Multi-parameter Monitor

ST2365

Learning Material
Ver. 1.1

An ISO 9001:2008 company

Scientech Technologies Pvt. Ltd.
94, Electronic Complex, Pardesipura, Indore - 452 010 India,
+ 91-731 4211100, : info@[Link] , : [Link]
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Multi-parameter Monitor
ST2365
Table of Contents
Ø Safety Instructions 6
Ø Introduction 7
Ø Features 8

Ø Technical Specifications 9
Ø Mimic Diagram 11
Ø Essential Signals of Life 12
Ø Button Functions 20
Ø Method for using the knob for operating on the screen 21
Ø Patient Information Setup 22

Ø System Setup 25
Ø Alarm Modes 36
Ø Drug Calculation and Titration Table 53
Ø Patient Safety 57
Ø Grounding the Monitor 58
Ø ECG/Resp Monitoring 60

Ø Monitoring Procedure 61
Ø ECG Alarm Information and Prompt 71
Ø ST Segment Monitoring (optional) 73
Ø ARR Alarm Menu 80
Ø Measuring Resp 84
Ø Resp Menu 85
Ø SpO2 88

Ø Monitoring Procedure 90
Ø Temp Monitoring 110

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Ø Operating Instructions 115

Ø Experiments
• Experiment 1 116
Study of ECG, HR, PVC and ST analysis
• Experiment 2 117
Study of Body Temperature
• Experiment 3 118
Study of Respiration (RA-LA impedance method)
• Experiment 4 119
Study of SPO2 and Pulse Rate measurement
Configuration
• Experiment 5 120
Study of NIBP (systolic, diastolic and MAP) measurement
Configuration
• Experiment 6 121
Study of simultaneous measurement of all parameter
Configurations
Ø Frequently Asked Questions 122
Ø Glossary of Human Cardiovascular System Terms 132
Ø Warranty 133
Ø List of Accessories 133

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Safety Instructions
Read the following safety instructions carefully before operating the instrument. To
avoid any personal injury or damage to the instrument or any product connected to it.
Do not operate the instrument if suspect any damage to it.
The instrument should be serviced by qualified personnel only.

For your safety:

Use proper Mains cord : Use only the mains cord designed for this instrument.
Ensure that the mains cord is suitable for your
country.
Ground the Instrument : This instrument is grounded through the protective
earth conductor of the mains cord. To avoid electric
shock the grounding conductor must be connected to
the earth ground. Before making connections to the
input terminals, ensure that the instrument is properly
grounded.
Observe Terminal Ratings : To avoid fire or shock hazards, observe all ratings and
marks on the instrument.
Use only the proper Fuse : Use the fuse type and rating specified for this
instrument.
Use in proper Atmosphere : Please refer to operating conditions given in the
manual.
Ø Do not operate in wet / damp conditions.
Ø Do not operate in an explosive atmosphere.
Ø Keep the product dust free, clean and dry.

Scientech Eco Foundation

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Introduction
Monitoring of several Vital Physiological parameters provides very essential
information about patient simultaneously in one common display board. It helps the
doctors to take quick decision in favour of the patient when there is no time for further
analysis and treatment. These parameters includes ECG, HR, ST segment analysis,
PVC’s analysis, Respiration rate (RR), Pulse rate (PR), Body temperature, NIBP and
SPO2 measurement.
ST2365 Multiparameter Monitor is capable of monitoring seven parameters
simultaneously over one window, with the help of only four sensors. Theses sensors
are for ECG (Up to seven leads), Temperature, SPO2 and NIBP. Measurement of
respiration has done by ECG sensor (RA-LA impedance method).
ST2365 has sufficient memory to store the important information of patient, different
kinds of Alarms etc.

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Features
• Specially design for educational purpose
• Light weight, compact and portable
• Both visual (Led) and audible (Buzzer) alarm indications
• High resolution 12.1" color TFT display
• Simultaneous monitoring of ECG, SPO2, NIBP, PR, Resp., and Temp.
• ECG waveforms up to 7-leads on the same screen
• Arrhythmia, S-T segment and PVC’s analysis
• 72-hours graphic and tabular trends of all parameters
• 72 alarm events of all parameters recall
• 32 seconds full-disclosure waveform review
• 500 NIBP measurement data can be storage and recall
• Data and waveforms color can be adjustable
• Suitable for adult, pediatric and neonatal patient

RoHS Compliance

Scientech Products are RoHS Complied.

RoHS Directive concerns with the restrictive use of Hazardous substances (Pb, Cd, Cr, Hg,
Br compounds) in electric and electronic equipments.

Scientech products are “Lead Free” and “Environment Friendly”.

It is mandatory that service engineers use lead free solder wire and use the soldering irons
upto (25 W) that reach a temperature of 450°C at the tip as the melting temperature of the
unleaded solder is higher than the leaded solder.

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Technical Specifications
Measurements
1. NIBP
Method : Oscillometric
Modes : Manual/Auto/Continuous
Auto measure time : Adjustable
Measurement range : 10 - 270 mmHg
2. ECG
Lead mode : 3/5 - lead
Lead selection : I, II, III, avR, avL, avF, V
Heart rate range : Adult: 15 - 300 bpm,
Paediatric / Neonatal (15-
300bpm)
ECG waveform : 2 channels
Accuracy : ±1 bpm or ±1 %, which is greater
Alarm : Yes, Audible and Visual alarm
3. SPO2
Measurement range : 0-100%
Accuracy : 70-100%, ±2% 0-69%,
Unspecified
4. Pulse rate
Range : 20-254 bpm
Accuracy : ± 3 bpm
5. Respiration
Method : RA-LL impedance method
Range : Adult: 0-120 rpm
Paediatric / Neonatal (0 - 150
rpm)
Apnea alarm : Yes

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6. Temperature
Range : 0-50 °C
Accuracy : ± 0.1 °C
Channel : Dual-channel

General Information
Environment:
• Temperature
a) Working : 5~40 (°C)
b) Transport and Storage : -20~60 (°C)
• Humidity
a) Working : ≤ 80%
b) Transport and Storage : ≤ 95%

• Altitude
a) Working : -500 to 4,600m (-1,600 to
15,000ft)
b) Transport and Storage : -500 to 13,100m (-1,600 to
43,000ft
Power Supply
• 100~240 (V) AC, 50/60 (Hz)
• Fuse T 1.6A

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Mimic Diagram

Figure 1

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Essential Signals of Life

There are some vital signals which are standard in most vital monitoring settings
Ø Heart Rate (HR)
Ø Electrocardiograph (ECG)
Ø Pulse Rate (PR)
Ø Blood Pressure (BP)
Ø Body Temperature (Temperature)
Ø Respiration Rate (RR)
Ø Oxygen Saturation (SPO2)
(1) Heart Rate (HR)
Heart rate is the number of heartbeats per unit of time and typically expressed as beats
per minute (bpm), which can vary as the body's need for oxygen changes, such as
during exercise or sleep. The measurement of heart rate is used by medical
professionals to assist in the diagnosis and tracking of medical conditions. Heart rate
can be directly measured by RR interval in ECG waveform. It is also measured for
finding the pulse of the body. This pulse rate can be measured at any point on the
body where an artery's pulsation is transmitted to the surface
Possible points for measuring the heart rate are:
Ø Radial artery (Wrist)
Ø Ulnar artery (Arm)
Ø Carotid artery (Neck)
Ø Brachial artery (Elbow)
Ø Groin femoral artery (Thigh)
Ø Posterior Tibial Artery (Feet)
Ø Dorsalis pedis (Foot)
Ø Popliteal artery (Knee)
Ø Abdominal aorta (Abdomen)

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A more precise method of determining Heart rate involves the use of an

Electrocardiograph, or ECG. Continuous electrocardiograph monitoring of the heart is
routinely done in many clinical settings, especially in critical care medicine.
Commercial heart rate monitors are also available, consisting of a chest strap with
electrodes. The signal is transmitted to a wrist receiver for display.
Average values of heart rates are as follows
Adult Males : 72 pulse/minute
Adult Females : 76-80 pulse/minute
Newborns : up to 140 pulse/minute
Children’s : 90 pulse/minute
Elderly : 50-65 pulse/minute
(2) Electrocardiograph (ECG)
An Electrocardiogram (ECG or EKG, abbreviated from the German
Electrocardiogram) is a graphical representation of an electrocardiograph, which
records the electrical activity of the heart over time. Analysis of the various waves
and normal vectors of depolarization and repolarization yields important diagnostic
information about Heart as mentioned below.
• It is the Gold standard for the diagnosis of Cardiac Arrhythmias
• It guides therapy for patients with suspected Acute Myocardial Infarction (AMI)
• It helps detect electrolyte disturbances in the walls of Heart
• It allows for the detection of conduction abnormalities

Normal ECG waveform and intervals

Figure 2

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(3) Pulse Rate (PR)

The pulse is the physical expansion of the artery. Its rate is usually measured either at
the wrist or the ankle and is recorded as beats per minute. The pulse commonly taken
is the radial artery at the wrist. Sometimes the pulse cannot be taken at the wrist and is
taken at the opposite of the elbow (brachial artery), at the neck against the carotid
artery (carotid pulse), behind the knee (popliteal artery), or in the foot dorsalis pedis
or posterior tibial arteries. The pulse rate can also be measured by listening directly to
the heartbeat using a stethoscope. The pulse varies with age. A newborn or infant can
have a heart rate of about 130-150 beats per minute. A toddler's heart will beat about
100-120 times per minute, an older child's heartbeat is around 90-110 beats per
minute, adolescents around 80-100 beats per minute, and adults pulse rate is anywhere
between 50 and 80 beats per minute.

Radial Pulse Rate is felt on the wrist

Figure 3

Normal Pulse wave forms

Figure 4

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(4) Blood pressure (BP)

Blood pressure (BP) is a force exerted by circulating blood on the walls of blood
vessels, and is one of the principal vital signs. During each heartbeat, BP varies
between a maximum (systolic) and a minimum (diastolic) pressure. The mean BP, due
to pumping by the heart and resistance in blood vessels, decreases as the circulating
blood moves away from the heart through arteries. It has its greatest decrease in the
small arteries, arterioles, and continues to decrease as the blood moves through the
capillaries and back to the heart through veins. Gravity, valves in veins, and pumping
from contraction of skeletal muscles, are some other influences on BP at various
places in the body.
The term blood pressure usually refers to the pressure measured at a person's upper
arm. It is measured on the inside of an elbow at the brachial artery, which is the upper
arm's major blood vessel that carries blood away from the heart. A person's BP is
usually expressed in terms of the systolic pressure and diastolic pressure, for example
120/80 (mmHg).
The blood pressure is recorded as two readings, a high Systolic pressure, which is the
maximal contraction of the heart, and the lower Diastolic or resting pressure.

Manual method of Blood pressure measurement

Figure 5
(5) Body Temperature
Temperature recording gives an indication of core body temperature which is
normally tightly controlled (thermoregulation) as it affects the rate of chemical
reactions.
It can be recorded in order to establish a baseline for the individual's normal
temperature for the site and measuring conditions. The main reason for checking body
temperature is to solicit any signs of systemic infection or inflammation in the
presence of a fever (temp > 38.5°C or sustained temp > 38°C), or elevated
significantly above the individuals normal temperature. Other causes of elevated
temperature include hyperthermia.

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Normal human body temperature is also known as Normothermia or Euthermia, is a

concept that depends upon the place in the body at which the measurement is made
and the time of day and level of activity of the person. There is no single number that
represents a normal or healthy temperature for all people under all circumstances
using any place of measurement.
Different parts of the body have different temperatures. Rectal and vaginal
measurements, or measurements taken directly inside the body cavity, are typically
slightly higher than oral measurements, and oral measurements are somewhat higher
than skin temperature. The commonly accepted average core body temperature (taken
internally) is 37.0 °C (98.6 °F). The typical oral (under the tongue) measurement is
36.8 ± 0.7 °C, or 98.2 ± 1.3 °F.
(6) Respiratory Rate (RR)
It is the rate of breaths per minute and varies with age and physical activity, but the
normal reference range for an adult is 12-20 breaths/minute. The value of respiratory
rate as an indicator of potential respiratory dysfunction has been investigated but
findings suggest it is of limited value.

Normal Breathing waveforms

Figure 6
(7) Oxygen Saturation (SPO2)
It indicates the Partial Pressure of Oxygen in Arterial Blood. Saturation of peripheral
oxygen (SPO2) is an estimation of the oxygen saturation level usually measured with
a pulse oximeter device. It can be calculated with the pulse oximetry according to the
following formula:

HbO2
SpO2 =
HbO2 + Hb
In medicine, oxygen saturation (SO2), commonly referred to as "sats", measures the
percentage of hemoglobin (Hb) binding sites in the bloodstream occupied by oxygen.
At low partial pressures of oxygen, most hemoglobin is deoxygenated. Generally its
value lies between 95 – 99 % in normal range. If it is less than 85% then indicates the
low oxygen level in bloodstream.

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Screen Display
The display of the monitor parameter is a colour LCD which can display the collected
patient parameters, waveforms, alarm information as well as bed number, time and
monitor status etc.
The screen is divided into three areas:
• Information area
• Waveform area
• Parameter area

Parameter
Waveform Area
Area

Information
Area Main Display
Figure 7

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Information Area
The Message Area is at the bottom part of the screen, displaying the current status of
both the monitor and the patient.
Patient information includes:
Bed No. : Bed numbers of all patients under monitoring
Patient type : Three options: Adult, Paediatric and Neonate
"01-01-2010" : Current date (DD-MM-YYYY)
"07: 11:17" : Current date and time
M/ F : Patient sex - Male or Female
Blood : Patient blood type
Other information in the Message Area will appear and disappear together with the
reported status. According to the content, the information is divided into:
• Prompt information, reporting the current status of the monitor or sensor/probe.

• Flag for alarm Pause. Press "Silence" button once (less than 1 second) to
mute all alarm sounds and the flag appears at the same time. Press the button
again to terminate the PAUSE status. The duration for PAUSE status can be 1
minute, 2 minutes or 3 minutes.

• Flag for alarm Silence. Press "Silence" button once (more than 1 second)
to manually mute the alarm sound and this flag appears at the same time. The
Silence status terminates when you discharge the status or new alarm occurs.

• Flag for Alarm Volume Off. It indicates that you have closed the
alarm sound permanently. This status terminates when you discharge the status.

• If symbol appears, the system will no longer give audible alarm sound.
You must be very careful in using this function. Two ways can be used to
discharge this status. One is set the alarm volume to an option other than Off in
the User Maintain menu. The other method is to press Silence button to make
the flag turn to . And then press Silence again and the system will restore
the normal alarm status.
• Parameter alarm information is always displayed on the upper right corner of
the screen.
• When the waveforms on the screen are frozen, the Freeze prompt will appear in
the bottom part of the screen.

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Waveform / Menu Area

The waveform area can maximally display 7 waveforms. The displaying order of the
waveforms on the screen can be adjusted. For the maximum configuration, the
waveforms provided by the system for selection are: 2 ECG waveform, SpO2
waveform, Resp. waveform.
All the waveforms in the system are listed out in the "Wave Setup" menu. The user
may adjust their displaying positions. The specific method is illustrated in the part:
Wave Setup, Wave Switch.
The name of the waveform is displayed on the upper left part of the waveform. The
user may choose ECG lead based on the requirements. The gain of the channel and
the filter way are also displayed on each ECG waveform. A 1mV scale bar is also
displayed to one side of ECG waveform.
When menu is needed during screen operation, the menu always occupies the fixed
position in the middle part of the waveform area; therefore part of waveform can not
be viewed temporarily. After exiting from the menu, the system restores the original
screen.
Parameter Area
The parameter area lies to the right side of the waveform area, whose position
basically corresponds to the waveform. The parameters displayed in the parameter
area include:
Ø ECG
• Heart rate or pulse rate (unit: beats/minute)
• ST analyzing result of channel 1 and 2: ST1, ST2 (unit: mV)
• PVCs (unit: times/minute)
Ø NIBP
• From left to right, there are Systolic pressure, Mean pressure and Diastolic -
pressure (unit: mmHg or KPa)
• SpO2 (unit: %)
• Pulse Rate (unit: beats/minute) (When "BOTH" item is selected)
Ø Resp
• Respiration Rate (unit: times/minute)
Ø Temp
• Temperature of channel 1 and 2: T1, T2 and the difference between them
TD.(unit: °C or F)
Alarm lamp and alarm status:
In normal status: the alarm lamp is not on. When alarm alarms, the alarm lamp
flashes or lights are switched on. The colour of the lamp corresponds to the alarm
level.

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Button Functions
All the operations in the monitor are done through the buttons and a knob at the
bottom of the screen. The names of the buttons are written above them. They are:
Main
At whatever levels of menu the system is in, press the button and the system will
always return to the main screen.
Freeze
Press this button and the system will access the Freeze status. In this status the user
may review the waveform of 34 seconds. Also, the frozen waveform can be printed
out. In the Freeze status, press this button again to discharge the Freeze status. For
detailed information, refer to related chapter: Freeze.
Silence
Push this button to suspend alarm for maximum 3 minutes (with 1 minute, 2 minutes
and 3 minutes selectable). In Alarm Pause status, a ~ symbol appears in the Message
Area. Push this button for more than 1 second to mute all kinds of sounds (including

alarm sound, heart beat, pulse tone, key sound). At the same time, a symbol
appears in the Message Area. Push this button again to restore all kinds of sounds and

the symbol disappears from the screen.

If new alarm occurs in Alarm Silence status, the system will discharge Pause/Silence
status automatically.
The system will begin to give alarm information again once there is alarm-triggering
event. Nevertheless, remember pushing Silence button can permanently shut off
audible alarm sound of ECG Lead off and SPO2 Sensor off alarms.
Start
Press to inflate the cuff to start a blood pressure measurement. When measuring,
press to cancel the measurement and deflate the cuff.
Rec/Stop
Press to start a real time recording. The recording time is set in REC Time of Record
Setup submenu. Press during recording to stop the recording. For detailed
information, refer 10 related chapters.
Menu
Press this button to call up the Main Menu, in which the user may set up system
information and perform review operation. For detailed information, refer to related
chapter: System Menu and Trend and Event.
Rotary Knob
The user may use the rotary knob to select the menu item and modify the setup. It can
be rotated clockwise or counter-clockwise and pressed like other buttons. The user
may use the knob to realize the operations on the screen and in the system menu and
parameter menu.

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Method for using the knob for operating on the screen

The rectangular mark on the screen that moves with the rotation of the knob is called
"cursor". Operation can, be performed at any position at which the cursor can stay.
When the cursor is in the waveform area, the user may immediately modify the
current setup. When the cursor is in the parameter area, the user may open the setup
menu of the corresponding parameter module so as to set up the menu items of the
module.
Operating method
• Move the cursor to the item where the operation is wanted
• Press the knob
• One of the following four situations may appear:
a) The cursor with background colour may become into the frame without
background colour, which implies that the content in the frame can change
with the rotation of the knob.
b) Menu or measuring window may appear on the screen, or the original
menu is replaced by the new menu.
c) A check mark" √" appears at the position, indicating that the item is
confirmed.
d) The system immediately executes a certain function.
System Menu
• New patient enrolment
• Recording
• Trend Graph/Table and Alarm Review, System Setup
• Maintenance
This Monitor features flexible configurations. You can customize monitoring content,
waveform sweep speed, sound volume, and output content.
Press the Menu button on the front panel of the monitor to call up the "Main Menu,
you can perform following operations in this menu

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Main Menu
Figure 8
Trend graph/table review, NIBP review and alarm review are discussed in Chapter:
Trend and Event.
Patient Information Setup
Note: To clear current patient data, refer to Delete Patient for details.
Pick the [PAT Setup] item in the "Main Menu" to call up the following menu.

Patient Setup
Figure 9
You can setup following patient information:

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Department : Department in which the patient receives treatment

Patient No. : Patient No.
Bed No. : Patient bed number (Range: 1-100)
Doctor : Name of the doctor.
Name : Patient name (Valid characters: A-Z, 0-9 and space bar;
Max. Length: 12 characters)
Sex : Patient gender ("F" for Female, "M" for Male)
Pat Type : Patient type (Available options: ADU, PED, and NEO)
Admit : Hospitalization starting date (format: year\month\ day)
Birth : Patient date of birth (format: year\month\day)
Height (cm/inch) : Patient height (turning the knob with the increase/
decrease of 0.5 cm/inch each time). The other HT. unit
in the other menus accord with the unit which you
choose here.
Weight (Kg/lb) : Patient weight (turning the knob with the increase/
decrease of 0.5 kg/lb each time) the other WT. Unit in
the other menus accord with the unit which you choose
here.
Blood : Patient blood type (Pick A, B, 0, AB, or N. "N"
represents unknown blood type)
Save : To change the patient's information you must click this
button to save.
Delete : To initialize the Patient Setup menu.
Also in this menu, you may select the [Delete] item to access the "Confirm to Delete"
dialog box as show bellow, in which you can decide whether to clear current patient
data.

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Confirm to delete
Figure 10
Pick [Yes] to initialize the previous menu and exit the menu.
Pick [No] to give up updating the patient and the system will keep the information of
the currently patient and exit the menu.

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System Setup
Select the [Sys Setup] item in the [Main Menu]:

Figure 11
System setup:
In the [System Setup] menu, users can setup the following items.
• Face Select: Select the [Face Select] item in the "System Setup" menu to call up
the following menu:

Figure 3-7 Face Select

Figure 12

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There are four available options:

a) Standard: the left part of the screen is the waveform area; the right part is the
parameter area.

Standard
Figure 13
b) OXYCRG: on the bottom part of the waveform area, there are the recent trend
graphs of HR, SpO2, RR or Respiration waveform. There are three hot key.

OXYCRG
Figure 14

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c) Trend: the system provides the recent 2 hours trend graphs of all the parameters.
The trend graphs' location is on the left to every corresponding parameter. And
you can adjust the hot key to review other parameter's trend graph.

Trend
Figure 15
d) Big Char: To view the parameter more clearly in a long distance, here is the big
char interface.

Big Char
Figure 16

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View Bed:
Wave Setup
Select the [Wave Setup] item in the "System Setup" menu to call up the following
menu:

Wave Setup
Figure 17
You can change the waveforms' position.
Wave Select
Select the [Wave Select] in the "System Setup" menu to call up the following menu

Tracing Waveforms Selection

Figure 18

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Parameter (PARAM) Setup

Select the [PARAM Set] item in the "System Setup" menu to call up the following
menu:

Param Setup
Figure 19
You can change the parameter’s position and replay colour.
Parameter (Param) Select
Select the [Param Select] item in the "System Setup" menu to call up the following
menu:

Param Select
Figure 20

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You can choose the parameters to be monitored in this menu. This can avoid the
interference from the parameters that need not attention.
Time Setup
Select the [Time Setup] item in the "System Setup" menu. The menu as shown below
is in the format of year, month, day, hour, minute and second. Use cursor to highlight
the option that you want to modify and turn the knob to select time. Then select
[Exit].
Note: You shall set up the system time upon turning on the monitor (if you need to set
up the system time: otherwise, when you review the content with time information,
the system may not display the correct time.

System Time Setup

Figure 21

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Alarm setup
The system provides three levels of alarm volume. You can select any of them as per
the clinical requirement. The procedures are:
Select the [Alarm Setup] item in the "System Setup" sub-menu of the "Main Menu"
menu. The menu as shown below will pop up, in which you can set up the alarm
volume and other alarm information. For detailed information, refer to Chapter
Alarm.

Alarm Setup
Figure 22
You can highlight the [Alarm Vol] item and then turn the knob to set up the alarm
volume. There are three options: Low, Med and High.

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Record setup
Select the [Record] in the "System Setup" menu to call up the following menu:

Record Setup
Figure 23

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In this menu, the user can set up to two output waveforms. The waveforms that can be
selected are
• ECG1-ECG2: Two ECG waveforms on the screen (If no ECG waveform is
currently displayed on the screen, this item cannot be picked).
• SPO2: SpO2 Plethysmogram.
• Resp: Resp waveform (If no Resp waveform is currently displayed on the
screen then this item cannot be picked).
• “Off”: No display for this waveform.
• RT REC Time: This item has two options, Continual and 8s. "Continual"
means once pushing the "REC/Stop" button on the recorder panel or the monitor
panel, the recorder will continuously print out the waveform or parameter until
this button is pushed again.
• Timing Rec Time off: It is used for setting up the time interval between two
recordings. 10 selections are available: "Off, 10min, 20min, 30min, 40min,
50min, 1hour, 2hours, 3hours and 4hours". The system will start the recording
process according to the selected time interval. The recording time is always 8
seconds.
Note: RT REC Time takes priority over Timing REC Time off.
• Rec Rate: this item has two options, 25.0 and 50.0 mm/s.
• Rec Grid: used to decide output format: Off is without grid, and On is with
grid.
• Clear Rec Task: used to clear the alarm event that has been generated and is
waiting for recording out
Note: If two same waveforms are selected, the system will automatically change one
of the waveform to different one.

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Event Setup
The monitor has four types of events. You can specify their representations by
yourself. Select the [Mark Event] item in the "System Setup" to call up the following
menu:

Mark Event Menu

Figure 24
How to mark the event: Use the rotary knob to select one from event A, B, C and D.
‘@’ symbol will appear in the frame of the event being selected. Once making a
wrong selection, you can push the knob on the even again to give up the selection.
Select [Exit] to exit the menu and consequently the selection will come into effect.
Event function has following significance: To classify the records into different
categories, such as those having influence on patients and those having influence on
parameter monitoring including dose taking, injection, therapy status. Event will be
displayed 0 the trend graph/table in order to assist the analysis on the patient
parameters when the event happens.
Monitor Version
Select the [Version] item in the "Main Menu" to know the software version of the
monitor.
Drug Calculation
You can use the drug calculation and titration table function of the monitor to
calculate the concentration of 15 kinds of drugs.

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Maintenance
Select the [Maintain] item in the "Main Menu" to call up the "System Maintain"
dialog box as shown below, in which you can enter password and then customize
maintenance settings. You cannot execute factory maintenance function, which is
only available for the service engineers of our company.
Demo function
Select the [Demo] item in the "Main Menu" to call up the "Input Demo Key". After
entering the password"2088", the system enters Demo status. The purpose of
waveform demonstration is only to demonstrate the machine performance, and for
training purpose. In clinical application, this function is forbidden because the demo
will mislead the medical staff to treat the Demo waveform and parameter as the
actual data of the patient, which may result in the delay treatment or mistreatment.
Therefore before entering this menu, you shall enter password

Input Demo Key

Figure 25
Alarm
It gives general information about the alarm and corresponding remedies. Alarm
setup and prompt messages are provided in respective parameter setup sections.
When the monitor is powered on, the system may verify the audio and visual alarm
function.
Upon turning on the monitor, a "Do" will be heard and at the same time the indicator
will flash once in orange and red. This is used to verify the audio and visual alarm
function of the system. Therefore, the user should be careful in observing the status.
If the audio and visual alarm function is not normal, it indicates that the monitor
cannot be used to monitor a patient. Please contact our company or service centre.

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Alarm Modes
Alarm Level
Each alarm, either technical or physiological, has its own level. For alarm of higher
level, when it occurs, the system will give prompt in a more alert way. Some alarm's
level can be set by the user via software. Others cannot be changed once defined by
the system. Alarms in the monitor are divided into three levels i.e. high, medium and
low.
High-level alarm indicates the patient's life is in danger or the monitor under using
has serious problem in technical respect. It is the most serious alarm.
Medium-level alarm means serious warning.
Low-level alarm is a general warning.
Alarms are classified into three categories, which are physiological alarm, technical
alarm and general alarm. Physiological alarm refer to those alarms triggered by
patient's physiological situation which could be considered dangerous to his or her
life, such as heart rate (HR) exceeding alarm limit (parameter alarms). Technical
alarm refer to system failure which can make certain monitoring process technically
impossible or make monitoring result unbelievable. Technical alarm is also called
System Error Message. General alarm belongs to those situations that can not be
categorized into these two cases but still need to pay some attention.
The monitor has preset the alarm level for the parameters. You can also modify the
alarm level using the method described in this chapter.
Alarm level of the System Error Message (Technical Alarm) is pre-set in the system.
All technical alarm level and general alarm level, some of the physiological alarm
level are pre-set in the system and can not be changed by user.
Alarm Modes
When alarm occurs, the monitor may raise the user's attention in at least three ways,
which are audio Prompt, visual prompt and description. Audio and visual prompt is
given by TFT display device and the alarm indicator. Description is displayed on the
screen. Physiological alarm displayed in the Physiological Alarm area. Most of
technical alarms are displayed in the Technical Alarm are Technical alarms related to
NIBP measurement are displayed in the NIBP Technical Alarm area at the bottle, of
NIBP parameter area.
Note: The Physiological Alarm area is on the upper right part of the screen. The
Technical Alarm area is II the left side of the Physiological Alarm area.
Note: The concrete presentation of each alarm prompt is related to the alarm level.
Screen Display
When an alarm occurs the parameter value triggering the alarm will become red. "*"
signal appears on the screen indicating the occurrence of alarm. Red "***" indicates
high-level alarm, yellow "**" indicates medium-level alarm, and yellow "*" indicates
low-level alarm. Technical alarm will not prompts "*" signal.

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Lamp light
The high/ medium /low-Level alarms are indicated by the system in following
different visual ways:
Alarm level Visual prompt
High Alarm indicator flashes in red with high frequency.
Medium Alarm indicator flashes in yellow with low frequency.
Low Alarm indicator lights on in yellow.
Alarm Sound
The high/medium/low-Level alarms are indicated by the system in following different
audio ways:
Alarm level Audio prompt
Mode is "00-00-00--00-00, 00-00-00---00-00", which is triggered
High
once every 8 seconds.
Medium Mode is "00-00-00", which is triggered once every 8 seconds.
Low Mode is "00-", which is triggered once every 8 seconds.

Note: When alarms of different levels occur at the same time, the monitor prompts
the one of the highest level.

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Alarm Setup
The setup of the alarms can be realized in the alarm menu
Press the "Alarm Setup" button on the System Setup menu to call up "Alarm Setup"
menu (default menu) as shown below.

Alarm Setup
Figure 26
• Alarm Vol: which has three selections: off, Low, Med and High.
• Alarm Rec Time: which has three selections: 8S, 16S, 32S.
• Alarm Pause Time: refers to the alarm suspension time span, which has three
selections: 1min, 2min and 3min.

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Alarm verification during power on

When the monitor is powered on audible and visual alarm capability will be tested by
the system. Every time when the monitor powers on, alarm beeps "00-", and the Led
indicator on the display device flashes orange once. If no beeps heard or no alarm
indicator flashing viewed, do not use this device to monitor any patient, and notify
Customer Service Center.
Alarm Cause
Alarm occurs when:
• Physiological alarm is evoked;
• Alarm for error of the system (technical alarm) is evoked;
• General alert occurs.
• Conditions that activate the parameter alarms: When the measurement value
exceeds the alarm limit and the alarm is set "On". Alarm will not activate if the
alarm is set "Off",
• Conditions that activate the system alarms (technical alarm): Upon the system
error, the monitor prompts alarm immediately and proceeds corresponding
remedy, stops all monitoring and eliminates the final results in order to avoid
faulted treatment. If more than one error occurs, they will be displayed by turns.
• General alert: In some circumstances, alerts will behave as physiological alarm
but in normal sense, we don't regard them as real patient health related items.
Silence and Pause
Silence
Press the Silence button on the panel for more than 1 second can shut off all sounds
until the Silence button is pressed again. When the system is in Silence status, any
newly generated alarm adjust the setting of alarm will discharge the Silence status and
make the system give normal state giving audio and visual alarm.

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Pause
Press the Silence button on the panel once to close all audio and visual prompt and
description about all the physiological alarms and to make the system enter Alarm
Pause status. The rest seconds f~ alarm pause is displayed in the Physiological Alarm
area. And the symbol: is displayed in the System Prompt area. The user may set
up the time for Alarm Pause in the Alarm Setup menu. Three selections a~ available:
1min, 2min and 3min.
When in the Pause status, press the Silence button to restore the normal alarm status.
Beside~ during Pause status, newly occurring technical alarm will discharge the Pause
status and the system will access the normal alarm status. The: symbol
disappears, too.

Note
Whether an alarm will be reset depends on the status of the alarm cause. But by
pressing Silence button can permanently shut off audio sound of Lead Off/Sensor Off
alarms.

Note
When the state is "silence", or "alarm" In every parameter's menu is "Off", or "alarm
sound" in the "user maintenance menu" is "off', turning the "alarm level "will trigger
the loudhailer to give out sound.

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Parameter Alarm
The setup for parameter alarms is in their menus. In the menu for a specific parameter,
you can check and set the alarm limit, alarm status. The setup is isolated from each
other.
When a parameter alarm is off, a symbol " " displays near the parameter. If the
alarms are turned 0' individually, they must be turned on individually.
For the parameters whose alarm is set to on, the alarm will be triggered when at least
one of them exceeds alarm limit. The following actions take place:
• Alarm message displays on the screen as described in alarm mode.
• The monitor beeps in its corresponding alarm class and volume
• Alarm lamp flashes.
• Store all parameter values during the alarm and 4,8 or 16 second waveform prior
to and after alarm.
• If alarm recording is on, the recorder starts alarm recording. For further
information on alarm recording please refer to Chapter Recording.
When an Alarm Occurs
Note
When an alarm occurs, you should always check the patient’s condition first.
The alarm message appears at the top of the screen on the right side. It is needed to
identify the alarm and act appropriately, according to the cause of the alarm.
• Check the patient's condition
• Identify the cause of the alarm
• Silence the alarm, if necessary
• When cause of alarm has been over, check that the alarm is working properly.
You will find the alarm messages for the individual parameter in their
appropriate parameter chapters of this manual
Freeze
• General
• Freeze & Unfreeze
• Review & Record Frozen Waveforms

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a) General
When monitoring a patient, you may freeze the waveforms of interest so as to view
them carefully. Generally you can review maximally 34 seconds of a frozen
waveform. If required, you may also use recorder to print out a frozen waveform. The
Freeze function of this monitor has following features:
• Freeze status can be activated on any operating screen.
• At the same time of entering the Freeze status, the system exits all other
operating menus. Beside the system freezes all waveforms in the
Waveform area of the Basic Screen, or Full-lead ECG waveforms and the
extra waveform (if available) on the Full-lead ECG screen. Nevertheless
the Parameter area refreshes normally.
• In the Freeze status, it does not affect the display and refresh of the Trend
Graph area on the trend screen, the display and refresh of the Viewed
window on the Viewed screen.
• The frozen waveforms can be reviewed or recorded
b) Enter/Exit Freeze Status
• Enter Freeze Status
In the Non-Freeze status, press the "Freeze" button on the front panel of the
monitor to let the system ex~ the Menu being currently displayed (if
available), then enter the Freeze status and display the popup "Freeze"
menu. In the Freeze status, except Viewed waveforms, all other waveforms
are frozen. In other words, the system will no longer refresh all other
waveforms.
• Exit Freeze Status
In the Freeze status, executing any of the following operations will
command the system to exit the Freeze status:
i. Select the "Exit" option on the "Freeze" menu.
ii. Press the "Freeze" button on the front panel again.
iii. Press the non-immediate-to-execute button (such as a button once
pressed, a menu will pop up for you to further select an option) on the
front panel and system buttons of Main and Menu;
Execute any operation that may trigger the adjustment of the screen or display of a
new menu. After exiting the Freeze status, the system will discharge the Freeze status,
clear screen waveform and resume displaying real-time waveforms. In the Screen
Refresh mode, the system begins scanning waveforms from the extreme left one. In
the Screen Scroll mode, the system begins displaying scrolled waveforms from the
extreme right one.

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c) Freeze Menu
Press the "Freeze" button on the button module, the Freeze menu will appear on the
bottom part of the screen. At the same time, the system enters the Freeze status.

Freeze menu
Figure 27
• Wave 1: used to select the first frozen waveform to record. The pull-down list of
this item gives you the names of all frozen waveforms displayed on the screen
• Wave 2: used to select the second frozen waveform to record. The pull-down list
of this item gives you the names of all waveforms displayed on the screen.
• Review: used to review frozen waveforms.
• Rec: after selected, the system begins recording the frozen waveforms selected
in "Wave 1" and "Wave 2
• Exit: after pressed, the system closes the Freeze menu and exits the Freeze status
Note: Pressing the "Freeze" button repeatedly in short time period may result in
discontinuous waveforms on the screen.
Reviewing Frozen Waveform
By moving the waveform, you may review a waveform of 34 seconds before the
moment when it is frozen. For a waveform less than 34 seconds, the remaining part is
displayed as a straight line. Use the rotary knob on the front panel to move the cursor
to the "Review" option on the Freeze menu. Press the knob, the option displays "L-
Right". By turning the knob left or right, frozen waveforms on the screen will move
left or right correspondingly. There is an arrow indicating upward under the right side
of the last waveform. There is also a time scale beside the arrow. "OS" is used to mark
the moment when waveforms are frozen. With waveforms moving right, this time
mark will in turn change into -15, -25, -35... These time marks are applied to all
waveforms on the screen.

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Recording Frozen Waveform

In the Freeze status, you may output displayed frozen waveforms via the recorder.
Maximum 2 waveforms can be output at one time. On the Freeze menu, the pull-down
lists of both "Wave 1" and "Wave 2" give you all names of frozen waveforms on the
screen, from which you may select two. Select the "REC" option on the Freeze menu
to output parameters generated upon the freezing moment and the two selected frozen
waveforms. If one of the two selected waveforms is closed or not available, only
parameters and the other waveform are recorded. If these two selected waveforms are
all closed or not available, only parameters are recorded. As for the function of
recording frozen waveforms, you can only record the waveforms displayed upon the
freezing moment. The recording time length is the same as the length of the waveform
displayed on the screen. For example, if the speed of a waveform is relatively fast,
then it needs shorter time to record it when recording frozen waveforms, the system is
still in the Freeze status. After completion of recording, you may select once more the
waveform to be output and select "Rec" option again to record the whole selected
waveforms. You may also record frozen waveforms by pressing the "Rec/Stop" button
Q the front panel. If the recorder does not exist, selecting the "REC" option can only
call out the prom;' "Recorder does not exist" in the Status bar. For more detailed
information about recording, please refer ~ the chapter of "Recording".

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Trend and Event

The monitor provides 72-hour trend data of all parameters, storage of 400 NIBP
measurement results and 71 alarm events.
Trend Graph
• The latest 1-hour trend is displayed every 1 or 5 seconds
• The latest 72-hour trend is displayed every 1, 5 or 10 minutes
Pick "Trend Graph" in the Main Menu to call up the following menu:

Trend Graph Menu

Figure 28

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• The uppermost part is the name of the parameter, in which y-axis stands for
value and x-axis time.
• "↓ " Indicates the value of the parameter, which it points to, is below the x-axis,
with corresponding time displayed beyond the trend graph. Other trends except
NIBP trend are displayed as continuous curves. three symbols"*" indicate the
position of the NIBP value, including systolic value, diastolic value, mean value.
• To select trend graph of a specific parameter:
• Pick Para Select item (the first selection of the upper line) and select a requested
parameter name by turning the knob.
• To select 1-hour or 72-hour trend graph:
• Pick Resolution item (the latter selection of the upper line), choose 1 or 5 sec for
1-hour trend graph and 1, 5 or 10 min for 72-hour trend graph.

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To view other trend curves:

When "→ "appears on the right part of the screen, pick "L-Right" (the button at the
extreme left of the lower line), turn the knob clockwise to view later trend curves.
When "← "appears on the left part of the screen, pick the same item, turn the knob
counter clockwise to view earlier trend curve.
To change the display scale
Pick the "Zoom" button in the lower line to adjust the y-axis scale and thus change the
trend curve in proportion. The value beyond maximum value will be represented by
the maximum value.
To obtain trend data of a specific time
The time to which the cursor points will change as the knob is turned. Parameter at this
time is displayed below the x-axis. When" →" appears on the right part of the screen,
the trend graph- pages down for later trend curve as the cursor moves here. When" ←"
appears on the left part of the screen, the trend graph pages up for earlier trend curve
as the cursor moves here.
To print out the trend curve
Press REC button to print out the trend curve of current selected parameter.
Mark event
If an event is marked A, B, C, or D, then the corresponding event type will display on
the axis time of the trend graph. The event sign (A, B, C or D) is displayed in a frame.
Operation example
To view the NIBP trend graph of the last 1 hour:
• Pick the Menu hot key lower right of the screen.
• Pick Trend Graph item.
• Pick the first item and switch to NIBP by turning the knob.
• Adjust the second item to be 1 or 5 sec.
• Pick the Zoom button and turn the knob to view changes of the trend graph time
and trend curve.
• Stop at requested trend time section for careful review. Pick the Zoom button to
adjust the display scale if necessary.
• For measurement result of a specific time, pick Cursor to move the cursor to the
point, corresponding time and value will display on above and below
respectively.
• For printout of trend graph, pick REC to start report printing of NIBP trend of
this hour.
• Pick Exit to return to trend graph display.

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Trend Table
The latest 72-trend table data can be displayed at every 1, 5, 10, 30, or 60 minutes.
Pick Trend Table in the System Menu to call up the following menu:

Trend Table Menu

Figure 29

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Time in response to each group of trend data is displayed at the leftmost list with date
in bracket. Marked event corresponds to marking time. Trend data of each parameter is
divided into 8 groups.
1. HR
2. PVCS
3. ST1, ST2
4. RR
5. Temp1, Temp2, Tempd
6. SPO2
7. PR
8. NIBP (S/M/D)
NIBP trend data presents different specificity. A certain NIBP measuring time is
displayed below the Test AT item, as well as the measurement value. For more than
one measurement in one time, it can display only one group, and mark a "*,, on the
More to indicate two and above measurement results.
To choose trend table of different resolution
Pick the leftmost item and change the time interval of trend data.
To view other trend data:
When" ↑" appears on the upper part of the screen, pick Up-Down button and turn the
knob clockwise to view later trend data. When" ↓" appears on the lower part of the
screen, pick the same item and turn the knob counter clockwise to view earlier trend
data.
To obtain trend data of different parameter
Pick L-Right to select one from the 8 groups of parameters. A ">" by the rightmost
item indicates following page available. And "<" by the leftmost item indicated
previous page available.
To print out the trend data
Pick REC to print out the trend data of current displayed parameter.
Mark event
If an event is marked A, B, C, or D, the corresponding event type will display on the
axis time of the trend table.

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Operation example
To view a NIBP trend table:
• Pick Menu button on the front panel of the monitor to access "Main Menu".
• Pick Trend Table.
• Pick L-Right and switch to NIBP by turning the knob.
• Pick the first item from the left and select requested time interval.
• Pick Up-Down and turn the knob to view NIBP trend data of different time.
• For printout of trend table, pick Rec to start report printing of all trend data
including NIBP of this time span.
• Pick Exit to return to Main Menu.
NIBP Recall
The monitor can review the latest 400 NIBP measurement data. Pick NIBP Recall in
the Main Menu to invoke the result and time of the latest 9 measurements, as shown in
the figure below.

NIBP Recall
Figure 30
Data is listed chronologically from the latest to the earliest. 9 measurements can be
displayed in one screen. Pick Up-Down to view other trend curve up to 400 results.
Pick REC to print out all measurement data of NIBP Recall.

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Alarm Event Recall

The monitor can display the latest 71 alarm events.
• Select "Alarm Recall" in the Main Menu to access Alarm Recall time menu as
shown below:

Alarm Recall Time Menu

Figure 31
In this menu, the user may select the conditions for alarm review, including:
1. Start and End time of review:
• The user may select the start time of review in the item of Start.
• Then the user may select the end time of review. Two selections are
available: current time and the user-defined time.
• For user-defined end time, the user can use the knob to select.
2. Alarm Recall Event
In the pull-down list of Alarm Recall Event, the user can select the parameter
whose alarm events he wants to review. The selections include all (alarm events of
all parameters), ECG, Resp, SPO2, NIBP, IBP, Temp, C02.
After setting up all the review conditions, press the "Alarm Recall" button to
access "Alarm Recall" window.

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Alarm Recall
The Alarm Recall window is as shown below, in which following data are displayed:
• CD Time span (Format: month-day-year hour: minute- month-day-year hour:
minute).
• Event type.
• Serial number (Format: NO. xx of XX).
• The value at the time of alarm. NIBP result is with time.
• Two 8/16/32-second waveforms

Alarm Recall Menus Figure 32

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To view all waveforms during the alarming process

Pick L-Right and turn the knob to view all 8/16/32-second waveforms stored.
To view other alarm events
Events of up to 71 are listed chronologically from the latest to the earliest. Pick UP-
Down button and turn the knob to view later or earlier events.
Drug Calculation and Titration Table
This Portable Patient Monitor provides Drug calculation and titration table display
functions for fifteen drugs and outputs the content of titration table on the recorder.
Drug Calculation
The drug calculations that can be performed by the system are AMINOPHYLLINE,
DOBUTAMINE, Dopamine, EPINEPHRINE, Heparin, ISUPREL, LIDOCAINE,
NIPRIDE, Nitroglycerin and PITOCIN. Besides Drug A, Drug B, Drug C, Drug D and
Drug E are also provided to flexibly replace any of the drugs.
Select "Drug CALC" in Main Menu, the following "Drug CALC" display appears:

Drug Calc
Figure 33

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The following formulas are applied for dose calculation: Concentrate = Amount I
Volume
INF Rate = Dose/Concentrate
Duration = Amount I Dose
Dose = Rate x Concentrate
Operating method
In the Drug Calculation window, the operator should first select the name of the drug
to be calculated, and then confirm the patient weight. Afterwards, the operator should
also enter other known values.
Turn the knob to select the value of the item to be calculated. Turn the knob to change
the value. When it is the required value, press the knob to view the calculation result.
Each item has its calculation range. If the result exceeds the range, display "-.-"
Note: For the drug calculation, the prerequisite is that the operator must first of all
enter the patient weight and drug name. The system first gives a group of random
initial values, which cannot be used by the operator as the calculation reference.
Instead, he should enter a new group of values at the doctor's instruction.
Note: Each drug has its fixed unit or unit series. Operator must select the proper unit at
the doctor's instruction. If the result exceeds the system-defined range, it will display
"___n.
Note: After entering a value, a conspicuous prompt will appear in the menu warning
the operator to confirm the correctness of the entered value. The correct value is the
guarantee for the reliability and safety of the calculated results.
Note: In neonate mode, Drip Rate and Drop Size items are disabled.
Note: For each entered value, the system will always give a dialog box asking for the
user's confirmation. You must be careful when answering each box. The calculated
result is reliable only after the entered value is confirmed to be correct.
Select the drug name:
Turn the knob to pick the Drug Name item in Drug Calc menu. The user may select
the drug name in the pull-down list, including AMINOPHYLLINE, DOBUTAMINE,
DOPAMINE, EPINEPHRINE, HEPARIN, ISUPREL LIDOCAINE, NIPRIDE,
NITROGLYCERIN, PITOCIN, Drug A, Drug B, Drug C, Drug D and Drug E.
Calculation for only one type can be generated each time.
Note: A, B, C, D, E are only codes for drugs instead of their real names. The units for
these five drugs are fixed. The operator may select the appropriate units according to
the convention of using these drugs. The rules for expressing the units are:
"mg" series units are fixedly used for drug A, Band C: g, mg, mcg. "Unit" series units
are fixedly used for drug D: unit, k unit, m unit. "mEq" is fixedly used for drug E.

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Patient weight:
After accessing the Drug Calc window, the operator should enter the patient weight
into the first or the second item. The entered weight will be used as the independent
data only for the calculation of drug concentration.
Note: This drug calculation function acts only as a calculator. That means the patient
weight in Drug Calculation menu and the patient weight in Patient Information menu
is independent from each other.
Therefore if the Weight in Drug Calculation changes the Weight in Patient Information
does not change. In this way, we can say that the Drug Calculation menu is
independent from other menus in the system. Any change of it will not affect other
information about the patient being currently monitored.
Titration Table
Access titration table:
Select Titration item in Drug Calc menu to enter titration table display. Titration table
display for drug is as following:

Titration
Figure 34

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Method to Operate the Titration Table:

1. In the Titration table, turn the knob to pick Basic item. Press and turn the knob to
select either Flow Rate or Dose or Drop Rate.
2. Then turn the knob to pick Step item. Press and turn the knob to select step. 1 -
10 are available for selection with the increment being 1.
3. Turn the knob to pick Dose Type item. Press and turn the knob to select the unit
in the pull-down list. 4. Use Up-Down item in the table to view the data in
previous or following pages.
4. Turn the knob to pick REC item. After pressing the knob, the recorder prints out
the data displayed in the current titration table.
5. Turn the knob to pick Exit to return to Drug Calc menu.
Total amount, dose, volume, flow-rate, drop rate and patient weight and drug name are
displayed on the top of the titration table. Meaning of each English identifier is:
• Amount : Drug amount
• Volume : Liquid volume
• Dose/min : Drug dose
• Flow Rate : Flow rate
• Drop Rate : Drop rate
• Weight : Patient weight

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Patient Safety
This Portable Patient Monitor is designed to comply with the International National
Safety requirements for medical electrical equipment. This device has floating inputs
and is protected against the effects of defibrillation and electro surgery. If the correct
electrodes are used and applied in accordance with the manufacturer instructions, the
screen display will recover within 10 seconds after defibrillation.

This symbol indicates that the instrument is IEC 60601-1 Type CF equipment.
The unit displaying this symbol contains an F-Type isolated (floating) patient applied
part providing a high degree of protection against shock, and is suitable for use during
defibrillation.
Warning
Do not touch the patient, bed or instrument during defibrillation.
Environment
Follow the instructions below to ensure a completely safe electrical installation. The
environment where the Monitor will be used should be reasonably free from vibration,
dust, corrosive or explosive gases, extremes of temperature, humidity, and so on. For a
cabinet mounted installation, allow sufficient room at the front for operation and
sufficient room at the rear for servicing with the cabinet access door open.
The Monitor operates within specifications at ambient temperatures between 5.C and
40.C. Ambient temperatures that exceed these limits could affect the accuracy of the
instrument and cause damage to the modules and circuits. Allow at least 2 inches
(5cms) clearance around the instrument for proper air circulation.

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Grounding the Monitor

To protect the patient and hospital personnel, the cabinet of the Monitor must be
grounded. The Monitor is equipped with a detachable 3-wire cable which grounds the
instrument to the power line ground (protective earth) when plugged into an
appropriate 3-wire receptacle. If a 3-wire receptacle is not available, consult the
hospital electrician. If completeness of the protective grounding wire is in doubt, the
equipment must be operated with internal power supply.
Warning
Do not use a 3-wire to 2-wire adapter with this instrument.
Connect the grounding wire to the Equipotential grounding terminal on the main
system. If it is not evident from the instrument specifications whether a particular
instrument combination is hazardous or not, for example due to summation of leakage
currents, the user should consult the manufacturers concerned or else an expert in the
field, to ensure that the necessary safety of all instruments concerned will not be
impaired by the proposed combination.
Equipotential Grounding
Protection class 1 instruments are already included in the protective grounding
(protective earth) system of the room by way of grounding contacts in the power plug.
For internal examinations on the heart or the brain, the Monitor must have a separate
connection to the equipotential grounding system. One end of the equipotential
grounding cable (potential equalization conductor) is connected to the equipotential
grounding terminal on the instrument rear panel and the other end to one point of the
equipotential grounding system. The equipotential grounding system assumes the
safety function of the protective grounding conductor if ever there is a break in the
protective grounding system. Examinations in or on the heart (or brain) should only be
carried out in medically used rooms incorporating an equipotential grounding system.
Check each time before use that the instrument is in perfect working order. The cable
connecting the patient to the instrument must be free of electrolyte.
Warning
If the protective grounding (protective earth) system is doubtful, the monitor must be
supplied by inner power only.
Condensation
Make sure that during operation, the instrument is free of condensation. Condensation
can form when equipment is moved from one building to another, thus being exposed
to moisture and differences in temperature.
Warning
Possible explosion hazard if used in the presence of flammable anaesthetics.

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Explanation of Symbols in the Monitor

This symbol means 'BE Careful' Refer to the manual.

This symbol indicates that the instrument is IEC 60601-1 Type CF equipment.
The unit displaying this symbol contains an F-Type isolated (floating) patient applied
part providing a high degree of protection against shock, and is suitable for use during
defibrillation.

This symbol indicates Equipotential grounding system.

This symbol indicates Protective earth ground.

This symbol indicates Partial On/Off

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ECG/Resp Monitoring
What Is ECG Monitoring
Monitoring the EGG produces a continuous waveform of the patient's cardiac electric
activity to enable an accurate assessment of his current physiological state. Only
proper connection of the EGG cables can ensure satisfactory measurement. On the
Normal Display, the monitor provides display of 2-channel EGG waveforms.
• The patient cable consists of 2 parts:
a) The cable that connects to the monitor.
b) The lead set that connects to the patient.
• Using a 5-lead set, the EGG can derive up to two waveforms from two different
leads. For requested lead, you may choose from the left side of EGG waveform.
• The monitor displays the Heart Rate (HR), ST segment and Arrhythmia analysis
• All of the parameters above can be set as alarm parameters.
Note: In the default settings of the monitor, the ECG waveforms are the first two
waveforms from top in the Waveform Area.
Precautions during ECG Monitoring
Warning
• Do not touch the patient, table nearby, or the equipment during defibrillation.
• Use only the original ECG cable for monitoring.
• When connecting the cables and electrodes, make sure no conductive part is in
contact with the ground. Verify that all ECG electrodes, including neutral
electrodes, are securely attached to the patient.
Note: Interference from a non-grounded instrument near the patient and ESU
interference can cause inaccuracy of the waveform

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Monitoring Procedure
Preparation
• Prepare the patient's skin prior to placing the electrodes.
a) The skin is a poor conductor of electricity; therefore preparation of the
patient's skin is important to facilitate good electrode contact to skin.
b) Shave hair from sites, if necessary.
c) Wash sites thoroughly with soap and water. (Never use ether or pure
alcohol, because this increases skin impedance).
d) Rub the skin briskly to increase capillary blood flow in the tissues and
remove skin scurf and grease.
• Attach clip or snap to electrodes prior to placement.
• Put the electrodes on the patient. Before attaching, apply some conductive jelly
on the electrodes if the electrodes are not electrolyte self-supplied.
• Connect the electrode lead to the patient's cable. 5. Make sure the monitor is
ready with power supply.
Warning
Check everyday whether there is skin irritation resulted from the ECG electrodes. If
so, replace electrodes every 24 hours or change their sites.
Note
For protecting environment, the electrodes must be recycled or disposed of properly.
Warning
Verify lead fault detection prior to the start of monitoring phase. Unplug the ECG
cable from the socket, the screen will display the error message "ECG Lead off" and
the audible alarm is activated.

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Installing ECG Lead

Placing the Electrodes for ECG Monitoring
Electrode placement for 5-Lead set
• Red (R) electrode - Be placed near the right shoulder, directly below the clavicle.
• Yellow (L) electrode - Be placed near the left shoulder, directly below the
clavicle.
• Black (N) electrode - Be placed on the right Hypogastrium.
• Green (F) electrode - Be placed on the left Hypogastrium.
• White (C) electrode - Be placed on the chest as illustrated in the figure.

Note: the following table gives the corresponding lead names used in Europe and
America respectively. (Lead names are represented by R, L, N, F and C respectively in
Europe, whose corresponding lead names in America are RA, LA, RL, LL and V.)

America Euro

Lead names Colour Lead names Colour

RA White R Red

LA Black L Yellow

LL Red F Green

RL Green N Black

V brown C White

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Electrode placement for 5-Lead set

Figure 35
Note: To ensure patient safety, all leads must be attached to the patient.
For 5-Lead set, attach the C-electrode to one of the indicated positions as below
(Figure):
• V1 On the 4th intercostals space at the right
sterna margin
• V2 On the 4th intercostals space at the left
sterna margin
• V3 Midway between V2 and V4 electrodes
• V4 On the 5th intercostals space at the left
clavicular line
• V5 On the left anterior auxiliary line, horizontal with V4 electrode
• V6 On the left middle auxiliary line, horizontal with V4
electrode
• V3R-V7ROn the right side of the chest in positions
corresponding to those on the left
• VE Over the Xiphoid position
• V7 On the 5th Intercostal space at the left posterior auxiliary
line of back.
• V7R On the 5th Intercostal space at the right posterior auxiliary
line of back.

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C-Electrode Placements for 5-Lead Set

Figure 36
Recommended ECG Lead Placement for Surgical Patients
Warning
When using Electro-surgery equipment, leads should be placed in a position in equal
distance from Electro-surgery electrotome and the grounding plate to avoid cautery.
Electro-surgery equipment wire and ECG cable must not be tangled up.
The placing of the ECG leads will depend on the type of surgery that is being
performed. For example, with open chest surgery the electrodes may be placed
laterally on the chest or on the back. In the operating room, artifacts can sometimes
affect the ECG waveform due to the use of ES (Electro-surgery) equipment. To help
reduce this you can place the electrodes on the right and left shoulders, the right and
left sides near the stomach, and the chest lead on the left side at mid-chest. Avoid
placing the electrodes on the upper arms; otherwise the ECG waveform will be too
small.
Warning
When using Electro surgery equipment, never place an electrode near the grounding
plate of the Electro surgery device, otherwise there will be a great deal of interference
with the ECG signal.

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Using 5-lead ECG set

The default setting is ECG CH1 corresponding to Channel II, and ECG CH2 to
Channel, you can modify the setting to meet your needs. You can set them to
correspond to any two from I, II, III, aVR, aVL, aVL & V. If you set both to the same
value, one of them will be adjusted to another option automatically. (Figure below)

ECG lead
Figure 37
Note: If an ECG waveform is not accurate, while the electrodes are tightly attached,
try to change the lead.
Note: Interference from a non-grounded instrument near the patient and ESU
interference can cause inaccuracy of the waveform.
Normal QRS complex should be:
• Tall and narrow with no notches.
• With tall R-wave completely above or below the baseline.
• With pacer spike no higher than R-wave height.
• With T-wave less than one-third of the R-wave height.
• With P-wave much smaller than the T-wave.
For getting 1mV calibrated ECG wave, choose ECG CAL button in ECG Setup menu.
A message "when CAL, can't monitor” prompts on the screen.

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Warning
Do not touch the patient, table nearby or the equipment during defibrillation.
ECG Screen Hot Keys

The hot key for ECG

Figure 38
1. Leads of channel 1:
a) The selectable leads are I, II, III, aVR, aVL, aVF & V
b) When the EGG is 5-lead, the selectable leads are: I, II, III, aVR, aVL, aVF
& V. when EGG is 3-lead, the selectable leads are: I, II & III.
c) Leads on the EGG wave must not have the same name. Otherwise, the
system will automatically change the EGG waveform name that has the
same name as the waveform being currently adjusted to another name.
2. Waveform gain of channel 1: used to adjust the size of EGG waveforms
Select gain value for each channel from X0.25, X0.5, X1 and X2. A 1 mV scale
displays on each EGG channel's one side. The height of 1m V bar is directly
proportional to the waveform amplitude.

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Note: When the input signals are too large, the peak of the waveform may be not able
to be displayed. In this case the user may manually change the setup method of ECG
waveform according to the actual waveform so as to avoid the occurrence of the
unfavorable phenomena.
3. Filter method: used for displaying clearer and more detailed waveform. There are
three filter modes for selection. Diagnostic, Monitor and Surgery modes may
reduce perturbance and interference from Electro-surgery equipment. The filter
method is the item applicable for both channels, which is always displayed at the
waveform place of the channel 1 EGG waveform
Note: Only in Diagnosis mode, the system can provide non-processed real signals. In
Monitor or Surgery mode, ECG waveforms may have distortion of different extent. In
either of the latter two modes, the system can only show the basic ECG and the results
of ST analysis may also be greatly affected. In Surgery mode, results of ARR analysis
may be somewhat affected. Therefore, it is suggested that in the environment having
relative small interference, you'd better monitor a patient in Diagnosis mode.
4. Leads of channel 2: refer to CD for detailed information.
5. Waveform gain of channel 2: refer to @ for detailed information.
Note: Pacemaker signal detected is marked by an "I" above the ECG waveform.
ECG Menu
ECG Setup Menu
Pick the ECG hot key on the screen, and the following menu will pop up.

ECG Setup Menu

Figure 39

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ECG alarm setting

• HR Alarm: pick "On" to enable prompt message and data record during the EGG
alarm; pick "Off" to disable the alarm function, and there will be a <I beside
"EGG".
• Alarm Lev: selectable from High, Med, Low. Level High represents the most
serious case.
• Alarm Reg: pick "On" to enable report printing upon EGG alarm.
• Alarm HI: used to set up the upper limit of EGG alarm.
• Alarm LO: used to set up the lower limit of EGG alarm.
EGG alarm is activated when the heart beat exceeds set Alarm HI value or falls below
Alarm Lo value. EGG alarm limits:
Max. ALM HI Min. ALM LO Step
HR ADU 300 15 1
HR PED 350 15 1
HR NEO 350 15 1

Note: Please set the alarm limits according to clinical condition of individual patient.
The upper limit shall not exceed 20 beats/ min higher than the patient's heart rate.
HR From
ECG, SpO2, Auto and Both may detect heart rate. Auto distinguishes heart rate source
according to the quality of signal. By picking ECG, the monitor prompts HR and
activates HR beep. By picking SpO2, the monitor prompts Pulse and activates pulse
beep. BOTH mode displays HR and PR simultaneously, when this item is picked, PR
parameter is displayed to the right side of SpO2' As for the sound of HR or PR in
BOTH mode, HR is given the priority, Le., if HR is available, whose sound will be
sent out, but if HR is not available, then the sound will be for PR
• HR Channel
"CH1" to count the heart rate by CH 1 waveform
"CH2" to count the heart rate by CH 2 waveform
"Auto" the monitor selects a channel automatically
• Lead Type: used to select either 5 Leads or 3 Leads.
• Sweep: Available options for ECG Sweep are 12.5, 25.0, and 50.0 mm/s.
• ST Analysis: Pick this item to access ST Analysis menu, the detailed information
about the menu is to be discussed in the following section.

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• ARR Analysis: Pick this item to access ARR Analysis menu, the detailed
information about the menu is to be discussed in the following section.
• Other Setup: Pick this item to access ECG Setup menu as shown below:

ECG Setup Menu

Figure 40

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In the sub-menu, following functions are available:

• Beat VOL
Four selections are available: “off”, Low, Med and High. High indicates
maximum volume. “Off” indicates no sound.
• Pace
"On": detected signal will be marked by an "I" above the ECG waveform
"Off": for non-pacemaker patient
Note: If monitoring a patient with the pacemaker, set "Pace" to “On”. If monitoring a
patient without pacemaker, set "Pace" to “Off”.
If "Pace" is on, the system will not perform some types of ARR analysis. For detailed
information, please refer to the section: ARR Alarm. In the table, the ARR type
marked by All types applies to the analysis in all situations, marked by Non-paced
applies only to the analysis in the situation when the patient does not use pacemaker.
• Notch: select the frequency of Notch.
• ECG CAL: pick this item to start calibrating ECG The method to end CAL: re-
select the CAL key in the menu or re-select the lead name on the screen.
• Default: pick this item to access the ECG Default CONFIG dialog box, in which
the user may select whether the Factory Default CON FIG or the User Default
Config is to be used. After selecting any of the items and exiting the dialog box,
the system will pop up the dialog box asking for the user's confirmation.
Note: For pacemaker patient, the pacing impulse analysis function must be
switched on; otherwise, the pacing impulse may be counted as normal QRS
complex, which results in failure of "ECG Lost" error detection.
• For monitor with ST segment & Arrhythmia analysis software, refer to ST
Segment Monitoring and Arrhythmia Analysis for details.
Note: When Pacer Switch is On, the Arrhythmia events related to PVCs will not
be monitored. At the same time, the ST analysis will not be performed either.

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ECG Alarm Information and Prompt

Alarm Message
Alarms occurring in the process of ECG measurement contain two types:
physiological alarm and technical alarm. Prompt message may also appear in the mean
time. For the audio and visual features during the appearance of these alarms and
prompt messages in the process of ECG measurement, please refer to the related
description in Chapter Alarm. In the screen, physiological alarm messages and the
prompt messages able to trigger alarms (general alerts) all displayed in the alarm area
of the monitor while technical alarms and prompt messages unable to trigger alarms
are then displayed in the information area of the monitor. This section does not
describe the content about Arr. and ST analysis.
Among physiological alarms, those belonging to the type that the parameter has
exceeded the limits may activate the recorder to automatically output the parameters
and related measured waveforms when the alarms occur on the condition that the
alarm record switch in the related menu is On. Tables below describe respectively the
possible various alarms those may occur during the measurement.

Message Cause Alarm level

EGG Lost No EGG signal of the patient is detected. High
HR measuring value is above the upper
HR Too High User-selectable
alarm limit
HR measuring value is below the lower
HR Too Low User-selectable
alarm limit

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Technical alarms
Alarm
Message Cause Remedy
level
ECG V Lead off or
ECG C Lead off
ECG LL Lead off or EGG electrodes
Make sure that all
ECG F Lead off fall off the skin
electrodes, leads and
or EGG cables Low
ECG LA Lead off or patient cables are properly
fall off the
ECG L Lead off connected.
monitor.
ECG RA Lead off or
ECG R Lead off
ECG INIT ERR1
ECG INIT ERR2
ECG INIT ERR3 Stop using measuring
ECG INIT ERR4 function provided by EGG
EGG module
High module, notifies biomedical
ECG INIT ERR5 failure
engineer or Our service
ECG INIT ERR6 staff.
ECG INIT ERR7
ECG INIT ERR8
Occasional If failure persists, notify
ECG COMM STOP communication High biomedical engineer or Our
failure service staff.
Occasional If failure persists, notify
ECG COMM ERR communication High biomedical engineer or Our
failure service staff.
Stop using HR alarm
Functional function; notify biomedical
HR ALM LMT ERR High
safety failure engineer or Our service
staff.
Make sure the patient is
ECG measuring quiet, the electrodes are
ECG Noise signal is greatly Low properly connected and AC
interfered. power system is well
grounded

Prompt message (include general alerts)

Message Cause Alarm level
HR Exceed HR measuring value exceeds the measurement range. High

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ST Segment Monitoring (optional)

ST Segment Monitoring (Optional)
• ST segment monitoring function is shutoff by default. You can switch it to ON
when necessary.
Note: When setting ST Analysis on, the monitor will select "Diagnostic" mode. You
can set it to "Monitor" mode or "Operate" mode as required. However at this time ST
value has been severely distorted. It is available to measure the variance of ST
segment with ST analysis at the waveform tracks for selected lead. The corresponding
ST measurement result displays numerically at ST1 and ST2 in the Parameter Area.
The trend can be viewed with table or graphic form.
• Measurement unit of ST segment: mV.
• Measurement symbol of ST segment: "+" = elevating, "-" = depressing.
• Measurement range of ST segment: -2.0 mV, ~ + 2.0 mV.
Pick the ST Analysis item in the ECG Setup menu to access the ST Analysis sub-
menu as shown below
ST Analysis Menu

ST Analysis Menu
Figure 41

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ST Analysis alarm setting

• ST ANAL: the switch for ST analysis. Set it to On to activate the ST analysis or
OFF to disable the ST analysis.
• ST ALM: pick "On" to enable prompt message and data record during the ST
analysis alarm; pick "Off" to disable the alarm function, and there will be a <I
beside ST. ST alarm is activated when the result exceeds set ST HI value or falls
below ST LO value.
• ALM LEV: used to set up the ST alarm level. There are three selections: High,
Med and Low.
• ALM REC: pick "On" to enable report printing upon ST analysis alarm.
• ALM HI: used to set up the upper limit of ST alarm. The maximum higher limit
is 2.0. The minimum higher limit is 0.1 larger than the set lower limit.
• ALM Low: used to set up the lower limit of ST alarm. The minimum lower limit
is -2.0. The maximum lower limit is 0.1 lower than the set higher limit.
ST analysis alarm limits:
Max ST HI Max ST LO Step
ST 2.0mV -2.0nV 0.1

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DEF Point picks this-item to access the DEF Point window, in which the position of
ISO and ST point can be set up.
• ISO: Base point
• ST: Measurement point

DEF Point window

Figure 42
The operator can adjust the position of both ISO and ST measurement points. The
reference point is the position where the peak of R-wave locates (see figure)
Note: The ST measurement for each beat complex is the vertical difference between
the two measurement points.
Note: The ST measurement point should be adjusted if the patient's HR or ECG
morphology changes significantly.
• Adjusting ISO, ST
These two points can be adjusted turning the knob.
When adjusting ST measurement point, the system will show the ST Measurement
Point Window. The QRS complex template displays in the window (If the template is
not established, a horizontal line will display. If the channel is not at ON position, a
horizontal line will also display). It is adjustable of the highlight bar in the window.
You may select ISO or ST and then switch the knob left or right to move the cursor
line. When the cursor is at the required position, you may select the base point or the
measurement point.
Note: Abnormal QRS complex is not considered in ST segment analysis.

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ST Alarm Message
Note: The alarm limits for two ST measurements are identical. No setting of alarm
limits can be made only for one channel.
Among physiological alarms, those belonging to the type that the parameter has
exceeded the limits may activate the recorder to automatically output the parameters
and related measured waveforms when the alarms occur on the condition that the
alarm record switch in the related menu is ON.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages during ST measurement.
Note
Physiological alarms:

Message Cause Alarm level

ST measuring value of
ST1 Too High channel 1 is above the User-selectable
uE.2er alarm limit.
ST measuring value of
ST1 Too Low channel 1 is below the User-selectable
lower alarm limit.
ST measuring value of
ST2 Too High channel 2 is above the User-selectable
upper alarm limit.

ST measuring value of
ST2 Too Low channel 2 is below the User-selectable
lower alarm limit.
Technical Alarms:

Message Cause Alarm level Remedy

Functional Stop using ST alarming

ST ALM LMT
Safety High function, notify biomedical
ERR
Failure engineer or Our service staff.

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Prompt messages (include general alerts):

Message Cause Alarm level
ST measuring value of channel 1
ST1 Exceed High
exceeds the measurement range.

ST measuring value of channel 2

ST2 Exceed High
exceeds the measurement range.

Arrhythmia Analysis
The arrhythmia algorithm is used to monitor ECG of neonate and adult patient in
clinical, detect the changing of heart rate and ventricular rhythm, and also save
arrhythmia events and generate alarming information. Arrhythmia algorithm can
monitor paced and non-paced patients. Qualified personnel can use arrhythmia
analysis to evaluate patient's condition (such as heart rate, PVCs frequency, rhythm
and ectopic beat) and decide the treatment. Besides detecting changing of ECG,
arrhythmia algorithm can also monitor patients and give proper alarm for arrhythmia.
• The arrhythmia monitoring is shutoff by default. You can enable it when
necessary.
• This function can call up the doctor's attention to the patient's heart rate by
measuring and classifying the arrhythmia and abnormal heart beat and triggering
the alarm.
• The monitor can conduct up to 13 different arrhythmia analyses.
• The monitor can store the latest 60 alarm events when taking arrhythmia analysis
to a peculiar buffer.
The operator can edit these arrhythmia events through the menu below.
Pick the item ARR Analysis in ECG Setup menu to access the ARR Analysis sub-
menu.

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ARR Analysis Menu

ARR Analysis Menu

Figure 43
• ARR ANAL: Pick “On” during monitoring. Default set is “Off”.
• PVCs ALM: pick “On” to enable prompt message and data record when alarm
occurs; pick “Off” to disable the alarm function, and there will be a <I beside
“PVCs”.
• ALM LEV: selectable from High, Med, Low. Level High represents the most
serious case. . ALM REC: pick “On” to enable report printing upon PVCs alarm.
• PVCs alarm is activated when the PVCs exceeds set PVCs ALM HI value.

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PVCs alarm and prompt message:

Among physiological alarms, those belonging to the type that the parameter has
exceeded the limits may activate the recorder to automatically output the parameters
and related measured waveforms when the alarms occur on the condition that the
alarm record switch in the related menu is On.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during PVC’s measurement.
Physiological alarms:
Message Cause Alarm level
PVCs measuring value is above upper
PVCs Too High User-selectable
alarm limit.

Technical Alarms:
Alarm
Message Cause Remedy
level
Stop using PVCs alarming
PVCs ALM LMT Functional safety function, notify biomedical
High
ERR failure engineer or Our service
staff.

• ARR Relearn Pick this item to start a learning procedure. (Don’t use)
• ARR Alarm Pick this item to access the ARR Alarm dialog box to set
arrhythmia alarm parameters.
Set ALM to “On/Off” to enable/disable the alarm function; Set REC to “On/Off” to
enable/disable alarm record function, turn the knob under LEV column to set alarm
level to High, Med or Low.

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ARR Alarm Menu

You can pick ALL ALM On to enable alarm function of all arrhythmia types and pick
ALL ALM “Off” to disable this function. Likewise, you can pick ALL REC On to
enable recording function for all arrhythmia types and pick ALL REC “Off” to disable
this function. Changing the ALM LEV can reset alarm level of all arrhythmia types to
the same value.
• ARR Recall Pick this item to review and edit the ARR analysis result.
The latest arrhythmia events (up to 60) are displayed.

ARR Recall Menu

Figure 44
• UP-Down: Observe other event lists of other page.
• Cursor: Select the Arr. event, whose name is displayed in a protruding frame.
• Rename: Rename the selected Arr. event, whose name is displayed in a sunken
frame. Switch the knob until the name you want appears. .
• Wave: To display the Arrhythmia waveform, time and parameter value.
• Up-Down: To observe waveforms of other Arrhythmia events.
• Right: To observe a-second waveform of Arrhythmia events
• Rec: To print out displayed Arrhythmia event.
• Exit: To return to ARR Recall menu of Arrhythmia event

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ARR Wave Recall Menu

Figure 45
Note: If there are more than 60 Arrhythmia events, the latest will be retained.
ARR Alarm
1. The alarm is triggered when an Arrhythmia occurs. If the ALM is on, the alarm
sounds and the alarm indicator flashes. If the REC is on, the alarm record will be
printed out (4 seconds prior to and after the alarm, with the ECG waveforms of
analysis channel).

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Physiological alarms:
Applicable Patient Alarm Level
Prompt Occurring Condition
Type
No QRS is detected for 4 User-
Asystole All patients selectable
consecutive seconds
Fibrillatory wave for consecutive 4
seconds; or
The number of continuous Vent User-
VFIB/VTC Without pacemaker selectable
beats is larger than the upper limit
of cluster Vent beats (>5).
The RR interval is less than 600ms.
User-
VT >2 Without pacemaker 3 ~ the number of cluster PVCs < 5 selectable
User-
Couplet Without pacemaker 2 consecutive PVCs selectable
Without pacemaker User-
Bigeminy Vent Bigeminy selectable

Without pacemaker User-

Trigeminy Vent. Trigeminy selectable

A type of single PVC under the

condition that HR<100, R-R
interval is less than 1/3 the average
interval, followed by a User-
RONT Without pacemaker selectable
compensating pause of 1.25X the
average R-R interval (the next R
wave advances onto the previous T
wave).
Single PVCs not belonging to the
PVC Without pacemaker
type of above mentioned PVCs.
5 consecutive QRS complex, RR
TACHY All patients
interval is less than 500ms.
5 consecutive QRS complex, RR
BRADY All patients
interval is longer than 1.5s.
When HR is lesser than 100
Missed beats/min., no heart beat is tested
Without pacemaker during the period 1.75 times of the
Beats
average RR interval; or When HR is
larger than100 beats/min., no beat is

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tested with 1 second.

No QRS complex and pacing pulse
are available during the period 1.75
PNP Without pacemaker times of the average R-R interval
(only considering patients with
pacemaker.)
When pacing pulse is available, no
QRS exists during the period 1.75
PNC Without pacemaker times of the average RR interval
(only considering patients with
pacemaker.)

Patient type:
All patients: refers to perform Arr. Analysis on patients either with pacemakers or
without pacemakers. Without pacemaker: refers to perform Arr. Analysis only on the
patients without pacemakers.
With pacemaker: refers to perform Arr. Analysis only on the patients with pacemakers.
Prompt message:
Message Cause Alarm Level
The QRS template
ARR Learning building required for Arr. No alarm
Analysis is in process.

Note: Arrhythmia name displays in the Alarm Message Area.

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Measuring Resp
How to measure Resp?
The monitor measures respiration from the amount of thoracic impedance between two
ECG electrodes. The change of impedance between the two electrodes, (due to the
thoracic movement), produces a respiratory waveform on the screen.
Setting up Resp measurement
For Resp monitoring, it is not necessary for additional electrodes, however, the placing
of electrodes is important.
Some patients, due to their clinical condition, expand their chest laterally, causing a
negative Intrathoracic pressure. In these cases it is better to place the two Resp
electrodes laterally in the right auxiliary and left lateral chest areas at the maximum
point of breathing movement to optimize the respiratory waveform.
Note: The Resp monitoring is not recommended to be used on patients who are very
active, as this can cause false alarms.
Checklist for Resp Monitoring
1. Prepare the patient’s skin prior to placing the electrodes.
2. Attach snap or clip to the electrodes and attach the electrodes to the patient as
described below.
3. Switch on the monitor.
Installing electrode for Resp measurement placing the Electrodes for Respiratory
Monitoring

Figure 46
Note: Place the red and green electrodes diagonally to optimize the respiration
waveform. Avoid the liver area and the ventricles of the heart in the line between the
RESP electrodes so as to avoid cardiac overlay or artifacts from pulsating blood flow.
This is particularly important for neonates.

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Resp Menu
Resp Setup Menu
Pick Resp hot key on the screen to call up the following menu:

Resp Setup Menu

Figure 47
Resp alarm setting
• ALM: pick "On" to enable prompt message and data record during the Resp
alarm; pick "Off" to disable the alarm function, and there will be a <] beside
"Resp".
• ALM REC: pick "On" to enable report printing upon Resp alarm.
• ALM LEV: selectable from High, Med and Low. Level High represents the most
serious case.
• ALM HI: used to set up the upper alarm limit.
• ALM LO: used to set up the lower alarm limit.

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Resp alarm is activated when the respiration rate exceeds set ALM HI value or falls
below ALM LO value. Resp alarm limits:
Max. RR HI Min. RR Lo Step
Resp ADU 120 0 1
Resp Neo/Ped 150 0 1

• APNEA ALM: to set the standard of judging an apnea case. It ranges from 10 to
40 seconds, increases /decreases by 5.
• Sweep: Available options for Resp Sweep are 6.25, 12.5 and 25.0 mm/s. Wave
AMP: The user may set up the displaying amplitude of the Resp waveform. The
selections are 0.25, 0.5,1,2.
• Default: pick this item to access the Resp Default CONFIG dialog box, in which
the user may select whether the Factory Default CONFIG or the User Default
CONFIG is to be used. After selecting any of the items and exiting the dialog box,
the system will pop up the dialog box asking for the user's confirmation
Resp Alarm Message
Among physiological alarms, those belonging to the type that the parameter has
exceeded the limits may activate the recorder to automatically output the parameters
and related measured waveforms when the alarms occur on the condition that the
alarm record switch in the related menu is ON.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during resp. measurement.

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Physiological alarms:
Message Cause Alarm Level
User-
RR too High Resp measuring value is above upper alarm limit.
selectable
User-
RR too Low Resp measuring value is below lower alarm limit.
selectable
Resp can not be measured within specific time
Resp APNEA High
interval.

Technical alarms:
Alarm
Message Cause Remedy
Level
Stop using Resp alarming
Resp ALM LMT Functional safety function; notify biomedical
High
ERR failure engineer or Our service
staff.

Prompt message (general alerts):

Message Cause Alarm Level
RR measuring value exceeds the measure
RR Exceed High
range.

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SpO2 Monitoring
What is SpO2 Monitoring?
SpO2 Plethysmogram measurement is employed to determine the oxygen saturation of
haemoglobin in the arterial blood. If, for example, 97% haemoglobin molecules in the
red blood cells of the arterial blood combine with oxygen, then the blood has a SpO2
oxygen saturation of 97%. The SpO2 numeric on the monitor will read 97% .The
SpO2 numeric shows the percentage of haemoglobin molecules which have combined
with oxygen molecules to form oxy-haemoglobin. The SpO2/Pleth parameter can also
provide a pulse rate signal and a Plethysmogram wave.
How does the SpO2 I Pleth Parameter Work?
• Arterial oxygen saturation is measured by a method called pulse oximeter. It is a
continuous, non-invasive method based on the different absorption spectra of
reduced haemoglobin and oxy-haemoglobin. It measures how much light, sent
from light sources on one side of the sensor, is transmitted through patient tissue
(such as a finger or an ear), to a receiver on the other side. The sensor
measurement wavelengths are nominally 660nm for the Red LED and 940nm for
Infrared Led. Maximum optical power output for Led is 4mW.
• The amount of light transmitted depends on many factors, most of which are
constant. However, one of these factors, the blood flow in the arteries, varies
with time, because it is pulsating. By measuring the light absorption during a
pulsation, it is possible to derive the oxygen saturation of the arterial blood.
Detecting the pulsation gives a Pleth waveform and pulse rate signal.
• The SpO2 value and the Pleth waveform can be displayed on the main screen.
SPO2 is a non-invasive measurement of the functional oxygen saturation.
Warning: Pulse oximeter can overestimate the SpO2 value in the presence of Hb-CO,
Met-Hb or dye dilution chemicals.
SpO2 / Pulse Monitoring
Warning: ES (Electro surgery) equipment wire and SpO2 cable must not be tangled
up.
Warning: Do not put the sensor on extremities with arterial catheter or venous
syringe.
Note: Do not perform SpO2 measuring and NIBP measuring on same arm at one time,
because obstruction of blood flow during NIBP measuring may adversely affect the
reading of SpO2 value.

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Precautions during SpO2/Pulse Monitoring

Note:
• Make sure the nail covers the light window;
• The wire should be on the backside of the hand.
Note:
• SpO2 value is always displayed at the same position.
• Pulse Rate will be displayed only under following situations:
• Select HR from as "SPO2" or "BOTH" in the ECG Setup menu.
• Select HR from as "Auto" in the ECG Setup menu and there is no ECG signal.
Note:
SpO2 waveform is not proportional to the pulse volume.
Warning
• Check if the sensor cable is in normal condition before monitoring. After
unplugging the SpO2 sensor cable from the socket, the system shall display the
error message "SPO2 Sensor off" and give the audible alarm.
• Do not use the SpO2 sensor once the package or the sensor is found damaged.
Instead, you shall return it to the vendor.
• Prolonged and continuous monitoring may increase jeopardy of unexpected
change of dermal condition such as abnormal sensitivity, rubescence, vesicle,
repressive putrescence, and so on. It is especially important to check the sensor
placement of neonate and patient of poor perfusion or immature dermogram by
light collimation and proper attaching strictly according to changes of the skin.
Check per 2-3 hours the sensor placement and move it when the skin
deteriorates. More frequent examinations may be required for different patients.

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Monitoring Procedure
SpO2 Plethysmogram measurement
1. Switch on the monitor
2. Attach the sensor to the appropriate site of the patient finger
3. Plug the connector of the sensor extension cable into the SpO2 socket on the SpO2
module

Position of the finger

Figure 48
Limitations for Measurement
In operation, the accuracy of oximeter readings can be affected by:
• High-frequency electrical noise, including noise created by the host system, or
noise from external sources, such as electrosurgical apparatus connected to the
system.
• Do not use oximeter and oximeter sensors during magnetic resonance imaging
(MRI) scanning.
• Induced current could potentially cause bums.
• Intravascular dye injections
• Excessive patient movement
• External light radiation
• Improper sensor installation or incorrect contact position of the patient
• Sensor temperature (optimal temperature between 28° C and 42° C)
• Placement of the sensor on an extremity that has a blood pressure cuff, arterial
catheter, or intravascular line.
• Significant concentrations of dysfunctional haemoglobin, such as Carboxy-
haemoglobin and Methemoglobin.
• SpO2 too low
• Bad circular injection of the part being measured

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• Shock, anaemia, low temperature and application of vasomotor may all cause the
arterial blood flow to reduce and hence make the measurement impossible.
• The absorption of oxy-haemoglobin (Hb02) and deoxy-haemoglobin to the light
of special wavelength may also affect SpO2 measurement. If there exist other
objects (carbon haemoglobin, Methemoglobin, methylene blue and indigo
carmine) absorbing the light of the same wavelength, they may result in false or
low SpO2 value.
• It is recommended to use SpO2 sensors described in chapter Accessories and
Ordering information.
SpO2 Menu
Turn the knob to move the cursor onto the SPO2 hot key in the Parameter area, push
the knob to access the SPO2 Setup menu.

SPO2 Setup menu

Figure 49
Warning
Setting the SpO2 upper alarm limit to 100% is equivalent to switching off the alarm on
upper limit. High oxygen levels may predispose a premature infant to retrolental
fibroplasia. Therefore, the upper alarm limit for oxygen saturation must be carefully
selected in accordance with commonly accepted clinical practices.

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SpO2 alarm setting

• ALM: pick "On", the system will give alarm prompt and store alarm information
when SpO2 alarm occurs; pick "Off", the system will not give alarm and instead
display a <I beside "SpO2".
• ALM REC: pick "On", the system will command the recorder to output alarm
information when SpO2 alarm occurs.
• ALM LEV: used to set up alarm level, selectable from High, Med and Low. High
represents the most serious case.
• SPO2 ALM HI and SPO2 ALM LO: SpO2 alarm is activated when the result
exceeds set SPO2 ALM HI value or falls below SPO2 ALM LO value.
• PR ALM HI and PR ALM LO: PR alarm is activated when the pulse rate exceeds
set PR ALM HI value or falls below PR ALM LO value.
SpO2 and PR alarm limits:
Max. upper Limit Min. Lower Limit Step
SpO2 100 0 1
PR 254 0 1

The default SpO2 and PR alarm limits:

Parameter Max. Upper Limit Min, Lower limit

Adult 100 90
SpO2 Paediatric 100 90
Neonatal 95 85
Adult 120 50
PR Paediatric 160 75
Neonatal 200 100

• Sweep: Available options are 12.5mm/s, 25.0 mm/s.

• PR Sound: Pulse beeps volume. Options are OFF, High, Med, Low.
• AVG Time: 4s, 8s, 16s represent times that SpO2 average value is counted.
• Default: Pick this item to access the SPO2 Default CONFIG dialog box, in which
you can select Factory Default CONFIG or User Default CONFIG. After selecting
one item and exiting the dialog box, the system will pop up the dialog box asking
for your confirmation.

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Alarm Description
SpO2 Alarm Message
When the alarm switches are set to ON in relevant menus, the physiological alarms
caused by the parameter exceeding the alarm limit may possibly trigger the recorder to
automatically output alarming parameter value and corresponding waveforms.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during SpO2 measurement.

Physiological alarm:
Message Cause Alarm Level
SpO2 measuring value is above
SPO2 Too High User-selectable
upper alarm limit.
SpO2 measuring value is
SPO2 Too Low User-selectable
below lower alarm limit.
PR measuring value is above
PR Too High User-selectable
upper alarm limit.
PR measuring value is below
PR Too Low User-selectable
lower alarm limit.
Technical alarms:
Alarm
Message Cause Remedy
Level
SpO2 sensor may
Make sure that the monitor
SPO2 SENSOR Be disconnected
Low and the patient are in correct
OFF from the patient or
connection with the cables
the monitor.
SPO21NIT ERR
SPO2 INIT ERR 1
SPO2 INIT ERR 2
SPO2 INIT ERR 3 Stop using the measuring
SpO2 module function of SpO2 module;
SPO2 INIT ERR 4 High
failure notify biomedical engineer or
SPO2 INIT ERR 5 our service staff.
SPO2 INIT ERR 6
SPO2 INIT ERR 7
SPO2 INIT ERR 8
SPO2 COMM SpO2 module High Stop using the measuring

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STOP failure or function of SpO2 module;

communication notify biomedical engineer or
error our service staff.
SpO2 module Stop using the measuring
SPO2 COMM failure Or function of SpO2 module,
High
ERR communication notify biomedical engineer or
error our service staff
Stop using the measuring
SPO2 ALM LMT Functional safety function of SpO2 module,
High
ERR failure notify biomedical engineer or
our service staff
Stop using the measuring
PR ALM LMT Functional safety function of SpO2 module,
High
ERR failure notify biomedical engineer or
our service staff

Message Cause Alarm level

SpO2 measuring value
SPO2 Exceed High
exceeds the range.
PR measuring value
PR Exceed High
exceeds the range.
SpO2 module is
Search Pulse No alarm
searching for pulse.

No Pulse SpO2 module cannot

detect SpO2 signal for a High
long time.
Maintenance and Cleaning
Care and Cleaning
Warning
• Turn of the monitor and disconnect the line power before cleaning the monitor or
the sensor
• Do not subject the sensor to autoclaving.
• Do not immerse the sensor into any liquid
• Do not use any sensor or cable that may be damaged or deteriorated.

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Cleaning
• Use a cotton ball or a soft mull moistened with hospital-grade ethanol to wipe the
surface of the sensor, and then dry it with a cloth. This cleaning method can also
be applied to the luminotron and receiving unit.
• The cable can be cleaned with 3% hydrogen dioxide, 7% isopropanol, or other
active reagent. However, connector of the sensor shall not be subjected to such
solution.
NIBP Monitoring
Introduction
• Reference to the European standard EN 1060-1: Specification for Non-invasive
sphygmomanometers Part 1, General requirements.
• The Non-invasive Blood Pressure (NIBP) module measures the blood pressure
using the oscillometric method.
• It is applicable for adult, paediatric, and neonatal usage.
• There are three modes of measurement available: manual, automatic and
continuous. Each mode displays the diastolic, systolic and mean blood pressure.
• In the Manual mode, only one measurement is conducted for each time.
• In the Auto mode, the measurement is cycled; you can set the interval time to
1/2/3/4/5/10/15/30/60/90 minutes.
• In the continuous mode, the monitor measures the blood pressure as many times
as possible in five minutes.
Warning
1. You must not perform NIBP measurements on patients with sickle-cell disease or
under any condition which the skin is damaged or expected to be damaged.
2. For a Thrombasthemia patient, it is important to determine whether measurement
of the blood pressure shall be done automatically. The determination should be
based on the clinical evaluation.
3. Ensure that the correct setting is selected when performing measurements on
children. It may be dangerous for the children to use an over pressure level.

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Warning
Make sure that the air conduit connecting the blood pressure cuff and the monitor is
neither blocked nor tangled
1. Plug in the air hose and switch on the system.
2. Apply the blood pressure cuff to the patient's arm or leg following the
instructions below (Figure 50).
• Ensure that the cuff is completely deflated.
• Apply the appropriate size cuff to the patient, and make sure that the
symbol "<1>" is over the appropriate artery. Ensure that the cuff is not
wrapped too tightly around the limb. Excessive tightness may cause
discoloration and eventual ischemia of the extremities.

Figure 50
Note: The width of the cuff should be either 40% of the limb circumference (50% for
neonates) or 2/3 of the upper arm length. The inflatable part of the cuff should be long
enough to encircle 50-80% of the limb. The wrong size of cuff can cause erroneous
readings. If the cuff size is in question, then use a larger cuff.

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Size of reusable cuff for neonate/children/adult

Patient Type Limb perimeter Cuff width Hose
Infant 10-19cm 8cm
Child 18-26cm 10.6 cm
1.5 m or
Adult 25 - 35 cm 14cm
3m
Large Adult 33-47cm 17 cm
Thigh 46 - 66 cm 21 cm

Size of disposable cuff for neonate/children/adult

Size No. Limb perimeter Cuff width Hose

1 3.1 - 5.7 cm 2.5 cm

2 4.3 - 8.0 cm 3.2 cm 1.5 m or

3 5.8 - 10.9 cm 4.3 cm 3m

4 7.1 -13.1 cm 5.1 cm

Note: Make sure that the cuff edge falls within the range of mark <->. If it does
not, use a larger or smaller cuff that fits better.
3. Connect the cuff to the air hose. The limb chosen for taking the measurement
should be placed at the same level as the patient's heart. If this is not possible you
should apply the following corrections to the measured values:
• If the cuff is placed higher than the heart level, add 0.75 mmHg (0.10 KPa)
for each inch of difference.
• If it is placed lower than the heart level, deduct 0.75 mmHg (0.10 KPa) for
each inch of difference.
4. Check whether the patient mode is appropriately selected. Access Patient Setup
menu from System Menu and pick PAT TYPE item and turn the knob to select
the required patient type.
Select a measurement mode in the NIBP Setup menu. Refer to the following
paragraphs Operation Hints for details 6. Press the Start button on the front panel to
start a measurement.

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Operation Hints
1. To start auto measuring: Access NIBP Setup menu and pick the Interval item, in
which the user may choose the selections other than Manual to set up the time
interval for auto measurement. After that, press Start button on the front panel to
start the auto measuring according to the selected time interval.
Warning: Prolonged non-invasive blood pressure measurements in Auto mode may
be associated with purport, ischemia and neuropathy in the limb wearing the cuff.
When monitoring a patient, examine the extremities of the limb frequently for normal
colour, warmth and sensitivity. If any abnormality is observed, stop the blood
pressure measurements.
2. To stop auto measuring: During auto measuring press Start button on the front
panel at any time to stop auto measurement.
3. To start a manual measuring:
• Access NIBP Setup menu and pick the Interval item. Select the Manual
selection. Then press the Start button on the front panel to start a manual
measurement.
• During the idle period of auto measuring process, press the Start button on
the front panel at any time to start a manual measurement. Then press the
Start button on the front panel to stop manual measurement and the system
continues executes auto-measuring program according to selected time
interval.
4. To start a manual measuring during the Auto mode: Press Start button on the
front panel.
5. To stop a manual measuring: Repress the Start button on the front panel again.
6. To perform continuous measuring: Access NIBP Setup menu and pick the
continual item to start the continuous measurement. The monitor will measure as
many times of NIBP as possible within 5 minutes.
Warning: Prolonged non-invasive blood pressure measurements in Auto mode
may be associated with purport, ischemia and neuropathy in the limb wearing the
cuff. When monitoring a patient, examine the extremities of the limb frequently for
normal color, warmth and sensitivity. If any abnormality is observed, stop the
blood pressure measurements.
7. To stop continuous measuring: During continuous measuring press Start button on
the front panel at any time to stop continuous measurement.
Note: If you are in doubt about the accuracy of any reading(s), check the patient's
vital signs by an alternative method before checking the functioning of the
monitor.

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Warning: If liquid is inadvertently splashed on the equipment or its accessories, or

may enter the conduit or inside the monitor, contact local Customer ~service
Center.
Measurement Limitations
To different patient conditions, the Oscillometric measurement has certain limitations.
The measurement is in search of regular arterial pressure pulse. In those circumstances
when the patient's condition makes it difficult to detect, the measurement becomes
unreliable and measuring time increases. The user should be aware that the following
conditions could interfere with the measurement, making the measurement unreliable
or longer to derive. In some cases, the patient's condition will make a measurement
impossible.
• Patient Movement: Measurements will be unreliable or may not be possible if the
patient is moving, shivering or having convulsions. These motions may interfere
with the detection of the arterial pressure pulses. In addition, the measurement
time will be prolonged.
• Cardiac Arrhythmia's: Measurements will be unreliable and may not be
possible if the patient's cardiac arrhythmia has caused an irregular heartbeat. The
measuring time thus will be prolonged.
• Heart-lung Machine: Measurements will not be possible if the patient is
connected to a heart-lung machine.
• Pressure Changes: Measurements will be unreliable and may not be possible, if
the patient's blood pressure is changing rapidly over the period of time during
which the arterial pressure pulses are being analyzed to obtain the measurement.
• Severe Shock: If the patient is in severe shock or hypothermia, measurements
will be unreliable since reduced blood flow to the peripheries will cause reduced
pulsation of the arteries.
• Heart Rate Extremes: Measurements can not be made at a heart rate of less than
40 bpm and greater than 240 bpm.

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NIBP monitoring screen

NIBP measurement result and corresponding message are displayed as follows

NIBP Setup Menu

Pick the NIBP hot key on the screen to call up the NIBP menu shown as below:

NIBP Setup Menu

Figure 51

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NIBP alarm setting

• ALM: pick "On" to enable prompt message and data record during the NIBP
alarm; pick "Off" to disable the alarm function, and there will be a <I beside
"NIBP" .
• ALM LEV: selectable from High, Med to low. High represents the most serious
case.
• ALM REC: pick "On" to enable report printing upon NIBP alarm.
• SYS ALM HI, SYS ALM Low, Mean ALM HI, Mean ALM La, DIA ALM HI,
DIA ALM La are for the user to set up the alarm limit for each type of pressure.
NIBP alarm is activated when the pressure exceeds set upper alarm limits or falls
below lower alarm limits.
NIBP alarm limits:
1. Adult Mode
• Sys 40-270 mmHg
• DIA 10-215 mmHg
• Mean 20-235 mmHg
2. Paediatric Mode
• Sys 40-200 mmHg
• DIA 10-150 mmHg
• Mean 20-165 mmHg

3. Neonatal Mode
• Sys 40-135 mmHg
• DIA 10-100 mmHg
• Mean 20-110 mmHg
Reset
1. Restore measurement status
2. Pick this item to restore initial settings of the pressure pump.
3. When the pressure does not work properly and the system fails to give message
for the problem, pick this item to activate self-test procedure, thus restore the
system from abnormal performance.
Continual
Start continuous measuring. When this item is picked, the menu will disappear
automatically.

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Interval
Interval time for automatic measuring-, Available selections: 1/2/3/4/5/10/15/30/60/90
minutes, Press Start/Stop button on the NIBP module to start the first auto measuring.
Pick Manual selection in Interval item to set up the measuring mode to Manual.
Unit
Pick this item to set measurement unit. (Option: mmHg or KPa)
Calibrate
Calibrate the cuff pressure reading with a calibrated reference manometer. Pick the
Calibrate item to start the calibration and the item will change into Stop CAL, which if
picked, the system will stop calibration.
Default
Pick this item to access the NIBP Default Config dialog box, in which the user may
select whether the Factory Default Config or the User Default Config is to be used.
After selecting any of the items and exiting the dialog box, the system will pop up the
dialog box asking for the user's confirmation.
Inflation
It can be set only for some customized module.
Warning
The calibration of the NIBP measurement is necessary for every two years (or as
frequently as dictated by your Hospital Procedures Policy). The performance should
be checked according to the following details.
Procedure of the Pressure Transducer Calibration:
Replace the cuff of the device with a rigid metal vessel with a capacity of 500 ml ±
5%. Connect a calibrated reference manometer with an error less than 0.8 mmHg and a
ball pump by means of a T-piece connector and hoses to the pneumatic system. Set the
monitor in Calibrate mode. Inflate the pneumatic system to 0, 50 and 200 mmHg by
ball pump separately. The difference between the indicated pressure of the reference
manometer and the indicated pressure of the monitor will not exceed 3 mmHg.
Otherwise, please contact our customer service.

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Diagram of NIBP calibration

Figure 52
Pneumatic
This item is used for air leakage test. Turn the knob to pick the item to start the air
leakage test. Then the item will change into Stop Penum, which if picked, the system
will stop air leakage test.
Warning
This pneumatic test other than being specified in the EN 1060-1 standard is to be used
by the user to simply determine whether there are air leaks in the NIBP airway. If at
the end of the test the system gives the prompt that the NIBP airway has air leaks,
please contact the manufacturer for repair.
Procedure of the air leakage test
1. Connect the cuff securely with the socket for NIBP air hole.
2. Wrap the cuff around the cylinder of an appropriate size.
3. Access the NIBP Setup menu.
4. Turn the knob to the Pneumatic item and press the knob. Then the prompt
"Pneum testing." Will appear on the bottom of the NIBP parameter area
indicating that the system has started performing pneumatic test.
5. The system will automatically inflate the pneumatic system to about 180mmHg.
6. After 20 seconds or so, the system will automatically open the deflating valve,
which marks the completion of a pneumatic measurement.
7. If no prompt appears on the bottom of the NIBP parameter area, it indicates that
the airway is in good situation and no air leaks exist. However if the prompt
"Pneumatic Leak" appears in the place, it indicates that the airway may have air
leaks. In this case, the user should check for loose connection. After confirming
secure connections, the user should re-perform the pneumatic test. If the failure
prompt still appears, please contact the manufacturer for repair.

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NIBP Alarm Message

Among physiological alarms, those belonging to the type that the parameter has
exceeded the limits may activate the recorder to automatically output the parameters
and related measured waveforms when the alarms occur on the condition that the
alarm record switch in the related menu is On.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during NIBP measurement.
Physiological alarms:
Message Cause Alarm Level
NIBP SYS measuring value is
NS Too High User-selectable
above upper alarm limit. .
NIBP SYS measuring value is
NS Too Low User-selectable
below lower alarm limit.
NIBP DIA measuring value is
ND Too High User-selectable
above upper alarm limit. .
NIBP DIA measuring value is
ND Too Low User-selectable
below lower alarm limit.
NIBP MAP measuring value is
NM Too High User-selectable
above upper alarm limit.
NIBP MAP measuring value is
NM Too Low User-selectable
below lower alarm limit.

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Technical alarms 1: (display in the area below the NIBP value)

Message Cause Alarm Level Remedy

Stop using alarming
functions of NIBP
Functional
NS ALM LMT ERR High module and notify
safety failure
biomedical engineer
or Our service staff.
Stop using alarming
NM ALM LMT
functions of NIBP
Functional safety
ERR High module and notify
failure
biomedical engineer
or Our service staff.
Stop using alarming
NO ALM LMT
functions of NIBP
Functional safety
ERR High module and notify
failure
biomedical engineer
or Our service staff.

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Technical alarms 2: (display in the area below the NIBP value)

Alarm
Message Cause Remedy
Level
Stop using measuring
Sensor or other function of NIBP
NIBP Self Test ERR hardware of NIBP High module; notify
module is incorrect. biomedical engineer
or Our service staff.
If failure persists, stop
using measuring
Communication with
function of NIBP
NIBP COMM ERR NIBP module is High
module, notify
failed.
biomedical engineer
or Our service staff.
Cuff is no properly
Properly wrap the
Loose CUFF wrapped or no cuff Low
cuff.
exists.
Check and replace the
Cuff, hose or leaking parts, if
AIR Leak connector is Low required, notify
damaged. biomedical engineer
or Our service staff.
Check if the hoses are
Stable pressure value tangled, if failure
AIR PRESSURE
is not available e.g. Low persists, notify
ERROR
hoses are tangled. biomedical engineer
or Our service staff.
Cuff is too loose or Use other method to
WEAK Signal patient pulse is too Low measure blood
weak. pressure.
Reset NIBP module,
if failure persists, stop
Measuring range using measuring
Range Exceeded exceeds the specified High function of NIBP
upper limit. module; notify
biomedical engineer
or Our service staff.
Affected by arm Make sure that the
motion, signal noise patient under
Excessive Motion Low
is too large or pulse monitoring is
rate is not regular. motionless.

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Measure again, if
failure persists, stop
Pressure has exceeded using measuring
Over Pressure the specified upper HIGH function of NIBP
safety limit. module and notify
biomedical engineer
or Our service staff.
Stop the patient from
Signal Saturated Excessive motion Low
moving.
Check and replace the
leaking parts, if
During pneumatic test
Pneumatic leak Low required, notify
leak is detected.
biomedical engineer
or Our service staff.
Stop using measuring
Operation of blood function of NIBP
NIBP System Failure pressure pump system High module; notify
is failed. biomedical engineer
or Our service staff.
Cuff type does not
Select appropriate
CUFF Type ERR comply with the High
cuff type
patient type.
Measuring time has
Measure again or use
exceeded. 120
NIBP Time Out High other measuring
seconds (adult) or 90
method.
seconds (neonatal).
Abnormal module
NIBP Illegally Reset High Reset again
reset
Happens when
measuring the curve. Check the cuff. Make
The system cannot sure that the patient
Measure Fail perform High under monitoring is
measurement, motionless. Measure
analysis or again.
calculation.

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Prompt message: (display in the prompt area below NIBP value)

Message Cause Alarm Level
During manual measuring
Manual measure...
mode.
During continuous measuring
Cont measuring..
mode.
During automatic measuring
Auto measuring...
mode.
After selecting interval
Please start between measurements in
Menu
Press Start/Stop key during No Alarm
Measurement over measuring to stop
measurement
Calibration During calibrating
Calibration over Calibration over
Pneum testing... During pneumatic test
Pneum test over pneumatic test over
Resetting... NIBP module in resetting
Reset failed module reset failed
Maintenance and Cleaning
Warning
• Do not squeeze the rubber tube on the cuff.
• Do not allow liquid to enter the connector socket at the front of the monitor.
• Do not wipe the inner part of the connector socket when cleaning the monitor.
• When the reusable cuff is not connected with the monitor, or being cleaned,
always place the cover on the rubber tube to avoid liquid permeation.

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Reusable Blood Pressure Cuff

The cuff can be sterilized by means of conventional autoclaving, gas, or radiation
sterilization in hot air ovens or disinfected by immersion in decontamination solutions,
but remember to remove the rubber bag if you use this method. The cuff should not be
dry-cleaned.
The cuff can also be machine-washed or hand-washed; the later method may prolong
the service life of the cuff. Before washing, remove the latex rubber bag, and for
machine-washing, close the Velcro fastening. Allow the cuff to dry thoroughly after
washing and then reinsert the rubber bag.

Replace Rubber Bag in Cuff

Figure 53
To replace the rubber bag in the cuff, first place the bag on top of the cuff so that the
rubber tubes line up with the large opening on the long side of the cuff. Now roll the
bag lengthwise and insert it into the opening on the long side of the cuff. Hold the
tubes and the cuff and shake the complete cuff until the bag is in position. Thread the
rubber tubes from inside the cuff, and out through the small hole under the internal
flap.
Disposable Blood Pressure Cuffs
Disposable cuffs are intended for one-patient use only. Do not use the same cuff on
any other patient. Do not sterilize or use autoclave on disposable cuffs. Disposable
cuffs can be cleaned using soap solution to prevent infection.
Note: For protecting environment, the disposable blood pressure cuffs must be
recycled or disposed of properly.

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Temp Monitoring
Temp Monitoring
Two Temp probes can be used together to obtain 2 temperature data and compare them
to work out the temperature difference.
Temp monitoring setup
• If you are using disposable Temp probes you need to plug the Temp cable into
the monitor and then connect the probe to the cable. With a reusable Temp probe
you can plug the probe directly into the monitor.
• Apply the Temp probe(s) securely to the patient.
• Switch on the system.
Warning: Verify probe cables fault detection before beginning of monitoring phase.
Unplug the temperature probe cable of the channel 1 from the socket, the screen will
display the error message "Temp Sensor1 off" and the audible alarm is activated. The
other channel is the same.
Note: Disposable Temp probe can only be used once for one patient.
Warning: The calibration of the temperature measurement is necessary for every two
years (or as frequently as dictated by your Hospital Procedures Policy). When you
need calibrate the temperature measurement, contact the manufacture please.
Note: The self-test of the temperature measurement is performed automatically once
per hour during the monitoring. The test procedure lasts about 2 seconds and does not
affect the normal measurement of the temperature monitoring.

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Temp Setup Menu

Pick the Temp hot key on the screen to call up the Temp Setup menu shown as below:

Temp Setup Menu Figure 54

Temp alarm setting
• ALM: pick "On" to enable prompt message and data record during the Temp
alarm; pick "Off" to disable the alarm function, and prompt the <I symbol beside
Temp numeric.
• ALM LEV: used to set up the alarm level, selectable from High, Med or Low.
• ALM REC: used to start/stop recording Temp alarms. Pick "On" to enable report
printing upon Temp alarm.
• Alarm for T1, T2 and TD occurs when the measured temperature exceeds set
alarm high limit or falls below alarm low limit.
T1 is Channel-l temperature, T2 is Channel-2 temperature and TD is the
temperature difference between the above two

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Temp alarm limits:

Max. Temp High Min. Temp Low Step
T1, T2 50 0 0.1
TD 50 0 0.1

• Unit: To set temperature unit (DC or OF).

• Default: Pick this item to access the Temp Default Config dialog box, in which
the user may select whether the Factory Default Config or the User Default
Config is to be used. After selecting any of the items and exiting the dialog box,
the system will pop up the dialog box asking for the user's confirmation.
Temp Alarm message
Among physiological alarms, those belonging to the type that the parameter has
exceeded the limits may activate the recorder to automatically output the parameters
and related measured waveforms when the alarms occur on the condition that the
alarm record switch in the related menu is on.
Tables below describe the possible physiological alarms, technical alarms and prompt
messages occurring during Temp measurement.

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Physiological alarms:
Message Cause Alarm Level
Measuring value of
T1 Too High channel 1 is above upper User-selectable
alarm limit.
Measuring value of
TI Too Low channel 1 IS below User-selectable
lower alarm limit.
Measuring value of
T2 Too High channel 2 is above upper User-selectable
alarm limit.
Measuring value of
T2 Too Low channel 2 IS below User-selectable
lower alarm limit.
Difference between two
TD Too High channels is larger than User-selectable
upper limit

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Technical alarms:
Alarm
Alarm Message Cause Remedy
Level
Temperature cable
of channel 1 may. Make sure that the cable
T1 Sensor Off Low
be disconnected is properly connected.
from the monitor.
Temperature cable
of channel 2 may Make sure that the cable
T2 Sensor Off Low
be disconnected is properly connected.
from the monitor.
Stop using alarming
function of Temp
T1 ALM LMT Functional safety
High module; notify
ERR High failure
biomedical engineer or
Our service staff.
Stop using alarming
function of Temp
T2 ALM LMT Functional safety
High module; notify
ERR High failure
biomedical engineer or
Our service staff.
Stop using alarming
function of TEMP
TD ALM LMT Functional safety
High module; notify
ERR High failure
biomedical engineer or
Our service staff.

Prompt message:
Message Cause Alarm Level
Measuring value of
T1 Exceed channel 1 is beyond High
measuring range.
Measuring value of
T2 Exceed channel 2 is beyond High
measuring range.

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Operating Instructions
1. Switch on the power supply only after connecting all the sensors cables to the
patient.
2. For getting the accurate wave shapes patient must be at rest and lying on the
bench.
3. If patient is in sitting or standing position then because of motion artefacts there
will be lot of disturbance into the signal of interest.
4. During measurement of ECG, patient should be at some distance from any
mains power source to avoid noise problem.
5. Do not talk or smile during measurement as it will increase the level of noise.
6. Do not take deep breath always take normal breath during measurement to avoid
motion artefacts.
7. Switch off your mobile phones, pager or any electronic battery operated device
1during measurement. It is also dangerous for the heart patient.

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Experiment 1
Objective: Study of ECG, HR, PVC’s and ST analysis
Equipments Needed:
1. Multiparameter Monitor ST2365
Procedure:
1. Connect one end of the power supply to Multiparameter Monitor ST2365 while
other end to mains power supply
2. Connect one end of ECG electrode leads cable to the patient while other end to
ST2365 (ECG socket)
3. Switch ON the Mains power supply, then ST2365
4. Set the desired Lead to be observed, amplitude levels, Alarms, ST and PVS’s
settings using selection switch knob
Observation:
1. Observe the real time ECG waveform of selected Lead Configuration in LCD
display
2. Adjust amplitude level if required
3. Observe the Heart Beat indication in the LCD screen
4. Observe the ST segment and PVC’s setting in the LCD screen
Conclusion:
1. Real time ECG waveform of Standard Lead I Configuration is observed in
proper shape and frequency
2. Heart rate is directly displayed on LCD screen
3. Different parameters like ST segment and PVS’s are in normal range
4. Abnormality like Tachycardia and Bradycardia are not shown
Questions:
1. How the heart rate is controlled?
2. What is the heart rate for various human beings?
3. To monitor the ECG signals where the electrodes are placed on human body?

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Experiment 2
Objective: Study of Body Temperature measurement
Equipments Needed:
1. Multiparameter Monitor ST2365
Procedure:
1. Connect one end of the power supply to Multiparameter Monitor ST2365 while
other end to mains power supply
2. Connect one end of Temperature sensor cable to the patient (at desired position)
while other end to ST2365 (Temperature Socket T1 or T2)
3. Switch ON the Mains power supply, then ST2365
4. Set the Alarms On/Off, Levels, High & Low values, Unit of temperature using
selection switch knob
Observation:
1. Observe the real time temperature values (T1 or T2) on LCD display
Conclusion:
1. LCD showing T1 or T2 temperatures in desired unit
2. TD (Temperature difference) is showing difference of T1 and T2 temperatures
(if T2 is also connected)
3. Temperature values lies in normal range
Questions:
1. What is the normal range of human body temperature
2. Temperature of human body is depends on which mechanism

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Experiment 3
Objective: Study of Respiration (RA-LA impedance method)
Equipments Needed:
1. Multiparameter Monitor ST2365
Procedure:
1. Connect one end of the power supply to Multiparameter Monitor ST2365 while
other end to mains power supply
2. Respiration rate is measured with the help of impedance change in ECG Leads
(RA and LL) when patient takes the breathing.
3. Switch On the Mains power supply, then ST2365
4. Set the Alarms “On/Off”, Levels, high & Low values for Respiration using
selection switch knob
Observation:
1. Observe the real time respiration wave forms and corresponding values on LCD
display
Conclusion:
1. Respiration waves and corresponding values are coming properly on LCD
display
2. There is no indication of Apnea
Questions:
1. What are the normal ranges of respiration values in different position in humans
2. What is Apnea

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Experiment 4
Objective: Study of SPO2 and Pulse Rate measurement
Equipments Needed:
1. Multiparameter Monitor ST2365
Procedure:
1. Connect one end of the power supply to Multiparameter Monitor ST2365 while
other end to mains power supply
2. Connect one end of SPO2 sensor to patient figure while other end to the ST2365
(SPO2 socket)
3. Switch On the Mains power supply, then ST2365
4. Set the Alarms “On/Off”, Levels, high & Low values for both SPO2 and Pulse
Rate using selection switch knob
Observation:
1. Observe the real time Plethysmograph wave forms and corresponding values in
LCD display
2. Pulse rate is directly shown in digits form simultaneously with SPO2
Conclusion:
1. Plethysmograph waves and corresponding are coming properly on LCD display
2. SPO2 values lies the range of 95-98% which shows it is normal
3. Pulse rate values is coming properly
Questions:
1. What is the difference between Heart rate and Pulse rate
2. What is the meaning of SPO2
3. Which sensor is used to measure SPO2

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Experiment 5
Objective: Study of NIBP (Systolic, Diastolic & MAP) measurement
Equipments Needed:
1. Multiparameter Monitor ST2365
Procedure:
1. Connect one end of the power supply to Multiparameter Monitor ST2360 while
other end to mains power supply
2. Connect one end of NIBP cuff sensor to patient left arm while other end to the
ST2365 (NIBP socket)
3. Switch On the Mains power supply, then ST2365
4. Set the Alarms On/Off, Levels, high & Low values, unit etc. For NIBP
measurement using selection switch knob
5. Press start button using key pad to start the motor to inflate the cuff
Observation:
1. Observe the real time NIBP (Sys. Dia. & Mean value) on LCD display
Conclusion:
1. NIBP (SYS, DIA, MAP) corresponding values are coming properly on LCD
display
2. Cuff automatically starts deflating when pressure exceeds over preset value
3. Both systolic and diastolic values lies in normal range
Questions:
1. What is the standard values of Systolic and diastolic pressures
2. What is Mean Arterial Pressure (MAP)

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Experiment 6
Objective: Study of simultaneous measurement of all parameters
Equipments Needed:
1. Multiparameter Monitor ST2365
Procedure:
1. Connect one end of the power supply to Multiparameter Monitor ST2365, while
other end to mains power supply
2. Connect one ends of all the sensor to patient while other ends to the ST2365
(Corresponding sockets)
3. Switch On the Mains power supply, then ST2365
4. Set the Alarms “On/Off”, Levels, high & Low values, unit etc. using selection
switch knob for all the parameters
5. Press start button using key pad to start the motor to inflate the cuff
Observation:
1. Observe all the wave forms and their corresponding values on LCD screen
2. Check the level of Alarm
Conclusion:
1. All the wave forms (ECG, Resp. SPO2) are coming properly
2. All the parameters are lies in normal range

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Frequently Asked Questions

1. What is the Anatomy of the human heart?
The heart is basically a hollow muscular pump, which pushes the blood through
out the body via the blood vessels. It is located between the lungs and slightly to
the left of centre
2. How many contractions does heart have?
The heart is an involuntary muscle that has approximately seventy to ninety
contractions per minute during a restful state. It begins to pump early in the life
of a fetus and will continue unceasingly until death.
3. In how many layers heart wall is divided, name them?
The heart wall is divided into three layers:
• Pericardium
• Myocardium
• Endocardium
4. How chamber is sub divided?
The heart is divided by a partition or septum into two halves. The halves are in
turn divided into chambers. The upper two chambers of the heart are called atria
and the lower two chambers are called ventricles.
5. How many chambers does heart have?
The heart has four distinct chambers.
i. Right atrium is the thin-walled area that receives the venous or "used" blood
returning to the body by the veins.
ii. Right ventricle is the "pump" area of the heart's right side. The atrium dumps
the blood into the ventricle where it is then pumped out the pulmonary
arteries and to the lungs.
iii. Left atrium receives the oxygenated blood returning from the lungs.
iv. Left ventricle has the thickest walls of all. It is from this chamber the blood
is pumped out of the heart, into the aorta and out to the rest of the body.
6. How many types of heart valves are there?
There are four types of heart valves which are as follows:
a. Tricuspid valve: is the one located at the entrance of the right ventricle. It
prevents the blood from washing back into the right atrium.
b. Pulmonary semi lunar valve: is located between the right ventricle and the
pulmonary artery.

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c. Mitral valve: is made of very heavy cusps and is located at the entrance of
the left ventricle. This is a powerful valve that closes as the left ventricle
begins each of its contractions to ensure the oxygenated blood doesn't re-
enter the left atrium.
d. Aortic valve: is located, as its name would imply, between the left ventricle's
exit and the aorta itself.
7. How right ventricle and left ventricle works?
As the right ventricle contracts and sends blood to the lungs, the left ventricle
contracts and squeezes blood out to the body.
8. What is systole and diastole?
Systole occurs when the ventricles contract, and diastole when they relax. One
complete contraction and relaxation of the heart muscle makes up one heartbeat.
9. How many components heart conduction system have?
There are four basic components to the heart's conduction system.
i. Sino atrial node (SA node)
ii. Inter-nodal fiber bundles
iii. Atrioventricular node (AV node)
iv. Atrioventricular bundle
10. What is the function of natural pacemaker?
A natural pacemaker generates electrical impulses at regular rate. To initiate the
heartbeat the action potentials generated by the natural pacemaker or S.A. node
gets propagated in all directions along the surface of both atria and
atrioventricular node.
11. What is the full form of ECG?
Electrocardiogram
12. How the electrical activity of heart can be sensed?
This electrical activity generated by the heart can be measured by an array of
electrodes placed on the body surface.
13. What does P wave represent?
The P wave represents the wave of depolarization that spreads from the SA node
throughout the atria, and is usually 0.08 to 0.1 seconds (80-100 ms) in duration.
14. What does QRS complex represent?
The QRS complex represents ventricular depolarization. The duration of the
QRS complex is normally 0.06 to 0.1 seconds. This relatively short duration
indicates that ventricular depolarization normally occurs very rapidly.

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15. What does T wave represent?

The T wave represents ventricular repolarization and is longer in duration than
depolarization (i.e., conduction of the repolarization wave is slower than the
wave of depolarization).
16. How much time period is required to complete one cycle by the heart?
The total time required for one complete cycle of the heart electrical activity
ranges from approximately 0.4 to 0.6 second.
17. Define heart rate?
The Heart-rate is a rate at which the heart beats per minute.
18 How is the heart rate controlled?
It is controlled by the frequency at which the natural pacemaker generates
electrical pulses.
19. What is the heart rate for various human beings?
The bigger a person is, the slower the heart rate. A newborn baby's heart beats
about 120 times per minute. The typical rate for adults is 72 beats per minute.
But doctors consider resting rates from 60 to 100 beats per minute within the
normal range.
20. To measure the ECG signals where are the electrodes placed on human
body?
To record the ECG pattern of a subject (human body) it is necessary to apply
ECG metal electrodes to the patient's limbs in special formats called leads, on
each arm and leg, and six electrodes are placed at defined locations on the chest.
21. How are the electrical signals generated through the heart?
As the heart undergoes depolarization and repolarization, the electrical currents
that are generated and spread not only within the heart, but also through out the
body.
22. How is the electrical current measured from the heart?
The electrical activity generated by the heart can be measured by an array of
electrodes placed on the body surface.
23. How are different waves generated?
The different waves that comprise the ECG represent the sequence of
depolarization and repolarization of the atria and ventricles.
24. What does ‘P’ wave represent?
The ‘P’ wave represents the wave of depolarization that spreads from the SA
node throughout the atria.
25. What is the duration of ‘P’ wave?
The duration is usually of 0.08 to 0.1 seconds (80-100 ms).

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26. What does ‘QRS’ complex represent?

The QRS complex represents ventricular depolarization.
27. What is the duration of ‘QRS’ wave?
The duration of the QRS complex is normally 0.06 to 0.1 seconds.
28. What does the short duration indicate in ‘QRS’ wave?
The relative short duration indicates that ventricular depolarization normally
occurs very rapidly.
29. What does ‘T’ wave represent?
The T wave represents ventricular repolarization and is longer in duration than
depolarization
30. What is the duration of ‘T’ wave?
Typically the total time required for one complete cycle of the heart electrical
activity ranges from approximately 0.4 to 0.6 second.
31. What is the standard value of one complete cycle for ‘T’ wave?
0.8 seconds is the standard value of one complete heart cycle.
32. What does ‘T’ wave represent?
This U wave represents the state of heart when all four chambers of heart
receive the blood generally this wave is not present in the normal ECG graph.
33. Which type of activity is held during ‘P’,’QRS’ and ‘T’ wave?
During a normal sinus rhythm, the atria are contracting first (around the time of
the P wave), and the ventricles contract second (around the time of the QRS
complex). Ventricular relaxation occurs around the time of the T wave.
34. What does heart's electrical axis refer to?
The heart's electrical axis refers to the general direction of the heart's
depolarization wave front (or mean electrical vector) in the frontal plane.
35. What is the orientation of heart's electrical axis?
It is usually oriented in a right shoulder to left Leg direction, which corresponds
to the left inferior quadrant of the hex axial reference system, although -30o to
+90o is considered to be normal.
36. What the electric axis of the heart usually denotes?
The concept of the electric axis of the heart usually denotes the average
direction of the electric activity throughout ventricular (or sometimes atrial)
activation.

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37. What is the range of electric axis?

The normal range of the electric axis lies between +30° and -110° in the frontal
plane and between +30° and -30° in the transverse plane. The direction of the
electric axis may be approximated from the 12-Lead ECG by finding the Lead in
the frontal plane, where the QRS-complex has largest positive deflection. The
direction of the electric axis is in the direction of this Lead vector. The result can
be checked by observing that the QRS-complex is symmetrically biphasic in the
Lead that is normal to the electric axis.
38. What does the deviation of the electric axis to the right indicate?
Deviation of the electric axis to the right is an indication of increased electric
activity in the right ventricle due to increased right ventricular mass.
39. Due to which type of diseases does the deviation of the electric axis to the
right occur?
This is usually a consequence of chronic obstructive lung disease, pulmonary
emboli, certain types of congenital heart disease, or other disorders causing
severe pulmonary hypertension.
40. What does the deviation of the electric axis to the left indicate?
Deviation of the electric axis to the left is an indication of increased electric
activity in the left ventricle due to increased left ventricular mass.
41. Due to which type of diseases does the deviation of the electric axis to the
left occur?
This is usually a consequence of hypertension, aortic Stenosis, ischemic heart
disease, or some inter ventricular conduction defect.
42. What is the amplitude of ‘P’ wave?
Amplitude : 0.25mV
43. What should be the dimensions of ‘P’ wave?
The P wave in general should not be more than 1 box wide or 1 box tall. If it
exceeds these, it generally means that either or both atria is enlarged
(hypertrophied).
44. What are the characteristics of ‘P’ wave?
Positive deflection of P wave greater than 1 box wide or 1 box in height
indicates right atrial hypertrophy Negative deflection of P wave greater than 1
box wide or 1 box in depth indicates left atrial hypertrophy.

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45. What is the duration of PR-Interval?

Duration: 180-220 m sec
The distance from the beginning of the P wave to the beginning of Q wave is
PR interval. It’s a period from the beginning of atria depolarization to the
beginning of ventricular depolarization.
46. What is PR-segment?
It is the distance from end of the P wave and beginning of Q wave.
47. What is the duration of PR-segment?
Duration: 0.01 sec (approximately)
48. What is the amplitude of Q wave?
Amplitude : 0.2 mV
49. What does normal Q wave represent?
Normal Q waves are small, less than 1 mm deep or wide and one fourth the
height of their R wave.
50. When does Q wave Develop?
Pathological Q waves usually develop when ST segments are elevated and
appear several hours or days after the clinical manifestations of the Myocardial
Infarction.
51. What does abnormal Q wave represent?
Abnormal Q must be one Small Square (0.04 sec) wide and greater than one-
third of QRS height in Lead III. Myocardial infarction causes pathological Q
waves over the affected area of the ventricle. The age of the infection can be
determined.
If only Q wave is present without elevated ST segment then it indicates old
infarction while if ST segment is there (with or without T wave inversion) then
it indicates acute infraction. Q waves with inverted T waves may indicate
undetermined age.
52. What is the amplitude of ‘R’ Wave?
Amplitude : 1mV
53. What does ‘R’ wave represent?
R wave is the largest wave of the ECG graph and it is always above is electric
line, No such thing as a "negative R-wave" exists.
54. What is the amplitude of ‘S’ Wave?
Amplitude : 0.4 - 0.5 mV

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55. What is the amplitude of ‘QRS’ Complex?

Amplitude : 1.5 mV
56. What is the duration of ST-Segment?
Short segment from end of S wave to beginning of T wave and has duration of
about 0.07 sec.
57. What is the amplitude of ‘T’ Wave?
Amplitude : 0.1 - 0.5 m sec
58. What does normal ‘T’ wave represent?
Normal T waves are in the same direction as their complex, wave is
asymmetrical and it peaks toward the end, instead of the middle. Normal T
wave in frontal plan is about 5 mm and in precordial plane 10 mm tall.
59. What is the duration of ST-Interval?
Period from end of S wave to end of T wave and has the duration of about 0.20 -
0.27 m sec.
60. What does QT-Interval represent?
It is the interval from beginning of Q wave to end of T wave, or we can say this
is the period from beginning of ventricular depolarization to the end of
repolarization.
61. What is the duration of QT-Interval?
It has the duration of about 0.26 - 0.49 m sec.
62. What does RR-Interval represent?
This is the distance between QRS-complexes.
63. What is the amplitude of ‘U’ Wave?
Amplitude : 0.15 mV
64. Classify Cardiac Rhythm Diagnosis?
Cardiac rhythms may be divided into two categories:
i. Supra ventricular (above the ventricles)
ii. Ventricular rhythms.
65. Which node does trigger the cardiac activation?
The sinus node triggers the cardiac activation.
66. How is the cardiac activation diagnosed?
This is easily diagnosed by noting that the three deflections, P-QRS-T, follow in
this order and are differentiable.

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67. Give the frequency range of sinus rhythm?

The sinus rhythm is normal if its frequency is between 60 and 100/Min.
68. What is sinus Bradycardia?
Sinus rhythm having frequency less than 60/Min is called sinus Bradycardia.
69. What is sinus tachycardia?
Sinus rhythm higher than 100/Min frequency is called sinus tachycardia. It
occurs most often as a physiological response to physical exercise or psychical
stress, but may also result from congestive heart failure.
70. What is sinus arrhythmia?
If the sinus rhythm is irregular such that the longest PP- or RR-interval exceeds
the shortest interval by 0.16 s, the situation is called sinus arrhythmia.
71. When the heart rate increase or decrease?
The nerve is active during respiration and, through its effect on the sinus node,
causes an increase in heart rate during inspiration and a decrease during
expiration. The effect is particularly pronounced in children.
72. What do you understand by atrial flutter?
When the heart rate is sufficiently elevated so that the iso-electric interval
between the end of T and beginning of P disappears, the arrhythmia is called
atrial flutter. The origin is also believed to involve a re-entrant atrial pathway.
73. What is frequency range of atrial flutter?
The frequency of these fluctuations is between 220 and 300/min. The AV-node
and, thereafter, the ventricles are generally activated by every second or every
third atrial impulse (2:1 or 3:1 heart block).
74. Due to what reason atrial fibrillation occurs?
Atrial fibrillation occurs as a consequence of rheumatic disease, atherosclerotic
disease, hyperthyroidism, and pericarditis (It may also occur in healthy subjects
as a result of strong sympathetic activation.)
75. What is the phenomenon of junctional rhythm?
If the heart rate is slow (40-55/Min.), the QRS-complex is normal, the P-waves
are possibly not seen, and then the origin of the cardiac rhythm is in the AV
node. Because the origin is in the junction between atria and ventricles, this is
called junctional rhythm.

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76. Why QRS-complex is of relatively short duration?

In ventricular arrhythmias ventricular activation does not originate from the AV
node and/or does not proceed in the ventricles in a normal way. If the activation
proceeds to the ventricles along the conduction system, the inner walls of the
ventricles are activated almost simultaneously and the activation front proceeds
mainly radically toward the outer walls. As a result, the QRS-complex is of
relatively short duration.
77. What does indicate abnormal ventricular activation?
A QRS-interval lasting longer than 0.1 s indicates abnormal ventricular
activation.
78. What is idioventricular rhythm?
If the ventricles are continuously activated by a ventricular focus whose rhythm
is under 40/Min, the rhythm is called idioventricular rhythm.
79. Which situation is called accelerated idioventricular rhythm?
The ventricular activity may also be formed from short (less than 20 s) bursts of
ventricular activity at higher rates (between 40 and 120/Min). This situation is
called accelerated idioventricular rhythm.
80. What is ventricular tachycardia?
A rhythm of ventricular origin may also be a consequence of a slower
conduction in ischemic ventricular muscle that leads to circular activation (re-
entry). The result is activation of the ventricular muscle at a high rate (over
120/Min.), causing rapid, bizarre, and wide QRS-complexes; the arrhythmia is
called ventricular tachycardia. As noted, ventricular tachycardia is often a
consequence of ischemia and myocardial infarction.
81. What is ventricular fibrillation?
When ventricular depolarization occurs chaotically, the situation is called
ventricular fibrillation.
82. What is the cause of ventricular fibrillation?
The cause of fibrillation is the establishment of multiple re-entry loops usually
involving diseased heart muscle. In this arrhythmia the contraction of the
ventricular muscle is also irregular and is ineffective at pumping blood. The lack
of blood circulation leads to almost immediate loss of consciousness and death
within minutes. The ventricular fibrillation may be stopped with an external
defibrillator pulse and appropriate medication.

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83. What are pacer rhythm and its frequency?

A ventricular rhythm originating from a cardiac pacemaker is associated with
wide QRS-complexes because the pacing electrode is (usually) located in the
right ventricle and activation does not involve the conduction system. In pacer
rhythm the ventricular contraction is usually preceded by a clearly visible pacer
impulse spike. The pacer rhythm is usually set to 72/min.
84. On what basis sinus rhythm is diagnosed?
If the P-waves always precede the QRS-complex with a PR-interval of 0.12-0.2
s, the AV conduction is normal and a sinus rhythm is diagnosed. If the PR-
interval is fixed but shorter than normal, either the origin of the impulse is closer
to the ventricles or the atrioventricular conduction is utilizing an (abnormal)
bypass tract leading to pre-excitation of the ventricles. The latter is called the
Wolff-Parkinson-White syndrome and is discussed below. The PR-interval may
also be variable, such as in a wandering atrial pacemaker and multifocal atrial
tachycardia.
85. How first-degree atrioventricular block is diagnosed?
When the P-wave always precedes the QRS-complex but the PR-interval is
prolonged over 0.2 s, first-degree atrioventricular block is diagnosed.
86. What is Wenkebach phenomenon?
If the PQ-interval is longer than normal and the QRS-complex sometimes does
not follow the P-wave, the atrioventricular block is of second-degree. If the PR-
interval progressively lengthens, leading finally to the drop out of a QRS-
complex, the second degree block is called a Wenkebach phenomenon.
87. What is third-degree atrioventricular block?
Bundle-branch block denotes a conduction defect in either of the bundle-
branches or in either fascicle of the left bundle-branch. If the two bundle-
branches exhibit a block simultaneously, the progress of activation from the
atria to the ventricles is completely inhibited; this is regarded as third-degree
atrioventricular block.
88. What is duration criterion for the QRS-complex bundle-branch block?
If the right bundle-branch is defective so that the electrical impulse cannot travel
through it to the right ventricle, activation reaches the right ventricle by
proceeding from the left ventricle. It then travels through the septal and right
ventricular muscle mass. This progress is, of course, slower than that through
the conduction system and leads to a QRS-complex wider than 0.1 s. Usually the
duration criterion for the QRS-complex in right bundle-branch block (RBBB) as
well as for the left bundle- branch block (LBBB) is >0.12 s.

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Glossary of Human Cardiovascular System Terms

Artery: A muscular blood vessel that carries blood away from the heart.
Arrhythmia: Is an abnormal heart rhythm.
Atrium: One of the chambers of the heart that receives blood directly from a vein.
Bradycardia: When the heart-rate less than the normal heart-rate rhythm.
Circulatory system: The system of the body responsible for internal transport. It
composed of the heart, blood vessels, lymphatic vessels, lymph, and the blood.
Cardiology: Is the branch of medicine that deals with the diagnosis and treatment of
disorders of the heart.
Diastole: Pronounced Dy AS tuh lee is the period of heart activity when the ventricles
relax.
Diastolic pressure: The decreased pressure due to the relaxation of the ventricles is
called diastolic pressure.
Electrocardiograph (ECG): Is an instrument used to detect heart damage or
diagnose heart disorders.
Heart: The muscular organ composed of cardiac muscle that is responsible for
pumping blood throughout the body.
Normal sinus rhythm: Normal pumping action of heart generates 60 -100 heartbeats
per minute.
Septum: The wall dividing the two ventricles.
Systole: Is the period of heart activity when the ventricles contract.
Systolic pressure: The increased pressure due to the contraction of the ventricles is
called systolic pressure.
Tachycardia: When the heart-rate exceeds than the normal heart-rate rhythm.
Ventricle: One of the muscular chambers of the heart that is responsible for pumping
blood from the heart into the arteries.

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Warranty
Ø We guarantee this product against all manufacturing defects for 24 months from
the date of sale by us or through our dealers. Consumables like dry cell etc. are
not covered under warranty.
Ø The guarantee will become void, if
● The product is not operated as per the instruction given in the Learning
Material
● The agreed payment terms and other conditions of sale are not followed.
● The customer resells the instrument to another party.
● Any attempt is made to service and modify the instrument.
Ø The non-working of the product is to be communicated to us immediately giving
full details of the complaints and defects noticed specifically mentioning the
type, serial number of the product and date of purchase etc.
Ø The repair work will be carried out, provided the product is dispatched securely
packed and insured. The transportation charges shall be borne by the customer.

List of Accessories

Quantity
● NIBP cuff....................................................................................................1.
● Temperature sensor......................................................................................1
● SPO2 sensor .................................................................................................1
● ECG Lead cable ..........................................................................................1
● ECG Disposable electrode cable ................................................................1
● Learning Material.........................................................................................1
● Power supply................................................................................................1
● Mains cord...................................................................................................1

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