figure 4b halved amplitude: 7.4 s (7.0 to 7.7 s)
Figure 4b normal amplitude: 6.2 s (4.7 to 8.1 s)
Figure 4b doubled amplitude: 6.4 s (4.4 to 8.2 s)
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Cardiocap/5 for Critical Care User’s Reference Manual—
The pacemaker pulses are absent but may cause interference at the auxiliary ECG
output.
An auxiliary device that fulfils the requirements of the IEC 60601-1 standard can be
connected to the auxiliary output. There are no other limitations, because the
auxiliary output of the monitor is galvanically isolated from patient applied part of
the ECG measurement.
Impedance respiration
Respiration range: 4 to 120 resp/minute
Accuracy: ± 5% or ± 5 resp/minute
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.
1-16
Monitor Description
Pulse rate
Measurement range: 30 to 250 bpm
Measurement accuracy: ± 5% or ± 5 bpm
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)
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Cardiocap/5 for Critical Care User’s Reference Manual—
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.
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%
FiCO2 high 3%, low Off
EtO2 high Off, low 10%
FiO2 high Off, low 18%
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: < 2 vol%
Effect of helium: Decreases CO2 readings < 0.6 vol% typically
1-18
Monitor Description
Patient Spirometry
Detection through D-lite™ or Pedi-lite™ flow sensor and gas sampler:
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
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Cardiocap/5 for Critical Care User’s Reference Manual—
1-20
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
2-1
Cardiocap/5 for Critical Care User’s Reference Manual
Key functions
Power On/Standby key.
NOTE: The monitor will start only when connected to mains power.
The next oval-shaped key can be Pulse Oximetry or Invasive Pressures, if your monitor
contains the built-in Invasive Pressures option.
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
Take Record
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 for Critical Care User’s Reference Manual
Using menus
A menu is a list of functions or commands displayed on the screen.
2-4
Monitoring Basics
2-5
Cardiocap/5 for Critical Care User’s Reference Manual
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 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
5. Prepare the patient connections. Refer to the applicable measurement parameter
chapter(s) later in this manual.
6. 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.
7. 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.
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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
10. Press the ComWheel to open the Main Menu.
11. To print necessary information, select Record/Print. Wait until printing is finished.
12. To clear patient data and return settings to their defaults:
Select Admit/Discharge in the Main Menu.
Select Discharge.
13. Turn the power switch to standby if the monitor will not be used.
14. Clean the monitor according to the instructions.
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Monitoring Basics
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Monitoring Basics
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Abbreviations
Abbreviations that appear on the monitor screen and in this manual are listed below.
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 foot (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
EMC electromagnetic compatibility
ESD electrostatic discharge
Eso esophageal temperature
ET, Et end tidal concentration
Exp expired
°F degrees Fahrenheit
FI, Fi fraction of inspired gas
FiO2 fraction of inspired oxygen
Flow airway gas flow
FVloop flow volume loop
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Monitoring Basics
Graph. Graphical
Hemo hemodynamic
Hgb hemoglobin
HR heart rate
I inspiratory
ICP intra cranial pressure
ID identification
Imped. impedance
indep. independent
Inv. invasive
O2 oxygen
Oxy oxygen
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Cardiocap/5 for Critical Care User’s Reference Manual
RR respiration rate
RVP right ventricular pressure
S/D systolic/diastolic
SaO2 arterial oxygen saturation
Skin skin temperature
Snaps. snapshot
Spiro spirometry
SpO2 oxygen saturation measured by pulse oximeter
Spont spontaneous breathing
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
Tab. tabular trends
Temp temperature
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.
Changes made separately are maintained when returning to the previous mode.
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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.
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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:
7. Press the ComWheel
and select Monitor Setup from the Main
Menu.
8. Select Screen Setup.
9. Select Waveform Fields.
10. Choose the parameter to be displayed in
each field.
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:
14. Press the ComWheel
and select Monitor Setup from the Main
Menu.
15. Select Screen Setup.
16. Select Digit Fields
17. Choose the parameter to be displayed in
each digit field.
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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:
21. Press the ComWheel and select Monitor Setup from the Main Menu.
22. Select Screen Setup.
23. Select Minitrend Length and choose 5 min or 30 min.
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Display brightness
To adjust display brightness according to environmental conditions:
27. Press the ComWheel
and select Monitor Setup from the Main
Menu.
28. Select Display Brightness.
29. Choose the desired adjustment
(30% to 100%).
3-8
Monitor Setup
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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
Transferring alarms.....................................................................4-10
Recording alarms automatically...................................................4-10
Other adjustable features............................................................4-11
Displaying limits .......................................................................................................... 4-11
Changing the tone pattern ......................................................................................... 4-11
Latching alarms............................................................................................................ 4-12
Automatic snapshots and printouts of them.......................................................... 4-12
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:
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, and General (the
default).
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.
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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.
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Alarms
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.
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Alarms
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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.
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.
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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.
21. Press the ComWheel and select Other Patients from the Main Menu.
22. Select Receive Alarms.
23. Select one of the sites on the list that is displayed.
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Alarms
Displaying limits
Alarm limits can be displayed next to the numerical parameter value as shown below.
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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:
37. Press the ComWheel
and select Monitor Setup from the Main Menu.
38. Select Install/Service and enter the password.
39. Select Installation.
40. Select Alarms Options.
41. Select Latching Alarms and choose YES.
Alarm behavior
If the alarm mode is latched, the technical alarms are latched as well. This does not
comply with the NIBP (IEC 60601-2-30) and invasive pressure (IEC 60601-2-34)
standard requirements.
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Alarms
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Contents
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, Resp)
• Respiration rate (RR)
• Temperature
• Airway pressure
• Airway flow
• Derived values from airway pressure and flow
Trend data is stored in memory for 15 minutes after the power is turned to Standby.
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Trends and Snapshots
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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, 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.
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Minitrend view
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:
26. Press the ComWheel
and select Monitor Setup from the Main
Menu.
27. Select Screen Setup.
28. Select Split Screen and choose Trend.
Removing a minitrend
To remove the minitrend from the display:
32. Press the ComWheel and select Monitor Setup from the Main Menu.
33. Select Screen Setup.
34. Select Split Screen and choose None.
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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.
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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.
To view snapshots:
35. Press the Trends key and select Snapshot from the Trends menu.
36. Select Next Snapshot.
37. Turn the ComWheel to move the cursor in the time and marker field.
38. 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.
39. Press the ComWheel to return to the menu.
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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.
Erasing snapshots
The snapshots will be erased when you reset discharge the patient or reset the trends.
They are also erased after 24 hours automatically.
To erase snapshots:
40. Press the ComWheel and select Admit/Discharge from the Main Menu.
41. Select Discharge and choose YES.
As memory fills up, older snapshots are overwritten automatically.
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Trends and Snapshots
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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 patient is admitted by selecting Admit Patient in the
Admit/Discharge menu. 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 iCentral 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 the 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 monitor network (the
Datex-Ohmeda S/5 Network and iCentral). 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.
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Memory cards
With the N-XDNET option, you can load collected patient data from a monitor that is
connected to the same monitor network or from a Data card.
The Data card and the Menu card are memory cards. Each is housed internally in a
built-in memory module.
• The Data card is for storing and transferring trend data.
• The Menu card is for storing menus.
When the Data card is inserted, continuous patient trend data is stored on it
automatically. The capacity of the card is approximately 48 hours, depending on the
complexity of the saved data. When the card is full, the oldest data is erased.
The trend data stored on a Data card can be transferred to and viewed at all S/5, AS/3,
and CS/3 systems as well as other Cardiocap/5 monitors.
See Loading a previous case later in this chapter for information about loading trend
data.
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.
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Admitting a patient
When you begin monitoring a new patient, you should admit the patient.
To admit a patient:
1. Press the ComWheel and select
Admit/Discharge from the Main Menu.
2. Select Admit Patient.
3. Enter the patient information.
Adding demographics
To add demographics:
4. Press the ComWheel and
select Admit/Discharge from the Main Menu.
5. Select Demographics.
6. Enter the patient’s height and weight.
6-4
Patient Data Management
Contin. Previous
When the network is not in use, you can retrieve the trend data of the previous patient
from the monitor memory. You can retrieve trend data that was stored during the
previous 24 hours under these circumstances:
• The monitor was turned off for less than 15 minutes.
• The monitor remained on (even if the patient was discharged).
Reloading trend data after the patient has been discharged for several hours is not
recommended. The period that contains no information results in empty record pages.
Stand-by
This selection is available when you disconnect and move a patient, but plan to resume
monitoring the same patient. See Setting the monitor on Stand-by later in this chapter.
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Marking events
During monitoring, you can place numbers beside the numerical trend to mark the
event by selecting Take Snapshot in the Trends menu. 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.
A trend printout is also marked with this number.
A snapshot is created at the same time. For more information about Snapshots, refer to
the Trends and Snapshots chapter.
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Patient Data Management
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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.
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 open the recorder paper compartment.
(4) Recorder paper.
(5) Recorder paper compartment.
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Recording waveforms
7-2
Recording and Printing
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NOTE: When recording is activated by alarms, the recording time is always 30 seconds.
7-4
Recording and Printing
If the monitor is connected to the Arrhythmia Workstation, Rapit VT and V Run alarms
will start recording.
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Recording trends
Adjust the parameter and time scales to record the desired level of trend detail.
Either Sys/Dia or mean pressures are recorded, depending on the digit format selected
in the pressure setups.
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Recording and Printing
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Recording and Printing
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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
Messages.................................................................................... 8-4
Other situations........................................................................... 8-7
Troubleshooting
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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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 – Ventilation – 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 for Critical Care User’s Reference Manual
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.
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.
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.
EtCO2 high / EtCO2 low Measured EtCO2 is equal to or above/below the alarm limit.
EtO2 high / EtO2 low Measured EtO2 is equal to or above/below the alarm limit.
FiO2 high / FiO2 low Measured FiO2 is equal to or above/below the alarm limit.
HR high / HR low Heart rate (ECG or invasive pressure) or pulse rate (pulse
oximetry) is equal to or exceeds the upper/lower alarm limit.
8-4
Troubleshooting
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Cardiocap/5 for Critical Care User’s Reference Manual
8-6
Troubleshooting
Other situations
Other problem situations which may occur during monitoring, with possible
explanations and instructions, are listed below.
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Cardiocap/5 for Critical Care User’s Reference Manual
8-8
Contents
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 for Critical Care User’s Reference Manual
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 service0 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 for Critical Care User’s Reference Manual
Monitor
To clean the monitor:
9. 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.
10. Wipe the monitor with a mild detergent solution such as the Datex-Ohmeda
Cleaning Fluid. Do not leave liquid spills on any metal part.
11. 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 for Critical Care User’s Reference Manual
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.
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Cardiocap/5 for Critical Care User’s Reference Manual
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.
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.
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.
Cable set
RED (IEC) YELLOW (IEC) RED (IEC) RED (IEC) YELLOW (IEC)
WHITE (AAMI ) BLACK (AAMI) WHITE (AAMI) WHITE (AAMI) BLACK (AAMI)
1 LEAD I
1 2
LE 3 4 5 6
AD
II
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 for Critical Care User’s Reference Manual
NOTE: The module input circuits are protected against the effects of electrosurgery
and defibrillation. However, the ECG trace on the monitor screen may be disturbed
during electrosurgery.
10-4
ECG
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.
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 high frequency artifacts 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 but catches the slow changes
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Cardiocap/5 for Critical Care User’s Reference Manual
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:
6. Press the ECG key.
7. Select ECG1 Lead.
You can select all the leads (ECG1, ECG2 and
ECG3) in the ECG 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 for Critical Care User’s Reference Manual
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.
10-8
ECG
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.
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.
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Cardiocap/5 for Critical Care User’s Reference Manual
(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
To do this:
14. Press the ComWheel and select Monitor Setup from the Main Menu.
15. Select Screen Setup.
16. Select Digit Fields.
10-10
ECG
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Cardiocap/5 for Critical Care User’s Reference Manual
NOTE: The ST algorithm has been tested for accuracy of the ST segment data. The
significance of the ST segment changes needs to be determined by a clinician.
WARNING: Do not rely entirely upon rate meter alarms when monitoring patients with
pacemakers. The monitor may count the pacemaker pulses as heartbeats. In this case,
asystole and ventricular fibrillation may go undetected. Always keep these patients under
close surveillance and monitor their vital signs carefully.
10-12
ECG
28. Press the ComWheel and select Monitor Setup from the Main Menu.
29. Select Install/Service and enter the password.
30. Select Installation.
31. Select Analog Outputs.
For more information, refer to the Technical Reference Manual.
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Cardiocap/5 for Critical Care User’s Reference Manual
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.
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.
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.
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Cardiocap/5 for Critical Care User’s Reference Manual
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.
1 LEAD I
1 2
LE 3 4 5 6
AD
II
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 for Critical Care User’s Reference Manual
11-4
Impedance Respiration
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Cardiocap/5 for Critical Care User’s Reference Manual
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 *
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Cardiocap/5 for Critical Care User’s Reference Manual
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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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.
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
3. 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
5. Position the sensor and attach it to the patient. For proper sensor positioning and
application, consult the instructions that accompany the sensor.
6. 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 for Critical Care User’s Reference Manual
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
Autocycling ................................................................................13-5
Setting the cycle time.................................................................................................. 13-5
Starting/stopping autocycling ................................................................................... 13-5
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) 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
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Cardiocap/5 for Critical Care User’s Reference Manual
Patient connections
13-2
Non-Invasive Blood Pressure (NIBP)
NOTE: When using infant cuffs, the white infant cuff hose must be used. Also make
sure the Inflation Limits selection is set to Infant or Auto.
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 for Critical Care User’s Reference Manual
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 automatically sets the inflation pressure according to the first
measurement. Discharge the patient 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.
Intervals below 10 minutes and STAT measurements are not recommended for
extended periods of time.
Blood pressure values may be affected by a change in the patient's position.
13-4
Non-Invasive Blood Pressure (NIBP)
Canceling a measurement
To cancel any measurement, press the NIBP Start/Cancel key.
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.
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Cardiocap/5 for Critical Care User’s Reference Manual
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.
(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
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Cardiocap/5 for Critical Care User’s Reference Manual
1
Disposable
2
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:
5. Connect the pressure transducer to the transducer cable and the cable to the
monitor’s red connector.
6. Prepare the transducer kit according to the manufacturer’s instructions. Mount the
kit with the transducer zeroing port at mid-heart level.
7. 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.
8. Connect the patient catheter to the pressure line.
9. Open the dome stopcock to room air.
10. Zero the transducer. See Starting with accurate values later in this chapter.
11. Open the dome stopcock to pressure catheter and check the quality of the
waveform.
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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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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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27. 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.
28. 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.
29. 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.
NOTE: You can also manually freeze the waveform before 20 seconds has elapsed by
selecting Freeze/Adjust.
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Invasive Blood Pressure
Adjusting PCWP
To manually adjust the PCWP pressure level:
30. In the Wedge menu, select Freeze/Adjust.
31. Turn the ComWheel to move the cursor to a point on the waveform that represents
the true PCWP level.
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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) Label
(2) Temperature measurement value
Patient connections
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Cardiocap/5 for Critical Care User’s Reference Manual
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.
6. 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. Attaching the regulator to the gas container .............................................. 16-5
Figure 16-5. Connecting a sampling line to the gas valve and feeding gas................. 16-6
Airway Gases
Overview
With the Datex-Ohmeda Cardiocap/5, you can measure and monitor the gases inhaled
and exhaled by the patient.
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
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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.
(2) Y-piece
(3) Airway adapter with
sampling line connector
(4) Heat and moisture exchanger
with filter (HMEF)
5. 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.
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.
16-2
Airway Gases
CO2 setup
6. Press the ComWheel and select Parameters from the Main Menu.
7. Select Ventilation.
8. Select CO2 Setup.
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Cardiocap/5 for Critical Care User’s Reference Manual
O2 setup
14. Press the ComWheel and select Parameters from the Main Menu.
15. Select Ventilation.
16. Select O2 Setup.
17. To select the scale for the waveform oxygram, select Scale.
The monitor measures inspiratory and expiratory O2 continuously and displays an
O2 waveform oxygram. It also calculates and displays the difference of inspired
and expired O2. The scale allows you to select the following ranges for oxygram:
difference scales DIFF 6, DIFF 10, DIFF 15, DIFF 30, 10 - 60%, 0 - 100%.
The monitor determines the maximum measured O2 concentration and
automatically sets the reference level for the difference scales. DIFF 30 and
10 - 60% are used in the recovery room when the patient is oxygenated, for example.
Scale 0 - 100% enables you to inspect the full range of O2. It is used during
pre-oxygenation, for example.
18. Select Measurement and choose ON or OFF.
You can turn off O2 measurement when no O2 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 O2 waveform field.
19. Select O2 Alarm to open the O2 Alarms Adjustment menu where you can change the
O2 alarm limits as described in the Alarms chapter.
This symbol is displayed beside the O2 value when the FiO2 low alarm
limit is set below 21%.
16-4
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.
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Cardiocap/5 for Critical Care User’s Reference Manual
22. 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 16-5. Connecting a sampling line to the gas valve and feeding gas
23. Press the ComWheel and select Parameters from the Main Menu.
24. Select Ventilation.
The Gas Calibration selection remains gray (inactive) until the “Calibrating gas
sensor” message is no longer displayed.
25. Select Gas Calibration.
26. 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.
27. Open the regulator and feed the calibration gas until “Adjust” appears, then close
the valve.
28. Check that the displayed gas values match the values on the calibration gas
container.
16-6
Airway Gases
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:
29. Select Gas Calibration in
the Ventilation menu.
30. Turn the ComWheel to
highlight the first gas to be adjusted. Press the
ComWheel to open an adjustment window.
31. Turn the ComWheel until the displayed value
matches the desired value. Press the
ComWheel to confirm the adjustment.
32. Repeat steps 2 and 3 for each 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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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:
33. Press the ComWheel and select Monitor Setup from the Main Menu.
34. Select Install/Service and enter the password.
35. Select Installation.
36. Select Units.
37. Select Parameters.
38. Select CO2 and choose the unit (%, kPa, or mmHg).
To change a color:
39. Press the ComWheel and select Monitor Setup from the Main Menu.
40. Select Install/Service and enter the password.
41. Select Colors.
42. Select Gases and choose the color.
16-8
Contents
Table of Figures
Figure 17-1. Patient spirometry waveform display .......................................................... 17-3
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 .................................. 17-4
Figure 17-4. Patient spirometry setup ................................................................................. 17-5
Figure 17-5. Connector positioning..................................................................................... 17-5
Figure 17-6. D-lite sensor ....................................................................................................... 17-6
Figure 17-7. Pedi-lite sensor.................................................................................................. 17-6
Figure 17-8. Vol Scale, Paw Scale, and Flow Scale options ......................................... 17-11
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)
Extrinsic positive and expiratory pressure (PEEPe, set PEEP)
Dynamic intrinsic positive and expiratory pressure (PEEPi, auto PEEP)
Static intrinsic positive and expiratory pressure (PEEPi stat)
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.
Pmean is the average pressure during one breath.
PEEP is the pressure in the lungs at the end of the expiration, measured at the moment
the expiratory phase changes to inspiratory flow.
PEEPe is the minimum pressure during the expiratory phase, reflecting the PEEP set
from the ventilator.
PEEPi, the dynamic intrinsic PEEP, reflects the presure value near the airway, whereas,
PEEPi stat gives an estimate of the average pressure in the lungs at the end of an
expiration.
• PEEPi is the difference between total PEEP and extrinsic PEEP (PEEP – PEEPe).
• PEEPi stat is the intrinsic PEEP measured during an occlusion situation. For the
measurement, perform an end expiratory pause of least four seconds at the
ventilator. During this time, the pressures are balanced in the lungs and the D-lite
and monitor detect the PEEPi stat value.
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).
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Figure 17-3. Spiro1 (left) and Spiro2 (right) split screen options
(1) Scale
(2) Label
(3) Real-time loop
(4) Digit field
Spiro1, the basic spirometry view, shows Ppeak, Pmean, PEEPe, PEEPi (stat),
Compliance, Tvexp/TVinsp, and MVexp/MVinsp.
Spiro2 shows the same parameters as the basic view plus PEEPi (dynamic or OFF), I:E,
and Raw.
For both views, Tvexp/TVinsp and /MVexp/MVinsp 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.
17-4
Patient Spirometry
Patient connections
To make the connections:
4. Connect a new spirometry tube to the flow sensor by inserting the angle
connectors into the sensor connectors.
5. Connect the other end of the spirometry tube to the pressure connectors on the
monitor.
6. Connect a gas sampling line to the luer connector on the other side of the flow
sensor.
7. 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.
8. Select the type of sensor you use, D-lite (the factory default) or Pedi-lite:
Press the ComWheel and select Parameters. Then, select Ventilation and Spirometry
Setup. Select Sensor Type and choose the sensor.
9. Complete the other patient connections as shown below.
Patient tubes
1 2 3 4
Sampling line
connector
Spirometry 5
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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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: Ventilators that have high continuous bypass flows may cause inaccurate
volume readings.
17-6
Patient Spirometry
Spirometry setup
To open the Spirometry Setup menu:
14. Press the ComWheel and select Parameters from the Main Menu.
15. Select Ventilation.
16. Select Spirometry Setup.
NOTE: For detailed information about the Scaling selection, refer to Scaling of
loops and waveforms later in this chapter.
17. Select Sensor Type and choose Adult (the factory default) or Pedi (pediatric) according
to the flow sensor in use.
18. 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.
19. Select Paw Alarms to open the Paw Alarms Adjustment menu. You can adjust Ppeak
and PEEP alarms in the same menu.
20. Select MVexp Alarm to open the MVexp Alarms Adjustment menu.
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Spirometry loops
Spirometry parameters are viewed in the Spirometry Loops 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:
21. Press the ComWheel and select Parameters from the Main Menu.
22. Select Ventilation.
23. Select Spirometry Loops.
17-8
Patient Spirometry
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.
Vol
ml
1200 0
Paw
cmH20
Ð60
0 40
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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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.
17-10
Patient Spirometry
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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TV measuring conditions
17-12