M1771A M1770A PageWriter 200/300pi User’s Guide
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About This Edition WARNING CAUTION Edition 2 Printed in the USA Publication number M1770-91930 As with electronic equipment, Radio Frequency (RF) interference between the cardiograph and any existing RF transmitting or receiving equipment at the installation site, including electrosurgical equipment, should be evaluated carefully and any limitations noted before the equipment is placed in service.
&RQYHQWLRQV Conventions Used in This Manual WARNING Warning statements describe conditions or actions that can result in personal injury or loss of life. CAUTION Caution statements describe conditions or actions that can result in damage to the equipment or software. NOTE Notes contain additional information on cardiograph usage. .H\ Represents keys on the key panel. Safety Summary Safety Symbols Marked on the Cardiograph The following safety symbols are used on the cardiograph.
&RQYHQWLRQV Fuse. Indicates power control for cardiograph. Recycle. Sealed Lead Acid Battery - Recycle or dispose of properly. Hz Indicates operating frequency in cycles per second. Please see "Maintaining the Cardiograph", for further information about operating your cardiograph safely. Cardiograph Packaging Symbols The following symbols appear on the packagin for the cardiograph: Keep dry. Temperature and relativey humidity ranges. Fragile. Keep upright.
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1 Getting Acquainted 1 This chapter describes to the new user the many features of the PageWriter 200/300pi cardiograph, patient and operational safety, A/C, and battery operation. The user should become familiar with this material, especially the safety information, prior to using the cardiograph. NOTE See Setting Up Your Cardiograph, for information on checking the voltage switch setting, installing the battery, connecting the cables, and loading paper.
Figure 1-1: The PageWriter 200/300pi Cardiograph A. Patient Cable B.
1 Figure 1-2: Bottom View of Cardiograph A. B. C.
The Keyboard and Front Panel The Keyboard and Front Panel Figure 1-3: The Keyboard and Front Panel of the Cardiograph 1-4 Getting Acquainted
The Keyboard and Front Panel $ Displays the configuration menu, unless an ECG report is in-process. Use Stop , or Exit , % softkey These five keys (F1 – F5), located directly beneath the display window, perform different functions at different times. They are called “softkeys.” When a softkey is active, a label describing its function is displayed above it on the screen. Press the key to perform the function displayed on the screen. & Shift Used to enter shifted characters.
The Keyboard and Front Panel Table 1-1: Characters by Language Key English French German DOW $/7 DOW $/7 DOW $/7 D Dutch DOW Italian $/7 DOW $/7 Spanish DOW $/7 j j l b l b j j i $ E ` ` ` ` ` ` F # _ # _ # _ # _ # _ # _ G ! ! ! ! ! ! ! ! ! ! ! ! r r s s p e I " " " " " " " " " " " " J ? ? ? ? ? ? K “ “ “ “ “ “ “ “ “ “ “ “ v v u u t t ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’ q
The Keyboard and Front Panel Key Norwegian Swedish DOW $/7 DOW $/7 D n c l b E ` ` Finnish DOW $/7 ` F # _ # _ # _ G ! ! ! ! ! ! H I Polish DOW ` $/7 " " " " $/7 j ! ! k Ç " " Key Russian DOW 1 $/7 ` " Portuguese DOW " " " J K “ “ “ “ “ “ “ “ ’ ’ ’ ’ ’ ’ ‘ ‘ P a @ a @ a @ Q > > > R ¡ | g | g ~ Ô m ® r È { Ñ r È } ¯ i É L M N O S “ T n c n
About Your Cardiograph About Your Cardiograph Your PageWriter 200/300pi cardiograph: l l l l l l l Acquires 12 leads simultaneously. Allows you to check lead quality on the preview screen before printing the ECG. Provides selectable formats (Auto and Manual). Reports measurements of the ECG. Operates on a rechargeable battery. AC power charges the battery. Has a digital array printer with continuous-feed paper. Has a 200 sheet Z-fold paper capacity.
About Your Cardiograph Reusable Electrodes Accessory Set — Options: ABG, ABK, ABM, AB2, AB4, AKV, ABK, AKM, ACQ, AC6, ACJ l l l l l l l l l Battery assembly Power cord Patient Cable 1 package of paper 6 Welsh bulb electrodes 4 limb plate electrodes and straps PageWriter 200/300pi User’s Guide Using the HP PageWriter 200/200i Cardiograph operator training video (also applicable to the PageWriter 300pi) Hewlett-Packard Interpretive Cardiograph Physician’s Guide 1 Disposable Electrodes Accessory Set — Opti
Patient and Operational Safety Notes Patient and Operational Safety Notes Your cardiograph isolates all connections to the patient from electrical ground and all other conductive circuits in the cardiograph. This reduces the possibility of hazardous currents passing from the cardiograph through the patient’s heart to ground.
Electromagnetic Compatibility connecting or disconnecting electrodes to/from a patient. The use of multiple instruments connected to the same patient may pose a safety hazard due to the summation of leakage currents from each instrument. Any combination of instruments should be evaluated by local safety personnel before being put into service. Do not pull on the paper while a report is being printed. This can cause distortion of the waveform and can lead to potential misdiagnosis.
Reducing Electromagnetic Interference Tests for the 200/300pi cardiographs show they do not emit interference that exceeds the IEC 601-1-2 limits. Reducing Electromagnetic Interference The M1770/M1771 PageWriter 200/300pi cardiographs are susceptible to interference from other RF energy sources and continuous, repetitive, power line bursts. Examples of other sources of RF interference are medical devices, cellular products, information technology equipment and radio/television transmission.
AC and Battery Operation l l l l l NOTE If the cardiograph is turned on while the battery is being charged, these charging times are doubled (10 minutes for an Auto ECG and 20 minutes for a 1-minute Manual ECG). l NOTE The Low Battery message on the display indicates the battery needs to be charged.
AC and Battery Operation NOTE The cardiograph’s battery charging circuit delivers less power than the cardiograph uses while printing an ECG. It is possible to run down the battery, even when the cardiograph is plugged into AC power, if the printer is being heavily used.
2 Recording an ECG This chapter describes how to: l l l l l l prepare the patient for an ECG check the signal quality of the patient leads enter patient ID and printed report information record an ECG change the report format understand the printed report 2 Samples of the different Manual and Auto ECG formats are also shown. NOTE If the cardiograph has not been setup, refer to Setting Up Your Cardiograph, for instructions.
Preparing the Patient Preparing the Patient For electrode placement information, refer to the diagram on the top of your cardiograph. NOTE Proper patient preparation and electrode placement are the most important elements in producing a high quality ECG trace. Prepare the patient by performing the following steps. 1. Reassure and relax the patient. A calm and quiet patient produces the best ECGs. 2. Make sure the electrode site is not covered by hair or clothing. 3.
Preparing the Patient Table 2-1: Leads Off Labels Designator (AHA/IEC) Meaning RL/N Right leg electrode not connected or only right leg electrode is connected and all other limb electrodes are not connected. RA/R Right arm electrode is not connected. LA/L Left arm electrode is not connected. LL/F Left leg electrode is not connected. V1...V6/ C1...C6 One or more chest electrodes are not connected. For example, V2 means the V2 electrode is not connected.
Understanding When a Signal is Acquired Understanding When a Signal is Acquired Your PageWriter 200/300pi cardiograph attempts to acquire a good signal for an Auto report before you press the $XWR key. This is called pre-acquisition. Pre-acquisition is activated when the cardiograph is turned on and remains active until an Auto report begins to print. Pre-acquisition is also suspended whenever an electrode is disconnected.
Checking Signal Quality Checking Signal Quality You can produce better ECGs by previewing the lead traces on the screen before you record and print the ECG. By observing the traces and adjusting the leads accordingly, you can make the best possible ECG recording. The screen displays the output from the selected three leads whenever the cardiograph is on. The leads are displayed in five groups of three leads each.
Entering Patient ID NOTE The ECG traces are updated by the erase bar that moves across the screen. Entering Patient ID Entering patient ID information is not required to record an ECG. Note that for the PageWriter 300pi, some ID fields affect the interpretation of Auto ECGs and this ID information should therefore be entered. See “Understanding ECG Analysis and the Predictive Instruments Applications” for more information.
Entering Patient ID B. If you press No, Edit Old ID to answer the New patient? query, the existing patient ID information is displayed for you to review or change, if necessary. 2. Type the patient ID number and press requests the patient’s name. , , or . The next line 3. Type the patient’s name and press the , , or . The next line requests the patient’s age. It also allows you to change the age designation (Years, Year of Birth, Months, Weeks, Days, or Hours). 4. Type the patient’s age.
Entering Patient ID Reviewing and Changing Patient ID To review and change the current patient ID information: 1. Press the ,' key. The message New Patient? displays. 2. Press No, Edit Old ID . The current patient ID screen displays, and you can change any field. NOTE To enter information more quickly, you can suppress the display of unused ID fields. Refer to Configuring Your Cardiograph for details. Table 2-3: Patient ID Fields Prompt Comments Entry # of char. ID: Type the patient ID number.
Entering Patient ID Table 2-3: Patient ID Fields Prompt Comments Entry # of char. Chest/LA pain entry? Blank Yes, Chief Complaint Yes, Secondary Complaint No Chest/Left Arm Pain 3 character field Acute Ischemic Sx time Entry? Type the time in minutes. 3 character field History Diabetes Entry? Yes or No 3 character field History Hypertension Entry? Yes or No 3 character field Height: Type the height. Numeric 3 Weight: Type the weight.
Recording a Manual ECG Table 2-3: Patient ID Fields Prompt Comments # of char. Entry Requested by: Type name or number of the person requesting the ECG. Alphanumeric 16 Custom Field One: This label can be configured as needed. See Table B-1. Alphanumeric 16 Custom Field Two: This label can be configured as needed. See Table B-1. Alphanumeric 16 Set ECG Mgmt Priority to Stat? Yes or No Setup ID entry for ECG management system priority to indicate a ‘STAT’ ECG.
Recording a Manual ECG ID, Continue? is displayed. Press Yes to record the ECG without a patient ID. Press No, Enter ID to enter patient ID information. l If you did not enter a patient ID in the above step but have entered patient ID information since the cardiograph was turned on, the question Continue using Old ID? is displayed. If you have entered a patient identification number and want to take more ECGs from the same patient, press Yes .
Restoring the ECG Trace After Defibrillation or Reconnecting Leads l The Leads key sequence is: 3 lead manual - Custom ⇒ I II III ⇒ aVR, aVL, aVF ⇒ V1 V2 V3 ⇒ V4 V5 V6 ⇒ Custom ... 6 lead manual - Custom Leads ⇒ Limb Leads ⇒ V1–V6 Leads ⇒ Custom Leads ... l The Speed key sequence is: 25 ⇒ 50 ⇒ 5 ⇒ 10 ⇒ 25 ... (numbers indicate chart speed in mm/sec). l The Size key sequence is: 1.0 ⇒ 1.0 ½V ⇒ 2.0 ⇒ 2.0 ½V ⇒ 0.5 ⇒ 0.5 ½V ⇒ 1.0 ... l The )LOWHU key sequence is an On/Off toggle.
Recording an Auto ECG l The Leads key sequence is: 3x4 1R: I ⇒ ΙΙ ⇒ ΙΙΙ ⇒ aVR ⇒ aVL ⇒ aVF ⇒ V1 ⇒ V2 ⇒ V3 ⇒ V4 ⇒ V5 ⇒ V6 ⇒ I ... 3x4 3R: Custom Leads ⇒ Ι, ΙΙ, ΙΙΙ ⇒ aVR, aVL, aVF ⇒ V1, V2, V3 ⇒ V4, V5, V6 ⇒ Custom Leads ... l The Speed key sequence is: 25 ⇒ 50 ⇒ 25 ...(numbers indicate chart speed in mm/sec). l The Size key sequence is: 1.0 ⇒ 1.0 ½V ⇒ 2.0 ⇒ 2.0 ½V ⇒ 0.5 ⇒ 0.5 ½V ⇒ 1.0 ... l The )LOWHU key sequence is an On/Off toggle. When )LOWHU is active, Filter is displayed on the screen. 6.
Making Copies of Auto ECGs Making Copies of Auto ECGs If you require additional copies of an Auto ECG, you may print a copy of the last ECG that was recorded. See Figures 2-1 through 2-6 for examples of the report formats available. To print a copy of your most recent Auto ECG, press the &RS\ key. The message Printing... is displayed and the copy is printed. To print a copy of the extended measurements report for the most recent ECG, press the 6KLIW and &RS\ keys at the same time.
Understanding the Printed Report Understanding the Printed Report The PageWriter 200/300pi provides Auto, Manual, and Extended Measurements reports. This section describes the Manual and Auto reports. The Manual report features closely resemble those of the Auto report. The Extended Measurements report is described in “Understanding ECG Analysis and the Predictive Instruments Applications”. Choosing a Report Format 2 An Auto report prints a one- or two-page summary of all 12 cardiograph leads.
Choosing a Report Format Changing the Report Format To change the report format: 1. Press 6WRS . The bottom of the display will be similar to the one shown below. Auto Report 3x4,3R Format I,II,III Leads 25mm/s Speed 1.0 Size 2. Press 5HSRUW to select between Auto or Manual report menus. Note that the data displayed above the )RUPDW and /HDGV softkeys will change as you switch between the Auto and Manual report formats. 3. Press )RUPDW to select the report presentation.
Choosing a Report Format Other lead groups can be selected while recording an ECG, and custom lead groups can also be selected. (See Power-On Report Fields in Configuring Your Cardiograph for information about setting up custom lead combinations for Manual ECG reports.) Refer to Figures 2-7, 2-8, and 2-9 for examples of these Manual report formats. The following tables show the standard and default-custom lead configurations.
Choosing a Report Format Table 2-6: Manual Report Cabrera Formats Number of Leads 12 Standard Lead Choices Default Custom Lead Choices aVL, I, -aVR, II, aVF, III, V1, V2, V3, V4, V5, V6 Predictive Instrument Auto Report Formats For PageWriter 300pi models, select the type of Auto report interpretation and analysis as follows: 1 Press 5HSRUW until ’Auto Analysis’ (F1) key appears. 2 Press (F3) key to select the type of interpretation and analysis report.
Choosing a Report Format For additional information on the Predictive Instruments and associated reports, refer to “Understanding ECG Analysis and the Predictive Instruments Applications” and the Predictive Instruments Physician’s Guide.
Choosing a Report Format Table 2-8: Auto Report Annotations Description 2-20 A Patient ID number B Leads Off Status C Age and Sex D Patient Name E Weight Height F Systolic/Diastolic Blood Pressure (BP) G Department Room No. Operator H Custom Field One Custom Field Two Note: These fields are for user-defined labels, such as insurance number or medications.
Choosing a Report Format Table 2-8: Auto Report Annotations Description P Cardiograph settings for speed, and for limb and chest lead sensitivity. Q Location code and cardiograph ID number (Options #A05 or StressWriter only) Basic Measurements The basic measurements table gives standard interval and duration measurements in milliseconds, and limb lead axis measurements in degrees. These are representative values for the dominant beat pattern in the ECG.
Choosing a Report Format l l l l l l 1.0 (normal or 10 mm/mV), 1.0 ½V (normal for leads other than V-leads, half-normal or 5 mm/ mV for V-leads), 0.5 (half-normal or 5 mm/mV), 0.5 ½V (half-normal for leads other than V-leads, quarter-normal for V-leads), 2.0 (twice-normal or 20 mm/mV), or 2.0 ½V (twice-normal for leads other than V-leads, normal for Vleads). Table 2-10: Calibration Signals ECG Size (mm/mV) Display Label Limb Leads V-leads V1 - V6 Calibration Pulse Auto Manual Limb Leads 2-22 0.
Choosing a Report Format Auto Report Examples The following figures show examples of Auto ECG report formats.
Choosing a Report Format Figure 2-3: An Auto 3x4 ECG with One Rhythm Strip (3x4, 1R) Figure 2-4: An Auto 3x4 ECG with Three Rhythm Strips (3x4, 3R) 2-24 Recording an ECG
Choosing a Report Format Figure 2-5: An Auto 6x2 ECG (6x2) 2 PageWriter 200/300pi M1771A/1770A Cardiograph 2-25
Choosing a Report Format Figure 2-6: A Cabrera Auto 6x2 ECG (6x2) 2-26 Recording an ECG
Choosing a Report Format Manual Report Examples The following figures show examples of Manual ECG report formats.
Choosing a Report Format Figure 2-8: A Manual 6-Lead ECG 2-28 Recording an ECG
Choosing a Report Format Figure 2-9: A Manual 12-Lead ECG 2 PageWriter 200/300pi M1771A/1770A Cardiograph 2-29
Choosing a Report Format Figure 2-10: The TPI Report (H0 page 1) 2-30 Recording an ECG
Choosing a Report Format Figure 2-11: The TPI Report (H0 page 2) 2 PageWriter 200/300pi M1771A/1770A Cardiograph 2-31
Choosing a Report Format Figure 2-12: The ACI-TIPI Report (T0) 2-32 Recording an ECG
Choosing a Report Format Figure 2-13: The ACI-TIPI/Std Adult Report (T8) 2 PageWriter 200/300pi M1771A/1770A Cardiograph 2-33
Choosing a Report Format Figure 2-14: The Risk Management Report (RM) 2-34 Recording an ECG
3 Understanding ECG Analysis and the Predictive Instruments Applications This chapter explains how the cardiograph measures, analyzes and interprets (PageWriter 300pi only) ECG data, and what information is included on the Extended Measurements report. In addition, the Predictive Instruments applications of the PageWriter 300pi are described. Understanding the ECG Analysis Program The ECG Analysis Program produces precise, accurate and consistent ECG measurements.
Understanding the ECG Analysis Program Figure 3-1: The ECG Analysis Program ECG & Patient Data ECG Analysis Program Feedback to Operator Quality Monitor Measurements Criteria Extended Measurement Matrix Interpretive Report Overreader The analysis process begins with the simultaneous acquisition of the ECG’s 12 conventional leads. It then proceeds through four steps before producing the interpreted ECG report. These steps are: 1. Quality Monitor—examines the technical quality of each ECG lead. 2.
How the PageWriter 200/300pi Measures ECGs Agilent Technologies provides two standard criteria programs, adult and pediatric, for the PageWriter 300pi cardiograph. Patient information, including age, sex, height, and weight can be used by the criteria programs in selecting the interpretive statements. NOTE For more information about interpretation, see the Interpretive Cardiograph Physician’s Guide.
How the PageWriter 200/300pi Measures ECGs Figure 3-2: ECG Morphology Measurements Waveform Recognition The first step of the measurement program involves waveform recognition and beat detection. A boundary indicator waveform in which QRS complexes and pacemaker spikes are enhanced is derived from all leads over the ten-second analysis period. After the approximate QRS complex and pacemaker spike locations are known, another boundary indicator waveform that enhances P and T wave detection is derived.
How the PageWriter 200/300pi Measures ECGs these measurements is created, from which the representative measurements are calculated. Group Measurements After all the beats have been measured, each beat in the ECG is classified into one of five rhythm groups based on rate and morphology parameters. Each group consists of beats with similar R-R intervals, durations, and shapes, except that all paced beats are grouped together, regardless of other parameters.
How the PageWriter 200/300pi Measures ECGs late group and global atrial rhythm parameters. If no conclusive result is achieved, no atrial rhythm parameters are calculated. Global Measurements The global measurements for the ECG, including the frontal and horizontal plane axis measurements, are reported to the right of the lead measurements in the Morphology Analysis section of the Extended Measurements report.
Automatically Measuring and Interpreting ECGs Automatically Measuring and Interpreting ECGs The PageWriter 200/300pi uses the ECG Analysis Program to produce precise, accurate and consistent ECG measurements. In the PageWriter 300pi, the program further provides interpretive statements that highlight key areas of concern for your review. The primary objective of interpretation is to help the physician in making a clinical diagnosis.
Understanding the Extended Measurements Report Understanding the Extended Measurements Report The Extended Measurements Report The two-part Extended Measurements report summarizes the morphology and rhythm characteristics for the individual leads and rhythm groups in the ECG. The ECG Analysis Program uses the Extended Measurements report information to generate interpretive statements. An Extended Measurements report is available for each ECG when it is recorded or later if the ECG is stored.
Understanding the Extended Measurements Report Morphology Analysis The following tables define the parameters in the order that they appear on the morphology analysis page of the extended measurements report. Individual Lead Measurements Table 3-1 lists every representative measurement in each lead. The parameters in the following tables are shown in Figure 3-4.
Understanding the Extended Measurements Report Table 3-1: Individual Lead Measurements (Continued) Parameter 3-10 Units or Value Description P AREA Ashman units (40 ms x 0.1 mV) P wave area for monophasic P waves or the area of the initial portion of a biphasic P wave. P NOTCH Yes or No Indicates the presence or absence of a notch in the P wave. P’ AMP millivolts P’ wave amplitude P’ DUR milliseconds P’ wave duration P’ AREA Ashman units (40 ms x 0.
Understanding the Extended Measurements Report Table 3-1: Individual Lead Measurements (Continued) Parameter Units or Value Description QRSNTCH + or - Indicates a notch in the QRS complex. A + indicates a notch or slur in the R or R’ wave. A - indicates a notch or slur in the Q, S, or S’ wave. DELTA Yes or No Indicates the presence or absence of pronounced delta waves preceding QRS complexes. ST ON millivolts Elevation or depression at the onset (J point) of the ST segment.
Understanding the Extended Measurements Report Table 3-1: Individual Lead Measurements (Continued) Parameter 3-12 Units or Value Description T’ AMP millivolts T’ wave amplitude T’ DUR milliseconds T’ wave duration T’ AREA Ashman units (40 ms x 0.1 mV) Area of the terminal portion of a biphasic T wave. PR INT milliseconds Interval from the onset of the P wave to the onset of the QRS complex. PR SEG milliseconds Interval from the end of the P wave to the onset of the QRS complex. V.A.T.
Understanding the Extended Measurements Report Table 3-1: Individual Lead Measurements (Continued) Parameter Units or Value Description QUALITY N/A Each character indicates a type of noise present in the lead: D - Baseline wander indicator. The onsets of two successive QRS complexes differ by more than 1/ 3 the calibration value. T - Artifact, most likely muscle tremor. Occurs when more than 16 up-and-down strokes exceeding 1 mm in amplitude are detected within 1 second.
Understanding the Extended Measurements Report Cal Factors The factor by which the ECG trace differs from standard scaling (10 mm/ mV). Standard scaling is indicated by a CAL factor of 1.00. Table 3-2: Cal Factors Parameter Units or Value Description **Cal Assumed** Appears only when true The cal pulses were measured to be of non-standard amplitude or shape. This may indicate a cardiograph malfunction.
Understanding the Extended Measurements Report Table 3-3: Frontal/Horizontal Parameter Units or Value Description ST degrees ST segment axis. T degrees T wave axis. Mean Ventr. Rate beats per minute Representative ventricular rate for the entire ECG. Mean PR Int. milliseconds Representative PR interval for the entire ECG. Mean PR Seg. milliseconds Representative PR segment for the entire ECG. Mean QRS Dur. milliseconds Representative QRS duration for the entire ECG. Mean QT Int.
Understanding the Extended Measurements Report Rhythm Analysis Group Measurements Figure 3-5: Extended Measurements Report (Rythm) 3-16 Understanding ECG Analysis and the Predictive Instruments Applications
Understanding the Extended Measurements Report The following are parameters given for each rhythm group detected by the PageWriter 200/300pi during the analysis interval. Table 3-4: Group Measurements Units or Value Parameter Description Member Count N/A Number of beats in the rhythm group. Member% percentage Percentage of the total number of beats represented by the rhythm group. Longest Run N/A Longest contiguous run of beats in the rhythm group.
Understanding the Extended Measurements Report Table 3-4: Group Measurements Parameter 3-18 Units or Value Description Low PR Interval milliseconds Shortest PR interval in the rhythm group. Mean PR Interval milliseconds Average PR interval in the rhythm group. High PR Interval milliseconds Longest PR interval in the rhythm group. PR Int. Std. Dev. N/A Standard deviation of the PR interval in the rhythm group. Mean PR Segment milliseconds Average PR segment in the rhythm group.
Understanding the Extended Measurements Report Group Flags The parameters in this part of the rhythm analysis indicate the presence or absence of various rhythm-related conditions in the rhythm groups identified. Table 3-5: Group Flags Parameter Units or Value Artificial Pace Yes or No Indicates that beats in the rhythm group are paced. All paced beats are grouped together. Interpolated Beat Yes or No Indicates that the rhythm group contains only interpolated beats.
Understanding the Extended Measurements Report Global Rhythm Parameters The following parameters provide global information for beats in the ECG. Table 3-6: Global Rhythm Parameters Parameter 3-20 Units or Value Description Atrial Rate Beats per minute The representative atrial rate for the analysis interval. This is not a simple arithmetic average. Low Ventr Rate Beats per minute The lowest ventricular rate during the analysis interval.
Understanding the PageWriter 300pi Predictive Instrument Applications Parameter Units or Value Description Trigeminy String N/A Total number of beats in the longest continuous trigeminy pattern. Wenckebach Count N/A Total number of Wenckebach cycles. A Wenckebach cycle is a series of beats whose PR intervals grow progressively longer, culminating in an unusually long RR interval, (a dropped beat). Wenckebach String N/A The number of beats preceding the dropped beat.
Understanding the PageWriter 300pi Predictive Instrument Applications patient age, gender, blood pressure, chest pain status and time since ischemic symptom onset. The cardiograph can be configured to automatically print these probabilities on the Auto ECG report. Figure 3-6 illustrates the Predictive Instrument Application process. If TPI is enabled, the Predictive Instrument Application produces the H0 report.
Understanding the PageWriter 300pi Predictive Instrument Applications The TPI is intended for use as an aid to clinicians identifying which patients with AMI are appropriate candidates for thrombolytic therapy. TPI is intended for adult patients, aged 35-75, diagnosed with symptoms of acute myocardial infarction.
Understanding the PageWriter 300pi Predictive Instrument Applications The three ECG features are: l l l the presence or absence of pathological or significant Q waves the presence and degree of ST segment elevation or depression the presence and degree of T wave elevation or inversion Understanding ACI TIPI Variables Seven variables are used to predict Acute Cardiac Ischemia. These variables include four clinical factors and detailed information on three ECG features.
Understanding the PageWriter 300pi Predictive Instrument Applications Using the TPI and ACI TIPI Applications To use the TPI and ACI TIPI applications, you must configure the cardiograph and enable the applications. There are several types of reports that are produced by the cardiograph. These reports are summarized in Table 3-7.
Understanding the PageWriter 300pi Predictive Instrument Applications NOTE To configure your cardiograph to interpret with ECL 08 criteria without the ACI-TIPI analysis, perform the following steps: 1. From the Configuration Menu, select Setup Predictive Instruments. 2. From the Setup Predictive Instruments Menu, set ’Interp Criteria?’ to Adult 08/TIPI." 3. Exit the Setup Predictive Instruments Menu and return to the configuration menu by pressing ’Exit’. 4. Use the arrow keys and select Setup ID Entry 5.
4 ECG Storage (Options #A05 or StressWriter) This chapter contains information about storing ECGs using the internal memory of the PageWriter 200/300pi, Options #A05 or StressWriter. Information about using and printing the Log of ECGs Taken and the Log of ECGs Stored is also included. Advantages of Storage Storing ECGs allows you to recall the ECGs later as needed. Individual ECGs or groups of ECGs can be recalled for re-analyzing, editing, printing, or transmitting.
Storing ECGs Storing ECGs To store the ECG, perform the following steps: 1. After the ECG report prints, the following message will appear on the screen: Store ECG? Patient ID: 23456 Name: Ian Harrison Yes F1 No F2 F4 F3 F5 2. Press Yes ( ) ) to store the ECG, OR press No ( ) ) to continue without storing the ECG. NOTE If you select No , you cannot store the ECG later, or transmit the ECG. 3. If you select Yes , the message “Storing ECG...” appears on the screen until storage is complete.
Storing ECGs 4. If the storage memory is full when you attempt to store an ECG, the following screen appears: Storage system is full. Do you want to delete an old ECG? Yes F1 No F2 F4 F3 F5 4 5. Press Yes ( ) ) to delete one or more old ECGs. The Manage Stored ECGs screen will appear. The ECGs will be listed oldest first and most recent last. See the next section, “Managing Stored ECGs” , for information on deleting ECGs. OR Press No ( ) ) to return to the “Store ECG?” screen.
Managing Stored ECGs Managing Stored ECGs Your PageWriter 200/300pi cardiograph with Options #A05 or StressWriter allows you to print, delete, and edit the patient ID information for stored ECGs. You cannot edit the date or time the ECG was acquired, the ECG measurements, or the ECG interpretive statements. Selecting Stored ECGs To select an ECG for printing, deletion, or editing the patient ID information, perform the following steps: 1. Press the key. The main menu appears.
Managing Stored ECGs 2. Select Manage Stored ECGs from the menu by pressing to move the cursor down, or by pressing or or to move the cursor up until the selection is highlighted. 3. Press Select ( ) ) or to display the Manage Stored ECGs menu.
Managing Stored ECGs 5. Press Select ( ) ) to select the ECG. An asterisk appears to the left of selected ECGs. The Select softkey changes to Unselect when a selected ECG is highlighted. NOTE You can select multiple ECGs to print or delete. For editing the patient ID information, you can select only one ECG at a time. Printing Stored ECGs Print previously selected ECGs by pressing Print ( ) ). The ECGs will print with the speed and format most recently selected for printed reports.
Managing Stored ECGs Editing Patient ID for Stored ECGs Edit the patient ID information by performing the following steps: 1. Press Edit ID ( ) ). The ID Edit screen appears. ID Edit Patient ID: 23456 Name: Ian Harrison Age: 54 Years Height: 180 cm Weight: 82 Kg Blood Pressure: 130/80 Operator: Department: Room: Requested by: Custom Field One: Custom Field two: Set ECG Mgmt Priority to Stat?: Exit Erase F1 F2 F3 F4 F5 4 2.
Printing the Log of ECGs Taken or the Log of ECGs Stored If you are using a PageWriter 300pi, the ECG will be re-interpreted and stored. The message Analyzing... appears on the screen during re-interpretation. The message Storing ECG... appears while the ECG is being stored. Printing the Log of ECGs Taken or the Log of ECGs Stored To print the Log of ECGs Taken or the Log of ECGs Stored, perform the following steps: 1. Press the key. The main menu appears.
Printing the Log of ECGs Taken or the Log of ECGs Stored cursor down, or by pressing or to move the cursor up until the desired menu selection is highlighted. 3. Press 6HOHFW ( ) ) or ECGs stored to print the log of ECGs taken or the log of The cardiograph automatically maintains two ECG logs: the Log of ECGs Taken and the Log of ECGs Stored. The Log of ECGs Taken is a list of the last sixty (60) Manual and Auto ECGs recorded on the cardiograph.
Printing the Log of ECGs Taken or the Log of ECGs Stored Table 4-1: The Log of ECGs Taken Description 4-10 A Log Title B Date and time of the report C Sequence number of the ECG D Date the ECG was taken E Time the ECG was taken F Patient identification number G Patient name H Mode used to record the ECG (Auto or Manual) I Person who recorded the ECG J Department identification number K Location code and cardiograph ID code L ECG transmitted indicator: (Y for transmitted, N for not
Printing the Log of ECGs Taken or the Log of ECGs Stored The Log of ECGs Stored lists all Auto ECGs stored in the cardiograph’s internal memory. The Log of ECGs Stored is updated automatically when you store an ECG, and when you delete a stored ECG.
Printing the Log of ECGs Taken or the Log of ECGs Stored Table 4-2: The Log of Stored ECGs Description 4-12 A Log Title B Date and time of the report C Sequence number of the ECG D Date the ECG was taken E Time the ECG was taken F Patient identification number G Patient name H Mode used to record the ECG (Auto or Manual) I Person who recorded the ECG J Department identification number K Location code and cardiograph ID code L ECG transmitted indicator: (Y for transmitted, N for not
5 Transmitting, Faxing, and Receiving Auto ECGs (Options #A05 or StressWriter only) If your PageWriter 200/300pi cardiograph is equipped with Options #A05 or StressWriter, it can transmit and receive ECGs. The cardiograph must be configured for these functions before using them. For more information about configuring your cardiograph for transmitting and receiving ECGs, see Configuring Your Cardiograph, and Setting Up Your Cardiograph.
Transmitting ECGs l l An ECG sent to another institution for overreading or further analysis. An ECG sent to a PC with ECG Manager software. NOTE If you transmit an ECG from a PageWriter 300pi with ECL 09 interpretation to either a PageWriter 200i with ECL 08 only or a TraceMaster without ECL 09 criteria, the resulting printed report will consist of ECG waveforms and measurements only.
Transmitting ECGs Your Institution Label 12:12:04 Fri 26 June 1998 Main Menu Transmit and Fax ECGs Request a remote ECG Manage stored ECGs Print the Log of ECGs Stored Print the Log of ECGs Taken Print the Configuration Configure the Cardiograph Exit Select F1 F2 F3 F4 F5 2. Select Transmit and Fax ECGs from the menu by pressing to move the cursor down, or by pressing or or to move the cur- sor up until Transmit and Fax ECGs is highlighted. 3.
Transmitting ECGs Transmit & Fax ECGs (30 ECGs stored) Screen 2 of 8 Patient Name/ID Time and Date Ian Harrison ID: 23456 00:37:58 6-Apr-98 Katharina Schmidt ID: 56321 09:17:35 9-Apr-98 John Picard ID: 45687 14:53:07 9-Apr-98 Renate Desimone ID:78654 10:34:45 11-Apr-98 = Transmitted * = Selected Select Select All Send New Send ECGs Exit F1 F2 F3 F4 F5 4. You can transmit one ECG, all ECGs, or all ECGs that have not been transmitted previously.
Transmitting ECGs OR Press Send New ( ) ) to select and send all ECGs not previously transmitted. 6. After selecting the ECGs you want to transmit, press 6HQG (&*V ( ) ). The telephone directory appears, listing up to four destinations for transmission. Telephone Directory Name Telephone Number Type/ Speed Dr. Moore 9W1,555-333-1212 Dr. Jones 9,1,555-444-1212 Modem 2400 Fax 19200 Direct 9600 Modem 2400 ECG Dept Dr. Niels P9W1,555-666-1212 Change Entry F1 Exit Send F2 F4 F3 7.
Transmitting ECGs Changing a Telephone Directory Entry You may need to add, delete, or change one of the entries stored in the telephone directory. To edit the telephone directory, perform the following steps: Change 1. Select Entry ( ) ) from the Telephone Directory menu. The softkeys will change as shown below: Telephone Directory Name Telephone Number Type/ Speed Dr. Moore 9W1,555-333-1212 Dr. Jones 9,1,555-444-1212 Modem 2400 Fax 19200 Direct 9600 Modem 2400 ECG Dept Dr.
Transmitting ECGs 4. Type the telephone number in the second space on the line. The modem ignores spaces and hyphens in the telephone number. Use the following special symbols to specify how you want the modem to dial the telephone number: l comma(,): causes the modem to pause for two seconds before continuing to dial. l W: causes the modem to wait for a second dial tone before continuing to dial.
Receiving ECGs 6. Move the cursor to the Speed field. Select the transmission speed by pressing Change ( ) ) until the appropriate transmission speed appears. See Table 5-1 for recommended transmission speed.
Receiving ECGs equipped with Options #A05 or StressWriter, or a PageWriter XLi, as long as it is turned on and idle. You can stop receiving the ECG at any time by pressing the 6WRS key on the front panel. For more information on configuring your cardiograph to receive ECGs, see Configuring Your Cardiograph. Requesting ECGs from a Remote Device Your cardiograph can request transmission of ECGs from a TraceMaster ECG Management system.
Receiving ECGs Your Institution Label 12:12:04 Fri 26 June 1998 Main Menu Transmit and Fax ECGs Request a remote ECG Manage stored ECGs Print the Log of ECGs Stored Print the Log of ECGs Taken Print the Configuration Configure the Cardiograph Exit Select F1 F2 F3 F4 F5 2. Select Request a Remote ECG from the menu by pressing to move the cursor down, or by pressing or or to move the cur- sor up until Request a Remote ECG is highlighted. 3.
Receiving ECGs Telephone Directory Name Telephone Number Type/ Speed Dr. Moore 9W1,555-333-1212 Dr. Jones 9,1,555-444-1212 Modem 2400 Fax 19200 Direct 9600 Modem 2400 ECG Dept Dr. Niels P9W1,555-666-1212 Change Entry F1 Request F2 4. Press F3 or Exit F4 F5 to move the cursor down, or press or to move the cursor up until the desired location is highlighted.
Receiving ECGs 5. Press Request ( ) ) or to begin the request process. The message “Dialing , ” appears on the screen, followed by another message “Query in progress...”. 6. When communication is established between the cardiograph and the remote site, the following screen appears requesting your password: Password Enter F1 NOTE F2 F4 F3 F5 See your ECG Management System systems administrator to obtain a password. 7.
Receiving ECGs 8. After you enter a valid institution number, you will be asked for the patient ID number. Enter the patient ID number for the desired ECG in the space provided, then press Enter ( ) ) or . The message “Searching the database, please wait...” appears on the screen during a pause. The duration of the search depends on how many ECGs are stored in the database, and how specific your search criteria are.
Receiving ECGs l When the search is successful, the results will be displayed on the screen as follows: 2 ECGs found for: 23456 5-14 Newest Oldest New Inst New ID F1 F2 F3 F4 F5 Transmitting, Faxing, and Receiving Auto ECGs (Options
Receiving ECGs 9. Press Newest ( ) ) to see the date and time of the most recent ECG found. OR Press Oldest ( ) ) to see the date and time of the oldest ECG found. OR If you want to see an ECG that is neither oldest or newest, select either oldest or newest and use the softkeys on the next screen to locate the desired ECG. 345 23456 Next Previous F1 F2 4/6/98 00:37:58 Select More F3 F4 F5 5 10. From this display you can scroll through a list of selected ECGs.
Receiving ECGs l Date and time this ECG was recorded (4/6/98 00:37:58) 11. Press Select ( ) ) to receive and print the displayed ECG. Press Next ( ) ) or Previous ( ) ) to view the other ECGs found. 12. Press More ( ) ) to access the additional softkeys shown below: 345 23456 4/6/98 00:37:58 Name New Inst New ID More F1 F2 F3 F4 l F5 If you wish to change the identification of the displayed ECG from patient ID number to name, press Name ( ) ).
Receiving ECGs displayed ECG from patient name to patient ID numbers, press ID ( ) ). l If you wish to start a new search through another institution, press New Inst l If you wish to start a new search for other patient ID numbers, press New ID l ( ) ). ( ) ). If you wish to return to the set of keys shown in step 4, press More ( ) ). You may end the interactive request session at any time by pressing the 6WRS key on the front panel. The transmission link will end immediately.
Receiving ECGs 5-18 Transmitting, Faxing, and Receiving Auto ECGs (Options
6 Troubleshooting 6 Your cardiograph is designed for reliable operation. If you have problems with an ECG, there are several things you may check before calling for service. This chapter tells how to solve basic ECG problems. Checking ECG Technique Many problems in taking an ECG may be related to electrode application. l l Review “Preparing the Patient” in “Recording an ECG” to ensure the patient leads are properly attached to the patient.
Identifying ECG Problems Table 6-1: Identification of Leads Off Connections Symptom Check Electrode All leads except III show discontinuities or dashed lines RA or R (right arm) electrode or cable wire Any combination of chest (V) leads shows discontinuities or dashed line Indicated chest (V) electrodes or cable wires Identifying ECG Problems The following table shows symptoms and solutions to problems that can occur when recording an ECG.
Identifying ECG Problems Table 6-2: ECG Problems and Solutions (Continued) Problem Wandering Baseline Cause Possible Solutions Patient movement. Reassure and relax the patient. Electrode movement. Poor electrode contact and skin preparation. Be sure that the lead wires are not pulling on the electrodes. Reapply elec- 6 trodes. Press the )LOWHU key if it is configured for Baseline Wander. Respiratory interference. Move lead wires away from areas with the greatest respiratory motion.
Identifying ECG Problems If the Recording Won’t Start If you press $XWR or 0DQXDO and the recording doesn’t start, investigate the following possibilities: l Is the cardiograph turned on? The screen should be on. l Is the AC power light on? If the cardiograph is plugged into AC power and the AC light is not on, check the two line fuses. See “Replacing the Fuses” in “Maintaining the Cardiograph” , for fuse information.
Error Messages 3. Press $XWR or 0DQXDO . If the cardiograph turns itself to Standby (off), the battery is not operating properly. If the cardiograph still won’t operate, call your local Agilent Technolgies service representative. If the Cardiograph Won’t Print a Manual Report l Is the paper sensor lens dirty or obstructed? Clean the paper sensor lens. See “Maintaining the Cardiograph” for more information. l Is the cardiograph out of paper? Load paper.
Identifying Storage Problems (Options #A05 or StressWriter only) Identifying Storage Problems (Options #A05 or StressWriter only) The following table shows symptoms and solutions to problems that can occur when storing an ECG. Table 6-3: Storage Problems and Solutions (Options #A05 or StressWriter only) Message ECG too noisy to store Likely Cause Poor electrode contact. Dry or dirty electrodes. Lead wires may be picking up interference from poorly grounded equipment near the patient.
Identifying Transmission Problems (Options #A05 or Table 6-3: Storage Problems and Solutions (Options #A05 or StressWriter only) Message Likely Cause Possible Solutions Unable to store ECG A fault exists in the storage hardware. Call service Unable to retrieve ECG A fault exists in the storage hardware. Call service 6 Identifying Transmission Problems (Options #A05 or StressWriter only) The following table shows symptoms and solutions to problems that can occur when transmitting an ECG.
Identifying Transmission Problems (Options #A05 or StressWriter only) Table 6-4: Transmission Problems and Solutions (Options #A05 or StressWriter only) 6-8 Message Likely Cause Possible Solutions Check modem or cable No power to modem, or poor modem cable connection. Check that the modem is turned on. Check the data communication cable connections between the modem and the cardiograph. Check cable Poor cable connection between cardiograph and TraceMaster system. Check all cable connections.
Identifying Transmission Problems (Options #A05 or Table 6-4: Transmission Problems and Solutions (Options #A05 or StressWriter only) Message Likely Cause Possible Solutions Transmission stopped unexpectedly. X of N ECGs sent. Cable/modem problem. Press any key to continue. No power to modem, or poor modem cable connection. Check that there is power to the modem. Check the data communication cable connections between the modem, and the cardiograph.
Identifying Transmission Problems (Options #A05 or StressWriter only) 6-10 Troubleshooting
7 Maintaining the Cardiograph Care and Cleaning The outside surfaces of the cardiograph and its accessories (except the patient cable) are designed to be cleaned by mild soap and water or isopropyl alcohol. The patient cable can be cleaned only with mild disinfectant or soap and water. The patient cable cannot be cleaned with isopropyl alcohol. Cleaning the Cardiograph 1. Unplug the power cord and ensure that the cardiograph is in Standby mode (the display is off). 2.
Care and Cleaning Cleaning the Electrodes and Cables Clean the electrodes and patient cables with a soft cloth moistened with a recommended disinfectant or cleaning agent from the following list: l l l l l l l l l l Cetylcide® (may discolor cable) Cidex® Lysol® Disinfectant Lysol® Deodorizing Cleaner (may discolor cable) Dial® Liquid Antibacterial Soap Ammonia 409® (may discolor cable) 10% solution of Clorox® in water (may discolor cable) Murphy® Household Cleaner, or Ves-phene II®.
Care and Cleaning Cleaning the Digital Array Printhead and Paper Sensor 7 Figure 7-1: Cleaning the Digital Array Printhead A. Printhead B. Paper Sensor If the print quality is uneven, it may be due to a dirty printhead. How frequently you must clean the printhead depends on how many ECGs you print and the quality of and type of paper you use. If the paper fails to stop at the end of a page, the paper sensor lens may be dirty.
Care and Cleaning To clean the printhead: CAUTION Touch the equipotential connector on the back of the cardiograph to discharge any static electricity stored on your skin before touching the printhead. The printhead can be damaged by static electricity. 1. From the front of the cardiograph, unlatch and open the paper door. The printhead is to the right under the paper blade and behind a brush. See Figure . 2. Wipe the printhead with a foam swab dipped in 90% isopropyl alcohol.
Loading the Paper Loading the Paper 7 Figure 7-2: Loading the Paper A. B. C. D. E. Paper Door Latch Paper Sensing Hole Paper Cardboard Backing 3DJH Key The cardiograph uses continuous-feed Z-fold paper. For best results use the recommended paper. See “Supplies” later in this chapter for ordering information.
Loading the Paper To load the paper: 1. From the front of the cardiograph, release the latch on the left side and slide the paper door to your left. 2. Remove the outer packaging from the paper stack. 3. Place the paper stack in the compartment so that the top side of the paper feeds grid side up over the top panel. The paper sensing hole will be in the lower corner of the paper. 4. Pull a sheet halfway out and over the paper door.
Loading the Paper l l l l l l l l Plastics containing plasticizers, such as vinyl chlorides (PVC) typically found in vinyl sheet protectors, separators and plastic envelopes. Other plasticizers include polyethylene glycol, dioctyl phthalate, and dioctyl adipate. Papers containing tributyl phosphate, dibutyl phthalate, or other organic solvents, such as FAX and other non-chemical/thermal recording paper, or product literature. Liquid or vaporous solvents, such as alcohols, ketones, esters, ethers, etc.
Evaluating the Patient Cable Evaluating the Patient Cable The following procedure should be followed to detect internally shorted lead wires in the electrocardiograph patient cable. It is also recommended that the patient cable not be tightly coiled. This test should be performed at least once each day prior to using the electrocardiograph. The test should be performed regardless of the condition of the patient cable and additionally, whenever you suspect that your patient cable may be damaged. 1.
Replacing the Fuses CAUTION Repeated undercharging of the battery will damage the battery and reduce battery life. NOTE It is recommended that the cardiograph be plugged into AC power whenever possible to maximize battery life. Battery life varies by how the battery is maintained and how much it is used. For improved battery life, keep the instrument plugged in when not in use. If the battery has been fully charged and requires recharging after a few ECGs, consider replacing it.
Replacing the Fuses 6. Remove the fuse. You may need to tap the fuse holder to shake the fuse out. 7. Insert a new fuse in the holder, slide the fuse cap back into the case. Fuse must be of the same type and rating as described on the label located next to the fuse holders. 8. Tighten the fuse cap 1/2 turn clockwise. 9. Repeat the operation for the other AC fuse. Figure 7-3: The AC Fuse Holders A.
Supplies Supplies A full range of cardiograph supplies is offered. The following list is a collection of the most frequently ordered items. Pricing and availability of these and other supplies are available from Agilent Technologies’ Medical Supplies Centers. l l USA: Call 1-800-225-0230 Outside USA: Please contact your local Agilent Technologies Sales Office or your authorized dealer or distributor. 7 Paper M2481A M2483A M2485A M2486A Paper, 8.
Supplies Electrodes 40490E 40491E 40494E 40421A 40424A 14030A 40420A 13943B M2253A 13943D 13944B Welsh electrode; 15mm base 5cc bulb; screw connection (IEC) Limb plate Electrode (IEC) (4 per pack) Limb plate Electrode; clothespin-style (4 per pack) Welsh electrodes; 15mm base 5cc bulb; push-in connection (AHA) (6 per box) Limb plate electrode (AHA) (4 per pack) 15" Rubber strap for limb plate electrode Disposable diagnostic pre-gelled electrode (1,000 pieces); snap style Disposable diagnostic solid gel el
Supplies Data Communications Several modem and cabling solutions are available from Agilent. Refer to the PageWriter 200/300pi sales literature.
Calling for Service Calling for Service For telephone assistance, call the Response Center nearest to you, or visit our website at: www.hp.com/go/medservices.
A Setting Up Your Cardiograph Before using your cardiograph for the first time you must prepare it by performing the following tasks: l l l l Check the voltage setting Install the battery Connect the power and patient cables Load the paper Also, performing the following tasks is strongly recommended: l l l l l Set the keyboard to uppercase or lowercase mode Set the cardiograph location and ID codes (Options #A05 or StressWriter only) Connect the modem and transmission cables (Options #A05 or StressWrite
Checking the Voltage Setting 2. Verify that the correct voltage is visible on the voltage select switch. If the voltage setting is incorrect, slide the voltage switch so the correct voltage is visible. The cardiograph operates with a line frequency of either 50 or 60 Hz. 3. Remove and discard the label covering the AC power receptacle. See Figure A-1 for the location of the AC power respectable. You are required to remove the label as a reminder to check the setting of the voltage select switch.
The Battery NOTE The equipotential connector is used when the cardiograph must be plugged into an ungrounded outlet. See Patient and Operational Safety Notes in Getting Acquainted for more information about using the equipotential connector. The Battery Your cardiograph requires the battery to be installed for proper operation— even if the cardiograph is plugged into AC power. The cardiograph cannot operate without the battery. Use only part number M2460A batteries in the cardiograph.
The Battery at least 16 hours is recommended. To charge the battery, plug the cardiograph into the wall outlet with the 2Q 6WDQGE\ switch set to Standby (off). Figure A-2: Removing the Battery Door. A. Battery Door Removing the Battery To Remove the Battery: 1. Make sure the cardiograph is unplugged from AC power. 2. Turn the cardiograph bottom-side up. 3. Slide the battery door in the direction of the arrow shown in Figure A-2 until it unlatches (approximately 1/2 inch). Lift off the door. 4.
The Battery WARNING Properly dispose of or recycle depleted batteries according to local regulations. Do not disassemble, puncture or incinerate the depleted batteries. A Figure A-3: The Battery Compartment. A. Battery B. Battery Cable C.
Connecting the Cables Connecting the Cables 1. Plug the power cord into the wall outlet. 2. Connect the power cord to the cardiograph as shown in Figure A-4. Figure A-4: Connecting the Power Cord. A. Power Cord B. Voltage Select Switch WARNING A-6 If you must use an ungrounded plug adapter to plug the power cord into the wall outlet, you must also use a ground strap to connect the equipotential connector at the rear of the cardiograph to the power source ground.
Connecting the Cables Connect the Patient cable to the front of the cardiograph as shown in Figure A-5 and screw in both thumbscrews. A Figure A-5: Connecting the Patient Cable. A.
Loading Paper Loading Paper For the best results, use only the recommended paper. See Supplies in Maintaining the Cardiograph for ordering information. The cardiograph uses continuous feed Z-fold paper. Figure A-6: Loading the Paper A. B. C. D. E.
Setting the Keyboard Mode To load the paper: 1. From the front of the cardiograph, release the latch on the left side and slide the paper door to your left. 2. Remove the outer packaging from the paper stack. 3. Place the paper stack in the compartment so that the top side of the paper feeds grid side up over the top panel. The paper sensing hole will be in the lower right corner of the paper. 4. Pull a sheet halfway out and to your left over the paper door.
Setting the Cardiograph Location and ID Codes (Options #A05 or StressWriter only) 7. Press Exit ( ) ) to save your selection. Setting the Cardiograph Location and ID Codes (Options #A05 or StressWriter only) The cardiograph location and ID codes should be set before transmitting or receiving ECGs. These codes are assigned by your a TraceMaster ECG Management System systems administrator. 1. Press the key. The Main Menu appears. 2.
Connecting the Direct Transmission Cable (Options #A05 Connecting the Direct Transmission Cable (Options #A05 or StressWriter only) You can transmit ECGs directly by cable to an a TraceMaster ECG Management System, or a PC. Connect the transmission cable as shown in Figures A7, A-8, and A-9, and screw in both thumbscrews. C A A B Figure A-7: Connecting the Direct Transmission Cable to TraceMaster A. PageWriter 200/300pi cardiograph connection B. Transmission cable (DB9F/DB25M serial modem cable1) C.
Connecting the Direct Transmission Cable (Options #A05 or StressWriter only) Power Power C Keyboard Mouse Power A B Figure A-8: Connecting the Direct Transmission Cable to a PC A. PageWriter 200/300pi cardiograph connection B. Transmission cable (DB9F/DB9F null modem cable1) C. PC connection 1. Quick-disconnect cabling is available from Agilent Technologies. Refer to the PageWriter 200/300pi sales literature.
Transmitting or Faxing ECGs by Modem (Options #A05 or Transmitting or Faxing ECGs by Modem (Options #A05 or StressWriter only) You can also use a modem to transmit or fax ECGs by telephone to any of the following: l l l l l PageWriter XLi cardiograph PageWriter 200/200i/300pi cardiograph TraceMaster ECG Management System ECG Manager Group III fax machine A PageWriter 200/300pi M1771A/1770A Cardiograph A-13
Transmitting or Faxing ECGs by Modem (Options #A05 or StressWriter only) Before using the M1706B modem, you must connect the cables. Figure A-9 shows how to connect the cables for transmitting ECGs using a modem. Figure A-9: Connecting the Modem Cables A. PageWriter 200/300pi cardiograph B. Modem power cord C. Modem (M1706B, U.S. only application) D. Modem data cable (DB9F/DB25M serial modem cable1) E. Phone line connector NOTE The following instructions support only the M1706B, U.S. only modem.
Setting Up the Telephone Directory (Options #A05 or 2. Turn the modem power switch off. 3. Insert the 9-pin female subminiature D connector end of the modem data cable into the RS-232 connector on the back of the cardiograph. 4. Refer to your modem manual for instructions on connecting the modem to the modem data cable, the modem power cable, and the telephone line. 5. Turn the modem on. 6. Turn the cardiograph on.
Setting Up the Telephone Directory (Options #A05 or StressWriter only) Setup Telephone Directory Name Telephone Number Type/ Speed 1. 2. 3. 4. Change Type Erase F1 F2 F3 Exit F4 F5 2. Add the name and telephone number by pressing cursor to a blank entry line. or to move the 3. Type the name in the first space on the line. Use the and the keys to move along the line. 4. If you are using Direct or Direct SCP transmission, leave the telephone number blank.
Setting Up the Telephone Directory (Options #A05 or l and then dial the telephone number to place a call outside your house telephone system. P: indicates pulse dialing (with a dial), instead of tone (with a keypad). For example, if you are using a pulse telephone with your modem, and your house telephone system requires dialing a 9 before placing an outside call, you would enter the telephone number as: P9W555,333,4444 NOTE See your modem documentation for more details on special dialing commands. 5.
Setting Up the Telephone Directory (Options #A05 or StressWriter only) Table A-1: Remote Sites, Transmission Types, and Recommended Speeds Remote Site Transmission Type Recommended Speed TraceMaster Modem Direct 2400 9600 Pagewriter XLi Modem 2400 PageWriter 200/200i/ 300pi Modem 2400 Group III Facsimile Machine Fax 19200 PC with ECG Manager software ModemSCP DirectSCP 57600 57600 7. Press Exit ( ) ) to save the directory and return to the Configuration menu.
Setting Up Predictive Instruments Setting Up Predictive Instruments Your PageWriter 300pi contains Predictive Instrument software applications which generate 0-100% predicted probabilityscores of Acute Cardiac Ischemia (ACI) and patient outcome, with and without thrombolytic therapy, for Acute Myocardial Infarction (AMI). Additional information on the Predictive Instrument applications can be found in “Understanding the ECG Analysis Program”.
Setting Up Predictive Instruments Table A-2: Risk Management Report Parameters Choicesa Parameter High Limit for Risk Mgmnt Report (0-100)? 80% Enable TPI Analysis? Yes/No Enable Automatic AMI Detection? Yes/No Print All TPI Reasons? Yes/No Interp Criteria? Default Adult Pediatric ACI-TIPI TPI 08/TIPI Comments Only available with TPI enabled — ‘Default’ prints reports according to the above settings — Std Adult 09 report without TPI or ACI TIPI — Std Pediatric P4 report without TPI or ACI
B Configuring Your Cardiograph Your cardiograph may be customized, or configured, to meet your particular requirements. This chapter describes how to configure your cardiograph and print out your configuration settings. NOTE The cardiograph maintains its configuration information in non-volatile memory—this means your configuration cannot be accidentally erased by discharging or removing the battery or AC power.
The Configuration Menu The Configuration Menu The Configuration menu allows you to choose the screens from which you can set your cardiograph’s configuration. Each configuration menu choice is described briefly in a list, then each is described in more detail in the sections that follow. Default configuration settings are also listed in the tables. Press to display the Main Menu screen..
The Configuration Menu If you have a PageWriter 200 or 300pi with Options #A05 or StressWriter, this screen will appear: Your Institution Label 12:12:04 Fri 26 June 1998 Main Menu Transmit and Fax ECGs Request a remote ECG Manage stored ECGs Print the Log of ECGs Stored Print the Log of ECGs Taken Print the Configuration Configure the Cardiograph Exit Select F1 F2 F3 F4 F5 B PageWriter 200/300pi M1771A/1770A Cardiograph B-3
The Configuration Menu 1. Select Configure the Cardiograph from the menu by pressing or to move the cursor down, or by pressing or to move the cursor up until Configure the Cardiograph is highlighted. 2. The Configuration Menu appears. (On PageWriter 200 models, the reference to the set up of predictive instruments is not included.
The Configuration Menu The following describes the basic functions for each entry in this menu. Setup ID Entry This selection allows you to choose: l l l the patient identification entries requested before recording an ECG the units used for patient Age, Height, and Weight the labels for the two Custom Fields. Setup Power-On Report Formats Allows you to select default report formats to be used when the instrument is turned on.
The Configuration Menu Setup Telephone Directory If your cardiograph is equipped with Options #A05 or StressWriter, this selection allows you to record the names, telephone numbers, and transmission types and speeds of four sites to which you send or receive ECGs. Setup Predictive Instruments (PageWriter 300pi Model only) Your cardiograph is equipped with Predictive Instrument capability; you must indicate the configuration and select the clinical mode of operation.
Navigating the Configuration Menus Navigating the Configuration Menus When you need to change the cardiograph configuration, use the following techniques: 1. To select from a menu, press press or or to move the cursor down, or to move the cursor up until the desired menu line is high- lighted. Then press Select ( ) ) or to display the selected item. 2.
Patient ID Entries Patient ID Entries This menu allows you to choose the patient identification entries requested prior to recording an ECG. Table B-1 shows the patient identification entries available for configuration. You can use Custom Label Field 1 and 2 to record information useful to your department that is not included in the standard Patient ID fields. For example, you may want to record patient medications that affect cardiac function on the ECG report.
Patient ID Entries Table B-1: Configurable Patient ID Entry Fields Parameter Choicesa Patient ID Yes or No Name Yes or No Age Yes - Years Yes - Year of Birth Yes - Months Yes - Weeks Yes - Days Yes - Hours No Sex Yes or No Chest/LA pain entry?b Yes or No Acute Ischemic Sx time Entry?b Yes or No History Diabetes Entry?b Yes or No History Hypertension Entry?b Yes or No Height Yes - cm Yes - in No Weight Yes - kg Yes - lb No Operator Yes or No Department Yes or No PageWriter 200/300p
Patient ID Entries Table B-1: Configurable Patient ID Entry Fields Parameter Choicesa Comments Room Yes or No Blood Pressure Yes or No Requested by Yes or No Custom label 1 Example: Insurance Number You can enter up to 16 characters, which will appear as a field label on the Patient ID Entry screenc. Custom label 2 Example: Medications You can enter up to 16 characters, which will appear as a field label on the Patient ID Entry screenc.
Power-On Report Fields Power-On Report Fields This menu allows you to choose the default report formats that will automatically be used when you power-on the cardiograph. Table B-2 shows the available report formats. Use ) , labeled Change Format , Change Speed , or Change Lead to change a field.
Filters Table B-2: Configurable Report Characteristics Parameter Custom Rhythm Leads (Cabrera) for: 3x4, 1R 3x4, 3R, Manual 3 Manual 6 Choicesa Comments I, II, III, -aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I, II, III, -aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 I, II, III, -aVR, aVF, aVL, V1, V2, V3, V4, V5, V6 Select any lead Select any three leads Select any six leads a. Default values are shown in boldface type.
Filters NOTE When the )LOWHU key is on, the user-configured combination of the Artifact, 0.5 Hz Wander, and 40 Hz Noise filters is enabled and the Filter status message appears in the upper-right corner of the display. Refer to Table B-3 for information on configuring the )LOWHU key. NOTE If accurate ST segment contours are required for ECGs recorded in Manual mode, do not use the 0.5 Hz baseline wander filter. This filter suppresses baseline wander to the extent that it may alter the ST segment.
Miscellaneous Report Fields Miscellaneous Report Fields Institution Label The Institution name is printed on all ECGs and is displayed at the top of the Configuration Menu. Press Erase ( ) ) to clear the field, then type a name. Set Keyboard Keyboard mode determines whether characters will be printed and displayed in uppercase or lowercase. Press Change ( ) ) to change from lower[case] to UPPER[case] and vice versa.
Miscellaneous Report Fields l Press Select ( ) ) or 6SDFH bar to select the desired setting. Table B-4: Miscellaneous Report Fields Choicesa Parameter Comments Institution Name Press Erase ( ) ) before typing the name to clear the field. Type the name of your institution. 40 character maximum Set keyboard lower UPPER Lowercase letters Uppercase letters Initial Interpretation Reasons None Measure Interpret PageWriter 300pi only. Reasons None Measure Interpret PageWriter 300pi only.
Setting Date and Time Table B-5: Miscellaneous Report Fields (Options #A05 or StressWriter only) Parameter Choices Comments Cardiograph Location Code Any five digit numeric code Options #A05 or StressWriter only. Must be set before transmitting to a TraceMaster ECG Management system. Cardiograph ID Any four digit numeric code Options #A05 or StressWriter only. Must be set before transmitting to a TraceMaster ECG Management system.
Printing the Configuration Printing the Configuration Print the configuration by selecting Print the Configuration from the Configuration Menu. Press Select ( ) ). The current configuration will print. Adjusting Display Screen Contrast Press 6KLIW with the cardiograph display.
Set-up Transmission (Options #A05 or StressWriter only) Fax Grid The fax grid controls the density of the ECG transmitted using the fax. l l Full: transmits both the five and one millimeter gridlines for the waveform portion of the ECG. Partial: transmits only the five millimeter gridlines for the waveform portion of the ECG. Connection Speed The connection speed determines the rate at which information is received by the cardiograph when a remote device initiates transmission.
Set-up Transmission (Options #A05 or StressWriter only) Table B-6: Set-up Transmission Fields (Options #A05 or StressWriter only) Choicesa Parameter Connection speed Comments 300 1200 2400 4800 9600 14400 96200 28800 38400 57600 76800 115200 a. Default values are shown in boldface font.
Set-up Transmission (Options #A05 or StressWriter only) B-20 Configuring Your Cardiograph
C Specifications Basic Controls ECG Controls: l l l l l l l l On/Standby Auto Manual Copy Filter Page Advance (paper feed) ID Stop ECG Format Selections: l l Auto (3x4 with 0, 1, or 3 rhythm leads; or 6x2) Manual (with 3, 6, or 12 leads) Keyboard Keyboard with full alphanumeric capability C Storage (Options #A05 or StressWriter only): 30 ECGs stored, maximum capacity 64 Kb each PageWriter 200/300pi M1771A/1770A Cardiograph C-1
Basic Controls Hardware Interface: l l l 9-pin Male subminiature D, EIA-232 port Connection Speed (DTE Speed) 300-115200 bps configurable Communications Protocols: DT, SCP Transmission (Options #A05 or StressWriter only) DT protocol is a data transmission standard used to transmit information between PageWriter cardiographs, and TraceMaster ECG Management Systems.
Frequency and Impulse Response Frequency and Impulse Response Meets AAMI EC11-1991 standard for Diagnostic Electrocardiograph Devices. Meets frequency response standard by methods A, D, and E when configured with 0.15-150 Hz filters. Instrument Test An extended self-test may be started by pressing and holding the $XWR and 0DQXDO keys simultaneously, and then pressing the 2Q 6WDQGE\ key. The test results are displayed on the LCD display and on a printed report for use by service personnel.
Power and Environment Fuse: l T 400mA, 250 V for both the 115 and 230 Vac switch settings. Environmental Operating Conditions: l l l 10 to 40° C (50 to 104° F) 15 to 80% relative humidity, non-condensing up to 4,550 m (15,000 ft.) altitude Environmental Storage Conditions: l l l 0 to 50° C (32 to 122° F) 15 to 90% relative humidity, non-condensing up to 4,550 m (15,000 ft.) altitude Cardiograph Dimensions: l 44 by 39 by 11 cm (17.0 by 15.3 by 3.9 in.) Cardiograph Weight: l C-4 8.5 kg (18.8 lbs.
Glossary AC filter: A filter that screens out ECG artifact caused by power line interference. This filter is built into the cardiograph and cannot be disabled. AC line interference: electrical signals originating from the alternating current carried by power cords or other electrical equipment. AC line interference may obscure important details of the ECG trace. adult criteria: Interpretive rules used when analyzing ECGs of persons aged 16 years or older.
battery saver: Term for the cardiograph turning itself to Standby (off) automatically after a preset time period to conserve power. The battery saver is factory set for 30 minutes of cardiograph inactivity. Cabrera: an alternative limb lead order in which aVR is inverted and shown as -aVR. Lead order is aVL, I, -aVR, II, aVF, III, V1 through V6. calibration pulse: A 200 ms, 1 mV square or stepped wave pulse which appears on the printed record.
front panel: the area of the Cardiograph that includes the preview display and keyboard. Hertz (Hz): A unit of frequency equal to one cycle per second. ID fields: Term for the areas where patient information can be entered. Using the ID fields, you can enter information such as patient identification number, name, and age. IEC leads: Lead names and identifying colors recommended by the International Electrotechnical Commission standard. IEC limb electrodes are labelled R, L, F, and N.
pediatric criteria: The interpretive rules used when analyzing ECGs of persons aged 15 years or younger. pre-acquisition: Term for acquiring ten seconds of ECG before the operator presses the $XWR key. preview screen: the LCD display screen that shows the ECG traces as they will appear on the printed ECG report. rhythm strip: the ten second recording of a particular lead that is printed at the bottom of an Auto ECG report.
Index A artifact Glossary-1 artifact filter B-12, Glossary-1 Auto baseline wander filter B-13 Auto ECG Glossary-1 and Copy key 2-14 copying 2-14 recording 2-12 Auto key 2-13 Auto report rhythm leads 2-16 automatic shut-off 1-13 AC fuse 7-8, 7-11 Fuse holders 7-9 fuse holders 1-3, 7-8 operation 1-12 power 1-13 power light 1-5 AC interference 6-2 AC line interference Glossary-1 AC operating frequency A-1 AC voltage setting A-1 accessories 1-8 ACI-TIPI report T0 2-33 adult criteria Glossary-1 AHA leads Gloss
Index configuration B-1, Glossary-2 and Change Format softkey B-7 and Change Lead softkey B-7 and Change softkey B-7 and Change Speed softkey B-7 and Change Value softkey B-7 and Exit softkey B-7 for transmission B-17 modem setup B-17 configuring the cardiograph A-1 connecting the patient cable A-7 connecting the power cord A-6 Continue using Old ID? 2-11, 2-13 copy interpretation B-5 Copy key 1-5, 2-14, 3-8 copying Auto ECGs 2-14 criteria adult Glossary-1 analysis Glossary-1 custom ID fields 2-10 cycle pow
Index Filter key 1-5, 2-11 and Manual ECGs 211 sequence 2-12, 2-13 filters artifact B-13 Auto ECG B-13 baseline wander B-12 Manual ECG B-13 noise Auto B-13 Manual B-13 Format softkey 2-11, 212, 2-16 sequence 2-11, 2-12 formats Auto ECG report B-11 front panel 1-4, Glossary3 fuse 7-9, 7-11 AC 7-11 battery 7-10 replacing 7-8 fuse holders AC 1-3 H Hertz (Hz) Glossary-3 I ID patient B-5 ID fields Glossary-3 ID key 1-5 ID, patient 2-6 changing 2-8 custom fields 2-8 entering 2-6 reviewing 2-8 IEC leads Glossar
Index noise filters B-12 Auto ECG B-13 Manual ECG B-13 O On/Standby key 1-5 operator Glossary-3 overread Glossary-3 P Page key 1-5, A-9 paper 7-10 anti-fade 7-10 loading 7-5, A-9 storing 7-6 paper problems 6-4 paper sensor cleaning 7-4 parameters, configuration B-5 iv patient cable 1-2, Glossary-3 AHA 7-10 and abrasives 7-2 and AC interference 110 and autoclaving 7-2 and isopropyl alcohol 7-2 and ultrasonic cleaners 7-2 connecting A-7 IEC 7-10 immersing 7-2 routing 1-10 patient ID 2-6 editing 4-7 enteri
Index storing ECG reports 7-6 ECGs 4-2 paper 7-6 the battery 7-8 rhythm leads Auto ECG B-11 rhythm strip Glossary-4 S safety 1-10 SCP A-16 Select softkey 4-5, 4-6, 53, 5-10, 5-16, B-6, B7 sending ECGs 5-1 direct 5-7, A-17 fax 5-7, A-17 modem 5-7 setting the date/time B-16 setting up the cardiograph A-1 shock hazard 1-10 shut-off, automatic 1-13 Size softkey 2-11, 2-13 sequence 2-12, 2-13 softkeys 1-5, Glossary-4 speed 2-11, 2-12 Auto report B-11 Speed softkey 2-11, 2-13 sequence 2-13 standard communicatio
Index vi
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