Central Monitoring System Operator’s Manual
© Copyright 2010-2011 Mindray DS USA, Inc. All rights reserved. For this Operator’s Manual, the issue date is 2011-11. WARNING z Federal Law (USA) restricts this device to sale by or on the order of a physician.
Intellectual Property Statement Mindray DS USA, Inc. (hereinafter called Mindray DS) owns the intellectual property rights to this product and this manual. This manual may refer to information protected by copyrights or patents and does not convey any license under the copyright or patent rights of Mindray DS, nor the rights of others. Mindray DS intends to maintain the contents of this manual as confidential information.
Manufacturer’s Responsibility All information contained in this manual is believed to be correct. Mindray DS shall not be liable for errors contained herein nor for incidental or consequential damages in connection with the furnishing or use of this manual.
Warranty THIS WARRANTY IS EXCLUSIVE AND IS IN LIEU OF ALL OTHER WARRANTIES, EXPRESSED OR IMPLIED, INCLUDING WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE.
Exemptions Mindray DS 's obligation or liability under this warranty does not include any transportation or other charges or liability for direct, indirect or consequential damages or delay resulting from the improper use or application of the product or the use of parts or accessories not approved by Mindray DS or repairs by people other than Mindray DS authorized personnel.
Company Contact Manufacturer: Mindray DS USA, Inc. Address: 800 MacArthur Blvd.Mahwah, New Jersey 07430 USA Tel: 1.800.288.2121 Website: www.mindray.com 1.201.995.
Preface Manual Purpose This manual provides the instructions necessary to operate the DPM Central Station in accordance with its function and intended use. Observance of this manual is a prerequisite for proper performance and correct operation, and ensures patient and operator safety. This manual is written based on the maximum configuration. Part of this manual may not apply to your DPM Central Station.
FOR YOUR NOTES 2
Contents 1 Safety ................................................................................................................................. 1-1 1.1 Safety Information .......................................................................................................... 1-1 1.1.1 Dangers .............................................................................................................. 1-2 1.1.2 Warnings...................................................................................
5 Patient Management ........................................................................................................ 5-1 5.1 Admitting Patient ............................................................................................................ 5-1 5.1.1 Admitting Patient through CMS......................................................................... 5-2 5.1.2 Admitting Patient through the Monitor .............................................................. 5-4 5.1.
7.4.10 Show/Hide Alarm High/Low Limits ................................................................ 7-7 7.4.11 Show/Hide Dynamic Short Trend .................................................................... 7-8 7.4.12 Parameter Order ............................................................................................... 7-8 7.4.13 Record .............................................................................................................. 7-8 7.4.14 Print..............................
10.1 Drug Calculation ......................................................................................................... 10-1 10.2 Hemodynamics Calculation ........................................................................................ 10-4 10.3 Oxygenation Calculation............................................................................................. 10-5 10.4 Ventilation Calculation................................................................................................
13.4.3 Authorization.................................................................................................. 13-5 13.5 Viewing Remote CMSs through VPN......................................................................... 13-5 14 Database Backup and Recovery.................................................................................. 14-1 14.1 Overview..................................................................................................................... 14-1 14.
FOR YOUR NOTES 8
1 Safety 1.1 Safety Information The safety statements presented in this chapter refer to the basic safety information that the operator of the central monitoring system (hereinafter referred to as CMS) shall pay attention to and abide by. There are additional safety statements in other chapters or sections, which may be the same as or similar to the followings, or specific to the operations. DANGER z Indicates an imminent hazard situation that, if not avoided, will result in death or serious injury.
1.1.1 Dangers There are no dangers that refer to the product in general. Specific “Danger” statements may be given in the respective sections of this operation manual 1.1.2 Warnings WARNING z The device is intended for use only by clinical professionals or under their guidance. It must only be used by persons who have received adequate training in its use. Anyone unauthorized or untrained must not perform any operation on it. z The CMS is a clinical information device.
1.1.3 Cautions CAUTION z Federal Law (USA) restricts this device to sale by or on the order of a physician. z Hospitals without stable power source should use an Uninterruptible Power Supply (UPS) to power the CMS. When there is a power failure, the system should be shut down by following the specified shutdown procedure before the UPS is turned off.
CAUTION z If Windows® XP® Professional Embedded operating system is installed, please do not use the system until you have read the end user license agreement (“EULA”). Any use of the system will constitute your agreement to the EULA. z When printing data through an external printer, be sure to follow the printer’s instructions. In case any problem occurs during printing, consult the printer’s instructions.
1.2 Equipment Symbols NOTE z Some symbols may not appear on all equipment. ATTENTION: Consult accompanying documents (this manual). CAUTION: To reduce the risk of electric shock, do NOT remove. cover. Refer servicing to qualified service personnel.
Sound output port Sound input port Microphone port TYPE B APPLIED PART Manufacture date Serial number The following definition of the WEEE label applies to EU member states only. This symbol indicates that this product should not be treated as household waste. By ensuring that this product is disposed of correctly, you will help prevent bringing potential negative consequences to the environment and human health.
2 The Basics 2.1 Intended Use The CMS network transfers information between DPM Central Station and other networked devices. It also allows information transfer between several CMS. Network connections consist of hardwired network cables and/or WLAN connections. CMS can be used for remote monitor management, storing, printing, reviewing or processing of information from networked devices, and it is operated by medical personnel in hospitals or medical institutions.
2.3 Contraindications None. 2.4 Functions The CMS comprises powerful system software and high-performance computer components. It constructs a monitoring network by connecting monitors and telemetry transmitters. By collecting, processing, analyzing and outputting the information coming from monitors and telemetry transmitters, the CMS can achieve centralized monitoring over multiple patients so as to greatly promote the efficiency and quality of the monitoring work.
Provides comprehensive help information, prompts and operational guide. Provides 1280×1024 high display resolution. Provides two waveform display modes: color and mono. Facilitates the setup of language, waveform and parameter color. Supports such peripherals as the keyboard, mouse, thermal recorder, laser printer, speaker, etc. Supports wired and wireless network.. Provides data output meeting the HL7 protocol. Refer to eGateway HL7 Reference Manual for details.
2.5 Components The CMS consists of system software, computer (optional), hardware dongle, network devices (optional), recorder (optional), printer (optional) and UPS (optional). 2 1 4 3 5 Figure 2-1 CMS As shown above, a typical CMS mainly consists of the following components: 1. Display 2. Host 3. Keyboard 4. USB dongle 5. Mouse You can equip a CMS with up to four displays. This manual is written based on the maximum configuration. Some contents may not apply to your system.
2.6 Networking Mode The typical networking diagram of a single CMS is shown below: Central monitoring system Wired network Wireless network Telemetry network Monitors equipped without wireless network adapters Monitors equipped with wireless network adapters Telemetry transmitters Figure 2-2 Central Monitoring Network Wire network The CMS, exchange and monitors interconnect through network cable.
2.7 Controls 2.7.1 Mouse Left Mouse Button The mouse is the primary means of user interaction with the CMS. Following are two basic ways to operate the mouse: Click: position the mouse pointer on a selection, and then press and immediately release the left mouse button; Drag: position the mouse pointer on a selection, and then hold the left mouse button down while moving the mouse pointer until your desired place is reached.
2.7.2 Keyboard The keyboard can be used to enter characters into text entry fields. To enter characters into a text entry field, position the mouse pointer inside the text entry field and then click the mouse. When the mouse pointer changes its shape from an arrow to an I-beam, it indicates that you can type, select, delete text, or reposition the insertion point. 2.7.
Radio Buttons Unselected Selected Radio buttons can be used to select one of a group of mutually exclusive options: ○ indicates unselected ⊙ indicates selected Command Buttons Command buttons can be used to execute designated operations. When a command button appears dimmed or pressed, it indicates that this command button is currently disabled. Check Boxes Partly checked Unchecked Checked Check boxes enable the users to select multiple options. Indicates active selection.
List Box Title Scroll bar A list of options The list box contains a list of options from which the user can select one or more. If there are too many options to be displayed in the list box, you can use the scroll bar to display the hidden options. Drop-down List Box Down arrow Drop-down list The drop-down list box has a down arrow button next to it, which can be used to open or close a list of options. You can make a selection from the drop-down list.
FOR YOUR NOTES 2-10
3 Installation and Maintenance 3.1 Unpacking and Inspection Be careful to remove the host, displays and other components from their packaging and check if every item on the Packing List has been received without mechanical damage. If you have any question, contact our company immediately. NOTE z Please save the packaging materials for later transport or storage use. WARNING z Be sure to keep the packaging materials from children’s reach.
3.2 Installation WARNING z The CMS should be installed by manufacturer designated personnel. The copyright of the CMS software is solely owned by our company. No organization or individual shall resort to juggling, copying, or exchanging it or to any other infringement on it in any form or by any means without due permission. NOTE z Never place the CMS within a patient environment. z Place the CMS in an environment that the system can be easily viewed, operated and maintained. 3.2.
3.2.2 Power Requirements Each component of the CMS must be powered by the specified power source. To protect the hospital personnel from electric shock, the CMS (including the host and displays) and its recorder must have their casings properly grounded. The host of the CMS is provided with a 3-wire power cable, which must be plugged into a properly grounded 3-wire receptacle. If a 3-wire, grounded receptacle is not available, consult the hospital electrician.
Receiver 1. Connect the input port of remote equipment (such as a display or a LCD TV) with the VGA interface of OUTPUT1 or OUTPUT2 of receiver. 2. Connect one end of network cable with the RJ45 IN interface of receiver. 3. Connect the power adapter with the POWER interface of receiver. 4. The brightness and contrast on the remote display equipment can be finely adjusted through “Brightness” and “Contrast” buttons on receiver. NOTE z The CMS supports VGA video extension.
3.3 Starting the System Follow this procedure to start your system: 1. Perform safety checks before starting your system. For details, refer to 3.5.1 General Inspection. 2. Connect the USB dongle to the USB interface of the host. (If the dongle has been connected, skip this step.) 3. Turn on the UPS and power on the system. 4. Press the power switches on the host and displays to start the operating system. 5.
3.4 Shutting down the System It is important to shut down the system properly. Follow this simple procedure to properly shut down your system. This prevents inadvertent errors from occurring during system shut down. 1. Click “System Setup” button. 2. Select “Shutdown” from “General Setup”. 3. The system will check if any patient is being monitored. If no patients are being monitored, directly enter the next step.
3.5 Maintenance WARNING z Failure on the part of the responsible hospital or institution employing the use of the CMS to implement a satisfactory maintenance schedule may cause undue equipment failure and possible health hazard. z The safety checks or servicing involving any disassembly or decomposition of devices should be performed by professional servicing personnel; otherwise, it may lead to undue equipment failure and possible health hazards. z Turn off the CMS if no patients are to be monitored.
3.5.2 General Cleaning WARNING z Be sure to shut down the system and disconnect all power cords from the outlet before cleaning the equipment. Your equipment should be cleaned on a regular basis. If there is heavy pollution in your place or your place is very dusty and sandy, the equipment should be cleaned more frequently. The equipment to be cleaned includes the host, displays, printer, recorder, keyboard and mouse.
To avoid damage to the equipment, follow these rules: CAUTION z Failure to follow these rules may melt, distort, or dull the finish of the case, blur lettering on the labels, or cause equipment failures. ALWAYS dilute the solutions according to the manufacturer’s suggestions. ALWAYS wipe off all the cleaning solution with a dry cloth after cleaning. NEVER SUBMERGE the equipment into water or any cleaning solution, or POUR or SPRAY water or any cleaning solution on the equipment.
FOR YOUR NOTES 3-10
4 Display 4.1 Overview The central monitoring system can support single-, dual- and multi- screen display modes. The main screen and auxiliary screen vary in different display modes. 4.2 Single-Screen Mode 4.2.1 Main Screen in Single-Screen Mode In single-screen mode, up to 16 monitors can be viewed simultaneously. The figure below shows the main screen in the single-screen mode. A 1 2 3 4 B 6 5 8 7 C Figure 4-1 Main Screen in Single Screen Mode A. System information area B.
NOTE z In single-screen mode, maximum 16 monitors can be viewed simultaneously. If monitors connected to a CMS are more than 16 but less than 32, we recommend you to use dual- or multi- screen mode. System Information Area In this area, the following information is displayed: 1 Hospital information: 2 System alarm icon area: Displays the hospital and office where the CMS is located. if in system silence or icon Display icon if in system alarm audio off.
System icons include: No. Icon name Icon Description 1 Alarm List Show the alarms of all being monitored patients within the specified time range. 2 USB state Indicates that the system connects other USB storage device besides the USB dongle. Indicates that the printer is normal. 3 Printer state Indicates a printer error. Indicates that no printer is connected. Indicates that the recorder is normal Indicates that the recorder is under test. 4 Recorder state Indicates a recorder error.
4.2.2 Auxiliary Screen in Single-Screen Mode Auxiliary Screen Figure 4-2 Auxiliary Screen in Single-Screen Mode In single-screen mode, you can enter the auxiliary screen by clicking the patient window, system buttons or icons area. As shown in the figure above, the auxiliary screen will occupy the lower half part of the screen and the system will automatically adjust the size and number of patient windows.
4.3 Dual-Screen Mode As to the CMS which supports dual-screen mode, two displays can be connected to the host, and the two displays are respectively called primary display and secondary display. The dual-screen mode is specified into two main screens and one main screen. Two Main Screens As shown below, both displays have the main screen by default if the number of main screen is configured to 2. The primary display’s screen is on the left and the secondary display’s screen on the right.
One Main Screen As shown below, if the number of main screen is configured to 1, the primary display on the left always shows main screen and the right secondary display always shows auxiliary screen. In this mode, up to 16 monitors can be viewed at one time. Figure 4-4 One Main Screen Comparing with the auxiliary screen in single-screen mode, the auxiliary screen in dual-screen mode enables you to view more information conveniently. As to the configuration for the above two modes, please refer to 12.
4.4 Multi-Screen Mode As to the CMS which supports tri-screen or quad-screen mode, three or four displays can be connected to the host. One display is set as secondary display, and others are primary displays As shown below by the tri-screen mode, the two primary displays on the left always show main screen, and the secondary display on the right always for auxiliary screen. In the mode of tri-screen or quad-screen, a maximum of 16 monitors can be viewed at one time on each primary display.
FOR YOUR NOTES 4-8
5 Patient Management The CMS enables you to manage patients by: Admitting patient Obtaining patient information Patient information synchronization Modifying patient information Discharging patient Transferring patient 5.1 Admitting Patient A patient can be monitored only after it is admitted by the CMS. Then the CMS can display the physiological parameters, waveforms and alarm messages and store the data related to this patient.
5.1.1 Admitting Patient through CMS When a monitor which has not admitted a patient is connected to the network, you can admit a patient either by: Clicking a patient window with no patient or an idle sector and selecting “Admit Patient” in the pop-up menu. This is applied to admit patient to a spot patient window. For detail, refer to 6.2 Patient Window,or Clicking in the icon area or the “Admit Patient” button in the button area and admitting the patient in the open window.
The monitoring status and corresponding details are shown in the following table. Monitoring status Details No Patient Admitted The monitor is in this CMS monitor list. The monitor is in CMS XX monitor list. The monitor is not in any CMS monitor list. Monitored by this CMS The monitor has admitted a patient and is being monitored by this CMS. Monitored by CMS XX The monitor has admitted a patient and is being monitored by CMS XX. The monitor has admitted a patient but is not in this CMS monitor list.
NOTE z If you directly click on the Admit Patient button before inputting patient information, the patient information will be blank. In this case, you can modify the patient information by referring to 5.4 Modifying Patient Information. z When there is no monitor online, an alarm message “No New Bed Online” will be shown. z When a patient is admitted, his bed number can not be identical to that of any other bed under monitoring. Otherwise, the patient can not be admitted.
5.2 Obtaining Patient Information Obtaining patient information means to obtain patient information from the HIS system through Gateway and display such information on the current CMS. There are two ways to obtain patient information: z ADT Query: 1. Click the “Obtain Patient Information” button and the “ADT System Patient Information” menu pops up. 2. Input query condition and click the “Query” button. The patient information queried is displayed. 3.
5.3 Patient Information Synchronization When the CMS is associated with HIS system, the CMS will automatically synchronize and update the patient information with HIS system. 5.4 Modifying Patient Information There are two ways to modify patient information: Modify patient information through the monitor. For more information, refer to the monitor’s operation manual. Modify patient information through the CMS.
5.4.2 Inconsistent Patient Information between Monitor and CMS If patient information is modified when the monitor is disconnected from the CMS, and then the monitor is re-connected to the CMS, inconsistent patient information may occur between the CMS and monitor. If this happens, low priority technical alarm will be displayed in the technical alarm area and prompt message on the patient management screen. In this case, you need to confirm whether to use patient information in the CMS or monitor. 5.
Procedure 2 (applied to both spot patients and non-spot patients): 1. Click the patient window for a spot patient or the block in the last patient window for a non-spot patient. 2. Select “Patient Mgmt.” tab sheet. 3. Click the “Discharge” button in the “Patient Mgmt.” tab sheet. 4. Perform Steps 2 through 4 of Procedure 1. CAUTION z When “The patient data storage space is nearly full. Please delete some discharged patients.” appears at the system prompt area, please follow the instruction.
5.8 Transferring a Patient In the process of monitoring, a patient may be transferred from one bed (source bed) to another (destination bed). In this case, the function of patient transference can ensure the continuity of monitoring data. After transference, the patient will be monitored in destination bed. 5.8.1 Transferring a Patient on CMS The CMS provides the “Transfer to” function.
NOTE z Transferring patient and combining with destination bed patient data may cause some patient data loss if the system time is inconsistent between the source and destination CMS. z Ensure that the same patient is monitored by both the source and destination beds when transferring patient and combining with destination bed patient data. Otherwise, select the function of discharging destination bed patient with data saved.
6 Multibed Screen 6.1 Overview Each screen of the CMS can display up to 16 patient windows. In single-screen mode, you can view 16 patients on the spot at one time; in dual- or multi– screen mode, you can view 32 patients on the spot at one time. The number of the patient windows to be displayed depends on the display format defined for the multibed screen. Refer to 12.2.2 Display Setup- Multibed View Window Layout for more information.
6.2 Patient Window 6.2.1 Non-Spot patient window The non-spot patient window shows information including bed number and status for each monitor displayed in it. If a monitor has no such information defined, its corresponding block will turn blank. For the monitors displayed in this window, different background colors represent different statuses. The following table shows each status of the non-spot patient monitor and the corresponding block’s look.
6.2.2 Spot Patient Windows In the process of monitoring, the spot patient window may stay in one of the following statuses: “No Patient Admitted” indicates that no patient is admitted by the monitor corresponding to this patient window. “Offline” indicates that this patient window has admitted a patient but its corresponding monitor may be turned off or disconnected from the CMS. Patient Window in Monitoring Status: This patient window indicates that the monitor has admitted a patient.
6.2.3 Patient Window in Monitoring Status In the monitoring status, a patient window displays real-time patient data transmitted from the monitor, including a maximum of 4 waveforms and 5 parameters as shown in the figure below. In an individual patient window, the number of waveforms and the layout of parameters are subject to the display format set for the multibed screen. 2 1 3 4 6 5 1. Drop-down menu button 2. Alarm icons 3. Technical alarm and patient information area 4.
6.2.3.2 Drop-down Menu Button Clicking this button will open a drop-down menu, in which you can perform these operations: Monitor Silence: In the normal status, you can select it to silence current bedside monitor. In the case that the bedside monitor is silenced, you can select it to reactivate the bedside monitor’s audible prompts. Audio Paused: In the normal status, you can select it to pause the alarm sound of the current bedside monitor for a period of time, which can be set on the monitor.
Night Mode: Open the “Multibed” menu, select and set current bed or all beds to Night Mode, and choose whether to stop NIBP measuring. ST Display Setup: Access the “ST Display Setup” of the telemetry system. Start/Stop NIBP Measurement: Used to start or stop NIBP measurement. Move zone to: Selecting it to switch over the current patient window to any destination window.
6.2.3.4 Technical Alarm and Patient Information Area The Technical Alarm and Patient Information Area displays: The technical alarms and messages coming from monitor or CMS; The work mode and initiated events of a defibrillator. When multiple messages occur, they will be displayed circularly. If there is no message, patient name will be shown in this area. 6.2.3.
6.2.3.7 Parameter Area This area is to display parameter values transmitted from the monitor. The icon beside the parameter indicates that alarms of this parameter are turned off. 6.2.3.8 Telemetry Icons The following icons are visible only for telemetry transmitter. Icon name Icon Description After the Nurse Call button is pressed on the transmitter, the Nurse Call icon will continuously flash and meanwhile corresponding prompt tone will sound.
Icon name Icon Description This icon tells the received signal strength for corresponding channel. With the received signal strength changing, the number of the signal bars and the color of the icon will change accordingly. Received Signal Strength Transmitter Number TEL XXXX White: indicates the received signal strength is normal. Yellow: indicates the received signal strength is weak. Red: indicates no signal is received. Shows the transmitter number corresponding to this channel. 6.
NOTE z When a patient is discharged, the settings in “Waveform Selection and Order” are saved. The waveforms will be shown as per the same configurations by default when a patient is admitted next time. 6.3.2 Multibed Numeric Setup Default numeric group cannot be modified or deleted. To change the parameters to be displayed and their order in the current patient window, you can follow this procedure: 1. Click on the “New Group” button, and “New Group 1” will appear under “Default Group”. 2.
7 Viewbed 7.1 Overview The CMS allows you to view a single patient through the “ViewBed” screen, in which you will have an enlarged view of that single patient’s information, waveforms and values. In this screen, you can freeze waveforms, review dynamic short trends, view multi-lead ECG waveforms and record waveforms, etc. To access the “ViewBed” screen, follow the instructions below: For a spot patient, click the left mouse button in its corresponding patient window.
7.2 ViewBed Screen 1 2 3 4 5 8 7 1. Patient information area 4. Technical alarm area 7. Waveform area 6 2. Alarm sound icons 5. Physiological alarm area 8. Parameter area 3. Telemetry icons 6. Button area Figure 7-1 ViewBed Screen In patient information area, patient name, gender and type are displayed. For description on physiological alarm area, sound icons, technical alarm area and telemetry icons, refer to Part 6.2.3 Patient Window in Monitoring Status.
7.2.1 Button Area Icon Name Description Alarm Silence Used to enter alarm silence status. Audio Paused Used to enter or exit audio paused status. The pause time is subject to the monitor settings. Monitor Silence Used to silence current bedside monitor or reactive the audible prompts of the silenced bedside monitor. Alarm Pause Used to enter or exit alarm paused status. The pause time is subject to the monitor settings. STANDBY Used to enter or exit the STANDBY mode.
7.2.3 Parameter Area This area is to display parameter values transmitted from the monitor. Each parameter module occupies a rectangular area, which is hereafter called parameter window. In the single-screen mode, this area can only accommodate part parameter values due to space confines of the screen. However, you can drag the vertical scroll bar to view more. Click in a parameter window. The border of the window will highlight when the window is selected.
7.4 Basic Operations 7.4.1 Alarm Setup Clicking the button will enter the “Alarm Setup” tab sheet, in which you can set parameter alarms, arrhythmia alarms, arrhythmia alarm threshold and alarm-related aspect. For details, refer to 8.4 Alarm Setup. 7.4.2 Silencing Alarms on Monitors By clicking the Silence icon , you can acknowledge the ongoing alarms. Both the monitor and telemetry transmitter enter the alarm silenced status.
7.4.6 STANDBY The STANDBY icon is applicable to the telemetry transmitter only. Clicking this icon will have the current patient to enter the STANDBY mode. In the STANDBY mode, you can click this icon again or click any place in the ViewBed to exit the STANDBY mode. For details about the STANDBY mode, refer to the manual of the telemetry monitoring system. 7.4.7 Controlling a Bedside Monitor to Exit STANDBY If a bedside monitor is in the state of STANDBY, click any place in the ViewBed window.
7.4.9 Freeze/Unfreeze Waveforms By clicking the button, you can freeze all dynamic waveforms in the waveform area. In this area, freeze time is displayed at the topmost and time scale (unit: s) below the first waveform. Clicking or will move the waveforms backward or forward one unit (s), and the time scale will change accordingly. You can view more frozen waveforms by dragging the vertical scroll bar in Figure 7-1. In the frozen status, clicking the button will restore the dynamic waveforms. 7.4.
7.4.11 Show/Hide Dynamic Short Trend Clicking the button will show or hide dynamic short trends for each physiological parameter. For details on dynamic short trend, refer to Part 9.1.1 Dynamic Short Trend. 7.4.12 Parameter Order Clicking the button will open a dialog box, in which you can set the waveforms and parameters displaying order. The parameters to be set depend on the configuration of the monitor. Select a parameter and then click “Move Up” or “Move Down” to adjust its position.
7.4.14 Print Printing in Real-time Click the button, the “Print Setup” dialog box will pop up. In this dialog box, you can select the waveforms to be printed. In the case that the printer is unusable or no printer is connected, this button will be disabled. Please refer to 11.2.4 Printing Control about the settings of printing general options.
7.4.15 Show/Hide Multi-lead ECG Click the button to turn on multi-lead ECG waveform display as shown below: Figure 7-3 Multi-lead ECG In case there is no ECG waveform, or the monitor is set to 3-lead, or your CMS does not support multi-lead ECG, the multi-lead ECG waveforms will not be displayed.
Click the button to turn on 12-lead ECG waveform display when the bedside monitor enters full-screen 12-lead screen, as shown below. Figure 7-4 12-lead ECG 7.4.16 Show/Hide OxyCRG Clicking the button will show OxyCRG in the waveform area. The OxyCRG shows the trends of HR, SpO2 and RR (or RESP). The RR and RESP share the same position, so you can switch between them by clicking “RR” or “RESP” button. Additionally, there are three resolution options: ×1, ×2 and ×4, from which you can select any one. 7.
7.4.18 Show/Hide BIS Expand View You can click button to open BIS Expand View. In BIS Expand View, you can select to view EEG waveforms, BIS trend and DSA graph. This button is enabled only when networked monitor supports BISx4 monitoring; otherwise, this button is disabled. 7.4.19 Show/Hide Device Integration Expand View Clicking the button will open Device Integration Expand View. This button is enabled only when networked monitor supports device integration; otherwise, this button is disabled.
7.4.20 Display ST Segments Display real-time ST segments In the ECG parameter setup menu, select “Display ST Segments”. In the viewbed window, the ECG waveform display area will display ST segments. Displays ST segments of one lead in case of 3-lead type; Displays ST segments of three leads in case of 5- and 12-lead types. Figure 7-5 Display ST segments of three leads As shown in the above figure, real-time ST segments and reference segments are overlapped.
Display ST-segments on the multi-lead ECG screen If multi-lead ECG screen is accessed, corresponding ST segments are displayed after the lead waveforms on the multi-lead or 12-lead screen, as shown below: Figure 7-6 Display ST segments on 12-lead ECG screen 7-14
8 Alarm Control 8.1 Alarm Structure Alarms, triggered by a vital sign that appears abnormal or by technical problems of the monitor, are sent to the CMS by the monitors and then indicated to the users by the CMS. Most of the alarms originally come from the monitors. The alarms coming from the CMS itself are displayed in the patient window’s technical alarm area or system alarm area on the upper screen. Please refer to Appendix B Central Monitoring System Alarms for the alarm messages.
8.2.1 Audible Alarms This system has three choices of alarm tones and patterns: ISO, Mode 1 and Mode 2. For each pattern, the alarm tones identify the alarm levels as follows: ISO pattern: High level alarms: triple+double+triple+double beep. Medium level alarms: triple beep. Low level alarms: single beep. Mode 1: High level alarms: high-pitched triple beep. Medium level alarms: double beep. Low level alarms: low-pitched single beep.
8.2.3 Alarm Messages The CMS alerts the users by giving alarm messages in the physiological or technical alarm area. Before the alarm messages, asterisks are used to indicate different alarm priorities: High priority alarms: Medium priority alarms: Low priority alarms: triple asterisks “***”. double asterisks “**”. single asterisk “*”. When alarms are latched, alarm time is displayed; otherwise, the alarm time is not displayed.
In the “General Setup” tab, you can set high alarm volume. High alarm volume can be set equal to or louder than the alarm volume. The choices are “alarm volume +0”, “alarm volume+1”and “alarm volume+2”. When a high level alarm occurs, the alarm will sound with the specified high alarm volume. For example, if the high alarm volume is set to “alarm volume+1”, and the current level of alarm volume is 5, then the high alarm volume level is 6.
8.4.2 Alarm Setup Tab Sheet Clicking the button in the “ViewBed” screen will enter the “Alarm Setup” tab sheet, in which you can set parameter alarms, arrhythmia alarms, arrhythmia alarm threshold and other aspect of alarms. 8.4.2.1 Setting Parameter Alarm In the “Parameter Alarm Settings” tab sheet, you can set the alarm properties of ECG, HR, SpO2 and other parameters.
8.4.2.3 Setting Arrh. Threshold The threshold of PVCs high limit, tachy and others can be set in “Arrh. Threshold Setup” sheet. 8.4.2.4 Others In “Others” tab sheet, the alarm latch can be set here. Please refer to 8.9 Latching Alarms for details. 8.
As for the monitor’s alarm silenced status and the classification of technical alarms, please refer to the monitor’s Operator’s Manual. The alarm silenced status will be automatically cancelled when a new alarm occurs. You can enable or disable the remote alarm control function on the CMS. When remote alarm control is disabled, the icon is inactive and the “Silence” control is not available in the drop-down menu in the multibed screen. Refer to Section 12.2.
8.8 Silencing the Monitors For the monitors supporting bidirectional control of monitor silence, you can enter the status of Monitor Silence of bedside monitor through following ways: In the viewbed screen, click the monitor silence icon In the multibed screen, you can click the right button of mouse when the cursor is in the window where the patient needs the setting of Monitor Silence, or select the option ‘Audio Paused’ in its drop-down menu. .
8.10 CMS System Silence CMS system silence only silences the CMS system sounds. Alarms from the monitors will not be affected. The CMS’ system sounds include alarm sound, nurse call, event, etc. To silence or reactivate CMS system sounds, click System Setup; then click Admin Setup; enter required password. In the Admin Setup tab sheet, select Alarm and select the “Silence Hotkey” as desired.
8.11 CMS Audio Alarm Off CMS Alarm Audio Off only switches off the audible alarms from CMS. Alarms from the monitors will not be affected. To switch on or off CMS audible alarms, click Admin Setup and then click Alarm; in the “Alarm” tab sheet, deselect or select the “Alarm Audio Off” check box. When audible alarms are switched off, the icon will appear on the main screen. In this case, the CMS gives no audible alarm, but other alarm indications and audible signals remain being presented.
9 Review 9.1 Online Review Online review is to review the dynamic short trends, C.O. measurements, waveforms, trends, NIBP measurements and alarms of a patient that is currently monitored by the CMS. 9.1.1 Dynamic Short Trend Clicking the button in the viewbed screen will show graphic short trends for each parameter module. The colors and order are subject to their respective parameter modules.
9.1.2 Trend Review 9.1.2.1 Overview Clicking the “Trend Review” tab will enter a tab sheet, through which you can store and review up to 240 hours of trend data. Change of trends can be observed through the graphic and tabular. You can switch between the tabular and graphic by simply clicking their buttons.
Viewing Parameter Values at a Certain Time Clicking at a place in the graphic, you can position the cursor at that place and view parameter values at the time corresponding to that place, and the cursor in the tabular is positioned in the row corresponding to that time. Contrarily, if you select a row in the tabular, the cursor in the graphic will be positioned at the time corresponding to that row.
9.1.3 Waveform Review The CMS can store 240 hours’ waveforms of all patients. 9.1.3.1 Overview In the Waveform Review window, you can review compressed or normal waves as required. 9.1.3.2 Compressed Waveform Review Compressed Waveform Review Screen Click the “Waveform Review” tab sheet to open the following window, through which, you can review the latest 240 hours’ waveforms of the patient. In the single screen mode, 10-minute compressed waveforms are displayed.
Time Scale Displays the time moment to which one-minute waveform of each line in the compressed waveform area corresponds. In the single screen mode, 10-minute time scale is displayed. In the dual- or multi- screen mode, 20-minute time scale is displayed. Compressed Waveform Area Displays compressed ECG waveforms. If no ECG signals are detected within a specific time period, square waves are displayed. In the single screen mode, 10-minute compressed waveforms are displayed.
Selecting waveforms to be saved By clicking the “Wave Save” button, you can select waveforms to be saved for each patient as desired following this procedure: 1. Select a patient from “Patient Info” list. 2. Select waveforms to be saved for this patient from the “Waveform” list. 3. Repeat Step 1 and Step 2 to select waveforms to be saved for other patients. 4. Select “OK” and the system will save all the selected waveforms. The CMS can save up to 240 hours’ waveforms of all patients.
Showing/Hiding Parameter Click the “Numeric Data” or “Hide Numerics” button, the non-compressed waveform area will respectively display the patient’s parameter information or compressed waveforms where the cursor is located with normal wave width. 9.1.3.3 Normal Waveform Review Normal Waveform Review Screen Click the “Waveform Review” tab sheet. Click the “Full Size” button to open the following window, through which, you can review the latest 240 hours’ waveforms about the patient. 1 2 3 1.
Within the time bar, there is a black line indicating the time moment to which the current cursor corresponds. While moving the cursor along the time bar, the time corresponding to the cursor location will appear above the time bar. By clicking the mouse, you can confirm the time moment to which the current cursor corresponds. In addition, you can further adjust the black line by using these buttons and the waveform will also move accordingly.
Waveform Time Display Area In this area, waveform start time and end time are respectively shown at leftmost and rightmost; the current cursor time is shown in the middle. By clicking the “Refresh” button, you can update the end time to current system time and the start time changes accordingly.
Selecting Sweep Speed By clicking the “Sweep Speed” button, you can set the width of waveforms displayed in the waveform area. Available options are 6.25 mm/s, 12.5 mm/s, 25 mm/s and 50 mm/s. Changing sweep speed will affect the time length of the waveform area. At the 1280×1024 resolution, the sweep speed and time length correlate as follows: Sweep Speed Time length (approximate) 6.25 mm/s 12.5 mm/s 25 mm/s 50 mm/s 52.0s 26.0s 13.0s 6.
9.1.4 C.O. Review 9.1.4.1 Overview Clicking the “C.O. Review” tab will enter a tab sheet, through which you can view up to 720 C.O. measurement curves and parameter values of a patient Below the C.O. review windows are the average C.O. and C.I. If you switch to the “Hemo Calcs” tab sheet from a C.O. review window, the system will take the average C.O. and C.I. corresponding to that C.O. review window as the inputs of hemodynamics calculation. 9.1.4.2 Operation In the C.O.
9.1.5 Event Review 9.1.5.1 Overview Clicking the “Event Review” tab will enter the following tab sheet, through which you can view all event parameters and waveforms of a patient. 3 2 1 1 Event list 2 Event parameter area 3 Event waveform area Figure 9-4 Event Review Tab Sheet 1. Event list: displays event status (locked or not), time, message, priority, and description. 2. Event parameter area: displays all parameter values for each event time.
9.1.5.2 Operation In the “Event Review” window, you can: Select event type and alarm priority Sequence the event list Lock and unlock Delete Print Record Save as Export to EMR For details about record, print and save as, refer to 11 Record, Print and Save as. Selecting Event Type and Alarm Priority Above the event list, there are two drop-down list boxes: “Filter by Event” and “Filter by Priority”.
Making Selection You can select single, multiple or all events in event list: Select one event: Click one event you wish to select. Select multiple events: You can select more than one event with Ctrl or Shift keys. Select the first event and then press and hold the Ctrl key. While holding down the Ctrl key, select each of the other events you wish to select. This will select multiple events that are not grouped together Select the first event and then press and hold the Shift key.
Export to EMR Select one event from event list, and then click “Export to EMR” button. The event related data can be exported to other systems. NOTE z When the item “Export Waveform Data” in “Service Setup” tab sheet from “Admin Setup” – “Other” – “Gateway Communication Setting” is enabled, the function of Export to EMR can be used. 9.1.6 ST Review 9.1.6.1 Overview Click “ST Review” to open the ST review window as shown below.
9.1.6.2 Operation In the ST review window, you can: View ST segment Set reference ST segment Select reference ST segment Delete reference ST segment Set waveform speed Set trend parameter Print Record For details about record and print, refer to 11 Record, Print and Save as. Viewing ST Segment In the setting control area, you can select “Realtime” to view real-time ST segments, “Historical” to view historical ST segments by using the “View Hist.” buttons.
Setting Trend Parameter You can click the “Trend Parameter” drop-down list to select two different trend parameters and “Zoom” drop-down list to set different time lengths. The parameter trend data is not refreshed automatically. You can click the “Refresh” button and set start time in the pop-up window, and then click “OK” to read the data again. NOTE z There is no data displayed in the trend parameter area when viewing real-time ST segments. 9.
9.2.1 All Patients 9.2.1.1 Overview In the “All patients” tab sheet, you can view discharged patients’ data of all CMSs on the network. Brief information of discharged patients on the selected CMS is shown in the patient list, with each line for one discharged patient. NOTE z The discharged patients on a CMS can be viewed only when the IP address of a CMS is added in the “System Setup” menu. Please refer to 12.2.8 Other Multi-CMS Communication Settings for adding an IP address. 9.2.1.
Deleting Discharged Patient 1. In the “Delete or not” column, select the check box corresponding to the patient that you want to delete. 2. Click the “Delete” button. 3. Select “Yes” from the pop-up dialog box. Refreshing Data Clicking the “Refresh” button will update the discharged patient list. NOTE z Only after selecting a discharged patient from the “All patients” tab sheet, you can switch to other tab sheets for review.
FOR YOUR NOTES 9-20
10 Calculation NOTE z If the version of currently used CMS system software is lower than 3.0, some of calculation results will be deleted or refreshed due to the update of calculation formula. 10.1 Drug Calculation Clicking the “Drug Calcs” tab will enter the tab sheet. The “Calculated Results List” shows the time corresponding to a maximum of 75 calculations. The drug parameter area is for you to enter parameter values and to display calculations. The titration table is to show titrated results.
Calculate From the “Name” drop-down list below, you can select one to calculate its amount, liquid volume, concentration, etc. Drug A Drug B Drug C Drug D Drug E AMINOPHYLLINE DOBUTAMINE DOPAMINE EPINEPHRINE HEPARIN ISUPREL LIDOCAINE NIPRIDE NITROGLYCERIN PITOCIN NOTE z Drug A through Drug E are user-defined drugs. Procedure 1. Confirm whether the patient type is correct and the weight entered. 2. Select a drug to be calculated. 3.
WARNING z Be sure to input correct parameter values. The user must verify the correctness of the calculations displayed on the screen before using them. z The calculations in the titration table are subject to the drug calculations, therefore, the correctness of the drug calculations must be ensured. Besides, the reference, step and dose type should be ensured correct. z We assume no responsibility for the results arising from incorrect inputs and operations.
10.2 Hemodynamics Calculation Clicking the “Hemo Calcs” tab will enter the tab sheet. The “Calculated Results List” shows the time corresponding to a maximum of 100 calculations. The “Input Item” area allows you to enter parameter values and the “Calculated Results” area is to display calculations. In this tab sheet, you can: Calculate Save results Delete Print Record Save as. For details about “Record”, “Print” and “Save as”, refer to 11 Record, Print and Save as. Calculate 1.
Save Results The CMS is capable of saving 100 calculations for each patient. To save calculations, you can click the “Save Results” button after calculation is finished. NOTE z If you continue to perform the “Save Results” operation when the number of calculations exceeds 100, the system will delete the earliest calculation and its corresponding time from the “Calculated Results List” before saving the new one. Delete To delete unnecessary or wrong calculations, follow this procedure: 1.
Calculate 1. Input parameter values needed into the “Input Item” area. 2. Pressure unit, Hb unit and Oxygen content unit can be changed by scrolling the pull-down lists at the right side of “Press Unit” or “OxyCont Unit”. Parameter values will automatically change and refresh accordingly. 3. Click the “Calc.” button. The calculations of other parameters will be displayed in the “Calculated Results” area. Parameter values which are beyond the normal range will be displayed on a yellow background.
10.4 Ventilation Calculation Clicking the “Ventilation Calc.” tab will enter the tab sheet. The “Calculated Results List” shows the time corresponding to a maximum of 100 calculations. The “Input Item” area allows you to enter parameter values and the “Calculated Results” area is to display calculations. In this tab sheet, you can: Calculate Save results Delete Print Record Save as. For details about “Record”, “Print” and “Save as”, refer to 11 Record, Print and Save as.
NOTE z If you continue to perform the “Save Results” operation when the number of calculations exceeds 100, the system will delete the earliest calculation and its corresponding time from the “Calculated Results List” before saving the new one. Delete To delete unnecessary or wrong calculations, follow the procedure: 1. Select the time corresponding to the calculation you want to delete from the “Calculated Results List”. 2. Click the “Delete” button below the “Calculated Results List”. 3.
Calculate 1. Input parameter values needed into the “Input Item” area. 2. Click the “Calc” button. The calculations of other parameters will be displayed in the “Calculated Results” area. Parameter values which are beyond the normal range will be displayed on a yellow background. WARNING z Be sure to input correct parameter values. The user must verify the correctness of the calculations displayed on the screen before using them.
FOR YOUR NOTES 10-10
11 Record, Print and Save as 11.1 Record As shown in the figure below, the CMS can be equipped with a thermal recorder, which, with a separate power supply, is connected with the host of the CMS via the general interface. Power indicator Figure 11-1 Front Panel Power switch Equipotential grounding connector Fuse RS232 connector Power inlet Figure 11-2 Back Panel Recording can be divided into manual recording and auto recording. The former requires you to press the “Record” button before recording.
Patient Information Drug Calculations Hemodynamics Calculations Oxygenation Calculations Ventilation Calculations Renal Calculations Waveforms Events C.O. Measurements ST Review ICG Hemodynamic Parameters CCO Hemodynamic Parameters SvO2/ScvO2 Oxygeneration Parameters OxyCRG Real-time Waveforms Real-time Frozen Waveforms Real-time Alarms. 11.1.
Installing Procedure To install recorder paper, follow the steps shown in Figure 11-3 through Figure 11-8: 1. Open the recorder door, and open the paper bail at the upper left corner of the recorder. 2. Insert a new roll of recorder paper into the paper compartment 3. Insert the paper with the thermal page facing the printer head. 4. Pull the paper out and adjust it in position. 5. Push down the paper bail. 6. Close the recorder door.
11.1.2 Recorder Operations Recording Patient Information 1. Enter the “Patient Mgmt.” tab sheet. 2. Make sure that the patient information is correct. 3. Click the “Record” button to print out the patient information. Recording Drug Calculations 1. Enter the “Drug Calcs” tab sheet. 2. Perform drug calculation as per part 10.1 Drug Calculation. 3. Click the “Record” button to print out the drug calculations result. Recording Hemodynamics Calculations 1. Enter the “Hemo Calcs” tab sheet. 2.
Recording Normal Waveforms 1. Enter the “Waveform Review” tab sheet. 2. Click the “Full Size” button. 3. Click the “Record” button. 4. Select a maximum of 2 waveforms from the pop-up dialog box. 5. Select “OK”. The selected waveforms will be printed out through the recorder. Recording Events 1. Enter the “Alarm Review” tab sheet. 2. Select an alarm from the alarm list per part 9.1.5 Event Review. 3. Click the “Record” button.
Recording CCO Hemodynamic Parameters 1. Enter the “ViewBed” tab sheet. 2. Select and then click CCO parameter area. 3. Select the “CCO” tab sheet and click the “Hemodynamic” button. 4. Click the “Record” button from the pop-up dialog box. Recording SvO2/ScvO2 Oxygeneration Parameters 1. Enter the “ViewBed” tab sheet. 2. Select and then click SvO2/ScvO2 parameter area. 3. Select the “SvO2” or “ScvO2” tab sheet and click the “Oxygeneration” button. 4.
11.1.3 Recording Control By clicking “System Setup” then “Recording Control”, you can enter a tab sheet. In this tab sheet, the current tasks to be printed out are displayed. After selecting one task, you can: Click the “Delete” button to delete this task. Click the “Move Up” button to increase its priority. Click the “Move Down” button to decrease its priority. Click the “Pause” button to pause this task. Click the “Continue” button to resume the paused task.
11.2 Print 11.2.1 Printing Support The CMS can be connected with a local printer or network printer to print out reports. With a separate power supply system, the local printer is directly connected to the CMS through the general interface. The network printer is connected to the CMS through the network interface. The recommended printer types for the CMS are listed in the following table.
ST segment waveform Real-time report 12-lead ECG report Multi-lead ECG report EEG report ICG Hemodynamic Parameters CCO Hemodynamic Parameters SvO2/ScvO2 Oxygeneration Parameters Alarm Settings Report Real-time Alarm Report 11.2.3 Printing Operations Printing Patient Information 1. Enter the “Patient Mgmt.” tab sheet. 2. Make sure if the patient information is correct. If not, click the “Modify” button to correct them. 3.
Printing Oxygenation Calculations 1. Enter the “Oxygenation Calc.” tab sheet. 2. Perform oxygenation calculation per part 10.3 Oxygenation Calculation. 3. Click the icon on the right side of the “Print” button and select “Print Preview” to preview the printout. 4. Click the “Print” button. Printing Ventilation Calculations 1. Enter the “Ventilation Calc.” tab sheet. 2. Perform ventilation calculation per part 10.4 Ventilation Calculation. 3.
Printing Normal Waveforms 1. Click the “Waveform Review” tab sheet. If compressed waves are displayed, click the “Full Size” button in the lower right corner of the screen. 2. Select the current review time. 3. Click the icon on the right side of the “Print” button and select “Print Setup” to perform print setups as prompted. 4. Click the icon on the right side of the “Print” button and select “Print Preview” to preview the printout. 5. Click the “Print” button. Printing ECG Report 1.
Printing Event Table 1. Enter the “Event Review” tab sheet. 2. Click the icon on the “Print” button under the eventalarm list and select “Print Setup” to perform print setups as prompted. 3. Click the icon on the right side of the “Print” button and select “Print Preview” to preview the printout. 4. Click the “Print” button. Printing an Event 1. Enter the “Event Review” tab sheet. 2. Select an event from the event list per part 9.1.5 Event Review. 3.
Printing in Real-time 1. Enter the “ViewBed” tab sheet. 2. Click the “Print” button. 3. Select the desired waveforms from the pop-up dialog box. 4. Click the “OK” button. or 1. Enter the “Multibed” tab sheet. 2. Click the drop-down menu button. 3. Click the “Print” button to print the displayed waveforms. Printing 12-lead ECG 1. Enter the 12-lead ECG analysis tab sheet from the monitor. 2. Enter the “ViewBed” tab sheet from the CMS. 3.
Printing ICG Hemodynamic Parameters 1. Enter the “ViewBed” tab sheet. 2. Select and then click ICG parameter area. 3. Select the “ICG” tab sheet and click the “Hemodynamic” button. 4. Click the “Print” button from the pop-up dialog box. Printing CCO Hemodynamic Parameters 1. Enter the “ViewBed” tab sheet. 2. Select and then click CCO parameter area. 3. Select the “CCO” tab sheet and click the “Hemodynamic” button. 4. Click the “Print” button from the pop-up dialog box.
11.2.4 Printing Control By clicking “System Setup” then “Printing Control”, you can select local printer or network printer from the printer drop-down list. In the tab sheet, the current tasks to be printed are displayed. After selecting one task, you can: Click the “Delete” button to delete this task. Click the “Pause” button to pause this task. Click the “Continue” button to resume the paused task. Click the “Delete All” button to delete all printing tasks.
11.3 Save as The CMS can save the following items as html files: Graphic trends Tabular trends Waveform review C.O. Review Event list review Event review Drug calculations Hemodynamics calculations Oxygenation calculations Ventilation calculations Renal calculations DSA Graph With the file name defaulted as “XXXX-patient name YYYY”, in which the “XXXX” represents one of the above items. If no patient name is input, the file name will has no patient name.
Graphic Trends 1. Enter the “Trend Review” tab sheet. 2. If tabular is currently displayed on the screen, click the “Graphic” button. 3. Click the “Save As” button. A dialog box will be displayed. 4. Select a disk driver name and click “OK”. The graphic currently displayed on the screen will be saved to the designated disk (floppy disk or mobile hard disk). Tabular Trends 1. Enter the “Trend Review” tab sheet. 2. If graphic is currently displayed on the screen, click the “Tabular” button. 3.
C.O. Review 1. Enter the “C.O. Review” tab sheet. 2. Select the C.O. measurements to be saved per part 9.1.4 C.O. Review 3. Click the “Save As” button. The “Save As” dialog box will be displayed. 4. Select a disk driver name and click “OK”. The currently selected C.O. measurements will be saved to the designated disk (floppy disk or mobile hard disk). Alarm Table Review 1. Enter the “Event Review” tab sheet. 2. Select “Filter by Event” and “Filter by Priority”. 3.
Hemodynamics Calculation 1. Enter the “Hemo Calcs” tab sheet. 2. Perform hemodynamics calculation per 10.2 Hemodynamics Calculation. 3. Click the “Save As” button. The “Save As” dialog box will be displayed. 4. Select a disk driver name and click “OK”. This set of hemodynamics calculations will be saved. Oxygenation Calculation 1. Enter the “Oxygenation Calc.” tab sheet. 2. Perform oxygenation calculation per 10.3 Oxygenation Calculation. 3. Click the “Save As” button.
FOR YOUR NOTES 11-20
12 System Setup 12.1 General Setup Clicking the “System Setup” will access a tab sheet. The CMS has three levels of setup: Low level: “General Setup”, Medium level: “Admin Setup”, and High level: “Factory Setup”. Certain authority is required if you want to modify certain setups of the system or execute certain operations.
Set Unit You can set unit for each parameter of the following modules as required: Module Parameter Options Defaults IBP IBP mmHg, kPa, cmH2O mmHg CO2 CO2 mmHg, kPa mmHg TEMP T1, T2, TD, TB ℃, ℉ ℃ Vascular Resistance SVR/PVR DS/cm , kPa-s/l DS/cm5 NIBP NIBP mmHg, kPa mmHg CO2 mmHg, kPa, % mmHg O2 mmHg, kPa, % mmHg ECG ST mV, mm mV Oxygenation Hb g/dl, g/l, mmol/l g/dl GAS 5 Telemetry Alarm Delay Setup You can set telemetry alarm delay time (6 sec by default) and ST al
12.2 Admin Setup Click the “Admin Setup” button in the “General Setup” tab sheet. The Input Password dialog box will pop up. After inputting the required password, select “OK” to enter a tab sheet. 12.2.1 Setting Color On the screen of the CMS, all related information of one monitored parameter appears in the same color.
12.2.2 Display Setup You can set screen size, number of main screen /display layout, multibed view window, and auxiliary window. Screen Size 1. Click the “Display Setup” tab. 2. Select the display type from the “Screen Size” drop-down menu. 3. Click the “Close” button. 4. Your choice will take effect after the system restarts. The CMS supports up to 4 screens at one time. It will check the number of screens every time it starts.
Multibed Display Select/deselect the check box before “Measurement Units” to show/hide parameter units on the multibed screen. Select/deselect the check box before “Patient Name” to show/hide patient name on the multibed screen. Name Displaying Hotkey You can set the hotkey which can be used to display only name in the technical alarm area of patient window on the multibed screen. The default hotkey is F9. Only name rather than technical alarm message displays when you press the hotkey.
12.2.3 Alarm Click “Alarm” to open a dialog box. Turn off Alarm Sound Refer to Section 8.11 CMS Audio Alarm Off. Switch on/off Alarm Off Reminder Tone and Set its Interval Select the “Alarm Off Reminder Tone” check box to turn on or turn off the alarm off reminder tone. You can set the reminder interval as “1 min”, “2 min” or “3 min”. The default one is “1 min”. Alarm Off Reminder Tone is same as the highest level alarm tone. Silence Hotkey For details, refer to 8.10 CMS System Silence.
Select Stored Waveforms In the “Alarm” tab sheet, you can select the relevant waves stored when alarms occurred to the specific parameter. 1. Click the “Alarm” tab sheet. 2. Select a parameter from the “Alarm Numeric” list. Then select the relevant wave stored from the “Related Waveform” when the alarm occurred. 3. Click “Save” to save the selected wave. 4. Click “Default” to restore all parameters to the default configuration.
12.2.5 Monitor List Clicking the “Monitor List” will enter a tab sheet, which lists all the monitors in the LAN including the monitors admitted by this CMS. The displayed items are: monitor name, unit, bed no., IP address and monitoring status. The patient can be admitted by the CMS only after the monitor is admitted by the CMS. Refresh You can update the list by clicking the “Refresh” button.
12.2.6 Log Clicking the “Log” tab will enter a tab sheet, which records the operating status of the CMS providing the convenience for the service personnel to track and maintain the system. Each log includes occurrence time, log level, and log description. Delete You can delete all logs by clicking the “Delete All” button. Refresh You can update the logs by clicking the “Refresh” button. Export 1. Click the “Export” button. The “Save As” dialog box will be displayed. 2.
12.2.7 Telemetry If your CMS is connected with telemetry monitors, select the “Telemetry” tab, you can set the following items in an opened tab sheet. System Information In the “System Information” area, the mainboard software version, receiveboard software version, total run-time and “IP Address” are displayed. Among them, the “IP Address” can be modified. Alarm Level Setup Click the “Alarm Level Setup” button.
Frequency Setup Select frequency range: 1. You can select the appropriate frequency segment from “Freq Segment”. The minimum “Start Freq” and maximum “End Freq.” corresponding to the frequency segment will be displayed automatically. 2. You can also click the drop-down menu to select other “Start Freq” and “End Freq.”. Frequency setup list: This area shows channel number, channel name, and the transmitter frequency and signal strength corresponding to each receiver channel in the tabular form. 1.
12.2.8 Other Clicking the “Other” tab will enter a tab sheet. In this tab sheet, you can turn on or off the following options: Password needed for the shutdown: If this option is turned on, you need to input a password before shutting down the system.
Change User Password 1. Click the “Change User Password” button. The dialog box will be displayed. 2. Input old password and new password before selecting “OK”. 3. If the change succeeds, the “Password changed, please remember new password” message box will be displayed. Select “OK” to activate you change. 4. If the old password you have entered is incorrect or the new password is entered inconsistently, the system will give a prompt message. You can select “OK” to repeat the input procedure.
Automatically change time 1. Click “Change Time” button, and the dialog box will be displayed. 2. Set “Time Synchronization” to “On”. 3. Input master time server IP and second time server IP. 4. Click “OK.”. Manually change time 1. Click the “Change Time” button, and the dialog box will be displayed. 2. Set “Time Synchronization” to “Off”. 3.
Gateway Communication Setting Gateway communication setting menu provides three (3) tabs which are Network Setup, Authorization Setup and Service Setup. Network Setup The “Network Setup” tab sheet lists the information about the network adapters configured on the CMS. One of the network adapters is for internal communication within the CMS and beside monitors; the other network adapter is for inter-communication between CMS and other systems.
NOTE z The "Obtain Patient Information" button is available on the patient management screen only when“ADT Query”is set to “Enable”. Date Export Setup Input multicast IP address and port. Export Waveform Data: When configured to “ON”, the button “Export to EMR” will be displayed on the Waveform Review and Alarm Review sheets and the waveform or event can be exported to other systems. When configured to “Off”, the waveform or event can not be exported to other systems.
Remote Control Settings Remote Control Settings menu is used to set up alarm paused, silence, alarm latched, privacy mode and night mode. Alarm Paused & Silence: Select the checkbox before “Alarm Paused & Silence” to switch on/off alarm paused or silence. If the checkbox is selected, you can remotely control the operations of alarm paused or silence on bedside monitors.
FOR YOUR NOTES 12-18
13 Remote CMS 13.1 Overview In the event that there are multiple CMSs in a LAN, the CMS can view a single patient connected to the target CMS in the LAN through the Remote CMS window. Through the Remote CMS window, you can only view the target monitor rather than setting and controlling the target CMS or monitor. NOTE z One CMS can be viewed by a maximum of 16 other CMSs simultaneously. 13.2 Remote CMS ViewBed Window Click the Remote CMS button at the bottom of the screen and enter the Remote CMS window.
13.2.1 Beds List The beds list displays the information about all CMSs and networked bedside monitors (target monitors) in the same network segment of an LAN. When the “Remote CMS” screen is accessed, the CMS will automatically list other CMSs which can be operated remotely. Only when the CMSs’IP addresses are added in the Multi-CMS Communication Settings menu, the names of the corresponding CMSs will be automatically displayed in the list.
13.2.4 Alarm Icon Area This area displays icons for alarm pause audio paused or alarm silenced , alarm off ,monitor silenced , alarm audio off , alarm and defibrillator . Please refer to 6.2.3.3 Alarm Icons. NOTE z In the Remote CMS window, only the alarm messages coming from the target monitor will be displayed; the alarm messages coming from the current CMS will not be displayed. 13.2.
13.4 Network Setup and Authorization 13.4.1 IP Address Setup To implement the Remote CMS function between CMSs, each CMS needs to be equipped with at least two network adapters, one of which is for internal communication within the current CMS and the other for inter-communication between the CMSs.The typical configuration is shown below: Current CMS A Target CMS B Target CMS C Network adapter A1 Network adapter A2 Network adapter B1 Network adapter B2 Network adapter C1 Network adapter C2 196.76.
Select “System Setup” → “Admin Setup” → “Other” → “Gateway Communication Setting” → “Network Setup” and set as follows: 1. Select network card type to be viewed through viewing other. 2. If there are multiple IP addresses in the “IP Address” area on the right side, select one of them based on your networking requirement. 3. Click the “OK” button. 13.4.3 Authorization Select “System Setup” → “Admin Setup” → “Other” → “Gateway Communication Setting” → “Authorization Setup”.
Figure 13-2 VPN Networking When the VPN network is set up, you can directly connect one of the network interface cards of the CMS with LAN port of VPN, or connect them through switching equipment, and set correct IP address for the CMS. When you use Remote CMS function to view other CMSs in VPN network, you need to add the IP addresses of other CMSs in Multi-CMS Communication Settings menu. Please refer to 12.2.8 Other - Multi-CMS Communication Settings for details.
14 Database Backup and Recovery 14.1 Overview The CMS provides database backup and recovery. The CMS will shut off automatically during database backup and recovery. You can start database backup and recovery by operating the CMS or the Windows operating system, or when you fail to log in the database. By operating the CMS Enter the “Admin Setup” menu; select “Other” to open a tab sheet. Click the “Database Backup and Recovery” button and a message box will pop up.
14.2 Backup Database 14.2.1 Select Operation Type When you run the “Database Backup and Recovery” program, a dialog will pop up for you to select the operation type. Select “Backup Database”. 14.2.2 Select Backup Path You can backup the database on the local hard disk or on a USB disk. Select a path from the drop-down list. The available hard disk partitions are listed automatically and a directory in which the backup file is stored is created automatically.
14.3 Recover Database CAUTION z The recovered database will overwrite the current one. Make sure whether you need to backup the current database before carrying out database recovery. NOTE z If the CMS cannot start normally due to database error resulting from abnormal shutoff or improper operation, recover the database. 14.3.1 Select Operation Type After the “Database Backup and Recovery” program starts up, the dialog box will appear. Select “Recover Database”. 14.3.
14.4 Rebuild Database After the “Database Backup and Recovery” program starts up, the dialog box will appear. Select “Rebuild Database”. NOTE z All the data in the current database will be deleted during rebuilding the database. 14.5 Shrink Database After the “Database Backup and Recovery” program starts up, the dialog box will appear. Select “Shrink Database”. If an abnormal condition occurs during database shrink, a message will be presented. 14.
15 System Help 15.1 Overview The CMS features a webpage-like on-line help so that you can obtain a better understanding of the system. Click the “Help” menu to enter the help screen. There are three icons on top left of the Help screen: : Page down. : Page up. : Return to the screen as shown in the above figure. : Display copyright information, including system software version, system software and database copyright information and so on.
FOR YOUR NOTES 15-2
A Technical Specifications A.1 Requirements The computer of the CMS should be highly reliable and stable. The commercial computer we recommend is HP COMPAQ 8180 ELITE. Recommended configurations of HP COMPAQ 6280 ELITE are: Components Requirements System Meet the IEC60950 requirements defined for ITE equipment, and comply with CE low voltage directives (LVD) and EMC directives. Intel Core i5-2400@3.
A.2 Recorder Size 210×100×100 mm Weight 1 kg Type Thermal recorder Record rate: 25 mm/s, 50 mm/s Interface RS232 interface Width of the recorder paper 50mm A.3 Wire Network Network structure Ethernet 802.3 Transmission rate 10/100 Mbps Network interface RJ45 Max alarm time delay < 2s A.4 Wireless Network Network structure 802.11b/g Wireless RF 2.4000 ~ 2.4835 GHz Transmission rate 11 Mbps/54 Mbps Max alarm time delay < 2s A.
A.6 Calculation Drug calculation 75 calculations for single patient Hemodynamics calculation 100 calculations for single patient Oxygenation calculation 100 calculations for single patient Ventilation calculation 100 calculations for single patient Renal calculation 100 calculations for single patient A.7 Save as File format Html Storage medium Floppy disk, mobile hard disk, flash drive Contents Graphic/table, waveform review, C.O.
FOR YOUR NOTES A-4
B Central Monitoring System Alarms The CMS alarms displayed in the system alarm area on the upper screen are shown in the table below. Alarms Level Cause and solution Enumerating Printer Failed Med The default printer may not be local printer or no printer is installed. Check the default printer. No Default Printer Med The default printer may not be local printer or no printer is installed. Check the default printer.
Alarms Level Cause and solution time. Wait until it cools down. Recorder Self-check Error Med Recorder Self-check Error: CPU Med Recorder Self-check Error: RAM Med Recorder Self-check Error: ROM Med Recorder Self-check Error: WatchDog Med Recorder Not Available Med Recorder S. Communication Error Med Check the connection cable of recorder serial port. Network is disconnected. Please check. High Check the network. Network is not configured or disabled. Please check.
C Units, Symbols and Terms C.
RPM breath per minute s second V volt W Watt C.2 Symbols - minus % percent & and / per, divide, or ~ to + Plus < Less than = Equal to > Greater than ± Plus or minus × Multiply C.
ABBREVIATION DEFINITIONS BC Burst count BIS bispectral index CCI Continuous Cardiac Index Cdyn Dynamic compliance CE Conformité Européenne CFI Cardiac Fuction Index CH channel C.I. cardiac index CMS central monitoring system C.O.
ABBREVIATION DEFINITIONS EtN2O end-tidal nitrous oxide EtO2 end-tidal oxygen EVLW Extravascular Lung Water ELWI Extravascular Lung Water Index Exp% Inspiration termination level Exp. Flow expiratory flow f Breath rate fapnea Breath rate for apnea ventilation FEV1.
ABBREVIATION DEFINITIONS ICP intracranial pressure ICU Intensive Care Unit ID identification I:E Inspiratory time:Expiratory time ratio IEC International Electrotechnical Commission △int.
ABBREVIATION DEFINITIONS pCVP Central Venous Pressure PEEP Positive end-expiratory pressure PEEP/CPAP PEEP/CPAP PEEPi Intrinsic positive end-expiratory pressure PEEPtot total PEEP PEF peak expiratory flow Phigh Upper pressure level PIF peak inspiratory flow Pinsp Pressure control level of inspiration PIP peak inspiratory pressure PLETH plethysmogram Plimit Pressure limit level Plow Lower pressure level Pmax Maximum airway pressure Pmean Mean pressure Ppeak Peak pressure Ppl
ABBREVIATION DEFINITIONS SvO2 mixed venous oxygen saturation ScvO2 central venous oxygen saturation SVR Systemic Vascular Resistance SVRI Systemic Vascular Resistance Index SVV Stroke Volume Variation SEV sevoflurane SpO2 arterial oxygen saturation from pulse oximetry SQI Signal quality index SR Suppression ratio S, SYS systole/systolic TB temperature of blood TCP/IP Telecommunication Control Protocol/Internet Protocol TEMP temperature Thigh Time for the upper pressure level TI
ABBREVIATION DEFINITIONS VTsigh Sigh tidal volume WOB work of breathing WOBimp Imposed work of breathing C-8
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